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CERTIFICATE OF LIABILITY INSURANCE (1010)
DATE(MM/DD/YYYY) ACORN® CERTIFICATE OF LIABILITY INSURANCEF �.� 12/11/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Frenkel & Company NAME:CONTACT Kathy Sullivan 260 Franklin Street PHONE Ext: 617-912-5613 A/C,No: 617-742-7744 Suite 1510 E-MAIL Boston, MA 02110 ADDRESS: ksuilivan@frenkel.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: Mitsui Sumitomo Insurance Co of America 20362 INSURED INSURER B: Hartford Casualty Insurance Company 29424 Tecogen Inc. INSURER C: Berkshire Hathaway Specialty Ins Company 22276 45 First Avenue Waltham MA 02451-1105 INSURER D: Twin City Fire Insurance Company 29459 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 52817203 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY A ✓ COMMERCIAL GENERAL LIABILITY ✓ ✓ PKG3127063 11/15/2019 11/15/2020 EACH OCCURRENCE $1,000,000 DA CLAIMS-MADE 1✓ OCCUR PREM SES OER,oecur Dr.nce $300,000 ✓ Primary&Non-contributory MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $2,000,000 PRO- POLICY ✓� ECT Z LOC PRODUCTS-COMP/OPAGG 62,000,000 OTHER: $ B AUTOMOBILE LIABILITY ✓ ✓ All Other States 11/15/2019 11/15/2020 EOa aBcdeDtSINGLE LIMIT 1'000'000 ✓ ANY AUTO 08UENAY6348 BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ B AUTOS ONLY AUTOS MASS Only11/15/2019 11/15/2020 HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY 08UENAY6402 Per accident C UMBRELLA LAB ,/ OCCUR ,/ ,/ 47UM030312804 11/15/2019 11/15/2020 EACH OCCURRENCE 620,000,000 ,/ EXCESS LAB CLAIMS-MADE AGGREGATE x20,000,000 DED ✓ RETENTION$10,000 $ D WORKERS COMPENSATION ✓ 08WEEK8563 11/15/2019 11/15/2020 ✓ STATUTE OERH AND EMPLOYERS'LIABILITY Y/N OFFICE R/MEMBEREXCLUDED?ECUTIVE ® N/A E.L.EACH ACCIDENT $1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) THE CITY OF CLEARWATER IS ADDED AS ADDITIONAL INSURED UNDER GENERAL AND AUTOMOBILE LIABILITY ONLY IF REQUIRED BY WRITTEN CONTRACT WITH THE NAMED INSURED.WAIVER OF SUBROGATION APPLIES ONLY IF AGREED TO IN WRITTEN CONTRACT WITH THE NAMED INSURED PRIOR TO A LOSS. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF CLEARWATER; CLEARWATER GAS SYSTEM THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 400 N. MYRTLE AVE ACCORDANCE WITH THE POLICY PROVISIONS. CLEARWATER FL 33755-0000 AUTHORIZED REPRESENTATIVE Casey Brown ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 52817203 1 19-20 CL AU UMB(20) WC Prof Poll I Casey Brown 1 12/11/2019 3:30:47 PM (EST) I Page 1 of 31 A Member of INSURANCE GROUP M S IG Policy Number PKG3127063 COMMON POLICY DECLARATIONS Insurance is afforded bythe company indicated low: IX I MITSUI SUMITOMO INSURANCE COMPANY OF AMERICA ❑ MITSUI SUMITOMO INSURANCE USA I . (each of the above being a capital stock corporation) Item 1. Named Insured and Mailing Address Agent Name and Address TECOGEN INC FRENKEL & CO. , INC . (SEE NAMED INSURED ENDORSEMENT) 210 HUDSON STREET, SUITE 601 45 'FIRST AVENUE JERSEY CITY NJ 07311 WALTHAM MA 02451 Agent No.0090030 Item 2. Policy Period From: 11-15-2019 To: 11-15-2020 IL— at 12:01 .,Standard Time at your mailing address shown above. Item 3. Business Description: Form of Business:CORPORATION Item 4. In return for the payment of the premium,and subject to all the terms of this policy,we agree with you to provide the insurance as stated in this policy. This policy consists of the following coverage parts for which a premium is indicated. Where no premium is shown,there is no coverage. This premium may be subject to adjustment. Coverage Part(s) Premium Commercial Property Coverage Part NOT COVERED Commercial General Liability Coverage Part $ Commercial Crime and Fidelity Coverage Part NOT COVERED Commercial Inland Marine Coverage Part NOT COVERED Commercial Output Coverage Part (AAIS) $ TAX, SURCHARGE OR FEE $ Total Polia Premium $ Item 5. Forms and Endorsements Form(s)and Endorsements)made a part of this policy at time of issue: See Schedule of Forms and Endorsements Countersigned: Date: By: THIS COMMON POLICY DECLARATION AND THE SUPPLEMENTAL DECLARATION(S),TOGETHER WITH THE COMMON POLICY CONDITIONS COVERAGE PART(S),COVERAGE FORM(S)AND FORMS AND ENDORSEMENTS,IF ANY,COMPLETE THE ABOVE NUMBERED POLICY. MS 0001 09 13 Page 1 of 1 INSURED COPY 52817203 1 19-20 CL AU UMB(20) WC Prof Poll I Casey Brown 1 12/11/2019 3:30:47 PM (EST) I Page 2 of 31 Policy r PKG3127063 SCHEDULEF NAMED INSURED(S) Named Insured TECOGEN INC . Effective Date: 11/15/2 019 12:01 A.M.,Standard Time Producer Name FRENKEL & CO. , INC . Producer No. 0090030 MS 0001 (cont . ) THE NAMED INSURED ON FORM MS 0001 IS AMENDED TO READ : TECOGEN INC . AMERICAN DG ENERGY INC . AMERICAN DG NewYOr , LLC TTCOGEN LLC MS 0103 01 16 2016 MSIG Holdings(Americas),All rights reserved. INSURED COPY 52817203 1 19-20 CL AU UMB(20) WC Prof Poll I Casey Brown 1 12/11/2019 3:30:47 PM (EST) I Page 3 of 31 Policy Number PKG3127063 SCHEDULE OF • - ENDORSEMENTS Named Insured TECOGEN INC . Effective Date: 11-15-19 (SEE NAMED INSURED DO' 12:01 A.M.,Standard Time Producer - FRENKEL & CO. , INC . Producer 0090030 illi 1 ;! � !:` -! : � - ♦ � ! 1 1 1 1 • :Fit 1 1 • Iwo ! - • •! - 1 1 a 1 1 1 : 1 1 1 - • � � � R 11 1 1 ' 1 : • ! • • ■1 1 11 1 ! ♦ • ♦ 1I • POLICYNUMBER: PKG3127063 THIS ENDORSEMENT CHANGES YOUR POLICY. PLEASE READ IT CAREFULLY. ENHANCED COMMERCIAL GENERAL LIABILITY COVERAGE FORM ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART COMMON POLICY CONDITIONS This endorsement modifies coverage and provides increased limits of insurance to enhance your insurance program. The Limits of Insurance stated below are granted by us as enhancements to your insurance program and are subject to the terms and conditions of this endorsement and the COMMERCIAL GENERAL LIABILITY COVERAGE FORM and COMMON POLICY CONDITIONS. If these Limits of Insurance are not sufficient, you may purchase additional Limits of Insurance. The premium charge will be based on the additional Limits of Insurance you purchase. When you purchase additional Limits of Insurance for any coverage, the Limit of Insurance stated in the Declarations will be in addition to any Limit of Insurance we have granted below. Summary Of Coverage 1. Broad Form Named Insured 2. Nonowned Watercraft 3. Property Damage— Property Loaned To You 4. Property Damage Liability - Elevators 5. Damage To Premises Rented To You 6. Personal and Advertising Injury Assumed By Contract 7. Medical Payments - Increased Period 3 Years 8. Supplementary Payments - Increased Limits Cost of Bail Bonds Up To $2,500 Loss of Earnings Up To $500 Per Day 9. Automatic Additional Insureds By Contract, Agreement Or Permit 10. Who Is An Insured Redefined - Fellow Employee Coverage and Incidental Medical Malpractice 11. Duties In The Event Of Occurrence, Claim Or Suit Redefined 12. Unintentional Failure To Disclose All Hazards 13. Waiver Of Transfer Of Rights Of Recovery Against Others To Us 14. Liberalization 15. Bodily Injury Redefined 16. Insured Contract Redefined 17. Mobile Equipment Redefined (This provision is not applicable in New York or Virginia) 18. Personal and Advertising Injury Redefined 19. Additional Definitions 20. Cancellation Condition 90 Days The following OPTIONAL COVERAGE applies only if a YES is indicated next to the coverage below. Additional Insured—Broad Form Vendors MS 6401 05 15 Page 1 of 9 (Includes copyrighted material of Insurance Services Offices, Inc. with its permission) AGENTS COPY 52817203 19-20 CL AU UMB(20) WC Prof Poll I Casey Brown 1 12/11/2019 3:30:47 ITE (EST) I Page 5 of 31 POL|CYNUMBER: PI(G3I27063 1. Broad Form Named Insured (a) Less than 75feet long; and a. The second paragraph ofthe preamble ofthis Coverage Form ioreplaced by (b) Not being used tocarry persons or the following: property for a charge; Throughout this policy the words "you" 3. Property Damnage — PropedyLoanedTo and "your" refer tothe Named Insured You shown in the Oec|arationo, any other person ororganization qualifying aoa Paragraph j.(3) of2. Exclusions ofSection Named Insured under this policy, and |—Coverage A Bodily Injury And any"controlled business entity" The Property Damage Liability ofthe words ''we". ''us'' and ''our' refer tothe COMMERCIAL GENERAL LIABILITY company providing this insurance. COVERAGE FORM ioamended byadding the following: Asused inthis endorsement, the term "controlled business entity" means any This exclusion j.(3) does not apply to business entity inwhich the Named property loaned toyou, which ionot being Insured owns aninterest ofmore than used byyou toperform "your work". 5Opercent during the policy period and for which similar coverage ionot Our obligation topay for damages because otherwise more specifically provided. ofsuch "property damage" ioexcess over However, wewill not pay any sums such any valid and collectible insurance (including m "controlled business entity" must pay any deductib|e). whether primary, excess, aodamages because of"bodily injury" contingent oronany other basis. or"property damage"towhich this insurance applies caused byan 4. Property DamnageLiabi|ity - E|evators "occurrence"that occurred before the Named Insured acquired orformed the Exclusions j. and h. ofSection | — "controlled business entity". orbecause Coverage A Bodily Injury And Property of"personal and advertising injury"to Damage Liability ofthe COMMERCIAL which this insurance applies caused by GENERAL LIABILITY COVERAGE FORM anoffense committed before the Named are amended aofollows: Insured acquired orformed the "controlled business entity." a. Exclusion j. ioamended toadd the Notwithstanding the foregoing, we will following: not pay any sums orperform any acts or services onbehalf ofany person or Paragraphs (3), (4) and (6) ofthis organization for which coverage io exclusion j. donot apply to "property specifically excluded byendorsement. damage" arising out ofthe use ofan elevator at premises you mwn, rent or b. Paragraph 3. ofSection U—Who |s An occupy. Insured ofthe COMMERCIAL GENERAL LIABILITY COVERAGE b. Exclusion h. ioamended toadd the FORM is deleted in its entirety. following: 2. NonovunedVVatercraft This exclusion h. does not apply to: Paragraph g.