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An application was received from Rickey Zeng representing Lanner Noodles & Bar, requesting permission for three (3) awnings at the premises numbered 24 Pearl Street. Approval has been received from Inspectional Services, Department of Public Works, Community Development Department, abutter and proof of mailing has been provided

APP 2024 #3·Council meeting Jan 29, 2024·82 pages·📄 Original PDF (city portal)

⚠ This document is a scan; its text was recovered by optical character recognition and may contain errors. The original PDF is authoritative.

1/24/2024 City of Cambridge, MA 251320 Primary Location Applicant Sign/Awning Permit 24 Pearl St Ricky Zeng Status: Active [phone removed] Cambridge, MA 02139 Submitted On: 12/5/2023 [email removed] Owner 259 Quincy Ave. CHAN, CHING-DA & HSOU Quincy, MA 02169 CHUN LIU CHAN 223 GREEN ST CAMBRIDGE, MA 02139 General Information What option best describes this application?* Sign(s) and Awning(s) Description of Proposed Work* Replace 3 existing awning covers only with three new signs on the awnings Lanner Noodles & Bar Estimated Cost of Awning(s) in dollars * Estimated Cost of Sign(s) in dollars * 1150 2150 Describe any existing signs or awnings that will remain (including the size of the remaining signs/awnings).* Awnings Cambridge City Council approval may be required. Will one or more of the proposed signs extend six (6) inches into the public sidewalk?* Yes
You must submit a Projected Sign Application and Abutter's Form to the City Clerk's Office. Sign Information Sign Text* Lanner Noodles & Bar Illumination* Type of Sign* Natural Projecting Height of Sign (feet)* Width of Sign (feet)* 4.58 2.92 Height from the ground to the top of the sign Area of Sign (square feet)* (feet)* 13.37 11.5 Height from the ground to bottom of the sign Sign Material* (feet)* acrylic 9.5 Projection from the Building (inches) Weight of the sign (Ibs)* 20 36 Width of Building Facade for Associated Use Is the sign an accessory to a first floor store?* (feet)* Yes 25.75
Sign Text* Lanner Noodles & Bar Illumination* Type of Sign* Natural Projecting Width of Sign (feet)* Height of Sign (feet)* 4.58 2.92 Area of Sign (square feet)* Height from the ground to the top of the sign (feet)* 13.37 11.5 Sign Material* Height from the ground to bottom of the sign (feet)* Acrylic 9.5 Projection from the Building (inches) Weight of the sign (Ibs)* 36 20 Is the sign an accessory to a first floor store?* Width of Building Facade for Associated Use (feet)* Yes 25.75 Sign Text* Lanner Noodles & Bar (+Chinese lettering)
Illumination* Type of Sign* Natural Projecting Height of Sign (feet)* Width of Sign (feet)* 3.92 4.67 Area of Sign (square feet)* Height from the ground to the top of the sign (feet)* 18.31 13.25 Height from the ground to bottom of the sign Sign Material* (feet)* Acrylic 9.5 Projection from the Building (inches) Weight of the sign (Ibs)* 3 20 Width of Building Facade for Associated Use Is the sign an accessory to a first floor store?* (feet)* Yes 25.75 Awning Information Width of Awning (feet)* Height of Awning (feet)* 5 7.6 Height from the ground to bottom of the awning Height from the ground to the top of the awning (feet)* (feet)* 9.5 13.5
Weight of the awning (Ibs)* Awning Material* 20 cooley translucent flexible Projection from the Building (inches)* 36 Height of Awning (feet)* Width of Awning (feet)* 6 4 Height from the ground to the top of the awning Height from the ground to bottom of the awning (feet)* (feet)* 13.5 9 Weight of the awning (Ibs)* Awning Material* 20 Black vinyl Projection from the Building (inches)* 36 Width of Awning (feet)* Height of Awning (feet)* 6 4 Height from the ground to bottom of the awning Height from the ground to the top of the awning (feet)* (feet)* 13.5 9
Weight of the awning (Ibs)* Awning Material* 20 Black vinyl Projection from the Building (inches)* 36 Contractor Contractor Name* RICKY Z ZENG Address* 1211 PLEASANT STREET E-mail* Telephone* [phone removed] [email removed] License Number* License Expiration Date* CS-113216 07/13/2024 Contractor's Signature Date* Signature of Licensed Contractor* 12/04/2023 Ricky Zeng
Community Development Approval & Sign conforms to requirements of Article 7.000 & Sign requires a variance from the Board of Zoning Appeal - - & Comments ® Exempt under Article 7.000 - City Clerk Internal & Bond Number Attachments REQUIRED Drawing of Sign(s) Lanner Noodle Bar.pdf Uploaded by Ricky Zeng on Dec 4, 2023 at 11:15 AM REQUIRED Contract with Sign Company Invoice.pdf Uploaded by Ricky Zeng on Dec 5, 2023 at 1:46 PM Proof of Insurance REQUIRED Umbrella Policy.pdf Uploaded by Ricky Zeng on Dec 4, 2023 at 11:15 AM
REQUIRED Signed contract between property owner and applicant Landlord approved.pdf Uploaded by Ricky Zeng on Dec 5, 2023 at 1:47 PM Workers Compensation Insurance Affidavit.pdf Workers Compensation Insurance Affidavit.pdf Uploaded by Ricky Zeng on Dec 5, 2023 at 1:47 PM SIGN CERT FORM 2019.pdf SIGN CERT FORM 2019.pdf Uploaded by Ricky Zeng on Dec 20, 2023 at 1:18 PM Workers Compensation Insurance Affidavit.pdf Workers Compensation Insurance Affidavit.pdf Uploaded by Ricky Zeng on Jan 2, 2024 at 9:15 AM Sign Application and Abutter Forms.pdf Sign Application and Abutter Forms.pdf Uploaded by Ricky Zeng on Jan 19, 2024 at 1:43 PM Image_20240119134304.jpg Image_20240119134304.jpg Uploaded by Ricky Zeng on Jan 19, 2024 at 1:44 PM History Activity Date 12/4/2023,10:40:59 Ricky Zeng started a draft of Record 251320 AM Ricky Zeng added attachment Workers Compensation Insurance 12/5/2023, 1:47:32 Affidavit.pdf to Record 251320 PM 12/5/2023, 1:47:41 Ricky Zeng submitted Record 251320 PM 12/5/2023, 1:47:41 Ricky Zeng submitted Record 251320 PM approval step Review for Completenesswas assigned to Branden 12/5/2023, 1:47:42 Vigneault on Record 251320 PM
Activity Date approval step Community Development Plan Reviewwas assigned to 12/5/2023, 1:47:42 Daniel Messplay on Record 251320 PM Ricky Zeng added attachment SIGN CERT FORM 2019. pdf to Record 12/20/2023, 1:18:04 251320 PM Daniel Messplay approved approval step Community Development 12/20/2023, 1:55:29 Plan Review on Record 251320 PM Branden Vigneault changed What option best describes this application? from "Awning(s)" to "Sign(s) and Awning(s)" on Record 1/2/2024, 8:41:27 AM 251320 Branden Vigneault changed Description of Proposed Work from "Existing awnings recover only." to "<div> Replace 3 existing awning 1/2/2024, 8:41:27 AM covers only with three new signs on the awnings Lanner Noodles &am..." on Record 251320 Branden Vigneault changed Estimated Cost of Sign(s) in dollars from 1/2/2024, 8:41:27 AM ''''to "2150" on Record 251320 Branden Vigneault changed Estimated Cost of Awning(s) in dollars 1/2/2024, 8:41:27 AM from "3150.00" to "1150" on Record 251320 Branden Vigneault approved approval step Review for Completeness 1/2/2024, 8:46:53 on Record 251320 AM approval step Department of Public Works Reviewwas assigned to 1/2/2024, 8:46:54 Brian McLane on Record 251320 AM Branden Vigneault reactivated approval step Review for Completeness 1/2/2024, 8:46:56 on Record 251320 AM Branden Vigneault added multi-entry field Type of Sign to Record 1/2/2024, 8:56:56 251320 AM Branden Vigneault added multi-entry field Illumination to Record 1/2/2024, 8:56:56 251320 AM Branden Vigneault added multi-entry field Height from the ground to 1/2/2024, 8:56:56 the top of the sign (feet) to Record 251320 AM Branden Vigneault added multi-entry field Height from the ground to 1/2/2024, 8:56:56 bottom of the sign (feet) to Record 251320 AM Branden Vigneault added multi-entry field Sign Material to Record 1/2/2024, 8:56:56 251320 AM Branden Vigneault added multi-entry field Weight of the sign (Ibs) to 1/2/2024, 8:56:56 Record 251320 AM Branden Vigneault added multi-entry field Projection from the Building 1/2/2024, 8:56:56 (inches) to Record 251320 AM
Activity Date Branden Vigneault added multi-entry field Width of Building Facade for 1/2/2024, 8:56:56 Associated Use (feet) to Record 251320 AM Branden Vigneault added multi-entry field Is the sign an accessory to a 1/2/2024, 8:56:56 first floor store? to Record 251320 AM 1/2/2024, 8:56:56 Branden Vigneault added multi-entry field Sign Text to Record 251320 AM Branden Vigneault added multi-entry field Area of Sign (square feet) to 1/2/2024, 8:56:56 Record 251320 AM Branden Vigneault added multi-entry field Height of Sign (feet) to 1/2/2024, 8:56:56 Record 251320 AM Branden Vigneault added multi-entry field Width of Sign (feet) to 1/2/2024, 8:56:56 Record 251320 AM Branden Vigneault added multi-entry field Type of Sign to Record 1/2/2024, 8:58:39 251320 AM Branden Vigneault added multi-entry field Illumination to Record 1/2/2024, 8:58:39 251320 AM Branden Vigneault added multi-entry field Height from the ground to 1/2/2024, 8:58:39 the top of the sign (feet) to Record 251320 AM Branden Vigneault added multi-entry field Height from the ground to 1/2/2024, 8:58:39 bottom of the sign (feet) to Record 251320 AM Branden Vigneault added multi-entry field Sign Material to Record 1/2/2024, 8:58:39 251320 AM Branden Vigneault added multi-entry field Weight of the sign (Ibs) to 1/2/2024, 8:58:39 Record 251320 AM Branden Vigneault added multi-entry field Projection from the Building 1/2/2024, 8:58:39 (inches) to Record 251320 AM Branden Vigneault added multi-entry field Width of Building Facade for 1/2/2024, 8:58:39 Associated Use (feet) to Record 251320 AM Branden Vigneault added multi-entry field Is the sign an accessory to a 1/2/2024, 8:58:39 first floor store? to Record 251320 AM 1/2/2024, 8:58:39 Branden Vigneault added multi-entry field Sign Text to Record 251320 AM Branden Vigneault added multi-entry field Area of Sign (square feet) to 1/2/2024, 8:58:39 Record 251320 AM Branden Vigneault added multi-entry field Height of Sign (feet) to 1/2/2024, 8:58:39 Record 251320 AM
Activity Date Branden Vigneault added multi-entry field Width of Sign (feet) to 1/2/2024, 8:58:39 Record 251320 AM Branden Vigneault added multi-entry field Type of Sign to Record 1/2/2024, 9:05:27 251320 AM Branden Vigneault added multi-entry field Illumination to Record 1/2/2024, 9:05:27 251320 AM Branden Vigneault added multi-entry field Height from the ground to 1/2/2024, 9:05:27 the top of the sign (feet) to Record 251320 AM Branden Vigneault added multi-entry field Height from the ground to 1/2/2024, 9:05:27 bottom of the sign (feet) to Record 251320 AM Branden Vigneault added multi-entry field Sign Material to Record 1/2/2024, 9:05:28 251320 AM Branden Vigneault added multi-entry field Weight of the sign (Ibs) to 1/2/2024, 9:05:28 Record 251320 AM Branden Vigneault added multi-entry field Projection from the Building 1/2/2024, 9:05:28 (inches) to Record 251320 AM Branden Vigneault added multi-entry field Width of Building Facade for 1/2/2024, 9:05:28 Associated Use (feet) to Record 251320 AM Branden Vigneault added multi-entry field Is the sign an accessory to a 1/2/2024, 9:05:28 first floor store? to Record 251320 AM 1/2/2024, 9:05:28 Branden Vigneault added multi-entry field Sign Text to Record 251320 AM Branden Vigneault added multi-entry field Area of Sign (square feet) to 1/2/2024, 9:05:28 Record 251320 AM Branden Vigneault added multi-entry field Height of Sign (feet) to 1/2/2024, 9:05:28 Record 251320 AM Branden Vigneault added multi-entry field Width of Sign (feet) to 1/2/2024, 9:05:28 Record 251320 AM Branden Vigneault added multi-entry field Height of Awning (feet) to 1/2/2024, 9:08:34 Record 251320 AM Branden Vigneault added multi-entry field Width of Awning (feet) to 1/2/2024, 9:08:34 Record 251320 AM Branden Vigneault added multi-entry field Height from the ground to 1/2/2024, 9:08:34 the top of the awning (feet) to Record 251320 AM Branden Vigneault added multi-entry field Height from the ground to 1/2/2024, 9:08:34 bottom of the awning (feet) to Record 251320 AM
Activity Date Branden Vigneault added multi-entry field Awning Material to Record 1/2/2024, 9:08:34 251320 AM Branden Vigneault added multi-entry field Weight of the awning (Ibs) 1/2/2024, 9:08:34 to Record 251320 AM Branden Vigneault added multi-entry field Projection from the Building 1/2/2024, 9:08:34 (inches) to Record 251320 AM Branden Vigneault added multi-entry field Height of Awning (feet) to 1/2/2024, 9:09:17 AM Record 251320 Branden Vigneault added multi-entry field Width of Awning (feet) to 1/2/2024, 9:09:17 AM Record 251320 Branden Vigneault added multi-entry field Height from the ground to 1/2/2024, 9:09:17 AM the top of the awning (feet) to Record 251320 Branden Vigneault added multi-entry field Height from the ground to 1/2/2024, 9:09:17 AM bottom of the awning (feet) to Record 251320 Branden Vigneault added multi-entry field Awning Material to Record 1/2/2024, 9:09:17 AM 251320 Branden Vigneault added multi-entry field Weight of the awning (Ibs) 1/2/2024, 9:09:17 AM to Record 251320 Branden Vigneault added multi-entry field Projection from the Building 1/2/2024, 9:09:17 AM (inches) to Record 251320 Branden Vigneault approved approval step Review for Completeness 1/2/2024, 9:13:01 AM on Record 251320 Ricky Zeng added attachment Workers Compensation Insurance 1/2/2024, 9:15:37 AM Affidavit.pdf to Record 251320 Brian McLane approved approval step Department of Public Works 1/2/2024, 11:33:43 Review on Record 251320 AM approval step City Clerk Reviewwas assigned to Lori Perez on Record 1/2/2024, 11:33:43 251320 AM Ricky Zeng added attachment Sign Application and Abutter Forms.pdf 1/19/2024, 1:43:35 to Record 251320 PM Ricky Zeng added attachment Image_20240119134304.jpg to Record 1/19/2024, 1:44:16 251320 PM Timeline Due Activated Label Completed Assignee Date Branden / Review for 1/2/2024, 12/5/2023, 1:47:41 PM 9:13:01 AM Completeness Vigneault
Due Activated Label Assignee Completed Date Community Daniel 12/5/2023, 12/20/2023, Development Plan 1:47:41 PM 1:55:29 PM Messplay Review Brian Department of 1/2/2024, 1/2/2024, McLane 11:33:43 AM 8:46:54 AM Public Works Review 1/2/2024, Lori Perez / City Clerk Review 11:33:43 AM / City Council Approval / Bond Building Inspector Review Sign Permit Fee Ricky Zeng B Sign Permit
OFFICE OF THE CITY CLERK CAMBRIDGE CITY HALL, 795 MASSACHUSETTS AVENUE CAMBRIDGE, MASSACHUSETTS 02139 PHONE [phone removed] FAX [phone removed] PAULA M. CRANE ANTHONY I. WILSON CITY CLERK DEPUTY CITY CLERK 01/04 Cambridge, _ 2024 To the Honorable, the City Council of the City of Cambridge: EACH PETITION MUST BE ACCOMPANIED BY A DRAWING OF PROPOSED SIGN, INDICATING DESIGN AND DIMENSIONS AND LOCATION ON PREMISES. The undersigned respectfully prays that Lanner Noodle & Bar (NAME OF BUSINESS) be granted permit to erect a sign of the following specifications in front of premises located at 24 Pearl St. Cambridge MA 02130 (ADDRESS) Type of Sign: Awning recover (state whether electric or otherwise and material used in construction) Reading matter to go on Sign: Lanner Noodle & Bar, and 2 Chinese characters means looking flower Size: 48"x72", 60"x92.45", 48"x72" Weight: 60LBS Public Way 3' Obstruction: A. в 9'5" (Give exact distance sign is to extend over sidewalk) (Also exact distance from bottom of sign to sidewalk) Top: 14'5" Height Above Grade: Bottom: 9'5" NOTICE - REGULATIONS [Section 12.08.010 Municipal Code - Encroachments onto Streets] Section 1212.0 State Building Code - Projecting Signs] • A projecting sign shall be constructed wholly of incombustible materials. • All signs must meet requirements of Zoning Ordinances and Building Code. • Note: Section 12.12.220 provides in part "every owner who maintains a ... structure in or over a street... shall do so only on the condition that such maintenance shall be considered as an agreement on his part to keep the same and the covers thereof in good repair and condition, at all times during his ownership, and to indemnify and save harmless the City against any and all damages, cost or expenses which it may sustain, or be required to pay by reason of such.. structure." PROPERTY OWNER OR AUTHORIZED AGENT HEREBY STATES THAT INFORMATION IS TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND UNDERSTANDING UNDER PAINS AND PENALTY OF PERJURY. 223 Green st Cambridge, MA 02139 774279211 (Address) (Propeity owner or authorized agent) (Tel. No.) 24 Pearl St, Cambridge, MA 02139 [phone removed] (Business owner) (Address) (Tel. No.) Reset Print
OFFICE OF THE CITY CLERK CAMBRIDGE CITY HALL, 795 MASSACHUSETTS AVENUE CAMBRIDGE, MASSACHUSETTS 02139 PHONE [phone removed] FAX 617) 349-4269 TTY/TDD [phone removed] PAULA M. CRANE ANTHONY I. WILSON CITY CLERK DEPUTY CITY CLERK ABUTTERS FORM FOR SIGN/AWNING PERMIT Date Jan 15'24 To Whom It May Concern: As Owner of Agent of Cambridge, Pepper Sky's of the Massachusetts, I do hereby declare my disapproval approval installment of: Canopy over the sidewalk entrance: _ Awnings over the windows: Projecting sign: Awning of said property. Signed: Date Jam 15'24 Address: 20 Pearl st. cambridge us 02/39 ABUTTERS: PLEASE COMPLETE FORM WHETHER OR NOT YOU APPROVE OF THE REQUESTED SIGN/AWNING AND RETURN IT TO THE APPLICANT WITHIN SEVEN (7) DAYS FOR INCLUSION IN THE APPLICATION. SIGN/AWNING APPLICANT: Yu ca PLEASE FILL IN DATE THAT FORM WAS DELIVERED TO ABUTTER (TOP RIGHT OF THIS FORM) Reset Form Print
