HomeMy WebLinkAboutJ. Johnson & Company, Inc.IOHNC01
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CERTIFICATE OF LIABILITY INSURANCE
COVERAGES CFRTIFIrATF NI IMRFR•
- - - --" "' '-"' � ""•`•""-" `• RG V IOIVIY IY VIYI r3C1[:
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.
DATE Y)
TYPE OF INSURANCE
08/10/2020
08/10/2020
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(les) 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).
PRODUCER 831-475-4314
UVIS Donald R Hardy Agency
P.O. Box 308
COME CT Charmane Phillips, CSR
_NAPHONE
831-475-4314 FAx
(A/c, No, Ext): (A/C. No):831-475-9524
Capitola, CA 95010
Donald R. Hardy
ADDRIEss: charmanep@hardyins.com
y
INSURERS AFFORDING COVERAGE NAIC #
INSURER A: Kinsale Insurance Company 38920
INSURED J. Johnson & Company, Inc.
600 Calabasas Road
Watsonville, CA 95076
INSURER B: Ohio Casualty Ins Co 24074
INSURER C: Kinsale Insurance Company 38920
INSURER D: State Compensation Ins. Fund 35076
INSURER E:
INSURER F:
COVERAGES CFRTIFIrATF NI IMRFR•
- - - --" "' '-"' � ""•`•""-" `• RG V IOIVIY IY VIYI r3C1[:
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.
INSR
TYPE OF INSURANCE
ADDL
INsn
SUBR
POLICY NUMBER
POLICY EFF
POLICY EXP
LIMITSILITY EACH OCCURRENCE 1,000,000
A
X COMMERCIAL GENERAL LIAB
CLAIMS -MADE F -v] OCCUR
y
01000355984
02/05/2020
02/05/2021
DAEAGETOREcTED a $ 100,000
MED EXP (Any one arson $ EXCLUDED
PERSONAL & ADV INJURY $ 1,000,000
GENT AGGREGATE LIMIT APPLIES PER:
X POLICY ❑ JECO- D LOC
GENERAL AGGREGATE $ 2,000,000
PRODUCTS -COMP/OP AGG $ 2,000,000
OTHER:
B
AUTOMOBILE
X
LIABILITY
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOSW D
AUTOS ONLY ATOS ONLY
y
BASS6694868
09/28/2019
09/28/2020
COMBINED SINGLE LIMIT
oda $ 1,000,000
BODILY INJURY Perperson) $
BODILY INJURY Per accident $
Pe0accRdenl AMAGE $
C
X
UMBRELLA LIAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
01001011901
02/05/2020
02/05/2021
EACH OCCURRENCE $ 2,000,000
AGGREGATE $ 2,000,000
DED RETENTION $
D
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N
OFFICER/MEMBE� EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTJQN OF, OPERAYJOJQ1iaVw,
Tools & Equipment
N / A
9067956
_ _
BM066694968
08/09/2020
09/28/2019
08/09/2021
09/28/2020
X PER OTH-
E
E.L. EACH ACCIDENT 1,000,000
1,000,000
E.L. DISEASE - EA EMPLOYEE $
I.L. DIS EASC,; P 1 y;,'JMI, 1,000,000
. , i.. lr � 4:... ..�.,..,......,.,.,,.._....1 ,
Tools &
Equipment 91,660
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule; may be attached if more space is required)
Town of Los Altos Hills is named as Additional Insured per attached
CG20100704 and CG20370704 as regard to General Liability and per attached
CA88100113 as regard to Commercial Auto.