(2) of2. Exclusions of (1) The use ofelevators; or Section |—Covenage A Bodily Injury And Property Damage Liability of the (2) Liability assumed under sidetrack COMMERCIAL GENERAL LIABILITY agreement. COVERAGE FORM ioreplaced bythe following: Our obligation topay sums for damages because ofsuch "property damage" io (2) Awatercraft you donot own that is: excess over any other valid and collectible R8SG4O1O515 Page 2 of (Includes copyrighted material of Insurance Services Offices, Inc. with its permission) POL|CYNUMBER: PI(G3I27063 insurance (including any deductib|e). purpose ofliability assumed inan whether primary, excess, contingent oron "insured oontrmct". where the "personal any other basis. and advertising injury" arises out ofmn offense committed subsequent tothe 5. Damage To Premises Rented To You execution ofthe "insured oontrmct^. reasonable attorney fees and necessary Paragraph 6. ofSection III— Limits Of litigation expenses incurred byorfor a Insurance ofthe COMMERCIAL party other than aninsured are deemed GENERAL LIABILITY COVERAGE FORM tobedamages because of"personal ioreplaced bythe following: and advertising injury". provided that: a. Subject toParagraph 5. above, the (a) Liability tosuch party for, orfor the Damage ToPremises Rented ToYou cost of, that party's defense has Limit iothe most vvewill pay under also been assumed inthe same Coverage Afor damages because of "insured contnact"; and "property damage"toany one premises, while rented toyou, orinthe case of (b) Such attorney fees and litigation damage byfire, lightning, or"exp|ooion". expenses are for defense ofthat while rented to you or temporarily party against a civil or alternative occupied byyou with permission ofthe dispute resolution proceeding in owner. which damages to which this insurance applies are alleged. b. The most vvewill pay for Damage To Premises Rented ToYou will bethe 7. Medical Payments - Increased Period greater of: Paragraph a. of1. Insuring Agreement of (1) $300,000; or Section | —Coverage CMedical Payments ofthe COMMERCIAL GENERAL (2) The amount shown in the LIABILITY COVERAGE FORM is replaced Declarations. by the following: 6. Personal and Advertising Injury a. VVewill pay medical expenses ao Assumed by Contract described below for"bodily injury" caused byanaccident: Paragraph e. Contractual Liability of2. Eoc|usionsofSection |—Covenage B (1) [)npremises you own orrent; Personal And Advertising Injury Liability ofthe COMMERCIAL GENERAL (2) [)nways next topremises you own LIABILITY COVERAGE FORM is replaced or rent; or bythe following: (3) Because ofyour operations; "Personal and advertising injury"for which the insured has assumed liability ina provided that: contract oragreement. This exclusion does not apply toliability for damages: (a) The accident takes place inthe "coverage territory" and during the (1) That the insured would have in the policy period; absence ofthe contract oragreement; or (b) The expenses are incurred and reported touowithin three years of (2) Assumed inan "insured contnacf'. the date of the accident; and provided the "personal and advertising injury" arises out ofanoffense (c) The injured person submits to committed subsequent tothe execution examination, atour expense, by ofthe "insured oontrmct". Solely for the MSG4O1O515 Page 3of8 (Includes copyrighted material of Insurance Services [)fficeo. Inc. with its permission) Policy Number PKG3127063 physicians ofour choice aooften ao 2. |fcoverage provided tothe vvereasonably require. additional insured iorequired bya written contract, agreement, or 8. Supplementary Paymnents - |ncmeased permit, the insurance afforded to Limits such additional insured will not be broader than that which you are Paragraphs 1.b. and 1.d. ofSection |— required bythe written contract, Supplementary Paymnents—Coverages A agreement, orpermit, toprovide for and Bofthe COMMERCIAL GENERAL such additional insured. LIABILITY COVEAGE FORM are replaced bythe following: b. The following additional exclusions apply tothe insurance afforded by b. Upto $2.5OOfor the cost ofbail bonds Paragraph a. above. required because ofaccidents ortraffic law violations arising out ofthe use of This insurance does not apply: any vehicle to which the Bodily Injury Liability Coverage applies. We do not (1) Unless the written contnact, have tofurnish these bonds. agreement orpermit has been issued prior to the "bodily injury". d. All reasonable expenses incurred bythe "property damage" or"personal and insured atour request toassist uointhe advertising injury"; investigation ordefense ofthe claim or (2) Tnany person ororganization "ouK". including actual loss ofearnings included aoaninsured byany other upto $5OOaday because oftime off endorsement issued byuoand from work. made part ofthis Coverage Form; 9. Automatic Additional Insureds By (3) Toany lessor ofequipment: Contract, Agreement OrPermit (a) After the equipment lease a. Paragraph 2. of Section || —VVho expires; or Is AnInsured ofthe COMMERCIAL GENERAL LIABILITY COVERAGE (b) |fthe "bodily injury". "property FORM ioamended byadding the damage" or"personal and following: advertising injury" arises out of the sole negligence ofthe Any person ororganization with whom lessor. you aAreed, in avvritten contract, agreement orpermit, toprovide (4) Toany engineer, architect or insurance such aoioafforded under this surveyor ifthe "bodily injur/'. Coverage Form, but only with respect to "property damage" or"personal and your operations, "your work" orfacilities advertising injury" arises out ofthe owned oroccupied by, orrented or rendering orthe failure torender loaned toyou. professional architectural, engineering orsurveying services However: byorfor you, including: 1. The insurance afforded tosuch (a) The preparing, approving or additional insured only applies to the failing to prepare or approve extent permitted bylaw; and maps, shop drawings, opinions, reports, ourveyo, field orders, change orders, ordrawings and specifications; and R8SG4O1O515 Page 4 of (Includes copyrighted material of Insurance Services Offices, Inc. with its permission) Policy Number PKG3127063 (b) Supervisory, inspection, whichever ioless. architectural or engineering activities. This endorsement shall not increase the applicable Limits ofInsurance shown in This exclusion applies even ifthe the Declarations. claims against any insured allege negligence orother wrongdoing in 1O. Who |s An |nsuredRedefined - FeUovu the supervision, hiring, employment, Employee Coverage and Incidental training or monitoring of others by Medical Malpractice that insured, ifthe "occurrence" which caused the "bodily injury" or Paragraph 2.a.(1) ofSection U—Who ksAn "property damaAe". orthe offense Insured ofthe COMMERCIAL GENERAL which caused the "personal and LIABILITY COVERAGE FORM ioreplaced advertising injury", involved the by the following: rendering oforthe failure torender any professional services byorfor (1) "Bodily injury" or"personal and you. advertising injury": (5) To any: (a) Tnyou, toyour partners or members (if you are a partnership or (a) Owners or other interests from joint venture) or to your members (if whom land has been leased; or you are alimited liability company); (b) Managers orlessors of (b) For which there ioanobligation to premises share damages with orrepay If: someone else who must pay (i) The "occurrence"takes damages because ofthe injury place after you cease tobea described inParagraph (1)(a) tenant ofsuch land orpremises; above; or or (c) Arising out ofhis orher providing or (ii) The "bodily injuryr. failing toprovide professional health "property damage" or"personal care services. However, this and advertising injury" arises exclusion does not apply tonurses, out of structural aKerationo, new emergency medical technicians or construction ordemolition paramedics who are employed by operations performed byoron you toprovide medical or behalf ofthe owner, manager or paramedical services. lessor. c. With respect tothe insurance afforded 11. Duties |nThe Event Of Occurrence, tothese additional insureds, the Offense, Claim, orSuit Redefined following ioadded toSection III— Limits QfInsurance: Paragraph 2. Duties |nThe Event Of |fcoverage provided tothe additional Occurrence, Offense, Claim orSuit of insured is required by avvritten contract. Section |V_Commercial General Liability agreement, orpermit, the most vvewill Conditions ofthe COMMERCIAL pay onbehalf ofthe additional insured io GENERAL LIABILITY COVERAGE FORM the amount ofinsurance: ioamended byadding the fnUmwinA:: 1. Required bythe written contract, e. With respect toan "occurrence". agreement, orpermit; or offense, claim or"ouit': 2. Available under the applicable (1) Knowledge ofan "occunence". Limits ofInsurance shown inthe offense, claim