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32 X * Apply white letter Specifications: & BAR * Existing awnings recover. NOODLES Existing LANNER STOP! * Use translucent flexible black vinyl banner Sign installed in location shown on attached photo Existing Awning Recover NOODLES LANNER & BAR LANNER LANGZEN 4507551 9A a Proposed & BAR NOODLES LANNER DIOT LANNER City State Phone Job No. Address Design # Designer Customer Original Date Revision Date LANNER LISTED Sign & Storefront. Account Representative: the ports or poets they pool Vastat NEW CC SIGN This design and engineering is nec written permission by New CC i cause tor acton tor domages was may occur 259 submitted as our proposal, and farm, is not authorized without type to be used - metallic insulated sealtite. sign & storefront •Disconnect switch as per N.E.C. Code 600.6. the right to use or exhibit in any • All electrical components shall be U.L. Listed. * Sign shall be grounded per N.E.C. Article 250. Ricky Zeng 12/01/2023 24 Pearl St. [phone removed] Sean 04968 insulated conductors as per w.t.c. Code 510.8 MA 02130 Cambridge All electrical scope to be completed in a U.L, approved
* Apply white letter Specifications: & BAR * Existing awnings recover. NOODLES Existing LANNER * Use translucent flexible black vinyl banner Sign installed in location shown on attached photo Existing Awning Recover LANNER Landlord signature feasie Chan 46.68 LANNER I authorized New CC Sign Inc. to install the sign to the building. Proposed & BAR NOODLES LANNER LANIVER HOOPERA City State Phone Job No. Address Design # Designer Customer Original Date Revision Date LANNER Sign & Stomfront. Account Representative: NEW CC SIGN a and shan meet carters s This design and engineering is written penission by. New CC submitted as our proposal, and sign & storefront form, is not authorized without •Disconnect switch as per NE.C. Code 600.6. the eight to use or expitin any sign shai be sounded per tea artice ca 24 Pearl St All rectal sope to be compete a Me sputo? Cambridge Ricky Zeng [phone removed] MA 02130 Sean 04968 * insulated conductors as per N.t.c. Code 310.8 12/01/2023
NEW CC SIGN INC. Tel:[phone removed] SIGNAGE INVOICE [phone removed] 259 Quincy Ave. Quincy, MA 02169 04968 E-mail: [email removed] Address: CLIENT: Lanner Noodle & Bar 24 Pearl St. Cambridge MA 02139 Contact Person: Telephone: Sean [phone removed] Date: El Installation • Pick-up • Delivery 11/29/2023 3x Existing Awning (change fabric ONLY) Supply & Installation included TOTAL $ 3150.00 TAX $ DEPOSIT S SIGNATURE OF CLIENT: Sean DATE: 11/29/2023 CASH CREDIT CARD CHECK NO. DATE: 1129/27 SIGNATURE OF THE SALE PERSON: BALANCE S DATE PAID IN FULL: COLLECTED BY : Payment to be made as follows: 50% Deposit
The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Lafayette City Center 2 Avenue de Lafayette, Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): New CC Sign Address: 259 Quincy Ave. Phone #: [phone removed] City/State/Zip: Quincy MA 02169 Are you an employer? Check the appropriate box: Type of project (required): 4. • I am a general contractor and I 1. Iam a employer with 2 6. • New construction have hired the sub-contractors employees (full and/or part-time).* listed on the attached sheet. 7. L Remodeling 2. • I am a sole proprietor or partner- These sub-contractors have 8. Demolition ship and have no employees employees and have workers' working for me in any capacity. 9. ] Building addition comp. insurance. [No workers' comp. insurance 10.L Electrical repairs or additions 5. We are a corporation and its required.] officers have exercised their 11.L Plumbing repairs or additions 3. L I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. 12.L Roof repairs c. 152, §1(4), and we have no insurance required.] * 13. Other Sign employees. [No workers' comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. * Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Travelers Policy # or Self-ins. Lic. #: UB-002W596558 Expiration Date: 12/24/2024 Job Site Address: 24 Pearl St. City/State/Zip: Cambridge MA 02130 Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Date: 01/02/2024 Signature: Ricky Zeng [phone removed] Phone #: Official use only. Do not write in this area, to be completed by city or town official. Permit/License # City or Town: Issuing Authority (check one): 1• Board of Health 2 Building Department 3OCity/Town Clerk 4. Electrical Inspector 5 Plumbing Inspector 6. Other Contact Person: Phone #:
Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractors) names), addresses) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in City _city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Lafayette City Center, 2 Avenue de Lafayette Boston, MA 02111 Tel. [phone removed] or 1-877-MASSAFE Fax 617) 727-7749 Revised 7-2019 www.mass.gov/dia
The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Lafayette City Center 2 Avenue de Lafayette, Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/ Electricians/Plumbers Please Print Legibly Applicant Information Name (Business/Organization/Individual): New CC Sign Address: 259 Quincy Ave. Phone #: [phone removed] City/State/Zip: Quincy MA 02169 Are you an employer? Check the appropriate box: Type of project (required): 4. ] I am a general contractor and I 1.- 1am a employer with 2 6. • New construction have hired the sub-contractors employees (full and/or part-time).* listed on the attached sheet. 7. • Remodeling 2. • I am a sole proprietor or partner- These sub-contractors have ship and have no employees 8. L Demolition employees and have workers' working for me in any capacity. 9. L J Bullding addition comp. insurance. [No workers' comp. insurance 10.L Electrical repairs or additions We are a corporation and its 5. required.] officers have exercised their 1.U Plumbing repairs or additions 3.• I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. 12.0 Roof repairs c. 152, §1(4), and we have no insurance required.] t 13. Other Sign employees. [No workers' comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. T Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Travelers Policy # or Self-ins. Lic. #: UB-002W596558 Expiration Date: 12/24/2024 Job Site Address: 24 Pearl St. City/State/Zip: Cambridge MA 02130 Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Date: 01/02/2024 Signature: Ricky Zeng [phone removed] Phone #: Official use only. Do not write in this area, to be completed by city or town official. Permit/License # City or Town: Issuing Authority (check one): 10 Board of Health 2 Building Department 3_City/Town Clerk 4. Electrical Inspector 5L Plumbing Inspector 6.Other Contact Person: Phone #:
Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractors) name(s), addresses) and phone numbers) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in City _(city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Lafayette City Center, 2 Avenue de Lafayette Boston, MA 02111 Tel. [phone removed] or 1-877-MASSAFE Fax 617) 727-7749 Revised 7-2019 www.mass.gov/dia
TRAVELERSJ Report Claims Immediately by Calling* [phone removed] Speak directly with a claim professional 24 hours a day, 365 days a year *Unless Your Policy Requires Written Notice or Reporting EXCESS FOLLOW-FORM AND UMBRELLA LIABILITY INSURANCE POLICY A Custom Insurance Policy Prepared for: NEW CC SIGN INC. 259 QUINCY AVE QUINCY MA 02169
This policy consists of this policy cover, the Policy Declarations and the Policy Forms, and endorsements listed in that declaration form. In return for payment of the premium, we agree with the Named Insured to provide the insurance afforded by this policy. That insurance will be provided by the company indicated as insuring company in the Declarations by the abbreviation of its name. The company listed below (a stock company) has executed this policy, but it is valid only if countersigned on the Declarations by our authorized representative. TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA (TIL) Wendy C. Sly President Secretary EU 00 06 08 18
POLICY NUMBER: CUP-2W659088-23-42 EFFECTIVE DATE: 05/11/2023 ISSUE DATE: 05/12/2023 LISTING OF FORMS, ENDORSEMENTS AND SCHEDULE NUMBERS THIS LISTING SHOWS THE NUMBER OF FORMS, SCHEDULES AND ENDORSEMENTS BY LINE OF BUSINESS IL T8 01 01 01 FORMS ENDORSEMENTS AND SCHEDULE NUMBERS UMBRELLA / EXCESS EU 00 02 09 POLICY DECLARATIONS EXCESS FOLLOW-FORM AND UMBRELLA 20 LIABILITY INSURANCE POLICY 03 18 00 08 SCHEDULE OF UNDERLYING INSURANCE EU EU 07 16 00 01 EXCESS FOLLOW-FORM AND UMBRELLA LIABILITY INSURANCE EU 07 34 16 02 AMENDMENT OF COVERAGE - DEFINITIONS EU 08 35 18 03 FUNGI OR BACTERIA EXCLUSION - COVERAGE B 46 18 NON CUMULATION OF OCCURRENCE LIMIT EU 03 08 16 07 44 01 EU COVERAGE FOR FINANCIAL INTEREST IN FOREIGN INSURED ORGANIZATIONS EU 15 08 18 03 AMENDMENT OF UNDERLYING INSURANCE DEFINITION EU 07 16 00 07 CAP LOSSES - CERT ACTS TERRORSM AND EXCL EU 02 08 NUCLEAR ENERGY LIABILITY EXCLUSION (BROAD FORM) - 18 09 COVERAGES A AND B EU 16 90 07 02 WATERCRAFT LIABILITY EXCLUSION - COVERAGE B EU 03 05 17 03 EXTERIOR INSULATION AND FINISH SYSTEM EXCLUSION - COVERAGE B 08 03 31 18 EU DISCRIMINATION EXCLUSION - COVERAGE B EU 03 18 08 63 SILICA OR SILICA-RELATED DUST EXCLUSION - COVERAGE B 70 EU 08 03 18 WRAP-UP INSURANCE PROGRAM EXCLUSION - COVERAGE B EU 21 04 21 09 INTELLECTUAL PROPERTY EXCLUSION - COVERAGE B INTERLINE ENDORSEMENTS IL T3 68 01 21 FEDERAL TERRORISM RISK INSURANCE ACT DISCLOSURE 1 1 OF PAGE: IL T8 01 01 01
One Tower Square, Hartford, Connecticut 06183 POLICY DECLARATIONS POLICY NO.: CUP-2W659088-23-42 EXCESS FOLLOW-FORM AND UMBRELLA ISSUE DATE: 05/12/2023 LIABILITY INSURANCE POLICY INSURING COMPANY: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA 1. NAMED INSURED AND MAILING ADDRESS: NEW CC SIGN INC. 259 QUINCY AVE QUINCY MA 02169 2. POLICY PERIOD: From 05/11/2023 to 12/24/202312:01 A.M. Standard Time at your mailing address. 3. LIMITS OF INSURANCE: COVERAGES LIMITS OF LIABILITY AGGREGATE LIMITS OF LIABILITY $4,000,000 General Aggregate $4,000,000 Products-Completed Operations Aggregate EXCESS FOLLOW-FORM AND $4,000,000 Occurrence Limit UMBRELLA LIABILITY CRISIS MANAGEMENT SERVICE all Crisis Management Events $50,000 EXPENSES any one occurrence or event $10,000 4. SELF-INSURED RETENTION: Adjustable (See Premium Schedule) 5. PREMIUM: $ 1,399 X Flat Charge 6. TAXES AND SURCHARGES: 7. On the effective date shown in Item 2., the Excess Follow-Form And Umbrella Liability Insurance Policy numbered above includes this Declarations Page and any forms and endorsements shown on the Listing Of Forms, Endorsements And Schedule Numbers. 8. If the Schedule Of Underlying Insurance includes any coverage provided on a claims-made basis, then the following disclaimer applies. COVERAGE WILL APPLY ON A CLAIMS-MADE BASIS WHEN FOLLOWING CLAIMS-MADE UNDERLYING INSURANCE. 9. If the Schedule Of Underlying Insurance includes any coverage which includes defense expenses within the limits of liability, then the following disclaimer applies: DEFENSE EXPENSES ARE PAYABLE WITHIN, AND ARE NOT IN ADDITION TO, THE LIMITS OF INSURANCE WITH RESPECT TO SOME OR ALL OF THE COVERAGES PROVIDED. NAME AND ADDRESS OF AGENT OR BROKER: COUNTERSIGNED BY: RICHARD SOO HOO INSURANC - CTK20 123 BEACH ST BOSTON MA 02111 Authorized Representative DATE: OFFICE: HUDSON EU 00 02 09 20 © 2019 The Travelers Indemnity Company. All rights reserved. Page 1 of 1
UMBRELLA ISSUE DATE: 05/12/2023 POLICY NUMBER: CUP-2W659088-23-42 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SCHEDULE OF UNDERLYING INSURANCE This endorsement modifies insurance provided under the following: EXCESS FOLLOW-FORM AND UMBRELLA LIABILITY INSURANCE Employers Liability Limits Of Liability Carrier THE TRAVELERS INDEMNITY $1,000,000* Bodily Injury By Accident ua Each Accident COMPANY OF CONNECTICUL Bodily Injury By Disease $1,000,000* Policy Number UB- 002W596558-22 Policy Limit Policy Period From: 12/24/2022 Bodily Injury By Disease $1,000,000* Each Employee to: 12/24/2023 *UNLIMITED IN THE STATE OF NEW YORK FOR SUBJECT EMPLOYEES Commercial General Liability Limits Of Liability Carrier FIDELITY AND GUARANTY General Aggregate $2,000,000 INSURANCE COMPANY Products-Completed $2,000,000 Operations Aggregate Policy Number BIP-002W590486-22 Personal and Policy Period $1,000,000 Advertising Injury From: 12/24/2022 Each Occurrence to: 12/24/2023 $1,000,000 Limits Of Liability Carrier Policy Number Policy Period From: to: OFFICE: HUDSON 126 PRODUCER:RICHARD SOO HOO INSURANC EU 00 03 08 18 © 2018 The Travelers Indemnity Company. All rights reserved. Page 1 of 1
UMBRELLA EXCESS FOLLOW-FORM AND UMBRELLA LIABILITY INSURANCE THIS POLICY, INPART, PROVIDES FOLLOW-FORM LIABILITY COVERAGE. COVERAGE WILL APPLY ON A CLAIMS-MADE BASIS WHEN FOLLOWING CLAIMS-MADE UNDERLYING INSURANCE. COVERAGE WILL APPLY ON A DEFENSE-WITHIN-LIMITS BASIS WHEN FOLLOWING UNDERLYING INSURANCE UNDER WHICH DEFENSE EXPENSES ARE PAYABLE WITHIN, AND NOT IN ADDITION TO, THE LIMITS OF INSURANCE. WHEN FOLLOWING SUCH UNDERLYING INSURANCE, PAYMENT OF DEFENSE EXPENSES UNDER THIS POLICY WILL REDUCE, AND MAY EXHAUST, THE LIMITS OF INSURANCE OF THIS POLICY. PLEASE READ THE ENTIRE POLICY CAREFULLY. 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 VI - DEFINITIONS. provisions to the contrary contained in this SECTION I - COVERAGES insurance. A. COVERAGE A - EXCESS FOLLOW-FORM 3. The amount we will pay for damages is limited LIABILITY as described in SECTION III - LIMITS OF 1. We will pay on behalf of the insured those INSURANCE. sums, in excess of the "applicable underlying 4. For the purposes of Paragraph 1. above: that the insured becomes limit", legally obligated to pay as damages to which a. The applicable limit of insurance stated Coverage A of this insurance applies, provided for the policies of "underlying insurance" in the Schedule Of Underlying Insurance that the "underlying insurance" would apply to will be considered to be reduced or such damages but for the exhaustion of its exhausted only by the following applicable limits of insurance. If a sublimit is payments: in any insurance", specified "underlying or Coverage A of this insurance applies to (1) Payments of judgments settlements for damages that are damages that are in excess of that sublimit only covered that if such sublimit is shown for that "underlying by "underlying However, if such insurance". insurance" in the Schedule Of Underlying "underlying insurance" has a policy Insurance. period which differs from the policy 2. Coverage A of this insurance is subject to the period of this Excess Follow-Form same agreements, terms, conditions, And Umbrella Liability Insurance, any exclusions and definitions as the "underlying such payments for damages that insurance", except with respect to any would not be covered by this Excess Follow-Form And Umbrella Liability EU 00 01 07 16 © 2016 The Travelers Indemnity Company. All rights reserved. Page 1 of 22