TOWNLG2
Town of Los Altos Hills
26379 Fremont Road
Los Altos Hills, CA 94002
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
Donald R. Hardy ,7'
rwvlw �v t�v Iv/v. / W 1VOO-LU i0 AUUKU CUKI'UKAI ION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
THIS ENDORSEMEIVT C84NQ&$ THE: P011M KEW RM IT CAReFULLY,
ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS
SCHEDULED PERSON OR ORGANIZATI 1\1
Attaehr d ro ane porjI
rilngpart of po TW)"
Add1t1onafA'rem1Utn,,
eylaTtwe —Date
02/05/2019
address thAIA I I 2'01A i M at the Nurned Insurcid
Returl)
This endorsement modifies Insurance Provided underthe following:
COMMERCIAL GENEIIAL LIABILITY Covph A
Name.rj lr;surod -
J Johnson & company Inc,
A. Se(tlO" 11 — Who Is An Insured Is Ornended to Include
as tern additional insured the person (s) or
Organization(s) shown In the Schedule, but only withrespact to Ilability for "bodily InjurV'. `'property
damage"or "personal and advertising 1
In Whole or In part, key;
WuW' caused,
1, Your acts or bmissiOns; or
2, The anis or Omissions of those acting on your
behalf;
.In the performance of.younpiliggIn& Operations for the
additional Insured(s) at the loco' ' '
above, d'on(s) designated
B. With respect to the Insurance afforded to these
additional Insureds, the following additional
apply: exclusions
This Insurance does not apply to "bodily injury,,
Property damag e,, occurring , after: o
All work, Including Materials, Parts or equipment
furnished In Connection With such work; on the
project (other than service, maintenance or
repairs) to be perforrned by or on behalf or the
additional Insured(s) at the.location of the
Operations has been completed; or covered
2. That portion of "your work" out of which the injury
or dbrnap arises, has: been put to Its Intended use
by -any person or OrgafflUtton other than another
contractor or subcontractor engaged in Oerformij,jp
operations for a principal as a part of the same,
project.
ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED,
GG 20 10,07,04 0 ISO Properties, Inc., 2004, pase 1. of i
THIS ENDORSeMeNT CHANGES THE po . LiCy. 111A1.9 REAr) IT CAREFULLY,
AL)DIT[ONAL INSURED - OWNERS, L8SSEES OR
CONTRACTORS,,
Attached i-, --,
d ana For.rn1t)o part
of pb)
44
:NOMe.d Insured - 777777-'"
J Johnson 6Compa '
nylnjc._
This enclorselljoilt MOdiflel Insurance Provided under the foji0wing:
COMM9RCIAL GENERAL LIABILITY COVERAGE PART
,qCWrn1 fre
" — vvJJU 15 An Ingured IS Aftlended to includeas
411 additional Insured' the p6r$011(5) or orgaftlzation . (s)
shown In the.,Schedule) but on:ly with respect to ljabjljty
for "bodily Injury"or , -
p.roperty damage,, caused, In
whole or in Part, by "Your work" at the location desig-
nated and described in tile schedule of tljjs endorse-
ment Pefformed for that a6ftfollal Insured and In.
eluded In the "products -completed operations fiazard?',
ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED,
CG 20-37.07xQ4-i 0 ISO PrOpertl4s, Inc., 2004 Page 1 of 1
COMMERCIAL. AUTO
CA 88 10 01 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
01W SINESS, AUTO OVERAGE ENHANCEMENT ENDORSEMENT
This endorsement modifies Insurance provided: under the following,
BUSINESS. AUTO COVERAGE FORM
With respect to: coverage afforded by this endorsement, the provisions of the policy apply unless modified
by the: endorsement,
COVERAGE INDEX
SUBJECI
ADDITIONAL.INSURED: BY CONTRACT, AGREEMENT OR PERMIT
ACCIDENTAL AIRSAG DEPLOYMENT
AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS
AMENDED FELLOW :EMPLOYEE EXCLUSION
AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT COVERAGE
BROAD FORM INSURED
BODILY INJURY REDEFINED
EMPLOYEESAS INSUREDS (including employee hired auto)
EXTENDED CANCELLATION CONDITION
EXTRA EXPENSE - BROAbENED COVERAGE
GLASS REPAIR - WAIVER OF DEDUCTIBLE
HIRED AUTO PHYSICAL DAMAGE (including employee hired auto and lose of use)
HIRED AUTO -COVERAGE TERRITORY
LOAN I LEASE GAP
PARKED AUTO COLLISION COVERAGE (WAIVER OF DEDUCTIBLE)
PERSONAL EFFECTS COVERAGE
PHYSICAL DAMAGE - ADDITIONAL TRANSPORTATION EXPENSE COVERAGE
RENTAL REIMBURSEMENT
SUPPLEMENTARY PAYMENTS
TOWING AND LABOR
TWO OR MORE DEDUCTIBLES
UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS
WAIVER OF TRANSFER OF RIGHTS OF RECOVERYAGAIN$T OTHERS TO -US
EROYISION NUM PER
SECTION It - LIABILITY COVERAGE Is amended as follows,.
