CITY OF RICHMOND
CONTRACT AMENDMENT
Department: Project Manager:
Project Manager E-mail:
Project Manager Phone No:
P.R. No: Vendor No: P.O./Contract No:
Description of Services:
Amendment No. ___ modifies the: (2nd or subsequent amendments attach Amendment History page)
Term, Payment Limit and Service Plan
Payment Limit and Service Plan
Term and Service Plan
Service Plan
The parties to this Contract Amendment do mutually agree and promise as follows:
1. Parties. The parties to this Contract Amendment are the City of Richmond, California, a municipal corporation (City), and the following named Contractor:
Company Name:
Street Address:
City, State, Zip Code:
Contact Person:
Telephone: Email:
Business License No: / Expiration Date:
A California [ ] corporation, [ ] limited liability corporation [ ] general partnership, [ ] limited partnership, [ ] individual, [ ] non-profit corporation, [ ] individual dba as [specify:]
[ ] other [specify:]
2. Purpose. This Contract Amendment is being entered into to amend the Contract between City and Contractor which was approved by the City Council of the City of Richmond or executed by the City Manager on , which original term commenced on and terminates with an original contract payment limit of $ . Said contract shall hereinafter be referred to as the "Original Contract" and is incorporated herein by reference.
3. Original Contract Provisions. The parties hereto agree to continue to abide by those terms and conditions of the Original Contract, and any amendments thereto, which are unaffected by this Contract Amendment.
Contract Amendment/EJ/TE 09-26-07
4. Amendment Provisions. This Contract Amendment is subject to the Amendment Provisions attached hereto, which are incorporated herein by reference, and which control over any conflicting provisions of the Original Contract, or any amendment thereto.
5. City of Richmond Business License Active Status Maintained. Pursuant to Municipal Code Section 7.04.030, the Contractor must maintain its City of Richmond business license for this Contract Amendment to be deemed to be in effect.
6. Insurance Coverage Updated and Maintained. Pursuant to the Original Contract, the Contractor shall provide the City with updated insurance certificates, and the Contractor shall maintain insurance coverage, for this Contract Amendment to be deemed to be in effect.
7. Signatures. These signatures attest the parties’ agreement hereto:
CITY OF RICHMOND, CALIFORNIA
a municipal corporation
By _______________________
Title:
I hereby certify that the Original Contract
and this Amendment have been approved
by the City Council or executed by the City
Manager.
By _______________________
City Clerk
Approved as to form:
By_______________________
City Attorney
List of Attachments:
1. Amendment Provisions
2. Updated Insurance Certificates
CONTRACTOR:
______________________________
(*The Corporation Chairperson of the Board, President or Vice-President should sign on the line below.)
By____________________________
Title:________________________
(*The Corporation Chief Financial Officer, Secretary or Assistant Secretary should sign on the line below.)
By:___________________________
Title:________________________
(NOTE: Pursuant to California Corporations
Code Section 313, if Contractor is a
corporation or nonprofit organization, this
Contract (1) should be signed by the
Chairperson of the Board, President or
Vice-President
and the Chief Financial
Officer, Secretary or Assistant Secretary; (2)
should have both signatures conform to
designated representative groups pursuant
to Corporations Code Section 313.
Contract Amendment between the City of Richmond and
Amendment No. P.O./Contract No.
AMENDMENT PROVISIONS (TERM, PAYMENT LIMIT AND SERVICE PLAN)
1. Paragraph 2 (Term) of the Original Contract is hereby amended to extend the Contract term. Paragraph 2 of the Original Contract is amended to read as follows:
"2. Term. The effective date of this Contract is
____________________________________________________________ (Insert original contract commencement date)
and it terminates
___________________________________________________.
(Insert new contract termination date)
unless sooner terminated as provided herein."
2. Paragraph 3 (Payment Limit) of the Original Contract is hereby amended to increase the payment limit by $ . Paragraph 3 of the Original Contract is amended to read as follows:
"3. Payment Limit. City's total payments to Contractor under this Contract shall not exceed $ including expenses."
“The City of Richmond shall not pay for services that exceed the Contract Payment Limit without the prior written approval of the City Manager if the total Contract amount does not exceed $10,000 or without the prior approval of the City Council if the total Contract amount is over $10,000.”
3. The Service Plan (Exhibit A) of the Original Contract is hereby amended to include the following tasks and/or services:
Contract Amendment/EJ/TE 9-26-07
EXHIBIT A
Scope of Work
Contractor shall, to the sa�sfac�on of the City’s Community Development Department, perform the following services and be compensated as outlined below. The City reserves the right to adjust the Service Specifica�ons, Timeline, and Project Outcomes of the Contractor as the Project’s performance is regularly evaluated.
A. SERVICES TO BE PROVIDED
Contractor will provide mental health support designed to promote the physical and emo�onal safety of a popula�on that is vulnerable to mental health challenges. The services outlined include crisis stabiliza�on, mental health assessments, individual counseling, and group counseling. The assessment structure, individual counseling, and group sessions aim to help residents experiencing a mental health crisis, provide ini�al crisis stabiliza�on and assessments, and connect them with addi�onal mental health resources, if required, for con�nued care.
B. SERVICES DETAIL
Program Specifics
Contractor will provide the following services to unhoused clients as part of the ERF R1 and R2 Encampment Resolu�on Programs.