UMBRELLA the retroactive date for Insurance because of its different policy date provision, Coverage A of this insurance is the same as period will not reduce or exhaust the applicable limit of insurance stated for the retroactive date of that "underlying insurance". such "underlying insurance"; (2) Payments of "medical expenses" that B. COVERAGE B - UMBRELLA LIABILITY are covered 1. We will pay on behalf of the insured those insurance" and are incurred for "bodily sums in excess of the "self-insured retention" injury" caused by an accident that takes that the insured becomes legally obligated to place during the policy period of this pay as damages because of "bodily injury", Excess Follow-Form And Umbrella or "property damage", "personal injury" Liability Insurance; or "advertising injury" to which Coverage B of (3) Payments of defense expenses that this insurance applies. "underlying are covered by 2. Coverage B of this insurance applies to if such "underlying insurance", only "bodily injury" or "property damage" only if: insurance" includes such payments a. The "bodily injury" or "property damage" is within the limits of insurance. However, caused by an "occurrence" that takes if such "underlying insurance" has a place anywhere in the world; policy period which differs from the policy period of this Excess Follow- b. The "bodily injury" or "property damage" Form And Umbrella Liability Insurance, occurs during the policy period; and such any payments for defense c. Prior to the policy period, no insured listed expenses that would not be covered by under Paragraph 1. in Paragraph B., this Excess Follow-Form And Umbrella - UMBRELLA COVERAGE Insurance because of its Liability LIABILITY, of SECTION II - WHO IS AN different policy period will not reduce or INSURED and no "employee" authorized of the exhaust limit applicable by you to give or receive notice of an insurance stated for such "underlying "occurrence" or claim, knew that the insurance". "bodily injury" or "property damage" had If the applicable limit of insurance stated for occurred, in whole or in part. If such a listed insured or authorized "employee" the policies of "underlying insurance" in the Schedule Of Underlying Insurance is knew, prior to the policy period, that the actually reduced or exhausted by other injury" or "property damage" "bodily payments, Coverage A of this insurance is occurred, in whole or in part, then any continuation, change or resumption of not invalidated. However, in the event of a loss, we will pay only to the extent that we such "bodily injury" or "property damage" would have paid had such limit not been during or after the policy period will be deemed to have been known prior to the actually reduced or exhausted by such other payments. policy period. b. If any "underlying insurance" has a limit of 3. Coverage B of this insurance applies to insurance greater than the amount shown "personal injury" or "advertising injury" caused for that insurance in the Schedule of by an offense arising out of your business, but only if the offense was committed during the Underlying Insurance, this insurance will apply in excess of that greater amount. If policy period anywhere in the world. any "underlying insurance" has a limit of 4. The amount we will pay for damages is limited insurance, prior to any reduction or as described in SECTION III - LIMITS OF exhaustion by payment of damages, INSURANCE "medical expenses" or defense expenses 5. "Bodily injury" or "property damage": described in Paragraph a. above, that is less than the amount a. Which occurs during the policy period; and insurance in the Schedule Of Underlying b. Which was not prior to, but was during, the Insurance, this insurance will apply in policy period known to have occurred by excess of the amount shown for such any insured listed under Paragraph 1. in B insurance in the Schedule Of Underlying COVERAGE B., Paragraph UMBRELLA LIABILITY of SECTION II - 5. When the "underlying insurance" applies on a WHO IS AN INSURED, or any "employee" claims-made basis and includes a retroactive authorized by you to give notice of an "occurrence" or claim; EU 00 01 07 16 © 2016 The Travelers Indemnity Company. All rights reserved. Page 2 of 22
UMBRELLA includes Management Service Expenses Limit has been exhausted, whichever occurs first. damage" after the end of the policy period. for "crisis 4. The amount we will pay 6. management service expenses" is limited as "Bodily injury" or "property damage" will be described in SECTION III - LIMITS OF deemed to have been known to have occurred INSURANCE. at the earliest time when any insured listed under Paragraph 1. in Paragraph B., 5. A "self-insured retention" does not apply to COVERAGE B - UMBRELLA LIABILITY, of "crisis management service expenses". SECTION II - WHO IS AN INSURED or any 6. Any payment of "crisis management service "employee" authorized by you to give or receive be expenses" that we make will not notice of an "occurrence" or claim: determinative of our obligations under this a. Reports all, or any part, of the "bodily injury" insurance with respect to any claim or "suit" or or "property damage" to us or any other create any duty to defend or indemnify any insurer; insured for any claim or "suit". b. Receives a written or verbal demand or D. DEFENSE AND SUPPLEMENTARY PAYMENTS claim for damages because of the "bodily 1. We will have the right and duty to defend the injury" or "property damage"; or insured: c. Becomes aware by any other means that a. Under Coverage A, against a "suit" the "bodily injury" or "property damage" has seeking damages to which such coverage occurred or has begun to occur. applies, if: 7. Damages because of "bodily injury" include (1) The "applicable underlying limit" is the claimed by or any person damages applicable limit of insurance stated for organization for care, loss of services or death a policy of "underlying insurance" in resulting at any time from the "bodily injury". the Schedule Of Underlying Insurance and such limit has been 8. Coverage B of this insurance does not apply to covered exhausted solely due to payments as damages "underlying insurance" or that would have been covered by permitted in Paragraphs 4.a.(1), (2) for the and (3) of COVERAGE A - EXCESS "underlying insurance" of LIABILITY FOLLOW-FORM exhaustion of its applicable limit of insurance. SECTION I - COVERAGES; or C. COVERAGE C - CRISIS MANAGEMENT SERVICE EXPENSES (2) The "applicable underlying limit" is the "other limit any of applicable 1. We will reimburse the insured, or pay on the insurance" and such limit has been insured's behalf, "crisis management service exhausted by payments of judgments, expenses" to which Coverage C applies. settlements or medical expenses, or 2. Coverage C of this insurance applies to "crisis related costs or expenses (if such management service expenses" that: costs or expenses reduce such limits). a. Arise out of a "crisis management event" that first commences during the policy For any "suit" for which we have the right period; and duty to defend the insured under Coverage A, defense expenses will be b. Are incurred by the insured, after a "crisis within the limits of insurance of this policy management event" first commences and when such expenses are within the limits before such event ends; and of insurance of the applicable "underlying c. Are submitted to us within 180 days after insurance"; or the "crisis management advisor" advises b. Under Coverage B, against a "suit" you that the "crisis management event" no seeking damages to which such coverage longer exists. applies. 3. A "crisis management event" will be deemed to: 2. We have no duty to defend any insured a. First commence at the time when any against any "suit": "executive officer" first becomes aware of a. Seeking damages to which this insurance an "event" or "occurrence" that leads to that does not apply; or "crisis management event"; and b. If any other insurer has a duty to defend. b. End when we decide that the crisis no exists when the Crisis longer EU 00 01 07 16 © 2016 The Travelers Indemnity Company. All rights reserved. Page 3 of 22
UMBRELLA With respect to a claim we investigate or 3. When we have the duty to defend, we may, at settle, or "suit" against an insured we defend our discretion, investigate and settle any claim under COVERAGE A - EXCESS FOLLOW- or "suit". In all other cases, we may, at our discretion, participate in the FORM LIABILITY, these payments will not investigation, defense and settlement of any claim or "suit" for reduce the applicable limits of insurance, but only if the applicable "underlying insurance" damages to which this insurance may apply. If all provides for such payments in addition to its we exercise such right to participate, expenses we incur in doing so will not reduce limits of insurance. With respect to a claim we the applicable limits of insurance. investigate or settle, or "suit" against an insured we defend under COVERAGE B- 4. Our duty to defend ends when we have used up UMBRELLA LIABILITY, these payments will the applicable limit of insurance in the payment not reduce the applicable limits of insurance. or defense of judgments or settlements, SECTION II - WHO IS AN INSURED expenses if such expenses are within the limits of insurance of this policy. A. COVERAGE A - EXCESS FOLLOW-FORM LIABILITY With respect to Coverage A, the following persons we defend: and organizations qualify as insureds: a. All expenses we incur. the 1. The Named Insured shown in Declarations; and b. The cost of: (1) Bail bonds required of because 2. Any other person or organization qualifying as accidents or traffic law violations arising an insured in the "underlying insurance". If out of the use of any vehicle to which you have agreed to provide insurance for that this insurance applies; or person or organization in a written contract or agreement: (2) Appeal bonds and bonds to release a. The limits of insurance afforded to such attachments; person or organization will be: amounts within the but only for bond applicable limit of insurance. We do not (1) The amount by which the minimum have to furnish these bonds. limits of insurance you agreed to provide such person or organization C. All reasonable expenses incurred by the in that written contract or agreement insured at our request to assist us in the exceed the total limits of insurance of investigation or defense of such claim or all applicable "underlying insurance"; "suit", including actual loss of earnings up or to $1,000 a day because of time off from work. (2) The limits of insurance of this policy; All court costs taxed against the insured in d. whichever is less; and the "suit". However, these payments do not b. Coverage under this policy does not apply fees attorneys' attorneys' include to such person or organization if the expenses taxed against the insured. minimum limits of insurance you agreed to provide such person or organization in e. Prejudgment interest awarded against the insured on that part of the judgment we that written contract or agreement are pay. If we make an offer to pay the wholly within the total limits of insurance applicable limit of insurance, we will not pay of all available applicable "underlying any prejudgment interest based on that insurance" period of time after the offer. B. COVERAGE B - UMBRELLA LIABILITY f. All interest that accrues on the full amount With respect to Coverage B: of any judgment after entry of the judgment in the 1. The Named Insured shown and before we have paid, offered to pay or Declarations is an insured. deposited in court the part of the judgment within the applicable limit of that is 2. If you are: insurance. If we do not pay part of the a. An individual, your spouse is also an judgment for any reason other than it is insured, but only with respect to the more than the applicable limit of insurance, conduct of a business of which you are we will not pay any interest that accrues on the sole owner. that portion of the judgment. EU 00 01 07 16 © 2016 The Travelers Indemnity Company. All rights reserved. Page 4 of 22
UMBRELLA damages because of the injury b. A partnership or joint venture, your described in Paragraph (1)(a) or members, your partners and their spouses (b) above; or are also insureds, but only with respect to the conduct of your business. (d) Arising out of his or her providing or failing to provide professional c. A limited liability company, your members health care services. are also insureds, but only with respect to the business. Your conduct of your Unless you are in the business or managers are also insureds, but only with occupation of providing professional respect to their duties as your managers. health care services, Paragraphs (1)(a), (b), (c) and (d) above do not d. An organization other than a partnership, apply to "bodily injury" arising out of joint venture or limited liability company, providing or failing to provide first aid your "officers" and directors are also or "Good Samaritan services" by any insureds, but only with respect to their of your "employees" or "volunteer duties as your "officers" or directors. Your workers" other than an employed or stockholders are also insureds, but only such volunteer doctor. to their respect with liability as "employees" or "volunteer workers" stockholders. providing or failing to provide first aid e. A trust, your trustees are also insureds, but or "Good Samaritan services" during only with respect to their duties as trustees. their work hours for you will be deemed to be acting within the scope 3. Each of the following is also an insured: of their employment by you while a. Your "volunteer workers" only performing duties related to the performing duties related to the conduct of conduct of your business. your business, or your "employees", other (2) "Property damage" to property: than either your "officers" (if you are an (a) Owned, occupied or used by; or organization other than a partnership, joint (b) Rented to, in the care, custody or venture or limited liability company or your managers if you are a limited liability control of, or over which physical control is being exercised for any company, but only for acts within the scope of their employment by you or while purpose by; performing duties related to the conduct of you, any of your "employees" or your business. However, none of these "volunteer workers", any of your "employees" or "volunteer workers" are partners or members if you are a insureds for: partnership or joint venture), or any of your members (if you are a limited (1) "Bodily injury" or "personal injury": liability company). (a) To you, to your partners or b. Any person (other than your "employee" members (if you are a partnership or or any "volunteer worker"), or joint venture), to your members organization, while acting as your real you are a limited liability estate manager. company, to a co-"employee" while in the course of his or her c. Any person or organization having proper temporary custody of your property if you employment or performing duties die, but only: related to the conduct of your business, or to your other (1) With respect to liability arising out of while "volunteer the maintenance or use of that workers" performing duties related to the property; and conduct of your business; (2) Until your legal representative has (b) To the spouse, child, parent, been appointed brother or sister of that co- d. Your legal representative if you die, but "employee" or "volunteer worker" only with respect to duties as such. That as a consequence of Paragraph representative will have all your rights and (1)(a) above; duties under this insurance. 4. Any organization, other than a partnership, (c) For which there is any obligation to share damages with or repay joint venture or limited liability company, of someone else who must pay which you are the sole owner, or in which you EU 00 01 07 16 © 2016 The Travelers Indemnity Company. All rights reserved. Page 5 of 22
UMBRELLA maintain an ownership interest of more than the date, if any, during the policy period, that 50%, on the first day of the policy period is an you no longer maintain an ownership interest insured and will qualify as a Named Insured. No of more than 50% in such organization. such organization is an insured or will qualify as 3. Any organization you newly acquire or form, a Named Insured for "bodily injury" or "property other than a partnership, joint venture or damage" that occurred, or "personal injury" or limited liability company, and of which you are "advertising injury" caused by an offense the sole owner, or in which you maintain an committed after the date, if any, during the ownership interest of more than 50%, if there policy period, that you no longer maintain an is no other similar insurance available to that ownership interest of more than 50% in such organization. However: organization. a. Coverage under this provision is afforded Any organization you newly acquire or form, only until the 180th day after you acquire other than a partnership, joint venture or limited or form the organization or the end of the liability company, and of which you are the sole policy period, whichever is earlier; and owner, or in which you maintain an ownership b. Coverage for such organization does not interest of more than 50%, is an insured and apply to "crisis management service will qualify as a Named Insured if there is no a out of "crisis expenses" arising other similar insurance available to that management event" that occurred before organization. However: you acquired or formed the organization, a. Coverage under this provision is afforded even if an "executive officer" only first only until the 180th day after you acquire or aware of an "event" or becomes form the organization or the end of the "occurrence" that leads to such "crisis management event" after the date you policy period, whichever is earlier; and acquired or formed the organization. b. Coverage for such organization does not No person or organization is an insured or will apply to: qualify as a Named Insured with respect to the (1) "Bodily injury" or "property damage" conduct of any current or past partnership, joint that occurred; or venture or limited liability company that is not (2) "Personal injury" or "advertising injury" shown as a Named Insured in the Declarations. arising out of an offense committed; SECTION III - LIMITS OF INSURANCE before you acquired or formed the A. The Limits of Insurance shown in the Declarations organization. and the rules below fix the most we will pay for the No person or organization is an insured or will amounts described below to which this insurance qualify as a Named Insured with respect to the applies regardless of the number of: conduct of any current or past partnership, joint 1. Insureds; as a Named Insured in the Declarations. This 2. Claims made or "suits" brought; paragraph does not apply to any such partnership, soured in the ry than hi sho 3. Number of vehicles involved; joint venture or limited liability company that otherwise qualifies as an insured under Paragraph 4. Persons or organizations making claims or B. of SECTION II - WHO IS AN INSURED. bringing "suits"; or - CRISIS MANAGEMENT C. COVERAGE 5. Coverages provided under this insurance. SERVICE EXPENSES As indicated in Paragraph D.1. of SECTION I - With respect to Coverage C, the following persons COVERAGES, for any "suit" for which we have and organizations are insureds and will qualify as the right and duty to defend the insured under Named Insureds: Coverage A, defense expenses will be within the 1. The Named Insured shown in the Declarations. such limits of insurance of this policy when expenses are within the limits of insurance of the 2. Any organization, other than a partnership, joint applicable "underlying insurance". venture or limited liability company, of which you are the sole owner, or in which you B. The General Aggregate Limit is the most we will pay for the sum of all: 1. Damages; and Done ray nestry are. such organization is an insured or will qualify as a Named Insured for "crisis management 2. Defense expenses if such expenses are service expenses" arising out of a "crisis within the limits of insurance of this policy; management event" that first commences after except: EU 00 01 07 16 © 2016 The Travelers Indemnity Company. All rights reserved. Page 6 of 22