1. BROAD FORM INSURED
SECTION 11 - LIABILITY COVERAGE, paragraph A.1. - WHO IS AN INSURED Is amended to Include
the following as an insured:
d. Any legally Incorporated entity of which you own more than 60 percent of the voting stock
during the policy period, However, "insured" cioes:not Include any organization that:
(1) Is a partnership or joint venture; or
(2) Is an Insured under any other automobile policy; or
(3) Has exhausted Its Limit of Insurance under any other automobile policy.
Paragraph d, (2) of this provision does not -apply to a policy written to apply specifically in
expess of this pollcy.
9, Any organization you newly acquire or form, other than a partnership or joint venture, of which
you own more than 60 percent of the voting stock, This automatic coverage 18afforded only for
IBO days from the date of acquisition or formation, However, coverage under this provision
does not apply:
(1) If there Is similar Insurance or a self -Insured retention plan available to that. organization;
0 2013 Liberty Mutual Insurance
CA 88 10 01 13 Includes copyrighted ftt6rlal -of Insurance Servici6s Office, Inc., Will Its permissl= Page 1 of 7
(2) If the Limits of Insurance of any other insurance policy have been exhausted) 'or
(3) To "bodily injury" or "property damage" that occurred before you :acquired o . r formed the
organization,
2, EMPLOYEES AS.IN$UREDS
SECTION It - LIABILITY COVERAGE, paragraph AJ, -I/VI-ICS 18 AN MOISD Is amended to Include
the following as 8n Insured,.
f. Any "employee" of yours whIIG using a covered "auto" you do not own, hire or borrow; but
Qnjy for acts within the scope of their employment by you, Insurance provided by this endorse -
ME merit is excess over any other Insurance- available to any "employee.",
g, An "employee" of yours whII6 operating an "auto" hired or --borrowed ! under a written contract
or agreement in that "empd'oyeasll name, with your permission, while performing . duties re -
opo of their employment, ment, Insurance
I@tod to tilo 0011duot of your buolnos and within the OQ
provided by t . hlq endorsement is excess - over any other Ihsuranoe available to the "employee""
mm 3. ADDITIONAL INSURED BY CONTRACT, AGREEMENT OR PERMIT
MM SECTION 11 - LIABILITY COVERAGE, paragraph AJ. - WHO IS AN INSURED Is amended to Include
the following as an Insured:
h, Any parson or organization with respect. to the operation., maintenance or use of a covered
auto", provided that you and such person or ofgani zation. -have. agreed In a written contract,
agreement, or permit. Issued to you by governmental or 0blia.-twthority, to, add such person, or
organization, or governmental or public authority to this policy as ani "Insured".
However, such person or organization Is an "Insured":
(1) Only with respect to the operation, malfttenshce or use of a covered "auto";
(2) Only for "bodily Injury" or "property damage" caused by an "accident" which takes
place after you aXacute.d the written contract or agreement, or the permit has been
Issued to you; and
(3) Only for tho duration of that contract, agreement or permit..
4. SUPPLEMENTARY PAYMENTS
SECTION 11 - LIABILITY COVERAGE, Coverage Extensions, 2 . ,a, Supple.,rnqntary Payments, para-
graph$ (2) and (4) are replaced by,the following:
(2) Up to $3,000 for cost of ball :bonds (Including bonds for related trafflo violations) required
because of an "accident" we cover, We do not have to furnish these bonds,.
