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24-165 Axis Mechanical Inc. On-Call AgreementAxis Mechanical Inc. On-Call Agreement On-Call Public Works Contract/ April 2024 Page 1 of 12 ON-CALL PUBLIC WORKS CONTRACT WITH AXIS MECHANICAL INC. 1. PARTIES This On-Call Public Works Contract (“Contract”) is made by and between the City of Cupertino, a municipal corporation (“City”), and Axis Mechanical Inc. (“Contractor”) a corporation for On-Call services, and is effective on the last date signed below (“Effective Date”). 2. SCOPE OF WORK 2.1 Scope of Work. Contractor will perform and provide all labor, materials, equipment, supplies, transportation and any other items or work necessary to perform and complete the work described in the Scope of Work (“Work”), attached and incorporated here as Exhibit A, on an as- needed basis. The Work must comply with this Contract and with each Service Order issued by the City’s Project Manager or his/her designee, in accordance with the following procedures, unless otherwise specified in Exhibit A. Contractor further agrees to carry out its work in compliance with any applicable local, State, or Federal order regarding COVID-19. 2.2 Service Orders. Before issuing a Service Order, the City Project Manager will request that Work be done in writing and hold a meeting with Contractor to discuss the Service Order. Contractor will submit a written proposal that includes a specific Scope of Work, Schedule of Performance, and Compensation, which the Parties will discuss. Thereafter, City will execute a Service Order Form for the Work, attached and incorporated here as Exhibit B. The Service Order will specify the Scope of Work, Schedule of Performance, Compensation, and any other conditions applicable to the Service Order. Issuance of a Purchase Order is discretionary. The City Project Manager is authorized to streamline these procedures based on the City’s best interests. In particular, in emergency situations, the City Project Manager may execute a Service Order for emergency work based on oral conversations with the Contractor, without adhering to the full process outlined in this section. Contractor will not be compensated for Work performed without a duly authorized and executed Service Order. 3. TIME OF PERFORMANCE 3.1 Term. This Contract begins on the Effective Date and ends on June 30, 2027 (“Contract Time”), unless terminated earlier as provided herein. The City’s appropriate department head or City Manager may extend the Contract Time through a written amendment to this Contract, provided such extension does not include additional contract funds. Extensions requiring additional contract funds are subject to the City’s purchasing policy. 3.2 Schedule of Performance. Contractor must complete the Work within the time specified in each Service Order, and under no circumstances should the Work go beyond the Contract Time. Axis Mechanical Inc. On-Call Agreement On-Call Public Works Contract/ April 2024 Page 2 of 12 3.3 Time is of the essence for the performance of all the Work required in this Contract and in each Service Order. Contractor must have sufficient time, resources, and qualified staff to deliver the Work on time. Contractor must respond promptly to each Service Order request. 4. COMPENSATION 4.1 Maximum Compensation. City will pay Contractor for satisfactory performance of the Work based upon actual costs and capped so as not to exceed $60,000.00 (“Contract Price”), based upon the Scope of Work in Exhibit A and the budget and rates included. The maximum compensation includes all expenses and reimbursements and will remain in place even if Contractor’s actual costs exceed the capped amount. 4.2 Per Service Order. Compensation for Work provided under a Service Order will be based on the rates set forth in the Service Order, which shall not exceed the capped amount specified in the Service Order. 4.3 Invoices and Payments. Contractor must submit an invoice on the first day of each month, describing the Work performed during the preceding month, itemizing labor, materials, equipment, and any incidental costs incurred. Contractor will be paid ninety-five percent (95%) of the undisputed amounts billed within thirty (30) days after City receives a properly submitted invoice. Any retained amounts will be included with Contractor’s final payment within sixty (60) days of City’s acceptance of the Work pursuant to a specific Service Order as complete. 5. INDEPENDENT CONTRACTOR 5.1 Status. Contractor is an independent contractor and not an employee, partner, or joint venture of City. Contractor is solely responsible for the means and methods of performing the Work and for the persons hired to work under this Contract. Contractor is not entitled to health benefits, worker’s compensation, or other benefits from the City. 5.2 Contractor’s Qualifications. Contractor warrants on behalf of itself and its subcontractors that they have the qualifications and skills to perform the Work in a competent and professional manner and according to the highest standards and best practices in the industry. 5.3 Permits and Licenses. Contractor warrants on behalf of itself and its subcontractors that they are properly licensed, registered, and/or certified to perform the Work as required by law and have procured a City Business License, if required by the Cupertino Municipal Code. Contractor shall possess a California Contractor’s License in good standing for the following classification(s): C10, which must remain valid for the entire Contract Time. 5.4 Subcontractors. Only Contractor’s employees are authorized to work under this Contract. Prior written approval from City is required for any subcontractor, and the terms and conditions of this Contract will apply to any approved subcontractor. 5.5 Tools, Materials, and Equipment. Contractor will supply all tools, materials, and equipment required to perform the Work under this Contract. Axis Mechanical Inc. On-Call Agreement On-Call Public Works Contract/ April 2024 Page 3 of 12 5.6 Payment of Benefits and Taxes. Contractor is solely responsible for the payment of employment taxes incurred under this Agreement and any similar federal or state taxes. Contractor and any of its employees, agents, and subcontractors shall not have any claim under this Agreement or otherwise against City for seniority, vacation time, vacation pay, sick leave, personal time off, overtime, health insurance, medical care, hospital care, insurance benefits, social security, disability, unemployment, workers compensation or employee benefits of any kind. Contractor shall be solely liable for and obligated to pay directly all applicable taxes, fees, contributions, or charges applicable to Contractor’s business including, but not limited to, federal and state income taxes. City shall have no obligation whatsoever to pay or withhold any taxes or benefits on behalf of Contractor. In the event that Contractor or any employee, agent, or subcontractor of Contractor providing services under this Agreement is determined by a court of competent jurisdiction, arbitrator, or administrative authority, including but not limited to the California Public Employees Retirement System (PERS) to be eligible for enrollment in PERS as an employee of City, Contractor shall indemnify, defend, and hold harmless City for the payment of any employee and/or employer contributions for PERS benefits on behalf of Contractor or its employees, agents, or subcontractors, as well as for the payment of any penalties and interest on such contributions, which would otherwise be the responsibility of City, and actual attorney’s fees incurred by City in connection with the above. 6. CHANGE ORDERS Amendments and change orders must be in writing and signed by City and Contractor. Contractor’s request for a change order must specify the proposed changes in the Work, Contract Price, and Contract Time. Each request must include all the supporting documentation, including but not limited to plans/drawings, detailed cost estimates, and impacts on schedule and completion date. 7. ASSIGNMENTS; SUCCESSORS Contractor shall not assign, hypothecate, or transfer this Contract or any interest therein, directly or indirectly, by operation of law or otherwise, without prior written consent of City. Any attempt to do so will be null and void. Any changes related to the financial control or business nature of Contractor as a legal entity is considered an assignment of the Contract and subject to City approval, which shall not be unreasonably withheld. Control means fifty percent (50%) or more of the voting power of the business entity. This Contract is binding on Contractor, its heirs, successors, and permitted assigns. 8. PUBLICITY / SIGNS Any publicity generated by Contractor for the Project during the Contract Time, and for one (1) year thereafter must credit City contributions to the Project. The words “City of Cupertino” must be displayed in all pieces of publicity, flyers, press releases, posters, brochures, interviews, public service announcements, and newspaper articles. No signs may be posted or displayed on or about City property, except signage required by law or this Contract, without prior written approval from the City. Axis Mechanical Inc. On-Call Agreement On-Call Public Works Contract/ April 2024 Page 4 of 12 9. SUBCONTRACTORS 9.1 Contractor must perform all the Work with its own forces, except that Contractor may hire qualified subcontractors to perform up to 25% of the Work under any give Service Order, provided that each subcontractor is required by contract to be bound by the provisions of this Contract and any applicable Service Order. Contractor must provide City with written proof of compliance with this provision upon request. 9.2 City may reject any subcontractor of any tier and bar a subcontractor from performing Work on the Project, if City in its sole discretion determines that subcontractor’s Work falls short of the requirements of this Contract or constitutes grounds for rejection under the Public Contract Code. If City rejects a subcontractor, Contractor at its own expense must perform the subcontractor’s Work or hire a new subcontractor that is acceptable to City. A Notice of Completion must be recorded within fifteen (15) days after City accepts the Work under a particular Service Order if the Work involves work by subcontractors. 10. RECORDS AND DAILY REPORTS 10.1 Contractor must maintain daily reports of the Work and submit them to City upon request and at completion of Work pursuant to a Service Order. The reports must describe the Work and specific tasks performed, the number of workers, the hours, the equipment, the weather conditions, and any circumstances affecting performance. City will have ownership of the reports, but Contractor will be permitted to retain copies. 10.2 If applicable, Contractor must keep a separate set of as-built drawings showing changes and updates to the Scope of Work or the original drawings as changes occur. Actual locations to scale must be identified for all major components of the Work, including mechanical, electrical and plumbing work; HVAC systems; utilities and utility connections; and any other components City determines should be included in the final drawings of the Project. Deviations from the original drawings must be shown in detail, and the location of all main runs, piping, conduit, ductwork, and drain lines must be shown by dimension and elevation. 10.3 Contractor must maintain complete and accurate accounting records of its Work, in accordance with generally accepted accounting principles, which must be available for City review and audit, kept separate from other records, and maintained for four (4) years from the date of City’s final payment. 11. INDEMNIFICATION 11.1 To the fullest extent allowed by law, and except for losses caused by the sole and active negligence or willful misconduct of City personnel, Contractor shall indemnify, defend, and hold harmless City, its City Council, boards and commissions, officers, officials, employees, agents, servants, volunteers, and Contractors (“Indemnitees”), through legal counsel acceptable to City, from and against any and all liability, damages, claims, actions, causes of action, demands, charges, losses, costs, and expenses (including attorney fees, legal costs, and expenses related to litigation and dispute resolution proceedings), of every nature, arising directly or indirectly from this Contract or in any manner relating to any of the following: Axis Mechanical Inc. On-Call Agreement On-Call Public Works Contract/ April 2024 Page 5 of 12 (a) Breach of contract, obligations, representations or warranties; (b) Performance or nonperformance of the Work or of any obligations under the Contract by Contractor, its employees, agents, servants, or subcontractors; (c) Payment or nonpayment by Contractor or its subcontractors or sub-subcontractors for Work performed on or off the Project Site; and (d) Personal injury, property damage, or economic loss resulting from the work or performance of Contractor or its subcontractors or sub-subcontractors. 11.2 Contractor must pay the costs City incurs in enforcing this provision. Contractor must accept a tender of defense upon receiving notice from City of a third-party claim, in accordance with California Public Contract Code Section 9201. At City’s request, Contractor will assist City in the defense of a claim, dispute, or lawsuit arising out of this Contract. 11.3 Contractor’s duties under this entire Section 11 are not limited to Contract Price, Workers’ Compensation, or other employee benefits, or the insurance and bond coverage required in this Contract. Nothing in the Contract shall be construed to give rise to any implied right of i ndemnity in favor of Contractor against City or any other Indemnitee. 11.4 Contractor’s payments may be deducted or offset to cover any money the City lost due to a claim or counterclaim arising out of this Contract, a purchase order or other transaction. 11.5 Contractor agrees to obtain executed indemnity agreements with provisions identical to those set forth here in this Section 11 from each and every subcontractor, or any other person or entity involved by, for, with, or on behalf of Contractor in the performance of this Contract. Failure of City to monitor compliance with these requirements imposes no additional obligations on City and will in no way act as a waiver of any rights hereunder. 11.6 This Section 11 shall survive termination of the Contract. 12. INSURANCE Contractor shall comply with the Insurance Requirements, attached and incorporated here as Exhibit C, and must maintain the insurance for the Contract Time, or longer as required by City. City will not execute the Contract until City approves receipt of satisfactory certificates of insurance and endorsements evidencing the type, amount, class of operations covered, and the effective and expiration dates of coverage. Failure to comply with this provision may result in City, at it s sole discretion and without notice, purchasing insurance for Contractor and deducting the costs from Contractor’s compensation or terminating the Contract. 13. COMPLIANCE WITH LAWS 13.1 General Laws. Contractor shall comply with all local, state, and federal laws and regulations applicable to this Contract. Contractor will promptly notify City of changes in the law or other conditions that may affect the Project or Contractor’s ability to perform. Contractor is responsible for verifying the employment authorization of employees performing the Work, as required by the Immigration Reform and Control Act. Axis Mechanical Inc. On-Call Agreement On-Call Public Works Contract/ April 2024 Page 6 of 12 13.2 Labor Laws. a. The following provisions apply to any Service Order of $1,000 or more: i.In General. For purposes of California labor law, this is a public works contract subject to the provisions of Part 7 of Division 2 of the California Labor Code (Sections 1720 et seq.). In accordance with Labor Code Section 1771, Contractor and all subcontractors shall pay not less than current prevailing wage rates as determined by the California Department of Industrial Relations (“DIR”) to all workers employed on this project. In accordance with Labor Code Section 1815, Contractor and all subcontractors shall pay all workers employed on this project 1 ½ the basic rate of pay for work performed in excess specified hour limitations. The work performed pursuant to this Contract is subject to compliance monitoring and enforcement by the Department of Industrial Relations. ii.Registration. Contractor and all subcontractors shall not engage in the performance of any work under this Contract unless currently registered and qualified to perform public work pursuant to section 1725.5 of the California Labor Code. Contractor represents and warrants that it is registered and qualified to perform public work pursuant to section 1725.5 of the Labor Code and will provide its DIR registration number, along with the registration numbers of any subcontractors as required, to the City. iii.Posting. Contractor shall post at the job site the determination of the DIR director of the prevailing rate of per diem wages together with all job notices that are required by regulations of the DIR. iv.Reporting. Contractor and any subcontractors shall keep accurate payroll records in accordance with Section 1776 of the Labor Code and shall furnish the payroll records directly to the Labor Commissioner in accordance with the law. v.Report on Prevailing Rate of Wages. The City has obtained the general prevailing rate of per diem wages in the vicinity of the project for each type of worker needed, a copy of which is on file at the City of Cupertino City Hall, and shall be made available to any interested party upon request. vi.Employment of Apprentices. Contractor’s attention is directed to the provisions in Sections 1777.5 and 1777.6 of the Labor Code concerning the employment of apprentices by the Contractor or any subcontractor. It shall be the responsibility of the Contractor to effectuate compliance on the part of itself and any subcontractors with the requirements of said sections in the employment of apprentices. Information relative to apprenticeship standards, wage schedules, and other requirements may be obtained from the Director of Industrial Relations, ex-officio the Administrator of Apprenticeship, San Francisco, California, or from the Division of Apprenticeship Standards and its branch offices. vii.Penalties. Contractor’s attention is directed to provisions in Labor Code Sections 1775 and 1813. In accordance with Labor Code Section 1775, Contractor and subcontractors may be subject to penalties for Contractor’s and subcontractors’ failure to pay prevailing wage rates. In accordance with Labor Code Section 1813, Contractor or subcontractors may be subject to penalties for Contractor’s or subcontractors’ failure to pay overtime pay rates for hours worked by workers employed on this project in excess specified hour limitations. b. Contractor must compensate workers who are paid less than prevailing wages or required to work more than a legal day’s work. Contractor will also be required to pay City a Axis Mechanical Inc. On-Call Agreement On-Call Public Works Contract/ April 2024 Page 7 of 12 penalty of $200.00 per worker for each day of violation. c. As required by Labor Code Section 1861, by signing this Contract Contractor certifies as follows: “I am aware of the provisions of Section 3700 of the Labor Code which require every employer to be insured against liability for workers’ compensation or to undertake self- insurance in accordance with the provisions of that code, and I will comply with such provisions before commencing the work of this contract.” 13.3 Discrimination Laws. Contractor shall not discriminate on the basis of race, religious creed, color, ancestry, national origin, ethnicity, handicap, disability, marital status, pregnancy, age, sex, gender, sexual orientation, gender identity, Acquired-Immune Deficiency Syndrome (AIDS), or any other protected classification. Contractor shall comply with all anti-discrimination laws, including Government Code Sections 12900 and 11135, and Labor Code Sections 1735, 1777, and 3077.5. Consistent with City policy prohibiting harassment and discrimination, Contractor understands that harassment and discrimination directed toward a job applicant, an employee, a City employee, or any other person, by Contractor or Contractor’s employees or subcontractors will not be tolerated. Contractor agrees to provide records and documentation to the City on request necessary to monitor compliance with this provision. 13.4 Conflicts of Interest. Contractor, its employees, subcontractors, servants, and agents, may not have, maintain, or acquire a conflict of interest in relation to this Contract in violation of law, including Government Code section 1090 and Government Code section 81000 and their accompanying regulations. No officer, official, employee, consultant, or other agent of the City (“City Representative”) may have, maintain, or acquire a “financial interest” in the Contract, as that term is defined by state law, or in violation of a City ordinance or policy while serving as a City Representative or for one year thereafter. Contractor, its employees, subcontractors, servants, and agents warrant they are not employees of City nor do they have any relationship with City officials, officers, or employees that creates a conflict of interest. Contractor may be required to file a conflict of interest form if it makes certain governmental decisions or serves in a staff capacity, as defined in Section 18700 of Title 2 of the California Code of Regulations. Contractor agrees to abide by City rules governing gifts to public officials and employees. 13.5 Remedies. Any violation of this Section 13 constitutes a material breach and may result in City suspending payments, requiring reimbursements, or terminating this Contract. City reserves all other rights and remedies available under the law and this Contract, including the right to seek indemnification under Section 11 of this Contract. 14. BONDS For any Service Order of $25,000 or more, Contractor must obtain a payment bond and a performance bond, each in the penal sum of 100% of the compensation pursuant to the Service Order, using the Bond Forms attached and incorporated here as Exhibit D. Each bond must be issued by a surety admitted in California, with a financial rating from A.M. Best Company of Class A- or higher, or as otherwise acceptable to City. If an issuing surety cancels a bond or becomes insolvent, Contractor must provide a substitute bond from a surety acceptable to City within seven (7) calendar days after written notice from City. If Contractor fails to do so, City may in its sole discretion and without prior notice, purchase bonds at Contractor’s expense, deduct the cost from payments due Contractor, or terminate the Service Order or Contract. City will not authorize work Axis Mechanical Inc. On-Call Agreement On-Call Public Works Contract/ April 2024 Page 8 of 12 under a Service Order until the required bonds are submitted. 15. UTILITIES, TRENCHING, AND EXCAVATION 15.1 Contractor must call the Underground Service Alert (“USA”) 811 hotline and request marking of utility locations before digging or commencing Work. For underground service alerts for street lighting and traffic signal conduits, City’s Service Center must be called at (408) 777- 3269. Government Code Section 4215 requires Contractor to notify City and Utility in writing if it discovers utilities or utility facilities not identified in the Contract. 15.2 Pursuant to Government Code Section 7104, Contractor must stop work, notify City in writing, and wait for instructions if one of the conditions below is found at the worksite. City will work with Contractor to amend the Contract or issue a change order if the discovered conditions materially change the Work/Performance, Contract Time or Contract Price. (a) Material believed to be hazardous waste under Health and Safety Code Section 25117, and which requires removal to a Class I, Class II, or Class III disposal site pursuant to law; (b) Subsurface or latent physical conditions at the Project worksite differing from those indicated by information about the worksite made available to Contractor; and (c) Unknown physical conditions at the Project worksite of any unusual nature, materially different from those ordinarily encountered and from those generally recognized as inherent in the character of the Work. 15.3 For Service Orders where compensation is $25,000 or higher that require excavation or involve trenches five feet or more in depth, Contractor must submit a detailed plan for City approval, per Labor Code Section 6705, prior to commencing work. The plan must show the design of shoring, bracing, sloping, and other provisions for worker protection from caving ground and other hazards. The protective system must comply with all Construction Safety Orders. If the plan varies from shoring system standards, it must be prepared by a registered civil or structural engineer. 16. URBAN RUNOFF MANAGEMENT 16.1 All Work must fully comply with federal, state, and local laws and regulations concerning storm water management. Contractor must avoid creating excess dust when breaking asphalt or concrete and during excavation and grading. If water is used for dust control, Contractor will use only the amount of water necessary to dampen the dust. Contractor will take all steps necessary to keep wash water out of the streets, gutters, and storm drains. Prior to the start of the Work, Contractor will implement erosion and sediment controls to prevent pollution of storm drains, and must upgrade and maintain these controls based on weather conditions or as otherwise required by City. These controls must be in place during the entire Contract Time and must be removed at the end of construction and completion of the Work. Such controls must include, but will not be limited to, the following requirements: (a) Install storm drain inlet protection devices such as sand bag barriers, filter fabric fences, and block and gravel filters at all drain inlets impacted by construction. During the annual rainy season, October 15 through June 15, storm drain inlets impacted by construction work must be filter-protected from onsite de-watering activities and saw-cutting activities. Shovel or vacuum saw-cut slurry and remove from the Work site; Axis Mechanical Inc. On-Call Agreement On-Call Public Works Contract/ April 2024 Page 9 of 12 (b) Cover exposed piles of soil or construction material with plastic sheeting. Store all construction materials in containers; (c) Sweep and remove all materials from paved surfaces that drain to streets, gutters and storm drains prior to rain and at the end of each work day. When the Work is completed, wash the streets, collect and dispose of the wash water offsite in lawful manner; (d) After breaking old pavement, remove debris to avoid contact with rainfall/runoff; (e) Maintain a clean work area by removing trash, litter, and debris at the end of each work day and when Work is completed. Clean up any leaks, drips, and other spills as they occur. These requirements must be used in conjunction with the California Stormwater Quality Association and California Best Management Practices Municipal and Construction Handbooks, local program guidance materials from municipalities, and any other applicable documents on stormwater quality controls for construction. Contractor’s failure to comply with this Section will result in the issuance of noncompliance notices, citations, Work stop orders and regulatory fines. 17. PROJECT COORDINATION City Project Manager. The City assigns Nathan Vasquez as the City’s representative for all purposes under this Contract, with authority to oversee the progress and performance of the Scope of Work. City reserves the right to substitute another Project manager at any time, and without prior notice to Contractor. Contractor Project Manager. Subject to City approval, Contractor assigns Manny Lopez as its single Representative for all purposes under this Contract, with authority to oversee the progress and performance of the Work. Contractor’s Project manager is responsible for coordinating and scheduling the Work in accordance with City instructions, service orders, and the Schedule of Performance. Contractor must regularly update the City’s project manager about the status, progress and any delays with the work. City’s written approval is required prior to Contractor substituting a new Representative which shall result in no additional costs to City. 18. ABANDONMENT AND TERMINATION 18.1 City may abandon or postpone the Work or parts thereof at any time. Contractor will be compensated for satisfactory Work performed through the date of abandonment and will be given reasonable time to close out Work under a Service Order. With City’s pre-approval in writing, the time spent in closing out Work under a Service Order will be compensated up to ten percent (10%) of the total time expended in performing the Work. 18.2 City may terminate the Contract for cause or without cause at any time. Contractor will be paid for satisfactory Work rendered through the termination date and will be given reasonable time to close out the Work. 18.3 Final payment will not be made until Contractor delivers the Work and provides records documenting the Work, products, and deliverables completed. 19. GOVERNING LAW, VENUE, AND DISPUTE RESOLUTION This Contract is governed by the laws of State of California. Venue for any legal action shall be the Axis Mechanical Inc. On-Call Agreement On-Call Public Works Contract/ April 2024 Page 10 of 12 Superior Court of the County of Santa Clara, California. The dispute resolution procedures of Public Contract Code Section 20104, et seq., incorporated here by reference, apply to this Contract and Contractor is required to continue the Work pending resolution of any dispute. Prior to filing a lawsuit, Contractor must comply with the claim filing requirements of the California Government Code. If the Parties elect arbitration, the arbitrator’s award must be supported by law and substantial evidence and include detailed written findings of law and fact. 20. ATTORNEY FEES If City initiates legal action, files a complaint or cross-complaint, or pursues arbitration, appeal, or other proceedings to enforce its rights or a judgment in connection with this Contract, the prevailing party will be entitled to reasonable attorney fees and costs. 21. SIGNS/ADVERTISEMENTS No signs may be displayed on or about City’s property, except signage which is required by law or by the Contract, without City’s prior written approval as to size, design and location. 22. THIRD PARTY BENEFICIARIES There are no intended third party beneficiaries of this Contract. 23. WAIVER Neither acceptance of the Work nor payment thereof shall constitute a waiver of any contract provision. City’s waiver of a breach shall not constitute waiver of another provision or breach. 24. WARRANTY Contractor warrants that materials and equipment used will be new, of good quality, and free from defective workmanship and materials, and that the Work will be free from material defects not intrinsic in the design or materials. All Work, materials, and equipment should pass to City free of claims, liens, or encumbrances. Contractor warrants the Work and materials for one year from the date of City’s acceptance of the Work as complete (“Warranty Period”), except when a longer guarantee is provided by a supplier, manufacturer or is required by this Contract. During the Warranty Period, Contractor will repair or replace any Work defects or materials, including damage that arises from Contractor’s Warranty Work, except any wear and tear or damage resulting from improper use or maintenance. 25. ENTIRE AGREEMENT This Contract and the attachments, documents, and statutes attached, referenced, or expressly incorporated herein, including authorized amendments or change orders constitute the final and complete contract between City and Contractor with respect to the Work and the Project. No oral contract or implied covenant will be enforceable against City. If there is any inconsistency between any term, clause, or provision of the main Contract and any term, clause, or provision of the attachments or exhibits thereto, the terms of the main Contract shall prevail and be controlling. Axis Mechanical Inc. On-Call Agreement On-Call Public Works Contract/ April 2024 Page 11 of 12 26. SEVERABILITY/PARTIAL INVALIDITY If a court finds any term or provision of this Contract to be illegal, invalid, or unenforceable, the legal portion of said provision and all other contract provisions will remain in full force and effect. 27. SURVIVAL The contract provisions which by their nature should survive the Contract or Completion of Project, including without limitation all provisions regarding warranties, indemnities, payment obligations, insurance, and bonds, shall remain in full force and effect after the Work is completed or Contract ends. 28. INSERTED PROVISIONS Each provision and clause required by law for this Contract is deemed to be included and will be inferred herein. Either party may request an amendment to cure mistaken insertions or omissions of required provisions. The Parties will collaborate to implement this Section, as appropriate. 29. HEADINGS The headings in this Contract are for convenience only, are not a part of the Contract and in no way affect, limit, or amplify the terms or provisions of this Contract. 30. COUNTERPARTS This Contract may be executed in counterparts, each of which is an original and all of which taken together shall form one single document. 31. NOTICES All notices, requests and approvals must be sent in writing to the persons below, which will be considered effective on the date of personal delivery or the date confirmed by a reputable overnight delivery service, on the fifth (5th) calendar day after deposit in the United States Mail, postage prepaid, registered or certified, or the next business day following electronic submission: To City of Cupertino Office of the City Manager 10300 Torre Ave. Cupertino, CA 95014 Attention: Nathan Vasquez Email: NathanV@cupertino.org To Contractor: Axis Mechanical Inc. 908 Bern Court San Jose, CA 95112 Attention: Manny Lopez Email: mannyl@axismechanicalinc.com SIGNATURES CONTINUE ON THE FOLLOWING PAGE Axis Mechanical Inc. On-Call Agreement On-Call Public Works Contract/ April 2024 Page 12 of 12 32. EXECUTION The persons signing below warrant they have the authority to enter into this Contract and to legally bind their respective Parties. If Contractor is a corporation, signatures from two officers of the corporation are required pursuant to California Corporations Code Section 313. This Contract may be executed in counterparts, each one of which is deemed an original and all of which, taken together, constitute a single binding instrument. IN WITNESS WHEREOF, the parties have caused the Contract to be executed. CITY OF CUPERTINO A Municipal Corporation By Name Title Date AXIS MECHANICAL INC. By Name Title Date APPROVED AS TO FORM: CHRISTOPHER D. JENSEN Cupertino City Attorney ATTEST: KIRSTEN SQUARCIA City Clerk Date Jonathan Diaz Jonathan Diaz Vice President 12/19/2024 Christopher D. Jensen Chad Mosley Director of Public Works 12/19/2024 12/19/2024 EXHIBIT A SCOPE OF WORK A. GENERAL REQUIREMENT A. The Contractor shall furnish all labor, tools, transportation, supplies, equipment, materials, and supervision necessary to perform the work as described in this section. B. All work shall be done in a first class, complete and workmanlike manner, confirming to best industry practices and applicable original manufacturer specifications. C. Contractor shall be responsible for initiating, maintaining, and supervising all safety precautions in connection with the work and shall comply with all applicable safety laws, best industry standards, and take all reasonable precautions for safety of the public, City employees and other persons on or about the property. D. , if applicable. E. The City normal (standard) working hours for this contract shall be from 6:00am to 3:30pm Monday through Thursday and 6:00am to 2:30pm on Friday. F. Contractor is to comply with all codes and regulations having jurisdiction for work to be performed under this contract. Project conditions will be identified individually. When contacted, Contractor may be required to meet with the project manager on site and receive a scope of work for the project. Contractor is required to have the capability to perform all work requested at multiple locations throughout the City in a timely manner. G. - of Service Order for specific sites during the term of the contract or to be provided during an emergency. H. All scheduled work with the City will require a written quote and schedule to be submitted prior to start of work. I. Each worker performing Work under this Contract shall be paid at a rate not less than the prevailing wage as defined in Sections 1771 and 1774 of the Labor Code for Service Order greater than $1,000, if applicable. The prevailing wage rates are available online at http://www.dir.ca.gov/dlsr. Contractor shall post a copy of the applicable prevailing rates at the Worksite. Responsibilities of the Contractor include, but are not limited to, the following: 1. Provide services to support ALL HVAC & Plumbing related service calls. 2.1 Perform emergency service calls on HVAC equipment; including but not limited to, AC equipment, boilers, chillers, package units, split systems, hydronic systems, pumps, fans, etc. 2.2 Perform emergency service calls on Plumbing equipment; including but not limited to Water heaters, Garbage Disposals, Showers, Kitchens, toilets, water softeners, boilers, etc. 3. Perform repair work on any HVAC/Plumbing related equipment 4. Perform maintenance on HVAC/Plumbing related equipment. 5. Provide Plumbing Sewer Line Locating, Sewer Line Clog Clearing & Cleaning 6.Provide Plumbing & Hydronic Line Freeze and Valve Installation. 7. Provide Service reports when work is completed 8.Provide proposals for repair work found on emergency service & or maintenance Please Attach Time and Materials Rate Sheets Please see attached Labor rates for Service Calls Date:11/27/2024 City Of Cupertino Attn:Tammy Rodriguez Project:For All Service Customers Good Until 7-1-25 The following rates include Mark-up, Fees, Gas and Overhead (Sell Rates). * Used on all Service tags. Break down rates only at request if needed. SHEET METAL SERVICE WORKERS LABOR:Staight Time Overtime Doubletime Jouneyman 197.78$ 255.29$ 312.78$ * Foreman 215.36$ 281.49$ 347.61$ General Foreman 227.09$ 298.97$ 370.84$ Materials: Material will be invoiced, which will include freight cost with Sliding Mark-Up. Equipment Rental and Subcontractors: Rentals cost and Subcontractors cost plus 10% Fee. Truck Rental per Weekly Trip Per Truck per week $85.00 the week following would be additional 908 Bern Court, San Jose, CA 95112 Phone (408) 573-7400 * Contractor License #974024 * Fax (408) 573-7900 MBE Certified Member of N.C.M.S.D.C. Exhibit B CITY OF CUPERTINO MASTER AGREEMENT CONSULTANT SERVICES SERVICE ORDER NO. Master Agreement Contract #: MA Date: Maximum Compensation: MA End Date: Consultant: Firm Name: Address: Contact: Ph: Project Name: Description: (simple project description if appropriate) Attachment A: Includes Description of Project, Scope of Service, Schedule of Performance and Compensation City Project Management Managing Department: Public Works Project Manager: ---------------- Fiscal/Budget : SO Acc't #: Project#: Approvals Signatures: Consultant/ Contractor Manager/ Supervisor: Master Agreement Maximum Compensation: ----------- Total Previously Encumbered to Date: ----------- Encumbrance this Service Order: ----------- Master Agreement Unencumbered Balance: ----------- PO#: Date: Date: Date: Appropriation Certification: I hereby certify that an unexpended appropriation is available in the above fund for the above contract as estimated and that fund are available as of this date of signature City Finance: Date: Management Analyst City of Cupertino Master Agreement Service Order Insurance Requirements for On-Call Public Works Construction Contracts Version: August 2024 1 Contractor shall procure and maintain for the duration of the contract, and for five years following the completion of the Project, insurance against claims for injuries to persons or damages to property which may arise from or in connection with the performance of the work hereunder by Contractor, its agents, representatives, employees or subcontractors. MINIMUM SCOPE AND LIMIT OF INSURANCE Coverage shall be at least as broad as: 1. Commercial General Liability (“CGL”): Insurance Services Office (ISO) Form CG 00 01 covering CGL on an “occurrence” basis, written on a comprehensive general liability form, and must include coverage for liability arising from Contractor’s or Subcontractor’s acts or omissions, including Contractor’s protected coverage, blanket contractual, products and completed operations, vehicle coverage and employer’s non-ownership liability coverage, with limits of at least $2,000,000 per occurrence. The CGL policy must protect against any and all liability for personal injury, death, property damage or destruction, and personal and advertising injury. If a general aggregate limit applies, either the general aggregate limit shall apply separately to this project/location (ISO CG 25 03 or 25 04) or the general aggregate limit shall be twice the required occurrence limit. a. It shall be a requirement under this agreement that any available insurance proceeds broader than or in excess of the specified minimum insurance coverage requirements and/or limits shall be made available to the Additional Insured and shall be (1) the minimum coverage/limits specified in this agreement; or (2) the broader coverage and maximum limits of coverage of any insurance policy, whichever is greater. b. Additional Insured coverage under Contractor's policy shall be "primary and non-contributory," will not seek contribution from City’s insurance/self-insurance, and shall be at least as broad as ISO CG 20 10 04 13 c. The limits of insurance required may be satisfied by a combination of primary and umbrella or excess insurance, provided each policy complies with the requirements set forth in this Contract. Any umbrella or excess insurance shall contain or be endorsed to contain a provision that such coverage shall also apply on a primary basis for the benefit of City before the City’s own insurance or self-insurance shall be called upon to protect City as a named insured. 2. Automobile Liability: ISO Form CA 00 01 covering any auto (Code 1), or if Contractor has no owned autos, then hired autos (Code 8) and non-owned autos (Code 9), with limit no less than $1,000,000 per accident for bodily injury and property damage. 3. Workers’ Compensation: As required by the State of California, with Statutory Limits, and Employer’s Liability Insurance of no less than $1,000,000 per accident for bodily injury or disease, or as otherwise required by statute. If Contractor is self-insured, Contractor must provide a Certificate of Permission to Self-Insure, duly authorized by the DIR. ☐ N/A if box checked (Contractor provides written verification it has no employees). 4. Professional Liability with limits no less than $1,000,000 per occurrence or claim, and $2,000,000 aggregate. ☐ N/A if box checked (Contract is not design/build). 5. Builder’s Risk. Course of Construction insurance utilizing an “All Risk” (Special Perils) coverage form, with limits equal to the completed value of the project and no coinsurance penalty provisions. ON-CALL PUBLIC WORKS CONSTRUCTION CONTRACTS Insurance Requirements: Exhibit C Insurance Requirements for On-Call Public Works Construction Contracts Version: August 2024 2 ☒ N/A if box checked (Project does not involve construction or improvements/installations to property). 6. Contractors’ Pollution Legal Liability and/or Asbestos Legal Liability and/or Errors and Omissions with limits no less than $1,000,000 per occurrence or claim, and $2,000,000 policy aggregate. ☐ N/A if box checked (Project does not involve environmental hazards) If Contractor maintains broader coverage and/or higher limits than the minimums shown above, City requires and shall be entitled to the broader coverage and/or higher limits maintained by the contractor. Any available insurance proceeds in excess of the specified minimum limits of insurance and coverage shall be available to the City. Self-Insured Retentions. Self-insured retentions must be declared to and approved by City. At City’s option, either: (1) Contractor shall cause the insurer to reduce or eliminate self-insured retentions as respects City, its officers, officials, employees, and volunteers; or (2) Contractor shall provide a financial guarantee satisfactory to City guaranteeing payment of losses and related investigations, claim administration, and defense expenses. The policy language shall provide, or be endorsed to provide, that the self-insured retention may be satisfied by either the named insured or the City. OTHER INSURANCE PROVISIONS The insurance policies are to contain, or be endorsed to contain, the following provisions: Additional Insured Status The City of Cupertino, its City Council, officers, officials, employees, agents, servants and volunteers are to be covered as additional insureds on the CGL and automobile liability policies with respect to liability arising out of the Services performed by or on behalf of Contractor including materials, parts, or equipment furnished. Endorsement of CGL coverage shall be at least as broad as ISO Form CG 20 10 11 85 or if not available, through the addition of both CG 20 10, CG 20 26, CG 20 33, or CG 20 38; and CG 20 37 if a later edition is used. Primary Coverage For any claims related to this Project, Contractor’s insurance coverage shall be “primary and non-contributory” and at least as broad as ISO CG 20 01 04 13 with respect to City, its officers, officials, employees and volunteers, and shall not seek contribution from City’s insurance. If the limits of insurance are satisfied in part by Umbrella/Excess Insurance, the Umbrella/Excess Insurance shall contain or be endorsed to contain a provision that such coverage shall also apply on a “primary and non-contributory” basis for the benefit of City. Notice of Cancellation Each insurance policy required shall provide that coverage shall not be canceled, except with notice to the City. Each certificate of insurance must state that the coverage afforded by the policy is in force and will not be reduced, cancelled or allowed to expire without at least 30 days advance written notice to City, unless due to non-payment of premiums, in which case ten days advance written notice must be provided to City. Such notice must be sent to City via certified mail and addressed to the attention of the City Manager. Builder’s Risk Contractor may submit Builder’s Risk insurance in the form of Course of Construction coverage, which shall name the City as a loss payee, as its interest may appear. The Builder’s Risk policy must be issued on an occurrence basis, for all-risk coverage on a 100% completed value basis on the insurable portion of the Project, with no coinsurance penalties, and for the benefit of City. If the Project does not involve new or major reconstruction, City may elect, acting in its sole discretion, to accept an Installation Floater policy instead of Builder’s Risk. For such projects, the Property Installation Floater shall include improvement, remodel, modification, alteration, conversion or adjustment to existing buildings, structures, processes, machinery and equipment, and shall provide property damage coverage for any Insurance Requirements for On-Call Public Works Construction Contracts Version: August 2024 3 building, structure, machinery or equipment damaged, impaired, broken, or destroyed during the performance of the Work, including during transit, installation, and testing at the City’s site. Waiver of Subrogation Each required policy must include an endorsement providing that the carrier agrees to waive any right of subrogation it may have against City. Contractor agrees to waive rights of subrogation which any insurer of Contractor may acquire from Contractor by virtue of the payment of any loss. Contractor agrees to obtain any endorsement that may be necessary to affect this waiver of subrogation. The Workers’ Compensation policy shall be endorsed with a waiver of subrogation in favor of the City for all work performed by the Contractor, its employees, agents and subcontractors. Acceptability of Insurers Insurance shall be placed with insurers admitted in the State of California and with an AM Best rating of A- VII or higher. Verification of Coverage Contractor shall furnish the City with original certificates and amendatory endorsements, or copies of the applicable insurance language, effecting coverage required by this contract. All certificates and endorsements are to be received and approved by the City before work commences. The City reserves the right to require complete, certified copies of all required insurance policies, including endorsements, required by these specifications, at any time. Subcontractors Contractor shall require and verify that all subcontractors maintain insurance meeting all the requirements stated herein, and Contractor shall ensure that City is an additional insured on insurance required from subcontractors. For CGL coverage subcontractors shall provide coverage with a form at least as broad as CG 20 38 04 13. Surety Bonds As required by Contract and described in the Contract Documents. The Payment and Performance Bonds shall be in a sum equal to the applicable Service Order Price. If the Performance Bond provides for a one-year warranty a separate Maintenance Bond is not necessary. If the warranty period specified in the Contract is for longer than one year a Maintenance Bond equal to 10% of the Contract Price is required. Bonds shall be duly executed by a responsible corporate surety, authorized to issue such bonds in the State of California and secured through an authorized agent with an office in California. Special Risks or Circumstances City reserves the right to modify these requirements, based on the nature of the risk, prior experience, insurer, coverage, or other circumstances. ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED? INSR ADDL SUBRLTR INSD WVD PRODUCER CONTACTNAME: FAXPHONE(A/C, No):(A/C, No, Ext): E-MAILADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY) AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATIONAND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $ DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT OTHER: $ COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $AUTOS ONLY AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE CLAIMS-MADE AGGREGATE $ DED RETENTION $ PER OTH-STATUTE ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y / N N / A (Mandatory in NH) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) $ $ $ $ $ The ACORD name and logo are registered marks of ACORD 10/30/2024 23434 Axis Mechanical, Inc. 908 Bern Ct San Jose, CA 95112 10172 A 1,000,000 X A0195129004 5/13/2024 5/13/2025 500,000 5,000 1,000,000 3,000,000 2,000,000 1,000,000A X A0195129001 5/13/2024 5/13/2025 5,000,000A A0195129005 5/13/2024 5/13/2025 5,000,000 A X A0195129006 5/13/2024 5/13/2025 1,000,000Y1,000,000 1,000,000 B Professional/E&O ANE4974882.24 5/13/2024 Limit (Occ/Agg) 2,000,000 C Pollution G70963632 006 5/13/2024 5/13/2025 Limit (Occ/Agg) 2,000,000 Re: 24-074-Qualin Community Center Cupertino. City of Cupertino, it’s Council, officers, officials, employees, agents, servants and volunteers are included as an additional insured on General Liability policy per the attached endorsement. Waiver of Subrogation apply to Automobile Liability and Workers Compensation policies per the attached endorsements. City of Cupertino 10300 Torre Avenue Cupertino, CA 95014 AXISMEC-03 MPADALA Acrisure Partners West Coast Insurance Services, LLC1950 W Corporate Way #1 Anaheim, CA 92801 Kelsey Koga kkoga@acrisure.com Middlesex Insurance Company Lloyd's Westchester Surplus Lines Insurance Company X 5/13/2025 X X X X X X Axis Mechanical, Inc.Axis Mechanical, Inc. 908 Bern Ct San Jose, CA 95112 COMMERCIAL GENERAL LIABILITY A0195129004 5/13/2025 1,000,000 3,000,000 AUTOMOBILE LIABILITY A0195129001 5/13/2025 1,000,000 EXCESS LIAB A0195129005 5/13/2025 5,000,000 WORKERS COMPENSATIONWORKERS COMPENSATIONAND EMPLOYERS' LIABILITY A0195129006 5/13/2025 1,000,000 Re: 24-074-Qualin Community Center Cupertino. City of Cupertino, it’s Council, officers, officials, employees, agents, servants and volunteers are included as an additional insured on General Liability policy City of Cupertino, it’s Council, officers, officials, employees, agents, servants and volunteers are included as an additional insured on General Liability policy per the attached endorsement. Waiver of Subrogation apply to Automobile Liability and Workers Compensation policies per the attached endorsements. City of Cupertino 10300 Torre Avenue City of Cupertino Cupertino, CA 95014 FORM NUMBER: EFFECTIVE DATE: The ACORD name and logo are registered marks of ACORD ADDITIONAL REMARKS ADDITIONAL REMARKS SCHEDULE FORM TITLE: Page of THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, ACORD 101 (2008/01) AGENCY CUSTOMER ID: LOC #: AGENCY NAMED INSURED POLICY NUMBER CARRIER NAIC CODE © 2008 ACORD CORPORATION. All rights reserved. Acrisure Partners West Coast Insurance Services, LLC AXISMEC-03 SEE PAGE 1 1 SEE PAGE 1 ACORD 25 Certificate of Liability Insurance 1 SEE P 1 Axis Mechanical, Inc.908 Bern CtSan Jose, CA 95112 SEE PAGE 1 MPADALA 1 Excess Liability $3M Excess Professional $3M Carrier: Lexington Ins. Co. Policy Number: 015136021 Effective Dates: 05/13/2024-05/13/2025 Limit: $3,000,000 Named Insured: Endorsement Effective Date: Name(s) Of Person(s) Or Organization(s): POLICY NUMBER:COMMERCIAL AUTO CA 04 44 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement,the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. SCHEDULE Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s)shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident"or the "loss"under a contract with that person or organization. © Insurance Services Office, Inc., 2011 Page 1 of 1CA 04 44 10 13 05/13/2024A0195129 Middlesex Insurance Company 00001 0000000000 24134 0 N1 23ce187a-b3e7-48fe-896d-e72920952ab023ce187a-b3e7-48fe-896d-e72920952ab0 (Ed. 4-84) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy.We will not enforce our right against the person or organization named in the Schedule.(This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule Name: Address:CA Description of Waiver: Any person or organization for whom the Named Insured has agreed by written contract executed prior to loss. JobID: (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Policy No. Endorsement No. Insured Premium Insurance Company Countersigned by This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. © 1983 National Council on Compensation Insurance. WC 00 03 13 (Ed. 4-84) Page 1 of 1 05/13/2024A0195129006 Middlesex Insurance Company 00001 0000000000 24134 0 N1 997c2911-53cc-491a-a4bb-ed0524c8e39c997c2911-53cc-491a-a4bb-ed0524c8e39c MMSEA Section 111 - A Federal Statute You Need to Know Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007 (MMSEA) statute institutes mandatory reporting requirements for claims involving a Medicare beneficiary. If you self administer these types of claims, you assume responsibility for reporting. As your insurance carrier, we handle the reporting requirements for you. However, employers who don't report claims to their insurance carrier and take on the ongoing responsibility for medical payments (ORM) for claimants are subject to federal fines if the claimant is, or becomes, a Medicare beneficiary. Employers may receive a fine of $1,000 per claim/per day and possible civil penalties, if the employer does not follow all reporting provisions in Section 111. For more information Below are answers to frequently asked questions to help clarify. For complete information, refer to the most recent MMSEA Section 111 Medicare Secondary Payer Mandatory User Guide - search the web by entering NGHP User Guide in the search field. Why the MMSEA and why would this affect my business? In December 2007, the MMSEA was signed into law in an effort to curb the rising cost of Medicare by enforcing Medicare's status as a secondary payer. Section 111 of the MMSEA adds new reporting provisions requiring that the Responsible Reporting Entity (RRE), typically the insurance carrier, report all workers’ compensation, liability and no fault bodily injury claims within the time frame designated by the Secretary of the Coordination of Benefits Contractor (COBC). Who is a Medicare beneficiary? A Medicare beneficiary, in general, is any person who is 65 years of age or older, has been a legal resident of the United States for at least 5 years and is eligible for Medicare. People with disabilities under the age of 65 may also be eligible if they receive Social Security Disability Insurance (SSDI) benefits. Also, people with specific medical conditions and dependents, including minors, in certain circumstances may become eligible to enroll in Medicare. Who is a Responsible Reporting Entity (RRE)? RREs are typically insurers or self insured entities; however, employers who don't report claims to their insurance carrier and assume the responsibility for ongoing medicals become the RRE and are held to all of the Section 111 reporting provisions, even if the employer has an insurance policy with a carrier. What defines Ongoing Responsibility for Medicals (ORM)? The entity that assumes responsibility for ongoing medicals must monitor the status of their claimants who are Medicare beneficiaries until the claimant dies, a settlement has been made or the Statute of Limitations is met and the claim cannot be reopened. In many cases involving Workers’ Compensation, and in certain No Fault states, there is no Statute of Limitations - the claim can be reopened at any time until the individual's death. Which claims need to be reported? All claims involving a Medicare beneficiary where a settlement, judgment, award or other payment is made must be reported. The entity who assumes ongoing responsibility for medicals (ORM) must monitor the status of a claimant for as long as their legal responsibilities for ORM remain open. In such circumstances the claim must be reported when the claimant becomes a Medicare beneficiary. Every RRE must register with the Centers for Medicare & Medicaid Service (CMS), and once registered will be assigned a CMS liaison to help work through the testing and reporting process. More information regarding Section 111 and the reporting requirements can be found on the CMS website, cms.gov/MandatoryInsRep. Page 1 of 120 3118 03 15 05/13/2024A0195129 Middlesex Insurance Company 00001 0000000000 24134 0 N1 a023011f-2be8-423a-96c3-28386148f772a023011f-2be8-423a-96c3-28386148f772 Billing Practices Your commercial insurance protection is critical to your business operations. To ensure continued protection of your assets, we encourage you to pay your invoice promptly. The information below outlines our billing practices. Payment Plans We offer a variety of interest-free premium payment plans for our eligible customers. Multiple late payments may result in the immediate forfeiture of the premium payment plan. Invoices Your invoice provides you with a description of premium transactions that affect your account. It includes the information you need to effectively track your costs and coverage periods. Your invoice will list the date your premium payment is due in our office. If you default on a premium payment, a notice of cancellation will be sent and may be applicable to your entire account with all of our companies. We reserve the right to apply any amount owed to you by any of our companies against unpaid amounts owed by you to any of our companies. In the event of policy cancelation, we reserve the right to request first party claim payment be applied to unpaid and past due earned premium on your account. Audited Coverages (estimated) If any of your coverages have been written on an estimated basis, at the end of the policy period you may be asked to provide information from your records, or an auditor may visit you. The purpose of the audit is to determine earned premium. After the audit, we will either credit your account with any return premium or bill you for any additional premium due. Customer Service If you have any questions or concerns regarding your invoice or about our payment plans, please contact our Customer Service Unit. Page 1 of 140 1613 03 15 05/13/2024A0195129 Middlesex Insurance Company 00001 0000000000 24134 0 N1 ec6da0c1-6ace-489e-8319-a97fa123fabdec6da0c1-6ace-489e-8319-a97fa123fabd 45-8 4/18 IMPORTANT NOTICE What You Should Know About Our Protection of Your Privacy Protecting the personal information of the individuals we serve is a priority for Sentry Insurance. We collect, retain and use personal information about individuals for the purpose of serving their insurance needs and providing services to them. This notice describes how we handle personal information of the individuals we serve. It is only for your information. No action on your part is needed. If you have questions regarding this notice, please write to Director of Privacy, 1800 North Point Drive, Stevens Point, WI 54481. What kinds of information are collected and disclosed? The types of information we may collect about you include: Information you provide on applications or other forms, or in your verbal responses to our questions. This may include identifying information such as name, address and information about your assets and income. Information about your transactions with us including policies purchased and premium payment history. Information we receive from a consumer reporting agency that indicates your credit worthiness and credit history. Information we collect from you as part of the claims process. We do not sell customer lists or any personal information regarding our customers. We only disclose nonpublic personal information about customers or former customers to other affiliated or nonaffiliated third parties as permitted or required by law. We may share personal financial information about you between affiliated companies within the Sentry Insurance Group in order to make additional services available to you (e.g. auto insurance customers may receive information about life insurance products, and vice versa). For those clients of Point Insurance Agency, LLC, Florists' Insurance Service, Inc. and/or the Parker Stevens agencies, these agencies may disclose your nonpublic personal information to nonaffiliated insurance companies as reasonably necessary to provide you with insurance products and services. How do we safeguard your privacy? We maintain physical, electronic and procedural safeguards to protect your personal financial information. We restrict access to nonpublic personal financial data to those associates who need to know that information in order to provide products or services to you. We communicate to associates in writing the importance of protecting confidential information. We may amend our privacy policies at any time. If we do, we will inform you in writing. This notice applies to each of the following companies. Companies may not be licensed in all states. Sentry Insurance Company (formerly known as Sentry Insurance a Mutual Company) Dairyland American Insurance Company Dairyland County Mutual Insurance Company of Texas Dairyland Insurance Company Dairyland National Insurance Company Middlesex Insurance Company Parker Assurance Ltd. Parker Centennial Assurance Company Parker Services, L.L.C. Florists' Insurance Service, Inc. Parker Stevens Agency, L.L.C. Parker Stevens Insurance Agency of Massachusetts, Inc. Patriot General Insurance Company Peak Property and Casualty Insurance Corporation Point Insurance Agency, LLC Point Insurance Company Sentry Casualty Company Florists' Mutual Insurance Company Sentry Equity Services, Inc. Sentry Life Insurance Company Sentry Life Insurance Company of New York Sentry Lloyds of Texas Sentry Select Insurance Company Viking Insurance Company of Wisconsin Florists' Insurance Company Page 1 of 1 05/13/2024A0195129 Middlesex Insurance Company 00001 0000000000 24134 0 N1 d6de0043-79b8-4a1c-926a-b1e5df7ef40dd6de0043-79b8-4a1c-926a-b1e5df7ef40d This notice applies to the following policy POLICYHOLDER DISCLOSURE RENEWAL OF TERRORISM COVERAGE Axis Mechanical , Inc. 908 Bern Ct San Jose, CA 95112 Middlesex Insurance Company 1800 North Point Drive PO Box 8048 Stevens Point, WI 54481-8048 Account Number: A0195129 Policy Effective: 05/13/2024 to 05/13/2025 Coverage Provided:General Liability Inland Marine Property Umbrella Your insurance policy provides coverage for acts of terrorism as defined in the Terrorism Risk Insurance Act. You are notified that under the Terrorism Risk Insurance Act, as amended, the definition of act of terrorism has changed. As defined in Section 102(1) of the Act: The term “act of terrorism” means any act or acts that are 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. Under your coverage, any losses resulting from certified acts of terrorism may be partially reimbursed by the United States Government under a formula established by the Terrorism Risk Insurance Act, as amended. However, your policy contains other exclusions which might affect your coverage, such as an exclusion for nuclear events. Under the formula, the United States Government generally reimburses 80% beginning on January 1, 2021, of covered terrorism losses exceeding the statutorily established deductible paid by the insurance company providing the coverage. The Terrorism Risk Insurance Act contains a $100 billion cap that limits the United States Government reimbursement as well as insurers’ liability for losses resulting from certified acts of terrorism when the amount of such losses exceeds $100 billion in any one calendar year. If the aggregate insured losses for all insurers exceed $100 billion, your coverage may be reduced. The premium for this coverage is specified in your policy and does not include any charges for the portion of losses covered by the United States Government under the Act. Page 1 of 280 1255 12 20 05/13/2024A0195129 Middlesex Insurance Company 00001 0000000000 24134 0 N1 cf89b27a-10da-4df9-924f-4ad5033277e9cf89b27a-10da-4df9-924f-4ad5033277e9 You are not required to continue this coverage. If you wish to reject renewal of this coverage, you must indicate your rejection on this form and return the rejection to us with your signature by 06/17/2024. I hereby reject the offer of Terrorism coverage. I understand that an exclusion of losses caused by certified acts of terrorism will be made part of this policy and that any coverage or exclusion presently contained in this policy for non-certified acts of terrorism will not be affected. Policyholder's signature Date Print name 80 1255 12 20Page 2 of 2 05/13/2024A0195129 Middlesex Insurance Company Sentry customer resources and contact information Customer Service Our customer service team is ready to help you find the answers to your policy questions. Phone: 800-473-6879 Online: sentry.com (click Log in) Email: sentryregionalsupport@sentry.com Fax: 800-672-4702 Hours:Mon-Fri, 7 a.m. - 5 p.m. CT Billing You can submit your premium payments securely over the phone, online, or by mail. Phone:800-473-6879 Online:sentry.com (click Make a payment) Mail: Sentry Insurance - Regional P.O. Box 8048 Stevens Point, WI 54481 Claim Reporting It's important to report claims immediately, even if you don't necessarily have all the information. With Sentry , you can report a claim by phone, fax, or online-24/7, 365 days a year. To speed up the process, please have your policy or account number ready. For more information, please refer to the claim reporting section. To report a claim or check the status of an existing claim, use the following contact information: Phone:800-473-6879 Online:sentry.com (click Log in) Fax:800-999-4642 Email:claimsmail@sentry.com (for claim reporting only) Mail: (Workers' compensation) Sentry Claims Service PO Box 8032 Stevens Point, WI 54481 Mail: (Liability-General/auto/property) Sentry Claims Service PO Box 8026 Stevens Point, WI 54481 Risk management resources As a Sentry customer, you have access to our valuable risk management programs and resources. We’re committed to providing market-leading products and services that make sense for you and your business. Our intuitive, secure online portal provides access to risk management resources designed to help you improve safety within your organization. To access, visit sentry.com and click Log in. Sentry Safety Trainer is our interactive, online safety training system offering your business significant training cost savings over instructor-led methods. To access your free safety training lessons, please call 800-443-9655, option 2. You can also visit sentrysafetytrainer.com for sample safety lessons. Page 1 of 140 1494 03 15 05/13/2024A0195129 Middlesex Insurance Company 00001 0000000000 24134 0 N1 ac21fc45-ad84-4eb0-9efc-00be888739d7ac21fc45-ad84-4eb0-9efc-00be888739d7 ACCOUNT NUMBER: A0195129 COMMON POLICY DECLARATIONS Middlesex Insurance Company (A Participating Stock Company) A member of the Sentry Insurance Group 1800 North Point Drive Stevens Point, WI 54481 Agency Acrisure of California, LLC 34 S 2nd St Campbell, CA 95008 Agency Code 10047536 First Named Insured: GENERAL INFORMATION Axis Mechanical , Inc. Address:908 Bern Ct San Jose, CA 95112 Business Type: Unless stated elsewhere, the coverage provided under the policies included in this Contract are effective 05/13/2024 to 05/13/2025 at 12:01 A.M. Standard Time at your mailing address shown above. In return for the payment of the premium, and subject to the terms of this Contract, we agree to provide the insurance as stated in the policies which are included in this Contract. Corporation NAMED INSUREDS The FIRST NAMED INSURED shown in the GENERAL INFORMATION above, and the person(s) or organization(s) shown as NAMED INSUREDS below are named insureds for all policies included in this contract, unless a specific exception is included in the Declarations for an individual policy. Not Applicable COVERED LOCATIONS/SCHEDULE OF PREMISES AddressPrem.#Bldg.#Construction Occupancy 1 2474 De La Cruz Blvd Santa Clara, CA 95050-2923 Joisted Masonry - Other Than Reinforced 1 Air Conditioning Equipment - dealers or distributors only - sales and/or storage with or without repair 2 908 Bern Ct San Jose, CA 95112-1236 Joisted Masonry - Other Than Reinforced 1 Air Conditioning Equipment Mfg. - Precision parts IL 89 00 10 14 Page 1 of 2 05/13/2024A0195129 Middlesex Insurance Company 00001 0000000000 24134 0 N1 587fd2c1-cc1e-4cf4-a411-e945aaecadd3587fd2c1-cc1e-4cf4-a411-e945aaecadd3 ACCOUNT NUMBER:A0195129 Page 2 of 2 IL 89 00 10 14 05/13/2024A0195129 Middlesex Insurance Company COVERAGES This Contract consists of the following Coverages: Policy Number Premium COMMERCIAL PROPERTY COVERAGE A0195129002 $6,513.00 COMMERCIAL INLAND MARINE COVERAGE A0195129003 $1,947.00 COMMERCIAL GENERAL LIABILITY COVERAGE A0195129004 $91,841.00 COMMERCIAL AUTO COVERAGE A0195129001 $99,278.00 COMMERCIAL EXCESS/UMBRELLA COVERAGE A0195129005 $63,721.00 PREMIUM SUMMARY The Premium for this policy:$ 263,300.00 1,865.00Terrorism:$ 265,165.00Total Cost:$ COMMON POLICY FORMS AND/OR ENDORSEMENTS The following forms and/or endorsements apply to all coverages included as part of this policy: Form/Endorsement Form/Endorsement Title Number and Edition Date 80 2313 01 21 Additional Conditions - Membership And Participation IL 00 17 11 98 Common Policy Conditions These declarations together with the common policy conditions, coverage part declarations, coverage part coverage form(s) and forms and endorsements, if any, issued to form a part thereof, complete the above numbered policy. 80 2313 01 21 ADDITIONAL CONDITIONS MEMBERSHIP AND PARTICIPATION Membership By virtue of this policy, you are a member of Sentry Mutual Holding Company of Stevens Point, Wisconsin. You are entitled to vote either in person or by proxy at any meeting of members of the Company. The annual meeting of the Company is held at the Company's Home Office in Stevens Point, Wisconsin at 9:00 A.M. on the third Wednesday in April. Participation You will share in any dividends in accordance with conditions established by the Board of Directors. This policy is not assessable. Vice President, Secretary President Page 1 of 180 2313 01 21 05/13/2024A0195129 Middlesex Insurance Company 00001 0000000000 24134 0 N1 db0ad047-ec40-43e0-9dfa-7d7f24266aacdb0ad047-ec40-43e0-9dfa-7d7f24266aac IL 00 17 11 98 Copyright, Insurance Services Office, Inc., 1998 COMMON POLICY CONDITIONS IL 00 17 11 98 All Coverage Parts included in this policy are subject to the following conditions. A.Cancellation 1.The first Named Insured shown in the Declara- tions may cancel this policy by mailing or de- livering to us advance written notice of can- cellation. 2.We may cancel this policy by mailing or deliv- ering to the first Named Insured written notice of cancellation at least: a.10 days before the effective date of cancel- lation if we cancel for nonpayment of pre- mium; or b.30 days before the effective date of cancel- lation if we cancel for any other reason. 3.We will mail or deliver our notice to the first Named Insured's last mailing address known to us. 4.Notice of cancellation will state the effective date of cancellation. The policy period will end on that date. 5.If this policy is cancelled, we will send the first Named Insured any premium refund due. If we cancel, the refund will be pro rata. If the first Named Insured cancels, the refund may be less than pro rata. The cancellation will be ef- fective even if we have not made or offered a refund. 6.If notice is mailed, proof of mailing will be suffi- cient proof of notice. B.Changes This policy contains all the agreements between you and us concerning the insurance afforded. The first Named Insured shown in the Declara- tions is authorized to make changes in the terms of this policy with our consent. This policy's terms can be amended or waived only by endorsement issued by us and made a part of this policy. C.Examination Of Your Books And Records We may examine and audit your books and re- cords as they relate to this policy at any time dur- ing the policy period and up to three years after- ward. D.Inspections And Surveys 1.We have the right to: a.Make inspections and surveys at any time; b.Give you reports on the conditions we find; and c.Recommend changes. 2.We are not obligated to make any inspections, surveys, reports or recommendations and any such actions we do undertake relate only to in- surability and the premiums to be charged. We do not make safety inspections. We do not undertake to perform the duty of any person or organization to provide for the health or safety of workers or the public. And we do not warrant that conditions: a.Are safe or healthful; or b.Comply with laws, regulations, codes or standards. 3.Paragraphs 1. and 2. of this condition apply not only to us, but also to any rating, advisory, rate service or similar organization which makes insurance inspections, surveys, reports or recommendations. 4.Paragraph 2. of this condition does not apply to any inspections, surveys, reports or recom- mendations we may make relative to certifica- tion, under state or municipal statutes, ordi- nances or regulations, of boilers, pressure ves- sels or elevators. E.Premiums The first Named Insured shown in the Declara- tions: 1.Is responsible for the payment of all premiums; and 2.Will be the payee for any return premiums we pay. F.Transfer Of Your Rights And Duties Under This Policy Your rights and duties under this policy may not be transferred without our written consent except in the case of death of an individual named in- sured. If you die, your rights and duties will be trans- ferred to your legal representative but only while acting within the scope of duties as your legal representative. Until your legal representative is appointed, anyone having proper temporary cus- tody of your property will have your rights and du- ties but only with respect to that property. Page 1 of 1 05/13/2024A0195129 Middlesex Insurance Company 00001 0000000000 24134 0 N1 6926053c-5a3f-454c-8d7b-6a94362d26e06926053c-5a3f-454c-8d7b-6a94362d26e0 COMMERCIAL PROPERTY COVERAGE DECLARATIONS POLICY NUMBER: A0195129002 Middlesex Insurance Company (A Participating Stock Company) A member of the Sentry Insurance Group 1800 North Point Drive Stevens Point, WI 54481 Agency Acrisure of California, LLC 34 S 2nd St Campbell, CA 95008 Agency Code 10047536 POLICY INFORMATION First Named Insured:Axis Mechanical , Inc. Address:908 Bern Ct San Jose, CA 95112 The Commercial Property Coverage applies from 05/13/2024 to 05/13/2025 at 12:01 A.M. Standard Time at the First Named Insured's mailing address shown above. Additional Named Insured In addition to the Named Insured’s listed in the Common Declarations, the following person(s) or organization(s) are named insured’s for the Commercial Property Liability Coverage only: Name:Axis Holdings 2 LLC Address:2474 De La Cruz Blvd Santa Clara, CA 95050-2923 Name:Axis Holdings Ltd LLC Address:2474 De La Cruz Blvd Santa Clara, CA 95050-2923 Additional Interests The persons or organizations listed as Additional Interests, in the Additional Interests Supplemental Schedule, are included as loss payees, lenders loss payees, mortgagees, or additional insureds, but only for the coverages and to the extent of their interest as indicated. Applicable Forms And Endorsements In addition to the common policy forms and endorsements, the following forms and endorsements apply to the Commercial Property Coverage: Form/Endorsement Form/Endorsement Title Number and Edition Date CP 00 10 10 12 Building And Personal Property Coverage Form CP 00 30 10 12 Business Income (And Extra Expense) Coverage Form CP 00 90 07 88 Commercial Property Conditions CP 01 40 07 06 Exclusion Of Loss Due To Virus Or Bacteria CP 89 01 10 14 Page 1 of 4 05/13/2024A0195129 Middlesex Insurance Company 00002 0000000000 24134 0 N1 2a7cd0e7-892c-41a8-9a5d-ba0082de00cd2a7cd0e7-892c-41a8-9a5d-ba0082de00cd POLICY NUMBER:A0195129002 Page 2 of 4 CP 89 01 10 14 05/13/2024A0195129 Middlesex Insurance Company Form/Endorsement Form/Endorsement Title Number and Edition Date CP 02 99 06 07 Cancellation Changes CP 04 11 09 17 Protective Safeguards CP 04 49 02 20 California Changes - Replacement Cost CP 10 30 09 17 Causes Of Loss - Special Form CP 10 36 10 12 Limitations On Coverage For Roof Surfacing CP 10 75 12 20 Cyber Incident Exclusion CP 12 18 10 12 Loss Payable Provisions CP 70 23 10 01 Personal Property Leased CP 70 47 10 13 Equipment Breakdown CP 80 26 10 18 Special Broadened Property Coverage IL 01 02 02 20 California Changes-Actual Cash Value IL 01 04 07 20 California Changes IL 02 70 07 20 California Changes - Cancellation And Nonrenewal IL 09 35 07 02 Exclusion Of Certain Computer-Related Losses IL 09 52 01 15 Cap On Losses From Certified Acts Of Terrorism IL 09 85 12 20 Disclosure Pursuant To Terrorism Risk Insurance Act IL 70 26 07 13 Multiple Line Occurrence Deductible COVERAGES PREMISES NO.: 1 BUILDING NO.: 1 DESCRIPTION: 2474 De La Cruz Blvd, Santa Clara, CA 95050-2923 Limit of Coinsurance Covered Causes Of LossInsuranceCoverage Deductible Building 80%$2,007,000 $1,000Special Including Theft Equipment Breakdown Optional Coverages Inflation Guard 8% Replacement Cost Limit of Coinsurance Covered Causes Of LossInsuranceCoverage Deductible Your Business Personal Property 90% Blanket 1, See Blanket Limits Schedule Special Including Theft Equipment Breakdown $1,000 Optional Coverages Inflation Guard 4% Replacement Cost POLICY NUMBER:A0195129002 CP 89 01 10 14 Page 3 of 4 05/13/2024A0195129 Middlesex Insurance Company 00002 0000000000 24134 0 N3 2a7cd0e7-892c-41a8-9a5d-ba0082de00cd2a7cd0e7-892c-41a8-9a5d-ba0082de00cd COVERAGES Coinsurance Limit of Insurance Covered Causes Of LossCoverage Business Income (And Extra Expense) Coverage: Including Rental Value $193,140 Special Including Theft Equipment Breakdown 80% PREMISES NO.: 2 BUILDING NO.: 1 DESCRIPTION: 908 Bern Ct, San Jose, CA 95112-1236 Limit of Coinsurance Covered Causes Of LossInsuranceCoverage Deductible Building 80%$5,660,302 $1,000Special Including Theft Equipment Breakdown Optional Coverages Inflation Guard 8% Replacement Cost Limit of Coinsurance Covered Causes Of LossInsuranceCoverage Deductible Your Business Personal Property including Property of Others 90% Blanket 1, See Blanket Limits Schedule Special Including Theft Equipment Breakdown $1,000 Optional Coverages Inflation Guard 4% Replacement Cost Coinsurance Limit of Insurance Covered Causes Of LossCoverage Business Income (And Extra Expense) Coverage: Other Than Rental Value $309,000 Special Including Theft Equipment Breakdown 80% BLANKET LIMITS SCHEDULE Blanket No.Blanket Limit of Insurance 1 $1,370,000 COMMERCIAL PROPERTY POLICY OPTIONAL COVERAGES Protective Safeguards Premises No. Building No. Protective Safeguards Symbols Applicable 2 1 P-1 POLICY NUMBER:A0195129002 Page 4 of 4 CP 89 01 10 14 05/13/2024A0195129 Middlesex Insurance Company COMMERCIAL PROPERTY POLICY OPTIONAL COVERAGES Special Broadened Property Coverage Endorsement Direct Loss Blanket Limit $250,000 Per building per occurrence Indirect Loss Blanket Limit $100,000 Per building per occurrence Crime Loss Blanket Limit $50,000 Per occurrence Special Broadened Property Coverage Endorsement Increased Limits Schedule The following limits of insurance replace those shown in the Special Broadened Property Coverage endorsement. If the Special Broadened Property coverage endorsement specifies that the Direct Loss Blanket Limit or the Indirect Loss Blanket Limit applies to any of the following coverages, the limit in the Schedule below is in addition to any insurance apportioned under the Direct Loss Blanket Limit or the Indirect Loss Blanket Limit The following limits apply to covered property that is not at a premise listed in the Description of Premises: Property at any Location $500,000 Property in transit in any one vehicle or vessel $50,000 Property in the custody of a Messenger or Salesperson $25,000 Property at any exhibit $100,000 Limitations On Coverage For Roof Surfacing Premises No. Building No. Indicate Applicability (Paragraph A. and/or Paragraph B.) 1 1 Paragraph B 2 1 Paragraph B POLICY NUMBER: A0195129002 ADDITIONAL INTEREST - SUPPLEMENTAL SCHEDULE The following persons or organizations are included as Additional Interests, but only to the extent provided in the listed endorsement: Additional Interest Prem.#Bldg.#Coverage Interest*Endorsement Number Community Bank of the Bay 1 1 PO Box 3308 Santa Rosa, CA 95402-3308 Building Coverage Mort Building Coverage CP 12 18 10 12LP Pinnacle Bank 2 1 Its Successors and/or Assigns/ATIMA 1276 S Main St Salinas, CA 93901-2287 Building Coverage Mort Building Coverage CP 12 18 10 12LP U.S. Small Business Administration 1 1 c/o The Mortgage Capital Development Co., 1720 Broadway 3rd Fl Oakland, CA 94612-2137 Building Coverage Mort Building Coverage CP 12 18 10 12LP U.S. Small Business Administration 2 1 c/o The Mortgage Capital Development Co., 1720 Broadway 3rd Fl Oakland, CA 94612-2137 Building Coverage Mort Building Coverage CP 12 18 10 12LP *Interest Descriptions As used in this Supplemental Schedule: “AI” means Additional Insured; “LP” means Loss Payee; “LLP" means Lenders Loss Payable; “Mort’” means Mortgage holder; “CSC” means Contract Of Sale Clause; “BLP” means Building Owners Loss Payable Clause CP 89 02 10 14 Page 1 of 1 05/13/2024A0195129 Middlesex Insurance Company 00001 0000000000 24134 0 N1 df909e13-3155-4a18-9c27-e30e67819de3df909e13-3155-4a18-9c27-e30e67819de3 A0195129 Middlesex Insurance Company 05/13/2024 34750536-c2d5-4ff4-8a5a-f1c7b311ebc8 Page 1 of 16CP 00 10 10 12 COMMERCIAL PROPERTY CP 00 10 10 12 BUILDING AND PERSONAL PROPERTY COVERAGE FORM Various provisions in this policy restrict coverage. Read the entire policy carefully to determine rights, duties and what is and is not covered. Throughout this policy, the words "you" and "your" refer to the Named Insured shown in the Declarations. The words "we", "us" and "our" refer to the company providing this insurance. Other words and phrases that appear in quotation marks have special meaning. Refer to Section H. Definitions. A.Coverage We will pay for direct physical loss of or damage to Covered Property at the premises described in the Declarations caused by or resulting from any Covered Cause of Loss. 1.Covered Property Covered Property, as used in this Coverage Part, means the type of property described in this section, A.1., and limited in A.2. Property Not Covered, if a Limit Of Insurance is shown in the Declarations for that type of property. a.Building, meaning the building or structure described in the Declarations, including: (1)Completed additions; (2)Fixtures, including outdoor fixtures; (3)Permanently installed: (a)Machinery; and (b)Equipment; (4)Personal property owned by you that is used to maintain or service the building or structure or its premises, including: (a)Fire-extinguishing equipment; (b)Outdoor furniture; (c)Floor coverings; and (d)Appliances used for refrigerating, ventilating, cooking, dishwashing or laundering; (5)If not covered by other insurance: (a)Additions under construction, alterations and repairs to the building or structure; (b)Materials, equipment, supplies and temporary structures, on or within 100 feet of the described premises, used for making additions, alterations or repairs to the building or structure. b.Your Business Personal Property consists of the following property located in or on the building or structure described in the Declarations or in the open (or in a vehicle) within 100 feet of the building or structure or within 100 feet of the premises described in the Declarations, whichever distance is greater: (1)Furniture and fixtures; (2)Machinery and equipment; (3)"Stock"; (4)All other personal property owned by you and used in your business; (5)Labor, materials or services furnished or arranged by you on personal property of others; (6)Your use interest as tenant in improvements and betterments. Improvements and betterments are fixtures, alterations, installations or additions: (a)Made a part of the building or structure you occupy but do not own; and © Insurance Services Office, Inc., 2011 A0195129 Middlesex Insurance Company 05/13/2024 34750536-c2d5-4ff4-8a5a-f1c7b311ebc8 (b)You acquired or made at your expense but cannot legally remove; (7)Leased personal property for which you have a contractual responsibility to insure, unless otherwise provided for under Personal Property Of Others. c.Personal Property Of Others that is: (1)In your care, custody or control; and (2)Located in or on the building or structure described in the Declarations or in the open (or in a vehicle) within 100 feet of the building or structure or within 100 feet of the premises described in the Declarations, whichever distance is greater. However, our payment for loss of or damage to personal property of others will only be for the account of the owner of the property. 2.Property Not Covered Covered Property does not include: a.Accounts, bills, currency, food stamps or other evidences of debt, money, notes or securities. Lottery tickets held for sale are not securities; b.Animals, unless owned by others and boarded by you, or if owned by you, only as "stock" while inside of buildings; c.Automobiles held for sale; d.Bridges, roadways, walks, patios or other paved surfaces; e.Contraband, or property in the course of illegal transportation or trade; f.The cost of excavations, grading, backfilling or filling; g.Foundations of buildings, structures, machinery or boilers if their foundations are below: (1)The lowest basement floor; or (2)The surface of the ground, if there is no basement; h.Land (including land on which the property is located), water, growing crops or lawns (other than lawns which are part of a vegetated roof); i.Personal property while airborne or waterborne; j.Bulkheads, pilings, piers, wharves or docks; k.Property that is covered under another coverage form of this or any other policy in which it is more specifically described, except for the excess of the amount due (whether you can collect on it or not) from that other insurance; l.Retaining walls that are not part of a building; m.Underground pipes, flues or drains; n.Electronic data, except as provided under the Additional Coverage, Electronic Data. Electronic data means information, facts or computer programs stored as or on, created or used on, or transmitted to or from computer software (including systems and applications software), on hard or floppy disks, CD-ROMs, tapes, drives, cells, data processing devices or any other repositories of computer software which are used with electronically controlled equipment. The term computer programs, referred to in the foregoing description of electronic data, means a set of related electronic instructions which direct the operations and functions of a computer or device connected to it, which enable the computer or device to receive, process, store, retrieve or send data. This paragraph, n., does not apply to your "stock" of prepackaged software, or to electronic data which is integrated in and operates or controls the building©s elevator, lighting, heating, ventilation, air conditioning or security system; o.The cost to replace or restore the information on valuable papers and records, including those which exist as electronic data. Valuable papers and records include but are not limited to proprietary information, books of account, deeds, manuscripts, abstracts, drawings and card index systems. Refer to the Coverage Extension for Valuable Papers And Records (Other Than Electronic Data) for limited coverage for valuable papers and records other than those which exist as electronic data; p.Vehicles or self-propelled machines (including aircraft or watercraft) that: (1)Are licensed for use on public roads; or (2)Are operated principally away from the described premises. This paragraph does not apply to: (a)Vehicles or self-propelled machines or autos you manufacture, process or warehouse; © Insurance Services Office, Inc., 2011 CP 00 10 10 12Page 2 of 16 A0195129 Middlesex Insurance Company 05/13/2024 34750536-c2d5-4ff4-8a5a-f1c7b311ebc8 (b)Vehicles or self-propelled machines, other than autos, you hold for sale; (c)Rowboats or canoes out of water at the described premises; or (d)Trailers, but only to the extent provided for in the Coverage Extension for Non-owned Detached Trailers; or q.The following property while outside of buildings: (1)Grain, hay, straw or other crops; (2)Fences, radio or television antennas (including satellite dishes) and their lead-in wiring, masts or towers, trees, shrubs or plants (other than trees, shrubs or plants which are "stock" or are part of a vegetated roof), all except as provided in the Coverage Extensions. 3.Covered Causes Of Loss See applicable Causes Of Loss form as shown in the Declarations. 4.Additional Coverages a.Debris Removal (1)Subject to Paragraphs (2), (3) and (4), we will pay your expense to remove debris of Covered Property and other debris that is on the described premises, when such debris is caused by or results from a Covered Cause of Loss that occurs during the policy period. The expenses will be paid only if they are reported to us in writing within 180 days of the date of direct physical loss or damage. (2)Debris Removal does not apply to costs to: (a)Remove debris of property of yours that is not insured under this policy, or property in your possession that is not Covered Property; (b)Remove debris of property owned by or leased to the landlord of the building where your described premises are located, unless you have a contractual responsibility to insure such property and it is insured under this policy; (c)Remove any property that is Property Not Covered, including property addressed under the Outdoor Property Coverage Extension; (d)Remove property of others of a type that would not be Covered Property under this Coverage Form; (e)Remove deposits of mud or earth from the grounds of the described premises; (f)Extract "pollutants" from land or water; or (g)Remove, restore or replace polluted land or water. (3)Subject to the exceptions in Paragraph (4), the following provisions apply: (a)The most we will pay for the total of direct physical loss or damage plus debris removal expense is the Limit of Insurance applicable to the Covered Property that has sustained loss or damage. (b)Subject to (a) above, the amount we will pay for debris removal expense is limited to 25% of the sum of the deductible plus the amount that we pay for direct physical loss or damage to the Covered Property that has sustained loss or damage. However, if no Covered Property has sustained direct physical loss or damage, the most we will pay for removal of debris of other property (if such removal is covered under this Additional Coverage) is $5,000 at each location. (4)We will pay up to an additional $25,000 for debris removal expense, for each location, in any one occurrence of physical loss or damage to Covered Property, if one or both of the following circumstances apply: (a)The total of the actual debris removal expense plus the amount we pay for direct physical loss or damage exceeds the Limit of Insurance on the Covered Property that has sustained loss or damage. (b)The actual debris removal expense exceeds 25% of the sum of the deductible plus the amount that we pay for direct physical loss or damage to the Covered Property that has sustained loss or damage. © Insurance Services Office, Inc., 2011 Page 3 of 16CP 00 10 10 12 A0195129 Middlesex Insurance Company 05/13/2024 34750536-c2d5-4ff4-8a5a-f1c7b311ebc8 Therefore, if (4)(a) and/or (4)(b) applies, our total payment for direct physical loss or damage and debris removal expense may reach but will never exceed the Limit of Insurance on the Covered Property that has sustained loss or damage, plus $25,000. (5)Examples The following examples assume that there is no Coinsurance penalty. Example 1 Limit of Insurance: $ 90,000 Amount of Deductible: $ 500 Amount of Loss: $ 50,000 Amount of Loss Payable: $ 49,500 ($50,000 - $500) Debris Removal Expense: $ 10,000 Debris Removal Expense Payable: $ 10,000 ($10,000 is 20% of $50,000.) The debris removal expense is less than 25% of the sum of the loss payable plus the deductible. The sum of the loss payable and the debris removal expense ($49,500 + $10,000 = $59,500) is less than the Limit of Insurance. Therefore, the full amount of debris removal expense is payable in accordance with the terms of Paragraph (3). Example 2 Limit of Insurance: $ 90,000 Amount of Deductible: $ 500 Amount of Loss: $ 80,000 Amount of Loss Payable: $ 79,500 ($80,000 - $500) Debris Removal Expense: $ 40,000 Debris Removal Expense Payable Basic Amount: $ 10,500 Additional Amount: $ 25,000 The basic amount payable for debris removal expense under the terms of Paragraph (3) is calculated as follows: $80,000 ($79,500 + $500) x .25 = $20,000, capped at $10,500. The cap applies because the sum of the loss payable ($79,500) and the basic amount payable for debris removal expense ($10,500) cannot exceed the Limit of Insurance ($90,000). The additional amount payable for debris removal expense is provided in accordance with the terms of Paragraph (4), because the debris removal expense ($40,000) exceeds 25% of the loss payable plus the deductible ($40,000 is 50% of $80,000), and because the sum of the loss payable and debris removal expense ($79,500 + $40,000 = $119,500) would exceed the Limit of Insurance ($90,000). The additional amount of covered debris removal expense is $25,000, the maximum payable under Paragraph (4). Thus, the total payable for debris removal expense in this example is $35,500; $4,500 of the debris removal expense is not covered. b.Preservation Of Property If it is necessary to move Covered Property from the described premises to preserve it from loss or damage by a Covered Cause of Loss, we will pay for any direct physical loss or damage to that property: (1)While it is being moved or while temporarily stored at another location; and (2)Only if the loss or damage occurs within 30 days after the property is first moved. c.Fire Department Service Charge When the fire department is called to save or protect Covered Property from a Covered Cause of Loss, we will pay up to $1,000 for service at each premises described in the Declarations, unless a higher limit is shown in the Declarations. Such limit is the most we will pay regardless of the number of responding fire departments or fire units, and regardless of the number or type of services performed. This Additional Coverage applies to your liability for fire department service charges: (1)Assumed by contract or agreement prior to loss; or (2)Required by local ordinance. No Deductible applies to this Additional Coverage. © Insurance Services Office, Inc., 2011 CP 00 10 10 12Page 4 of 16 A0195129 Middlesex Insurance Company 05/13/2024 34750536-c2d5-4ff4-8a5a-f1c7b311ebc8 d.Pollutant Clean-up And Removal We will pay your expense to extract "pollutants" from land or water at the described premises if the discharge, dispersal, seepage, migration, release or escape of the "pollutants" is caused by or results from a Covered Cause of Loss that occurs during the policy period. The expenses will be paid only if they are reported to us in writing within 180 days of the date on which the Covered Cause of Loss occurs. This Additional Coverage does not apply to costs to test for, monitor or assess the existence, concentration or effects of "pollutants". But we will pay for testing which is performed in the course of extracting the "pollutants" from the land or water. The most we will pay under this Additional Coverage for each described premises is $10,000 for the sum of all covered expenses arising out of Covered Causes of Loss occurring during each separate 12-month period of this policy. e.Increased Cost Of Construction (1)This Additional Coverage applies only to buildings to which the Replacement Cost Optional Coverage applies. (2)In the event of damage by a Covered Cause of Loss to a building that is Covered Property, we will pay the increased costs incurred to comply with the minimum standards of an ordinance or law in the course of repair, rebuilding or replacement of damaged parts of that property, subject to the limitations stated in e.(3) through e.(9) of this Additional Coverage. (3)The ordinance or law referred to in e.(2) of this Additional Coverage is an ordinance or law that regulates the construction or repair of buildings or establishes zoning or land use requirements at the described premises and is in force at the time of loss. (4)Under this Additional Coverage, we will not pay any costs due to an ordinance or law that: (a)You were required to comply with before the loss, even when the building was undamaged; and (b)You failed to comply with. (5)Under this Additional Coverage, we will not pay for: (a)The enforcement of or compliance with any ordinance or law which requires demolition, repair, replacement, reconstruction, remodeling or remediation of property due to contamination by "pollutants" or due to the presence, growth, proliferation, spread or any activity of "fungus", wet or dry rot or bacteria; or (b)Any costs associated with the enforcement of or compliance with an ordinance or law which requires any insured or others to test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of "pollutants", "fungus", wet or dry rot or bacteria. (6)The most we will pay under this Additional Coverage, for each described building insured under this Coverage Form, is $10,000 or 5% of the Limit of Insurance applicable to that building, whichever is less. If a damaged building is covered under a blanket Limit of Insurance which applies to more than one building or item of property, then the most we will pay under this Additional Coverage, for that damaged building, is the lesser of: $10,000 or 5% times the value of the damaged building as of the time of loss times the applicable Coinsurance percentage. The amount payable under this Additional Coverage is additional insurance. (7)With respect to this Additional Coverage: (a)We will not pay for the Increased Cost of Construction: (i)Until the property is actually repaired or replaced at the same or another premises; and (ii)Unless the repair or replacement is made as soon as reasonably possible after the loss or damage, not to exceed two years. We may extend this period in writing during the two years. © Insurance Services Office, Inc., 2011 Page 5 of 16CP 00 10 10 12 A0195129 Middlesex Insurance Company 05/13/2024 34750536-c2d5-4ff4-8a5a-f1c7b311ebc8 (b)If the building is repaired or replaced at the same premises, or if you elect to rebuild at another premises, the most we will pay for the Increased Cost of Construction, subject to the provisions of e.(6) of this Additional Coverage, is the increased cost of construction at the same premises. (c)If the ordinance or law requires relocation to another premises, the most we will pay for the Increased Cost of Construction, subject to the provisions of e.(6) of this Additional Coverage, is the increased cost of construction at the new premises. (8)This Additional Coverage is not subject to the terms of the Ordinance Or Law Exclusion to the extent that such Exclusion would conflict with the provisions of this Additional Coverage. (9)The costs addressed in the Loss Payment and Valuation Conditions and the Replacement Cost Optional Coverage, in this Coverage Form, do not include the increased cost attributable to enforcement of or compliance with an ordinance or law. The amount payable under this Additional Coverage, as stated in e.(6) of this Additional Coverage, is not subject to such limitation. f.Electronic Data (1)Under this Additional Coverage, electronic data has the meaning described under Property Not Covered, Electronic Data. This Additional Coverage does not apply to your "stock" of prepackaged software, or to electronic data which is integrated in and operates or controls the building©s elevator, lighting, heating, ventilation, air conditioning or security system. (2)Subject to the provisions of this Additional Coverage, we will pay for the cost to replace or restore electronic data which has been destroyed or corrupted by a Covered Cause of Loss. To the extent that electronic data is not replaced or restored, the loss will be valued at the cost of replacement of the media on which the electronic data was stored, with blank media of substantially identical type. (3)The Covered Causes of Loss applicable to Your Business Personal Property apply to this Additional Coverage, Electronic Data, subject to the following: (a)If the Causes Of Loss - Special Form applies, coverage under this Additional Coverage, Electronic Data, is limited to the "specified causes of loss" as defined in that form and Collapse as set forth in that form. (b)If the Causes Of Loss - Broad Form applies, coverage under this Additional Coverage, Electronic Data, includes Collapse as set forth in that form. (c)If the Causes Of Loss form is endorsed to add a Covered Cause of Loss, the additional Covered Cause of Loss does not apply to the coverage provided under this Additional Coverage, Electronic Data. (d)The Covered Causes of Loss include a virus, harmful code or similar instruction introduced into or enacted on a computer system (including electronic data) or a network to which it is connected, designed to damage or destroy any part of the system or disrupt its normal operation. But there is no coverage for loss or damage caused by or resulting from manipulation of a computer system (including electronic data) by any employee, including a temporary or leased employee, or by an entity retained by you or for you to inspect, design, install, modify, maintain, repair or replace that system. © Insurance Services Office, Inc., 2011 CP 00 10 10 12Page 6 of 16 A0195129 Middlesex Insurance Company 05/13/2024 34750536-c2d5-4ff4-8a5a-f1c7b311ebc8 (4)The most we will pay under this Additional Coverage, Electronic Data, is $2,500 (unless a higher limit is shown in the Declarations) for all loss or damage sustained in any one policy year, regardless of the number of occurrences of loss or damage or the number of premises, locations or computer systems involved. If loss payment on the first occurrence does not exhaust this amount, then the balance is available for subsequent loss or damage sustained in but not after that policy year. With respect to an occurrence which begins in one policy year and continues or results in additional loss or damage in a subsequent policy year(s), all loss or damage is deemed to be sustained in the policy year in which the occurrence began. 5.Coverage Extensions Except as otherwise provided, the following Extensions apply to property located in or on the building described in the Declarations or in the open (or in a vehicle) within 100 feet of the described premises. If a Coinsurance percentage of 80% or more, or a Value Reporting period symbol, is shown in the Declarations, you may extend the insurance provided by this Coverage Part as follows: a.Newly Acquired Or Constructed Property (1)Buildings If this policy covers Building, you may extend that insurance to apply to: (a)Your new buildings while being built on the described premises; and (b)Buildings you acquire at locations, other than the described premises, intended for: (i)Similar use as the building described in the Declarations; or (ii)Use as a warehouse. The most we will pay for loss or damage under this Extension is $250,000 at each building. (2)Your Business Personal Property (a)If this policy covers Your Business Personal Property, you may extend that insurance to apply to: (i)Business personal property, including such property that you newly acquire, at any location you acquire other than at fairs, trade shows or exhibitions; or (ii)Business personal property, including such property that you newly acquire, located at your newly constructed or acquired buildings at the location described in the Declarations. The most we will pay for loss or damage under this Extension is $100,000 at each building. (b)This Extension does not apply to: (i)Personal property of others that is temporarily in your possession in the course of installing or performing work on such property; or (ii)Personal property of others that is temporarily in your possession in the course of your manufacturing or wholesaling activities. (3)Period Of Coverage With respect to insurance provided under this Coverage Extension for Newly Acquired Or Constructed Property, coverage will end when any of the following first occurs: (a)This policy expires; (b)30 days expire after you acquire the property or begin construction of that part of the building that would qualify as covered property; or (c)You report values to us. We will charge you additional premium for values reported from the date you acquire the property or begin construction of that part of the building that would qualify as covered property. © Insurance Services Office, Inc., 2011 Page 7 of 16CP 00 10 10 12 A0195129 Middlesex Insurance Company 05/13/2024 34750536-c2d5-4ff4-8a5a-f1c7b311ebc8 b.Personal Effects And Property Of Others You may extend the insurance that applies to Your Business Personal Property to apply to: (1)Personal effects owned by you, your officers, your partners or members, your managers or your employees. This Extension does not apply to loss or damage by theft. (2)Personal property of others in your care, custody or control. The most we will pay for loss or damage under this Extension is $2,500 at each described premises. Our payment for loss of or damage to personal property of others will only be for the account of the owner of the property. c.Valuable Papers And Records (Other Than Electronic Data) (1)You may extend the insurance that applies to Your Business Personal Property to apply to the cost to replace or restore the lost information on valuable papers and records for which duplicates do not exist. But this Extension does not apply to valuable papers and records which exist as electronic data. Electronic data has the meaning described under Property Not Covered, Electronic Data. (2)If the Causes Of Loss - Special Form applies, coverage under this Extension is limited to the "specified causes of loss" as defined in that form and Collapse as set forth in that form. (3)If the Causes Of Loss - Broad Form applies, coverage under this Extension includes Collapse as set forth in that form. (4)Under this Extension, the most we will pay to replace or restore the lost information is $2,500 at each described premises, unless a higher limit is shown in the Declarations. Such amount is additional insurance. We will also pay for the cost of blank material for reproducing the records (whether or not duplicates exist) and (when there is a duplicate) for the cost of labor to transcribe or copy the records. The costs of blank material and labor are subject to the applicable Limit of Insurance on Your Business Personal Property and, therefore, coverage of such costs is not additional insurance. d.Property Off-premises (1)You may extend the insurance provided by this Coverage Form to apply to your Covered Property while it is away from the described premises, if it is: (a)Temporarily at a location you do not own, lease or operate; (b)In storage at a location you lease, provided the lease was executed after the beginning of the current policy term; or (c)At any fair, trade show or exhibition. (2)This Extension does not apply to property: (a)In or on a vehicle; or (b)In the care, custody or control of your salespersons, unless the property is in such care, custody or control at a fair, trade show or exhibition. (3)The most we will pay for loss or damage under this Extension is $10,000. e.Outdoor Property You may extend the insurance provided by this Coverage Form to apply to your outdoor fences, radio and television antennas (including satellite dishes), trees, shrubs and plants (other than trees, shrubs or plants which are "stock" or are part of a vegetated roof), including debris removal expense, caused by or resulting from any of the following causes of loss if they are Covered Causes of Loss: (1)Fire; (2)Lightning; (3)Explosion; (4)Riot or Civil Commotion; or (5)Aircraft. The most we will pay for loss or damage under this Extension is $1,000, but not more than $250 for any one tree, shrub or plant. These limits apply to any one occurrence, regardless of the types or number of items lost or damaged in that occurrence. © Insurance Services Office, Inc., 2011 CP 00 10 10 12Page 8 of 16 A0195129 Middlesex Insurance Company 05/13/2024 34750536-c2d5-4ff4-8a5a-f1c7b311ebc8 Subject to all aforementioned terms and limitations of coverage, this Coverage Extension includes the expense of removing from the described premises the debris of trees, shrubs and plants which are the property of others, except in the situation in which you are a tenant and such property is owned by the landlord of the described premises. f.Non-owned Detached Trailers (1)You may extend the insurance that applies to Your Business Personal Property to apply to loss or damage to trailers that you do not own, provided that: (a)The trailer is used in your business; (b)The trailer is in your care, custody or control at the premises described in the Declarations; and (c)You have a contractual responsibility to pay for loss or damage to the trailer. (2)We will not pay for any loss or damage that occurs: (a)While the trailer is attached to any motor vehicle or motorized conveyance, whether or not the motor vehicle or motorized conveyance is in motion; (b)During hitching or unhitching operations, or when a trailer becomes accidentally unhitched from a motor vehicle or motorized conveyance. (3)The most we will pay for loss or damage under this Extension is $5,000, unless a higher limit is shown in the Declarations. (4)This insurance is excess over the amount due (whether you can collect on it or not) from any other insurance covering such property. g.Business Personal Property Temporarily In Portable Storage Units (1)You may extend the insurance that applies to Your Business Personal Property to apply to such property while temporarily stored in a portable storage unit (including a detached trailer) located within 100 feet of the building or structure described in the Declarations or within 100 feet of the premises described in the Declarations, whichever distance is greater. (2)If the applicable Covered Causes of Loss form or endorsement contains a limitation or exclusion concerning loss or damage from sand, dust, sleet, snow, ice or rain to property in a structure, such limitation or exclusion also applies to property in a portable storage unit. (3)Coverage under this Extension: (a)Will end 90 days after the business personal property has been placed in the storage unit; (b)Does not apply if the storage unit itself has been in use at the described premises for more than 90 consecutive days, even if the business personal property has been stored there for 90 or fewer days as of the time of loss or damage. (4)Under this Extension, the most we will pay for the total of all loss or damage to business personal property is $10,000 (unless a higher limit is indicated in the Declarations for such Extension) regardless of the number of storage units. Such limit is part of, not in addition to, the applicable Limit of Insurance on Your Business Personal Property. Therefore, payment under this Extension will not increase the applicable Limit of Insurance on Your Business Personal Property. (5)This Extension does not apply to loss or damage otherwise covered under this Coverage Form or any endorsement to this Coverage Form or policy, and does not apply to loss or damage to the storage unit itself. Each of these Extensions is additional insurance unless otherwise indicated. The Additional Condition, Coinsurance, does not apply to these Extensions. B.Exclusions And Limitations See applicable Causes Of Loss form as shown in the Declarations. C.Limits Of Insurance The most we will pay for loss or damage in any one occurrence is the applicable Limit Of Insurance shown in the Declarations. The most we will pay for loss or damage to outdoor signs, whether or not the sign is attached to a building, is $2,500 per sign in any one occurrence. © Insurance Services Office, Inc., 2011 Page 9 of 16CP 00 10 10 12 A0195129 Middlesex Insurance Company 05/13/2024 34750536-c2d5-4ff4-8a5a-f1c7b311ebc8 CP 00 10 10 12Page 10 of 16 The amounts of insurance stated in the following Additional Coverages apply in accordance with the terms of such coverages and are separate from the Limit(s) Of Insurance shown in the Declarations for any other coverage: 1.Fire Department Service Charge; 2.Pollutant Clean-up And Removal; 3.Increased Cost Of Construction; and 4.Electronic Data. Payments under the Preservation Of Property Additional Coverage will not increase the applicable Limit of Insurance. D.Deductible In any one occurrence of loss or damage (hereinafter referred to as loss), we will first reduce the amount of loss if required by the Coinsurance Condition or the Agreed Value Optional Coverage. If the adjusted amount of loss is less than or equal to the Deductible, we will not pay for that loss. If the adjusted amount of loss exceeds the Deductible, we will then subtract the Deductible from the adjusted amount of loss, and will pay the resulting amount or the Limit of Insurance, whichever is less. When the occurrence involves loss to more than one item of Covered Property and separate Limits of Insurance apply, the losses will not be combined in determining application of the Deductible. But the Deductible will be applied only once per occurrence. Example 1 (This example assumes there is no Coinsurance penalty.) Deductible: $ 250 Limit of Insurance - Building 1: $ 60,000 Limit of Insurance - Building 2: $ 80,000 Loss to Building 1: $ 60,100 Loss to Building 2: $ 90,000 The amount of loss to Building 1 ($60,100) is less than the sum ($60,250) of the Limit of Insurance applicable to Building 1 plus the Deductible. The Deductible will be subtracted from the amount of loss in calculating the loss payable for Building 1: $ 60,100 ± 250 $ 59,850 Loss Payable - Building 1 The Deductible applies once per occurrence and therefore is not subtracted in determining the amount of loss payable for Building 2. Loss payable for Building 2 is the Limit of Insurance of $80,000. Total amount of loss payable: $59,850 + $80,000 = $139,850 Example 2 (This example, too, assumes there is no Coinsurance penalty.) The Deductible and Limits of Insurance are the same as those in Example 1. Loss to Building 1:$ 70,000 (Exceeds Limit of Insurance plus Deductible) Loss to Building 2:$ 90,000 (Exceeds Limit of Insurance plus Deductible) Loss Payable - Building 1:$ 60,000 (Limit of Insurance) Loss Payable - Building 2:$ 80,000 (Limit of Insurance) Total amount of loss payable:$ 140,000 E.Loss Conditions The following conditions apply in addition to the Common Policy Conditions and the Commercial Property Conditions: 1.Abandonment There can be no abandonment of any property to us. 2.Appraisal If we and you disagree on the value of the property or the amount of loss, either may make written demand for an appraisal of the loss. In this event, each party will select a competent and impartial appraiser. The two appraisers will select an umpire. If they cannot agree, either may request that selection be made by a judge of a court having jurisdiction. The appraisers will state separately the value of the property and amount of loss. If they fail to agree, they will submit their differences to the umpire. A decision agreed to by any two will be binding. Each party will: a.Pay its chosen appraiser; and b.Bear the other expenses of the appraisal and umpire equally. If there is an appraisal, we will still retain our right to deny the claim. 3.Duties In The Event Of Loss Or Damage a.You must see that the following are done in the event of loss or damage to Covered Property: (1) Notify the police if a law may have been broken. © Insurance Services Office, Inc., 2011 A0195129 Middlesex Insurance Company 05/13/2024 34750536-c2d5-4ff4-8a5a-f1c7b311ebc8 (2)Give us prompt notice of the loss or damage. Include a description of the property involved. (3)As soon as possible, give us a description of how, when and where the loss or damage occurred. (4)Take all reasonable steps to protect the Covered Property from further damage, and keep a record of your expenses necessary to protect the Covered Property, for consideration in the settlement of the claim. This will not increase the Limit of Insurance. However, we will not pay for any subsequent loss or damage resulting from a cause of loss that is not a Covered Cause of Loss. Also, if feasible, set the damaged property aside and in the best possible order for examination. (5)At our request, give us complete inventories of the damaged and undamaged property. Include quantities, costs, values and amount of loss claimed. (6)As often as may be reasonably required, permit us to inspect the property proving the loss or damage and examine your books and records. Also, permit us to take samples of damaged and undamaged property for inspection, testing and analysis, and permit us to make copies from your books and records. (7)Send us a signed, sworn proof of loss containing the information we request to investigate the claim. You must do this within 60 days after our request. We will supply you with the necessary forms. (8)Cooperate with us in the investigation or settlement of the claim. b.We may examine any insured under oath, while not in the presence of any other insured and at such times as may be reasonably required, about any matter relating to this insurance or the claim, including an insured©s books and records. In the event of an examination, an insured©s answers must be signed. 4.Loss Payment a.In the event of loss or damage covered by this Coverage Form, at our option, we will either: (1)Pay the value of lost or damaged property; (2)Pay the cost of repairing or replacing the lost or damaged property, subject to b. below; (3)Take all or any part of the property at an agreed or appraised value; or (4)Repair, rebuild or replace the property with other property of like kind and quality, subject to b. below. We will determine the value of lost or damaged property, or the cost of its repair or replacement, in accordance with the applicable terms of the Valuation Condition in this Coverage Form or any applicable provision which amends or supersedes the Valuation Condition. b.The cost to repair, rebuild or replace does not include the increased cost attributable to enforcement of or compliance with any ordinance or law regulating the construction, use or repair of any property. c.We will give notice of our intentions within 30 days after we receive the sworn proof of loss. d.We will not pay you more than your financial interest in the Covered Property. e.We may adjust losses with the owners of lost or damaged property if other than you. If we pay the owners, such payments will satisfy your claims against us for the owners© property. We will not pay the owners more than their financial interest in the Covered Property. f.We may elect to defend you against suits arising from claims of owners of property. We will do this at our expense. g.We will pay for covered loss or damage within 30 days after we receive the sworn proof of loss, if you have complied with all of the terms of this Coverage Part, and: (1)We have reached agreement with you on the amount of loss; or (2)An appraisal award has been made. © Insurance Services Office, Inc., 2011 Page 11 of 16CP 00 10 10 12 A0195129 Middlesex Insurance Company 05/13/2024 34750536-c2d5-4ff4-8a5a-f1c7b311ebc8 CP 00 10 10 12Page 12 of 16 h.A party wall is a wall that separates and is common to adjoining buildings that are owned by different parties. In settling covered losses involving a party wall, we will pay a proportion of the loss to the party wall based on your interest in the wall in proportion to the interest of the owner of the adjoining building. However, if you elect to repair or replace your building and the owner of the adjoining building elects not to repair or replace that building, we will pay you the full value of the loss to the party wall, subject to all applicable policy provisions including Limits of Insurance, the Valuation and Coinsurance Conditions and all other provisions of this Loss Payment Condition. Our payment under the provisions of this paragraph does not alter any right of subrogation we may have against any entity, including the owner or insurer of the adjoining building, and does not alter the terms of the Transfer Of Rights Of Recovery Against Others To Us Condition in this policy. 5.Recovered Property If either you or we recover any property after loss settlement, that party must give the other prompt notice. At your option, the property will be returned to you. You must then return to us the amount we paid to you for the property. We will pay recovery expenses and the expenses to repair the recovered property, subject to the Limit of Insurance. 6.Vacancy a.Description Of Terms (1)As used in this Vacancy Condition, the term building and the term vacant have the meanings set forth in (1)(a) and (1)(b) below: (a)When this policy is issued to a tenant, and with respect to that tenant©s interest in Covered Property, building means the unit or suite rented or leased to the tenant. Such building is vacant when it does not contain enough business personal property to conduct customary operations. (b)When this policy is issued to the owner or general lessee of a building, building means the entire building. Such building is vacant unless at least 31% of its total square footage is: (i)Rented to a lessee or sublessee and used by the lessee or sublessee to conduct its customary operations; and/or (ii)Used by the building owner to conduct customary operations. (2)Buildings under construction or renovation are not considered vacant. b.Vacancy Provisions If the building where loss or damage occurs has been vacant for more than 60 consecutive days before that loss or damage occurs: (1)We will not pay for any loss or damage caused by any of the following, even if they are Covered Causes of Loss: (a)Vandalism; (b)Sprinkler leakage, unless you have protected the system against freezing; (c)Building glass breakage; (d)Water damage; (e)Theft; or (f)Attempted theft. (2)With respect to Covered Causes of Loss other than those listed in b.(1)(a) through b.(1)(f) above, we will reduce the amount we would otherwise pay for the loss or damage by 15%. 7.Valuation We will determine the value of Covered Property in the event of loss or damage as follows: a.At actual cash value as of the time of loss or damage, except as provided in b., c., d. and e. below. b.If the Limit of Insurance for Building satisfies the Additional Condition, Coinsurance, and the cost to repair or replace the damaged building property is $2,500 or less, we will pay the cost of building repairs or replacement. © Insurance Services Office, Inc., 2011 A0195129 Middlesex Insurance Company 05/13/2024 34750536-c2d5-4ff4-8a5a-f1c7b311ebc8 The cost of building repairs or replacement does not include the increased cost attributable to enforcement of or compliance with any ordinance or law regulating the construction, use or repair any property. However, the following property will be valued at the actual cash value, even when attached to the building: (1) Awnings or floor coverings; (2) Appliances for refrigerating, ventilating, cooking, dishwashing or laundering; or (3) Outdoor equipment or furniture. c."Stock" you have sold but not delivered at the selling price less discounts and expenses you otherwise would have had. d.Glass at the cost of replacement with safety-glazing material if required by law. e.Tenants© Improvements and Betterments at: (1)Actual cash value of the lost or damaged property if you make repairs promptly. (2)A proportion of your original cost if you do not make repairs promptly. We will determine the proportionate value as follows: (a)Multiply the original cost by the number of days from the loss or damage to the expiration of the lease; and (b)Divide the amount determined in (a) above by the number of days from the installation of improvements to the expiration of the lease. If your lease contains a renewal option, the expiration of the renewal option period will replace the expiration of the lease in this procedure. (3)Nothing if others pay for repairs or replacement. F.Additional Conditions The following conditions apply in addition to the Common Policy Conditions and the Commercial Property Conditions: 1.Coinsurance If a Coinsurance percentage is shown in the Declarations, the following condition applies: a.We will not pay the full amount of any loss if the value of Covered Property at the time of loss times the Coinsurance percentage shown for it in the Declarations is greater than the Limit of Insurance for the property. Instead, we will determine the most we will pay using the following steps: (1)Multiply the value of Covered Property at the time of loss by the Coinsurance percentage; (2)Divide the Limit of Insurance of the property by the figure determined in Step (1); (3)Multiply the total amount of loss, before the application of any deductible, by the figure determined in Step (2); and (4)Subtract the deductible from the figure determined in Step (3). We will pay the amount determined in Step (4) or the Limit of Insurance, whichever is less. For the remainder, you will either have to rely on other insurance or absorb the loss yourself. Example 1 (Underinsurance) When:The value of the property is: $ 250,000 The Coinsurance percentage for it is: 80% The Limit of Insurance for it is:$ 100,000 The Deductible is:$ 250 The amount of loss is:$ 40,000 Step (1):$250,000 x 80% = $200,000 (the minimum amount of insurance to meet your Coinsurance requirements) Step (2):$100,000 ÷ $200,000 = .50 Step (3):$40,000 x .50 = $20,000 Step (4):$20,000 ± $250 = $19,750 We will pay no more than $19,750. The remaining $20,250 is not covered. Example 2 (Adequate Insurance) When:The value of the property is: $ 250,000 The Coinsurance percentage for it is: 80% The Limit of Insurance for it is:$ 200,000 The Deductible is:$ 250 The amount of loss is:$ 40,000 The minimum amount of insurance to meet your Coinsurance requirement is $200,000 ($250,000 x 80%). Therefore, the Limit of Insurance in this example is adequate and no penalty applies. We will pay no more than $39,750 ($40,000 amount of loss minus the deductible of $250). © Insurance Services Office, Inc., 2011 Page 13 of 16CP 00 10 10 12 A0195129 Middlesex Insurance Company 05/13/2024 34750536-c2d5-4ff4-8a5a-f1c7b311ebc8 b.If one Limit of Insurance applies to two or more separate items, this condition will apply to the total of all property to which the limit applies. Example 3 When:The value of the property is: Building at Location 1: $ 75,000 Building at Location 2: $ 100,000 Personal Property at Location 2: $ 75,000 $ 250,000 The Coinsurance percentage for it is:90% The Limit of Insurance for Buildings and Personal Property at Locations 1 and 2 is: $ 180,000 The Deductible is: $ 1,000 The amount of loss is: Building at Location 2: $ 30,000 Personal Property at Location 2: $ 20,000 $ 50,000 Step (1):$250,000 x 90% = $225,000 (the minimum amount of insurance to meet your Coinsurance requirements and to avoid the penalty shown below) Step (2):$180,000 ÷ $225,000 = .80 Step (3):$50,000 x .80 = $40,000 Step (4):$40,000 ± $1,000 = $39,000 We will pay no more than $39,000. The remaining $11,000 is not covered. 2.Mortgageholders a.The term mortgageholder includes trustee. b.We will pay for covered loss of or damage to buildings or structures to each mortgageholder shown in the Declarations in their order of precedence, as interests may appear. c.The mortgageholder has the right to receive loss payment even if the mortgageholder has started foreclosure or similar action on the building or structure. d.If we deny your claim because of your acts or because you have failed to comply with the terms of this Coverage Part, the mortgageholder will still have the right to receive loss payment if the mortgageholder: (1)Pays any premium due under this Coverage Part at our request if you have failed to do so; (2)Submits a signed, sworn proof of loss within 60 days after receiving notice from us of your failure to do so; and (3)Has notified us of any change in ownership, occupancy or substantial change in risk known to the mortgageholder. All of the terms of this Coverage Part will then apply directly to the mortgageholder. e.If we pay the mortgageholder for any loss or damage and deny payment to you because of your acts or because you have failed to comply with the terms of this Coverage Part: (1)The mortgageholder©s rights under the mortgage will be transferred to us to the extent of the amount we pay; and (2)The mortgageholder©s right to recover the full amount of the mortgageholder©s claim will not be impaired. At our option, we may pay to the mortgageholder the whole principal on the mortgage plus any accrued interest. In this event, your mortgage and note will be transferred to us and you will pay your remaining mortgage debt to us. f.If we cancel this policy, we will give written notice to the mortgageholder at least: (1)10 days before the effective date of cancellation if we cancel for your nonpayment of premium; or (2)30 days before the effective date of cancellation if we cancel for any other reason. g.If we elect not to renew this policy, we will give written notice to the mortgageholder at least 10 days before the expiration date of this policy. G.Optional Coverages If shown as applicable in the Declarations, the following Optional Coverages apply separately to each item: 1.Agreed Value a.The Additional Condition, Coinsurance, does not apply to Covered Property to which this Optional Coverage applies. We will pay no more for loss of or damage to that property than the proportion that the Limit of Insurance under this Coverage Part for the property bears to the Agreed Value shown for it in the Declarations. © Insurance Services Office, Inc., 2011 CP 00 10 10 12Page 14 of 16 A0195129 Middlesex Insurance Company 05/13/2024 34750536-c2d5-4ff4-8a5a-f1c7b311ebc8 b.If the expiration date for this Optional Coverage shown in the Declarations is not extended, the Additional Condition, Coinsurance, is reinstated and this Optional Coverage expires. c.The terms of this Optional Coverage apply only to loss or damage that occurs: (1)On or after the effective date of this Optional Coverage; and (2)Before the Agreed Value expiration date shown in the Declarations or the policy expiration date, whichever occurs first. 2.Inflation Guard a.The Limit of Insurance for property to which this Optional Coverage applies will automatically increase by the annual percentage shown in the Declarations. b.The amount of increase will be: (1)The Limit of Insurance that applied on the most recent of the policy inception date, the policy anniversary date, or any other policy change amending the Limit of Insurance, times (2)The percentage of annual increase shown in the Declarations, expressed as a decimal (example: 8% is .08), times (3)The number of days since the beginning of the current policy year or the effective date of the most recent policy change amending the Limit of Insurance, divided by 365. Example If:The applicable Limit of Insurance is: $100,000 The annual percentage increase is: 8% The number of days since the beginning of the policy year (or last policy change) is: 146 The amount of increase is: $100,000 x .08 x 146 ÷ 365 = $ 3,200 3.Replacement Cost a.Replacement Cost (without deduction for depreciation) replaces Actual Cash Value in the Valuation Loss Condition of this Coverage Form. b.This Optional Coverage does not apply to: (1)Personal property of others; (2)Contents of a residence; (3)Works of art, antiques or rare articles, including etchings, pictures, statuary, marbles, bronzes, porcelains and bric-a-brac; or (4)"Stock", unless the Including "Stock" option is shown in the Declarations. Under the terms of this Replacement Cost Optional Coverage, tenants© improvements and betterments are not considered to be the personal property of others. c.You may make a claim for loss or damage covered by this insurance on an actual cash value basis instead of on a replacement cost basis. In the event you elect to have loss or damage settled on an actual cash value basis, you may still make a claim for the additional coverage this Optional Coverage provides if you notify us of your intent to do so within 180 days after the loss or damage. d.We will not pay on a replacement cost basis for any loss or damage: (1)Until the lost or damaged property is actually repaired or replaced; and (2)Unless the repair or replacement is made as soon as reasonably possible after the loss or damage. With respect to tenants© improvements and betterments, the following also apply: (3)If the conditions in d.(1) and d.(2) above are not met, the value of tenants© improvements and betterments will be determined as a proportion of your original cost, as set forth in the Valuation Loss Condition of this Coverage Form; and (4)We will not pay for loss or damage to tenants© improvements and betterments if others pay for repairs or replacement. e.We will not pay more for loss or damage on a replacement cost basis than the least of (1), (2) or (3), subject to f. below: (1)The Limit of Insurance applicable to the lost or damaged property; (2)The cost to replace the lost or damaged property with other property: (a)Of comparable material and quality; and (b)Used for the same purpose; or (3)The amount actually spent that is necessary to repair or replace the lost or damaged property. If a building is rebuilt at a new premises, the cost described in e.(2) above is limited to the cost which would have been incurred if the building had been rebuilt at the original premises. © Insurance Services Office, Inc., 2011 Page 15 of 16CP 00 10 10 12 A0195129 Middlesex Insurance Company 05/13/2024 34750536-c2d5-4ff4-8a5a-f1c7b311ebc8 f.The cost of repair or replacement does not include the increased cost attributable to enforcement of or compliance with any ordinance or law regulating the construction, use or repair of any property. 