UMBRELLA 1. Asbestos 1. Damages and defense expenses because of "bodily injury" or "property damage" included in a. Damages arising out of the actual or the "auto hazard"; alleged presence or actual, alleged or threatened 2. Damages and defense expenses because of of dispersal asbestos, "bodily injury" or "property damage" included in asbestos fibers or products containing the "products-completed operations hazard"; or asbestos, provided that the damages are and defense expenses for which caused or contributed to by the hazardous 3. Damages insurance is provided under any Aircraft Liability properties of asbestos. coverage included as "underlying insurance" to Damages arising out of the actual or b. which no aggregate limit applies. alleged presence or actual, alleged or C. The Products-Completed Operations Aggregate threatened dispersal of any solid, liquid, Limit is the most we will pay for the sum of all: Or irritant or thermal gaseous 1. Damages; and contaminant, including smoke, vapors, soot, fumes, acids, alkalis, chemicals and 2. Defense expenses if such expenses are within the limits of insurance of this policy; waste, and that are part of any claim or "suit" which also alleges any damages because of "bodily injury" or "property damage" described in Paragraph a. above. included in the "products-completed operations hazard". c. Any loss, cost or expense arising out of any: Subject to Paragraph B. or C. above, whichever D. applies, the Occurrence Limit is the most we will (1) Request, demand, order or statutory pay for the sum of all: or regulatory requirement that any expenses if such 1. Damages, and defense insured or others test for, monitor, are within the limits of insurance of expenses clean up, remove, contain, treat, this policy, under Coverage A arising out of any detoxify or neutralize, or in any way one "event" to which the "underlying insurance" respond to, or assess the effects of, applies a limit of insurance that is separate asbestos, asbestos fibers or products from any aggregate limit of insurance; and containing asbestos; or Damages under Coverage B because of all (2) Claim or "suit" by or on behalf of any "personal "property damage", "bodily injury", governmental authority or any other injury" or "advertising injury" arising out of any person or organization because of one "occurrence". testing for, monitoring, cleaning up, removing, containing, treating, For the purposes of determining the applicable acts or omissions detoxifying or neutralizing, or in any Occurrence Limit, all related way responding to, or assessing the committed in the providing or failing to provide first effects of, asbestos, asbestos fibers aid or "Good Samaritan services" to any one person will be considered one "occurrence". or products containing asbestos. 2. Employment-Related Practices E. The Crisis Management Service Expenses Limit is the most we will pay for the sum of all "crisis Damages because of injury to: management service expenses" arising out of all a. A person arising out of any: "crisis management events". Payment of such "crisis management service expenses" is in addition (1) Refusal to employ that person; to, and will not reduce, any other limit of insurance (2) Termination 1 of that person's of this policy. employment; or F. The limits of insurance of this policy apply (3) Employment-related practice, policy, separately to each consecutive annual period and act or omission, such as coercion, to any remaining period of less than 12 months, demotion, evaluation, reassignment, starting with the beginning of the policy period discipline, failure to promote or shown in the Declarations. If the policy period is harassment, advance, humiliation, extended after issuance for an additional period of discrimination, libel, slander, violation less than 12 months, the additional period will be of the person's right of privacy, for deemed part of the last preceding period malicious prosecution or false arrest, purposes of determining the limits of insurance. detention or imprisonment, applied to SECTION IV - EXCLUSIONS or directed at that person, regardless of whether such practice, policy, act This insurance does not apply to: or omission occurs, is applied or is A. With respect to Coverage A and Coverage B: EU 00 01 07 16 © 2016 The Travelers Indemnity Company. All rights reserved. Page 7 of 22
UMBRELLA committed before, during or after the c. Auto no-fault or other first-party personal time of that person's employment; or injury protection (PIP); b. The spouse, child, parent, brother or sister uninsured/underinsured d. Supplementary of that person as a consequence of injury motorists (New York); or to that person as described in Paragraphs e. Medical expense benefits and income a.(1), (2) or (3) above. loss benefits (Virginia). This exclusion applies: 7. War a. Whether the insured may be liable as an Damages arising out of: employer or in any other capacity; and a. War, including undeclared or civil war; or b. To any obligation to share damages with or b. Warlike action by a military force, who else repay someone must pay including action in hindering or defending damages because of the injury. against an actual or expected attack, by 3. ERISA, COBRA And Similar Laws sovereign or other any government, Any obligation of the insured under: authority using military personnel or other agents; or Retirement Income a. The Employees c. Insurrection, rebellion, revolution, usurped Security Act Of 1974 (ERISA) or any of its amendments; power or action taken by governmental authority in hindering or defending against b. The Consolidated Budget Omnibus any of these. Reconciliation Act of 1985 (COBRA) or any of its amendments; or 8. Workers Compensation And Similar Laws c. Any similar common or statutory law of any Any obligation of the insured under a workers or benefits disability jurisdiction. compensation, unemployment compensation law or any 4. Medical Expenses Or Payments similar law. Any obligation of the insured under any "medical expenses" or medical payments B. With respect to Coverage B: coverage. 1. Expected Or Intended Bodily Injury Or Property Damage 5. Nuclear Material "Bodily injury" or "property damage" expected Damages arising out of: or intended from the standpoint of the insured. a. The actual, alleged or threatened exposure This exclusion does not apply to "bodily injury" of any person or property to; or or "property damage" resulting from the use of reasonable force to protect persons or b. The "hazardous properties" of; property. any "nuclear material". 2. Contractual Liability As used in this exclusion: "Bodily injury", "property damage", "personal includes properties" a. "Hazardous injury" or "advertising injury" for which the radioactive, toxic or explosive properties; insured is obligated to pay damages by material" means "source b. "Nuclear reason of the assumption of liability in a material", "special nuclear material" or "by- contract or agreement. This exclusion does product material"; and not apply to liability for damages that the insured would have in the absence of the c. "Source nuclear "special material, contract or agreement. material" and "by-product material" have the meanings given them in the Atomic 3. Liquor Liability Act Energy of 1954 or any of its "Bodily injury" or "property damage" for which amendments. any insured may be liable by reason of: 6. Uninsured or Underinsured Motorists, No- a. Causing or contributing to the intoxication Fault And Similar Laws of any person, including causing or Any liability imposed on the insured, or the contributing to the intoxication of any insured's insurer, under any of the following person because alcoholic beverages were permitted to be brought on your premises for consumption on your premises; a. Uninsured motorists; b. Underinsured motorists; © 2016 The Travelers Indemnity Company. All rights reserved. EU 00 01 07 16 Page 8 of 22
UMBRELLA This exclusion applies even if the claims b. The furnishing of alcoholic beverages to a against any insured allege negligence or other person under the legal drinking age or wrongdoing in the supervision, hiring, under the influence of alcohol; or employment, training or monitoring of others c. Any statute, ordinance or regulation relating by that insured, if the "occurrence" which to the sale, gift, distribution or use of caused the "bodily injury" or "property alcoholic beverages. involved the ownership, damage" 4. Employers Liability maintenance, use or entrustment to others of any aircraft that is owned or operated by or "Bodily injury" to: rented or loaned to any insured. a. An "employee" of the insured arising out of and in the course of: 7. Auto "Bodily injury" or "property damage" arising (1) Employment by the insured; or out of the ownership, maintenance, use or (2) Performing duties related to entrustment to others of any "auto". Use conduct of the insured's business; or includes operation and "loading or unloading". The spouse, child, parent, brother or sister b. This exclusion applies even if the claims against any insured allege negligence or other *guy des as in Palageace at hiring, wrongdoing in the supervision, above. employment, training or monitoring of others This exclusion applies: by that insured, if the "occurrence" which a. Whether the insured may be liable as an caused the "bodily injury" or "property the ownership, employer or in any other capacity; and damage" involved maintenance, use or entrustment to others of b. To any obligation to share damages with or any "auto". repay someone else who must pay This exclusion does not apply to "bodily injury" damages because of the "bodily injury". or "property damage" caused by an 5. Pollution "occurrence" that takes place outside of the "property damage", a. "Bodily injury", United States of America (including its "personal injury" or "advertising injury" territories and possessions), Puerto Rico and out of the actual, alleged or arising Canada. threatened discharge, dispersal, seepage, 8. Watercraft migration, release or escape of "pollutants". "Bodily injury" or "property damage" arising b. Any loss, cost or expense arising out of out of the ownership, maintenance, use or entrustment to others of any watercraft owned (1) Request, demand, order or statutory or or operated by or rented or loaned to any regulatory requirement that any insured insured. Use includes operation and "loading or any other person or organization test or unloading". for, monitor, clean up, remove, contain, This exclusion applies even if the claims treat, detoxify or neutralize, or in any against any insured allege negligence or other way respond to, or assess the effects the supervision, wrongdoing hiring, of, "pollutants"; or employment, training or monitoring of others (2) Claim or "suit" by or on behalf of any by that insured, if the "occurrence" which governmental authority or any other caused the "bodily injury" or "property person or organization because of the ownership, damage" involved testing for, monitoring, cleaning up, maintenance, use or entrustment to others of containing, removing, treating, any watercraft that is owned or operated by or detoxifying or neutralizing, or in any rented or loaned to any insured. way responding to, or assessing the This exclusion does not apply to a watercraft: effects of, "pollutants". a. While ashore on premises owned by or 6. Aircraft rented to any insured; or "Bodily injury" or "property damage" arising out use or maintenance, of the ownership, b. That is 50-feet long or less and that: entrustment to others of any aircraft owned or (1) You own; or operated by or rented or loaned to any insured. Use includes operation and "loading or unloading". EU 00 01 07 16 © 2016 The Travelers Indemnity Company. All rights reserved Page 9 of 22
UMBRELLA "your work" after it has been put to its (2) You do not own and is not being used intended use. to carry any person or property for a charge. 12. Recall Of Products, Work Or Impaired Property 9. Electronic Data or Damages claimed for any loss, cost Damages claimed for the loss of, loss of use of, expense incurred by you or others for the loss damage to, corruption of, inability to access, or of use, withdrawal, recall, inspection, repair, inability to manipulate "electronic data". replacement, adjustment, removal or disposal 10. Damage To Property, Products Or Work of: "Property damage" to: a. "Your product"; a. Property you own, rent or occupy, including b. "Your work"; or any costs or expenses incurred by you, or c. "Impaired property"; any other person or organization, for repair, replacement, enhancement, restoration or if such product, work or property is withdrawn maintenance of such property for any or recalled from the market or from use by any person or organization because of a reason, including prevention of injury to a known or suspected defect, deficiency, person or damage to another's property; inadequacy or dangerous condition in it. b. Premises you sell, give away or abandon if 13. Violation Of Consumer Financial the "property damage" arises out of any Protection Laws part of those premises; "Bodily injury", "property damage", "personal c. Property loaned to you; injury" or "advertising injury" arising out of any d. Personal property in the care, custody or actual or alleged violation of a "consumer control of the insured; financial protection law", or any other "bodily e. That particular part of real property on injury", "property damage", "personal injury" or or which you or any contractors "advertising injury" alleged in any claim or "suit" that also alleges any such violation. 14. Unsolicited Communication actor are die direct or indirectly the "property damage" arises out of those "Bodily injury", "property damage", "personal operations; injury" or "advertising injury" arising out of any f. That particular part of any property that actual or alleged violation of any law that must be restored, repaired or replaced restricts or prohibits the sending, transmitting work" because "your or distributing of "unsolicited communication". performed on it; 15. Access Or Disclosure Of Confidential Or g. "Your product" arising out of "your product" Personal Information or any part of it; or "Bodily injury", "property damage", "personal h. "Your work" arising out of "your work" or injury" or "advertising injury" arising out of any access to or disclosure of any person's or any part of it and included in the "products- completed operations hazard". organization's confidential or personal information. 11. Damage To Impaired Property Or Property Not Physically Injured 16. Knowing Violation Of Rights Of Another "Property damage" to "impaired property", or "Personal injury" or "advertising injury" caused by or at the direction of the insured with the property that has not been physically injured, arising out of: knowledge that the act would violate the rights of another and would inflict "personal injury" a. A defect, deficiency, inadequacy or or "advertising injury". dangerous condition in "your product" or "your work"; or 17. Material Published With Knowledge Of Falsity b. A delay or failure by you, or anyone acting on your behalf, to fulfill the terms of "Personal injury" or "advertising injury" arising out of oral or written publication, including contract or agreement. publication by electronic means, of material, if This exclusion does not apply to the loss of use done by or at the direction of the insured with of other property arising out of sudden and knowledge of its falsity. accidental physical injury to "your product" or Page 10 of 22 EU 00 01 07 16 © 2016 The Travelers Indemnity Company. All rights reserved.