• Resident Assessments - Contractor will meet with individual unhoused clients that are referred to them under the ERF R1 and ERF R2 programs to develop individual assessments and follow up plans.
• Individual counseling – Contractor will schedule individual counseling mee�ngs with unhoused clients per their assessment plan.
• Group Sessions - Contractor will schedule group sessions with unhoused clients, separately for Castro clients and citywide ERF R2 unhoused clients, at loca�ons to be determined.
• Treatment team coordina�on/Case Management - Contractor will coordinate case management services between treatment team providers to provide a con�nuity of mental health care. This coordina�on includes an exchange of diagnos�c informa�on, psychiatric appointments, medica�on management, and treatment planning.
Goal and Objec�ves
• Crisis stabiliza�on and psychological first aid for homeless residents • Mental health assessments and interviewing for treatment planning • Ongoing mental health support by licensed providers
Providing mental health resources to homeless individuals can have several benefits, including:
• Improved mental health: Homeless individuals o�en experience high stress levels, trauma, and mental health condi�ons such as depression, anxiety, and post-trauma�c stress disorder (PTSD). Access to mental health resources, such as therapy, counseling, and medica�on, can help alleviate symptoms and improve overall mental health. • Increased housing stability: Mental health issues can be a significant barrier to securing and maintaining stable housing. Homeless individuals may be beter equipped to secure and maintain housing by addressing mental health concerns. • Reduced substance abuse: Homelessness and mental health issues are o�en associated with substance abuse. Providing mental health resources can help address the underlying causes of substance abuse and support individuals in achieving and maintaining sobriety.
• Reduced healthcare costs: Homeless individuals with untreated mental health condi�ons o�en u�lize emergency rooms and other costly healthcare services at higher rates. By providing mental health resources, healthcare costs can be reduced by preven�ng the need for emergency care.
• Improved overall well-being: Access to mental health resources can improve overall well-being, leading to increased engagement in educa�on, work, and other meaningful ac�vi�es.
• Overall, providing mental health resources to homeless individuals can help address the complex and interconnected issues that contribute to homelessness and support individuals in achieving greater stability and well-being.
EXHIBIT B
BUDGET
Healing Spot - Mental Health Support Castro ERF R1
Description Hourly Fee
# Hours /
Meetings Total
Resident Assessments 315.75$ 15 4,736.25$
Resident Counseling Sessions 150.00$ 160 24,000.00$ Bi-Monthly Group Meetings 500.00$ 10 5,000.00$
Treatment Team/Case
Management Coordination 150.00$ 200 30,000.00$
Total Casto ERF R1 63,736.25$
Healing Spot - Mental Health Support Citywide ERF R2
Description Hourly Fee
# Hours /
Meetings Total
Resident Assessments 325.00$ 60 19,500.00$
Resident Counseling Sessions 150.00$ 1140 171,000.00$ Bi-Monthly Group Meetings 550.00$ 36 19,800.00$
Treatment Team/Case
Management Coordination 175.00$ 760 133,000.00$
Total Casto ERF R2 343,300.00$
Total Additional Contract Amount 407,036.25$
Contract Amendment between the City of Richmond and
Amendment No. P.O./Contract No.
AMENDMENT PROVISIONS (AMENDMENT HISTORY)
The first Contract Amendment was approved by City Council of the City of Richmond or executed by the City Manager on for one or more of the following provisions (check those that apply):
Increased contract payment limit by $ ________________for a payment limit not to exceed $ _________________________.
Term Amendment (insert new termination date):________________________
Service Plan
The second Contract Amendment was approved by City Council of the City of Richmond or executed by the City Manager on for one or more of the following provisions (check those that apply):
Increased contract payment limit by $ ________________for a payment limit not to exceed $ _________________________.
Term Amendment (insert new termination date):________________________
Service Plan
The third Contract Amendment was approved by City Council of the City of Richmond or executed by the City Manager on for one or more of the following provisions (check those that apply):
Increased contract payment limit by $ ________________for a payment limit not to exceed $ _________________________.
Term Amendment (insert new termination date):________________________
Service Plan
The fourth Contract Amendment was approved by City Council of the City of Richmond or executed by the City Manager on for one or more of the following provisions (check those that apply):
Increased contract payment limit by $ ________________for a payment limit not to exceed $ _________________________.
Term Amendment (insert new termination date):________________________
Service Plan
The fifth Contract Amendment was approved by City Council of the City of Richmond or executed by the City Manager on for one or more of the following provisions (check those that apply):
Increased contract payment limit by $ ________________for a payment limit not to exceed $ _________________________.
Term Amendment (insert new termination date):________________________
Service Plan
___ Exhibit F
___ Section 8
City of Richmond - Insurance Requirements - Type 2:
Professional Services
Type 2 – Page 1 of 3
Revised: September 2011
In all instances where CONTRACTOR or its representatives will provide professional services (architects, engineers, construction management, counselors, medical professionals, hospitals, clinics, attorneys, consultants, accountants, etc.) to the City of Richmond (City), the City requires the following MINIMUM insurance requirements and limits.