4.Extension Of Replacement Cost To Personal Property Of Others a.If the Replacement Cost Optional Coverage is shown as applicable in the Declarations, then this Extension may also be shown as applicable. If the Declarations show this Extension as applicable, then Paragraph 3.b.(1) of the Replacement Cost Optional Coverage is deleted and all other provisions of the Replacement Cost Optional Coverage apply to replacement cost on personal property of others. b.With respect to replacement cost on the personal property of others, the following limitation applies: If an item(s) of personal property of others is subject to a written contract which governs your liability for loss or damage to that item(s), then valuation of that item(s) will be based on the amount for which you are liable under such contract, but not to exceed the lesser of the replacement cost of the property or the applicable Limit of Insurance. H.Definitions 1."Fungus" means any type or form of fungus, including mold or mildew, and any mycotoxins, spores, scents or by-products produced or released by fungi. 2."Pollutants" means any solid, liquid, gaseous or thermal irritant or contaminant, including smoke, vapor, soot, fumes, acids, alkalis, chemicals and waste. Waste includes materials to be recycled, reconditioned or reclaimed. 3."Stock" means merchandise held in storage or for sale, raw materials and in-process or finished goods, including supplies used in their packing or shipping. © Insurance Services Office, Inc., 2011 CP 00 10 10 12Page 16 of 16 A0195129 Middlesex Insurance Company 05/13/2024 e9f72e6b-fd33-4bb9-95b5-41779576a4f6 Page 1 of 9CP 00 30 10 12 COMMERCIAL PROPERTY CP 00 30 10 12 BUSINESS INCOME (AND EXTRA EXPENSE) COVERAGE FORM Various provisions in this policy restrict coverage. Read the entire policy carefully to determine rights, duties and what is and is not covered. Throughout this policy, the words "you" and "your" refer to the Named Insured shown in the Declarations. The words "we", "us" and "our" refer to the company providing this insurance. Other words and phrases that appear in quotation marks have special meaning. Refer to Section F. Definitions. A.Coverage 1.Business Income Business Income means the: a.Net Income (Net Profit or Loss before income taxes) that would have been earned or incurred; and b.Continuing normal operating expenses incurred, including payroll. For manufacturing risks, Net Income includes the net sales value of production. Coverage is provided as described and limited below for one or more of the following options for which a Limit Of Insurance is shown in the Declarations: (1)Business Income Including "Rental Value". (2)Business Income Other Than "Rental Value". (3)"Rental Value". If option (1) above is selected, the term Business Income will include "Rental Value". If option (3) above is selected, the term Business Income will mean "Rental Value" only. If Limits of Insurance are shown under more than one of the above options, the provisions of this Coverage Part apply separately to each. We will pay for the actual loss of Business Income you sustain due to the necessary "suspension" of your "operations" during the "period of restoration". The "suspension" must be caused by direct physical loss of or damage to property at premises which are described in the Declarations and for which a Business Income Limit Of Insurance is shown in the Declarations. The loss or damage must be caused by or result from a Covered Cause of Loss. With respect to loss of or damage to personal property in the open or personal property in a vehicle, the described premises include the area within 100 feet of such premises. With respect to the requirements set forth in the preceding paragraph, if you occupy only part of a building, your premises means: (a)The portion of the building which you rent, lease or occupy; (b)The area within 100 feet of the building or within 100 feet of the premises described in the Declarations, whichever distance is greater (with respect to loss of or damage to personal property in the open or personal property in a vehicle); and (c)Any area within the building or at the described premises, if that area services, or is used to gain access to, the portion of the building which you rent, lease or occupy. 2.Extra Expense a.Extra Expense Coverage is provided at the premises described in the Declarations only if the Declarations show that Business Income Coverage applies at that premises. b.Extra Expense means necessary expenses you incur during the "period of restoration" that you would not have incurred if there had been no direct physical loss or damage to property caused by or resulting from a Covered Cause of Loss. We will pay Extra Expense (other than the expense to repair or replace property) to: (1)Avoid or minimize the "suspension" of business and to continue operations at the described premises or at replacement premises or temporary locations, including relocation expenses and costs to equip and operate the replacement location or temporary location. © Insurance Services Office, Inc., 2011 A0195129 Middlesex Insurance Company 05/13/2024 e9f72e6b-fd33-4bb9-95b5-41779576a4f6 (2)Minimize the "suspension" of business if you cannot continue "operations". We will also pay Extra Expense to repair or replace property, but only to the extent it reduces the amount of loss that otherwise would have been payable under this Coverage Form. 3.Covered Causes Of Loss, Exclusions And Limitations See applicable Causes Of Loss form as shown in the Declarations. 4.Additional Limitation - Interruption Of Computer Operations a.Coverage for Business Income does not apply when a "suspension" of "operations" is caused by destruction or corruption of electronic data, or any loss or damage to electronic data, except as provided under the Additional Coverage, Interruption Of Computer Operations. b.Coverage for Extra Expense does not apply when action is taken to avoid or minimize a "suspension" of "operations" caused by destruction or corruption of electronic data, or any loss or damage to electronic data, except as provided under the Additional Coverage, Interruption Of Computer Operations. c.Electronic data means information, facts or computer programs stored as or on, created or used on, or transmitted to or from computer software (including systems and applications software), on hard or floppy disks, CD-ROMs, tapes, drives, cells, data processing devices or any other repositories of computer software which are used with electronically controlled equipment. The term computer programs, referred to in the foregoing description of electronic data, means a set of related electronic instructions which direct the operations and functions of a computer or device connected to it, which enable the computer or device to receive, process, store, retrieve or send data. d.This Additional Limitation does not apply when loss or damage to electronic data involves only electronic data which is integrated in and operates or controls a building©s elevator, lighting, heating, ventilation, air conditioning or security system. 5.Additional Coverages a.Civil Authority In this Additional Coverage, Civil Authority, the described premises are premises to which this Coverage Form applies, as shown in the Declarations. When a Covered Cause of Loss causes damage to property other than property at the described premises, we will pay for the actual loss of Business Income you sustain and necessary Extra Expense caused by action of civil authority that prohibits access to the described premises, provided that both of the following apply: (1)Access to the area immediately surrounding the damaged property is prohibited by civil authority as a result of the damage, and the described premises are within that area but are not more than one mile from the damaged property; and (2)The action of civil authority is taken in response to dangerous physical conditions resulting from the damage or continuation of the Covered Cause of Loss that caused the damage, or the action is taken to enable a civil authority to have unimpeded access to the damaged property. Civil Authority Coverage for Business Income will begin 72 hours after the time of the first action of civil authority that prohibits access to the described premises and will apply for a period of up to four consecutive weeks from the date on which such coverage began. Civil Authority Coverage for Extra Expense will begin immediately after the time of the first action of civil authority that prohibits access to the described premises and will end: (1)Four consecutive weeks after the date of that action; or (2)When your Civil Authority Coverage for Business Income ends; whichever is later. © Insurance Services Office, Inc., 2011 CP 00 30 10 12Page 2 of 9 A0195129 Middlesex Insurance Company 05/13/2024 e9f72e6b-fd33-4bb9-95b5-41779576a4f6 b.Alterations And New Buildings We will pay for the actual loss of Business Income you sustain and necessary Extra Expense you incur due to direct physical loss or damage at the described premises caused by or resulting from any Covered Cause of Loss to: (1)New buildings or structures, whether complete or under construction; (2)Alterations or additions to existing buildings or structures; and (3)Machinery, equipment, supplies or building materials located on or within 100 feet of the described premises and: (a)Used in the construction, alterations or additions; or (b)Incidental to the occupancy of new buildings. If such direct physical loss or damage delays the start of "operations", the "period of restoration" for Business Income Cov- erage will begin on the date "operations" would have begun if the direct physical loss or damage had not occurred. c.Extended Business Income (1)Business Income Other Than "Rental Value" If the necessary "suspension" of your "operations" produces a Business Income loss payable under this policy, we will pay for the actual loss of Business Income you incur during the period that: (a)Begins on the date property (except "finished stock") is actually repaired, rebuilt or replaced and "operations" are resumed; and (b)Ends on the earlier of: (i)The date you could restore your "operations", with reasonable speed, to the level which would generate the business income amount that would have existed if no direct physical loss or damage had occurred; or (ii)60 consecutive days after the date determined in (1)(a) above. However, Extended Business Income does not apply to loss of Business Income incurred as a result of unfavorable business conditions caused by the impact of the Covered Cause of Loss in the area where the described premises are located. Loss of Business Income must be caused by direct physical loss or damage at the described premises caused by or resulting from any Covered Cause of Loss. (2)"Rental Value" If the necessary "suspension" of your "operations" produces a "Rental Value" loss payable under this policy, we will pay for the actual loss of "Rental Value" you incur during the period that: (a)Begins on the date property is actually repaired, rebuilt or replaced and tenantability is restored; and (b)Ends on the earlier of: (i)The date you could restore tenant occupancy, with reasonable speed, to the level which would generate the "Rental Value" that would have existed if no direct physical loss or damage had occurred; or (ii)60 consecutive days after the date determined in (2)(a) above. However, Extended Business Income does not apply to loss of "Rental Value" incurred as a result of unfavorable business conditions caused by the impact of the Covered Cause of Loss in the area where the described premises are located. Loss of "Rental Value" must be caused by direct physical loss or damage at the described premises caused by or resulting from any Covered Cause of Loss. d.Interruption Of Computer Operations (1)Under this Additional Coverage, electronic data has the meaning described under Additional Limitation - Interruption Of Computer Operations. © Insurance Services Office, Inc., 2011 Page 3 of 9CP 00 30 10 12 A0195129 Middlesex Insurance Company 05/13/2024 e9f72e6b-fd33-4bb9-95b5-41779576a4f6 (2)Subject to all provisions of this Additional Coverage, you may extend the insurance that applies to Business Income and Extra Expense to apply to a "suspension" of "operations" caused by an interruption in computer operations due to destruction or corruption of electronic data due to a Covered Cause of Loss. However, we will not provide coverage under this Additional Coverage when the Additional Limitation - Interruption Of Computer Operations does not apply based on Paragraph A.4.d. therein. (3)With respect to the coverage provided under this Additional Coverage, the Covered Causes of Loss are subject to the following: (a)If the Causes Of Loss - Special Form applies, coverage under this Additional Coverage, Interruption Of Computer Operations, is limited to the "specified causes of loss" as defined in that form and Collapse as set forth in that form. (b)If the Causes Of Loss - Broad Form applies, coverage under this Additional Coverage, Interruption Of Computer Operations, includes Collapse as set forth in that form. (c)If the Causes Of Loss form is endorsed to add a Covered Cause of Loss, the additional Covered Cause of Loss does not apply to the coverage provided under this Additional Coverage, Interruption Of Computer Operations. (d)The Covered Causes of Loss include a virus, harmful code or similar instruction introduced into or enacted on a computer system (including electronic data) or a network to which it is connected, designed to damage or destroy any part of the system or disrupt its normal operation. But there is no coverage for an interruption related to manipulation of a computer system (including electronic data) by any employee, including a temporary or leased employee, or by an entity retained by you or for you to inspect, design, install, maintain, repair or replace that system. (4)The most we will pay under this Additional Coverage, Interruption Of Computer Operations, is $2,500 (unless a higher limit is shown in the Declarations) for all loss sustained and expense incurred in any one policy year, regardless of the number of interruptions or the number of premises, locations or computer systems involved. If loss payment relating to the first interruption does not exhaust this amount, then the balance is available for loss or expense sustained or incurred as a result of subsequent interruptions in that policy year. A balance remaining at the end of a policy year does not increase the amount of insurance in the next policy year. With respect to any interruption which begins in one policy year and continues or results in additional loss or expense in a subsequent policy year(s), all loss and expense is deemed to be sustained or incurred in the policy year in which the interruption began. (5)This Additional Coverage, Interruption Of Computer Operations, does not apply to loss sustained or expense incurred after the end of the "period of restoration", even if the amount of insurance stated in (4) above has not been exhausted. 6.Coverage Extension If a Coinsurance percentage of 50% or more is shown in the Declarations, you may extend the insurance provided by this Coverage Part as follows: Newly Acquired Locations a.You may extend your Business Income and Extra Expense Coverages to apply to property at any location you acquire other than fairs or exhibitions. b.The most we will pay under this Extension, for the sum of Business Income loss and Extra Expense incurred, is $100,000 at each location, unless a higher limit is shown in the Declarations c.Insurance under this Extension for each newly acquired location will end when any of the following first occurs: (1)This policy expires; © Insurance Services Office, Inc., 2011 CP 00 30 10 12Page 4 of 9 A0195129 Middlesex Insurance Company 05/13/2024 e9f72e6b-fd33-4bb9-95b5-41779576a4f6 (2)30 days expire after you acquire or begin to construct the property; or (3)You report values to us. We will charge you additional premium for values reported from the date you acquire the property. The Additional Condition, Coinsurance, does not apply to this Extension. B.Limits Of Insurance The most we will pay for loss in any one occurrence is the applicable Limit Of Insurance shown in the Declarations. Payments under the following coverages will not increase the applicable Limit of Insurance: 1.Alterations And New Buildings; 2.Civil Authority; 3.Extra Expense; or 4.Extended Business Income. The amounts of insurance stated in the Interruption Of Computer Operations Additional Coverage and the Newly Acquired Locations Coverage Extension apply in accordance with the terms of those coverages and are separate from the Limit(s) Of Insurance shown in the Declarations for any other coverage. C.Loss Conditions The following conditions apply in addition to the Common Policy Conditions and the Commercial Property Conditions: 1.Appraisal If we and you disagree on the amount of Net Income and operating expense or the amount of loss, either may make written demand for an appraisal of the loss. In this event, each party will select a competent and impartial appraiser. The two appraisers will select an umpire. If they cannot agree, either may request that selection be made by a judge of a court having jurisdiction. The appraisers will state separately the amount of Net Income and operating expense or amount of loss. If they fail to agree, they will submit their differences to the umpire. A decision agreed to by any two will be binding. Each party will: a.Pay its chosen appraiser; and b.Bear the other expenses of the appraisal and umpire equally. If there is an appraisal, we will still retain our right to deny the claim. 2.Duties In The Event Of Loss a.You must see that the following are done in the event of loss: (1)Notify the police if a law may have been broken. (2)Give us prompt notice of the direct physical loss or damage. Include a description of the property involved. (3)As soon as possible, give us a description of how, when and where the direct physical loss or damage occurred. (4)Take all reasonable steps to protect the Covered Property from further damage, and keep a record of your expenses necessary to protect the Covered Property, for consideration in the settlement of the claim. This will not increase the Limit of Insurance. However, we will not pay for any subsequent loss or damage resulting from a cause of loss that is not a Covered Cause of Loss. Also, if feasible, set the damaged property aside and in the best possible order for examination. (5)As often as may be reasonably required, permit us to inspect the property proving the loss or damage and examine your books and records. Also permit us to take samples of damaged and undamaged property for inspection, testing and analysis, and permit us to make copies from your books and records. (6)Send us a signed, sworn proof of loss containing the information we request to investigate the claim. You must do this within 60 days after our request. We will supply you with the necessary forms. (7)Cooperate with us in the investigation or settlement of the claim. (8)If you intend to continue your business, you must resume all or part of your "operations" as quickly as possible. b.We may examine any insured under oath, while not in the presence of any other insured and at such times as may be reasonably required, about any matter relating to this insurance or the claim, including an insured©s books and records. In the event of an examination, an insured©s answers must be signed. © Insurance Services Office, Inc., 2011 Page 5 of 9CP 00 30 10 12 A0195129 Middlesex Insurance Company 05/13/2024 e9f72e6b-fd33-4bb9-95b5-41779576a4f6 3.Loss Determination a.The amount of Business Income loss will be determined based on: (1)The Net Income of the business before the direct physical loss or damage occurred; (2)The likely Net Income of the business if no physical loss or damage had occurred, but not including any Net Income that would likely have been earned as a result of an increase in the volume of business due to favorable business conditions caused by the impact of the Covered Cause of Loss on customers or on other businesses; (3)The operating expenses, including payroll expenses, necessary to resume "operations" with the same quality of service that existed just before the direct physical loss or damage; and (4)Other relevant sources of information, including: (a)Your financial records and accounting procedures; (b)Bills, invoices and other vouchers; and (c)Deeds, liens or contracts. b.The amount of Extra Expense will be determined based on: (1)All expenses that exceed the normal operating expenses that would have been incurred by "operations" during the "period of restoration" if no direct physical loss or damage had occurred. We will deduct from the total of such expenses: (a)The salvage value that remains of any property bought for temporary use during the "period of restoration", once "operations" are resumed; and (b)Any Extra Expense that is paid for by other insurance, except for insurance that is written subject to the same plan, terms, conditions and provisions as this insurance; and (2)Necessary expenses that reduce the Business Income loss that otherwise would have been incurred. c.Resumption Of Operations We will reduce the amount of your: (1)Business Income loss, other than Extra Expense, to the extent you can resume your "operations", in whole or in part, by using damaged or undamaged property (including merchandise or stock) at the described premises or elsewhere. (2)Extra Expense loss to the extent you can return "operations" to normal and discontinue such Extra Expense. d.If you do not resume "operations", or do not resume "operations" as quickly as possible, we will pay based on the length of time it would have taken to resume "operations" as quickly as possible. 4.Loss Payment We will pay for covered loss within 30 days after we receive the sworn proof of loss, if you have complied with all of the terms of this Coverage Part, and: a.We have reached agreement with you on the amount of loss; or b.An appraisal award has been made. D.Additional Condition COINSURANCE If a Coinsurance percentage is shown in the Declarations, the following condition applies in addition to the Common Policy Conditions and the Commercial Property Conditions. We will not pay the full amount of any Business Income loss if the Limit of Insurance for Business Income is less than: 1.The Coinsurance percentage shown for Business Income in the Declarations; times 2.The sum of: a.The Net Income (Net Profit or Loss before income taxes), and b.Operating expenses, including payroll expenses, that would have been earned or incurred (had no loss occurred) by your "operations" at the described premises for the 12 months following the inception, or last previous anniversary date, of this policy (whichever is later). © Insurance Services Office, Inc., 2011 CP 00 30 10 12Page 6 of 9 A0195129 Middlesex Insurance Company 05/13/2024 e9f72e6b-fd33-4bb9-95b5-41779576a4f6 Instead, we will determine the most we will pay using the following steps: Step (1):Multiply the Net Income and operating expense for the 12 months following the inception, or last previous anniversary date, of this policy by the Coinsurance percentage; Step (2):Divide the Limit of Insurance for the described premises by the figure determined in Step (1); and Step (3):Multiply the total amount of loss by the figure determined in Step (2). We will pay the amount determined in Step (3) or the Limit of Insurance, whichever is less. For the remainder, you will either have to rely on other insurance or absorb the loss yourself. In determining operating expenses for the purpose of applying the Coinsurance condition, the following expenses, if applicable, shall be deducted from the total of all operating expenses: (1)Prepaid freight - outgoing; (2)Returns and allowances; (3)Discounts; (4)Bad debts; (5)Collection expenses; (6)Cost of raw stock and factory supplies consumed (including transportation charges); (7)Cost of merchandise sold (including transportation charges); (8)Cost of other supplies consumed (including transportation charges); (9)Cost of services purchased from outsiders (not employees) to resell, that do not continue under contract; (10)Power, heat and refrigeration expenses that do not continue under contract (if Form CP 15 11 is attached); (11)All payroll expenses or the amount of payroll expense excluded (if Form CP 15 10 is attached); and (12)Special deductions for mining properties (royalties unless specifically included in coverage; actual depletion commonly known as unit or cost depletion - not percentage depletion; welfare and retirement fund charges based on tonnage; hired trucks). Example 1 (Underinsurance) When:The Net Income and operating expenses for the 12 months following the inception, or last previous anniversary date, of this policy at the described premises would have been:$400,000 The Coinsurance percentage is:50% The Limit of Insurance is:$150,000 The amount of loss is:$ 80,000 Step (1):$400,000 X 50% = $200,000 (the minimum amount of insurance to meet your Coinsurance requirements) Step (2):$150,000 ÷ $200,000 = .75 Step (3):$80,000 x .75 = $60,000 We will pay no more than $60,000. The remaining $20,000 is not covered. Example 2 (Adequate Insurance) When:The Net Income and operating expenses for the 12 months following the inception, or last previous anniversary date, of this policy at the described premises would have been:$400,000 The Coinsurance percentage is:50% The Limit of Insurance is:$200,000 The amount of loss is:$ 80,000 The minimum amount of insurance to meet your Coinsurance requirement is $200,000 ($400,000 x 50%). Therefore, the Limit of Insurance in this example is adequate and no penalty applies. We will pay no more than $80,000 (amount of loss). This condition does not apply to Extra Expense Coverage. E.Optional Coverages If shown as applicable in the Declarations, the following Optional Coverages apply separately to each item. 1.Maximum Period Of Indemnity a.The Additional Condition, Coinsurance, does not apply to this Coverage Form at the described premises to which this Optional Coverage applies. © Insurance Services Office, Inc., 2011 Page 7 of 9CP 00 30 10 12 A0195129 Middlesex Insurance Company 05/13/2024 e9f72e6b-fd33-4bb9-95b5-41779576a4f6 b.The most we will pay for the total of Business Income loss and Extra Expense is the lesser of: (1)The amount of loss sustained and expenses incurred during the 120 days immediately following the beginning of the "period of restoration"; or (2)The Limit Of Insurance shown in the Declarations. 2.Monthly Limit Of Indemnity a.The Additional Condition, Coinsurance, does not apply to this Coverage Form at the described premises to which this Optional Coverage applies. b.The most we will pay for loss of Business Income in each period of 30 consecutive days after the beginning of the "period of restoration" is: (1)The Limit of Insurance, multiplied by (2)The fraction shown in the Declarations for this Optional Coverage. Example When:The Limit of Insurance is:$ 120,000 The fraction shown in the Declarations for this Optional Coverage is:1/4 The most we will pay for loss in each period of 30 consecutive days is:$ 30,000 ($120,000 x 1/4 = $30,000) If, in this example, the actual amount of loss is: Days 1-30:$ 40,000 Days 31-60:$ 20,000 Days 61-90:$ 30,000 $ 90,000 We will pay: Days 1-30:$ 30,000 Days 31-60:$ 20,000 Days 61-90:$ 30,000 $ 80,000 The remaining $10,000 is not covered. 3.Business Income Agreed Value a.To activate this Optional Coverage: (1)A Business Income Report/Work Sheet must be submitted to us and must show financial data for your "operations": (a)During the 12 months prior to the date of the Work Sheet; and (b)Estimated for the 12 months immediately following the inception of this Optional Coverage. (2)The Declarations must indicate that the Business Income Agreed Value Optional Coverage applies, and an Agreed Value must be shown in the Declarations. The Agreed Value should be at least equal to: (a)The Coinsurance percentage shown in the Declarations; multiplied by (b)The amount of Net Income and operating expenses for the following 12 months you report on the Work Sheet. b.The Additional Condition, Coinsurance, is suspended until: (1)12 months after the effective date of this Optional Coverage; or (2)The expiration date of this policy; whichever occurs first. c.We will reinstate the Additional Condition, Coinsurance, automatically if you do not submit a new Work Sheet and Agreed Value: (1)Within 12 months of the effective date of this Optional Coverage; or (2)When you request a change in your Business Income Limit of Insurance. d.If the Business Income Limit of Insurance is less than the Agreed Value, we will not pay more of any loss than the amount of loss multiplied by: (1)The Business Income Limit of Insurance; divided by (2)The Agreed Value. Example When:The Limit of Insurance is:$100,000 The Agreed Value is:$200,000 The amount of loss is:$ 80,000 Step (1):$100,000 ÷ $200,000 = .50 Step (2):.50 x $80,000 = $40,000 We will pay $40,000. The remaining $40,000 is not covered. 4.Extended Period Of Indemnity Under Paragraph A.5.c., Extended Business Income, the number 60 in Subparagraphs (1)(b) and (2)(b) is replaced by the number shown in the Declarations for this Optional Coverage. © Insurance Services Office, Inc., 2011 CP 00 30 10 12Page 8 of 9 A0195129 Middlesex Insurance Company 05/13/2024 e9f72e6b-fd33-4bb9-95b5-41779576a4f6 F.Definitions 1."Finished stock" means stock you have manufactured. "Finished stock" also includes whiskey and alcoholic products being aged, unless there is a Coinsurance percentage shown for Business Income in the Declarations. "Finished stock" does not include stock you have manufactured that is held for sale on the premises of any retail outlet insured under this Coverage Part. 2."Operations" means: a.Your business activities occurring at the described premises; and b.The tenantability of the described premises, if coverage for Business Income Including "Rental Value" or "Rental Value" applies. 3."Period of restoration" means the period of time that: a.Begins: (1)72 hours after the time of direct physical loss or damage for Business Income Coverage; or (2)Immediately after the time of direct physical loss or damage for Extra Expense Coverage; caused by or resulting from any Covered Cause of Loss at the described premises; and b.Ends on the earlier of: (1)The date when the property at the described premises should be repaired, rebuilt or replaced with reasonable speed and similar quality; or (2)The date when business is resumed at a new permanent location. "Period of restoration" does not include any increased period required due to the enforcement of or compliance with any ordinance or law that: (1)Regulates the construction, use or repair, or requires the tearing down, of any property; or (2)Requires any insured or others to test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of "pollutants". The expiration date of this policy will not cut short the "period of restoration". 4."Pollutants" means any solid, liquid, gaseous or thermal irritant or contaminant, including smoke, vapor, soot, fumes, acids, alkalis, chemicals and waste. Waste includes materials to be recycled, reconditioned or reclaimed. 5."Rental Value" means Business Income that consists of: a.Net Income (Net Profit or Loss before income taxes) that would have been earned or incurred as rental income from tenant occupancy of the premises described in the Declarations as furnished and equipped by you, including fair rental value of any portion of the described premises which is occupied by you; and b.Continuing normal operating expenses incurred in connection with that premises, including: (1)Payroll; and (2)The amount of charges which are the legal obligation of the tenant(s) but would otherwise be your obligations. 6."Suspension" means: a.The slowdown or cessation of your business activities; or b.That a part or all of the described premises is rendered untenantable, if coverage for Business Income Including "Rental Value" or "Rental Value" applies. © Insurance Services Office, Inc., 2011 Page 9 of 9CP 00 30 10 12 A0195129 Middlesex Insurance Company 05/13/2024 76787833-b831-44b5-982b-93559a68e8fb Page 1 of 2CP 00 90 07 88 COMMERCIAL PROPERTY CP 00 90 07 88 COMMERCIAL PROPERTY CONDITIONS This Coverage Part is subject to the following conditions, the Common Policy Conditions and applicable Loss Conditions and Additional Conditions in Commercial Property Coverage Forms. A.CONCEALMENT, MISREPRESENTATION OR FRAUD This Coverage Part is void in any case of fraud by you as it relates to this Coverage Part at any time. It is also void if you or any other insured, at any time, intentionally conceal or misrepresent a material fact concerning: 1.This Coverage Part; 2.The Covered Property; 3.Your interest in the Covered Property; or 4.A claim under this Coverage Part. B.CONTROL OF PROPERTY Any act or neglect of any person other than you beyond your direction or control will not affect this insurance. The breach of any condition of this Coverage Part at any one or more locations will not affect coverage at any location where, at the time of loss or damage, the breach of condition does not exist. C.INSURANCE UNDER TWO OR MORE COVER- AGES If two or more of this policy©s coverages apply to the same loss or damage, we will not pay more than the actual amount of the loss or damage. D.LEGAL ACTION AGAINST US No one may bring a legal action against us under this Coverage Part unless: 1.There has been full compliance with all of the terms of this Coverage Part; and 2.The action is brought within 2 years after the date on which the direct physical loss or damage occurred. E.LIBERALIZATION If we adopt any revision that would broaden the coverage under this Coverage Part without additional premium within 45 days prior to or during the policy period, the broadened coverage will immediately apply to this Coverage Part. F.NO BENEFIT TO BAILEE No person or organization, other than you, having custody of Covered Property will benefit from this insurance. G.OTHER INSURANCE 1.You may have other insurance subject to the same plan, terms, conditions and provisions as the insurance under this Coverage Part. If you do, we will pay our share of the covered loss or damage. Our share is the proportion that the applicable Limit of Insurance under this Coverage Part bears to the Limits of Insurance of all insurance covering on the same basis. 2.If there is other insurance covering the same loss or damage, other than that described in 1. above, we will pay only for the amount of covered loss or damage in excess of the amount due from that other insurance, whether you can collect on it or not. But we will not pay more than the applicable Limit of Insurance. H.POLICY PERIOD, COVERAGE TERRITORY Under this Coverage Part: 1.We cover loss or damage commencing: a.During the policy period shown in the Declarations; and b.Within the coverage territory. 2.The coverage territory is: a.The United States of America (including its territories and possessions); b.Puerto Rico; and c.Canada. Copyright, ISO Commercial Risk Services, Inc., 1983, 1987 A0195129 Middlesex Insurance Company 05/13/2024 76787833-b831-44b5-982b-93559a68e8fb Page 2 of 2 I.TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US If any person or organization to or for whom we make payment under this Coverage Part has rights to recover damages from another, those rights are transferred to us to the extent of our payment. That person or organization must do everything necessary to secure our rights and must do nothing after loss to impair them. But you may waive your rights against another party in writing: 1.Prior to a loss to your Covered Property or Covered Income. 2.After a loss to your Covered Property or Covered Income only if, at time of loss, that party is one of the following: a.Someone insured by this insurance; b.A business firm: (1)Owned or controlled by you; or (2)That owns or controls you; or c.Your tenant. This will not restrict your insurance. Copyright, ISO Commercial Risk Services, Inc., 1983, 1987 CP 00 90 07 88 A0195129 Middlesex Insurance Company 05/13/2024 41c28dab-729e-425d-af00-c6ad4c0342f1 Page 1 of 1CP 01 40 07 06 COMMERCIAL PROPERTY CP 01 40 07 06 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION OF LOSS DUE TO VIRUS OR BACTERIA This endorsement modifies insurance provided under the following: COMMERCIAL PROPERTY COVERAGE PART STANDARD PROPERTY POLICY A.The exclusion set forth in Paragraph B. applies to all coverage under all forms and endorsements that comprise this Coverage Part or Policy, including but not limited to forms or endorsements that cover property damage to buildings or personal property and forms or endorsements that cover business income, extra expense or action of civil authority. B.We will not pay for loss or damage caused by or resulting from any virus, bacterium or other microorganism that induces or is capable of inducing physical distress, illness or disease. However, this exclusion does not apply to loss or damage caused by or resulting from "fungus", wet rot or dry rot. Such loss or damage is addressed in a separate exclusion in this Coverage Part or Policy. C.With respect to any loss or damage subject to the exclusion in Paragraph B., such exclusion supersedes any exclusion relating to "pollutants". D.The following provisions in this Coverage Part or Policy are hereby amended to remove reference to bacteria: 1.Exclusion of "Fungus", Wet Rot, Dry Rot And Bacteria; and 2.Additional Coverage - Limited Coverage for "Fungus", Wet Rot, Dry Rot And Bacteria, including any endorsement increasing the scope or amount of coverage. E.The terms of the exclusion in Paragraph B., or the inapplicability of this exclusion to a particular loss, do not serve to create coverage for any loss that would otherwise be excluded under this Coverage Part or Policy. © ISO Properties, Inc., 2006 A0195129 Middlesex Insurance Company 05/13/2024 77a0fdc7-dd50-4b79-9022-b3d799bdbdda Page 1 of 1CP 02 99 06 07 COMMERCIAL PROPERTY CP 02 99 06 07 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CANCELLATION CHANGES This endorsement modifies insurance provided under the following: COMMERCIAL PROPERTY COVERAGE PART STANDARD PROPERTY POLICY The following is added to the Cancellation Common Policy Condition: If any one of the following conditions exists at any building that is Covered Property in this policy, we may cancel this Coverage Part by mailing or delivering to the first Named Insured written notice of cancellation at least five days before the effective date of cancellation. A.The building has been vacant or unoccupied 60 or more consecutive days. This does not apply to: 1.Seasonal unoccupancy; 2.Buildings in the course of construction, renovation or addition; or 3.Buildings to which the Vacancy Permit endorsement applies. Buildings with 65% or more of the rental units or floor area vacant or unoccupied are considered unoccupied under this provision. B.After damage by a covered cause of loss, permanent repairs to the building: 1.Have not started; and 2.Have not been contracted for, within 30 days of initial payment of loss. C.The building has: 1.An outstanding order to vacate; 2.An outstanding demolition order; 3.Been declared unsafe by governmental authority. D.Fixed and salvageable items have been or are being removed from the building and are not being replaced. This does not apply to such removal that is necessary or incidental to any renovation or remodeling. E.Failure to: 1.Furnish necessary heat, water, sewer service or electricity for 30 consecutive days or more, except during a period of seasonal unoccupancy; or 2.Pay property taxes that are owing and have been outstanding for more than one year following the date due, except that this provision will not apply where you are in a bona fide dispute with the taxing authority regarding payment of such taxes. © ISO Properties, Inc., 2007 A0195129 Middlesex Insurance Company 05/13/2024 a4b9b2ca-84da-43c7-b1a6-9ba00df97641 Page 1 of 2CP 04 11 09 17 POLICY NUMBER: Describe Any "P-9": COMMERCIAL PROPERTY CP 04 11 09 17 PROTECTIVE SAFEGUARDS This endorsement modifies insurance provided under the following: COMMERCIAL PROPERTY COVERAGE PART STANDARD PROPERTY POLICY SCHEDULE A.The following is added to the Commercial Property Conditions: Protective Safeguards As a condition of this insurance, you are required to: 1.Maintain the protective safeguards listed in the Schedule, and over which you have control, in complete working order; 2.Actively engage and maintain in the "on" position at all times any automatic fire alarm or other automatic system listed in the Schedule; and 3.Notify us if you know of any suspension of or impairment in any protective safeguard listed in the Schedule. However, if part of an Automatic Sprinkler System or Automatic Commercial Cooking Exhaust And Extinguishing System is shut off due to breakage, leakage, freezing conditions or opening of sprinkler heads, notification to us will not be necessary if you can restore full protection within 48 hours. B.The following is added to the Exclusions section of: Causes Of Loss - Basic Form Causes Of Loss - Broad Form Causes Of Loss - Special Form Mortgageholders Errors And Omissions Coverage Form Standard Property Policy We will not pay for loss or damage caused by or resulting from fire if, prior to the fire, you failed to comply with any condition set forth in Paragraph A. C.The protective safeguards to which this endorsement applies are identified by the following symbols: "P-1" Automatic Sprinkler System, including related supervisory services. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Premises Number Building Number Protective Safeguards Symbols Applicable © Copyright, Washington Surveying & Rating Bureau, 2017 © Insurance Services Office, Inc., 2016 A0195129 Middlesex Insurance Company 05/13/2024 a4b9b2ca-84da-43c7-b1a6-9ba00df97641 Automatic Sprinkler System means: a.Any automatic fire protective or extinguishing system, including connected: (1)Sprinklers and discharge nozzles; (2)Ducts, pipes, valves and fittings; (3)Tanks, their component parts and supports; and (4)Pumps and private fire protection mains. b.When supplied from an automatic fire protective system: (1)Non-automatic fire protective systems; and (2)Hydrants, standpipes and outlets. "P-2" Automatic Fire Alarm, protecting the entire building, that is: a.Connected to a central station; or b.Reporting to a public or private fire alarm station. "P-3" Security Service, with a recording system or watch clock, making hourly rounds covering the entire building, when the premises are not in actual operation. "P-4" Service Contract with a privately owned fire department providing fire protection service to the described premises. "P-5" Automatic Commercial Cooking Exhaust And Extinguishing System installed on cooking appliances and having the following components: a.Hood; b.Grease removal device; c.Duct system; and d.Wet chemical fire extinguishing equipment. "P-9", the protective system described in the Schedule. © Copyright, Washington Surveying & Rating Bureau, 2017 © Insurance Services Office, Inc., 2016 CP 04 11 09 17Page 2 of 2 A0195129 Middlesex Insurance Company 05/13/2024 64f51376-2cde-4104-a7c8-a19b182b7f25 © Insurance Services Office, Inc., 2019 COMMERCIAL PROPERTY CP 04 49 02 20 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALIFORNIA CHANGES - REPLACEMENT COST This endorsement modifies insurance provided under the following: COMMERCIAL PROPERTY COVERAGE PART A.An "open policy" is a policy under which the value of Covered Property is not fixed at policy inception, but is determined at the time of loss in accordance with policy provisions on valuation. The term "open policy" does not apply to Covered Property that is subject to an Agreed Value clause or similar clause that establishes an agreed value prior to loss, unless such clause has expired. B.Under an "open policy", when the Replacement Cost Optional Coverage (Replacement Cost) is shown as applicable in the Declarations, that Coverage is replaced by the following: Replacement Cost 1.Replacement Cost (without deduction for depreciation) replaces Actual Cash Value in the Loss Condition, Valuation, of the applicable Coverage Form. 2.This Optional Coverage does not apply to: a.Personal property of others; b.Contents of a residence; c.Works of art, antiques or rare articles, including etchings, pictures, statuary, marbles, bronzes, porcelains and bric-a-brac; or d."Stock", unless the Including "Stock" option is shown in the Declarations. Under the terms of this Replacement Cost Optional Coverage, tenants' improvements and betterments are not considered to be the personal property of others. 3.We will not pay on a replacement cost basis for any loss or damage until the lost or damaged property is actually repaired or replaced. Prior to such repair or replacement, and in accordance with the terms of the applicable Loss Payment conditions in this policy, we will pay the actual cash value of the lost or damaged property as described in Paragraph 4. below. If the actual cash value does not exhaust the applicable Limit of Insurance, we will then pay the difference between the actual cash value and the replacement cost, provided that the repair or replacement is completed: a. Within 12 months after our payment of the actual cash value; or b. Within 36 months after we pay the actual cash value if the loss or damage relates to a state of emergency under California Law. The following provision applies to real property which is used predominantly for residential purposes and consisting of not more than four dwelling units, and to coverage on tenants© household personal property in a residential unit: Page 1 of 3CP 04 49 02 20 A0195129 Middlesex Insurance Company 05/13/2024 64f51376-2cde-4104-a7c8-a19b182b7f25 © Insurance Services Office, Inc., 2019 If you, acting in good faith and with reasonable diligence, encounter a delay or delays in approval for, or reconstruction of, the residence that are beyond your control, we shall provide one or more additional extensions of six months for good cause. Circumstances beyond your control include, but are not limited to: a.Unavoidable construction permit delays; b.The lack of necessary construction materials; or c.The unavailability of contractors to perform the necessary work. The foregoing provisions do not constitute a waiver of our right to deny the claim for any valid reason or to restrict payment in cases of suspected fraud. 4.Actual cash value is determined as follows: a.In the event of a partial or total loss to a building or structure, actual cash value is calculated as a.(1) or a.(2), whichever is less: (1)The amount it would cost to repair, rebuild or replace the property less a fair and reasonable deduction for physical depreciation of the components of the building or structure that are normally subject to repair or replacement during its useful life. Physical depreciation is based upon the condition of the property at the time of the loss; or (2)The Limit of Insurance applicable to the property. b.In the event of a partial or total loss to Covered Property other than a building or structure, actual cash value is calculated as b.(1) or b.(2), whichever is less: (1)The amount it would cost to repair or replace the property less a fair and reasonable deduction for physical depreciation, based on the condition of the property at the time of loss; or (2)The Limit of Insurance applicable to the property. 5.With respect to tenants© improvements and betterments, the following also apply: a.If the property is not repaired or replaced, the value of tenants© improvements and betterments will be determined as a proportion of your original cost, as set forth in the Valuation Condition of the applicable Coverage Form. b.We will not pay for loss or damage to tenants© improvements and betterments if others pay for repair or replacement. 6.We will not pay more for loss or damage on a replacement cost basis than the least of a., b. or c., subject to 7. below: a.The Limit of Insurance applicable to the lost or damaged property; b.The cost to replace the lost or damaged property with other property: (1)Of comparable material and quality; and (2)Used for the same purpose; or c.The amount actually spent that is necessary to repair or replace the lost or damaged property. If a building is rebuilt at a new premises, the cost described in 6.b. above is limited to the cost which would have been incurred if the building had been rebuilt at the original premises. CP 04 49 02 20Page 2 of 3 A0195129 Middlesex Insurance Company 05/13/2024 64f51376-2cde-4104-a7c8-a19b182b7f25 © Insurance Services Office, Inc., 2019 7.The cost of repair or replacement does not include the increased cost attributable to enforcement of any ordinance or law regulating the construction, use or repair of any property. C.Extension Of Replacement Cost To Personal Property Of Others 1.Under an "open policy", when the Replacement Cost Optional Coverage is shown as applicable in the Declarations, then this Extension may also be shown as applicable. If the Declarations show this Extension as applicable, then Paragraph B.2.a. of the Replacement Cost Optional Coverage is deleted and all other provisions of the Replacement Cost Optional Coverage apply to replacement cost on personal property of others. 2.With respect to replacement cost on the personal property of others, the following limitation applies: If an item(s) of personal property of others is subject to a written contract which governs your liability for loss or damage to that item(s), then valuation of that item(s) will be based on the amount for which you are liable under such contract, but not to exceed the lesser of the replacement cost of the property or the applicable Limit of Insurance. Page 3 of 3CP 04 49 02 20 A0195129 Middlesex Insurance Company 05/13/2024 cfe29179-9fcc-43ec-bbe7-c57f5ac5d1f9 Page 1 of 10CP 10 30 09 17 COMMERCIAL PROPERTY CP 10 30 09 17 CAUSES OF LOSS - SPECIAL FORM Words and phrases that appear in quotation marks have special meaning. Refer to Section G. Definitions. A.Covered Causes Of Loss When Special is shown in the Declarations, Covered Causes of Loss means direct physical loss unless the loss is excluded or limited in this policy. B.Exclusions 1.We will not pay for loss or damage caused directly or indirectly by any of the following. Such loss or damage is excluded regardless of any other cause or event that contributes concurrently or in any sequence to the loss. a.Ordinance Or Law The enforcement of or compliance with any ordinance or law: (1)Regulating the construction, use or repair of any property; or (2)Requiring the tearing down of any property, including the cost of removing its debris. This exclusion, Ordinance Or Law, applies whether the loss results from: (a)An ordinance or law that is enforced even if the property has not been damaged; or (b)The increased costs incurred to comply with an ordinance or law in the course of construction, repair, renovation, remodeling or demolition of property, or removal of its debris, following a physical loss to that property. b.Earth Movement (1)Earthquake, including tremors and aftershocks and any earth sinking, rising or shifting related to such event; (2)Landslide, including any earth sinking, rising or shifting related to such event; (3)Mine subsidence, meaning subsidence of a man-made mine, whether or not mining activity has ceased; (4)Earth sinking (other than sinkhole collapse), rising or shifting including soil conditions which cause settling, cracking or other disarrangement of foundations or other parts of realty. Soil conditions include contraction, expansion, freezing, thawing, erosion, improperly compacted soil and the action of water under the ground surface. But if Earth Movement, as described in b.(1) through (4) above, results in fire or explosion, we will pay for the loss or damage caused by that fire or explosion. (5)Volcanic eruption, explosion or effusion. But if volcanic eruption, explosion or effusion results in fire, building glass breakage or Volcanic Action, we will pay for the loss or damage caused by that fire, building glass breakage or Volcanic Action. Volcanic Action means direct loss or damage resulting from the eruption of a volcano when the loss or damage is caused by: (a)Airborne volcanic blast or airborne shock waves; (b)Ash, dust or particulate matter; or (c)Lava flow. With respect to coverage for Volcanic Action as set forth in (5)(a), (5)(b) and (5)(c), all volcanic eruptions that occur within any 168-hour period will constitute a single occurrence. Volcanic Action does not include the cost to remove ash, dust or particulate matter that does not cause direct physical loss or damage to the described property. This exclusion applies regardless of whether any of the above, in Paragraphs (1) through (5), is caused by an act of nature or is otherwise caused. © Copyright, Washington Surveying & Rating Bureau, 2017 © Insurance Services Office, Inc., 2016 A0195129 Middlesex Insurance Company 05/13/2024 cfe29179-9fcc-43ec-bbe7-c57f5ac5d1f9 c.Governmental Action Seizure or destruction of property by order of governmental authority. But we will pay for loss or damage caused by or resulting from acts of destruction ordered by governmental authority and taken at the time of a fire to prevent its spread, if the fire would be covered under this Coverage Part. d.Nuclear Hazard Nuclear reaction or radiation, or radioactive contamination, however caused. But if nuclear reaction or radiation, or radioactive contamination, results in fire, we will pay for the loss or damage caused by that fire. e.Utility Services The failure of power, communication, water or other utility service supplied to the described premises, however caused, if the failure: (1)Originates away from the described premises; or (2)Originates at the described premises, but only if such failure involves equipment used to supply the utility service to the described premises from a source away from the described premises. Failure of any utility service includes lack of sufficient capacity and reduction in supply. Loss or damage caused by a surge of power is also excluded, if the surge would not have occurred but for an event causing a failure of power. But if the failure or surge of power, or the failure of communication, water or other utility service, results in a Covered Cause of Loss, we will pay for the loss or damage caused by that Covered Cause of Loss. Communication services include but are not limited to service relating to Internet access or access to any electronic, cellular or satellite network. f.War And Military Action (1)War, including undeclared or civil war; (2)Warlike action by a military force, including action in hindering or defending against an actual or expected attack, by any government, sovereign or other authority using military personnel or other agents; or (3)Insurrection, rebellion, revolution, usurped power, or action taken by governmental authority in hindering or defending against any of these. g.Water (1)Flood, surface water, waves (including tidal wave and tsunami), tides, tidal water, overflow of any body of water, or spray from any of these, all whether or not driven by wind (including storm surge); (2)Mudslide or mudflow; (3)Water that backs up or overflows or is otherwise discharged from a sewer, drain, sump, sump pump or related equipment; (4)Water under the ground surface pressing on, or flowing or seeping through: (a)Foundations, walls, floors or paved surfaces; (b)Basements, whether paved or not; or (c)Doors, windows or other openings; or (5)Waterborne material carried or otherwise moved by any of the water referred to in Paragraph (1), (3) or (4), or material carried or otherwise moved by mudslide or mudflow. This exclusion applies regardless of whether any of the above, in Paragraphs (1) through (5), is caused by an act of nature or is otherwise caused. An example of a situation to which this exclusion applies is the situation where a dam, levee, seawall or other boundary or containment system fails in whole or in part, for any reason, to contain the water. © Copyright, Washington Surveying & Rating Bureau, 2017 © Insurance Services Office, Inc., 2016 CP 10 30 09 17Page 2 of 10 A0195129 Middlesex Insurance Company 05/13/2024 cfe29179-9fcc-43ec-bbe7-c57f5ac5d1f9 But if any of the above, in Paragraphs (1) through (5), results in fire, explosion or sprinkler leakage, we will pay for the loss or damage caused by that fire, explosion or sprinkler leakage (if sprinkler leakage is Covered Cause of Loss). h."Fungus", Wet Rot, Dry Rot And Bacteria Presence, growth, proliferation, spread or any activity of "fungus", wet or dry rot or bacteria. But if "fungus", wet or dry rot or bacteria result in a "specified cause of loss", we will pay for the loss or damage caused by that "specified cause of loss". This exclusion does not apply: (1)When "fungus", wet or dry rot or bacteria result from fire or lightning; or (2)To the extent that coverage is provided in the Additional Coverage, Limited Coverage For "Fungus", Wet Rot, Dry Rot And Bacteria, with respect to loss or damage by a cause of loss other than fire or lightning. Exclusions B.1.a. through B.1.h. apply whether or not the loss event results in widespread damage or affects a substantial area. 2.We will not pay for loss or damage caused by or resulting from any of the following: a.Artificially generated electrical, magnetic or electromagnetic energy that damages, disturbs, disrupts or otherwise interferes with any: (1)Electrical or electronic wire, device, appliance, system or network; or (2)Device, appliance, system or network utilizing cellular or satellite technology. For the purpose of this exclusion, electrical, magnetic or electromagnetic energy includes but is not limited to: (a)Electrical current, including arcing; (b)Electrical charge produced or conducted by a magnetic or electromagnetic field; (c)Pulse of electromagnetic energy; or (d)Electromagnetic waves or microwaves. But if fire results, we will pay for the loss or damage caused by that fire. b.Delay, loss of use or loss of market. c.Smoke, vapor or gas from agricultural smudging or industrial operations. d.(1) Wear and tear; (2)Rust or other corrosion, decay, deterioration, hidden or latent defect or any quality in property that causes it to damage or destroy itself; (3)Smog; (4)Settling, cracking, shrinking or expansion; (5) Nesting or infestation, or discharge or release of waste products or secretions, by insects, birds, rodents or other animals. (6) Mechanical breakdown, including rupture or bursting caused by centrifugal force. But if mechanical breakdown results in elevator collision, we will pay for the loss or damage caused by that elevator collision. (7) The following causes of loss to personal property: (a)Dampness or dryness of atmosphere; (b)Changes in or extremes of temperature; or (c)Marring or scratching. But if an excluded cause of loss that is listed in 2.d.(1) through (7) results in a "specified cause of loss" or building glass breakage, we will pay for the loss or damage caused by that "specified cause of loss" or building glass breakage. e.Explosion of steam boilers, steam pipes, steam engines or steam turbines owned or leased by you, or operated under your control. But if explosion of steam boilers, steam pipes, steam engines or steam turbines results in fire or combustion explosion, we will pay for the loss or damage caused by that fire or combustion explosion. We will also pay for loss or damage caused by or resulting from the explosion of gases or fuel within the furnace of any fired vessel or within the flues or passages through which the gases of combustion pass. f.Continuous or repeated seepage or leakage of water, or the presence or condensation of humidity, moisture or vapor, that occurs over a period of 14 days or more. © Copyright, Washington Surveying & Rating Bureau, 2017 © Insurance Services Office, Inc., 2016 Page 3 of 10CP 10 30 09 17 A0195129 Middlesex Insurance Company 05/13/2024 cfe29179-9fcc-43ec-bbe7-c57f5ac5d1f9 g.Water, other liquids, powder or molten material that leaks or flows from plumbing, heating, air conditioning or other equipment (except fire protective systems) caused by or resulting from freezing, unless: (1)You do your best to maintain heat in the building or structure; or (2) You drain the equipment and shut off the supply if the heat is not maintained. h.Dishonest or criminal act (including theft) by you, any of your partners, members, officers, managers, employees (including temporary employees and leased workers), directors, trustees or authorized representatives, whether acting alone or in collusion with each other or with any other party; or theft by any person to whom you entrust the property for any purpose, whether acting alone or in collusion with any other party. This exclusion: (1)Applies whether or not an act occurs during your normal hours of operation; (2)Does not apply to acts of destruction by your employees (including temporary employees and leased workers) or authorized representatives; but theft by your employees (including temporary employees and leased workers) or authorized representatives is not covered. i.Voluntary parting with any property by you or anyone else to whom you have entrusted the property if induced to do so by any fraudulent scheme, trick, device or false pretense. j.Rain, snow, ice or sleet to personal property in the open. k.Collapse, including any of the following conditions of property or any part of the property: (1) An abrupt falling down or caving in; (2) Loss of structural integrity, including separation of parts of the property or property in danger of falling down or caving in; or (3)Any cracking, bulging, sagging, bending, leaning, settling, shrinkage or expansion as such condition relates to (1) or (2) above. But if collapse results in a Covered Cause of Loss at the described premises, we will pay for the loss or damage caused by that Covered Cause of Loss. This exclusion, k., does not apply: (a)To the extent that coverage is provided under the Additional Coverage, Collapse; or (b)To collapse caused by one or more of the following: (i)The "specified causes of loss"; (ii)Breakage of building glass; (iii)Weight of rain that collects on a roof; or (iv)Weight of people or personal property. l.Discharge, dispersal, seepage, migration, release or escape of "pollutants" unless the discharge, dispersal, seepage, migration, release or escape is itself caused by any of the "specified causes of loss". But if the discharge, dispersal, seepage, migration, release or escape of "pollutants" results in a "specified cause of loss", we will pay for the loss or damage caused by that "specified cause of loss". This exclusion, I., does not apply to damage to glass caused by chemicals applied to the glass. m.Neglect of an insured to use all reasonable means to save and preserve property from further damage at and after the time of loss. 3.We will not pay for loss or damage caused by or resulting from any of the following, 3.a. through 3.c. But if an excluded cause of loss that is listed in 3.a. through 3.c. results in a Covered Cause of Loss, we will pay for the loss or damage caused by that Covered Cause of Loss. a.Weather conditions. But this exclusion only applies if weather conditions contribute in any way with a cause or event excluded in Paragraph 1. above to produce the loss or damage. b.Acts or decisions, including the failure to act or decide, of any person, group, organization or governmental body. c.Faulty, inadequate or defective: (1)Planning, zoning, development, surveying, siting; (2)Design, specifications, workmanship, repair, construction, renovation, remodeling, grading, compaction; (3)Materials used in repair, construction, renovation or remodeling; or (4)Maintenance; © Copyright, Washington Surveying & Rating Bureau, 2017 © Insurance Services Office, Inc., 2016 CP 10 30 09 17Page 4 of 10 A0195129 Middlesex Insurance Company 05/13/2024 cfe29179-9fcc-43ec-bbe7-c57f5ac5d1f9 of part or all of any property on or off the described premises. 4.Special Exclusions The following provisions apply only to the specified Coverage Forms: a.Business Income (And Extra Expense) Coverage Form, Business Income (Without Extra Expense) Coverage Form, Or Extra Expense Coverage Form We will not pay for: (1)Any loss caused by or resulting from: (a)Damage or destruction of "finished stock"; or (b)The time required to reproduce "finished stock". This exclusion does not apply to Extra Expense. (2)Any loss caused by or resulting from direct physical loss or damage to radio or television antennas (including satellite dishes) and their lead-in wiring, masts or towers. (3)Any increase of loss caused by or resulting from: (a)Delay in rebuilding, repairing or replacing the property or resuming "operations", due to interference at the location of the rebuilding, repair or replacement by strikers or other persons; or (b)Suspension, lapse or cancellation of any license, lease or contract. But if the suspension, lapse or cancellation is directly caused by the "suspension" of "operations", we will cover such loss that affects your Business Income during the "period of restoration" and any extension of the "period of restoration" in accordance with the terms of the Extended Business Income Additional Coverage and the Extended Period Of Indemnity Optional Coverage or any variation of these. (4)Any Extra Expense caused by or resulting from suspension, lapse or cancellation of any license, lease or contract beyond the "period of restoration". (5)Any other consequential loss. b.Leasehold Interest Coverage Form (1)Paragraph B.1.a., Ordinance Or Law, does not apply to insurance under this Coverage Form. (2)We will not pay for any loss caused by: (a)Your cancelling the lease; (b)The suspension, lapse or cancellation of any license; or (c)Any other consequential loss. c.Legal Liability Coverage Form (1)The following exclusions do not apply to insurance under this Coverage Form: (a)Paragraph B.1.a. Ordinance Or Law; (b)Paragraph B.1.c. Governmental Action; (c)Paragraph B.1.d. Nuclear Hazard; (d)Paragraph B.1.e. Utility Services; and (e)Paragraph B.1.f. War And Military Action. (2)The following additional exclusions apply to insurance under this Coverage Form: (a)Contractual Liability We will not defend any claim or "suit", or pay damages that you are legally liable to pay, solely by reason of your assumption of liability in a contract or agreement. But this exclusion does not apply to a written lease agreement in which you have assumed liability for building damage resulting from an actual or attempted burglary or robbery, provided that: (i)Your assumption of liability was executed prior to the accident; and (ii)The building is Covered Property under this Coverage Form. (b)Nuclear Hazard We will not defend any claim or "suit", or pay any damages, loss, expense or obligation, resulting from nuclear reaction or radiation, or radioactive contamination, however caused. © Copyright, Washington Surveying & Rating Bureau, 2017 © Insurance Services Office, Inc., 2016 Page 5 of 10CP 10 30 09 17 A0195129 Middlesex Insurance Company 05/13/2024 cfe29179-9fcc-43ec-bbe7-c57f5ac5d1f9 5.Additional Exclusion The following provisions apply only to the specified property: Loss Or Damage To Products We will not pay for loss or damage to any merchandise, goods or other product caused by or resulting from error or omission by any person or entity (including those having possession under an arrangement where work or a portion of the work is outsourced) in any stage of the development, production or use of the product, including planning, testing, processing, packaging, installation, maintenance or repair. This exclusion applies to any effect that compromises the form, substance or quality of the product. But if such error or omission results in a Covered Cause of Loss, we will pay for the loss or damage caused by that Covered Cause of Loss. C.Limitations The following limitations apply to all policy forms and endorsements, unless otherwise stated: 1.We will not pay for loss of or damage to property, as described and limited in this section. In addition, we will not pay for any loss that is a consequence of loss or damage as described and limited in this section. a.Steam boilers, steam pipes, steam engines or steam turbines caused by or resulting from any condition or event inside such equipment. But we will pay for loss of or damage to such equipment caused by or resulting from an explosion of gases or fuel within the furnace of any fired vessel or within the flues or passages through which the gases of combustion pass. b.Hot water boilers or other water heating equipment caused by or resulting from any condition or event inside such boilers or equipment, other than an explosion. c.The interior of any building or structure, or to personal property in the building or structure, caused by or resulting from rain, snow, sleet, ice, sand or dust, whether driven by wind or not, unless: (1) The building or structure first sustains damage by a Covered Cause of Loss to its roof or walls through which the rain, snow, sleet, ice, sand or dust enters; or (2) The loss or damage is caused by or results from thawing of snow, sleet or ice on the building or structure. d.Building materials and supplies not attached as part of the building or structure, caused by or resulting from theft. However, this limitation does not apply to: (1) Building materials and supplies held for sale by you, unless they are insured under the Builders Risk Coverage Form; or (2) Business Income Coverage or Extra Expense Coverage. e.Property that is missing, where the only evidence of the loss or damage is a shortage disclosed on taking inventory, or other instances where there is no physical evidence to show what happened to the property. f.Property that has been transferred to a person or to a place outside the described premises on the basis of unauthorized instructions. g.Lawns, trees, shrubs or plants which are part of a vegetated roof, caused by or resulting from: (1)Dampness or dryness of atmosphere or of soil supporting the vegetation; (2)Changes in or extremes of temperature; (3)Disease; (4)Frost or hail; or (5)Rain, snow, ice or sleet. 2.We will not pay for loss of or damage to the following types of property unless caused by the "specified causes of loss" or building glass breakage: a.Animals, and then only if they are killed or their destruction is made necessary. b.Fragile articles such as statuary, marbles, chinaware and porcelains, if broken. This restriction does not apply to: (1) Glass; or (2) Containers of property held for sale. c.Builders© machinery, tools and equipment owned by you or entrusted to you, provided such property is Covered Property. However, this limitation does not apply: (1) If the property is located on or within 100 feet of the described premises, unless the premises is insured under the Builders Risk Coverage Form; or © Copyright, Washington Surveying & Rating Bureau, 2017 © Insurance Services Office, Inc., 2016 CP 10 30 09 17Page 6 of 10 A0195129 Middlesex Insurance Company 05/13/2024 cfe29179-9fcc-43ec-bbe7-c57f5ac5d1f9 (2)To Business Income Coverage or to Extra Expense Coverage. 3.The special limit shown for each category, a. through d., is the total limit for loss of or damage to all property in that category. The special limit applies to any one occurrence of theft, regardless of the types or number of articles that are lost or damaged in that occurrence. The special limits are (unless a higher limit is shown in the Declarations): a.$2,500 for furs, fur garments and garments trimmed with fur. b.$2,500 for jewelry, watches, watch movements, jewels, pearls, precious and semiprecious stones, bullion, gold, silver, platinum and other precious alloys or metals. This limit does not apply to jewelry and watches worth $100 or less per item. c.$2,500 for patterns, dies, molds and forms. d.$250 for stamps, tickets, including lottery tickets held for sale, and letters of credit. These special limits are part of, not in addition to, the Limit of Insurance applicable to the Covered Property. This limitation, C.3., does not apply to Business Income Coverage or to Extra Expense Coverage. 4.We will not pay the cost to repair any defect to a system or appliance from which water, other liquid, powder or molten material escapes. But we will pay the cost to repair or replace damaged parts of fire-extinguishing equipment if the damage: a.Results in discharge of any substance from an automatic fire protection system; or b.Is directly caused by freezing. However, this limitation does not apply to Business Income Coverage or to Extra Expense Coverage. D.Additional Coverage - Collapse The coverage provided under this Additional Coverage, Collapse, applies only to an abrupt collapse as described and limited in D.1. through D.7. 1.For the purpose of this Additional Coverage, Collapse, abrupt collapse means an abrupt falling down or caving in of a building or any part of a building with the result that the building or part of the building cannot be occupied for its intended purpose. 2.We will pay for direct physical loss or damage to Covered Property, caused by abrupt collapse of a building or any part of a building that is insured under this Coverage Form or that contains Covered Property insured under this Coverage Form, if such collapse is caused by one or more of the following: a.Building decay that is hidden from view, unless the presence of such decay is known to an insured prior to collapse; b.Insect or vermin damage that is hidden from view, unless the presence of such damage is known to an insured prior to collapse; c.Use of defective material or methods in construction, remodeling or renovation if the abrupt collapse occurs during the course of the construction, remodeling or renovation. d.Use of defective material or methods in construction, remodeling or renovation if the abrupt collapse occurs after the construction, remodeling or renovation is complete, but only if the collapse is caused in part by: (1)A cause of loss listed in 2.a. or 2.b.; (2)One or more of the "specified causes of loss"; (3)Breakage of building glass; (4)Weight of people or personal property; or (5)Weight of rain that collects on a roof. 3.This Additional Coverage - Collapse does not apply to: a.A building or any part of a building that is in danger of falling down or caving in; b.A part of a building that is standing, even if it has separated from another part of the building; or c.A building that is standing or any part of a building that is standing, even if it shows evidence of cracking, bulging, sagging, bending, leaning, settling, shrinkage or expansion. 4.With respect to the following property: a.Outdoor radio or television antennas (including satellite dishes) and their lead-in wiring, masts or towers; © Copyright, Washington Surveying & Rating Bureau, 2017 © Insurance Services Office, Inc., 2016 Page 7 of 10CP 10 30 09 17 A0195129 Middlesex Insurance Company 05/13/2024 cfe29179-9fcc-43ec-bbe7-c57f5ac5d1f9 b.Awnings, gutters and downspouts; c.Yard fixtures; d.Outdoor swimming pools; e.Fences; f.Piers, wharves and docks; g.Beach or diving platforms or appurtenances; h.Retaining walls; and i.Walks, roadways and other paved surfaces; if an abrupt collapse is caused by a cause of loss listed in 2.a. through 2.d., we will pay for loss or damage to that property only if: (1)Such loss or damage is a direct result of the abrupt collapse of a building insured under this Coverage Form; and (2)The property is Covered Property under this Coverage Form. 5.If personal property abruptly falls down or caves in and such collapse is not the result of abrupt collapse of a building, we will pay for loss or damage to Covered Property caused by such collapse of personal property only if: a.The collapse of personal property was caused by a cause of loss listed in 2.a. through 2.d.: b.The personal property which collapses is inside a building; and c.The property which collapses is not of a kind listed in 4., regardless of whether that kind of property is considered to be personal property or real property. The coverage stated in this Paragraph 5. does not apply to personal property if marring and/or scratching is the only damage to that personal property caused by the collapse. 6.This Additional Coverage, Collapse, does not apply to personal property that has not abruptly fallen down or caved in, even if the personal property shows evidence of cracking, bulging, sagging, bending, leaning, settling, shrinkage or expansion. 7.This Additional Coverage, Collapse, will not increase the Limits of Insurance provided in this Coverage Part. 8.The term Covered Cause of Loss includes the Additional Coverage, Collapse, as described and limited in D.1. through D.7. E.Additional Coverage - Limited Coverage For "Fungus", Wet Rot, Dry Rot And Bacteria 1.The coverage described in E.2. and E.6. only applies when the "fungus", wet or dry rot or bacteria are the result of one or more of the following causes that occur during the policy period and only if all reasonable means were used to save and preserve the property from further damage at the time of and after that occurrence: a.A "specified cause of loss" other than fire or lightning; or b.Flood, if the Flood Coverage Endorsement applies to the affected premises. This Additional Coverage does not apply to lawns, trees, shrubs or plants which are part of a vegetated roof. 2.We will pay for loss or damage by "fungus", wet or dry rot or bacteria. As used in this Limited Coverage, the term loss or damage means: a.Direct physical loss or damage to Covered Property caused by "fungus", wet or dry rot or bacteria, including the cost of removal of the "fungus", wet or dry rot or bacteria; b.The cost to tear out and replace any part of the building or other property as needed to gain access to the "fungus", wet or dry rot or bacteria; and c.The cost of testing performed after removal, repair, replacement or restoration of the damaged property is completed, provided there is a reason to believe that "fungus", wet or dry rot or bacteria are present. 3.The coverage described under E.2. of this Limited Coverage is limited to $15,000. Regardless of the number of claims, this limit is the most we will pay for the total of all loss or damage arising out of all occurrences of "specified causes of loss" (other than fire or lightning) and Flood which take place in a 12-month period (starting with the beginning of the present annual policy period). With respect to a particular occurrence of loss which results in "fungus", wet or dry rot or bacteria, we will not pay more than a total of $15,000 even if the "fungus", wet or dry rot or bacteria continue to be present or active, or recur, in a later policy period. © Copyright, Washington Surveying & Rating Bureau, 2017 © Insurance Services Office, Inc., 2016 CP 10 30 09 17Page 8 of 10 A0195129 Middlesex Insurance Company 05/13/2024 cfe29179-9fcc-43ec-bbe7-c57f5ac5d1f9 4.The coverage provided under this Limited Coverage does not increase the applicable Limit of Insurance on any Covered Property. If a particular occurrence results in loss or damage by "fungus", wet or dry rot or bacteria, and other loss or damage, we will not pay more, for the total of all loss or damage, than the applicable Limit of Insurance on the affected Covered Property. If there is covered loss or damage to Covered Property, not caused by "fungus", wet or dry rot or bacteria, loss payment will not be limited by the terms of this Limited Coverage, except to the extent that "fungus", wet or dry rot or bacteria causes an increase in the loss. Any such increase in the loss will be subject to the terms of this Limited Coverage. 5.The terms of this Limited Coverage do not increase or reduce the coverage provided under Paragraph F.2. (Water Damage, Other Liquids, Powder Or Molten Material Damage) of this Causes Of Loss form or under the Additional Coverage, Collapse. 6.The following, 6.a. or 6.b., applies only if Business Income and/or Extra Expense Coverage applies to the described premises and only if the "suspension" of "operations" satisfies all terms and conditions of the applicable Business Income and/or Extra Expense Coverage Form: a.If the loss which resulted in "fungus", wet or dry rot or bacteria does not in itself necessitate a "suspension" of "operations", but such "suspension" is necessary due to loss or damage to property caused by "fungus", wet or dry rot or bacteria, then our payment under Business Income and/or Extra Expense is limited to the amount of loss and/or expense sustained in a period of not more than 30 days. The days need not be consecutive. b.If a covered "suspension" of "operations" was caused by loss or damage other than "fungus", wet or dry rot or bacteria but remediation of "fungus", wet or dry rot or bacteria prolongs the "period of restoration", we will pay for loss and/or expense sustained during the delay (regardless of when such a delay occurs during the "period of restoration"), but such coverage is limited to 30 days. The days need not be consecutive. F.Additional Coverage Extensions 1.Property In Transit This Extension applies only to your personal property to which this form applies. a.You may extend the insurance provided by this Coverage Part to apply to your personal property (other than property in the care, custody or control of your salespersons) in transit more than 100 feet from the described premises. Property must be in or on a motor vehicle you own, lease or operate while between points in the coverage territory. b.Loss or damage must be caused by or result from one of the following causes of loss: (1)Fire, lightning, explosion, windstorm or hail, riot or civil commotion, or vandalism. (2)Vehicle collision, upset or overturn. Collision means accidental contact of your vehicle with another vehicle or object. It does not mean your vehicle©s contact with the roadbed. (3)Theft of an entire bale, case or package by forced entry into a securely locked body or compartment of the vehicle. There must be visible marks of the forced entry. c.The most we will pay for loss or damage under this Extension is $5,000. This Coverage Extension is additional insurance. The Additional Condition, Coinsurance, does not apply to this Extension. 2.Water Damage, Other Liquids, Powder Or Molten Material Damage If loss or damage caused by or resulting from covered water or other liquid, powder or molten material damage loss occurs, we will also pay the cost to tear out and replace any part of the building or structure to repair damage to the system or appliance from which the water or other substance escapes. This Coverage Extension does not increase the Limit of Insurance. © Copyright, Washington Surveying & Rating Bureau, 2017 © Insurance Services Office, Inc., 2016 Page 9 of 10CP 10 30 09 17 A0195129 Middlesex Insurance Company 05/13/2024 cfe29179-9fcc-43ec-bbe7-c57f5ac5d1f9 CP 10 30 09 17Page 10 of 10 3.Glass a.We will pay for expenses incurred to put up temporary plates or board up openings if repair or replacement of damaged glass is delayed. b.We will pay for expenses incurred to remove or replace obstructions when repairing or replacing glass that is part of a building. This does not include removing or replacing window displays. This Coverage Extension F.3. does not increase the Limit of Insurance. G.Definitions 1."Fungus" means any type or form of fungus, including mold or mildew, and any mycotoxins, spores, scents or by-products produced or released by fungi. 2."Specified causes of loss" means the following: fire; lightning; explosion; windstorm or hail; smoke; aircraft or vehicles; riot or civil commotion; vandalism; leakage from fire-extinguishing equipment; sinkhole collapse; volcanic action; falling objects; weight of snow, ice or sleet; water damage. a.Sinkhole collapse means the sudden sinking or collapse of land into underground empty spaces created by the action of water on limestone or dolomite. This cause of loss does not include: (1)The cost of filling sinkholes; or (2)Sinking or collapse of land into man-made underground cavities. b.Falling objects does not include loss or damage to: (1)Personal property in the open; or (2)The interior of a building or structure, or property inside a building or structure, unless the roof or an outside wall of the building or structure is first damaged by a falling object. c.Water damage means: (1)Accidental discharge or leakage of water or steam as the direct result of the breaking apart or cracking of a plumbing, heating, air conditioning or other system or appliance (other than a sump system including its related equipment and parts), that is located on the described premises and contains water or steam; and (2)Accidental discharge or leakage of water or waterborne material as the direct result of the breaking apart or cracking of a water or sewer pipe caused by wear and tear, when the pipe is located off the described premises and is connected to or is part of a potable water supply system or sanitary sewer system operated by a public or private utility service provider pursuant to authority granted by the state or governmental subdivision where the described premises are located. But water damage does not include loss or damage otherwise excluded under the terms of the Water Exclusion. Therefore, for example, there is no coverage under this policy in the situation in which discharge or leakage of water results from the breaking apart or cracking of a pipe which was caused by or related to weather-induced flooding, even if wear and tear contributed to the breakage or cracking. As another example, and also in accordance with the terms of the Water Exclusion, there is no coverage for loss or damage caused by or related to weather-induced flooding which follows or is exacerbated by pipe breakage or cracking attributable to wear and tear. To the extent that accidental discharge or leakage of water falls within the criteria set forth in c.(1) or c.(2) of this definition of "specified causes of loss," such water is not subject to the provisions of the Water Exclusion which preclude coverage for surface water or water under the surface of the ground. © Copyright, Washington Surveying & Rating Bureau, 2017 © Insurance Services Office, Inc., 2016 A0195129 Middlesex Insurance Company 05/13/2024 7da5f953-78aa-486f-9400-737d71c38481 Page 1 of 1CP 10 36 10 12 SCHEDULE Premises Number Building Number (Paragraph A. and/or Paragraph B.) Indicate Applicability Information required to complete this Schedule, if not shown above, will be shown in the Declarations. POLICY NUMBER:COMMERCIAL PROPERTY CP 10 36 10 12 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. LIMITATIONS ON COVERAGE FOR ROOF SURFACING This endorsement modifies insurance provided under the following: BUILDERS RISK COVERAGE FORM BUILDING AND PERSONAL PROPERTY COVERAGE FORM CONDOMINIUM ASSOCIATION COVERAGE FORM CONDOMINIUM COMMERCIAL UNIT-OWNERS COVERAGE FORM STANDARD PROPERTY POLICY A.The following applies with respect to loss or damage by a Covered Cause of Loss (including wind and hail if covered) to a building or structure identified in the Schedule as being subject to this Paragraph A.: Replacement Cost coverage (if otherwise applicable to such property) does not apply to roof surfacing. Instead, we will determine the value of roof surfacing at actual cash value as of the time of loss or damage. B.The following applies with respect to loss or damage by wind and/or hail to a building or structure identified in the Schedule as being subject to this Paragraph B.: We will not pay for cosmetic damage to roof surfacing caused by wind and/or hail. For the purpose of this endorsement, cosmetic damage means that the wind and/or hail caused marring, pitting or other superficial damage that altered the appearance of the roof surfacing, but such damage does not prevent the roof from continuing to function as a barrier to entrance of the elements to the same extent as it did before the cosmetic damage occurred. C.For the purpose of this endorsement, roof surfacing refers to the shingles, tiles, cladding, metal or synthetic sheeting or similar materials covering the roof and includes all materials used in securing the roof surface and all materials applied to or under the roof surface for moisture protection, as well as roof flashing. © Insurance Services Office, Inc., 2011 A0195129 Middlesex Insurance Company 05/13/2024 44c5ad0e-9276-482c-a2d0-61fb4f2b23ed © Insurance Services Office, Inc., 2020 COMMERCIAL PROPERTY CP 10 75 12 20 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CYBER INCIDENT EXCLUSION This endorsement modifies insurance provided under the following: COMMERCIAL PROPERTY COVERAGE PART STANDARD PROPERTY POLICY A.The following exclusion is added to Paragraph B. Exclusions: We will not pay for loss or damage caused directly or indirectly by the following. Such loss or damage is excluded regardless of any other cause or event that contributes concurrently or in any sequence to the loss. Cyber Incident 1.Unauthorized access to or use of any computer system (including electronic data). 2.Malicious code, virus or any other harmful code that is directed at, enacted upon or introduced into any computer system (including electronic data) and is designed to access, alter, corrupt, damage, delete, destroy, disrupt, encrypt, exploit, use or prevent or restrict access to or the use of any part of any computer system (including electronic data) or otherwise disrupt its normal functioning or operation. 3.Denial of service attack which disrupts, prevents or restricts access to or use of any computer system, or otherwise disrupts its normal functioning or operation. B.Exceptions And Limitations 1.Fire Or Explosion If a cyber incident as described in Paragraphs A.1. through A.3. of this exclusion results in fire or explosion, we will pay for the loss or damage caused by that fire or explosion. 2.Additional Coverage The exclusion in Paragraph A. does not apply to the extent that coverage is provided in the: a.Additional Coverage - Electronic Data; or b.Additional Coverage - Interruption Of Computer Operations. 3.Electronic Commerce Endorsement The exclusion in Paragraph A. does not apply to the Electronic Commerce (E-Commerce) endorsement when attached to your policy. C.Vandalism The following is added to Vandalism, if Vandalism coverage is not otherwise excluded under the Standard Property Policy or the Causes Of Loss - Basic, Broad or Special Forms and if applicable to the premises described in the Declarations: Vandalism does not include a cyber incident as described in Paragraph A. Page 1 of 1CP 10 75 12 20 Location Number:Building Number: Description Of Property: Loss Payee Name: Loss Payee Address: Building Number: Description Of Property: Loss Payee Name: Loss Payee Address: Building Number: Description Of Property: Loss Payee Name: Loss Payee Address: Location Number: Location Number: COMMERCIAL PROPERTY CP 12 18 10 12 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. LOSS PAYABLE PROVISIONS This endorsement modifies insurance provided under the following: BUILDERS' RISK COVERAGE FORM BUILDING AND PERSONAL PROPERTY COVERAGE FORM CONDOMINIUM ASSOCIATION COVERAGE FORM CONDOMINIUM COMMERCIAL UNIT-OWNERS COVERAGE FORM STANDARD PROPERTY POLICY SCHEDULE POLICY NUMBER: Applicable Clause (Enter C.1., C.2., C.3., or C.4.): Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Applicable Clause (Enter C.1., C.2., C.3., or C.4.): Applicable Clause (Enter C.1., C.2., C.3., or C.4.): 00002 0000000000 24134 0 N1 9899db85-3247-402c-9c41-3eedd5fa69a69899db85-3247-402c-9c41-3eedd5fa69a6 Page 1 of 3CP 12 18 10 12 © Insurance Services Office, Inc., 2011 05/13/2024A0195129 Middlesex Insurance Company A.When this endorsement is attached to the Standard Property Policy CP 00 99, the term Coverage Part in this endorsement is replaced by the term Policy. B.Nothing in this endorsement increases the applicable Limit of Insurance. We will not pay any Loss Payee more than their financial interest in the Covered Property, and we will not pay more than the applicable Limit of Insurance on the Covered Property. C.The following is added to the Loss Payment Loss Condition, as indicated in the Declarations or in the Schedule: 1.Loss Payable Clause For Covered Property in which both you and a Loss Payee shown in the Schedule or in the Declarations have an insurable interest, we will: a.Adjust losses with you; and b.Pay any claim for loss or damage jointly to you and the Loss Payee, as interests may appear. 2.Lender's Loss Payable Clause a.The Loss Payee shown in the Schedule or in the Declarations is a creditor, including a mortgageholder or trustee, whose interest in Covered Property is established by such written instruments as: (1)Warehouse receipts; (2)A contract for deed; (3)Bills of lading; (4)Financing statements; or (5)Mortgages, deeds of trust, or security agreements. b.For Covered Property in which both you and a Loss Payee have an insurable interest: (1)We will pay for covered loss or damage to each Loss Payee in their order of precedence, as interests may appear. (2)The Loss Payee has the right to receive loss payment even if the Loss Payee has started foreclosure or similar action on the Covered Property. (3)If we deny your claim because of your acts or because you have failed to comply with the terms of the Coverage Part, the Loss Payee will still have the right to receive loss payment if the Loss Payee: (a)Pays any premium due under this Coverage Part at our request if you have failed to do so; (b)Submits a signed, sworn proof of loss within 60 days after receiving notice from us of your failure to do so; and (c)Has notified us of any change in ownership, occupancy or substantial change in risk known to the Loss Payee. All of the terms of this Coverage Part will then apply directly to the Loss Payee. (4)If we pay the Loss Payee for any loss or damage and deny payment to you because of your acts or because you have failed to comply with the terms of this Coverage Part: (a)The Loss Payee's rights will be transferred to us to the extent of the amount we pay; and (b)The Loss Payee's rights to recover the full amount of the Loss Payee's claim will not be impaired. At our option, we may pay to the Loss Payee the whole principal on the debt plus any accrued interest. In this event, you will pay your remaining debt to us. c.If we cancel this policy, we will give written notice to the Loss Payee at least: (1)10 days before the effective date of cancellation if we cancel for your nonpayment of premium; or (2)30 days before the effective date of cancellation if we cancel for any other reason. d.If we elect not to renew this policy, we will give written notice to the Loss Payee at least 10 days before the expiration date of this policy. CP 12 18 10 12Page 2 of 3 © Insurance Services Office, Inc., 2011 05/13/2024A0195129 Middlesex Insurance Company 3.Contract Of Sale Clause a.The Loss Payee shown in the Schedule or in the Declarations is a person or organization you have entered a contract with for the sale of Covered Property. b.For Covered Property in which both you and the Loss Payee have an insurable interest we will: (1)Adjust losses with you; and (2)Pay any claim for loss or damage jointly to you and the Loss Payee, as interests may appear. c.The following is added to the Other Insurance Condition: For Covered Property that is the subject of a contract of sale, the word "you" includes the Loss Payee. 4.Building Owner Loss Payable Clause a.The Loss Payee shown in the Schedule or in the Declarations is the owner of the described building, in which you are a tenant. b.We will adjust losses to the described building with the Loss Payee. Any loss payment made to the Loss Payee will satisfy your claims against us for the owner's property. c.We will adjust losses to tenants' improvements and betterments with you, unless the lease provides otherwise. 00002 0000000000 24134 0 N3 9899db85-3247-402c-9c41-3eedd5fa69a6 Page 3 of 3CP 12 18 10 12 © Insurance Services Office, Inc., 2011 05/13/2024A0195129 Middlesex Insurance Company A0195129 Middlesex Insurance Company 05/13/2024 43ba9648-be0e-41e4-aede-c82ffd495b3e Page 1 of 1CP 70 23 10 01 COMMERCIAL PROPERTY CP 70 23 10 01 PERSONAL PROPERTY LEASED TO YOU This endorsement modifies insurance provided under the following: BUILDING AND PERSONAL PROPERTY COVERAGE FORM CONDOMINIUM ASSOCIATION COVERAGE FORM CONDOMINIUM COMMERCIAL UNIT-OWNERS COVERAGE FORM 1.The final sub-paragraph of Section A.1.b, Your Business Personal Property, is replaced by the following: (7) Leased personal property. 2.Section A.1.c, Personal Property Of Others, does not apply to personal property of others in your care, custody or control under a written lease agreement. Page 1 of 3CP 70 47 10 13 05/13/2024A0195129 Middlesex Insurance Company COMMERCIAL PROPERTY CP 70 47 10 13 EQUIPMENT BREAKDOWN This endorsement modifies insurance provided under the following: BUILDING AND PERSONAL PROPERTY COVERAGE FORM CONDOMINIUM ASSOCIATION COVERAGE FORM CONDOMINIUM COMMERCIAL UNIT-OWNERS COVERAGE FORM CAUSES OF LOSS SPECIAL FORM I.Insurance provided by this endorsement is subject to all of the terms of the Coverage Form and Causes of Loss Form except as specified below. II.The following changes apply to the Coverage Form: A.Coverage Pollutant Clean-up and Removal. For insurance provided by this endorsement, the limit of insurance that applies to Additional Coverage A.4.d. is increased to $250,000 unless otherwise stated in the Declarations. B.Additional Conditions The following is added to Section F of the Coverage Form: Suspension: Whenever Equipment Breakdown Covered Property is found to be in, or exposed to, a dangerous condition, any of our representatives may immediately suspend the insurance against loss or damage to that Covered Property. This can be done by delivering or mailing a written notice of suspension to: a.Your last known address; or b.The address where the Covered Property is located. If we suspend your insurance, you will get a pro rata refund of premium. But the suspension will be effective even if we have not yet made or offered a refund. III.Service Interruption Additional Coverage Any insurance provided for Business Income or Extra Expense is extended to apply to your loss or expense caused by an "Equipment Breakdown" to equipment that is owned by a utility, landlord or other supplier, that is located within 1,000 feet of the described premises, with whom you have a contract to supply you with any of the following services: electrical power, waste disposal, air conditioning, refrigeration, heating, natural gas, compressed air, water, steam, internet access, telecommunications services, wide area networks or data transmission. The equipment must meet the definition of "Equipment Breakdown" except that it is not Covered Property. IV.CFC Refrigerants We will pay for the additional cost to repair or replace Covered Property because of the use or presence of a refrigerant containing CFC (chlorofluorocarbon) substances. Additional costs means those in excess of what would have been required to repair or replace covered property, had no CFC refrigerant been involved. We pay no more than the least of the following: A.The cost to repair the damaged property and replace any lost CFC refrigerant; B.The cost to repair the damaged property, retrofit the system to accept a non-CFC refrigerant, and charge the system with a non-CFC refrigerant; or C.The cost to replace the system with one using a non-CFC refrigerant. V.Jurisdictional Inspections If any Covered Property under this endorsement requires inspection to comply with state or municipal boiler and pressure vessel regulations, we agree to perform such inspections on your behalf. We do not warrant that conditions are safe or healthful. VI.Environmental, Safety and Efficiency Improvements If Covered Property requires replacement due to an equipment breakdown, we will pay your additional costs to replace with equipment that is better for the environment, safer, or more energy efficient than the equipment it replaced. However, we will not pay more than 125% of what the cost would have been to repair or replace with like kind and quality. This condition does not apply to any property where Actual Cash Value provisions apply. 00002 0000000000 24134 0 N1 47a9560e-3183-4d7c-a275-b1d1ec7ade2247a9560e-3183-4d7c-a275-b1d1ec7ade22 VII.The following changes apply to the Causes of Loss Special Form: A.Exclusions 1.Equipment Breakdown Caused by Water. If Water, as excluded elsewhere in this policy, results in equipment breakdown, we will pay for the loss or damage caused by that equipment breakdown. This provision is added to the final paragraph of the Water exclusion in this policy. 2.Exclusion B.2.b. is replaced by the following: b.Delay, loss of use or loss of market, except that we will pay for loss of perishable goods due to spoilage resulting from lack of power, light, heat, steam or refrigeration caused by coverages provided by this endorsement to types of property covered by this policy, that are: (1)Located on or within 1,500 feet of your described premises and are: (a)Owned by the building owner at your described premises, or owned by a public utility; and (b)Used to supply telephone, electricity, air conditioning, heating, gas, water or steam to your described premises; or (2)Located on your owned or leased trucks and trailers. Unless otherwise stated in the Declarations, the most we will pay for loss or damage under this coverage is $250,000. 3.The following exclusions do not apply to coverage provided by this endorsement: a.Exclusion B.2.a; b.Exclusion B.2.d.6.; and c.Exclusion B.2.e. B.Limitations Limitations C.1.a. and C.1.b. of the Causes of Loss Special Form do not apply to coverage provided by this endorsement. C.Additional Coverage Extensions The following provisions are added to Section F of the Causes of Loss Special Form: 1.Expediting Expenses For coverage provided by this endorsement, with respect to your damaged Covered Property, we will pay the reasonable extra cost to: (i)Make temporary repairs; (ii)Expedite permanent repairs; and (iii)Expedite permanent replacement. 2.Refrigerant Contamination Contamination by a refrigerant resulting from coverage provided by this endorsement, with respect to your damaged Covered Property to refrigerating, cooling or humidity control equipment, at the described premises and on your owned or leased trucks and trailers. Unless otherwise stated in the Declarations, the most we will pay for loss or damage under this coverage is $250,000. D.Definitions Definition G.2. of the Causes of Loss Special Form is replaced by the following: G.Definitions 2."Specified causes of loss" means the following: Fire, lightning; explosion; windstorm or hail; smoke; aircraft or vehicles; riot or civil commotion; vandalism; leakage from fire extinguishing equipment; sinkhole collapse; volcanic action; falling objects; weight of snow, ice or sleet; water damage; equipment breakdown. a.Sinkhole collapse means the sudden sinking or collapse of land into underground empty spaces created by the action of water on limestone or dolomite. This cause of loss does not include: (1)The cost of filling sinkholes; or (2)Sinking or collapse of land into man-made underground cavities. b.Falling objects does not include loss or damage to: (1)Personal property in the open; (2)The interior of a building or structure, or property inside a building or structure, unless the roof or an outside wall of the building or structure is first damaged by a falling object. c.Water damage means accidental discharge or leakage of water or steam as the direct result of the breaking apart or cracking of any part of a system or appliance (other than a sump system including its related equipment and parts) containing water or steam. CP 70 47 10 13Page 2 of 3 05/13/2024A0195129 Middlesex Insurance Company d.Equipment breakdown means direct damage to Covered Property as follows: (1)Mechanical breakdown, including rupture or bursting caused by centrifugal force; (2)Artificially generated electrical current; including electrical arcing, that disturbs electrical devices, appliances or wires; (3)Explosion of steam boilers, steam piping, steam engines or steam turbines owned or leased by you, or operated under your control; (4)Loss or damage to steam boilers, steam pipes, steam engines or steam turbines; or (5)Loss or damage to hot water boilers or other water heating equipment. If covered electrical equipment requires drying out as a result of a flood we will pay for the direct expenses of such drying out. None of the following are Covered Property as respects equipment breakdown: (a)Insulating or refractory material; (b)Buried vessel or piping; (c)Sewer piping, piping forming a part of a fire protection system or water piping other than: i.Feed water piping between any boiler and its feed pump or injector; or ii.Boiler condensate return piping; or iii.Water piping used forming a part of refrigerating and air conditioning vessels and piping used for cooling, humidifying or space heating purposes. (d)Structure, foundation, cabinet or compartment containing the object; (e)Power shovel, dragline, excavator, automobiles, mobile equipment held for sale, floating vessel or structure, penstock, draft tube or well casing; (f)Conveyor, crane, elevator, escalator or hoist, but not excluding any electrical machine or electrical apparatus mounted on or used with this equipment; (g)Felt, wire, screen, die, extrusion, plate, swing hammer, grinding disc, cutting blade, cable, chain, belt, rope, clutch plate, brake pad, non-metallic part or any part or tool subject to frequent, periodic replacement. Page 3 of 3CP 70 47 10 13 05/13/2024A0195129 Middlesex Insurance Company 00002 0000000000 24134 0 N3 47a9560e-3183-4d7c-a275-b1d1ec7ade2247a9560e-3183-4d7c-a275-b1d1ec7ade22 COMMERCIAL PROPERTY CP 80 26 10 18 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SPECIAL BROADENED PROPERTY COVERAGE This endorsement modifies the insurance provided by the following: BUILDING AND PERSONAL PROPERTY COVERAGE FORM CONDOMINIUM COMMERCIAL UNIT-OWNERS COVERAGE FORM BUSINESS INCOME COVERAGE FORM CAUSES OF LOSS - SPECIAL FORM I.The following changes apply to the Building and Personal Property Coverage Form and the Condominium Commercial Unit-Owners Coverage Form: A.Coverage 1.Covered Property a.Extended Premises Definition Covered personal property (including building materials used for making additions, alterations or repairs to covered buildings) is covered while it is: (1)In or on the building described in the Declarations; or (2)In the open (or in a vehicle) within 1,500 feet of the described premises. This provision modifies Sections A.1.a.(5)(b), A.1.b. and A.1.c.(2) of the Building and Personal Property Coverage Form and Sections A.1.a. and A.1.b.(2) of the Condominium Commercial Unit-Owners Coverage Form. b.Additions to Your Business Personal Property The insurance that applies to Your Business Personal Property includes the following property: (1)Data processing equipment; (2)Valuable papers and electronic media; (3)Fine arts; and (4)The following property at premises rented or leased to you if you have a contractual responsibility to pay for repair or replacement after damage by a Covered Cause of Loss: (a)Building glass; (b)Outdoor fixtures; and (c)Heating or air conditioning systems that service only the premises leased to you. This property will be considered to be tenant's improvements and betterments. The types of property described in this provision are added to Section A.1.b. of the Building and Personal Property Coverage Form and Section A.1.b. of the Condominium Commercial Unit-Owners Coverage Form. 2.Additional Coverages a.The following provisions revise the Additional Coverages provided by the Coverage Form. (1)Debris Removal The additional limit provided by Section A.4.a.(4) of the Coverage Form is $50,000 or the Debris Removal Limit shown in the Declarations. (2)Preservation of Property (a)Coverage under this Additional Coverage is extended to apply for 180 days after the property is first moved. The time period specified in Section A.4.b.(2) of the Coverage Form does not apply to this Additional Coverage. (b)During the first 180 days after the property is moved this Additional Coverage is subject to the Limit of Insurance that applies to the Covered Property. Thereafter, this Additional Coverage is subject to the Limit of Insurance that applies to Property At Any Location. Page 1 of 23CP 80 26 10 18 05/13/2024A0195129 Middlesex Insurance Company 00012 0000000000 24134 0 N1 c80301cf-9b4b-4eac-9aa5-aff8e3c3e803c80301cf-9b4b-4eac-9aa5-aff8e3c3e803 (3)Fire Department Service Charge Coverage provided by the Fire Department Service Charge Additional Coverage is subject to the Direct Loss Blanket Limit. The limit in Section A.4.c. of the Coverage Form does not apply to this Additional Coverage. (4)Pollutant Clean-Up and Removal The most we will pay for under this Additional Coverage for each described building is $100,000 or the Pollutant Clean-Up and Removal limit shown in the Declarations for the sum of all covered expenses arising out of Covered Causes of Loss occurring during each separate 12-month period of this policy. This provision replaces the Final Paragraph of Section A.4.d. of the Building and Personal Property Coverage Form. (5)Electronic Data (a)Electronic data are covered for loss or damage by any Covered Cause of Loss. Paragraph A.4.f.(3) of the Building and Personal Property Coverage Form and Paragraph A.4.e.(3) of the Condominium Commercial Unit-Owners Coverage are deleted. (b)Coverage provided by the Electronic Data Additional Coverage is subject to the Direct Loss Blanket Limit. The limit in Paragraph A.4.f.(4) of the Building and Personal Property Coverage Form and Paragraph A.4.e.(4) of the Condominium Commercial Unit-Owners Coverage Form are deleted. b.The following Additional Coverages are added to your policy: (1)Building Ordinance Coverage (a)This Additional Coverage applies separately to each covered building. (b)Coverage provided by this Additional Coverage applies only if both of the following conditions are satisfied. 1)The ordinance or law: a)Regulates the demolition, construction or repair of buildings, or establishes zoning or land use requirements at the described premises; and b)Is in force at the time of the loss. 2)a)The building sustains direct physical damage that is covered under this policy and such damage results in enforcement of the ordinance or law you are required to comply with; or b)The building sustains both direct physical damage that is covered under this policy and direct physical damage that is not covered under this policy, and the building damage in its entirety results in enforcement of the ordinance or law you are required to comply with. In this situation, we will not pay the full amount of loss otherwise payable under the terms of this Additional Coverage. Instead, we will pay a proportion of the loss; meaning the proportion that covered direct physical damage bears to the total direct physical damage. However, if the covered direct physical damage, alone, would have resulted in enforcement of the ordinance or law you are required to comply with, then we will pay the full amount of loss otherwise payable under this Additional Coverage. c)But if the building sustains direct physical damage that is not covered under this policy, and such damage is the subject of the ordinance or law you are required to comply with, then there is no coverage under this endorsement even if the building has also sustained covered direct physical loss or damage. CP 80 26 10 18Page 2 of 23 05/13/2024A0195129 Middlesex Insurance Company Coverage under this Additional Coverage applies only in response to the minimum requirements of the ordinance or law. Losses and costs incurred in complying with recommended actions or standards that exceed actual requirements are not covered. (c)Coverage 1)Loss to the Undamaged Portion of the Building: With respect to the building that has sustained covered direct physical damage, we will pay for the loss in value of the undamaged portion of the building as a consequence of a requirement to comply with an ordinance or law that requires demolition of undamaged parts of the same building. When there is a loss in value of an undamaged portion of a building, the loss payment for that building, including damaged and undamaged portions is limited to the lesser of: a)The value of the building at the time of the loss; or b)The Limit Of Insurance shown in the Declarations for that building. This coverage is included within the Limit of Insurance shown in the Declarations as applicable to the covered Building Property. This coverage does not increase the Limit of Insurance. 2)Demolition Cost Coverage: With respect to the building that has sustained covered direct physical damage, we will pay the cost you actually spend to demolish and clear the site of undamaged parts of the same building, as a consequence of a requirement to comply with an ordinance or law that requires demolition of such undamaged property. The Coinsurance Additional Condition does not apply to Demolition Cost Coverage. Demolition Cost Coverage is subject to the Direct Loss Blanket Limit. Demolition Cost Coverage provided by this Additional Coverage is excess above similar coverage provided by an Ordinance or Law Coverage Endorsement included in this policy. 3)Increased Cost of Construction: a)With respect to the building that has sustained covered direct physical damage, we will pay the increased cost to: (i)Repair or reconstruct damaged portions of that building; and/or (ii)Reconstruct or remodel undamaged portions of that building, whether or not demolition is required; when the increased cost is a consequence of a requirement to comply with the minimum standards of the ordinance or law. However: (i)This coverage applies only if the restored or remodeled property is intended for similar occupancy as the current property, unless such occupancy is not permitted by zoning or land use ordinance or law. (ii)We will not pay for the increased cost of construction if the building is not repaired, reconstructed or remodeled. Page 3 of 23CP 80 26 10 18 05/13/2024A0195129 Middlesex Insurance Company 00012 0000000000 24134 0 N3 c80301cf-9b4b-4eac-9aa5-aff8e3c3e803c80301cf-9b4b-4eac-9aa5-aff8e3c3e803 The Coinsurance Additional Condition does not apply to Increased Cost of Construction Coverage. b)When covered Building property is damaged or destroyed by a Covered Cause of Loss and Increased Cost of Construction Coverage applies to that property in accordance with Paragraph a) above, coverage for the increased cost of construction also applies to repair or reconstruction of the following, subject to the same conditions stated in Paragraph a): (i)The cost of excavations, grading, backfilling and filling; (ii)Foundation of the building; (iii)Pilings; and (iv)Underground pipes, flues and drains. The items listed in Sections (i) through (iv) of this paragraph are deleted from Property Not Covered, but only with respect to coverage described in this Paragraph. We will not pay under Increased Cost of Construction Coverage until the property is actually repaired or replaced, at the same premises or another premises. We will not pay under Increased Cost of Construction Coverage unless the repairs or replacement are made as soon as reasonably possible after the loss or damage, not to exceed two years. We may extend this period in writing during the two years. If the building is repaired or replaced at the same premises, or if you elect to rebuild at another premises, the most we will pay under Increased Cost of Construction Coverage is the increased cost of construction at the same premises. If the ordinance or law requires relocation to another premises, the most we will pay under the Increased Cost of Construction Coverage is the increased cost of construction at the new premises. Increased Cost of Construction Coverage is subject to the Direct Loss Blanket Limit. Increased Cost of Construction Coverage provided by this Additional Coverage is excess above similar coverage provided by an Ordinance or Law Coverage Endorsement included in this policy. (d)Exclusions 1)We will not pay for costs associated with the enforcement of any ordinance or law which requires any insured or others to test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to or assess the effects of "pollutants". 2)Building Ordinance Coverage does not apply to loss due to any ordinance or law that: a)You were required to comply with before the loss, even if the building was undamaged; and b)You failed to comply with. (e)The Increased Construction Cost Additional Coverage in Section A.4.e. of the Building and Personal Property Coverage Form does not apply to your policy. CP 80 26 10 18Page 4 of 23 05/13/2024A0195129 Middlesex Insurance Company (2)Fire Extinguisher Recharging We will pay the expenses you incur to recharge fire extinguishers or commercial fire suppression systems that have been used to fight a fire at a described building. Coverage under this Additional Coverage is subject to the Direct Loss Blanket Limit. (3)Accounts Receivable We will pay for the following after your records of accounts receivable are damaged or destroyed by a Covered Cause of Loss. (a)Amounts due from your customers that you are unable to collect; (b)Interest charges on any loan required to offset amounts you are unable to collect pending our payment of those amounts; (c)Collection expenses in excess of your normal collection expenses that are made necessary by the loss or damage; and (d)Other reasonable expenses you incur to reestablish your records of accounts receivable. Coverage under this Additional Coverage is subject to the Indirect Loss Blanket Limit. (4)Expenses to Protect Property Coverage for the reasonable expenses you incur to protect Covered Property from further damage by a Covered Cause of Loss is subject to the Direct Loss Blanket Limit. These expenses are not subject to the Limit of Insurance that applies to the damaged or destroyed property. (5)Employee Property We will pay for loss by a Covered Cause of Loss to any property that is owned by your employees and that is used in your business. But we will not pay for property which is at the employee's place of residence when the loss or damage occurs. Coverage under this Additional Coverage is subject to the Direct Loss Blanket Limit. Our payment for loss or damage under this Additional Coverage will only be for the account of the employee. If employee's property is the only property lost or damaged in an occurrence we will deduct $100 from the amount of each employee's claim. No other deductible will apply to the occurrence. This Additional Coverage replaces any coverage for employee property used in your business which may be afforded by other provisions of the Coverage Form. (6)Arson or Theft Reward We will pay a reward for information which leads to an arson conviction in connection with a fire or theft loss covered by this policy. The most we will pay as a reward is 25% of the amount of the fire or theft loss, or $50,000; whichever is smaller. This Additional Coverage is provided in addition to the applicable Limit of Insurance. (7)Consequential Damage to "Stock" If a Covered Cause of Loss damages covered "stock" we will pay any reduction in value or remaining parts of covered "stock". Payment for any reduced value of "stock" is subject to the Limit of Insurance that applies to the premises at which the "stock" is located. (8)Business Income We will pay for your loss of business income due to the necessary suspension of your operations because of direct physical loss of or damage to property at the building described in the Declarations by a Covered Cause of Loss. We will also pay if the suspension results from damage to personal property in the open within 1,500 feet of such premises described in the Declarations. Business income means: (a)The net income (net profit or loss before income taxes) that you would have earned if the Covered Cause of Loss had not occurred; and (b)Continuing normal operating expenses that you incur while your operations are suspended. Page 5 of 23CP 80 26 10 18 05/13/2024A0195129 Middlesex Insurance Company 00012 0000000000 24134 0 N5 c80301cf-9b4b-4eac-9aa5-aff8e3c3e803c80301cf-9b4b-4eac-9aa5-aff8e3c3e803 Coverage under this Additional Coverage is subject to the Indirect Loss Blanket Limit. We will pay for loss of business income in addition to the amount that we pay for the direct physical loss. The coverage provided by this Additional Coverage is excess above any insurance provided by a Business Income Coverage Form included in this policy. (9)Extra Expense We will pay for the extra expense you incur because of direct physical loss of or damage to property at the building described in the Declarations by a Covered Cause of Loss. We will also pay for the extra expense you incur because of damage to personal property in the open within 1,500 feet of such premises described in the Declarations. Extra expense means necessary expenses you incur while the property that has been damaged or destroyed is repaired or replaced that you would not have incurred if there had been no direct physical loss or damage to property caused by or resulting from a Covered Cause of Loss. The extra expense must be incurred for the following purposes: (a)To avoid or minimize the suspension of business and to continue operations: 1)At replacement buildings or at temporary locations, including: a)Relocation expenses; and b)Costs to equip and operate the replacement or temporary locations; 2)To minimize the suspension of business if you cannot continue operations; or 3)a)To repair or replace any property; or b)To research, replace or restore the lost information on damaged valuable papers or records; to the extent that it reduces the amount of loss that otherwise would have been payable under this Additional Coverage. Coverage under this Additional Coverage is subject to the Indirect Loss Blanket Limit. We will pay for extra expense in addition to the amount that we pay for the direct physical loss. The coverage provided by this Additional Coverage is excess above any insurance provided by a Business Income Coverage Form or Extra Expense Coverage Form included in this policy. (10)Claim Preparation Expenses We will pay the reasonable expenses you necessarily incur with our permission to prepare documentation, including inventories of damaged and undamaged property, that substantiates your claim for loss or damage to Covered Property. This coverage does not apply to public adjuster fees or to attorney fees or other costs for legal services. Coverage under this Additional Coverage is subject to the Direct Loss Blanket Limit. (11)Installment Sales Coverage We will pay for direct loss by a Covered Cause of Loss to personal property you sold under a conditional sale or trust agreement or under any installment or deferred payment plan. Payment for loss under this Additional Coverage is limited to the amount of your interest in the property. Coverage under this Additional Coverage is subject to the Direct Loss Blanket Limit. CP 80 26 10 18Page 6 of 23 05/13/2024A0195129 Middlesex Insurance Company (12)Leasehold Interest Coverage for Undamaged Improvements and Betterments We will pay for the replacement cost of undamaged improvements and betterments to buildings rented or leased to you if your lease is cancelled by the lessor following direct physical loss or damage to property at the building by a Covered Cause of Loss. This Additional Coverage applies only when a valid condition of your lease permits cancellation following damage to the property. (a)If you rent the entire building, we will pay only if: 1)At least 25% of the building has been damaged; and 2)The unexpired portion of your lease is at least six months and at least six months will be required to repair the building for your occupancy. (b)If you do not rent the entire building, we will pay only if: 1)The unexpired portion of your lease is at least six months; and 2)At least six months will be required to repair the building for your occupancy. Coverage under this Additional Coverage is subject to the Direct Loss Blanket Limit. (13)Contract Penalty Expenses We will pay expenses you incur for contract penalties assessed as a result of your failure to deliver your product accordingly to the terms of a contract. The failure and subsequent penalties must be due to a direct physical loss to a Covered Property by a Covered Cause of Loss. The most we will pay under this Additional Coverage is $50,000. (14)Franchise Replacement Cost Valuation In the event of a covered direct physical loss or damage by a Covered Cause of Loss to a Building or your Business Personal Property that is covered property at the described premises to which Replacement Cost Valuation applies, we will pay the increased costs you incur to repair or replace the damaged Covered Property to comply with the minimum standards of franchisor specifications in effect at the time of loss, which you are required to comply with under written contract with your franchisor in effect at the time of loss. (a) Conditions 1)This only applies if the damaged property is actually repaired or replaced as soon as reasonably possible after the loss or damage; and 2)Only to the increased costs incurred to repair or replace the damaged portions of the covered Building property and the damaged items of the covered Business Personal Property. It does not apply to any additional costs incurred to bring undamaged portions of the Building or Personal Property into compliance with franchisor specifications. (b)This does not apply to the following: 1)Any increased costs incurred to comply with any franchisor specifications that: a)You were required to comply with prior to the loss or damage to the covered property, even if there was no loss or damage to the property; and you failed to comply with. 2)Any increased costs incurred due to enforcement of ordinance or law. (c)Coverage provided by the Franchise Replacement Cost Valuation extension is subject to a $10,000 annual aggregate limit. 3.Coverage Extensions a.The Coverage Extensions in the Coverage Form and in this endorsement apply to property located in or on buildings described in the Declarations or in the open (or in a vehicle) within 1,500 feet of the described premises. The Coverage Extensions also apply to Covered Property away from described premises. Page 7 of 23CP 80 26 10 18 05/13/2024A0195129 Middlesex Insurance Company 00012 0000000000 24134 0 N7 c80301cf-9b4b-4eac-9aa5-aff8e3c3e803c80301cf-9b4b-4eac-9aa5-aff8e3c3e803 This paragraph replaces the introduction to Section A.5. in the Coverage Form. b.The following provisions modify the Coverage Extensions in the Coverage Form. (1)Newly Constructed or Acquired Property (a)Period of Coverage With respect to insurance provided under this Coverage Extension for Newly Acquired Or Constructed Property Coverage will end when any of the following first occurs: 1)This policy expires; 2)180 days expire after you acquire the property or begin construction of that part of the building that would qualify as Covered Property; or 3)You report values to us. We will charge you additional premium from the date you acquire the property or begin construction of that part of the building that would qualify as Covered Property. (b)Buildings If this policy covers Building, you may extend that insurance to apply to: 1)Your new buildings while being built on the described premises; and 2)Buildings you acquire, and buildings while being built, at locations other than the described premises, intended for: a)Similar use as the building described in the Declarations; or b)Use as a warehouse. The most we will pay under this Extension for loss or damage to any building or structure is $1,500,000 or the Newly Acquired or Constructed Building Limit shown in the Declarations. (c)Your Business Personal Property 1)If this policy covers Your Business Personal Property, you may extend that insurance to apply to: a)Business personal property, including such property that you newly acquire at any location you acquire; or b)Business personal property, including such property that you newly acquire, located at your newly constructed or acquired buildings at the location described in the Declarations. The most we will pay for loss or damage under this Extension is the greater of the Property At Any Location Limit of Insurance shown in the Declarations or $750,000. 2)This Extension does not apply to: a)Personal property of others that is temporarily in your possession in the course of installing or performing work on such property; or b)Personal property of others that is temporarily in your possession in the course of your manufacturing or wholesaling activities. c)Personal property covered as part of Paragraph 3.b.(4) of this endorsement, Property Off-Premises. These provisions replace Section A.5.a. of the Coverage Form. (2)Personal Effects and Property of Others (a)Coverage provided by the Personal Effects and Property of Others Coverage Extension is subject to the Direct Loss Blanket Limit. The limit in Section A.5.b. of the Coverage Form does not apply to this Coverage Extension. (b)The Personal Effects Theft Limitation in the Coverage Form does not apply to this Coverage Extension. (c)This Coverage Extension applies to property of others while it is in transit. CP 80 26 10 18Page 8 of 23 05/13/2024A0195129 Middlesex Insurance Company Property of others is considered to be under your control from the time you receive it from the owner or another person responsible for the property until you return it to the owner or other person responsible for the property. Property of others in the custody of a carrier for hire is considered to be under your control while it is being shipped to you or by you. The Property in Transit Limit shown in the Declarations applies to property of others while it is in transit. (3)Valuable Papers and Records (Other Than Electronic Data) Section A.5.c. of the Coverage Form is replaced by the following: c.Valuable Papers and Records (Other Than Electronic Data) (1)You may extend the insurance that applies to Your Business Personal Property to apply to the cost you incur to repair or restore the lost information on valuable papers and records for which duplicates do not exist. But this Extension does not apply to valuable papers and records which exist as electronic data. Electronic data has the meaning described under Property Not Covered, Electronic Data. (2)Coverage under this Extension is subject to the Direct Loss Blanket Limit. Coverage under the Direct Loss Blanket Limit is additional insurance. We will also pay for the additional cost of blank material for reproducing the records (whether or not duplicates exist), and (when there is a duplicate) for the cost of labor to transcribe or copy the records. The costs of blank material and labor are subject to the applicable Limit of Insurance on Your Business Personal Property and therefore coverage of such costs is not additional insurance. (4)Property Off-Premises The following provisions replace Coverage Extension A.5.d. of the Coverage Form. d.You may extend the insurance provided by the coverage form to apply to your Covered Property while it is away from the described premises if: 1)It is: a)At a location you do not own, lease or operate; or b)In storage at a location you lease, provided the lease was executed after the beginning of the current policy term. The most we will pay for loss or damage to this property is the limit shown in the Declarations for property at any location. 2)It is in transit, including airborne and waterborne shipments. Paragraph A.2.i. of the Building and Personal Property Coverage Form and Paragraph A.2.f. of the Condominium Commercial Unit-Owners Coverage Form do not apply to this Coverage Extension. The following property in transit is not covered: a)Property in route to or from Alaska, Hawaii or Puerto Rico. b)Property being shipped by way of the Panama Canal. c)Property covered under an import or export ocean marine policy. d)Export shipments that have been loaded on board the exporting vessel or vehicle. e)Import shipments that have not been unloaded from the importing vessel or vehicle. The most we will pay for loss or damage to this property is the limit shown in the Declarations for property in transit. 3)It is in your care, custody or control or in the care, custody or control of your agent, employee, messenger or salesperson. Page 9 of 23CP 80 26 10 18 05/13/2024A0195129 Middlesex Insurance Company 00012 0000000000 24134 0 N9 c80301cf-9b4b-4eac-9aa5-aff8e3c3e803c80301cf-9b4b-4eac-9aa5-aff8e3c3e803 The most we will pay for loss or damage to this property is the limit shown in the Declarations for property in the custody of a messenger or salesperson. 4)It is at any fair, trade show or exhibition. The most we will pay for loss or damage to this property is the limit shown in the Declarations for property at any exhibit. This Coverage Extension applies to property in the Coverage Territory. This Coverage Extension applies to Covered Property at job sites before it has been installed. Coverage continues after the property has been installed until the owner of the building or structure accepts the work. This Coverage Extension applies to construction machinery, materials handling machinery and similar self-propelled machinery that you use in your operations. But these provisions do not apply to autos, aircraft or watercraft. (5)Outdoor Property (a)Coverage under the Outdoor Property Coverage Extension is extended to include damage caused by vehicles. (b)Coverage provided by the Outdoor Property Coverage Extension is subject to the Direct Loss Blanket Limit. But we will not pay more than $2,500 for any one tree, shrub or plant. c.The following Coverage Extensions are added to the Coverage Form. Each of these Extensions is additional Insurance. The Additional Condition, Coinsurance, does not apply to these Extensions. (1)Building Foundations You may extend the building insurance provided by this policy to apply to foundations of buildings, structures, machinery or boilers that are below: (a)The lowest basement floor; or (b)The surface of the ground, if there is no basement. Coverage under this Coverage Extension is subject to the Direct Loss Blanket Limit. (2)Key Replacement and Lock Repair or Replacement You may extend the insurance provided by this policy to apply to the following expenses after a covered theft loss: (a)Replacement of stolen keys; or (b)Lock repair or replacement. Coverage under this Coverage Extension is subject to the Direct Loss Blanket Limit. (3)Limited International Coverage for Your Business Personal Property (a)Coverage You may extend the insurance that applies to Your Business Personal Property to apply to Your Business Personal Property that is temporarily outside the Coverage Territory if it is: 1)In your care, custody or control; or 2)In the care, custody or control of your authorized representative, including another insured or your salesperson(s); or 3)While located at a business location owned or operated by you or leased by you; or 4)While at any fair, trade show or exhibition. (b)This Coverage Extension does not apply to: 1)Business Personal Property exported from the Coverage Territory or held for sale outside the Coverage Territory; or 2)Property while in the care, custody or control of a common or contract carrier or bailee for hire, except for property while being handled or stored by the carrier that is at the same time transporting you or your authorized representative. (c)Limit of Insurance CP 80 26 10 18Page 10 of 23 05/13/2024A0195129 Middlesex Insurance Company 1)The most we will pay under Paragraphs (a)1), (a)2) or (a)3) of this Coverage Extension is the limit shown in the Declarations for property in the custody of a messenger or salesperson. 2)The most we will pay under Paragraph (a)4) of this Coverage Extension is the Limit of Insurance shown in the Declarations for property at any exhibit. (d)Loss Settlement The value of property and the cost of its repair or replacement will be determined in United States currency based on values and costs in the area of the described premises where Your Business Personal Property is permanently located, and subject to all applicable policy provisions including the Valuation and Loss Payment Conditions. (e)Legal Action Against Us Any legal action against us concerning coverage provided under this Coverage Extension must be commenced in a court of law in the United States of America or in any other forum to which we consent. (4)Appurtenant Buildings You may extend the insurance provided by this policy to: (a)Storage buildings, garages and other appurtenant structures within 1,500 feet of a described premises. The most we will pay for loss or damage in a single occurrence under this extension is $50,000. (b)Business Personal Property located in a storage building, garage or other appurtenant structure within 1,500 feet of a described premises. The most we will pay for loss or damage in a single occurrence under this extension is $25,000. (5)Lessor Move Back Expenses You may extend the insurance provided by this policy to include expenses you pay to move a tenant back into the portion of your building temporarily vacated. The vacancy must have occurred due to a direct physical loss to Covered Property resulting from a Covered Cause of Loss during the policy period. The tenant must move back within 90 days after the portion of the building rented is ready for occupancy. Coverage under this Coverage Extension is subject to the Direct Loss Blanket Limit. (6)Underground Pipes, Flues or Drains You may extend the building insurance provided by this policy to apply to underground pipes, flues or drains. Coverage under this Coverage Extension is subject to the Direct Loss Blanket Limit. 