UMBRELLA 18. Material Published Or Used Prior To Policy b. Any other "personal injury" or "advertising Period injury" alleged in any claim or "suit" that also alleges any such infringement or a. "Personal injury" or "advertising injury" "title" or violation of another's copyright, arising out of oral or written publication, "slogan" in your "advertisement". including publication by electronic means, of material whose first publication took 24. Insureds In Media And Internet Type Business place before the beginning of the policy period; or "Personal injury" or "advertising injury" arising • of arising "Advertising out of an offense committed by an insured injury" whose business is: infringement of copyright, "title" or "slogan" "advertisement" first in your whose a. Advertising, "broadcasting" or publishing; infringement in your "advertisement" was b. Designing or determining content of web- committed before the beginning of the sites for others; or policy period. c. An Internet search, access, content or 19. Criminal Acts service provider. "Personal injury" or "advertising injury" arising This exclusion does not apply to Paragraphs out of a criminal act committed by or at the a.(1), (2) and (3) of the definition of "personal direction of the insured. injury". 20. Breach Of Contract For the purposes of this exclusion: "Personal injury" or "advertising injury" arising out of a breach of contract. a. Creating and producing correspondence written in the conduct of your business, 21. Quality Or Performance Of Goods - Failure bulletins, financial or annual reports, or To Conform To Statements newsletters about your goods, products or "Advertising injury" arising out of the failure of services will not be considered the goods, products or services to conform with any business of publishing; and statement of quality or performance made in b. The placing of frames, borders or links, or your "advertisement". advertising, for you or others anywhere on 22. Wrong Description Of Prices the Internet will not, by itself, be considered the business of advertising, "broadcasting" or publishing. services stated in your "advertisement". 25. Electronic Chatrooms Or Bulletin Boards 23. Intellectual Property "Personal injury" or "advertising injury" arising out of an electronic chatroom or bulletin board "Personal injury" or "advertising injury" arising the insured hosts, owns or over which the out of any actual or alleged infringement or insured exercises control. violation of any of the following rights or laws, or any other "personal injury" or "advertising injury" 26. Unauthorized Use Of Another's Name Or alleged in any claim or "suit" that also alleges Product any such infringement or violation: "Personal injury" or "advertising injury" arising out of the unauthorized use of another's name a. Copyright; or product in your e-mail address, domain b. Patent; name or metatag, or any other similar tactics c. Trade dress; to mislead another's potential customers. d. Trade name; C. With respect to Coverage C: e. Trademark; Newly Acquired, Controlled Or Formed f. Trade secret; or Entities g. Other intellectual property rights or laws. "Crisis management service expenses" arising out of a "crisis management event" that involves any This exclusion does not apply to: organization you newly acquire or form and that a. "Advertising injury" arising out of any actual occurred prior to the date you acquired or formed or alleged infringement or violation that organization, even if an "executive officer" another's copyright, "title" or "slogan" in only first becomes aware of an "event" or your "advertisement"; or that leads to such "occurrence" "crisis EU 00 01 07 16 © 2016 The Travelers Indemnity Company. All rights reserved. Page 11 of 22
UMBRELLA management event" after the date you acquired or D. CHANGES formed such organization. This policy contains all the agreements between SECTION V - CONDITIONS you and us concerning the insurance afforded. No terms of this change can be made in the A. APPEALS insurance except with our consent. The terms of this insurance can be amended or waived only by endorsement issued by us and made a part of this exceeds the "applicable underlying limit" or it nor ape a leg men miche policy. "self-insured retention", we may do so. E. CURRENCY 2. If we appeal such a judgment, we will pay all Payments for damages or expenses described in costs of the appeal. These payments will not Paragraph 5. of Paragraph D., DEFENSE AND reduce the applicable limits of insurance. In no SUPPLEMENTARY PAYMENTS, of SECTION I event will our liability exceed the applicable limit - COVERAGES will be in the currency of the of insurance. United States of America. At our sole option, we may make these payments in a different currency. B. BANKRUPTCY Any necessary currency conversion for such 1. Bankruptcy or insolvency of the insured or of payments will be calculated based on the rate of the insured's estate will not relieve us of our exchange published in the Wall Street Journal obligations under this insurance. immediately preceding the date the payment is 2. In the event of bankruptcy or insolvency of any processed. "underlying insurer", this insurance will not F. DUTIES REGARDING AN EVENT, replace such bankrupt or insolvent "underlying OCCURRENCE, CLAIM OR SUIT insurer's" policy, and this insurance will apply as 1. You must see to it that we are notified as if such "underlying insurer" had not become soon as practicable of an "event" or bankrupt or insolvent. "occurrence" which may result in a claim C. CANCELLATION under this insurance. To the extent possible, 1. The first Named Insured shown in the notice should include: Declarations may cancel this insurance by a. How, when and where the "event" or mailing or delivering to us advance written "occurrence" took place; notice of cancellation. b. The names and addresses of any We may cancel this insurance by mailing or persons or organizations sustaining injury, delivering to such first Named Insured written damage or loss, and the names and notice of cancellation at least: addresses of any witnesses; and a. 10 days before the effective date of C. The nature and location of any injury or cancellation if we cancel for nonpayment of damage arising out of the "event" or premium; or "occurrence". b. 60 days before the effective date of 2. If a claim is made or "suit" is brought against cancellation if we cancel for any other any insured which may result in a claim under reason. this insurance, you must see to it that we receive written notice of the claim or "suit" as 3. We will mail or deliver our notice to such first soon as practicable. Named Insured's last mailing address known to 3. With respect to Coverage A, the insured must: 4. Notice of cancellation will state the effective date of cancellation. The policy period will end a. Cooperate with us in the investigation, on that date. settlement or defense of any claim or If this insurance is cancelled, we will send such "suit"; first Named Insured any premium refund due. If b. Comply with the terms of the "underlying insurance"; and we cancel, the refund will be pro rata. If such first Named Insured cancels, the refund may be c. Pursue all rights of contribution or less than pro rata. The cancellation will be Or indemnity against any person effective even if we have not made or offered a organization who may be liable to the refund. insured because of the injury, damage or 6. If notice is mailed, proof of mailing will be loss for which insurance is provided under sufficient proof of notice. EU 00 01 07 16 © 2016 The Travelers Indemnity Company. All rights reserved. Page 12 of 22
UMBRELLA c. The nature and location of any injury or this policy or any policy of "underlying insurance" damage arising out of that "crisis management event"; and 4. With respect to Coverage B, the insured must: d. The reason that "crisis management a. Immediately send us copies of any event" is likely to involve damages demands, notices, summonses or legal covered by this insurance in excess of the papers received in connection with the "applicable underlying limit" or "self- claim or "suit"; insured retention" and involve regional or b. Authorize us to obtain necessary records national media coverage. and other information; H. EXAMINATION OF YOUR BOOKS AND c. Cooperate with us in the investigation, RECORDS settlement or defense of any claim or "suit"; We may examine and audit your books and and records as they relate to this insurance: d. Assist us, upon our request, in the 1. At any time during the policy period; any enforcement of any right against person or organization which may be liable 2. Up to three years after the end of the policy to the insured because of injury or damage period; and to which Coverage B may apply. 3. Within one year after final settlement of all claims under this insurance. 5. No insured will, except at that insured's own expense, voluntarily make a payment, assume I. EXTENDED REPORTING PERIOD OPTION any obligation, make any admission or incur 1. When the "underlying insurance" applies on a any expense, other than for first aid for "bodily claims-made basis, any automatic or basic injury" covered by this insurance, without our "extended in such reporting period" consent. "underlying insurance" will apply to this 6. Knowledge of an "event", "occurrence", claim or insurance. "suit" by your agent, servant or "employee" will 2. When the "underlying insurance" applies on a not constitute knowledge by you, unless your claims-made basis and you elect to purchase insurance or risk manager, or anyone working an optional or "extended supplemental in the capacity as your insurance or risk in such reporting "underlying period" manager, or anyone you designate with the insurance," that "extended reporting period" reporting responsibility "event", will apply to this insurance only if: "occurrence", claim or "suit": a. A written request to purchase an a. Has received notice of such "event", Extended Reporting Period endorsement "occurrence" , claim or "suit" from such for this insurance is made by you and agent, servant or "employee"; or received by us within 90 days after the b. Otherwise has knowledge of such "event", end of the policy period; "occurrence", claim or "suit". b. You have paid all premiums due for this G. DUTIES REGARDING A CRISIS MANAGEMENT policy at the time you make such request; EVENT c. You promptly pay the additional premium we charge for the Extended Reporting You must: Period endorsement for this insurance "crisis 1. Notify us within 30 days of a determine that when due. We will management event" that may result in "crisis additional premium after we have management service expenses". received your request for the Extended "crisis 2. Provide written notice of the Reporting Period endorsement for this insurance. That additional premium is not management event" as soon as practicable. To subject to any limitation stated in the the extent possible, notice should include: "underlying insurance" on the amount or where that "crisis a. How, when and percentage of additional premium that management event" took place; "extended may be charged for the b. The names and addresses of any persons reporting period" in such "underlying or organizations sustaining injury, damage insurance"; and or loss, and the named and addresses of any witnesses; EU 00 01 07 16 © 2016 The Travelers Indemnity Company. All rights reserved. Page 13 of 22
UMBRELLA / Period d. That Extended Reporting the full policy period of this Excess Follow- Form And Umbrella Liability Insurance. This endorsement is issued by us and made a provision does not apply to the reduction or part of this policy. exhaustion of the aggregate limit or limits of 3. Any Extended Reporting Period endorsement such "underlying insurance" solely by for this insurance will not reinstate or increase payments as permitted in Paragraphs 4.a.(1), the Limits of Insurance or extend the policy (2) and (3) of COVERAGE A - EXCESS period. FOLLOW-FORM LIABILITY of SECTION I - Except with respect to any provisions to the COVERAGES. As such policies expire, you contrary contained in Paragraphs 1., 2. or 3. will renew them at limits and with coverage at above, all provisions of any option to purchase least equal to the expiring limits of insurance. an "extended reporting period" granted to you in If you fail to comply with the above insurance" the "underlying requirements, Coverage A is not invalidated insurance. However, in the event of a loss, we will pay J. INSPECTIONS AND SURVEYS only to the extent that we would have paid had 1. We have the right but are not obligated to: you complied with the above requirements. 2. The first Named Insured shown in the a. Make inspections and surveys at any time; b. Give you reports on the conditions we find; and respects: c. Recommend changes. a. Coverage; or reports 2. Any inspections, surveys, b. Limits of insurance; recommendations relate only to insurability and the premiums to be charged. We do not make c. Termination of any coverage; or safety inspections. We do not undertake to d. Exhaustion of aggregate limits. perform the duty of any person or organization 3. If you are unable to recover from any to provide for the health or safety of workers or "underlying insurer" because you fail to the public. We do not warrant that conditions: comply with any term or condition of the a. Are safe or healthful; or "underlying insurance", Coverage A is not b. Comply with laws, regulations, codes or invalidated. However, we will pay for any loss standards. only to the extent that we would have paid had K. LEGAL ACTION AGAINST US you complied with that term or condition in that "underlying insurance". 1. No person or organization has a right under this insurance: M. OTHER INSURANCE a. To join us as a party or otherwise bring us This insurance is excess over any valid and into a "suit" asking for damages from an collectible "other insurance" whether such "other insured; or insurance" is stated to be primary, contributing, excess, contingent or otherwise. This provision b. To sue us on this insurance unless all of its does not apply to a policy bought specifically to terms have been fully complied with. apply as excess of this insurance. 2. A person or organization may sue us to recover on an agreed settlement or on a final judgment However, if you specifically agree in a written against an insured. We will not be liable for contract or agreement that the insurance provided to any person or organization that qualifies as an damages that: insured under this insurance must apply on a a. Are not payable under the terms of this primary basis, or a primary and non-contributory insurance; or basis, then insurance provided under Coverage A b. Are in excess of the applicable limit of is subject to the following provisions: insurance. An agreed settlement means a settlement and release of liability signed by us, the insured and claimant or the claimant's legal representative. L. MAINTENANCE OF UNDERLYING INSURANCE 1. The insurance afforded by each policy of "underlying insurance" will be maintained for EU 00 01 07 16 © 2016 The Travelers Indemnity Company. All rights reserved. Page 14 of 22
UMBRELLA provide insurance in such country or 1. This insurance will apply before any "other insurance" that is available to such additional jurisdiction; or insured or covers which that person b. The furnishing of certificates or other organization as a named insured, and we will evidence of insurance in any country or jurisdiction in which we are not licensed to not share with that "other insurance", provided provide insurance. that the injury or damage for which coverage is sought is caused by an "event" that takes place Q. PROHIBITED COVERAGE - TRADE OR or is committed subsequent to the signing of ECONOMIC SANCTIONS that contract or agreement by you. or We will provide coverage for any loss, 2. This insurance is still excess over any valid and otherwise will provide any benefit, only to the collectible "other insurance", , whether primary, extent that providing such coverage or benefit excess, contingent or otherwise, which covers does not expose us or any of our affiliated or that person or organization as an additional parent companies to: insured or as any other insured that does not 1. Any trade or economic sanction under any law qualify as a named insured or regulation of the United States of America; N. PREMIUM or 1. The first Named Insured shown in the 2. Any other applicable trade or economic Declarations is responsible for the payment of sanction, prohibition or restriction. all premiums and will be the payee for any R. REPRESENTATIONS return premiums. By accepting this insurance, you agree: 2. If the premium is a flat charge, it is not subject 1. The statements in the Declarations and any to adjustment except as provided in Paragraph subsequent notice relating to "underlying 4. below. insurance" are accurate and complete; 3. If the premium is other than a flat charge, it is statements are based upon 2. Those an earned advance premium only. The representations you made to us; and premium will be computed at the end of the policy period, or at the end of each year of the 3. We have issued this insurance in reliance policy period if the policy period is two years or upon your representations. longer, at the rate shown in the Declarations, S. SEPARATION OF INSUREDS subject to the Minimum Premium. Except with respect to the Limits of Insurance, 4. Additional premium may become payable when and any rights or duties specifically assigned in coverage is provided for additional insureds this policy to the first Named Insured shown in the under the provisions of SECTION II - WHO IS Declarations, this insurance applies: AN INSURED. 1. As if each Named Insured were the only O. PREMIUM AUDIT Named Insured; and The premium for this policy is the amount stated in 2. Separately to each insured against whom Item 5. of the Declarations. The premium is a flat claim is made or "suit" is brought. charge unless it is specified in the Declarations as T. WAIVER OR TRANSFER OF RIGHTS OF adjustable. RECOVERY AGAINST OTHERS TO US P. PROHIBITED COVERAGE - UNLICENSED 1. If the insured has rights to recover all or part INSURANCE of any payment we have made under this insurance, those rights are transferred to us 1. With respect to loss sustained by any insured in and the insured must do nothing after loss to a country or jurisdiction in which we are not impair them. At our request, the insured will this licensed to provide this insurance, bring suit or transfer those rights to us and insurance does not apply to the extent that help us, and with respect to Coverage A, the insuring such loss would violate the laws or regulations of such country or jurisdiction. "underlying insurer", enforce them. If the insured has agreed in a contract or 2. We do not assume responsibility for: agreement to waive that insured's right of a. The payment of any fine, fee, penalty or recovery against any person or organization, other charge that may be imposed on any we waive our right of recovery against that person or organization in any country or person or organization, but only for payments jurisdiction because we are not licensed to we make because of an "event" that takes place or is committed subsequent to the EU 00 01 07 16 © 2016 The Travelers Indemnity Company. All rights reserved. Page 15 of 22
UMBRELLA execution of that contract or agreement by such SECTION VI - DEFINITIONS insured. A. With respect to all coverages of this insurance: 2. Reimbursement of any amount recovered will 1. "Applicable underlying limit" means the sum of: be made in the following order: a. The applicable limit of insurance stated organization a. First, to any person or for the policies of "underlying insurance" (including us or the insured) who has paid in the Schedule Of Underlying Insurance subject to the provisions in Paragraphs of insurance; 4.a.(1), (2) and (3) of COVERAGE A - insurance in excess of the apocabies imit b. Next, to us; and EXCESS FOLLOW-FORM LIABILITY of SECTION I - COVERAGES; and C. Then, to any person or organization (including the insured and with respect to b. The applicable limit of insurance of any Coverage A, the "underlying insurer") that "other insurance" that applies. is entitled to claim the remainder, if any. The limits of insurance in any policy of 3. Expenses incurred in the process of recovery "underlying insurance" will apply even if: or all will persons divided among a. The "underlying insurer" claims the organizations receiving amounts recovered insured failed to comply with any term or according to the ratio of their respective recoveries. insurer" becomes b. The "underlying U. TRANSFER OF YOUR RIGHTS AND DUTIES bankrupt or insolvent. UNDER THIS INSURANCE 2. "Auto hazard" means all "bodily injury" and 1. Your rights and duties under this insurance may "property damage" to which liability insurance not be transferred without our written consent afforded under an auto policy of "underlying except in the case of death of an individual insurance" would apply but for the exhaustion Named Insured. of its applicable limits of insurance. 2. If you die, your rights and duties will be 3. "Electronic data" means information, facts or transferred to your legal representative but only programs stored as or on, created or used on, while acting within the scope of duties as your representative. or transmitted to or from computer software (including systems and applications software), representative is appointed, anyone having proper temporary custody of your property will hard or floppy disks, CD-ROMs, tapes, drives, have your rights and duties but only with cells, data processing devices or any other respect to that property. media which are used with electronically controlled equipment. V. UNINTENTIONAL OMISSION OR ERROR 4. "Event" means an "occurrence", offense, The unintentional omission of, or unintentional error accident, act, error, omission, wrongful act or in, any information provided by you which we relied loss. upon in issuing this policy will not prejudice your rights under this insurance. However, this provision "Extended reporting period" means any period does not affect our right to collect additional of time, starting with the end of the policy premium or to exercise our rights of cancellation or period of your claims-made insurance, during in accordance nonrenewal with applicable which claims or "suits" may be first made, insurance laws or regulations. brought or reported for that insurance. W. WHEN LOSS IS PAYABLE "Medical expenses" means expenses to If we are liable under this insurance, we will pay for which any Medical Payments section of any of Commercial General Liability injury, damage or loss after: "underlying insurance" applies. 1. The insured's liability is established by: "Other insurance" means insurance, or the a. A court decision; or funding of losses, that is provided by, through b. A written agreement between the claimant, or on behalf of: the insured, any "underlying insurer" and a. Another insurance company; us; and b. Us or any of our affiliated insurance 2. The amount of the "applicable underlying limit" companies; or "self-insured retention" is paid by or on behalf of the insured. c. Any risk retention group; EU 00 01 07 16 © 2016 The Travelers Indemnity Company. All rights reserved. Page 16 of 22