CONTRACTOR shall procure and maintain for the duration of the contract, agreement, or other order for work, services or supplies, insurance against claims for injuries to persons or damages to property which may arise from or in connection with the performance of the work hereunder and the results of that work by the CONTRACTOR, its agents, representatives, employees or subcontractors. Maintenance of proper insurance coverage is a material element of the contract. Failure to maintain or renew coverage or to provide evidence of renewal may be treated by the City as a material breach of contract.
CONTRACTOR agrees that in the event of loss due to any of the perils for which it has agreed to provide Commercial General Liability insurance, CONTRACTOR shall look solely to its insurance for recovery.
CONTRACTOR hereby grants to CITY, on behalf of any insurer providing Commercial General Liability insurance to either CONTRACTOR or CITY with respect to the services of CONSULTANT herein, a waiver of any right to subrogation which any such insurer of said CONTRACTOR may acquire against the CITY by virtue of the payment of any loss under such insurance.
Original, signed certificates and original, separate policy endorsements, naming the City as an additional insured for general liability coverage, as well as a waiver of subrogation for Workers’ Compensation insurance, shall be received and approved by the City before any work may begin. However, failure to do so shall not operate as a waiver of these insurance requirements.
City reserves the right to modify or require additional coverages for specific risk exposures depending on scope of CONTRACTORS work.
Minimum coverage is detailed below. The policy limits of coverage shall be made available to the full limits of the policy. The minimum limits stated herein shall not serve to reduce the policy limits of coverage of CONTRACTOR.
Minimum Scope of Insurance – the following forms shall be provided and coverage shall be at least as broad as the following:
1. Insurance Services Office Commercial General Liability coverage (ISO Occurrence Form CG 0001), and including coverage for bodily and personal injury, property damage, and products and completed operations (if applicable).
2. Insurance Services Office Automobile Liability coverage (ISO Form CA 0001, Code 1, Any Auto).
3. Original and Separate Additional Insured Endorsement for General Liability (ISO Form CG 20 10 11/85 or its equivalent) with primary and non-contributory language.
4. Workers’ Compensation Insurance as required by the State of California including Employer’s Liability coverage.
5. Original and Separate Waiver of Subrogation for Workers’ Compensation insurance.
6. Professional Liability or Errors & Omissions Liability Insurance appropriate to the CONTRACTOR’s profession (if required.)
Required Coverage Minimum Limits
Workers’ Compensation and
Employers’ Liability
Statutory limits as required by the State of California including $1 million Employers’ Liability per accident, per employee for bodily injury or disease.
If CONTRACTOR is self-insured, provide a certificate of Permission to Self- Insure, signed by the California Department of Industrial Relations and Self- Insurance. If contractor is a sole proprietor (has no employees) than contractor must sign “Contractor Release of Liability” found at:
http://www.ci.richmond.ca.us/index.aspx?nid=61.
General Liability
(primary and excess limits
combined)
$2,000,000 per occurrence for bodily injury, personal injury and property damage. If the policy includes a general aggregate, either the general aggregate shall apply separately to this project, service or location or the minimum required aggregate limit shall be twice the per occurrence limit ($4 million aggregate limit).
Policy shall be endorsed to name the City of Richmond as an additional insured per the conditions detailed below.
___ Exhibit F
___ Section 8
City of Richmond - Insurance Requirements - Type 2:
Professional Services
Type 2 – Page 2 of 3
Revised: September 2011
Automobile Liability $1,000,000 per occurrence for bodily injury and property damage.
PROJECT COST R EQUIRED LIMIT
$0 - $1 million $1 million p/o
$1 million - $5 million $2 million p/o
Over $5 million $5 million p/o
Professional Liability or Errors &
Omissions Liability –
Required for all professionals
including architects, engineers,
consultants, construction
management, counselors, medical
professionals, hospitals, clinics,
attorneys and accountants, & other
consultants as may be required by
the City.
Required Policy Conditions
Additional Insured Endorsement
Applicable to General Liability coverage.
The City of Richmond, its officers, officials, employees, agents and volunteers are to be named as additional insureds for all liability arising out of the operations by or on behalf of the named insured including bodily injury, deaths and property damage or destruction arising in any respect directly or indirectly in the performance of this contract.
ISO form CG 20 10 (11/85) or its equivalent is required. If the Contractor is supplying their product or providing a service then the endorsement must not
exclude products and completed operations
coverage. If it does, then CG 20 37 (10/01) is also required.
SAMPLE Endorsements can be found at
http://www.ci.richmond.ca.us/index.aspx?nid=61
.
Primary and Noncontributory The contractor’s insurance coverage must be primary coverage as it pertains to the City, its officers, officials, employees, agents and volunteers. Any insurance or self insurance maintained by the City is wholly separate from the insurance of the contractor and in no way relieves the contractor from its responsibility to provide insurance.
Waiver of Subrogation
Endorsement Form
Contractor’s insurer will provide a Waiver of Subrogation in favor of the City for Workers’ Compensation Insurance during the life of this contract.
SAMPLE Endorsements can be found at
http://www.ci.richmond.ca.us/index.aspx?nid=61.
Deductibles and Self-Insured
Retentions
Any deductible or self-insured retention must be declared to and approved by the City. At the option of the City either the insurer shall reduce or eliminate such deductibles or self-insured retention as respects the City or the CONTRACTOR shall procure a financial guarantee in an amount equal to the deductible or self-insured retention guaranteeing payment of losses and related investigations, claims administration and defense expenses.