or"suK" byanagent, Declarations; MSG4O1O515 Page 5 of (Includes copyrighted material of Insurance Services Offices, Inc. with its permission) Policy r PKG3127063 servant or"employee" of any provided by this Coverage Form, provided insured, and receipt of any demand, such failure or omission was not intentional. notice, summons or other legal However, this provision does not affect our paper in connection with a claim or right to collect additional premium for any "suit" by any agent, servant or such hazard or to exercise our right of "employee" of any insured, shall not cancellation or nonrenewal in itself constitute knowledge or receipt of such information by you or 13. Waiver Of Transfer Of Rights Of by an involved insured, unless and Recovery Against Others To Us until you, or an "executive officer", in-house or outside counsel, risk Paragraph 8. Transfer Of Rights Of manager or"employee" assigned to Recovery Against Others To Us of the risk management, insurance or Section IV—Conditions of the safety department (other than COMMERCIAL GENERAL LIABILITY clerical staff), or any other agent or COVERAGE FORM is amended by adding "employee" designated to receive or the following: handle notices of an "occurrence" or offense which may result in a claim We waive any right of recovery we may or"suit" shall have such knowledge have against a person or organization or shall have received such because of payments we make for injury or demand, notice, summons or legal damage arising out of your ongoing paper from the agent, servant or operations or"your work" done under a "employee." contract with that person or organization and included in the "products-completed (2) Failure of any agent, servant or operations hazard", if: "employee" of any insured to notify us of a known 'occurrence", a. The waiver of such rights is required in a offense, claim or"suit" shall not written contract or agreement with that prejudice coverage afforded by this person or organization; and policy, provided that we are notified of the 'occurrence", offense, claim b. You have assumed the liability of that or"suit" once it is known to you, or person or organization in that same to an "executive officer", in-house or contract, and it is an "insured contract"; outside counsel, risk manager, or but, "employee" assigned to the risk management, insurance or safety these provisions only apply to the person or department (other than clerical staff) organization addressed in a. and b. above, or any other agent or"employee" and only if the injury or damage occurs after designated to receive or handle the execution of the written contract of notices of an 'occurrence" or agreement. offense which may result in a claim or"suit." 14. Liberalization 12. Unintentional Failure To Disclose All Section IV—Commercial General Liability Hazards Conditions of the COMMERCIAL GENERAL LIABILITY COVERAGE FORM Paragraph 6. Representations of Section is amended by adding the following: IV—Commercial General Liability Conditions of the COMMERCIAL Liberalization GENERAL LIABILITY COVERAGE FORM is amended by adding the following: If we adopt a change in the insurance provided by this policy that would broaden Your failure to disclose hazards existing as the scope of insurance afforded to you of the inception date of this policy shall not without additional premium charge, then the prejudice you with respect to the insurance broader insurance will apply. It will apply S 6401 05 15 Page 6 of 9 (Includes copyrighted material of Insurance Services Offices, Inc. with its permission) INSURED COPY 52817203 19-20 CL AU UMB(20) WC Prof Poll I Casey Brown 1 12/11/2019 3:30:47 PM (EST) I Page 10 of 31 POL|CYNUMBER: PI(G3I27063 when the change becomes effective inyour liability that would beimposed bylaw in state. the absence ofany contract or agreement. 15. Bodily Injury Redefined Paragraph f. does not include that part of any contractor agreement: The definition of"bodily injury" inParagraph 3. ofSection V—Definitions ofthe (1) That indemnifies anarchitect, COMMERCIAL GENERAL LIABILITY engineer orsurveyor for injury or COVERAGE FORM ioreplaced bythe damage arising out of: following: (a) Preparing, approving, orfailing 3. "Bodily injury" means bodily injury, to prepare orapprove, mapo, oickneoo, disease or"incidental medical shop drawinAo, opiniono, malpractice" sustained byaperson, reports, surveys, field orders, including mental anguish orinjury, change orders ordrawings and humiliation, embarrassment, or death specifications; or resulting from any ofthese atany time. (b) Giving directions orinstructions, 16. Insured Contract Redefined orfailing togive them, ifthat io the primary cause ofthe injury The definition of" insured contract" in ordamage; or Paragraph 8. of Section V— Definitions of the COMMERCIAL GENERAL LIABILITY (2) Under which the insured, ifan COVERAGE FORM is amended as follows: architect, engineer orsurveyor, assumes liability for an injury or Paragraph a. ioreplaced bythe following: damage arising out ofthe inoured'o rendering or failure to render a. Acontract for a lease of premises. professional services, including However, that portion ofthe contract for those listed inParagraph (1) above alease ofpremises that indemnifies any and supervisory, inspection, person ororganization for damage by architectural orengineering water, fire. |iAhtninA, exp|ooion, or activities. smoke to premises while rented to you ortemporarily occupied byyou with 17. Mobile Equipment Redefined -This permission ofthe owner ionot an provision is not applicable in New York "insured contract"; orVi����� Paragraph c. ioreplaced bythe following: Paragraph f.(1) ofthe definition of"Mobile Equipment" inParagraph 12. ofSection V— c. Any easement orlicense agreement; Definitions ofthe COMMERCIAL GENERAL LIABILITY COVERAGE FORM Paragraph f. ioreplaced bythe following: does not apply toself-propelled vehicles of |eoo than 1.000 pounds gross vehicle f. That part of any other contract or weight, designed for use principally off highways.aAreementpertaininAtoyourbuoineoo (including an indemnification of 18. Personal and Advertising Injury municipality in connection with work Redefined performed for municipality) under which you assume the tort liability of The definition of"Personal and Advertising another party topay for"bodily injury'" Injury" in Paragraph 14. of Section V— "property Definitions ofthe COMMERCIAL advertising injury"to a third person or GENERAL LIABILITY COVERAGE FORM organization. Tort liability means a ioamended byadding the following: R8SG4O1O515 Page 7of8 (Includes copyrighted material of Insurance Services [)fficeo. Inc. with its permission) POL|CYNUMBER: PI(G3I27063 h. Discrimination orhumiliation that results orleased byyou, oroperated under ininjury tothe feelings orreputation ofa your control; or natural person, but only ifsuch discrimination orhumiliation is: d. Rupture orbursting caused by (1) Not done intentionally byoratthe centrifugal force. direction of; 2O. Cancellation Condition (a) Aninsured; or Paragraph 2.b. of Section A. Cancellation (b) Any"executive officer', director. ofthe COMMON POLICY CONDITIONS is stockholder, partner ormember replaced bythe following: ofthe insured; and a. 90 days before the effective date of (2) Not directly orindirectly related to cancellation ifvvecancel for any other the employment, prospective reason. employment ortermination of employment of any person or OPTIONAL COVERAGE persons byany insured. The COMMERCIAL GENERAL LIABILITY 18. Additional Definition COVERAGE FORM is amended to provide the following Optional Coverage only ifaYES io SectionV—Definitionsofthe indicatednexttoAdditiona| |nsumed —Bmoad COMMERCIAL GENERAL LIABILITY Form Vendors onthe first page ofthis COVERAGE FORM ioamended byadding endorsement. the following definitions: Additional Insured - Broad Form Vendors "Incidental medical malpractice" means injury arising out ofthe negligent rendering 1. SectionU —VVho |s AnInsured ioamended of, orfailure torender medical or toinclude aoanadditional insured any paramedical services topersons byany person(o) ororAanization(o) (referred to phyoician, dentiot, nurse, emergency below aovendor)with whom you have medical technician or paramedic who is aAreed, in a written contract or written employed byyou toprovide such services agreement toprovide insurance, but only provided you are not engaged inthe with respect to "bodily injury" or"property business oroccupation ofproviding any damage" arising out of"your product"which services referred to in this definition. is distributed or sold in the regular course of the vendor's business. "Exp|ooion" means asudden release of expanding pressure accompanied bya However: noise, abursting forth ofmaterial and a. The insurance afforded tosuch vendor evidence ofthe scattering ofdebris to only applies tothe extent permitted by locations further than would have resulted law; and bygravity alone. b. |fcoverage provided tothe vendor io ^Exp|oaion^ does not include any ofthe required byacontract oragreement, the following: insurance afforded tosuch vendor will not bebroader than that which you are a. Artificially generated electrical current required by the contract oragreement to including electrical arcinA, that disturbs provide for such vendor. electrical devices, appliances orwires; 2. The insurance afforded bythis paragraph b. Rupture or bursting of water pipes; does not apply to: c. Explosion of steam boi|ers, steam