(4) All reasonable expenses Incurred by the Insured at our reqvest,. Including actual loss of earn -
Ings up to $500 a day because of time off from work.
6, AMENDED FELLOW EMPLOYEE EXCLUSION
In those] urlsd lotions where, by law, fellow employees are not entitled to the protection afforded to
I the following
the employer by the workers compensation excuslylty rule, or �Irnllar protection,.
provision Is added:
SECTION 11 - LIABILITY, exclusion 6,5, FELLOW ENIPLOYEE does not apply If the "bodily injury"
res . ults frofti the use of a covered "auto" you own or hire.
SECTION III - PHYSICAL DAMAGE COVERAGE Is amended as follows'
6. HIRED AUTO PHYSICAL DAMAGE
Paragraph AACoverage I5xtans.Ion§- of SECTION III - PHYSICAL DAMAGE COVERAGE, Is amended
by adding the following:
If hired "autos" are covered "autos" for Liability Coverage, and it Comprehensive., Specified
causes of Loss or Colliqlon coverage are provided under the Business Auto Covorager Form for any
"auto'" you own, then the Physical Damage coverages provided are extended to "autos":
a, You hire, rent or borrow; or
0 20J3,LlberlyiMUtuall Insurance
CA 88 10 01 13. includes copyrighted material of Insurance ServIC09 WOO, Ina,,with its permission, Page. 2 of 7
b, Your "employee" hires or rents under a written contract or agreement In that "employee's"
name, but only If the damage occurs while the vehicle Is being used In the conduct of your
buss
subject to the following limit and deductible;
A. The most we will pay for "logs" In any one "accident" or "loss" Is the smallest of:
(1) $60,000, or
(2) The actual cash value of1he damaged or stolen property as of the time of the "loss"; or
(3) The, cost of repeffing or replacing the damaged or stolen property with other property of
like kind and quality, minus adeduotible.
13, The deductible will be equal to the largest deductible applicable to any owned "auto" for that
coverage.
C. Subject to the limit, deductible and excess provisions described In this provision, we will
provide coverage equal to the, broadest coverage applicable to any covered "auto" you own.
D. Subject to a maximum of $1,000 per "accident", we will also cover the actual loss of use of thea
hired "auto" If It results from an "accident", you are legally liable and the lessor Incurs an
actual financial los8,
E, This coverage extension does not apply to:
(1) Any "auto" that Is hired., rented or borrowed with a driver, or
(2) Any "auto" that Is hired, rented or borrowed from your "employee".
For the purposes of this provision, SECTION V - DEFINITIONS Is amended by adding the following:
"Total loss" means a "lose,, In which the cost of repairs plus the selvage value exceeds the actual
cash value.
7, TOWING AND LABOR
SECTION III - PHYSICAL DAMAGE COVERAGE, paragraph A.2. Towing, Is amended by the addition
of the following:
We will pay towing and labor costs Incurred, up to the limits shown below, each time a covered
""auto"" classified and rated as a private passenger type, '(1191)t truck" or "medium truck" Is dis-
abled:
a. For private passenger type vehicles, we will pay up to $50.p.or disablement,
bf For "light trucks", we will -pay up to $60 per disablement, ""Licht trucks" are trucks that have a
gross vehicle weight (GVW) of 10,000 pounds or less,
c, For "medium trucks" , we will payup to $150 per disablement, "Medium trucks" are trucks that
have a gross vehicle weight. (GVW) of 10,001 - 20,0.00 pounds,
However, the labor must be performed at the place of dlaablemont.