Contractor is responsible for satisfaction of the deductible and/or self-insured retention for each loss.
A. M. Best Rating A:VII or Better. If the A.M. Best Rating falls below the required rating, CONTRACTOR must replace coverage immediately and provide notice to City.
Umbrella/Excess Liability Policies
If an Umbrella or Excess Liability Policy is used to meet the liability limits, coverage shall be as broad as specified for underlying coverage’s and cover those insured in the underlying policies.
___ Exhibit F
___ Section 8
City of Richmond - Insurance Requirements - Type 2:
Professional Services
Type 2 – Page 3 of 3
Revised: September 2011
Claims-Made Policies
If any insurance policy is written on a claims-made form: 1) the retroactive date must be shown, and must be before the date of the contract or the beginning of contract work. 2) Insurance must be maintained and evidence of insurance must be provided for at least five (5) years after completion of the contract of work. 3) If coverage is canceled or non-renewed, and not replaced with another claims-made policy form with a retroactive date prior to the contract effective date, the Contractor must purchase an extended period coverage for a minimum of five (5) years after completion of contract work.
Subcontractors
CONTRACTOR
shall include all subcontractors as insured under its policies or shall furnish to the City for review and approval, separate certificates and endorsements for each subcontractor. All coverage for subcontractors shall be subject to all of the requirements stated herein.
CONTRACTOR agrees to defend and indemnify the City of Richmond for any damage resulting to it from failure of either CONTRACTOR or any subcontractor to take out or maintain the required insurance policies.
The fact that
insurance is obtained by CONTRACTOR, and/or CONTRACTOR’s subcontractors, will not be deemed to release or diminish the liability of CONTRACTOR, including, without limitation, liability under the indemnity provisions of this contract. Damages recoverable by CITY from CONTRACTOR or any third party will not be limited by the amount of the required insurance coverage.
Verification of Coverage
All original certificates and endorsements shall be received and approved by the City before work may begin .
The City of Richmond reserves the right to require complete, certified copies of all required insurance policies including endorsements affecting the coverage at any time.
Original insurance certificates and required policy endorsements shall be mailed or delivered to the Designated Project Manager for the City of Richmond.
Insurance certificates and endorsements may be faxed to the Designated Project Manger. However, CONTRACTOR must mail the original certificates and endorsements to Designated Project Manager once faxed.
Continuous Coverage
CONTRACTOR shall maintain the required insurance for the life of the contract. Should the CONTRACTOR cease to have insurance as required during this time, all work by the CONTRACTOR pursuant to this agreement shall cease until insurance acceptable to the City is provided. In the event that CONTRACTOR fails to comply with the City’s insurance requirements, the City may take such action as it deems necessary to protect the City’s interests. Such action may include but is not limited to termination of the contract, withholding of payments, or other actions as the City deems appropriate.
If services or the scope of work extend beyond the expiration dates of the required insurance policies initially approved by the City, CONTRACTOR must provide updated certificates and endorsements indicating that the required coverage, terms and conditions are still in place. Renewal certificates and updated endorsements shall be mailed to the Designated Project Manager.
Cancellation
CONTRACTOR shall ensure that coverage shall not be cancelled, reduced or otherwise materially changed except after thirty (30) days’ prior written notice has been given to the City.
Reporting Requirements
Any failure to comply with reporting or other provisions of the policies including breaches of warranties shall not affect coverage provided to the City, its officers, officials, employees or volunteers.
Consistent with Public Policy
The insuring provisions, insofar as they may be judged to be against public policy shall be void and unenforceable only to the minimum extent necessary so that the remaining terms and provisions herein may be consistent with public policy and thus enforceable.
Hiscox Insurance Company Inc.
Your Insurance Documents
Enclosed you will find the policy documents that make up your insurance contract with us.
Please read through all of these documents. If you have any questions or need to update any of your information please call us at 844-357-0840 (Mon-Fri, 7am-10pm ET).
Your insurance documents
Declarations Page
This contains specific policy information, such as the limits and deductibles you have selected.
Policy Wording
This details the terms and conditions of your coverage, subject to policy endorsements.
Endorsements
These documents modify the Policy Wording or Declarations Page. These include relevant terms and conditions as required by your state and are part of your policy.
Notices
These documents provide information that may affect your coverage such as optional terrorism coverage (if purchased) and other important items required by your state.
Application Summary
This is a summary of the information that you provided to us as part of your application. Please review this document and let us know if any of the information is incorrect.
Reporting a claim
Please inform us immediately if you have a claim or loss to report. Please have your policy number available, which can be found on the declarations page, so we can handle your call quickly. Contact us via the methods below or file a claim using our online form at https://www.hiscox.com/manage-your-policy/claims-center.
Email: [email protected]
Phone: 866-424-8508
Mail: Hiscox Claims Center
5 Concourse Parkway
Suite 2150
Atlanta, GA 30328
Declarations Page
HISCOX INSURANCE COMPANY INC. (A Stock Company)
104 South Michigan Avenue, Suite 600, Chicago, Illinois 60603 CGL D001 10 18 Includes copyrighted material of Insurance Services Office, Inc., with its permission. © ISO Properties, Inc., 2000
Commercial General Liability Declarations
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.
Declaration effective from: July 28, 2023
Policy No.: P102.176.827.1
Named Insured: Healing Spot Counseling Center Inc.