pipes, a. "Bodily Injury" or"property damage"for steam engines orsteam turbines owned which the vendor ioobligated topay R8S64O1O515 Page 8 of (Includes copyrighted material of Insurance Services Offices, Inc. with its permission) POL|CYNUMBER: PI(G3I27063 damages byreason ofthe assumption 3. This insurance does not apply toany insured ofliability inacontract oragreement. person ororganization, from whom you have This exclusion does not apply toliability acquired such products orany ingredient, for damages that the vendor would have part orcontainer, entering into, inthe absence ofthe contract or accompanying orcontaining such products. agreement; 4. With respect tothe insurance afforded to b. Any express warranty unauthorized by these vendors, the following ioadded to you; Section U|— Linnits Of Insurance: c. Any physical orchemical change in |fcoverage provided tothe vendor io "your product" made intentionally bythe required byacontract oragreement, the vendor; most vvewill pay onbehalf ofthe vendor io the amount ofinsurance: d. Repackaging, except when unpacked solely for the purpose of inspection, a. Required by the contract or agreement; or demonotnation, teotinA, or the substitution orparts under instructions b. Available under the applicable Limits of from the manufacturer, and then Insurance shown inthe Declarations; repackaged inthe original container; whichever ioless. e. Any failure tomake such inspections, adjustments, tests orservicing aothe This endorsement shall not increase the vendor has agreed tomake ornormally applicable Limits ofInsurance shown inthe undertakes tomake inconnection with Declarations. the sale of"your product"; All other terms and conditions remain f. Demonstration, installation, servicing or unchanged. repair operations, except such operations performed atthe vendor's premises inconnection with the sale of "your product"; or g. "Your product"which, after distribution orsale byyou, has been labeled or relabeled orused aoacontainer, part or ingredient of any other thing or substance byorfor the vendor; or h. "Bodily injury" or"property damage" arising out ofthe sole negligence ofthe vendor for its own acts oromissions or those ofits ^emp|oyeeo^ oranyone else acting onits behalf. However, this exclusion does not apply to: (1) The exceptions contained in Paragraphs d. orf. above; or (2) Such inspections, adjustments, tests orservicing aothe vendor has agreed tomake ornormally undertakes tomake inconnection with the sale of"your product.^ R8SG4O1O515 Page 8of8 (Includes copyrighted material of Insurance Services Offices, Inc. with its permission) Policy r PKG3127063 COMMERCIALL LIABILITY CG 20 0104 13 CAREFULLY.THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT PRIMARY AND NONCONTRIBUTORY OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance ( ) You have agreed in writing in a contract or Condition and supersedes any provision to the agreement that this insurance would be contrary: primary and would not seek contribution Primary Noncontributory Insurance from any other insurance available to the additional insured. This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and CG 20 0104 13 ©insurance Services Office, Inc., 2012 Page 1 of 1 INSURED COPY 52817203 19-20 CL AU UMB(20) WC Prof Poll I Casey Brown 1 12/11/2019 3:30:47 PM (EST) I Page 14 of 31 POLICY NUMBER: PKG3127063 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 CAREFULLY.THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Narne Of Additional Insured Per ( ) Or OEganizafionN Locations Of Coveredr ions ANY PERSON OR ORGANIZATION WHOM YOU HAVE AGREED TO INCLUDE AS AN ADDITIONAL INSURED UNDER A WRITTEN CONTRACT OR AGREEMENT, Information re uired to complete this Schedule if not shown above will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for "bodily injury", "property This insurance does nota I to "bodily injury"or damage" or "personal and advertising injury" a apply y caused, in whole or in part, by: property damage occurring after: 1. All work, including materials, parts or 1. Your acts or omissions; or equipment furnished in connection with such . The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the location(s) location of the covered operations has been designated above. completed;or However: 2. That portion of "your work" out of which the injury or damage arises has been put to its 1. The insurance afforded to such additional intended use by any person or organization insured only applies to the extent permitted by other than another contractor or subcontractor law; and engaged in performing operations for a 2. If coverage provided to the additional insured principal as a part of the same project. is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 10 04 13 ©insurance Services Office, Inc., 2012 Page 1 of 2 AGENTS COPY 52817203 19-20 CL AU UMB(20) WC Prof Poll I Casey Brown 1 12/11/2019 3:30:47 PM (EST) I Page 15 of 31 POLICY NUMBER: PKG3127063 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Narne Of Additional Insured Person(s) Or OEganizafionN Locations Of Covered Op2rations PROVIDED SUCH CONTRACT WAS EXECUTED PRIOR TO THE DATE OF LOSS Information reguired to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section 11 — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for "bodily injury", "property This insurance does not apply to "bodily injury"or damage" or "personal and advertising injury" "property damage occurring after: caused, in whole or in part, by: 1. All work, including materials, parts or 1. Your acts or omissions; or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the location(s) location of the covered operations has been designated above. completed;or However: 2. That portion of "your work" out of which the injury or damage arises has been put to its 1. The insurance afforded to such additional intended use by any person or organization insured only applies to the extent permitted by other than another contractor or subcontractor law; and engaged in performing operations for a 2. If coverage provided to the additional insured principal as a part of the same project. is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 10 04 13 @insurance Services Office, Inc., 2012 Page 1 of 2 AGENTS COPY 52817203 19-20 CL AU UMB(20) WC Prof Poll I Casey Brown 1 12/11/2019 3:30:47 ITE (EST) I Page 16 of 31 POLICYNUMBER: PKG3127063 C. With respect to the insurance afforded to these 2. Available under the applicable Limits of additional insureds, the following is added to Insurance shown in the Declarations; Section III —LI `t Of Insurance: whichever is less. If coverage provided to the additional insured is This endorsement shall not increase the required by a contract or agreement, the most we applicable Limits of Insurance shown in the will pay on behalf of the additional insured is the Declarations. amount of insurance: 1. Required by the contract or agreement;or Page 2 of 2 @insurance Services Office, Inc., 2012 CG 20 10 04 13 AGENTS COPY 52817203 1 19-20 CL AU UMB(20) WC Prof Poll I Casey Brown 1 12/11/2019 3:30:47 ITE (EST) I Page 17 of 31 POLICY NUMBER:PKG312 7 0 63 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 CAREFULLY.THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Narne Of Additional Insured er ( ) Or r i ions Location And Description Of Completedr ions ANY PERSON OR ORGANIZATION WHOM YOU HAVE AGREED TO INCLUDE AS AN ADD' L INSURED UNDER A WRITTEN CONTRACT OR AGREEMENT, PROVIDED SUCH CONTRACT WAS EXECUTED PRIOR TO THE DATE OF LOSS Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III —Lirnits Of Insurance: with respect to liability for "bodily injury" or If coverage provided to the additional insured is "property damage"caused, in whole or in part, by required by a contract or agreement, the most we "your work" at the location designated and will pay on behalf of the additional insured is the described in the Schedule of this endorsement amount of insurance: performed for that additional insured and included in the "products-completed operations 1. Required by the contract or agreement;or hazard". 2. Available under the applicable Limits of However: Insurance shown in the Declarations; 1. The insurance afforded to such additional whichever is less. insured only applies to the extent permitted by This endorsement shall not increase the applicable law; and Limits of Insurance shown in the Declarations. 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 37 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 AGENTS COPY 52817203 19-20 CL AU UMB(20) WC Prof Poll I Casey Brown 1 12/11/2019 3:30:47 PM (EST) I Page 18 of 31 VL THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT Policy Number: 08 WE EK8563 Endorsement Number: Effective Date: 11/15/19 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: TECOGEN INC 45 1 STAVE WALTHAM MA 02451 We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. SCHEDULE Any person or organization from whom you are required by contract or agreement to obtain this waiver from us. Endorsement is not applicable in KY, NH, NJ or for any MO construction risk Countersigned by Authorized Representative Form WC 00 03 13 Printed in U.S.A. Process Date: 11/15/18 Policy Expiration Date: 11/15/19 52817203 1 19-20 CL AU UMB(20) WC Prof Poll I Casey Brown 1 12/11/2019 3:30:47 ITE (EST) I Page 19 of 31 COMMERCIAL AUTOMOBILE COVERAGE PART - DECLARATIONS THE BUSINESS AUTO COVERAGE FORM HARTFORD POLICY NUMBER: 08 UEN AY6402 This COMMERCIAL AUTOMOBILE COVERAGE PART consists of: A. This Declarations Form; B. Business Auto Coverage Form; and C. Any Endorsements issued to be a part of this Coverage Form and listed below. IT ONE - NAMED INSURED AND ADDRESS The Named Insured is stated on the Common Policy Declarations. ADVANCE PREMIUM: $ AUDIT PERIOD: Except in this Declarations, when we use the word "Declarations" in this Coverage Part, we mean this "Declarations" or the "Common Policy Declarations". Form Numbers of Coverage Forms, Endorsements and Schedules that are part of this Coverage Part: HA00040302 HAO0120615T CA00011013 HA21020614 MM99350411 MM99130411 MM99280411 MM99540411 CA99231013 HAO0240614 HA99080614 HA99460712 HA99481214 HD99020912 MM99111011 MM99170411 MM99230411 MM99670411 Form HA 00 25 06 15 Page 1 of 4 C 2015, The Hartford (Includes copyrighted material of Insurance Services Office, Inc., with its permission.) 