UMBRELLA Commercial General Liability d. Any self-insurance method or program, in ¡ insurance" states that which case the insured will be deemed to "underlying products-completed operations are be the provider of such insurance; or subject to the General Aggregate Any similar risk transfer or risk e. Limit. management method. 9. "Suit" means a civil proceeding which alleges "Other insurance" does not include: damages. "Suit" includes: a. Any "underlying insurance"; or a. An arbitration proceeding in which of insurance b. Any policy specifically damages are claimed and to which the purchased to be excess of the limits of insured must submit or does submit with insurance of this policy shown in the our consent; or Declarations. b. Any other alternative dispute resolution 8. "Products-completed operations hazard": proceeding to which the insured submits a. Includes all "bodily injury" and "property with our consent. damage" occurring away from premises 10. "Underlying insurance": you own or rent and arising out of "your a. Means the policy or policies of insurance product" or "your work" except: listed in the Schedule Of Underlying (1) Products that are still in your physical Insurance. possession; or b. Includes any renewal or replacement of (2) Work that has not yet been completed renewal or such policies if such or abandoned. However, "your work" replacement is during the policy period of deemed completed at the this Excess Follow-Form And Umbrella earliest of the following times: Liability Insurance. (a) When all the work called for in your c. Does not include any part of the policy contract has been completed; period of any of the policies described in (b) When all the work to be done at the Paragraphs a. or b. above that began job site has been completed if your before, or that continues after, the policy contract calls for work at more than period of this Excess Follow-Form And one job site; or Umbrella Liability Insurance. (c) When that part of the work done at 11. "Underlying insurer" means any insurer which a job site has been put to its provides a policy of insurance listed in the intended use by any person or Schedule Of Underlying Insurance. organization other than another B. With respect to Coverage Band, to the extent that contractor or subcontractor working on the same project. the following terms are not defined in the "underlying insurance", to Coverage A: that may need service, repair or maintenance, correction, 1. "Advertisement" means a notice that is replacement, but which is otherwise broadcast or published to the general public complete, will be treated as completed. or specific market segments about your goods, products or services for the purpose of b. Does not include "bodily injury" or "property attracting customers or supporters. For the damage" arising out of: purposes of this definition: (1) The transportation of property, unless a. Notices that are published include the injury or damage arises out of a condition in or on a vehicle not owned material placed on the Internet or on means electronic of similar or operated by you, and that condition communication; and was created unloading" of that vehicle by any b. Regarding web sites, only that part of a insured; web site that is about your goods, products or services for the purposes of (2) The existence of tools, uninstalled or unused equipment or abandoned customers or supporters is attracting considered an advertisement. materials; or (3) Products or operations for which the 2. "Advertising injury": classification listed in policy of EU 00 01 07 16 © 2016 The Travelers Indemnity Company. All rights reserved. Page 17 of 22
UMBRELLA b. In, by or with any other electronic means a. Means injury, other than "personal injury", caused by one or more of the following of communication, such as the Internet, if offenses: that material is part of: or television programming (1) Radio (1) Oral or written publication, including publication by electronic means, of being transmitted; material in your "advertisement" that (2) Other entertainment, educational, slanders or libels a person news music or instructional, organization or disparages a person's programming being transmitted; or or organization's goods, products or (3) Advertising transmitted with any such services, provided that the claim is programming. made or the "suit" is brought by a 6. "Consumer financial identity information" person or organization that claims to means any of the following information for a have been slandered or libeled, or that person that is used or collected for the claims to have had its goods, products purpose of serving as a factor in establishing or services disparaged; such person's eligibility for personal credit, (2) Oral or written publication, including insurance or employment or for the purpose publication by electronic means, of of conducting a business transaction: material in your "advertisement" that: a. Part or all of the account number, the name, (a) Appropriates a person's any expiration date or the balance of voice, photograph or likeness; or credit, debit, bank or other financial (b) Unreasonably places a person in a account; false light; or b. Information bearing on a person's credit (3) Infringement of copyright, "title" or worthiness, credit standing or credit "slogan" "advertisement", capacity; provided that the claim is made or the c. Social security number; "suit" is brought by a person or organization that claims ownership of d. Driver's license number; or such copyright, "title" or "slogan". e. Birth date. b. Includes "bodily injury" caused by one or 7. "Consumer financial protection law" means: more of the offenses described in a. The Fair Credit Reporting Act (FCRA) and Paragraph a. above. any of its amendments, including the Fair 3. "Auto" means: and Accurate Credit Transactions Act a. A land motor vehicle, trailer or semitrailer (FACTA); designed for travel roads, on public b. California's Song-Beverly Credit Card Act including any attached machinery or and any of its amendments; or equipment; or c. Any other law or regulation that restricts b. Any other land vehicle that is subject to a or prohibits the collection, dissemination, compulsory or financial responsibility law or or use transmission, distribution other motor vehicle insurance law where it "consumer financial identity information". is licensed or principally garaged. a "leased worker". 8. "Employee" includes However, "auto" does not include "mobile "Employee" does not include a "temporary equipment". worker". 4. "Bodily injury" means: 9. "Good Samaritan services" means any harm, emergency medical services for which no including sickness or a. Physical disease, sustained by a person; or compensation is demanded or received. b. Mental anguish, injury or illness, 10. "Impaired property" means tangible property, emotional distress, resulting at any time other than "your product" or "your work", that cannot be used or is less useful because: from such physical harm, sickness or disease. a. It incorporates "your product" or "your 5. "Broadcasting" means transmitting any audio or work" that is known or thought to be deficient, inadequate or visual material for any purpose: defective, dangerous; or a. By radio or television; or EU 00 01 07 16 © 2016 The Travelers Indemnity Company. All rights reserved. Page 18 of 22
UMBRELLA exploration, lighting and well servicing b. You have failed to fulfill the terms of a equipment; or contract or agreement; (2) Cherry pickers and similar devices if such property can be restored to use by the used to raise or lower workers. repair, replacement, adjustment or removal of "your product" or "your work" or your fulfilling f. Vehicles not described in Paragraph a., b., the terms of the contract or agreement. c. or d. above maintained primarily for purposes other than the transportation of 11. "Leased worker" means a person leased to you persons or cargo. by a labor leasing firm under an agreement However, self-propelled vehicles with the perform duties related to the conduct of your following types of permanently attached business. "Leased worker" does not include a equipment are not "mobile equipment" but will be considered "autos": "temporary worker". 12. "Loading or unloading" means the handling of (1) Equipment designed primarily for: property: (a) Snow removal; a. After it is moved from the place where it is but not (b) Road maintenance, an into or onto accepted for movement construction or resurfacing; or aircraft, watercraft or "auto"; (c) Street cleaning; b. While it is in or on an aircraft, watercraft or (2) Cherry pickers and similar devices "auto"; or mounted on automobile or truck chassis and used to raise or lower c. While it is being moved from an aircraft, watercraft or "auto" to the place where it is workers; and finally delivered; pumps and (3) Air compressors, spraying, generators, including but "loading or unloading" does not include the welding, building cleaning, geophysical exploration, lighting and well servicing equipment. that is not attached to the aircraft, watercraft or "auto". However, "mobile equipment" does not include any land vehicle that is subject to a compulsory 13. "Mobile equipment" means any of the following types of land vehicles, including any attached or financial responsibility law, or other motor vehicle insurance law, where it is licensed or machinery or equipment: principally garaged. Such land vehicles are a. Bulldozers, farm machinery, forklifts and considered "autos". other vehicles designed for use principally off 14. "Occurrence" means: public roads. a. With respect to "bodily injury" or "property b. Vehicles maintained for use solely on or next damage": to premises you own or rent. (1) An accident, including continuous or c. Vehicles that travel on crawler treads. repeated exposure to substantially the d. Vehicles, whether self-propelled or not, same general harmful conditions, maintained primarily to provide mobility to which results in "bodily injury" or permanently mounted: "property damage". All "bodily injury" or "property damage" caused by such (1) Power cranes, shovels, loaders, diggers exposure to substantially the same or drills; or general harmful conditions will be construction resurfacing (2) Road deemed to be caused by one equipment such as graders, scrapers or "occurrence"; or rollers. 2) An act or omission committed in e. Vehicles not described in Paragraph a., b., providing or failing to provide first aid c. or d. above that are not self-propelled and or "Good Samaritan services" to a are maintained primarily to provide mobility person by any of your "employees" or to permanently attached equipment of the "volunteer workers" other than an following types: employed or volunteer doctor, unless you are in the business or occupation and compressors, (1) Air pumps of providing professional health care generators, including spraying, welding, services; building cleaning, geophysical EU 00 01 07 16 © 2016 The Travelers Indemnity Company. All rights reserved. Page 19 of 22
UMBRELLA (5) Oral or written publication, including b. With respect to "personal injury", an offense arising out of your business that publication by electronic means, of results in "personal injury". All "personal material that: injury" caused by the same or related (a) Appropriates a person's name, injurious material, act or offense will be voice, photograph or likeness; or deemed to be caused by one "occurrence", regardless of the frequency or repetition (b) Unreasonably places a person in thereof, the number and kind of media a false light. used or the number of persons or b. Includes "bodily injury" caused by one or organizations making claims or bringing in offenses described more of the "suits"; and Paragraph a. above. C. With respect to "advertising injury", an 17. "Pollutants" mean any solid, liquid, gaseous or committed in the course of offense thermal irritant or contaminant, including and goods, products advertising your smoke, vapor, soot, fumes, acids, alkalis, services that results in "advertising injury". and waste. Waste chemicals includes All "advertising injury" caused by the same or materials to be recycled, reconditioned or related injurious material, act or offense reclaimed. will be deemed to be caused by one "occurrence", regardless of the frequency 18. "Property damage" means: or repetition thereof, the number and kind to tangible property, a. Physical injury of media used or the number of persons or including all resulting loss of use of that organizations making claims or bringing property. All such loss of use will be "suits" deemed to occur at the time of the 15. "Officer" means a person holding any of the physical injury that caused it; or officer positions created b. Loss of use of tangible property that is not constitution, bylaws or any other similar physically injured. All such loss of use will governing document. be deemed to occur at the time of the 16. "Personal injury": "occurrence" that caused it. a. Means injury, other than "advertising For the purposes of this insurance, "electronic injury", caused by one or more of the data" is not tangible property. following offenses: or • detention (1) False arrest, 19. "Self-insured retention" is the greater of: imprisonment; a. The amount shown in the Declarations (2) Malicious prosecution; which the insured must first pay under Coverage B for damages because of all (3) The wrongful eviction from, wrongful "bodily injury", "property damage", entry into, or invasion of the right of "personal injury" or "advertising injury" private occupancy of a room, dwelling arising out of any one "occurrence"; or or premises that a person occupies, provided that the wrongful eviction, b. The applicable limit of insurance of any wrongful entry or invasion of the right of "other insurance" that applies. private occupancy is committed by or 20. "Slogan": on behalf of the owner, landlord or or lessor of that room, dwelling a. Means a phrase that others use for the premises; purpose of attracting attention in their advertising. (4) Oral or written publication, including publication by electronic means, of b. Does not include a phrase used as, or in, material that slanders or libels a person the name of: a or organization or disparages or organization's person's (1) Any person or organization other than goods, products or services, provided that the you; or claim is made or the "suit" is brought by (2) Any business, or any of the premises, a person or organization that claims to goods, products, services or work, of have been slandered or libeled, or that any person or organization other than claims to have had its goods, products you. or services disparaged; or EU 00 01 07 16 © 2016 The Travelers Indemnity Company. All rights reserved. Page 20 of 22
UMBRELLA 21. "Temporary worker" means a person who is (1) Warranties or representations made at any time with respect to the fitness, furnished to you to substitute for a permanent quality, durability, performance or use "employee" on leave or to meet seasonal or of "your work"; and short-term workload conditions. 22. "Title" means the name of a literary or artistic (2) The providing of or failure to provide warnings or instructions. work. C. With respect to Coverage C: communication" means 23. "Unsolicited communication, in any form, that the recipient 1. "Crisis management advisor" means any of such communication did not specifically public relations firm or crisis management request to receive. firm approved by us that is hired by you to perform "crisis management services" in 24. "Volunteer worker" means a person who is not connection with a "crisis management event". your "employee", , and who donates his or her work and acts at the direction of and within the "Crisis management event" means an "event" 2. or "occurrence" that your "executive officer" scope of duties determined by you, and is not reasonably determines has resulted, or may paid a fee, salary or other compensation by you result, in: or anyone else for their work performed by you. a. Damages covered by this Coverage A or 25. "Your product": Coverage B that are in excess of the total a. Means: of the applicable limits "underlying (1) Any goods or products, other than real insurance" or "self-insured retention"; and property, manufactured, sold, handled, b. Significant adverse regional or national distributed or disposed of by: media coverage. (a) You; 3. "Crisis management service expenses" (b) Others trading under your name; or means amounts incurred by you, after a "crisis management event" first commences (c) A person or organization whose and before such event ends: business or assets you have a. For the reasonable and necessary: acquired; and of a "crisis (1) Fees and expenses than other vehicles), (2) Containers advisor" management in the materials, parts or equipment furnished performance for you of "crisis in connection with such goods or management services" solely for a products. "crisis management event"; and b. Includes: (2) Costs for printing, advertising, mailing materials or travel of by your (1) Warranties or representations made at or employees directors, officers, any time with respect to the fitness, or a agents management "crisis quality, durability, performance or use advisor" "crisis for a solely of "your product"; and management event"; and (2) The providing of or failure to provide b. For the following expenses resulting from warnings or instructions. such "crisis management event", provided that such expenses have been approved c. Does not include vending machines or by us: other property rented to or located for the use of others but not sold. (1) Medical expenses; (2) Funeral expenses; 26. "Your work": (3) Psychological counseling; a. Means: (4) Travel expenses; (1) Work or operations performed by you (5) Temporary living expenses; or on your behalf; and (6) Expenses to secure the scene of a (2) Materials, parts or equipment furnished "crisis management event"; or in connection with such work or operations. (7) Any other expenses pre-approved by uS. b. Includes: EU 00 01 07 16 © 2016 The Travelers Indemnity Company. All rights reserved. Page 21 of 22
UMBRELLA 4. "Crisis management services" means those c. Chief Financial Officer; services performed by a "crisis management d. President; advisor" in advising you or minimizing potential e. General Counsel; harm to you from a "crisis management event" by maintaining or restoring public confidence in a are General partner if you you. partnership); or 5. "Executive officer" means your: sole g. Sole proprietor (if you are a proprietorship); a. Chief Executive Officer; or any person acting in the same capacity as b. Chief Operating Officer; any individual listed above. EU 00 01 07 16 © 2016 The Travelers Indemnity Company. All rights reserved. Page 22 of 22
UMBRELLA THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT OF COVERAGE - DEFINITIONS This endorsement modifies insurance provided under the following: EXCESS FOLLOW-FORM AND UMBRELLA LIABILITY INSURANCE The following replaces the introduction to Paragraph B. of SECTION VI - DEFINITIONS: With respect to Coverages B and C and, to the extent that the following terms are not defined in the "underlying insurance", to Coverage A: © 2016 The Travelers Indemnity Company. All rights reserved. EU 02 34 07 16 Page 1 of 1
UMBRELLA THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. FUNGI OR BACTERIA EXCLUSION - COVERAGE B This endorsement modifies insurance provided under the following: EXCESS FOLLOW-FORM AND UMBRELLA LIABILITY INSURANCE PROVISIONS c. Any loss, cost or expense arising out of any: (1) Request, demand, order or statutory or 1. The following exclusion is added to Paragraph B. regulatory requirement that any insured of SECTION IV - EXCLUSIONS: or any other person or organization test Fungi Or Bacteria for, monitor, clean up, remove, contain, a. "Bodily injury", "property damage", "personal treat, detoxity or neutralize, or in any injury" or "advertising injury" arising out of way respond to, or assess the effects of, the actual, alleged or threatened inhalation "fungi" or bacteria; or of, ingestion of, contact with, exposure to, (2) Claim or suit by or on behalf of any existence of or presence of any "fungi" or governmental authority or any other bacteria on or within a building or structure, person or organization because of including its contents, regardless of whether testing for, monitoring, cleaning up, any other cause, event, material or product treating, removing, containing, contributed concurrently or in any sequence detoxifying or neutralizing, or in any way to such injury or damage; or responding to, or assessing the effects "personal b. "Bodily injury", "property damage", of, "fungi" or bacteria. injury" or "advertising injury" arising out of This exclusion does not apply to any "fungi" or the actual or alleged or threatened inhalation bacteria that are, are on, or are contained in, a of, ingestion of, contact with, exposure to, good or product intended for consumption. existence of or presence of any other solid, or thermal irritant or gaseous 2. The following is added to Paragraph B. of liquid, contaminant, including smoke, vapors, soot, SECTION VI - DEFINITIONS: fumes, acids, alkalis, chemicals and waste, "Fungi" means any type or form of fungus, and that is part of any claim or "suit" which including mold or mildew and any mycotoxins, also alleges any injury or damage described or scents or byproducts produced spores, in Paragraph a. of this exclusion. released by fungi. EU 03 35 08 18 © 2017 The Travelers Indemnity Company. All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc. with its permission.
UMBRELLA THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NON CUMULATION OF OCCURRENCE LIMIT This endorsement modifies insurance provided under the following: EXCESS FOLLOW-FORM AND UMBRELLA LIABILITY INSURANCE PROVISIONS 2. The following is added to the definition of "other insurance" in Paragraph A. of SECTION VI - 1. The following is added to Paragraph D. of DEFINITIONS: SECTION III - LIMITS OF INSURANCE: "Other insurance" also does not include insurance Non cumulation of Occurrence Limit - If the that is provided by, through or on behalf of us or following arise out of any one "event": any of our affiliated insurance companies when the Non cumulation of Occurrence Limit provision a. Damages, or defense expenses if such expenses are within the limits of insurance of of Paragraph D. of SECTION III - LIMITS OF this policy, to which this Excess Follow-Form INSURANCE applies. And Umbrella Liability Insurance applies; and 3. The following is added to Paragraph 4. in Damages to which Excess Follow-Form And Paragraph A., COVERAGE A - EXCESS Umbrella Liability Insurance, or any other FOLLOW-FORM LIABILITY, of SECTION 1 - umbrella or excess liability coverage, included COVERAGES: in one or more prior or future policies issued to you by us, or any of our affiliated insurance For the purposes of Paragraph a.(1) above, payments of judgments or settlements for such companies, or defense expenses if damages that would have been covered by expenses are within the limits of insurance of "underlying insurance", but are not only because such policy, applies; of an Amendment - Non Cumulation Of Each this policy's Occurrence Limit applicable to that Occurrence Limit Of Liability and Non Cumulation "event" also will be reduced by the amount of Of Personal and Advertising injury each payment made for the damages and endorsement in that "underlying insurance" will be defense expenses described in Paragraph b. to be payments of judgments above by us or any of our affiliated insurance settlements for damages that are covered by that companies under, and within the applicable limit "underlying insurance". of insurance of, each such other policy. If a Non For the purposes of Paragraph a.(3) above, cumulation of Personal and Advertising Injury payments of defense expenses that would have Limit or a Non cumulation of Each Occurrence Limit provision in any such prior policy refers to a been covered by that "underlying insurance", but are not only because of an Amendment - Non COMMERCIAL LIABILITY EXCESS Cumulation Of Each Occurrence Limit Of Liability (UMBRELLA) INSURANCE policy, this Excess and Non Cumulation Of Personal and Advertising Follow-Form And Umbrella Liability Insurance will Injury Limit endorsement in that "underlying be deemed to be a COMMERCIAL EXCESS insurance" will be deemed to be payments of LIABILITY (UMBRELLA) INSURANCE policy for defense expenses that are covered by that the purposes of each such provision. "underlying insurance". Page 1 of 1 EU 03 46 08 18 © 2017 The Travelers Indemnity Company. All rights reserved.