Address: 5065 Deer Valley Road
Antioch, CA 94531
Email Address: [email protected]
Policy period: From: July 28, 2023 To: July 28, 2024
At 12:01 A.M. (Standard Time) at the address shown above.
Form of Business: Not for profit Corporation
Each Occurrence Limit: $2,000,000
Damage to Premises Rented to You Limit: $100,000 Any one premises Medical Expense Limit: $5,000 Any one person
Personal & Advertising Injury Limit: $2,000,000 Any one person or organization General Aggregate Limit: $2,000,000
Products/Completed Operations
Aggregate Limit:
Products-completed operations are subject to the General Aggregate Limit Supplemental Business Personal Property Floater
Coverage Limit:
$0
Supplemental Business Personal Property Floater
Coverage Deductible:
Not Applicable
All Premises You Own, Rent or Occupy
Premises Number:
1 Address: 5065 Deer Valley Road
Antioch, CA 94531
Total Premium: 381.00
Attachments: See attached Forms and Endorsements Schedule.
HISCOX INSURANCE COMPANY INC. (A Stock Company)
104 South Michigan Avenue, Suite 600, Chicago, Illinois 60603 CGL D001 10 18 Includes copyrighted material of Insurance Services Office, Inc., with its permission. © ISO Properties, Inc., 2000
IN WITNESS WHEREOF, the Insurer indicated above has caused this Policy to be signed by its President and Secretary, but this Policy shall not be effective unless also signed by the Insurer's duly authorized representative.
President
Secretary
Authorized Representative
HISCOX INSURANCE COMPANY INC. (A Stock Company)
104 South Michigan Avenue, Suite 600, Chicago, Illinois 60603 INT D001 01 10 Page 1 of 1
Forms and Endorsements Schedule
Forms and Endorsements made part of this policy at time of issue:
CGL D001 10 18 - Commercial General Liability Declarations INT D001 01 10 - Forms and Endorsements Schedule
CG 00 01 12 07 - General Liability Coverage Form
CGL E5401 CW (03/10) - Definition of Employee
CGL E5403 CW (03/10) - Notice Information
CGL E5404 CW (03/10) - Exclusion - Personal Information CGL E5407 CW (03/10) - Exclusion - Professional Services CGL E5408 CW (03/10) - Cancellation Provision (14 Day Full Refund) CGL E5409 CW (03/10) - Right and Duty to Select Defense Counsel CGL E5421 CW (02/14) - Additional Insured - Automatic Status IL 00 17 11 98 - Common Policy Conditions
IL 00 21 09 08 - Nuclear Energy Liability Exclusion Endorsement (Broad Form) CG 00 68 05 09 - Recording and Distribution of Material or Information in Violation of Law Exclusion CG 21 41 11 85 - Exclusion - Intercompany Products Suits CG 21 46 07 98 - Abuse or Molestation Exclusion
CG 22 44 07 98 - Exclusion - Services Furnished By Health Care Providers Endorsement CG 21 57 07 98 - Exclusion - Counseling Services
IL 02 70 09 08 - California Changes - Cancellation and Nonrenewal CG 32 34 01 05 - California Changes
CGL E5402 CW (03/10) - Modified Waiver of Transfer of Rights of Recovery Against Others To Us CG 21 73 01 15 - Exclusion Of Certified Acts Of Terrorism CGL E1954 CW (05/20) - Asbestos - Exclusion
CGL E1975 CW (05/20) - Limitation of Coverage to Business Operations CG 21 32 05 09 - Communicable Disease Exclusion
INT N003 CW (01/19) - Policyholder Notice Electronic Delivery INT N001 CW (01/09) - Economic And Trade Sanctions Policyholder Notice Policy Wording
COMMERCIAL GENERAL LIABILITY
CG 00 01 12 07
CG 00 01 12 07 © ISO Properties, Inc., 200
6 Page 1 of 16
COMMERCIAL GENERAL LIABILITY COVERAGE FORM
Various provisions in this policy restrict coverage.
Read the entire policy carefully to determine rights,
duties and what is and is not covered.
Throughout this policy the words "you" and "your"
refer to the Named Insured shown in the Declarations,
and any other person or organization qualifying as a
Named Insured under this policy. The words "we",
"us" and "our" refer to the company providing this
insurance.
The word "insured" means any person or organization
qualifying as such under Section II – Who Is An In-
sured.
Other words and phrases that appear in quotation
marks have special meaning. Refer to Section V –
Definitions.
SECTION I – COVERAGES
COVERAGE A BODILY INJURY AND PROPERTY
DAMAGE LIABILITY
1. Insuring Agreement
a. We will pay those sums that the insured be-
comes legally obligated to pay as damages
because of "bodily injury" or "property damage"
to which this insurance applies. We will have
the right and duty to defend the insured against
any "suit" seeking those damages. However,
we will have no duty to defend the insured
against any "suit" seeking damages for "bodily
injury" or "property damage" to which this in-
surance does not apply. We may, at our discre-
tion, investigate any "occurrence" and settle
any claim or "suit" that may result. But:
(1) The amount we will pay for damages is
limited as described in Section III – Limits
Of Insurance; and
(2) Our right and duty to defend ends when we
have used up the applic able limit of insur-
ance in the payment of judgments or set-
tlements under Coverages A or B or medi-
cal expenses under Coverage C.