52817203 19-20 CL AU UMB(20) WC Prof Poll I Casey Brown 1 12/11/2019 3:30:47 ITE (EST) I Page 20 of 31 POLICY NUMBER: 08 UEm Ar6402 COMMERCIAL AUTOMOBILE HD 99 02 0912 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL AUTOMOBILE BROAD FORM ENDORSEMENT MASSACHUSETTS This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified bythis endorsement. 1. BROAD FORM INSURED B. Employees as Insureds A. Subsidiaries and Newly Acquired or Paragraph 4`.1. - who is an insured - of Formed Organizations section ii - liability coverage is amended to The Named Insured shown in the add: Declarations is amended to include: d. Any "employee" of yours while using a (1) Any legal business entity other than a covered "auto" you don't own, hire or partnership or joint venture, formed as a borrow in your business or your subsidiary in which you have an personal affairs. ownership interest of more than 50Y6 on C. Lessors as Insureds the effective date of the Coverage Form. However, the Named Insured does not Paragraph A.1 - VVH{} IS AN INSURED - nf include any subsidiary: Section || - Liability Coverage is amended to add: (a) That is an "insured" under any other eThe lessor of covered "auto" while the automobile policy or � "auto" is leased to you under a written (b) That vvnu|d be an "insured" under agreement it such a policy but for (i) its termination or (ii) the exhaustion of (1) The agreement requires you to its Limit nfInsurance. provide direct primary insurance for the lessor and (2) Any organization that is acquired or formed by you and over which you (2) The "autn" isleased without adriver. maintain majority ownership. However, Such a leased "auto" will be considered a the Named Insured does not include any covered "auto" you own and not a covered newly formed or acquired organization: "auto"you hire. (a) That is a partnership or joint D. Additional Insured if n�m �Required �byv venture, Contract (b) That is an "insured" under any other (1) Paragraph A.1. - VVH{} IS AN INSURED policy, - of Section || - Liability Coverage is � (n) That has exhausted its Limit of amended tnadd� Insurance under any other policy, or f. When you have agreed, in a written contract or written agreement that (d) 18O days or more after its ` acquisition or formation by you, person or organization be added as unless you have given us notice of an additional insured on your the acquisition nrformation. business auto policy, such person nr organization is an "insured", but only Coverage does not apply to "bodily to the extent such person or injury" or "property damage" that results organization is liable for "bodily from an "accident" that occurred before injury" or "property damage" caused you formed or acquired the organization. by the conduct of an "insured" under paragraphs a. or b. of Who Is An C2O1O, The Hartford (Includes copyrighted material Form HD 99 02 09 12 of ISO Properties, Inc., with its permission.) Page 1 of LIC : 08 UEN AY6402 Insured with regard to the CLAIM , SUIT OR LOSS — OF SECTION ownership, maintenance or use of a IV— BUSINESS AUTO CONDITIONS, in the covered "auto" same manner as the Named Insured. The insurance afforded to any such E. Primary and Non-Contributory if additional insured applies only if the Required by Contract "bodily injury" or "property damage" Only with respect to insurance provided to occurs: an additional insured in 1.D. - Additional (1) During the policy period, and Insured If Required by Contract, the (2) Subsequent to the execution of such following provisions apply: written contract, and (3) Primary Insurance When Required By (3) Prior to the expiration of the period Contract of time that the written contract This insurance is primary if you have requires such insurance be provided agreed in a written contract or written to the additional insured. agreement that this insurance be (2) How Limits Apply primary. If other insurance is also primary, we will share with all that other If you have agreed in a written contract insurance by the method described in or written agreement that another Other Insurance 5.d. person or organization be added as an additional insured on your policy, the (4) Primary And Non-Contributory To Other most we will pay on behalf of such Insurance When Required By Contract additional insured is the lesser of: If you have agreed in a written contract (a) The limits of insurance specified in or written agreement that this insurance the written contract or written is primary and non-contributory with the agreement; or additional insured's own insurance, this insurance is primary and we will not (b) The Limits of Insurance shown in seek contribution from that other the Declarations. insurance. Such amount shall be a part of and not Paragraphs (3) and ( ) do not apply to other in addition to Limits of Insurance shown insurance to which the additional insured in the Declarations and described in this has been added as an additional insured. Section. When this insurance is excess, we will have no (3) Additional Insureds Other Insurance duty to defend the insured against any "suit" if If we cover a claim or "suit" under this any other insurer has a duty to defend the Coverage Part that may also be covered insured against that "suit". If no other insurer by other insurance available to an defends, we will undertake to do so, but we will additional insured, such additional be entitled to the insured's rights against all insured must submit such claim or "suit" those other insurers. to the other insurer for defense and When this insurance is excess over other indemnity. insurance, we will pay only our share of the However, this provision does not apply amount of the loss, if any, that exceeds the sum to the extent that you have agreed in a of: written contract or written agreement (1) The total amount that all such other that this insurance is primary and non- insurance would pay for the loss in the contributory with the additional insured's absence of this insurance; and own insurance. (2) The total of all deductible and self-insured (4) Duties in The Event Of Accident, Claim, amounts under all that other insurance. Suit or Loss If you have agreed in a written contract or We will share the remaining loss, if any, by the method described in Other Insurance 5.d. written agreement that another person or organization be added as an additional OTOS T EMPLOYEES insured on your policy, the additional insured Any "auto" hired or rented by your "employee" shall be required to comply with the on your behalf and at your direction will be provisions in LOSS CONDITIONS 2. - considered an "auto"you hire. DUTIES IN THE EVENT OF ACCIDENT, C 2010, The Hartford (Includes copyrighted material Page 2 of 5 of ISO Properties, Inc., with its permission.) Form HD 99 02 09 1 52817203 19-20 CL AU UMB(20) WC Prof Poll I Casey Brown 1 12/11/2019 3:30:47 PM (EST) I Page 22 of 31 POLICY NUMBER: 08 UEm Ar6402 The OTHER INSURANCE Condition isamended 5. PHYSICAL DAMAGE - ADDITIONAL byadding the following: TEMPORARY TRANSPORTATION EXPENSE If an "employee's" personal insurance also COVERAGE applies on an excess basis tnacovered "autn" Paragraph 4`A.a. of SECTION ||| - PHYSICAL hired or rented by your "employee" on your DAMAGE COVERAGE isamended tnprovide a behalf and at your direction, this insurance will limit of $50 per day and a maximum limit of be primary to the "employee's" personal $1,000. insurance. 