UMBRELLA THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COVERAGE FOR FINANCIAL INTEREST IN FOREIGN INSURED ORGANIZATIONS This endorsement modifies insurance provided under the following: EXCESS FOLLOW-FORM AND UMBRELLA LIABILITY INSURANCE made or brought against any insured that is PROVISIONS not a "foreign insured organization". 1. The following is added to Paragraph A., COVERAGE A - EXCESS FOLLOW-FORM 3. The following is added to Paragraph A. of SECTION VI - DEFINITIONS: LIABILITY, and Paragraph B., COVERAGE B - "Financial interest" means the insurable interest UMBRELLA LIABILITY, of SECTION ! - COVERAGES: in a "foreign insured organization" because of: If a "foreign loss" is incurred by a "foreign insured a. Sole ownership of, or majority ownership insured interest such "foreign organization", or by any other insured for whom in, such "foreign insured organization" is liable, we organization", either directly or through one will reimburse the first Named Insured, or any or more intervening subsidiaries; other Named Insured that is not a "foreign -Indemnification of, or an obligation to insured organization", for such "foreign loss" indemnify: because of its "financial interest" in that "foreign insured (1) Such "foreign insured organization"; or organization". For purposes of this insurance, amounts we reimburse under: such (2) Any other insured for whom "foreign insured organization" is liable; a. Paragraph a. of the definition of "foreign loss" will be deemed to be sums that such for a "foreign loss"; or Named Insured becomes legally obligated to c. An obligation to obtain insurance for such pay as damages under this policy; and "foreign insured organization". b. Paragraph b. of the definition of "foreign "Foreign insured organization" means any loss" will be deemed to be payments we organization that: make under Paragraph 5. of Paragraph D., a. Is an insured under SECTION II - WHO IS AND SUPPLEMENTARY DEFENSE AN INSURED; and PAYMENTS, in SECTION I - COVERAGES. b. Is located in a country or jurisdiction in which The Following SECTION V- we are not licensed to provide this insurance CONDITIONS: and where providing this insurance would DUTIES IN THE EVENT OF A CLAIM OR SUIT such violate the laws or regulations of FOR FOREIGN LOSS country or jurisdiction. If a claim or "suit" for "foreign loss" is made or "Foreign loss" means: brought against a "foreign insured organization", a. Sums, in excess the "applicable or any other insured for whom such "foreign underlying limit" or "self-insured retention", insured organization" is liable, the first Named that an insured becomes legally obligated to Insured must: pay as damages because of loss to which the insurance provided under this policy 1. Arrange to investigate and defend such claim would have applied; or or "suit"; 2. Notify us in writing Payments described in Paragraph 5. of in advance of any Paragraph AND proposed settlement of such claim or "suit"; DEFENSE and SUPPLEMENTARY PAYMENTS SECTION I - COVERAGES that we would 3. Comply with all other conditions of this have made with respect to any claim or "suit" insurance as if such claim or "suit" were against an insured: EU 01 44 07 16 © 2016 The Travelers Indemnity Company. All rights reserved Page 1 of 2
UMBRELLA we but for the fact that such insured is located in any would have defended, (1) That investigated or settled; or country or jurisdiction in which we are not licensed to provide this insurance and where (2) For which we would have paid our part providing this insurance would violate the laws or of a judgment; regulations of such country or jurisdiction. © 2016 The Travelers Indemnity Company. All rights reserved. EU 01 44 07 16 Page 2 of 2
UMBRELLA THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT OF UNDERLYING INSURANCE DEFINITION This endorsement modifies insurance provided under the following: EXCESS FOLLOW-FORM AND UMBRELLA LIABILITY INSURANCE The following replaces the definition of "underlying c. Does not include: insurance" in Paragraph A. of SECTION VI - (1) Any part of the policy period of any insurance DEFINITIONS: described in Paragraphs a. or b. above that "Underlying insurance": began before, or that continues after, the policy period of this Excess Follow-Form And a. Means the insurance that: Umbrella Liability Insurance; or (1) Is listed in the Schedule Of Underlying (2) Any coverage provided under any insuring Insurance; and agreement added by endorsement to any (2) Has amounts stated for its limits of liability in insurance described in Paragraphs a. or b. that schedule. unless such coverage is separately listed in Includes any renewal or replacement of such b. the Schedule Of Underlying Insurance and insurance if such renewal or replacement is has amounts stated for its limits of liability in during the policy period of this Excess Follow- that schedule. Form And Umbrella Liability Insurance. EU 03 15 08 18 © 2017 The Travelers Indemnity Company. All rights reserved. Page 1 of 1
UMBRELLA ISSUE DATE: 05/12/2023 POLICY NUMBER: CUP-2W659088-23-42 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM AND EXCLUSION OF OTHER ACTS OF TERRORISM COMMITTED OUTSIDE THE UNITED STATES This endorsement modifies insurance provided under the following: EXCESS FOLLOW-FORM AND UMBRELLA LIABILITY INSURANCE CERTIFIED ACTS OF TERRORISM SELF-INSURED RETENTION SCHEDULE Each Occurrence Self-Insured Retention For Certified Acts Of Terrorism: $ 10,000 PROVISIONS injury" or "advertising injury" included in any one "occurrence". If no entry appears in the is added to SECTION I- 1. The following Certified Acts Of Terrorism Self-Insured COVERAGES: the Self-Insured Retention Schedule, insured losses attributable to If aggregate Retention For Certified Acts Of Terrorism is "certified acts of terrorism" exceed $100 billion in deemed to be $1,000,000. a calendar year and we have met our insurer deductible under "TRIA", we will not be liable for 3. The following exclusion is added to Paragraph A. of SECTION IV - EXCLUSIONS: the payment of any portion of the amount of such losses that exceeds $100 billion, and in such Acts Of Terrorism Committed Outside The case, insured losses up to that amount are United States subject to pro rata allocation in accordance with Damages arising out of any "act of terrorism" that procedures established by the Secretary of the is committed outside the United States of territories and its America (including 2. With respect to COVERAGE B - UMBRELLA possessions) and Puerto Rico. LIABILITY for any "bodily injury", "property This exclusion does not apply to damages damage", "personal injury" or "advertising injury" arising out of any "act of terrorism" that results in arising out of a "certified act of terrorism": loss occurring to: a. The following replaces Paragraph 1. in (1) An air carrier (as defined in Section 40102 of DEFENSE D., AND Paragraph title 49, United States Code) or a United SUPPLEMENTARY PAYMENTS, of States flag vessel or a vessel based SECTION I - COVERAGES: principally in the United States, on which 1. We will have the right, but not the duty, United States income tax is paid and whose to defend the insured under insurance coverage is subject to regulation in - UMBRELLA COVERAGE B the United States; or LIABILITY against a "suit" seeking (2) The premises of any United States mission. damages to which such coverage applies. 4. The following is added to Paragraph A. of SECTION VI - DEFINITIONS: b. The following replaces the definition of "self- "Act of terrorism" means a violent act or an act insured retention" in Paragraph B. of SECTION VI - DEFINITIONS: that is dangerous to human life, property or infrastructure that is committed by an individual "Self-insured retention" means the Self- or individuals and that appears to be part of an Insured Retention For Certified Acts Of coerce a civilian effort to population or to Terrorism shown in the Certified Acts Of influence the policy or affect the conduct of any Terrorism Self-Insured Retention Schedule government by coercion. which the insured must first pay under "Certified act of terrorism" means an act that is Coverage B for damages because of all any certified by the Secretary of the Treasury, in "bodily injury", "property damage", "personal © 2016 The Travelers Indemnity Company. All rights reserved. EU 00 07 07 16 Page 1 of 2 Includes copyrighted material of Insurance Services Office, Inc. with its permission.
UMBRELLA infrastructure and is committed by an accordance with the provisions of "TRIA", to be an act of terrorism pursuant to "TRIA". The individual or individuals as part of an effort to coerce the civilian population of the United criteria contained in "TRIA" for a "certified act of terrorism" include the following: States or to influence the policy or affect the conduct of the United States Government by a. The act resulted in insured losses in excess coercion. of $5 million in the aggregate, attributable to "TRIA" means the federal Terrorism Risk all types of insurance subject to "TRIA"; and Insurance Act of 2002 as amended. b. The act is a violent act or an act that is dangerous to human life, property or © 2016 The Travelers Indemnity Company. All rights reserved. EU 00 07 07 16 Page 2 of 2 Includes copyrighted material of Insurance Services Office, Inc. with its permission
UMBRELLA THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NUCLEAR ENERGY LIABILITY EXCLUSION (BROAD FORM) - COVERAGES A AND B This endorsement modifies insurance provided under the following: EXCESS FOLLOW-FORM AND UMBRELLA LIABILITY INSURANCE or on behalf of, an insured or (b) has been PROVISIONS discharged or dispersed therefrom; 1. The following replaces Exclusion 5., Nuclear Material, in Paragraph A. of SECTION IV - (2) The "nuclear material" is contained in "spent fuel" or "waste" at any time EXCLUSIONS: possessed, handled, used, processed, Nuclear Energy Liability (Broad Form) stored, transported or disposed of, by or on behalf of an insured; or a. Under any Liability Coverage, to "bodily injury" or "property damage": (3) The "bodily injury" or "property damage" (1) With respect to which an insured under arises out of the furnishing by an insured the policy is also an insured under a of services, materials, parts or equipment in connection with the planning, nuclear energy liability policy issued by Nuclear Insurance Energy Liability construction, maintenance, operation or Association, Mutual Atomic Energy use of any "nuclear facility", but if such Liability Underwriters, Nuclear Insurance facility is located within the United States Association of Canada or any of their of America, its territories or possessions successors, or would be an insured under or Canada, this exclusion (3) applies only any such policy but for its termination upon to "property damage" to such "nuclear exhaustion of its limit of liability; or facility" and any property thereat. (2) Resulting from the "hazardous properties" 2. The following is added to Paragraph A. of of "nuclear material" and with respect to SECTION VI - DEFINITIONS: which (a) any person or organization is required to maintain financial protection "Hazardous properties" includes radioactive, toxic or explosive properties. pursuant to the Atomic Energy Act of 1954, or any law amendatory thereof, or "Nuclear material" means "source material", (b) the insured is, or had this policy not "special nuclear material" or "by-product material". been issued would to be, entitled "Source material", "special nuclear material", and indemnity from the United States of "by-product material" have the meanings given America, or any agency thereof, under any agreement entered into by the United them in the Atomic Energy Act of 1954 or in any law amendatory thereof. States of America, or any agency thereof, with any person or organization. "Spent fuel" means any fuel element or fuel b. Under any Medical Payments coverage, to component, solid or liquid, which has been used or exposed to radiation in a "nuclear reactor". "bodily expenses incurred with respect to from "hazardous resulting injury" "Waste" means any waste material (a) containing "by-product material" other than the tailings or • or inton or ateria nading wastes produced by the extraction or concentration any person or organization. of uranium or thorium from any ore processed c. Under any Liability Coverage, to "bodily primarily for its "source material" content, and (b) injury" or "property damage" resulting from resulting from the operation by any person or "hazardous properties" of "nuclear material" if: organization of any "nuclear facility" included under the first two paragraphs of the definition of "nuclear (1) The "nuclear material" (a) is at any facility". "nuclear facility" owned by, or operated by © 2017 The Travelers Indemnity Company. All rights reserved. EU 02 09 08 18 Page 1 of 2 Includes copyrighted material of Insurance Services Office, Inc. with its permission.
UMBRELLA any combination thereof, or more than 250 "Nuclear facility" means: grams of uranium 235; or a. Any "nuclear reactor"; d. Any structure, basin, excavation, premises or b. Any equipment or device designed or used for place prepared or used for the storage or (1) separating the isotopes of uranium or disposal of "waste". plutonium, (2) processing or utilizing "spent and includes the site on which any of the foregoing fuel", or (3) handling, processing or packaging "waste"; is located, all operations conducted on such site and all premises used for such operations. C. Any equipment or device used for the "Nuclear reactor" means any apparatus designed processing, fabricating or alloying of "special or used to sustain nuclear fission in a self- nuclear material" if at any time the total amount supporting chain reaction or to contain a critical of such material in the custody of the insured mass of fissionable material. at the premises where such equipment or device is located consists of or contains "Property damage" includes all forms of radioactive than 25 grams of plutonium or uranium 233 or contamination of property. EU 02 09 08 18 © 2017 The Travelers Indemnity Company. All rights reserved Page 2 of 2 Includes copyrighted material of Insurance Services Office, Inc. with its permission.
UMBRELLA THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WATERCRAFT LIABILITY EXCLUSION - COVERAGE B This endorsement modifies insurance provided under the following: EXCESS FOLLOW-FORM AND UMBRELLA LIABILITY INSURANCE This exclusion applies even if the claims against any The following exclusion replaces Paragraph B.8., insured allege negligence or other wrongdoing in the Watercraft, of SECTION IV - EXCLUSIONS: or supervision, hiring, training employment, Watercraft the kofothers bythat insured, if monitoring "Bodily injury" or "property damage" arising out of the "occurrence" which caused the "bodily injury" or ownership, maintenance, use or entrustment to others ownership, "property damage" involved of any watercraft owned or operated by or rented or maintenance, use or entrustment to others of any loaned to any insured. Use includes operation and watercraft that is owned or operated or rented or "loading or unloading" loaned to any insured. © 2016 The Travelers Indemnity Company. All rights reserved. EU 02 90 07 16 Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc. with its permission.
UMBRELLA THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXTERIOR INSULATION AND FINISH SYSTEM EXCLUSION - COVERAGE B This endorsement modifies insurance provided under the following: EXCESS FOLLOW-FORM AND UMBRELLA LIABILITY INSURANCE b. "Your product" or "your work" with respect to PROVISIONS any exterior component, fixture or feature of 1. The following exclusion is added to Paragraph B. any structure if an "exterior insulation and of SECTION IV - EXCLUSIONS: finish system", or any substantially similar Exterior Insulation And Finish System system, is used on any part of that structure. "Bodily injury", "property damage", "personal 2. The following is added to Paragraph B. of injury" or "advertising injury" arising out of: SECTION VI - DEFINITIONS: "Exterior insulation and finish system" means an construction, a. The design, manufacture, exterior cladding or finish system used on any fabrication, distribution, sale, preparation, part of any structure and consisting of: installation, application, maintenance service, repair, remodeling, including a. A rigid or semi rigid insulation board made of of any "exterior correction or replacement, expanded polystyrene or other materials; insulation and finish system" (commonly b. The adhesive and/or mechanical fasteners used to attach the insulation board to the substrate; system or any part thereof, including the c. A reinforced base coat; and application or use of conditioners, primers, accessories, flashing, coatings, caulking or d. A finish coat providing surface texture and sealants in connection with such a system; or color. EU 03 05 03 17 © 2017 The Travelers Indemnity Company. All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc. with its permission.
UMBRELLA THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DISCRIMINATION EXCLUSION - COVERAGE B This endorsement modifies insurance provided under the following: EXCESS FOLLOW-FORM AND UMBRELLA LIABILITY INSURANCE pregnancy, race, color, creed, religion The following exclusion is added to Paragraph B. of national origin, citizenship, veteran status, age, SECTION IV - EXCLUSIONS: genetic information or physical or mental disability, or Discrimination any other characteristic, attribute, trait, condition or status that qualifies a person for protection against "Bodily injury", "property damage", "personal injury" or "advertising injury" arising out of discrimination based discrimination under federal, state or local law. orientation, marital upon a person's sex, sexual EU 03 31 08 18 © 2017 The Travelers Indemnity Company. All rights reserved. Page 1 of 1
UMBRELLA THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SILICA OR SILICA-RELATED DUST EXCLUSION - COVERAGE B This endorsement modifies insurance provided under the following: EXCESS FOLLOW-FORM AND UMBRELLA LIABILITY INSURANCE PROVISIONS (1) Request, demand, order or statutory or regulatory requirement that any insured 1. The following exclusion is added to Paragraph B. or any other person or organization test of SECTION IV - EXCLUSIONS: for, monitor, clean up, remove, contain, Silica or Silica-Related Dust treat, detoxify or neutralize, or in any way respond to, or assess the effects of, "personal a. "Bodily injury", "property damage", "silica" or "silica-related dust; or injury" or "advertising injury" arising out of the actual, alleged or threatened discharge, (2) Claim or suit by or on behalf of any escape, dispersal, governmental authority or any other handling, contact with, exposure to or or organization because person of inhalation or respiration of "silica" or "silica- up, for, monitoring, cleaning testing related dust". treating, containing, removing, b. "Bodily injury", "property damage", "personal detoxifying or neutralizing, or in any way injury" or "advertising injury" arising out of responding to, or assessing the effects the actual, alleged or threatened discharge, of, "silica" or "silica-related dust". escape, release, dispersal, emission, exposure to or 2. The following is added to Paragraph B. of contact with, handling, SECTION VI - DEFINITIONS: inhalation or respiration of any other solid, or thermal irritant or liquid, gaseous "Silica" means silica dioxide (occurring in contaminant, including smoke, vapors, soot, crystalline, amorphous and impure forms), silica fumes, acids, alkalis, chemicals and waste, particles, silica dust or silica compounds. and that is part of any claim or "suit" which "Silica-related dust" means a mixture or also alleges any injury or damage described combination of "silica" and other dust or in Paragraph a. of this exclusion. particles. c. Any loss, cost or expense arising out of any: © 2017 The Travelers Indemnity Company. All rights reserved. EU 03 63 08 18 Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc. with its permission.