No other obligation or liability to pay sums or
perform acts or services is covered unless ex-
plicitly provided for under Supplementary Pay-
ments – Coverages A and B.
b. This insurance applies to "bodily injury" and
"property damage" only if:
(1) The "bodily injury" or "property damage" is
caused by an "occurrence" that takes place
in the "coverage territory";
(2) The "bodily injury" or "property damage"
occurs during the policy period; and
(3) Prior to the policy period, no insured listed
under Paragraph 1. of Section II – Who Is
An Insured and no "employee" authorized
by you to give or receive notice of an "oc-
currence" or claim, knew that the "bodily in-
jury" or "property damage" had occurred, in
whole or in part. If such a listed insured or
authorized "employee" knew, prior to the
policy period, that the "bodily injury" or
"property damage" occurred, then any con-
tinuation, change or resumption of such
"bodily injury" or "property damage" during
or after the policy period will be deemed to
have been known prior to the policy period.
c. "Bodily injury" or "property damage" which
occurs during the policy period and was not,
prior to the policy period, known to have oc-
curred by any insured listed under Paragraph
1. of Section II – Who Is An Insured or any
"employee" authorized by you to give or re-
ceive notice of an "occurrence" or claim, in-
cludes any continuation, change or resumption
of that "bodily injury" or "property damage" af-
ter the end of the policy period.
d. "Bodily injury" or "property damage" will be
deemed to have been known to have occurred
at the earliest time when any insured listed un-
der Paragraph 1. of Section II – Who Is An In-
sured or any "employee" authorized by you to
give or receive notice of an "occurrence" or
claim:
(1) Reports all, or any part, of the "bodily injury"
or "property damage" to us or any other in-
surer;
(2) Receives a written or verbal demand or
claim for damages because of the "bodily
injury" or "property damage"; or
(3) Becomes aware by any other means that
"bodily injury" or "property damage" has oc-
curred or has begun to occur.
e. Damages because of "bodily injury" include
damages claimed by any person or organiza-
tion for care, loss of services or death resulting
at any time from the "bodily injury".
2. Exclusions
This insurance does not apply to:
a. Expected Or Intended Injury
"Bodily injury" or "property damage" expected
or intended from the standpoint of the insured.
This exclusion does not apply to "bodily injury"
resulting from the use of reasonable force to
protect persons or property.
b. Contractual Liability
"Bodily injury" or "property damage" for which
the insured is obligated to pay damages by
reason of the assumption of liability in a con-
tract or agreement. This exclusion does not
apply to liability for damages:
(1) That the insured would have in the absence
of the contract or agreement; or
(2) Assumed in a contract or agreement that is
an "insured contract", provided the "bodily
injury" or "property damage" occurs subse-
quent to the execution of the contract or
agreement. Solely for the purposes of liabil-
ity assumed in an "insured contract", rea-
sonable attorney fees and necessary litiga-
tion expenses incurred by or for a party
other than an insured are deemed to be
damages because of "bodily injury" or
"property damage", provided:
(a) Liability to such party for, or for the cost
of, that party's defense has also been
assumed in the same "insured contract";
and
(b) Such attorney fees and litigation ex-
penses are for defense of that party
against a civil or alternative dispute
resolution proceeding in which damages
to which this insurance applies are al-
leged.
c. Liquor Liability
"Bodily injury" or "property damage" for which
any insured may be held liable by reason of:
(1) Causing or contributing to the intoxication of
any person;
(2) The furnishing of alcoholic beverages to a
person under the legal drinking age or un-
der the influence of alcohol; or
(3) Any statute, ordinance or regulation relating
to the sale, gift, distribution or use of alco-
holic beverages.
This exclusion applies only if you are in the
business of manufacturing, distributing, selling,
serving or furnishing alcoholic beverages.
d. Workers' Compensation And Similar Laws
Any obligation of the insured under a workers'
compensation, disability benefits or unem-
ployment compensation law or any similar law.
e. Employer's Liability
"Bodily injury" to:
(1) An "employee" of the insured arising out of
and in the course of:
(a) Employment by the insured; or
(b) Performing duties related to the conduct
of the insured's business; or
(2) The spouse, child, parent, brother or sister
of that "employee" as a consequence of
Paragraph (1) above.
This exclusion applies whether the insured
may be liable as an employer or in any other
capacity and to any obligation to share dam-
ages with or repay someone else who must
pay damages because of the injury.
This exclusion does not apply to liability as-
sumed by the insured under an "insured con-
tract".