4.Crime Additional Coverages Crime Coverages A.4.a. through A.4.f. are added to your policy: a.Employee Theft (1)We will pay for direct loss of or damage to Business Personal Property and "money" and "securities" resulting from dishonest acts committed by an employee acting alone or in collusion with other persons (except you or your partner) with the manifest intent to: (a)Cause you to sustain loss or damage; and also (b)Obtain financial benefit (other than salaries, commissions, fees, bonuses, promotions, awards, profit sharing, pensions or other employee benefits earned in the normal course of employment) for: 1)Any employee; or 2)Any other person or organization. (2)We will not pay for loss or damage: (a)Resulting from any dishonest or criminal act that you or any of your partners or "members" commit whether acting alone or in collusion with other persons. (b)Resulting from any dishonest act committed by any of your employees (except as provided in Paragraph (1)), "managers" or directors: 1)Whether acting alone or in collusion with other persons; or Page 11 of 23CP 80 26 10 18 05/13/2024A0195129 Middlesex Insurance Company 00012 0000000000 24134 0 N11 c80301cf-9b4b-4eac-9aa5-aff8e3c3e803c80301cf-9b4b-4eac-9aa5-aff8e3c3e803 2)While performing services for you or otherwise. (c)The only proof of which as to its existence or amount is: 1)An inventory computation; or 2)A profit and loss computation. (d)Caused by an employee if the employee had also committed theft or any other dishonest act prior to the effective date of this policy and you or any of your partners, “members”, “managers” officers, directors or trustees, not in collusion with the employee, learned of that theft or dishonest act prior to the policy period shown in the Declarations. (3)If any loss is covered (a)Partly by this insurance; and (b)Partly by any prior cancelled or terminated insurance that we or any affiliate had issued to you or any predecessor in interest; the most we will pay is the larger of the amount recoverable under this insurance or the prior insurance. We will pay only for loss or damage you sustain through acts committed or events occurring during the policy period. Regardless of the number of years this policy remains in force or the number of premiums paid, no Limit of Insurance cumulates from year to year or period to period. (4)This Additional Crime Coverage is cancelled as to any Employee immediately upon discovery by: (a)You; or (b)Any of your partners, "members", "managers", officers or directors not in collusion with employee; of any dishonest act committed by that employee before or after being hired by you. (5)We will pay only for covered loss or damage sustained during the policy period and discovered no later than one year from the end of the policy period. (6)If you (or any predecessor in interest) sustained loss or damage during the policy period or any prior insurance that you could have recovered under that insurance except that the time within which to discover loss or damage had expired, we will pay for it under this Additional Crime Coverage, provided: (a)This Additional Crime Coverage became effective at the time of cancellation or termination of the prior insurance; and (b)The loss or damage would have been covered by this Additional Crime Coverage had it been in effect when the acts or events causing the loss or damage were committed or occurred. (7)The insurance under Paragraph (6) above is part of, not in addition to, the Limit of Insurance applying to this Additional Crime Coverage and is limited to the lesser of the amount recoverable under: (a)This Additional Crime Coverage as of its effective date; or (b)The prior insurance had it remained in effect. (8)With respect to the Employee Theft Additional Coverage, employee means: (a)Any natural person: 1)While in your service or for 30 days after termination of service; 2)Who you compensate directly by salary, wages or commissions; and 3)Who you have the right to direct and control while performing services for you; (b)Any natural person who is furnished temporarily to you: 1)To substitute for a permanent employee as defined in Paragraph (a) above, who is on leave; or 2)To meet seasonal or short-term workload conditions; (c)Any natural person who is leased to you under a written agreement between you and a labor firm, to perform duties related to the conduct of your business, but does not mean a temporary employee as defined in Paragraph (b) above; CP 80 26 10 18Page 12 of 23 05/13/2024A0195129 Middlesex Insurance Company (d)Any natural person who is a former employee, director, partner, member, manager, representative or trustee retained as a consultant while performing services for you; or (e)Any natural person who is a guest student or intern pursuing studies or duties, excluding, however, any such person while having care and custody of property outside any building you occupy in conducting your business. But employee does not mean: (a)Any agent, broker, factor, commission merchant, consignee, independent contractor or representative of the same general character; or (b)Any "manager", director or trustee except while performing acts coming within the usual duties of an employee. b.Forgery or Alteration (1)We will pay for loss resulting directly from forgery or alteration of any check, draft, promissory note, bill of exchange or similar written promises in "money" that you or your agent has issued, or that was issued by someone who impersonates you or your agent. (2)If you are sued for refusing to pay any instrument covered in Paragraph (1) above, on the basis that it has been forged or altered, and you have our written consent to defend against the suit, we will pay for any reasonable legal expenses that you incur and pay in that defense. (3)For the purpose of this Additional Crime Coverage, check includes a substitute check as defined in the Check Clearing for the 21st Century Act, and will be treated the same as the original it replaced. c.Money and Securities (1)We will pay for loss of "money" and "securities" used in your business while at a bank or savings institution, within your living quarters or the living quarters of your partners or any employee (including a temporary or leased employee) having use and custody of the property, at the described premises, or in transit between any of these places, resulting directly from: (a)Theft, meaning any act of stealing; (b)Disappearance; or (c)Destruction. (2)In addition to the Limitations and Exclusions in the Causes of Loss Special Form, we will not pay for loss from this Additional Crime Coverage: (a)Resulting from accounting or arithmetical errors or omissions; (b)Due to the giving or surrendering of property in any exchange or purchase; (c)Of property contained in any "money"-operated device unless the amount of "money" deposited in it is recorded by a continuous recording instrument in the device; or (d)For damage to "money" and "securities" following and directly related to the use of any computer to fraudulently cause a transfer of that property from inside the described premises, bank or savings institution: 1)To a person (other than a messenger) outside those premises; or 2)To a place outside those premises. (3)You must keep records of "money" and "securities" so we can verify the amount of any loss or damage. d.Computer Fraud and Funds Transfer Fraud (1)We will pay for loss or damage to "money", "securities" and "other property" following and directly related to the use of any computer to fraudulently cause a transfer of that property from inside the described premises, bank or savings institution (a)To a person (other than a "messenger") outside the described premises; or (b)To a place outside the described premises. (2)We will pay for loss of "money" and "securities" resulting directly from a "fraudulent instruction" directing a financial institution to transfer, pay or deliver "money" and "securities" from your "transfer account". Page 13 of 23CP 80 26 10 18 05/13/2024A0195129 Middlesex Insurance Company 00012 0000000000 24134 0 N13 c80301cf-9b4b-4eac-9aa5-aff8e3c3e803c80301cf-9b4b-4eac-9aa5-aff8e3c3e803 (3)We will not pay for loss resulting from: (a)The use or purported use of credit, debit, charge, access, convenience, identification, stored-value or other cards of the information contained on such cards; except for as provided by the Unauthorized Business Card Use Additional Coverage. (b)Loss, or that part of any loss, the proof of which as to its existence or amount is dependent upon: 1)An inventory computation; or 2)A profit and loss computation. e.Money Orders and Counterfeit Money We will pay for loss resulting directly from your having accepted in good faith, in exchange for merchandise, "money" or services: (1)Money orders issued by any post office, express company or bank that are not paid upon presentation (2)"Counterfeit money" that is acquired during the regular course of business f.Unauthorized Business Card Use (1)We will pay for loss resulting from the theft or unauthorized use of a Credit, Debit or Charge Card issued in your business name, and to be used solely for business purposes. Coverage includes reasonable legal expenses incurred. (2)We will not pay for loss resulting from the theft or unauthorized use of a business card entrusted to others or any of your employees. g.Crime Additional Coverages Limit of Insurance (1)All loss or damage; (a)Caused by one or more persons; or (b)Involving a single act or series of acts; is considered one occurrence. (2)The most we will pay for loss or damage in any one occurrence for one or any combination of the Crime Additional Coverages 4. a. through 4. f. is the Crime Loss Blanket Limit shown in the Declarations. h.Fraudulent Impersonation We will pay for loss resulting directly from your having, in good faith, transferred “money”, “securities” or “other property” in reliance upon a “transfer instruction” purportedly issued by: (1)An “employee”, or any of your partners, “members”, “managers”, officers, directors or trustees, or you (if sole proprietorship); or (2)Your “customer” or “vendor” But which “transfer instruction” proves to have been fraudulently issued by an imposter without the knowledge or consent of the person in Paragraphs h. (1) or h. (2). The most we will pay in any one occurrence and in aggregate for the policy is $10,000. There is a $1,000 deductible that will be applied to this coverage. i.The following definitions are added for the Crime Additional Coverages. (1)"Counterfeit money" means an imitation of "money" which is intended to deceive and be taken as genuine. (2)“Customer” means an entity or individual to whom you sell goods or provide services under a written contract. (3)"Fraudulent instruction" means: (a)An electronic, telegraphic, cable, teletype, telefacsimile or telephone instruction which purports to have been transmitted by you, but which was in fact fraudulently transmitted by someone else without your knowledge or consent; (b)A written instruction (other than those described in Paragraph A.4.b. of this endorsement) issued by you, which was forged or altered by someone other than you without your knowledge or consent or which purports to have been issued by you, but was in fact fraudulently issued without your knowledge or consent; or (4)"Manager" means a person serving in a directional capacity for a limited liability company. CP 80 26 10 18Page 14 of 23 05/13/2024A0195129 Middlesex Insurance Company (5)"Member" means an owner of a limited liability company represented by its membership interest, who may also serve as a manager. (6)"Messenger" means you, or a relative of yours, or any of your partners or "members", or any employee while having care and custody of property outside the premises; (7)"Money" means: (a)Currency, coins and bank notes in current use and having a face value; and (b)Travelers checks, register checks and money orders held for sale to the public. Money does not include virtual or electronic currency , such as (but not limited to) bitcoin. (8)"Other property" means any tangible property other than "money" and "securities" that has an intrinsic value. "Other property" does not include computer programs, electronic data or any property specifically excluded under this insurance. (9)"Securities" means negotiable and nonnegotiable instruments or contracts representing either "money" or property and includes: (a)Tokens, tickets, revenues and other stamps (whether represented by actual stamps or unused value in a meter) in current use; and (b)Evidences of debt issued in connection with credit or charge cards, which cards are not issued by you; but does not include "money". Securities does not include virtual or electronic currency, such as (but not limited to) bitcoin. (10)"Transfer account" means an account maintained by you at a financial institution from which you can initiate the transfer, payment or delivery of "money" and "securities": (a)By means of electronic, telegraphic, cable, teletype, telefacsimile or telephone instructions communicated directly through an electronic funds transfer system; or (b)By means of written instructions (other than those described in Paragraph A.4.b. of this endorsement) establishing the conditions under which such transfers are to be initiated by such financial institution through an electronic funds transfer system. (11)“Transfer instruction” means an instruction directing you to transfer “money”, “securities”, or “other property”. (12)“Vendor” means an entity or individual from whom you purchase goods or receive services under a written contract. B.Limits Of Insurance 1.Outdoor Signs a.The limit that applies to covered buildings includes outdoor signs attached to the building. The limit shown in Section C. of the Coverage Form does not apply to this policy. b.The limit that applies to covered business personal property includes detached signs. The limit shown in Section C. of the Coverage Form does not apply to this policy. 2.The following provisions are added to Section C. of the Coverage Form. a.Business Personal Property - Seasonal Increase (1)The Limits of Insurance for Your Business Personal Property and Personal Property of Others will automatically increase by 50% to provide for seasonal variations. This increase will apply only if the Limit of Insurance for your business personal property shown in the Declarations is at least 100% of your average monthly values during the lesser of: (a)The twelve months immediately preceding the date the loss or damage occurs; or (b)The period of time you have been in business as of the date the loss or damage occurs. (2)This section does not apply to property covered under a value reporting form or to property subject to a blanket limit of insurance that applies to coverage for a building. Page 15 of 23CP 80 26 10 18 05/13/2024A0195129 Middlesex Insurance Company 00012 0000000000 24134 0 N15 c80301cf-9b4b-4eac-9aa5-aff8e3c3e803c80301cf-9b4b-4eac-9aa5-aff8e3c3e803 b.Direct Loss Blanket Limit The Direct Loss Blanket Limit shown in the Declarations applies separately to each building specifically described in the Declarations. At the time of loss you may apportion the Direct Loss to any coverage subject to the limit, or to any combination of coverages subject to the limit. The total amount apportioned at a building may not exceed the Direct Loss Blanket Limit. If a specific Limit of Insurance is shown in the Declarations for a coverage subject to the Direct Loss Blanket Limit, the specific limit applies in addition to any amount apportioned under the Direct Loss Blanket Limit. Coverages subject to the Direct Loss Blanket Limit are subject to the Deductible that applies to loss or damage in an occurrence under this policy. c.Indirect Loss Blanket Limit The indirect Loss Blanket Limit shown in the Declarations applies separately to each building specifically described in the Declarations. At the time of loss you may apportion the Indirect Loss Blanket Limit to any coverage subject to the limit, or to any combination of coverages subject to the limit. The total amount apportioned at a building may not exceed the Indirect Loss Blanket Limit. If a specific Limit of Insurance is shown in the Declarations for a coverage subject to the Indirect Loss Blanket Limit, the specific limit applies in addition to any amount apportioned under the Indirect Loss Blanket Limit. d.Crime Loss Blanket Limit The Crime Loss Blanket Limit in the Declarations applies separately to each building specifically described in the Declarations. At the time of loss you may apportion the Crime Loss Blanket Limit to any coverage subject to the limit, or to any combination of coverages subject to the limit. The total amount apportions at a building may not exceed the Crime Loss Blanket Limit. Coverages included in the Crime Loss Blanket Limit are excess over any insurance provided by a Crime Coverage Form included with this policy. C.Deductible The following provision is added to Section D. of the Coverage Form: Glass Deductible Regardless of the amount of the Deductible, the most we will deduct from any loss to covered building glass in any one occurrence is $250. This deductible amount will not increase the deductible shown in the Declarations. This deductible will be used to satisfy the requirements of the deductible shown in the Declarations. D.Loss Conditions 1.Section E.7. Valuation, of the Building and Personal Property Coverage Form and Section E.8. Valuation, of the Condominium Commercial Unit-Owners Coverage Form are replaced by the following provisions. But these provisions do not apply to property insured subject to a functional valuation endorsement. 7.Valuation In the event of loss or damage we will determine the value of the Covered Property as follows: a.Replacement Cost - Building Damage Less than $5,000 (1)If the Limit of Insurance for Building satisfies the Additional Condition, Coinsurance, and the cost to repair or replace the damaged building property is $5,000 or less, we will pay the cost of building repairs or replacement. (2)This provision does not apply to the following even when attached to the building: (a)Awnings or floor coverings; (b)Appliances for refrigerating, ventilating, cooking, dishwashing or laundering; or (c)Outdoor equipment or furniture. b.Finished Stock The value of finished "stock" you have sold but not delivered and of unsold "stock" you manufactured is the selling price less discounts and expenses you otherwise would have had. CP 80 26 10 18Page 16 of 23 05/13/2024A0195129 Middlesex Insurance Company At your option, you may make claim for loss or damage to sold and unsold finished "stock" on an actual cash value basis instead of a selling price basis. c.Glass The value of glass is its replacement cost. If safety-glazing material is required by statute the value of glass is the cost of replacement with safety-glazing material. d.Tenants’ Improvements and Betterments (1)The value of tenants' improvements and betterments to which you do not make repairs promptly is a proportion of your original cost. We will determine the proportionate value as follows: (a)Multiply the original cost by the number of days from the loss or damage to the expiration of the lease; and (b)Divide by the number of days from the installation of the improvements to the expiration of the lease. If your lease contains a renewal option, the expiration of the renewal option period will replace the expiration of the lease in this procedure. (2)We will not pay for improvements or betterments if others pay for repair or replacement. e.Exhibitions and Displays The value of exhibitions and displays is your cost. f.Patterns and Dies The value of patterns and dies that are replaced is replacement cost (without deduction for depreciation). The value of patterns and dies that you do not replace is actual cash value. Replacement cost settlement is available only if the pattern or die is replaced within 2 years after the date of loss or damage. If the original payment for loss is an actual cash value settlement, payment may be extended to replacement cost (as of the date of loss) if the pattern or die is replaced within two years. g.Fine Arts The value of fine arts is the lowest of the following amounts: (1)The market value of the property; (2)The cost of reasonably restoring the property to its condition immediately before loss; or (3)The cost of replacing the property with substantially identical property. h.All Other Property The value of all other property is its actual cash value as of the time of loss or damage. Replacement cost means the cost to replace lost or damaged property with new property or to repair damaged property using new materials. i.Coinsurance Waiver If a coinsurance percentage is shown in the Declarations, this condition only applies when the loss or damage in any one occurrence is greater than $10,000. 2.The following is added to amend Loss Conditions E.7., Valuation, of the Building and Personal Property Coverage Form and Loss Conditions E.8., Valuation, of the Condominium Commercial Unit-Owners Coverage Form for Crime Additional Coverages: Valuation - Settlement The value of loss for money and securities shall be determined as follows: 1)Loss of "money" but only up to and including its face value. We will, at your option, pay for loss of "money" issued by any country other than the United States of America: (a)At face value of the "Money" issued by that country; or (b)In the United States of America dollar equivalent determined by the rate of exchange published in the Wall Street Journal on the day the loss was discovered. Page 17 of 23CP 80 26 10 18 05/13/2024A0195129 Middlesex Insurance Company 00012 0000000000 24134 0 N17 c80301cf-9b4b-4eac-9aa5-aff8e3c3e803c80301cf-9b4b-4eac-9aa5-aff8e3c3e803 2)Loss of "securities" but only up to and including their value at the close of business on the day the loss was discovered. We may at our option: (a)Pay the market value of such "securities" or replace them in kind, in which event you must assign to us all your rights, title and interest in and to those "securities"; or (b)Pay the cost of any lost securities bond required in connection with issuing duplicates of the "securities". However, we will be liable only for the payment of so much of the cost of the bond as would be charged for a bond having a penalty not exceeding the lesser of the: (i)Market value of the "securities" at the close of business on the day the loss was discovered; or (ii)The Limit of Insurance applicable to the "securities". Discovered means the time when you first become aware of facts which would cause a reasonable person to assume that a loss of a type covered by this insurance has been or will be incurred, regardless of when the act or acts causing or contributing to such loss occurred, even though the exact amount or details of loss may not then be known. It also means the time when you first receive notice of an actual or potential claim in which it is alleged that you are liable to a third party under circumstances which, if true, would constitute a loss under this insurance. 3.The following is added to amend Loss Conditions E.4., Loss Payment, of the Building and Personal Property Coverage Form and Loss Conditions E.5., Loss Payment, of the Condominium Commercial Unit-Owners Coverage Form: Brands And Labels If branded or labeled merchandise that is Covered Property is damaged by a Covered Cause of Loss, we may take all or any part of the property at an agreed or appraised value. If so, you may: 1.Stamp "salvage" in the merchandise or its containers, if the stamp will not physically damage the merchandise; or 2.Remove the brands or labels, if doing so will not physically damage the merchandise. You must relabel the merchandise or its containers to comply with the law. The most we will pay under the brands and labels provisions is $50,000. Pair, Sets Or Parts 1.Pair Or Set In case of loss or damage to any part of a pair or set we may: a.Repair or replace any part to restore the pair or set to its value before the loss or damage; or b.Pay the difference between the value of the pair or set before and after the loss or damage. E.Additional Conditions The following provisions are added to Section F. of the Coverage Form. 1.If this policy provides a separate limit for your business personal property at each building, you may, at your option, combine the Limits of Insurance for all buildings and the values at all buildings for the purposes of the Additional Condition, Coinsurance. This will not change the Limit of Insurance that applies at any building. If you do not exercise this option, the Coinsurance Condition will be applied separately at each building. 2.The Additional Condition, Coinsurance, does not apply to Personal Property of Others. This section does not apply to Personal Property of Others subject to a blanket Limit of Insurance that also applies to other types of property. II.The following changes apply to the Business Income Coverage Form, if your policy includes a Business Income Coverage Form: A.Coverage Extended Premises Definition The business income insurance, if any, provided by this policy applies to suspension caused by direct physical loss of or damage to property at the building described in the Declarations, or premises described in the Declarations, whichever distance is greater; including personal property in the open (or in a vehicle) within 1,500 feet, caused by or resulting from any Covered Cause of Loss. This provision Modifies Section A. of the Business Income Coverage Form. B.Additional Limitation - Interruption Of Computer Operations 1.We will pay up to $50,000 per policy period for loss from a "suspension" of "operations" caused by destruction or corruption of electronic data, or any loss or damage to electronic data. CP 80 26 10 18Page 18 of 23 05/13/2024A0195129 Middlesex Insurance Company Paragraphs a. and b. of the Additional Limitation - Interruption of Computer Operations are deleted. The Interruption of Computer Operations Additional Coverage is deleted. C.Additional Coverages 1.The following provisions modify the Additional Coverages in the Business Income Coverage Form: a.Civil Authority (1)The Civil Authority Additional Coverage provided by the Business Income Coverage Form applies when access to the area immediately surrounding the damaged property is prohibited by civil authority as the result of the damage and the described premises are within that area. The provision that limits coverage to described premises that are one mile from the damage does not apply to your policy. (2)The Civil Authority Coverage provided by the Business Income Coverage Form applies for a period of up to 30 days from the date of action by the civil authority unless a longer period is specified in an endorsement included in the policy. b.Alterations and New Buildings The Alterations and New Buildings Additional Coverage of the Business Income Coverage Form applies to loss you sustain due to damage to building machinery, equipment, supplies and materials located on or within 1,500 feet of the described premises. This provision changes Section (3) of the Additional Coverage. c.Extended Business Income The period during which the Extended Business Income Additional Coverage of the Business Income Coverage Form applies is increased to 90 days unless a longer period is shown in the Declarations. 2.The following Additional Coverages are added to the Business Income Coverage Form: a.Business Income From Dependent Properties We will pay for the actual loss of business income you sustain due to the necessary suspension of your "operations" during the "period of restoration". The suspension must result from a Covered Cause of Loss which causes direct physical loss or damage to property at a contingent business premises. All exclusions in this policy that apply to coverage for business income apply to this Additional Coverage. Coverage under this Additional Coverage is subject to the Indirect Loss Blanket Limit and to any Contingent Business Income Limit shown in the Declarations. Coverage under the Indirect Loss Blanket Limit is excess over any insurance provided subject to the Contingent Business Income Limit. Contingent business premises means premises operated by others that: (1)Deliver material or services (other than water supply services, wastewater removal services, communications or power supply services) to you, or to others for your account. (2)Accept your products or services. (3)Manufacture products for delivery to your customers under contract of sale. (4)Attract customers to your business. The "period of restoration" definition in the Business Income Coverage Form applies to loss covered by this Additional Coverage. But the "period of restoration" begins when the damage to the contingent business premises occurs and ends when that damage should be repaired, rebuilt or replaced. The coverage provided by this Additional Coverage is excess above any insurance provided by a Business Income Dependent Properties Endorsement included in this policy. b.Business Income From Interruption of Utility Services We will pay for loss of business income at the building described in the Declarations if the business income loss is caused by the interruption of utility service to the building. The interruption must result from direct physical loss or damage by a Covered Cause of Loss to the following property, not on the premises described in the Declarations. (1)Water Supply Property, meaning the following types of property that supply water to the premises: (a)Pumping station; and (b)Water mains. Page 19 of 23CP 80 26 10 18 05/13/2024A0195129 Middlesex Insurance Company 00012 0000000000 24134 0 N19 c80301cf-9b4b-4eac-9aa5-aff8e3c3e803c80301cf-9b4b-4eac-9aa5-aff8e3c3e803 (2)Wastewater Removal Property, meaning a utility system for removing wastewater and sewage from the described premises, other than a system designed primarily for draining storm water. The utility property includes sewer mains, pumping stations and similar equipment for moving the effluent to a holding, treatment or disposal facility, and includes such facility. (3)Communication Supply Property, meaning property supplying communication services, including telephone, radio, microwave or television services to the premises, such as: (a)Communication transmission lines, including fiber optic transmission lines; (b)Coaxial cable; and (c)Microwave relay radios except satellites. (4)Power Supply Property, meaning the following types of property supplying electricity, steam or gas to the premises; (a)Utility generating plants; (b)Switching stations; (c)Substations; (d)Transformers; and (e)Transmission lines. As used in this Additional Coverage, the term transmission lines includes all lines which serve to transmit communication service or power, including lines which may be identified as distribution lines. Coverage under this Additional Coverage is subject to the Indirect Loss Blanket Limit. But we will not pay for any interruption of less than 12 hours. The coverage provided by this Additional Coverage is excess above any insurance provided by an Off Premises Services - Time Element Endorsement contained in this policy. All exclusions in this policy that apply to coverage for business income apply to this Additional Coverage. All interruptions arising from a single event are a single occurrence. The definition of business income in the Business Income Coverage Form applies to this Additional Coverage. c.Business Income Resulting From Damage to Property Away from Described Premises. We will pay for the actual loss of business income you sustain due to necessary suspension of your "operations" as a result of direct physical loss of or damage to Covered Property away from described premises by any Covered Cause of Loss. This coverage is provided only during the "period of restoration". Coverage under this Additional Coverage is subject to the Indirect Loss Blanket Limit and to any Business Income Resulting From Damage to Property Away From Described Premises Limit shown in the Declarations. Coverage under the Indirect Loss Blanket Limit is excess over any insurance provided subject to the Business Income Resulting From Damage to Property Away From Described Premises Limit. d.Claim Preparation Expenses We will pay the reasonable expenses you necessarily incur with our permission to prepare documentation that substantiates your claim for loss under the Business Income Coverage Form. This coverage does not apply to public adjuster fees or to attorney fees or other costs for legal services. Coverage under this Additional Coverage is subject to the Indirect Loss Blanket Limit. CP 80 26 10 18Page 20 of 23 05/13/2024A0195129 Middlesex Insurance Company e.Ordinance or Law - Increased Period of Restoration We will pay the amount of actual and necessary loss you sustain during the increase period of "suspension" of "operations" caused by or resulting from enforcement requirement to comply with any ordinance or law that: (1)Regulates the construction or repair of any property; (2)Requires the tearing down of parts of any property not damaged by a Covered Cause of Loss; and (3)Is in force at the time of loss. Coverage is not extended under this endorsement to include loss caused by or resulting from the enforcement of or compliance with any ordinance or law which requires: (1)The demolition, repair, replacement, reconstruction, remodeling or remediation of property due to contamination by "pollutants" or due to the presence, growth, proliferation, spread or any activity of "fungus", wet or dry rot or bacteria; or (2)Any insured or others to test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of "pollutants", "fungus", wet or dry rot or bacteria. For this coverage, the third paragraph of Definition F.3. is replaced with the following: "Period of Restoration" includes any increased period required to repair or reconstruct the property to comply with the minimum standards of any ordinance or law, in force at the time of loss, that regulates the construction or repair, or requires the tearing down of any property. Coverage under this Additional Coverage is subject to the Indirect Loss Blanket Limit. D.Coverage Extension 1.The following provision modifies the Coverage Extensions in the Business Income Coverage Form. Newly Acquired Locations a.The most we will pay for loss under this Extension, for the sum of Business Income and Extra Expense (if applicable), is the highest Limit of Insurance for Business Income Coverage at any building shown in the Declarations, but not more than $500,000 or the Business Income - Newly Acquired Locations limit shown in the Declarations. This change modifies Paragraph b. of the Coverage Extension. b.Coverage at newly acquired locations expires 180 days after you acquire or begin to construct the property. This change modifies Paragraph c.(2) of the Coverage Extension. 2.The following Additional Coverage Extensions are added to the Business Income Coverage Form: Lessor's Lease Cancellation - Loss of Income If "Rental Value" is shown in the Declaration for Business Income Coverage you may extend your Business Income Coverage to include the cancellation of a lease by your tenant due to untenantability caused by a Covered Cause of Loss to a covered building. The tenant must have occupied the building prior to the loss. Coverage extends from the end of the period of restoration until such time you are able to lease the space to another tenant or the end of the policy period, whichever occurs first. Coverage under this Coverage Extension is subject to the Indirect Loss Blanket Limit. E.Limits The following is added to Section B. of the Business Income Form: Indirect Loss Blanket Limit The indirect Loss Blanket Limit shown in the Declarations applies separately to each premises specifically described in the Declarations. At the time of loss you may apportion the Indirect Loss Blanket Limit to any coverage subject to the limit, or to any combination of coverages subject to the limit. The total amount apportioned at a building may not exceed the Indirect Loss Blanket Limit. Page 21 of 23CP 80 26 10 18 05/13/2024A0195129 Middlesex Insurance Company 00012 0000000000 24134 0 N21 c80301cf-9b4b-4eac-9aa5-aff8e3c3e803c80301cf-9b4b-4eac-9aa5-aff8e3c3e803 If a specific Limit of Insurance is shown in the Declarations for a coverage subject to the Indirect Loss Blanket Limit, the specific limit applies in addition to any amount apportioned under the Indirect Loss Blanket Limit. F.Definitions Period of Restoration 1.Paragraph a.(1) of Definition F.3. is replaced by the following, except for loss caused by earthquake to buildings over 4 stories in height: (1)Immediately after the time of direct physical loss or damage for Business Income Coverage; or 2.Paragraph a.(1) of Definition F.3. applies to loss caused by earthquake to buildings over 4 stories in height. III.The following provisions modify the Causes of Loss Special Form: A.Building Ordinance Coverage The building insurance, if any, provided by this policy covers loss caused by the enforcement of building laws that regulate the construction, use or repair of property, or which require property to be torn down. Exclusion B.1.a. of the Causes of Loss Special Form does not apply to the Building Ordinance Coverage provided by this policy. B.Property Away From Described Premises - Earth Movement and Water Damage We will pay for personal property away from described premises if loss is caused by Earth Movement or Water. The Earth Movement exclusion in Section B.1.b. of the Causes of Loss Special Form and the Water exclusion in section B.1.g. of the Causes of Loss Special Form or in an endorsement attached to this policy do not apply to personal property away from described premises. C.Utility Services We will pay for loss caused by failure of power supply property, communication supply property, water supply property, wastewater removal property or other utility service to the described premises. The interruption in Utility Service must result from a direct physical loss or damage by a Covered Cause of Loss. This coverage deletes Exclusion B.1.e. of the Causes of Loss Special Form. D.Sewer Back Up or Underground Seepage We will pay for loss or damage caused by: 1.Water that backs up from a sewer or drain; or 2.Water under the ground surface pressing on, or flowing or seeping through: (a)Foundations, walls, floors or paved surfaces; (b)Basements, whether paved or not; or (c)Doors, windows or other openings. We will not pay more than $25,000 or the Sewer Back Up Limit shown in the Declarations for loss or damage by these causes of loss in any one occurrence. The third and fourth numbered paragraphs of the Water exclusion in the Causes of Loss Special Form or in an endorsement attached to this policy do not apply to this coverage. E.Electrical Damage We will pay for loss caused by artificially generated electrical current and by electrical arcing. This coverage deletes Exclusion B.2.a. of the Causes of Loss Special Form. F.Humidity, Temperature, Marring or Scratching We will pay for personal property damaged by the following: 1.Dampness or dryness of atmosphere; 2.Changes in or extremes of temperature; or 3.Marring or scratching. We will not pay more than $25,000 or the Humidity, Temperature, Marring or Scratching limit shown in the Declarations for loss or damage by these causes of loss in any one occurrence. Exclusion B.2.d.(7) of the Causes of Loss Special Form does not apply to this coverage. G.False Pretense We will pay for property you rent or lease to others and for property temporarily away from your premises for trial or demonstration if someone caused you to voluntarily part with the property by any fraudulent scheme, trick, device or false pretense. You must notify the police in the event of loss or damage under this coverage. You must also make every effort to recover the property when it is located. The most we will pay for loss in any one occurrence is $5,000. Occurrence means an act or a series of related acts involving one or more persons. We will deduct $250 from the amount that we will pay for loss or damage in any one occurrence. CP 80 26 10 18Page 22 of 23 05/13/2024A0195129 Middlesex Insurance Company Exclusion B.2.i. of the Causes of Loss Special Form does not apply to this coverage. H.Property in the Open We will pay for loss caused by rain, snow, ice or sleet that damages personal property in the open. We will not pay more than $10,000 or the Property in the Open Limit shown in the Declarations for loss or damage by these causes of loss in any one occurrence. Exclusion B.2.j. of the Causes of Loss Special Form does not apply to this coverage. I.Damage to Finished "Stock" Business Income Coverage includes loss resulting from damage or destruction of finished "stock" or the time to replace finished "stock". This coverage deletes exclusion B.4.a.(1) of the Causes of Loss Special Form. J.Interior Damage Damage caused by rain, snow, sleet, ice, sand or dust to the interior of any covered building or structure, or to any Covered Property in a building or structure, is covered. This coverage deletes Limitation C.1.c. of the Causes of Loss Special Form. K.Theft of Building Materials Away From Described Premises Building materials away from described premises are covered for loss caused by theft. Limitation C.1.d. of the Causes of Loss Special Form does not apply to building materials away from described premises. L.Builders Machinery, Tools and Equipment Builders machinery, tools and equipment that are away from described premises are covered up to the applicable Limit of Insurance. This coverage deletes Limitation C.2.c. of the Causes of Loss Special Form. M.Industrial Diamonds and Precious Metals We will pay up to $25,000 or the Industrial Diamonds and Precious Metals Limit shown in the Declarations for theft of industrial diamonds or bullion, gold, silver, platinum and other precious alloys or metals. Limitation C.3.b. of the Causes of Loss Special Form does not apply to this coverage. N.Patterns and Dies We will pay for theft of patterns, dies, molds or forms up to the applicable Limit of Insurance. This coverage deletes Limitation C.3.c. of the Causes of Loss Special Form. O.Property in Transit Covered Property in transit is included in the coverage for personal property away from described premises. Additional Coverage Extension F.1. of the Causes of Loss Special Form does not apply to this policy. Page 23 of 23CP 80 26 10 18 05/13/2024A0195129 Middlesex Insurance Company 00012 0000000000 24134 0 N23 c80301cf-9b4b-4eac-9aa5-aff8e3c3e803c80301cf-9b4b-4eac-9aa5-aff8e3c3e803 IL 01 02 02 20 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALIFORNIA CHANGES - ACTUAL CASH VALUE © Insurance Services Office, Inc., 2019 This endorsement modifies insurance provided under the following: CAPITAL ASSETS PROGRAM (OUTPUT POLICY) COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL PROPERTY COVERAGE PART FARM COVERAGE PART STANDARD PROPERTY POLICY With respect to an "open policy", the following are added to any provision which uses the term actual cash value: A.In the event of a partial or total loss to a building or structure, actual cash value is calculated as the lesser of the following: 1.The amount it would cost to repair, rebuild or replace the property less a fair and reasonable deduction for physical depreciation of the components of the building or structure that are normally subject to repair or replacement during its useful life. Physical depreciation is based upon the condition of the property at the time of the loss; or 2.The Limit of Insurance applicable to the property. B.In the event of a partial or total loss to Covered Property other than a building or structure, actual cash value is calculated as the lesser of the following: 1.The amount it would cost to repair or replace the property less a fair and reasonable deduction for physical depreciation, based on the condition of the property at the time of loss; or 2.The Limit of Insurance applicable to the property. C.An "open policy" is a policy under which the value of Covered Property is not fixed at policy inception, but is determined at the time of loss in accordance with policy provisions on valuation. The term "open policy" does not apply to Covered Property that is subject to an Agreed Value clause or similar clause that establishes an agreed value prior to loss, unless such clause has expired. Page 1 of 1IL 01 02 02 20 05/13/2024A0195129 Middlesex Insurance Company 00001 0000000000 24134 0 N1 f8c48663-3d87-4521-ab4b-abebe022dda0f8c48663-3d87-4521-ab4b-abebe022dda0 © Insurance Services Office, Inc., 2020 IL 01 04 07 20 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALIFORNIA CHANGES This endorsement modifies insurance provided under the following: COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL PROPERTY COVERAGE PART EQUIPMENT BREAKDOWN COVERAGE PART FARM COVERAGE PART - FARM PROPERTY - OTHER FARM PROVISIONS FORM - ADDITIONAL COVERAGES, CONDITIONS, DEFINITIONS FARM COVERAGE PART - LIVESTOCK COVERAGE FORM FARM COVERAGE PART - MOBILE AGRICULTURAL MACHINERY AND EQUIPMENT COVERAGE FORM STANDARD PROPERTY POLICY A.When this endorsement is attached to the Standard Property Policy CP 00 99 the term Coverage Part in this endorsement is replaced by the term Policy. B.The Concealment, Misrepresentation Or Fraud Condition is replaced by the following with respect to loss ("loss") or damage caused by fire: We do not provide coverage to the insured ("insured") who, whether before or after a loss ("loss"), has committed fraud or intentionally concealed or misrepresented any material fact or circumstance concerning: 1.This Coverage Part; 2.The Covered Property; 3.That insured's ("insured's") interest in the Covered Property; or 4.A claim under this Coverage Part or Coverage Form. C.The Concealment, Misrepresentation Or Fraud Condition is replaced by the following with respect to loss ("loss") or damage caused by a Covered Cause of Loss other than fire: This Coverage Part is void if any insured ("insured"), whether before or after a loss ("loss"), has committed fraud or intentionally concealed or misrepresented any material fact or circumstance concerning: 1.This Coverage Part; 2.The Covered Property; 3.An insured's ("insured's") interest in the Covered Property; or 4.A claim under this Coverage Part or Coverage Form. D.Except as provided in E., the Appraisal Condition is replaced by the following: If we and you disagree on the value of the property or the actual cash value or the amount of loss ("loss"), either may make written request for an appraisal of the loss ("loss"). In this event, each party will select a competent and impartial appraiser. However, in the event of a government-declared disaster, as defined in the Government Code, appraisal may be requested by either you or us but shall not be compelled. Each party shall notify the other of the appraiser selected within 20 days of the request. The two appraisers will select an umpire. If they cannot agree within 15 days, either may request that selection be made by a judge of a court having jurisdiction. The appraisers will state separately the value of the property and actual cash value and amount of loss ("loss"). If they fail to agree, they will submit their differences to the umpire. A decision agreed to by any two will set the amount of actual cash value and loss ("loss") and will be binding. Each party will: 1.Pay its chosen appraiser; and Page 1 of 2IL 01 04 07 20 05/13/2024A0195129 Middlesex Insurance Company 00001 0000000000 24134 0 N1 6066343d-ab11-4e9c-8964-b5c288e6a4f76066343d-ab11-4e9c-8964-b5c288e6a4f7 © Insurance Services Office, Inc., 2020 2.Bear the other expenses of the appraisal and umpire equally. If there is an appraisal, we will still retain our right to deny the claim. E.The Appraisal Condition in: 1.Business Income (And Extra Expense) Coverage Form CP 00 30; and 2.Business Income (Without Extra Expense) Coverage Form CP 00 32; is replaced by the following: If we and you disagree on the amount of Net Income and operating expense or the amount of loss, either may make written request for an appraisal of the loss. If the request is accepted, each party will select a competent and impartial appraiser. Each party shall notify the other of the appraiser selected within 20 days of the request. The two appraisers will select an umpire. If they cannot agree within 15 days, either may request that selection be made by a judge of a court having jurisdiction. The appraisers will state separately the amount of Net Income and operating expense or amount of loss. If they fail to agree, they will submit their differences to the umpire. A decision agreed to by any two will be binding. Each party will: a.Pay its chosen appraiser; and b.Bear the other expenses of the appraisal and umpire equally. If there is an appraisal, we will still retain our right to deny the claim. IL 01 04 07 20Page 2 of 2 05/13/2024A0195129 Middlesex Insurance Company © Insurance Services Office, Inc., 2020 IL 02 70 07 20 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALIFORNIA CHANGES - CANCELLATION AND NONRENEWAL This endorsement modifies insurance provided under the following: CAPITAL ASSETS PROGRAM (OUTPUT POLICY) COVERAGE PART COMMERCIAL AUTOMOBILE COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL PROPERTY COVERAGE PART CRIME AND FIDELITY COVERAGE PART EMPLOYMENT-RELATED PRACTICES LIABILITY COVERAGE PART EQUIPMENT BREAKDOWN COVERAGE PART FARM COVERAGE PART LIQUOR LIABILITY COVERAGE PART MEDICAL PROFESSIONAL LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART A.Paragraphs 2. and 3. of the Cancellation Common Policy Condition are replaced by the following: 2.All Policies In Effect For 60 Days Or Less If this policy has been in effect for 60 days or less, and is not a renewal of a policy we have previously issued, we may cancel this policy by mailing or delivering to the first Named Insured, at the mailing address shown in the policy, and to the producer of record, advance written notice of cancellation, stating the reason for cancellation, at least: a.10 days before the effective date of cancellation if we cancel for: (1)Nonpayment of premium; or (2)Discovery of fraud by: (a)Any insured or his or her representative in obtaining this insurance; or (b)You or your representative in pursuing a claim under this policy. b.30 days before the effective date of cancellation if we cancel for any other reason. 3.All Policies In Effect For More Than 60 Days a.If this policy has been in effect for more than 60 days, or is a renewal of a policy we issued, we may cancel this policy only upon the occurrence, after the effective date of the policy, of one or more of the following: (1)Nonpayment of premium, including payment due on a prior policy we issued and due during the current policy term covering the same risks. (2)Discovery of fraud or material misrepresentation by: (a)Any insured or his or her representative in obtaining this insurance; or (b)You or your representative in pursuing a claim under this policy. (3)A judgment by a court or an administrative tribunal that you have violated a California or Federal law, having as one of its necessary elements an act which materially increases any of the risks insured against. Page 1 of 4IL 02 70 07 20 05/13/2024A0195129 Middlesex Insurance Company 00002 0000000000 24134 0 N1 d695d085-759e-454c-bd56-062da8b36513d695d085-759e-454c-bd56-062da8b36513 © Insurance Services Office, Inc., 2020 (4)Discovery of willful or grossly negligent acts or omissions, or of any violations of state laws or regulations establishing safety standards, by you or your representative, which materially increase any of the risks insured against. (5)Failure by you or your representative to implement reasonable loss control requirements, agreed to by you as a condition of policy issuance, or which were conditions precedent to our use of a particular rate or rating plan, if that failure materially increases any of the risks insured against. (6)A determination by the Commissioner of Insurance that the: (a)Loss of, or changes in, our reinsurance covering all or part of the risk would threaten our financial integrity or solvency; or (b)Continuation of the policy coverage would: (i)Place us in violation of California law or the laws of the state where we are domiciled; or (ii)Threaten our solvency. (7)A change by you or your representative in the activities or property of the commercial or industrial enterprise, which results in a materially added, increased or changed risk, unless the added, increased or changed risk is included in the policy. b.We will mail or deliver advance written notice of cancellation, stating the reason for cancellation, to the first Named Insured, at the mailing address shown in the policy, and to the producer of record, at least: (1)10 days before the effective date of cancellation if we cancel for nonpayment of premium or discovery of fraud; or (2)30 days before the effective date of cancellation if we cancel for any other reason listed in Paragraph 3.a. B.The following provision is added to the Cancellation Common Policy Condition: 7.Residential Property This provision applies to coverage on real property which is used predominantly for residential purposes and consisting of not more than four dwelling units, and to coverage on tenants' household personal property in a residential unit, if such coverage is written under one of the following: Commercial Property Coverage Part Farm Coverage Part - Farm Property - Farm Dwellings, Appurtenant Structures And Household Personal Property Coverage Form a.If such coverage has been in effect for 60 days or less, and is not a renewal of coverage we previously issued, we may cancel this coverage for any reason, except as provided in b. and c. below. b.We may not cancel this policy solely because the first Named Insured has: (1)Accepted an offer of earthquake coverage; or (2)Cancelled or did not renew a policy issued by the California Earthquake Authority (CEA) that included an earthquake policy premium surcharge. However, we shall cancel this policy if the first Named Insured has accepted a new or renewal policy issued by the CEA that includes an earthquake policy premium surcharge but fails to pay the earthquake policy premium surcharge authorized by the CEA. c.We may not cancel such coverage solely because corrosive soil conditions exist on the premises. This restriction (c.) applies only if coverage is subject to one of the following, which exclude loss or damage caused by or resulting from corrosive soil conditions: (1)Commercial Property Coverage Part - Causes Of Loss - Special Form; or (2)Farm Coverage Part - Causes Of Loss Form - Farm Property, Paragraph D. Covered Causes Of Loss - Special. IL 02 70 07 20Page 2 of 4 05/13/2024A0195129 Middlesex Insurance Company © Insurance Services Office, Inc., 2020 d.If a state of emergency under California Law is declared and the residential property is located in any ZIP Code within or adjacent to the fire perimeter, as determined by California Law, we may not cancel this policy for one year, beginning from the date the state of emergency is declared, solely because the dwelling or other structure is located in an area in which a wildfire has occurred. However, we may cancel: (1)When you have not paid the premium, at any time by letting you know at least 10 days before the date cancellation takes effect; (2)If willful or grossly negligent acts or omissions by the Named Insured, or his or her representatives, are discovered that materially increase any of the risks insured against; or (3)If there are physical changes in the property insured against, beyond the catastrophe-damaged condition of the structures and surface landscape, which result in the property becoming uninsurable. C.The following is added and supersedes any provisions to the contrary: Nonrenewal 1.Subject to the provisions of Paragraphs C.2. and C.3. below, if we elect not to renew this policy, we will mail or deliver written notice, stating the reason for nonrenewal, to the first Named Insured shown in the Declarations, and to the producer of record, at least 60 days, but not more than 120 days, before the expiration or anniversary date. We will mail or deliver our notice to the first Named Insured, and to the producer of record, at the mailing address shown in the policy. 2.Residential Property This provision applies to coverage on real property used predominantly for residential purposes and consisting of not more than four dwelling units, and to coverage on tenants' household property contained in a residential unit, if such coverage is written under one of the following: Commercial Property Coverage Part Farm Coverage Part - Farm Property - Farm Dwellings, Appurtenant Structures And Household Personal Property Coverage Form a.If this policy provides coverage as described in the preceding paragraph, and we elect not to renew this policy, we will mail or deliver written notice, stating the reason for nonrenewal, to the first Named Insured shown in the Declarations, and to the producer of record, at the mailing address shown in the policy, at least 75 days, but not more than 120 days, before the expiration or anniversary date. If we fail to give the first Named Insured shown in the Declarations notice of nonrenewal at least 75 days prior to the policy expiration, as required in the paragraph above, this policy, with no change in its terms and conditions, shall remain in effect for 75 days from the date that the notice of nonrenewal is delivered or mailed to the Named Insured. A notice to this effect shall be provided by us to the first Named Insured with the notice of nonrenewal. b.We may elect not to renew such coverage for any reason, except as provided in Paragraphs c., d. and e. below. c.We will not refuse to renew such coverage solely because the first Named Insured has accepted an offer of earthquake coverage. However, the following applies only to insurers who are associate participating insurers as established by Cal. Ins. Code Section 10089.16. We may elect not to renew such coverage after the first Named Insured has accepted an offer of earthquake coverage, if one or more of the following reasons applies: (1)The nonrenewal is based on sound underwriting principles that relate to the coverages provided by this policy and that are consistent with the approved rating plan and related documents filed with the Department of Insurance as required by existing law; Page 3 of 4IL 02 70 07 20 05/13/2024A0195129 Middlesex Insurance Company 00002 0000000000 24134 0 N3 d695d085-759e-454c-bd56-062da8b36513d695d085-759e-454c-bd56-062da8b36513 © Insurance Services Office, Inc., 2020 (2)The Commissioner of Insurance finds that the exposure to potential losses will threaten our solvency or place us in a hazardous condition. A hazardous condition includes, but is not limited to, a condition in which we make claims payments for losses resulting from an earthquake that occurred within the preceding two years and that required a reduction in policyholder surplus of at least 25% for payment of those claims; or (3)We have: (a)Lost or experienced a substantial reduction in the availability or scope of reinsurance coverage; or (b)Experienced a substantial increase in the premium charged for reinsurance coverage of our residential property insurance policies; and the Commissioner has approved a plan for the nonrenewals that is fair and equitable, and that is responsive to the changes in our reinsurance position. d.We will not refuse to renew such coverage solely because the first Named Insured has cancelled or did not renew a policy, issued by the California Earthquake Authority, that included an earthquake policy premium surcharge. e.We will not refuse to renew such coverage solely because corrosive soil conditions exist on the premises. This restriction (e.) applies only if coverage is subject to one of the following, which exclude loss or damage caused by or resulting from corrosive soil conditions: (1)Commercial Property Coverage Part - Causes Of Loss - Special Form; or (2)Farm Coverage Part - Causes Of Loss Form - Farm Property, Paragraph D. Covered Causes Of Loss - Special. f.If a state of emergency under California Law is declared and the residential property is located in any ZIP Code within or adjacent to the fire perimeter, as determined by California Law, we may not nonrenew this policy for one year, beginning from the date the state of emergency is declared, solely because the dwelling or other structure is located in an area in which a wildfire has occurred. However, we may nonrenew: (1)If willful or grossly negligent acts or omissions by the Named Insured, or his or her representatives, are discovered that materially increase any of the risks insured against; (2)If losses unrelated to the postdisaster loss condition of the property have occurred that would collectively render the risk ineligible for renewal; or (3)If there are physical changes in the property insured against, beyond the catastrophe-damaged condition of the structures and surface landscape, which result in the property becoming uninsurable. 3.We are not required to send notice of nonrenewal in the following situations: a.If the transfer or renewal of a policy, without any changes in terms, conditions or rates, is between us and a member of our insurance group. b.If the policy has been extended for 90 days or less, provided that notice has been given in accordance with Paragraph C.1. c.If you have obtained replacement coverage, or if the first Named Insured has agreed, in writing, within 60 days of the termination of the policy, to obtain that coverage. d.If the policy is for a period of no more than 60 days and you are notified at the time of issuance that it will not be renewed. e.If the first Named Insured requests a change in the terms or conditions or risks covered by the policy within 60 days of the end of the policy period. f.If we have made a written offer to the first Named Insured, in accordance with the timeframes shown in Paragraph C.1., to renew the policy under changed terms or conditions or at an increased premium rate, when the increase exceeds 25%. IL 02 70 07 20Page 4 of 4 05/13/2024A0195129 Middlesex Insurance Company IL 09 35 07 02 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION OF CERTAIN COMPUTER-RELATED LOSSES IL 09 35 07 02 © ISO Properties, Inc., 2001 EXCLUSION OF CERTAIN COMPUTER-RELATED LOSSES This endorsement modifies insurance provided under the following: COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL PROPERTY COVERAGE PART CRIME AND FIDELITY COVERAGE PART STANDARD PROPERTY POLICY A.We will not pay for loss ("loss") or damage caused directly or indirectly by the following. Such loss ("loss") or damage is excluded regardless of any other cause or event that contributes concurrently or in any sequence to the loss ("loss") or damage. 1.The failure, malfunction or inadequacy of: a.Any of the following, whether belonging to any insured or to others: (1) Computer hardware, including micro- processors; (2) Computer application software; (3) Computer operating systems and re- lated software; (4) Computer networks; (5) Microprocessors (computer chips) not part of any computer system; or (6) Any other computerized or electronic equipment or components; or b.Any other products, and any services, data or functions that directly or indirectly use or rely upon, in any manner, any of the items listed in Paragraph A.1.a. of this endorse- ment; due to the inability to correctly recognize, process, distinguish, interpret or accept one or more dates or times. An example is the in- ability of computer software to recognize the year 2000. 2.Any advice, consultation, design, evaluation, inspection, installation, maintenance, repair, replacement or supervision provided or done by you or for you to determine, rectify or test for, any potential or actual problems described in Paragraph A.1. of this endorsement. B.If an excluded Cause of Loss as described in Paragraph A. of this endorsement results: 1.In a Covered Cause of Loss under the Crime and Fidelity Coverage Part, the Commercial In- land Marine Coverage Part or the Standard Property Policy; or 2.Under the Commercial Property Coverage Part: a.In a "Specified Cause of Loss", or in eleva- tor collision resulting from mechanical breakdown, under the Causes of Loss - Special Form; or b.In a Covered Cause of Loss under the Causes Of Loss - Basic Form or the Causes Of Loss - Broad Form; we will pay only for the loss ("loss") or damage caused by such "Specified Cause of Loss", eleva- tor collision, or Covered Cause of Loss. C.We will not pay for repair, replacement or modifi- cation of any items in Paragraphs A.1.a. and A.1.b. of this endorsement to correct any defi- ciencies or change any features. Page 1 of 1 05/13/2024A0195129 Middlesex Insurance Company 00001 0000000000 24134 0 N1 5a9b2dc2-93fd-4ce9-9c5a-0e14aa96efa55a9b2dc2-93fd-4ce9-9c5a-0e14aa96efa5 Page 1 of 1IL 09 52 01 15 05/13/2024A0195129 Middlesex Insurance Company IL 09 52 01 15 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM This endorsement modifies insurance provided under the following: BOILER AND MACHINERY COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL PROPERTY COVERAGE PART EQUIPMENT BREAKDOWN COVERAGE PART FARM COVERAGE PART STANDARD PROPERTY POLICY A.Cap On Certified Terrorism Losses "Certified act of terrorism" means an act that is certified by the Secretary of the Treasury, in accordance with the provisions of the federal Terrorism Risk Insurance Act, to be an act of terrorism pursuant to such Act. The criteria contained in the Terrorism Risk Insurance Act for a "certified act of terrorism" include the following: 1.The act resulted in insured losses in excess of $5 million in the aggregate, attributable to all types of insurance subject to the Terrorism Risk Insurance Act; and 2.The act is a violent act or an act that is dangerous to human life, property or infrastructure and is 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. If aggregate insured losses attributable to terrorist acts certified under the Terrorism Risk Insurance Act exceed $100 billion in a calendar year and we have met our insurer deductible under the Terrorism Risk Insurance Act, we shall not be liable for the payment of any portion of the amount of such losses that exceeds $100 billion, and in such case insured losses up to that amount are subject to pro rata allocation in accordance with procedures established by the Secretary of the Treasury. B.Application Of Exclusions The terms and limitations of any terrorism exclusion, or the inapplicability or omission of a terrorism exclusion, do not serve to create coverage for any loss which would otherwise be excluded under this Coverage Part or Policy, such as losses excluded by the Nuclear Hazard Exclusion or the War And Military Action Exclusion. © Insurance Services Office, Inc., 2015 00001 0000000000 24134 0 N1 f40989b4-721e-4671-b8aa-5f269f82a381f40989b4-721e-4671-b8aa-5f269f82a381 POLICY NUMBER: IL 09 85 12 20 SCHEDULE - PART I THIS ENDORSEMENT IS ATTACHED TO AND MADE PART OF YOUR POLICY IN RESPONSE TO THE DISCLOSURE REQUIREMENTS OF THE TERRORISM RISK INSURANCE ACT. THIS ENDORSEMENT DOES NOT GRANT ANY COVERAGE OR CHANGE THE TERMS AND CONDITIONS OF ANY COVERAGE UNDER THE POLICY. DISCLOSURE PURSUANT TO TERRORISM RISK INSURANCE ACT SCHEDULE Terrorism Premium (Certified Acts) $652.00 This premium is the total Certified Acts premium attributable to the following Coverage Part(s), Coverage Form(s) and/or Policy(ies): A0195129002 Commercial Property Additional information, if any, concerning the terrorism premium: SCHEDULE - PART II Federal share of terrorism losses 80% (Refer to Paragraph B. in this endorsement.) Information required to complete this Schedule, if not shown above, will be shown in the Declarations. © Insurance Services Office, Inc., 2020 Page 1 of 2IL 09 85 12 20 05/13/2024A0195129 Middlesex Insurance Company 00001 0000000000 24134 0 N1 5b2b14ac-2c74-4a34-a114-1821f4c8caa85b2b14ac-2c74-4a34-a114-1821f4c8caa8 A.Disclosure Of Premium In accordance with the federal Terrorism Risk Insurance Act, we are required to provide you with a notice disclosing the portion of your premium, if any, attributable to coverage for terrorist acts certified under the Terrorism Risk Insurance Act. The portion of your premium attributable to such coverage is shown in the Schedule of this endorsement or in the policy Declarations. B.Disclosure Of Federal Participation In Payment Of Terrorism Losses The United States Government, Department of the Treasury, will pay a share of terrorism losses insured under the federal program. The federal share equals a percentage (as shown in Part II of the Schedule of this endorsement or in the policy Declarations) of that portion of the amount of such insured losses that exceeds the applicable insurer retention. However, if aggregate insured losses attributable to terrorist acts certified under the Terrorism Risk Insurance Act exceed $100 billion in a calendar year, the Treasury shall not make any payment for any portion of the amount of such losses that exceeds $100 billion. C.Cap On Insurer Participation In Payment Of Terrorism Losses If aggregate insured losses attributable to terrorist acts certified under the Terrorism Risk Insurance Act exceed $100 billion in a calendar year and we have met our insurer deductible under the Terrorism Risk Insurance Act, we shall not be liable for the payment of any portion of the amount of such losses that exceeds $100 billion, and in such case insured losses up to that amount are subject to pro rata allocation in accordance with procedures established by the Secretary of the Treasury. © Insurance Services Office, Inc., 2020 IL 09 85 12 20Page 2 of 2 05/13/2024A0195129 Middlesex Insurance Company Page 1 of 1IL 70 26 07 13 05/13/2024A0195129 Middlesex Insurance Company MULTIPLE LINE OCCURRENCE DEDUCTIBLE This endorsement modifies insurance provided under the following: BUSINESSOWNERS POLICY COMMERCIAL CRIME COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL PROPERTY COVERAGE PART A.If an occurrence causes loss or damage insured by more than one policy or coverage part issued by us, only one deductible will apply to the total loss or damage. We will apply the largest deductible in any policy or coverage part that provides insurance for the loss or damage to the occurrence. The other deductibles that would otherwise apply to the loss or damage will be waived. B.If an occurrence causes loss or damage insured by more than one coverage form in a policy or coverage part issued by us, only one deductible will apply to the total loss or damage. We will apply the largest deductible in any coverage form that provides insurance for the loss or damage to the occurrence. The other deductibles that would otherwise apply to the loss or damage will be waived. C.We will separately apply the individual deductibles that would otherwise apply to the loss or damage if that would result in a larger total payment to the insured. If we separately apply the individual deductibles, the provisions in Paragraphs A. and B. will not apply. D.This endorsement does not apply to loss covered by any of the following: 1.Earthquake 2.Equipment breakdown coverage IL 70 26 07 13 00001 0000000000 24134 0 N1 520d065a-efef-4e61-8357-a8c27afcd997520d065a-efef-4e61-8357-a8c27afcd997 COMMERCIAL INLAND MARINE COVERAGE DECLARATION POLICY NUMBER: A0195129003 Middlesex Insurance Company (A Participating Stock Company) A member of the Sentry Insurance Group 1800 North Point Drive Stevens Point, WI 54481 Agency Acrisure of California, LLC 34 S 2nd St Campbell, CA 95008 Agency Code 10047536 POLICY INFORMATION First Named Insured:Axis Mechanical , Inc. Address:908 Bern Ct San Jose, CA 95112 The Commercial Inland Marine Coverage applies from 05/13/2024 to 05/13/2025 at 12:01 A.M. Standard Time at the First Named Insured's mailing address shown above. APPLICABLE FORMS AND ENDORSEMENTS In addition to the common policy forms and endorsements, the following forms and endorsements apply to the Commercial Inland Marine Coverage: Form/Endorsement Form/Endorsement Title Number and Edition Date CM 00 01 09 04 Commercial Inland Marine Conditions CM 70 13 03 97 Liberalization CM 71 44 04 15 Contractors Equipment Coverage Enhancement Form CM 88 26 10 12 Tools Coverage Form IH 00 68 12 13 Contractors Equipment Coverage Form IL 01 02 05 05 California Changes-Actual Cash Value IL 01 04 09 07 California Changes IL 02 70 09 12 California Changes - Cancellation And Nonrenewal IL 09 35 07 02 Exclusion Of Certain Computer-Related Losses IL 09 52 01 15 Cap On Losses From Certified Acts Of Terrorism IL 09 85 12 20 Disclosure Pursuant To Terrorism Risk Insurance Act IL 70 26 07 13 Multiple Line Occurrence Deductible CM 89 01 01 15 Page 1 of 2 05/13/2024A0195129 Middlesex Insurance Company 00001 0000000000 24134 0 N1 d7ec2984-5401-4f04-afb7-04582396b7f9d7ec2984-5401-4f04-afb7-04582396b7f9 POLICY NUMBER:A0195129003 Page 2 of 2 CM 89 01 01 15 05/13/2024A0195129 Middlesex Insurance Company COVERAGES CONTRACTORS EQUIPMENT COVERAGE Schedule of Covered Equipment Description of Covered Equipment Coinsurance Percentage DeductibleReplacement Cost Limit of Insurance Item # 1 2020 Leica Geosystems RTC360 S#2981119 $80,000 $1,000 80% 2 George Fisher Pipe Fusing Machine S#790.131.005 $49,183 $1,000 80% 3 George Fisher Pipe Fusing Power Converter S#790.103.095 $1,993 $1,000 80% 4 Trimble S5 3" Jobsite Point Locator S#37050077 $35,830 $1,000 80% 5 AMI Orbital Welding Machine S#7830 $25,277 $1,000 80% 6 Milwaukee Pipe Press Joining Tool $5,668 $1,000 80% 7 Equipment Rented Leased or Borrowed From Others $50,000 $1,000 80% TOOLS COVERAGE Limits of Insurance and Deductibles Insured’s Tools Limit of Insurance: Deductible: $35,000 $1,000 Optional Coverage Replacement Cost applies A0195129 Middlesex Insurance Company 05/13/2024 f114159b-3908-473c-a82c-8bf26cc22209 Page 1 of 3CM 00 01 09 04 © ISO Properties, Inc., 2003 COMMERCIAL INLAND MARINE CONDITIONS COMMERCIAL INLAND MARINE CM 00 01 09 04 The following conditions apply in addition to the Common Policy Conditions and applicable Additional Conditions in Commercial Inland Marine Coverage Forms: LOSS CONDITIONS A.Abandonment There can be no abandonment of any property to us. B.Appraisal If we and you disagree on the value of the prop- erty or the amount of loss, either may make writ- ten demand for an appraisal of the loss. In this event, each party will select a competent and im- partial appraiser. The two appraisers will select an umpire. If they cannot agree, either may request that selection be made by a judge of a court hav- ing jurisdiction. The appraisers will state sepa- rately the value of the property and amount of loss. If they fail to agree, they will submit their dif- ferences to the umpire. A decision agreed to by any two will be binding. Each party will: 1.Pay its chosen appraiser; and 2.Bear the other expenses of the appraisal and umpire equally. If there is an appraisal, we will still retain our right to deny the claim. C.Duties In The Event Of Loss You must see that the following are done in the event of loss or damage to Covered Property: 1.Notify the police if a law may have been bro- ken. 2.Give us prompt notice of the loss or damage. Include a description of the property involved. 3.As soon as possible, give us a description of how, when and where the loss or damage oc- curred. 4.Take all reasonable steps to protect the Cov- ered Property from further damage, and keep a record of your expenses necessary to pro- tect the Covered Property, for consideration in the settlement of the claim. This will not in- crease the Limit of Insurance. However, we will not pay for any subsequent loss or damage re- sulting from a cause of loss that is not a Cov- ered Cause of Loss. Also, if feasible, set the damaged property aside and in the best possi- ble order for examination. 5.You will not, except at your own cost, volun- tarily make a payment, assume any obligation, or incur any expense without our consent. 6.As often as may be reasonably required, per- mit us to inspect the property proving the loss or damage and examine your books and re- cords. Also permit us to take samples of damaged and undamaged property for inspection, test- ing and analysis, and permit us to make copies from your books and records. 7.We may examine any insured under oath, while not in the presence of any other insured and at such times as may be reasonably re- quired, about any matter relating to this insur- ance or the claim, including an insured©s books and records. In the event of an exami- nation, an insured©s answers must be signed. 8.Send us a signed, sworn proof of loss contain- ing the information we request to settle the claim. You must do this within 60 days after our request. We will supply you with the nec- essary forms. 9.Immediately send us copies of any demands, notices, summonses or legal papers received in connection with the claim or suit. 10.Cooperate with us in the investigation or set- tlement of the claim. D.Insurance Under Two Or More Coverages If two or more of this policy©s coverages apply to the same loss or damage, we will not pay more than the actual amount of the loss or damage. E.Loss Payment 1.We will give notice of our intentions within 30 days after we receive the sworn proof of loss. 2.We will not pay you more than your financial interest in the Covered Property. 3.We may adjust losses with the owners of lost or damaged property if other than you. If we pay the owners, such payments will satisfy your claim against us for the owners© property. We will not pay the owners more than their fi- nancial interest in the Covered Property. 4.We may elect to defend you against suits aris- ing from claims of owners of property. We will do this at our expense. A0195129 Middlesex Insurance Company 05/13/2024 f114159b-3908-473c-a82c-8bf26cc22209 © ISO Properties, Inc., 2003 5.We will pay for covered loss or damage within 30 days after we receive the sworn proof of loss if you have complied with all the terms of this Coverage Part and: a.We have reached agreement with you on the amount of the loss; or b.An appraisal award has been made. 6.We will not be liable for any part of a loss that has been paid or made good by others. F.Other Insurance 1.You may have other insurance subject to the same plan, terms, conditions and provisions as the insurance under this Coverage Part. If you do, we will pay our share of the covered loss or damage. Our share is the proportion that the applicable Limit of Insurance under this Coverage Part bears to the Limits of Insur- ance of all insurance covering on the same ba- sis. 2.If there is other insurance covering the same loss or damage, other than that described in 1. above, we will pay only for the amount of cov- ered loss or damage in excess of the amount due from that other insurance, whether you can collect on it or not. But we will not pay more than the applicable Limit of Insurance. G.Pair, Sets Or Parts 1.Pair Or Set In case of loss or damage to any part of a pair or set we may: a.Repair or replace any part to restore the pair or set to its value before the loss or damage; or b.Pay the difference between the value of the pair or set before and after the loss or dam- age. 2.Parts In case of loss or damage to any part of Cov- ered Property consisting of several parts when complete, we will only pay for the value of the lost or damaged part. H.Recovered Property If either you or we recover any property after loss settlement, that party must give the other prompt notice. At your option, the property will be re- turned to you. You must then return to us the amount we paid to you for the property. We will pay recovery expenses and the expenses to re- pair the recovered property, subject to the Limit of Insurance. I.Reinstatement Of Limit After Loss The Limit of Insurance will not be reduced by the payment of any claim, except for total loss or damage of a scheduled item, in which event we will refund the unearned premium on that item. J.Transfer Of Rights Of Recovery Against Others To Us If any person or organization to or for whom we make payment under this Coverage Part has rights to recover damages from another, those rights are transferred to us to the extent of our payment. That person or organization must do everything necessary to secure our rights and must do nothing after loss to impair them. But you may waive your rights against another party in writing: 1.Prior to a loss to your Covered Property. 2.After a loss to your Covered Property only if, at time of loss, that party is one of the following: a.Someone insured by this insurance; or b.A business firm: (1)Owned or controlled by you; or (2)That owns or controls you. This will not restrict your insurance. GENERAL CONDITIONS A.Concealment, Misrepresentation Or Fraud This Coverage Part is void in any case of fraud, in- tentional concealment or misrepresentation of a material fact, by you or any other insured, at any time, concerning: 1.This Coverage Part; 2.The Covered Property; 3.Your interest in the Covered Property; or 4.A claim under this Coverage Part. B.Control Of Property Any act or neglect of any person other than you beyond your direction or control will not affect this insurance. The breach of any condition of this Coverage Part at any one or more locations will not affect cover- age at any location where, at the time of loss or damage, the breach of condition does not exist. C.Legal Action Against Us No one may bring a legal action against us under this Coverage Part unless: 1.There has been full compliance with all the terms of this Coverage Part; and 2.The action is brought within 2 years after you first have knowledge of the direct loss or dam- age. CM 00 01 09 04Page 2 of 3 A0195129 Middlesex Insurance Company 05/13/2024 f114159b-3908-473c-a82c-8bf26cc22209 CM 00 01 09 04 © ISO Properties, Inc., 2003 D.No Benefit To Bailee No person or organization, other than you, having custody of Covered Property will benefit from this insurance. E.Policy Period, Coverage Territory We cover loss or damage commencing: 1.During the policy period shown in the Declara- tions; and 2.Within the coverage territory. F.Valuation The value of property will be the least of the fol- lowing amounts: 1.The actual cash value of that property; 2.The cost of reasonably restoring that property to its condition immediately before loss or damage; or 3.The cost of replacing that property with sub- stantially identical property. In the event of loss or damage, the value of prop- erty will be determined as of the time of loss or damage. Page 3 of 3 A0195129 Middlesex Insurance Company 05/13/2024 b97d2120-d4de-48fd-aa48-96fa22f318f1 COMMERCIAL INLAND MARINE CM 70 13 03 97 LIBERALIZATION This endorsement modifies insurance provided under the following: COMMERCIAL INLAND MARINE CONDITIONS The following general condition is added: If we adopt any revision that would broaden the coverage under this coverage part without additional premium within 45 days prior to or during the policy period, the Broadened Coverage will apply immediately to this coverage part. Page 1 of 1CM 70 13 03 97 A0195129 Middlesex Insurance Company 05/13/2024 1b577d45-9cd2-4a25-8e98-903bc68e01b9 COMMERCIAL INLAND MARINE CM 71 44 04 15 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY NUMBER: CONTRACTORS EQUIPMENT COVERAGE ENHANCEMENT FORM This endorsement modifies insurance provided under the following: CONTRACTORS EQUIPMENT COVERAGE FORM 1.Paragraph A. Coverage 1. Covered Property is deleted and replaced with the following: Covered Property, as used in this Coverage Form, means the following property: a.Your contractor's equipment described in the Declarations; and b.Similar property of others in your care, custody or control described in the Declarations; and c.Contractor's equipment with an actual cash value for any single item less than $100,000 and not specifically described in the Declarations that you rent or lease from others. 2.Paragraph A. Coverage 2. Property Not Covered d. is deleted and replaced by the following: d.Property while waterborne, except while in the care, custody or control of a carrier for hire. 3.Paragraph A. Coverage 2. Property Not Covered h. is deleted and replaced by the following: h.Tools and clothing belonging to your employees that is not specifically described in the Declarations. 4.In Paragraph 4. Additional Coverages a. Additionally Acquired property (2) the amount of $50,000 is increased to $100,000. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1CM 71 44 04 15 A0195129 Middlesex Insurance Company 05/13/2024 9656e3e0-a92b-483b-93ae-ac69720a2d72 COMMERCIAL INLAND MARINE CM 88 26 10 12 TOOLS COVERAGE FORM Various provisions in this policy restrict coverage. Read the entire policy carefully to determine rights, duties, and what is and is not covered. Throughout this policy, the words "you" and "your" refer to the Named Insured shown in the Declarations. The words "we", "us" and "our" refer to the Company providing this insurance. Words and phrases that appear in quotation marks have special meaning. Refer to Section F. - Definitions. A.Coverage We will pay for direct physical loss of or damage to Covered Property from any of the Covered Causes of Loss. 1.Covered Property, as used in this Coverage Form, means the following types of property for which a limit is shown in the Declarations: a.Tools you own while away from your premises. b.Tools that are owned and used by your employees at your premises or in the operation of your business. 2.Property Not Covered Covered Property does not include: a.Contraband or property in the course of illegal transportation or trade. b.Tools or equipment that you lease or rent to others. 3.Covered Causes of Loss Covered Causes of Loss means direct physical loss or damage to Covered Property except those causes of loss listed in the Exclusions. 4.Additional Coverage - Collapse The coverage provided under this Additional Coverage - Collapse applies only to an abrupt collapse as described and limited in Paragraphs a. through c. a.For the purpose of this Additional Coverage - Collapse, abrupt collapse means an abrupt falling down or caving in of a building or any part of a building with the result that the building or part of the building cannot be occupied for its intended purpose. b.We will pay for direct physical loss or damage to Covered Property, caused by abrupt collapse of a building or any part of a building that contains Covered Property insured under this Coverage Form, if such collapse is caused by one or more of the following: (1)Building decay that is hidden from view, unless the presence of such decay is known to an insured prior to collapse; (2)Insect or vermin damage that is hidden from view, unless the presence of such damage is known to an insured prior to collapse; (3)Use of defective material or methods in construction, remodeling or renovation if the abrupt collapse occurs during the course of the construction, remodeling or renovation. (4)Use of defective material or methods in construction, remodeling or renovation if the abrupt collapse occurs after the construction, remodeling or renovation is complete, but only if the collapse is caused in part by: (a)A cause of loss listed in Paragraph (1) or (2); (b)One or more of the following causes of loss: Fire; lightning; windstorm; hail; explosion; smoke; aircraft; vehicles; riot; civil commotion; vandalism; leakage from fire extinguishing equipment; sinkhole collapse; volcanic action; breakage of building glass; falling objects; weight of snow, ice or sleet; water damage; all only as insured against in this Coverage Form; (c)Weight of people or personal property; or (d)Weight of rain that collects on a roof. c.This Additional Coverage - Collapse will not increase the Limits of Insurance provided in this Coverage Form. Contains copyrighted material of ISO Properties, Inc., with its permission.Page 1 of 5CM 88 26 10 12 A0195129 Middlesex Insurance Company 05/13/2024 9656e3e0-a92b-483b-93ae-ac69720a2d72 5.Coverage Extensions a.Debris Removal (1)Subject to Paragraphs (2), (3) and (4), we will pay your expenses to remove debris of Covered Property and other debris that is on the described building, when such debris is caused by or results from a Covered Cause of Loss that occurs during the policy period. The expenses will be paid only if they are reported to us in writing within 180 days of the date of direct physical loss or damage. (2)Debris Removal does not apply to costs to: (a)Remove debris of property of yours that is not insured under this policy, or property in your possession that is not Covered Property; (b)Remove debris of property owned by or leased to the landlord of the building where your described buildings are located, unless you have a contractual responsibility to insure such property and it is insured under this policy; (c)Remove any property that is Property Not Covered; (d)Remove property of others of a type that would not be Covered Property under this Coverage Form; (e)Remove deposits of mud or earth from the grounds of the described building; (f)Extract "pollutants" from land or water; or (g)Remove, restore or replace polluted land or water. (3)Subject to the exceptions in Paragraph (4), the following provisions apply: (a)The most we will pay for the total of direct physical loss or damage plus debris removal expense is the Limit of Insurance applicable to the Covered Property that has sustained loss or damage. (b)Subject to (a) above, the amount we will pay for debris removal expense is limited to 25% of the sum of the deductible plus the amount that we pay for direct physical loss or damage to the Covered Property that has sustained loss or damage. However, if no Covered Property has sustained direct physical loss or damage, the most we will pay for removal of debris of other property (if such removal is covered under this Additional Coverage) is $5,000 at each location. (4)We will pay up to an additional $25,000 for debris removal expense, for each location, in any one occurrence of physical loss or damage to Covered Property, if one or both of the following circumstances apply: (a)The total of the actual debris removal expense plus the amount we pay for direct physical loss or damage exceeds the Limit of Insurance on the Covered Property that has sustained loss or damage. (b)The actual debris removal expense exceeds 25% of the sum of the deductible plus the amount that we pay for direct physical loss or damage to the Covered Property that has sustained loss or damage. Therefore, if (4)(a) and/or (4)(b) applies, our total payment for direct physical loss or damage and debris removal expense may reach but will never exceed the Limit of Insurance on the Covered Property that has sustained loss or damage, plus $25,000. (5)Examples Example #1 Limit of Insurance $90,000 Amount of Deductible $ 500 Amount of Loss $50,000 Amount of Loss Payable $49,500 ($50,000 - $500) Debris Removal Expense $10,000 Debris Removal Expense Payable $10,000 ($10,000 is 20% of $50,000) Contains copyrighted material of ISO Properties, Inc., with its permission.CM 88 26 10 12Page 2 of 5 A0195129 Middlesex Insurance Company 05/13/2024 9656e3e0-a92b-483b-93ae-ac69720a2d72 The debris removal expense is less than 25% of the sum of the loss payable plus the deductible. The sum of the loss payable and the debris removal expense ($49,500 + $10,000 = $59,500) is less than the Limit of Insurance. Therefore the full amount of debris removal expense is payable in accordance with the terms of Paragraph (3). Example #2 Limit of Insurance $90,000 Amount of Deductible $ 500 Amount of Loss $80,000 Amount of Loss Payable $79,500 ($80,000 - $500) Debris Removal Expense $40,000 Debris Removal Expense Payable Basic Amount $10,500 Additional Amount $25,000 The basic amount payable for debris removal expense under the terms of Paragraph (3) is calculated as follows: $80,000 ($79,500 + $500) x .25 = $20,000; capped at $10,500. The cap applies because the sum of the loss payable ($79,500) and the basic amount payable for debris removal expense ($10,500) cannot exceed the Limit of Insurance ($90,000). The additional amount payable for debris removal expense is provided in accordance with the terms of Paragraph (4), because the debris removal expense ($40,000) exceeds 25% of the loss payable plus the deductible ($40,000 is 50% of $80,000), and because the sum of the loss payable and debris removal expense ($79,500 + $40,000 = $119,500) would exceed the Limit of Insurance ($90,000). The additional amount of covered debris removal expense is $25,000, the maximum amount payable under Paragraph (4). Thus the total payment for debris removal expense in this example is $30,500; $4,500 of the debris removal expense is not covered. b.Pollutant Clean Up and Removal We will pay your expenses to extract "pollutants" from land or water if the discharge, dispersal, seepage, migration, release or escape of the pollutants is caused by or results from a Covered Cause of Loss that occurs during the policy period. The expenses will be paid only if they are reported to us in writing within 180 days of the date on which the Covered Cause of Loss occurs. This Coverage Extension does not apply to costs to test for, monitor or assess the existence, concentration or effects of "pollutants". But we will pay for testing which is performed in the course of extracting the "pollutants" from the land or water. The most we will pay under this Coverage Extension is $10,000 for the sum of all covered expenses arising out of Covered Causes of Loss occurring during each 12 month period of this policy. The limit for this Coverage Extension is in addition to the Limit of Insurance. c.Theft Damage to Buildings (1)We will pay for damage caused directly by theft or attempted theft to: (a)That part of any building containing Covered Property; or (b)Equipment within the building used to maintain or service the building; only if you own the building or are legally responsible for the damage. (2)But, we will not pay for damage: (a)Caused by fire; or (b)To glass or to lettering or art work on glass. This Coverage Extension is included within the Limit of Insurance applicable to the Covered Property at the building where the damage occurs. B.Exclusions 1.We will not pay for loss or damage caused directly or indirectly by any of the following. Such loss or damage is excluded regardless of any other cause or event that contributes concurrently or in any sequence to the loss. Contains copyrighted material of ISO Properties, Inc., with its permission. Page 3 of 5CM 88 26 10 12 A0195129 Middlesex Insurance Company 05/13/2024 9656e3e0-a92b-483b-93ae-ac69720a2d72 a.Governmental Action Seizure or destruction of property by order of governmental authority. But we will pay for acts of destruction ordered by governmental authority and taken at the time of a fire to prevent its spread if the fire would be covered under this Coverage Form. b.Nuclear Hazard Nuclear reaction or radiation, or radioactive contamination, however caused. But if nuclear reaction or radiation, or radioactive contamination results in fire, we will pay for the direct loss or damage caused by that fire if the fire would be covered under this Coverage Form. c.War and Military Action (1)War, including undeclared or civil war; (2)Warlike action by a military force, including action in hindering or defending against an actual or expected attack, by any government, sovereign, or other authority using military personnel or other agents; or (3)Insurrection, rebellion, revolution, usurped power, or action taken by governmental authority in hindering or defending against any of these. Exclusions B.1.a. through B.1.c. apply whether or not the loss event results in widespread damage or affects a substantial area. 2.We will not pay for a loss or damage caused by or resulting from any of the following: a.Delay, loss of use, loss of market or any other consequential loss. b.Unexplained disappearance. c.Shortage found upon taking inventory. d.Dishonest or criminal act committed by: (1)You, any of your partners, employees directors, trustees, or authorized representatives; (2)A manager or a member if you are a limited liability company; (3)Anyone else with an interest in the property, or their employees or authorized representatives; or (4)Anyone else to whom the property is entrusted for any purpose. This exclusion applies whether or not such persons are acting alone or in collusion with other persons or such acts occur during the hours of employment. This exclusion does not apply to Covered Property that is entrusted to others who are carriers for hire or to acts of destruction by your employees. But theft by employees is not covered. e.Processing or work upon the property. But if processing or work upon the property results in fire or explosion, we will pay for the direct loss or damage caused by that fire or explosion, if the fire or explosion would be covered under this Coverage Form. f.Artificially generated electrical, magnetic or electromagnetic energy that damages, disturbs, disrupts or otherwise interferes with any: (1)Electrical or electronic wire, device, appliance, system or network; or (2)Device, appliance, system or network utilizing cellular or satellite technology; creating a short circuit or other electric disturbance within an article covered under this Coverage Form. For the purpose of this exclusion, electrical, magnetic or electromagnetic energy includes, but is not limited to, electrical current, including arcing; electrical charge produced or conducted by a magnetic or electromagnetic field; pulse of electromagnetic energy; electromagnetic waves or microwaves. But if artificially generated electrical, magnetic, or electromagnetic energy, as described above, results in fire or explosion, we will pay for the direct loss or damage caused by that fire or explosion, if the fire or explosion would be covered under this Coverage Form. This exclusion only applies to loss or damage to that article in which the disturbance occurs. g.Voluntary parting with any property by you or anyone entrusted with the property if induced to do so by any fraudulent scheme, trick, device, or false pretense. h.Unauthorized instructions to transfer property to any person or to any place. i.Neglect of an insured to use all reasonable means to save and preserve property from further damage at and after the time of loss. 3.We will not pay for loss or damage caused by or resulting from any of the following. But if loss or damage by a Covered Cause of Loss results, we will pay for the loss or damage caused by that Covered Cause of Loss. Contains copyrighted material of ISO Properties, Inc., with its permission.CM 88 26 10 12Page 4 of 5 A0195129 Middlesex Insurance Company 05/13/2024 9656e3e0-a92b-483b-93ae-ac69720a2d72 a.Weather conditions but this exclusion only applies if weather conditions contribute in any way with a cause or event excluded in Paragraph 1. above to produce the loss or damage. b.Acts or decisions, including the failure to act or decide, of any person, group, organization or governmental body. c.Faulty, inadequate or defective: (1)Planning, zoning, development, surveying, siting; (2)Design, specifications, workmanship, repair, construction, renovation, remodeling, grading, compaction; (3)Materials used in repair, construction, renovation or remodeling; or (4)Maintenance; of part or all of any property wherever located. d.Collapse including any of the following conditions of property or any part of the property: (1)An abrupt falling down or caving in; (2)Loss of structural integrity, including separation of parts of the property or property in danger of falling down or caving in; or (3)Any cracking, bulging, sagging, bending, leaning, settling, shrinking, or expansion as such condition relates to Paragraph (1) or (2). This Exclusion, d., does not apply to the extent that coverage is provided under the Additional Coverage - Collapse or to collapse caused by one or more of the following: Fire; lightning; windstorm; hail; explosion; smoke; aircraft; vehicles; riot; civil commotion; vandalism; leakage from fire extinguishing equipment; sinkhole collapse; volcanic action; breakage of building glass; falling objects; weight of snow, ice or sleet; water damage; weight of people or personal property; weight of rain that collects on a roof. e.Wear and tear, any quality in the property that causes it to damage or destroy itself, hidden or latent defect, gradual deterioration, depreciation; mechanical breakdown; insects, vermin, rodents; corrosion, rust, dampness, cold, or heat. C.Limits of Insurance The most we will pay for loss or damage in any one occurrence is the applicable Limit of Insurance shown in the Declarations. D.Deductible We will not pay for loss or damage in any one occurrence until the amount of the adjusted loss or damage before applying the applicable Limits of Insurance exceeds the Deductible shown in the Declarations. We will then pay the amount of the adjusted loss or damage in excess of the Deductible, up to the applicable Limit of Insurance. E.Additional Conditions The following conditions apply in addition to the Commercial Inland Marine Conditions and the Common Policy Conditions. Coverage Territory We will cover property wherever located within: 1.The United States of America (including its territories and possessions); 2.Puerto Rico; and 3.Canada. F.Definitions "Pollutants" means any solid, liquid, gaseous or thermal irritant or contaminant, including smoke, vapor, soot, fumes, acids, alkalis, chemicals and waste. Waste includes materials to be recycled, reconditioned or reclaimed. G.Optional Coverage The following optional coverage will apply only if an entry is shown in the Declarations. Replacement Cost General Condition F., Valuation, in the Commercial Inland Marine Conditions is replaced by the following: 1.The most we will pay for loss or damage to Covered Property shall not exceed the smallest of the following: a.The applicable Limit of Insurance; b.The cost to replace the property at the time of loss or damage without deduction for depreciation; or c.The cost to repair at the time of loss or damage. 2.We will not pay on a replacement cost basis for any loss or damage: a.Until you repair or replace the lost or damaged property. b.The repairs or replacement are made as soon as reasonably possible after the loss or damage. 3.You may make a claim for the loss or damage covered by this insurance on an actual cash value basis if you decide not to repair or replace the damaged property. You may still make a claim for the replacement cost if you elect, within 180 days after the loss or damage, to repair or replace the damaged property. Contains copyrighted material of ISO Properties, Inc., with its permission.Page 5 of 5CM 88 26 10 12 Page 1 of 4IH 00 68 12 13 05/13/2024A0195129 Middlesex Insurance Company COMMERCIAL INLAND MARINE IH 00 68 12 13 CONTRACTORS EQUIPMENT COVERAGE FORM Various provisions in this Policy restrict coverage. Read the entire policy carefully to determine rights, duties and what is and is not covered. Throughout this Policy, the words "you" and "your" refer to the Named Insured shown in the Declarations. The words "we", "us" and "our" refer to the Company providing this insurance. Other words and phrases that appear in quotation marks have special meaning. Refer to Section F. Definitions. A.Coverage We will pay for direct physical loss of or damage to Covered Property from any of the Covered Causes of Loss. 1.Covered Property Covered Property, as used in this Coverage Form, means the following property described in the Declarations: a.Your contractor's equipment; and b.Similar property of others in your care, custody or control. 2.Property Not Covered Covered Property does not include: a.Automobiles, motor trucks, trailers or other vehicles licensed for use on public roads; b.Aircraft or watercraft; c.Plans, blueprints, designs or specifications; d.Property while waterborne, except while on ferries operating on the navigable waters of the Continental United States and Canada (other than to or from Alaska); e.Property while underground or under water; f.Property that you loan, lease or rent to others; g.Contraband, or property in the course of illegal transportation or trade; or h.Tools and clothing belonging to your employees. 3.Covered Causes Of Loss Covered Causes of Loss means Direct Physical Loss Or Damage to Covered Property except those causes of loss listed in the Exclusions. 4.Additional Coverages a. Additionally Acquired Property If during the policy period you acquire additional property of a type already covered by this Coverage Form, we will cover such equipment for up to 60 days, but not beyond the end of the policy period. The most we will pay for loss or damage is the lesser of: (1)25% of the total Limit Of Insurance shown in the Declarations for all scheduled equipment; or (2)$50,000. You will report values of such property to us within 60 days from the date you take possession and will pay any additional premium due. If you do not report such property, coverage will cease automatically 60 days after the date the property is acquired or at the end of the policy period, whichever occurs first. The Coinsurance Additional Condition does not apply to this coverage. This Additional Coverage does not increase the applicable Limit Of Insurance shown in the Declarations. b.Debris Removal (1)We will pay your expenses to remove debris of Covered Property caused by or resulting from a Covered Cause of Loss that occurs during the policy period. The expenses will be paid only if they are reported to us in writing within 180 days of the date of direct physical loss or damage. (2)The most we will pay under this Additional Coverage is 25% of: (a)The amount we pay for the direct physical loss or damage to Covered Property; plus (b)The deductible in this Policy applicable to that loss or damage. © Insurance Services Office, Inc., 2013 00002 0000000000 24134 0 N1 5323ab54-3adc-4913-a2df-3bb8eeeb8b995323ab54-3adc-4913-a2df-3bb8eeeb8b99 (3)Payment under this Additional Coverage will not increase the applicable Limit of Insurance, but if: (a)The sum of direct physical loss or damage and debris removal expense exceeds the Limit of Insurance; or (b)The debris removal expense exceeds the amount payable under the 25% limitation; we will pay up to an additional $5,000 in any one occurrence under this Additional Coverage. (4)This Additional Coverage does not apply to costs to: (a)Extract "pollutants" from land or water; or (b)Remove, restore or replace polluted land or water. c.Preservation Of Property If it is necessary to move Covered Property to preserve it from loss or damage by a Covered Cause of Loss, we will pay for any direct physical loss or damage to that property: (1)While it is being moved or while temporarily stored at another location; and (2)Only if the loss or damage occurs within 30 days after the property is first moved. This Additional Coverage does not increase the Limit of Insurance. d.Pollutant Cleanup And Removal We will pay your expense to extract "pollutants" from land or water if the discharge, dispersal, seepage, migration, release or escape of the "pollutants" is caused by or results from a Covered Cause of Loss that occurs during the policy period. The expenses will be paid only if they are reported to us in writing within 180 days of the date on which the Covered Cause of Loss occurs. This Additional Coverage does not apply to costs to test for, monitor or assess the existence, concentration or effects of "pollutants". But we will pay for testing which is performed in the course of extracting the "pollutants" from the land or water. The most we will pay under this Additional Coverage is $10,000 for the sum of all covered expenses arising out of Covered Causes of Loss occurring during each separate 12-month period of this Policy. The limit for this Additional Coverage is in addition to the Limit of Insurance. B.Exclusions 1.We will not pay for loss or damage caused directly or indirectly by any of the following. Such loss or damage is excluded regardless of any other cause or event that contributes concurrently or in any sequence to the loss or damage. a.Governmental Action Seizure or destruction of property by order of governmental authority. But we will pay for loss or damage caused by or resulting from acts of destruction ordered by governmental authority and taken at the time of a fire to prevent its spread if the fire would be covered under this Coverage Form. b.Nuclear Hazard Nuclear reaction or radiation, or radioactive contamination, however caused. But if nuclear reaction or radiation, or radioactive contamination results in fire, we will pay for the direct loss or damage caused by that fire if the fire would be covered under this Coverage Form. c.War And Military Action (1)War, including undeclared or civil war; (2)Warlike action by a military force, including action in hindering or defending against an actual or expected attack, by any government, sovereign or other authority using military personnel or other agents; or (3)Insurrection, rebellion, revolution, usurped power, or action taken by governmental authority in hindering or defending against any of these. Exclusions B.1.a. through B.1.c. apply whether or not the loss event results in widespread damage or affects a substantial area. © Insurance Services Office, Inc., 2013 IH 00 68 12 13Page 2 of 4 05/13/2024A0195129 Middlesex Insurance Company 2.We will not pay for loss or damage caused by or resulting from any of the following: a.Delay, loss of use, loss of market or any other consequential loss. b.Dishonest or criminal act (including theft) committed by: (1)You, any of your partners, employees (including temporary employees and leased workers), officers, directors, trustees, or authorized representatives; (2)A manager or a member if you are a limited liability company; or (3)Anyone else with an interest in the property, or their employees (including temporary employees and leased workers) or authorized representatives; whether acting alone or in collusion with each other or with any other party. This exclusion applies whether or not an act occurs during your normal hours of operation. This exclusion does not apply to acts of destruction by your employees (including temporary employees and leased workers) or authorized representatives; but theft by your employees (including temporary employees and leased workers) or authorized representatives is not covered. c.Work upon the property. But if work upon the property results in fire or explosion, we will pay for direct loss or damage caused by that fire or explosion if the fire or explosion would be covered under this Coverage Form. d.Artificially generated electrical, magnetic or electromagnetic energy that damages, disturbs, disrupts or otherwise interferes with any: (1)Electrical or electronic wire, device, appliance, system or network; or (2)Device, appliance, system or network utilizing cellular or satellite technology; creating a short circuit or other electric disturbance within an article covered under this Coverage Form. For the purpose of this exclusion, electrical, magnetic or electromagnetic energy includes, but is not limited to, electrical current, including arcing; electrical charge produced or conducted by a magnetic or electromagnetic field; pulse of electromagnetic energy; electromagnetic waves or microwaves. But if artificially generated electrical, magnetic or electromagnetic energy, as described above, results in fire or explosion, we will pay for the direct loss or damage caused by that fire or explosion if the fire or explosion would be covered under this Coverage Form. This exclusion only applies to loss or damage to that article in which the disturbance occurs. e.Voluntary parting with any property by you or anyone entrusted with the property if induced to do so by any fraudulent scheme, trick, device or false pretense. f.Unauthorized instructions to transfer property to any person or to any place. g.Neglect of an insured to use all reasonable means to save and preserve property from further damage at and after the time of loss. h.Theft by any person (except carriers for hire) to whom you entrust the property for any purpose, whether acting alone or in collusion with any other party. This exclusion applies whether or not an act occurs during your normal hours of operation. 3.We will not pay for loss or damage caused by or resulting from any of the following. But if loss or damage by a Covered Cause of Loss results, we will pay for the loss or damage caused by that Covered Cause of Loss. a.Wear and tear, depreciation. b.Any quality in the property that causes it to damage or destroy itself, hidden or latent defect, gradual deterioration. c.Insects, vermin, rodents. d.Corrosion, rust. e.Mechanical breakdown or failure of the Covered Property. © Insurance Services Office, Inc., 2013 Page 3 of 4IH 00 68 12 13 05/13/2024A0195129 Middlesex Insurance Company 00002 0000000000 24134 0 N3 5323ab54-3adc-4913-a2df-3bb8eeeb8b995323ab54-3adc-4913-a2df-3bb8eeeb8b99 C.Limits Of Insurance The most we will pay for loss or damage in any one occurrence is the applicable Limit Of Insurance shown in the Declarations. D.Deductible We will not pay for loss or damage in any one occurrence until the amount of the adjusted loss or damage before applying the applicable Limits of Insurance exceeds the Deductible shown in the Declarations. We will then pay the amount of the adjusted loss or damage in excess of the Deductible, up to the applicable Limit of Insurance. E.Additional Conditions The following conditions apply in addition to the Commercial Inland Marine Conditions and the Common Policy Conditions: 1.Coverage Territory a.We cover property wherever located within: (1)The United States of America (including its territories and possessions); (2)Puerto Rico; and (3)Canada. b.We also cover property being shipped by air within and between points in Paragraph a. 2.Coinsurance If a Coinsurance percentage is shown in the Declarations, the following condition applies: We will not pay the full amount of any loss or damage if the value of an item of Covered Property at the time of loss or damage times the Coinsurance percentage is greater than the Limit of Insurance for the item. Instead, we will determine the most we will pay using the following steps: a.Multiply the value of the item of Covered Property at the time of loss or damage by the Coinsurance percentage; b.Divide the Limit of Insurance of the property by the figure determined in Step a.; c.Multiply the total amount of loss or damage, before the application of any deductible, by the figure determined in Step b.; and d.Subtract the deductible from the figure determined in Step c. We will pay the amount determined in Step d. or the Limit of Insurance, whichever is less. For the remainder, you will either have to rely on other insurance or absorb the loss yourself. This provision does not apply to blanket property or rented equipment. F.Definitions "Pollutants" means any solid, liquid, gaseous or thermal irritant or contaminant, including smoke, vapor, soot, fumes, acids, alkalis, chemicals and waste. Waste includes materials to be recycled, reconditioned or reclaimed. © Insurance Services Office, Inc., 2013 IH 00 68 12 13Page 4 of 4 05/13/2024A0195129 Middlesex Insurance Company IL 01 02 05 05 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALIFORNIA CHANGES - ACTUAL CASH VALUE IL 01 02 05 05 © ISO Properties, Inc., 2005 This endorsement modifies insurance provided under the following: CAPITAL ASSETS PROGRAM (OUTPUT POLICY) COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL PROPERTY COVERAGE PART FARM COVERAGE PART STANDARD PROPERTY POLICY With respect to an "open policy", the following are added to any provision which uses the term actual cash value: A.In the event of a total loss to a building or structure, actual cash value is calculated as the lesser of the following: 1.The Limit of Insurance applicable to that building or structure; or 2.The fair market value of the building or structure. B.In the event of a partial loss to a building or structure, actual cash value is calculated as the lesser of the following: 1.The amount it would cost to repair, rebuild or replace the property less a fair and reasonable deduction for physical depreciation of the components of the building or structure that are normally subject to repair or replacement during its useful life. Physical depreciation is based upon the condition of the property at the time of the loss; or 2.The Limit of Insurance applicable to the property. C.In the event of a partial or total loss to Covered Property other than a building or structure, actual cash value is calculated as the lesser of the following: 1.The amount it would cost to repair or replace the property less a fair and reasonable deduction for physical depreciation, based on the condition of the property at the time of loss; or 2.The Limit of Insurance applicable to the property. D.An "open policy" is a policy under which the value of Covered Property is not fixed at policy inception, but is determined at the time of loss in accordance with policy provisions on valuation. The term "open policy" does not apply to Covered Property that is subject to an Agreed Value clause or similar clause that establishes an agreed value prior to loss, unless such clause has expired. Page 1 of 1 05/13/2024A0195129 Middlesex Insurance Company 00001 0000000000 24134 0 N1 e033c0ba-3ac5-4652-bb2e-cc89ceef63dce033c0ba-3ac5-4652-bb2e-cc89ceef63dc IL 01 04 09 07 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALIFORNIA CHANGES IL 01 04 09 07 © ISO Properties, Inc., 2006 This endorsement modifies insurance provided under the following: COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL PROPERTY COVERAGE PART EQUIPMENT BREAKDOWN COVERAGE PART FARM COVERAGE PART - FARM PROPERTY - OTHER FARM PROVISIONS FORM - ADDITIONAL COVERAGES, CONDITIONS, DEFINITIONS FARM COVERAGE PART - LIVESTOCK COVERAGE FORM FARM COVERAGE PART - MOBILE AGRICULTURAL MACHINERY AND EQUIPMENT COVERAGE FORM STANDARD PROPERTY POLICY A.When this endorsement is attached to the Standard Property Policy CP 00 99 the term Coverage Part in this endorsement is replaced by the term Policy. B.The Concealment, Misrepresentation Or Fraud Condition is replaced by the following with respect to loss ("loss") or damage caused by fire: We do not provide coverage to the insured ("insured") who, whether before or after a loss ("loss"), has committed fraud or intentionally concealed or misrepresented any material fact or circumstance concerning: 1.This Coverage Part; 2.The Covered Property; 3.That insured's ("insured's") interest in the Covered Property; or 4.A claim under this Coverage Part or Coverage Form. C.The Concealment, Misrepresentation Or Fraud Condition is replaced by the following with respect to loss ("loss") or damage caused by a Covered Cause of Loss other than fire: This Coverage Part is void if any insured ("insured"), whether before or after a loss ("loss"), has committed fraud or intentionally concealed or misrepresented any material fact or circumstance concerning: 1.This Coverage Part; 2.The Covered Property; 3.An insured's ("insured's") interest in the Covered Property; or 4.A claim under this Coverage Part or Coverage Form. D.Except as provided in E., the Appraisal Condition is replaced by the following: If we and you disagree on the value of the property or the amount of loss ("loss"), either may make written request for an appraisal of the loss ("loss"). If the request is accepted, each party will select a competent and impartial appraiser. Each party shall notify the other of the appraiser selected within 20 days of the request. The two appraisers will select an umpire. If they cannot agree within 15 days, either may request that selection be made by a judge of a court having jurisdiction. The appraisers will state separately the value of the property and amount of loss ("loss"). If they fail to agree, they will submit their differences to the umpire. A decision agreed to by any two will be binding. Each party will: 1.Pay its chosen appraiser; and 2.Bear the other expenses of the appraisal and umpire equally. If there is an appraisal, we will still retain our right to deny the claim. E.The Appraisal Condition in: 1.Business Income (And Extra Expense) Coverage Form CP 00 30; and 2.Business Income (Without Extra Expense) Coverage Form CP 00 32; Page 1 of 2 05/13/2024A0195129 Middlesex Insurance Company 00001 0000000000 24134 0 N1 ede60d2c-ad30-4600-bb6b-78454ecb61bfede60d2c-ad30-4600-bb6b-78454ecb61bf © ISO Properties, Inc., 2006 IL 01 04 09 07 is replaced by the following: If we and you disagree on the amount of Net Income and operating expense or the amount of loss, either may make written request for an appraisal of the loss. If the request is accepted, each party will select a competent and impartial appraiser. Each party shall notify the other of the appraiser selected within 20 days of the request. The two appraisers will select an umpire. If they cannot agree within 15 days, either may request that selection be made by a judge of a court having jurisdiction. The appraisers will state separately the amount of Net Income and operating expense or amount of loss. If they fail to agree, they will submit their differences to the umpire. A decision agreed to by any two will be binding. Each party will: a.Pay its chosen appraiser; and b.Bear the other expenses of the appraisal and umpire equally. If there is an appraisal, we will still retain our right to deny the claim. Page 2 of 2 05/13/2024A0195129 Middlesex Insurance Company IL 02 70 09 12 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. © Insurance Services Office, Inc., 2012 CALIFORNIA CHANGES - CANCELLATION AND NONRENEWAL This endorsement modifies insurance provided under the following: CAPITAL ASSETS PROGRAM (OUTPUT POLICY) COVERAGE PART COMMERCIAL AUTOMOBILE COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL PROPERTY COVERAGE PART CRIME AND FIDELITY COVERAGE PART EMPLOYMENT-RELATED PRACTICES LIABILITY COVERAGE PART EQUIPMENT BREAKDOWN COVERAGE PART FARM COVERAGE PART LIQUOR LIABILITY COVERAGE PART MEDICAL PROFESSIONAL LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART A.Paragraphs 2. and 3. of the Cancellation Common Policy Condition are replaced by the following: 2.All Policies In Effect For 60 Days Or Less If this policy has been in effect for 60 days or less, and is not a renewal of a policy we have previously issued, we may cancel this policy by mailing or delivering to the first Named Insured, at the mailing address shown in the policy, and to the producer of record, advance written notice of cancellation, stating the reason for cancellation, at least: a.10 days before the effective date of cancellation if we cancel for: (1)Nonpayment of premium; or (2)Discovery of fraud by: (a)Any insured or his or her representative in obtaining this insurance; or (b)You or your representative in pursuing a claim under this policy. b.30 days before the effective date of cancellation if we cancel for any other reason. 3.All Policies In Effect For More Than 60 Days a.If this policy has been in effect for more than 60 days, or is a renewal of a policy we issued, we may cancel this policy only upon the occurrence, after the effective date of the policy, of one or more of the following: (1)Nonpayment of premium, including payment due on a prior policy we issued and due during the current policy term covering the same risks. (2)Discovery of fraud or material misrepresentation by: (a)Any insured or his or her representative in obtaining this insurance; or (b)You or your representative in pursuing a claim under this policy. (3)A judgment by a court or an administrative tribunal that you have violated a California or Federal law, having as one of its necessary elements an act which materially increases any of the risks insured against. Page 1 of 4IL 02 70 09 12 05/13/2024A0195129 Middlesex Insurance Company 00002 0000000000 24134 0 N1 9f593b2e-a8c5-4ab7-a49d-5dd458d5d4fc9f593b2e-a8c5-4ab7-a49d-5dd458d5d4fc © Insurance Services Office, Inc., 2012 (4)Discovery of willful or grossly negligent acts or omissions, or of any violations of state laws or regulations establishing safety standards, by you or your representative, which materially increase any of the risks insured against. (5)Failure by you or your representative to implement reasonable loss control requirements, agreed to by you as a condition of policy issuance, or which were conditions precedent to our use of a particular rate or rating plan, if that failure materially increases any of the risks insured against. (6)A determination by the Commissioner of Insurance that the: (a)Loss of, or changes in, our reinsurance covering all or part of the risk would threaten our financial integrity or solvency; or (b)Continuation of the policy coverage would: (i)Place us in violation of California law or the laws of the state where we are domiciled; or (ii)Threaten our solvency. (7)A change by you or your representative in the activities or property of the commercial or industrial enterprise, which results in a materially added, increased or changed risk, unless the added, increased or changed risk is included in the policy. b.We will mail or deliver advance written notice of cancellation, stating the reason for cancellation, to the first Named Insured, at the mailing address shown in the policy, and to the producer of record, at least: (1)10 days before the effective date of cancellation if we cancel for nonpayment of premium or discovery of fraud; or (2)30 days before the effective date of cancellation if we cancel for any other reason listed in Paragraph 3.a. B.The following provision is added to the Cancellation Common Policy Condition: 7.Residential Property This provision applies to coverage on real property which is used predominantly for residential purposes and consisting of not more than four dwelling units, and to coverage on tenants' household personal property in a residential unit, if such coverage is written under one of the following: Commercial Property Coverage Part Farm Coverage Part - Farm Property - Farm Dwellings, Appurtenant Structures And Household Personal Property Coverage Form a.If such coverage has been in effect for 60 days or less, and is not a renewal of coverage we previously issued, we may cancel this coverage for any reason, except as provided in b. and c. below. b.We may not cancel this policy solely because the first Named Insured has: (1)Accepted an offer of earthquake coverage; or (2)Cancelled or did not renew a policy issued by the California Earthquake Authority (CEA) that included an earthquake policy premium surcharge. However, we shall cancel this policy if the first Named Insured has accepted a new or renewal policy issued by the CEA that includes an earthquake policy premium surcharge but fails to pay the earthquake policy premium surcharge authorized by the CEA. c.We may not cancel such coverage solely because corrosive soil conditions exist on the premises. This restriction (c.) applies only if coverage is subject to one of the following, which exclude loss or damage caused by or resulting from corrosive soil conditions: (1)Commercial Property Coverage Part - Causes Of Loss - Special Form; or (2)Farm Coverage Part - Causes Of Loss Form - Farm Property, Paragraph D. Covered Causes Of Loss - Special. IL 02 70 09 12Page 2 of 4 05/13/2024A0195129 Middlesex Insurance Company © Insurance Services Office, Inc., 2012 C.The following is added and supersedes any provisions to the contrary: Nonrenewal 1.Subject to the provisions of Paragraphs C.2. and C.3. below, if we elect not to renew this policy, we will mail or deliver written notice, stating the reason for nonrenewal, to the first Named Insured shown in the Declarations, and to the producer of record, at least 60 days, but not more than 120 days, before the expiration or anniversary date. We will mail or deliver our notice to the first Named Insured, and to the producer of record, at the mailing address shown in the policy. 2.Residential Property This provision applies to coverage on real property used predominantly for residential purposes and consisting of not more than four dwelling units, and to coverage on tenants' household property contained in a residential unit, if such coverage is written under one of the following: Commercial Property Coverage Part Farm Coverage Part - Farm Property - Farm Dwellings, Appurtenant Structures And Household Personal Property Coverage Form a.We may elect not to renew such coverage for any reason, except as provided in b., c. and d. below. b.We will not refuse to renew such coverage solely because the first Named Insured has accepted an offer of earthquake coverage. However, the following applies only to insurers who are associate participating insurers as established by Cal. Ins. Code Section 10089.16. We may elect not to renew such coverage after the first Named Insured has accepted an offer of earthquake coverage, if one or more of the following reasons applies: (1)The nonrenewal is based on sound underwriting principles that relate to the coverages provided by this policy and that are consistent with the approved rating plan and related documents filed with the Department of Insurance as required by existing law; (2)The Commissioner of Insurance finds that the exposure to potential losses will threaten our solvency or place us in a hazardous condition. A hazardous condition includes, but is not limited to, a condition in which we make claims payments for losses resulting from an earthquake that occurred within the preceding two years and that required a reduction in policyholder surplus of at least 25% for payment of those claims; or (3)We have: (a)Lost or experienced a substantial reduction in the availability or scope of reinsurance coverage; or (b)Experienced a substantial increase in the premium charged for reinsurance coverage of our residential property insurance policies; and the Commissioner has approved a plan for the nonrenewals that is fair and equitable, and that is responsive to the changes in our reinsurance position. c.We will not refuse to renew such coverage solely because the first Named Insured has cancelled or did not renew a policy, issued by the California Earthquake Authority, that included an earthquake policy premium surcharge. d.We will not refuse to renew such coverage solely because corrosive soil conditions exist on the premises. This restriction (d.) applies only if coverage is subject to one of the following, which exclude loss or damage caused by or resulting from corrosive soil conditions: (1)Commercial Property Coverage Part - Causes Of Loss - Special Form; or (2)Farm Coverage Part - Causes Of Loss Form - Farm Property, Paragraph D. Covered Causes Of Loss - Special. 3.We are not required to send notice of nonrenewal in the following situations: a.If the transfer or renewal of a policy, without any changes in terms, conditions or rates, is between us and a member of our insurance group. Page 3 of 4IL 02 70 09 12 05/13/2024A0195129 Middlesex Insurance Company 00002 0000000000 24134 0 N3 9f593b2e-a8c5-4ab7-a49d-5dd458d5d4fc9f593b2e-a8c5-4ab7-a49d-5dd458d5d4fc © Insurance Services Office, Inc., 2012 b.If the policy has been extended for 90 days or less, provided that notice has been given in accordance with Paragraph C.1. c.If you have obtained replacement coverage, or if the first Named Insured has agreed, in writing, within 60 days of the termination of the policy, to obtain that coverage. d.If the policy is for a period of no more than 60 days and you are notified at the time of issuance that it will not be renewed. e.If the first Named Insured requests a change in the terms or conditions or risks covered by the policy within 60 days of the end of the policy period. f.If we have made a written offer to the first Named Insured, in accordance with the timeframes shown in Paragraph C.1., to renew the policy under changed terms or conditions or at an increased premium rate, when the increase exceeds 25%. IL 02 70 09 12Page 4 of 4 05/13/2024A0195129 Middlesex Insurance Company IL 09 35 07 02 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION OF CERTAIN COMPUTER-RELATED LOSSES IL 09 35 07 02 © ISO Properties, Inc., 2001 EXCLUSION OF CERTAIN COMPUTER-RELATED LOSSES This endorsement modifies insurance provided under the following: COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL PROPERTY COVERAGE PART CRIME AND FIDELITY COVERAGE PART STANDARD PROPERTY POLICY A.We will not pay for loss ("loss") or damage caused directly or indirectly by the following. Such loss ("loss") or damage is excluded regardless of any other cause or event that contributes concurrently or in any sequence to the loss ("loss") or damage. 1.The failure, malfunction or inadequacy of: a.Any of the following, whether belonging to any insured or to others: (1) Computer hardware, including micro- processors; (2) Computer application software; (3) Computer operating systems and re- lated software; (4) Computer networks; (5) Microprocessors (computer chips) not part of any computer system; or (6) Any other computerized or electronic equipment or components; or b.Any other products, and any services, data or functions that directly or indirectly use or rely upon, in any manner, any of the items listed in Paragraph A.1.a. of this endorse- ment; due to the inability to correctly recognize, process, distinguish, interpret or accept one or more dates or times. An example is the in- ability of computer software to recognize the year 2000. 