6. LOAN/LEASE GAP COVERAGE 3 ���A��D�D ��LL�V� ��A�L���� ��K�LU�|{J� ' Under SECTION ||| - PHYSICAL DAMAGE EXCLUSION 5. - FELLOW EMPLOYEE - of COVERAGE, in the event of total "loss" to a SECTION || - LIABILITY COVERAGE does not covered "autn", vvewill pay your additional legal apply if you have workers' compensation obligation for any difference between the actual insurance in-force covering all of your cash value of the "auto" at the time of the "loss" "employees". and the "outstanding balance"nfthe |nan/|ease. Coverage is excess over any other collectible "Outstanding balance" means the amount you insurance. nvve on the loan/lease at the time of "loss" less 4. HIRED AUTO PHYSICAL DAMAGE COVERAGE any amounts representing taxes; overdue If hired "autos" are covered "autos" for Liability payments; penalties, interest or charges r�su|ting from overdue payments; additional Coverage and if Comprehensive, Specified mi|�ag� nharg�s� �xn�ssvv�arandt�arnharg�s� Causes of Loss, or Collision coverages are lease termination fees; security deposits not provided under this Coverage Form for any returned by the lessor; costs for extended "auto" you own, then the Physical Damage warranties, credit life Insurance, health, accident (�nveragesprovided are extended tn "autns" you nrdisabi|ityinsurann� purnhas�dvvithth� |nannr hire or borrow, subject to the following limit. lease; and carry-over balances from previous The most we will pay for "loss" to any hired loans nrleases. "auto" is:� 7. AIRBAG COVERAGE (1) $100,000; Under Paragraph B. EXCLUSIONS -of SECTION (2) The actual cash value of the damaged or ||| - PHYSICAL DAMAGE COVERAGE, the stolen property atthe time nfthe "|nss"; nr following isadded: (3) The cost of repairing or replacing the The exclusion relating tnmechanical breakdown damaged or stolen property, does not apply to the accidental discharge of an whichever is smallest, minus a deductible. The airbag. deductible will be equal tnthe largest deductible 8. ELECTRONIC EQUIPMENT - BROADENED applicable tnany owned 'auto" for that coverage. COVERAGE No deductible applies tn "|nss" caused byfire nr a. The exceptions to Paragraphs BA - lightning. Hired Auto Physical Damage coverage EXCLUSIONS - of SECTION ||| - is excess over any other collectible insurance. PHYSICAL DAMAGE COVERAGE are Subject to the above limit, deductible and excess replaced by the following: provisions, we will provide coverage equal to the broadest coverage applicable to any covered Exclusions 4.�� and 4.d� do nntapp|ytn "auto"you own. equipment designed to be operated solely by use of the power from the VVewill also cover loss nfuse nfthe hired "autn" . autn.s. electrical system that, at the if it results from an "accident", you are legally time nf"|nss" is: liable and the lessor incurs an actual financial ' loss, subject to a maximum of $1,OOO per (1) Permanently installed in or upon " the nnv�nadautn " "� "accident". ` This extension of coverage does not apply to (2) Removable from a housing unit any "auto" you hire or borrow from any of your which is permanently installed in "employees", partners (if you are a partnership), or upon the covered "auto"; members (if you are a limited liability company), (3) An integral part of the sane unit or members of their households. housing any electronic equipment described in Paragraphs (1) and (2)above; nr C2O1O, The Hartford (Includes copyrighted material Form HD 99 02 09 12 of ISO Properties, Inc., with its permission.) Page 3 of POLICY NUMBER: V8 UEm Ar6402 (4) Necessary for the nnnna| 10. AMENDED DUTIES IN THE EVENT OF operation of the covered "auto" ACCIDENT, CLAIM, SUIT{JRLOSS or the monitoring of the covered The requirement in LOSS CONDITIONS 2.a. - "autn's" operating system. DUTIES IN THE EVENT OF ACCIDENT, b. SECTION ||| — Versinn CA 00 01 03 10 of CLAIM, SUIT OR LOSS - of SECTION |V - the Business Auto Coverage Form, BUSINESS AUTO CONDITIONS that you must PHYSICAL DAMAGE COVERAGE, Limit of notify us of an "accident" applies only when the Insurance, Paragraph C2 and Version CA "annident" isknown to: 00 01 10 01 nfthe Business Auto Coverage (1) You, ifyou are anindividual Form, PHYSICAL DAMAGE COVERAGE, Limit of Insurance, Paragraph C. are each (2) 4`pa�n�r, ifynu ar� apa�n�rship� nr amended tnadd the following: (3) 4` member, if you are a limited liability $1,500 is the most wewillpay for "loss" company; or in any one "accident" to all electronic (4) Auexecutive officer nrinsurance manager, if equipment (other than equipment you are acorporation. designed sn|ek/ for the reproduction of 11. UNINTENTIONAL FAILURE TO DISCLOSE sound, and accessories used with such HAZARDS equipment) that naprndunes nan�iv�snr ` |fyou unintentionally fail tndisclose any hazards transmits audio, visual or data signals existing at inception date of wevvhinh atth�tim� nf"|nss" �is� ` ` ` will not deny coverage under this Coverage (1) Permanently installed in or upon Form because nfsuch failure. the covered "auto" in a housing, 12. H|REDAUTO -COVERAGE TERRITORY opening or other location that is not normally used by the "auto" paragraph e. of GENERAL CONDITIONS 7. - manufacturer for the installation of POLICY PERIOD, COVERAGE TERRITORY - such equipment; of SECTION |V - BUSINESS 4`UT{} CONDITIONS is replaced by the fn||nvving� (2) ��mnwab|� from a permanently � installed housing unit as described e. For short-term hired "autos", the coverage in Paragraph 2.a above or is an territory with respect to Liability Coverage is integral part nfthat equipment; or anywhere in the vvnr|d provided that if the (3) 4`nintegral part nfsuch equipment insured's responsibility to pay damages for "bodily bndi|y injury" or "property damage" is n. For each covered "auto", should loss be determined ina "suit," the "suit' isbrought in limited to electronic equipment only, our the United States of America, the territories obligation to pay for, repair, return or replace and possessions of the United States of damaged or stolen electronic equipment will America, Puerto Rico or Canada or in a be reduced by the applicable deductible settlement vveagree to. shown in the Declarations, or �25O ` 13. WAIVER OF SUBROGATION whichever deductible is less. TRANSFER {}F RIGHTS OF RECOVERY�. TWO OR MORE D�DU��|�L�� AGAINST OTHERS TO US - of SECTION |V - Under- DEDUCTIBLE - of PHYSICAL DAMAGE BUSINESS AUTO CONDITIONS is amended by COVERAGE, the following isadded: adding the following: If another Hartford Financial Services Group, We waive any right of recovery we may have Inc. company policy nrcoverage form that is not against any person or organization with whom anautomobile policy nrcoverage form applies tn you have a written nnntnsnt that requires such the same "annident", the following applies: waiver because of payments we make for (1) If the deductible under this Business 4mtn damagesund�r this nv�nsg� Form. Coverage Form is the smaller (or smallest) 14. RESULTANT MENTAL ANGUISH COVERAGE deductible, it be ` The definition nf "bodily injury" inSECTION V - (2) If the deductible under this Business 4mtn DEFINITIONS is replaced by the following: Coverage Form is not the smaller (or "Bodily injury" means bodily injury, sickness or smallest) deductible, it vviU be reduced by ` disease sustained by any person, including the amount of the smaller (or smallest) mental anguish or death resulting from any of deductible. these. C2O1O, The Hartford (Includes copyrighted material Page 4of5 nfISO Properties, |nn., with its permissinnj Form HD99 02 0912 POLICY NUMBER: 08 UEm Ar6402 15. EXTENDED CANCELLATION C{JND|l0{JN Hybrid, Electric, or Natural Gas Vehicle Condition 4`., Cancellation, of the payment Coverage provision for any one MASSACHUSETTS MANDATORY ENDORSE- "loss" is $10,000. MENTapplies except asfollows: For the purposes nfthe coverage provision, If we cancel for any reason other than a. 4` "non-hybrid" auto is defined as an auto nonpayment of premium, any notice of that uses only aninternal combustion engine cancellation will be sent to you at your last to move the auto but does not include autos address shown on the Declarations at least GO powered solely byelectricity nrnatural gas.. days prior to the effective date. b. 4` "hybrid" auto is defined as an auto with an 16. EXTRA EXPENSE- BROADENED COVERAGE internal combustion engine and one or more ` �|�ntrin motors; and that uses the internal Under Paragraph A. - COVERAGE - of SECTION ||| - PHYSICAL DAMAGE combustion engine and one nrmore electric motors to move the auto, or the internal COVERAGE, wewillpay for the expense of ` returning a stolen covered "autn"tnyou. combustion engine to charge one or more electric motors, which move the auto. 17. HYBRID, �L����|�. OR NATURAL ��� 1� VEHICLE WRAP COVERAGEVEHICLE PAYMENT COVERAGE ' In the event of total loss to a "non-hybrid" auto In the event of a total loss to an "auto" for for which Comprehensive, Specified Causes of which Comprehensive, Specified Causes of Loss, or Collision coverages are provided under Loss, or Collision coverages are provided this Coverage Form, then such Physical under this Coverage Form, then such Damage Coverages are amended asfollows: Physical Damage Coverages are amended tn a. |fthe auto is replaced with a "hybhd" auto nr add the following: In addition to the actual cash value of the an auto pn��nad solely by electricity or natural gas, vvewill pay an additional 10%, "auto", vve will pay up to $1,000 for vinyl to a maximum of$2,500, of the "non-hybrid" vehicle wrapswhich are displayed on the nnv�nad "auto" at the time of total loss. auto's actual mash value or replacement . cost, whichever is less, Regardless of the number of autos deemed a total loss, the most wewillpay under this b. The auto must be replaced and a copy of Vehicle Wrap Coverage provision fnranynn� bill of sale or new lease agreement received "loss" is $5,OOO. For purposes of this by us within GO calendar days of the date of coverage provision, signs or other graphics "loss, painted or magnetically affixed to the vehicle n. Regardless of the number nfautos deemed are not considered vehicle wraps. a total loss, the most we will pay under this C2O1O, The Hartford (Includes copyrighted material Form HD 99 02 09 12 of ISO Properties, Inc., with its permission.) Page 5 of COMMERCIAL AUTOMOBILE COVERAGE PART - DECLARATIONS THE BUSINESS AUTO COVERAGE FORM HARTFORD POLICY NUMBER: 08 UEN AY6348 This COMMERCIAL AUTOMOBILE COVERAGE PART consists of: A. This Declarations Form; B. Business Auto Coverage Form; and C. Any Endorsements issued to be a part of this Coverage Form and listed below. IT ONE - NAMED INSURED AND ADDRESS The Named Insured is stated on the Common Policy Declarations. ADVANCE PREMIUM: $ AUDIT PERIOD: SUPPLEMENTARY UNINSURED/UNDER INSURED MOTORISTS (UM/UIM) COVERAGE (SUM) THE MAXIMUM AMOUNT PAYABLE UNDER SUM COVERAGE SHALL BE THE POLICY'S SUM LIMITS REDUCED AND THUS OFFSET BY MOTOR VEHICLE BODILY INJURY LIABILITY INSURANCE POLICY OR BOND PAYMENTS RECEIVED FROM, OR ON BEHALF OF, ANY NEG- LIGENT PARTY INVOLVED IN THE ACCIDENT, AS SPECIFIED IN THE SUM ENDORSEMENT. Except in this Declarations, when we use the word "Declarations" in this Coverage Part, we mean this "Declarations" or the "Common Policy Declarations". Form Numbers of Coverage Forms, Endorsements and Schedules that are part of this Coverage Part: HA00040302 HAO0120615T CA00011013 CA22200416 CA22241013 CA22301116 CA22321113 HA22070800 CA22371013 CA99031013 CA21541013 CA21570316 CA21741013 CA21311013 CA21271013 CA21141016 CA31071013 CA21921013 CA21931013 CA01071013 CA01100916 CA01341013 CA01361013 CA01430517 CA01800616 CA01881013 CA02250814 CA22221013 CA99231013 CA99391013 HAO0240614 HAO1061215 HAO1080300 HA21020614 HA99080614 HA99150614 HA99170614 IH12011185 Form HA 00 25 06 15 Page 1 of 4 C 2015, The Hartford (Includes copyrighted material of Insurance Services Office, Inc., with its permission.) 