CG 00 01 12 07 © ISO Properties, Inc., 2006 Page 3 of 16
f. Pollution
(1) "Bodily injury" or "property damage" arising
out of the actual, alleged or threatened dis-
charge, dispersal, seepage, migration, re-
lease or escape of "pollutants":
(a) At or from any premises, site or location
which is or was at any time owned or
occupied by, or rented or loaned to, any
insured. However, this subparagraph
does not apply to:
(i) "Bodily injury" if sustained within a
building and caused by smoke,
fumes, vapor or soot produced by or
originating from equipment that is
used to heat, cool or dehumidify the
building, or equipment that is used to
heat water for personal use, by the
building's occupants or their guests;
(ii) "Bodily injury" or "property damage"
for which you may be held liable, if
you are a contractor and the owner
or lessee of such premises, site or
location has been added to your pol-
icy as an additional insured with re-
spect to your ongoing operations
performed for that additional insured
at that premises, site or location and
such premises, site or location is not
and never was owned or occupied
by, or rented or loaned to, any in-
sured, other than that additional in-
sured; or
(iii) "Bodily injury" or "property damage"
arising out of heat, smoke or fumes
from a "hostile fire";
(b) At or from any premises, site or location
which is or was at any time used by or
for any insured or others for the han-
dling, storage, disposal, processing or
treatment of waste;
(c) Which are or were at any time trans-
ported, handled, stored, treated, dis-
posed of, or processed as waste by or
for:
(i) Any insured; or
(ii) Any person or organization for whom
you may be legally responsible; or
(d) At or from any premises, site or location
on which any insured or any contractors
or subcontractors working directly or in-
directly on any insured's behalf are per-
forming operations if the "pollutants" are
brought on or to the premises, site or lo-
cation in connection with such opera-
tions by such insured, contractor or sub-
contractor. However, this subparagraph
does not apply to:
(i) "Bodily injury" or "property damage"
arising out of the escape of fuels, lu-
bricants or other operating fluids
which are needed to perform the
normal electrical, hydraulic or me-
chanical functions necessary for the
operation of "mobile equipment" or
its parts, if such fuels, lubricants or
other operating fluids escape from a
vehicle part designed to hold, store
or receive them. This exception does
not apply if the "bodily injury" or
"property damage" arises out of the
intentional discharge, dispersal or re-
lease of the fuels, lubricants or other
operating fluids, or if such fuels, lu-
bricants or other operating fluids are
brought on or to the premises, site or
location with the intent that they be
discharged, dispersed or released as
part of the operations being per-
formed by such insured, contractor
or subcontractor;
(ii) "Bodily injury" or "property damage"
sustained within a building and
caused by the release of gases,
fumes or vapors from materials
brought into that building in connec-
tion with operations being performed
by you or on your behalf by a con-
tractor or subcontractor; or
(iii) "Bodily injury" or "property damage"
arising out of heat, smoke or fumes
from a "hostile fire".
(e) At or from any premises, site or location
on which any insured or any contractors
or subcontractors working directly or in-
directly on any insured's behalf are per-
forming operations if the operations are
to test for, monitor, clean up, remove,
contain, treat, detoxify or neutralize, or
in any way respond to, or assess the ef-
fects of, "pollutants".
(2) Any loss, cost or expense arising out of
any:
(a) Request, demand, order or statutory or
regulatory requirement that any insured
or others test for, monitor, clean up, re-
move, contain, treat, detoxify or neutral-
ize, or in any way respond to, or assess
the effects of, "pollutants"; or
(b) Claim or "suit" by or on behalf of a gov-
ernmental authority for damages be-
cause of testing for, monitoring, cleaning
up, removing, containing, treating, de-
toxifying or neutralizing, or in any way
responding to, or assessing the effects
of, "pollutants".
However, this paragraph does not apply to
liability for damages be cause of "property
damage" that the insured would have in the
absence of such request, demand, order or
statutory or regulatory requirement, or such
claim or "suit" by or on behalf of a govern-
mental authority.
g. Aircraft, Auto Or Watercraft
"Bodily injury" or "property damage" arising out
of the ownership, maintenance, use or en-
trustment to others of any aircraft, "auto" or wa-
tercraft owned or operated by or rented or
loaned to any insured. Use includes operation
and "loading or unloading".
This exclusion applies even if the claims
against any insured allege negligence or other
wrongdoing in the supervision, hiring, employ-
ment, training or monitoring of others by that
insured, if the "occurrence" which caused the
"bodily injury" or "property damage" involved
the ownership, maintenance, use or entrust-
ment to others of any aircraft, "auto" or water-
craft that is owned or operated by or rented or
loaned to any insured.
This exclusion does not apply to:
(1) A watercraft while ashore on premises you
own or rent;
(2) A watercraft you do not own that is:
(a) Less than 26 feet long; and
(b) Not being used to carry persons or
property for a charge;
(3) Parking an "auto" on, or on the ways next
to, premises you own or rent, provided the
"auto" is not owned by or rented or loaned
to you or the insured;
(4) Liability assumed under any "insured con-
tract" for the ownership, maintenance or
use of aircraft or watercraft; or
(5) "Bodily injury" or "property damage" arising
out of:
(a) The operation of machinery or equip-
ment that is attached to, or part of, a
land vehicle that would qualify under the
definition of "mobile equipment" if it were
not subject to a compulsory or financial
responsibility law or other motor vehicle
insurance law in the state where it is li-
censed or principally garaged; or
(b) the operation of any of the machinery or
equipment listed in Paragraph f.(2) or
f.(3) of the definition of "mobile equip-
ment".
h. Mobile Equipment
"Bodily injury" or "property damage" arising out
of:
(1) The transportation of "mobile equipment" by
an "auto" owned or operated by or rented or
loaned to any insured; or
(2) The use of "mobile equipment" in, or while
in practice for, or while being prepared for,
any prearranged racing, speed, demolition,
or stunting activity.