2.Any advice, consultation, design, evaluation, inspection, installation, maintenance, repair, replacement or supervision provided or done by you or for you to determine, rectify or test for, any potential or actual problems described in Paragraph A.1. of this endorsement. B.If an excluded Cause of Loss as described in Paragraph A. of this endorsement results: 1.In a Covered Cause of Loss under the Crime and Fidelity Coverage Part, the Commercial In- land Marine Coverage Part or the Standard Property Policy; or 2.Under the Commercial Property Coverage Part: a.In a "Specified Cause of Loss", or in eleva- tor collision resulting from mechanical breakdown, under the Causes of Loss - Special Form; or b.In a Covered Cause of Loss under the Causes Of Loss - Basic Form or the Causes Of Loss - Broad Form; we will pay only for the loss ("loss") or damage caused by such "Specified Cause of Loss", eleva- tor collision, or Covered Cause of Loss. C.We will not pay for repair, replacement or modifi- cation of any items in Paragraphs A.1.a. and A.1.b. of this endorsement to correct any defi- ciencies or change any features. Page 1 of 1 05/13/2024A0195129 Middlesex Insurance Company 00001 0000000000 24134 0 N1 608fc987-6458-4308-af31-ad65806c23b1608fc987-6458-4308-af31-ad65806c23b1 Page 1 of 1IL 09 52 01 15 05/13/2024A0195129 Middlesex Insurance Company IL 09 52 01 15 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM This endorsement modifies insurance provided under the following: BOILER AND MACHINERY COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL PROPERTY COVERAGE PART EQUIPMENT BREAKDOWN COVERAGE PART FARM COVERAGE PART STANDARD PROPERTY POLICY A.Cap On Certified Terrorism Losses "Certified act of terrorism" means an act that is certified by the Secretary of the Treasury, in accordance with the provisions of the federal Terrorism Risk Insurance Act, to be an act of terrorism pursuant to such Act. The criteria contained in the Terrorism Risk Insurance Act for a "certified act of terrorism" include the following: 1.The act resulted in insured losses in excess of $5 million in the aggregate, attributable to all types of insurance subject to the Terrorism Risk Insurance Act; and 2.The act is a violent act or an act that is dangerous to human life, property or infrastructure and is 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. If aggregate insured losses attributable to terrorist acts certified under the Terrorism Risk Insurance Act exceed $100 billion in a calendar year and we have met our insurer deductible under the Terrorism Risk Insurance Act, we shall not be liable for the payment of any portion of the amount of such losses that exceeds $100 billion, and in such case insured losses up to that amount are subject to pro rata allocation in accordance with procedures established by the Secretary of the Treasury. B.Application Of Exclusions The terms and limitations of any terrorism exclusion, or the inapplicability or omission of a terrorism exclusion, do not serve to create coverage for any loss which would otherwise be excluded under this Coverage Part or Policy, such as losses excluded by the Nuclear Hazard Exclusion or the War And Military Action Exclusion. © Insurance Services Office, Inc., 2015 00001 0000000000 24134 0 N1 1b53e590-c9cd-4bb7-84ae-d379ba6177db1b53e590-c9cd-4bb7-84ae-d379ba6177db POLICY NUMBER: IL 09 85 12 20 SCHEDULE - PART I THIS ENDORSEMENT IS ATTACHED TO AND MADE PART OF YOUR POLICY IN RESPONSE TO THE DISCLOSURE REQUIREMENTS OF THE TERRORISM RISK INSURANCE ACT. THIS ENDORSEMENT DOES NOT GRANT ANY COVERAGE OR CHANGE THE TERMS AND CONDITIONS OF ANY COVERAGE UNDER THE POLICY. DISCLOSURE PURSUANT TO TERRORISM RISK INSURANCE ACT SCHEDULE Terrorism Premium (Certified Acts) $23.00 This premium is the total Certified Acts premium attributable to the following Coverage Part(s), Coverage Form(s) and/or Policy(ies): A0195129003 Commercial Inland Marine Additional information, if any, concerning the terrorism premium: SCHEDULE - PART II Federal share of terrorism losses 80% (Refer to Paragraph B. in this endorsement.) Information required to complete this Schedule, if not shown above, will be shown in the Declarations. © Insurance Services Office, Inc., 2020 Page 1 of 2IL 09 85 12 20 05/13/2024A0195129 Middlesex Insurance Company 00001 0000000000 24134 0 N1 f15d1498-7881-4dcc-9acc-8899423cfd26f15d1498-7881-4dcc-9acc-8899423cfd26 A.Disclosure Of Premium In accordance with the federal Terrorism Risk Insurance Act, we are required to provide you with a notice disclosing the portion of your premium, if any, attributable to coverage for terrorist acts certified under the Terrorism Risk Insurance Act. The portion of your premium attributable to such coverage is shown in the Schedule of this endorsement or in the policy Declarations. B.Disclosure Of Federal Participation In Payment Of Terrorism Losses The United States Government, Department of the Treasury, will pay a share of terrorism losses insured under the federal program. The federal share equals a percentage (as shown in Part II of the Schedule of this endorsement or in the policy Declarations) of that portion of the amount of such insured losses that exceeds the applicable insurer retention. However, if aggregate insured losses attributable to terrorist acts certified under the Terrorism Risk Insurance Act exceed $100 billion in a calendar year, the Treasury shall not make any payment for any portion of the amount of such losses that exceeds $100 billion. C.Cap On Insurer Participation In Payment Of Terrorism Losses If aggregate insured losses attributable to terrorist acts certified under the Terrorism Risk Insurance Act exceed $100 billion in a calendar year and we have met our insurer deductible under the Terrorism Risk Insurance Act, we shall not be liable for the payment of any portion of the amount of such losses that exceeds $100 billion, and in such case insured losses up to that amount are subject to pro rata allocation in accordance with procedures established by the Secretary of the Treasury. © Insurance Services Office, Inc., 2020 IL 09 85 12 20Page 2 of 2 05/13/2024A0195129 Middlesex Insurance Company Page 1 of 1IL 70 26 07 13 05/13/2024A0195129 Middlesex Insurance Company MULTIPLE LINE OCCURRENCE DEDUCTIBLE This endorsement modifies insurance provided under the following: BUSINESSOWNERS POLICY COMMERCIAL CRIME COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL PROPERTY COVERAGE PART A.If an occurrence causes loss or damage insured by more than one policy or coverage part issued by us, only one deductible will apply to the total loss or damage. We will apply the largest deductible in any policy or coverage part that provides insurance for the loss or damage to the occurrence. The other deductibles that would otherwise apply to the loss or damage will be waived. B.If an occurrence causes loss or damage insured by more than one coverage form in a policy or coverage part issued by us, only one deductible will apply to the total loss or damage. We will apply the largest deductible in any coverage form that provides insurance for the loss or damage to the occurrence. The other deductibles that would otherwise apply to the loss or damage will be waived. C.We will separately apply the individual deductibles that would otherwise apply to the loss or damage if that would result in a larger total payment to the insured. If we separately apply the individual deductibles, the provisions in Paragraphs A. and B. will not apply. D.This endorsement does not apply to loss covered by any of the following: 1.Earthquake 2.Equipment breakdown coverage IL 70 26 07 13 00001 0000000000 24134 0 N1 7bf6ad7f-9a5e-47bb-a67b-a6370a15f3497bf6ad7f-9a5e-47bb-a67b-a6370a15f349 A0195129 Middlesex Insurance Company 05/13/2024 3a3cbf22-51de-407d-8f9b-4e62119bb856 80 3105C 10 21 SUBCONTRACTORS INSURANCE REQUIREMENTS MAINTAINING RECORDS THAT CAN SAVE YOU MONEY o o o This notice is not a part of your policy. Only the provisions of your policy determine the scope of your insurance protection. To minimize your general liability and workers' compensation insurance premiums, you should know your responsibilities regarding subcontractor record keeping. In most states, if a subcontractor is not "adequately" (see below) insured, you will be held responsible for injuries sustained by the subcontractor or damages arising out of the subcontractor©s negligence. Generally, your general liability and workers' compensation insurance will respond to such losses, just as though the subcontractors were your employees. Unfortunately, this coverage extension is at your expense, since the payroll of the inadequately insured subcontractors will be included in the calculation of your insurance premiums. To minimize subcontractor insurance costs, it is essential that your records include: Subcontractors used; Amounts paid; and Certificates of insurance covering the dates when the subcontracted work was performed. If you do not maintain such records, our premium auditor will calculate your general liability and workers compensation premiums as though the subcontractor was your employee. For general liability, "adequate" subcontractor insurance must include at least: Protection against third party liability arising from ongoing operations as well as products and completed work, Limits of insurance consisting of, at a minimum: $1,000,000 each occurrence; $2,000,000 general aggregate; and $2,000,000 products and completed operations aggregate We wish to provide you with the best possible service. We hope that this notice will enable you to maintain adequate subcontractor records and save you premium dollars. If you have any questions or require any additional information, please contact your representative. Page 1 of 180 3105C 10 21 COMMERCIAL GENERAL LIABILITY COVERAGE DECLARATIONS POLICY NUMBER: A0195129004 Middlesex Insurance Company (A Participating Stock Company) A member of the Sentry Insurance Group 1800 North Point Drive Stevens Point, WI 54481 Agency Acrisure of California, LLC 34 S 2nd St Campbell, CA 95008 Agency Code 10047536 First Named Insured: POLICY INFORMATION Axis Mechanical , Inc. Address:908 Bern Ct San Jose, CA 95112 The Commercial General Liability Coverage applies from 05/13/2024 to 05/13/2025 at 12:01 A.M. Standard Time at the First Named Insured's mailing address shown above. Additional Named Insured In addition to the Named Insured’s listed in the Common Declarations, the following person(s) or organization(s) are named insured’s for the Commercial General Liability Coverage only: Name:Axis Holdings 2 LLC Address:2474 De La Cruz Blvd Santa Clara, CA 95050-2923 Name:Axis Holdings Ltd LLC Address:2474 De La Cruz Blvd Santa Clara, CA 95050-2923 Additional Insureds The persons or organizations, listed in the Additional Insureds Supplemental Declarations are included as Additional Insureds, but only to the extent provided in the listed endorsement. CG 89 01 10 14 Page 1 of 4 05/13/2024A0195129 Middlesex Insurance Company 00002 0000000000 24134 0 N1 bdc24a4e-002a-4a03-8276-b4603601f5bfbdc24a4e-002a-4a03-8276-b4603601f5bf POLICY NUMBER:A0195129004 Page 2 of 4 CG 89 01 10 14 05/13/2024A0195129 Middlesex Insurance Company LIMITS OF INSURANCE General Aggregate Limit (Other than Products/Completed Operations) 3,000,000$ Products/Completed Operations Aggregate Limit 2,000,000$ Each Occurrence Limit 1,000,000$ 500,000Damage To Premises Rented To You Limit Any one premises$ 5,000Medical Expense Limit Any one person $ Personal and Advertising Injury Limit 1,000,000 Any one person or organization$ Coverage provided under certain endorsements included with this policy will be subject to separate limits of insurance which will be included in the Schedule for that endorsement or the portion of this Declarations pertaining to that endorsement. SCHEDULE OF CLASSIFICATIONS AND RATING BASIS See Composite Rate/Premium Endorsement. Premium is subject to annual audit. APPLICABLE FORMS AND ENDORSEMENTS In addition to the common policy forms and endorsements, the following forms and endorsements apply to the Commercial General Liability Coverage: Form/Endorsement Form/Endorsement Title Number and Edition Date CG 00 01 04 13 Commercial General Liability Coverage Form CG 03 00 01 96 Deductible Liability Insurance CG 20 10 07 04 Additional Insured - Owners, Lessees Or Contractors - Scheduled Person Or Organization CG 20 10 10 01 Additional Insured - Owners, Lessees Or Contractors - Scheduled Person Or Organization CG 20 37 07 04 Additional Insured - Owners, Lessees Or Contractors - Completed Operations CG 20 37 10 01 Additional Insured - Owners, Lessees Or Contractors - Completed Operations CG 21 06 05 14 Exclusion - Access Or Disclosure Of Confidential Or Personal Information And Data - Related Liability - With Limited Bodily Injury Exception CG 21 47 12 07 Employment-Related Practices Exclusion CG 21 54 12 19 Exclusion - Designated Operations Covered By A Controlled (Wrap-Up) Insurance Program CG 21 67 12 04 Fungi Or Bacteria Exclusion CG 21 70 01 15 Cap On Losses From Certified Acts Of Terrorism CG 21 76 01 15 Exclusion Of Punitive Damages Related To A Certified Act Of Terrorism CG 21 96 03 05 Silica Or Silica-Related Dust Exclusion CG 22 34 04 13 Exclusion - Construction Management Errors And Omissions CG 22 79 04 13 Exclusion - Contractors - Professional Liability CG 24 26 04 13 Amendment Of Insured Contract Definition CG 70 01 04 13 Employee Benefits Liability Endorsement CG 71 04 03 18 Non-Cumulation Of Limits CG 71 05 03 18 Continuous Or Progressive Injury Or Damage Limitation CG 71 07 03 18 Exclusion - Residential Construction Operations CG 71 11 07 20 General Liability Enhancement Endorsement CG 71 12 11 22 General Liability Extension Endorsement CG 71 18 06 20 Each Construction Project General Aggregate Limit POLICY NUMBER:A0195129004 CG 89 01 10 14 Page 3 of 4 05/13/2024A0195129 Middlesex Insurance Company 00002 0000000000 24134 0 N3 bdc24a4e-002a-4a03-8276-b4603601f5bfbdc24a4e-002a-4a03-8276-b4603601f5bf APPLICABLE FORMS AND ENDORSEMENTS Form/Endorsement Form/Endorsement Title Number and Edition Date CG 71 21 06 22 Third Party Discrimination CG 71 25 06 22 Contractors Blanket Additional Insureds, Primary & Noncontributory, Waiver Of Subrogation CG 71 27 01 20 Exclusion - Auto Liability CG 80 02 06 22 Total Pollution Exclusion Endorsement CG 80 27 06 20 Composite Rate/Premium Endorsement CG 88 08 12 04 Exclusion - Asbestos CG 88 39 04 13 Distribution Of Material In Violation Of Statutes Amended Exclusion IL 00 21 09 08 Nuclear Energy Liability Exclusion Endorsement (Broad Form) IL 02 70 09 12 California Changes - Cancellation And Nonrenewal IL 09 85 12 20 Disclosure Pursuant To Terrorism Risk Insurance Act IL 70 60 08 15 Notice Of Cancellation To Others IL 70 61 07 16 Cyber Liability And Data Breach Response Coverage IL 80 05 07 16 Exclusion - Infectious Or Communicable Disease OPTIONAL ENDORSEMENT SCHEDULES For information not shown below, refer to the individual endorsements. Deductible Liability Insurance Coverage Amount and Basis of Deductible “Bodily Injury” Liability Not Applicable “Property Damage” Liability $5,000 Per Occurrence EXCLUSION/LIMITATION ENDORSEMENTS Exclusion - Residential Construction Operations Description of Operations: Exclusion - Designated Operations Covered By A Controlled (Wrap-Up) Insurance Program Description and Location of Operation(s): All owner or contractor controlled insurance programs in which you were enrolled or intended to enroll. MISCELLANEOUS OPTIONAL COVERAGE ENDORSEMENTS Notice of Cancellation To Others Name Of Person(s) Or Organization(s) Truebeck Construction, Inc. C/O: myCOI Number of Days Notice 30 Murray Company C/O: myCOI Number of Days Notice 30 Riverpark Tower I Owner LLC c/o DivcoWest Real Estate Asset Management Inc Number of Days Notice 30 General Liability Extension Endorsement Stop Gap - Employers Liability Coverage Bodily Injury by Accident - Each Accident $ 1,000,000 Bodily Injury by Disease - Each Employee $ 1,000,000 POLICY NUMBER:A0195129004 Page 4 of 4 CG 89 01 10 14 05/13/2024A0195129 Middlesex Insurance Company MISCELLANEOUS OPTIONAL COVERAGE ENDORSEMENTS Bodily Injury by Disease - Aggregate Limit $ 3,000,000 Each Employee Limit Employee Benefits Liability Endorsement 1,000,000$ Each Employee Deductible 1,000$ Policy Maximum Each Construction Project General Aggregate Limit Each Construction Project General Aggregate Limit Designated Construction Project: 10,000,000$ All construction projects away from premise owned by or rented by insured. POLICY NUMBER: A0195129004 ADDITIONAL INSURED - SUPPLEMENTAL DECLARATIONS The following persons or organizations are included as Additional Insureds, but only to the extent provided in the listed endorsement: DPR Construction, A General Partnership, its joint venture and joint venture partner if one exists, the Owner, Kaiser Foundation Hospitals, Kaiser Foundation Health Plan, Inc., their parent, subsidiary and affiliated companies, and their Boards of Directors, employees, representatives, consultants, and agents, and their respective officers, partners, agents, employees, affiliates, members, owners and successors. The person or organization indicated above is included as an additional insured under the following endorsement(s): Additional Insured - Owners, Lessees Or Contractors - Completed Operations CG 20 37 07 04 Location and Description of Completed Operations: 250 Hospital Parkway, San Jose, CA 95119 Job #: D0-A22036-00 Kaiser SJ (E) Hosp Cooling Tower 1+2 & Chiller Replacement Contract #: A22036-00-001 DPR Construction, A General Partnership, its joint venture and joint venture partner if one exists, the Owner, Kaiser Foundation Hospitals, Kaiser Foundation Health Plan, Inc., their parent, subsidiary and affiliated companies, and their Boards of Directors, employees, representatives, consultants, and agents, and their respective officers, partners, agents, employees, affiliates, members, owners and successors. The person or organization indicated above is included as an additional insured under the following endorsement(s): Additional Insured - Owners, Lessees Or Contractors - Scheduled Person Or Organization CG 20 10 07 04 Location of Covered Operations: 250 Hospital Parkway, San Jose, CA 95119 Job Description: Job #: D0-A22036-00 Kaiser SJ (E) Hosp Cooling Tower 1+2 & Chiller Replacement Contract #: A22036-00-001 CG 89 05 10 14 Page 1 of 6 05/13/2024A0195129 Middlesex Insurance Company 00003 0000000000 24134 0 N1 b752e19b-c598-40f6-a1c2-f7d4fe84f540b752e19b-c598-40f6-a1c2-f7d4fe84f540 POLICY NUMBER:A0195129004 Page 2 of 6 CG 89 05 10 14 05/13/2024A0195129 Middlesex Insurance Company BBI Construction, Owner, their respective officers and employees and any other individuals or entities designated by the Owner in the General Contract Documents The person or organization indicated above is included as an additional insured under the following endorsement(s): Additional Insured - Owners, Lessees Or Contractors - Completed Operations CG 20 37 07 04 Location and Description of Completed Operations: Project Names: McKay Demo and Alameda Respite Address: 1250 & 1245 McKay Ave, Alameda, CA 94501 Additional Insured - Owners, Lessees Or Contractors - Scheduled Person Or Organization CG 20 10 07 04 Location of Covered Operations: Address: 1250 & 1245 McKay Ave, Alameda, CA 94501 Job Description: Project names: McKay Demo and Alameda Respite DPR Construction A General Partnership its joint venture and joint venture partner where applicable, its/their officers, owners, employees, agents, parents, partners, subs officers, partners, agents, employees, affiliates, members, owners and successors The person or organization indicated above is included as an additional insured under the following endorsement(s): Additional Insured - Owners, Lessees Or Contractors - Completed Operations CG 20 37 07 04 Location and Description of Completed Operations: Kaiser SC Central Plant Improvements IDIQ 700 Lawrence Expressway Santa Clara CA 95051 Description: DPR Job #: D0-A22016-00 Additional Insured - Owners, Lessees Or Contractors - Scheduled Person Or Organization CG 20 10 07 04 Location of Covered Operations: Kaiser SC Central Plant Improvements IDIQ 700 Lawrence Expressway Santa Clara CA 95051 Job Description: DPR Job #: D0-A22016-00 POLICY NUMBER:A0195129004 CG 89 05 10 14 Page 3 of 6 05/13/2024A0195129 Middlesex Insurance Company 00003 0000000000 24134 0 N3 b752e19b-c598-40f6-a1c2-f7d4fe84f540b752e19b-c598-40f6-a1c2-f7d4fe84f540 DPR Construction A General Partnership its joint venture and joint venture partner, where applicable, its/their officers, owners, employees, agents, parents, partners, subsidiaries and affiliates; the Owner and any person or organization that Owner requires by written contract Kaiser Foundation Hospitals, Kaiser Foundation Health Plan, Inc., their parent, subsidiary and affiliated companies, and their Boards of Directors, employees, representatives, consultants, and agents. The person or organization indicated above is included as an additional insured under the following endorsement(s): Additional Insured - Owners, Lessees Or Contractors - Completed Operations CG 20 37 07 04 Location and Description of Completed Operations: Job# D0-A22016-00 Kaiser SC Central Plant Improvements IDIQ 700 Lawrence Expressway Santa Clara CA 95051 Additional Insured - Owners, Lessees Or Contractors - Scheduled Person Or Organization CG 20 10 07 04 Location of Covered Operations: Kaiser SC Central Plant Improvements IDIQ 700 Lawrence Expressway Santa Clara CA 95051 Job Description: Job# D0-A22016-00 DPR Construction a General Partnership, its joint venture & joint venture partner if one exists, the owner, Facebook Inc and their respective officers, partners, agents, employees, affiliates, members, owners and successors, and any person or organization that any of the foregoing is required to indemnify or defend or add as an additional insured by written contract. The person or organization indicated above is included as an additional insured under the following endorsement(s): Additional Insured - Owners, Lessees Or Contractors - Completed Operations CG 20 37 07 04 Location and Description of Completed Operations: Job/Location: Facebook MPK21 Dish Room Exhaust Upgrade 1 Hacker Way, Building 21 Menlo Park, CA 94025 Job #: D0-A21016-26 Additional Insured - Owners, Lessees Or Contractors - Scheduled Person Or Organization CG 20 10 07 04 Location of Covered Operations: Facebook MPK21 Dish Room Exhaust Upgrade 1 Hacker Way, Building 21 Menlo Park, CA 94025 POLICY NUMBER:A0195129004 Page 4 of 6 CG 89 05 10 14 05/13/2024A0195129 Middlesex Insurance Company Job Description: Job #: D0-A21016-26 DPR Construction A General Partnership. DPR Construction, A General Partnership, its joint venture and joint venture partner, where applicable, its/their officers, owners, employees, agents, parents, partners, subsidiaries and affiliates. Kaiser Foundation Hospitals, Kaiser Foundation Health Plan, Inc., their parent, subsidiary and affiliated companies, and their Boards of Directors, employees, representatives, consultants, and agents. The person or organization indicated above is included as an additional insured under the following endorsement(s): Additional Insured - Owners, Lessees Or Contractors - Completed Operations CG 20 37 07 04 Location and Description of Completed Operations: Re: Job #21-015, #D0-D21006-00, Subcontract #D21006-00-007, Kaiser SJ Service Building Trane Chiller Replacement IDIQ, 258 International Circle, San Jose, CA 95119. Additional Insured - Owners, Lessees Or Contractors - Scheduled Person Or Organization CG 20 10 07 04 Location of Covered Operations: 258 International Circle, San Jose, CA 95119 Job Description: Re: Job #21-015, #D0-D21006-00, Subcontract #D21006-00-007, Kaiser SJ Service Building Trane Chiller Replacement IDIQ DPR Construction, A General Partnership DPR Construction, A General Partnership, its joint venture and joint venture partner if one exists, the Amazon.com LLC, Harbor Group Management Co., LLC and Torre Plaza Associates, LLC, and their respective officers, partners, agents, employees, affiliates, members, owners and successors, and any person or organization The person or organization indicated above is included as an additional insured under the following endorsement(s): Additional Insured - Owners, Lessees Or Contractors - Completed Operations CG 20 37 07 04 Location and Description of Completed Operations: Job #D0-D21017-00-SJC3 AWS Lab Phase 2 Job #D0-D21017-002 , Amazon - SJC3 CQ-002 HVAC True Up Job #D0-D21017-03 Job# D0-D21017-04 10201 Torre Avenue, Cupertino, CA 95014 Additional Insured - Owners, Lessees Or Contractors - Scheduled Person Or Organization CG 20 10 07 04 POLICY NUMBER:A0195129004 CG 89 05 10 14 Page 5 of 6 05/13/2024A0195129 Middlesex Insurance Company 00003 0000000000 24134 0 N5 b752e19b-c598-40f6-a1c2-f7d4fe84f540b752e19b-c598-40f6-a1c2-f7d4fe84f540 Location of Covered Operations: 10201 Torre Avenue, Cupertino, CA 95014 Job Description: Job #D0-D21017-00-SJC3 AWS Lab Phase 2 Job #D0-D21017-002 , Amazon - SJC3 CQ-002 HVAC True Up Job #D0-D21017-03 Job# D0-D21017-04 DPR Construction, A General Partnership, its joint venture and joint venture partner if one exists, the Owner, and their respective officers, partners, agents, employees, affiliates, members, owners and successors, and any other person or organization that any of the foregoing is required to indemnify or defend or add as an additional insured by written contract and those entities required by separate Work Authorization. The person or organization indicated above is included as an additional insured under the following endorsement(s): Additional Insured - Owners, Lessees Or Contractors - Completed Operations CG 20 37 07 04 Location and Description of Completed Operations: All locations and jobs performed that have a written contract, agreement or permit Additional Insured - Owners, Lessees Or Contractors - Scheduled Person Or Organization CG 20 10 07 04 Location of Covered Operations: All locations per written contract, agreement or permit Job Description: All jobs performed that have a written contract, agreement or permit DPR Construction, A General Partnership. DPR Construction, A General Partnership, its joint venture and joint venture partner if one exists, the Owner, Boehringer Ingelheim Fremont, Inc., and their respective officers, partners, agents, employees, affiliates, members, owners and successors. The person or organization indicated above is included as an additional insured under the following endorsement(s): Additional Insured - Owners, Lessees Or Contractors - Completed Operations CG 20 37 07 04 Location and Description of Completed Operations: Job/location: Job #: D0-A21008-00 Job Name: BI - B4 Office Project TI Jobsite Address: 6701 Kaiser Drive Fremont, CA 94555 Contract #: A21008-00-003 Additional Insured - Owners, Lessees Or Contractors - Scheduled Person Or Organization CG 20 10 07 04 POLICY NUMBER:A0195129004 Page 6 of 6 CG 89 05 10 14 05/13/2024A0195129 Middlesex Insurance Company Location of Covered Operations: Job/location: Job #: D0-A21008-00 Jobsite Address: 6701 Kaiser Drive Fremont, CA 94555 Job Description: Job Name: BI - B4 Office Project TI Contract #: A21008-00-003 Truebeck Construction, Inc. C/O: myCOI The person or organization indicated above is included as an additional insured under the following endorsement(s): Additional Insured - Owners, Lessees Or Contractors - Completed Operations CG 20 37 10 01 Location and Description of Completed Operations: Jobsite: Microsoft COLO Lab Expansion, 2820 Northwestern Parkway, Santa Clara, California 95051 Additional Insured - Owners, Lessees Or Contractors - Scheduled Person Or Organization CG 20 10 10 01 Location of Covered Operations: 2820 Northwestern Parkway, Santa Clara, California 95051 Job Description: Jobsite: Microsoft COLO Lab Expansion Notice Of Cancellation To OthersIL 70 60 08 15 Number of Days Notice 30 POLICY NUMBER: CYBER LIABILITY AND DATA BREACH RESPONSE COVERAGE SUPPLEMENTAL DECLARATIONS A0195129004 NOTICE •EXCEPT TO SUCH EXTENT AS MAY OTHERWISE BE PROVIDED HEREIN, THE COVERAGES PROVIDED UNDER INSURING AGREEMENTS A., C., D., E. AND F. OF THIS COVERAGE PART ARE LIMITED TO LIABILITY FOR ONLY THOSE CLAIMS OR SUITS THAT ARE FIRST MADE AGAINST THE INSUREDS DURING THE CYBER LIABILITY AND DATA BREACH RESPONSE COVERAGE PERIOD AND REPORTED IN WRITING TO THE INSURER PURSUANT TO THE TERMS HEREIN. VARIOUS PROVISIONS IN THIS COVERAGE PART RESTRICT COVERAGE. PLEASE READ THE ENTIRE COVERAGE PART CAREFULLY TO DETERMINE RIGHTS, DUTIES AND WHAT IS AND IS NOT COVERED. •THE LIMIT OF LIABILITY AVAILABLE TO PAY JUDGMENTS OR SETTLEMENTS FOR COVERAGE PROVIDED UNDER INSURING AGREEMENTS A., C., D., E., F., G. AND H. UNDER THIS COVERAGE PART SHALL BE REDUCED BY AMOUNTS INCURRED FOR LEGAL DEFENSE. AMOUNTS INCURRED FOR LEGAL DEFENSE SHALL BE APPLIED AGAINST THE DEDUCTIBLE AMOUNT. •EXCEPT TO SUCH EXTENT AS MAY OTHERWISE BE PROVIDED HEREIN, THE COVERAGES PROVIDED UNDER INSURING AGREEMENTS B., G. AND H. OF THIS COVERAGE PART PROVIDE FIRST PARTY COVERAGE ON AN INCIDENT DISCOVERED AND REPORTED BASIS. COVERAGE UNDER INSURING AGREEMENTS B., G. AND H. APPLIES ONLY TO INCIDENTS FIRST DISCOVERED BY THE INSURED AND REPORTED TO THE INSURER DURING THE POLICY PERIOD. The Cyber Liability and Data Breach Response Coverage applies from 05/13/2024 to 05/13/2025 at 12:01A.M. Standard Time at the First Named Insured's mailing address shown on the Declarations page of this policy. Cyber Liability and Data Breach Response Retroactive Date Cyber Liability Aggregate Limit of Insurance Aggregate for all “loss”, including “defense costs”, subject to the following: 05/13/2022 $50,000 Regulatory Defense and “Penalties” Sublimit $25,000 “PCI Fines, Expenses and Costs” Sublimit $10,000 “Cyber Extortion” Sublimit “First Party Data Protection” Sublimit “First Party Network Business Interruption” Sublimit $25,000 $25,000 $25,000 “Period of Restoration” Waiting Period Cyber Liability and Data Breach Response Retention - Each “Claim” 12 hours $2,500 Privacy Breach Response Services Limits of Insurance The following are separate from and in addition to the Cyber Liability Aggregate Limit of Insurance: Number of “Notified Individuals” “Computer Expert Services”, “Legal Services” and “Public Relations and Crisis Management Expenses” Sublimit Privacy Breach Response Services Retention - Each “Claim” 5,000 $25,000 $2,500 “Optional Extension Period” and Premium If dates and premium are not shown, the “Optional Extension Period” does not apply. IL 89 05 07 16 Page 1 of 1 05/13/2024A0195129 Middlesex Insurance Company 00001 0000000000 24134 0 N1 dcc9341e-7c9c-4d7c-8433-a3daf13d21e4dcc9341e-7c9c-4d7c-8433-a3daf13d21e4 A0195129 Middlesex Insurance Company 05/13/2024 22deb6ae-f4a4-4e3e-91dd-4d5472e3c8d3 Page 1 of 16CG 00 01 04 13 COMMERCIAL GENERAL LIABILITY CG 00 01 04 13 COMMERCIAL GENERAL LIABILITY COVERAGE FORM Various provisions in this policy restrict coverage. Read the entire policy carefully to determine rights, duties and what is and is not covered. Throughout this policy the words "you" and "your" refer to the Named Insured shown in the Declarations, and any other person or organization qualifying as a Named Insured under this policy. The words "we", "us" and "our" refer to the company providing this insurance. The word "insured" means any person or organization qualifying as such under Section II - Who Is An Insured. Other words and phrases that appear in quotation marks have special meaning. Refer to Section V - Definitions. SECTION I - COVERAGES COVERAGE A - BODILY INJURY AND PROPERTY DAMAGE LIABILITY 1.Insuring Agreement a.We will pay those sums that the insured becomes legally obligated to pay as damages because of "bodily injury" or "property damage" to which this insurance applies. We will have the right and duty to defend the insured against any "suit" seeking those damages. However, we will have no duty to defend the insured against any "suit" seeking damages for "bodily injury" or "property damage" to which this insurance does not apply. We may, at our discretion, investigate any "occurrence" and settle any claim or "suit" that may result. But: (1)The amount we will pay for damages is limited as described in Section III - Limits Of Insurance; and (2)Our right and duty to defend ends when we have used up the applicable limit of insurance in the payment of judgments or settlements under Coverages A or B or medical expenses under Coverage C. No other obligation or liability to pay sums or perform acts or services is covered unless explicitly provided for under Supplementary Payments - Coverages A and B. b.This insurance applies to "bodily injury" and "property damage" only if: (1)The "bodily injury" or "property damage" is caused by an "occurrence" that takes place in the "coverage territory"; (2)The "bodily injury" or "property damage" occurs during the policy period; and (3)Prior to the policy period, no insured listed under Paragraph 1. of Section II - Who Is An Insured and no "employee" authorized by you to give or receive notice of an "occurrence" or claim, knew that the "bodily injury" or "property damage" had occurred, in whole or in part. If such a listed insured or authorized "employee" knew, prior to the policy period, that the "bodily injury" or "property damage" occurred, then any continuation, change or resumption of such "bodily injury" or "property damage" during or after the policy period will be deemed to have been known prior to the policy period. c."Bodily injury" or "property damage" which occurs during the policy period and was not, prior to the policy period, known to have occurred by any insured listed under Paragraph 1. of Section II - Who Is An Insured or any "employee" authorized by you to give or receive notice of an "occurrence" or claim, includes any continuation, change or resumption of that "bodily injury" or "property damage" after the end of the policy period. d."Bodily injury" or "property damage" will be deemed to have been known to have occurred at the earliest time when any insured listed under Paragraph 1. of Section II - Who Is An Insured or any "employee" authorized by you to give or receive notice of an "occurrence" or claim: (1)Reports all, or any part, of the "bodily injury" or "property damage" to us or any other insurer; (2)Receives a written or verbal demand or claim for damages because of the "bodily injury" or "property damage"; or (3)Becomes aware by any other means that "bodily injury" or "property damage" has occurred or has begun to occur. e.Damages because of "bodily injury" include damages claimed by any person or organization for care, loss of services or death resulting at any time from the "bodily injury". © Insurance Services Office, Inc., 2012 A0195129 Middlesex Insurance Company 05/13/2024 22deb6ae-f4a4-4e3e-91dd-4d5472e3c8d3 2.Exclusions This insurance does not apply to: a.Expected Or Intended Injury "Bodily injury" or "property damage" expected or intended from the standpoint of the insured. This exclusion does not apply to "bodily injury" resulting from the use of reasonable force to protect persons or property. b.Contractual Liability "Bodily injury" or "property damage" for which the insured is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages: (1)That the insured would have in the absence of the contract or agreement; or (2)Assumed in a contract or agreement that is an "insured contract", provided the "bodily injury" or "property damage" occurs subsequent to the execution of the contract or agreement. Solely for the purposes of liability assumed in an "insured contract", reasonable attorneys© fees and necessary litigation expenses incurred by or for a party other than an insured are deemed to be damages because of "bodily injury" or "property damage", provided: (a)Liability to such party for, or for the cost of, that party©s defense has also been assumed in the same "insured contract"; and (b)Such attorneys© fees and litigation expenses are for defense of that party against a civil or alternative dispute resolution proceeding in which damages to which this insurance applies are alleged. c.Liquor Liability "Bodily injury" or "property damage" for which any insured may be held liable by reason of: (1)Causing or contributing to the intoxication of any person; (2)The furnishing of alcoholic beverages to a person under the legal drinking age or under the influence of alcohol; or (3)Any statute, ordinance or regulation relating to the sale, gift, distribution or use of alcoholic beverages. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in: (a)The supervision, hiring, employment, training or monitoring of others by that insured; or (b)Providing or failing to provide transportation with respect to any person that may be under the influence of alcohol; if the "occurrence" which caused the "bodily injury" or "property damage", involved that which is described in Paragraph (1), (2) or (3) above. However, this exclusion applies only if you are in the business of manufacturing, distributing, selling, serving or furnishing alcoholic beverages. For the purposes of this exclusion, permitting a person to bring alcoholic beverages on your premises, for consumption on your premises, whether or not a fee is charged or a license is required for such activity, is not by itself considered the business of selling, serving or furnishing alcoholic beverages. d.Workers© Compensation And Similar Laws Any obligation of the insured under a workers© compensation, disability benefits or unemployment compensation law or any similar law. e.Employer©s Liability "Bodily injury" to: (1)An "employee" of the insured arising out of and in the course of: (a)Employment by the insured; or (b)Performing duties related to the conduct of the insured©s business; or (2)The spouse, child, parent, brother or sister of that "employee" as a consequence of Paragraph (1) above. This exclusion applies whether the insured may be liable as an employer or in any other capacity and to any obligation to share damages with or repay someone else who must pay damages because of the injury. This exclusion does not apply to liability assumed by the insured under an "insured contract". © Insurance Services Office, Inc., 2012 CG 00 01 04 13Page 2 of 16 A0195129 Middlesex Insurance Company 05/13/2024 22deb6ae-f4a4-4e3e-91dd-4d5472e3c8d3 f.Pollution (1)"Bodily injury" or "property damage" arising out of the actual, alleged or threatened discharge, dispersal, seepage, migration, release or escape of "pollutants": (a)At or from any premises, site or location which is or was at any time owned or occupied by, or rented or loaned to, any insured. However, this subparagraph does not apply to: (i)"Bodily injury" if sustained within a building and caused by smoke, fumes, vapor or soot produced by or originating from equipment that is used to heat, cool or dehumidify the building, or equipment that is used to heat water for personal use, by the building©s occupants or their guests; (ii)"Bodily injury" or "property damage" for which you may be held liable, if you are a contractor and the owner or lessee of such premises, site or location has been added to your policy as an additional insured with respect to your ongoing operations performed for that additional insured at that premises, site or location and such premises, site or location is not and never was owned or occupied by, or rented or loaned to, any insured, other than that additional insured; or (iii)"Bodily injury" or "property damage" arising out of heat, smoke or fumes from a "hostile fire"; (b)At or from any premises, site or location which is or was at any time used by or for any insured or others for the handling, storage, disposal, processing or treatment of waste; (c)Which are or were at any time transported, handled, stored, treated, disposed of, or processed as waste by or for: (i)Any insured; or (ii)Any person or organization for whom you may be legally responsible; or (d)At or from any premises, site or location on which any insured or any contractors or subcontractors working directly or indirectly on any insured©s behalf are performing operations if the "pollutants" are brought on or to the premises, site or location in connection with such operations by such insured, contractor or subcontractor. However, this subparagraph does not apply to: (i)"Bodily injury" or "property damage" arising out of the escape of fuels, lubricants or other operating fluids which are needed to perform the normal electrical, hydraulic or mechanical functions necessary for the operation of "mobile equipment" or its parts, if such fuels, lubricants or other operating fluids escape from a vehicle part designed to hold, store or receive them. This exception does not apply if the "bodily injury" or "property damage" arises out of the intentional discharge, dispersal or release of the fuels, lubricants or other operating fluids, or if such fuels, lubricants or other operating fluids are brought on or to the premises, site or location with the intent that they be discharged, dispersed or released as part of the operations being performed by such insured, contractor or subcontractor; (ii)"Bodily injury" or "property damage" sustained within a building and caused by the release of gases, fumes or vapors from materials brought into that building in connection with operations being performed by you or on your behalf by a contractor or subcontractor; or (iii)"Bodily injury" or "property damage" arising out of heat, smoke or fumes from a "hostile fire". (e)At or from any premises, site or location on which any insured or any contractors or subcontractors working directly or indirectly on any insured©s behalf are performing operations if the operations are to test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of, "pollutants". © Insurance Services Office, Inc., 2012 Page 3 of 16CG 00 01 04 13 A0195129 Middlesex Insurance Company 05/13/2024 22deb6ae-f4a4-4e3e-91dd-4d5472e3c8d3 (2)Any loss, cost or expense arising out of any: (a)Request, demand, order or statutory or regulatory requirement that any insured or others test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of, "pollutants"; or (b)Claim or suit by or on behalf of a governmental authority for damages because of testing for, monitoring, cleaning up, removing, containing, treating, detoxifying or neutralizing, or in any way responding to, or assessing the effects of, "pollutants". However, this paragraph does not apply to liability for damages because of "property damage" that the insured would have in the absence of such request, demand, order or statutory or regulatory requirement, or such claim or "suit" by or on behalf of a governmental authority. g.Aircraft, Auto Or Watercraft "Bodily injury" or "property damage" arising out of the ownership, maintenance, use or entrustment to others of any aircraft, "auto" or watercraft owned or operated by or rented or loaned to any insured. Use includes operation and "loading or unloading". This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage" involved the ownership, maintenance, use or entrustment to others of any aircraft, "auto" or watercraft that is owned or operated by or rented or loaned to any insured. This exclusion does not apply to: (1)A watercraft while ashore on premises you own or rent; (2)A watercraft you do not own that is: (a)Less than 26 feet long; and (b)Not being used to carry persons or property for a charge; (3)Parking an "auto" on, or on the ways next to, premises you own or rent, provided the "auto" is not owned by or rented or loaned to you or the insured; (4)Liability assumed under any "insured contract" for the ownership, maintenance or use of aircraft or watercraft; or (5)"Bodily injury" or "property damage" arising out of: (a)The operation of machinery or equipment that is attached to, or part of, a land vehicle that would qualify under the definition of "mobile equipment" if it were not subject to a compulsory or financial responsibility law or other motor vehicle insurance law where it is licensed or principally garaged; or (b)The operation of any of the machinery or equipment listed in Paragraph f.(2) or f.(3) of the definition of "mobile equipment". h.Mobile Equipment "Bodily injury" or "property damage" arising out of: (1)The transportation of "mobile equipment" by an "auto" owned or operated by or rented or loaned to any insured; or (2)The use of "mobile equipment" in, or while in practice for, or while being prepared for, any prearranged racing, speed, demolition, or stunting activity. i.War "Bodily injury" or "property damage", however caused, arising, directly or indirectly, out of: (1)War, including undeclared or civil war; (2)Warlike action by a military force, including action in hindering or defending against an actual or expected attack, by any government, sovereign or other authority using military personnel or other agents; or (3)Insurrection, rebellion, revolution, usurped power, or action taken by governmental authority in hindering or defending against any of these. j.Damage To Property "Property damage" to: (1)Property you own, rent, or occupy, including any costs or expenses incurred by you, or any other person, organization or entity, for repair, replacement, enhancement, restoration or maintenance of such property for any reason, including prevention of injury to a person or damage to another©s property; (2)Premises you sell, give away or abandon, if the "property damage" arises out of any part of those premises; (3)Property loaned to you; © Insurance Services Office, Inc., 2012 CG 00 01 04 13Page 4 of 16 A0195129 Middlesex Insurance Company 05/13/2024 22deb6ae-f4a4-4e3e-91dd-4d5472e3c8d3 (4)Personal property in the care, custody or control of the insured; (5)That particular part of real property on which you or any contractors or subcontractors working directly or indirectly on your behalf are performing operations, if the "property damage" arises out of those operations; or (6)That particular part of any property that must be restored, repaired or replaced because "your work" was incorrectly performed on it. Paragraphs (1), (3) and (4) of this exclusion do not apply to "property damage" (other than damage by fire) to premises, including the contents of such premises, rented to you for a period of seven or fewer consecutive days. A separate limit of insurance applies to Damage To Premises Rented To You as described in Section III - Limits Of Insurance. Paragraph (2) of this exclusion does not apply if the premises are "your work" and were never occupied, rented or held for rental by you. Paragraphs (3), (4), (5) and (6) of this exclusion do not apply to liability assumed under a sidetrack agreement. Paragraph (6) of this exclusion does not apply to "property damage" included in the "products-completed operations hazard". k.Damage To Your Product "Property damage" to "your product" arising out of it or any part of it. l.Damage To Your Work "Property damage" to "your work" arising out of it or any part of it and included in the "products-completed operations hazard". This exclusion does not apply if the damaged work or the work out of which the damage arises was performed on your behalf by a subcontractor. m.Damage To Impaired Property Or Property Not Physically Injured "Property damage" to "impaired property" or property that has not been physically injured, arising out of: (1)A defect, deficiency, inadequacy or dangerous condition in "your product" or "your work"; or (2)A delay or failure by you or anyone acting on your behalf to perform a contract or agreement in accordance with its terms. This exclusion does not apply to the loss of use of other property arising out of sudden and accidental physical injury to "your product" or "your work" after it has been put to its intended use. n.Recall Of Products, Work Or Impaired Property Damages claimed for any loss, cost or expense incurred by you or others for the loss of use, withdrawal, recall, inspection, repair, replacement, adjustment, removal or disposal of: (1)"Your product"; (2)"Your work"; or (3)"Impaired property"; if such product, work, or property is withdrawn or recalled from the market or from use by any person or organization because of a known or suspected defect, deficiency, inadequacy or dangerous condition in it. o.Personal And Advertising Injury "Bodily injury" arising out of "personal and advertising injury". p.Electronic Data Damages arising out of the loss of, loss of use of, damage to, corruption of, inability to access, or inability to manipulate electronic data. However, this exclusion does not apply to liability for damages because of "bodily injury". As used in this exclusion, electronic data means information, facts or programs stored as or on, created or used on, or transmitted to or from computer software, including systems and applications software, hard or floppy disks, CD-ROMs, tapes, drives, cells, data processing devices or any other media which are used with electronically controlled equipment. q.Recording And Distribution Of Material Or Information In Violation Of Law "Bodily injury" or "property damage" arising directly or indirectly out of any action or omission that violates or is alleged to violate: (1)The Telephone Consumer Protection Act (TCPA), including any amendment of or addition to such law; (2)The CAN-SPAM Act of 2003, including any amendment of or addition to such law; (3)The Fair Credit Reporting Act (FCRA), and any amendment of or addition to such law, including the Fair and Accurate Credit Transactions Act (FACTA); or © Insurance Services Office, Inc., 2012 Page 5 of 16CG 00 01 04 13 A0195129 Middlesex Insurance Company 05/13/2024 22deb6ae-f4a4-4e3e-91dd-4d5472e3c8d3 (4)Any federal, state or local statute, ordinance or regulation, other than the TCPA, CAN-SPAM Act of 2003 or FCRA and their amendments and additions, that addresses, prohibits, or limits the printing, dissemination, disposal, collecting, recording, sending, transmitting, communicating or distribution of material or information. Exclusions c. through n. do not apply to damage by fire to premises while rented to you or temporarily occupied by you with permission of the owner. A separate limit of insurance applies to this coverage as described in Section III - Limits Of Insurance. COVERAGE B - PERSONAL AND ADVERTISING INJURY LIABILITY 1.Insuring Agreement a.We will pay those sums that the insured becomes legally obligated to pay as damages because of "personal and advertising injury" to which this insurance applies. We will have the right and duty to defend the insured against any "suit" seeking those damages. However, we will have no duty to defend the insured against any "suit" seeking damages for "personal and advertising injury" to which this insurance does not apply. We may, at our discretion, investigate any offense and settle any claim or "suit" that may result. But: (1)The amount we will pay for damages is limited as described in Section III - Limits Of Insurance; and (2)Our right and duty to defend end when we have used up the applicable limit of insurance in the payment of judgments or settlements under Coverages A or B or medical expenses under Coverage C. No other obligation or liability to pay sums or perform acts or services is covered unless explicitly provided for under Supplementary Payments - Coverages A and B. b.This insurance applies to "personal and advertising injury" caused by an offense arising out of your business but only if the offense was committed in the "coverage territory" during the policy period. 2.Exclusions This insurance does not apply to: a.Knowing Violation Of Rights Of Another "Personal and advertising injury" caused by or at the direction of the insured with the knowledge that the act would violate the rights of another and would inflict "personal and advertising injury". b.Material Published With Knowledge Of Falsity "Personal and advertising injury" arising out of oral or written publication, in any manner, of material, if done by or at the direction of the insured with knowledge of its falsity. c.Material Published Prior To Policy Period "Personal and advertising injury" arising out of oral or written publication, in any manner, of material whose first publication took place before the beginning of the policy period. d.Criminal Acts "Personal and advertising injury" arising out of a criminal act committed by or at the direction of the insured. e.Contractual Liability "Personal and advertising injury" for which the insured has assumed liability in a contract or agreement. This exclusion does not apply to liability for damages that the insured would have in the absence of the contract or agreement. f.Breach Of Contract "Personal and advertising injury" arising out of a breach of contract, except an implied contract to use another©s advertising idea in your "advertisement". g.Quality Or Performance Of Goods - Failure To Conform To Statements "Personal and advertising injury" arising out of the failure of goods, products or services to conform with any statement of quality or performance made in your "advertisement". h.Wrong Description Of Prices "Personal and advertising injury" arising out of the wrong description of the price of goods, products or services stated in your "advertisement". © Insurance Services Office, Inc., 2012 CG 00 01 04 13Page 6 of 16 A0195129 Middlesex Insurance Company 05/13/2024 22deb6ae-f4a4-4e3e-91dd-4d5472e3c8d3 i.Infringement Of Copyright, Patent, Trademark Or Trade Secret "Personal and advertising injury" arising out of the infringement of copyright, patent, trademark, trade secret or other intellectual property rights. Under this exclusion, such other intellectual property rights do not include the use of another©s advertising idea in your "advertisement". However, this exclusion does not apply to infringement, in your "advertisement", of copyright, trade dress or slogan. j.Insureds In Media And Internet Type Businesses "Personal and advertising injury" committed by an insured whose business is: (1)Advertising, broadcasting, publishing or telecasting; (2)Designing or determining content of web sites for others; or (3)An Internet search, access, content or service provider. However, this exclusion does not apply to Paragraphs 14.a., b. and c. of "personal and advertising injury" under the Definitions section. For the purposes of this exclusion, the placing of frames, borders or links, or advertising, for you or others anywhere on the Internet, is not by itself, considered the business of advertising, broadcasting, publishing or telecasting. k.Electronic Chatrooms Or Bulletin Boards "Personal and advertising injury" arising out of an electronic chatroom or bulletin board the insured hosts, owns, or over which the insured exercises control. l.Unauthorized Use Of Another©s Name Or Product "Personal and advertising injury" arising out of the unauthorized use of another©s name or product in your e-mail address, domain name or metatag, or any other similar tactics to mislead another©s potential customers. m.Pollution "Personal and advertising injury" arising out of the actual, alleged or threatened discharge, dispersal, seepage, migration, release or escape of "pollutants" at any time. n.Pollution-related Any loss, cost or expense arising out of any: (1)Request, demand, order or statutory or regulatory requirement that any insured or others test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of, "pollutants"; or (2)Claim or suit by or on behalf of a governmental authority for damages because of testing for, monitoring, cleaning up, removing, containing, treating, detoxifying or neutralizing, or in any way responding to, or assessing the effects of, "pollutants". o.War "Personal and advertising injury", however caused, arising, directly or indirectly, out of: (1)War, including undeclared or civil war; (2)Warlike action by a military force, including action in hindering or defending against an actual or expected attack, by any government, sovereign or other authority using military personnel or other agents; or (3)Insurrection, rebellion, revolution, usurped power, or action taken by governmental authority in hindering or defending against any of these. p.Recording And Distribution Of Material Or Information In Violation Of Law "Personal and advertising injury" arising directly or indirectly out of any action or omission that violates or is alleged to violate: (1)The Telephone Consumer Protection Act (TCPA), including any amendment of or addition to such law; (2)The CAN-SPAM Act of 2003, including any amendment of or addition to such law; (3)The Fair Credit Reporting Act (FCRA), and any amendment of or addition to such law, including the Fair and Accurate Credit Transactions Act (FACTA); or (4)Any federal, state or local statute, ordinance or regulation, other than the TCPA, CAN-SPAM Act of 2003 or FCRA and their amendments and additions, that addresses, prohibits, or limits the printing, dissemination, disposal, collecting, recording, sending, transmitting, communicating or distribution of material or information. © Insurance Services Office, Inc., 2012 Page 7 of 16CG 00 01 04 13 A0195129 Middlesex Insurance Company 05/13/2024 22deb6ae-f4a4-4e3e-91dd-4d5472e3c8d3 COVERAGE C - MEDICAL PAYMENTS 1.Insuring Agreement a.We will pay medical expenses as described below for "bodily injury" caused by an accident: (1)On premises you own or rent; (2)On ways next to premises you own or rent; or (3)Because of your operations; provided that: (a)The accident takes place in the "coverage territory" and during the policy period; (b)The expenses are incurred and reported to us within one year of the date of the accident; and (c)The injured person submits to examination, at our expense, by physicians of our choice as often as we reasonably require. b.We will make these payments regardless of fault. These payments will not exceed the applicable limit of insurance. We will pay reasonable expenses for: (1)First aid administered at the time of an accident; (2)Necessary medical, surgical, X-ray and dental services, including prosthetic devices; and (3)Necessary ambulance, hospital, professional nursing and funeral services. 2.Exclusions We will not pay expenses for "bodily injury": a.Any Insured To any insured, except "volunteer workers". b.Hired Person To a person hired to do work for or on behalf of any insured or a tenant of any insured. c.Injury On Normally Occupied Premises To a person injured on that part of premises you own or rent that the person normally occupies. d.Workers© Compensation And Similar Laws To a person, whether or not an "employee" of any insured, if benefits for the "bodily injury" are payable or must be provided under a workers© compensation or disability benefits law or a similar law. e.Athletics Activities To a person injured while practicing, instructing or participating in any physical exercises or games, sports, or athletic contests. f.Products-Completed Operations Hazard Included within the "products-completed operations hazard". g.Coverage A Exclusions Excluded under Coverage A. SUPPLEMENTARY PAYMENTS - COVERAGES A AND B 1.We will pay, with respect to any claim we investigate or settle, or any "suit" against an insured we defend: a.All expenses we incur. b.Up to $250 for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these bonds. c.The cost of bonds to release attachments, but only for bond amounts within the applicable limit of insurance. We do not have to furnish these bonds. d.All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or "suit", including actual loss of earnings up to $250 a day because of time off from work. e.All court costs taxed against the insured in the "suit". However, these payments do not include attorneys© fees or attorneys© expenses taxed against the insured. f.Prejudgment interest awarded against the insured on that part of the judgment we pay. If we make an offer to pay the applicable limit of insurance, we will not pay any prejudgment interest based on that period of time after the offer. © Insurance Services Office, Inc., 2012 CG 00 01 04 13Page 8 of 16 A0195129 Middlesex Insurance Company 05/13/2024 22deb6ae-f4a4-4e3e-91dd-4d5472e3c8d3 g.All interest on the full amount of any judgment that accrues after entry of the judgment and before we have paid, offered to pay, or deposited in court the part of the judgment that is within the applicable limit of insurance. These payments will not reduce the limits of insurance. 2.If we defend an insured against a "suit" and an indemnitee of the insured is also named as a party to the "suit", we will defend that indemnitee if all of the following conditions are met: a.The "suit" against the indemnitee seeks damages for which the insured has assumed the liability of the indemnitee in a contract or agreement that is an "insured contract"; b.This insurance applies to such liability assumed by the insured; c.The obligation to defend, or the cost of the defense of, that indemnitee, has also been assumed by the insured in the same "insured contract"; d.The allegations in the "suit" and the information we know about the "occurrence" are such that no conflict appears to exist between the interests of the insured and the interests of the indemnitee; e.The indemnitee and the insured ask us to conduct and control the defense of that indemnitee against such "suit" and agree that we can assign the same counsel to defend the insured and the indemnitee; and f.The indemnitee: (1)Agrees in writing to: (a)Cooperate with us in the investigation, settlement or defense of the "suit"; (b)Immediately send us copies of any demands, notices, summonses or legal papers received in connection with the "suit"; (c)Notify any other insurer whose coverage is available to the indemnitee; and (d)Cooperate with us with respect to coordinating other applicable insurance available to the indemnitee; and (2)Provides us with written authorization to: (a)Obtain records and other information related to the "suit"; and (b)Conduct and control the defense of the indemnitee in such "suit". So long as the above conditions are met, attorneys© fees incurred by us in the defense of that indemnitee, necessary litigation expenses incurred by us and necessary litigation expenses incurred by the indemnitee at our request will be paid as Supplementary Payments. Notwithstanding the provisions of Paragraph 2.b.(2) of Section I - Coverage A - Bodily Injury And Property Damage Liability, such payments will not be deemed to be damages for "bodily injury" and "property damage" and will not reduce the limits of insurance. Our obligation to defend an insured©s indemnitee and to pay for attorneys© fees and necessary litigation expenses as Supplementary Payments ends when we have used up the applicable limit of insurance in the payment of judgments or settlements or the conditions set forth above, or the terms of the agreement described in Paragraph f. above, are no longer met. SECTION II - WHO IS AN INSURED 1.If you are designated in the Declarations as: a.An individual, you and your spouse are insureds, but only with respect to the conduct of a business of which you are the sole owner. b.A partnership or joint venture, you are an insured. Your members, your partners, and their spouses are also insureds, but only with respect to the conduct of your business. c.A limited liability company, you are an insured. Your members are also insureds, but only with respect to the conduct of your business. Your managers are insureds, but only with respect to their duties as your managers. d.An organization other than a partnership, joint venture or limited liability company, you are an insured. Your "executive officers" and directors are insureds, but only with respect to their duties as your officers or directors. Your stockholders are also insureds, but only with respect to their liability as stockholders. e.A trust, you are an insured. Your trustees are also insureds, but only with respect to their duties as trustees. © Insurance Services Office, Inc., 2012 Page 9 of 16CG 00 01 04 13 A0195129 Middlesex Insurance Company 05/13/2024 22deb6ae-f4a4-4e3e-91dd-4d5472e3c8d3 CG 00 01 04 13Page 10 of 16 2.Each of the following is also an insured: a.Your "volunteer workers" only while performing duties related to the conduct of your business, or your "employees", other than either your "executive officers" (if you are an organization other than a partnership, joint venture or limited liability company) or your managers (if you are a limited liability company), but only for acts within the scope of their employment by you or while performing duties related to the conduct of your business. However, none of these "employees" or "volunteer workers" are insureds for: (1)"Bodily injury" or "personal and advertising injury": (a)To you, to your partners or members (if you are a partnership or joint venture), to your members (if you are a limited liability company), to a co-"employee" while in the course of his or her employment or performing duties related to the conduct of your business, or to your other "volunteer workers" while performing duties related to the conduct of your business; (b)To the spouse, child, parent, brother or sister of that co-"employee" or "volunteer worker" as a consequence of Paragraph (1)(a) above; (c)For which there is any obligation to share damages with or repay someone else who must pay damages because of the injury described in Paragraph (1)(a) or (b) above; or (d)Arising out of his or her providing or failing to provide professional health care services. (2)"Property damage" to property: (a)Owned, occupied or used by; (b)Rented to, in the care, custody or control of, or over which physical control is being exercised for any purpose by; you, any of your "employees", "volunteer workers", any partner or member (if you are a partnership or joint venture), or any member (if you are a limited liability company). b.Any person (other than your "employee" or "volunteer worker"), or any organization while acting as your real estate manager. c.Any person or organization having proper temporary custody of your property if you die, but only: (1)With respect to liability arising out of the maintenance or use of that property; and (2)Until your legal representative has been appointed. d.Your legal representative if you die, but only with respect to duties as such. That representative will have all your rights and duties under this Coverage Part. 3.Any organization you newly acquire or form, other than a partnership, joint venture or limited liability company, and over which you maintain ownership or majority interest, will qualify as a Named Insured if there is no other similar insurance available to that organization. However: a.Coverage under this provision is afforded only until the 90th day after you acquire or form the organization or the end of the policy period, whichever is earlier; b.Coverage A does not apply to "bodily injury" or "property damage" that occurred before you acquired or formed the organization; and c.Coverage B does not apply to "personal and advertising injury" arising out of an offense committed before you acquired or formed the organization. No person or organization is an insured with respect to the conduct of any current or past partnership, joint venture or limited liability company that is not shown as a Named Insured in the Declarations. SECTION III - LIMITS OF INSURANCE 1.The Limits of Insurance shown in the Declarations and the rules below fix the most we will pay regardless of the number of: a.Insureds; b.Claims made or "suits" brought; or c.Persons or organizations making claims or bringing "suits". 2.The General Aggregate Limit is the most we will pay for the sum of: a.Medical expenses under Coverage C; b.Damages under Coverage A, except damages because of "bodily injury" or "property damage" included in the "products-completed operations hazard"; and c.Damages under Coverage B. © Insurance Services Office, Inc., 2012 A0195129 Middlesex Insurance Company 05/13/2024 22deb6ae-f4a4-4e3e-91dd-4d5472e3c8d3 3.The Products-Completed Operations Aggregate Limit is the most we will pay under Coverage A for damages because of "bodily injury" and "property damage" included in the "products-completed operations hazard". 4.Subject to Paragraph 2. above, the Personal And Advertising Injury Limit is the most we will pay under Coverage B for the sum of all damages because of all "personal and advertising injury" sustained by any one person or organization. 5.Subject to Paragraph 2. or 3. above, whichever applies, the Each Occurrence Limit is the most we will pay for the sum of: a.Damages under Coverage A; and b.Medical expenses under Coverage C because of all "bodily injury" and "property damage" arising out of any one "occurrence". 6.Subject to Paragraph 5. above, the Damage To Premises Rented To You Limit is the most we will pay under Coverage A for damages because of "property damage" to any one premises, while rented to you, or in the case of damage by fire, while rented to you or temporarily occupied by you with permission of the owner. 7.Subject to Paragraph 5. above, the Medical Expense Limit is the most we will pay under Coverage C for all medical expenses because of "bodily injury" sustained by any one person. The Limits of Insurance of this Coverage Part apply separately to each consecutive annual period and to any remaining period of less than 12 months, starting with the beginning of the policy period shown in the Declarations, unless the policy period is extended after issuance for an additional period of less than 12 months. In that case, the additional period will be deemed part of the last preceding period for purposes of determining the Limits of Insurance. SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS 1.Bankruptcy Bankruptcy or insolvency of the insured or of the insured©s estate will not relieve us of our obligations under this Coverage Part. 2.Duties In The Event Of Occurrence, Offense, Claim Or Suit a.You must see to it that we are notified as soon as practicable of an "occurrence" or an offense which may result in a claim. To the extent possible, notice should include: (1)How, when and where the "occurrence" or offense took place; (2)The names and addresses of any injured persons and witnesses; and (3)The nature and location of any injury or damage arising out of the "occurrence" or offense. b.If a claim is made or "suit" is brought against any insured, you must: (1)Immediately record the specifics of the claim or "suit" and the date received; and (2)Notify us as soon as practicable. You must see to it that we receive written notice of the claim or "suit" as soon as practicable. c.You and any other involved insured must: (1)Immediately send us copies of any demands, notices, summonses or legal papers received in connection with the claim or "suit"; (2)Authorize us to obtain records and other information; (3)Cooperate with us in the investigation or settlement of the claim or defense against the "suit"; and (4)Assist us, upon our request, in the enforcement of any right against any person or organization which may be liable to the insured because of injury or damage to which this insurance may also apply. d.No insured will, except at that insured©s own cost, voluntarily make a payment, assume any obligation, or incur any expense, other than for first aid, without our consent. 3.Legal Action Against Us No person or organization has a right under this Coverage Part: a.To join us as a party or otherwise bring us into a "suit" asking for damages from an insured; or b.To sue us on this Coverage Part unless all of its terms have been fully complied with. A person or organization may sue us to recover on an agreed settlement or on a final judgment against an insured; but we will not be liable for damages that are not payable under the terms of this Coverage Part or that are in excess of the applicable limit of insurance. An agreed settlement means a settlement and release of liability signed by us, the insured and the claimant or the claimant©s legal representative. © Insurance Services Office, Inc., 2012 Page 11 of 16CG 00 01 04 13 A0195129 Middlesex Insurance Company 05/13/2024 22deb6ae-f4a4-4e3e-91dd-4d5472e3c8d3 CG 00 01 04 13Page 12 of 16 4.Other Insurance If other valid and collectible insurance is available to the insured for a loss we cover under Coverages A or B of this Coverage Part, our obligations are limited as follows: a.Primary Insurance This insurance is primary except when Paragraph b. below applies. If this insurance is primary, our obligations are not affected unless any of the other insurance is also primary. Then, we will share with all that other insurance by the method described in Paragraph c. below. b.Excess Insurance (1)This insurance is excess over: (a)Any of the other insurance, whether primary, excess, contingent or on any other basis: (i)That is Fire, Extended Coverage, Builder©s Risk, Installation Risk or similar coverage for "your work"; (ii)That is Fire insurance for premises rented to you or temporarily occupied by you with permission of the owner; (iii)That is insurance purchased by you to cover your liability as a tenant for "property damage" to premises rented to you or temporarily occupied by you with permission of the owner; or (iv)If the loss arises out of the maintenance or use of aircraft, "autos" or watercraft to the extent not subject to Exclusion g. of Section I - Coverage A - Bodily Injury And Property Damage Liability. (b)Any other primary insurance available to you covering liability for damages arising out of the premises or operations, or the products and completed operations, for which you have been added as an additional insured. (2)When this insurance is excess, we will have no duty under Coverages A or B to defend the insured against any "suit" if any other insurer has a duty to defend the insured against that "suit". If no other insurer defends, we will undertake to do so, but we will be entitled to the insured©s rights against all those other insurers. (3)When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of: (a)The total amount that all such other insurance would pay for the loss in the absence of this insurance; and (b)The total of all deductible and self-insured amounts under all that other insurance. (4)We will share the remaining loss, if any, with any other insurance that is not described in this Excess Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this Coverage Part. c.Method Of Sharing If all of the other insurance permits contribution by equal shares, we will follow this method also. Under this approach each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. If any of the other insurance does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer©s share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. 5.Premium Audit a.We will compute all premiums for this Coverage Part in accordance with our rules and rates. b.Premium shown in this Coverage Part as advance premium is a deposit premium only. At the close of each audit period we will compute the earned premium for that period and send notice to the first Named Insured. The due date for audit and retrospective premiums is the date shown as the due date on the bill. If the sum of the advance and audit premiums paid for the policy period is greater than the earned premium, we will return the excess to the first Named Insured. c.The first Named Insured must keep records of the information we need for premium computation, and send us copies at such times as we may request. 6.Representations By accepting this policy, you agree: a.The statements in the Declarations are accurate and complete; © Insurance Services Office, Inc., 2012 A0195129 Middlesex Insurance Company 05/13/2024 22deb6ae-f4a4-4e3e-91dd-4d5472e3c8d3 b.Those statements are based upon representations you made to us; and c.We have issued this policy in reliance upon your representations. 7.Separation Of Insureds Except with respect to the Limits of Insurance, and any rights or duties specifically assigned in this Coverage Part to the first Named Insured, this insurance applies: a.As if each Named Insured were the only Named Insured; and b.Separately to each insured against whom claim is made or "suit" is brought. 8.Transfer Of Rights Of Recovery Against Others To Us If the insured has rights to recover all or part of any payment we have made under this Coverage Part, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request, the insured will bring "suit" or transfer those rights to us and help us enforce them. 9.When We Do Not Renew If we decide not to renew this Coverage Part, we will mail or deliver to the first Named Insured shown in the Declarations written notice of the nonrenewal not less than 30 days before the expiration date. If notice is mailed, proof of mailing will be sufficient proof of notice. SECTION V - DEFINITIONS 1."Advertisement" means a notice that is broadcast or published to the general public or specific market segments about your goods, products or services for the purpose of attracting customers or supporters. For the purposes of this definition: a.Notices that are published include material placed on the Internet or on similar electronic means of communication; and b.Regarding web sites, only that part of a web site that is about your goods, products or services for the purposes of attracting customers or supporters is considered an advertisement. 2."Auto" means: a.A land motor vehicle, trailer or semitrailer designed for travel on public roads, including any attached machinery or equipment; or b.Any other land vehicle that is subject to a compulsory or financial responsibility law or other motor vehicle insurance law where it is licensed or principally garaged. However, "auto" does not include "mobile equipment". 3."Bodily injury" means bodily injury, sickness or disease sustained by a person, including death resulting from any of these at any time. 4."Coverage territory" means: a.The United States of America (including its territories and possessions), Puerto Rico and Canada; b.International waters or airspace, but only if the injury or damage occurs in the course of travel or transportation between any places included in Paragraph a. above; or c.All other parts of the world if the injury or damage arises out of: (1)Goods or products made or sold by you in the territory described in Paragraph a. above; (2)The activities of a person whose home is in the territory described in Paragraph a. above, but is away for a short time on your business; or (3)"Personal and advertising injury" offenses that take place through the Internet or similar electronic means of communication; provided the insured©s responsibility to pay damages is determined in a "suit" on the merits, in the territory described in Paragraph a. above or in a settlement we agree to. 5."Employee" includes a "leased worker". "Employee" does not include a "temporary worker". 6."Executive officer" means a person holding any of the officer positions created by your charter, constitution, bylaws or any other similar governing document. 7."Hostile fire" means one which becomes uncontrollable or breaks out from where it was intended to be. 8."Impaired property" means tangible property, other than "your product" or "your work", that cannot be used or is less useful because: a.It incorporates "your product" or "your work" that is known or thought to be defective, deficient, inadequate or dangerous; or b.You have failed to fulfill the terms of a contract or agreement; if such property can be restored to use by the repair, replacement, adjustment or removal of "your product" or "your work" or your fulfilling the terms of the contract or agreement. © Insurance Services Office, Inc., 2012 Page 13 of 16CG 00 01 04 13 A0195129 Middlesex Insurance Company 05/13/2024 22deb6ae-f4a4-4e3e-91dd-4d5472e3c8d3 9."Insured contract" means: a.A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire to premises while rented to you or temporarily occupied by you with permission of the owner is not an "insured contract"; b.A sidetrack agreement; c.Any easement or license agreement, except in connection with construction or demolition operations on or within 50 feet of a railroad; d.An obligation, as required by ordinance, to indemnify a municipality, except in connection with work for a municipality; e.An elevator maintenance agreement; f.That part of any other contract or agreement pertaining to your business (including an indemnification of a municipality in connection with work performed for a municipality) under which you assume the tort liability of another party to pay for "bodily injury" or "property damage" to a third person or organization. Tort liability means a liability that would be imposed by law in the absence of any contract or agreement. Paragraph f. does not include that part of any contract or agreement: (1)That indemnifies a railroad for "bodily injury" or "property damage" arising out of construction or demolition operations, within 50 feet of any railroad property and affecting any railroad bridge or trestle, tracks, road-beds, tunnel, underpass or crossing; (2)That indemnifies an architect, engineer or surveyor for injury or damage arising out of: (a)Preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (b)Giving directions or instructions, or failing to give them, if that is the primary cause of the injury or damage; or (3)Under which the insured, if an architect, engineer or surveyor, assumes liability for an injury or damage arising out of the insured©s rendering or failure to render professional services, including those listed in (2) above and supervisory, inspection, architectural or engineering activities. 10."Leased worker" means a person leased to you by a labor leasing firm under an agreement between you and the labor leasing firm, to perform duties related to the conduct of your business. "Leased worker" does not include a "temporary worker". 11."Loading or unloading" means the handling of property: a.After it is moved from the place where it is accepted for movement into or onto an aircraft, watercraft or "auto"; b.While it is in or on an aircraft, watercraft or "auto"; or c.While it is being moved from an aircraft, watercraft or "auto" to the place where it is finally delivered; but "loading or unloading" does not include the movement of property by means of a mechanical device, other than a hand truck, that is not attached to the aircraft, watercraft or "auto". 12."Mobile equipment" means any of the following types of land vehicles, including any attached machinery or equipment: a.Bulldozers, farm machinery, forklifts and other vehicles designed for use principally off public roads; b.Vehicles maintained for use solely on or next to premises you own or rent; c.Vehicles that travel on crawler treads; d.Vehicles, whether self-propelled or not, maintained primarily to provide mobility to permanently mounted: (1)Power cranes, shovels, loaders, diggers or drills; or (2)Road construction or resurfacing equipment such as graders, scrapers or rollers; e.Vehicles not described in Paragraph a., b., c. or d. above that are not self-propelled and are maintained primarily to provide mobility to permanently attached equipment of the following types: (1)Air compressors, pumps and generators, including spraying, welding, building cleaning, geophysical exploration, lighting and well servicing equipment; or (2)Cherry pickers and similar devices used to raise or lower workers; f.Vehicles not described in Paragraph a., b., c. or d. above maintained primarily for purposes other than the transportation of persons or cargo. © Insurance Services Office, Inc., 2012 CG 00 01 04 13Page 14 of 16 A0195129 Middlesex Insurance Company 05/13/2024 22deb6ae-f4a4-4e3e-91dd-4d5472e3c8d3 However, self-propelled vehicles with the following types of permanently attached equipment are not "mobile equipment" but will be considered "autos": (1)Equipment designed primarily for: (a)Snow removal; (b)Road maintenance, but not construction or resurfacing; or (c)Street cleaning; (2)Cherry pickers and similar devices mounted on automobile or truck chassis and used to raise or lower workers; and (3)Air compressors, pumps and generators, including spraying, welding, building cleaning, geophysical exploration, lighting and well servicing equipment. However, "mobile equipment" does not include any land vehicles that are subject to a compulsory or financial responsibility law or other motor vehicle insurance law where it is licensed or principally garaged. Land vehicles subject to a compulsory or financial responsibility law or other motor vehicle insurance law are considered "autos". 13."Occurrence" means an accident, including continuous or repeated exposure to substantially the same general harmful conditions. 14."Personal and advertising injury" means injury, including consequential "bodily injury", arising out of one or more of the following offenses: a.False arrest, detention or imprisonment; b.Malicious prosecution; c.The wrongful eviction from, wrongful entry into, or invasion of the right of private occupancy of a room, dwelling or premises that a person occupies, committed by or on behalf of its owner, landlord or lessor; d.Oral or written publication, in any manner, of material that slanders or libels a person or organization or disparages a person©s or organization©s goods, products or services; e.Oral or written publication, in any manner, of material that violates a person©s right of privacy; f.The use of another©s advertising idea in your "advertisement"; or g.Infringing upon another©s copyright, trade dress or slogan in your "advertisement". 15."Pollutants" mean any solid, liquid, gaseous or thermal irritant or contaminant, including smoke, vapor, soot, fumes, acids, alkalis, chemicals and waste. Waste includes materials to be recycled, reconditioned or reclaimed. 16."Products-completed operations hazard": a.Includes all "bodily injury" and "property damage" occurring away from premises you own or rent and arising out of "your product" or "your work" except: (1)Products that are still in your physical possession; or (2)Work that has not yet been completed or abandoned. However, "your work" will be deemed completed at the earliest of the following times: (a)When all of the work called for in your contract has been completed. (b)When all of the work to be done at the job site has been completed if your contract calls for work at more than one job site. (c)When that part of the work done at a job site has been put to its intended use by any person or organization other than another contractor or subcontractor working on the same project. Work that may need service, maintenance, correction, repair or replacement, but which is otherwise complete, will be treated as completed. b.Does not include "bodily injury" or "property damage" arising out of: (1)The transportation of property, unless the injury or damage arises out of a condition in or on a vehicle not owned or operated by you, and that condition was created by the "loading or unloading" of that vehicle by any insured; (2)The existence of tools, uninstalled equipment or abandoned or unused materials; or (3)Products or operations for which the classification, listed in the Declarations or in a policy Schedule, states that products-completed operations are subject to the General Aggregate Limit. 17."Property damage" means: a.Physical injury to tangible property, including all resulting loss of use of that property. All such loss of use shall be deemed to occur at the time of the physical injury that caused it; or b.Loss of use of tangible property that is not physically injured. All such loss of use shall be deemed to occur at the time of the "occurrence" that caused it. For the purposes of this insurance, electronic data is not tangible property. © Insurance Services Office, Inc., 2012 Page 15 of 16CG 00 01 04 13 A0195129 Middlesex Insurance Company 05/13/2024 22deb6ae-f4a4-4e3e-91dd-4d5472e3c8d3 As used in this definition, electronic data means information, facts or programs stored as or on, created or used on, or transmitted to or from computer software, including systems and applications software, hard or floppy disks, CD-ROMs, tapes, drives, cells, data processing devices or any other media which are used with electronically controlled equipment. 18."Suit" means a civil proceeding in which damages because of "bodily injury", "property damage" or "personal and advertising injury" to which this insurance applies are alleged. "Suit" includes: a.An arbitration proceeding in which such damages are claimed and to which the insured must submit or does submit with our consent; or b.Any other alternative dispute resolution proceeding in which such damages are claimed and to which the insured submits with our consent. 19."Temporary worker" means a person who is furnished to you to substitute for a permanent "employee" on leave or to meet seasonal or short-term workload conditions. 20."Volunteer worker" means a person who is not your "employee", and who donates his or her work and acts at the direction of and within the scope of duties determined by you, and is not paid a fee, salary or other compensation by you or anyone else for their work performed for you. 21."Your product": a.Means: (1)Any goods or products, other than real property, manufactured, sold, handled, distributed or disposed of by: (a)You; (b)Others trading under your name; or (c)A person or organization whose business or assets you have acquired; and (2)Containers (other than vehicles), materials, parts or equipment furnished in connection with such goods or products. b.Includes: (1)Warranties or representations made at any time with respect to the fitness, quality, durability, performance or use of "your product"; and (2)The providing of or failure to provide warnings or instructions. c.Does not include vending machines or other property rented to or located for the use of others but not sold. 22."Your work": a.Means: (1)Work or operations performed by you or on your behalf; and (2)Materials, parts or equipment furnished in connection with such work or operations. b.Includes: (1)Warranties or representations made at any time with respect to the fitness, quality, durability, performance or use of "your work"; and (2)The providing of or failure to provide warnings or instructions. © Insurance Services Office, Inc., 2012 CG 00 01 04 13Page 16 of 16 A0195129 Middlesex Insurance Company 05/13/2024 030872e0-5145-4094-9d21-4e0824f06378 CG 03 00 01 96 COMMERCIAL GENERAL LIABILITY CG 03 00 01 96 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DEDUCTIBLE LIABILITY INSURANCE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART A.Our obligation under the Bodily Injury Liability and Property Damage Liability Coverages to pay damages on your behalf applies only to the amount of damages in excess of any deductible amounts stated in the Schedule above as applicable to such coverages. B.You may select a deductible amount on either a per claim or a per "occurrence" basis. Your selected deductible applies to the coverage option and to the basis of the deductible indicated by the placement of the deductible amount in the Schedule above. The deductible amount stated in the Schedule above applies as follows: 1.PER CLAIM BASIS. If the deductible amount indicated in the Schedule above is on a per claim basis, that deductible applies as follows: a.Under Bodily Injury Liability Coverage, to all damages sustained by any one person because of "bodily injury"; b.Under Property Damage Liability Coverage, to all damages sustained by any one person because of "property damage"; or c.Under Bodily Injury Liability and/or Property Damage Liability Coverage Combined, to all damages sustained by any one person because of: (1)"Bodily injury"; (2)"Property damage"; or (3)"Bodily injury" and "property damage" combined as the result of any one "occurrence". If damages are claimed for care, loss of services or death resulting at any time from "bodily injury", a separate deductible amount will be applied to each person making a claim for such damages. With respect to "property damage", person includes an organization. SCHEDULE POLICY NUMBER: (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) APPLICATION OF ENDORSEMENT (Enter below any limitations on the application of this endorsement. If no limitation is entered, the deductibles apply to damages for all "bodily injury" and "property damage", however caused): Copyright, Insurance Services Office, Inc., 1994 Coverage Amount and Basis of Deductible PER CLAIM or PER OCCURRENCE Bodily Injury Liability $$ OR Property Damage Liability $$ OR Bodily Injury Liability and/or $$ Property Damage Liability Combined Page 1 of 2 A0195129 Middlesex Insurance Company 05/13/2024 030872e0-5145-4094-9d21-4e0824f06378 2.PER OCCURRENCE BASIS. If the deductible amount indicated in the Schedule above is on a "per occurrence" basis, that deductible amount applies as follows: a.Under Bodily Injury Liability Coverage, to all damages because of "bodily injury"; b.Under Property Damage Liability Coverage, to all damages because of "property damage"; or c.Under Bodily Injury Liability and/or Property Damage Liability Coverage Combined, to all damages because of: (1)"Bodily injury"; (2)"Property damage"; or (3)"Bodily injury" and "property damage" combined as the result of any one "occurrence", regardless of the number of persons or organizations who sustain damages because of that "occurrence". C.The terms of this insurance, including those with respect to: 1.Our right and duty to defend the insured against any "suits" seeking those damages; and 2.Your duties in the event of an "occurrence", claim, or "suit" apply irrespective of the application of the deductible amount. D.We may pay any part or all of the deductible amount to effect settlement of any claim or "suit" and, upon notification of the action taken, you shall promptly reimburse us for such part of the deductible amount as has been paid by us. Copyright, Insurance Services Office, Inc., 1994 CG 03 00 01 96Page 2 of 2 POLICY NUMBER: © ISO Properties, Inc., 2000 COMMERCIAL GENERAL LIABILITY CG 20 10 10 01 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A.Section II - Who Is An Insured is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of your ongoing operations performed for that insured. B.With respect to the insurance afforded to these additional insureds, the following exclusion is added: 2.Exclusions This insurance does not apply to "bodily injury" or "property damage" occurring after: (1)All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the site of the covered operations has been completed; or (2)That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. Page 1 of 1CG 20 10 10 01 05/13/2024A0195129 Middlesex Insurance Company 00001 0000000000 24134 0 N1 a56aa8df-e581-4f4d-af2a-519d910bea9ba56aa8df-e581-4f4d-af2a-519d910bea9b POLICY NUMBER:COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A.Section II - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1.Your acts or omissions; or 2.The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. B.With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1.All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2.That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. SCHEDULE Name Of Additional Insured Person(s) Or Organization(s):Location(s) Of Covered Operations Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Page 1 of 1CG 20 10 07 04 05/13/2024A0195129 Middlesex Insurance Company © ISO Properties, Inc., 2004 00001 0000000000 24134 0 N1 1674a085-e476-46d4-a712-5ba6ce7ceb721674a085-e476-46d4-a712-5ba6ce7ceb72 POLICY NUMBER: © ISO Properties, Inc., 2000 COMMERCIAL GENERAL LIABILITY CG 20 37 10 01 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Location And Description of Completed Operations: Additional Premium: (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) Section II - Who Is An Insured is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of "your work" at the location designated and described in the schedule of this endorsement performed for that insured and included in the "products-completed operations hazard". Page 1 of 1CG 20 37 10 01 05/13/2024A0195129 Middlesex Insurance Company 00001 0000000000 24134 0 N1 3cb7308d-1790-4f18-bc22-210d6bb723bc3cb7308d-1790-4f18-bc22-210d6bb723bc POLICY NUMBER: Name Of Additional Insured Person(s) Or Organization(s):Location And Description Of Completed Operations Information required to complete this Schedule, if not shown above, will be shown in the Declarations. COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Section II - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the "products-completed operations hazard". Page 1 of 1CG 20 37 07 04 05/13/2024A0195129 Middlesex Insurance Company © ISO Properties, Inc., 2004 00001 0000000000 24134 0 N1 e4988206-7cb2-4a1a-ae09-831c8acbb0c1e4988206-7cb2-4a1a-ae09-831c8acbb0c1 A0195129 Middlesex Insurance Company 05/13/2024 8d074942-b878-4903-9606-200c32d3780f Page 1 of 1CG 21 06 05 14 COMMERCIAL GENERAL LIABILITY CG 21 06 05 14 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION - ACCESS OR DISCLOSURE OF CONFIDENTIAL OR PERSONAL INFORMATION AND DATA-RELATED LIABILITY - WITH LIMITED BODILY INJURY EXCEPTION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A.Exclusion 2.p. of Section I - Coverage A - Bodily Injury And Property Damage Liability is replaced by the following: 2.Exclusions This insurance does not apply to: p.Access Or Disclosure Of Confidential Or Personal Information And Data-related Liability Damages arising out of: (1)Any access to or disclosure of any person©s or organization©s confidential or personal information, including patents, trade secrets, processing methods, customer lists, financial information, credit card information, health information or any other type of nonpublic information; or (2)The loss of, loss of use of, damage to, corruption of, inability to access, or inability to manipulate electronic data. This exclusion applies even if damages are claimed for notification costs, credit monitoring expenses, forensic expenses, public relations expenses or any other loss, cost or expense incurred by you or others arising out of that which is described in Paragraph (1) or (2) above. However, unless Paragraph (1) above applies, this exclusion does not apply to damages because of "bodily injury". As used in this exclusion, electronic data means information, facts or programs stored as or on, created or used on, or transmitted to or from computer software, including systems and applications software, hard or floppy disks, CD-ROMs, tapes, drives, cells, data processing devices or any other media which are used with electronically controlled equipment. B.The following is added to Paragraph 2. Exclusions of Section I - Coverage B - Personal And Advertising Injury Liability: 2.Exclusions This insurance does not apply to: Access Or Disclosure Of Confidential Or Personal Information "Personal and advertising injury" arising out of any access to or disclosure of any person©s or organization©s confidential or personal information, including patents, trade secrets, processing methods, customer lists, financial information, credit card information, health information or any other type of nonpublic information. This exclusion applies even if damages are claimed for notification costs, credit monitoring expenses, forensic expenses, public relations expenses or any other loss, cost or expense incurred by you or others arising out of any access to or disclosure of any person©s or organization©s confidential or personal information. © Insurance Services Office, Inc., 2013 A0195129 Middlesex Insurance Company 05/13/2024 5ccb894c-8f4f-4f3e-807e-bb9462590a8e COMMERCIAL GENERAL LIABILITY CG 21 47 12 07 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. © ISO Properties, Inc., 2006CG 21 47 12 07 EMPLOYMENT-RELATED PRACTICES EXCLUSION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A.The following exclusion is added to Paragraph 2., Exclusions of Section I - Coverage A - Bodily Injury And Property Damage Liability: This insurance does not apply to: "Bodily injury" to: (1)A person arising out of any: (a)Refusal to employ that person; (b)Termination of that person©s employment; or (c)Employment-related practices, policies, acts or omissions, such as coercion, demotion, evaluation, reassignment, disci- pline, defamation, harassment, humiliation, discrimination or malicious prosecution directed at that person; or (2)The spouse, child, parent, brother or sister of that person as a consequence of "bodily injury" to that person at whom any of the employment-related practices described in Paragraphs (a), (b), or (c) above is directed. This exclusion applies: (1)Whether the injury-causing event described in Paragraphs (a), (b) or (c) above occurs before employment, during employment or after employment of that person; (2)Whether the insured may be liable as an employer or in any other capacity; and (3)To any obligation to share damages with or repay someone else who must pay damages because of the injury. B.The following exclusion is added to Paragraph 2., Exclusions of Section I - Coverage B - Personal And Advertising Injury Liability: This insurance does not apply to: "Personal and advertising injury" to: (1)A person arising out of any: (a)Refusal to employ that person; (b)Termination of that person©s employment; or (c)Employment-related practices, policies, acts or omissions, such as coercion, demotion, evaluation, reassignment, disci- pline, defamation, harassment, humiliation, discrimination or malicious prosecution directed at that person; or (2)The spouse, child, parent, brother or sister of that person as a consequence of "personal and advertising injury" to that person at whom any of the employment-related practices described in Paragraphs (a), (b), or (c) above is directed. This exclusion applies: (1)Whether the injury-causing event described in Paragraphs (a), (b) or (c) above occurs before employment, during employment or after employment of that person; (2)Whether the insured may be liable as an employer or in any other capacity; and (3)To any obligation to share damages with or repay someone else who must pay damages because of the injury. Page 1 of 1 A0195129 Middlesex Insurance Company 05/13/2024 d63126dc-89b7-4852-bd74-832ecf04f583 POLICY NUMBER: © Insurance Services Office, Inc., 2018 COMMERCIAL GENERAL LIABILITY CG 21 54 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION - DESIGNATED OPERATIONS COVERED BY A CONTROLLED (WRAP-UP) INSURANCE PROGRAM This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Description And Location(s) Of Operation(s): Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A.The following exclusion is added to Paragraph 2. Exclusions of Section I - Coverage A - Bodily Injury And Property Damage Liability: This insurance does not apply to "bodily injury" or "property damage": 1.Arising out of your ongoing operations; or 2.Included in the "products-completed operations hazard"; at the location(s) described in the Schedule of this endorsement, but only if you are enrolled in a "controlled (wrap-up) insurance program" with respect to the "bodily injury" or "property damage" described in Paragraphs A.1. and A.2. above at such location(s). This exclusion applies whether or not the "controlled (wrap-up) insurance program": a.Provides coverage identical to that provided by this Coverage Part; b.Has limits adequate to cover all claims; or c.Remains in effect. B.The following definition is added to the Definitions section: "Controlled (wrap-up) insurance program" means a centralized insurance program under which one party has secured either insurance or self-insurance covering some or all of the contractors or subcontractors performing work on one or more specific project(s). Page 1 of 1CG 21 54 12 19 A0195129 Middlesex Insurance Company 05/13/2024 de9f90d9-2f4f-47fd-a102-b3482a1a3069 COMMERCIAL GENERAL LIABILITY CG 21 67 12 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. FUNGI OR BACTERIA EXCLUSION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A.The following exclusion is added to Paragraph 2. Exclusions of Section I - Coverage A - Bodily Injury And Property Damage Liability: 2.Exclusions This insurance does not apply to: Fungi Or Bacteria a."Bodily injury" or "property damage" which would not have occurred, in whole or in part, but for the actual, alleged or threatened inhalation of, ingestion of, contact with, exposure to, existence of, or presence of, any "fungi" or bacteria on or within a building or structure, including its contents, regardless of whether any other cause, event, material or product contributed concurrently or in any sequence to such injury or damage. b.Any loss, cost or expenses arising out of the abating, testing for, monitoring, cleaning up, removing, containing, treating, detoxifying, neutralizing, remediating or disposing of, or in any way responding to, or assessing the effects of, "fungi" or bacteria, by any insured or by any other person or entity. This exclusion does not apply to any "fungi" or bacteria that are, are on, or are contained in, a good or product intended for bodily consumption. B.The following exclusion is added to Paragraph 2. Exclusions of Section I - Coverage B - Personal And Advertising Injury Liability: 2.Exclusions This insurance does not apply to: Fungi Or Bacteria a."Personal and advertising injury" which would not have taken place, in whole or in part, but for the actual, alleged or threatened inhalation of, ingestion of, contact with, exposure to, existence of, or presence of any "fungi" or bacteria on or within a building or structure, including its contents, regardless of whether any other cause, event, material or product contributed concurrently or in any sequence to such injury. b.Any loss, cost or expense arising out of the abating, testing for, monitoring, cleaning up, removing, containing, treating, detoxifying, neutralizing, remediating or disposing of, or in any way responding to, or assessing the effects of, "fungi" or bacteria, by any insured or by any other person or entity. C.The following definition is added to the Definitions Section: "Fungi" means any type or form of fungus, including mold or mildew and any mycotoxins, spores, scents or byproducts produced or released by fungi. © ISO Properties, Inc., 2003 Page 1 of 1CG 21 67 12 04 A0195129 Middlesex Insurance Company 05/13/2024 c5b1c04b-5dfe-4677-9d7e-edd180936fc9 Page 1 of 1CG 21 70 01 15 COMMERCIAL GENERAL LIABILITY CG 21 70 01 15 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY A.If aggregate insured losses attributable to terrorist acts certified under the federal Terrorism Risk Insurance Act exceed $100 billion in a calendar year and we have met our insurer deductible under the Terrorism Risk Insurance Act, we shall not be liable for the payment of any portion of the amount of such losses that exceeds $100 billion, and in such case insured losses up to that amount are subject to pro rata allocation in accordance with procedures established by the Secretary of the Treasury. "Certified act of terrorism" means an act that is certified by the Secretary of the Treasury, in accordance with the provisions of the federal Terrorism Risk Insurance Act, to be an act of terrorism pursuant to such Act. The criteria contained in the Terrorism Risk Insurance Act for a "certified act of terrorism" include the following: 1.The act resulted in insured losses in excess of $5 million in the aggregate, attributable to all types of insurance subject to the Terrorism Risk Insurance Act; and 2.The act is a violent act or an act that is dangerous to human life, property or infrastructure and is 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. B.The terms and limitations of any terrorism exclusion, or the inapplicability or omission of a terrorism exclusion, do not serve to create coverage for injury or damage that is otherwise excluded under this Coverage Part. © Insurance Services Office, Inc., 2015 A0195129 Middlesex Insurance Company 05/13/2024 ce9279c4-db98-47b2-97a0-62b38f18d96d Page 1 of 1CG 21 76 01 15 COMMERCIAL GENERAL LIABILITY CG 21 76 01 15 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION OF PUNITIVE DAMAGES RELATED TO A CERTIFIED ACT OF TERRORISM This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY A.The following exclusion is added: This insurance does not apply to: TERRORISM PUNITIVE DAMAGES Damages arising, directly or indirectly, out of a "certified act of terrorism" that are awarded as punitive damages. B.The following definition is added: "Certified act of terrorism" means an act that is certified by the Secretary of the Treasury, in accordance with the provisions of the federal Terrorism Risk Insurance Act, to be an act of terrorism pursuant to such Act. The criteria contained in the Terrorism Risk Insurance Act for a "certified act of terrorism" include the following: 1.The act resulted in insured losses in excess of $5 million in the aggregate, attributable to all types of insurance subject to the Terrorism Risk Insurance Act; and 2.The act is a violent act or an act that is dangerous to human life, property or infrastructure and is 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. C.The terms and limitations of any terrorism exclusion, or the inapplicability or omission of a terrorism exclusion, do not serve to create coverage for injury or damage that is otherwise excluded under this Coverage Part. © Insurance Services Office, Inc., 2015 A0195129 Middlesex Insurance Company 05/13/2024 90cc84d3-1ef8-4c13-853e-9f9a1d4d59c0 Page 1 of 1CG 21 96 03 05 COMMERCIAL GENERAL LIABILITY CG 21 96 03 05 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SILICA OR SILICA-RELATED DUST EXCLUSION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A.The following exclusion is added to Paragraph 2., Exclusions of Section I - Coverage A - Bodily Injury And Property Damage Liability: 2.Exclusions This insurance does not apply to: Silica Or Silica-Related Dust a."Bodily injury" arising, in whole or in part, out of the actual, alleged, threatened or suspected inhalation of, or ingestion of, "silica" or "silica-related dust". b."Property damage" arising, in whole or in part, out of the actual, alleged, threatened or suspected contact with, exposure to, existence of, or presence of, "silica" or "silica-related dust". c.Any loss, cost or expense arising, in whole or in part, out of the abating, testing for, monitoring, cleaning up, removing, containing, treating, detoxifying, neutralizing, remediating or disposing of, or in any way responding to or assessing the effects of, "silica" or "silica-related dust", by any insured or by any other person or entity. B.The following exclusion is added to Paragraph 2., Exclusions of Section I - Coverage B - Personal And Advertising Injury Liability: 2.Exclusions This insurance does not apply to: Silica Or Silica-Related Dust a."Personal and advertising injury" arising, in whole or in part, out of the actual, alleged, threatened or suspected inhalation of, ingestion of, contact with, exposure to, existence of, or presence of, "silica" or "silica-related dust". b.Any loss, cost or expense arising, in whole or in part, out of the abating, testing for, monitoring, cleaning up, removing, containing, treating, detoxifying, neutralizing, remediating or disposing of, or in any way responding to or assessing the effects of, "silica" or "silica-related dust", by any insured or by any other person or entity. C.The following definitions are added to the Definitions Section: 1."Silica" means silicon dioxide (occurring in crystalline, amorphous and impure forms), silica particles, silica dust or silica compounds. 2."Silica-related dust" means a mixture or combination of silica and other dust or particles. © ISO Properties, Inc., 2004 A0195129 Middlesex Insurance Company 05/13/2024 16472be2-317a-4150-bd3a-0cd76397af61 COMMERCIAL GENERAL LIABILITY CG 22 34 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION - CONSTRUCTION MANAGEMENT ERRORS AND OMISSIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following exclusion is added to Paragraph 2. Exclusions of Section I - Coverage A - Bodily Injury And Property Damage Liability and Paragraph 2. Exclusions of Section I - Coverage B - Personal And Advertising Injury Liability: This insurance does not apply to "bodily injury", "property damage" or "personal and advertising injury" arising out of: 1.The preparing, approving, or failure to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications by any architect, engineer or surveyor performing services on a project on which you serve as construction manager; or 2.Inspection, supervision, quality control, architectural or engineering activities done by or for you on a project on which you serve as construction manager. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved that which is described in Paragraph 1. or 2. This exclusion does not apply to "bodily injury" or "property damage" due to construction or demolition work done by you, your "employees" or your subcontractors. © Insurance Services Office, Inc., 2012 Page 1 of 1CG 22 34 04 13 A0195129 Middlesex Insurance Company 05/13/2024 74e94423-f5d2-4ffd-930a-042812f47981 COMMERCIAL GENERAL LIABILITY CG 22 79 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION - CONTRACTORS - PROFESSIONAL LIABILITY This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following exclusion is added to Paragraph 2. Exclusions of Section I - Coverage A - Bodily Injury And Property Damage Liability and Paragraph 2. Exclusions of Section I - Coverage B - Personal And Advertising Injury Liability: 1.This insurance does not apply to "bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of or failure to render any professional services by you or on your behalf, but only with respect to either or both of the following operations: a.Providing engineering, architectural or surveying services to others in your capacity as an engineer, architect or surveyor; and b.Providing, or hiring independent professionals to provide, engineering, architectural or surveying services in connection with construction work you perform. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of or failure to render any professional services by you or on your behalf with respect to the operations described above. 2.Subject to Paragraph 3. below, professional services include: a.Preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders, or drawings and specifications; and b.Supervisory or inspection activities performed as part of any related architectural or engineering activities. 3.Professional services do not include services within construction means, methods, techniques, sequences and procedures employed by you in connection with your operations in your capacity as a construction contractor. © Insurance Services Office, Inc., 2012 Page 1 of 1CG 22 79 04 13 A0195129 Middlesex Insurance Company 05/13/2024 b565b90a-601e-4e22-b763-adf269a0c98a Page 1 of 1CG 24 26 04 13 COMMERCIAL GENERAL LIABILITY CG 24 26 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT OF INSURED CONTRACT DEFINITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The definition of "insured contract" in the Definitions section is replaced by the following: "Insured contract" means: a.A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire to premises while rented to you or temporarily occupied by you with permission of the owner is not an "insured contract"; b.A sidetrack agreement; c.Any easement or license agreement, except in connection with construction or demolition operations on or within 50 feet of a railroad; d.An obligation, as required by ordinance, to indemnify a municipality, except in connection with work for a municipality; e.An elevator maintenance agreement; f.That part of any other contract or agreement pertaining to your business (including an indemnification of a municipality in connection with work performed for a municipality) under which you assume the tort liability of another party to pay for "bodily injury" or "property damage" to a third person or organization, provided the "bodily injury" or "property damage" is caused, in whole or in part, by you or by those acting on your behalf. However, such part of a contract or agreement shall only be considered an "insured contract" to the extent your assumption of the tort liability is permitted by law. Tort liability means a liability that would be imposed by law in the absence of any contract or agreement. Paragraph f. does not include that part of any contract or agreement: (1)That indemnifies a railroad for "bodily injury" or "property damage" arising out of construction or demolition operations, within 50 feet of any railroad property and affecting any railroad bridge or trestle, tracks, road-beds, tunnel, underpass or crossing; (2)That indemnifies an architect, engineer or surveyor for injury or damage arising out of: (a)Preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (b)Giving directions or instructions, or failing to give them, if that is the primary cause of the injury or damage; or (3)Under which the insured, if an architect, engineer or surveyor, assumes liability for an injury or damage arising out of the insured©s rendering or failure to render professional services, including those listed in (2) above and supervisory, inspection, architectural or engineering activities. © Insurance Services Office, Inc., 2012 A0195129 Middlesex Insurance Company 05/13/2024 7bd1905e-fcab-4d07-a5ab-4b1b9a535ffd COMMERCIAL GENERAL LIABILITY CG 70 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EMPLOYEE BENEFITS LIABILITY ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. The following is added to Section I - Coverages: Coverage D. Employee Benefits Liability 1.Insuring Agreement a.We will pay those sums that the insured becomes legally obligated to pay as "damages" because of an "occurrence" to which this insurance applies. We will have the right and duty to defend the insured against any "suit" seeking those "damages". However, we will have no duty to defend the insured against any "suit" seeking "damages" to which this insurance does not apply. We may at our discretion investigate any "occurrence" and settle any claim or "suit" that may result. But: (1)The amount we will pay for "damages" is limited as described in Paragraph B. of this endorsement; and (2)Our right and duty to defend end when we have used up the applicable limit of insurance in the payment of judgments or settlements under Coverage D. No other obligation or liability to pay sums or perform acts or services is covered unless explicitly provided for under Supplementary Payments. b.This insurance applies only to "damages" caused by an "occurrence" during the policy period. The "occurrence" must take place in the "coverage territory". c."Damages" sustained by any one "employee", including "damages" sustained by such "employee©s" dependents and beneficiaries, as a result of a series of related errors or omissions shall be considered one "occurrence". 2.Exclusions This insurance does not apply to: a."Bodily injury" or mental injury to any person, "property damage" or "personal and advertising injury". b.Liability assumed by the insured under any contract or agreement. c. Any claim for: (1)Failure of performance of a contract by any insurer or other fiduciary entrusted with monies intended to fund "employee benefits"; (2)Insufficiency of funds to meet any obligations under any "employee benefits"; (3)Inadequacy of performance of investments, errors in providing information on past performance of investment vehicles or advice given with respect to participation; (4)Your failure to establish any "employee benefits" in compliance with the mandatory provisions of any law governing workers' compensation, unemployment insurance, social security or disability benefits or any similar state or federal laws; (5)Advice given to any person to participate or not to participate in any "employee benefits"; (6)Taxes, fines or penalties, including those imposed under the Internal Revenue Code or any similar state or local law; (7)"Damages" arising out of wrongful termination of employment, discrimination, or other employment-related practices. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 3CG 70 01 04 13 A0195129 Middlesex Insurance Company 05/13/2024 7bd1905e-fcab-4d07-a5ab-4b1b9a535ffd d.Liability based on: (1)Medical malpractice of any physician or surgeon; (2)Dishonest, fraudulent, criminal or malicious acts or omissions committed by any insured; (3)The Employee Retirement Income Security Act of 1974 or any amendment thereof; or (4)Circumstances of which you were aware or should have been aware, at the inception of this insurance. 3.The Supplementary Payments provisions are extended to Coverage D. B.Section III - Limits Of Insurance, is amended as follows: 1.Paragraph 1. is replaced by the following: 1.The Limits of Insurance shown in the Declarations and the rules below fix the most we will pay regardless of the number of: a.Insureds; b.Claims made or "suits" brought; c.Persons or organizations making claims or bringing "suits"; or d.Benefits included in your "employee benefits". 2.Paragraph 2. is replaced by the following: 2.The General Aggregate Limit is the most we will pay for the sum of: a.Medical Expenses under Coverage C.; b.Damages under Coverage A., except damages because of "bodily injury" and "property damage" included in the "products-completed operations hazard"; c.Damages under Coverage B.; and d."Damages" under Coverage D. 3.Paragraph 8. is added as follows: 8.Subject to 2. above, the Each Employee Limit is the most we will pay under Coverage D. for all "damages" sustained by any one "employee", including "damages" sustained by such "employee©s" dependents and beneficiaries, because of any one "occurrence". C.Deductible 1.Our obligation under Coverage D. to pay "damages" on behalf of the insured applies only to the amount of "damages" in excess of any Each Employee deductible amount shown in the Declarations. 2.The deductible amount applies to all "damages" sustained by any one "employee", including such "employee©s" dependents and beneficiaries, because of any one "occurrence". 3.The terms of this insurance, including those with respect to: a.Our right and duty to defend the insured against "suits" seeking those "damages"; and b.Your duties in the event of an "occurrence", claim, or "suit" apply regardless of the application of the deductible amount. 4.We may pay any part or all of the deductible amount to effect settlement of any claim or "suit" and, upon notification of the action taken, you shall promptly reimburse us for such part of the deductible amount as has been paid by us. D.Coverage D Definitions For the coverage provided by this endorsement: 1.The following definitions replace those definitions found in the Commercial General Liability Coverage Form: "Employee" includes a person actively employed, formerly employed, on leave of absence or disabled, or retired. "Employee" does not include a "leased worker" or "temporary worker". "Occurrence" means an error or omission in the "administration" of "employee benefits". 2.The definition of "suit" in the Commercial General Liability Coverage Form is amended by the addition of the following: "Suit" includes a civil proceeding in which "damages" because of an "occurrence" to which this insurance applies are alleged. 3.The following definitions are added Administration means: a.Providing information to "employees", including their dependents and beneficiaries, with respect to eligibility for or scope of "employee benefits"; Includes copyrighted material of Insurance Services Office, Inc., with its permission. CG 70 01 04 13Page 2 of 3 A0195129 Middlesex Insurance Company 05/13/2024 7bd1905e-fcab-4d07-a5ab-4b1b9a535ffd b.Interpreting "employee benefits"; c.Handling of records in connection with the "employee benefits"; or d.Effecting, continuing or terminating any "employee©s" participation in any benefit included in "employee benefits" by you or a person or organization authorized by you to perform such acts. However, "administration" does not include handling payroll deductions. "Damages" means: a.Those sums that the "insured" is legally obligated to pay as a result of negligent errors or omissions to which this insurance applies. For the purpose of this coverage, "damages" does not include punitive or exemplary damages, requests for restitution, requests for injunctive or declarative relief including associated requests for costs or fees or any other costs, fees or penalties that are not insurable by law; or b.Other costs, fees or penalties required to be paid by order of enforcement of any federal, state or local statutes to the extent they are insurable by law. "Employee benefits" means: a.Insurance programs for: (1)Group life; (2)Group accident and health; (3)Dental, vision and hearing plans; (4)Flexible spending accounts; (5)Workers' compensation; (6)Unemployment; and (7)Social security and disability benefits. b.Group plans for: (1)Profit sharing; (2)Pension; (3)"Employee" stock subscription; (4)"Employee" savings plans; and (5)"Employee" stock ownership plans. c.Vacation plans, including buy and sell programs; leave of absence programs, including military, maternity, family, and civil leave; tuition assistance plans; transportation and health club subsidiaries; and d.Other similar employee benefits identified by separate endorsement. The above plans must be provided by you and are applicable only to you and your "employees". Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 3 of 3CG 70 01 04 13 A0195129 Middlesex Insurance Company 05/13/2024 7228d053-0722-425a-b7b4-96a7c049acc8 COMMERCIAL GENERAL LIABILITY CG 71 04 03 18 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NON-CUMULATION OF LIMITS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A.The following is added to Paragraph 5. in Section III - Limits of Insurance: However, if one "occurrence" causes "bodily injury", "property damage" or "personal and advertising injury" during the policy period and during the policy period of one or more prior, or future, general liability policies issued by us, then this policy©s Each Occurrence Limit will be reduced by the amount of each payment made by us under those prior or future general liability policies because of such "occurrence". B.Definitions For the purposes of this endorsement, the term "us" also includes any other company included in or affiliated with the Sentry Group of Companies. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1CG 71 04 03 18 A0195129 Middlesex Insurance Company 05/13/2024 a436826b-ae13-46c3-9214-a5f28f7f0922 COMMERCIAL GENERAL LIABILITY CG 71 05 03 18 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTINUOUS OR PROGRESSIVE INJURY OR DAMAGE LIMITATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following is added to the Insuring Agreement of Coverage A - Bodily Injury and Property Damage and Coverage B - Personal and Advertising Injury Liability: All "property damage", "bodily injury", or "personal and advertising injury" arising from, caused by or contributed to by, or in consequence of an "occurrence" shall be deemed to take place at the time of the first such damage, even though the nature and extent of such damage or injury may change and even though the damage may be continuous, progressive, cumulative, changing or evolving, and even though the "occurrence" causing such "property damage", "bodily injury" or "personal and advertising injury" may be continuous or repeated exposure to substantially the same general harm. The following is added to Paragraph 2. Exclusions of Section I - Coverages, Coverage A - Bodily Injury and Property Damage Liability and Coverage B - Personal and Advertising Injury Liability: This insurance does not apply to: "Bodily injury", "property damage", or "personal and advertising injury" which: 1.First occurred or is alleged to have first occurred prior to the inception date of this policy; or 2.Which is, or is alleged to be, in the process of occurring as of the inception date of this policy. This exclusion applies regardless of whether such "bodily injury", "property damage", or "personal and advertising injury" continues, becomes progressively worse, accumulates, changes or evolves during the policy period, even though the nature and extent of such damage or injury may change, and even though the "occurrence" causing such "property damage", "bodily injury" or "personal and advertising injury" may be continuous or repeated exposure to substantially the same general harm. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1CG 71 05 03 18 A0195129 Middlesex Insurance Company 05/13/2024 6ac6e450-465a-4926-aaef-90a004a8b5d9 COMMERCIAL GENERAL LIABILITY CG 71 07 03 18 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION - RESIDENTIAL CONSTRUCTION OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Project(s): Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A.The following is added to Paragraph 2. Exclusions under Section I - Coverages, Coverage A - Bodily Injury and Property Damage Liability and Coverage B - Personal and Advertising Injury Liability: Residential Construction This insurance does not apply to "bodily injury", "property damage", or "personal and advertising injury" arising out of "designated work", regardless of whether such work or operations was performed by you or on your behalf. This exclusion does not apply to: 1.Designated construction project(s) shown in the Schedule above; 2.Dormitories, military base housing, assisted living centers; or 3."Your work" which only began after a certificate of occupancy, or other similar document issued by the applicable government agency evidencing a structure©s completion, was issued for the property. However, this exception does not apply to warranty work whenever undertaken. B.Definitions The following definition is added for the purposes of this endorsement: "Designated work" means "your work", prior to or subsequent to the effective date of the policy to which this endorsement is attached, on any part of any project or development comprised of: 1.New residential construction, including: single or multiple family dwellings, apartments, residential condominiums, town homes, residential timeshare units, retirement homes or other structures built for residential use; or 2.The conversion of any existing structure to a residential occupancy. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1CG 71 07 03 18 A0195129 Middlesex Insurance Company 05/13/2024 9ed3d6f9-9e69-4a76-ad8e-8cbdd15d2115 Page 1 of 4CG 71 11 07 20 COMMERCIAL GENERAL LIABILITY CG 71 11 07 20 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. GENERAL LIABILITY ENHANCEMENT ENDORSEMENT This endorsement modifies the coverage provided under the following Coverage Forms(s): COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE 1.Bodily Injury - Mental Anguish The definition of "bodily injury" under Section V - Definitions is replaced by the following: "Bodily injury" means bodily injury, sickness or disease sustained by a person, including "mental anguish" or death resulting from any of these at any time. The following definition is added to Section V - Definitions: "Mental anguish" means extreme pain or distress inflicted upon an individual©s emotional and intellectual condition with regard to the individual©s response to the environment. 2.Broad Knowledge Of Occurrence, Claim Suit Under Section IV - Commercial General Liability Conditions, Condition 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit is amended by the addition of the following: Knowledge of an "occurrence", offense, claim or "suit" by an agent or "employee" of any insured or receipt of any demand, notice, summons or other legal paper in connection with a claim or "suit" by any agent or "employee" of any insured shall not in itself constitute knowledge of the named insured or With respect to the coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. A summary list of coverage changes is shown in the schedule for ease of reference. For details of each coverage, see the corresponding policy provisions in the body of the endorsement. Includes copyrighted material of Insurance Services Office, Inc., with its permission. 1.Bodily Injury ± Mental Anguish 2.Broad Knowledge Of Occurrence, Claim Or Suit 3.Damage To Premises Rented To You Broadened coverage Increased limit (see declarations for limit) 4.Expected or Intended Injury Amendment Reasonable force ± property damage, bodily injury 5.Extended Non-Owned Watercraft Increased to 55 ft. 6.Fellow Employee Bodily Injury 7.Hostile Fire ± Pollutant Clean Up $25,000 8.Incidental Medical Malpractice 9.Liberalization Clause 10.Medical Payments Reporting increased to three years from the date of the accident Waiver of subrogation 11.Newly Acquired Organizations Up to 180 days after acquisition or formation Including limited liability companies 12.Supplementary Payments Increased Limits $3,000 for cost of bail bonds $750 per day for time off work 13.Unintentional Failure To Disclose Hazards A0195129 Middlesex Insurance Company 05/13/2024 9ed3d6f9-9e69-4a76-ad8e-8cbdd15d2115 receipt of the named insured, unless a partner, member, manager, "executive officer" or director shall have such knowledge or shall have received such demand, notice, summons or legalpaper. 3.Damage To Premises Rented To You a.The final paragraph under Paragraph 2., Exclusions of Section I - Coverage A - Bodily Injury And Property Damage Liability is replaced by the following: Exclusions c., d., e. and g. through n. do not apply to damage to premises while rented to you or temporarily occupied by you with permission of the owner. A separate limit of insurance applies to this coverage as described in Section III - Limits Of Insurance. This insurance does not apply to "property damage" (other than damage by fire) to premises rented to you for a period of 7 or fewer consecutive days. b.Except for damage arising out of fire, explosion or water discharge, our obligation under this coverage to pay for premises "property damage" on your behalf applies only to the amount of damages in excess of a $5,000 per claim deductible. The deductible applies to all damages sustained by any one person or organization because of premises "property damage". The terms of this insurance, including those with respect to: (1)Our right and duty to defend the insured against any "suit" seeking damages to which this insurance applies; and (2)Your duties in the event of an "occurrence", claim or "suit" Apply irrespective of the application of the deductible amount. We may pay any part of or all of the deductible amount to effect settlement of any claim or "suit" and, upon notification of the action taken, you shall promptly reimburse us for such part of the deductible amount as has been paid by us. 4.Expected or Intended Injury Amendment Exclusion a. under Paragraph 2., Exclusions of Section I - Coverage A - Bodily Injury And Property Damage Liability is replaced by the following: a."Bodily injury" or "property damage" expected or intended from the standpoint of the insured. This exclusion does not apply to "bodily injury" or "property damage" resulting from the use of reasonable force to protect persons or property. 5.Extended Non-Owned Watercraft Paragraph (2)(a) of Exclusion g. under Paragraph 2., Exclusions of Section I - Coverage A - Bodily Injury And Property Damage Liability is amended, substituting 55 feet for 26 feet. 6.Fellow Employee Bodily Injury Paragraph 2.a. of Section II - Who Is An Insured is replaced by the following: 2.Each of the following is also an insured: a.Your "volunteer workers" only while performing duties related to the conduct of your business, or your "employees", other than either your "executive officers" (if you are an organization other than a partnership, joint venture or limited liability company) or your managers (if you are a limited liability company), but only for acts within the scope of their employment by you or while performing duties related to the conduct of your business. However, none of these "employees" or "volunteer workers" are insureds for: (1)"Personal and advertising injury": (a)To you, to your partners or members (if you are a partnership or joint venture), to your members (if you are limited liability company), to a co- "employee" while in the course of his or her employment or performing duties related to the conduct of your business or to your other "volunteer workers" while performing duties related to the conduct of your business; (b)To the spouse, child, parent, brother or sister of that co- "employee" or "volunteer worker" as a consequence of paragraph (1)(a) above or (c)For which there is any obligation to share damages with or repay someone else who must pay damages because of the injury described in paragraphs (1)(a) or (b) above. (2)Bodily injury or "personal and advertising injury" arising out of his or her providing or failing to provide professional health care services. But this does not apply to "bodily injury" arising out of nurses, emergency medical technicians or paramedics providing or failing to provide professional health care services. Includes copyrighted material of Insurance Services Office, Inc., with its permission. CG 71 11 07 20Page 2 of 4 A0195129 Middlesex Insurance Company 05/13/2024 9ed3d6f9-9e69-4a76-ad8e-8cbdd15d2115 (3)Property damage" to property: (a)Owned, occupied or used by; (b)Rented to, in the care, custody or control of, or over which physical control is being exercised for any purpose by; you, any of your "employees", "volunteer workers", any partner or member (if you are a partnership or joint venture), or any member (if you are a limited liability company). 7.Hostile Fire-Pollution Clean Up The following is added to Paragraph (2) of Exclusion f. under Paragraph 2., Exclusions of Section I - Coverage A - Bodily Injury And Property Damage Liability: Subparagraphs (2)(a) and (b) do not apply to loss, cost or expense arising out of heat, smoke or fumes from a "hostile fire" covered under paragraph f.(1). above. A separate aggregate limit of $25,000 is the most we will pay under this coverage for losses during the policy period. The above provision does not apply if a Total Pollution Exclusion endorsement is attached to this policy. 8.Incidental Medical Malpractice a.Under Section V - Definitions, the definition of "bodily injury" is amended to include injury arising out of the rendering or failure to render medical services to persons by any physician, dentist, nurse, emergency medical technician or paramedic who is employed by you to provide such services. b.This insurance does not apply: (1)If you are engaged in the business or occupation of providing medical services; or (2)To liability assumed in a contract or agreement. 9.Liberalization Clause If we revise this endorsement to provide more coverage without an additional premium charge, your policy will automatically provide the additional coverage as of the day of the revision is effective in your state. 10.Medical Payments a.Section I - Coverage C - Medical Payments is extended to apply to medical expenses incurred and reported to us within three years of the date of the accident. b.Under Section IV - Commercial General Liability Conditions, Condition 8. Transfer 3. a. b. c. d. Of Rights Of Recovery Against Others To Us is amended by the addition of the following: We waive the right of recovery we may have because of payments we make for "bodily injury" under Section I - Coverage C - Medical Payments. 