52817203 19-20 CL AU UMB(20) WC Prof Poll I Casey Brown 1 12/11/2019 3:30:47 ITE (EST) I Page 26 of 31 POLICYNUMBER: 08 UEN AY6348 POLICY . COMMERCIAL AUTO HA 9917061 CAREFULLY.THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT COMMERCIAL AUTOMOBILE BROAD FORM ENDORSEMENT NEW YORK This endorsement modifies insurance provided under the following: BUSINESS To the extent that the provisions of this endorsement provide broader benefits to the "insured" than other provisions of the Coverage Form, the provisions of this endorsement apply. 1. BROAD FORM INSURED d. Any "employee" of yours while using a A. Subsidiaries and Newly Acquired or covered "auto" you don't own, hire or Formed Organizations borrow in your business or your personal affairs. The Named Insured shown in the Declarations is amended to include: Lessors s Insureds (1) Any legal business entity other than a Paragraph A.1. - WHO IS AN INSURED - of partnership or joint venture, formed as a Section II - Covered Autos Liability Coverage subsidiary in which you have an is amended to add: ownership interest of more than 50% on e. The lessor of a covered "auto" while the the effective date of the Coverage Form. "auto" is leased to you under a written However, the Named Insured does not agreement if: include any subsidiary that is an "insured" (1) The agreement requires you to under any other automobile policy or would provide direct primary insurance for be an "insured" under such a policy but for the lessor and its termination or the exhaustion of its Limit (2) The "auto" is leased without a driver. of Insurance. (2) Any organization that is acquired or Such a leased "auto" will be considered a farmed by you and over which you covered "auto" you own and not a covered maintain majority ownership. However, "auto"you hire. the Named Insured does not include any D. Additional Insured if Required by Contracts newly formed or acquired organization: (1) Paragraph A.1. - WHO IS AN INSURED (a) That is a partnership or joint - of Section II - Covered Autos Liability venture, Coverage is amended to add: (b) That is an "insured" under any other f. When you have agreed, in a written policy, contract or written agreement, that a (c) That has exhausted its Limit of person or organization be added as Insurance under any other policy, or an additional insured on your business auto policy, such person or (d) 180 days or more after its organization is an "insured", but only acquisition or formation by you, to the extent such person or unless you have given us notice of organization is liable for "bodily the acquisition or formation. injury" or "property damage" caused Coverage does not apply to "bodily by the conduct of an "insured" under injury" or "property damage" that results paragraphs a. or b. of Who Is An from an "accident" that occurred before Insured with regard to the you formed or acquired the organization. ownership, maintenance or use of a B. Employees as Insureds covered "auto." Paragraph A.1. - WHO IS AN INSURED - of The insurance afforded to any such SECTION II - COVERED AUTOS LIABILITY additional insured applies only if the "bodily COVERAGE is amended to add: injury"or"property damage"occurs: ©2015,The Hartford(Includes copyrighted material Form 17 06 14 of ISO Properties, Inc.,with its permission.) Page 1 of 5 52817203 19-20 CL AU UMB(20) WC Prof Poll I Casey Brown 1 12/11/2019 3:30:47 PM (EST) I Page 27 of 31 LI : 08 UEN AY6348 (1) During the policy period, and E. Primary and Non-Contributory if Required (2) Subsequent to the execution of such by Contract written contract, and Only with respect to insurance provided to (3) Prior to the expiration of the period an additional insured in 1.D. - Additional of time that the written contract Insured If Required by Contract, the requires such insurance be provided fallowing provisions apply: to the additional insured. (3) Primary Insurance When Required By (2) Haw Limits Apply Contract If you have agreed in a written contract This insurance is primary if you have or written agreement that another agreed in a written contract or written person or organization be added as an agreement that this insurance be additional insured on your policy, the primary. If other insurance is also most we will pay on behalf of such primary, we will share with all that other additional insured is the lesser of: insurance by the method described in (a) The limits of insurance specified in Other Insurance 5.d. the written contract or written ( ) Primary And Nan-Contributory To Other agreement; or Insurance When Required By Contract (b) The Limits of Insurance shown in If you have agreed in a written contract the Declarations. or written agreement that this insurance Such amount shall be a part of and not is primary and non-contributory with the in addition to Limits of Insurance shown additional insured's awn insurance, this in the Declarations and described in this insurance is primary and we will not Section. seek contribution from that other insurance. (3) Additional Insureds Other Insurance Paragraphs ( ) and ( ) do not apply to other If we cover a claim or "suit" under this insurance to which the additional insured Coverage Part that may also be covered has been added as an additional insured. by other insurance available to an When this insurance is excess, we will have no additional insured, such additional duty to defend the insured against any "suit" if insured must submit such claim or "suit" any other insurer has a duty to defend the to the other insurer for defense and insured against that "suit". If no other insurer indemnity. defends, we will undertake to do so, but we will However, this provision does not apply be entitled to the insured's rights against all to the extent that you have agreed in a those other insurers. written contract or written agreement When this insurance is excess over other that this insurance is primary and non- contributory with the additional insured's insurance, we will pay only our share of the awn insurance. amount of the loss, if any, that exceeds the sum of: ( ) Duties in The Event Of Accident, Claim, (1) The total amount that all such other Suit or Lass insurance would pay for the loss in the If you have agreed in a written contract absence of this insurance; and or written agreement that another (2) The total of all deductible and self-insured person or organization be added as an amounts under all that other insurance. additional insured on your policy, the additional insured shall be required to We will share the remaining loss, if any, by the comply with the provisions in LOSS method described in Other Insurance 5.d. CONDITIONS 2. - DUTIES IN THE 2. AUTOS RENTED BY EMPLOYEES EVENT OF ACCIDENT, CLAIM , SUIT Any"auto" hired or rented by your"employee" on OR LOSS - OF SECTION IV - your behalf and at your direction will be BUSINESS AUTO CONDITIONS, in the considered an "auto"you hire. same manner as the Named Insured. The OTHER INSURANCE Condition is amended by adding the fallowing: ©2615,The Hartford(Includes copyrighted material Form 17 06 14 of ISO Properties, Inc.,with its permission.) Page 52817203 19-20 CL AU UMB(20) WC Prof Poll I Casey Brown 1 12/11/2019 3:30:47 PM (EST) I Page 28 of 31 POLICYNUMBER: 08 UEN AY6348 If an "employee's" personal insurance also 5. AIRBAG COVERAGE applies on an excess basis to a covered "auto" Under Paragraph B. EXCLUSIONS - of SECTION hired or rented by your "employee" on your III - PHYSICAL DAMAGE COVERAGE, the behalf and at your direction, this insurance will following is added: be primary to the "employee's" personal insurance. The exclusion relating to mechanical breakdown 3. HIRED AUTO PHYSICAL DAMAGE COVERAGE does not apply to the accidental discharge of an airbag. If hired "autos" are covered "autos" for Covered 6. ELECTRONIC EQUIPMENT - BROADENED Autos Liability Coverage and if Comprehensive, COVERAGE Specified Causes of Loss, or Collision coverages are provided under this Coverage Form for any a. The exceptions to Paragraphs BA - "auto" you own, then the Physical Damage EXCLUSIONS - of SECTION III - PHYSICAL Coverages provided are extended to "autos" you DAMAGE COVERAGE are replaced by the hire or