8. PHYSICAL DAMAGE. - ADDITIONAL TRANSPORTATION EXPENSE cove -11401
Paragraph AA.a., Coverage Extension of SECTION III - PHYSICAL DAMAGE COVERAGE, Is amend-
ed to provide a limit of $50 per day and a maximum limit of $1,500
CABs 10 01 13 0 2013Uberty Mutual Insurance
IncludescopyrIghted material of InsurancoServicbs office, Inc.,with Its permisslon, Page 3 of 7
9. RENTAL REIMBURSEMENT
SECTION III - PHYSICAL DAMAGE COVERAQE, A, COVERAGE, Is arnended by addlpg 'thefollowing:
a, We Will Pay up to $75 per clay for rental reimbursement 'expenses Incurred by you for the rental
Of an "auto" because of "acoldent" or loss", to an "auto" for which we also pay a "bsO
under Comprehensive, Speolfled Causes of Loss or Collision Coverages, We will pay only for
those expenses Incurred after the first 24 hours following the "accident" or "loss" to the
covered "auto.11
b, Rental Relrrib.ursernent will be based on the rental of a comparable vehicle, which In many
bases may be sulbstantl ' ally,..less .than $75 per .day, and., will - only .be allow ' ed for the period of
time Ashould take to repair or repl4e the vehicle with reasonable s' ' '
peed end sihillar quality, up
to a maximum of 30 days, I i , I
c. We will also pay up to $500 for reasonable and necessary expenses IncWed by you to remove
and r6place your tools and equipm4n't from the covered "auto",
d. This coverage does not apply Unless. you have a business necessity that other "autos" avail-
able for your use and operation cannot fill.
0, If "lose" reoult,.,4 from the total thoft of- a '06yered 'auto" of the private passenger type, we will
pay Linder this coverage only that amount of your rental relmbursement expenses which. Is not
already provided under Paragraph 4, Coverage Extension.
f, No deductlble',Pappltea t,o this coverage..
For the purposes of this endorsement provision, materials and equipment do not Include "personal
effects" as defined In provision 11,
10, EXTRA EXPENSE - BROADENED COVERAGE
Under SECTION, III - PHYSICAL DAMAGE COVERAGE, A, COVERAGE, we will, pay for the expense of
returning a stolen covered "auto', to you, The maximum amount. we Will pay is $'1000.
11, PERSONAL EFFECTS COVERAGE
A, SECTION III - PHYSICAL DAMAGE COVERAGE, A. COVERAGE, 18 amended by adding the
to llowln�:
If you have purchased Comprehensive Coverage on tI its policy for. an "auto" you own and that
„auto" Is stolen, we will, pay, without aPPlicstiOn Of 0 d6duddlb, `tap to for "personal
effects" stolen with the "auto,"
The Insurance provided under this provision Is excess over any other collectible Insurance,
8, SECTION V - DEFINITIONS Is amended by adding the following,
For the purposes of this provision, "personal effects" mean tangible property that Is worn or
carried by an Insured," "Personal -effects" does not Include tools, eClulpment, jewelry, money
or securities,
12, AC,01DENTAL AIRBAG DEPLOYMENT
SECTION III - PHYSICA 'DMAGE 06V,ERA615, 13'XCLUS IONS" Io, amendedby iaddln�- the follow -
Ing;
If you have purchased Comprehensive or Collision Coverage wider this policy, the exclusion for
"loss" relating to mechanical breakdown does not apply to the accidental discharge of an alrbag.
Any Insurance we provide shall bb excess over any other collectible Insurance or reimbursement by
manufacturer's warranty. 1-1 . oweveri we agree to pay any deductible' applicable to the other cov.