11.Newly Acquired Organizations A.Paragraph 3. under Section II ± Who Is An Insured is replaced by the following: Any organization you newly acquire or form, other than a partnership or joint venture, and over which you maintain ownership or majority interest, will qualify as a Named Insured if there is no other similar insurance available to that organization. However: Coverage under this provision is afforded only until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier; Coverage A does not apply to "bodily injury" or "property damage" that occurred before you acquired or formed the organization; Coverage B does not apply to "personal and advertising injury" arising out of an offense committed before you acquired or formed the organization; and No other coverage afforded by this Coverage Part applies with respect to any loss prior to you acquiring or forming the organization. B.The last paragraph of Section II ± Who Is An Insured is replaced by the following: No person or organization is an insured with respect to the conduct of any current or past: 1.Partnership or joint venture; or 2.Limited liability company, unless Paragraph A. above applies; that is not shown as a Named Insured in the Declarations. 12.Supplementary Payments Increased Limits Under Section I - Coverages, Supplementary Payments - Coverages A And B: a.Paragraph 1.b. is amended to pay up to $3,000 for cost of bail bonds; and b.Paragraph 1.d. is amended to pay for loss of earnings up to $750 a day because of time off from work. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 3 of 4CG 71 11 07 20 A0195129 Middlesex Insurance Company 05/13/2024 9ed3d6f9-9e69-4a76-ad8e-8cbdd15d2115 13.Unintentional Failure To Disclose Hazards Under Section IV Commercial General Liability Conditions, the following is added to Condition 6. Representations: If in your representations to us you unintentionally failed to disclose all hazards and exposures subject to this insurance, we shall not deny coverage under this policy solely because of such oversight. Includes copyrighted material of Insurance Services Office, Inc., with its permission. CG 71 11 07 20Page 4 of 4 A0195129 Middlesex Insurance Company 05/13/2024 3d1e71f0-7084-443b-b152-b11d6cdc0e91 COMMERCIAL GENERAL LIABILITY CG 71 12 11 22 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. GENERAL LIABILITY EXTENSION ENDORSEMENT This endorsement modifies the coverage provided under the following Coverage Form(s): COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE A summary list of coverage changes is shown in the schedule for ease of reference. For details of each coverage, see the corresponding policy provisions in the body of the endorsement. 1.Aircraft Charted With A Crew 2.Coverage Territory Amendment 3.Alienated Premises 4.Stop Gap Liability With respect to the coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. 1.Aircraft Chartered With A Crew The following is added to Exclusion g. under Paragraph 2. Exclusions of Section I - Coverage A - Bodily Injury And Property Damage Liability: This exclusion does not apply to an aircraft, not owned by any insured, charted with a crew by or on behalf of the insured. This insurance is excess over any other valid and collectible aircraft insurance available to the insured, whether such insurance is primary, excess, contingent or on any other basis. 2.Coverage Territory Amendment a.Under Section V - Definitions, Paragraph 4. is replaced by the following: 4."Coverage territory" means: a.The United States of America (including its territories and possessions), Puerto Rico and Canada; b.International waters or airspace, but only if the injury or damage occurs in the course of travel or transportation between any places included in Paragraph a. above; or c.All other parts of the world if the injury or damage arises out of: (1)Goods or products made or sold by you in the territory described in Paragraph a. above; (2)The activities of a person whose home is in the territory described in Paragraph a. above, but is away for a short time on your business; or (3)"Personal and advertising injury" offenses that take place through the Internet or similar electronic means of communication; provided the insured©s responsibility to pay damages is determined in a "suit" on the merits, in the territory described in Paragraph a. above or in a settlement we agree to. b.The following is added to Section IV - Conditions: Expanded Coverage Territory (1)If a "suit" to which this insurance applies is brought outside the United States of America (including its territories and possessions), Puerto Rico or Canada, we will have the right but not the duty to defend the insured against such "suit". In any such case in which we elect not to defend, the insured will at our option and under our supervision: (a)Make or cause to be made such investigation and defense as are reasonably necessary; and (b)To the extent possible, effect such settlement or settlements as we shall deem proper. We will reimburse the insured, under Supplementary Payments, for the reasonable cost of such investigation and defense and, within the limits of liability, for the amounts of such authorized settlement. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 6CG 71 12 11 22 A0195129 Middlesex Insurance Company 05/13/2024 3d1e71f0-7084-443b-b152-b11d6cdc0e91 (2)All payments or reimbursements we make for damages because of judgments or settlements will be made in U.S. currency at the prevailing exchange rate at the time the insured became legally obligated to pay such sums. All payments or reimbursements we make for expenses under Supplementary Payments will be made in U.S. currency at the prevailing exchange rate at the time the expenses were incurred. (3)Any disputes between you and us as to whether there is coverage under this policy must be filed in the courts of the United States of America (including its territories and possessions), Puerto Rico or Canada. c.The following is added to Paragraph 4.b. under the Conditions section: 4.Other Insurance b.Excess Insurance This insurance is excess over: (3)Any of the other insurance, whether primary, excess, contingent or on any other basis: (a)If the insured©s liability to pay damages is determined in a "suit" brought outside the United States of America (including its territories and possessions), Puerto Rico or Canada; or (b)That is coverage required by law, regulation or other governmental authority in a part of the "coverage territory" that is outside of the United States of America (including its territories and possessions), Puerto Rico or Canada. 3.Alienated Premises Exclusion j.(2) under Paragraph 2., Exclusions of Section I - Coverage A - Bodily Injury And Property Damage Liability does not apply. 4.Stop Gap - Employers Liability Coverage A.The following is added to Section I - Coverages: Stop Gap - Employers Liability Coverage 1.Insuring Agreement a.We will pay those sums that the insured becomes legally obligated by North Dakota, Ohio, Washington, or Wyoming Law to pay as damages because of "bodily injury by accident" or "bodily injury by disease" to your "employee" to which this insurance applies. We will have the right and duty to defend the insured against any "suit" seeking those damages. However, we will have no duty to defend the insured against any "suit" seeking damages to which this insurance does not apply. We may, at our discretion, investigate any accident and settle any claim or "suit" that may result. But: (1)The amount we will pay for damages is limited as described in Section III - Limits Of Insurance; and (2)Our right and duty to defend end when we have used up the applicable limit of insurance in the payment of judgments or settlements under this coverage. No other obligation or liability to pay sums or perform acts or services is covered unless explicitly provided for under Supplementary Payments. b.This insurance applies to "bodily injury by accident" or "bodily injury by disease" only if: (1)The: (a)"Bodily injury by accident" or "bodily injury by disease" takes place in the "coverage territory"; (b)"Bodily injury by accident" or "bodily injury by disease" arises out of and in the course of the injured "employee©s" employment by you; and (c)"Employee", at the time of the injury, was covered under a worker©s compensation policy and subject to a "workers compensation law" of North Dakota, Ohio, Washington, or Wyoming; and (2)The: (a)"Bodily injury by accident" is caused by an accident that occurs during the policy period; or (b)"Bodily injury by disease" is caused by or aggravated by conditions of employment by you and the injured "employee©s" last day of last exposure to the conditions causing or Includes copyrighted material of Insurance Services Office, Inc., with its permission. CG 71 12 11 22Page 2 of 6 A0195129 Middlesex Insurance Company 05/13/2024 3d1e71f0-7084-443b-b152-b11d6cdc0e91 aggravating such "bodily injury by disease" occurs during the policy period. c.If North Dakota, Washington, or Wyoming law applies, the damages we will pay, where recovery is permitted by law, include damages: (1)For: (a)Which you are liable to a third party by reason of a claim or "suit" against you by that third party to recover the damages claimed against such third party as a result of injury to your "employee"; (b)Care and loss of services; and (c)Consequential "bodily injury by accident" or "bodily injury by disease" to a spouse, child, parent, brother or sister of the injured "employee"; provided that these damages are the direct consequence of "bodily injury by accident" or "bodily injury by disease" that arises out of and in the course of the injured "employee©s" employment by you; and (2)Because of "bodily injury by accident" or "bodily injury by disease" to your "employee" that arises out of and in the course of employment, claimed against you in a capacity other than as employer. d.If Ohio law applies, the damages we will pay, where recovery is permitted by law, include damages: (1)Which you are liable to a third party by reason of a claim or "suit" against you by that third party to recover the damages claimed against such third party as a result of "bodily injury by accident" or "bodily injury by disease" to your "employee"; (2)Care and loss of services resulting from the injury referred to in d.(1); and (3)"Bodily injury by accident" or "bodily injury by disease" to a spouse, child, parent, brother or sister of the injured "employee" as a consequence of the injury referred to in d.(1); provided that these damages are the direct consequence of "bodily injury by accident" or "bodily injury by disease" that arises out of and in the course of the injured "employee©s" employment by you. 2.Exclusions This insurance does not apply to: a.Intentional Injury "Bodily injury by accident" or "bodily injury by disease" intentionally caused or aggravated by you, or "bodily injury by accident" or "bodily injury by disease" resulting from an act which is determined to have been committed by you if it was reasonable to believe that an injury is substantially certain to occur. b.Fines Or Penalties Any assessment, penalty, or fine levied by any regulatory inspection agency or authority. c.Statutory Obligations Any obligation of the insured under a workers© compensation, disability benefits or unemployment compensation law or any similar law. d.Contractual Liability Liability assumed by you under any contract or agreement. e.Violation Of Law "Bodily injury by accident" or "bodily injury by disease" suffered or caused by any employee while employed in violation of law with your actual knowledge or the actual knowledge of any of your "executive officers". f.Termination, Coercion Or Discrimination Damages arising out of coercion, criticism, demotion, evaluation, reassignment, discipline, defamation, harassment, humiliation, discrimination against or termination of any "employee", or arising out of other employment or personnel decisions concerning the insured. g.Failure To Comply With "Workers' Compensation Law" "Bodily injury by accident" or "bodily injury by disease" to an "employee" when you are: (1)Deprived of common law defenses; or (2)Otherwise subject to penalty; because of your failure to secure your obligations or other failure to comply Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 3 of 6CG 71 12 11 22 A0195129 Middlesex Insurance Company 05/13/2024 3d1e71f0-7084-443b-b152-b11d6cdc0e91 with any "workers' compensation law". h.Violation Of Age Laws Or Employment Of Minors "Bodily injury by accident" or "bodily injury by disease" suffered or caused by any person: (1)Knowingly employed by you in violation of any law as to age; or (2)Under the age of 14 years, regardless of any such law. i.Federal Laws Any premium, assessment, penalty, fine, benefit, liability or other obligation imposed by or granted pursuant to: (1)The Federal Employer©s Liability Act (45 USC Section 51-60); (2)The Non-appropriated Fund Instrumentalities Act (5 USC Sections 8171- 8173); (3)The Longshore and Harbor Workers© Compensation Act (33 USC Sections 910-950); (4)The Outer Continental Shelf Lands Act (43 USC Section 1331-1356); (5)The Defense Base Act (42 USC Sections 1651-1654); (6)The Federal Coal Mine Health and Safety Act of 1969 (30 USC Sections 901-942); (7)The Migrant and Seasonal Agricultural Worker Protection Act (29 USC Sections 1801-1872); (8)Any other workers compensation, unemployment compensation or disability laws or any similar law; or (9)Any subsequent amendments to the laws listed above. j.Punitive Damages Multiple, exemplary or punitive damages. k.Crew Members "Bodily injury by accident" or "bodily injury by disease" to a master or member of the crew of any vessel or any member of the flying crew of an aircraft. B.The Supplementary Payments provisions apply to Stop Gap - Employers Liability Coverage as well as to Coverages A and B. C.For the purposes Stop Gap Liability coverage provided in this endorsement, Section II - Who Is An Insured is replaced by the following: Section II - Who Is An Insured If you are designated in the Declarations as: 1.An individual, you and your spouse are insureds, but only with respect to the conduct of a business of which you are the sole owner. 2.A partnership or joint venture, you are an insured. Your members, your partners, and their spouses are also insureds, but only with respect to the conduct of your business. 3.A limited liability company, you are an insured. Your members are also insureds, but only with respect to the conduct of your business. Your managers are insureds, but only with respect to their duties as your managers. 4.An organization other than a partnership, joint venture or limited liability company, you are an insured. Your "executive officers" and directors are insureds, but only with respect to their duties as your officers or directors. Your stockholders are also insureds, but only with respect to their liability as stockholders. No person or organization is an insured with respect to the conduct of any current or past partnership, joint venture or limited liability company that is not shown as a Named Insured in the Declarations. D.For the purposes of Stop Gap Liability coverage provided in this endorsement, Section III Limits Of Insurance, is replaced by the following: Section III - Limits Of Insurance 1.The Limits Of Insurance shown in the Declarations and the rules below fix the most we will pay regardless of the number of: a.Insureds; b.Claims made or "suits" brought; or c.Persons or organizations making claims or bringing "suits". 2.The "Bodily Injury By Accident" - Each Accident Limit shown in the declarations is the most we will pay for all damages covered by this insurance because of "bodily injury by accident" to one or more "employees" in any one accident. 3.The "Bodily Injury By Disease" - Aggregate Limit shown in the declarations and is the most we will pay for all damages covered by this insurance and arising out of "bodily injury by disease", regardless of the number of "employees" who sustain "bodily injury by disease". Includes copyrighted material of Insurance Services Office, Inc., with its permission. CG 71 12 11 22Page 4 of 6 A0195129 Middlesex Insurance Company 05/13/2024 3d1e71f0-7084-443b-b152-b11d6cdc0e91 4.Subject to Paragraph D.3. of this endorsement, the "Bodily Injury By Disease" - Each "Employee" Limit shown in the declarations is the most we will pay for all damages because of "bodily injury by disease" to any one "employee". The limits of the coverage apply separately to each consecutive annual period and to any remaining period of less than 12 months, starting with the beginning of the policy period shown in the Declarations, unless the policy period is extended after issuance for an additional period of less than 12 months. In that case, the additional period will be deemed part of the last preceding period for purposes of determining the Limits of Insurance. E.For the purposes of Stop Gap Liability coverage provided in this endorsement, Condition 2. Duties In The Event Of Occurrence, Claim Or Suit under Section IV - Conditions is replaced by the following: 2.Duties In The Event Of Injury, Claim Or Suit a.You must see to it that we or our agent is notified as soon as practicable of a "bodily injury by accident" or "bodily injury by disease" which may result in a claim. To the extent possible, notice should include: (1)How, when and where the "bodily injury by accident" or "bodily injury by disease" took place; (2)The names and addresses of any injured persons and witnesses; and (3)The nature and location of any injury. b.If a claim is made or "suit" is brought against any insured, you must: (1)Immediately record the specifics of the claim or "suit" and the date received; and (2)Notify us as soon as practicable. You must see to it that we receive written notice of the claim or "suit" as soon as practicable. c.You and any other involved insured must: (1)Immediately send us copies of any demands, notices, summonses or legal papers received in connection with the injury, claim, proceeding or "suit"; (2)Authorize us to obtain records and other information; (3)Cooperate with us and assist us, as we may request, in the investigation or settlement of the claim or defense against the "suit"; (4)Assist us, upon our request, in the enforcement of any right against any person or organization which may be liable to the insured because of injury to which this insurance may also apply; and (5)Do nothing after an injury occurs that would interfere with our right to recover from others. d.No insured will, except at that insured©s own cost, voluntarily make a payment, assume any obligation, or incur any expense, other than for first aid, without our consent. F.For the purposes of Stop Gap Liability coverage provided in this endorsement, Paragraphs 4. and 18. of the Definitions section are replaced by the following: 4."Coverage territory" means: a.The United States of America (including its territories and possessions), Puerto Rico and Canada; b.International waters or airspace, but only if the injury or damage occurs in the course of travel or transportation between any places included in a. above; or c.All other parts of the world if the injury or damage arises out of the activities of a person whose home is in the territory described in a. above, but who is away for a short time on your business; provided the insured©s responsibility to pay damages is determined in the United States (including its territories and possessions), Puerto Rico, or Canada, in a suit on the merits according to the substantive law in such territory, or in a settlement we agree to. 18."Suit" means a civil proceeding in which damages because of "bodily injury by accident" or "bodily injury by disease" to which this insurance applies are alleged. "Suit" includes: a.An arbitration proceeding in which such damages are claimed and to which the insured must submit or does submit with our consent; or b.Any other alternative dispute resolution proceeding in which such damages are claimed and to which the insured submits with our consent. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 5 of 6CG 71 12 11 22 A0195129 Middlesex Insurance Company 05/13/2024 3d1e71f0-7084-443b-b152-b11d6cdc0e91 G.The following are added to the Definitions section: 1."Workers' Compensation Law" means the Workers' Compensation Law and any Occupational Disease Law of North Dakota, Ohio, Washington, or Wyoming. This does not include provisions of any law providing non-occupational disability benefits. 2."Bodily injury by accident" means bodily injury, sickness or disease sustained by a person, including death, resulting from an accident. A disease is not "bodily injury by accident" unless it results directly from "bodily injury by accident". 3."Bodily injury by disease" means a disease sustained by a person, including death. "Bodily injury by disease" does not include a disease that results directly from an accident. H.For the purposes of Stop Gap Liability coverage provided in this endorsement, the definition of "bodily injury" does not apply. Includes copyrighted material of Insurance Services Office, Inc., with its permission. CG 71 12 11 22Page 6 of 6 CG 71 18 06 20 Page 1 of 2 COMMERCIAL GENERAL LIABILITY CG 71 18 06 20 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EACH CONSTRUCTION PROJECT GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Policy Maximum Each Construction Project General Aggregate Limit: $10,000,000 Designated Construction Project(s): All construction projects away from premise owned by or rented by insured. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A.For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under Section I - Coverage A, and for all medical expenses caused by accidents under Section I - Coverage C, which can be attributed only to ongoing operations at a single designated construction project shown in the Schedule above: 1.Subject to Paragraph 2. below, a separate Each Construction Project General Aggregate Limit applies to each designated construction project, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 2.If shown in the Schedule, the Policy Maximum Each Construction Project General Aggregate Limit is the most we will pay for the sum of all damages paid under all Each Construction Project General Aggregate Limits included in this policy. 3.Subject to Paragraph 2. above, the Each Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under Coverage A, except damages because of "bodily injury" or "property damage" included in the "products-completed operations hazard", and for medical expenses under Coverage C regardless of the number of: a.Insureds; b.Claims made or "suits" brought; or c.Persons or organizations making claims or bringing "suits". 4.Subject to Paragraph 2. above, any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the Each Construction Project General Aggregate Limit for that designated construction project. Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they reduce any other Each Construction Project General Aggregate Limit for any other designated construction project shown in the Schedule above. 5.Subject to Paragraph 2. above, the limits shown in the Declarations for Each Occurrence, Damage To Premises Rented To You and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Each Construction Project General Aggregate Limit. Includes copyrighted material of Insurance Services Office, Inc., with its permission.05/13/2024A0195129 Middlesex Insurance Company 00001 0000000000 24134 0 N1 c819b93c-6f55-4d40-87be-775aa80bb5cec819b93c-6f55-4d40-87be-775aa80bb5ce Page 2 of 2 CG 71 18 06 20 B.For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under Section I - Coverage A, and for all medical expenses caused by accidents under Section I - Coverage C, which cannot be attributed only to ongoing operations at a single designated construction project shown in the Schedule above: 1.Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the amount available under the General Aggregate Limit or the Products-completed Operations Aggregate Limit, whichever is applicable; and 2.Such payments shall not reduce any Each Construction Project General Aggregate Limit provided under this policy. C.When coverage for liability arising out of the "products-completed operations hazard" is provided, any payments for damages because of "bodily injury" or "property damage" included in the "products-completed operations hazard" will reduce the Products-completed Operations Aggregate Limit, and not reduce the General Aggregate Limit nor any Each Construction Project General Aggregate Limit provided under this policy. D.If the applicable designated construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same construction project. E.The provisions of Section III - Limits Of Insurance not otherwise modified by this endorsement shall continue to apply as stipulated. Includes copyrighted material of Insurance Services Office, Inc., with its permission.05/13/2024A0195129 Middlesex Insurance Company A0195129 Middlesex Insurance Company 05/13/2024 7b1fab6b-ae27-41cd-9276-64f856522b2b COMMERCIAL GENERAL LIABILITY CG 71 21 06 22 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIRD PARTY DISCRIMINATION This endorsement modifies the coverage provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART With respect to the coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. 1.The following is added to the definition of ªpersonal and advertising injuryº under Section V - Definitions: Injury, including consequential ªbodily injuryº, arising out of discrimination against or harassment of a person if: a.Coverage for such discrimination or harassment is permitted by law; and b.The discrimination or harassment is not committed by or at the direction of: (1)You; (2)If you are an individual, your spouse; (3)If you are a partnership, a partner or his or her spouse; (4)If you are a joint venture, a member of the joint venture or his or her spouse; (5)If you are a limited liability company, any of your members or managers; or (6)If you are an organization other than a partnership, joint venture, or limited liability company, any of your ªexecutive officersº, directors or stockholders. 2.This insurance does not apply to ªpersonal and advertising injuryº: a.Directly or indirectly related to employment, prospective employment, past employment or termination of employment of any person or persons by any insured; or b.Arising out of: (1)Any insured©s failure to comply with any responsibilities or duties required by the Americans With Disabilities Act, any amendments or additions or any similar state or local law; (2)Discrimination against a person by failure to provide equal access to goods, services, or employment via a website, telephone, computer terminal, kiosk, smart device, software application, or any other means of remote or electronic access; (3)Failure to comply with the Web Content Accessibility Guidelines or any amendments thereto; or (4)Discrimination against or harassment of person who is an independent contractor to the insured. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1CG 71 21 06 22 A0195129 Middlesex Insurance Company 05/13/2024 99cfa56f-24dd-4ddf-a171-8d4d4ff4de70 COMMERCIAL GENERAL LIABILITY CG 71 25 06 22 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS BLANKET ADDITIONAL INSUREDS, PRIMARY & NONCONTRIBUTORY, WAIVER OF SUBROGATION This endorsement modifies the coverage provided under the following Coverage Form(s): COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE 1.Additional Insureds - Automatic Status for 13 Additional Insured Types Section II - Who Is An Insured is amended to include the following as additional insureds when you have agreed to add that person or organization as an Additional Insured on your policy in a written contract or written agreement with that person or organization, or because of a permit issued by a state or political subdivision; provided the injury or damage occurs subsequent to the execution of the contract or agreement or issuance of the permit and while the contract, agreement or permit remains in effect. A.Owners, Lessees Or Contractors - Automatic Status When Required In A Written Construction Agreement With You 1)A person or organization with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: a.Your acts or omissions; or b.The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured. With respect to the coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. Coverage enhancements are listed below. For details of each coverage, please read the corresponding policy provisions in the body of this endorsement. 1.Additional Insureds - Automatic Status for 13 Additional Insured Types A.Owners, Lessees Or Contractors - Automatic Status When Required In A Written Construction Agreement With You B.Owners, Lessees Or Contractors - Automatic Status When Required In Written Construction Agreement With You (Completed Operations) C.State or Governmental Agency or Subdivision or Political Subdivision - Permits or Authorizations D.Lessor of Leased Equipment E.Owners or Other Interests From Whom Land Has Been Leased F.Manager or Lessor of Premise G.Mortgagee, Assignee, or Receiver H.Controlling Interest I.Co-owner Of Insured Premises J.Executors, Administrators, Trustees Or Beneficiaries K.State Or Governmental Agency Or Subdivision Or Political Subdivision - Permits Or Authorizations Relating To Premises L.Vendors M.Grantor of Franchise 2.Primary and Noncontributory - Other Insurance Condition 3.Waiver Of Transfer Of Rights Of Recovery Against Others To Us (Waiver Of Subrogation) - Automatic Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 5CG 71 25 06 22 A0195129 Middlesex Insurance Company 05/13/2024 99cfa56f-24dd-4ddf-a171-8d4d4ff4de70 A person©s or organization©s status as an additional insured under this endorsement ends when your operations for that additional insured are completed. 2)With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: a."Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: 1.The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or 2.Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of or the failure to render any professional architectural, engineering or surveying services. b."Bodily injury" or "property damage" occurring after: 1.All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2.That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. B.Owners, Lessees Or Contractors - Automatic Status When Required In Written Construction Agreement With You (Completed Operations) 1)Any person(s) or organization(s) with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" performed for that additional insured and included in the "products-completed operations hazard", but only when that portion of the ªproducts-completed operations hazardº is not excluded by endorsement. 2)With respect to the insurance afforded to these additional insureds, the following additional exclusion applies: This insurance does not apply to: "Bodily injury" or "property damage" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: a.The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or b.Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage" involved the rendering of or the failure to render any professional architectural, engineering or surveying services. C.State or Governmental Agency or Subdivision or Political Subdivision - Permits or Authorizations Any state or governmental agency or subdivision or political subdivision, subject to the following provisions: 1)This insurance applies only with respect to operations performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization. 2)This insurance does not apply to: Includes copyrighted material of Insurance Services Office, Inc., with its permission. CG 71 25 06 22Page 2 of 5 A0195129 Middlesex Insurance Company 05/13/2024 99cfa56f-24dd-4ddf-a171-8d4d4ff4de70 a."Bodily injury", "property damage" or "personal and advertising injury" arising out of operations performed for the federal government, state or municipality; or b."Bodily injury" or "property damage" included within the "products-completed operations hazard". D.Lessor of Leased Equipment 1)Any person(s) or organization(s) with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your maintenance, operation or use of equipment leased to you by such person(s) or organization(s). 2)With respect to the insurance afforded to these additional insureds, this insurance does not apply to any "occurrence" which takes place after the equipment lease expires. E.Owners or Other Interests From Whom Land Has Been Leased 1)Any person(s) or organization(s) with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by you or those acting on your behalf in connection with the ownership, maintenance or use of that part of the land leased to you by the additional insured person(s) or organization(s). 2)With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: a.Any "occurrence" which takes place after you cease to lease that land; b.Structural alterations, new construction or demolition operations performed by or on behalf of the additional insured person(s) or organization(s). F.Manager or Lessor of Premise Any person(s) or organization(s) with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by you or those acting on your behalf in connection with the ownership, maintenance or use of that part of the premises leased to you by the additional insured person(s) or organization(s), subject to the following additional exclusions: This insurance does not apply to: 1)Any "occurrence" which takes place after you cease to be a tenant in that premises. 2)Structural alterations, new construction or demolition operations performed by or on behalf of the person(s) or organization(s) shown in the Schedule. G.Mortgagee, Assignee, or Receiver Any person(s) or organization(s) with respect to their liability as mortgagee, assignee or receiver and arising out of the ownership, maintenance or use of a premises by you. This insurance does not apply to structural alterations, new construction and demolition operations performed by or for such additional insured person(s) or organization(s). H.Controlling Interest 1)Any person(s) or organization(s) with respect to their liability arising out of: a.Their financial control of you; or b.Premises they own, maintain or control while you lease or occupy these premises. 2)This insurance does not apply to structural alterations, new construction and demolition operations performed by or for that person or organization. I.Co-owner Of Insured Premises Any person(s) or organization(s) with respect to their liability as co-owner of a premises co-owned by you and covered under this insurance. J.Executors, Administrators, Trustees Or Beneficiaries Any executor, administrator, trustee or beneficiary of your estate or living trust while acting within the scope of their duties as such. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 3 of 5CG 71 25 06 22 A0195129 Middlesex Insurance Company 05/13/2024 99cfa56f-24dd-4ddf-a171-8d4d4ff4de70 K.State Or Governmental Agency Or Subdivision Or Political Subdivision - Permits Or Authorizations Relating To Premises Any state or governmental agency or subdivision or political subdivision, subject to the following additional provision: This insurance applies only with respect to the following hazards for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization in connection with premises you own, rent or control and to which this insurance applies: 1)The existence, maintenance, repair, construction, erection or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults, street banners or decorations and similar exposures; or 2)The construction, erection or removal of elevators; or 3)The ownership, maintenance or use of any elevators covered by this insurance. L.Vendors 1)Any person(s) or organization(s) (referred to throughout this endorsement as vendor), but only with respect to liability for "bodily injury" or "property damage" arising out of "your products" which are distributed or sold in the regular course of the vendor©s business. However: a.The insurance afforded to such vendor only applies to the extent permitted by law; and b.If coverage provided to the vendor is required by a contract or agreement, the insurance afforded to such vendor will not be broader than that which you are required by the contract or agreement to provide for such vendor. 2)With respect to the insurance afforded to these vendors, the following additional exclusions apply: a.The insurance afforded the vendor does not apply to: 1)"Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; 2)Any express warranty unauthorized by you; 3)Any physical or chemical change in the product made intentionally by the vendor; 4)Repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; 5)Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products; 6)Demonstration, installation, servicing or repair operations, except such operations performed at the vendor©s premises in connection with the sale of the product; 7)Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor; or 8)"Bodily injury" or "property damage" arising out of the sole negligence of the vendor for its own acts or omissions or those of its employees or anyone else acting on its behalf. However, this exclusion does not apply to: (1)The exceptions contained in Subparagraphs d. or f.; or Includes copyrighted material of Insurance Services Office, Inc., with its permission. CG 71 25 06 22Page 4 of 5 A0195129 Middlesex Insurance Company 05/13/2024 99cfa56f-24dd-4ddf-a171-8d4d4ff4de70 (2)Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products. b.This insurance does not apply to any insured person or organization, from whom you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing such products. M.Grantor of Franchise Any person(s) or organization(s) with respect to their liability as grantor of a franchise to you. However: 1.The insurance afforded to such additional insureds only applies to the extent permitted by law; and 2.If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1.Required by the contract or agreement; or 2.Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. If there is any difference in coverage afforded to an additional insured in this endorsement and that provided under another additional insured endorsement attached to this policy, the broader coverage will apply to that additional insured. 2.Primary And Noncontributory Insurance The following is added to the Other Insurance Condition and supersedes any provision to the contrary: This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1)The additional insured is a Named Insured under such other insurance; and (2)You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. 3.Waiver Of Transfer Of Rights Of Recovery Against Others To Us (Waiver Of Subrogation) - Automatic The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV - Conditions: We waive any right of recovery against any person or organization, because of any payment we make under this Coverage Part, to whom the insured has waived its right of recovery in a written contract or agreement. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person or organization prior to loss. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 5 of 5CG 71 25 06 22 A0195129 Middlesex Insurance Company 05/13/2024 abaed7bd-a845-43ca-b38c-8d527217d58d COMMERCIAL GENERAL LIABILITY CG 71 27 01 20 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION - AUTO LIABILITY This endorsement modifies the insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Exclusion g. Aircraft, Auto or Watercraft of paragraph 2. Exclusions of Section I - Coverages is replaced with: This insurance does not apply to: a.Aircraft Or Watercraft "Bodily injury" or "property damage" arising out of the ownership, maintenance, use or entrustment to others of any aircraft or watercraft owned or operated by or rented or loaned to any insured. Use includes operation and "loading or unloading". This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage" involved the ownership, maintenance, use or entrustment to others of any aircraft or watercraft that is owned or operated by or rented or loaned to any insured. This exclusion does not apply to: (1)A watercraft while ashore on premises you own or rent; (2)A watercraft you do not own that is: (a)Less than 26 feet long; and (b)Not being used to carry persons or property for a charge; or (3)Liability assumed under any "insured contract" for the ownership, maintenance or use of aircraft or watercraft. b.Auto ªBodily injuryº or ªproperty damageº arising out of the ownership, maintenance, or use of any ªautoº, by any insured or any other person or organization. Use includes operation and ªloading or unloadingº. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the ªoccurrenceº which caused the ªbodily injuryº or ªproperty damageº involved the ownership, maintenance, or use of any ªautoº. This exclusion does not apply to: (1)Parking an ªautoº on, or on the ways next to, premises you own or rent, provided the ªautoº is not owned by or rented or loaned to you or any insured; (2)"Bodily injury" or "property damage" arising out of: (a)The operation of machinery or equipment that is attached to, or part of, a land vehicle that would qualify under the definition of "mobile equipment" if it were not subject to a compulsory or financial responsibility law or other motor vehicle insurance law where it is licensed or principally garaged; or (b)The operation of any of the equipment listed in paragraph f. (2) or f. (3) of the definition of "mobile equipment". Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1CG 71 27 01 20 A0195129 Middlesex Insurance Company 05/13/2024 41500119-a39f-4784-9c1d-607888485242 COMMERCIAL GENERAL LIABILITY CG 80 02 06 22 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. TOTAL POLLUTION EXCLUSION ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A.Exclusion f. under Paragraph 2., Exclusions of Section I - Coverage, A - Bodily Injury And Property Damage Liability is replaced by the following: This insurance does not apply to: f.Pollution (1)"Bodily injury" or "property damage" which would not have occurred in whole or part but for the actual, alleged or threatened discharge, dispersal, seepage, migration, release or escape of "pollutants" at any time. (2)Any loss, cost or expense arising out of any: (a)Request, demand, order or statutory or regulatory requirement that any insured or others test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of "pollutants", or (b)Claim or "suit" by or on behalf of a governmental authority for damages because of testing for, monitoring, cleaning up, removing, containing, treating, detoxifying or neutralizing, or in any way responding to, or assessing the effects of, "pollutants". (3)This pollution exclusion applies whether or not: (a)Such irritant or contaminant is "your product" or has any function in your business, operations, premises, site or location, or (b)The "bodily injury" or "property damage" arises from environmental damage or pollution of the environment and this exclusion applies for example and without limitation from exposure to "pollutants" within a residential or commercial building or from discharges of "pollutants" from "your product". B.The definition of "pollutants" in Section V - Definitions is replaced by the following: "Pollutants" means any solid, liquid, gaseous, bacterial, fungal, viral, electromagnetic, thermal, or other substance that is toxic or hazardous, causes irritation to animals, vegetation, or persons, and/or causes contamination to property or the environment, including, but not limited to, smoke, vapor, soot, fumes (including welding fumes, paint fumes, and glue fumes), acids, alkalis, chemicals, and waste. Specific examples identified as "pollutants" include, but are not limited to, gasoline, diesel, kerosene, transmission fluid, antifreeze, brake fluid, any other fuel oils, any other motor oils, any other petroleum products, any other lubricants, and any of their additives, derivatives, degradation products, and individual chemical components including, but not limited to, benzene, toluene, ethylbenzene, xylenes, phenanthrene, naphthalene, 2-methyl-naphthalene, trimethylbenzene isomers; carbon monoxide and other exhaust gases; solvents, mineral spirits, adhesives, pesticides, insecticides, herbicides, asbestos, lead, lead based paint, silica, sewage, perfluorooctane sulfonate (PFOS), perfluorooctanoic acid (PFOA), Perfluorobutane sulfonic acid (PFBS), Perfluorobutanesulfonate, Potassium Perfluorobutane Sulfonate, Sodium fluoroacetate, 2,2-Difluoropropane, 1-Chloro-1, 1-difluoroethane, 1,1,1,2-Tetrafluoroethane, 1,1,1-Trifluoroethane, 1,1-Difluoroethane, Dichlorodifluoromethane, Trichlorofluoromethane, Chlorodifluoromethane, and 1,1,2-Trichloro-1, 2,2-trifluoroethane, and other per- and polyfluoroalkyl substances (PFAS), including, but not limited to, all substances listed on the USEPA Master List of PFAS Substances, which has been available online at: https://comptox.epa.gov/dashboard/chemical_ lists/pfasmaster, and any of their associated homologues, isomers, salts, esters, alcohols, acids, precursor chemicals, additives, derivatives, degradation products, by-products, and individual chemical components. Solvents include, but are Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 2CG 80 02 06 22 A0195129 Middlesex Insurance Company 05/13/2024 41500119-a39f-4784-9c1d-607888485242 not limited to, tetrachlorethylene or perchloroethylene (PCE), trichloroethylene (TCE), dichloroacetylene, chloroacetylene, 1,1,1- trichloroethane (1,1,1-TCA), 1,1,2-trichloroethane (1,1,2-TCA), 1,4-dioxane, cis-1,2-dichloroethylene (cis-1,2-DCE), trans-1,2-dichloroethylene (trans-1,2-DCE), 1,1-dichloroethylene (1,1-DCE), 1,1-dichloroethane (1,1-DCA), 1,2-dichloroethane (1,2-DCA), acetate, acetylene, vinyl chloride, methylene chloride, methylene chloroform, chloromethane, ethene, ethane, ethanol, formate, glycolate, methane, carbon dioxide, any other dry cleaning chemicals, chlorofluorocarbons, chlorinated hydrocarbons, any other chlorinated solvents, any other halogenated solvents, and any of their additives, derivatives, degradation products, and individual chemical components. Solvents also include naturally occurring metals that dissolve as the result of solvents in the environment, including, but not limited to, arsenic, barium, copper, iron, manganese, magnesium, and selenium. ªPollutantsº also include, but are not limited to, all substances specifically listed, identified, or described by one or more of the following references: Agency for Toxic Substance and Disease Registry ToxFAQs Substance Priority List, which has been available online at https://www.atsdr.cdc.gov/SPL, US Environmental Protection Agency EMCI Chemical Reference Complete Index, which has been available online at https://enviro.epa.gov/, United States Environmental Protection Agency, Regional Screening Levels for Chemical Contaminants at Superfund Sites, which has been available online at: https://www.epa.gov/risk/regional-screening- levels-rsls, the Comprehensive Environmental Response Compensation and Liability Act (CERCLA) Priority List Hazardous Substances, 40 CFR 302.4, Table 302.4 (1997 and all subsequent editions), and/or the Indiana Department of Environmental Management risk based tables, including the 1996 Voluntary Remediation Program Tier II Table, Default Closure Level Tables (2001 and all subsequent editions), Screening Level Tables (2012 and all subsequent editions),which have been available online at https://www.in.gov/idem/cleanups/resources/ technical-guidance-for-cleanups/idem-screening- and-closure-level-tables/. Waste includes, but is not limited to, material to be recycled, reconditioned or reclaimed. A substance does not lose its character of being a "pollutant" by virtue of having a useful function. Includes copyrighted material of Insurance Services Office, Inc., with its permission. CG 80 02 06 22Page 2 of 2 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1CG 80 27 06 20 05/13/2024A0195129 Middlesex Insurance Company CG 80 27 06 20 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMPOSITE RATE/PREMIUM ENDORSEMENT This endorsement modifies insurance under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS COVERAGE PART SCHEDULE Rating Basis Type Estimated Annual Basis Amount Annual Premium Composite Group Description Rate Payroll $6,000,000 $62,208.00Annual GL Payroll - 95647 Effective 05/13/2024 to 05/13/2025 $10.368 Per 1,000 Cost of Work $5,000,000 $24,155.00Annual Subcontractor Costs - 91581 Effective 05/13/2024 to 05/13/2025 $4.831 Per 1,000 Area 7,858 $192.00Area - 61212 Effective 05/13/2024 to 05/13/2025 $24.434 Per 1,000 Additional Description: Premium for this policy will be determined on a composite rated basis in accordance with the information shown in the Schedule. The premium shown is an advance deposit premium that is subject to the policy audit provisions. Premiums shown in the Schedule may not be reflective of the entire policy cost. See the Common Policy Declarations for the total policy cost, including any applicable endorsement premium, taxes, fees, and surcharges. Effective dates shown in the Schedule indicate the timeframe during which the policy utilized a particular composite rate group to develop premium. Premiums shown in the Schedule reflect annual premium and may not be reflective of the actual premium due under your policy if any composite groups are added to your policy midterm. 00001 0000000000 24134 0 N1 7cc43d57-e55f-4f20-8d7c-39bd8f9368287cc43d57-e55f-4f20-8d7c-39bd8f936828 A0195129 Middlesex Insurance Company 05/13/2024 0609f208-91df-420a-b8e1-8d7a62d1094e Page 1 of 1CG 88 08 12 04 COMMERCIAL GENERAL LIABILITY CG 88 08 12 04 EXCLUSION - ASBESTOS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following exclusion is added to Paragraph 2., Exclusions of Section I - Coverage A - Bodily Injury And Property Damage Liability and Paragraph 2., Exclusions of Section I - Coverage B - Personal And Advertising Injury Liability: This insurance does not apply to: 1."Bodily injury", "property damage" or "personal and advertising injury" caused in whole or in part by the actual, alleged or threatened: a.Inhalation of, ingestion of or physical exposure to "asbestos"; b.Use of "asbestos" in construction or manufacture of any goods, products or structures; c.Removal of "asbestos" from any goods, products or structures; d.Manufacture, sale, transport, storage or disposal of "asbestos"; or e.Discharge, dispersal, seepage, migration, release or escape of "asbestos". 2.Any loss, cost or expense arising out of any: a.Request, demand, order or statutory or regulatory requirement that any insured or others test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of "asbestos"; or b.Claim or suit by or on behalf of a governmental authority for damages because of testing for, monitoring, cleaning up, removing, containing, treating, detoxifying or neutralizing, or In any way responding to, or assessing the effects of "asbestos". As used herein, "asbestos" means not only the natural fibrous mineral forms of impure magnesium silicate, but also any material, good, product or structure of which it is a part. A0195129 Middlesex Insurance Company 05/13/2024 9463538c-2d40-4352-b842-9c5fc63fea6b Page 1 of 1CG 88 39 04 13 COMMERCIAL LIABILITY CG 88 39 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DISTRIBUTION OF MATERIAL IN VIOLATION OF STATUTES AMENDED EXCLUSION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM 1.Section I - Coverages, Coverage A - Bodily Injury And Property Damage Liability Paragraph 2. Exclusions exclusion q. Recording And Distribution Of Material or Information In Violation Of Law is replaced by the following: This insurance does not apply to: q.Recording And Distribution Of Material Or Information In Violation Of Law "Bodily injury" or "property damage" arising directly or indirectly out of any action or omission that violates or is alleged to violate: (1)The Telephone Consumer Protection Act (TCPA) including any amendment of or addition to such law; or (2)The CAN-SPAM Act of 2003, including any amendment of or addition to such law; or (3)The Fair Credit Reporting Act (FCRA), and any amendment of or addition to such law including the Fair and Accurate Credit Transaction Act (FACTA); or (4)The Fair Debt Collection Practices Act (FDCPA), including any amendment of or addition to such law; or (5)Any federal, state or local statute, ordinance or regulation other than the TCPA, CAN-SPAM Act of 2003, FCRA or FDCPA and their amendments and additions, that addresses, prohibits or limits the printing, dissemination, disposal, collecting, recording, sending, transmitting, communicating or distribution of material or information. 2.Section I - Coverage, Coverage B - Personal And Advertising Injury Liability Paragraph 2. Exclusions Exclusion p. Recording And Distribution Of Material Or Information In Volation Of Law is replaced by the following: This insurance does not apply to: p.Recording And Distribution Of Material In Violation Of Law "Personal and advertising injury" arising directly or indirectly out of any action or omission that violates or is alleged to violate: (1)The Telephone Consumer Protection Act (TCPA) including any amendment of or addition to such law; or (2)The CAN-SPAM Act of 2003, including any amendment of or addition to such law; or (3)The Fair Credit Reporting Act (FCRA), and any amendment of or addition to such law, including the Fair and Accurate Credit Transaction Act (FACTA); or (4)The Fair Debt Collection Practices Act (FDCPA), including any amendment of or addition to such law; or (5)Any federal, state or local statute, ordinance or regulation other than the TCPA, CAN-SPAM Act of 2003, FCRA or FDCPA and their amendments and additions, that addresses, prohibits or limits the printing, dissemination, disposal, collecting, recording, sending, transmitting, communicating or distribution of material or information. All other terms and provisions of this policy remain unchanged Page 1 of 2 05/13/2024A0195129 Middlesex Insurance Company IL 00 21 09 08 IL 00 21 09 08 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NUCLEAR ENERGY LIABILITY EXCLUSION ENDORSEMENT (Broad Form) This endorsement modifies insurance provided under the following: COMMERCIAL AUTOMOBILE COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART FARM COVERAGE PART LIQUOR LIABILITY COVERAGE PART MEDICAL PROFESSIONAL LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY 1.The insurance does not apply: A.Under any Liability Coverage, to "bodily injury" or "property damage": (1)With respect to which an "insured" under the policy is also an insured under a nuclear energy liability policy issued by Nuclear Energy Liability Insurance Association, Mutual Atomic Energy Liability Underwriters, Nuclear Insurance Association of Canada or any of their successors, or would be an insured under any such policy but for its termination upon exhaustion of its limit of liability; or (2)Resulting from the "hazardous properties" of "nuclear material" and with respect to which (a) any person or organization is required to maintain financial protection pursuant to the Atomic Energy Act of 1954, or any law amendatory thereof, or (b) the "insured" is, or had this policy not been issued would be, entitled to indemnity from the United States of America, or any agency thereof, under any agreement entered into by the United States of America, or any agency thereof, with any person or organization. B.Under any Medical Payments coverage, to expenses incurred with respect to "bodily injury" resulting from the "hazardous properties" of "nuclear material" and arising out of the operation of a "nuclear facility" by any person or organization. C.Under any Liability Coverage, to "bodily injury" or "property damage" resulting from "hazardous properties" of "nuclear material", if: (1)The "nuclear material" (a) is at any "nuclear facility" owned by, or operated by or on behalf of, an "insured" or (b) has been discharged or dispersed therefrom; (2)The "nuclear material" is contained in "spent fuel" or "waste" at any time possessed, handled, used, processed, stored, transported or disposed of, by or on behalf of an "insured"; or (3)The "bodily injury" or "property damage" arises out of the furnishing by an "insured" of services, materials, parts or equipment in connection with the planning, construction, maintenance, operation or use of any "nuclear facility", but if such facility is located within the United States of America, its territories or possessions or Canada, this exclusion (3) applies only to "property damage" to such "nuclear facility" and any property thereat. 2.As used in this endorsement: "Hazardous properties" includes radioactive, toxic or explosive properties. "Nuclear material" means "source material", "special nuclear material" or "by-product material". © ISO Properties, Inc., 2007 00001 0000000000 24134 0 N1 d51efcbd-1f7b-4c12-b9cf-1bfaec02fcbad51efcbd-1f7b-4c12-b9cf-1bfaec02fcba Page 2 of 2 "Source material", "special nuclear material", and "by-product material" have the meanings given them in the Atomic Energy Act of 1954 or in any law amendatory thereof. "Spent fuel" means any fuel element or fuel component, solid or liquid, which has been used or exposed to radiation in a "nuclear reactor". "Waste" means any waste material (a) containing "by-product material" other than the tailings or wastes produced by the extraction or concentration of uranium or thorium from any ore processed primarily for its "source material" content, and (b) resulting from the operation by any person or organization of any "nuclear facility" included under the first two paragraphs of the definition of "nuclear facility". "Nuclear facility" means: (a)Any "nuclear reactor"; (b)Any equipment or device designed or used for (1) separating the isotopes of uranium or plutonium, (2) processing or utilizing "spent fuel", or (3) handling, processing or packaging "waste"; (c)Any equipment or device used for the processing, fabricating or alloying of "special nuclear material" if at any time the total amount of such material in the custody of the "insured" at the premises where such equipment or device is located consists of or contains more than 25 grams of plutonium or uranium 233 or any combination thereof, or more than 250 grams of uranium 235; (d)Any structure, basin, excavation, premises or place prepared or used for the storage or disposal of "waste"; and includes the site on which any of the foregoing is located, all operations conducted on such site and all premises used for such operations. "Nuclear reactor" means any apparatus designed or used to sustain nuclear fission in a self-supporting chain reaction or to contain a critical mass of fissionable material. "Property damage" includes all forms of radioactive contamination of property. © ISO Properties, Inc., 2007 IL 00 21 09 08 05/13/2024A0195129 Middlesex Insurance Company IL 02 70 09 12 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. © Insurance Services Office, Inc., 2012 CALIFORNIA CHANGES - CANCELLATION AND NONRENEWAL This endorsement modifies insurance provided under the following: CAPITAL ASSETS PROGRAM (OUTPUT POLICY) COVERAGE PART COMMERCIAL AUTOMOBILE COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL PROPERTY COVERAGE PART CRIME AND FIDELITY COVERAGE PART EMPLOYMENT-RELATED PRACTICES LIABILITY COVERAGE PART EQUIPMENT BREAKDOWN COVERAGE PART FARM COVERAGE PART LIQUOR LIABILITY COVERAGE PART MEDICAL PROFESSIONAL LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART A.Paragraphs 2. and 3. of the Cancellation Common Policy Condition are replaced by the following: 2.All Policies In Effect For 60 Days Or Less If this policy has been in effect for 60 days or less, and is not a renewal of a policy we have previously issued, we may cancel this policy by mailing or delivering to the first Named Insured, at the mailing address shown in the policy, and to the producer of record, advance written notice of cancellation, stating the reason for cancellation, at least: a.10 days before the effective date of cancellation if we cancel for: (1)Nonpayment of premium; or (2)Discovery of fraud by: (a)Any insured or his or her representative in obtaining this insurance; or (b)You or your representative in pursuing a claim under this policy. b.30 days before the effective date of cancellation if we cancel for any other reason. 3.All Policies In Effect For More Than 60 Days a.If this policy has been in effect for more than 60 days, or is a renewal of a policy we issued, we may cancel this policy only upon the occurrence, after the effective date of the policy, of one or more of the following: (1)Nonpayment of premium, including payment due on a prior policy we issued and due during the current policy term covering the same risks. (2)Discovery of fraud or material misrepresentation by: (a)Any insured or his or her representative in obtaining this insurance; or (b)You or your representative in pursuing a claim under this policy. (3)A judgment by a court or an administrative tribunal that you have violated a California or Federal law, having as one of its necessary elements an act which materially increases any of the risks insured against. Page 1 of 4IL 02 70 09 12 05/13/2024A0195129 Middlesex Insurance Company 00002 0000000000 24134 0 N1 99caa6ef-6bea-4169-bdae-def863d3fafd99caa6ef-6bea-4169-bdae-def863d3fafd © Insurance Services Office, Inc., 2012 (4)Discovery of willful or grossly negligent acts or omissions, or of any violations of state laws or regulations establishing safety standards, by you or your representative, which materially increase any of the risks insured against. (5)Failure by you or your representative to implement reasonable loss control requirements, agreed to by you as a condition of policy issuance, or which were conditions precedent to our use of a particular rate or rating plan, if that failure materially increases any of the risks insured against. (6)A determination by the Commissioner of Insurance that the: (a)Loss of, or changes in, our reinsurance covering all or part of the risk would threaten our financial integrity or solvency; or (b)Continuation of the policy coverage would: (i)Place us in violation of California law or the laws of the state where we are domiciled; or (ii)Threaten our solvency. (7)A change by you or your representative in the activities or property of the commercial or industrial enterprise, which results in a materially added, increased or changed risk, unless the added, increased or changed risk is included in the policy. b.We will mail or deliver advance written notice of cancellation, stating the reason for cancellation, to the first Named Insured, at the mailing address shown in the policy, and to the producer of record, at least: (1)10 days before the effective date of cancellation if we cancel for nonpayment of premium or discovery of fraud; or (2)30 days before the effective date of cancellation if we cancel for any other reason listed in Paragraph 3.a. B.The following provision is added to the Cancellation Common Policy Condition: 7.Residential Property This provision applies to coverage on real property which is used predominantly for residential purposes and consisting of not more than four dwelling units, and to coverage on tenants' household personal property in a residential unit, if such coverage is written under one of the following: Commercial Property Coverage Part Farm Coverage Part - Farm Property - Farm Dwellings, Appurtenant Structures And Household Personal Property Coverage Form a.If such coverage has been in effect for 60 days or less, and is not a renewal of coverage we previously issued, we may cancel this coverage for any reason, except as provided in b. and c. below. b.We may not cancel this policy solely because the first Named Insured has: (1)Accepted an offer of earthquake coverage; or (2)Cancelled or did not renew a policy issued by the California Earthquake Authority (CEA) that included an earthquake policy premium surcharge. However, we shall cancel this policy if the first Named Insured has accepted a new or renewal policy issued by the CEA that includes an earthquake policy premium surcharge but fails to pay the earthquake policy premium surcharge authorized by the CEA. c.We may not cancel such coverage solely because corrosive soil conditions exist on the premises. This restriction (c.) applies only if coverage is subject to one of the following, which exclude loss or damage caused by or resulting from corrosive soil conditions: (1)Commercial Property Coverage Part - Causes Of Loss - Special Form; or (2)Farm Coverage Part - Causes Of Loss Form - Farm Property, Paragraph D. Covered Causes Of Loss - Special. IL 02 70 09 12Page 2 of 4 05/13/2024A0195129 Middlesex Insurance Company © Insurance Services Office, Inc., 2012 C.The following is added and supersedes any provisions to the contrary: Nonrenewal 1.Subject to the provisions of Paragraphs C.2. and C.3. below, if we elect not to renew this policy, we will mail or deliver written notice, stating the reason for nonrenewal, to the first Named Insured shown in the Declarations, and to the producer of record, at least 60 days, but not more than 120 days, before the expiration or anniversary date. We will mail or deliver our notice to the first Named Insured, and to the producer of record, at the mailing address shown in the policy. 2.Residential Property This provision applies to coverage on real property used predominantly for residential purposes and consisting of not more than four dwelling units, and to coverage on tenants' household property contained in a residential unit, if such coverage is written under one of the following: Commercial Property Coverage Part Farm Coverage Part - Farm Property - Farm Dwellings, Appurtenant Structures And Household Personal Property Coverage Form a.We may elect not to renew such coverage for any reason, except as provided in b., c. and d. below. b.We will not refuse to renew such coverage solely because the first Named Insured has accepted an offer of earthquake coverage. However, the following applies only to insurers who are associate participating insurers as established by Cal. Ins. Code Section 10089.16. We may elect not to renew such coverage after the first Named Insured has accepted an offer of earthquake coverage, if one or more of the following reasons applies: (1)The nonrenewal is based on sound underwriting principles that relate to the coverages provided by this policy and that are consistent with the approved rating plan and related documents filed with the Department of Insurance as required by existing law; (2)The Commissioner of Insurance finds that the exposure to potential losses will threaten our solvency or place us in a hazardous condition. A hazardous condition includes, but is not limited to, a condition in which we make claims payments for losses resulting from an earthquake that occurred within the preceding two years and that required a reduction in policyholder surplus of at least 25% for payment of those claims; or (3)We have: (a)Lost or experienced a substantial reduction in the availability or scope of reinsurance coverage; or (b)Experienced a substantial increase in the premium charged for reinsurance coverage of our residential property insurance policies; and the Commissioner has approved a plan for the nonrenewals that is fair and equitable, and that is responsive to the changes in our reinsurance position. c.We will not refuse to renew such coverage solely because the first Named Insured has cancelled or did not renew a policy, issued by the California Earthquake Authority, that included an earthquake policy premium surcharge. d.We will not refuse to renew such coverage solely because corrosive soil conditions exist on the premises. This restriction (d.) applies only if coverage is subject to one of the following, which exclude loss or damage caused by or resulting from corrosive soil conditions: (1)Commercial Property Coverage Part - Causes Of Loss - Special Form; or (2)Farm Coverage Part - Causes Of Loss Form - Farm Property, Paragraph D. Covered Causes Of Loss - Special. 3.We are not required to send notice of nonrenewal in the following situations: a.If the transfer or renewal of a policy, without any changes in terms, conditions or rates, is between us and a member of our insurance group. Page 3 of 4IL 02 70 09 12 05/13/2024A0195129 Middlesex Insurance Company 00002 0000000000 24134 0 N3 99caa6ef-6bea-4169-bdae-def863d3fafd99caa6ef-6bea-4169-bdae-def863d3fafd © Insurance Services Office, Inc., 2012 b.If the policy has been extended for 90 days or less, provided that notice has been given in accordance with Paragraph C.1. c.If you have obtained replacement coverage, or if the first Named Insured has agreed, in writing, within 60 days of the termination of the policy, to obtain that coverage. d.If the policy is for a period of no more than 60 days and you are notified at the time of issuance that it will not be renewed. e.If the first Named Insured requests a change in the terms or conditions or risks covered by the policy within 60 days of the end of the policy period. f.If we have made a written offer to the first Named Insured, in accordance with the timeframes shown in Paragraph C.1., to renew the policy under changed terms or conditions or at an increased premium rate, when the increase exceeds 25%. IL 02 70 09 12Page 4 of 4 05/13/2024A0195129 Middlesex Insurance Company POLICY NUMBER: IL 09 85 12 20 SCHEDULE - PART I THIS ENDORSEMENT IS ATTACHED TO AND MADE PART OF YOUR POLICY IN RESPONSE TO THE DISCLOSURE REQUIREMENTS OF THE TERRORISM RISK INSURANCE ACT. THIS ENDORSEMENT DOES NOT GRANT ANY COVERAGE OR CHANGE THE TERMS AND CONDITIONS OF ANY COVERAGE UNDER THE POLICY. DISCLOSURE PURSUANT TO TERRORISM RISK INSURANCE ACT SCHEDULE Terrorism Premium (Certified Acts) $866.00 This premium is the total Certified Acts premium attributable to the following Coverage Part(s), Coverage Form(s) and/or Policy(ies): A0195129004 Commercial General Liability Additional information, if any, concerning the terrorism premium: SCHEDULE - PART II Federal share of terrorism losses 80% (Refer to Paragraph B. in this endorsement.) Information required to complete this Schedule, if not shown above, will be shown in the Declarations. © Insurance Services Office, Inc., 2020 Page 1 of 2IL 09 85 12 20 05/13/2024A0195129 Middlesex Insurance Company 00001 0000000000 24134 0 N1 575d186c-cd76-40eb-9600-04d19161ffc0575d186c-cd76-40eb-9600-04d19161ffc0 A.Disclosure Of Premium In accordance with the federal Terrorism Risk Insurance Act, we are required to provide you with a notice disclosing the portion of your premium, if any, attributable to coverage for terrorist acts certified under the Terrorism Risk Insurance Act. The portion of your premium attributable to such coverage is shown in the Schedule of this endorsement or in the policy Declarations. B.Disclosure Of Federal Participation In Payment Of Terrorism Losses The United States Government, Department of the Treasury, will pay a share of terrorism losses insured under the federal program. The federal share equals a percentage (as shown in Part II of the Schedule of this endorsement or in the policy Declarations) of that portion of the amount of such insured losses that exceeds the applicable insurer retention. However, if aggregate insured losses attributable to terrorist acts certified under the Terrorism Risk Insurance Act exceed $100 billion in a calendar year, the Treasury shall not make any payment for any portion of the amount of such losses that exceeds $100 billion. C.Cap On Insurer Participation In Payment Of Terrorism Losses If aggregate insured losses attributable to terrorist acts certified under the Terrorism Risk Insurance Act exceed $100 billion in a calendar year and we have met our insurer deductible under the Terrorism Risk Insurance Act, we shall not be liable for the payment of any portion of the amount of such losses that exceeds $100 billion, and in such case insured losses up to that amount are subject to pro rata allocation in accordance with procedures established by the Secretary of the Treasury. © Insurance Services Office, Inc., 2020 IL 09 85 12 20Page 2 of 2 05/13/2024A0195129 Middlesex Insurance Company POLICY NUMBER: IL 70 60 08 15 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION TO OTHERS This endorsement modifies the coverage provided under the following: COMMERCIAL AUTO COVERAGE PART COMMERCIAL EXCESS/UMBRELLA COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE PART With respect to the coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. SCHEDULE Name Of Person(s) Or Organization(s)Number of Days Notice Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following additional condition is added: A.Notice of Cancellation to Others 1.If we send notice of cancellation to the Named Insured shown in the declarations, for a reason other than nonpayment of premium, we will provide notice of such cancellation to the person(s) or organization(s) listed in the schedule of this endorsement (the schedule); 2.This notice: a.Will be provided not less than the number of days shown in the schedule prior to the cancellation effective date indicated in the schedule; b.If mailed, will be sent to the mailing address known to us at that time, with proof of mailing constituting sufficient proof of notice; and c.Will not extend the cancellation effective date nor impact or negate any cancellation of the policy; 3.We are not obligated to notify the person(s) or organization(s) shown in the schedule of the expiration, renewal on different terms or nonrenewal of the policy to which this endorsement is attached; and 4.The provisions of this endorsement do not entitle the person(s) or organization(s) listed in the schedule to any benefits, rights nor protections not already provided for under the policy. All other terms and conditions of the policy remain unchanged. Page 1 of 1IL 70 60 08 15 05/13/2024A0195129 Middlesex Insurance Company 00001 0000000000 24134 0 N1 2d860aec-2745-43a8-9663-de86f1b6f1952d860aec-2745-43a8-9663-de86f1b6f195 POLICY NUMBER: IL 70 61 07 16 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CYBER LIABILITY AND DATA BREACH RESPONSE COVERAGE THIS ENDORSEMENT PROVIDES CLAIMS-MADE COVERAGE. PLEASE READ THE ENTIRE ENDORSEMENT CAREFULLY. This endorsement modifies the coverage provided under the following Coverage Form(s): BUSINESSOWNERS COVERAGE PART COMMERCIAL AUTO COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS COVERAGE PART With respect to the coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. The provisions of this endorsement apply solely to the coverage provided herein, and will not modify or alter coverage contained elsewhere in this policy. If there is a conflict between the Coverage Form and the coverage provided by this endorsement, the provisions of this endorsement shall prevail. Paragraphs A., C., D., E. and F. of SECTION I - INSURING AGREEMENTS provide coverage on a claims-made and reported basis and apply only to claims first made against the insured during the policy period and reported to us during the policy period or the “optional extension period” (if applicable). Paragraphs B., G., and H. of SECTION I - INSURING AGREEMENTS provide first party coverage on an incident discovered and reported basis and apply only to incidents first discovered and reported to us during the policy period. SECTION I - INSURING AGREEMENTS A.Information Security And Privacy Liability We will pay those sums the insured becomes legally obligated to pay as “damages” and “claims expenses”, in excess of the “retention”, because of any “claim”, including a “claim” for violation of a “privacy law”, for: 1.Theft, loss, or “unauthorized disclosure” of “personally identifiable information” or “third party information” that is in the care, custody or control of the “insured organization”, or a third party for whose theft, loss or “unauthorized disclosure” of “personally identifiable information” or “third party information” the “insured organization” is legally liable; 2.One or more of the following acts or incidents that directly result from a failure of “computer security” to prevent a “security breach”: a.The alteration, corruption, destruction, deletion, or damage to data stored on “computer systems”; b.The failure to prevent transmission of malicious code from “computer systems” to computer or network systems that are not owned, operated or controlled by an insured; or c.The participation by the “insured organization’s” “computer system” in a denial of service attack directed against computer or network systems that are not owned, operated or controlled by an insured; 3.The “insured organization’s” failure to timely disclose an incident described in paragraphs A.1. or A.2. in violation of any “breach notice law”; 4.Failure by the insured to comply with that part of a “privacy policy” that specifically: a.Prohibits or restricts the “insured organization’s” disclosure, sharing or selling of a person’s “personally identifiable information”; b.Requires the “insured organization” to provide access to “personally identifiable information” or to correct incomplete or Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 19IL 70 61 07 16 05/13/2024A0195129 Middlesex Insurance Company 00010 0000000000 24134 0 N1 d2b51271-8990-4101-9991-31e61c4fbdfbd2b51271-8990-4101-9991-31e61c4fbdfb inaccurate “personally identifiable information” after a request is made by a person; or c.Mandates procedures and requirements to prevent the loss of “personally identifiable information”; Provided the “insured organization” must, at the time of such acts, errors or omissions have in force a “privacy policy” that addresses subsections 4a. - 4.c. above that are relevant to such “claim”; or 5.Failure by the insured to administer: a.An identity theft prevention program required by regulations and guidelines promulgated pursuant to 15 U.S.C. §1681m(e), commonly known as the Red Flags Rule, as amended; or b.An information disposal program required by regulations and guidelines promulgated pursuant to 15 U.S.C §1681W, commonly known as the Disposal Rule, as amended. This insurance applies only if all acts, incidents, failures to timely disclose, failures to comply, thefts, losses, errors or omissions described first take place on or after the retroactive date listed in the Declarations and prior to the end of the “policy period” and are reported to us prior to the end of the “policy period” or any “optional extension period”, if applicable. B.Privacy Breach Response Services We will provide to the “insured organization” “privacy breach response services” in excess of the “retention” because of an incident described in Paragraphs 1. or 2. of SECTION I, A. Information Security And Privacy Liability. C.Regulatory Defense And Penalties We will pay those sums the insured becomes legally obligated to pay as “claims expenses” and “penalties”, in excess of the “retention”, because of any “claim” in the form of a “regulatory proceeding”, caused by an incident described in Paragraphs 1., 2. or 3. of SECTION I, A. Information Security And Privacy Liability that first takes place on or after the “retroactive date” and before the end of the “policy period” and is reported to us prior to the end of the “policy period” or any applicable “optional extension period”. D.Website Media Content Liability We will pay those sums the insured becomes legally obligated to pay as “damages” and “claims expenses”, in excess of the “retention”, because of a “claim” resulting from one or more of the following acts committed in the course of the “insured organization’s” display of “media material” on its web site or on social media web pages created and maintained by or on behalf of the “insured organization”: 1.Defamation, libel, slander, trade libel, infliction of emotional distress, outrage, outrageous conduct, or other tort related to disparagement or harm to the reputation or character of any person or organization; 2.A violation of the rights of privacy of an individual, including false light and public disclosure of private facts; 3.Invasion or interference with an individual’s right of publicity, including commercial appropriation of name, persona, voice or likeness; 4.Plagiarism, piracy, misappropriation of ideas under implied contract; 5.Infringement of copyright; 6.Infringement of domain name, trademark, trade name, trade dress, logo, title, metatag, or slogan, service mark, or service name; or 7.Improper deep-linking or framing within electronic content. This insurance applies only if all acts described first take place on or after the “retroactive date” listed in the Declarations but prior to the end of the “policy period” and are reported to us prior to the end of the “policy period” or any applicable “optional extension period”. E.PCI Fines, Expenses And Costs We will indemnify the insured for “PCI Fines, Expenses, and Costs”, in excess of the “retention”, which the insured becomes legally obligated to pay because of a “claim” first made against any insured and reported to us during the “policy period” or any applicable “optional extension period”. F.Cyber Extortion We will reimburse the insured for a “claim” resulting in “cyber extortion loss”, in excess of the “retention”, which the insured becomes obligated to pay as a direct result of an “extortion threat” which is first made against the insured on or after the “retroactive date” and before the end of the “policy period” by a person, other than the insured’s employees, directors, officers, principals, trustees, governors, “managers”, Includes copyrighted material of Insurance Services Office, Inc., with its permission. IL 70 61 07 16Page 2 of 19 05/13/2024A0195129 Middlesex Insurance Company members, management committee members, members of the management board, partners, contractors, outsourcers, or any person in collusion with any of the foregoing. This insurance only applies if such “claim” is reported to us prior to the end of the “policy period” or any applicable “optional reporting period”. Coverage under this Insuring Agreement is subject to the applicable conditions and reporting requirements, including those set forth in SECTION XIV - OBLIGATIONS IN THE EVENT OF AN EXTORTION THREAT. G.First Party Data Protection We will indemnify the insured for “data protection loss” in excess of the “retention”, incurred by the insured as a direct result of one or more of the following that first takes place on or after the “retroactive date” and before the end of the “policy period”: 1.alteration, corruption, destruction, deletion or damage to a “data asset”, or 2.inability to access a “data asset”, and is directly caused by a failure of “computer security” to prevent a “security breach”; provided that such “security breach” must take place on or after the “retroactive date” and before the end of the “policy period”. H.First Party Network Business Interruption We will indemnify the insured for “business interruption loss”, in excess of the “retention”, incurred by the insured during the “period of restoration” or the “extended interruption period”, if applicable, as a direct result of the actual and necessary interruption or suspension of “computer systems” that first takes place during the “policy period” and is directly caused by a failure of “computer security” to prevent a “security breach”; provided that such “security breach” must first take place on or after the “retroactive date” and before the end of the “policy period”. SECTION II - DEFENSE AND SETTLEMENT OF CLAIMS A.We shall have the right and duty to defend: 1.Any “claim” against the insured seeking “damages”, even if any of the allegations of the “claim” are groundless, false or fraudulent; or 2.Under SECTION I, C. Regulatory Defense And Penalties, any “claim” in the form of a “regulatory proceeding”. B.Selection of defense counsel shall be mutually agreed upon between us and the “named insured”, but in the absence of such agreement, our decision shall be final. C.We have no duty to defend any “claim” or pay any “claims expenses” associated with a "claim” brought under SECTION I, E. PCI Fines, Expenses And Costs. D.With respect to any “claim” against the insured seeking “damages” or “penalties”, we will pay “claims expenses” incurred with our prior written consent. The Limit of Insurance available to pay “damages” and “penalties” shall be reduced and may be completely exhausted by payment of “claims expenses”. “Damages”, “penalties”, and “claims expenses” will be applied against the each “claim retention” payable by the insured. E.If the insured refuses to consent to any settlement or compromise recommended by us and acceptable to the claimant and elects to contest the “claim”, our liability for any “damages”, “penalties” and “claims expenses” shall not exceed the lesser of: 1.The amount for which the “claim” could have been settled, less the remaining “retention”, plus the “claims expenses” incurred up to the time of such refusal; or 2.The applicable Limit of Insurance. We have the right to withdraw from further defense by tendering control of said defense to the insured. The portion of any proposed settlement or compromise that requires the insured to cease, limit or refrain from actual or alleged infringing or otherwise injurious activity or is attributable to future royalties or other amounts that are not “damages” (or “penalties” for “claims” covered under SECTION I, C. Regulatory Defense And Penalties) will not be considered in determining the amount for which a “claim” could have been settled. SECTION III - WHO IS AN INSURED A.Whether expressed in singular or plural, insured shall mean: 1.The “named insured” and any “subsidiaries” of the “named insured” (together the “insured organization”); 2.A director, manager of a limited liability company (“manager”) or officer of the “insured organization”, but only with respect to the performance of their duties as such on behalf of the “insured organization”. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 3 of 19IL 70 61 07 16 05/13/2024A0195129 Middlesex Insurance Company 00010 0000000000 24134 0 N3 d2b51271-8990-4101-9991-31e61c4fbdfbd2b51271-8990-4101-9991-31e61c4fbdfb 3.An “employee” or “volunteer worker” of the “insured organization”, but only for work done while acting within the scope of their employment and related to the conduct of the “insured organization's” business; 4.A principal if the “named insured” is a sole proprietorship, or a partner if the “named insured” is a partnership, but only with respect to the performance of their duties as such on behalf of the “insured organization”; 5.Any person who previously qualified as an insured under Paragraphs A. or B. of SECTION III - WHO IS AN INSURED prior to the termination of the required relationship with the “insured organization”, but only with respect to the performance of their duties as such on behalf of the “insured organization”. SECTION IV - EXCLUSIONS This insurance does not apply to any “claim” or “loss”: A.Arising out of or resulting from any contractual liability or obligation, or arising out of or resulting from a breach of contract or agreement either oral or written. However, this exclusion will not apply: 1.Only with respect to the coverage provided pursuant to Paragraph 1. of SECTION I, A. Information Security And Privacy Liability, to any obligation of the “insured organization” to maintain the confidentiality or security of “personally identifiable information” or of “third party information”; 2.Only with respect to Paragraph 4. of SECTION I, D. Website Media Content Liability, for misappropriation of ideas under implied contract; or 3.To the extent the insured would have been liable in the absence of such contract or agreement; B.Arising out of or resulting from any liability or obligation under a “merchant services agreement”; however, this exclusion does not apply to: 1.“PCI Fines, Expenses, and Costs” covered under SECTION I, E. PCI Fines, Expenses, and Costs; or 2.“Computer expert services” or “legal services” covered under SECTION I, B. Privacy Breach Response Services. C.Arising out of or resulting from any actual or alleged false, deceptive or unfair trade practices; however, this exclusion does not apply to: 1.Any “claim” covered under Paragraphs 1., 2., or 3. of SECTION I, A. Information Security And Privacy Liability or SECTION I, C. Regulatory Defense and Penalties; or 2.The providing of “privacy breach response services” covered under SECTION I, B. Privacy Breach Response Services. D.Arising out of or resulting from: 1.The actual or alleged unlawful collection, acquisition or retention of “personally identifiable information”, except as otherwise covered under Paragraph 5. of SECTION I, A. Information Security And Privacy Liability, or other personal information by, on behalf of, or with the consent or cooperation of the “insured organization”; or 2.The failure to comply with a legal requirement to provide individuals with the ability to assent to or withhold assent (e.g. opt-in or opt-out) from the collection, disclosure or use of “personally identifiable information”; This exclusion does not apply to the actual or alleged unlawful collection, acquisition or retention of “personally identifiable information” by a person or entity that is not a “related party” and without the knowledge of the “insured organization”. E.Arising out of or resulting from any act, error, omission, incident, failure of “computer security”, or “security breach” committed or occurring prior to the inception date of this coverage: 1.If any member of the “control group” of the “insured organization” on or before the inception date of this coverage knew or could have reasonably foreseen that such act, error or omission, incident, failure of “computer security”, or “security breach” might be expected to be the basis of a “claim” or “loss”; or 2.If any insured has given notice of a circumstance, which might lead to a “claim” or “loss”, to the insurer of any other policy in force prior to the inception date of this coverage. F.Arising out of or resulting from any related or continuing acts, errors, omissions, incidents or events, where the first such act, error, omission, incident or event was committed or occurred prior to the “retroactive date.” G.Arising out of or resulting from any actual or alleged theft of or “unauthorized disclosure” of Includes copyrighted material of Insurance Services Office, Inc., with its permission. IL 70 61 07 16Page 4 of 19 05/13/2024A0195129 Middlesex Insurance Company data; under Paragraph 2. of SECTION I, A. Information Security And Privacy Liability. H.In connection with or resulting from a “claim” brought by or on behalf of the Federal Trade Commission, the Federal Communications Commission, or any other state, federal, local or foreign governmental entity, in such entity's regulatory or official capacity; provided, this exclusion shall not apply to an otherwise covered “claim” under SECTION I, C. Regulatory Defense and Penalties or to the providing of “privacy breach response services” under SECTION I, B. Privacy Breach Response Services to the extent such services are legally required to comply with a “breach notice law”; I.Arising out of or resulting from a “claim” by or on behalf of one or more insureds under this coverage against any other insured or insureds under this coverage; provided this exclusion shall not apply to an otherwise covered “claim” under Paragraphs 1., 2., or 3. of SECTION I, A. Information Security And Privacy Liability made by a current or former “employee” of the “insured organization”; J.Arising out of or resulting from: 1.Any “claim” made or “loss” sustained by any “subsidiary” prior to such entity becoming a “subsidiary”; 2.Any “claim” made by any business enterprise in which any insured has greater than a fifteen percent (15%) ownership interest or made by any parent company or other entity which owns more than fifteen percent (15%) of the “named insured’s” business; or 3.The insured’s activities as a trustee, partner, member, “manager”, officer, director or employee of any employee trust, charitable organization, corporation, company or business other than that of the “insured organization”; K.Arising out of or resulting from: 1.The actual or alleged obligation to make licensing fee or royalty payments; 2.Any costs or expenses incurred or to be incurred by the insured or others for the reprinting, reposting, recall, removal or disposal of any “media material” or any other information, content or media, including any media or products containing such “media material”, information, content or media; 3.Any “claim” brought by or on behalf of any intellectual property licensing bodies or organizations; 4.The actual or alleged inaccurate, inadequate or incomplete description of the price of goods, products or services, cost guarantees, cost representations, or contract price estimates, the authenticity of any goods, products or services, or the failure of any goods or services to conform with any represented quality or performance; 5.Any actual or alleged gambling, contest, lottery, promotional game or other game of chance; or 6.Any “claim” made by or on behalf of any independent contractor, joint venture or venture partner arising out of or resulting from disputes over ownership of rights in “media material” or services provided by such independent contractor, joint venture or venture partner; L.With respect to SECTION I, F. Cyber Extortion, G. Data Protection Loss and H. Business Interruption Loss arising out of or resulting from any criminal, dishonest, fraudulent, or malicious act, error or omission, any “security breach”, “extortion threat”, or intentional or knowing violation of the law, if committed by any member of the “control group” or any person in participation or collusion with any member of the “control group”; M.With respect to SECTION I, G. Data Protection Loss and H. Business Interruption Loss, arising out of or resulting from: 1.Any failure or malfunction of electrical or telecommunications infrastructure or services, provided that this exclusion does not apply to any otherwise covered “claim” or “loss” arising out of a failure of “computer security” to prevent a “security breach” that was solely caused by a failure or malfunction of telecommunications infrastructure or services under the insured’s direct operational control; 2.Fire, flood, earthquake, volcanic eruption, explosion, lightning, wind, hail, tidal wave, landslide, act of God or other physical event; or 3.Any satellite failures. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 5 of 19IL 70 61 07 16 05/13/2024A0195129 Middlesex Insurance Company 00010 0000000000 24134 0 N5 d2b51271-8990-4101-9991-31e61c4fbdfbd2b51271-8990-4101-9991-31e61c4fbdfb N.With respect to SECTION I, F. Cyber Extortion arising out of or resulting from: 1.any threat to physically harm or kidnap any person; or 2.any threat to harm, take, or transfer property other than any “data asset”, even if such threat is made in conjunction with a threat to a “data asset” or by carrying out such threat to, harm, theft, or transfer, a “data asset” may be damaged, corrupted, altered, taken, disseminated or transferred; O.Arising out of or resulting from any seizure, nationalization, confiscation, or destruction of “computer systems” or “data assets” by order of any governmental or public authority; P.Arising out of or resulting from, directly or indirectly occasioned by, happening through or in consequence of: war, invasion, acts of foreign enemies, hostilities (whether war be declared or not), civil war, rebellion, revolution, insurrection, military or usurped power or confiscation or nationalization or requisition or destruction of or damage to property by or under the order of any government or public or local authority. SECTION V - LIMITS OF INSURANCE A.The Limits of Insurance shown in the Declarations and the rules below determine the most we will pay regardless of the number of: 1.Insureds; 2.“Claims” made or “suits” brought; or 3.Persons or organizations making “claims” or bringing “suits”. B.The Cyber Liability Aggregate Limit of Insurance set forth in the Declarations is the most we will pay for the sum of all “damages”, “penalties”, “PCI Fines, Expenses, and Costs”, “crisis management and public relations expenses”, “cyber extortion loss”, “data protection loss”, “business interruption loss” and “claims expenses” payable under this coverage. C.The following are part of, not in addition to, the Cyber Liability Aggregate Limit of Insurance: 1.The Regulatory Defense and Penalties Sublimit is the most we will pay for all “claims expenses” and “penalties” under SECTION I,, C. Regulatory Defense and Penalties ; 2.The “PCI Fines, Expenses, and Costs” Sublimit is the most we will pay for all “PCI Fines, Expenses, and Costs” under SECTION I, E. PCI Fines, Expenses, and Costs; 3.The “Cyber Extortion” Sublimit is the most we will pay for all “claims” under SECTION I, F. Cyber Extortion; 4.The “First Party Data Protection” Sublimit is the most we will pay for all “data protection loss” under SECTION I, G. First Party Data Protection; and 5.The “First Party Network Business Interruption” Sublimit is the most we will pay for all “business interruption loss” under SECTION I, H. First Party Network Business Interruption. D.We shall not be obligated to pay any “damages”, “penalties”, or “claims expenses”, or to undertake or continue defense of any “suit” or proceeding after the Cyber Liability Aggregate Limit of Insurance has been exhausted by payment of “damages”, “penalties”, “PCI Fines, Expenses and Costs”, “crisis management and public relations expenses”, “cyber extortion loss”, “data protection loss”, “business interruption loss” or “claims expenses”, or after deposit of such payments in a court of competent jurisdiction. Upon such payment, we shall have the right to withdraw from further defense of any “claim” under this coverage by tendering control of said defense to the insured. E.The following Privacy Breach Response Services Limits of Insurance are separate from and in addition to the Cyber Liability Aggregate Limit of Insurance: 1.The Number of “Notified Individuals” limit stated in the Declarations is the maximum total number of “notified individuals” to whom notification will be provided or attempted for all incidents or series of related incidents giving rise to an obligation to provide “notification services”, “call center services” or “breach resolution and mitigation services”; and 2.The “Computer Expert Services”, “Legal Services”, and “Public Relations and Crisis Management Services” Limit is the most we will pay for the sum of all “computer expert services”, “legal services” and “public relations and crisis management services” combined. F.If the total number of notifications made pursuant to Paragraph 3. of SECTION I, B. Privacy Breach Response Services exceeds the Number of “Notified Individuals” limit stated in the Declarations, the “insured organization” will be responsible for paying for “privacy breach response services” with respect to any excess Includes copyrighted material of Insurance Services Office, Inc., with its permission. IL 70 61 07 16Page 6 of 19 05/13/2024A0195129 Middlesex Insurance Company notification, and such costs will not be covered under this coverage. If an incident involves notifications made pursuant to Paragraph 3. of SECTION I, B. Privacy Breach Response Services both within the Number of “Notified Individuals” limit and in excess of such limit, all excess notifications will be provided by the same service provider that provides “notification services” covered under this coverage, and the costs will be allocated between us and the “insured organization” pro rata based on the number of covered and non-covered notifications. G.Unless otherwise specified in this coverage, “privacy breach response services” will be provided by a service provider selected by us from the service providers listed in the “information packet”. H.To the extent that costs to provide “privacy breach response services” are covered pursuant to a “claim” described in Paragraph D.4. of SECTION XV - DEFINITIONS., such costs shall be covered solely under SECTION I, A. Information Security and Privacy Liability. SECTION VI - RETENTION A.The Cyber Liability and Data Breach Response Retention - Each “Claim” amount set forth in the Declarations applies separately to each incident, event or related incidents or events, giving rise to a “claim”. The “retention” shall be satisfied by monetary payments by the “named insured” of “damages”, “claims expenses”, “crisis management and public relations expenses”, “penalties”, “cyber extortion loss”, “data protection loss”, “business interruption loss”, or “PCI Fines, Expenses and Costs”. B.There is no “retention” applicable to “Notification Services”, “Call Center Services” and “Breach Resolution and Mitigation Services”. C.With respect to Section I, H. First Party Network Business Interruption, the “retention” applies separately to each “business interruption loss”. The “retention” shall be as follows: 1.With respect to “income loss”, the “retention” shall be the greater of: a.The amount of any payments within the “retention” for covered “loss” under Insuring Agreement H. made in accordance with Paragraph A. of Section VI., Retention; or b.The amount of “income loss” during the “waiting period”. 2.With respect to “extra expense”, the “retention” shall be the amount specified in the Declarations, provided that the “retention” for “extra expense” shall be reduced on a dollar-for-dollar basis (up to the amount stated in the Declarations) by the amount of “income loss” in excess of the applicable “income loss” “retention”. D.For all “computer expert services”, “legal services”, and “public relations and crisis management services”, the Privacy Breach Response Services Retention - Each “Claim” amount set forth in the Declarations applies separately to each incident, event or related incidents or events, giving rise to an obligation to provide such services; where such amount shall be satisfied by monetary payments by the “named insured” for such services. E.In the event that “damages”, “claims expenses”, “penalties” or “PCI Fines, Expenses and Costs” arising out of a “claim” are subject to more than one “retention”, the applicable “retention” amounts shall apply to such “damages”, “claims expenses”, penalties” or “PCI Fines, Expenses and Costs”, provided that the sum of such “retention” amounts shall not exceed the largest applicable “retention” amount. F.Satisfaction of the applicable “retention” is a condition precedent to the payment by us of any amounts or providing of any services hereunder, and we shall be liable only for the amounts in excess of such “retention” subject to our total liability not exceeding the “policy aggregate limit” or Limits of Coverage for “privacy breach response services” set forth in the Declarations. The “named insured” shall make direct payments within the “retention” to appropriate other parties designated by us. G.We may pay any or all of the “retention” amount to effect settlement of any “claim” or “suit” and, upon notification of the action taken, you shall promptly reimburse us for such part of the “retention” amount as has been paid by us. SECTION VII - OPTIONAL EXTENSION PERIOD A.We will provide an “optional extension period” as described below in the event of the termination of this coverage for any reason except the non-payment of premium. B.The “optional extension period” does not extend the “policy period” or change the scope of the coverage provided. C.A “claim” first made against any insured and reported to us during the “optional extension Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 7 of 19IL 70 61 07 16 05/13/2024A0195129 Middlesex Insurance Company 00010 0000000000 24134 0 N7 d2b51271-8990-4101-9991-31e61c4fbdfbd2b51271-8990-4101-9991-31e61c4fbdfb period” will be deemed to have been made on the last day of the policy period provided that the “claim” is for any act, error, or omission committed on or after the “retroactive date” and before the end of the “policy period”. D.Coverage provided by the “optional extension period” is part of, and not in addition to, the applicable limits of insurance for the “policy period” contained in SECTION V - LIMITS OF INSURANCE. The purchase of the “optional extension period” does not in any way increase or reinstate these limits. E.The “optional extension period” does not apply to SECTION I, B. Privacy Breach Response Services. F.You must give us a written request for the “optional extension period” within thirty (30) days after the end of the policy period or the effective date of cancellation, whichever comes first. Payment of the full additional premium for the “optional extension period” endorsement is due within thirty (30) days of the termination of this coverage. If notice of election and payment for the “optional extension period” is not given to us within such thirty (30) day period, there shall be no right to purchase the “optional extension period”. G.At the commencement of the “optional extension period”, the entire premium shall be deemed earned and, in the event the “named insured” terminates the “optional extension period” for any reason prior to its natural expiration, we will not be liable to return any premium paid for the “optional extension period”. SECTION VIII - NOTICE OF CLAIM, LOSS OR CIRCUMSTANCE THAT MIGHT LEAD TO A CLAIM A.If any “claim” is made against the insured, the insured shall forward as soon as practicable to us written notice of such “claim” in the form of a facsimile, express or certified mail together with every demand, notice, summons or other process received by the insured or the insured's representative. B.With respect to SECTION I, B. Privacy Breach Response Services, for a legal obligation to comply with a “breach notice law” because of an incident described in Paragraph 1. or 2. of SECTION I, A. Information Security And Privacy Liability, such incident or reasonably suspected incident must be reported as soon as practicable during the “policy period” after discovery by the insured. C.If, during the “policy period”, the insured becomes aware of any circumstance that could reasonably be the basis for a “claim”, it may give written notice to us in the form of a facsimile, email or express or certified mail as soon as practicable during the “policy period”. Such a notice must include: 1.The specific details of the act, error, omission, or “security breach” that could reasonably be the basis for a “claim”; 2.The injury or damage which may result or has resulted from the circumstance; and 3.The facts by which the insured first became aware of the act, error, omission or “security breach”. Any subsequent “claim” made against the insured arising out of such circumstance which is the subject of the written notice will be deemed to have been made at the time written notice complying with the above requirements was first given to us. An incident or reasonably suspected incident reported to us during the “policy period” and in conformance with Paragraph B. of SECTION VIII - NOTICE OF CLAIM, LOSS OR CIRCUMSTANCE THAT MIGHT LEAD TO A CLAIM shall also constitute notice of a circumstance under this Paragraph C. D.A “claim” or legal obligation under Paragraphs A. or B. of SECTION VIII - NOTICE OF CLAIM, LOSS OR CIRCUMSTANCE THAT MIGHT LEAD TO A CLAIM shall be considered to be reported to us when written notice is first received by us in the form of a facsimile, email or express or certified mail or email of the “claim” or legal obligation, or of an act, error, or omission, which could reasonably be expected to give rise to a “claim” if provided in compliance with Paragraph C. of SECTION VIII - NOTICE OF CLAIM, LOSS OR CIRCUMSTANCE THAT MIGHT LEAD TO A CLAIM. E.With respect to SECTION I, H. First Party Network Business Interruption, the insured shall forward immediately to us written notice of the interruption or suspension of “computer systems” to which this coverage applies in the form of a facsimile, email or express mail. Such notice must be provided during the “policy period”, or no later than ten (10) days after the end of the “policy period” for interruptions or suspensions occurring within ten (10) days of the end of the “policy period”; provided, all covered “business interruption loss” must be reported to us (in accordance with SECTION XIII - Proof of Includes copyrighted material of Insurance Services Office, Inc., with its permission. IL 70 61 07 16Page 8 of 19 05/13/2024A0195129 Middlesex Insurance Company Loss and Appraisal) no later than six (6) months after the end of the “policy period”. SECTION IX - OTHER INSURANCE The insurance provided under this coverage is excess over any other valid and collectible insurance available to any insured, including any self-insured “retention” or deductible portion thereof unless such other insurance is written only as specific excess insurance over the “policy aggregate limit of liability” or any other applicable Limit of Liability of this coverage. However, if there is an overlap between the coverage provided by this endorsement and elsewhere in any policy issued by us, the coverage provided by this endorsement will be primary with respect to such coverage. SECTION X - NAMED INSURED AS AGENT The “named insured” shall be considered the agent of all insureds and shall act on behalf of all insureds with respect to the giving of or receipt of all notices pertaining to this coverage and the acceptance of any modifications. With respect to SECTION I, G - Cyber Extortion, in the event of an “extortion threat” to which this insurance applies, the insured shall notify us immediately upon receipt of any “extortion threat”, and shall thereafter also provide written notice by facsimile, email or express mail within five (5) days following the “extortion threat”. SECTION XI - CONDITIONS APPLICABLE TO PRIVACY BREACH RESPONSE SERVICES AND COVERAGE A.With respect to Section I, H. First Party Network Business Interruption, the insured must forward written notice by express mail, email or facsimile to us immediately upon discovery of alteration, corruption, destruction, deletion or damage to or inability to access a “data asset” to which this insurance applies. All covered “data protection loss” must be discovered and reported (in accordance with Paragraph XII. Proof and Appraisal of Loss below) to us no later than six (6) months after the end of the “policy period”. B.Insuring Agreements A., C., D., G. and H. only apply if: 1.The “insured organization” initiates the notification services described in Paragraph 3. of SECTION I, B. Privacy Breach Response Services as soon as practicable after the insured's discovery of the “claim”; 2.The “claim” is made against the insured no later than two years after the “insured organization” initiates the notification services described in Paragraph 3. of Section I, B. Privacy Breach Response Services; and 3.The insured reports the “claim” to us in writing as soon as practicable. SECTION XII - PROOF AND APPRAISAL OF LOSS A.Proof of Loss. With respect to Section I, G. Data Protection Loss and H. Business Interruption, before coverage will apply, the insured must: 1.Prepare and submit to us a written and detailed proof of loss sworn by an officer of the “named insured” within ninety (90) days after the insured discovers a “data protection loss” or the “insured organization” sustains a “business interruption loss” (as applicable), but in no event later than six (6) months following the end of the “policy period” (unless such period has been extended by our written consent). Such proof of loss shall include a narrative with full particulars of such “data protection loss” or “business interruption loss”, including the time, place and cause of the “data protection loss” or “business interruption loss”, a detailed calculation of any “data protection loss” or “business interruption loss”, the “insured organization’s” interest and the interest of all others in the property, the sound value thereof and the amount of “data protection loss” or “business interruption loss” or damage thereto and all other insurance thereon; and 2.Upon our request, submit to an examination under oath and provide copies of the underlying documents, data and materials that reasonably relate to or are part of the basis of the claim for such “data protection loss” or “business interruption loss”. The costs and expenses of preparing and submitting a proof of loss, and establishing or proving “data protection loss”, “business interruption loss” or any other “loss” under this insurance shall be the insured's obligation, and are not covered under this insurance. B.Appraisal of Loss. If we do not agree with the insured on the amount of a “loss”, each party shall select and pay an appraiser or other qualified expert (the “Appraiser”) to state the amount of the loss or reasonable expenses, and the Appraisers shall choose an umpire. If the Appraisers cannot agree on an umpire, the “named insured” or we may request a judge of a court having jurisdiction to make the selection. Each Appraiser shall submit the amount of the “loss” or reasonable expenses to the umpire, and agreement by the Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 9 of 19IL 70 61 07 16 05/13/2024A0195129 Middlesex Insurance Company 00010 0000000000 24134 0 N9 d2b51271-8990-4101-9991-31e61c4fbdfbd2b51271-8990-4101-9991-31e61c4fbdfb umpire and at least one of the Appraisers as to the amount of a “loss” shall be binding on all Insureds and us. The “named insured” and we will equally share the costs of the umpire and any other costs other than the cost of the Appraisers. This provision shall govern only the appraisal of the amount of a “loss”, and shall not control the determination of whether such “loss” is otherwise covered by this insurance. We will still retain and do not waive their rights to deny coverage or enforce any obligation under this insurance. SECTION XIII - RECOVERED PROPERTY If the insured or we recover any property, money or “data assets” after a loss payment is made, the party making the recovery must give prompt notice of the recovery to the other party. If the recovered property is money or other funds, the recovery shall be applied first to any costs incurred by us in recovering the property, second to loss payments made by us, and third to any “retention” payment made by the “named insured”. If property other than money or funds is recovered, then the “named insured” may keep the recovered property and return the loss payment, plus any costs of recovery incurred by us, or keep the loss payment less the costs of recovery incurred by us and transfer all rights in the property to us. SECTION XIV - OBLIGATIONS IN THE EVENT OF AN EXTORTION THREAT A.Insured's Duty of Confidentiality The insured shall use its best efforts at all times to ensure that knowledge regarding the existence of this insurance for “cyber extortion loss” afforded by this insurance is kept confidential. We may terminate the insurance provided by this policy for “cyber extortion loss” upon ten (10) days written notice to the “named insured” if the existence of insurance for “cyber extortion loss” provided by this insurance becomes public knowledge or is revealed to a person making an “extortion threat” through no fault of ours. B.Insured Organization’s Obligation to Investigate Extortion Threat and Avoid or Limit Extortion Payment Prior to the payment of any “extortion payment”, the insured shall make every reasonable effort to determine that the “extortion threat” is not a hoax, or otherwise not credible. The insured shall take all steps reasonable and practical to avoid or limit the payment of an “extortion payment”. C.Conditions Precedent As conditions precedent to this insurance for “cyber extortion loss” under the terms of this insurance: 1.Insured's Obligation to Demonstrate Duress The insured must be able to demonstrate that the “extortion payment” was surrendered under duress. 2.Notification of Police The insured must allow us or their representative to notify the police or other responsible law enforcement authorities of any “extortion threat”. SECTION XV - DEFINITIONS A.“Breach notice law” means any statute or regulation that requires notice to persons whose “personally identifiable information” was accessed or reasonably may have been accessed by an unauthorized person. B.“Breach resolution and mitigation services” means a credit monitoring, identity monitoring or other solution selected from the products listed in the “information packet” and offered to “notified individuals”. The product offered to “notified individuals” will be selected by us in consultation with the “insured organization” and in accordance with the “information packet”. The product offer will be included in the communication provided pursuant to Paragraph 3. of SECTION I, B. Privacy Breach Response Services. C.“Business interruption loss” means the total of: 1.“Income loss” and “extra expense” during the “period of restoration”, and 2.“Extended income loss” if the “income loss” during the “period of restoration” is in excess of the applicable “retention”. Provided that “business interruption loss” shall not mean and SECTION I, H. First Party Network Business Interruption shall not cover any of the following: “loss” arising out of any liability to any third party for whatever reason; legal costs or legal expenses of any type; “loss” incurred as a result of unfavorable business conditions, loss of market or any other consequential loss; or costs or expenses the “insured organization” incurs to identify and remove software program errors or vulnerabilities. Includes copyrighted material of Insurance Services Office, Inc., with its permission. IL 70 61 07 16Page 10 of 19 05/13/2024A0195129 Middlesex Insurance Company All “business interruption loss” resulting from multiple covered interruptions or suspensions of “computer systems” that arise out of the same or a continuing “security breach”, from related or repeated “security breaches”, or from multiple “security breaches” resulting from a failure of “computer security” shall be deemed to be a single “business interruption loss”; provided, however, that a separate “waiting period” shall apply to each “period of restoration”. D.“Call center services” means the provision of a call center to answer calls during standard business hours for a period of ninety (90) days following notification (or longer if required by applicable law or regulation) of an incident for which notice is provided pursuant to SECTION I, B. Privacy Breach Response Services (Notification Services). “Call center services” will be provided by a service provider selected by us in consultation with the “insured organization” for the list of service providers in the “information packet”. E.“Claim” means: 1.A written demand received by any “insured” for money or services; including service of a “suit” or institution of regulatory or arbitration proceedings; 2.With respect to coverage provided under SECTION I, C. Regulatory Defense And Penalties only, institution of a “regulatory proceeding” against any insured; 3.A written request or agreement to toll or waive a statute of limitations relating to a potential “claim” described in Paragraph 1. above; and 4.With respect to coverage provided under Paragraph 1. of SECTION I, A. Information Security And Privacy Liability only, a demand received by any insured to fulfill the “insured organization's” contractual obligation to provide notice of an incident (or reasonably suspected incident) described in Paragraph 1. of SECTION I, A. Information Security And Privacy Liability pursuant to a “breach notice law”. Multiple “claims” arising from the same or a series of related or repeated acts, errors, or omissions, or from any continuing acts, errors, omissions, or from multiple “security breaches” arising from a failure of “computer security”, shall be considered a single “claim”, irrespective of the number of claimants or insureds involved in the “claim”. All such “claims” shall be deemed to have been made at the time of the first such “claim”. F.“Claims expenses” means: 1.Reasonable and necessary fees charged by an attorney designated pursuant to Paragraph A. of SECTION II - DEFENSE AND SETTLEMENT OF CLAIMS; 2.All other reasonable legal costs and expenses resulting from the investigation, adjustment, defense and appeal of a “claim”, “suit”, or proceeding arising in connection therewith, or circumstance which might lead to a “claim”, if incurred by us, or by the insured with the prior written consent of us; and 3.The premium cost for appeal bonds for covered judgments or bonds to release property used to secure a legal obligation, if required in any “claim” against an “insured’ provided that we shall have no obligation to appeal or to obtain bonds. “Claims expenses” do not include any salary, overhead, or other charges by the insured for any time spent in cooperating in the defense and investigation of any “claim” or circumstance that might lead to a “claim”, or costs to comply with any regulatory orders, settlements or judgments. G.“Computer expert services” means costs for: 1.A computer security expert to determine the existence and cause of an actual or suspected electronic data breach which may require the “insured organization” to comply with a “breach notice law” and to determine the extent to which such information was accessed by an unauthorized person or persons; 2.A Payment Card Industry (PCI) Forensic Investigator that is approved by the PCI Security Standards Council and is retained by the “insured organization” in order to comply with the terms of a “merchant services agreement” to investigate the existence and extent of an actual or suspect compromise of credit card data; and in our discretion, where a computer security expert described in Paragraph 1. above has not been retained, for a computer security expert to provide advice and oversight in connection with the investigation conducted by the PCI Forensic Investigator; and 3.A computer security expert, which amount is part of and not in addition to the combined aggregate limit of coverage for all “computer Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 11 of 19IL 70 61 07 16 05/13/2024A0195129 Middlesex Insurance Company 00010 0000000000 24134 0 N11 d2b51271-8990-4101-9991-31e61c4fbdfbd2b51271-8990-4101-9991-31e61c4fbdfb expert services”, “legal services”, and “public relations and crisis management expenses” stated in the Declarations to demonstrate the insured's ability to prevent a future electronic data breach as required by a “merchant services agreement”. “Computer expert services” will be provided in accordance with the terms and conditions set forth in the “information packet” and will be provided by a service provider selected by the “insured organization” in consultation with us from the list of service providers in the “information packet”. H.“Computer security” means software, computer or network hardware devices, as well as the “insured organization's” written information security policies and procedures, the function or purpose of which is to prevent “unauthorized access or use”, a denial of service attack against “computer systems”, infection of “computer systems” by malicious code or transmission of malicious code from “computer systems”. “Computer security” includes anti-virus and intrusion detection software, firewalls and electronic systems that provide access control to “computer systems” through the use of passwords, biometric or similar identification of authorized users. I.“Computer systems” means computers and associated input and output devices, data storage devices, networking equipment, and back up facilities: 1.Operated by and either owned by or leased to the “insured organization”; or 2.Systems operated by a third party service provider and used for the purpose of providing hosted computer application services to the “insured organization” or for processing, maintaining, hosting or storing the “insured organization's” electronic data, pursuant to written contract with the “insured organization” for such services. 3.With respect to SECTION I, H. Business Interruption Loss only, operated by a third party service provider and used for the purpose of providing hosted computer application services to the ”insured organization” or for processing, maintaining, hosting or storing the “insured organization's” electronic data, pursuant to written contract with the “insured organization” for such services, provided such coverage is subject to the sublimit of liability set forth in the Declarations. J.“Control group” means the individuals holding the following positions in the “insured” organization: 1.President; 2.Members of the Board of Directors; 3.Executive Officers, including the Chief Executive Officer, Chief Operating Officer, and Chief Financial Officer; General Counsel, Chief Information Officer, Chief Security Officer, Chief Privacy Officer; 4.Staff attorneys employed by the “insured organization”; 5.“Manager”; and 6.Any individual in a substantially similar position or with substantially similar responsibilities as those referenced above. K.“Cyber extortion loss” means: 1.Any “extortion payment” that has been made under duress by or on behalf of the insured with our prior written consent, but solely to prevent or terminate an “extortion threat” and in an amount that does not exceed the covered “damages” and “claims expenses” that would have been incurred had the “extortion payment” not been paid; 2.An otherwise covered “extortion payment” that is lost in transit by actual destruction, disappearance or wrongful abstraction while being conveyed by any person authorized by or on behalf of the insured to make such conveyance; and 3.Fees and expenses paid by or on behalf of the insured for security consultants retained with our prior written approval, but solely to prevent or terminate an “extortion threat”. L.“Damages” means a monetary judgment, award or settlement; provided that the term “damages” shall not include or mean: 1.Future profits, restitution, disgorgement of unjust enrichment or profits by an insured, or the costs of complying with orders granting injunctive or equitable relief; 2.Return or offset of fees, charges, or commissions charged by or owed to an insured for goods or services already provided or contracted to be provided; 3.Any damages which are a multiple of compensatory damages, fines, taxes or loss of tax benefits, sanctions or penalties; Includes copyrighted material of Insurance Services Office, Inc., with its permission. IL 70 61 07 16Page 12 of 19 05/13/2024A0195129 Middlesex Insurance Company 4.Punitive or exemplary damages, unless insurable by law in any applicable venue; 5.Discounts, coupons, prizes, awards or other incentives offered to the insured's customers or clients; 6.Liquidated damages to the extent that such damages exceed the amount for which the insured would have been liable in the absence of such liquidated damages agreement; or 7.Any amounts for which the insured is not liable, or for which there is no legal recourse against the insured. M.“Data asset” means any software or electronic data that exists in “computer systems” and that is subject to regular back up procedures, including computer programs, applications, account information, customer information, private or personal information, marketing information, financial information and any other information maintained by the “insured organization” in its ordinary course of business. N.“Data protection loss” means: 1.With respect to any “data asset” that is altered, corrupted, destroyed, deleted or damaged the actual, reasonable and necessary costs and expenses incurred by the insured to restore a “data asset” from back-ups or from originals or to gather, assemble and recollect such “data asset” from other sources to the level or condition in which it existed immediately prior to its alteration, corruption, destruction, deletion or damage; or 2.With respect to any “data asset” that the insured is unable to access, the lesser of the actual, reasonable and necessary costs and expenses incurred by the “insured organization” to: a.Regain access to such “data asset”; or b.Restore such “data asset” from back-ups or originals or gather, assemble and recollect such “data asset” from other sources, to the level or condition in which it existed immediately prior to the insured's inability to access it; Provided that if such “data asset” cannot reasonably be accessed, restored, gathered, assembled or recollected, then “data protection loss” means the actual, reasonable and necessary costs and expenses incurred by the insured to reach this determination. Provided further that “data protection loss” shall not exceed, and shall not mean, any amount in excess of the amount by which the net profit before income taxes of the insured would have decreased had the insured failed to restore, gather, assemble or recollect as set forth in sub-paragraphs N.1. and N.2. above. A “data protection loss” will be deemed to occur at the time such alteration, corruption, destruction, deletion or damage to or inability to access a “data asset” is first discovered by the insured. All “data protection loss” that arises out of the same or a continuing “security breach”, from related or repeated “security breaches”, or from multiple “security breaches” resulting from a failure of “computer security” shall be deemed to be a single “data protection loss”. “Data protection loss” does not mean, and there shall be no coverage under SECTION I, G. First Party Data Protection for: 1.Costs or expenses incurred by the insured to identify or remediate software program errors or vulnerabilities or update, replace, restore, gather, assemble, reproduce, recollect or enhance a “data asset” or “computer systems” to a level beyond that which existed prior to the alteration, corruption, destruction, deletion or damage of such “data asset”; 2.Costs or expenses to research or develop any “data asset”, including but not limited to trade secrets or other proprietary information; 3.The monetary value of profits, royalties, or lost market share related to a “data asset”, including but not limited to trade secrets or other proprietary information or any other amount pertaining to the value of the “data asset”; 4.Loss arising out of any liability to any third party for whatever reason; or 5.Legal costs or legal expenses of any type. O.“Denial of service attack” means an attack intended by the perpetrator to overwhelm the capacity of a “computer system” by sending an excessive volume of electronic data to such “computer system” in order to prevent authorized access to such “computer system”. P.“Dependent business” means any third party service provider that provides hosted computer application services to the insured or processes, maintains, hosts or stores the insured's electronic data, pursuant to written contract with the insured for such services. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 13 of 19IL 70 61 07 16 05/13/2024A0195129 Middlesex Insurance Company 00010 0000000000 24134 0 N13 d2b51271-8990-4101-9991-31e61c4fbdfbd2b51271-8990-4101-9991-31e61c4fbdfb Q.“Extended income loss” means the “income loss” during the “extended interruption period”. R.“Extended interruption period” means the period of time that: 1.Begins on the date and time that the “period of restoration” ends; and 2.Terminates on the date and time the insured restores, or would have restored if the insured had exercised due diligence and dispatch, the net profit before income taxes that would have been earned by the insured directly through its business operations had the actual and necessary interruption or suspension of “computer systems” not occurred; Provided that in no event shall the “extended interruption period” mean more than or exceed thirty (30) days. S.“Extortion payment” means cash, marketable goods or services demanded to prevent or terminate an “extortion threat”. T.“Extortion threat” means a threat to breach “computer security” in order to: 1.Alter, destroy, damage, delete or corrupt any “data asset”; 2.Prevent access to “computer systems” or a “data asset”, including a “denial of service attack” or encrypting a “data asset” and withholding the decryption key for such “data asset”; 3.Perpetrate a theft or misuse of a “data asset” on “computer systems” through external access; 4.Introduce “malicious code” into “computer systems” or to third party computers and systems from “computer systems”; or 5.Interrupt or suspend “computer systems”; Unless an “extortion payment” is received from or on behalf of the insured. Multiple related or continuing “extortion threats” shall be considered a single “extortion threat” for purposes of this insurance and shall be deemed to have occurred at the time of the first such “extortion threat”. U.“Extra expense” means: 1.Reasonable and necessary expenses that are incurred by the insured during the “period of restoration” to minimize, reduce or avoid an “income loss”, provided: a.That such expenses are over and above those the insured would have incurred had no interruption or suspension of the “computer systems” occurred; and b.Do not exceed the amount by which the “income loss” in excess of the “retention” and covered under this insurance is thereby reduced; and 2.“Forensic expenses”, subject to the sublimit set forth in the Declarations; Provided that “extra expense” shall not mean, and there shall be no coverage under SECTION I, H. Business Interruption Loss for expenses incurred by the insured to update, upgrade, enhance or replace “computer systems” to a level beyond that which existed prior to the actual and necessary interruption or suspension of “computer systems”; or the costs and expenses incurred by the insured to restore, reproduce, or regain access to any “data asset” that was altered, corrupted, destroyed, deleted, damaged or rendered inaccessible as a result of the failure of “computer security” to prevent a “security breach”. V.“Forensic expenses” means reasonable and necessary expenses incurred by the insured to investigate the source or cause of the failure of “computer security” to prevent a “security breach”. W.“Income loss” means: 1.The net profit before income taxes that the insured is prevented from earning through its business operations or the net loss before income taxes that the insured is unable to avoid through its business operations as a direct result of the actual and necessary interruption or suspension of “computer systems”; and 2.Fixed operating expenses incurred by the insured (including payroll), but only to the extent that: a.Such operating expenses must necessarily continue during the “period of restoration” (or “extended interruption period”, if applicable); and b.Such expenses would have been incurred by the insured had such interruption or suspension not occurred. “Income loss” shall be reduced to the extent the insured or “dependent business” (if applicable) is Includes copyrighted material of Insurance Services Office, Inc., with its permission. IL 70 61 07 16Page 14 of 19 05/13/2024A0195129 Middlesex Insurance Company able, with reasonable dispatch and due diligence, to reduce or limit such interruption or suspension of “computer systems” or conduct its business operations by other means. In determining “income loss”, due consideration shall be given to the prior experience of the insured's business operations before the beginning of the “period of restoration” and to the probable business operations the “insured organization” could have performed had no actual and necessary interruption or suspension occurred as result of a failure of “computer security” to prevent a “security breach”. “Income loss” will be calculated on an hourly basis based on the insured's net profit (or loss) and fixed operating expenses as set forth above. X.“Information packet” means the information packet, which is incorporated into and forms part of this coverage part and which includes a list of service providers who provide “privacy breach response services”. Y.“Legal services” means fees charged by an attorney: 1.To determine the applicability of and actions necessary for the “insured organization” to comply with “breach notice laws” due to an actual or reasonably suspected theft, loss or “unauthorized disclosure” of “personally identifiable information”; 2.To provide necessary legal advice to the “insured organization” in responding to actual or suspected theft, loss or “unauthorized disclosure” of “personally identifiable information”; and 3.To advise the “insured organization” in responding to credit card system operating regulation requirements for any actual or suspected compromise of credit card data that is required to be reported to the “insured organization's” merchant bank under the terms of a “merchant services agreement”, but “legal services” does not include fees incurred in any actual or threatened legal proceeding, arbitration or mediation, or any advice in responding to credit card system operating regulation in connection with an assessment of “PCI Fines, Expenses, and Costs”. “Legal services” will be provided in accordance with the terms and conditions set forth in this Coverage Part. The “information packet” will be provided by an attorney selected by the “insured organization” in consultation with us, from the list of attorney's in the “information packet”. Z.“Loss” means: 1.