borrow, subject to the following limit. following: The amount we will pay for any partial "loss" to Exclusions 4.c. and 4.d. do not apply to any hired "auto" is the cost of repairing or equipment designed to be operated solely replacing the damaged property minus a by use of the power from the "auto's" deductible. electrical system that, at the time of"loss", The amount we will pay for any one total "loss"to is: any hired "auto" is the smaller of the retail value (1) Permanently installed in or upon for a substantially similar vehicle, a quotation for the covered "auto"; a substantially similar vehicle obtained by us (2) Removable from a housing unit from a qualified dealer, or the purchase price, which is permanently installed in or plus the cost of substantiated improvements. upon the covered "auto"; However, the most we will pay in the event of a (3) An integral part of the same unit total "loss" to any hired "auto" is $100,000 (Not housing any electronic equipment applicable to settlements subject to New York described in Paragraphs (1) and (2) State law.) A deductible applies for each above; or covered hired "auto". The deductible will be equal to the largest (4) Necessary for the normal operation of the covered "auto" or the deductible applicable to any owned "auto" for that coverage. Hired Auto Physical Damage monitoring of the covered "auto's" operating system. coverage is excess over any other collectible insurance. Subject to the above limit, deductible b. Section III -of the Business Auto Coverage and excess provisions, we will provide coverage Form, Physical Damage Coverage, Limit of equal to the broadest coverage applicable to any Insurance, Paragraph C is amended to add covered "auto"you own. the following: We will also cover loss of use of the hired "auto" $1,500 is the most we will pay for "loss" in if it results from an "accident", you are legally any one "accident" to all electronic liable and the lessor incurs an actual financial equipment (other than equipment designed loss, subject to a maximum of $1000 per solely for the reproduction of sound, and "accident". accessories used with such equipment) This extension of coverage does not apply to any that reproduces, receives or transmits "auto" you hire or borrow from any of your audio, visual or data signals which, at the "employees", partners (if you are a partnership), time of"loss", is: members (if you are a limited liability company), (1) Permanently installed in or upon or members of their households. the covered "auto" in a housing, 4. PHYSICAL DAMAGE - ADDITIONAL opening or other location that is not TEMPORARY TRANSPORTATION EXPENSE normally used by the "auto" manufacturer for the installation of COVERAGE such equipment; Paragraph A.4.a. of SECTION III - PHYSICAL DAMAGE COVERAGE is amended to provide a limit of $40 per day and a maximum limit of $1200. @ 2015,The Hartford(includes copyrighted material Form HA 99 17 06 14 of ISO Properties, Inc.,with its permission.) Page 3 of 5 52817203 1 19-20 CL AU UMB(20) WC Prof Poll I Casey Brown 1 12/11/2019 3:30:47 ITE (EST) I Page 29 of 31 POLICY NUMBER: 08 UEN AY6348 (2) Removable from a permanently 11. UNINTENTIONAL FAILURE TO DISCLOSE installed housing unit as described HAZARDS in Paragraph (1) above or is an If you unintentionally fail to disclose any hazards integral part of that equipment; or existing at the inception date of your policy, we (3) An integral part of such equipment. will not deny coverage under this Coverage c. For each covered "auto", should loss be Form because of such failure. limited to electronic equipment only, our 12. HIRED AUTO -COVERAGE TERRITORY obligation to pay for, repair, return or replace Paragraph e. of GENERAL CONDITIONS 7. - damaged or stolen electronic equipment will POLICY PERIOD, COVERAGE TERRITORY- of be reduced by the applicable deductible shown SECTION IV - BUSINESS AUTO CONDITIONS in the Declarations, or $250, whichever is replaced by the following: deductible is less. 7. EXTRA EXPENSE- BROADENED COVERAGE e. For short-term hired "autos", the coverage territory with respect to Covered Autos Under Paragraph A. - COVERAGE - of SECTION Liability Coverage is anywhere in the world III - PHYSICAL DAMAGE COVERAGE, we will provided that if the "insured's" responsibility pay for the expense of returning a stolen covered to pay damages for "bodily injury" or "auto"to you. "property damage" is determined in a "suit," 8. GLASS REPAIR -WAIVER OF DEDUCTIBLE the "suit" is brought in the United States of Under Paragraph D. - DEDUCTIBLE-of SECTION America, the territories and possessions of III - PHYSICAL DAMAGE COVERAGE, the the United States of America, Puerto Rico or following is added: Canada or in a settlement we agree to. No deductible applies to glass damage if the 13. WAIVER OF SUBROGATION glass is repaired rather than replaced. TRANSFER OF RIGHTS OF RECOVERY 9. TWO OR MORE DEDUCTIBLES AGAINST OTHERS TO US - of SECTION IV - BUSINESS AUTO CONDITIONS is amended by Under Paragraph D. - DEDUCTIBLE-of SECTION adding the following: III - PHYSICAL DAMAGE COVERAGE, the We waive any right of recovery we may have following is added: against any person or organization with whom If another Hartford Financial Services Group, you have a written contract that requires such Inc. company policy or coverage form that is not waiver because of payments we make for an automobile policy or coverage form applies to damages underthis Coverage Form. the same "accident", the following applies: 14. RESULTANT MENTAL ANGUISH COVERAGE (1) If the deductible under this Business Auto The definition of "bodily injury" in SECTION V- Coverage Form is the smaller (or smallest) DEFINITIONS is replaced by the following: deductible, it will be waived; (2) If the deductible under this Business Auto "Bodily injury" means bodily injury, sickness or Coverage Form is not the smaller (or disease sustained by any person, including mental smallest) deductible, it will be reduced by the anguish or death resulting from any of these. amount of the smaller (or smallest) 15. EXTENDED CANCELLATION CONDITION deductible. Paragraph 2. of the COMMON POLICY 10. AMENDED DUTIES IN THE EVENT OF CONDITIONS - CANCELLATION - applies ACCIDENT, CLAIM, SUIT OR LOSS except as follows: The requirement in LOSS CONDITIONS 2.a. - If we cancel for any reason other than DUTIES IN THE EVENT OF ACCIDENT, nonpayment of premium, we will mail or deliver CLAIM, SUIT OR LOSS - of SECTION IV - to the first Named Insured written notice of BUSINESS AUTO CONDITIONS that you must cancellation at least 60 days before the effective notify us of an "accident" applies only when the date of cancellation. "accident" is known to: 16. HYBRID, ELECTRIC, OR NATURAL GAS (1) You, if you are an individual; VEHICLE PAYMENT COVERAGE (2) A partner, if you are a partnership; In the event of a total loss to a "non-hybrid" auto (3) A member, if you are a limited liability or an auto powered solely by electricity or natural company; or gas for which Comprehensive, Specified Causes of Loss, or Collision coverages are provided under (4) An executive officer or insurance manager, if this Coverage Form, then such Physical Damage you are a corporation. Coverages are amended as follows: @ 2015,The Hartford(includes copyrighted material Form HA 99 17 06 14 of ISO Properties, Inc.,with its permission.) Page 4 of 5 52817203 19-20 CL AU UMB(20) WC Prof Poll I Casey Brown 1 12/11/2019 3:30:47 ITE (EST) I Page 30 of 31 POLICYNUMBER: 08 UEN AY6348 a. If the auto is replaced with a "hybrid" auto, we 17. VEHICLE WRAP COVERAGE will pay an additional 10%, to a maximum of In the event of a total loss to an "auto" for which $2,500, of the "non-hybrid" auto's actual cash Comprehensive, Specified Causes of Loss, or value or replacement cost, whichever is less, Collision coverages are provided under this b. The auto must be replaced and a copy of a bill Coverage Form, then such Physical Damage of sale or new lease agreement received by Coverages are amended to add the following: us within 60 calendar days of the date of In addition to the actual cash value of the "Ioss,"c. Regardless of the number of autos "auto", we will pay up to $1,000 for vinyl deemed a total loss, the most we will pay vehicle wraps which are displayed on the under this Hybrid, Electric, or Natural Gas covered "auto" at the time of total loss. Vehicle Payment Coverage provision for any Regardless of the number of autos deemed one "loss" is $10,000. a total loss, the most we will pay under this For the purposes of the coverage provision, Vehicle Wrap Coverage provision for any a. A "non-hybrid" auto is defined as an auto that one "loss" is $5,000. For purposes of this uses only an internal combustion engine to coverage provision, signs or other graphics move the auto but does not include autos painted or magnetically affixed to the vehicle powered solely by electricity or natural gas. are not considered vehicle wraps. b. A "hybrid" auto is defined as an auto with an internal combustion engine and one or more electric motors; and that uses the internal combustion engine and one or more electric motors to move the auto, or the internal combustion engine to charge one or more electric motors, which move the auto. @ 2015,The Hartford(includes copyrighted material Form HA 99 17 06 14 of ISO Properties, Inc.,with its permission.) Page 5 of 5 52817203 19-20 CL AU UMB(20) WC Prof Poll I Casey Brown 1 12/11/2019 3:30:47 PM (EST) I Page 31 of 31