UMBRELLA THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WRAP-UP INSURANCE PROGRAM EXCLUSION- COVERAGE B This endorsement modifies insurance provided under the following: EXCESS FOLLOW-FORM AND UMBRELLA LIABILITY INSURANCE contractor-controlled, owner-controlled or similar PROVISIONS insurance program, under which: 1. The following exclusion is added to Paragraph B. a. Some or all of the contractors working on a of SECTION IV - EXCLUSIONS: specific project, or specific projects, are Wrap-Up Insurance Program required to enroll in a program to obtain "Bodily injury" or "property damage" arising out of insurance that: any project that is or was subject to a "wrap-up (1) Includes liability insurance; and insurance program". (2) Is issued specifically for injury or damage 2. The following definition is added to Paragraph B. arising out of such project or projects; and of SECTION VI - DEFINITIONS: b. You are or were enrolled or allowed to enroll. insurance program" means "Wrap-up any any agreement or arrangement, including EU 03 70 08 18 © 2017 The Travelers Indemnity Company. All rights reserved. Page 1 of 1
UMBRELLA THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. INTELLECTUAL PROPERTY EXCLUSION - COVERAGE B This endorsement modifies insurance provided under the following: EXCESS FOLLOW-FORM AND UMBRELLA LIABILITY INSURANCE The following replaces Exclusion 23., Intellectual g. Other intellectual property rights or laws. SECTION IV - Property, in Paragraph B. of This exclusion applies regardless of whether the EXCLUSIONS: allegation of infringement or violation of any of these rights or laws is made by any person or 23. Intellectual Property organization making the claim or bringing the "Personal injury" or "advertising injury" arising out "suit", by any insured or by any other party to the of any actual or alleged infringement or violation claim or "suit". of any of the following rights or laws, or any other "personal injury" or "advertising injury" alleged in This exclusion does not apply to: any claim or "suit" that also alleges any such a. "Advertising injury" arising out of any actual or infringement or violation: alleged infringement or violation of another's "title" Or copyright, a. Copyright; "slogan" in your "advertisement"; or b. Patent; C. Trade dress; Any other "personal injury" or "advertising injury" alleged in any claim or "suit" that also d. Trade name; alleges any such infringement or violation of e. Trademark; another's copyright, "title" or "slogan" in your "advertisement". f. Trade secret; or EU 04 21 09 21 © 2021 The Travelers Indemnity Company. All rights reserved. Page 1 of 1
INTERLINE ENDORSEMENTS
INTERLINE ENDORSEMENTS
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. FEDERAL TERRORISM RISK INSURANCE ACT DISCLOSURE This endorsement applies to the insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CYBERFIRST ESSENTIALS GENERAL PROVISIONS FORM CYBERFIRST GENERAL PROVISIONS FORM EMPLOYEE BENEFITS LIABILITY COVERAGE PART EMPLOYMENT-RELATED PRACTICES LIABILITY COVERAGE PART EMPLOYMENT PRACTICES LIABILITY* WITH IDENTITY FRAUD EXPENSE REIMBURSEMENT ENVIRONMENTAL HAZARD POLICY EXCESS FOLLOW-FORM AND UMBRELLA LIABILITY INSURANCE EXCESS (FOLLOWING FORM) LIABILITY INSURANCE LAW ENFORCEMENT LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART MANUFACTURERS ERRORS AND OMISSIONS LIABILITY COVERAGE PART MEDFIRST PRODUCTS/COMPLETED OPERATIONS, ERRORS AND OMISSIONS, AND INFORMATION SECURITY LIABILITY COVERAGE FORM OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART PUBLIC ENTITY MANAGEMENT LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART SPECIAL PROTECTIVE AND HIGHWAY LIABILITY POLICY - NEW YORK DEPARTMENT OF TRIBAL BUSINESS MANAGEMENT LIABILITY COVERAGE PART Any other Commercial Liability coverage included in this policy that is subject to the federal Terrorism Risk Insurance Act of 2002 as amended Insured Losses in excess of each Insurer's "Insurer PROVISIONS Deductible" (as defined in TRIA), subject to the The federal Terrorism Risk Insurance Act of 2002 as "Program Trigger" (as defined in TRIA). In no event, amended ("TRIA") establishes a program under which however, will the Federal Government be required to the Federal Government may partially reimburse pay any portion of the amount of such Insured Losses "Insured Losses" (as defined in TRIA) caused by occurring in a calendar year that in the aggregate "Acts Of Terrorism" (as defined in TRIA). Act Of exceeds $100 billion, nor will any Insurer be required Terrorism is defined in Section 102(1) of TRIA to to pay any portion of such amount provided that such mean any act that is certified by the Secretary of the Insurer has met its Insurer Deductible. Therefore, if Treasury - in consultation with the Secretary of such Insured Losses occurring in a calendar year exceed $100 billion in the aggregate, the amount of Homeland Security and the Attorney General of the any payments by the Federal Government and any United States - to be an act of terrorism; to be a coverage provided by this policy for losses caused by violent act or an act that is dangerous to human life, Acts Of Terrorism may be reduced. property, or infrastructure; to have resulted in damage within the United States, or outside the United States For each coverage provided by this policy that applies in the case of certain air carriers or vessels or the to such Insured Losses, the charge for such Insured premises of a United States Mission; and to have Losses is included in the premium for such coverage. The charge for such Insured Losses that has been been committed by an individual or individuals as part included for each such coverage is the percentage of of an effort to coerce the civilian population of the the premium for such coverage indicated below, and United States or to influence the policy or affect the does not include any charge for the portion of such conduct of the United States Government by Insured Losses covered by the Federal Government under TRIA: The Federal Government's share of compensation for such Insured Losses is 80% of the amount of such 1%. IL T3 68 01 21 © 2020 The Travelers Indemnity Company. All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc. with its permission.
POLICYHOLDER NOTICES
POLICYHOLDER NOTICES
IMPORTANT NOTICE - INDEPENDENT AGENT AND BROKER COMPENSATION NO COVERAGE IS PROVIDED BY THIS NOTICE. THIS NOTICE DOES NOT AMEND ANY YOU SHOULD REVIEW YOUR ENTIRE POLICY PROVISION OF YOUR POLICY. CAREFULLY FOR COMPLETE INFORMATION ON THE COVERAGES PROVIDED AND TO DETERMINE YOUR RIGHTS AND DUTIES UNDER YOUR POLICY. PLEASE CONTACT YOUR AGENT OR BROKER IF YOU HAVE ANY QUESTIONS ABOUT THIS NOTICE OR ITS CONTENTS. IF THERE IS ANY CONFLICT BETWEEN YOUR POLICY AND THIS NOTICE, THE PROVISIONS OF YOUR POLICY PREVAIL. For information about how Travelers compensates independent agents and brokers, please www.travelers.com, call our toll-tree telephone number [phone removed], or request a written copy trom Marketing at One Tower Square, 2GSA, Hartford, CT 06183. PN T4 54 01 08 Page 1 of 1
CITY OF CAMBRIDGE Community Development Department IRAM FAROOQ SIGN CERTIFICATION FORM Assistant City Manager for COVER SHEET Community Development SANDRA CLARKE Lanner Noodles & Bar Deputy Director Sign Text: Chief of Administration Location of Sign: 24 Pearl St. KHALIL MOGASSABI Deputy Director Chief of Planning Applicant: Ricky Zeng Zoning District: Overlay District: Area of Special Planning Concern: (Sec. 19.46 & 19.42.1) 12/05/2023 Application Date: No Sketch of sign enclosed: Yes_ PLEASE NOTE: All signs must receive a permit from the Inspectional Services Department (ISD) before installation. Community Development Department Certification action does NOT constitute issuance of a permit or certification that all other code requirements have been met. Do not contract for the fabrication of a sign until all permits have been issued including City Council approval, if necessary for signs in the public way* * Any sign or portion of a sign extending more than six (6) inches into the public way/sidewalk, must receive approval from the Cambridge City Council; a bond must be posted with the City Clerk. The Sign Ordinance is available online under Article 7.000 at https://www.cambridgema.gov/CDD/zoninganddevelopment/Zoning/Ordinance Contact Liza Paden at [phone removed] or Ipaden@cambridgema.gov for further information. 344 Broadway Cambridge, MA 02139 Voice: [phone removed] Fax: [phone removed] TTY: [phone removed] www.cambridgema.gov
Proposed PROJECTING Sign (including signs on awnings) 86.5 Dimensions: 4'X6', 5'x7'9", 4'х6'x Area in Square feet: External Internal Illumination: Natural V Height (from ground to the top of the sign): 13.5 1. COMPLETE WHEN SIGN IS ACCESSORY TO A FIRST FLOOR STORE Area of signs allowed accessory to store: Length in feet of store front facing street: (a) 25.9 • Area of all existing signs on behind windows (0.5 x a) outside (1 x a) yes • Area of additional signs the store front to remain (including any freestanding sign):_ permitted: no 2. COMPLETE FOR ANY OTHER SIGN _ Area of signs allowed accessory to Length in feet of building facade facing street: (a). • Area of - behind windows (0.5 x a). the building facade: outside (1 x a). all existing signs on the building facade to remain (including any freestanding sign: Area of additional signs permitted: SUMMARY OF LIMITATIONS FOR PROJECTING SIGNS (see reverse side for more general summary of the sign regulations; review Article 7.000 of the Zoning Ordinance for all zoning requirements.) AREA: 13 square feet maximum. HEIGHT ABOVE THE GROUND: 20 feet but below the sills of second floor windows. ILLUMINATION: Natural or external only. NUMBER: one per store plus one per entry to the remainder of the building. COMMUNITY DEVELOPMENT DEPARTMENT CERTIFICATION NO Sign conforms to requirements of Article 7.000: YES Sign requires a variance from the Board of Zoning Appeal: YES Relevant sections: COMMENTS: CDD Representative Date:
Proposed WALL Sign X Dimensions: Area in Square feet: Internal Natural Illumination: _ External Height (from ground to the top of the sign): 1. COMPLETE WHEN SIGN IS ACCESSORY TO A FIRST FLOOR STORE Length in feet of store front facing street: (a). • Area of signs allowed accessory to store: Area of all existing signs on , behind windows (0.5 x a). outside (1 x a) Area of additional signs the store front to remain (including any freestanding sign: permitted: 2. COMPLETE FOR ANY OTHER SIGN Length in feet of building facade facing street: (a) . Area of signs allowed accessory to Area of the building facade: outside (1 x a). - behind windows (0.5 x a) all existing signs on the building facade to remain (including any freestanding sign: Area of additional signs permitted: SUMMARY OF LIMITATIONS FOR WALL SIGNS (see reverse side for more general summary of the sign regulations; review Article 7.000 of the Zoning Ordinance for all zoning requirements.) AREA: 60 square feet maximum. HEIGHT ABOVE THE GROUND: 20 feet but below the sills of second floor windows. ILLUMINATION: Natural or external, or internal illumination with significant limitations. NUMBER: No limit. COMMUNITY DEVELOPMENT DEPARTMENT CERTIFICATION NO Sign conforms to requirements of Article 7.000: YES Sign requires a variance from the Board of Zoning Appeal: YES Relevant sections: COMMENTS: Date: CDD Representative
Proposed FREESTANDING Sign X Dimensions: Area in Square feet: Internal External Illumination: Natural Height (from ground to the top of the sign):_ 1. COMPLETE WHEN SIGN IS ACCESSORY TO A FIRST FLOOR STORE Area of signs allowed accessory to store: Length in feet of store front facing street: (a)_ _ Area of all existing signs on outside (1 x a) , behind windows (0.5 x a) the store front to remain (including any freestanding sign): - Area of additional signs permitted: 2. COMPLETE FOR ANY OTHER SIGN Area of signs allowed accessory to Length in feet of building facade facing street: (a) Area of all the building facade: outside (1 x a). _ behind windows (0.5 x a) existing signs on the building facade to remain (including any freestanding sign): Area of additional signs permitted: SUMMARY OF LIMITATIONS FOR FREESTANDING SIGNS (see reverse side for more general summary of the sign regulations; review Article 7.000 of the Zoning Ordinance for all zoning requirements.) AREA: 30 square feet maximum. HEIGHT ABOVE THE GROUND: 15 feet. ILLUMINATION: Natural or external only. NUMBER: Two per lot (but not exceeding 30 square feet in total area. COMMUNITY DEVELOPMENT DEPARTMENT CERTIFICATION NO Sign conforms to requirements of Article 7.000: YES Sign requires a variance from the Board of Zoning Appeal: YES Relevant sections: COMMENTS: Date: CDD Representative
Existing Legally Established NONCONFORMING Sign Dimensions: Area in Square feet: Internal Natural Illumination: _External Height (from ground to the top of the sign):_ 1. TYPE OF SIGN a. wall_ b. projecting. c. freestanding_ 2. REASON FOR NONCONFORMITY c. other b. illumination a. dimensions 3. NATURE OF ALTERATIONS c. other b. repainting of face a. replacement of plastic face _ I certify that the above referenced sign was legally erected and in conformance with the requirements of Article 7.000 at that time and further that the alterations now proposed, and any others made within the last three (3) years, do not exceed fifty (50%) percent of the current replacement value of the sign.). Date: Applicant signature: COMMUNITY DEVELOPMENT DEPARTMENT CERTIFICATION NO Sign conforms to requirements of Article 7.000: YES Sign requires a variance from the Board of Zoning Appeal: YES Relevant sections: COMMENTS: CDD Representative Date:
SIGN CERTIFICATION FORM COMMUNITY DEVELOPMENT DEPARTMENT CERTIFCATION OF EXEMPTION Ricky Zeng/ New CC Sign Inc. Applicant: Signature Ricky Zeng [phone removed] FAX: Telephone: Location of Premises: 24 Pearl St. Zoning District: Overlay District: 12/05/2023 Date Application Submitted: No Sketch of Sign Enclosed: Yes PLEASE NOTE: Signs, even if exempt under Article 7.000, may require a permit from the Inspectional Services Department (ISD) before installation. Community Development Department (CDD) action does NOT constitute issuance of a permit or certification that all other code requirements have been met. Awnings of any kind projecting over a city sidewalk require City Council approval. Exempt signs in Section 7.16.11 REASON FOR EXEMPTION: Awning without graphics (including directional signs). Date: CDD Representative CDD Applicant_ City Clerk* Copies: ISD
Summary of Major Provisions for Office, Business and Industrial Districts (Please consult Article 7.000 of the Zoning Ordinance for specific requirements) Limitations on Total Area of the Signs on a Building (See definition of sign frontage) For Ground Floor stores: Width of store x 1 square foot equals area of all signs permitted on the outside of the storefront For all signs on a single façade of a building: (including those in paragraph 1 above): Width of building façade facing a street x 1 square foot equals area of all signs permitted on that façade. ** (Note: An additional 0.5 square feet per foot of sign frontage is permitted for signs located behind the glass of a window). Limitations on the Height of Signs Above the Ground Fifteen (15) for free-standing signs; twenty (20) feet for all other signs with expectation for certain hotel and theater signs. Limitations on Area of Individual Signs 1. Wall signs: Sixty (60) Square feet Maximum. * 2. Projecting Signs: Thirteen (13) square feet maximum. * 3. Free-standing signs: Thirty (30) Square feet maximum. * * However no sign may exceed that area determined by the formula: sign frontage x 1 square foot. Limitations on Number of Signs Permitted 1. No limit 2. Projecting signs: one per ground floor establishment plus one per door serving the remainder of the building. 3. Free-standing Signs: Two per lot. Limitations on Kinds of Illumination 1. Projecting (including awning signs) and free-standing signs: Natural and external only. Wall signs: Natural or external without limit. Internal under the following conditions: 2. At least one dimension is 30" or less; and b. The sign is located behind window glass or projects no more than 2" from the building face; or the sign consists only of individual letters, or channel letters, or only the letters in a box sign illuminated. ** Where the sign frontage is more than 100 feet from a street the multiplier may be increased to 2 square feet.
City of Cambridge Community Development Department STOREFRONT IMPROVEMENT PROGRAM The City of Cambridge Community Development Department (CDD) established the Storefront Improvement Program to provide financial assistance to property owners or retail tenants seeking to remove architectural barriers, renovate the commercial building façade and enhance exterior signage. The Program's objectives are to improve accessibility and physical appearance of retail establishments and enhance commercial districts. The Program provides a matching grant for the funding of well-designed improvements • that will coordinate all the important features of the storefront into a more attractive image while creating an accessible entrance for the public. This may include removal of physical barriers, restoration of architectural details, better windows and doors, and well-proportioned signage and lighting. Past matching grants have ranged from $2,500 to $35,000 with accessible design • upgrades getting 90% reimbursement based on scope of work and available funds. Grants vary each year so contact CDD for further information. Applicants; are responsible for hiring licensed designers, architects, contractors, and sign fabricators. A retail tenant is defined as a commercial establishment selling goods or services directly to members of the public for personal use and whose use is not solely for re-sale purposes (wholesale). Included in this definition are food and creative for-profit businesses. Improvements made prior to a signed contract with the City of Cambridge will not be funded. The following criteria must be met for participation in the Program: 1. Applicants must be property owners or commercial retail tenants whose storefronts face onto a Cambridge street; 2. Commercial retail tenants must offer goods or services that are open to the public; 3. Preference will be given to independent businesses not required by contractual arrangement to maintain standardized décor, architecture, signs or similar features; 14. Preference will be given to commercial retail tenants in a commercial district or corridor; 5. Tenants must have written approval from property owners to participate in program; 6. Billboards on property, if applicable, must be permanently removed as part of the improvement; 7. Property owners must be up to date on all municipal taxes prior to participation in the program; 8. Applicants must comply with all State and local laws and regulations pertaining to licensing, permits, building code and zoning requirements. The City of Cambridge reserves the right to apply additional criteria before accepting a project if program demand exceeds budgeted resources. For more information, please contact Christina DiLisio, [phone removed], cdilisio@cambridgema.gov