“Business Interruption Loss” 2.“Damages”; 3.“Claims Expenses”; 4.“Cyber Extortion Loss”; 5.“Data Protection Loss”; 6.“Crisis Management and Public Relations”; 7.“Penalties”; 8.“PCI Fines, Expenses and Costs”; and 9.“Privacy Breach Response Services”. AA.“Malicious code” means any virus, Trojan horse, worm or any other similar software program, code or script intentionally designed to insert itself into computer memory or onto a computer disk and spread itself from one computer to another. BB.“Management control” means: 1.Owning, directly or indirectly, more than fifty percent (50%) of the outstanding securities, representing the present right to vote for the election of an entity's directors, members of the board of managers, management committee members or persons serving in a functionally equivalent role for such an entity operating or organization outside of the United States; or 2.Having the right, pursuant to a written contract or the bylaws, charter, operating agreement or similar documents of an entity to elect, appoint or designate a majority of: a.The Board of Directors of a corporation; b.The Management Committee of a joint venture or partnership; c.The Management Board of a Limited Liability Company; or d.Persons serving in a functionally equivalent role for such an entity operating or organized outside of the United States. CC.“Media material” means any information in electronic form, including words, sounds, numbers, images, or graphics and shall include advertising, video, streaming content, web-casting, online forum, bulletin board and chat room content, but does not mean computer software or the actual goods, products or services Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 15 of 19IL 70 61 07 16 05/13/2024A0195129 Middlesex Insurance Company 00010 0000000000 24134 0 N15 d2b51271-8990-4101-9991-31e61c4fbdfbd2b51271-8990-4101-9991-31e61c4fbdfb described, illustrated or displayed in such “media material”. DD.“Merchant Services agreement” means any agreement between an insured and a financial institution, credit/debit company, credit/debit card processor or independent service operator enabling an insured to accept credit card, debit card, prepaid card, or other payment cards for payments or donations. EE.“Named insured” means the entity or individual shown as the first named insured in the Declarations. FF.“Notification services” means: 1.Notification by first class mail or e-mail to United States or Canadian residents; and 2.Notification by first class mail or e-mail to individuals residing outside the United States or Canada, but only to the extent reasonably practicable. “Notification services” will be provided by a service provider selected by us in consultation with the “insured organization” from the list of service providers in the “information packet” and will be provided in accordance with the terms and conditions set forth in the “information packet”. GG.“Notified individual” means an individual person to whom notice is given or attempted to be given under Paragraph 3. of SECTION I, B. Privacy Breach Response Services pursuant to a “breach notice law” as defined in Paragraph A. of SECTION XI - DEFINITIONS. HH.“PCI Fines, Expenses and Costs” means the direct monetary fines, penalties, reimbursements, fraud recoveries or assessments owed by the “insured organization” under the terms of a “merchant services agreement”, but only where such fines, penalties, reimbursements, fraud recoveries or assessments result both from the “insured organization's” actual or alleged noncompliance with published Payment Card Industry (PCI) Data Security Standards and from a data breach caused by an incident (or reasonably suspected incident) described in Paragraphs 1. and 2. of SECTION I - A. Information Security And Privacy Liability; provided, that the term “PCI Fines, Expenses and Costs” shall not include, or mean any charge backs, interchangeable fees, discount fees or prospective service fees. II.“Penalties” means: 1.Any civil fine or punitive sum of money payable to a governmental entity that was imposed in a “regulatory proceeding” by the Federal Trade Commission, Federal Communications Commission, or any other federal, state, local or foreign governmental entity, in such entity's regulatory or official capacity; the insurability of “penalties” shall be in accordance with the law in the applicable venue that most favors coverage for such “penalties”; and 2.Amounts which the insured is legally obligated to deposit in a fund as equitable relief for the payment of consumer claims due to an adverse judgment or settlement of a “regulatory proceeding”; “Penalties” does not include: 1.Costs to remediate or improve “computer systems”; 2.Costs to establish, implement, maintain, improve or remediate security or privacy practices, procedures, programs or policies; 3.Audit, assessment, compliance or reporting costs; or 4.Costs to protect the confidentiality, integrity and/or security of “personally identifiable information” from theft, loss or disclosure. 5.Payments to charitable organizations or disposition of such funds other than for payment of consumer claims for losses caused by an event covered pursuant to Paragraphs 1., 2., or 3. of SECTION I, A. Information Security And Privacy Liability. JJ.“Personally identifiable information” means: 1.Information concerning the individual that constitutes nonpublic personal information as defined in the Gramm-Leach Bliley Act of 1999, as amended, and regulations issued pursuant to the Act; 2.Medical or health care information concerning the individual, including protected health information as defined in the Health Insurance Portability and Accountability Act of 1996, as amended, and regulations issued pursuant to the Act. 3.Information concerning the individual that is defined as private personal information under statutes enacted to protect such information in foreign countries, for “claims” subject to the law of such jurisdiction; Includes copyrighted material of Insurance Services Office, Inc., with its permission. IL 70 61 07 16Page 16 of 19 05/13/2024A0195129 Middlesex Insurance Company 4.Information concerning the individual that is defined as private personal information under a “breach notice law”; 5.Education records as defined by the Family Educational Rights and Privacy Act (FERPA), which are directly related to an individual's attendance as a student; or 6.The individual's driver's license or state identification number, social security number, unpublished telephone number, and credit, debit, or other financial account numbers in combination with associated security codes, access codes, passwords or pins; If such information allows an individual to be uniquely and reliably identified or contacted or allows access to the individual's financial account or medial record information. “Personally identifiable information” does not include publicly available information that is lawfully made available to the general public from government records. KK.“Period of restoration” means the time period that: 1.Begins on the specific date and time that the actual and necessary interruption or suspension of “computer systems” first occurred; and 2.Ends on the specific date and time that the actual and necessary interruption or suspension of “computer systems” ends, or would have ended had the insured or “dependent business” (if applicable) acted with due diligence and dispatch; Provided that in no event shall the “period of restoration” mean more than or exceed thirty (30) days; and provided further that restoration of “computer systems” will not end the “period of restoration” if such systems are actually and necessarily interrupted or suspended again within one hour of such restoration due to the same cause as the original interruption or suspension. LL.“Policy period” means the period of time between the inception date shown in the “declarations” and the effective date of termination, expiration or cancellation of this “insurance” that specifically excludes any “optional extension period” or any prior policy period or renewal period. MM.“Privacy breach response services” means: 1.“Computer expert services”; 2.“Legal services”; 3.“Public relations and crisis management expenses”. 4. “Notification services” to provide notification to: a.Individuals who are required to be notified by the “insured organization” under the applicable “breach notice law”; or b.Individuals, who at our discretion, have been affected by an incident in which their “personally identifiable information” has been subject to theft, loss, or “unauthorized disclosure” in a manner which compromises the security or privacy of such individual by posing a significant risk of financial, reputational or other harm to the individual; 5.“Call center services”; and 6.“Breach resolution and mitigation services”; “Privacy breach response services” also includes assistance from our breach response services team and access to education and loss control information at no charge. “Privacy breach response services” will be provided subject to the terms and conditions of this endorsement and the “information packet” and shall not include any internal salary or overhead expenses of the “insured organization”. NN.“Privacy law” means a federal, state or foreign statute or regulation requiring the “insured organization” to protect the confidentiality and/or security of “personally identifiable information”. OO.“Privacy policy” means the “insured organization's” public declaration of its policy for collection, use, disclosure, sharing, dissemination and correction or supplementation of, and access to “personally identifiable information”. PP.“Public relations and crisis management expense” shall mean the following costs approved in advance by us, and which are directly related to mitigating harm to the “insured organization's” reputation or potential “loss” covered by this Coverage Part resulting from an incident described in Paragraphs 1. and 2. of SECTION I, A. Information Security And Privacy Liability or from a “public relations event”: 1.Costs incurred by a public relations or crisis management consultant; Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 17 of 19IL 70 61 07 16 05/13/2024A0195129 Middlesex Insurance Company 00010 0000000000 24134 0 N17 d2b51271-8990-4101-9991-31e61c4fbdfbd2b51271-8990-4101-9991-31e61c4fbdfb 2.Costs for media purchasing or for printing or mailing materials intended to inform the general public about the incident, such costs to be limited to the amount noted in the Schedule or Declarations Page for SECTION I, B. Privacy Breach Response Services; 3.For incidents or events in which notifications services are not otherwise provided pursuant to SECTION I, A. Information Security And Privacy Liability and B. Privacy Breach Response Services, costs to provide notifications and notices via e-mail or first class mail to customers or patients where such notifications are not required by law (voluntary notifications), including non-affected customers or patients of the “insured organization”; 4.Costs to provide government mandated public notices related to breach events, including such notifications required under HIPAA/Health Information Technology for Economic and Clinical Health Act ("HITECH"); 5.Costs to provide services to restore healthcare records of “notified individuals” residing in the United States whose “personally identifiable information” was compromised as a result of theft, loss or “unauthorized disclosure”; and 6.Other costs approved in advance by us. “Public relations and crisis management expenses” must be incurred no later than twelve (12) months following the reporting of such “claim” or breach event to us and, with respect to Paragraphs 1. and 2. above, within ninety (90) days following the first publication of such “claim” or incident. If voluntary notifications are provided, e-mail notification will be provided in lieu of first class mail to the extent practicable. QQ.“Public relations event” means the publication or imminent publication in a newspaper (or other general circulation print publication) or on radio, television or a publically accessible website of a covered “claim” under this Coverage Part. RR.“Regulatory proceeding” means a request for information, civil investigative demand or civil proceeding commenced by service of a compliant or similar proceeding brought by or on behalf of the Federal Trade Commission, Federal Communications Commission, or any federal, state, local or foreign governmental entity in such entity's regulatory or official capacity in connection with such proceeding. SS.“Related party” means the “insured organization” and any past, present or future employees, directors, officers, “managers”, partners or natural person independent contractors of the “insured organization”. TT.“Retention” means the applicable retention amount as specified in the Declarations. UU.“Retroactive date” means the Cyber Liability and Data Breach Response Retroactive Date specified in the Declarations. VV.“Security breach” means: 1.“Unauthorized access or use of computer systems”, including “unauthorized access or use” resulting from the theft of a password from a “computer system” or from any insured; 2.A denial or service attack against “computer systems” or “computer systems” that are not owned, operated or controlled by an insured; or 3.Infection of “computer systems” by malicious code or transmission of malicious code from “computer systems”. A series of continuing “security breaches”, related or repeated “security breaches”, or multiple “security breaches” resulting from a continuing failure of “computer security” shall be considered a single “security breach” and be deemed to have occurred at the time of the first such “security breach”. WW.“Subsidiary” means any corporation, limited liability company, joint venture or partnership while the “named insured” has “management control” over such entity, if the “named insured”: 1.had “management control” over such entity on the inception date of this coverage or such entity was an insured under a policy issued by us of which this coverage is a renewal; 2.acquires “management control” after the inception date of this coverage, provided the revenues of the entity do not exceed ten percent (10%) of the “named insured’s” annual revenues for the four quarterly periods directly preceding inception of the “policy period”; or 3.acquires “management control” after the inception date of this coverage, provided that if the revenues of the entity exceed ten percent (10%) of the “named insured’s” annual revenues for the four quarterly periods directly preceding inception of the Includes copyrighted material of Insurance Services Office, Inc., with its permission. IL 70 61 07 16Page 18 of 19 05/13/2024A0195129 Middlesex Insurance Company “policy period”, the provisions of Clause XVI., Mergers and Acquisitions, must be fulfilled; provided that this coverage only provides for acts, errors, omissions, incidents or events that take place while the “named insured” has “management control” over such entity. XX.“Third party information” means any trade secret, data, design, interpretation, crop data, forecast, formula, method, practice, credit or debit card magnetic strip information, process, record, report or other item of information of a third party not insured under this endorsement which is not available to the general public and is provided to the insured subject to a mutually executed written confidentiality agreement or which the “insured organization” is legally required to maintain in confidence; however, “third party information” shall not include “personally identifiable information”. YY.“Unauthorized access or use” means the gaining of access to or use of “computer systems” by an unauthorized person or persons or the use of “computer systems” in an unauthorized manner”. ZZ.“Unauthorized disclosure” means the disclosure of (including disclosure resulting from phishing) or access to information in a manner that is not authorized by the “insured organization” and is without knowledge of, consent, or acquiescence of any member of the “control group”. AAA.“Waiting period” means the period of time beginning when the “period of restoration” begins and expiring after the elapse of the number of hours set forth in the Declarations. A “waiting period” shall apply to each “period of restoration”. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 19 of 19IL 70 61 07 16 05/13/2024A0195129 Middlesex Insurance Company 00010 0000000000 24134 0 N19 d2b51271-8990-4101-9991-31e61c4fbdfbd2b51271-8990-4101-9991-31e61c4fbdfb POLICY NUMBER: IL 80 05 07 16 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION - INFECTIOUS OR COMMUNICABLE DISEASE This endorsement modifies insurance provided under the following: COMMERCIAL AUTOMOBILE COVERAGE PART COMMERCIAL EXCESS/UMBRELLA COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS COVERAGE PART With respect to the coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. A.The following exclusion is added: EXCLUSION - INFECTIOUS OR COMMUNICABLE DISEASE This insurance does not apply to: 1.“Bodily injury”, “property damage” or “personal and advertising injury” arising out of the actual or alleged transmission of an “infectious or communicable disease”; or 2.Any loss, cost or expense arising out of any: a.Request, demand, order or statutory or regulatory requirement that any insured or others test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of an “infectious or communicable disease”; or b.Claim or suit by or on behalf of a governmental authority for damages because of testing for, monitoring, cleaning up, removing, containing, treating, detoxifying or neutralizing, or in any way responding to, or assessing the effects of, an “infectious or communicable disease”. 3.This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the: a.Supervising, hiring, employing, training or monitoring of others that may be infected with and spread an “infectious or communicable disease”; b.Failure to prevent the spread of an “infectious or communicable disease”; or c.Failure to report an “infectious or communicable disease” to authorities. B.The following definition is added: “Infectious or communicable disease” 1.Means an illness or contamination resulting from an infectious agent or its by-products that occurs through the direct or indirect transmission by an infected human or animal host, organism or from the inanimate environment to a human or animal host; and 2.Includes, but is not limited to, Chronic Wasting Disease (CWD); Ebola; Escherichia coli (E. coli); Hepatitis, Influenza, including, but not limited to, all strains and mutations of avian, human or swine; Measles, Methicillin-resistant Staphylococcus Aureus (MRSA), Salmonellosis; Severe Acute Respiratory Syndrome (SARS); Sexually Transmitted Diseases (STDs); Transmissible Spongiform Encephalopathy (TSE), including Bovine Spongiform Encephalopathy (BSE, or mad cow disease); Tuberculosis and West Nile Virus. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1IL 80 05 07 16 05/13/2024A0195129 Middlesex Insurance Company 00001 0000000000 24134 0 N1 0c9e9cab-36c3-43d0-8250-2111c9312c410c9e9cab-36c3-43d0-8250-2111c9312c41 CALIFORNIA UNINSURED MOTORISTS COVERAGE REJECTION/SELECTION REJECTION OF UNINSURED MOTORISTS COVERAGE The California Insurance Code requires an insurer to provide uninsured motorists coverage in each bodily injury liability insurance policy it issues covering liability arising out of the ownership, maintenance, or use of a motor vehicle. Those provisions also permit the insurer and the applicant to delete the coverage completely or to delete the coverage when a motor vehicle is operated by a natural person or persons designated by name. Uninsured motorists coverage insures the insured, his or her heirs, or legal representatives for all sums within the limits established by law, that the person or persons entitled to recover as damages for bodily injury, including any resulting sickness, disease, or death, to the insured from the owner or operator of an uninsured motor vehicle not owned or operated by the insured or a resident of the same household. An uninsured motor vehicle includes an underinsured motor vehicle as defined in subdivision (p) of Section 11580.2 of the Insurance Code. Subdivision (p) of Section 11580.2 of the Insurance Code defines an underinsured motor vehicle as a motor vehicle that is an insured motor vehicle but insured for an amount that is less than the uninsured motorist limit carried on the motor vehicle of the injured person. Please initial the line below to reject Uninsured Motorists Coverage. I reject Uninsured Motorists Coverage entirely for all vehicles insured by this policy. SELECTION OF UNINSURED MOTORISTS COVERAGE The California Insurance Code requires an insurer to provide uninsured motorists coverage in each bodily injury liability insurance policy it issues covering liability arising out of the ownership, maintenance, or use of a motor vehicle. Those provisions also permit the insurer and the applicant to agree to provide the coverage in an amount less than that required by subdivision (m) of Section 11580.2 of the Insurance Code but not less than the financial responsibility requirements. Uninsured motorists coverage insures the insured, his or her heirs, or legal representatives for all sums within the limits established by law, that the person or persons are legally entitled to recover as damages for bodily injury, including any resulting sickness, disease, or death, to the insured from the owner or operator of an uninsured motor vehicle not owned or operated by the insured or a resident of the same household. An uninsured motor vehicle includes an underinsured motor vehicle as defined in subdivision (p) of Section 11580.2 of the Insurance Code. Subdivision (p) of Section 11580.2 of the Insurance Code defines an underinsured motor vehicle as a motor vehicle that is an insured motor vehicle but insured for an amount that is less than the uninsured motorist limit carried on the motor vehicle of the injured person. Please initial the line next to the option you select if you are selecting Uninsured Motorists Coverage. I select Uninsured Motorists Coverage with a coverage limit of: $30,000 (minimum) $500,000 Other Specify Limit $ I select Uninsured Motorists Coverage with a limit equal to the bodily injury liability limit of my Business Auto or Auto Dealer policy. The coverage limit may not exceed the bodily injury and property damage limit of your Business Auto, Motor Carrier or Auto Dealer policy. Page 1 of 240 530 02 15 05/13/2024A0195129 Middlesex Insurance Company 00001 0000000000 24134 0 N1 80f44746-63e2-4d6a-a897-c9c782b639ed80f44746-63e2-4d6a-a897-c9c782b639ed Named Insured Signature of Named Insured Print Name and Title Policy Number Date UNINSURED MOTORISTS PROPERTY DAMAGE COVERAGE Note: Uninsured Motorists Property Damage Coverage is available for vehicles, except commercial vehicles maintained primarily for transportation of property or persons for hire that have Uninsured Motorists Coverage and do not have Collision Coverage. Uninsured Motorists Property Damage Coverage will pay for loss or damage to an insured motor vehicle resulting from physical damage caused by an at-fault uninsured motor vehicle. The maximum amount payable will be $3,500 or the actual cash value, whichever is less. Please initial the line next to the appropriate option if you wish to select Uninsured Motorists Property Damage. I select Uninsured Motorists Property Damage Coverage for all vehicles insured under this policy. I select Uninsured Motorists Property Damage Coverage for the following private passenger vehicles only: COLLISION DEDUCTIBLE WAIVER Note: This option is available for vehicles, except commercial vehicles maintained primarily for transportation of property or persons for hire, if Uninsured Motorists coverage is purchased without Uninsured Motorists Property Damage Coverage. If this option is selected, your collision deductible will be waived when a covered collision loss is caused by an uninsured motor vehicle. Please initial the line below if you wish to select the Collision Deductible Waiver. I select the Collision Deductible Waiver for the following private passenger vehicles: THIS REJECTION/SELECTION FORM DOES NOT PROVIDE COVERAGE. READ THE POLICY FOR DETAILS. I understand this rejection/selection of coverage will apply to all subsequent renewals, reinstatements, and replacement policies until a change is requested by me in writing. Axis Mechanical , Inc.A0195129 40 530 02 15Page 2 of 2 05/13/2024A0195129 Middlesex Insurance Company A0195129 Middlesex Insurance Company 05/13/2024 760fdc86-90a0-447a-a069-ae20d52d789b Page 1 of 180 3701 02 15 CALIFORNIA AUTO BODY REPAIR CONSUMER BILL OF RIGHTS A Consumer is entitled to: 1.Select the auto body repair shop to repair auto body damage covered by the insurance company. An insurance company may not require the repairs to be done at a specific auto body repair shop. 2.An itemized written estimate for auto body repairs and, upon completion of repairs, a detailed invoice. The estimate and the invoice must include an itemized list of parts and labor along with the total price for the work performed. The estimate and invoice must also identify all parts as new, used, aftermarket, reconditioned, or rebuilt. 3.Be informed about coverage for towing and storage services. 4.Be informed about the extent of coverage, if any, for a replacement rental vehicle while a damaged vehicle is being repaired. 5.Be informed of where to report suspected fraud or other complaints and concerns about auto body repairs. 6.To seek and obtain an independent repair estimate directly from a registered auto body repair shop for repair of a damaged vehicle, even when pursuing an insurance claim for repair of that vehicle. Complaints within the jurisdiction of the Bureau of Automotive Repair Complaints concerning the repair of a vehicle by an auto body repair shop should be directed to: Toll Free (866)799-3811 California Department of Consumer Affairs Bureau of Automotive Repair 10949 North Mather Blvd. Rancho Cordova, CA 95670 The Bureau of Automotive Repair can also accept complaints over its web site at: www.autorepair.ca.gov Complaints within the jurisdiction of the California Insurance Commissioner Any concerns regarding how an auto insurance claim is being handled should be submitted to the California Department of Insurance at: (800)927-4357 or (213)897-8921 California Department of Insurance Consumer Services Division 300 S. Spring Street Los Angeles, CA 90013 The California Department of Insurance can also accept complaints over its web site at www.insurance.ca.gov BUSINESS AUTO COVERAGE DECLARATIONS POLICY NUMBER: A0195129001 Middlesex Insurance Company (A Participating Stock Company) A member of the Sentry Insurance Group 1800 North Point Drive Stevens Point, WI 54481 Agency Acrisure of California, LLC 34 S 2nd St Campbell, CA 95008 Agency Code 10047536 ITEM ONE First Named Insured: POLICY INFORMATION Axis Mechanical , Inc. Address:908 Bern Ct San Jose, CA 95112 The Business Auto Coverage applies from 05/13/2024 to 05/13/2025 at 12:01 A.M. Standard Time at the First Named Insured's mailing address shown above. Additional Named Insureds In addition to the Named Insured's listed in the Common Declarations, the following person(s) or organization(s) are named insured's for the Business Auto Coverage only. Additional Interests For additional interests which apply to a specified covered “auto” refer to the Schedule of Covered Autos. For additional interests which apply to all covered “autos”, refer to the Additional Interests Supplemental Declarations. APPLICABLE FORMS AND ENDORSEMENTS In addition to the common policy forms and endorsements, the following forms and endorsements apply to the Business Auto Coverage: Form/Endorsement Form/Endorsement Title Number and Edition Date CA 00 01 10 13 Business Auto Coverage Form CA 01 21 10 13 Limited Mexico Coverage CA 01 43 05 17 California Changes CA 03 05 10 13 California Changes - Waiver Of Collision Deductible CA 04 24 10 13 California Auto Medical Payments Coverage CA 04 44 10 13 Waiver Of Transfer Of Rights Of Recovery Against Others To Us (Waiver Of Subrogation) CA 21 54 11 16 California Uninsured Motorists Coverage - Bodily Injury CA 23 84 10 13 Exclusion Of Terrorism CA 23 94 10 13 Silica Or Silica-Related Dust Exclusion For Covered Autos Exposure CA 70 57 10 13 Special Broad Form Auto Endorsement CA 89 01 10 14 Page 1 of 4 05/13/2024A0195129 Middlesex Insurance Company 00002 0000000000 24134 0 N1 d818de30-4957-4e36-9195-679776e3e16ed818de30-4957-4e36-9195-679776e3e16e POLICY NUMBER:A0195129001 Page 2 of 4 CA 89 01 10 14 05/13/2024A0195129 Middlesex Insurance Company APPLICABLE FORMS AND ENDORSEMENTS Form/Endorsement Form/Endorsement Title Number and Edition Date CA 76 01 06 15 Designated Insured - Primary and Noncontributory - Covered Autos Liability Coverage CA 99 44 10 13 Loss Payable Clause IL 00 21 09 08 Nuclear Energy Liability Exclusion Endorsement (Broad Form) IL 02 70 07 20 California Changes - Cancellation And Nonrenewal ITEM TWO Schedule of Coverages and Covered Autos This policy provides only those coverages, shown below. Each of these coverages will apply only to those “autos” shown as covered “autos”. “Autos” are shown as covered “autos” for a particular coverage by the entry of one or more of the symbols from the Covered Autos Section of the Business Auto Coverage Form next to the name of the coverage. Coverages Covered Autos Limit Or Deductible Covered Autos Liability 01 $1,000,000 Auto Medical Payments $5,000 Each Insured 07 08 Uninsured Motorists $1,000,00007 Underinsured Motorists Included in Uninsured Motorists Coverage Physical Damage - Comprehensive Coverage 07 08 Actual cash value or cost of repair, whichever is less minus deductible shown in ITEM THREE for each covered “auto”. A deductible of $100 applies to covered “autos” not listed in ITEM THREE. Deductibles do not apply to loss caused by fire or lightning. Physical Damage – Collision Coverage 07 08 Actual cash value or cost of repair, whichever is less minus deductible shown in ITEM THREE for each covered “auto”. A deductible of $250 applies to covered “autos” not listed in ITEM THREE. Physical Damage – Towing And Labor 03 Refer to Item Three - Schedule Of Covered Autos ITEM THREE Schedule of Covered Autos You Own See attached Schedule of Covered Autos You Own POLICY NUMBER:A0195129001 CA 89 01 10 14 Page 3 of 4 05/13/2024A0195129 Middlesex Insurance Company 00002 0000000000 24134 0 N3 d818de30-4957-4e36-9195-679776e3e16ed818de30-4957-4e36-9195-679776e3e16e ITEM FOUR Schedule of Hired or Borrowed Covered Auto Coverages Refer to ITEM TWO. Other than Physical Damage Coverage – Cost of Hire Rating Basis Covered Autos Liability Coverage Coverage Estimated Annual Cost of Hire* Premium If AnyPrimary Coverage Included$ * For the above coverages, cost of hire means the total amount you incur for the hire of “autos” you don’t own (not including “autos” you borrow or rent from your partners or “employees” or their family members). Cost of hire does not include charges for services performed by motor carriers of property or passengers. Physical Damage Coverage – Cost of Hire Rating Basis Estimated Cost of Hire*Limit of InsuranceCoverage Premium IncludedComprehensiveIf AnyActual cash value or cost of repair, whichever is less, minus $100 deductible for each covered auto, but no deductible applies to loss caused by fire or lightning $ IncludedCollisionIf AnyActual cash value or cost of repair, whichever is less, minus $250 deductible for each covered auto. $ Included *For Physical Damage Coverages, cost of hire means the total amount you incur for the hire of “autos” you don’t own (not including “autos” you borrow or rent from your partners or “employees” or their family members). Cost of hire does not include charges for any “auto” that is leased, hired, rented or borrowed with a driver. Total Premium $ ITEM FIVE Schedule for Non-Ownership Liability NumberNamed Insured’s Business Rating Basis Premium IncludedNumber of employeesOther than garage service operations and other than social service agencies 15 $ POLICY NUMBER:A0195129001 Page 4 of 4 CA 89 01 10 14 05/13/2024A0195129 Middlesex Insurance Company ITEM SIX OPTIONAL ENDORSEMENT SCHEDULES For information not shown below, refer to the individual endorsements. Waiver Of Transfer Of Rights Of Recovery Against Others To Us Name of Person or Organization: Any person or organization from whom you are required to waive your right to recover under a written contract or agreement in effect prior to any loss or damage POLICY NUMBER: A0195129001 ITEM THREE – SCHEDULE OF COVERED AUTOS YOU OWN For the covered “autos” listed below, only the coverages indicated for a covered “auto” apply to that covered auto. The absence of a coverage for an individual covered “auto” means that the coverage does not apply. Vehicle Number Description of Covered Auto Vehicle ID Number (VIN)Premium Class Code:Original Cost New: $ Garage Location and Territory License Plate: Coverage Premium 2019 FORD RANGER $ San Jose, CA 95112 Limit of Insurance Or Deductible Coverage 1 1FTER1EH7KLA99465 03483 32,760 153 2,623.00 Covered Autos Liability $ $1,000,000 1987.00 Medical Payments Each Insured $ $5,000 9.00 See Item Two $ Uninsured Motorists including Underinsured Motorists 75.00 Comprehensive Actual Cash Value minus $1,000 deductible $ 48.00 Collision Actual Cash Value minus $1,000 deductible $504.00 Rental Reimbursement Any OneAny OneCoverage Day No. of Days Period Comprehensive $$$ 50 1,00020 0.00 Collision $$$ 50 1,00020 0.00 Vehicle Number Description of Covered Auto Vehicle ID Number (VIN)Premium Class Code:Original Cost New: $ Garage Location and Territory License Plate: Coverage Premium 2020 FORD F150 $ San Jose, CA 95112 Limit of Insurance Or Deductible Coverage 2 1FTMF1CB1LKD19404 03483 40,138 153 2,978.00 Covered Autos Liability $ $1,000,000 2139.00 Medical Payments Each Insured $ $5,000 9.00 See Item Two $ Uninsured Motorists including Underinsured Motorists 75.00 Comprehensive Actual Cash Value minus $1,000 deductible $ 64.00 Collision Actual Cash Value minus $1,000 deductible $691.00 Rental Reimbursement Any OneAny OneCoverage Day No. of Days Period Comprehensive $$$ 50 1,00020 0.00 Collision $$$ 50 1,00020 0.00 CA 89 02 10 14 Page 1 of 20 05/13/2024A0195129 Middlesex Insurance Company 00010 0000000000 24134 0 N1 01443144-0564-4b98-ae43-b849ebf6c1c201443144-0564-4b98-ae43-b849ebf6c1c2 POLICY NUMBER: A0195129001 Page 2 of 20 CA 89 02 10 14 05/13/2024A0195129 Middlesex Insurance Company Vehicle Number Description of Covered Auto Vehicle ID Number (VIN)Premium Class Code:Original Cost New: $ Garage Location and Territory License Plate: Coverage Premium 2020 FORD F150 $ San Jose, CA 95112 Limit of Insurance Or Deductible Coverage 3 1FTMF1CB3LKD19405 03483 40,198 153 2,978.00 Covered Autos Liability $ $1,000,000 2139.00 Medical Payments Each Insured $ $5,000 9.00 See Item Two $ Uninsured Motorists including Underinsured Motorists 75.00 Comprehensive Actual Cash Value minus $1,000 deductible $ 64.00 Collision Actual Cash Value minus $1,000 deductible $691.00 Rental Reimbursement Any OneAny OneCoverage Day No. of Days Period Comprehensive $$$ 50 1,00020 0.00 Collision $$$ 50 1,00020 0.00 Vehicle Number Description of Covered Auto Vehicle ID Number (VIN)Premium Class Code:Original Cost New: $ Garage Location and Territory License Plate: Coverage Premium 2020 FORD TRANSIT $ San Jose, CA 95112 Limit of Insurance Or Deductible Coverage 4 1FTBR1Y8XLKA34468 03483 56,037 153 3,160.00 Covered Autos Liability $ $1,000,000 2238.00 Medical Payments Each Insured $ $5,000 9.00 See Item Two $ Uninsured Motorists including Underinsured Motorists 75.00 Comprehensive Actual Cash Value minus $1,000 deductible $ 74.00 Collision Actual Cash Value minus $1,000 deductible $764.00 Rental Reimbursement Any OneAny OneCoverage Day No. of Days Period Comprehensive $$$ 50 1,00020 0.00 Collision $$$ 50 1,00020 0.00 POLICY NUMBER: A0195129001 CA 89 02 10 14 Page 3 of 20 05/13/2024A0195129 Middlesex Insurance Company 00010 0000000000 24134 0 N3 01443144-0564-4b98-ae43-b849ebf6c1c201443144-0564-4b98-ae43-b849ebf6c1c2 Vehicle Number Description of Covered Auto Vehicle ID Number (VIN)Premium Class Code:Original Cost New: $ Garage Location and Territory License Plate: Coverage Premium 2017 FORD F250 $ San Jose, CA 95112 Limit of Insurance Or Deductible Coverage 5 1FT7W2BT1HEE71914 03483 61,625 153 2,700.00 Covered Autos Liability $ $1,000,000 2020.00 Medical Payments Each Insured $ $5,000 9.00 See Item Two $ Uninsured Motorists including Underinsured Motorists 75.00 Comprehensive Actual Cash Value minus $1,000 deductible $ 59.00 Collision Actual Cash Value minus $1,000 deductible $537.00 Rental Reimbursement Any OneAny OneCoverage Day No. of Days Period Comprehensive $$$ 50 1,00020 0.00 Collision $$$ 50 1,00020 0.00 Vehicle Number Description of Covered Auto Vehicle ID Number (VIN)Premium Class Code:Original Cost New: $ Garage Location and Territory License Plate: Coverage Premium 2013 FORD F150 $ San Jose, CA 95112 Limit of Insurance Or Deductible Coverage 6 1FTMF1CM3DKE71090 03483 24,070 153 1,870.00 Covered Autos Liability $ $1,000,000 1598.00 Medical Payments Each Insured $ $5,000 9.00 See Item Two $ Uninsured Motorists including Underinsured Motorists 75.00 Comprehensive Actual Cash Value minus $1,000 deductible $ 25.00 Collision Actual Cash Value minus $1,000 deductible $163.00 Rental Reimbursement Any OneAny OneCoverage Day No. of Days Period Comprehensive $$$ 50 1,00020 0.00 Collision $$$ 50 1,00020 0.00 POLICY NUMBER: A0195129001 Page 4 of 20 CA 89 02 10 14 05/13/2024A0195129 Middlesex Insurance Company Vehicle Number Description of Covered Auto Vehicle ID Number (VIN)Premium Class Code:Original Cost New: $ Garage Location and Territory License Plate: Coverage Premium 2010 FORD F150 $ San Jose, CA 95112 Limit of Insurance Or Deductible Coverage 7 1FTMF1CW2AKA50071 03483 22,060 153 1,781.00 Covered Autos Liability $ $1,000,000 1512.00 Medical Payments Each Insured $ $5,000 9.00 See Item Two $ Uninsured Motorists including Underinsured Motorists 75.00 Comprehensive Actual Cash Value minus $1,000 deductible $ 22.00 Collision Actual Cash Value minus $1,000 deductible $163.00 Rental Reimbursement Any OneAny OneCoverage Day No. of Days Period Comprehensive $$$ 50 1,00020 0.00 Collision $$$ 50 1,00020 0.00 Vehicle Number Description of Covered Auto Vehicle ID Number (VIN)Premium Class Code:Original Cost New: $ Garage Location and Territory License Plate: Coverage Premium 2010 FORD F150 $ San Jose, CA 95112 Limit of Insurance Or Deductible Coverage 8 1FTMF1CW6AKC20514 03483 22,060 153 1,781.00 Covered Autos Liability $ $1,000,000 1512.00 Medical Payments Each Insured $ $5,000 9.00 See Item Two $ Uninsured Motorists including Underinsured Motorists 75.00 Comprehensive Actual Cash Value minus $1,000 deductible $ 22.00 Collision Actual Cash Value minus $1,000 deductible $163.00 Rental Reimbursement Any OneAny OneCoverage Day No. of Days Period Comprehensive $$$ 50 1,00020 0.00 Collision $$$ 50 1,00020 0.00 POLICY NUMBER: A0195129001 CA 89 02 10 14 Page 5 of 20 05/13/2024A0195129 Middlesex Insurance Company 00010 0000000000 24134 0 N5 01443144-0564-4b98-ae43-b849ebf6c1c201443144-0564-4b98-ae43-b849ebf6c1c2 Vehicle Number Description of Covered Auto Vehicle ID Number (VIN)Premium Class Code:Original Cost New: $ Garage Location and Territory License Plate: Coverage Premium 2013 FORD F150 $ San Jose, CA 95112 Limit of Insurance Or Deductible Coverage 9 1FTMF1CM1DKG52401 03483 24,070 153 1,870.00 Covered Autos Liability $ $1,000,000 1598.00 Medical Payments Each Insured $ $5,000 9.00 See Item Two $ Uninsured Motorists including Underinsured Motorists 75.00 Comprehensive Actual Cash Value minus $1,000 deductible $ 25.00 Collision Actual Cash Value minus $1,000 deductible $163.00 Rental Reimbursement Any OneAny OneCoverage Day No. of Days Period Comprehensive $$$ 50 1,00020 0.00 Collision $$$ 50 1,00020 0.00 Vehicle Number Description of Covered Auto Vehicle ID Number (VIN)Premium Class Code:Original Cost New: $ Garage Location and Territory License Plate: Coverage Premium 2013 FORD F150 $ San Jose, CA 95112 Limit of Insurance Or Deductible Coverage 10 1FTMF1CM0DKG32706 03483 24,070 153 1,870.00 Covered Autos Liability $ $1,000,000 1598.00 Medical Payments Each Insured $ $5,000 9.00 See Item Two $ Uninsured Motorists including Underinsured Motorists 75.00 Comprehensive Actual Cash Value minus $1,000 deductible $ 25.00 Collision Actual Cash Value minus $1,000 deductible $163.00 Rental Reimbursement Any OneAny OneCoverage Day No. of Days Period Comprehensive $$$ 50 1,00020 0.00 Collision $$$ 50 1,00020 0.00 POLICY NUMBER: A0195129001 Page 6 of 20 CA 89 02 10 14 05/13/2024A0195129 Middlesex Insurance Company Vehicle Number Description of Covered Auto Vehicle ID Number (VIN)Premium Class Code:Original Cost New: $ Garage Location and Territory License Plate: Coverage Premium 2007 FORD ECONOLINE $ San Jose, CA 95112 Limit of Insurance Or Deductible Coverage 11 1FTNE24W37DA40920 03483 24,595 153 1,708.00 Covered Autos Liability $ $1,000,000 1443.00 Medical Payments Each Insured $ $5,000 9.00 See Item Two $ Uninsured Motorists including Underinsured Motorists 75.00 Comprehensive Actual Cash Value minus $1,000 deductible $ 18.00 Collision Actual Cash Value minus $1,000 deductible $163.00 Rental Reimbursement Any OneAny OneCoverage Day No. of Days Period Comprehensive $$$ 50 1,00020 0.00 Collision $$$ 50 1,00020 0.00 Vehicle Number Description of Covered Auto Vehicle ID Number (VIN)Premium Class Code:Original Cost New: $ Garage Location and Territory License Plate: Coverage Premium 2015 FORD F150 $ San Jose, CA 95112 Limit of Insurance Or Deductible Coverage 12 1FTMF1CP9FKE53089 03483 26,215 153 2,086.00 Covered Autos Liability $ $1,000,000 1717.00 Medical Payments Each Insured $ $5,000 9.00 See Item Two $ Uninsured Motorists including Underinsured Motorists 75.00 Comprehensive Actual Cash Value minus $1,000 deductible $ 33.00 Collision Actual Cash Value minus $1,000 deductible $252.00 Rental Reimbursement Any OneAny OneCoverage Day No. of Days Period Comprehensive $$$ 50 1,00020 0.00 Collision $$$ 50 1,00020 0.00 POLICY NUMBER: A0195129001 CA 89 02 10 14 Page 7 of 20 05/13/2024A0195129 Middlesex Insurance Company 00010 0000000000 24134 0 N7 01443144-0564-4b98-ae43-b849ebf6c1c201443144-0564-4b98-ae43-b849ebf6c1c2 Vehicle Number Description of Covered Auto Vehicle ID Number (VIN)Premium Class Code:Original Cost New: $ Garage Location and Territory License Plate: Coverage Premium 2015 ISUZU NPR HD $ San Jose, CA 95112 Limit of Insurance Or Deductible Coverage 13 JALC4W169F7003906 23483 49,286 153 2,459.00 Covered Autos Liability $ $1,000,000 1969.00 Medical Payments Each Insured $ $5,000 9.00 See Item Two $ Uninsured Motorists including Underinsured Motorists 75.00 Comprehensive Actual Cash Value minus $1,000 deductible $ 48.00 Collision Actual Cash Value minus $1,000 deductible $358.00 Rental Reimbursement Any OneAny OneCoverage Day No. of Days Period Comprehensive $$$ 50 1,00020 0.00 Collision $$$ 50 1,00020 0.00 Vehicle Number Description of Covered Auto Vehicle ID Number (VIN)Premium Class Code:Original Cost New: $ Garage Location and Territory License Plate: Coverage Premium 2014 FORD F150 $ San Jose, CA 95112 Limit of Insurance Or Deductible Coverage 14 1FTNF1CF0EKD84559 03483 25,215 153 2,017.00 Covered Autos Liability $ $1,000,000 1682.00 Medical Payments Each Insured $ $5,000 9.00 See Item Two $ Uninsured Motorists including Underinsured Motorists 75.00 Comprehensive Actual Cash Value minus $1,000 deductible $ 31.00 Collision Actual Cash Value minus $1,000 deductible $220.00 Rental Reimbursement Any OneAny OneCoverage Day No. of Days Period Comprehensive $$$ 50 1,00020 0.00 Collision $$$ 50 1,00020 0.00 POLICY NUMBER: A0195129001 Page 8 of 20 CA 89 02 10 14 05/13/2024A0195129 Middlesex Insurance Company Vehicle Number Description of Covered Auto Vehicle ID Number (VIN)Premium Class Code:Original Cost New: $ Garage Location and Territory License Plate: Coverage Premium 2014 FORD F150 $ San Jose, CA 95112 Limit of Insurance Or Deductible Coverage 15 1FTNF1CF4EKE28059 03483 25,215 153 2,017.00 Covered Autos Liability $ $1,000,000 1682.00 Medical Payments Each Insured $ $5,000 9.00 See Item Two $ Uninsured Motorists including Underinsured Motorists 75.00 Comprehensive Actual Cash Value minus $1,000 deductible $ 31.00 Collision Actual Cash Value minus $1,000 deductible $220.00 Rental Reimbursement Any OneAny OneCoverage Day No. of Days Period Comprehensive $$$ 50 1,00020 0.00 Collision $$$ 50 1,00020 0.00 Vehicle Number Description of Covered Auto Vehicle ID Number (VIN)Premium Class Code:Original Cost New: $ Garage Location and Territory License Plate: Coverage Premium 2016 FORD F150 $ San Jose, CA 95112 Limit of Insurance Or Deductible Coverage 16 1FTMF1CP6GKE25638 03483 27,110 153 2,166.00 Covered Autos Liability $ $1,000,000 1753.00 Medical Payments Each Insured $ $5,000 9.00 See Item Two $ Uninsured Motorists including Underinsured Motorists 75.00 Comprehensive Actual Cash Value minus $1,000 deductible $ 36.00 Collision Actual Cash Value minus $1,000 deductible $293.00 Rental Reimbursement Any OneAny OneCoverage Day No. of Days Period Comprehensive $$$ 50 1,00020 0.00 Collision $$$ 50 1,00020 0.00 POLICY NUMBER: A0195129001 CA 89 02 10 14 Page 9 of 20 05/13/2024A0195129 Middlesex Insurance Company 00010 0000000000 24134 0 N9 01443144-0564-4b98-ae43-b849ebf6c1c201443144-0564-4b98-ae43-b849ebf6c1c2 Vehicle Number Description of Covered Auto Vehicle ID Number (VIN)Premium Class Code:Original Cost New: $ Garage Location and Territory License Plate: Coverage Premium 2016 FORD F150 $ San Jose, CA 95112 Limit of Insurance Or Deductible Coverage 17 1FTMF1CP0GKD95939 03483 27,110 153 2,166.00 Covered Autos Liability $ $1,000,000 1753.00 Medical Payments Each Insured $ $5,000 9.00 See Item Two $ Uninsured Motorists including Underinsured Motorists 75.00 Comprehensive Actual Cash Value minus $1,000 deductible $ 36.00 Collision Actual Cash Value minus $1,000 deductible $293.00 Rental Reimbursement Any OneAny OneCoverage Day No. of Days Period Comprehensive $$$ 50 1,00020 0.00 Collision $$$ 50 1,00020 0.00 Vehicle Number Description of Covered Auto Vehicle ID Number (VIN)Premium Class Code:Original Cost New: $ Garage Location and Territory License Plate: Coverage Premium 2014 FORD F150 $ San Jose, CA 95112 Limit of Insurance Or Deductible Coverage 18 1FTMF1CM6EKD06734 03483 24,215 153 1,922.00 Covered Autos Liability $ $1,000,000 1632.00 Medical Payments Each Insured $ $5,000 9.00 See Item Two $ Uninsured Motorists including Underinsured Motorists 75.00 Comprehensive Actual Cash Value minus $1,000 deductible $ 27.00 Collision Actual Cash Value minus $1,000 deductible $179.00 Rental Reimbursement Any OneAny OneCoverage Day No. of Days Period Comprehensive $$$ 50 1,00020 0.00 Collision $$$ 50 1,00020 0.00 POLICY NUMBER: A0195129001 Page 10 of 20 CA 89 02 10 14 05/13/2024A0195129 Middlesex Insurance Company Vehicle Number Description of Covered Auto Vehicle ID Number (VIN)Premium Class Code:Original Cost New: $ Garage Location and Territory License Plate: Coverage Premium 2018 FORD F150 $ San Jose, CA 95112 Limit of Insurance Or Deductible Coverage 19 1FTEW1EG1JFB59740 03483 55,625 153 2,828.00 Covered Autos Liability $ $1,000,000 2080.00 Medical Payments Each Insured $ $5,000 9.00 See Item Two $ Uninsured Motorists including Underinsured Motorists 75.00 Comprehensive Actual Cash Value minus $1,000 deductible $ 62.00 Collision Actual Cash Value minus $1,000 deductible $602.00 Rental Reimbursement Any OneAny OneCoverage Day No. of Days Period Comprehensive $$$ 50 1,00020 0.00 Collision $$$ 50 1,00020 0.00 Vehicle Number Description of Covered Auto Vehicle ID Number (VIN)Premium Class Code:Original Cost New: $ Garage Location and Territory License Plate: Coverage Premium 2018 FORD TRANSIT $ San Jose, CA 95112 Limit of Insurance Or Deductible Coverage 20 1FTYR1YGXJKA31939 03483 35,100 153 2,581.00 Covered Autos Liability $ $1,000,000 1951.00 Medical Payments Each Insured $ $5,000 9.00 See Item Two $ Uninsured Motorists including Underinsured Motorists 75.00 Comprehensive Actual Cash Value minus $1,000 deductible $ 50.00 Collision Actual Cash Value minus $1,000 deductible $496.00 Rental Reimbursement Any OneAny OneCoverage Day No. of Days Period Comprehensive $$$ 50 1,00020 0.00 Collision $$$ 50 1,00020 0.00 POLICY NUMBER: A0195129001 CA 89 02 10 14 Page 11 of 20 05/13/2024A0195129 Middlesex Insurance Company 00010 0000000000 24134 0 N11 01443144-0564-4b98-ae43-b849ebf6c1c201443144-0564-4b98-ae43-b849ebf6c1c2 Vehicle Number Description of Covered Auto Vehicle ID Number (VIN)Premium Class Code:Original Cost New: $ Garage Location and Territory License Plate: Coverage Premium 2018 FORD ESCAPE $ San Jose, CA 95112 Limit of Insurance Or Deductible Coverage 21 1FMCU0F74JUC48957 03483 23,940 153 2,265.00 Covered Autos Liability $ $1,000,000 1804.00 Medical Payments Each Insured $ $5,000 9.00 See Item Two $ Uninsured Motorists including Underinsured Motorists 75.00 Comprehensive Actual Cash Value minus $1,000 deductible $ 35.00 Collision Actual Cash Value minus $1,000 deductible $342.00 Rental Reimbursement Any OneAny OneCoverage Day No. of Days Period Comprehensive $$$ 50 1,00020 0.00 Collision $$$ 50 1,00020 0.00 Vehicle Number Description of Covered Auto Vehicle ID Number (VIN)Premium Class Code:Original Cost New: $ Garage Location and Territory License Plate: Coverage Premium 2018 FORD F250 $ San Jose, CA 95112 Limit of Insurance Or Deductible Coverage 22 1FDBF2A62JEC14624 03483 35,747 153 2,581.00 Covered Autos Liability $ $1,000,000 1951.00 Medical Payments Each Insured $ $5,000 9.00 See Item Two $ Uninsured Motorists including Underinsured Motorists 75.00 Comprehensive Actual Cash Value minus $1,000 deductible $ 50.00 Collision Actual Cash Value minus $1,000 deductible $496.00 Rental Reimbursement Any OneAny OneCoverage Day No. of Days Period Comprehensive $$$ 50 1,00020 0.00 Collision $$$ 50 1,00020 0.00 POLICY NUMBER: A0195129001 Page 12 of 20 CA 89 02 10 14 05/13/2024A0195129 Middlesex Insurance Company Vehicle Number Description of Covered Auto Vehicle ID Number (VIN)Premium Class Code:Original Cost New: $ Garage Location and Territory License Plate: Coverage Premium 2021 FORD RANGER $ San Jose, CA 95112 Limit of Insurance Or Deductible Coverage 23 1FTER4EH1MLD84246 03483 35,085 153 2,952.00 Covered Autos Liability $ $1,000,000 2081.00 Medical Payments Each Insured $ $5,000 9.00 See Item Two $ Uninsured Motorists including Underinsured Motorists 75.00 Comprehensive Actual Cash Value minus $1,000 deductible $ 63.00 Collision Actual Cash Value minus $1,000 deductible $724.00 Rental Reimbursement Any OneAny OneCoverage Day No. of Days Period Comprehensive $$$ 50 1,00020 0.00 Collision $$$ 50 1,00020 0.00 Vehicle Number Description of Covered Auto Vehicle ID Number (VIN)Premium Class Code:Original Cost New: $ Garage Location and Territory License Plate: Coverage Premium 2016 FORD F150 $ San Jose, CA 95112 Limit of Insurance Or Deductible Coverage 24 1FTMF1CP8GKD46505 03483 27,110 153 2,166.00 Covered Autos Liability $ $1,000,000 1753.00 Medical Payments Each Insured $ $5,000 9.00 See Item Two $ Uninsured Motorists including Underinsured Motorists 75.00 Comprehensive Actual Cash Value minus $1,000 deductible $ 36.00 Collision Actual Cash Value minus $1,000 deductible $293.00 Rental Reimbursement Any OneAny OneCoverage Day No. of Days Period Comprehensive $$$ 50 1,00020 0.00 Collision $$$ 50 1,00020 0.00 POLICY NUMBER: A0195129001 CA 89 02 10 14 Page 13 of 20 05/13/2024A0195129 Middlesex Insurance Company 00010 0000000000 24134 0 N13 01443144-0564-4b98-ae43-b849ebf6c1c201443144-0564-4b98-ae43-b849ebf6c1c2 Vehicle Number Description of Covered Auto Vehicle ID Number (VIN)Premium Class Code:Original Cost New: $ Garage Location and Territory License Plate: Coverage Premium 2017 FORD F150 $ San Jose, CA 95112 Limit of Insurance Or Deductible Coverage 25 1FTMF1CP9HKC66745 03483 32,700 153 2,377.00 Covered Autos Liability $ $1,000,000 1860.00 Medical Payments Each Insured $ $5,000 9.00 See Item Two $ Uninsured Motorists including Underinsured Motorists 75.00 Comprehensive Actual Cash Value minus $1,000 deductible $ 43.00 Collision Actual Cash Value minus $1,000 deductible $390.00 Rental Reimbursement Any OneAny OneCoverage Day No. of Days Period Comprehensive $$$ 50 1,00020 0.00 Collision $$$ 50 1,00020 0.00 Loss Payable First Citizens Bank & Trust Company Vehicle Number Description of Covered Auto Vehicle ID Number (VIN)Premium Class Code:Original Cost New: $ Garage Location and Territory License Plate: Coverage Premium 2022 FORD ESCAPE $ San Jose, CA 95112 Limit of Insurance Or Deductible Coverage 26 1FMCU0G62NUA27725 03483 27,595 153 2,753.00 Covered Autos Liability $ $1,000,000 1948.00 Medical Payments Each Insured $ $5,000 9.00 See Item Two $ Uninsured Motorists including Underinsured Motorists 75.00 Comprehensive Actual Cash Value minus $1,000 deductible $ 54.00 Collision Actual Cash Value minus $1,000 deductible $667.00 Rental Reimbursement Any OneAny OneCoverage Day No. of Days Period Comprehensive $$$ 50 1,00020 0.00 Collision $$$ 50 1,00020 0.00 POLICY NUMBER: A0195129001 Page 14 of 20 CA 89 02 10 14 05/13/2024A0195129 Middlesex Insurance Company Vehicle Number Description of Covered Auto Vehicle ID Number (VIN)Premium Class Code:Original Cost New: $ Garage Location and Territory License Plate: Coverage Premium 2022 GMC SIERRA $ San Jose, CA 95112 Limit of Insurance Or Deductible Coverage 27 1GT49REY2NF129095 23483 75,450 153 3,497.00 Covered Autos Liability $ $1,000,000 2422.00 Medical Payments Each Insured $ $5,000 9.00 See Item Two $ Uninsured Motorists including Underinsured Motorists 75.00 Comprehensive Actual Cash Value minus $1,000 deductible $ 95.00 Collision Actual Cash Value minus $1,000 deductible $896.00 Rental Reimbursement Any OneAny OneCoverage Day No. of Days Period Comprehensive $$$ 50 1,00020 0.00 Collision $$$ 50 1,00020 0.00 Vehicle Number Description of Covered Auto Vehicle ID Number (VIN)Premium Class Code:Original Cost New: $ Garage Location and Territory License Plate: Coverage Premium 2013 FORD FLEX $ San Jose, CA 95112 Limit of Insurance Or Deductible Coverage 28 2FMGK5C81DBD25022 7398 33,225 153 1,421.00 Covered Autos Liability $ $1,000,000 908.00 Medical Payments Each Insured $ $5,000 13.00 See Item Two $ Uninsured Motorists including Underinsured Motorists 132.00 Comprehensive Actual Cash Value minus $1,000 deductible $ 16.00 Collision with Waiver of Deductible See $ CA 03 05 352.00 Actual Cash Value minus $1,000 deductible Towing and Labor $ 0.00$100 Rental Reimbursement Any OneAny OneCoverage Day No. of Days Period Comprehensive $$$ 50 1,00020 0.00 Collision $$$ 50 1,00020 0.00 POLICY NUMBER: A0195129001 CA 89 02 10 14 Page 15 of 20 05/13/2024A0195129 Middlesex Insurance Company 00010 0000000000 24134 0 N15 01443144-0564-4b98-ae43-b849ebf6c1c201443144-0564-4b98-ae43-b849ebf6c1c2 Vehicle Number Description of Covered Auto Vehicle ID Number (VIN)Premium Class Code:Original Cost New: $ Garage Location and Territory License Plate: Coverage Premium 2022 FORD F350 $ San Jose, CA 95112 Limit of Insurance Or Deductible Coverage 29 1FT8W3BT0NED75715 23483 65,600 153 3,392.00 Covered Autos Liability $ $1,000,000 2359.00 Medical Payments Each Insured $ $5,000 9.00 See Item Two $ Uninsured Motorists including Underinsured Motorists 75.00 Comprehensive Actual Cash Value minus $1,000 deductible $ 90.00 Collision Actual Cash Value minus $1,000 deductible $859.00 Rental Reimbursement Any OneAny OneCoverage Day No. of Days Period Comprehensive $$$ 50 1,00020 0.00 Collision $$$ 50 1,00020 0.00 Vehicle Number Description of Covered Auto Vehicle ID Number (VIN)Premium Class Code:Original Cost New: $ Garage Location and Territory License Plate: Coverage Premium 2022 FORD F150 $ San Jose, CA 95112 Limit of Insurance Or Deductible Coverage 30 1FTMF1CB9NKE25862 03483 35,750 153 2,975.00 Covered Autos Liability $ $1,000,000 2044.00 Medical Payments Each Insured $ $5,000 9.00 See Item Two $ Uninsured Motorists including Underinsured Motorists 75.00 Comprehensive Actual Cash Value minus $1,000 deductible $ 66.00 Collision Actual Cash Value minus $1,000 deductible $781.00 Rental Reimbursement Any OneAny OneCoverage Day No. of Days Period Comprehensive $$$ 50 1,00020 0.00 Collision $$$ 50 1,00020 0.00 POLICY NUMBER: A0195129001 Page 16 of 20 CA 89 02 10 14 05/13/2024A0195129 Middlesex Insurance Company Vehicle Number Description of Covered Auto Vehicle ID Number (VIN)Premium Class Code:Original Cost New: $ Garage Location and Territory License Plate: Coverage Premium 2023 FORD F150 $ San Jose, CA 95112 Limit of Insurance Or Deductible Coverage 31 1FTVW1EV9PWG07343 03483 90,234 153 3,588.00 Covered Autos Liability $ $1,000,000 2291.00 Medical Payments Each Insured $ $5,000 9.00 See Item Two $ Uninsured Motorists including Underinsured Motorists 75.00 Comprehensive Actual Cash Value minus $1,000 deductible $ 99.00 Collision Actual Cash Value minus $1,000 deductible $1114.00 Rental Reimbursement Any OneAny OneCoverage Day No. of Days Period Comprehensive $$$ 50 1,00020 0.00 Collision $$$ 50 1,00020 0.00 Vehicle Number Description of Covered Auto Vehicle ID Number (VIN)Premium Class Code:Original Cost New: $ Garage Location and Territory License Plate: Coverage Premium 2021 FORD F150 $ San Jose, CA 95112 Limit of Insurance Or Deductible Coverage 32 1FTEW1EP7MKE42770 03483 47,000 153 3,095.00 Covered Autos Liability $ $1,000,000 2160.00 Medical Payments Each Insured $ $5,000 9.00 See Item Two $ Uninsured Motorists including Underinsured Motorists 75.00 Comprehensive Actual Cash Value minus $1,000 deductible $ 70.00 Collision Actual Cash Value minus $1,000 deductible $781.00 Rental Reimbursement Any OneAny OneCoverage Day No. of Days Period Comprehensive $$$ 50 1,00020 0.00 Collision $$$ 50 1,00020 0.00 POLICY NUMBER: A0195129001 CA 89 02 10 14 Page 17 of 20 05/13/2024A0195129 Middlesex Insurance Company 00010 0000000000 24134 0 N17 01443144-0564-4b98-ae43-b849ebf6c1c201443144-0564-4b98-ae43-b849ebf6c1c2 Vehicle Number Description of Covered Auto Vehicle ID Number (VIN)Premium Class Code:Original Cost New: $ Garage Location and Territory License Plate: Coverage Premium 2019 FORD TRANSIT CONNECT $ San Jose, CA 95112 Limit of Insurance Or Deductible Coverage 33 NM0LS7E73K1420139 03483 29,777 153 2,512.00 Covered Autos Liability $ $1,000,000 1930.00 Medical Payments Each Insured $ $5,000 9.00 See Item Two $ Uninsured Motorists including Underinsured Motorists 75.00 Comprehensive Actual Cash Value minus $1,000 deductible $ 43.00 Collision Actual Cash Value minus $1,000 deductible $455.00 Rental Reimbursement Any OneAny OneCoverage Day No. of Days Period Comprehensive $$$ 50 1,00020 0.00 Collision $$$ 50 1,00020 0.00 Vehicle Number Description of Covered Auto Vehicle ID Number (VIN)Premium Class Code:Original Cost New: $ Garage Location and Territory License Plate: Coverage Premium 2020 FORD F150 $ San Jose, CA 95112 Limit of Insurance Or Deductible Coverage 34 1FTMF1CBXLKE46961 03483 34,510 153 2,824.00 Covered Autos Liability $ $1,000,000 2060.00 Medical Payments Each Insured $ $5,000 9.00 See Item Two $ Uninsured Motorists including Underinsured Motorists 75.00 Comprehensive Actual Cash Value minus $1,000 deductible $ 54.00 Collision Actual Cash Value minus $1,000 deductible $626.00 Rental Reimbursement Any OneAny OneCoverage Day No. of Days Period Comprehensive $$$ 50 1,00020 0.00 Collision $$$ 50 1,00020 0.00 POLICY NUMBER: A0195129001 Page 18 of 20 CA 89 02 10 14 05/13/2024A0195129 Middlesex Insurance Company Vehicle Number Description of Covered Auto Vehicle ID Number (VIN)Premium Class Code:Original Cost New: $ Garage Location and Territory License Plate: Coverage Premium 2023 FORD F150 $ San Jose, CA 95112 Limit of Insurance Or Deductible Coverage 35 1FTMF1CB1PKE90725 03483 42,800 153 3,085.00 Covered Autos Liability $ $1,000,000 2045.00 Medical Payments Each Insured $ $5,000 9.00 See Item Two $ Uninsured Motorists including Underinsured Motorists 75.00 Comprehensive Actual Cash Value minus $1,000 deductible $ 70.00 Collision Actual Cash Value minus $1,000 deductible $886.00 Rental Reimbursement Any OneAny OneCoverage Day No. of Days Period Comprehensive $$$ 50 1,00020 0.00 Collision $$$ 50 1,00020 0.00 Vehicle Number Description of Covered Auto Vehicle ID Number (VIN)Premium Class Code:Original Cost New: $ Garage Location and Territory License Plate: Coverage Premium 2017 FORD TRANSIT CONNECT $ San Jose, CA 95112 Limit of Insurance Or Deductible Coverage 36 NM0LS7E77H1314589 03483 37,934 153 2,449.00 Covered Autos Liability $ $1,000,000 1895.00 Medical Payments Each Insured $ $5,000 9.00 See Item Two $ Uninsured Motorists including Underinsured Motorists 75.00 Comprehensive Actual Cash Value minus $1,000 deductible $ 47.00 Collision Actual Cash Value minus $1,000 deductible $423.00 Rental Reimbursement Any OneAny OneCoverage Day No. of Days Period Comprehensive $$$ 50 1,00020 0.00 Collision $$$ 50 1,00020 0.00 POLICY NUMBER: A0195129001 CA 89 02 10 14 Page 19 of 20 05/13/2024A0195129 Middlesex Insurance Company 00010 0000000000 24134 0 N19 01443144-0564-4b98-ae43-b849ebf6c1c201443144-0564-4b98-ae43-b849ebf6c1c2 Vehicle Number Description of Covered Auto Vehicle ID Number (VIN)Premium Class Code:Original Cost New: $ Garage Location and Territory License Plate: Coverage Premium 2021 FORD F-150 $ Santa Clara, CA 95050 Limit of Insurance Or Deductible Coverage 37 1FTMF1CB6MKE66352 03483 31,000 153 2,878.00 Covered Autos Liability $ $1,000,000 2042.00 Medical Payments Each Insured $ $5,000 9.00 See Item Two $ Uninsured Motorists including Underinsured Motorists 75.00 Comprehensive Actual Cash Value minus $1,000 deductible $ 61.00 Collision Actual Cash Value minus $1,000 deductible $691.00 Rental Reimbursement Any OneAny OneCoverage Day No. of Days Period Comprehensive $$$ 50 1,00020 0.00 Collision $$$ 50 1,00020 0.00 Loss Payable First Citizens Bank & Trust Company Vehicle Number Description of Covered Auto Vehicle ID Number (VIN)Premium Class Code:Original Cost New: $ Garage Location and Territory License Plate: Coverage Premium 2018 Ford F150 $ Santa Clara, CA 95050 Limit of Insurance Or Deductible Coverage 38 1FTMF1C51JKF62332 03483 44,320 153 2,649.00 Covered Autos Liability $ $1,000,000 1988.00 Medical Payments Each Insured $ $5,000 9.00 See Item Two $ Uninsured Motorists including Underinsured Motorists 75.00 Comprehensive Actual Cash Value minus $1,000 deductible $ 57.00 Collision Actual Cash Value minus $1,000 deductible $520.00 Rental Reimbursement Any OneAny OneCoverage Day No. of Days Period Comprehensive $$$ 50 1,00020 0.00 Collision $$$ 50 1,00020 0.00 POLICY NUMBER: A0195129001 Page 20 of 20 CA 89 02 10 14 05/13/2024A0195129 Middlesex Insurance Company Vehicle Number Description of Covered Auto Vehicle ID Number (VIN)Premium Class Code:Original Cost New: $ Garage Location and Territory License Plate: Coverage Premium 2024 ISUZU FTR $ San Jose, CA 95112 Limit of Insurance Or Deductible Coverage 39 54DK6S1F8RSAA0148 03483 140,842 153 3,788.00 Covered Autos Liability $ $1,000,000 2334.00 Medical Payments Each Insured $ $5,000 9.00 See Item Two $ Uninsured Motorists including Underinsured Motorists 75.00 Comprehensive Actual Cash Value minus $1,000 deductible $ 118.00 Collision Actual Cash Value minus $1,000 deductible $1252.00 Rental Reimbursement Any OneAny OneCoverage Day No. of Days Period Comprehensive $$$ 50 1,00020 0.00 Collision $$$ 50 1,00020 0.00 ADDITIONAL INTEREST SUPPLEMENTAL DECLARATIONS POLICY NUMBER: A0195129001 The following additional interests apply to this policy. Any person or organization you are required to add as an additional insured under a written contract or agreement in effect prior to any accident, injury, loss or damage 908 Bern Ct San Jose, CA 95112 CA 76 01 06 15 Designated Insured - Primary and Noncontributory - Covered Autos Liability Coverage First Citizens Bank & Trust Company PO Box 202137 Florence, SC 29502-2137 Any person or organization from whom you are required to waive your right to recover under a written contract or agreement in effect prior to any loss or damage 2474 De La Cruz Blvd Santa Clara, CA 95050-2923 CA 04 44 10 13 Waiver Of Transfer Of Rights Of Recovery Against Others To Us (Waiver Of Subrogation) Page 1 of 1CA 89 04 10 14 05/13/2024A0195129 Middlesex Insurance Company 00001 0000000000 24134 0 N1 820f04c5-5047-42ec-86bb-eabc1c0c64fc820f04c5-5047-42ec-86bb-eabc1c0c64fc Page 1 of 12CA 00 01 10 13 05/13/2024A0195129 Middlesex Insurance Company Symbol Description Of Covered Auto Designation Symbols 1 2 3 4 5 6 7 8 9 COMMERCIAL AUTO CA 00 01 10 13 BUSINESS AUTO COVERAGE FORM Various provisions in this policy restrict coverage. Read the entire policy carefully to determine rights, duties and what is and is not covered. Throughout this policy the words "you" and "your" refer to the Named Insured shown in the Declarations. The words "we", "us" and "our" refer to the company providing this insurance. Other words and phrases that appear in quotation marks have special meaning. Refer to Section V - Definitions. Section I - Covered Autos Item Two of the Declarations shows the "autos" that are covered "autos" for each of your coverages. The following numerical symbols describe the "autos" that may be covered "autos". The symbols entered next to a coverage on the Declarations designate the only "autos" that are covered "autos". A.Description Of Covered Auto Designation Symbols Any "Auto" Only those "autos" you own (and for Covered Autos Liability Coverage any "trailers" you don't own while attached to power units you own). This includes those "autos" you acquire ownership of after the policy begins. Only those "autos" you own that are not of the private passenger type (and for Covered Autos Liability Coverage any "trailers" you don't own while attached to power units you own). This includes those "autos" not of the private passenger type you acquire ownership of after the policy begins. Only those "autos" you lease, hire, rent or borrow. This does not include any "auto" you lease, hire, rent or borrow from any of your "employees", partners (if you are a partnership), members (if you are a limited liability company) or members of their households. Only those "autos" you own that because of the law in the state where they are licensed or principally garaged are required to have and cannot reject Uninsured Motorists Coverage. This includes those "autos" you acquire ownership of after the policy begins provided they are subject to the same state uninsured motorists requirement. Owned Private Passenger "Autos" Only Owned "Autos" Only Owned "Autos" Subject To No-fault Owned "Autos" Other Than Private Passenger "Autos" Only Owned "Autos" Subject To A Compulsory Uninsured Motorists Law Specifically Described "Autos" Hired "Autos" Only Only the private passenger "autos" you own. This includes those private passenger "autos" you acquire ownership of after the policy begins. Only those "autos" you own that are required to have no-fault benefits in the state where they are licensed or principally garaged. This includes those "autos" you acquire ownership of after the policy begins provided they are required to have no- fault benefits in the state where they are licensed or principally garaged. Only those "autos" described in Item Three of the Declarations for which a premium charge is shown (and for Covered Autos Liability Coverage any "trailers" you don't own while attached to any power units described in Item Three). Non-owned "Autos" Only Only those "autos" you do not own, lease, hire, rent or borrow that are used in connection with your business. This includes "autos" owned by your "employees", partners (if you are a partnership), members (if you are a limited liability company) or members of their households but only while used in your business or your personal affairs. © Insurance Services Office, Inc., 2011 00006 0000000000 24134 0 N1 90738294-592f-4c73-a2d7-1ad730bc6ef390738294-592f-4c73-a2d7-1ad730bc6ef3 19 Mobile Equipment Subject To Compulsory Or Financial Responsibility Or Other Motor Vehicle Insurance Law Only Only those "autos" that are land vehicles and that would qualify under the definition of "mobile equipment" under this policy if they were not subject to a compulsory or financial responsibility law or other motor vehicle insurance law where they are licensed or principally garaged. B.Owned Autos You Acquire After The Policy Begins 1.If Symbols 1, 2, 3, 4, 5, 6 or 19 are entered next to a coverage in Item Two of the Declarations, then you have coverage for "autos" that you acquire of the type described for the remainder of the policy period. 2.But, if Symbol 7 is entered next to a coverage in Item Two of the Declarations, an "auto" you acquire will be a covered "auto" for that coverage only if: a.We already cover all "autos" that you own for that coverage or it replaces an "auto" you previously owned that had that coverage; and b.You tell us within 30 days after you acquire it that you want us to cover it for that coverage. C.Certain Trailers, Mobile Equipment And Temporary Substitute Autos If Covered Autos Liability Coverage is provided by this Coverage Form, the following types of vehicles are also covered "autos" for Covered Autos Liability Coverage: 1."Trailers" with a load capacity of 2,000 pounds or less designed primarily for travel on public roads. 2."Mobile equipment" while being carried or towed by a covered "auto". 3.Any "auto" you do not own while used with the permission of its owner as a temporary substitute for a covered "auto" you own that is out of service because of its: a.Breakdown; b.Repair; c.Servicing; d."Loss"; or e.Destruction. Section II - Covered Autos Liability Coverage A.Coverage We will pay all sums an "insured" legally must pay as damages because of "bodily injury" or "property damage" to which this insurance applies, caused by an "accident" and resulting from the ownership, maintenance or use of a covered "auto". We will also pay all sums an "insured" legally must pay as a "covered pollution cost or expense" to which this insurance applies, caused by an "accident" and resulting from the ownership, maintenance or use of covered "autos". However, we will only pay for the "covered pollution cost or expense" if there is either "bodily injury" or "property damage" to which this insurance applies that is caused by the same "accident". We have the right and duty to defend any "insured" against a "suit" asking for such damages or a "covered pollution cost or expense". However, we have no duty to defend any "insured" against a "suit" seeking damages for "bodily injury" or "property damage" or a "covered pollution cost or expense" to which this insurance does not apply. We may investigate and settle any claim or "suit" as we consider appropriate. Our duty to defend or settle ends when the Covered Autos Liability Coverage Limit of Insurance has been exhausted by payment of judgments or settlements. 1.Who Is An Insured The following are "insureds": a.You for any covered "auto". b.Anyone else while using with your permission a covered "auto" you own, hire or borrow except: (1)The owner or anyone else from whom you hire or borrow a covered "auto". This exception does not apply if the covered "auto" is a "trailer" connected to a covered "auto" you own. © Insurance Services Office, Inc., 2011 CA 00 01 10 13Page 2 of 12 05/13/2024A0195129 Middlesex Insurance Company (2)Your "employee" if the covered "auto" is owned by that "employee" or a member of his or her household. (3)Someone using a covered "auto" while he or she is working in a business of selling, servicing, repairing, parking or storing "autos" unless that business is yours. (4)Anyone other than your "employees", partners (if you are a partnership), members (if you are a limited liability company) or a lessee or borrower or any of their "employees", while moving property to or from a covered "auto". (5)A partner (if you are a partnership) or a member (if you are a limited liability company) for a covered "auto" owned by him or her or a member of his or her household. c.Anyone liable for the conduct of an "insured" described above but only to the extent of that liability. 2.Coverage Extensions a.Supplementary Payments We will pay for the "insured": (1)All expenses we incur. (2)Up to $2,000 for cost of bail bonds (including bonds for related traffic law violations) required because of an "accident" we cover. We do not have to furnish these bonds. (3)The cost of bonds to release attachments in any "suit" against the "insured" we defend, but only for bond amounts within our Limit of Insurance. (4)All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $250 a day because of time off from work. (5)All court costs taxed against the "insured" in any "suit" against the "insured" we defend. However, these payments do not include attorneys' fees or attorneys' expenses taxed against the "insured". (6)All interest on the full amount of any judgment that accrues after entry of the judgment in any "suit" against the "insured" we defend, but our duty to pay interest ends when we have paid, offered to pay or deposited in court the part of the judgment that is within our Limit of Insurance. These payments will not reduce the Limit of Insurance. b.Out-of-state Coverage Extensions While a covered "auto" is away from the state where it is licensed, we will: (1)Increase the Limit of Insurance for Covered Autos Liability Coverage to meet the limits specified by a compulsory or financial responsibility law of the jurisdiction where the covered "auto" is being used. This extension does not apply to the limit or limits specified by any law governing motor carriers of passengers or property. (2)Provide the minimum amounts and types of other coverages, such as no-fault, required of out-of-state vehicles by the jurisdiction where the covered "auto" is being used. We will not pay anyone more than once for the same elements of loss because of these extensions. B.Exclusions This insurance does not apply to any of the following: 1.Expected Or Intended Injury "Bodily injury" or "property damage" expected or intended from the standpoint of the "insured". 2.Contractual Liability assumed under any contract or agreement. But this exclusion does not apply to liability for damages: a.Assumed in a contract or agreement that is an "insured contract", provided the "bodily injury" or "property damage" occurs subsequent to the execution of the contract or agreement; or b.That the "insured" would have in the absence of the contract or agreement. 3.Workers' Compensation Any obligation for which the "insured" or the "insured's" insurer may be held liable under any workers' compensation, disability benefits or unemployment compensation law or any similar law. © Insurance Services Office, Inc., 2011 Page 3 of 12CA 00 01 10 13 05/13/2024A0195129 Middlesex Insurance Company 00006 0000000000 24134 0 N3 90738294-592f-4c73-a2d7-1ad730bc6ef390738294-592f-4c73-a2d7-1ad730bc6ef3 4.Employee Indemnification And Employer's Liability "Bodily injury" to: a.An "employee" of the "insured" arising out of and in the course of: (1)Employment by the "insured"; or (2)Performing the duties related to the conduct of the "insured's" business; or b.The spouse, child, parent, brother or sister of that "employee" as a consequence of Paragraph a. above. This exclusion applies: (1)Whether the "insured" may be liable as an employer or in any other capacity; and (2)To any obligation to share damages with or repay someone else who must pay damages because of the injury. But this exclusion does not apply to "bodily injury" to domestic "employees" not entitled to workers' compensation benefits or to liability assumed by the "insured" under an "insured contract". For the purposes of the Coverage Form, a domestic "employee" is a person engaged in household or domestic work performed principally in connection with a residence premises. 5.Fellow Employee "Bodily injury" to: a.Any fellow "employee" of the "insured" arising out of and in the course of the fellow "employee's" employment or while performing duties related to the conduct of your business; or b.The spouse, child, parent, brother or sister of that fellow "employee" as a consequence of Paragraph a. above. 6.Care, Custody Or Control "Property damage" to or "covered pollution cost or expense" involving property owned or transported by the "insured" or in the "insured's" care, custody or control. But this exclusion does not apply to liability assumed under a sidetrack agreement. 7.Handling Of Property "Bodily injury" or "property damage" resulting from the handling of property: a.Before it is moved from the place where it is accepted by the "insured" for movement into or onto the covered "auto"; or b.After it is moved from the covered "auto" to the place where it is finally delivered by the "insured". 8.Movement Of Property By Mechanical Device "Bodily injury" or "property damage" resulting from the movement of property by a mechanical device (other than a hand truck) unless the device is attached to the covered "auto". 9.Operations "Bodily injury" or "property damage" arising out of the operation of: a.Any equipment listed in Paragraphs 6.b. and 6.c. of the definition of "mobile equipment"; or b.Machinery or equipment that is on, attached to or part of a land vehicle that would qualify under the definition of "mobile equipment" if it were not subject to a compulsory or financial responsibility law or other motor vehicle insurance law where it is licensed or principally garaged. 10.Completed Operations "Bodily injury" or "property damage" arising out of your work after that work has been completed or abandoned. In this exclusion, your work means: a.Work or operations performed by you or on your behalf; and b.Materials, parts or equipment furnished in connection with such work or operations. Your work includes warranties or representations made at any time with respect to the fitness, quality, durability or performance of any of the items included in Paragraph a. or b. above. Your work will be deemed completed at the earliest of the following times: (1)When all of the work called for in your contract has been completed; (2)When all of the work to be done at the site has been completed if your contract calls for work at more than one site; or (3)When that part of the work done at a job site has been put to its intended use by any person or organization other than another contractor or subcontractor working on the same project. © Insurance Services Office, Inc., 2011 CA 00 01 10 13Page 4 of 12 05/13/2024A0195129 Middlesex Insurance Company Work that may need service, maintenance, correction, repair or replacement, but which is otherwise complete, will be treated as completed. 11.Pollution "Bodily injury" or "property damage" arising out of the actual, alleged or threatened discharge, dispersal, seepage, migration, release or escape of "pollutants": a.That are, or that are contained in any property that is: (1)Being transported or towed by, handled or handled for movement into, onto or from the covered "auto"; (2)Otherwise in the course of transit by or on behalf of the "insured"; or (3)Being stored, disposed of, treated or processed in or upon the covered "auto"; b.Before the "pollutants" or any property in which the "pollutants" are contained are moved from the place where they are accepted by the "insured" for movement into or onto the covered "auto"; or c.After the "pollutants" or any property in which the "pollutants" are contained are moved from the covered "auto" to the place where they are finally delivered, disposed of or abandoned by the "insured". Paragraph a. above does not apply to fuels, lubricants, fluids, exhaust gases or other similar "pollutants" that are needed for or result from the normal electrical, hydraulic or mechanical functioning of the covered "auto" or its parts if: (1)The "pollutants" escape, seep, migrate or are discharged, dispersed or released directly from an "auto" part designed by its manufacturer to hold, store, receive or dispose of such "pollutants"; and (2)The "bodily injury", "property damage" or "covered pollution cost or expense" does not arise out of the operation of any equipment listed in Paragraphs 6.b. and 6.c. of the definition of "mobile equipment". Paragraphs b. and c. above of this exclusion do not apply to "accidents" that occur away from premises owned by or rented to an "insured" with respect to "pollutants" not in or upon a covered "auto" if: (a)The "pollutants" or any property in which the "pollutants" are contained are upset, overturned or damaged as a result of the maintenance or use of a covered "auto"; and (b)The discharge, dispersal, seepage, migration, release or escape of the "pollutants" is caused directly by such upset, overturn or damage. 12.War "Bodily injury" or "property damage" arising directly or indirectly out of: a.War, including undeclared or civil war; b.Warlike action by a military force, including action in hindering or defending against an actual or expected attack, by any government, sovereign or other authority using military personnel or other agents; or c.Insurrection, rebellion, revolution, usurped power or action taken by governmental authority in hindering or defending against any of these. 13.Racing Covered "autos" while used in any professional or organized racing or demolition contest or stunting activity, or while practicing for such contest or activity. This insurance also does not apply while that covered "auto" is being prepared for such a contest or activity. C.Limit Of Insurance Regardless of the number of covered "autos", "insureds", premiums paid, claims made or vehicles involved in the "accident", the most we will pay for the total of all damages and "covered pollution cost or expense" combined resulting from any one "accident" is the Limit Of Insurance for Covered Autos Liability Coverage shown in the Declarations. © Insurance Services Office, Inc., 2011 Page 5 of 12CA 00 01 10 13 05/13/2024A0195129 Middlesex Insurance Company 00006 0000000000 24134 0 N5 90738294-592f-4c73-a2d7-1ad730bc6ef390738294-592f-4c73-a2d7-1ad730bc6ef3 All "bodily injury", "property damage" and "covered pollution cost or expense" resulting from continuous or repeated exposure to substantially the same conditions will be considered as resulting from one "accident". No one will be entitled to receive duplicate payments for the same elements of "loss" under this Coverage Form and any Medical Payments Coverage endorsement, Uninsured Motorists Coverage endorsement or Underinsured Motorists Coverage endorsement attached to this Coverage Part. Section III - Physical Damage Coverage A.Coverage 1.We will pay for "loss" to a covered "auto" or its equipment under: a.Comprehensive Coverage From any cause except: (1)The covered "auto's" collision with another object; or (2)The covered "auto's" overturn. b.Specified Causes Of Loss Coverage Caused by: (1)Fire, lightning or explosion; (2)Theft; (3)Windstorm, hail or earthquake; (4)Flood; (5)Mischief or vandalism; or (6)The sinking, burning, collision or derailment of any conveyance transporting the covered "auto". c.Collision Coverage Caused by: (1)The covered "auto's" collision with another object; or (2)The covered "auto's" overturn. 2.Towing We will pay up to the limit shown in the Declarations for towing and labor costs incurred each time a covered "auto" of the private passenger type is disabled. However, the labor must be performed at the place of disablement. 3.Glass Breakage - Hitting A Bird Or Animal - Falling Objects Or Missiles If you carry Comprehensive Coverage for the damaged covered "auto", we will pay for the following under Comprehensive Coverage: a.Glass breakage; b."Loss" caused by hitting a bird or animal; and c."Loss" caused by falling objects or missiles. However, you have the option of having glass breakage caused by a covered "auto's" collision or overturn considered a "loss" under Collision Coverage. 4.Coverage Extensions a.Transportation Expenses We will pay up to $20 per day, to a maximum of $600, for temporary transportation expense incurred by you because of the total theft of a covered "auto" of the private passenger type. We will pay only for those covered "autos" for which you carry either Comprehensive or Specified Causes Of Loss Coverage. We will pay for temporary transportation expenses incurred during the period beginning 48 hours after the theft and ending, regardless of the policy's expiration, when the covered "auto" is returned to use or we pay for its "loss". b.Loss Of Use Expenses For Hired Auto Physical Damage, we will pay expenses for which an "insured" becomes legally responsible to pay for loss of use of a vehicle rented or hired without a driver under a written rental contract or agreement. We will pay for loss of use expenses if caused by: (1)Other than collision only if the Declarations indicates that Comprehensive Coverage is provided for any covered "auto"; (2)Specified Causes Of Loss only if the Declarations indicates that Specified Causes Of Loss Coverage is provided for any covered "auto"; or © Insurance Services Office, Inc., 2011 CA 00 01 10 13Page 6 of 12 05/13/2024A0195129 Middlesex Insurance Company (3)Collision only if the Declarations indicates that Collision Coverage is provided for any covered "auto". However, the most we will pay for any expenses for loss of use is $20 per day, to a maximum of $600. B.Exclusions 1.We will not pay for "loss" caused by or resulting from any of the following. Such "loss" is excluded regardless of any other cause or event that contributes concurrently or in any sequence to the "loss". a.Nuclear Hazard (1)The explosion of any weapon employing atomic fission or fusion; or (2)Nuclear reaction or radiation, or radioactive contamination, however caused. b.War Or Military Action (1)War, including undeclared or civil war; (2)Warlike action by a military force, including action in hindering or defending against an actual or expected attack, by any government, sovereign or other authority using military personnel or other agents; or (3)Insurrection, rebellion, revolution, usurped power or action taken by governmental authority in hindering or defending against any of these. 2.We will not pay for "loss" to any covered "auto" while used in any professional or organized racing or demolition contest or stunting activity, or while practicing for such contest or activity. We will also not pay for "loss" to any covered "auto" while that covered "auto" is being prepared for such a contest or activity. 3.We will not pay for "loss" due and confined to: a.Wear and tear, freezing, mechanical or electrical breakdown. b.Blowouts, punctures or other road damage to tires. This exclusion does not apply to such "loss" resulting from the total theft of a covered "auto". 4.We will not pay for "loss" to any of the following: a.Tapes, records, discs or other similar audio, visual or data electronic devices designed for use with audio, visual or data electronic equipment. b.Any device designed or used to detect speed-measuring equipment, such as radar or laser detectors, and any jamming apparatus intended to elude or disrupt speed-measuring equipment. c.Any electronic equipment, without regard to whether this equipment is permanently installed, that reproduces, receives or transmits audio, visual or data signals. d.Any accessories used with the electronic equipment described in Paragraph c. above. 5.Exclusions 4.c. and 4.d. do not apply to equipment designed to be operated solely by use of the power from the "auto's" electrical system that, at the time of "loss", is: a.Permanently installed in or upon the covered "auto"; b.Removable from a housing unit which is permanently installed in or upon the covered "auto"; c.An integral part of the same unit housing any electronic equipment described in Paragraphs a. and b. above; or d.Necessary for the normal operation of the covered "auto" or the monitoring of the covered "auto's" operating system. 6.We will not pay for "loss" to a covered "auto" due to "diminution in value". C.Limits Of Insurance 1.The most we will pay for: a."Loss" to any one covered "auto" is the lesser of: (1)The actual cash value of the damaged or stolen property as of the time of the "loss"; or (2)The cost of repairing or replacing the damaged or stolen property with other property of like kind and quality. b.All electronic equipment that reproduces, receives or transmits audio, visual or data signals in any one "loss" is $1,000, if, at the time of "loss", such electronic equipment is: (1)Permanently installed in or upon the covered "auto" in a housing, opening or other location that is not normally used by the "auto" manufacturer for the installation of such equipment; © Insurance Services Office, Inc., 2011 Page 7 of 12CA 00 01 10 13 05/13/2024A0195129 Middlesex Insurance Company 00006 0000000000 24134 0 N7 90738294-592f-4c73-a2d7-1ad730bc6ef390738294-592f-4c73-a2d7-1ad730bc6ef3 (2)Removable from a permanently installed housing unit as described in Paragraph b.(1) above; or (3)An integral part of such equipment as described in Paragraphs b.(1) and b.(2) above. 2.An adjustment for depreciation and physical condition will be made in determining actual cash value in the event of a total "loss". 3.If a repair or replacement results in better than like kind or quality, we will not pay for the amount of the betterment. D.Deductible For each covered "auto", our obligation to pay for, repair, return or replace damaged or stolen property will be reduced by the applicable deductible shown in the Declarations. Any Comprehensive Coverage Deductible shown in the Declarations does not apply to "loss" caused by fire or lightning. Section IV - Business Auto Conditions The following conditions apply in addition to the Common Policy Conditions: A.Loss Conditions 1.Appraisal For Physical Damage Loss If you and we disagree on the amount of "loss", either may demand an appraisal of the "loss". In this event, each party will select a competent appraiser. The two appraisers will select a competent and impartial umpire. The appraisers will state separately the actual cash value and amount of "loss". If they fail to agree, they will submit their differences to the umpire. A decision agreed to by any two will be binding. Each party will: a.Pay its chosen appraiser; and b.Bear the other expenses of the appraisal and umpire equally. If we submit to an appraisal, we will still retain our right to deny the claim. 2.Duties In The Event Of Accident, Claim, Suit Or Loss We have no duty to provide coverage under this policy unless there has been full compliance with the following duties: a.In the event of "accident", claim, "suit" or "loss", you must give us or our authorized representative prompt notice of the "accident" or "loss". Include: (1)How, when and where the "accident" or "loss" occurred; (2)The "insured's" name and address; and (3)To the extent possible, the names and addresses of any injured persons and witnesses. b.Additionally, you and any other involved "insured" must: (1)Assume no obligation, make no payment or incur no expense without our consent, except at the "insured's" own cost. (2)Immediately send us copies of any request, demand, order, notice, summons or legal paper received concerning the claim or "suit". (3)Cooperate with us in the investigation or settlement of the claim or defense against the "suit". (4)Authorize us to obtain medical records or other pertinent information. (5)Submit to examination, at our expense, by physicians of our choice, as often as we reasonably require. c.If there is "loss" to a covered "auto" or its equipment, you must also do the following: (1)Promptly notify the police if the covered "auto" or any of its equipment is stolen. (2)Take all reasonable steps to protect the covered "auto" from further damage. Also keep a record of your expenses for consideration in the settlement of the claim. (3)Permit us to inspect the covered "auto" and records proving the "loss" before its repair or disposition. (4)Agree to examinations under oath at our request and give us a signed statement of your answers. 3.Legal Action Against Us No one may bring a legal action against us under this Coverage Form until: a.There has been full compliance with all the terms of this Coverage Form; and b.Under Covered Autos Liability Coverage, we agree in writing that the "insured" has an obligation to pay or until the amount of that obligation has finally been determined by judgment after trial. No one has the right under this policy to bring us into an action to determine the "insured's" liability. © Insurance Services Office, Inc., 2011 CA 00 01 10 13Page 8 of 12 05/13/2024A0195129 Middlesex Insurance Company 4.Loss Payment - Physical Damage Coverages At our option, we may: a.Pay for, repair or replace damaged or stolen property; b.Return the stolen property, at our expense. We will pay for any damage that results to the "auto" from the theft; or c.Take all or any part of the damaged or stolen property at an agreed or appraised value. If we pay for the "loss", our payment will include the applicable sales tax for the damaged or stolen property. 5.Transfer Of Rights Of Recovery Against Others To Us If any person or organization to or for whom we make payment under this Coverage Form has rights to recover damages from another, those rights are transferred to us. That person or organization must do everything necessary to secure our rights and must do nothing after "accident" or "loss" to impair them. B.General Conditions 1.Bankruptcy Bankruptcy or insolvency of the "insured" or the "insured's" estate will not relieve us of any obligations under this Coverage Form. 2.Concealment, Misrepresentation Or Fraud This Coverage Form is void in any case of fraud by you at any time as it relates to this Coverage Form. It is also void if you or any other "insured", at any time, intentionally conceals or misrepresents a material fact concerning: a.This Coverage Form; b.The covered "auto"; c.Your interest in the covered "auto"; or d.A claim under this Coverage Form. 3.Liberalization If we revise this Coverage Form to provide more coverage without additional premium charge, your policy will automatically provide the additional coverage as of the day the revision is effective in your state. 4.No Benefit To Bailee - Physical Damage Coverages We will not recognize any assignment or grant any coverage for the benefit of any person or organization holding, storing or transporting property for a fee regardless of any other provision of this Coverage Form. 5.Other Insurance a.For any covered "auto" you own, this Coverage Form provides primary insurance. For any covered "auto" you don't own, the insurance provided by this Coverage Form is excess over any other collectible insurance. However, while a covered "auto" which is a "trailer" is connected to another vehicle, the Covered Autos Liability Coverage this Coverage Form provides for the "trailer" is: (1)Excess while it is connected to a motor vehicle you do not own; or (2)Primary while it is connected to a covered "auto" you own. b.For Hired Auto Physical Damage Coverage, any covered "auto" you lease, hire, rent or borrow is deemed to be a covered "auto" you own. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". c.Regardless of the provisions of Paragraph a. above, this Coverage Form's Covered Autos Liability Coverage is primary for any liability assumed under an "insured contract". d.When this Coverage Form and any other Coverage Form or policy covers on the same basis, either excess or primary, we will pay only our share. Our share is the proportion that the Limit of Insurance of our Coverage Form bears to the total of the limits of all the Coverage Forms and policies covering on the same basis. 6.Premium Audit a.The estimated premium for this Coverage Form is based on the exposures you told us you would have when this policy began. We will compute the final premium due when we determine your actual exposures. The estimated total premium will be credited against the final premium due and the first Named Insured will be billed for the balance, if any. The due date for the final premium or retrospective premium is the date shown as the due date on the bill. If the estimated total premium exceeds the final premium due, the first Named Insured will get a refund. b.If this policy is issued for more than one year, the premium for this Coverage Form will be computed annually based on our rates or premiums in effect at the beginning of each year of the policy. © Insurance Services Office, Inc., 2011 Page 9 of 12CA 00 01 10 13 05/13/2024A0195129 Middlesex Insurance Company 00006 0000000000 24134 0 N9 90738294-592f-4c73-a2d7-1ad730bc6ef390738294-592f-4c73-a2d7-1ad730bc6ef3 CA 00 01 10 13Page 10 of 12 05/13/2024A0195129 Middlesex Insurance Company 7.Policy Period, Coverage Territory Under this Coverage Form, we cover "accidents" and "losses" occurring: a.During the policy period shown in the Declarations; and b.Within the coverage territory. The coverage territory is: (1)The United States of America; (2)The territories and possessions of the United States of America; (3)Puerto Rico; (4)Canada; and (5)Anywhere in the world if a covered "auto" of the private passenger type is leased, hired, rented or borrowed without a driver for a period of 30 days or less, provided that the "insured's" responsibility to pay damages is determined in a "suit" on the merits, in the United States of America, the territories and possessions of the United States of America, Puerto Rico or Canada, or in a settlement we agree to. We also cover "loss" to, or "accidents" involving, a covered "auto" while being transported between any of these places. 8.Two Or More Coverage Forms Or Policies Issued By Us If this Coverage Form and any other Coverage Form or policy issued to you by us or any company affiliated with us applies to the same "accident", the aggregate maximum Limit of Insurance under all the Coverage Forms or policies shall not exceed the highest applicable Limit of Insurance under any one Coverage Form or policy. This condition does not apply to any Coverage Form or policy issued by us or an affiliated company specifically to apply as excess insurance over this Coverage Form. Section V - Definitions A."Accident" includes continuous or repeated exposure to the same conditions resulting in "bodily injury" or "property damage". B."Auto" means: 1.A land motor vehicle, "trailer" or semitrailer designed for travel on public roads; or 2.Any other land vehicle that is subject to a compulsory or financial responsibility law or other motor vehicle insurance law where it is licensed or principally garaged. However, "auto" does not include "mobile equipment". C."Bodily injury" means bodily injury, sickness or disease sustained by a person, including death resulting from any of these. D."Covered pollution cost or expense" means any cost or expense arising out of: 1.Any request, demand, order or statutory or regulatory requirement that any "insured" or others test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of, "pollutants"; or 2.Any claim or "suit" by or on behalf of a governmental authority for damages because of testing for, monitoring, cleaning up, removing, containing, treating, detoxifying or neutralizing, or in any way responding to, or assessing the effects of, "pollutants". "Covered pollution cost or expense" does not include any cost or expense arising out of the actual, alleged or threatened discharge, dispersal, seepage, migration, release or escape of "pollutants": a.That are, or that are contained in any property that is: (1)Being transported or towed by, handled or handled for movement into, onto or from the covered "auto"; (2)Otherwise in the course of transit by or on behalf of the "insured"; or (3)Being stored, disposed of, treated or processed in or upon the covered "auto"; b.Before the "pollutants" or any property in which the "pollutants" are contained are moved from the place where they are accepted by the "insured" for movement into or onto the covered "auto"; or c.After the "pollutants" or any property in which the "pollutants" are contained are moved from the covered "auto" to the place where they are finally delivered, disposed of or abandoned by the "insured". © Insurance Services Office, Inc., 2011 Paragraph a. above does not apply to fuels, lubricants, fluids, exhaust gases or other similar "pollutants" that are needed for or result from the normal electrical, hydraulic or mechanical functioning of the covered "auto" or its parts, if: (1)The "pollutants" escape, seep, migrate or are discharged, dispersed or released directly from an "auto" part designed by its manufacturer to hold, store, receive or dispose of such "pollutants"; and (2)The "bodily injury", "property damage" or "covered pollution cost or expense" does not arise out of the operation of any equipment listed in Paragraph 6.b. or 6.c. of the definition of "mobile equipment". Paragraphs b. and c. above do not apply to "accidents" that occur away from premises owned by or rented to an "insured" with respect to "pollutants" not in or upon a covered "auto" if: (a)The "pollutants" or any property in which the "pollutants" are contained are upset, overturned or damaged as a result of the maintenance or use of a covered "auto"; and (b)The discharge, dispersal, seepage, migration, release or escape of the "pollutants" is caused directly by such upset, overturn or damage. E."Diminution in value" means the actual or perceived loss in market value or resale value which results from a direct and accidental "loss". F."Employee" includes a "leased worker". "Employee" does not include a "temporary worker". G."Insured" means any person or organization qualifying as an insured in the Who Is An Insured provision of the applicable coverage. Except with respect to the Limit of Insurance, the coverage afforded applies separately to each insured who is seeking coverage or against whom a claim or "suit" is brought. H."Insured contract" means: 1.A lease of premises; 2.A sidetrack agreement; 3.Any easement or license agreement, except in connection with construction or demolition operations on or within 50 feet of a railroad; 4.An obligation, as required by ordinance, to indemnify a municipality, except in connection with work for a municipality; 5.That part of any other contract or agreement pertaining to your business (including an indemnification of a municipality in connection with work performed for a municipality) under which you assume the tort liability of another to pay for "bodily injury" or "property damage" to a third party or organization. Tort Liability means a liability that would be imposed by law in the absence of any contract or agreement; or 6.That part of any contract or agreement entered into, as part of your business, pertaining to the rental or lease, by you or any of your "employees", of any "auto". However, such contract or agreement shall not be considered an "insured contract" to the extent that it obligates you or any of your "employees" to pay for "property damage" to any "auto" rented or leased by you or any of your "employees". An "insured contract" does not include that part of any contract or agreement: a.That indemnifies a railroad for "bodily injury" or "property damage" arising out of construction or demolition operations, within 50 feet of any railroad property and affecting any railroad bridge or trestle, tracks, roadbeds, tunnel, underpass or crossing; b.That pertains to the loan, lease or rental of an "auto" to you or any of your "employees", if the "auto" is loaned, leased or rented with a driver; or c.That holds a person or organization engaged in the business of transporting property by "auto" for hire harmless for your use of a covered "auto" over a route or territory that person or organization is authorized to serve by public authority. I."Leased worker" means a person leased to you by a labor leasing firm under an agreement between you and the labor leasing firm to perform duties related to the conduct of your business. "Leased worker" does not include a "temporary worker". J."Loss" means direct and accidental loss or damage. K."Mobile equipment" means any of the following types of land vehicles, including any attached machinery or equipment: 1.Bulldozers, farm machinery, forklifts and other vehicles designed for use principally off public roads; 2.Vehicles maintained for use solely on or next to premises you own or rent; 3.Vehicles that travel on crawler treads; © Insurance Services Office, Inc., 2011 Page 11 of 12CA 00 01 10 13 05/13/2024A0195129 Middlesex Insurance Company 00006 0000000000 24134 0 N11 90738294-592f-4c73-a2d7-1ad730bc6ef390738294-592f-4c73-a2d7-1ad730bc6ef3 CA 00 01 10 13Page 12 of 12 05/13/2024A0195129 Middlesex Insurance Company 4.Vehicles, whether self-propelled or not, maintained primarily to provide mobility to permanently mounted: a.Power cranes, shovels, loaders, diggers or drills; or b.Road construction or resurfacing equipment such as graders, scrapers or rollers; 5.Vehicles not described in Paragraph 1., 2., 3. or 4. above that are not self-propelled and are maintained primarily to provide mobility to permanently attached equipment of the following types: a.Air compressors, pumps and generators, including spraying, welding, building cleaning, geophysical exploration, lighting and well-servicing equipment; or b.Cherry pickers and similar devices used to raise or lower workers; or 6.Vehicles not described in Paragraph 1., 2., 3. or 4. above maintained primarily for purposes other than the transportation of persons or cargo. However, self-propelled vehicles with the following types of permanently attached equipment are not "mobile equipment" but will be considered "autos": a.Equipment designed primarily for: (1)Snow removal; (2)Road maintenance, but not construction or resurfacing; or (3)Street cleaning; b.Cherry pickers and similar devices mounted on automobile or truck chassis and used to raise or lower workers; and c.Air compressors, pumps and generators, including spraying, welding, building cleaning, geophysical exploration, lighting or well-servicing equipment. However, "mobile equipment" does not include land vehicles that are subject to a compulsory or financial responsibility law or other motor vehicle insurance law where it is licensed or principally garaged. Land vehicles subject to a compulsory or financial responsibility law or other motor vehicle insurance law are considered "autos". L."Pollutants" means any solid, liquid, gaseous or thermal irritant or contaminant, including smoke, vapor, soot, fumes, acids, alkalis, chemicals and waste. Waste includes materials to be recycled, reconditioned or reclaimed. M."Property damage" means damage to or loss of use of tangible property. N."Suit" means a civil proceeding in which: 1.Damages because of "bodily injury" or "property damage"; or 2.A "covered pollution cost or expense"; to which this insurance applies, are alleged. "Suit" includes: a.An arbitration proceeding in which such damages or "covered pollution costs or expenses" are claimed and to which the "insured" must submit or does submit with our consent; or b.Any other alternative dispute resolution proceeding in which such damages or "covered pollution costs or expenses" are claimed and to which the insured submits with our consent. O."Temporary worker" means a person who is furnished to you to substitute for a permanent "employee" on leave or to meet seasonal or short-term workload conditions. P."Trailer" includes semitrailer. © Insurance Services Office, Inc., 2011 A0195129 Middlesex Insurance Company 05/13/2024 39a90c93-3462-418b-962f-47186dc6e960 Page 1 of 1CA 01 21 10 13 POLICY NUMBER:COMMERCIAL AUTO CA 01 21 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. LIMITED MEXICO COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. WARNING AUTO ACCIDENTS IN MEXICO ARE SUBJECT TO THE LAWS OF MEXICO ONLY - NOT THE LAWS OF THE UNITED STATES OF AMERICA. THE REPUBLIC OF MEXICO CONSIDERS ANY AUTO ACCIDENT A CRIMINAL OFFENSE AS WELL AS A CIVIL MATTER. IN SOME CASES THE COVERAGE PROVIDED UNDER THIS ENDORSEMENT MAY NOT BE RECOGNIZED BY THE MEXICAN AUTHORITIES AND WE MAY NOT BE ALLOWED TO IMPLEMENT THIS COVERAGE AT ALL IN MEXICO. YOU SHOULD CONSIDER PURCHASING AUTO COVERAGE FROM A LICENSED MEXICAN INSURANCE COMPANY BEFORE DRIVING INTO MEXICO. THIS ENDORSEMENT DOES NOT APPLY TO ACCIDENTS OR LOSSES WHICH OCCUR OUTSIDE OF 25 MILES FROM THE BOUNDARY OF THE UNITED STATES OF AMERICA. SCHEDULE Mexico Coverage $Premium Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A.Coverage 1.Paragraph 7. Policy Period, Coverage Territory of the General Conditions is amended by the addition of the following: The coverage territory is extended to include Mexico but only for: a."Accidents" or "losses" occurring within 25 miles of the United States border; and b.Trips into Mexico of 10 days or less. 2.The Other Insurance Condition in the Business Auto and Auto Dealers Coverage Forms and the Other Insurance - Primary And Excess Insurance Provisions Condition in the Motor Carrier Coverage Form are replaced by the following: The insurance provided by this endorsement will be excess over any other collectible insurance. B.Physical Damage Coverage is amended by the addition of the following: If a "loss" to a covered "auto" occurs in Mexico, we will pay for such "loss" in the United States. If the covered "auto" must be repaired in Mexico in order to be driven, we will not pay more than the actual cash value of such "loss" at the nearest United States point where the repairs can be made. C.Additional Exclusions For the purposes of this endorsement, the following additional exclusions are added: This insurance does not apply: 1.If the covered "auto" is not principally garaged and principally used in the United States. 2.To any "insured" who is not a resident of the United States. © Insurance Services Office, Inc., 2011 COMMERCIAL AUTO CA 01 43 05 17 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALIFORNIA CHANGES © Insurance Services Office, Inc., 2016 For a covered "auto" licensed or principally garaged in, or "auto dealer operations" conducted in, California, this endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. A.The following are added to the Other Insurance Condition in the Auto Dealers and Business Auto Coverage Forms and the Other Insurance - Primary And Excess Insurance Provisions Condition in the Motor Carrier Coverage Form and supersede any provisions to the contrary: 1.When this Coverage Form and any other Coverage Form or policy providing liability coverage apply to an "auto" and: a.One provides coverage to a Named Insured engaged in the business of selling, repairing, servicing, delivering, testing or road-testing "autos"; and b.The other provides coverage to a person not engaged in that business; and c.At the time of an "accident", a person described in Paragraph 1.b. is operating an "auto" owned by the business described in Paragraph 1.a., then that person's liability coverage is primary and the Coverage Form issued to a business described in Paragraph 1.a. is excess over any coverage available to that person. 2.When this Coverage Form and any other Coverage Form or policy providing liability coverage apply to an "auto" and: a.One provides coverage to a Named Insured engaged in the business of selling, repairing, servicing, delivering, testing or road-testing "autos"; and b.The other provides coverage to a person not engaged in that business; and c.At the time of an "accident", an "insured" under the Coverage Form described in Paragraph 2.a. is operating an "auto" owned by a person described in Paragraph 2.b., then the Coverage Form issued to the business described in Paragraph 2.a. is primary and the liability coverage issued to a person described in Paragraph 2.b. is excess over any coverage available to the business. 3.When this Coverage Form and any other Coverage Form or policy providing liability coverage apply to a "commercial vehicle" and: a.One provides coverage to a Named Insured, who in the course of business, rents or leases "commercial vehicles" without operators; and b.The other provides coverage to a person other than as described in Paragraph 3.a.; and c.At the time of an "accident", a person who is not the Named Insured of the Policy described in Paragraph 3.a., and who is not the agent or "employee" of such Named Insured, is operating a "commercial vehicle" provided by the business covered by the Coverage Form or policy described in Paragraph 3.a., then the liability coverage provided by the Coverage Form or policy described in Paragraph 3.b. is primary, and the liability coverage provided by the Coverage Form or policy described in Paragraph 3.a. is excess over any coverage available to that person. Page 1 of 2CA 01 43 05 17 05/13/2024A0195129 Middlesex Insurance Company 00001 0000000000 24134 0 N1 44a99ece-d6ed-4bb8-b1fc-6448f55d04df44a99ece-d6ed-4bb8-b1fc-6448f55d04df © Insurance Services Office, Inc., 2016 4.Notwithstanding Paragraph A.3., when this Coverage Form and any other Coverage Form or policy providing liability coverage apply to a power unit and any connected "trailer" or "trailers" and: a.One provides coverage to a Named Insured engaged in the business of transporting property by "auto" for hire; and b.The other provides coverage to a Named Insured not engaged in that business; and c.At the time of an "accident", a power unit is being operated by a person insured under the Coverage Form or policy described in Paragraph 4.a., then that Coverage Form or policy is primary for both the power unit and any connected "trailer" or "trailers" and the Coverage Form or policy described in Paragraph 4.b. is excess over any other coverage available to such power unit and attached "trailer" or "trailers". B.As used in this endorsement: "Commercial vehicle" means an "auto" subject to registration or identification under California law which is: 1.Used or maintained for the transportation of persons for hire, compensation or profit; 2.Designed, used or maintained primarily for the transportation of property; or 3.Leased for a period of six months or more. CA 01 43 05 17Page 2 of 2 05/13/2024A0195129 Middlesex Insurance Company A0195129 Middlesex Insurance Company 05/13/2024 cf4f6da2-3a85-422c-b3e8-0cfc0b4ace42 Page 1 of 3CA 03 05 10 13 POLICY NUMBER: SCHEDULE Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Waiver Of Collision Deductible Premium $ $ $ COMMERCIAL AUTO CA 03 05 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALIFORNIA CHANGES - WAIVER OF COLLISION DEDUCTIBLE Named Insured: Endorsement Effective Date: © Insurance Services Office, Inc., 2012 For a covered "auto" licensed or principally garaged in, or "auto dealer operations" conducted in, California, this endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. Designation Or Description Of Covered "Auto" A0195129 Middlesex Insurance Company 05/13/2024 cf4f6da2-3a85-422c-b3e8-0cfc0b4ace42 A.When Physical Damage Coverage provides coverage for a "loss" to a covered "auto" caused by its collision or upset, and: 1.The "loss" involves an "uninsured motor vehicle"; and 2.You are legally entitled to recover the full amount of your "loss" from the owner or operator of the "uninsured motor vehicle"; and 3.The Schedule indicates that the Waiver Of Collision Deductible provision applies to the covered "auto"; then we will pay the full deductible. Subject to the above, if you are legally entitled to recover only a percentage of your "loss", we will pay that percentage of your deductible. However, if the amount of the "loss" is less than your deductible, we will pay the percentage of the "loss" that you are legally entitled to recover. In no event will we pay more than the amount of the "loss". B.Conditions 1.The following is added to the Conditions section: Arbitration a.If we and an "insured" disagree whether the "insured" is legally entitled to recover damages from the owner or operator of an "uninsured motor vehicle" or do not agree as to the amount of damages that are recoverable by that "insured", the disagreement will be settled by a single neutral arbitrator. However, disputes concerning coverage under this endorsement may not be arbitrated. The arbitration must be formally instituted by the "insured" within one year from the date of the "accident". Each party will bear the expenses of the arbitrator equally. b.Unless both parties agree otherwise, arbitration will take place in the county in which the "insured" lives. Local rules of law as to arbitration procedure and evidence will apply. The decision of the arbitrator will be binding. 2.Paragraph 2.a. of the Duties In The Event Of Accident, Claim, Suit Or Loss Condition in the Business Auto and Motor Carrier Coverage Forms and Paragraph 2.a. of the Duties In The Event Of Accident, Claim, Offense, Suit, Loss Or Acts, Errors Or Omissions Condition in the Auto Dealers Coverage Form are replaced by the following: a.You must report the "accident" or "loss" to us or our agent within 10 business days. You must tell us how, when and where the "loss" happened. You must assist in obtaining names and addresses of any injured persons and witnesses. C.Additional Definitions As used in this endorsement: 1.For Physical Damage Coverage: a."Auto" means a self-propelled motor vehicle. However, it does not include: (1)A vehicle transporting persons for hire, compensation or profit, other than a van pool vehicle; (2)A vehicle designed, used or maintained primarily for the transportation of property; or (3)"Mobile equipment". b."Uninsured motor vehicle" means a land motor vehicle or trailer which is involved in a collision with a covered "auto" and for which: (1)No liability bond or policy at the time of an "accident" provides at least the amount required for property damage liability by the California Financial Responsibility Law; or (2)The insuring or bonding company denies coverage or refuses to admit coverage except conditionally or with reservation or becomes insolvent. © Insurance Services Office, Inc., 2012 CA 03 05 10 13Page 2 of 3 A0195129 Middlesex Insurance Company 05/13/2024 cf4f6da2-3a85-422c-b3e8-0cfc0b4ace42 The collision must involve direct physical contact between a covered "auto" and the "uninsured motor vehicle" and: (1)The owner or operator of that vehicle must be identified; or (2)The "uninsured motor vehicle" must be identified by its license number. However, "uninsured motor vehicle" does not include any vehicle: (1)Owned or operated by a self-insurer under any applicable motor vehicle law except a self-insurer who is or becomes insolvent and cannot provide the amounts required by that motor vehicle law; (2)Owned by a governmental unit or agency; or (3)Designed for use mainly off public roads while not on public roads. © Insurance Services Office, Inc., 2012 Page 3 of 3CA 03 05 10 13 COMMERCIAL AUTO CA 04 24 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALIFORNIA AUTO MEDICAL PAYMENTS COVERAGE © Insurance Services Office, Inc., 2012 This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. A.Coverage We will pay reasonable expenses incurred for necessary medical and funeral services to or for an "insured" who sustains "bodily injury" caused by "accident". We will pay only those expenses incurred, for services rendered within three years from the date of the "accident". B.Who Is An Insured 1.You while "occupying" or, while a pedestrian, when struck by any "auto". 2.If you are an individual, any "family member" while "occupying" or, while a pedestrian, when struck by any "auto". 3.Anyone else "occupying" a covered "auto" or a temporary substitute for a covered "auto". The covered "auto" must be out of service because of its breakdown, repair, servicing, loss or destruction. C.Exclusions This insurance does not apply to any of the following: 1."Bodily injury" sustained by an "insured" while "occupying" a vehicle located for use as a premises. 2."Bodily injury" sustained by you or any "family member" while "occupying" or struck by any vehicle (other than a covered "auto") owned by you or furnished or available for your regular use. 3."Bodily injury" sustained by any "family member" while "occupying" or struck by any vehicle (other than a covered "auto") owned by or furnished or available for the regular use of any "family member". 4."Bodily injury" to your "employee" arising out of and in the course of employment by you. However, we will cover "bodily injury" to your domestic "employees" if not entitled to workers' compensation benefits. For the purposes of this endorsement, a domestic "employee" is a person engaged in household or domestic work performed principally in connection with a residence premises. 5."Bodily injury" to an "insured" while working in a business of selling, servicing, repairing or parking "autos" unless that business is yours. 6."Bodily injury" arising directly or indirectly out of: a.War, including undeclared or civil war; b.Warlike action by a military force, including action in hindering or defending against an actual or expected attack, by any government, sovereign or other authority using military personnel or other agents; or c.Insurrection, rebellion, revolution, usurped power, or action taken by governmental authority in hindering or defending against any of these. Page 1 of 2CA 04 24 10 13 05/13/2024A0195129 Middlesex Insurance Company 00001 0000000000 24134 0 N1 90c0dc90-7f00-4d07-b1d3-de321c13ea8f90c0dc90-7f00-4d07-b1d3-de321c13ea8f © Insurance Services Office, Inc., 2012 7."Bodily injury" to anyone using a vehicle without a reasonable belief that the person is entitled to do so. 8."Bodily injury" sustained by an "insured" while "occupying" any covered "auto" while used in any professional racing or demolition contest or stunting activity, or while practicing for such contest or activity. This insurance also does not apply to any "bodily injury" sustained by an "insured" while the "auto" is being prepared for such a contest or activity. D.Limit Of Insurance Regardless of the number of covered "autos", "insureds", premiums paid, claims made or vehicles involved in the "accident", the most we will pay for "bodily injury" for each "insured" injured in any one "accident" is the Limit Of Insurance for Auto Medical Payments Coverage shown in the Declarations. No one will be entitled to receive duplicate payments for the same elements of "loss" under this coverage and any Liability Coverage form, Uninsured Motorists Coverage endorsement or Underinsured Motorists Coverage endorsement attached to this Coverage Part. E.Changes In Conditions The Conditions are changed for Auto Medical Payments Coverage as follows: 1.The Transfer Of Rights Of Recovery Against Others To Us Condition does not apply. 2.The reference in Other Insurance in the Auto Dealers and Business Auto Coverage Forms and Other Insurance - Primary And Excess Insurance Provisions in the Motor Carrier Coverage Form to "other collectible insurance" applies only to other collectible auto medical payments insurance. F.Additional Definitions As used in this endorsement: 1."Family member" means a person related to you by blood, adoption, marriage or registered domestic partnership under California law, who is a resident of your household, including a ward or foster child. 2."Occupying" means in, upon, getting in, on, out or off. CA 04 24 10 13Page 2 of 2 05/13/2024A0195129 Middlesex Insurance Company Named Insured: Endorsement Effective Date: Name(s) Of Person(s) Or Organization(s): POLICY NUMBER: COMMERCIAL AUTO CA 04 44 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. SCHEDULE Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization. © Insurance Services Office, Inc., 2011 Page 1 of 1CA 04 44 10 13 05/13/2024A0195129 Middlesex Insurance Company 00001 0000000000 24134 0 N1 23ce187a-b3e7-48fe-896d-e72920952ab023ce187a-b3e7-48fe-896d-e72920952ab0 POLICY NUMBER: SCHEDULE COMMERCIAL AUTO CA 21 54 11 16 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALIFORNIA UNINSURED MOTORISTS COVERAGE - BODILY INJURY For a covered "auto" licensed or principally garaged in, or "auto dealer operations" conducted in, California, this endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the Policy effective on the inception date of the Policy unless another date is indicated below. Named Insured: Endorsement Effective Date: Limit Of Insurance:$Each "Accident" Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A.Coverage 1.We will pay all sums the "insured" is legally entitled to recover as compensatory damages from the owner or driver of an "uninsured motor vehicle". The damages must result from "bodily injury" sustained by the "insured" caused by an "accident". The owner's or driver's liability for these damages must result from the ownership, maintenance or use of the "uninsured motor vehicle". 2.We will pay only after the limits of liability under any liability bonds or policies have been exhausted by payment of judgments or settlements. 3.Any judgment for damages arising out of a "suit" brought without our written consent is not binding on us. B.Who Is An Insured If the Named Insured is designated in the Declarations as: 1.An individual, then the following are "insureds": a.The Named Insured and any "family members". b.Anyone else "occupying" a covered "auto" or a temporary substitute for a covered "auto". The covered "auto" must be out of service because of its breakdown, repair, servicing, "loss" or destruction. c.Anyone for damages he or she is entitled to recover because of "bodily injury" sustained by another "insured". © Insurance Services Office, Inc., 2016 A0195129001 Page 1 of 5CA 21 54 11 16 05/13/2024A0195129 Middlesex Insurance Company 00003 0000000000 24134 0 N1 c3946ca2-29fd-4a88-b4e9-a3d5f6b78c92c3946ca2-29fd-4a88-b4e9-a3d5f6b78c92 2.A partnership, limited liability company, corporation or any other form of organization, then the following are "insureds": a.Anyone "occupying" a covered "auto" or a temporary substitute for a covered "auto". The covered "auto" must be out of service because of its breakdown, repair, servicing, "loss" or destruction. b.Anyone for damages he or she is entitled to recover because of "bodily injury" sustained by another "insured". C.Exclusions This insurance does not apply to any of the following: 1.Punitive or exemplary damages. 2.Any claim settled without our consent. However, this exclusion does not apply to a settlement made with the insurer of a vehicle described in Paragraph b. of the definition of "uninsured motor vehicle". 3.The direct or indirect benefit of any insurer or self-insurer under any workers' compensation, disability benefits or similar law or to the direct benefit of the United States, a state or its political subdivisions. 4."Bodily injury" sustained by: a.An individual Named Insured while "occupying" or when struck by any vehicle owned by that Named Insured that is not a covered "auto" for Uninsured Motorists Coverage under this Coverage Form; b.Any "family member" while "occupying" or when struck by any vehicle owned by that "family member" that is not a covered "auto" for Uninsured Motorists Coverage under this Coverage Form; or c.Any "family member" while "occupying" or when struck by any vehicle owned by the Named Insured that is insured for Uninsured Motorists Coverage on a primary basis under any other Coverage Form or policy. However, Exclusion 4. shall not apply to "bodily injury" sustained by an individual Named Insured or "family member" when struck by a vehicle owned by that "insured" and operated or caused to be operated by a person without that "insured's" consent in connection with criminal activity that has been documented in a police report and to which that "insured" is not a party to. 5."Bodily injury" sustained by an individual Named Insured or any "family member" while "occupying" any vehicle leased by that Named Insured or any "family member" under a written contract for a period of six months or more that is not a covered "auto". 6.Anyone using a vehicle without a reasonable belief that the person is entitled to do so. 7."Bodily injury" sustained by an "insured" while "occupying" any "auto" that is rented or leased to that "insured" for use as a public or livery conveyance. However, this exclusion does not apply if the "insured" is in the business of providing public or livery conveyance. As used in this exclusion, public or livery conveyance includes, but is not limited to, any period of time an "auto" is being used by an "insured" who is logged into a "transportation network platform" as a driver, whether or not a passenger is "occupying" the "auto". 8."Bodily injury" arising directly or indirectly out of: a.War, including undeclared or civil war; b.Warlike action by a military force, including action in hindering or defending against an actual or expected attack, by any government, sovereign or other authority using military personnel or other agents; or c.Insurrection, rebellion, revolution, usurped power, or action taken by governmental authority in hindering or defending against any of these. D.Limit Of Insurance 1.Regardless of the number of covered "autos", "insureds", premiums paid, claims made or vehicles involved in the "accident", the most we will pay for all damages resulting from any one "accident" is the Limit Of Insurance for Uninsured Motorists Coverage shown in the Schedule or Declarations. 2.For a vehicle described in Paragraph b. of the definition of "uninsured motor vehicle", our Limit of Insurance shall be reduced by all sums paid because of "bodily injury" by or for anyone who is legally responsible, including all sums paid or payable under this policy's Covered Autos Liability Coverage. 3.No one will be entitled to receive duplicate payments for the same elements of "loss" under this coverage and any Liability Coverage form or Medical Payments Coverage endorsement attached to this Coverage Part. © Insurance Services Office, Inc., 2016 CA 21 54 11 16Page 2 of 5 05/13/2024A0195129 Middlesex Insurance Company We will not make a duplicate payment under this coverage for any element of "loss" for which payment has been made by or for anyone who is legally responsible. We will not pay for any element of "loss" if a person is entitled to receive payment for the same element of "loss" under any workers' compensation, disability benefits or similar law. E.Changes In Conditions The Conditions are changed for California Uninsured Motorists Coverage - Bodily Injury as follows: 1.Duties In The Event Of Accident, Claim, Suit Or Loss in the Business Auto and Motor Carrier Coverage Forms and Duties In The Event Of Accident, Claim, Offense, Suit, Loss Or Acts, Errors Or Omissions in the Auto Dealers Coverage Form are changed by adding the following: a.Promptly notify the police if a hit-and-run driver is involved; and b.Send us copies of the legal papers if a "suit" is brought. In addition, a person seeking coverage under Paragraph b. of the definition of "uninsured motor vehicle" must: (1)Provide us with a copy of the complaint by personal service or certified mail if the "insured" brings an action against the owner or operator of such "uninsured motor vehicle"; (2)Within a reasonable time, make all pleadings and depositions available for copying by us or furnish us copies at our expense; and (3)Provide us with proof that the limits of insurance under any applicable liability bonds or policies have been exhausted by payment of judgments or settlements. 2.Legal Action Against Us is replaced by the following: Legal Action Against Us No legal action may be brought against us under this Coverage Form until there has been full compliance with all the terms of this Coverage Form and with respect to Paragraphs a., c. and d. of the definition of "uninsured motor vehicle" unless within two years from the date of the "accident": a.Agreement as to the amount due under this insurance has been concluded; b.The "insured" has formally instituted arbitration proceedings against us. In the event that the "insured" decides to arbitrate, the "insured" must formally begin arbitration proceedings by notifying us in writing, sent by certified mail, return receipt requested; or c."Suit" for "bodily injury" has been filed against the uninsured motorist in a court of competent jurisdiction. Written notice of the "suit" must be given to us within a reasonable time after the "insured" knew, or should have known, that the other motorist is uninsured. In no event will such notice be required before two years from the date of the accident. Failure of the "insured" or his or her representative to give us such notice of the "suit" will relieve us of our obligations under this Coverage Form only if the failure to give notice prejudices our rights. 3.Transfer Of Rights Of Recovery Against Others To Us is replaced by the following: Transfer Of Rights Of Recovery Against Others To Us a.With respect to Paragraphs a., c. and d. of the definition of "uninsured motor vehicle", if we make any payment, we are entitled to recover what we paid from other parties. Any person to or for whom we make payment must transfer to us his or her rights of recovery against any other party. This person must do everything necessary to secure these rights and must do nothing that would jeopardize them. b.With respect to Paragraph b. of the definition of "uninsured motor vehicle", if we make any payment and the "insured" recovers from another party, the "insured" shall hold the proceeds in trust for us and pay us back the amount we have paid. 4.Other Insurance in the Auto Dealers and Business Auto Coverage Forms and Other Insurance - Primary And Excess Insurance Provisions in the Motor Carrier Coverage Form are replaced by the following: If there is other applicable insurance available under one or more policies or provisions of coverage: a.The maximum recovery under all Coverage Forms or policies combined may equal but not exceed the highest applicable limit for any one vehicle under any Coverage Form or policy providing coverage on either a primary or excess basis. © Insurance Services Office, Inc., 2016 Page 3 of 5CA 21 54 11 16 05/13/2024A0195129 Middlesex Insurance Company 00003 0000000000 24134 0 N3 c3946ca2-29fd-4a88-b4e9-a3d5f6b78c92c3946ca2-29fd-4a88-b4e9-a3d5f6b78c92 b.Any insurance we provide with respect to a vehicle the Named Insured does not own shall be excess over any other collectible uninsured motorists insurance providing coverage on a primary basis. c.If the coverage under this Coverage Form is provided: (1)On a primary basis, we will pay only our share of the "loss" that must be paid under insurance providing coverage on a primary basis. Our share is the proportion that our limit of liability bears to the total of all applicable limits of liability for coverage on a primary basis. (2)On an excess basis, we will pay only our share of the "loss" that must be paid under insurance providing coverage on an excess basis. Our share is the proportion that our limit of liability bears to the total of all applicable limits of liability for coverage on an excess basis. 5.The following condition is added: Arbitration a.If we and an "insured" disagree whether the "insured" is legally entitled to recover damages from the owner or driver of an "uninsured motor vehicle" or do not agree as to the amount of damages that are recoverable by that "insured", the disagreement will be settled by arbitration. Such arbitration may be initiated by a written demand for arbitration made by either party. The arbitration shall be conducted by a single neutral arbitrator. However, disputes concerning coverage under this endorsement may not be arbitrated. Each party will bear the expenses of the arbitrator equally. b.Unless both parties agree otherwise, arbitration will take place in the county in which the "insured" lives. Local rules of law as to arbitration procedures and evidence will apply. The decision of the arbitrator will be binding. F.Additional Definitions The following are added to the Definitions section: 1."Family member" means the individual Named Insured's spouse, whether or not a resident of the individual Named Insured's household, and any other person related to such Named Insured by blood, adoption, marriage or registered domestic partnership under California law, who is a resident of such Named Insured's household, including a ward or foster child. 2."Occupying" means in, upon, getting in, on, out or off. 3."Transportation network platform" means an online-enabled application or digital network used to connect passengers with drivers using vehicles for the purpose of providing prearranged transportation services for compensation. 