erage or warranty,
13. AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT COVERAGE
SECTION III - PHYSICAL DAMAGE COVERAGE, 13,. EXCLUSIONS, exception paragraph a. to exclu.,
slons 4,oA and 4A, Is deleted and
jeplaQed with the following:
0 2013 Liberty Mutual Insurance
CA 88 10 01 13 Inaludoscapyrightod material of insurance Services Off Ice, Inc„ with its perailsslon. Page 4 of 7
Exclusion 4ic,. and 4.d. do not apply to,
a. Electronic equipment that receives or transmits audio, visual or data signals, whether or not
designed solely for 'the reproduction of sound, It tho equipment Is prmenently Installed In the
covered "auto" at the time of the "loss" and such equipment Is designed to be solely operated
by use of the power from the "auto's" electrical system., In or upon the covered "auto" and
PhYSIcal damage coverages .are provided for the covered "auto"; or
If the "loss" occurs solely to audio, visual or data electronic equipment or accessories used with
this equipment, then our obligation to prey for, repair,'jeturri or replace damaged''or stolen property
will be reduced by a $100 deductible,
14, LOAN / LEASE GAP. COV RACE
A. Paragraph C., LIMIT OF INSURANCI= of S15CTION III - PHYSICAL DAMAGE COVF-RAGE- is
amended by adding the following:
The most we will pay for a "total loss" to a covered "auto" owned by or leased to you In any
one "accident" is the greater of the,
1. Balance due under the terms of the loan or lease to Which > the damaged covered "auto', is
subject at the time of the "loss" less the amount of.,
a. Overdue payments and financlal penalties associated with those payments as of the
date of the "loss'",
b. Financial penalties Imposed under a lease due to high mileage, excessive use or 0, b -
normal wear and tear,
C. Costs for extended warranties, Credit Life Insurance, 116alth, Accident or Disability
Insurance purchased with the loan or lease, *
d, Transfer or rollover balances from previous loans or leases.,
o. Final payment due under a "Balloon Loan",
f. The dollar amount of any unrepaired damage which occurred prior to the "total loss"
of a covered "auto",
g. Security deposits not refunded by a lessor,
h, All refunds payable or paid to you as 8 result of the early termination of a lease
agreement or as a result of the early termination of any warranty or extended service
agreement on a covered "auto",
1, Any amount reprasentinq taxes,
I. Loan or lease termination fees; or
2-1 The actual cash value of the damage or stolen Property as of the time of the "loss",
An adjustment for depreciation and physical condftl6n will be—made
e — ma ' d 6 In ' d' ete , r , rn I In I , ng the actual
cash value at the time of the "Ioss'% This
- . I , .. : adjustment Is not applicable In Texa,-,.:.
B0 ADDITIONAL. CONDITIONS*
This coverage applies only to the original loan for which the covered "auto" that Incurred the
loss serves as collateral, or lease written on the covered "auto" that incurred the loss.
0, 85CTION V - DEFINTIONS Is changed by adding the following:
As used in this endorsement provision, the following definitions apply:
"Total 1086" means a "loss'" In which the cost of repairs plus thee salvage value exceeds the
actual cash value,
A "balloon loan" Is one with periodic payments that are Insufficient to repay the balance over
the term of the loan, thereby requiring a large final payment,
0 2013 Liberty Mutuol Insurance
CA 88 U 01 13 Includes copyrighted material of Insurance Servloes Office, Inc.. witti Its permission. Page 5 of 7
15, GLASS REPAIR. WAIVER OF D11DUCTISWE
Paragraph D, Deduotlble of SECTION. III . PHYSICAL DAMAGa COVERAGE Is amended by the
addition of the following:
No deduclibla Wks to 918$9 damage If the glass 18,� repaired rather than r.pplaoed,
16, PARKED AUTO OOLLISION COVERAGEi (WAIVER OF DEDUCTIBLE)
Paragraph 0. Deductible of SECTION III . PHYS16AL DAMAGE COVERAGE Is Amended by the
addition of the following,.