4."Uninsured motor vehicle" means a land motor vehicle or "trailer": a.For which no liability bond or policy at the time of an "accident" provides at least the amounts required by the applicable law where a covered "auto" is principally garaged; b.That is an underinsured motor vehicle. An underinsured motor vehicle is a land motor vehicle or "trailer" for which the sum of all liability bonds or policies at the time of an "accident" provides at least the amounts required by the applicable law where a covered "auto" is principally garaged but that sum is less than the Limit of Insurance for this coverage; c.For which an insuring or bonding company denies coverage or refuses to admit coverage except conditionally or with reservation or becomes insolvent; © Insurance Services Office, Inc., 2016 CA 21 54 11 16Page 4 of 5 05/13/2024A0195129 Middlesex Insurance Company d.That is a hit-and-run vehicle and neither the driver nor owner can be identified. The vehicle must make physical contact with an "insured", a covered "auto" or a vehicle an "insured" is "occupying"; or e.That is owned by an individual Named Insured or "family member" and operated or caused to be operated by a person without the owner's consent in connection with criminal activity that has been documented in a police report. However, "uninsured motor vehicle" does not include any vehicle: a.Owned or operated by a self-insurer under any applicable motor vehicle law except a self-insurer who is or becomes insolvent and cannot provide the amounts required by that motor vehicle law; b.Owned by the United States of America, Canada, a state or political subdivision of any of those governments or an agency of any of the foregoing; or c.Designed or modified for use primarily off public roads while not on public roads. © Insurance Services Office, Inc., 2016 Page 5 of 5CA 21 54 11 16 05/13/2024A0195129 Middlesex Insurance Company 00003 0000000000 24134 0 N5 c3946ca2-29fd-4a88-b4e9-a3d5f6b78c92c3946ca2-29fd-4a88-b4e9-a3d5f6b78c92 COMMERCIAL AUTO CA 23 84 10 13 © Insurance Services Office, Inc., 2013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION OF TERRORISM This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM SINGLE INTEREST AUTOMOBILE PHYSICAL DAMAGE INSURANCE POLICY With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. A.The following definitions are added and apply under this endorsement wherever the term terrorism, or the phrase any injury, damage, loss or expense, is enclosed in quotation marks: 1."Terrorism" means activities against persons, organizations or property of any nature: a.That involve the following or preparation for the following: (1)Use or threat of force or violence; or (2)Commission or threat of a dangerous act; or (3)Commission or threat of an act that interferes with or disrupts an electronic, communication, information or mechanical system; and b.When one or both of the following apply: (1)The effect is to intimidate or coerce a government or the civilian population or any segment thereof, or to disrupt any segment of the economy; or (2)It appears that the intent is to intimidate or coerce a government, or to further political, ideological, religious, social or economic objectives or to express (or express opposition to) a philosophy or ideology. 2."Any injury, damage, loss or expense" means any injury, damage, loss or expense covered under any Coverage Form or Policy to which this endorsement is applicable, and includes but is not limited to "bodily injury", "property damage", "personal and advertising injury", "loss", loss of use, rental reimbursement after "loss" or "covered pollution cost or expense", as may be defined under this Coverage Form, Policy or any applicable endorsement. B.Except with respect to Physical Damage Coverage, Trailer Interchange Coverage, Garagekeepers Coverage, Garagekeepers Coverage - Customers' Sound Receiving Equipment or the Single Interest Automobile Physical Damage Insurance Policy, the following exclusion is added: Exclusion Of Terrorism We will not pay for "any injury, damage, loss or expense" caused directly or indirectly by "terrorism", including action in hindering or defending against an actual or expected incident of "terrorism". "Any injury, damage, loss or expense" is excluded regardless of any other cause or event that contributes concurrently or in any sequence to such injury, damage, loss or expense. But this exclusion applies only when one or more of the following are attributed to an incident of "terrorism": 1.The "terrorism" is carried out by means of the dispersal or application of radioactive material, or through the use of a nuclear weapon or device that involves or produces a nuclear reaction, nuclear radiation or radioactive contamination; or Page 1 of 3CA 23 84 10 13 05/13/2024A0195129 Middlesex Insurance Company 00002 0000000000 24134 0 N1 5fbbb320-b14a-4fa3-aae8-da069790b18d5fbbb320-b14a-4fa3-aae8-da069790b18d © Insurance Services Office, Inc., 2013 2.Radioactive material is released, and it appears that one purpose of the "terrorism" was to release such material; or 3.The "terrorism" is carried out by means of the dispersal or application of pathogenic or poisonous biological or chemical materials; or 4.Pathogenic or poisonous biological or chemical materials are released, and it appears that one purpose of the "terrorism" was to release such materials; or 5.The total of insured damage to all types of property exceeds $25,000,000. In determining whether the $25,000,000 threshold is exceeded, we will include all insured damage sustained by property of all persons and entities affected by the "terrorism" and business interruption losses sustained by owners or occupants of the damaged property. For the purpose of this provision, insured damage means damage that is covered by any insurance plus damage that would be covered by any insurance but for the application of any terrorism exclusions; or 6.Fifty or more persons sustain death or serious physical injury. For the purposes of this provision, serious physical injury means: a.Physical injury that involves a substantial risk of death; or b.Protracted and obvious physical disfigurement; or c.Protracted loss of or impairment of the function of a bodily member or organ. Multiple incidents of "terrorism" which occur within a 72-hour period and appear to be carried out in concert or to have a related purpose or common leadership will be deemed to be one incident, for the purpose of determining whether the thresholds in Paragraphs B.5. and B.6. are exceeded. With respect to this exclusion, Paragraphs B.5. and B.6. describe the thresholds used to measure the magnitude of an incident of "terrorism" and the circumstances in which the threshold will apply, for the purpose of determining whether this exclusion will apply to that incident. When the exclusion applies to an incident of "terrorism", there is no coverage under this Coverage Form, Policy or any applicable endorsement. C.With respect to Physical Damage Coverage, Trailer Interchange Coverage, Garagekeepers Coverage, Garagekeepers Coverage - Customers' Sound Receiving Equipment or the Single Interest Automobile Physical Damage Insurance Policy, the following exclusion is added: Exclusion Of Terrorism We will not pay for any "loss", loss of use or rental reimbursement after "loss" caused directly or indirectly by "terrorism", including action in hindering or defending against an actual or expected incident of "terrorism". But this exclusion applies only when one or more of the following are attributed to an incident of "terrorism": 1.The "terrorism" is carried out by means of the dispersal or application of radioactive material, or through the use of a nuclear weapon or device that involves or produces a nuclear reaction, nuclear radiation or radioactive contamination; or 2.Radioactive material is released, and it appears that one purpose of the "terrorism" was to release such material; or 3.The "terrorism" is carried out by means of the dispersal or application of pathogenic or poisonous biological or chemical materials; or 4.Pathogenic or poisonous biological or chemical materials are released, and it appears that one purpose of the "terrorism" was to release such materials; or 5.The total of insured damage to all types of property exceeds $25,000,000. In determining whether the $25,000,000 threshold is exceeded, we will include all insured damage sustained by property of all persons and entities affected by the "terrorism" and business interruption losses sustained by owners or occupants of the damaged property. For the purpose of this provision, insured damage means damage that is covered by any insurance plus damage that would be covered by any insurance but for the application of any terrorism exclusions. Multiple incidents of "terrorism" which occur within a 72-hour period and appear to be carried out in concert or to have a related purpose or common leadership will be deemed to be one incident, for the purpose of determining whether the threshold in Paragraph C.5. is exceeded. CA 23 84 10 13Page 2 of 3 05/13/2024A0195129 Middlesex Insurance Company © Insurance Services Office, Inc., 2013 With respect to this exclusion, Paragraph C.5. describes the threshold used to measure the magnitude of an incident of "terrorism" and the circumstances in which the threshold will apply, for the purpose of determining whether this exclusion will apply to that incident. When the exclusion applies to an incident of "terrorism", there is no coverage under this Coverage Form, Policy or any applicable endorsement. D.In the event of any incident of "terrorism" that is not subject to the exclusion in Paragraph B. or C., coverage does not apply to "any injury, damage, loss or expense" that is otherwise excluded under this Coverage Form, Policy or any applicable endorsement. Page 3 of 3CA 23 84 10 13 05/13/2024A0195129 Middlesex Insurance Company 00002 0000000000 24134 0 N3 5fbbb320-b14a-4fa3-aae8-da069790b18d5fbbb320-b14a-4fa3-aae8-da069790b18d A0195129 Middlesex Insurance Company 05/13/2024 e0a22f5f-bf5b-4e3d-bc0e-65c5d54eaff9 COMMERCIAL AUTO CA 23 94 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SILICA OR SILICA-RELATED DUST EXCLUSION FOR COVERED AUTOS EXPOSURE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. A.The following exclusion is added to Covered Autos Liability Coverage: Silica Or Silica-related Dust Exclusion For Covered Autos Exposure This insurance does not apply to: 1."Bodily injury" arising, in whole or in part, out of the actual, alleged, threatened or suspected inhalation of, or ingestion of, "silica" or "silica-related dust". 2."Property damage" arising, in whole or in part, out of the actual, alleged, threatened or suspected contact with, exposure to, existence of, or presence of, "silica" or "silica-related dust". 3.Any loss, cost or expense arising, in whole or in part, out of the abating, testing for, monitoring, cleaning up, removing, containing, treating, detoxifying, neutralizing, remediating or disposing of, or in any way responding to or assessing the effects of, "silica" or "silica-related dust", by any "insured" or by any other person or entity. B.Additional Definitions As used in this endorsement: 1."Silica" means silicon dioxide (occurring in crystalline, amorphous and impure forms), silica particles, silica dust or silica compounds. 2."Silica-related dust" means a mixture or combination of silica and other dust or particles. © Insurance Services Office, Inc., 2011 Page 1 of 1CA 23 94 10 13 A0195129 Middlesex Insurance Company 05/13/2024 5cff8d97-efc4-4a46-aea7-a1bfb3172b54 COMMERCIAL AUTO CA 70 57 10 13 SPECIAL BROAD FORM AUTO ENDORSEMENT This endorsement modifies the insurance provided under the following: BUSINESS AUTO COVERAGE FORM 1.Broadened Who Is An Insured Under Section II - Covered Autos Liability Coverage, the following is added to Coverage A.1. Who Is An Insured: A.Employees As Insureds Any "employee" of yours is an "insured" while using a covered "auto" you don©t own, hire or borrow in your business or personal affairs. B.Newly Acquired Organizations Any organization you newly acquire or form, other than a partnership, joint venture or limited liability company, and over which you maintain ownership or majority interest, will qualify as a Named Insured if there is no other similar insurance available to that organization. However: 1.Coverage under this provision is afforded only until the 90th day after you acquire or form the organization of the end of the policy period; whichever is earlier; and 2.Coverage does not apply to "bodily injury", "property damage" or "covered pollution cost or expense" that occurred before you acquired or formed the organization. 2.Broadened Supplementary Payments Coverage Extension 2.a. Supplementary Payments under Section II - Covered Autos Liability Coverages is amended as follows: A.Paragraph 2.a.(2) is amended to pay up to $3000 for cost of bail bonds; and B.Paragraph 2.a.(4) is amended to pay for loss of earnings up to $500 a day because of time off from work. 3.Fellow Employee Bodily Injury Extension The Fellow Employee exclusion contained in Section II - Covered Autos Liability Coverage does not apply. 4.Accidental Airbag Discharge The following is added to Exclusion B.3.a. under Section III - PHYSICAL DAMAGE: This exclusion does not apply to the accidental discharge of an airbag in a covered auto for a loss that Physical Damage Coverage is shown in the Declarations. 5.Towing We will pay up to the limit shown in the Declarations for towing and labor costs incurred each time a covered ªautoº of the private passenger type is disabled. However, the labor must be performed at the place of disablement. 6.Physical Damage Coverage Extensions The following replaces the Coverage Extensions under Section III - PHYSICAL DAMAGE: A.Transportation Expenses We will pay up to $50 per day to a maximum of $1000 for temporary transportation expense incurred by you because of the total theft of a covered "auto" of the private passenger type. We will pay up to $75 per day to a maximum of $1500 for temporary transportation expense incurred by you because of the total theft of a covered "auto" of the truck or van type with a Gross Vehicle Weight of less than 10,000 pounds used as a private passenger vehicle. We will pay only for those covered "autos" for which you carry either Comprehensive or Specified Causes of Loss Coverage. We will pay for temporary transportation expenses incurred during the period beginning 48 hours after the theft and ending, regardless of the policy©s expiration, when the covered "auto" is returned to use or we pay for its "loss". B.Loss Of Use Expenses For Hired Auto Physical Damage, we will pay expenses for which an "insured" becomes legally responsible to pay for loss of use of a vehicle rented or hired without a driver under a written rental contract or agreement. We will pay for loss of use expense if caused by: 1.Other than collision only if the Declarations indicate that Comprehensive Coverage is provided for any covered "auto"; 2.Specified Causes Of Loss only if the Declarations indicate that Specified Causes of Loss Coverage is provided for any covered "auto"; or Page 1 of 3CA 70 57 10 13 A0195129 Middlesex Insurance Company 05/13/2024 5cff8d97-efc4-4a46-aea7-a1bfb3172b54 SPECIAL BROAD FORM AUTO ENDORSEMENT - CONTINUED 3.Collision only if the Declarations indicate that Collision Coverage is provided for any covered "auto". However, the most we will pay for any expenses for loss of use is $50 per day, to a maximum of $1000. 7.Rental Reimbursement A.For any covered "auto" for which Comprehensive and Collision coverages are provided, we will pay for rental reimbursement expenses incurred by you for the rental of an "auto" because of "loss" to a covered "auto". Payment applies in addition to the otherwise applicable amount of each coverage you have on a covered "auto". No Physical Damage Coverage deductibles apply to this coverage. B.We will pay only for those expenses incurred during the policy period beginning 24 hours after the "loss" and ending, regardless of the policy©s expiration, with the number of days reasonably required to repair or replace the covered "auto". If "loss" is caused by theft, this number of days is added to the number of days it takes to locate the covered "auto" and return it to you. C.Our payment is limited to the lesser of the following amounts: (1)Necessary and actual expenses incurred; or (2)$50 per day, to a maximum of $1000. D.Our payment under this coverage extension is excess over any other rental reimbursement coverage available to you. E.This coverage does not apply while there are spare or reserve "autos" available to you for your operations. F.If "loss" results from the total theft of a covered "auto" of the private passenger type, we will pay under this coverage only that amount of your rental reimbursement expenses which is not already provided for under the Physical Damage Coverage Extension. 8. Hired Auto Physical Damage A.If you have Comprehensive or Specified Causes of Loss and Collision Coverages provided on your owned "autos" you may extend Physical Damage Coverage to any "autos" you lease, hire, rent or borrow; provided you have Liability Coverage for hired "autos". B.The hired "auto" must be of like kind and used as the "autos" owned and covered under this Coverage Form. C.The most we will pay for "loss" to any hired "auto" in any one "accident" is the lesser of: (1)$50,000 (2)The actual cash value of the "auto" at the time of the "loss" (3)The cost of repair or replacement with other property of like kind and quality D.The following deductible provisions apply: (1)The deductible will be equal to the largest deductible applicable to any owned "auto" for that coverage shown in the Declarations. (2)No deductible will apply to "loss" caused by fire or lightning. E.Any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto" under this coverage extension. 9.Auto Loan And Lease Gap Coverage Section III - PHYSICAL DAMAGE is amended by the addition of the following: A.In the event of a total "loss" to a covered "auto" shown in the Declarations, we will pay any unpaid amount due on the lease or loan for a covered "auto", less: (1)The amount paid under the policy's Physical Damage Coverage; and (2)Any: (a)Overdue lease/loan payments at the time of the "loss"; (b)Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage; (c)Security deposits not returned by the lessor; (d)Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance purchased with the loan or lease; and (e)Carry-over balances from previous loans or leases. B.This coverage extension applies to covered autos that are loaned or leased for a period of six months or longer and which have been provided Physical Damage Coverage. The "loss" must be caused by damage for which coverage is shown in the Declarations. 10.Personal Effects The following is added to A. Coverage under Section III - Physical Damage Coverage: CA 70 57 10 13Page 2 of 3 A0195129 Middlesex Insurance Company 05/13/2024 5cff8d97-efc4-4a46-aea7-a1bfb3172b54 SPECIAL BROAD FORM AUTO ENDORSEMENT - CONTINUED A.We will extend Physical Damage Coverage on a covered "auto" to include personal property owned by you, a relative or an "employee" that is in the covered "auto" at the time of "loss". The "loss" must be caused by damage for which coverage is shown in the Declarations. There must be evidence of forced entry for loss caused by theft. B.The exclusion referring to tapes, records, discs or other similar audio, visual or data electronic devices designated for use with audio, visual or data electronic equipment does not apply. C.The most we will pay for any one "loss" under this coverage extension is $500. No Physical Damage Coverage deductible applies to this coverage extension. D.Coverage provided by this Personal Effects extension is excess over any other collectible insurance. E.The coverage extension does not apply to the following property: (1)Any device designed or used to detect speed-measuring equipment such as radar or laser detectors and any jamming apparatus intended to elude or disrupt speed-measurement equipment; (2)Any electronic equipment that reproduces, receives or transmits audio, visual or data signals; (3)Tools; (4)Jewelry, precious metals and loose gems; (5)Money and securities; or (6)Property specifically insured or covered under the Business Personal Property Coverage of this policy. 11.Glass Deductible Under Section III - PHYSICAL DAMAGE, the following is added to A.3. Glass Breakage - Hitting A Bird Or Animal - Falling Objects Or Missiles Coverage: The Comprehensive Coverage deductible shown in the Declarations does not apply to glass breakage if such glass is repaired rather than replaced. 12.Broad Knowledge Of Accident, Claim, Suit Or Loss Under Section IV - Business Auto Conditions, the following is added to Loss Conditions A.2. Duties In The Event Of Accident, Claim, Suit Or Loss: Knowledge of an "accident", claim, "suit" or "loss" by an agent or "employee" of an insured or receipt of any demand, notice, summons or other legal paper in connection with a claim or "suit" by any agent or "employee" of any insured shall not in itself constitute knowledge of the named insured or receipt of the named insured, unless a partner, member, manager, executive officer or director shall have such knowledge or shall have received such demand, notice, summons or legal paper. 13.Unintentional Failure To Disclose Hazards Under Section IV - Business Auto Conditions, the following is added to General Conditions B.2. Concealment, Misrepresentation Or Fraud: If in your representations to us you unintentionally failed to disclose all hazards and exposures subject to this insurance, we shall not deny all coverage under this policy because of such oversight. 14.Mental Anguish A.The definition of "bodily injury" under Section V - Definitions is replaced by the following: "Bodily injury" means bodily injury, sickness or disease sustained by a person, including "mental anguish" or death resulting from any of these at any time. B.The following definition is added to Section V - Definitions: "Mental anguish" means extreme pain or distress inflicted upon an individual©s emotional and intellectual condition with regard to the individual©s response to the environment. Page 3 of 3CA 70 57 10 13 POLICY NUMBER: SCHEDULE COMMERCIAL AUTO CA 76 01 06 15 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED - PRIMARY AND NONCONTRIBUTORY - COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM AUTO DEALERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated. Named Insured: Endorsement Effective Date: Name Of Person(s) Or Organization(s): Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A.Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in: (1)Paragraph A.1. of Section II - Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms; or (2)Paragraph D.2. of Section I - Covered Autos Coverages of the Auto Dealers Coverage Form. B.Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other auto insurance issued to the person or organization in the schedule under your policy provided that: (1)The person or organization is a Named Insured under such other insurance; and (2)Prior to the “accident” you have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the person or organization. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1CA 76 01 06 15 05/13/2024A0195129 Middlesex Insurance Company 00001 0000000000 24134 0 N1 ae9ec01b-5a3f-4227-8efc-8508e2cd2c32ae9ec01b-5a3f-4227-8efc-8508e2cd2c32 COMMERCIAL AUTO CA 99 44 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. LOSS PAYABLE CLAUSE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. A.We will pay, as interest may appear, you and the loss payee named in the policy for "loss" to a covered "auto". B.The insurance covers the interest of the loss payee unless the "loss" results from conversion, secretion or embezzlement on your part. C.We may cancel the policy as allowed by the Cancellation Common Policy Condition. Cancellation ends this agreement as to the loss payee's interest. If we cancel the policy, we will mail you and the loss payee the same advance notice. D.If we make any payments to the loss payee, we will obtain his or her rights against any other party. © Insurance Services Office, Inc., 2011 Page 1 of 1CA 99 44 10 13 05/13/2024A0195129 Middlesex Insurance Company 00001 0000000000 24134 0 N1 741b02ae-b4b9-47e5-9a0e-d8cc0d89d93f741b02ae-b4b9-47e5-9a0e-d8cc0d89d93f Page 1 of 2 05/13/2024A0195129 Middlesex Insurance Company IL 00 21 09 08 IL 00 21 09 08 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NUCLEAR ENERGY LIABILITY EXCLUSION ENDORSEMENT (Broad Form) This endorsement modifies insurance provided under the following: COMMERCIAL AUTOMOBILE COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART FARM COVERAGE PART LIQUOR LIABILITY COVERAGE PART MEDICAL PROFESSIONAL LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY 1.The insurance does not apply: A.Under any Liability Coverage, to "bodily injury" or "property damage": (1)With respect to which an "insured" under the policy is also an insured under a nuclear energy liability policy issued by Nuclear Energy Liability Insurance Association, Mutual Atomic Energy Liability Underwriters, Nuclear Insurance Association of Canada or any of their successors, or would be an insured under any such policy but for its termination upon exhaustion of its limit of liability; or (2)Resulting from the "hazardous properties" of "nuclear material" and with respect to which (a) any person or organization is required to maintain financial protection pursuant to the Atomic Energy Act of 1954, or any law amendatory thereof, or (b) the "insured" is, or had this policy not been issued would be, entitled to indemnity from the United States of America, or any agency thereof, under any agreement entered into by the United States of America, or any agency thereof, with any person or organization. B.Under any Medical Payments coverage, to expenses incurred with respect to "bodily injury" resulting from the "hazardous properties" of "nuclear material" and arising out of the operation of a "nuclear facility" by any person or organization. C.Under any Liability Coverage, to "bodily injury" or "property damage" resulting from "hazardous properties" of "nuclear material", if: (1)The "nuclear material" (a) is at any "nuclear facility" owned by, or operated by or on behalf of, an "insured" or (b) has been discharged or dispersed therefrom; (2)The "nuclear material" is contained in "spent fuel" or "waste" at any time possessed, handled, used, processed, stored, transported or disposed of, by or on behalf of an "insured"; or (3)The "bodily injury" or "property damage" arises out of the furnishing by an "insured" of services, materials, parts or equipment in connection with the planning, construction, maintenance, operation or use of any "nuclear facility", but if such facility is located within the United States of America, its territories or possessions or Canada, this exclusion (3) applies only to "property damage" to such "nuclear facility" and any property thereat. 2.As used in this endorsement: "Hazardous properties" includes radioactive, toxic or explosive properties. "Nuclear material" means "source material", "special nuclear material" or "by-product material". © ISO Properties, Inc., 2007 00001 0000000000 24134 0 N1 abe610ac-aa05-418c-abf5-4c0f613d87ecabe610ac-aa05-418c-abf5-4c0f613d87ec Page 2 of 2 "Source material", "special nuclear material", and "by-product material" have the meanings given them in the Atomic Energy Act of 1954 or in any law amendatory thereof. "Spent fuel" means any fuel element or fuel component, solid or liquid, which has been used or exposed to radiation in a "nuclear reactor". "Waste" means any waste material (a) containing "by-product material" other than the tailings or wastes produced by the extraction or concentration of uranium or thorium from any ore processed primarily for its "source material" content, and (b) resulting from the operation by any person or organization of any "nuclear facility" included under the first two paragraphs of the definition of "nuclear facility". "Nuclear facility" means: (a)Any "nuclear reactor"; (b)Any equipment or device designed or used for (1) separating the isotopes of uranium or plutonium, (2) processing or utilizing "spent fuel", or (3) handling, processing or packaging "waste"; (c)Any equipment or device used for the processing, fabricating or alloying of "special nuclear material" if at any time the total amount of such material in the custody of the "insured" at the premises where such equipment or device is located consists of or contains more than 25 grams of plutonium or uranium 233 or any combination thereof, or more than 250 grams of uranium 235; (d)Any structure, basin, excavation, premises or place prepared or used for the storage or disposal of "waste"; and includes the site on which any of the foregoing is located, all operations conducted on such site and all premises used for such operations. "Nuclear reactor" means any apparatus designed or used to sustain nuclear fission in a self-supporting chain reaction or to contain a critical mass of fissionable material. "Property damage" includes all forms of radioactive contamination of property. © ISO Properties, Inc., 2007 IL 00 21 09 08 05/13/2024A0195129 Middlesex Insurance Company © Insurance Services Office, Inc., 2020 IL 02 70 07 20 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALIFORNIA CHANGES - CANCELLATION AND NONRENEWAL This endorsement modifies insurance provided under the following: CAPITAL ASSETS PROGRAM (OUTPUT POLICY) COVERAGE PART COMMERCIAL AUTOMOBILE COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL PROPERTY COVERAGE PART CRIME AND FIDELITY COVERAGE PART EMPLOYMENT-RELATED PRACTICES LIABILITY COVERAGE PART EQUIPMENT BREAKDOWN COVERAGE PART FARM COVERAGE PART LIQUOR LIABILITY COVERAGE PART MEDICAL PROFESSIONAL LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART A.Paragraphs 2. and 3. of the Cancellation Common Policy Condition are replaced by the following: 2.All Policies In Effect For 60 Days Or Less If this policy has been in effect for 60 days or less, and is not a renewal of a policy we have previously issued, we may cancel this policy by mailing or delivering to the first Named Insured, at the mailing address shown in the policy, and to the producer of record, advance written notice of cancellation, stating the reason for cancellation, at least: a.10 days before the effective date of cancellation if we cancel for: (1)Nonpayment of premium; or (2)Discovery of fraud by: (a)Any insured or his or her representative in obtaining this insurance; or (b)You or your representative in pursuing a claim under this policy. b.30 days before the effective date of cancellation if we cancel for any other reason. 3.All Policies In Effect For More Than 60 Days a.If this policy has been in effect for more than 60 days, or is a renewal of a policy we issued, we may cancel this policy only upon the occurrence, after the effective date of the policy, of one or more of the following: (1)Nonpayment of premium, including payment due on a prior policy we issued and due during the current policy term covering the same risks. (2)Discovery of fraud or material misrepresentation by: (a)Any insured or his or her representative in obtaining this insurance; or (b)You or your representative in pursuing a claim under this policy. (3)A judgment by a court or an administrative tribunal that you have violated a California or Federal law, having as one of its necessary elements an act which materially increases any of the risks insured against. Page 1 of 4IL 02 70 07 20 05/13/2024A0195129 Middlesex Insurance Company 00002 0000000000 24134 0 N1 182376ad-15e7-4081-8616-85a379a649d8182376ad-15e7-4081-8616-85a379a649d8 © Insurance Services Office, Inc., 2020 (4)Discovery of willful or grossly negligent acts or omissions, or of any violations of state laws or regulations establishing safety standards, by you or your representative, which materially increase any of the risks insured against. (5)Failure by you or your representative to implement reasonable loss control requirements, agreed to by you as a condition of policy issuance, or which were conditions precedent to our use of a particular rate or rating plan, if that failure materially increases any of the risks insured against. (6)A determination by the Commissioner of Insurance that the: (a)Loss of, or changes in, our reinsurance covering all or part of the risk would threaten our financial integrity or solvency; or (b)Continuation of the policy coverage would: (i)Place us in violation of California law or the laws of the state where we are domiciled; or (ii)Threaten our solvency. (7)A change by you or your representative in the activities or property of the commercial or industrial enterprise, which results in a materially added, increased or changed risk, unless the added, increased or changed risk is included in the policy. b.We will mail or deliver advance written notice of cancellation, stating the reason for cancellation, to the first Named Insured, at the mailing address shown in the policy, and to the producer of record, at least: (1)10 days before the effective date of cancellation if we cancel for nonpayment of premium or discovery of fraud; or (2)30 days before the effective date of cancellation if we cancel for any other reason listed in Paragraph 3.a. B.The following provision is added to the Cancellation Common Policy Condition: 7.Residential Property This provision applies to coverage on real property which is used predominantly for residential purposes and consisting of not more than four dwelling units, and to coverage on tenants' household personal property in a residential unit, if such coverage is written under one of the following: Commercial Property Coverage Part Farm Coverage Part - Farm Property - Farm Dwellings, Appurtenant Structures And Household Personal Property Coverage Form a.If such coverage has been in effect for 60 days or less, and is not a renewal of coverage we previously issued, we may cancel this coverage for any reason, except as provided in b. and c. below. b.We may not cancel this policy solely because the first Named Insured has: (1)Accepted an offer of earthquake coverage; or (2)Cancelled or did not renew a policy issued by the California Earthquake Authority (CEA) that included an earthquake policy premium surcharge. However, we shall cancel this policy if the first Named Insured has accepted a new or renewal policy issued by the CEA that includes an earthquake policy premium surcharge but fails to pay the earthquake policy premium surcharge authorized by the CEA. c.We may not cancel such coverage solely because corrosive soil conditions exist on the premises. This restriction (c.) applies only if coverage is subject to one of the following, which exclude loss or damage caused by or resulting from corrosive soil conditions: (1)Commercial Property Coverage Part - Causes Of Loss - Special Form; or (2)Farm Coverage Part - Causes Of Loss Form - Farm Property, Paragraph D. Covered Causes Of Loss - Special. IL 02 70 07 20Page 2 of 4 05/13/2024A0195129 Middlesex Insurance Company © Insurance Services Office, Inc., 2020 d.If a state of emergency under California Law is declared and the residential property is located in any ZIP Code within or adjacent to the fire perimeter, as determined by California Law, we may not cancel this policy for one year, beginning from the date the state of emergency is declared, solely because the dwelling or other structure is located in an area in which a wildfire has occurred. However, we may cancel: (1)When you have not paid the premium, at any time by letting you know at least 10 days before the date cancellation takes effect; (2)If willful or grossly negligent acts or omissions by the Named Insured, or his or her representatives, are discovered that materially increase any of the risks insured against; or (3)If there are physical changes in the property insured against, beyond the catastrophe-damaged condition of the structures and surface landscape, which result in the property becoming uninsurable. C.The following is added and supersedes any provisions to the contrary: Nonrenewal 1.Subject to the provisions of Paragraphs C.2. and C.3. below, if we elect not to renew this policy, we will mail or deliver written notice, stating the reason for nonrenewal, to the first Named Insured shown in the Declarations, and to the producer of record, at least 60 days, but not more than 120 days, before the expiration or anniversary date. We will mail or deliver our notice to the first Named Insured, and to the producer of record, at the mailing address shown in the policy. 2.Residential Property This provision applies to coverage on real property used predominantly for residential purposes and consisting of not more than four dwelling units, and to coverage on tenants' household property contained in a residential unit, if such coverage is written under one of the following: Commercial Property Coverage Part Farm Coverage Part - Farm Property - Farm Dwellings, Appurtenant Structures And Household Personal Property Coverage Form a.If this policy provides coverage as described in the preceding paragraph, and we elect not to renew this policy, we will mail or deliver written notice, stating the reason for nonrenewal, to the first Named Insured shown in the Declarations, and to the producer of record, at the mailing address shown in the policy, at least 75 days, but not more than 120 days, before the expiration or anniversary date. If we fail to give the first Named Insured shown in the Declarations notice of nonrenewal at least 75 days prior to the policy expiration, as required in the paragraph above, this policy, with no change in its terms and conditions, shall remain in effect for 75 days from the date that the notice of nonrenewal is delivered or mailed to the Named Insured. A notice to this effect shall be provided by us to the first Named Insured with the notice of nonrenewal. b.We may elect not to renew such coverage for any reason, except as provided in Paragraphs c., d. and e. below. c.We will not refuse to renew such coverage solely because the first Named Insured has accepted an offer of earthquake coverage. However, the following applies only to insurers who are associate participating insurers as established by Cal. Ins. Code Section 10089.16. We may elect not to renew such coverage after the first Named Insured has accepted an offer of earthquake coverage, if one or more of the following reasons applies: (1)The nonrenewal is based on sound underwriting principles that relate to the coverages provided by this policy and that are consistent with the approved rating plan and related documents filed with the Department of Insurance as required by existing law; Page 3 of 4IL 02 70 07 20 05/13/2024A0195129 Middlesex Insurance Company 00002 0000000000 24134 0 N3 182376ad-15e7-4081-8616-85a379a649d8182376ad-15e7-4081-8616-85a379a649d8 © Insurance Services Office, Inc., 2020 (2)The Commissioner of Insurance finds that the exposure to potential losses will threaten our solvency or place us in a hazardous condition. A hazardous condition includes, but is not limited to, a condition in which we make claims payments for losses resulting from an earthquake that occurred within the preceding two years and that required a reduction in policyholder surplus of at least 25% for payment of those claims; or (3)We have: (a)Lost or experienced a substantial reduction in the availability or scope of reinsurance coverage; or (b)Experienced a substantial increase in the premium charged for reinsurance coverage of our residential property insurance policies; and the Commissioner has approved a plan for the nonrenewals that is fair and equitable, and that is responsive to the changes in our reinsurance position. d.We will not refuse to renew such coverage solely because the first Named Insured has cancelled or did not renew a policy, issued by the California Earthquake Authority, that included an earthquake policy premium surcharge. e.We will not refuse to renew such coverage solely because corrosive soil conditions exist on the premises. This restriction (e.) applies only if coverage is subject to one of the following, which exclude loss or damage caused by or resulting from corrosive soil conditions: (1)Commercial Property Coverage Part - Causes Of Loss - Special Form; or (2)Farm Coverage Part - Causes Of Loss Form - Farm Property, Paragraph D. Covered Causes Of Loss - Special. f.If a state of emergency under California Law is declared and the residential property is located in any ZIP Code within or adjacent to the fire perimeter, as determined by California Law, we may not nonrenew this policy for one year, beginning from the date the state of emergency is declared, solely because the dwelling or other structure is located in an area in which a wildfire has occurred. However, we may nonrenew: (1)If willful or grossly negligent acts or omissions by the Named Insured, or his or her representatives, are discovered that materially increase any of the risks insured against; (2)If losses unrelated to the postdisaster loss condition of the property have occurred that would collectively render the risk ineligible for renewal; or (3)If there are physical changes in the property insured against, beyond the catastrophe-damaged condition of the structures and surface landscape, which result in the property becoming uninsurable. 3.We are not required to send notice of nonrenewal in the following situations: a.If the transfer or renewal of a policy, without any changes in terms, conditions or rates, is between us and a member of our insurance group. b.If the policy has been extended for 90 days or less, provided that notice has been given in accordance with Paragraph C.1. c.If you have obtained replacement coverage, or if the first Named Insured has agreed, in writing, within 60 days of the termination of the policy, to obtain that coverage. d.If the policy is for a period of no more than 60 days and you are notified at the time of issuance that it will not be renewed. e.If the first Named Insured requests a change in the terms or conditions or risks covered by the policy within 60 days of the end of the policy period. f.If we have made a written offer to the first Named Insured, in accordance with the timeframes shown in Paragraph C.1., to renew the policy under changed terms or conditions or at an increased premium rate, when the increase exceeds 25%. IL 02 70 07 20Page 4 of 4 05/13/2024A0195129 Middlesex Insurance Company COMMERCIAL EXCESS/UMBRELLA LIABILITY COVERAGE DECLARATIONS POLICY NUMBER: A0195129005 Middlesex Insurance Company (A Participating Stock Company) A member of the Sentry Insurance Group 1800 North Point Drive Stevens Point, WI 54481 Agency Acrisure of California, LLC 34 S 2nd St Campbell, CA 95008 Agency Code 10047536 First Named Insured: POLICY INFORMATION Axis Mechanical , Inc. Address:908 Bern Ct San Jose, CA 95112 The Commercial Excess/Umbrella Liability Coverage provided under this policy is effective 05/13/2024 to 05/13/2025 at 12:01 A.M. Standard Time at your mailing address shown above. Additional Named Insureds In addition to the Named Insured’s listed in the Common Declarations, the following person(s) or organization(s) are named insured’s for the Commercial Excess/Umbrella Liability Coverage only: LIMITS OF INSURANCE AND RETAINED LIMIT General Aggregate Limit 5,000,000 $ Products/Completed Operations Aggregate Limit 5,000,000$ Each Occurrence Limit 5,000,000 $ Retained Limit (Each Occurrence) 0 $ APPLICABLE FORMS AND ENDORSEMENTS In addition to the common policy forms and endorsements, the following forms and endorsements apply to the Commercial Excess/Umbrella Liability Coverage: Form/Endorsement Form/Endorsement Title Number and Edition Date EU 21 54 12 19 Exclusion - Designated Operations Covered By A Controlled (Wrap-Up) Insurance Program EU 21 70 01 15 Cap On Losses From Certified Acts Of Terrorism EU 70 00 09 22 Commercial Excess/Umbrella Liability Coverage EU 70 03 09 12 California Changes - Cancellation And Nonrenewal EU 70 17 12 04 Contractors Limitation Endorsement EU 70 82 01 20 Total Pollution Exclusion EU 89 01 10 14 Page 1 of 2 05/13/2024A0195129 Middlesex Insurance Company 00001 0000000000 24134 0 N1 ab7c6100-5ad5-4eaa-aa4a-1f4221fe9090ab7c6100-5ad5-4eaa-aa4a-1f4221fe9090 POLICY NUMBER:A0195129005 Page 2 of 2 EU 89 01 10 14 05/13/2024A0195129 Middlesex Insurance Company APPLICABLE FORMS AND ENDORSEMENTS Form/Endorsement Form/Endorsement Title Number and Edition Date EU 70 89 05 14 Exclusion - Access Or Disclosure Of Confidential Or Personal Information And Data Related Activity EU 71 04 03 18 Non-Cumulation Of Limits EU 71 06 07 20 Continuous Or Progressive Injury Or Damage Limitation EU 71 38 09 22 Punitive Damages Exclusion IL 09 85 12 20 Disclosure Pursuant To Terrorism Risk Insurance Act IL 80 05 07 16 Exclusion - Infectious Or Communicable Disease Basis of Premium is not subject to audit. PREMIUMS Annual Premium:$64,045.00 SCHEDULE OF UNDERLYING INSURANCE Policy, Insurer and Limits of Liability Commercial General Liability Middlesex Insurance Company A0195129004 Including Products/Completed Operations General Aggregate Limit $ 3,000,000 (Other Than Products/Completed Operations) Products/Completed Operations Aggregate Limit $ 2,000,000 Personal and Advertising Injury Limit $ 1,000,000 Each Occurrence Limit $ 1,000,000 Employee Benefits Each Employee Limit $ 1,000,000 Stop Gap (Employers Liability) Bodily Injury by Accident - Each Accident $ 1,000,000 Bodily Injury by Disease - Each Employee $ 1,000,000 Bodily Injury by Disease - Aggregate Limit $ 3,000,000 Employers Liability Middlesex Insurance Company A0195129006 Bodily Injury by Accident - Each Accident $ 1,000,000 Bodily Injury by Disease - Each Employee $ 1,000,000 Bodily Injury by Disease - Policy Limit $ 1,000,000 Commercial Auto Insurance Middlesex Insurance Company A0195129001 $Each Accident Limit 1,000,000 OPTIONAL COVERAGE ENDORSEMENTS Exclusion - Designated Operations Covered By A Controlled (Wrap-Up) Insurance Program Description and Location(s) of Operation(s): All owner or contractor controlled insurance programs in which you were enrolled or intended to enroll. POLICY NUMBER:COMMERCIAL EXCESS/UMBRELLA LIABILITY EU 21 54 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION - DESIGNATED OPERATIONS COVERED BY A CONTROLLED (WRAP-UP) INSURANCE PROGRAM This endorsement modifies the coverage provided under the following: COMMERCIAL EXCESS/UMBRELLA LIABILITY COVERAGE PART SCHEDULE Description And Location(s) Of Operation(s): Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A.The following exclusion is added to Coverage U - Umbrella Liability, Paragraph C. Exclusions of Section I - Coverages: 1.This insurance does not apply to “bodily injury” or “property damage”: a.Arising out of your ongoing operations; or b.Included in the “products-completed operations hazard”; At the location(s) described in the Schedule of this endorsement, but only if you are enrolled in a “controlled (wrap-up) insurance program” with respect to the “bodily injury” or “property damage” described in Paragraphs 1.a. and 1.b. above at such location(s). 2.This exclusion applies whether or not the “controlled (wrap-up) insurance program”: a.Provides coverage identical to that provided by this Coverage Part; b.Has limits adequate to cover all claims; or c.Remains in effect. B.This following definition is added to the Definitions section: “Controlled (wrap-up) insurance program” means a centralized insurance program under which one party has secured either insurance or self-insurance covering some or all of the contractors or subcontractors performing work on one or more specific project(s). Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1EU 21 54 12 19 05/13/2024A0195129 Middlesex Insurance Company 00001 0000000000 24134 0 N1 639cc491-aa41-46ba-88f9-3ec4c94ebe72639cc491-aa41-46ba-88f9-3ec4c94ebe72 Page 1 of 1EU 21 70 01 15 05/13/2024A0195129 Middlesex Insurance Company COMMERCIAL EXCESS/UMBRELLA LIABILITY EU 21 70 01 15 CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM This endorsement modifies insurance provided under the following: COMMERCIAL EXCESS/UMBRELLA LIABILITY COVERAGE PART A.If aggregate insured losses attributable to terrorist acts certified under the federal Terrorism Risk Insurance Act exceed $100 billion in a calendar year and we have met our insurer deductible under the Terrorism Risk Insurance Act, we shall not be liable for the payment of any portion of the amount of such losses that exceeds $100 billion, and in such case insured losses up to that amount are subject to pro rata allocation in accordance with procedures established by the Secretary of the Treasury. "Certified act of terrorism" means an act that is certified by the Secretary of the Treasury, in accordance with the provisions of the federal Terrorism Risk Insurance Act, to be an act of terrorism pursuant to such Act. The criteria contained in the Terrorism Risk Insurance Act for a "certified act of terrorism" include the following: 1.The act resulted in insured losses in excess of $5 million in the aggregate, attributable to all types of insurance subject to the Terrorism Risk Insurance Act; and 2.The act is a violent act or an act that is dangerous to human life, property or infrastructure and is 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. B.The terms and limitations of any terrorism exclusion, or the inapplicability or omission of a terrorism exclusion, do not serve to create coverage for injury or damage that is otherwise excluded under this Coverage Part. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 00001 0000000000 24134 0 N1 1fd0220b-aea3-4535-9ffd-545a5f01478a1fd0220b-aea3-4535-9ffd-545a5f01478a A0195129 Middlesex Insurance Company 05/13/2024 6c5cd353-b0fb-4abe-8396-a4db5bc2124b COMMERCIAL EXCESS/UMBRELLA LIABILITY COVERAGE EU 70 00 09 22 COMMERCIAL EXCESS/UMBRELLA LIABILITY COVERAGE Various provisions of this policy restrict coverage. Read the entire policy carefully to determine rights, duties and what is and is not covered. Throughout this policy the words "you" and "your" refer to the Named Insured shown in the Declarations, and any other person qualifying as a Named Insured under this policy. The words "we", "us" and "our" refer to the company providing this insurance. The word "insured" means any person or organization qualifying as such under Section II - Who Is An Insured. Other words and phrases that appear in quotation marks have special meaning. Refer to Section V - Definitions. Section I - Coverages Coverage E - Excess Liability A.Insuring Agreement 1.We will pay on behalf of the insured the "ultimate net loss" in excess of "underlying insurance" because of: a."Bodily injury"; b."Property damage"; c."Personal and advertising injury"; or d."Error or omission" to which this insurance applies. 2.This insurance applies to "bodily injury", "property damage", "personal and advertising injury" and "error or omission" only if: a.Caused by an "occurrence"; b.The "bodily injury", "property damage", "personal and advertising injury" or "error or omission" occurs during the policy period; and c."Underlying insurance" applies. 3.This insurance is subject to the same terms, conditions, agreements, exclusions and definitions as the "underlying insurance" except: a.We will have no obligation under this insurance with respect to any claim that is settled without our consent; and b.With respect to any provisions to the contrary contained in this insurance. 4.We will be liable only for "ultimate net loss" resulting from any one "occurrence" in excess of: a.The applicable limits of liability of the "underlying insurance" as stated in the Declarations; or b.The limits of "underlying insurance" that have been reduced or exhausted by payment of loss. 5.The amount we will pay for the "ultimate net loss" is limited as described in Section III - Limits of Insurance. 6.We will have no other obligation or liability to pay sums or perform acts or services unless such obligation or liability is explicitly provided for under Coverage E Defense or Supplementary Payments - Coverage E & U. B.Defense 1.When the limits of the "underlying insurance" have been used up in the payment of judgments or settlements, we will have the: a.Right and duty to defend the insured against any "suit"; or b.Right, at our discretion, to investigate and settle any claim to which this insurance applies. 2.When the limits of "underlying insurance" have not been used up in the payment of judgments or settlements, but the claim or "suit" is likely to involve us, we will have the right and shall be given the opportunity to associate with the insured and the insured's "underlying insurer" in the investigation or settlement of a claim or defense of a "suit". 3.We will have no duty to defend any insured against any "suit": a.Seeking damages to which this insurance does not apply; or b.After the applicable Limit of Insurance of this Coverage Part has been used up in the payment of judgments or settlements. C.Exclusions This insurance does not apply to: 1.No Underlying Insurance "Bodily injury", "property damage", "personal and advertising injury" or "error or omission" to which "underlying insurance" does not apply for any reason other than the exhaustion of "underlying insurance" limits of liability. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 19EU 70 00 09 22 A0195129 Middlesex Insurance Company 05/13/2024 6c5cd353-b0fb-4abe-8396-a4db5bc2124b 2.Unscheduled Underlying Insurance Except as provided in the definition of "underlying insurance", any injury, damage, loss, cost or expense to which "underlying insurance" applies if the injury, damage, loss, cost or expense is the subject of a separate limit of liability which is not stated in the Declarations of this Coverage Part under the schedule of "underlying insurance". 3.Pollution a."Bodily injury", "property damage", "personal and advertising injury" or "error or omission" which would not have occurred in whole or in part but for the actual, alleged or threatened discharge, dispersal, seepage, migration, release or escape of "pollutants" at any time. This exclusion does not apply: (1)To "bodily injury" if sustained within a building which is or was at any time owned or occupied by, or rented or loaned to, any insured and caused by smoke, fumes, vapor or soot produced by or originating from equipment that is used to heat, cool or dehumidify the building, or equipment that is used to heat water for personal use, by the building's occupants or their guests; (2)To "bodily injury" or "property damage" arising out of heat, smoke or fumes from a "hostile fire"; or (3)To "bodily injury" to any "employee" of the insured arising out of and in the course of: (a)Employment by the insured; or (b)Performing duties related to the conduct of the insured's business. b.Any loss, cost or expense arising out of any: (1)Request, demand, order or statutory or regulatory requirement that any insured or others test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of, "pollutants"; or (2)Claim or "suit" by or on behalf of a governmental authority for damage because of testing for, monitoring, cleaning up, removing, containing, treating, detoxifying or neutralizing, or in any way responding to, or assessing the effects of, "pollutants". c.This Pollution Exclusion applies whether or not: (1)Such irritant or contaminant is "your product" or has any function in your business, operations, premises, site or location; or (2)The "bodily injury", "property damage", "personal and advertising injury" or "error or omission" arises from environmental damage or pollution of the environment. This exclusion applies to all "bodily injury", "property damage", "personal and advertising injury" or "error or omission" within the scope of this exclusion, including, for example and without limitation, from exposure to "pollutants" within a residential or commercial building or from discharges of "pollutants" from "your product". 4.Asbestos a."Bodily injury", "property damage", "personal and advertising injury" or "error or omission" caused in whole or in part by the actual, alleged or threatened: (1)Inhalation of, ingestion of or physical exposure to "asbestos"; (2)Use of "asbestos" in construction or manufacture of any goods, products or structures; (3)Removal of "asbestos" from any goods, products or structures; (4)Manufacture, sale, transport, storage or disposal of "asbestos"; or (5)Discharge, dispersal, seepage, migration, release or escape of "asbestos". b.Any loss, cost or expense arising out of any: (1)Request, demand, order or statutory or regulatory requirement that any insured or others test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of, "asbestos"; or (2)Claim or "suit" by or on behalf of a governmental authority for damages because of testing for, monitoring, cleaning up, removing, containing, treating, detoxifying or neutralizing, or in any way responding to, or assessing the effects of, "asbestos". 5.Employment-related Practices "Bodily injury" or "personal and advertising injury" to: a.A person arising out of any: (1)Refusal to employ that person; (2)Termination of that person's employment; or Includes copyrighted material of Insurance Services Office, Inc., with its permission. EU 70 00 09 22Page 2 of 19 A0195129 Middlesex Insurance Company 05/13/2024 6c5cd353-b0fb-4abe-8396-a4db5bc2124b (3)Employment-related practices, poli- cies, acts or omissions, such as co- ercion, demotion, evaluation, reas- signment, discipline, defamation, harassment, humiliation, discrimina- tion or malicious prosecution di- rected at that person; or b.The spouse, child, parent, brother or sister of that person as a consequence of "bodily injury" or "personal and advertising injury" to that person at whom any of the employment-related practices described in Paragraph a. (1), a. (2) or a. (3) above is directed. c.This exclusion applies: (1)Whether the injury-causing event described in Paragraphs a. (1), a. (2) or a. (3) above occurs before employment, during employment or after employment of that person; (2)Whether the insured may be liable as an employer or in any other capacity; and (3)To any obligation to share damages with or repay someone else who must pay damages because of the injury. 6.Damage To Your Work "Property damage" to "your work" arising out of it or any part of it and included in the "products-completed operations hazard". This exclusion does not apply if the damaged work or the work out of which the damage arises was performed on your behalf by a subcontractor. 7.Laws Any liability or obligation for which the insured or the insured's "underlying insurer" may be held liable under: a.Workers' Compensation, disability ben- efits or unemployment compensation law; b.The Employee's Retirement Income Security Act (E.R.I.S.A.), and any amendments thereto; c.Any "auto" no-fault, personal injury protection or uninsured or underinsured motorist law; or d.Any federal, state or local odometer law, auto damage disclosure law, used car disclosure law or aftermarket parts disclosure law; e.Any federal, state or local truth in lend- ing, truth in leasing, consumer credit protection or consumer leasing law; or f.Any other similar federal, state or local law. 8.Title Paper Preparation Liability arising out of any negligent act, omission or other error in "title paper preparation". Coverage U - Umbrella Liability A.Insuring Agreement 1.We will pay on behalf of the insured the "ultimate net loss" in excess of the Retained Limit stated in the Declarations because of "bodily injury" or "property damage" to which this insurance applies. 2.This insurance applies to "bodily injury" and "property damage" only if: a.Caused by an "occurrence" anywhere in the world; b.The "bodily injury" or "property damage" occurs during the policy period; c."Underlying insurance" does not apply; and d.Prior to the policy period, no insured listed under Paragraph A.1. of Section II - Who Is An Insured Coverage U - Umbrella Liability and no "employee" authorized by you to give or receive notice of an "occurrence" or claim, knew that the "bodily injury" or "property damage" had occurred in whole or in part. If such a listed insured or authorized "employee" knew prior to the policy period, that the "bodily injury" or "property damage" occurred, then any continuation, change or resumption of such "bodily injury" or "property damage" during or after the policy period will be deemed to have been known prior to the policy period. 3."Bodily injury" or "property damage" which occurs during the policy period and was not, prior to the policy period, known to have occurred by any insured listed under Paragraph A.1. of Section II - Who Is An Insured Coverage U -Umbrella Liability or any "employee" authorized by you to give or receive notice of an "occurrence" or claim, includes any continuation, change or resumption of that "bodily injury" or "property damage" after the end of the policy period. 4."Bodily injury" or "property damage" will be deemed to have been known to have occurred at the earliest time when any insured listed under Paragraph A.1. of Section II - Who Is An Insured Coverage U - Umbrella Liability or any "employee" authorized by you to give or receive notice of an "occurrence" or claim: a.Reports all, or any part, of the "bodily injury" or "property damage" to us or any other insurer; Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 3 of 19EU 70 00 09 22 A0195129 Middlesex Insurance Company 05/13/2024 6c5cd353-b0fb-4abe-8396-a4db5bc2124b b.Receives a written or verbal demand or claim for damages because of the "bodily injury" or "property damage"; or c.Becomes aware by any other means that "bodily injury" or "property damage" has occurred or has begun to occur. 5.The amount we pay for the "ultimate net loss" is limited as described in Section III - Limits of Insurance. 6.No other obligation or liability to pay sums or perform acts is covered unless explicitly provided for under Coverage U Defense or Supplementary Payments - Coverage E and U. B.Defense 1.In the absence of "underlying insurance", we will have the: a.Right and duty to defend the insured against any "suit"; or b.Right, at our discretion, to investigate and settle any claim to which this insurance applies. 2.We will have no duty to defend any insured against any "suit": a.Seeking damages to which this insurance does not apply; or b.After the applicable Limit of Insurance of this Coverage Part has been used up in the payment of judgments or settlements. C.Exclusions This insurance does not apply to: 1.Expected Or Intended "Bodily injury" or "property damage" expected or intended from the standpoint of the insured. This exclusion does not apply to "bodily injury" or "property damage" resulting from the use of reasonable force to protect persons or property. 2.Contractual Liability Damages which the insured is obligated to pay by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability that the insured would have in the absence of the contract or agreement. 3.Liquor Liability "Bodily injury" or "property damages" for which any insured may be held liable by reason of: (1)Causing or contributing to the intoxication of any person; (2)The furnishing of alcoholic beverages to a person under the legal drinking age or under the influence of alcohol; or (3)Any statute, ordinance or regulation relating to the sale, gift, distribution or use of alcoholic beverages. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in: (a)The supervision, hiring, employment, training or monitoring of others by that insured; or (b)Providing or failing to provide transportation with respect to any person that may be under the influence of alcohol; if the "occurrence" which caused the "bodily injury" or "property damage" involved that which is described in Paragraph (1), (2) or (3) above. This exclusion applies only if you are in the business of manufacturing, distributing, selling, serving or furnishing alcoholic beverages. For the purposes of this exclusion, permitting a person to bring alcoholic beverages on your premises, whether or not a fee is charged or a license is required for such activity, is not by itself considered the business of selling, serving or furnishing alcoholic beverages. 4.Employers Liability "Bodily injury" to: a.An "employee" or "temporary worker" of the insured arising out of and in the course of: (1)Employment by the insured; or (2)Performing duties related to the conduct of the insured's business; or b.The spouse, child, parent, brother or sister of that "employee" or "temporary worker" as a consequence of Paragraph a. above. This exclusion applies whether the insured may be liable as an employer or in any other capacity and to any obligation to share damages with or repay someone else who must pay damages because of the injury. 5.Auto "Bodily injury" or "property damage" arising out of the ownership, maintenance, use or entrustment to others of any "auto" rented or loaned to any insured within the United States (including its territories and possessions), Puerto Rico, Canada and Mexico. Use includes operation and "loading and unloading". This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage" involved the ownership, maintenance, use or entrustment to others of any "auto" rented or loaned to any insured. Includes copyrighted material of Insurance Services Office, Inc., with its permission. EU 70 00 09 22Page 4 of 19 A0195129 Middlesex Insurance Company 05/13/2024 6c5cd353-b0fb-4abe-8396-a4db5bc2124b 6.Aircraft Or Watercraft "Bodily injury" or "property damage" arising out of the ownership, maintenance, use or entrustment to others of any aircraft or watercraft owned or operated by or rented or loaned to any insured. Use includes operation and "loading and unloading". This exclusion does not apply to an aircraft that is: a.Chartered by, loaned to, or hired by you with a paid crew; and b.Not owned by any insured. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage" involved the ownership, maintenance, use or entrustment to others of an aircraft or watercraft that is owned or operated by or rented or loaned to any insured. 7.Damage To Property "Property damage" to: a.Property you own, rent or occupy, including any costs or expenses incurred by you or any other person, organization or entity for repair, replacement, enhancement, restoration or maintenance of such property for any reason, including prevention of injury to a person or damage to another's property; b.Property loaned to you; c.Personal property in the care, custody or control of the insured; d.That particular part of real property on which you or any contractors or subcontractors working directly or indirectly on your behalf are performing operations, if the "property damage" arises out of those operations; or e.That particular part of any property that must be restored, repaired or replaced because "your work" was incorrectly performed on it. 8.Damage To Your Product "Property damage" to "your product" arising out of it or any part of it. 9.Damage To Impaired Property Or Property Not Physically Injured "Property damage" to "impaired property" or property that has not been physically injured, arising out of: a.A defect, deficiency, inadequacy or dangerous condition in "your product" or "your work"; or b.A delay or failure by you or anyone acting on your behalf to perform a contract or agreement in accordance with its terms. 10.Recall Of Products, Work Or Impaired Property Damages claimed for any loss, cost or expense incurred by you or others for the loss of use, withdrawal, recall, inspection, repair, replacement, adjustment, removal or disposal of: a."Your product"; b."Your work"; or c."Impaired property"; if such product, work, or property is withdrawn or recalled from the market or from use by any person or organization because of a known or suspected defect, deficiency, inadequacy or dangerous condition in it. 11.Personal And Advertising Injury "Personal and advertising injury". 12.Excess Liability Any damages or expenses to which Coverage E. applies. 13.Electronic Year Recognition "Bodily injury" or "property damage" arising directly or indirectly out of: a.Any actual or alleged failure, malfunction or inadequacy of: (1)Any of the following, whether belonging to any insured or to others: (a)Computer hardware, including microprocessors; (b)Computer application hardware; (c)Computer operating systems and related software; (d)Computer networks; (e)Microprocessors (computer chips) not part of any computer system; or (f)Any other computerized or electronic equipment or components; or (2)Any other products, and any services, data or functions that directly or indirectly use or rely upon, in any manner, any of the items listed in Paragraph a.(1) above; due to the inability to correctly recognize, process, distinguish, interpret or accept any calendar date or time of day. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 5 of 19EU 70 00 09 22 A0195129 Middlesex Insurance Company 05/13/2024 6c5cd353-b0fb-4abe-8396-a4db5bc2124b b.Any advice, consultation, design, evaluation, inspection, installation, maintenance, repair, replacement or supervision provided or done by you or for you to determine, rectify or test for, any potential or actual problems described in Paragraph a. of this exclusion. 14.Products-Completed Operations Hazard "Bodily injury" or "property damage" included within the "products-completed operations hazard". 15.Employee Benefits Damages arising out of the "administration" of "employee benefits". 16.Professional Services "Bodily injury" or "property damage" due to the rendering or failure to render any professional service, including but not limited to: a.Legal, accounting or advertising services; b.Preparing, approving, or failing to prepare or approve maps, drawings, opinions, reports, surveys, change orders, designs or specifications; c.Electronic data processing, computer consulting, computer programming or computer software services, advice or instruction; d.Supervisory, inspection or engineering services; e.Medical, surgical, dental, x-ray or nursing services; f.Any health or therapeutic service, treatment, advice or instruction; g.Any service, treatment, advice or instruction for the purpose of appearance or skin enhancement, hair removal or replacement or personal grooming or therapy; h.Optometry or optical or hearing aid services including the prescribing, preparation, fitting, demonstration or distribution of ophthalmic lenses and similar products or hearing aid services; i.Body piercing services; j.Services in the practice of pharmacy; k.Law enforcement or firefighting services; and l.Handling, embalming, disposal, burial, cremation or disinterment of dead bodies. m.Any insured's activities as an "insurance agent"; n.Floral Design Schools; o.Wedding Planning; p.Any service, treatment, advice or instruction relating to physical fitness, including service, treatment, advice or instruction in connection with diet, cardiovascular fitness, bodybuilding or physical training programs. 17.War "Bodily injury" or "property damage", however caused, arising directly or indirectly out of: a.War, including undeclared or civil war; b.Warlike action by a military force, including action in hindering or defending against an actual or expected attack, by any government, sovereign or other authority using military personnel or other agents; or c.Insurrection, rebellion, revolution, usurped power, or action taken by governmental authority in hindering or defending against any of these. 18.Electronic Data Damages arising out of the loss of, loss of use of, damage to, corruption of, inability to access, or inability to manipulate "electronic data". 19.Fungi Or Bacteria a."Bodily injury" or "property damage" which would not have occurred, in whole or in part, but for the actual, alleged or threatened inhalation of, ingestion of, contact with, exposure to, existence of, or presence of, any "fungi" or bacteria on or within a building or structure, including its contents, regardless of whether any other cause, event, material or product contributed concurrently or in any sequence to such injury or damage. b.Any loss, cost or expenses arising out of the abating, testing for, monitoring, cleaning up, removing, containing, treating, detoxifying, neutralizing, remediating or disposing of, or in any way responding to, or assessing the effects of "fungi" or bacteria, by any insured or by any other person or entity. 20.Racing Activities "Bodily injury" or "property damage" arising out of the sponsorship or use of "all-terrain vehicles", "mobile equipment", snowmobiles, motorcycles, watercraft or "autos" in, or while in practice for or while being prepared for, any prearranged professional or organized racing, speed, demolition, or stunting activity or contest. Includes copyrighted material of Insurance Services Office, Inc., with its permission. EU 70 00 09 22Page 6 of 19 A0195129 Middlesex Insurance Company 05/13/2024 6c5cd353-b0fb-4abe-8396-a4db5bc2124b 21.Pollution a."Bodily injury" or "property damage", which would not have occurred in whole or in part but for the actual, alleged or threatened discharge, dispersal, seepage, migration, release or escape of "pollutants" at any time. b.Any loss, cost or expense arising out of any: (1)Request, demand, order or statutory or regulatory requirement that any insured or others test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of "pollutants"; or (2)Claims or "suit" by or on behalf of a governmental authority for damages because of testing for, monitoring, cleaning up, removing, containing, treating, detoxifying or neutralizing, or in any way responding to or assessing the effects of, "pollutants". c.This Pollution Exclusion applies whether or not: (1)Such irritant or contaminant is "your product" or has any function in your business, operations, premises, site or location; or (2)The "bodily injury" or "property damage" arises from environmental damage or pollution of the environment. This exclusion applies to all "bodily injury" and "property damage" within the scope of this exclusion, including, for example and without limitation, from exposure to "pollutants" within a residential or commercial building or from discharges of "pollutants" from "your product". 22.Asbestos a."Bodily injury" or "property damage" caused in whole or in part by the actual, alleged or threatened: (1)Inhalation of, ingestion of or physical exposure to "asbestos"; (2)Use of "asbestos" in construction or manufacture of any goods, products or structures; (3)Removal of "asbestos" from any goods, products or structures; (4)Manufacture, sale, transport, storage or disposal of "asbestos"; or (5)Discharge, dispersal, seepage, migration, release or escape of "asbestos". b.Any loss, cost or expense arising out of any: (1)Request, demand, order or statutory or regulatory requirement that any insured or others test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of, "asbestos", or (2)Claim or "suit" by or on behalf of a governmental authority for damages because of testing for, monitoring, cleaning up, removing, containing, treating, detoxifying or neutralizing, or in any way responding to, or assessing the effects of, "asbestos". 23.Employment-related Practices "Bodily injury" to: a.A person arising out of any: (1)Refusal to employ that person; (2)Termination of that person's employment; or (3)Employment-related practices, policies, acts or omissions, such as coercion, demotion, evaluation, reassignment, discipline, defamation, harassment, humiliation, discrimination, malicious prosecution or wrongful termination directed at that person; or b.The spouse, child, parent, brother or sister of that person as a consequence of "bodily injury" to that person at whom any of the employment-related practices described in Paragraph a. (1), a. (2) or a. (3) above is directed. c.This exclusion applies: (1)Whether the injury-causing event described in Paragraphs a. (1), a. (2) or a. (3) above occurs before employment, during employment or after employment of that person: (2)Whether the insured may be liable as an employer or in any other capacity; and (3)To any obligation to share damages with or repay someone else who must pay damages because of the injury. 24.Laws Any liability or obligation for which the insured may be held liable under: a.Workers' Compensation, disability benefits or unemployment compensation law; b.The Employee's Retirement Income Security Act (E.R.I.S.A.), and any amendments thereto; c.Any "auto" no-fault, personal injury protection or uninsured or underinsured motorist law; Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 7 of 19EU 70 00 09 22 A0195129 Middlesex Insurance Company 05/13/2024 6c5cd353-b0fb-4abe-8396-a4db5bc2124b d.Any federal, state or local odometer law, auto damage disclosure law, used car disclosure law or aftermarket parts disclosure law; e.Any federal, state or local truth in lending, truth in leasing or consumer leasing law; f.Recording and distribution of material or information in violation of: (1)The Telephone Consumer Protection Act (TCPA), including any amendment of or addition to such law; (2)The CAN-SPAM Act of 2003, including any amendment of or addition to such law; or (3)Any statute, ordinance or regulation, other than the TCPA or CAN-SPAM Act of 2003, that prohibits or limits the sending or transmitting, communicating, or distribution of material or information; (4)The Fair Credit Reporting Act (FCRA), including any amendment of or addition to such law, including the Fair and Accurate Credit Transaction Act (FACTA); (5)The Fair Debt Collection Practices Act (FDCPA), including any amendment of or addition to such law; or (6)Any federal, state or local statute, ordinance or regulation other than TCPA, CAN-SPAM Act of 2003, FCRA or FDCPA and their amendments and additions, that addresses, prohibits or limits the printing, dissemination, disposal, collecting, recording, sending, transmitting, communicating or distribution of material or information; or g.Any other similar federal, state or local law. 25.All-Terrain Vehicle "Bodily injury" or "property damage" arising out of the ownership, maintenance or use, lease, rental or entrustment to others of any " all-terrain vehicle", utility task vehicle, snowmobile, miniature motorcycle (also known as a mini-bike or pocket bike), motorcycle (designed for off public road use) or other vehicle designed for use off public roads and paved surfaces that is owned or operated by or rented or loaned to any insured. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by the insured if the "occurrence" which caused the "bodily injury" or "property damage" involved in the ownership, maintenance or use, lease, rental or entrustment to others of an "all-terrain vehicle", utility task vehicle, snowmobile, miniature motorcycle (also known as a mini-bike or pocket bike) or motorcycle (designed for off public road use) that is owned or operated by or rented or loaned to any insured. 26.Terrorism "Bodily injury" or "property damage" caused directly or indirectly by "terrorism", including action in hindering or defending against an actual or expected incident of "terrorism". This exclusion applies regardless of any other cause or event that contributes concurrently or in any sequence to such injury or damage. 27.Silica Or Silica-Related Dust a."Bodily injury" arising, in whole or in part, out of the actual, alleged, threatened or suspected inhalation of, or ingestion of, "silica" or "silica-related dust". b."Property damage" arising, in whole or in part, out of the actual, alleged, threatened or suspected contact with, exposure to, existence of, or presence of, "silica" or "silica-related dust". c.Any loss, cost or expense arising, in whole or in part, out of the abating, testing for, monitoring, cleaning up, removing, containing, treating, detoxifying, neutralizing, remediating or disposing of or in any way responding to or assessing the effect of "silica" or "silica-related dust", by any insured or by any other person or entity. 28.Nuclear Energy a.To "bodily injury" or "property damage"; (1)With respect to which an insured under Coverage U is also an insured under a nuclear energy liability policy issued by Nuclear Energy Liability Insurance Association, Mutual Atomic Energy Liability Underwriters, Nuclear Insurance Association of Canada or any of their successors or would be an insured under any such policy but for its termination upon exhaustion of its limit of liability; or (2)Resulting from the "hazardous properties" of "nuclear material" with respect to which: (a)Any person or organization is required to maintain financial protection pursuant to the Atomic Energy Act of 1954, or any law amendatory thereof; or Includes copyrighted material of Insurance Services Office, Inc., with its permission. EU 70 00 09 22Page 8 of 19 A0195129 Middlesex Insurance Company 05/13/2024 6c5cd353-b0fb-4abe-8396-a4db5bc2124b (b)The insured is, or had this policy not been issued would be, entitled to indemnity from the United States of America, or any agency thereof, under any agreement entered into by the United States of America, or any agency thereof, with any person or organization. b.To "bodily injury" or "property damage" resulting from "hazardous properties" of "nuclear material", if: (1)The "nuclear material": (a)Is at any "nuclear facility" owned by or operated by or on behalf of an insured; or (b)Has been discharged or dispersed there from. (2)The "nuclear material" is contained in "spent fuel" or "waste material" at any time possessed, handled, used, processed, stored, transported or disposed of, by or on behalf of an insured; or (3)The "bodily injury" or "property damage" arises out of the furnishing by an insured of services, materials, parts or equipment in connection with the planning, construction, maintenance, operation or use of any "nuclear facility", but if such facility is located within the United States of America, its territories or possessions or Canada, this Exclusion (3) applies only to "property damage" to such "nuclear facility" and any property thereat. Supplementary Payments - Coverage E and U 1.When we have the duty to defend, we will pay, with respect to any claim we investigate or settle, or any "suit" against an insured we defend: a.All expenses we incur. b.Up to $2,000 for the cost of bail bonds (including bonds for related traffic law violations) required because of an "occurrence" we cover. We do not have to furnish these bonds. c.The cost of bonds to release attachments, but only for bond amounts within the applicable limit of insurance. We do not have to furnish these bonds. d.All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or "suit" including actual loss of earnings up to $300 a day because of time off from work. e.All court costs taxed against the insured in the "suit". However, these payments do not include attorneys' fees or attorneys' expenses taxed against the insured. f.Prejudgment interest awarded against the insured on that part of the judgment we pay. If we make an offer to pay the applicable limit of insurance, we will not pay any prejudgment interest based on that period of time after the offer. g.All interest on the full amount of any judgment that accrues after entry of the judgment and before we have paid, offered to pay, or deposited in court the part of the judgment that is within the applicable limit of insurance. 2.When we have the right but not the duty to defend the insured and elect to participate in the defense, we will pay our own expenses but will not contribute to the expenses of the insured or the "underlying insurer". 3.These payments will not reduce the limits of insurance. 4.Under Coverage U, these payments are not subject to the Retained Limit stated in the Declarations. Section II - Who Is An Insured The following persons or organizations are insureds under this Coverage Part. Coverage E - Excess Liability A.The Named insured shown in the Declarations; and B.Any person or organization who is an insured or an additional insured in the "underlying insurance", but only to the extent the "underlying insurance" applies. If coverage provided to an additional insured is required by contract or agreement, the most we will pay on behalf of the additional insured is the lesser of the amount payable under Section III - Limits of Insurance or the amount of insurance required by the contract or agreement, less any amount payable by "underlying insurance". Coverage U - Umbrella Liability A.Except for liability arising out of the ownership, maintenance or use of an "auto": 1.If you are designated in the Declarations as: a.An Individual, you and your spouse are insureds, but only with respect to the conduct of a business of which you are the sole owner. b.A Partnership or Joint Venture, you are an insured. Your members, your partners, and their spouses are also insureds, but only with respect to the conduct of your business. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 9 of 19EU 70 00 09 22 A0195129 Middlesex Insurance Company 05/13/2024 6c5cd353-b0fb-4abe-8396-a4db5bc2124b c.A Limited Liability Company, you are an insured. Your members are also insureds, but only with respect to the conduct of your business. Your managers are insureds, but only with respect to their duties as your managers. d.An organization other than a Partnership, Joint Venture or Limited Liability Company, you are an insured. Your "executive officers" and directors are insureds, but only with respect to their duties as your officers or directors. Your stockholders are also insureds, but only with respect to their liability as stockholders. e.A trust, you are an insured. Your trustees are also insureds, but only with respect to their duties as trustees. 2.Each of the following is also an insured: a.Your "volunteer workers" only while performing duties related to the conduct of your business, your "employees", other than either your "executive officers" (if you are an organization other than a Partnership, Joint Venture or Limited Liability Company) or your managers (if you are a Limited Liability Company), but only for acts within the scope of their employment by you or while performing duties related to the conduct of your business. However, none of these "employees" or "volunteer workers" are an insured for: (1)"Bodily injury": (a)To you, to your partners or members (if you are a partnership or joint venture), to your members (if you are a limited liability company), to a co-"employee" in the course of his or her employment or performing duties related to the conduct of your business or to your other "volunteer workers" while performing duties related to the conduct of your business; (b)To the spouse, child, parent, brother or sister of that co-"employee" or "volunteer worker" as a consequence of Paragraph (1)(a) above; (c)For which there is any obligation to share damages with or repay someone else who must pay damages because of the injury described in Paragraphs (1)(a) or (b) above; or (d)Arising out of his or her providing or failing to provide professional health care services. (2)"Property damage" to property: (a)Owned, occupied or used by; (b)Rented to, in the care, custody or control of, or over which physical control is being exercised for any purpose by You, any of your "employees", "volunteer workers", any partner or member (if you are a Partnership or Joint Venture), or any member (if you are a Limited Liability Company). b.Any person (other than your "employees" or "volunteer worker"), or any organization while acting as your real estate manager. c.Any person or organization having proper temporary custody of your property if you die, but only: (1)With respect to liability arising out of the maintenance or use of that property; and (2)Until your legal representative has been appointed. d.Your legal representative if you die, but only with respect to duties as such. That representative will have all your rights and duties under this Coverage Part. 3.Any organization you newly acquire or form, other than a Partnership, Joint Venture or Limited Liability Company, and over which you maintain ownership or majority interest, will qualify as a Named Insured if there is no other similar insurance available to the organization. However: a.Coverage under this provision is afforded only until the 90th day after you acquire or form the organization or the end of the policy period, whichever is earlier; and b.Coverage does not apply to "bodily injury", "property damage" or ªpersonal and advertising injuryº that occurred before you acquired or formed the organization. B.Only with respect to liability arising out of the ownership, maintenance or use of an "auto": 1.You are an insured. 2.Anyone else while using with your permission an "auto" you own, hire or borrow is also an insured except: a.The owner or anyone else from whom you hire or borrow an "auto". This exception does not apply if the "auto" is a trailer or semi-trailer connected to an "auto" you own. b.Your "employee" if the "auto" is owned by that "employee" or a member of his or her household. Includes copyrighted material of Insurance Services Office, Inc., with its permission. EU 70 00 09 22Page 10 of 19 A0195129 Middlesex Insurance Company 05/13/2024 6c5cd353-b0fb-4abe-8396-a4db5bc2124b Includes copyrighted material of Insurance Services Office, Inc., with its permission. c.Someone using an "auto" while he or she is working in a business of selling, servicing, repairing, parking or storing "autos" unless that business is yours. d.Anyone other than your "employees", partners (if you are a Partnership) or a member (if you are a Limited Liability Company), or a lessee or borrower or any of their "employees", while moving property to or from an "auto". e.A partner (if you are a Partnership), or a member (if you are a Limited Liability Company) for an "auto" owned by him or her or a member of his or her family. f."Employees" with respect to "bodily injury" to any fellow "employee" of the insured arising out of and in the course of the fellow "employee's" employment or while performing duties related to the conduct of your business. 3.Anyone liable for the conduct of an insured described in Paragraphs B.1. and 2. above is also an insured, but only to the extent of that liability. No person or organization is an insured with respect to the conduct of any current or past Partnership, Joint Venture or Limited Liability Company that is not shown as a Named Insured in the Declarations. Section III - Limits Of Insurance A.The Limits of Insurance shown in the Declarations and the rules below fix the most we will pay under Coverages E and U combined, regardless of the number of: 1.Insureds; 2.Coverage provided by this Coverage Part; 3.Claims made, "suits" brought, or number of vehicles or watercraft involved; or 4.Persons or organizations making claims or bringing "suits". B.The General Aggregate Limit is the most we will pay for the sum of all "ultimate net loss" under Coverages E and U, except "ultimate net loss" because of "bodily injury" or "property damage": 1.Arising out of the ownership, maintenance, use, "loading or unloading" or entrustment to others of an "auto"; or 2.Included in the "products-completed operations hazard". C.The Products-Completed Operations Aggregate Limit is the most we will pay for the sum of all "ultimate net loss" under Coverage E because of "bodily injury" or "property damage" included in the "products-completed operations hazard". D.Subject to Paragraph B. or Paragraph C. above, whichever applies, the Each Occurrence Limit is the most we will pay for the sum of all "ultimate net loss" under Coverages E and U because of all damages arising out of any one "occurrence". The Aggregate Limits, as described in Paragraphs B. and C. above, apply separately to each consecutive annual period and to any remaining period of less than 12 months, starting with the beginning of the policy period shown in the Declarations, unless the policy period is extended after issuance for an additional period of less than 12 months. In that case, the additional period will be deemed part of the last preceding period for purposes of determining Limits of Insurance. Section IV - Conditions We have no duty to provide coverage under this Coverage Part unless you and any other insured have fully complied with the Conditions contained in this Coverage Part. A.Appeals If the "underlying insurer" or insured elects not to appeal a judgment in excess of the available limit of "underlying insurance" or the retained limit stated in the Declarations, we may do so at our own expense. We will be liable for taxable costs, interest and disbursements. Such appeal does not increase the Limits of Insurance. B.Bankruptcy 1.Bankruptcy Of Insured Bankruptcy or insolvency of the insured or of the insured's estate will not relieve us of our obligations under this Coverage Part. 2.Bankruptcy of Underlying Insurer Bankruptcy of the "underlying insurer" will not relieve us of our obligations under Coverage E. However, this insurance will apply as if the "underlying insurance" were in full effect. C.Duties In The Event Of Occurrence, Claim Or Suit 1.You must see to it that we are notified as soon as practicable of an "occurrence", regardless of the amount, which may result in a claim. To the extent possible, notice should include: a.How, when and where the "occurrence" took place; b.The names and addresses of any injured persons and witnesses; and c.The nature and location of any injury or damage arising out of the "occurrence". 2.If a claim is made or "suit" is brought against any insured, you must: a.Immediately record the specifics of the claim or "suit" and the date received; and Page 11 of 19EU 70 00 09 22 A0195129 Middlesex Insurance Company 05/13/2024 6c5cd353-b0fb-4abe-8396-a4db5bc2124b Includes copyrighted material of Insurance Services Office, Inc., with its permission. b.Notify us as soon as practicable. You must see to it that we receive written notice of the claim or "suit" as soon as practicable. 3.You and any other involved insured must: a.Immediately send us copies of any demands, notices, summonses or legal papers received in connection with the claim or "suit"; b.Authorize us to obtain records and other information; c.Cooperate with us in the investigation or settlement of the claim or defense against the "suit"; and d.Assist us, upon our request, in the enforcement of any right against any person or organization which may be liable to the insured because of injury or damage to which this insurance may also apply. 4.No insured will, except at the insured's own cost, voluntarily make a payment, assume any obligation or incur any expense, other than for first aid, without our consent. D.Expanded Coverage Territory 1.If a "suit" to which this insurance applies is brought outside the United States of America (including its territories and possessions), Puerto Rico or Canada, we will have the right but not the duty to defend the insured against such "suit". In any such case in which we elect not to defend, the insured will at our option and under our supervision: a.Make or cause to be made such investigation and defense as are reasonably necessary; and b.To the extent possible, effect such settlement or settlements as we shall deem proper. We will reimburse the insured, under Supplementary Payments - Coverage E and U for the reasonable cost of such investigation and defense and, within the limits of liability, for the amounts of such authorized settlement. 2.All payments or reimbursements we make for damages because of judgments or settlements will be made in U.S. currency at the prevailing exchange rate at the time the insured became legally obligated to pay such sums. All payments or reimbursements we make for expenses under Supplementary Payments - Coverages E and U will be made in U.S. currency at the prevailing exchange rate at the time the expenses are incurred. 3.Any disputes between you and us as to whether there is coverage under this Coverage Part must be filed in the courts of the United States of America (including its territories and possessions), Puerto Rico or Canada. E.Legal Action Against Us No person or organization has a right under this Coverage Part: 1.To join us as a party or otherwise bring us into a "suit" asking for damages from an insured; or 2.To sue us on this Coverage Part unless all of its terms have been fully complied with. A person or organization may sue us to recover on an agreed settlement or on a final judgment against an insured; but we will not be liable for damages that are not payable under the terms of this Coverage Part or that are in excess of the applicable limit of insurance. An agreed settlement means a settlement and release of liability signed by us, the insured and the claimant or the claimant's legal representative. F.Loss Payable We will have no liability under Coverage E unless and until the insured's "underlying insurer" has become obligated to pay the underlying limit. We will have no liability under Coverage U unless and until the insured has become obligated to pay the retained limit. Such obligation to pay part of the "ultimate net loss" shall have been previously determined by a final settlement or judgment after an actual trial or written agreement between the insured, claimant and us. The first Named Insured shown in the Declarations will promptly reimburse us for any damages we pay which are within the Retained Limit stated in the Declarations. G.Maintenance Of Underlying Insurance - Coverage E - Excess Liability You shall maintain in full force and effect during the term of this Coverage Part all "underlying insurance" stated in the Declarations. In the event you fail to do so: 1.Coverage E will apply only to the extent that it would have been applied if the "underlying insurance" had been maintained as specified; and 2.Coverage U will not fill the "underlying insurance" gap created by your failure to maintain Coverage E "underlying insurance". Failure to reinstate any aggregate limit reduced or exhausted solely by "occurrences" which take place during the term of this Coverage Part shall not be interpreted as failure to maintain the "underlying insurance" in force. EU 70 00 09 22Page 12 of 19 A0195129 Middlesex Insurance Company 05/13/2024 6c5cd353-b0fb-4abe-8396-a4db5bc2124b Includes copyrighted material of Insurance Services Office, Inc., with its permission. H.Other Insurance 1.This insurance is excess over, and shall not contribute with, any other insurance, whether primary, excess, contingent or on any other basis. This condition will not apply to insurance specifically written as excess over this Coverage Part. When this insurance is excess, we will have no duty to defend the insured against any "suit" if any other insurer has a duty to defend the insured against that "suit". If no other insurer defends, we will undertake to do so, but we will be entitled to the insured's rights against those other insurers. 2.When this insurance is excess over other insurance, we will pay only our share of the "ultimate net loss" that exceeds the sum of: a.The total amount that all such other insurance would pay for the loss in the absence of this insurance; and b.The total of all deductible and self-insured amounts under all that other insurance. I.Premium Audit 1.We will compute all premiums for the Coverage Part in accordance with our rules and rates. 2.The premium for this Coverage Part is designated in the Declarations as an Advance Premium or a Flat Charge Premium. a.An Advance Premium is a deposit premium only. At the close of each audit period we will compute the earned premium for that period. Audit premiums are due and payable on notice to the first Named Insured. If the sum of the advance and audit premiums paid for the policy period is greater than the earned premium, we will return the excess to the first Named Insured. b.A Flat Charge Premium is not subject to audit or adjustment. 3.The first Named Insured must keep records of the information we need for premium computation and send us copies at such times as we may request. J.Representations Or Fraud By accepting this policy, you agree: 1.The statements in the Declarations are accurate and complete; 2.Those statements are based upon representations you made to us; 3.We have issued this policy in reliance upon your representations; and 4.This policy is void in any case of fraud by you as it relates to this policy or any claim under this policy. K.Separation Of Insureds Except with respect to Limits of Insurance, and any rights or duties specifically assigned to the first Named Insured, this insurance applies: 1.As if each Named Insured were the only Named Insured; and 2.Separately to each insured against whom claim is made or "suit" is brought. L.Coverage E - Transfer Of Defense When the underlying limits of insurance have been used up in the payment of judgments or settlements, the duty to defend will be transferred to us. We will cooperate in the transfer of control to us of any outstanding claims or "suits" seeking damages to which this insurance applies which would have been covered by the "underlying insurance" had the applicable limit not been used up. M.Transfer Of Rights Of Recovery Against Others To Us If the insured has rights to recover all or part of any payment we have made under this Coverage Part, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request, the insured will bring "suit" or transfer those rights to us and help us to enforce them. Any amounts recovered shall be apportioned in reverse order to payment, as follows: 1.The payer of any amount over and above our payment shall first be reimbursed; 2.We shall be reimbursed for the amount paid hereunder; and 3.Lastly any remainder shall be applied to the interests of those to whom this coverage is excess. Each concerned interest will share expenses of recovery in proportion to the amounts recovered. N.When We Do Not Renew If we decide not to renew this Coverage Part, we will mail or deliver to the first Named Insured shown in the Declarations written notice of the nonrenewal not less than 30 days before the expiration date. If notice is mailed, proof of mailing will be sufficient proof of notice. O.Two Or More Coverage Forms Or Policies Issued By Us If this Coverage Form and any other Coverage Form or policy issued to you by us or any company affiliated with us apply to the same "occurrence", the aggregate maximum Limit of Insurance under all the Coverage Forms or Page 13 of 19EU 70 00 09 22 A0195129 Middlesex Insurance Company 05/13/2024 6c5cd353-b0fb-4abe-8396-a4db5bc2124b policies shall not exceed the highest applicable Limit of Insurance under any one Coverage Form or policy. This condition does not apply to any Coverage Form or policy issued by us or any affiliated company to apply: 1.As "underlying insurance"; or 2.Specifically, as excess insurance over this Coverage Form or policy. Section V - Definitions 1."Administration" means: a.Providing information to "employees", including their dependents and beneficiaries, with respect to eligibility for or scope of "employee benefits"; b.Interpreting "employee benefits"; c.Handling of records in connection with the "employee benefits"; or d.Effecting, continuing or terminating any "employee's" participation in any benefit included in "employee benefits" by you or a person or organization authorized by you to perform such acts. However, "administration" does not include handling payroll deductions. 2."Advertisement" means a notice that is broadcast or published to the general public or specific market segments about your goods, products or services for the purpose of attracting customers or supporters. For the purpose of this definition: a.Notices that are published include material placed on the Internet or on similar electronic means of communication; and b.Regarding web-sites, only that part of a web-site that is about your goods, products or services for the purposes of attracting customers or supporters is considered an advertisement. 3."All-terrain vehicles" means a land motor vehicle whether or not subject to motor vehicle registration: a.With three or four broad, low pressure tires (less than 10 pounds per square inch); b.With a seat to be staddled by the operator and, where applicable, a passenger; c.With handlebars for steering; and d.Designed for off-road use. 4."Asbestos" means not only the natural fibrous mineral forms of impure magnesium silicate, but also any material, goods, product or structure of which it is a part. 5."Auto" means: a.A land motor vehicle, trailer or semitrailer designed for travel on public roads, including attached machinery or equipment; or b.Any other land vehicle that is subject to a compulsory or financial responsibility law or other motor vehicle insurance law in the state where it is licensed or principally garaged. However, "auto" does not include "mobile equipment". 6."Bodily injury" means bodily injury, disability, sickness or disease sustained by a person, including death resulting from any of these at any time. "Bodily injury" includes mental anguish or other mental injury resulting from "bodily injury". Damages because of "bodily injury" include damages claimed by any person or organization for care, loss of services or death resulting at any time from the "bodily injury". 7."Electronic data" means information, facts or programs stored as or on, created or used on, or transmitted to or from computer software, including systems and applications software, hard or floppy disks, CD-ROMS, tapes, drives, cells, data processing devices or any other media which are used with electromagnetically controlled equipment. 8."Employee" includes a "leased worker". "Employee" does not include a "temporary worker" However, with respect to "employee benefits" to which: a.Coverage E may apply, "employee" does not include a "leased worker" or a "temporary worker". b.Coverage U does not apply, "employee" means a person actively employed, formerly employed, on leave of absence, disabled or retired. "Employee" includes a "leased worker" or a "temporary worker". 9."Employee benefits" means: a.Insurance programs for: (1)Group life; (2)Group accident and health; (3)Dental, vision and hearing plans; (4)Flexible Spending Accounts; (5)Social Security and disability benefits; (6)Workers Compensation; and (7)Unemployment. b.Group plans for: (1)Profit sharing; (2)Pension; (3)Employee stock subscription; (4)Employee savings plans; and (5)Employee stock ownership plans. c.Vacation plans, including buy and sell programs; leave of absence programs, including military, maternity, family and civil leave, tuition assistance plans; transportation and health club subsidiaries; and Includes copyrighted material of Insurance Services Office, Inc., with its permission. EU 70 00 09 22Page 14 of 19 A0195129 Middlesex Insurance Company 05/13/2024 6c5cd353-b0fb-4abe-8396-a4db5bc2124b Includes copyrighted material of Insurance Services Office, Inc., with its permission. d.Other similar employee benefits identified by separate endorsement. The above plans must be provided by you and are applicable to your and your "employees". 10."Error or omission" means an act negligently committed in: a.The "administration" of your "employee benefits"; or b.Providing printing and graphic arts services or any other business service c.An insured's activities as an "insurance agent". specifically identified in the Declarations of this Coverage Part under the schedule of "underlying insurance". 11."Executive officer" means a person holding any of the officer positions created by your charter, constitution, by-laws or any other similar governing document. 12."Fungi" means any type or form of fungus, including mold or mildew and any mycotoxins, spores, scents or byproducts produced or released by "fungi". 13."Hazardous properties" includes radioactive, toxic or explosive properties. 14."Hostile fire" means one which becomes uncontrollable or breaks out from where it was intended to be. 15."Impaired property" means tangible property, other than "your products" or "your work" that cannot be used or is less useful because: a.It incorporates "your product" or "your work" that is known or thought to be defective, deficient, inadequate or dangerous; or b.You have failed to fulfill the terms of a contract or agreement. if such property can be restored to use by: a.The repair, replacement, adjustment or removal of "your product" or "your work"; or b.Your fulfilling the terms of the contract or agreement. 16."Insurance agent" means a person or organization duly licensed as an insurance agent, or the equivalent, by the regulatory authority in the state(s) in which you engage in the insurance business, "Insurance agent" does not mean an insurance solicitor, broker or consultant. 17."Leased worker" means a person leased to you by a labor leasing firm under an agreement between you and the labor leasing firm, to perform duties related to the conduct of your business. "Leased worker" does not include a "temporary worker". 18."Loading or unloading" means the handling of property: a.After it is moved from the place where it is accepted for movement into or onto an aircraft, watercraft or "auto"; b.While it is in or on an aircraft, watercraft or "auto"; or c.While it is being moved from an aircraft, watercraft or "auto" to the place where it is finally delivered; but "loading or unloading" does not include the movement of property by means of a mechanical device, other than a hand truck that is not attached to the aircraft, watercraft or "auto". 19."Mobile equipment" means any of the following types of land vehicles, including any attached machinery or equipment; a.Bulldozers, farm machinery, forklifts and other vehicles designed for use principally off public roads; b.Vehicles maintained for use solely on or next to premises you own or rent; c.Vehicles that travel on crawler treads; d.Vehicles, whether self-propelled or not, maintained primarily to provide mobility to permanently mounted: (1)Power cranes, shovels, loaders, diggers or drills; or (2)Road construction or resurfacing equipment such as graders, scrapers or rollers; e.Vehicles not described in Paragraph a., b., c. or d. above that are not self-propelled and are maintained primarily to provide mobility to permanently attached equipment of the following types: (1)Air compressors, pumps and generators, including spraying, welding, building cleaning, geophysical exploration, lighting and well servicing equipment; or (2)Cherry pickers and similar devices used to raise or lower workers; f.Vehicles not described in Paragraphs a., b., c. or d. above maintained primarily for purposes other than the transportation of person or cargo. However, self-propelled vehicles with the following types of permanently attached equipment are not "mobile equipment" but will be considered "autos"; Page 15 of 19EU 70 00 09 22 A0195129 Middlesex Insurance Company 05/13/2024 6c5cd353-b0fb-4abe-8396-a4db5bc2124b Includes copyrighted material of Insurance Services Office, Inc., with its permission. (1)Equipment designed primarily for: (a)Snow removal; (b)Road maintenance, but not construction or resurfacing; or (c)Street cleaning; (2)Cherry pickers and similar devices mounted on automobile or truck chassis and used to raise or lower workers; and (3)Air compressors, pumps and generators, including spraying, welding, building cleaning, geophysical exploration, lighting and well servicing equipment. However, "mobile equipment" does not include any land vehicles that are subject to a compulsory or financial responsibility law or other motor vehicle insurance law in the state where it is licensed or principally garaged. Land vehicles subject to a compulsory or financial responsibility law or other motor vehicle insurance laws are considered "autos". 20."Nuclear facility" means: a.Any "nuclear reactor" b.Any equipment or device designed or used for: (1)Separating the isotopes of uranium or plutonium; (2)Processing or utilizing "spent fuel"; or (3)Handling, processing or packaging "waste material"; c.Any equipment or device used for the processing, fabricating or alloying of "special nuclear material" if at any time the total amount of such material in the custody of the insured at the premises where such equipment or device is located consists of or contains more than 25 grams of plutonium or uranium 233 or any combination thereof or more than 250 grams of uranium 235; d.Any structure, basin, excavation, premises or place prepared or used for the storage or disposal of "waste material"; and includes the site on which any of the foregoing is located, all operations conducted on such site and all premises used for such operations. 21."Nuclear material" means "source material", "special nuclear material" or "by-products material". "Source material", "special nuclear material" and "by-product material" have the meanings given them in the Atomic Energy Act of 1954 or in any law amendatory thereof. 22."Nuclear reactor" means any apparatus designed or used to sustain nuclear fission in a self supporting chain reaction or to contain a critical mass of fissionable material. 23."Occurrence" means: a.With respect to "bodily injury" and "property damage", an accident, including continuous or repeated exposure to substantially the same general harmful conditions. b.With respect to "personal and advertising injury", an offense; and c.With respect to "error or omission", a negligent act. 24."Personal and advertising injury" means injury, including consequential "bodily injury" arising out of one or more of the following offenses: a.False arrest, detention or imprisonment; b.Malicious prosecution; c.The wrongful eviction from, wrongful entry into or invasion of the right of private occupancy of a room, dwelling or premises that a person occupies, committed by or on behalf of its owner, landlord or lessor; d.Oral or written publication, in any manner, of material that slanders or libels a person or organization or disparages a person's or organization's goods, products or services; e.Oral or written publication, in any manner of material that violates a person's right of privacy; f.The use of another's advertising idea in your "advertisement" or g.Infringing upon another's copyright, trade dress or slogan in your "advertisement". 25."Pollutants" means any solid, liquid, gaseous, bacterial, fungal, viral, electromagnetic, thermal, or other substance that is toxic or hazardous, causes irritation to animals, vegetation, or persons, and/or causes contamination to property or the environment, including, but not limited to, smoke, vapor, soot, fumes (including welding fumes, paint fumes, and glue fumes), acids, alkalis, chemicals and waste. Specific examples identified as "pollutants" include, but are not limited to, gasoline, diesel, kerosene, transmission fluid, antifreeze, brake fluid, any other fuel oils, any other motor oils, any other petroleum products, any other lubricants, and any of their additives, derivatives, degradation products, and individual chemical components including, but not limited to, benzene, toluene, ethylbenzene, xylenes, phenanthrene, naphthalene, 2-methyl-naphthalene, trimethylbenzene isomers; carbon monoxide and other exhaust gases; solvents, mineral spirits, adhesives, pesticides, insecticides, herbicides, asbestos, lead, lead based paint, silica, sewage, perfluorooctane sulfonate (PFOS), perfluorooctanoic acid (PFOA), EU 70 00 09 22Page 16 of 19 A0195129 Middlesex Insurance Company 05/13/2024 6c5cd353-b0fb-4abe-8396-a4db5bc2124b Includes copyrighted material of Insurance Services Office, Inc., with its permission. Perfluorobutane sulfonic acid (PFBS), Perfluorobutanesulfonate, Potassium Perfluorobutane Sulfonate, Sodium fluoroacetate, 2,2-Difluoropropane, 1-Chloro-1,1-difluoroethane, 1,1,1,2-Tetrafluoroethane, 1,1,1-Trifluoroethane, 1,1-Difluoroethane, Dichlorodifluoromethane, Trichlorofluoromethane, Chlorodifluoromethane, and 1,1,2-Trichloro-1,2,2-trifluoroethane, and other per- and polyfluoroalkyl substances (PFAS), including, but not limited to, all substances listed on the USEPA Master List of PFAS Substances, which has been available online at: https://comptox.epa.gov/ dashboard/chemical_lists/ pfasmaster, and any of their associated homologues, isomers, salts, esters, alcohols, acids, precursor chemicals, additives, derivatives, degradation products, by-products, and individual chemical components. Solvents include, but are not limited to, tetrachlorethylene or perchloroethylene (PCE), trichloroethylene (TCE), dichloroacetylene, chloroacetylene, 1,1,1-trichloroethane (1,1,1-TCA), 1,1,2-trichloroethane (1,1,2-TCA), 1,4-dioxane, cis-1,2-dichloroethylene (cis-1,2-DCE), trans-1,2-dichloroethylene (trans-1,2-DCE), 1,1-dichloroethylene (1,1-DCE), 1,1-dichloroethane (1,1-DCA), 1,2-dichloroethane (1,2-DCA), acetate, acetylene, vinyl chloride, methylene chloride, methylene chloroform, chloromethane, ethene, ethane, ethanol, formate, glycolate, methane, carbon dioxide, any other dry cleaning chemicals, chlorofluorocarbons, chlorinated hydrocarbons, any other chlorinated solvents, any other halogenated solvents, and any of their additives, derivatives, degradation products, and individual chemical components. Solvents also include naturally occurring metals that dissolve as the result of solvents in the environment, including, but not limited to, arsenic, barium, copper, iron, manganese, magnesium, and selenium. ªPollutantsº also include, but are not limited to, all substances specifically listed, identified or described by one or more of the following references: Agency for Toxic Substance and Disease Registry ToxFAQs Substance Priority List, which has been available online at https://www.atsdr.cdc.gov/SPL, US Environmental Protection Agency EMCI Chemical Reference Complete Index, which has been available online at https://enviro.epa.gov/, United States Environmental Protection Agency, Regional Screening Levels for Chemical Contaminants at Superfund Sites, which has been available online at: https://www.epa.gov/risk/ regional-screening-levels-rsls, the Comprehensive Environmental Response Compensation and Liability Act (CERCLA) Priority List Hazardous Substances, 40 CFR 302.4, Table 302.4 (1997 and all subsequent editions), and/or the Indiana Department of Environmental Management risk based tables, including the 1996 Voluntary Remediation Program Tier II Table, Default Closure Level Tables (2001 and all subsequent editions), Screening Level Tables (2012 and all subsequent editions),which have been available online at https://www.in.gov/idem/cleanups/ resources/technical-guidance-for-cleanups/ idem-screening-and-closure-level-tables/. Waste includes, but is not limited to, material to be recycled, reconditioned or reclaimed. A substance does not lose its character of being a "pollutant" by virtue of having a useful function. 26."Products-completed operations hazard" a.Includes all "bodily injury" and "property damage" occurring away from premises you own or rent and arising out of "your product" or "your work" except: (1)Products that are still in your physical possession; or (2)Work that has not been completed or abandoned. However, "your work" will be deemed completed at the earliest of the following times: (a)When all of the work called for in your contract has been completed. (b)When all of the work to be done at the job site has been completed if your contract calls for work at more than one job site. (c)When that part of the work done at a job site has been put to its intended use by any person or organization other than another contractor or subcontractor working on the same project. Work that may need service, maintenance, correction, repair or replacement, but which is otherwise complete, will be treated as completed. b.Does not include "bodily injury" or "property damage" arising out of: Page 17 of 19EU 70 00 09 22 A0195129 Middlesex Insurance Company 05/13/2024 6c5cd353-b0fb-4abe-8396-a4db5bc2124b EU 70 00 09 22Page 18 of 19 Includes copyrighted material of Insurance Services Office, Inc., with its permission. (1)The transportation of property, unless the injury or damage arises out of a condition in or on a vehicle not owned or operated by you, and that condition was created by the "loading or unloading" of that vehicle by any insured; (2)The existence of tools, uninstalled equipment or abandoned or unused materials; or (3)Products or operations for which the classification on the Declarations of a policy of "underlying insurance" states that products-completed operations are subject to the General Aggregate Limit. 27."Property damage" means: a.Physical injury to tangible property, including all resulting loss of use of that property. All such loss of use shall be deemed to occur at the time of the physical injury that caused it; or b.Loss of use of tangible property that is not physically injured. All such loss of use shall be deemed to occur at the time of the "occurrence" that caused it. "Property damage" includes all forms of radioactive contamination of property. For the purposes of this insurance, "electronic data" is not tangible property. 28."Silica" means silicon dioxide (occurring in crystalline, amorphous and impure forms), silica particles, silica dust or silica compounds. 29."Silica-related dust" means a mixture or combination of silica and other dust or particles. 30."Spent fuel" means any fuel element or fuel component, solid or liquid, which has been used or exposed to radiation in a "nuclear reactor". 31."Suit" means a civil proceeding in which damages because of "bodily injury", "property damage", "personal and advertising injury" or "errors and omissions" to which this insurance applies are alleged. "Suit" includes: a.An arbitration proceeding in which such damages are claimed and to which the insured must submit or does submit with our consent; or b.Any other alternative dispute resolution proceeding in which such damages are claimed and to which the insured submits with our consent or the "underlying insurer's" consent. 32."Temporary worker" means a person who is furnished to you to substitute for a permanent "employee" on leave or to meet seasonal or short-term workload conditions. 33."Terrorism" means activities against persons, organizations, or property of any nature: a.That involve the following or preparation for the following: (1)Use or threat of force or violence; (2)Commission or threat of a dangerous act; or (3)Commission or threat of an act that interferes with or disrupts an electronic, communication, information or mechanical system; and b.When one or both of the following applies: (1)The effect is to intimidate or coerce a government or the civilian population or any segment thereof, or to disrupt any segment of the economy; or (2)It appears that the intent is to intimidate or coerce a government, or to further political, ideological, religious, social or economic objectives or to express (or express opposition to) a philosophy or ideology. 34."Title paper preparation" means the preparation of official title papers for registering an "auto" sold by an insured, including the designation of an lienholder or legal ownder having a financial interest in such "auto". 35."Ultimate net loss" means the total sum, after reduction for recoveries or salvages collectible, that the insured becomes legally obligated to pay as damages by reason of settlement or judgments or any arbitration or other alternative dispute method entered into with our consent. 36."Underlying insurance" means any policies of insurance listed in the Declarations under the schedule of "underlying insurance". "Underlying insurance" that would apply but for the exhaustion of its Limit of Insurance is still considered to be applicable "underlying insurance". 37."Underlying insurer" means any insurer who provides any policy of insurance listed in the Declarations under the schedule of "underlying insurance". A0195129 Middlesex Insurance Company 05/13/2024 6c5cd353-b0fb-4abe-8396-a4db5bc2124b Page 19 of 19EU 70 00 09 22 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 38."Volunteer worker" means a person who is not your "employee" and who donates his or her work and acts at the direction of and within the scope of duties determined by you, and is not paid a fee, salary or other compensation by you or anyone else for their work performed for you. 39."Waste material" means any waste material: a.Containing "by-product material" other than the tailings or wastes produced by the extraction or concentration of uranium or thorium from any ore processed primarily for its "source material" content; and b.Resulting from the operation by any person or organization of any "nuclear facility" included under the first two paragraphs of the definition of "nuclear facility". 40."Your product": a.Means: (1)Any goods or products, other than real property, manufactured, sold, handled, distributed or disposed of by: (a)You; (b)Others trading under your name; or (c)A person or organization whose business or assets you have acquired; and (2)Containers (other than vehicles), materials, parts or equipment furnished in connection with such goods or products. b.Includes: (1)Warranties or representations made at any time with respect to the fitness, quality, durability, performance or use of "your product"; and (2)The providing of or failure to provide warnings or instructions. c.Does not include vending machines or other property rented to or located for the use of others but not sold. 41."Your work": a.Means: (1)Work or operations performed by you or on your behalf; and (2)Materials, parts or equipment furnished in connection with such work or operations. b.Includes: (1)Warranties or representations made at any time with respect to the fitness, quality, durability, performance or use of "your work" and (2)The providing of or failure to provide warnings or instructions. COMMERCIAL EXCESS/UMBRELLA LIABILITY EU 70 03 09 12 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALIFORNIA CHANGES - CANCELLATION AND NONRENEWAL This endorsement modifies insurance provided under the following: COMMERCIAL EXCESS/UMBRELLA LIABILITY COVERAGE PART A.Paragraphs 2. and 3. of the Cancellation Common Policy Condition are replaced by the following: 2.All Policies In Effect For 60 Days Or Less If this policy has been in effect for 60 days or less, and is not a renewal of a policy we have previously issued, we may cancel this policy by mailing or delivering to the first Named Insured at the mailing address shown in the policy and to the producer of record, advance written notice of cancellation, stating the reason for cancellation, at least: a.10 days before the effective date of cancellation if we cancel for: (1)Nonpayment of premium; or (2)Discovery of fraud by: (a)Any insured or his or her representative in obtaining this insurance; or (b)You or your representative in pursuing a claim under this policy. b.30 days before the effective date of cancellation if we cancel for any other reason. 3.All Policies In Effect For More Than 60 Days a.If this policy has been in effect for more than 60 days, or is a renewal of a policy we issued, we may cancel this policy only upon occurrence after the effective date of the policy on one or more of the following: (1)Nonpayment of premium, including payment due prior on a prior policy we issued and due during the current policy term covering the same risks. (2)Discovery of fraud by: (a)Any insured or his or her representative in obtaining this insurance; or (b)You or your representative in pursuing a claim under this policy. (3)A judgment by a court or an administrative tribunal, that you have violated a California or Federal Law, having as one of its necessary elements an act which materially increases any of the risks insured against. (4)Discovery of willful or grossly negligent acts or omissions, or of any violation of state laws or regulations establishing safety standard, by you or your representative, which materially increase any of the risks insured against. (5)Failure by you or your representative to implement reasonable loss control requirements, agreed to by you as a condition of policy issuance, or which were conditions precedent to our use of a particular rate or rating plan, if that failure materially increases any of the risks insured against. (6)A determination by the Commissioner of Insurance that the: (a)Loss of, or changes in, our reinsurance covering all or part of the risk would threaten our financial integrity or solvency; or (b)Continuation of the policy would (i)Place us in violation of California Law or the laws of the state where we are domiciled; or (ii)Threaten our solvency. Page 1 of 2EU 70 03 09 12 05/13/2024A0195129 Middlesex Insurance Company 00001 0000000000 24134 0 N1 94c118cc-03cb-4562-b630-95de7450712194c118cc-03cb-4562-b630-95de74507121 (7)A change you or your representative in the activities or property of the commercial or industrial enterprise, which results in a materially added, increased or changed risk, unless the added, increased or changed risk is included in the policy. b.We will mail or deliver advance written notice of cancellation, stating the reason for cancellation, to the first Named Insured, at the mailing address shown in the policy, and to the producer of record, at least: (1)10 days before the effective date of cancellation if we cancel for nonpayment of premium or discovery of fraud; or (2)30 days before the effective date of cancellation if we cancel for any other reason listed in Paragraph 3.a. B.The following is added and supersedes any provisions to the contrary: Nonrenewal 1.Subject to the provisions of Paragraph B.2. below, if we elect not to renew this policy, we will mail or deliver written notice stating the reason for nonrenewal to the first Named Insured shown in the Declarations and to the producer of record, at least 60 days, but not more than 120 days, before the expiration or anniversary date. We will mail or deliver our notice to the first Named Insured and to the producer of record, at the mailing address shown in the policy. 2.We are not required to send notice of nonrenewal in the following situations: a.If the transfer or renewal of a policy, without any changes on terms, conditions, or rates, is between us and a member of our insurance group. b.If the policy has been extended for 90 days or less, provided that notice has been given in accordance with Paragraph B.1. c.If you have obtained replacement coverage, or if the first Named Insured has agreed, in writing, within 60 days of the termination of the policy, to obtain that coverage. d.If the policy is for a period of no more than 60 days and you are notified at the time of issuance that it will not be renewed. e.If the first Named Insured requests a change in the terms or conditions or risks covered by the policy within 60 days of the end of the policy period. f.If we have made a written offer to the first Named Insured, in accordance with the timeframes shown in Paragraph B.1., to renew the policy under changed terms or conditions or at an increased premium rate, when the increase exceeds 24%. EU 70 03 09 12Page 2 of 2 05/13/2024A0195129 Middlesex Insurance Company COMMERCIAL EXCESS/UMBRELLA LIABILITY CONTRACTORS LIMITATION ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL EXCESS/UMBRELLA LIABILITY COVERAGE PART A.The following exclusion is added to Coverage U - Umbrella Liability, Paragraph C. Exclusions of Section I - Coverages: This insurance does not apply to: 1."Bodily injury" or "property damage" arising out of any project insured under consolidated (wrap-up) insurance program or similar rating plan; 2."Property damage" included within the "explo- sion hazard", the "collapse hazard" or the "underground property damage hazard". B.The following definitions are added to Section V - Definitions: 1."Collapse hazard" includes "structural prop- erty damage" and any resulting "property damage" to any other property at any time. 2."Explosion hazard" includes "property damage" arising out of blasting or explosion. The "explosion hazard" does not include "property damage" arising out of the explosion of air or steam vessels, piping under pressure, prime movers, machinery or power transmission equipment. 3."Structural property damage" means the collapse of or structural injury to any building or structure due to: A.Grading of land, excavating, burrowing, filling, back-filling, tunneling, pile driving, coffer dam work or caisson work; or B.Moving, shoring, underpinning, raising or demolition of any building or structure or removal or rebuilding of any structural support of that building or structure. 