The deductible does not apply to, Q"I s" caused by� collision to 'Such do d "auto of the private s ve ro au o
passenger type or light Weighttruck; with 'a gross' vOklOW: w6lghi: of 16,000 (be" or less as defined by
the manufacturer as maximum loaded weight the "auto" Is. designed to carry while It Is;
A, In the charge of an "Insured";
b, Legally parkod, and
c. Unoccupied,
The. "loss" must be reported to the police. authorities! within 24 hours- of known darriage
The total amount.of the domago to the covored -11autoll 'rnust� 6Xcedd the deductible shown in the
Doolaration.e. i
This provision does. not apply to any "loss" If the covered "auto" Is In. the charge of any person or
organization engoged In the automobile business,
17. TWO OR MORE DEDUCTIBLES,
Under SECTION- III PHYSICAL DAMAGE COVERAGE, If two or more compen * y policies or coverage
forms apply to the same. accident, the following applies to paragraph 0, De.,ductlble;
a, If the applloab.le Business Auto deductible Is the smaller (or smallest) deductible It: will be
waived; or
b. If the appiloeble Business, Auto deductible Is not the smaller (or smallest) deductible It will be
reduced by the amount of the smaller (or smallest) deduotl ' ble; or
c, If the loss Involves two or more Business Auto coverage forms or policies, the smaller (or
smallest) deductible will ;be waived,
For the. purpose of this endorsement company means: any company. that Is part of. the Liberty
Mutual Group,
SECTION IV - BUSINESS AUTO CONDITIONS Is.,amended as follows:
18, UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS
SECTION IV- BUSINESS AUTO CONDITIONS, Paragraph 13.2. Is amended by adding the following,,
If YOU unintentionally fall to disolose any hazards, exposures or material facts existing as of the
Inception date or renewal date of the Business Auto Coverage Form, the coverage afforded by this
policy will not be prejudlonod.
However, you must report the undisclosed hazard of exposure -as soon as practicable after Its
discovery, and we have the right to collect additional premium for any euoh hazard or exposure,
% AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM., SUIT, OR LOS$
SECTION IV - BUSJNESS AUTO CONDITIONS, paragraph A,2.a. Is replaced In. Its entirety by the
following:
a. In the event of "accident", Claim, "$Ult" or "loss", you must promptly notify Lis when It Is
known to,
1, You, If you are an Individual,,,
2, A partner, If you are a partnership;
3. Member, If you are a limited liability company;
4. An executive officer or the "employee" designated by the Named Insured to give such
notice, If you are a corporation.
0 201 3Ubarty Mutual In8urence
CA 60 10 01 13 Includes copyrighted material of Imsurance Services Office, Inc,, with Its permission. Pagq 6 of 7
To the extent possible, notice to us should Include,,
(1) How, when and where the '"eQcldent" or "loss" took place;
(2) The `"insureds" name and address; and
(3) The names and addresses of any Injured Persons and witnesses,
20, WAIVER OF TRANSFER ,017 RIGHTS OF RECOVERY AGAINsr OTHERS TO US
SECTION IV - BUSINESS AUTO CONDITIONS, paragraph A.S., Transfer of Rights of Recovery
Against Others to Us, Is amended 'by the addition of thofollowlng:
If the person or organization has waived those rights before an "accident" or "loss", our rights are
waived also,
K HIRED AUTO COVERAGE TERRITORY
SECTION IV -BUSINESS AUTO CONDITIONS, paragraph 8.7,, Policy Period, Coverage Territory, is
amended by the -addition of the following:
C .,For "autos", hired. 30.,.days or less, t1le-.,00veragO territory is anywhere 1h the World, provided that
the Insured's responsibility to pay for damages Is deterrnIned In a "suit", on the merits, In the
United States, the territories and possessions of the United States of America, Puerto Rico or
Canhda or In a settlement we agree to.
This extension Of coverage does not apply to all "auto" hired, leased, rented or borrowed with
a driver,
SECTION V - DEFINITION$ Is amended as follows:
.22, BODILY INJURY RMEFINED
Under SECTION V - DEFINTIONS, definition C. 'is replaced by the following:
"Bodily Injury" means physical Injury, sickness or disease sustained by a person, Including mental
anguish, mental Injury, shook, fright
ht or death resulting from any of these at, any time,
COMMMON POLICY CONDITIONS
23, EXTENDED CANCELLATION CONDITION
COMMON POLICY CONDITIONS, paragraph A. - CANCELLATION condition applies except as fol-
lows:
. 0
If we cancel for any reason other than nonpayment of premium, we Will mail to the first: Named
Insured written notice of cancellation at least 60 days before the effective date of cancellation. This
provision does not apply In those states which require more than 6.0 days prior notice of oancelia-
flon,
0) 2013 Liberty Mutual Insurance
CA 88 14 01 13 Includes copyrighted materiel af Insurance Services office, Inc., with Its'peftnissibn. Page 7 of 7