4."Underground property damage hazard" includes "underground property damage" and any result- ing "property damage" to any other property at any time. 5."Underground property damage" means "property damage" to wires, conduits, pipes, mains, sewers, tanks, tunnels, any similar property, and any apparatus used with them beneath the surface of the ground or water, caused by and occurring during the use of mechanical equipment for the purpose of grading land, paving, excavating, drilling, burrowing, filling, back-filling or pile driving. EU 70 17 12 04 Page 1 of 1EU 70 17 12 04 05/13/2024A0195129 Middlesex Insurance Company 00001 0000000000 24134 0 N1 0875b701-36e1-454f-a8da-9dbd2cd5c1d30875b701-36e1-454f-a8da-9dbd2cd5c1d3 POLICY NUMBER:COMMERCIAL EXCESS/UMBRELLA LIABILITY EU 70 82 01 20 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. TOTAL POLLUTION EXCLUSION This endorsement modifies insurance provided under the following: COMMERCIAL EXCESS/UMBRELLA LIABILITY COVERAGE PART A.Exclusion C.3. POLLUTION of SECTION I - COVERAGES, COVERAGE E - EXCESS LIABILITY is replaced by the following: 3.POLLUTION a."Bodily injury", "property damage", "personal and advertising injury" or "error or omission" which would not have occurred in whole or in part but for the actual, alleged, or threatened discharge, dispersal, seepage, migration, release or escape of "pollutants" at any time. This exclusion does not apply to "bodily injury" to any "employee" of the insured arising out of and in the course of: (1)Employment by the insured; or (2)Performing duties related to the conduct of the insured's business. b.Any loss, cost or expense arising out of any: (1)Request, demand, order or statutory or regulatory requirement that any insured or others test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of "pollutants"; or (2)Claim or "suit" by or on behalf of a governmental authority for damage because of testing for, monitoring, cleaning up, removing, containing, treating, detoxifying or neutralizing, or in any way responding to, or assessing the effects of, "pollutants". c.This Pollution Exclusion applies whether or not: (1)Such "pollutants", irritant or contaminant is "your product" or has any function in your business, operations, premises, site or location; or (2)The "bodily injury", "property damage", "personal and advertising injury" or "error or omission" arises from environmental damage or pollution of the environment. This exclusion applies to all "bodily injury", "property damage", "personal and advertising injury" or "error or omission" within the scope of this exclusion, including, for example and without limitation, from exposure to "pollutants" within a residential or commercial building or from discharges of "pollutants" from "your product". B.The definition of "pollutants" in Section V - Definitions is replaced by the following: “Pollutants” means any solid, liquid, gaseous, bacterial, fungal, viral, electromagnetic, thermal or other substance that is toxic or hazardous, causes irritation to animals, vegetation, or persons and/or causes contamination to property or the environment including, but not limited to, smoke, vapor, soot, fumes (including welding fumes, paint fumes and glue fumes), acids, alkalis, chemicals and waste. Specific examples identified as “pollutants” include, but are not limited to gasoline, diesel, kerosene transmission fluid, antifreeze, brake fluid, any other fuel oils, any other motor oils, any other petroleum products, any other lubricants, and any of their additives, derivatives, degradation products, and individual chemical components including, but not limited to, benzene, toluene, ethylbenzene, xylenes, phenanthrene, naphthalene, 2-methyl-napthalene, trimethylbenzene isomers; carbon monoxide and other exhaust gases; solvents, mineral spirits, adhesives, pesticides, insecticides, herbicides, asbestos, lead, lead based paint, silica, sewage, and other solvents, perfluorooctane sulfonate (PFOS), perfluorooctanoic acid (PFOA), Perfluorobutane sulfonic acid (PFBS), Perfluorobutanesulfonate, Potassium Perfluorobutane Sulfonate, Sodium fluoroacetate, 2,2-Difluoropropane, 1-Chloro-1, 1-difluoroethane, 1,1,1,2-Tetrafluoroethane, 1,1,1-Trifluoroethane, 1,1-Difluoroethane, Dichlorodifluoromethane, Trichlorofluoromethane, Chlorodifluoromethane, and 1,1,2-Trichloro-1,2,2-trifluoroethane, and other per- and polyfluoroalkyl substances (PFAS), including, but not limited to, all substances listed on the USEPA Master List of PFAS Substances, which has been available online at: https://comptox.epa.gov/dashboard/chemical_ lists/pfasmaster, and any of their associated homologues, isomers, salts, esters, alcohols, Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 2EU 70 82 01 20 05/13/2024A0195129 Middlesex Insurance Company 00001 0000000000 24134 0 N1 641e68a4-0c45-4c78-9ae0-c572d8763525641e68a4-0c45-4c78-9ae0-c572d8763525 acids, precursor chemicals, additives, derivatives, degradation products, by-products, and individual chemical components. Solvents include, but are not limited to, tetrachlorethylene or perchloroethylene (PCE), trichloroethylene (TCE), dichloroacetylene, chloroacetylene, 1,1,1-trichloroethane (1,1,1-TCA), 1,1,2-trichloroethane (1,1,2-TCA), 1,4-dioxane, cis-1,2-dichloroethylene (cis-1,2-DCE), trans-1,2-dichloroethylene (trans-1,2-DCE), 1,1-dichloroethylene (1,1-DCE), 1,1-dichloroethane (1,1-DCA), 1,2-dichloroethane (1,2-DCA), acetate, acetylene, vinyl chloride, methylene chloride, methylene chloroform, chloromethane, ethene, ethane, ethanol, formate, glycolate, methane, carbon dioxide, any other dry cleaning chemicals, chlorofluorocarbons, chlorinated hydrocarbons, any other chlorinated solvents, any other halogenated solvents, and any of their additives, derivatives, degradation products, and individual chemical components. Solvents also include naturally occurring metals that dissolve as the result of solvents in the environment, including, but not limited to, arsenic, barium, copper, iron, manganese, magnesium, an selenium. "Pollutants" also include, but are not limited to, all substances specifically listed, identified or described by one or more of the following references: Agency for Toxic Substance and Disease Registry ToxFAQs Substance Priority List, which has been available online at https://www.atsdr.cdc.gov/SPL, US Environmental Protection Agency EMCI Chemical Reference Complete Index, which has been available online at https://enviro.epa.gov/, United States Environmental Protection Agency, Regional Screening Levels for Chemical Contaminants at Superfund Sites, which has been available online at: https//www.epa.gov/risk/regional-screening- levels-rsls, the Comprehensive Environmental Response Compensation and Liability Act (CERCLA) Priority List Hazardous Substances, 40 CFR 302.4, Table 302.4 (1997 and all subsequent editions), and/or the Indiana Department of Environmental Management risk based tables, including the 1996 Voluntary Remediation Program Tier II Table, Default Closure Level Tables (2001 and all subsequent editions), Screening Level Tables (2012 and all subsequent editions), which have been available online at https://www.in.gov/idem/cleanups/resources/ technical-guidance-for-cleanups/idem- screening-and-closure-level-tables/. Waste includes, but is not limited to, material to be recycled, reconditioned or reclaimed. A substance does not lose its character of being a "pollutant" by virtue of having a useful function. Includes copyrighted material of Insurance Services Office, Inc., with its permission. EU 70 82 01 20Page 2 of 2 05/13/2024A0195129 Middlesex Insurance Company COMMERCIAL EXCESS/UMBRELLA LIABILITY EU 70 89 05 14 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION - ACCESS OR DISCLOSURE OF CONFIDENTIAL OR PERSONAL INFORMATION AND DATA RELATED ACTIVITY This endorsement modifies insurance provided under the following: COMMERCIAL EXCESS/UMBRELLA LIABILITY COVERAGE PART Section I – Coverages, Coverage U – Umbrella Liability, Exclusion C. 17. Electronic Data, is replaced by the following: C.Exclusions This insurance does not apply to: 17.Access Or Disclosure Of Confidential Or Personal Information And Data Related Liability Damages arising out of: a.Any access to or disclosure of any person’s or organization’s confidential or personal information, including patents, trade secrets, processing methods, customer lists, financial information, credit card information, health information or any other type of nonpublic information; or b.The loss of, loss of use of, damage to, corruption of, inability to access, or inability to manipulate "electronic data". This exclusion applies even if damages are claimed for notification costs, credit monitoring expenses, forensic expenses, public relations expenses, or any other loss cost or expense incurred by you or others arising out of that which is described in Paragraph a. or b. above. Page 1 of 1EU 70 89 05 14 05/13/2024A0195129 Middlesex Insurance Company 00001 0000000000 24134 0 N1 f0486c2a-807e-46ee-8ae0-63f6c8e07b60f0486c2a-807e-46ee-8ae0-63f6c8e07b60 POLICY NUMBER:COMMERCIAL EXCESS/UMBRELLA LIABILITY EU 71 04 03 18 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NON-CUMULATION OF LIMITS This endorsement modifies insurance provided under the following: COMMERCIAL EXCESS/UMBRELLA COVERAGE PART A.The following is added to Paragraph D. in Section III - Limits of Insurance: However, if one "occurrence" causes "bodily injury" or "property damage" during the policy period and during the policy period of one or more prior, or future, excess/umbrella policies issued by us, then this policy's Each Occurrence Limit will be reduced by the amount of each payment made by us under those prior or future excess/umbrella policies because of such "occurrence". B.Definitions For the purposes of this endorsement, the term "us" also includes any other company included in or affiliated with the Sentry Group of Companies. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1EU 71 04 03 18 05/13/2024A0195129 Middlesex Insurance Company 00001 0000000000 24134 0 N1 3eed0181-a2a3-4ac9-8836-f389bced0fc63eed0181-a2a3-4ac9-8836-f389bced0fc6 POLICY NUMBER:COMMERCIAL EXCESS/UMBRELLA LIABILITY EU 71 06 07 20 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTINUOUS OR PROGRESSIVE INJURY OR DAMAGE LIMITATION This endorsement modifies the insurance provided under the following: COMMERCIAL EXCESS/UMBRELLA LIABILITY COVERAGE PART A.The following is added to A. Insuring Agreement of Section I - Coverages, Coverage U - Umbrella Liability: All “bodily injury” or “property damage” arising from, caused by or contributed to by, or in consequence of an “occurrence” shall be deemed to take place at the time of the first such damage, even though the nature and extent of such damage or injury may change and even though the damage may be continuous, progressive, cumulative, changing or evolving, and even though the “occurrence” causing such “bodily injury” or “property damage” may be continuous or repeated exposure to substantially the same general harm. B.The following is added to paragraph C. Exclusions of Section I - Coverages, Coverage U - Umbrella Liability: This insurance does not apply to: “Bodily injury” or “property damage” which: 1.First occurred or is alleged to have first occurred prior to the inception date of this policy; or 2.Which is, or is alleged to be, in the process of occurring as of the inception date of this policy. This exclusion applies regardless of whether such “bodily injury” or “property damage” continues, becomes progressively worse, accumulates, changes or evolves during the policy period, even though the nature and extent of such damage or injury may change, and even though the “occurrence” causing such “bodily injury” or “property damage” may be continuous or repeated exposure to substantially the same general harm. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1EU 71 06 07 20 05/13/2024A0195129 Middlesex Insurance Company 00001 0000000000 24134 0 N1 54dee177-b9d6-4add-8a17-fde5d044aa5e54dee177-b9d6-4add-8a17-fde5d044aa5e POLICY NUMBER:COMMERCIAL EXCESS/UMBRELLA LIABILITY EU 71 38 09 22 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION-PUNITIVE DAMAGES This endorsement modifies the insurance provided under the following: COMMERCIAL EXCESS/UMBRELLA LIABILITY COVERAGE PART With respect to the coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. A.The following exclusion is added to Section I -Coverages, Coverage E - Excess Liability, paragraph C. Exclusions and Section I - Coverages, Coverage U - Umbrella Liability, paragraph C. Exclusions: Punitive or Exemplary Damages Where applicable by state law, this policy does not apply to fines, penalties and/or judgments and awards or portions thereof which are based upon "punitive or exemplary damages", including related judgments and awards or portions thereof for attorneys' fees, costs or expenses of litigation of whatever kind or amount. B.The following is added to Section V - Definitions: "Punitive or exemplary damages" mean those sums for which the insured is legally liable and are imposed as punishment and to deter others from similar conduct. Included are awards expressed as multiples of compensatory damages, such as double or treble damages, founded upon willful, intentional or other conduct prescribed by law. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1EU 71 38 09 22 05/13/2024A0195129 Middlesex Insurance Company 00001 0000000000 24134 0 N1 db5cfb7e-e5f9-49f8-94fc-333e463ab415db5cfb7e-e5f9-49f8-94fc-333e463ab415 POLICY NUMBER: IL 09 85 12 20 SCHEDULE - PART I THIS ENDORSEMENT IS ATTACHED TO AND MADE PART OF YOUR POLICY IN RESPONSE TO THE DISCLOSURE REQUIREMENTS OF THE TERRORISM RISK INSURANCE ACT. THIS ENDORSEMENT DOES NOT GRANT ANY COVERAGE OR CHANGE THE TERMS AND CONDITIONS OF ANY COVERAGE UNDER THE POLICY. DISCLOSURE PURSUANT TO TERRORISM RISK INSURANCE ACT SCHEDULE Terrorism Premium (Certified Acts) $324.00 This premium is the total Certified Acts premium attributable to the following Coverage Part(s), Coverage Form(s) and/or Policy(ies): A0195129005 Commercial Excess/Umbrella Liability Additional information, if any, concerning the terrorism premium: SCHEDULE - PART II Federal share of terrorism losses 80% (Refer to Paragraph B. in this endorsement.) Information required to complete this Schedule, if not shown above, will be shown in the Declarations. © Insurance Services Office, Inc., 2020 Page 1 of 2IL 09 85 12 20 05/13/2024A0195129 Middlesex Insurance Company 00001 0000000000 24134 0 N1 46ec7aa1-6953-4dc6-9c81-ab5f991bc4e946ec7aa1-6953-4dc6-9c81-ab5f991bc4e9 A.Disclosure Of Premium In accordance with the federal Terrorism Risk Insurance Act, we are required to provide you with a notice disclosing the portion of your premium, if any, attributable to coverage for terrorist acts certified under the Terrorism Risk Insurance Act. The portion of your premium attributable to such coverage is shown in the Schedule of this endorsement or in the policy Declarations. B.Disclosure Of Federal Participation In Payment Of Terrorism Losses The United States Government, Department of the Treasury, will pay a share of terrorism losses insured under the federal program. The federal share equals a percentage (as shown in Part II of the Schedule of this endorsement or in the policy Declarations) of that portion of the amount of such insured losses that exceeds the applicable insurer retention. However, if aggregate insured losses attributable to terrorist acts certified under the Terrorism Risk Insurance Act exceed $100 billion in a calendar year, the Treasury shall not make any payment for any portion of the amount of such losses that exceeds $100 billion. C.Cap On Insurer Participation In Payment Of Terrorism Losses If aggregate insured losses attributable to terrorist acts certified under the Terrorism Risk Insurance Act exceed $100 billion in a calendar year and we have met our insurer deductible under the Terrorism Risk Insurance Act, we shall not be liable for the payment of any portion of the amount of such losses that exceeds $100 billion, and in such case insured losses up to that amount are subject to pro rata allocation in accordance with procedures established by the Secretary of the Treasury. © Insurance Services Office, Inc., 2020 IL 09 85 12 20Page 2 of 2 05/13/2024A0195129 Middlesex Insurance Company POLICY NUMBER: IL 80 05 07 16 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION - INFECTIOUS OR COMMUNICABLE DISEASE This endorsement modifies insurance provided under the following: COMMERCIAL AUTOMOBILE COVERAGE PART COMMERCIAL EXCESS/UMBRELLA COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS COVERAGE PART With respect to the coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. A.The following exclusion is added: EXCLUSION - INFECTIOUS OR COMMUNICABLE DISEASE This insurance does not apply to: 1.“Bodily injury”, “property damage” or “personal and advertising injury” arising out of the actual or alleged transmission of an “infectious or communicable disease”; or 2.Any loss, cost or expense arising out of any: a.Request, demand, order or statutory or regulatory requirement that any insured or others test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of an “infectious or communicable disease”; or b.Claim or suit by or on behalf of a governmental authority for damages because of testing for, monitoring, cleaning up, removing, containing, treating, detoxifying or neutralizing, or in any way responding to, or assessing the effects of, an “infectious or communicable disease”. 3.This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the: a.Supervising, hiring, employing, training or monitoring of others that may be infected with and spread an “infectious or communicable disease”; b.Failure to prevent the spread of an “infectious or communicable disease”; or c.Failure to report an “infectious or communicable disease” to authorities. B.The following definition is added: “Infectious or communicable disease” 1.Means an illness or contamination resulting from an infectious agent or its by-products that occurs through the direct or indirect transmission by an infected human or animal host, organism or from the inanimate environment to a human or animal host; and 2.Includes, but is not limited to, Chronic Wasting Disease (CWD); Ebola; Escherichia coli (E. coli); Hepatitis, Influenza, including, but not limited to, all strains and mutations of avian, human or swine; Measles, Methicillin-resistant Staphylococcus Aureus (MRSA), Salmonellosis; Severe Acute Respiratory Syndrome (SARS); Sexually Transmitted Diseases (STDs); Transmissible Spongiform Encephalopathy (TSE), including Bovine Spongiform Encephalopathy (BSE, or mad cow disease); Tuberculosis and West Nile Virus. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1IL 80 05 07 16 05/13/2024A0195129 Middlesex Insurance Company 00001 0000000000 24134 0 N1 a88d41bc-64e0-4f71-90e6-079deab14616a88d41bc-64e0-4f71-90e6-079deab14616 80 2313 CA 01 21 ADDITIONAL CONDITIONS MEMBERSHIP AND PARTICIPATING PROVISION Membership By virtue of this policy, you are a member of Sentry Mutual Holding Company of Stevens Point, Wisconsin. You are entitled to vote either in person or by proxy at any meeting of members of the Company. The annual meeting of the Company is held at the Company's Home Office in Stevens Point, Wisconsin at 9:00 A.M. on the third Wednesday in April. Participation You will share in any dividends in accordance with conditions established by the Board of Directors. This policy is not assessable. Vice President, Secretary President This endorsement must be attached to a policy showing California in item 3.A. of the Information Page. Under California Law it is unlawful for an insurer [us] to promise the future payment of dividends under an unexpired workers' compensation policy or to misrepresent the conditions for dividend payment. Dividends are payable only pursuant to conditions determined by the [our] Board of Directors or other governing board [of the Company] following policy expiration. Forfeiture of a right to, reduction in the amount of, or delay in the payment of a policyholder's dividend due to the policyholder's failure to accept renewal of the policy or subsequent policies issued by the same insurer is illegal and constitutes an unfair practice. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. Endorsement Effective Policy No.Endorsement No. Insured Insurance Company Countersigned by Page 1 of 180 2313 CA 01 21 05/13/2024A0195129 Middlesex Insurance Company 00001 0000000000 24134 0 N1 81ebefe9-0e01-4020-ad20-1bff86bae9c481ebefe9-0e01-4020-ad20-1bff86bae9c4 POLICY NUMBER: A0195129006 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE Middlesex Insurance Company (A Participating Stock Company) A member of the Sentry Insurance Group 1800 North Point Drive Stevens Point, WI 54481 Carrier Code No Policy Number Renewal of Policy Number Acrisure of California, LLC 34 S 2nd St Campbell, CA 95008 Agency Code 10047536 408-680-0200 10960 A0195129006 A0195129006 First Named Insured: ITEM Axis Mechanical , Inc. 1.INSURED Address:908 Bern Ct San Jose, CA 95112 Phone Number: Business Description:Corporation See Schedule of Entities for Other Insured Entities Other workplaces not shown above: See Extension of information page 408-573-7400 2.POLICY PERIOD The policy period is from 05/13/2024 to 05/13/2025 at 12:01A.M, Standard Time at the First Named Insured’s mailing address shown above. 3.COVERAGE A.Workers Compensation Insurance: Part One of the policy applies to the workers compensation law of the states listed here: California Copyright 1987 National Council on Compensation InsuranceWC 00 00 01 A CA Page 1 of 6 05/13/2024A0195129006 Middlesex Insurance Company 00003 0000000000 24134 0 N1 9c9ac33b-d397-4595-ada5-371a4e9c88099c9ac33b-d397-4595-ada5-371a4e9c8809 POLICY NUMBER:A0195129006 Copyright 1987 National Council on Compensation InsurancePage 2 of 6 WC 00 00 01 A CA 05/13/2024A0195129006 Middlesex Insurance Company 3.COVERAGE B.Employers Liability Insurance: Part Two of the policy applies to work in each state listed in Item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident Bodily Injury by Disease Bodily Injury by Disease Each accident Each employee Policy limit 1,000,000 1,000,000 1,000,000 $ $ $ C.Other States Insurance: Part Three of the policy applies in all states except those listed in Item 3.A., and the following: ND OH WA WY D.This policy includes these Endorsements and Schedules: Form/Endorsement Form/Endorsement Title Number and Edition Date WC 00 00 00 C 01 15 Workers Compensation And Employers Liability Insurance Policy WC 00 03 13 04 84 Waiver Of Our Right To Recover From Others Endorsement WC 00 04 06 A 07 95 Premium Discount Endorsement WC 00 04 19 01 01 Premium Due Date Endorsement WC 00 04 22 C 01 21 Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement WC 04 03 01 D 02 18 Policy Amendatory Endorsement-California WC 04 03 03 C 07 18 Endorsement Agreement Limiting And Restricting This Insurance Officers And Directors Coverage / Exclusion-California WC 04 03 60 B 01 15 Employers' Liability Coverage Amendatory Endorsement - California WC 04 04 21 01 08 Optional Premium Increase Endorsement - California WC 04 06 01 B 01 22 California Cancelation Endorsement WC 04 06 04 A 01 23 Covid-19 Reporting Requirement Endorsement - California 4.PREMIUM The premium for this policy will be determined by our Manuals of Rules, Classification, Rates and Rating Plans. All information required below is subject to verification and change by audit. See Schedule for premium summary breakdown by state Code No. Classifications $100 of Annual Premium Premium Basis Total Estimated Annual Remuneration Rate Per Remuneration Estimated See Schedule for premium breakdown by state, location and classification Total Estimated Standard Premium Excluding Increased Limits $150,216.00 Total Premium Discount $-17,473.00 9812 $Increased Limits Premium - Standard Coverage 5,789.00 0900 $Policy Expense Constant (CA)200.00 9740 $Terrorism 800.00 Total Estimated Annual Premium $139,532.00 POLICY NUMBER:A0195129006 Copyright 1987 National Council on Compensation InsuranceWC 00 00 01 A CA Page 3 of 6 05/13/2024A0195129006 Middlesex Insurance Company 00003 0000000000 24134 0 N3 9c9ac33b-d397-4595-ada5-371a4e9c88099c9ac33b-d397-4595-ada5-371a4e9c8809 4.PREMIUM Std Min (CA)$1,000.00 STD EL MINIMUM (CA)$150.00 *Total Non Premium Charges $8,441.27 Total Estimate due to this policy $147,973.27 *Non-Premium charges are state mandated tax/assessments/etc SCHEDULE OF ENTITIES AND LOCATIONS Entity: Named insured: 1 Axis Mechanical , Inc. Name Link Code Federal Id: Entity Type:Corporation XXXXXX5336 Location: Address: 1 2474 De La Cruz Blvd Santa Clara, CA 95050-2923 6339220RRisk ID: Location: Address: 2 908 Bern Ct San Jose, CA 95112-1236 6339220RRisk ID: SCHEDULE OF CLASS DESCRIPTIONS Class Code Class Code Descriptions 5183 Heating - Air Conditioning Equip - Low Wage 5187 Heating - Air Conditioning Equip - High Wage 5538 Sheet Metal Work - Low Wage 5542 Sheet Metal - Low Wage 8742 Salespersons - Outside 8810 Clerical Office Employees SCHEDULE OF PREMIUM AND NON-PREMIUM BY STATE States Not Subject To Retro Premium Non-Premium $139,532.00CaliforniaOperations Per Schedule $8,441.27 SCHEDULE OF PREMIUM BY STATE, ENTITY, LOCATION AND CLASSIFICATION CALIFORNIASTATE - Period:05/13/2024 - 05/13/2025 Entity name:Federal Id:Axis Mechanical , Inc.XXXXXX5336 Location: Address: 1 2474 De La Cruz Blvd Santa Clara, CA 95050-2923 NAICS Code:238220 POLICY NUMBER:A0195129006 Copyright 1987 National Council on Compensation InsurancePage 4 of 6 WC 00 00 01 A CA 05/13/2024A0195129006 Middlesex Insurance Company SCHEDULE OF PREMIUM BY STATE, ENTITY, LOCATION AND CLASSIFICATION Code NoClassification $100 of Annual Premium Premium Basis Total Estimated Annual Rate Per Remuneration Estimated Remuneration 5187Heating - Air Conditioning Equip - High Wage 0.00$ If Any $3.28 $ Territory Deviation 1.0000 Class Minimum $ 643.00 5542Sheet Metal - Low Wage 0.00$ If Any $3.20 $ Territory Deviation 1.0000 Class Minimum $ 632.00 Location: Address: 2 908 Bern Ct San Jose, CA 95112-1236 NAICS Code:238220 Code NoClassification $100 of Annual Premium Premium Basis Total Estimated Annual Rate Per Remuneration Estimated Remuneration 5183Heating - Air Conditioning Equip - Low Wage 7,955.00$ 119,449.00 $6.66 $ Territory Deviation 0.9500 Class Minimum $ 1,000.00 5187Heating - Air Conditioning Equip - High Wage 116,041.00$ 3,719,254.00 $3.12 $ Territory Deviation 0.9500 Class Minimum $ 643.00 5538Sheet Metal Work - Low Wage 19,686.00$ 271,905.00 $7.24 $ Territory Deviation 0.9500 Class Minimum $ 1,000.00 5542Sheet Metal - Low Wage 57,437.00$ 1,889,391.00 $3.04 $ Territory Deviation 0.9500 Class Minimum $ 632.00 8742Salespersons - Outside 2,384.00$ 701,064.00 $0.34 $ Territory Deviation 0.9500 Class Minimum $ 249.00 8810Clerical Office Employees 3,247.00$ 1,298,936.00 $0.25 $ Territory Deviation 0.9500 Class Minimum $ 235.00 206,750.00$Total Entity Class Premium POLICY NUMBER:A0195129006 Copyright 1987 National Council on Compensation InsuranceWC 00 00 01 A CA Page 5 of 6 05/13/2024A0195129006 Middlesex Insurance Company 00003 0000000000 24134 0 N5 9c9ac33b-d397-4595-ada5-371a4e9c88099c9ac33b-d397-4595-ada5-371a4e9c8809 SCHEDULE OF PREMIUM BY STATE, ENTITY, LOCATION AND CLASSIFICATION Total State Class Premium $206,750.00 0930 $Blanket Waiver of Our Right To Recover From Others (0.020) 4,135.00 Premium for Increased Limits Part Two 9812 $(2.80%) Increased Limits Premium - Standard Coverage 5,789.00 Premium subject to Modification $216,674.00 9898 $Experience Rating Modification Factor (0.800) -43,335.00 Premium modified to reflect Exp. Mod. of 0.800 $173,339.00 9887 $Schedule Rating Modification Factor (0.900) -17,334.00 (CA) Estimated Standard Premium $156,005.00 0063 $(11.20%) Premium Discount (CA) -17,473.00 9740 $Terrorism (0.010)800.00 (CA) Estimated Annual Premium $139,332.00 Non-Premium Charges $(2.46%) CA State WC Administrative Surcharge 3,433.05 $(0.15%) CA Uninsured Employers Benefits Trust Fund Assessment 210.00 $(1.59%) CA Subsequent Injuries Benefits Assessment 2,217.30 $(0.73%) CA Occupational Safety and Health Fund Assessment 1,013.84 $(0.71%) CA Labor Enforcement and Compliance Fund Assessment 991.93 $(0.41%) CA WC Fraud Assessment 575.15 $(0.00%) California Insurance Guarantee Association Surcharge 0.00 Total Estimate due to this State $147,773.27 *Non-Premium charges are state mandated tax/assessments/etc The following endorsements apply to this state Form/Endorsement Form/Endorsement Title Number and Edition Date WC 00 00 00 C 01 15 Workers Compensation And Employers Liability Insurance Policy WC 00 03 13 04 84 Waiver Of Our Right To Recover From Others Endorsement WC 00 04 06 A 07 95 Premium Discount Endorsement WC 00 04 19 01 01 Premium Due Date Endorsement WC 00 04 22 C 01 21 Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement POLICY NUMBER:A0195129006 Copyright 1987 National Council on Compensation InsurancePage 6 of 6 WC 00 00 01 A CA 05/13/2024A0195129006 Middlesex Insurance Company SCHEDULE OF PREMIUM BY STATE, ENTITY, LOCATION AND CLASSIFICATION Form/Endorsement Form/Endorsement Title Number and Edition Date WC 04 03 01 D 02 18 Policy Amendatory Endorsement-California WC 04 03 03 C 07 18 Endorsement Agreement Limiting And Restricting This Insurance Officers And Directors Coverage / Exclusion-California WC 04 03 60 B 01 15 Employers' Liability Coverage Amendatory Endorsement - California WC 04 04 21 01 08 Optional Premium Increase Endorsement - California WC 04 06 01 B 01 22 California Cancelation Endorsement WC 04 06 04 A 01 23 Covid-19 Reporting Requirement Endorsement - California Number of pages including cover: Workers' Compensation Claim Report Fax Cover Sheet IMMEDIATE ACTION REQUIRED FIRST REPORT OF INJURY ATTACHED From: Business Name: Account/Policy Number: Phone #: Fax #: Location Code:Department Code: (if applicable) PLEASE INDICATE WHICH OF THE FOLLOWING APPLY: Lost time involved Employee is currently completely off work Employee is currently working restricted duty or restricted hours Medical only claim (involving no lost time from work or wage loss) Record only (informational purposes only - no treatment outside the workplace has been sought or prescriptions filled) Questionable Claim - Please lnvestigate (Please list concerns on a separate page, not on the First Report of lnjury form) Due to federally mandated Medicare reporting requirements, you must report the date of birth and Social Security number on all WC claims. To:Sentry Claims Service Center Fax #:800-726-8631 Axis Mechanical , Inc. A0195129006 Page 1 of 290 226 01 18 05/13/2024A0195129006 Middlesex Insurance Company 00001 0000000000 24134 0 N1 11fe8a65-dbd5-4d91-9a3c-3fa561b8f60611fe8a65-dbd5-4d91-9a3c-3fa561b8f606 Timely reporting of accidents and losses is a critical factor in controlling Workers' Compensation costs. Delays can increase Workers' Compensation costs by 20 to 30 percent and the rate of litigation by as much as 45 percent. Sentry provides a toll-free fax service to report accidents. lt can significantly improve the timely reporting of Workers' Compensation claims by: Allowing investigations to start sooner and preventing the loss of critical evidence Providing the opportunity to implement medical cost-containment measures to ensure your employees receive quality care at a reasonable cost Encouraging prompt resolution of claims, reducing the likelihood of litigation and the potential of fraudulent claims TO REPORT WORKERS' COMPENSATION CLAIMS BY FAX Sentry allows you to fax Employer's First Reports to Sentry, eliminating mail delays. We will mail the completed Workers' Compensation First Report of lnjury Form to your state's Workers' Compensation bureau, where applicable. Steps to reporting claims by fax: 1.Complete your state-specific First Report of lnjury Form for a Workers' Compensation claim 2.Fill out the fax cover sheet from page 1 of this document based on the specifics of the claim being reported and print off a copy of the completed cover sheet. 3.Fax a copy of the completed cover sheet and your completed First Report of lnjury Form to Sentry at: 800-726-8631 90 226 01 18Page 2 of 2 05/13/2024A0195129006 Middlesex Insurance Company Three Ways to Take Control of Your Workers’ Compensation Medical Expenses What you can do to impact the cost of your insurance and favorably add to your company's bottom line. 1. 2. 3. Encourage injured employees to seek treatment from members of the Sentry utilized Workers' Compensation Medical Network offerings. Your employees receive high quality medical care, and you'll benefit from pre-negotiated rates. In some states, you are allowed to direct the injured worker to a preselected physician for a limited period of time, if you post the names of those doctors in a readily visible area. These states include AL, CO, FL, GA, IA, ID, IN, KS, ME, MI, MO, NJ, NM, NC, PA, SC, TN, UT, VT, and VA. If your State Workers' Compensation law does not allow you to direct an injured worker to a preselected physician, the injured employee may still appreciate your help in identifying a qualified care provider. However, never infringe on the legal right of injured workers to select their own physicians. Use the pharmacy network to fill prescriptions for work-related injuries. Sentry's pharmacy network allows injured employees to have their medications filled at a local pharmacy with no out-of-pocket expense and at a discounted rate to your business. Visit www.workcompauto.optum.com/resources/pharmacy-locator or call 1-877-470-9572 to see a full list of network pharmacies. Use the First Fill program so your injured employee can immediately receive pharmaceutical care, before the first notice of loss for the claim is fully processed. The program eliminates prescription issues by allowing a pharmacy to identify the carrier and process prescriptions electronically. In these situations, providing a completed First Fill Prescription Form to a participating pharmacy within 30 days of the injury, Optum will allow a pharmacy to provide a 10-day supply (a Samaritan dose) to the injured employee, if the prescribed medication is part of the standard formulary. If the first notice of loss is not received or the claim is deemed non-compensable, Optum will absorb the cost of the 10-day supply at no cost to you or the injured employee. Report all injuries promptly so Sentry can investigate the injury and ensure proper handling. Proper handling of a claim will ensure you get the best treatment at the best price. Note: Workers’ compensation claim handling can vary by state. For example, state regulations may differ on the waiting period before the injured employee can collect wage replacement benefits, or when he or she may be considered well enough to stop workers’ compensation benefit payments. Page 1 of 4WC 80 99 0009 11 18 05/13/2024A0195129006 Middlesex Insurance Company 00002 0000000000 24134 0 N1 512bd861-cd43-4477-b7f9-a34b564fc43f512bd861-cd43-4477-b7f9-a34b564fc43f 1.Sentry Workers’ Compensation Medical Network Frequently Asked Questions 1) 2) 3) 4) QUESTION:What will the Sentry utilized Coventry Workers’ Compensation Medical Network do for me? ANSWER:It is an excellent tool to control medical expenses, which in turn allows Sentry to provide you with significant, long-term savings. Medical care costs are a function of both volume and price per unit. By establishing contracts with hospitals, physicians, and outpatient care providers over a multi-year period, caps are obtained on annual increases and substantial discounts are obtained for our insureds who receive treatment from Coventry participating providers. QUESTION:Must my employees seek medical treatment only from members of the Coventry Workers’ Compensation Medical Network? ANSWER:No. Depending on your state Workers’ Compensation laws, your employees may receive treatment either from a provider you select, or from their choice of provider. You can encourage any injured employee to use a specific participating provider in the Coventry Workers’ Compensation Medical Network by placing worksite posters in each of your locations. Your employees will receive high quality medical care, and you'll benefit from the pre-negotiated rates that can decrease your medical costs. QUESTION:What forms or procedures do I follow to qualify for the discounts offered by the Sentry utilized-Coventry Workers’ Compensation Medical Network? ANSWER:There are no additional forms. Participating providers automatically accept contractual rates for employees covered by a Sentry Workers’ Compensation plan. QUESTION:How can I find out if a hospital or doctor is a participating member of the Coventry Workers Compensation Medical Network? ANSWER:You may access participating providers and create a customized worksite poster by visiting the Perspecta website at https://www.goperspecta.com/VPD/Sentry/public. Instructions for accessing participating providers in your area are provided in the 4-step process noted below or, you may call 855-346-4866 and choose option 3 to request the names of California MPN providers, option 5 to request the names of Texas HCN providers, or option 6 to request the names of providers in all other states. Access the Perspecta website https://www.goperspecta.com/VPD/Sentry/public Select the Provider Search option Limit your search by provider name, specialty, or location. Click the magnifying glass action button. QUESTION:Can I recommend a doctor or hospital to become part of the Coventry Workers Compensation Medical Network? ANSWER:Yes. Contact your Sentry sales representative with the name of the provider. To become part of the network, the provider must meet quality assurance requirements, agree to annual cap increases, and negotiate fixed rates of reimbursement for services delivered. WC 80 99 0009 11 18Page 2 of 4 05/13/2024A0195129006 Middlesex Insurance Company QUESTION:What does the star display mean next to providers that are displayed in the provider search tool and on worksite posters? ANSWER:The indicator identifies those WC providers who have been statistically shown to have better overall claim outcomes as compared to their peers and should be referred to whenever possible or as applicable by state law. HOW TO CREATE WORKSITE POSTERS To create a worksite poster to display participating providers close to your business: Step 1 Visit the Perspecta website at, https://www.goperspecta.com/VPD/Sentry/public. Step 2 Choose the Panel Card option. Step 3 Enter data in required fields flagged with a red asterisk and click the Continue, Review Providers action button. Step 4 If necessary, edit or add providers or provider categories by selecting the Add New Provider and Add New Category action buttons. Step 5 Click the Continue, Create Poster action button. Step 6 Select Email Poster or Print Poster action button based on poster delivery preference. Page 3 of 4WC 80 99 0009 11 18 05/13/2024A0195129006 Middlesex Insurance Company 00002 0000000000 24134 0 N3 512bd861-cd43-4477-b7f9-a34b564fc43f512bd861-cd43-4477-b7f9-a34b564fc43f 2.RETAIL PRESCRIPTION PROGRAM Sentry Insurance is pleased to provide a pharmacy benefits program that can help reduce your Workers’ Compensation costs - Optum. Optum applies extensive clinical expertise along with workflow-driven technology to improve claims outcomes, increase efficiency, and reduce the total cost of prescription drugs while raising the quality of care for injured workers. This program includes: A First Fill program Comprehensive drug utilization review applied to all retail, mail-order, and paper transactions Efficient processes to minimize third-party billing A network with more than 65,000 participating pharmacies 24/7 multilingual support We have enclosed a first fill form for your convenience. If you have any questions, contact Optum at 1-877-470-9572, Sentry Insurance at 1-800-473-6879, or your sales representative. WC 80 99 0009 11 18Page 4 of 4 05/13/2024A0195129006 Middlesex Insurance Company WC 80 99 0012 04 19 Hello, We’re your workers' compensation insurance carrier in California. In accordance with California Labor Code 4600.2, effective April 1, 2019 Sentry Insurance has established a Pharmacy Benefit Network (PBN) to process all California jurisdiction workers' compensation pharmacy prescriptions. Sentry Insurance has contracted with Optum, which owns the Tmesys pharmacy network, to process these prescriptions. Included with this inquiry you’ll find information about the Tmesys PBN. We’ve also included first fill forms that should be provided to employees at time of injury. If you have questions, give us a call at 800-473-6879 and select claims or e-mail managedcare@sentry.com. Thank you. Page 1 of 4 05/13/2024A0195129006 Middlesex Insurance Company 00004 0000000000 24134 0 N1 61cafd13-cf3c-4858-8323-0b0f82bd83c461cafd13-cf3c-4858-8323-0b0f82bd83c4 WC 80 99 0012 04 19 Page 2 of 4 05/13/2024A0195129006 Middlesex Insurance Company 00004 0000000000 24134 0 N2 61cafd13-cf3c-4858-8323-0b0f82bd83c461cafd13-cf3c-4858-8323-0b0f82bd83c4 WC 80 99 0012 04 19 Page 3 of 4 05/13/2024A0195129006 Middlesex Insurance Company 00004 0000000000 24134 0 N3 61cafd13-cf3c-4858-8323-0b0f82bd83c461cafd13-cf3c-4858-8323-0b0f82bd83c4 WC 80 99 0012 04 19 Page 4 of 4 05/13/2024A0195129006 Middlesex Insurance Company 00004 0000000000 24134 0 N4 61cafd13-cf3c-4858-8323-0b0f82bd83c461cafd13-cf3c-4858-8323-0b0f82bd83c4 Page 1 of 1WC 80 04 0012 08 12 05/13/2024A0195129006 Middlesex Insurance Company NOTICE TO CALIFORNIA WC POLICYHOLDERS OCCUPATIONAL INJURY AND ILLNESS PREVENTION CONSULTATION SERVICES As part of our insurance program, the following occupational injury and illness prevention consultation services are provided at no additional cost to our insureds. 1.Surveys of buildings and operations for hazardous conditions. 2.Consultation to aid in the resolution of occupational injury and illness prevention problems. 3.Analysis of loss data to identify and evaluate actual or potential exposures which can result in employee injury and illness. 4.Assistance in training managers, supervisors and employees with regard to injury and illness prevention principles and techniques. 5.Provide information on safety and health standards, codes, regulations, safety equipment and technical data. 6.Assist in the evaluation of existing injury and illness prevention programs or development of an appropriate program to fit your needs. 7. Provide visual aids to supplement your injury and illness prevention program. If you have an immediate need for any of these services, please write, fax, or call: Safety Services Sentry Insurance 1800 North Point Drive Stevens Point, WI 54481 1-800-473-6879 Fax: 715-346-8015 Notice:Workers' compensation insurance policyholders may direct questions or complaints about an insurer's loss control consultation services by contacting: State of California, Department of Industrial Relations; Loss Control Services Coordinator, The Commission on Health, Safety & Workers' Compensation, 455 Golden Gate Avenue, 10th Floor, San Francisco, CA 94102 (415) 703-4220. 00001 0000000000 24134 0 N1 e53c5609-1158-48ff-a759-c9683c13bfb1e53c5609-1158-48ff-a759-c9683c13bfb1 Page 1 of 2 05/13/2024A0195129006 Middlesex Insurance Company WC 80 04 0017 12 04 POLICYHOLDER NOTICE CALIFORNIA WORKERS' COMPENSATION California requires employers to provide to new employees a written notice which covers the contents of Labor Code sections 3550, 3551, and the Division of Workers' Compensation Regulations 9880. The written notice requirements pursuant to Labor Code section 3551 must be provided to every new employee, either at the time the employee is hired or by the end of the first pay period. Failure to comply with the posted and written notice requirements "shall constitute a misdemeanor, and shall be prima facie evidence of non-insurance." In addition, "failure of an employer to provide the notice...shall automatically permit the employee to be treated by his or her personal physician with respect to an injury occurring during that failure." English and Spanish versions of Posters and Pamphlets are available. THE FOLLOWING ARE EXCERPTS FROM THE LABOR CODE SECTIONS AND REGULATION 9880: 3550.(a)Every employer subject to the compensation provisions of this division shall post and keep posted in a conspicuous location frequented by employees and where the notice may be easily read by employees during the hours of the workday, a notice that states the name of the current compensation insurance carrier of the employer, or when such is the fact, that the employer is self-insured, and who is responsible for claims adjustment. (b)Failure to keep any notice required by this section conspicuously posted shall constitute a misdemeanor, and shall be prima facie evidence of noninsurance. (c)This section shall not apply with respect to the employment of employees as defined in subdivision (d) of Section 3351. (d)The form and content of the notice required by this section shall be prescribed by the administrative director, after consultation with the Commission on Health and Safety and Workers' Compensation, and shall advise employees that all injuries should be reported to their employer. The notice shall be easily understandable. It shall be posted in both English and Spanish where there are Spanish-speaking employees. The notice shall include the following information: (1)How to get emergency medical treatment, if needed. (2)The kinds of events, injuries, and illnesses covered by Workers' Compensation. (3)The injured employee's right to receive medical care. (4)The rights of the employee to select and change the treating physician pursuant to the provisions of Section 4600. (5)The rights of the employee to receive temporary disability indemnity, vocational rehabilitation services, and death benefits, as appropriate. (6)To whom injuries should be reported. (7)The existence of time limits for the employer to be notified of an occupational injury. (8)The protections against discrimination provided pursuant to Section 132a. (9)The location and telephone number of the nearest information and assistance officer. (e)Failure of an employer to provide the notice required by this section shall automatically permit the employee to be treated by his or her personal physician with respect to an injury occurring during that failure. (f)The form and content of the notice required to be posted by this section shall be made available to self-insured employers and insurers by the administrative director. Insurers shall provide this notice to each of their policyholders, with advice concerning the requirements of this section and the penalties for a failure to post this notice. 00001 0000000000 24134 0 N1 77de289a-83f7-4b2d-b663-f34fb6f1b54b77de289a-83f7-4b2d-b663-f34fb6f1b54b POLICYHOLDER NOTICE - CONTINUED WC 80 04 0017 12 04 The "Facts About Workers' Compensation" pamphlets referred to in the Labor Code section below will be released to you when available. 3551.(a)Every employer subject to the compensation provisions of this code, except employers of employees defined in subdivision (d) of Section 3351, shall give every new employee, either at the time the employee is hired or by the end of the first pay period, written notice of the information contained in Section 3350. The content of the notice required by this section shall be prescribed by the administrative director after consultation with the Commission on Health and Safety and Workers' Compensation. (b)The notice required by this section shall be easily understandable and available in both English and Spanish. In addition to the information contained in Section 3350, the content of the notice required by this section shall include: (1)Generally, how to obtain appropriate medical care for a job injury. (2)The role and junction of the primary treating physician. (3)A form that the employee may use as an optional method for notifying the employer of the name of the employee's "personal physician," as defined in Section 4600, or "personal chiropractor," as defined by Section 4601. (c)The content of the notice required by this section shall be made available to employers and insurers by the administrative director. Insurers shall provide this notice to each of their policyholders, with advice concerning the requirements of this section and the penalties for a failure to provide this notice to all employees. DEFINITION OF "PERSONAL PHYSICIAN" For the purpose of this article, "personal physician" means the employee's regular physician and surgeon, licensed pursuant to Chapter 5 (commencing with Section 2000) of Division 2 of the Business and Professional Code, who has previously directed the medical treatment of the employee, and who retains the employee's medical records, including his or her medical history. DEFINITION OF "PERSONAL CHIROPRACTOR" For the purpose of this article, "personal chiropractor" means the employee's regular chiropractor licensed pursuant to Chapter 2 (commencing with Section 1000) of Division 2 of the Business and Professional Code, who has previously directed treatment of the employee, and who retains the employee's chiropractic records, including his or her chiropractic history. DIVISION OF WORKERS' COMPENSATION (DWC) REGULATION 9880: (a)Every employer shall provide to every new employee, either at the time of hire or no later than the end of the first pay period, information concerning the rights, benefits, and obligations under Workers' Compensation law. (b)The notice provided shall be in writing, in non-technical terms and shall include the following information: (1)An explanation of the extent and scope of coverage provided by the Workers' Compensation law. (2)An explanation of an injured employee's rights to medical care and to select and change the treating physician. (3)An explanation of an injured employee's rights to indemnity payments for disability or death and the availability of vocational rehabilitation services. (4)The procedures for reporting accidents and injuries to the employer. (5)Where further information may be obtained, including an explanation of services available from an Information and Assistance Officer. Page 2 of 2 05/13/2024A0195129006 Middlesex Insurance Company POLICYHOLDER NOTICE YOUR RIGHT TO RATING AND DIVIDEND INFORMATION I.Information Available to You A.Information Available from Us - Middlesex Insurance Company (1)General questions regarding your policy should be directed to: Sentry Insurance Group 16815 Von Karman Avenue, Ste. 200 Irvine, CA 92606 Telephone: 949-930-6100 Fax: 888-729-2225 Sentry.com (2)Dividend Calculation. If this is a participating policy (a policy on which a dividend may be paid), upon payment or non-payment of a dividend, we shall provide a written explanation to you that sets forth the basis of the dividend calculation. The explanation will be in clear, understandable language and will express the dividend as a dollar amount and as a percentage of the earned premium for the policy year on which the dividend is calculated. (3)Claims Information. Pursuant to Sections 3761 and 3762 of the California Labor Code, you are entitled to receive information in our claim files that affects your premium. Copies of documents will be supplied at your expense during reasonable business hours. For claims covered under this policy, we will estimate the ultimate cost of unsettled claims for statistical purposes eighteen months after the policy becomes effective and will report those estimates to the Workers’ Compensation Insurance Rating Bureau of California (WCIRB) no later than twenty months after the policy becomes effective. The cost of any settled claims will also be reported at that time. At twelve-month intervals thereafter, we will update and report to the WCIRB the estimated cost of any unsettled claims and the actual final cost of any claims settled in the interim. The amounts we report will be used by the WCIRB to compute your experience modification if you are eligible for experience rating. B.Information Available from the Workers’ Compensation Insurance Rating Bureau of California (1)The WCIRB is a licensed rating organization and the California Insurance Commissioner’s designated statistical agent. As such, the WCIRB is responsible for administering the California Workers’ Compensation Uniform Statistical Reporting Plan-1995 (USRP) and the California Workers’ Compensation Experience Rating Plan-1995 (ERP). WCIRB contact information is: WCIRB, 1901 Harrison Street, 17th Floor, Oakland, CA 94612, Attn: Customer Service; 888.229.2472 (phone); 415.778.7272 (fax); and customerservice@wcirb.com (email). The regulations contained in the USRP and ERP are available for public viewing through the WCIRB’s website at wcirb.com. (2)Policyholder Information. Pursuant to California Insurance Code (CIC) Section 11752.6, upon written request, you are entitled to information relating to loss experience, claims, classification assignments, and policy contracts as well as rating plans, rating systems, manual rules, or other information impacting your premium that is maintained in the records of the WCIRB. Complaints and Requests for Action requesting policyholder information should be forwarded to: WCIRB, 1901 Harrison Street, 17th Floor, Oakland, CA 94612, Attn: Custodian of Records. The Custodian of Records can be reached at 415.777.0777 (phone) and 415.778.7272 (fax). (3)Experience Rating Form. Each experience rated risk may receive a single copy of its current Experience Rating Form/Worksheet free of charge by completing a Policyholder Experience Rating Worksheet Request Form on the WCIRB’s website at wcirb.com/ratesheet. The Experience Rating Form/Worksheet will include a Loss-Free Rating, which is the experience modification that would have been calculated if $0 (zero) actual losses were incurred during the experience period. This hypothetical rating calculation is provided for informational purposes only. II.Dispute Process You may dispute our actions or the actions of the WCIRB pursuant to CIC Sections 11737 and 11753.1. A.Our Dispute Resolution Process. If you are aggrieved by our decision adopting a change in a classification assignment that results in increased premium, or by the application of our rating system to your workers’ compensation insurance, you may dispute these matters with us. If you are dissatisfied with the outcome of the initial dispute with us, you may send us a written Complaint and Request for Action as outlined below. You may send us a written Complaint and Request for Action requesting that we reconsider a change in a classification assignment that results in an increased premium and/or requesting that we review the manner in which our rating system has been applied in connection with the insurance afforded or offered you. Page 1 of 2WC 80 04 0020 02 22 05/13/2024A0195129 Middlesex Insurance Company 00001 0000000000 24134 0 N1 6dc734f1-8724-4b0a-927c-bde53736c04b6dc734f1-8724-4b0a-927c-bde53736c04b Written Complaints and Requests for Action should be forwarded to: Sentry Insurance Group 16815 Von Karman Avenue, Ste. 200 Irvine, CA 92606 Telephone: 949-930-6100 Fax: 888-729-2225 Website: Sentry.com After you send your Complaint and Request for Action, we have 30 days to send you a written notice indicating whether or not your written request will be reviewed. If we agree to review your request, we must conduct the review and issue a decision granting or rejecting your request within 60 days after sending you the written notice granting review. If we decline to review your request, if you are dissatisfied with the decision upon review, or if we fail to grant or reject your request or issue a decision upon review, you may appeal to the Insurance Commissioner as described in Paragraph II.C., below. B.Disputing the Actions of the WCIRB. If you have been aggrieved by any decision, action, or omission to act of the WCIRB, you may request, in writing, that the WCIRB reconsider its decision, action, or omission to act. You may also request, in writing, that the WCIRB review the manner in which its rating system has been applied in connection with the insurance afforded or offered you. For requests related to classification disputes, the reporting of experience, or coverage issues, your initial request for review must be received by the WCIRB within 12 months after the expiration date of the policy to which the request for review pertains, except if the request involves the application of the Revision of Losses rule. For requests related to your experience modification, your initial request for review must be received by the WCIRB within 6 months after the issuance, or 12 months after the expiration date, of the experience modification to which the request for review pertains, whichever is later, except if the request for review involves the application of the Revision of Losses rule. If the request involves the Revision of Losses rule, the time to state your appeal may be longer. (See Section VI, Rule 7 of the ERP). You may commence the review process by sending the WCIRB a written Inquiry. Written Inquiries should be sent to: WCIRB, 1901 Harrison Street, 17th Floor, Oakland, CA 94612, Attn: Customer Service. Customer Service can be reached at 888.229.2472 (phone), 415.778.7272 (fax) and customerservice@wcirb.com (email). If you are dissatisfied with the WCIRB’s decision upon an Inquiry, or if the WCIRB fails to respond within 90 days after receipt of the Inquiry, you may pursue the subject of the Inquiry by sending the WCIRB a written Complaint and Request for Action. After you send your Complaint and Request for Action, the WCIRB has 30 days to send you written notice indicating whether or not your written request will be reviewed. If the WCIRB agrees to review your request, it must conduct the review and issue a decision granting or rejecting your request within 60 days after sending you the written notice granting review. If the WCIRB declines to review your request, if you are dissatisfied with the decision upon review, or if the WCIRB fails to grant or reject your request or issue a decision upon review, you may appeal to the Insurance Commissioner as described in Paragraph II.C., below. Written Complaints and Requests for Action should be forwarded to: WCIRB, 1901 Harrison Street, 17th Floor, Oakland, CA 94612, Attn: Complaints and Reconsideration. The WCIRB’s contact information is 888.229.2472 (phone), 415.371.5204 (fax) and customerservice@wcirb.com (email). C.California Department of Insurance - Appeals to the Insurance Commissioner. After you follow the appropriate dispute resolution process described above, if (1) we or the WCIRB decline to review your request, (2) you are dissatisfied with the decision upon review, or (3) we or the WCIRB fail to grant or reject your request or issue a decision upon review, you may appeal to the Insurance Commissioner pursuant to CIC Sections 11737, 11752.6, 11753.1 and Title 10, California Code of Regulations, Section 2509.40 et seq. You must file your appeal within 30 days after we or the WCIRB send you the notice rejecting review of your Complaint and Request for Action or the decision upon your Complaint and Request for Action. If no written decision regarding your Complaint and Request for Action is sent, your appeal must be filed within 120 days after you sent your Complaint and Request for Action to us or to the WCIRB. The filing address for all appeals to the Insurance Commissioner is: Administrative Hearing Bureau California Department of Insurance 1901 Harrison Street, 3rd Floor Oakland, CA 94612 415.538.4243 You have the right to a hearing before the Insurance Commissioner, and our action, or the action of the WCIRB, may be affirmed, modified or reversed. III.Resources Available to You in Obtaining Information and Pursuing Disputes A.Policyholder Ombudsman. Pursuant to California Insurance Code Section 11752.6, a policyholder ombudsman is available at the WCIRB to assist you in obtaining and evaluating the rating, policy, and claims information referenced in I.A. and I.B., above. The ombudsman may advise you on any dispute with us, the WCIRB, or on an appeal to the Insurance Commissioner pursuant to Section 11737 of the Insurance Code. The address of the policyholder ombudsman is WCIRB, 1901 Harrison Street, 17th Floor, Oakland, CA 94612, Attn: Policyholder Ombudsman. The policyholder ombudsman can be reached at 415.778.7159 (phone), 415.371.5288 (fax) and ombudsman@wcirb.com (email). B.California Department of Insurance - Information and Assistance. Information and assistance on policy questions can be obtained from the Department of Insurance Consumer HOTLINE, 800.927.HELP (4357) or insurance.ca.gov. For questions and correspondence regarding appeals to the Administrative Hearing Bureau, see the contact information in Paragraph II.C. This notice does not change the policy to which it is attached. WC 80 04 0020 02 22Page 2 of 2 05/13/2024A0195129 Middlesex Insurance Company Page 1 of 2 05/13/2024A0195129006 Middlesex Insurance Company WC 80 04 0021 03 14 POLICYHOLDER NOTICE CALIFORNIA WORKERS' COMPENSATION INSURANCE RATING LAWS Pursuant to Section 11752.8 of the California Insurance Code, we are providing you with an explanation of the California workers' compensation rating laws. 1.We establish our own rates for workers' compensation. Our rates, rating plans, and related information are filed with the insurance commissioner and are open for public inspection. 2.The insurance commissioner can disapprove our rates, rating plans, or classifications only if he or she has determined after public hearing that our rates might jeopardize our ability to pay claims or might create a monopoly in the market. A monopoly is defined by law as a market where one insurer writes 20% or more of that part of the California workers' compensation insurance that is not written by the State Compensation Insurance Fund. If the insurance commissioner disapproves our rates, rating plans, or classifications, he or she may order an increase in the rates applicable to outstanding policies. 3.Rating organizations may develop pure premium rates that are subject to the insurance commissioner's approval. A pure premium rate reflects the anticipated cost and expense of claims per $100 of payroll for a given classification. Pure premium rates are advisory only, as we are not required to use the pure premium rates developed by any rating organization in establishing our own rates. 4.We must adhere to a single, uniform experience rating plan. If you are eligible for experience rating under the plan, we will be required to adjust your premium to reflect your claim history. A better claim history generally results in a lower experience rating modification; more claims, or more expensive claims, generally results in a higher experience rating modification. The uniform experience rating plan, which is developed by the insurance rating organization designated by the insurance commissioner, is subject to approval by the insurance commissioner. 5.A standard classification system, developed by the insurance rating organization designated by the insurance commissioner, is subject to approval by the insurance commissioner. The standard classification system is a method of recognizing and separating policyholders into industry or occupational groups according to their similarities and/or differences. We can adopt and apply the standard classification system or develop and apply our own classification system, provided we can report the payroll, expenses, and other costs of claims in a way that is consistent with the uniform statistical plan or the standard classification system. 6.Our rates and classifications may not violate the Unruh Civil Rights Act or be unfairly discriminatory. 7.We will provide an appeal process for you to appeal the way we rate your insurance policy. The process requires us to respond to your written appeal within 30 days. If you are not satisfied with the result of your appeal, you may appeal our decision to the insurance commissioner. © 2002 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. 00001 0000000000 24134 0 N1 2e95808a-967b-4c45-bb19-0499c8050d882e95808a-967b-4c45-bb19-0499c8050d88 POLICYHOLDER NOTICE CALIFORNIA WORKERS' COMPENSATION INSURANCE RATING LAWS - CONTINUED WC 80 04 0021 03 14 CALIFORNIA WORKERS' COMPENSATION INSURANCE NOTICE OF NONRENEWAL Section 11664 of the California Insurance Code requires us, in most instances, to provide you with a notice of nonrenewal. Except as specified in paragraphs 1 through 6 below, if we elect to nonrenew your policy, we are required to deliver or mail to you a written notice stating the reason or reasons for the nonrenewal of the policy. The notice is required to be sent to you no earlier than 120 days before the end of the policy period and no later than 30 days before the end of the policy period. If we fail to provide you the required notice, we are required to continue the coverage under the policy with no change in the premium rate until 60 days after we provide you with the required notice. We are not required to provide you with a notice of nonrenewal in any of the following situations: 1.Your policy was transferred or renewed without a change in its terms or conditions or the rate on which the premium is based to another insurer or other insurers who are members of the same insurance group as us. 2.The policy was extended for 90 days or less and the required notice was given prior to the extension. 3.You obtained replacement coverage or agreed, in writing, within 60 days of the termination of the policy, to obtain that coverage. 4.The policy is for a period of no more than 60 days and you were notified at the time of issuance that it may not be renewed. 5.You requested a change in the terms or conditions or risks covered by the policy within 60 days prior to the end of the policy period. 6.We made a written offer to you to renew the policy at a premium rate increase of less than 25 percent. (A)If the premium rate in your governing classification is to be increased 25 percent or greater and we intend to renew the policy, we shall provide a written notice of a renewal offer not less than 30 days prior to the policy renewal date. The governing classification shall be determined by the rules and regulations established in accordance with California Insurance Code Section 11750.3(c). (B)For purposes of this Notice, "premium rate" means the cost of insurance per unit of exposure prior to the application of individual risk variations based on loss or expense considerations such as scheduled rating and experience rating. This notice does not change the policy to which it is attached. © 2002 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved.Page 2 of 2 05/13/2024A0195129006 Middlesex Insurance Company Page 1 of 1WC 80 04 0022 03 14 05/13/2024A0195129006 Middlesex Insurance Company POLICYHOLDER NOTICE CALIFORNIA INSURANCE GUARANTEE ASSOCIATION (CIGA) SURCHARGE Companies writing property and casualty insurance business in California are required to participate in the California Insurance Guarantee Association. If a company becomes insolvent, the California Insurance Guarantee Association settles unpaid claims and assesses each insurance company for its fair share. California law requires all companies to surcharge policies to recover these assessments. If your policy is surcharged, "CA Surcharge" with an amount will be displayed on your policy declaration page. This notice does not change the policy to which it is attached. 00001 0000000000 24134 0 N1 7ff7287d-0609-4a1b-8d78-350c0091cd3e7ff7287d-0609-4a1b-8d78-350c0091cd3e WAIVER FORM Insured Name: Axis Mechanical , Inc. Insurer: Middlesex Insurance Company Policy No.: A0195129 CORPORATE OFFICERS/DIRECTORS - WAIVER OF WORKERS' COMPENSATION COVERAGE Pursuant to California Labor Code section 3352(a)(16)(A)(i), I hereby certify that I am an officer or director as described in Labor Code section 3351, subdivision (c) of the above-named insured, and that I either (1) own at least ten percent (10%) of the issued and outstanding stock of the above-named insured corporation, or (2) own at least one percent (1%) of the issued and outstanding stock of the corporation if my parent, grandparent, sibling, spouse, or child owns at least ten percent (10%) of the issued and outstanding stock of the corporation and am covered by a health insurance policy or a health service plan. As a qualifying officer or director, I elect to be excluded from the corporation's workers’ compensation insurance policy with the above-referenced insurer. I understand and agree that this written waiver will be effective upon the date of receipt and acceptance by the corporation's insurer, that the insurer may elect to backdate the acceptance of the waiver up to 15 days prior to the date of receipt of the waiver, and that it shall remain in effect until I provide the insurer with a written withdrawal of this waiver. I understand and agree that by signing this waiver, I will not be entitled to coverage under the insured's workers’ compensation policy with the above-referenced insurer if an employment-related injury occurs. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. DATED: OFFICER/DIRECTOR SIGNATURE PRINT OFFICER’S/DIRECTOR’S FULL NAME/TITLE ACCEPTED: Middlesex Insurance Company [Insurance Company]DATE NOTE TO EMPLOYER: The exclusion will be endorsed to the policy upon our receipt and acceptance of a signed and properly completed form. The person electing exclusion must sign this form. Company representatives may not sign on behalf of the individual. One exclusion per form. Submit additional forms if needed. Page 1 of 1WC 80 04 0023 07 18 05/13/2024A0195129006 Middlesex Insurance Company 00001 0000000000 24134 0 N1 c3fc4607-569d-4aac-a77a-3fa82a6e2341c3fc4607-569d-4aac-a77a-3fa82a6e2341 WAIVER FORM Insured Name: Axis Mechanical , Inc. Insurer: Middlesex Insurance Company Policy No.: A0195129 GENERAL PARTNERS AND LLC MANAGING MEMBERS - WAIVER OF WORKERS' COMPENSATION COVERAGE Pursuant to California Labor Code section 3352(a)(17)(A), I hereby certify that I am a general partner (if the insured is a partnership) or a managing member (if the insured is a limited liability company) of the above-named insured. As a qualifying general partner or managing member, I elect to be excluded from the insured's workers’ compensation insurance policy with the above-referenced insurer. I understand and agree that this written waiver will be effective upon the date of receipt and acceptance by the partnership's or limited liability company's insurer, that the insurer may elect to backdate the acceptance of the waiver up to 15 days prior to the date of receipt of the waiver, and that it shall remain in effect until I provide the insurer with a written withdrawal of this waiver. I understand and agree that by signing this waiver, I will not be entitled to coverage under the insured's workers’ compensation insurance policy with the above-referenced insurer if an employment-related injury occurs. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. DATED: GENERAL PARTNER’S/MANAGING PRINT FULL NAME/TITLE MEMBER’S SIGNATURE ACCEPTED: Middlesex Insurance Company [Insurance Company]DATE NOTE TO EMPLOYER: The exclusion will be endorsed to the policy upon our receipt and acceptance of a signed and properly completed form. The person electing exclusion must sign this form. Company representatives may not sign on behalf of the individual. One exclusion per form. Submit additional forms if needed. Page 1 of 1WC 80 04 0024 07 18 05/13/2024A0195129006 Middlesex Insurance Company 00001 0000000000 24134 0 N1 81f66e1c-2a32-48c1-be61-65fb352b141a81f66e1c-2a32-48c1-be61-65fb352b141a IMPORTANT NOTICE TO POLICYHOLDERS CALIFORNIA WORKERS’ COMPENSATION REPORTING FIRST AID CLAIMS Effective January 1, 2017, employers will be required to report all injuries, including those that meet the definition of first aid, to their insurance carrier. First aid means any one-time treatment, and any follow-up visit for the purpose of observation of minor scratches, cuts, burns, splinters, or other minor industrial injury, which do not ordinarily require medical care. This one-time treatment, and follow-up visit for the purpose of observation, is considered first aid even though provided by a physician or registered professional personnel. Insurers are required to report the medical costs incurred on first aid claims to the Workers’ Compensation Insurance Rating Bureau (WCIRB), even if paid by the employer, as any other medical loss. In order to be compliant with this reporting requirement we ask that you report all incidents that meet the definition of “first aid” to us and forward all medical bills to us for payment. When we pay medical bills directly we may pay a discounted rate. If you pay the bill directly you will be required to report the bill and payment amount to us. By reporting all claims to us, you are also avoiding the risk of becoming a Medicare reporting entity (RRE). Page 1 of 1WC 80 04 0026 01 17 05/13/2024A0195129006 Middlesex Insurance Company 00001 0000000000 24134 0 N1 196df70a-59f6-4548-ae7c-6b03c66d1ed9196df70a-59f6-4548-ae7c-6b03c66d1ed9 PN 04 99 06 D 01 20 POLICYHOLDER NOTICE PAYROLL RECORD AND AUDIT REQUIREMENTS FOR DUAL WAGE CONSTRUCTION OR ERECTION CLASSIFICATIONS Your policy includes one or more construction or erection classifications. Dual wage classifications are pairs of classifications that describe the same construction or erection operation yet are assigned based upon whether the employee's hourly wage is above or below a specified threshold. Each pair of dual wage classifications contains one “high wage” classification that is assignable to payrolls earned by employees whose regular hourly wage equals or exceeds a specified wage threshold and one “low wage” classification that is assignable to payrolls earned by employees whose regular hourly wage is less than the specified threshold. Payroll Record Requirements The assignment of a high wage classification is contingent on verifying that the employee's hourly wage equals or exceeds the specified wage threshold. The determination of the regular hourly wage for any non-salaried employee must be supported by one of the following sources: Original time cards or time book entries for each employee. Original records must include the operations performed, the total hours worked each day and the times the employee started and ended each work period throughout the workday. At job locations where all of the employer's operations cease for a uniform unpaid meal period, recording the start and stop times of the uniform break period is not required. A valid collective bargaining agreement that shows the regular hourly wage rate by job classification of a worker. If using a collective bargaining agreement, the records must include an employee roster by job classification that permits the reconciliation of individual employees to the job classifications set forth in the collective bargaining agreement. The non-salaried employee's regular hourly wage shall be determined by dividing that employee's total remuneration by the hours worked during the pay period, irrespective of whether the employee is paid on an hourly, piecework, production or commission basis. The payroll earned by any non-salaried employees for whom the records specified above are not maintained and/or made available will be assigned to the low wage classification that describes the operations performed. The regular hourly wage of salaried employees is determined by dividing the total annual remuneration by 2000 hours. If an employee is salaried for less than 12 months, the regular hourly wage for the salaried period is calculated on a prorated basis. Audit Requirements If your policy has an effective date on or after January 1, 2020 and produces a final premium of $10,500 or more, a physical audit is required at least once a year; if it produces a final premium of less than $10,500 and develops payroll in a high wage classification, a physical audit of the policy is required unless the policy is a renewal and a physical audit was completed for one of the two immediately preceding policy periods. A “physical audit” is defined as an audit of payroll, whether conducted at the policyholder's location or at a remote site, that is based upon an auditor's examination of the policyholder's books of accounts and original payroll records (in either electronic or hard copy form) as necessary to determine and verify the exposure amounts by classification. If you hold a C-39 Roofing Contractor license from the California Contractors State License Board, a physical audit is required on the complete policy period of each policy regardless of the amount of final premium. See California Insurance Code Section 11665(a) for additional requirements regarding the audit of C-39 license holders. Page 1 of 1WC 80 04 0027 (Ed. 01 20) 05/13/2024A0195129006 Middlesex Insurance Company 00001 0000000000 24134 0 N1 88b5ce75-106b-4b0a-8746-ce1d162ba35388b5ce75-106b-4b0a-8746-ce1d162ba353 PN 04 99 08 12 19 POLICYHOLDER NOTICE CALIFORNIA ASSEMBLY BILL NO. 5, INDEPENDENT CONTRACTORS Summary of Assembly Bill No. 5 (AB 5) For the purposes of wages, workers’ compensation and other benefits, AB 5 creates a presumption that an entity's workers are employees unless the hiring entity can show that the worker meets three conditions, known as the “ABC Test”. With respect to workers’ compensation, AB 5 goes into effect on July 1, 2020 and applies to policies issued on or after July 1, 2020, as well as policies in force as of July 1, 2020. The bill adds Section 2750.3 to the California Labor Code, which provides in pertinent part: 2750.3. (a)(1) For purposes of the provisions of this code and the Unemployment Insurance Code, and for the wage orders of the Industrial Welfare Commission, a person providing labor or services for remuneration shall be considered an employee rather than an independent contractor unless the hiring entity demonstrates that all of the following conditions are satisfied: (A) The person is free from the control and direction of the hiring entity in connection with the performance of the work, both under the contract for the performance of the work and in fact. (B) The person performs work that is outside the usual course of the hiring entity's business. (C) The person is customarily engaged in an independently established trade, occupation, or business of the same nature as that involved in the work performed. (2) Notwithstanding paragraph (1), any exceptions to the terms “employee,” “employer,” “employ,” or “independent contractor,” and any extensions of employer status or liability, that are expressly made by a provision of this code, the Unemployment Insurance Code, or in an applicable order of the Industrial Welfare Commission, including, but not limited to, the definition of “employee” in subdivision 2(E) of Wage Order No. 2, shall remain in effect for the purposes set forth therein. (3) If a court of law rules that the three-part test in paragraph (1) cannot be applied to a particular context based on grounds other than an express exception to employment status as provided under paragraph (2), then the determination of employee or independent contractor status in that context shall instead be governed by the California Supreme Court's decision in S.G. Borello & Sons, Inc. v. Department of Industrial Relations (1989) 48 Cal.3d 341. AB 5 also provides an extensive list of occupations that are exempt from the application of Section 2750.3(a)(1). These exemptions are subject to revision. In addition, AB 5 amends Section 3351 of the California Labor Code and Sections 606.5 and 621 of the Unemployment Insurance Code. The pertinent sections of the California Labor Code and Unemployment Insurance Code may be accessed at http://leginfo.legislature.ca.gov. You may also access the California Labor & Workforce Development Agency webpage at https://www.labor.ca.gov/employmentstatus/ for more information. This notice does not change the policy to which it is attached. Page 1 of 1WC 80 04 0028 (Ed. 07 20) 05/13/2024A0195129006 Middlesex Insurance Company 00001 0000000000 24134 0 N1 6f2ce189-d474-4b3a-8bf8-f4eb67be82f56f2ce189-d474-4b3a-8bf8-f4eb67be82f5 Page 1 of 1WC 80 99 0005 04 12 05/13/2024A0195129006 Middlesex Insurance Company POLICYHOLDER NOTICE NEW YORK OUT-OF-STATE EMPLOYERS The New York Workers Compensation Board enforces New York Workers’ Compensation Law (WCL) verifying that employers maintain proper New York Workers’ Compensation Coverage. The New York Compensation Board issued a policy statement on their website to address out-of-state employers. The policy states that employers meeting any of the following criteria will be required to maintain New York WC coverage (New York must be listed in Item 3A of the Policy Information Page): The employer (as defined in the WCL) is required to register with the NYS Department of Labor and pay Unemployment Insurance for any period in question. The employer has a permanent physical location in New York or has employees whose primary work location is in New York. The employer is operating in New York under a permit, contract, or license granted by the State of New York, its counties or any municipality as defined under Subsection 57 of the Workers’ Compensation Law. The employer is working as a contractor/general contractor/subcontractor on a construction project in New York. In the previous year, the employer had employees physically in New York for at least 40 hours of every week for a period of longer than 2 consecutive weeks or had employees present in New York for 25 or more individual days (e.g. - 5 employees working for 5 days in New York equals 25 individual employee days). Employees traveling through the state of New York not stopping for deliveries, pick-ups, or other work are not deemed to have worked in New York. An employer that has reason to know that it will meet these criteria in the current year, even if it has not done so in the prior year, must obtain the required coverage. Out-of-state employers that are sending employees into New York that are only attending infrequent (not more than one per month) meetings, seminars, conferences or conventions in New York will not be required to provide full statutory coverage. Failure to provide required New York coverage may result in fines and penalties. Additional information may be obtained on the Board's website: http://www.wcb.ny.gov. Please contact your Sentry Representative to add New York to your Workers’ Compensation policy if you anticipate meeting any of the above criteria or if you have questions. 00001 0000000000 24134 0 N1 4da92ef1-b73a-4a5b-8acf-67331e91ade34da92ef1-b73a-4a5b-8acf-67331e91ade3 05/13/2024A0195129006 Middlesex Insurance Company 00003 0000000000 24134 0 N1 810f339b-152a-4e75-8290-7d9bb6653bf7810f339b-152a-4e75-8290-7d9bb6653bf7 1 of 6 (Ed. 1-15) © Copyright 2013 National Council on Compensation Insurance, Inc. All Rights Reserved. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 00 00 C WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY In return for the payment of the premium and subject to all terms of this policy, we agree with you as follows: GENERAL SECTION A.The Policy This policy includes at its effective date the Information Page and all endorsements and schedules listed there. It is a contract of insurance between you (the employer named in Item 1 of the Information Page) and us (the insurer named on the Information Page). The only agreements relating to this insurance are stated in this policy. The terms of this policy may not be changed or waived except by endorsement issued by us to be part of this policy. B.Who is Insured You are insured if you are an employer named in Item 1 of the Information Page. If that employer is a partnership, and if you are one of its partners, you are insured, but only in your capacity as an employer of the partnership’s employees. C.Workers Compensation Law Workers Compensation Law means the workers or workmen’s compensation law and occupational disease law of each state or territory named in Item 3.A. of the Information Page. It includes any amendments to that law which are in effect during the policy period. It does not include any federal workers or workmen’s compensation law, any federal occupational disease law or the provisions of any law that provide nonoccupational disability benefits. D.State State means any state of the United States of America, and the District of Columbia. E.Locations This policy covers all of your workplaces listed in Items 1 or 4 of the Information Page; and it covers all other workplaces in Item 3.A. states unless you have other insurance or are self-insured for such workplaces. PART ONE WORKERS COMPENSATION INSURANCE A.How This Insurance Applies This workers compensation insurance applies to bodily injury by accident or bodily injury by disease. Bodily injury includes resulting death. 1.Bodily injury by accident must occur during the policy period. 2.Bodily injury by disease must be caused or aggravated by the conditions of your employment. The employee’s last day of last exposure to the conditions causing or aggravating such bodily injury by disease must occur during the policy period. B.We Will Pay We will pay promptly when due the benefits required of you by the workers compensation law. C.We Will Defend We have the right and duty to defend at our expense any claim, proceeding or suit against you for benefits payable by this insurance. We have the right to investigate and settle these claims, proceedings or suits. We have no duty to defend a claim, proceeding or suit that is not covered by this insurance. D.We Will Also Pay We will also pay these costs, in addition to other amounts payable under this insurance, as part of any claim, proceeding or suit we defend: 1.reasonable expenses incurred at our request, but not loss of earnings; 2.premiums for bonds to release attachments and for appeal bonds in bond amounts up to the amount payable under this insurance; 3.litigation costs taxed against you; 4.interest on a judgment as required by law until we offer the amount due under this insurance; and 5.expenses we incur. E.Other Insurance We will not pay more than our share of benefits and costs covered by this insurance and other (Ed. 1-15) 2 of 6 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICYWC 00 00 00 C insurance or self-insurance. Subject to any limits of liability that may apply, all shares will be equal until the loss is paid. If any insurance or self-insurance is exhausted, the shares of all remaining insurance will be equal until the loss is paid. F.Payments You Must Make You are responsible for any payments in excess of the benefits regularly provided by the workers compensation law including those required because: 1.of your serious and willful misconduct; 2.you knowingly employ an employee in violation of law; 3.you fail to comply with a health or safety law or regulation; or 4.you discharge, coerce or otherwise discriminate against any employee in violation of the workers compensation law. If we make any payments in excess of the benefits regularly provided by the workers compensation law on your behalf, you will reimburse us promptly. G.Recovery From Others We have your rights, and the rights of persons entitled to the benefits of this insurance, to recover our payments from anyone liable for the injury. You will do everything necessary to protect those rights for us and to help us enforce them. H.Statutory Provisions These statements apply where they are required by law. 1.As between an injured worker and us, we have notice of the injury when you have notice. 2.Your default or the bankruptcy or insolvency of you or your estate will not relieve us of our duties under this insurance after an injury occurs. 3.We are directly and primarily liable to any person entitled to the benefits payable by this insurance. Those persons may enforce our duties; so may an agency authorized by law. Enforcement may be against us or against you and us. 4.Jurisdiction over you is jurisdiction over us for purposes of the workers compensation law. We are bound by decisions against you under that law, subject to the provisions of this policy that are not in conflict with that law. 5.This insurance conforms to the parts of the workers compensation law that apply to: a.benefits payable by this insurance; b.special taxes, payments into security or other special funds, and assessments payable by us under that law. 6.Terms of this insurance that conflict with the workers compensation law are changed by this statement to conform to that law. Nothing in these paragraphs relieves you of your duties under this policy. PART TWO EMPLOYERS LIABILITY INSURANCE A.How This Insurance Applies This employers liability insurance applies to bodily injury by accident or bodily injury by disease. Bodily injury includes resulting death. 1.The bodily injury must arise out of and in the course of the injured employee’s employment by you. 2.The employment must be necessary or incidental to your work in a state or territory listed in Item 3.A. of the Information Page. 3.Bodily injury by accident must occur during the policy period. 4.Bodily injury by disease must be caused or aggravated by the conditions of your employment. The employee’s last day of last exposure to the conditions causing or aggravating such bodily injury by disease must occur during the policy period 5.If you are sued, the original suit and any related legal actions for damages for bodily injury by accident or by disease must be brought in the United States of America, its territories or possessions, or Canada. B.We Will Pay We will pay all sums that you legally must pay as damages because of bodily injury to your employees, provided the bodily injury is covered by this Employers Liability Insurance. The damages we will pay, where recovery is permitted by law, include damages: 1.For which you are liable to a third party by reason of a claim or suit against you by that third party to recover the damages claimed against such third party as a result of injury to your employee; © Copyright 2013 National Council on Compensation Insurance, Inc. All Rights Reserved.05/13/2024A0195129006 Middlesex Insurance Company (Ed. 1-15) 3 of 6 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 00 00 C 2.For care and loss of services; and 3.For consequential bodily injury to a spouse, child, parent, brother or sister of the injured employee; provided these damages are the direct consequence of bodily injury that arises out of and in the course of the injured employee’s employment by you;and 4.Because of bodily injury to your employee that arises out of and in the course of employment, claimed against you in a capacity other than as employer. C.Exclusions This insurance does not cover: 1.Liability assumed under a contract. This exclusion does not apply to a warranty that your work will be done in a workmanlike manner; 2.Punitive or exemplary damages because of bodily injury to an employee employed in violation of law; 3.Bodily injury to an employee while employed in violation of law with your actual knowledge or the actual knowledge of any of your executive officers; 4.Any obligation imposed by a workers compensation, occupational disease, unemployment compensation, or disability benefits law, or any similar law; 5.Bodily injury intentionally caused or aggravated by you; 6.Bodily injury occurring outside the United States of America, its territories or possessions, and Canada. This exclusion does not apply to bodily injury to a citizen or resident of the United States of America or Canada who is temporarily outside these countries; 7.Damages arising out of coercion, criticism, demotion, evaluation, reassignment, discipline, defamation, harassment, humiliation, discrimination against or termination of any employee, or any personnel practices, policies, acts or omissions; 8.Bodily injury to any person in work subject to the Longshore and Harbor Workers’ Compensation Act (33 U.S.C. Sections 901 et seq.), the Nonappropriated Fund Instrumentalities Act (5 U.S.C. Sections 8171 et seq.), the Outer Continental Shelf Lands Act (43 U.S.C. Sections 1331 et seq.), the Defense Base Act (42 U.S.C. Sections 1651-1654), the Federal Mine Safety and Health Act (30 U.S.C. Sections 801 et seq. and 901-944), any other federal workers or workmen’s compensation law or other federal occupational disease law, or any amendments to these laws; 9.Bodily injury to any person in work subject to the Federal Employers’ Liability Act (45 U.S.C. Sections 51 et seq.), any other federal laws obligating an employer to pay damages to an employee due to bodily injury arising out of or in the course of employment, or any amendments to those laws; 10.Bodily injury to a master or member of the crew of any vessel, and does not cover punitive damages related to your duty or obligation to provide transportation, wages, maintenance, and cure under any applicable maritime law; 11.Fines or penalties imposed for violation of federal or state law; and 12.Damages payable under the Migrant and Seasonal Agricultural Worker Protection Act (29 U.S.C. Sections 1801 et seq.) and under any other federal law awarding damages for violation of those laws or regulations issued thereunder, and any amendments to those laws. D.We Will Defend We have the right and duty to defend, at our expense, any claim, proceeding or suit against you for damages payable by this insurance. We have the right to investigate and settle these claims, proceedings and suits. We have no duty to defend a claim, proceeding or suit that is not covered by this insurance. We have no duty to defend or continue defending after we have paid our applicable limit of liability under this insurance. E.We Will Also Pay We will also pay these costs, in addition to other amounts payable under this insurance, as part of any claim, proceeding, or suit we defend: 1.Reasonable expenses incurred at our request, but not loss of earnings; 2.Premiums for bonds to release attachments and for appeal bonds in bond amounts up to the limit of our liability under this insurance; 3.Litigation costs taxed against you; 4.Interest on a judgment as required by law until we offer the amount due under this insurance; and 5.Expenses we incur. © Copyright 2013 National Council on Compensation Insurance, Inc. All Rights Reserved.05/13/2024A0195129006 Middlesex Insurance Company 00003 0000000000 24134 0 N3 810f339b-152a-4e75-8290-7d9bb6653bf7810f339b-152a-4e75-8290-7d9bb6653bf7 (Ed. 1-15) 4 of 6 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICYWC 00 00 00 C F.Other Insurance We will not pay more than our share of damages and costs covered by this insurance and other insurance or self-insurance. Subject to any limits of liability that apply, all shares will be equal until the loss is paid. If any insurance or self-insurance is exhausted, the shares of all remaining insurance and self-insurance will be equal until the loss is paid. G.Limits of Liability Our liability to pay for damages is limited. Our limits of liability are shown in Item 3.B. of the Information Page. They apply as explained below. 1.Bodily Injury by Accident. The limit shown for “bodily injury by accident-each accident” is the most we will pay for all damages covered by this insurance because of bodily injury to one or more employees in any one accident. A disease is not bodily injury by accident unless it results directly from bodily injury by accident. 2.Bodily Injury by Disease. The limit shown for “bodily injury by disease-policy limit” is the most we will pay for all damages covered by this insurance and arising out of bodily injury by disease, regardless of the number of employees who sustain bodily injury by disease. The limit shown for “bodily injury by disease-each employee” is the most we will pay for all damages because of bodily injury by disease to any one employee. Bodily injury by disease does not include disease that results directly from a bodily injury by accident. 3.We will not pay any claims for damages after we have paid the applicable limit of our liability under this insurance. H.Recovery From Others We have your rights to recover our payment from anyone liable for an injury covered by this insurance. You will do everything necessary to protect those rights for us and to help us enforce them. I.Actions Against Us There will be no right of action against us under this insurance unless: 1.You have complied with all the terms of this policy; and 2.The amount you owe has been determined with our consent or by actual trial and final judgment. This insurance does not give anyone the right to add us as a defendant in an action against you to determine your liability. The bankruptcy or insolvency of you or your estate will not relieve us of our obligations under this Part. PART THREE OTHER STATES INSURANCE A.How This Insurance Applies 1.This other states insurance applies only if one or more states are shown in Item 3.C. of the Information Page. 2.If you begin work in any one of those states after the effective date of this policy and are not insured or are not self-insured for such work, all provisions of the policy will apply as though that state were listed in Item 3.A. of the Information Page. 3.We will reimburse you for the benefits required by the workers compensation law of that state if we are not permitted to pay the benefits directly to persons entitled to them. 4.If you have work on the effective date of this policy in any state not listed in Item 3.A. of the Information Page, coverage will not be afforded for that state unless we are notified within thirty days. B.Notice Tell us at once if you begin work in any state listed in Item 3.C. of the Information Page. PART FOUR YOUR DUTIES IF INJURY OCCURS Tell us at once if injury occurs that may be covered by this policy. Your other duties are listed here. 1.Provide for immediate medical and other services required by the workers compensation law. 2.Give us or our agent the names and addresses of the injured persons and of witnesses, and other information we may need. 3.Promptly give us all notices, demands and legal papers related to the injury, claim, proceeding or suit. © Copyright 2013 National Council on Compensation Insurance, Inc. All Rights Reserved.05/13/2024A0195129006 Middlesex Insurance Company (Ed. 1-15) 5 of 6 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 00 00 C 4.Cooperate with us and assist us, as we may request, in the investigation, settlement or defense of any claim, proceeding or suit. 5.Do nothing after an injury occurs that would interfere with our right to recover from others. 6.Do not voluntarily make payments, assume obligations or incur expenses, except at your own cost. PART FIVE PREMIUM A.Our Manuals All premium for this policy will be determined by our manuals of rules, rates, rating plans and classifications. We may change our manuals and apply the changes to this policy if authorized by law or a governmental agency regulating this insurance. B.Classifications Item 4 of the Information Page shows the rate and premium basis for certain business or work classifications. These classifications were assigned based on an estimate of the exposures you would have during the policy period. If your actual exposures are not properly described by those classifications, we will assign proper classifications, rates and premium basis by endorsement to this policy. C.Remuneration Premium for each work classification is determined by multiplying a rate times a premium basis. Remuneration is the most common premium basis. This premium basis includes payroll and all other remuneration paid or payable during the policy period for the services of: 1.all your officers and employees engaged in work covered by this policy; and 2.all other persons engaged in work that could make us liable under Part One (Workers Compensation Insurance) of this policy. If you do not have payroll records for these persons, the contract price for their services and materials may be used as the premium basis. This paragraph 2 will not apply if you give us proof that the employers of these persons lawfully secured their workers compensation obligations. D.Premium Payments You will pay all premium when due. You will pay the premium even if part or all of a workers compensation law is not valid. E.Final Premium The premium shown on the Information Page, schedules, and endorsements is an estimate. The final premium will be determined after this policy ends by using the actual, not the estimated, premium basis and the proper classifications and rates that lawfully apply to the business and work covered by this policy. If the final premium is more than the premium you paid to us, you must pay us the balance. If it is less, we will refund the balance to you. The final premium will not be less than the highest minimum premium for the classifications covered by this policy. If this policy is canceled, final premium will be determined in the following way unless our manuals provide otherwise: 1.If we cancel, final premium will be calculated pro rata based on the time this policy was in force. Final premium will not be less than the pro rata share of the minimum premium. 2.If you cancel, final premium will be more than pro rata; it will be based on the time this policy was in force, and increased by our short-rate cancelation table and procedure. Final premium will not be less than the minimum premium. F.Records You will keep records of information needed to compute premium. You will provide us with copies of those records when we ask for them. G.Audit You will let us examine and audit all your records that relate to this policy. These records include ledgers, journals, registers, vouchers, contracts, tax reports, payroll and disbursement records, and programs for storing and retrieving data. We may conduct the audits during regular business hours during the policy period and within three years after the policy period ends. Information developed by audit will be used to determine final premium. Insurance rate service organizations have the same rights we have under this provision. © Copyright 2013 National Council on Compensation Insurance, Inc. All Rights Reserved.05/13/2024A0195129006 Middlesex Insurance Company 00003 0000000000 24134 0 N5 810f339b-152a-4e75-8290-7d9bb6653bf7810f339b-152a-4e75-8290-7d9bb6653bf7 (Ed. 1-15) 6 of 6 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICYWC 00 00 00 C PART SIX CONDITIONS A.Inspection We have the right, but are not obliged to inspect your workplaces at any time. Our inspections are not safety inspections. They relate only to the insurability of the workplaces and the premiums to be charged. We may give you reports on the conditions we find. We may also recommend changes. While they may help reduce losses, we do not undertake to perform the duty of any person to provide for the health or safety of your employees or the public. We do not warrant that your workplaces are safe or healthful or that they comply with laws, regulations, codes or standards. Insurance rate service organizations have the same rights we have under this provision. B.Long Term Policy If the policy period is longer than one year and sixteen days, all provisions of this policy will apply as though a new policy were issued on each annual anniversary that this policy is in force. C.Transfer of Your Rights and Duties Your rights or duties under this policy may not be transferred without our written consent. If you die and we receive notice within thirty days after your death, we will cover your legal representative as insured. D.Cancelation 1.You may cancel this policy. You must mail or deliver advance written notice to us stating when the cancelation is to take effect. 2.We may cancel this policy. We must mail or deliver to you not less than ten days advance written notice stating when the cancelation is to take effect. Mailing that notice to you at your mailing address shown in Item 1 of the Information Page will be sufficient to prove notice. 3.The policy period will end on the day and hour stated in the cancelation notice. 4.Any of these provisions that conflict with a law that controls the cancelation of the insurance in this policy is changed by this statement to comply with the law. E.Sole Representative The insured first named in Item 1 of the Information Page will act on behalf of all insureds to change this policy, receive return premium, and give or receive notice of cancelation. © Copyright 2013 National Council on Compensation Insurance, Inc. All Rights Reserved.05/13/2024A0195129006 Middlesex Insurance Company (Ed. 4-84) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule Name: Address: CA Description of Waiver:Any person or organization for whom the Named Insured has agreed by written contract executed prior to loss. JobID: (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Policy No.Endorsement No. Insured Premium Insurance Company Countersigned by This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. © 1983 National Council on Compensation Insurance. WC 00 03 13 (Ed. 4-84) Page 1 of 1 05/13/2024A0195129006 Middlesex Insurance Company 00001 0000000000 24134 0 N1 997c2911-53cc-491a-a4bb-ed0524c8e39c997c2911-53cc-491a-a4bb-ed0524c8e39c (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. Endorsement Effective Policy No.Endorsement No. Insured Premium Insurance Company Countersigned by © 1995 National Council on Compensation Insurance, Inc. WC 00 04 06 A (Ed. 7-95) Page 1 of 1 05/13/2024A0195129006 Middlesex Insurance Company (Ed. 7-95) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 04 06 A PREMIUM DISCOUNT ENDORSEMENT The premium for this policy and the policies, if any, listed in Item 3 of the Schedule may be eligible for a discount. This endorsement shows your estimated discount in Items 1 or 2 of the Schedule. The final calculation of premium discount will be determined by our manuals and your premium basis as determined by audit. Premium subject to retrospective rating is not subject to premium discount. Schedule 1.State Estimated Eligible Premium California First Next Next $10,000 $190,000 $1,550,000 Balance 0.00%10.90%12.60%14.40% 2.Average percentage discount: _____% 3.Other policies: 4.If there are no entries in Items 1, 2 and 3 of the Schedule, see the Premium Discount Endorsement attached to your policy number: 00001 0000000000 24134 0 N1 7571c7be-7683-44e4-8256-6a34959c80a27571c7be-7683-44e4-8256-6a34959c80a2 Page 1 of 1 05/13/2024A0195129006 Middlesex Insurance Company © 2000 National Council on Compensation Insurance, Inc. WC 00 04 19 (Ed. 1-01) (Ed. 1-01) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 04 19 PREMIUM DUE DATE ENDORSEMENT This endorsement is used to amend: Section D. of Part Five of the policy is replaced by this provision. PART FIVE PREMIUM D.Premium is amended to read: You will pay all premium when due. You will pay the premium even if part or all of a workers compensation law is not valid. The due date for audit and retrospective premiums is the date of the billing. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Policy No.Endorsement No. Insured Premium $ Insurance Company Countersigned by This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. 00001 0000000000 24134 0 N1 6f95d169-0698-4ce5-96e8-3a9bedd6cd076f95d169-0698-4ce5-96e8-3a9bedd6cd07 (Ed. 1-21) © Copyright 2020 National Council on Compensation Insurance, Inc. All Rights Reserved. (Ed. 1-21) WC 00 04 22 C WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 04 22 C TERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION ACT DISCLOSURE ENDORSEMENT This endorsement addresses the requirements of the Terrorism Risk Insurance Act of 2002 as amended and extended by the Terrorism Risk Insurance Program Reauthorization Act of 2019. It serves to notify you of certain limitations under the Act, and that your insurance carrier is charging premium for losses that may occur in the event of an Act of Terrorism. Your policy provides coverage for workers compensation losses caused by Acts of Terrorism, including workers compensation benefit obligations dictated by state law. Coverage for such losses is still subject to all terms, definitions, exclusions, and conditions in your policy, and any applicable federal and/or state laws, rules, or regulations. Definitions The definitions provided in this endorsement are based on and have the same meaning as the definitions in the Act. If words or phrases not defined in this endorsement are defined in the Act, the definitions in the Act will apply. “Act” means the Terrorism Risk Insurance Act of 2002, which took effect on November 26, 2002, and any amendments thereto, including any amendments resulting from the Terrorism Risk Insurance Program Reauthorization Act of 2019. “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, as meeting all of the following requirements: a.The act is an act of terrorism. b.The act is violent or dangerous to human life, property, or infrastructure. c.The act resulted in damage within the United States, or outside of the United States in the case of the premises of United States missions or certain air carriers or vessels. d.The act has 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. “Insured Loss” means any loss resulting from an act of terrorism (and, except for Pennsylvania, including an act of war, in the case of workers compensation) that is covered by primary or excess property and casualty insurance issued by an insurer if the loss occurs in the United States or at the premises of United States missions or to certain air carriers or vessels. “Insurer Deductible” means, for the period beginning on January 1, 2021, and ending on December 31, 2027, an amount equal to 20% of our direct earned premium during the immediately preceding calendar year. Page 1 of 2 05/13/2024A0195129006 Middlesex Insurance Company 00001 0000000000 24134 0 N1 fbd7e4db-b828-45d4-ae76-ff7dd91272e1fbd7e4db-b828-45d4-ae76-ff7dd91272e1 (Ed. 1-21) WC 00 04 22 C (Ed. 1-21) © Copyright 2020 National Council on Compensation Insurance, Inc. All Rights Reserved. WC 00 04 22 C WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY Limitation of Liability The Act limits our liability to you under this policy. If aggregate Insured Losses exceed $100,000,000,000 in a calendar year and if we have met our Insurer Deductible, we are not liable for the payment of any portion of the amount of Insured Losses that exceeds $100,000,000,000; and for aggregate Insured Losses up to $100,000,000,000, we will pay only a pro rata share of such Insured Losses as determined by the Secretary of the Treasury. Policyholder Disclosure Notice 1.Insured Losses would be partially reimbursed by the United States Government. If the aggregate industry Insured Losses occurring in any calendar year exceed $200,000,000, the United States Government would pay 80% of our Insured Losses that exceed our Insurer Deductible. 2.Notwithstanding item 1 above, the United States Government will not make any payment under the Act for any portion of Insured Losses that exceed $100,000,000,000. 3.The premium charge for the coverage your policy provides for Insured Losses is included in the amount shown in Item 4 of the Information Page or in the Schedule below. Schedule State Rate Premium (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. Endorsement Effective Policy No.Endorsement No. Insured Premium Insurance Company Countersigned by Page 2 of 2 05/13/2024A0195129006 Middlesex Insurance Company Page 1 of 2 05/13/2024A0195129006 Middlesex Insurance Company (Ed. 02-18) WC 04 03 01 D (Ed. 02-18) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 01 D POLICY AMENDATORY ENDORSEMENT-CALIFORNIA It is agreed that, anything in the policy to the contrary notwithstanding, such insurance as is afforded by this policy by reason of the designation of California in Item 3 of the Information Page is subject to the following provisions: 1.Minors Illegally Employed – Not Insured. This policy does not cover liability for additional compensation imposed on you under Section 4557, Division IV, Labor Code of the State of California, by reason of injury to an employee under sixteen years of age and illegally employed at the time of injury. 2.Punitive or Exemplary Damages – Uninsurable. This policy does not cover punitive or exemplary damages where insurance of liability therefor is prohibited by law or contrary to public policy. 3.Increase in Indemnity Payment – Reimbursement. You are obligated to reimburse us for the amount of increase in indemnity payments made pursuant to Subdivision (d) of Section 4650 of the California Labor Code, if the late indemnity payment which gives rise to the increase in the amount of payment is due less than seven (7) days after we receive the completed claim form from you. You are obligated to reimburse us for any increase in indemnity payments not covered under this policy and will reimburse us for any increase in indemnity payment not covered under the policy when the aggregate total amount of the reimbursement payments paid in a policy year exceeds one hundred dollars ($100). If we notify you in writing, within 30 days of the payment, that you are obligated to reimburse us, we will bill you for the amount of increase in indemnity payment and collect it no later than the final audit. You will have 60 days, following notice of the obligation to reimburse, to appeal the decision of the insurer to the Department of Insurance. 4.Application of Policy. Part One, “Workers Compensation Insurance”, A, “How This Insurance Applies”, is amended to read as follows: This workers compensation insurance applies to bodily injury by accident or disease, including death resulting therefrom. Bodily injury by accident must occur during the policy period. Bodily injury by disease must be caused or aggravated by the conditions of your employment. Your employee’s exposure to those conditions causing or aggravating such bodily injury by disease must occur during the policy period. 5.Rate Changes. The premium and rates with respect to the insurance provided by this policy by reason of the designation of California in Item 3 of the Information Page are subject to change if ordered by the Insurance Commissioner of the State of California pursuant to Section 11737 of the California Insurance Code. 6.Long Term Policy. If this policy is written for a period longer than one year, all the provisions of this policy shall apply separately to each consecutive twelve-month period or, if the first or last consecutive period is less than twelve months, to such period of less than twelve months, in the same manner as if a separate policy had been written for each consecutive period. 7.Statutory Provision. Your employee has a first lien upon any amount which becomes owing to you by us on account of this policy, and in the case of your legal incapacity or inability to receive the money and pay it to the claimant, we will pay it directly to the claimant. 8.Part Five, “Premium”, E, “Final Premium”, is amended to read as follows: The premium shown on the Information Page, schedules, and endorsements is an estimate. The final premium will be determined after this policy ends by using the actual, not the estimated, premium basis and the proper classifications and rates that lawfully apply to the business and work covered by this policy. If the final premium is more than the premium you paid to us, you must pay us the balance. If it is less, we will refund the balance to you. The final premium will not be less than the highest minimum premium for the classifications covered by this policy. If this policy is cancelled, final premium will be determined in the following way unless our manuals provide otherwise: a.If we cancel, final premium will be calculated pro rata based on the time this policy was in force. Final premium will not be less than the pro rata share of the minimum premium. b.If you cancel, final premium may be more than pro rata; it will be based on the time this policy was in force, and may be increased by our short-rate cancellation table and procedure. Final premium will not be less than the pro rata share of the minimum premium. It is further agreed that this policy, including all endorsements forming a part thereof, constitutes the entire contract of insurance. No condition, provision, agreement, or understanding not set forth in this policy or such endorsements shall affect such contract or any rights, duties, or privileges arising therefrom. © Copyright 2011 by the Workers Compensation Insurance Rating Bureau of California. All rights reserved. From the WCIRB’s California Workers’ Compensation Insurance Forms Manual © 2001 00001 0000000000 24134 0 N1 af904798-5223-4e4b-8f5f-c283f58e834eaf904798-5223-4e4b-8f5f-c283f58e834e (Ed. 02-18) WC 04 03 01 D (Ed. 02-18) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICYWC 04 03 01 D Note: 1.This endorsement may be used to amend the Workers Compensation and Employers Liability Insurance Policy, WC 00 00 00 C, to comply with California law. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. Endorsement Effective Policy No.Endorsement No. Insured Insurance Company Countersigned By Page 2 of 2 05/13/2024A0195129006 Middlesex Insurance Company (Ed. 07-18) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 03 C ENDORSEMENT AGREEMENT LIMITING AND RESTRICTING THIS INSURANCE OFFICERS AND DIRECTORS COVERAGE / EXCLUSION-CALIFORNIA 1. 2. 3. If the employer named in Item 1 of the Information Page is a quasi-public or private corporation, this policy applies to all officers and members of boards of directors while rendering actual service for the corporation for pay, as employees, except those excluded below who individually own at least 10 percent of the corporation's issued and outstanding stock, or individually own at least 1 percent of the corporation's issued and outstanding stock if that officer's or member's parent, grandparent, sibling, spouse, or child owns at least 10 percent of the corporation's issued and outstanding stock and that officer or member is covered by a health insurance policy or a health care service plan, or are officers or members of the board of directors of a cooperative corporation organized pursuant to the Cooperative Corporation Law (Corporations Code, Sections 12200 - 12704) who state that he or she is covered by both a health care service plan or health insurance policy, and a disability insurance policy that is comparable in scope and coverage, as determined by the Insurance Commissioner, to a workers’ compensation policy. If the employer named in Item 1 of the Information Page is a private corporation, or a private cooperative corporation organized pursuant to the Cooperative Corporation Law, this policy applies to an officer or director who is the sole shareholder of the corporation, as an employee, except if excluded below. The insurance under this policy is limited as follows: It is AGREED that, anything in this policy to the contrary notwithstanding, this policy DOES NOT INSURE: Officers, Directors and Trustees Excluded Title Jonathan Diaz Secretary Mike Herrera Chief Executive Officer Tom Best Chief Financial Officer Nothing in this endorsement shall be held to vary, alter, waive or extend any of the terms, conditions, agreements, or limitations of this policy other than as above stated. Nothing elsewhere in this policy shall be held to vary, alter, waive or limit the terms, conditions, agreements or limitations in this endorsement. It is further agreed that “remuneration” when used as a premium basis for such insurance as is afforded by this policy shall not include the remuneration of any person excluded from coverage in accordance with the foregoing. FAILURE TO SECURE THE PAYMENT OF FULL COMPENSATION BENEFITS FOR ALL EMPLOYEES AS REQUIRED BY LABOR CODE SECTION 3700 IS A VIOLATION OF LAW AND MAY SUBJECT THE EMPLOYER TO THE IMPOSITION OF A WORK STOP ORDER, LARGE FINES, AND OTHER SUBSTANTIAL PENALTIES (Labor Code Section 3710.1, et seq.). (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. Endorsement Effective Policy No.Endorsement No. Insured Insurance Company Countersigned By WC 04 03 03 C (Ed. 07-18) Page 1 of 1 05/13/2024A0195129006 Middlesex Insurance Company 00001 0000000000 24134 0 N1 aceaf525-d0ae-4882-869a-64e73ca79b31aceaf525-d0ae-4882-869a-64e73ca79b31 Page 1 of 1 05/13/2024A0195129006 Middlesex Insurance Company (Ed. 01-15) (Ed. 01-15) WC 04 03 60 B WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 60 B EMPLOYERS' LIABILITY COVERAGE AMENDATORY ENDORSEMENT - CALIFORNIA The insurance afforded by Part Two (Employers' Liability Insurance) by reason of designation of California in Item 3 of the Information Page is subject to the following provisions: A."How This Insurance Applies", is amended to read as follows: A.How This Insurance Applies This Employers' Liability Insurance applies to bodily injury by accident or bodily injury by disease. Bodily injury means a physical injury, including resulting death. 1.The bodily injury must arise out of and in the course of the injured employee's employment by you. 2.The employment must be necessary or incidental to your work in California. 3.Bodily injury by accident must occur during the policy period. 4.Bodily injury by disease must be caused or aggravated by the conditions of your employment. The employee's last day of last exposure to the conditions causing or aggravating such bodily injury by disease must occur during the policy period. 5.If you are sued, the original suit and any related legal actions for damages for bodily injury by accident or by disease must be brought in the United States of America, its territories or possessions, or Canada. C.The "Exclusions" section is modified as follows (all other exclusions in the "Exclusions" section remain as is): 1.Exclusion 1 is amended to read as follows: 1.Liability assumed under a contract. 2.Exclusion 2 is deleted. 3.Exclusion 7 is amended to read as follows: 7.Damages arising out of coercion, criticism, demotion, evaluation, reassignment, discipline, defamation, harassment, humiliation, discrimination against or termination of any employee, termination of employment, or any personnel practices, policies, acts or omissions. 4.The following exclusions are added: 1.Bodily injury to any member of the flying crew of any aircraft. 2.Bodily injury to an employee when you are deprived of statutory or common law defenses or are subject to penalty because of your failure to secure your obligations under the Workers' Compensation Law(s) applicable to you or otherwise fail to comply with that law. 3.Liability arising from California Labor Code Section 2810.3 which relates to labor contracting. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) © Copyright 1999 Workers' Compensation Insurance Rating Bureau of California. Endorsement Effective Insured Policy No. Insurance Company Endorsement No. Countersigned By 00001 0000000000 24134 0 N1 d9250de8-f446-437a-9b90-b946f36b2b9fd9250de8-f446-437a-9b90-b946f36b2b9f Note: 1.This endorsement may be used to amend policy form WC 00 00 00 C (Ed. 01-15) Page 1 of 1 05/13/2024A0195129006 Middlesex Insurance Company (Ed. 1-08) WC 04 04 21 (Ed. 1-08) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 04 21 OPTIONAL PREMIUM INCREASE ENDORSEMENT - CALIFORNIA You must provide us, or our authorized representative, access to records necessary to perform a payroll verification audit. If you fail to provide access within 90 days after expiration of the policy, you are liable to pay a total premium equal to 3 times our current estimate of the annual premium for your policy. In addition, if you fail to provide access after our third request within a 90 day or longer period, you are also liable for our costs in attempting to perform the audit unless you provide a compelling business reason for your failure. We may contact you to schedule appointments during normal business hours. We will notify you of your failure to provide access by mailing a certified, return-receipt document stating the increased premium and the total amount of our costs incurred in our attempt(s) to perform an audit. In addition to any other obligations under this contract, 30 days after your receive the notification, you will be obligated to pay the total premium and costs referenced above. If, thereafter, you provide access to your records within three years after the policy expires, or within another mutually agreed upon time, and we succeed in performing the audit to our satisfaction, we will revise your total premium and the costs due to reflect the results of the audit. 00001 0000000000 24134 0 N1 cfa0df3a-18d5-475f-a4b1-ba081870aedacfa0df3a-18d5-475f-a4b1-ba081870aeda (Ed. 01-22) WC 04 06 01 B (Ed. 01-22) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 06 01 B CALIFORNIA CANCELATION ENDORSEMENT This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of the Information Page. The cancelation condition in Part Six (Conditions) of the policy is replaced by these conditions: Cancelation: 1.You may cancel this policy. You must mail or deliver advance written notice to us stating when the cancelation is to take effect. 2.We may cancel this policy for one or more of the following reasons: a.Non-payment of premium; b.Failure to report payroll; c.Failure to permit us to audit payroll as required by the terms of this policy or of a previous policy issued by us; d.Failure to pay any additional premium resulting from an audit of payroll required by the terms of this policy or any previous policy issued by us; e.Material misrepresentation made by you or your agent; f.Failure to cooperate with us in the investigation of a claim; g.Material failure to comply with federal or state safety orders or written recommendations of our designated loss control representatives; h.The occurrence of a material change in the ownership of your business; i.The occurrence of any change in your business or operations that materially increases the hazard for frequency or severity of loss; j.The occurrence of any change in your business or operation that requires additional or different classification for premium calculation; k.The occurrence of any change in your business or operation which contemplates an activity excluded by our reinsurance treaties. 3.If we cancel your policy for any of the reasons listed in (a) through (f), we will give you 10 days advance written notice, stating when the cancelation is to take effect. Mailing that notice to you at your mailing address shown in Item 1 of the Information Page will be sufficient to prove notice. If we cancel your policy for any of the reasons listed in Items (g) through (k), we will give you 30 days advance written notice; however, we agree that in the event of cancelation and reissuance of a policy effective upon a material change in ownership or operations, notice will not be provided. 4.If we mail the notice to you, the stated periods of notice and your right to remedy the condition will be extended by 5 days if the place of mailing and your mailing address is within California, 10 days if the place of mailing or your mailing address is outside of California and 20 days if the place of mailing or your mailing address is outside of the United States. 5.The policy period will end on the day and hour stated in the cancelation notice. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. Endorsement Effective Policy No.Endorsement No. Insured Insurance Company Countersigned By Page 1 of 1 05/13/2024A0195129006 Middlesex Insurance Company 00001 0000000000 24134 0 N1 3e0ac4dd-5eac-4e1e-9fc6-342e37d8b5963e0ac4dd-5eac-4e1e-9fc6-342e37d8b596 (Ed. 01-23) WC 04 06 04 A (Ed. 01-23) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 06 04 A COVID-19 REPORTING REQUIREMENT ENDORSEMENT - CALIFORNIA In addition to the requirements under Part 4, “Your Duties if Injury Occurs” of your policy, if you have five or more employees and an employee that is not described in California Labor Code section 3212.87 tests positive for COVID-19, you are required to report the following information as provided below. Pursuant to California Labor Code Section 3212.88(i), when you know, or reasonably should know, that an employee has tested positive for COVID-19 between September 17, 2020 and January 1, 2024, you must report to your claims administrator in writing via electronic mail or facsimile within 3 business days all of the following: (1)An employee has tested positive. For purposes of this reporting, do not provide any personally identifiable information regarding the employee who tested positive for COVID-19 unless the employee asserts the infection is work related or has filed a claim form pursuant to California Labor Code Section 5401. (2)The date that the employee tests positive, which is the date the specimen was collected for testing. (3)The specific address or addresses of the employee's specific place of employment during the 14-day period preceding the date of the employee's positive test. (4)The highest number of employees who reported to work at the employee's specific place of employment in the 45-day period preceding the last day the employee worked at each specific place of employment. Labor Code Section 3212.88(j) states that the intentional submission of false or misleading information or the failure to report the above information as required may subject you to a civil penalty in the amount of up to $10,000 to be assessed by the Labor Commissioner. For the purposes of these reporting requirements, California Labor Code Section 3212.88(m) provides the following: (1)“COVID-19” means the 2019 novel coronavirus disease. (2)“Test” or “testing” means a PCR (Polymerase Chain Reaction) test approved for use or approved for emergency use by the United States Food and Drug Administration to detect the presence of viral RNA. “Test” or “testing” does not include serologic testing, also known as antibody testing. “Test” or “testing” may include any other viral culture test approved for use or approved for emergency use by the United States Food and Drug Administration to detect the presence of viral RNA which has the same or higher sensitivity and specificity as the PCR test. (3)“A specific place of employment” means the building, store, facility, or agricultural field where an employee performs work at the employer's direction. “A specific place of employment” does not include the employee's home or residence, unless the employee provides home health care services to another individual at the employee's home or residence. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Policy No.Endorsement No. Insured Insurance Company Countersigned By Page 1 of 1 05/13/2024A0195129 Middlesex Insurance Company 00001 0000000000 24134 0 N1 e71ac560-825d-4400-9de2-7d91944269a2e71ac560-825d-4400-9de2-7d91944269a2 <Project Title> 2021 Form PAYMENT BOND <Project Number> Page 30 Payment Bond <________________________________> (“City”) and ________________________ (“Contractor”) have entered into a contract for work on the <_________________________________________________> Project (“Project”). The Contract is incorporated by reference into this Payment Bond (“Bond”). 1. General. Under this Bond, Contractor as principal and ____________________________, its surety (“Surety”), are bound to City as obligee in an amount not less than $_________________, under California Civil Code § 9550 et seq., to ensure payment to authorized claimants. This Bond is binding on the respective successors, assigns, owners, heirs, or executors of Surety and Contractor. 2. Surety’s Obligation. If Contractor or any of its Subcontractors fails to pay a person authorized in California Civil Code § 9100 to assert a claim against a payment bond, any amounts due under the Unemployment Insurance Code with respect to work or labor performed under the Contract, or any amounts required to be deducted, withheld, and paid over to the Employment Development Department from the wages of employees of Contractor and its Subcontractors under California Unemployment Insurance Code § 13020 with respect to the work and labor, then Surety will pay the obligation. 3. Beneficiaries. This Bond inures to the benefit of any of the persons named in California Civil Code § 9100, so as to give a right of action to those persons or their assigns in any suit brought upon this Bond. Contractor must promptly provide a copy of this Bond upon request by any person with legal rights under this Bond. 4. Duration. If Contractor promptly makes payment of all sums for all labor, materials, and equipment furnished for use in the performance of the Work required by the Contract, in conformance with the time requirements set forth in the Contract and as required by California law, Surety’s obligations under this Bond will be null and void. Otherwise, Surety’s obligations will remain in full force and effect. 5. Waivers. Surety waives any requirement to be notified of alterations to the Contract or extensions of time for performance of the Work under the Contract. Surety waives the provisions of Civil Code §§ 2819 and 2845. City waives the requirement of a new bond for any supplemental contract under Civil Code § 9550. Any notice to Surety may be given in the manner specified in the Contract and delivered or transmitted to Surety as follows: Attn: _____________________________________________________ Address: __________________________________________________ City/State/Zip: ______________________________________________ Phone: ___________________________________________________ Email: ____________________________________________________ 6. Law and Venue. This Bond will be governed by California law, and venue for any dispute pursuant to this Bond will be in the <__________________> County Superior Court, and no other place. Surety will be responsible for City’s attorneys’ fees and costs in any action to enforce the provisions of this Bond. [Signatures are on the following page.] <Project Title> 2021 Form PAYMENT BOND <Project Number> Page 31 7. Effective Date; Execution. This Bond is entered into and is effective on __________, 20__. SURETY: ___________________________________ Business Name s/__________________________________ ______________________________ Date ___________________________________ Name, Title (Attach Acknowledgment with Notary Seal and Power of Attorney) CONTRACTOR: ___________________________________ Business Name s/__________________________________ ______________________________ Date ___________________________________ Name, Title END OF PAYMENT BOND <Project Title> 2021 Form PERFORMANCE BOND <Project Number> Page 32 Performance Bond <______________________________> (“City”) and __________________________ (“Contractor”) have entered into a contract for work on the <_______________________________________________> Project (“Project”). The Contract is incorporated by reference into this Performance Bond (“Bond”). 1. General. Under this Bond, Contractor as Principal and ___________________________, its surety (“Surety”), are bound to City as obligee for an amount not less than $__________________ to ensure Contractor’s faithful performance of its obligations under the Contract. This Bond is binding on the respective successors, assigns, owners, heirs, or executors of Surety and Contractor. 2. Surety’s Obligations. Surety’s obligations are co-extensive with Contractor’s obligations under the Contract. If Contractor fully performs its obligations under the Contract, including its warranty obligations under the Contract, Surety’s obligations under this Bond will become null and void. Otherwise, Surety’s obligations will remain in full force and effect. 3. Waiver. Surety waives any requirement to be notified of and further consents to any alterations to the Contract made under the applicable provisions of the Contract Documents, including changes to the scope of Work or extensions of time for performance of Work under the Contract. Surety waives the provisions of Civil Code §§ 2819 and 2845. 4. Application of Contract Balance. Upon making a demand on this Bond for completion of the Work prior to acceptance of the Project, City will make the Contract Balance available to Surety for completion of the Work under the Contract. For purposes of this provision, the Contract Balance is defined as the total amount payable by City to Contractor as the Contract Price minus amounts already paid to Contractor, and minus any liquidated damages, credits, or backcharges to which City is entitled under the terms of the Contract. 5. Contractor Default. Upon written notification from City of Contractor’s termination for default under Article 13 of the Contract General Conditions, time being of the essence, Surety must act within the time specified in Article 13 to remedy the default through one of the following courses of action: 5.1 Arrange for completion of the Work under the Contract by Contractor, with City’s consent, but only if Contractor is in default solely due to its financial inability to complete the Work; 5.2 Arrange for completion of the Work under the Contract by a qualified contractor acceptable to City, and secured by performance and payment bonds issued by an admitted surety as required by the Contract Documents, at Surety’s expense; or 5.3 Waive its right to complete the Work under the Contract and reimburse City the amount of City’s costs to have the remaining Work completed. 6. Surety Default. If Surety defaults on its obligations under the Bond, City will be entitled to recover all costs it incurs due to Surety’s default, including legal, design professional, or delay costs. 7. Notice. Any notice to Surety may be given in the manner specified in the Contract and sent to Surety as follows: Attn: _____________________________________________________ <Project Title> 2021 Form PERFORMANCE BOND <Project Number> Page 33 Address: __________________________________________________ City/State/Zip: ______________________________________________ Phone: ___________________________________________________ Fax: ______________________________________________________ Email: ____________________________________________________ 8. Law and Venue. This Bond will be governed by California law, and venue for any dispute pursuant to this Bond will be in the <___________> County Superior Court, and no other place. Surety will be responsible for City’s attorneys’ fees and costs in any action to enforce the provisions of this Bond. 9. Effective Date; Execution. This Bond is entered into and effective on ____________________, 20___. SURETY: ___________________________________ Business Name s/__________________________________ ______________________________ Date ___________________________________ Name, Title (Attach Acknowledgment with Notary Seal and Power of Attorney) CONTRACTOR: ___________________________________ Business Name s/__________________________________ ______________________________ Date ___________________________________ Name, Title END OF PERFORMANCE BOND Axis Mechanical Inc. On-Call Agreement Final Audit Report 2024-12-19 Created:2024-12-11 By:Webmaster Admin (webmaster@cupertino.org) Status:Signed Transaction ID:CBJCHBCAABAACVDN5EpcbScj-dKs93twZdqW1f7sPTGr "Axis Mechanical Inc. On-Call Agreement" History Document created by Webmaster Admin (webmaster@cupertino.org) 2024-12-11 - 2:22:58 AM GMT- IP address: 35.229.54.2 Document emailed to Sundari Pilaka (Sundarip@cupertino.org) for approval 2024-12-11 - 2:33:00 AM GMT Email viewed by Sundari Pilaka (Sundarip@cupertino.org) 2024-12-11 - 2:33:14 AM GMT- IP address: 3.232.50.116 Document approved by Sundari Pilaka (Sundarip@cupertino.org) Approval Date: 2024-12-11 - 2:36:38 AM GMT - Time Source: server- IP address: 64.165.34.3 Document emailed to Araceli Alejandre (aracelia@cupertino.org) for approval 2024-12-11 - 2:36:43 AM GMT Email viewed by Araceli Alejandre (aracelia@cupertino.org) 2024-12-11 - 2:36:51 AM GMT- IP address: 52.202.236.132 Document approved by Araceli Alejandre (aracelia@cupertino.org) Approval Date: 2024-12-11 - 4:09:37 PM GMT - Time Source: server- IP address: 64.165.34.3 Document emailed to mannyl@axismechanicalinc.com for signature 2024-12-11 - 4:09:42 PM GMT Webmaster Admin (webmaster@cupertino.org) replaced signer mannyl@axismechanicalinc.com with johnd@axismechanicalinc.com 2024-12-12 - 9:52:53 PM GMT- IP address: 76.103.212.163 Document emailed to johnd@axismechanicalinc.com for signature 2024-12-12 - 9:52:54 PM GMT Email viewed by johnd@axismechanicalinc.com 2024-12-12 - 11:38:11 PM GMT- IP address: 107.128.99.82 Signer johnd@axismechanicalinc.com entered name at signing as Jonathan Diaz 2024-12-19 - 8:03:33 PM GMT- IP address: 107.128.99.82 Document e-signed by Jonathan Diaz (johnd@axismechanicalinc.com) Signature Date: 2024-12-19 - 8:03:42 PM GMT - Time Source: server- IP address: 107.128.99.82 Document emailed to Christopher Jensen (christopherj@cupertino.org) for signature 2024-12-19 - 8:03:45 PM GMT Email viewed by Christopher Jensen (christopherj@cupertino.org) 2024-12-19 - 8:03:52 PM GMT- IP address: 3.232.50.116 Signer Christopher Jensen (christopherj@cupertino.org) entered name at signing as Christopher D. Jensen 2024-12-19 - 8:51:04 PM GMT- IP address: 64.165.34.3 Document e-signed by Christopher D. Jensen (christopherj@cupertino.org) Signature Date: 2024-12-19 - 8:51:06 PM GMT - Time Source: server- IP address: 64.165.34.3 Document emailed to Chad Mosley (chadm@cupertino.org) for signature 2024-12-19 - 8:51:12 PM GMT Email viewed by Chad Mosley (chadm@cupertino.org) 2024-12-19 - 8:51:20 PM GMT- IP address: 3.232.50.116 Document e-signed by Chad Mosley (chadm@cupertino.org) Signature Date: 2024-12-19 - 9:48:12 PM GMT - Time Source: server- IP address: 64.165.34.3 Document emailed to Kirsten Squarcia (kirstens@cupertino.org) for signature 2024-12-19 - 9:48:18 PM GMT Email viewed by Kirsten Squarcia (kirstens@cupertino.org) 2024-12-19 - 9:48:23 PM GMT- IP address: 52.202.236.132 Document e-signed by Kirsten Squarcia (kirstens@cupertino.org) Signature Date: 2024-12-19 - 10:34:57 PM GMT - Time Source: server- IP address: 64.165.34.3 Agreement completed. 2024-12-19 - 10:34:57 PM GMT