i. War
"Bodily injury" or "property damage", however
caused, arising, directly or indirectly, out of:
(1) War, including undeclared or civil war;
(2) Warlike action by a m ilitary force, including
action in hindering or defending against an
actual or expected attack, by any govern-
ment, sovereign or other authority using
military personnel or other agents; or
(3) Insurrection, rebellion, revolution, usurped
power, or action taken by governmental au-
thority in hindering or defending against any
of these.
j. Damage To Property
"Property damage" to:
(1) Property you own, rent, or occupy, including
any costs or expenses incurred by you, or
any other person, organization or entity, for
repair, replacement, enhancement, restora-
tion or maintenance of such property for
any reason, including prevention of injury to
a person or damage to another's property;
(2) Premises you sell, give away or abandon, if
the "property damage" arises out of any
part of those premises;
(3) Property loaned to you;
(4) Personal property in the care, custody or
control of the insured;
CG 00 01 12 07 © ISO Properties, Inc., 2006 Page 5 of 16
(5) That particular part of real property on
which you or any contractors or subcontrac-
tors working directly or indirectly on your
behalf are performing operations, if the
"property damage" arises out of those op-
erations; or
(6) That particular part of any property that
must be restored, repaired or replaced be-
cause "your work" was incorrectly per-
formed on it.
Paragraphs (1), (3) and (4) of this exclusion do
not apply to "property damage" (other than
damage by fire) to premises, including the con-
tents of such premises, rented to you for a pe-
riod of 7 or fewer consecutive days. A separate
limit of insurance applie s to Damage To Prem-
ises Rented To You as described in Section III
– Limits Of Insurance.
Paragraph (2) of this exclusion does not apply
if the premises are "your work" and were never
occupied, rented or held for rental by you.
Paragraphs (3), (4), (5) and (6) of this exclu-
sion do not apply to liability assumed under a
sidetrack agreement.
Paragraph (6) of this exclusion does not apply
to "property damage" included in the "products-
completed operations hazard".
k. Damage To Your Product
"Property damage" to "your product" arising out
of it or any part of it.
l. Damage To Your Work
"Property damage" to "your work" arising out of
it or any part of it and included in the "products-
completed operations hazard".
This exclusion does not apply if the damaged
work or the work out of which the damage
arises was performed on your behalf by a sub-
contractor.
m. Damage To Impaired Property Or Property
Not Physically Injured
"Property damage" to "impaired property" or
property that has not been physically injured,
arising out of:
(1) A defect, deficiency, inadequacy or danger-
ous condition in "your product" or "your
work"; or
(2) A delay or failure by you or anyone acting
on your behalf to perform a contract or
agreement in accordance with its terms.
This exclusion does not apply to the loss of use
of other property arising out of sudden and ac-
cidental physical injury to "your product" or
"your work" after it has been put to its intended
use.
n. Recall Of Products, Work Or Impaired
Property
Damages claimed for any loss, cost or ex-
pense incurred by you or others for the loss of
use, withdrawal, recall, inspection, repair, re-
placement, adjustment, removal or disposal of:
(1) "Your product";
(2) "Your work"; or
(3) "Impaired property";
if such product, work, or property is withdrawn
or recalled from the market or from use by any
person or organization because of a known or
suspected defect, deficiency, inadequacy or
dangerous condition in it.
o. Personal And Advertising Injury
"Bodily injury" arising out of "personal and ad-
vertising injury".
p. Electronic Data
Damages arising out of the loss of, loss of use
of, damage to, corruption of, inability to access,
or inability to manipulate electronic data.
As used in this exclusion, electronic data
means information, facts or programs stored as
or on, created or used on, or transmitted to or
from computer software, including systems and
applications software, hard or floppy disks, CD-
ROMS, tapes, drives, cells, data processing
devices or any other media which are used
with electronically controlled equipment.
q. Distribution Of Material In Violation Of
Statutes
"Bodily injury" or "property damage" arising di-
rectly or indirectly out of any action or omission
that violates or is alleged to violate:
(1) The Telephone Consumer Protection Act
(TCPA), including any amendment of or
addition to such law; or
(2) The CAN-SPAM Act of 2003, including any
amendment of or addition to such law; or
(3) Any statute, ordinance or regulation, other
than the TCPA or CAN-SPAM Act of 2003,
that prohibits or limits the sending, transmit-
ting, communicating or distribution of mate-
rial or information.
Exclusions c. through n. do not apply to damage
by fire to premises while rented to you or tempo-
rarily occupied by you with permission of the
owner. A separate limit of insurance applies to this
coverage as described in Section III – Limits Of
Insurance.
COVERAGE B PERSONAL AND ADVERTISING
INJURY LIABILITY
1. Insuring Agreement
a. We will pay those sums that the insured be-
comes legally obligated to pay as damages
because of "personal and advertising injury" to
which this insurance applies. We will have the
right and duty to defend the insured against
any "suit" seeking those damages. However,
we will have no duty to defend the insured
against any "suit" seeking damages for "per-
sonal and advertising inju ry" to which this in-
surance does not apply. We may, at our discre-
tion, investigate any offense and settle any
claim or "suit" that may result. But:
(1) The amount we will pay for damages is
limited as described in Section III – Limits
Of Insurance; and
(2) Our right and duty to defend end when we
have used up the applic able limit of insur-
ance in the payment of judgments or set-
tlements under Coverages A or B or medi-
cal expenses under Coverage C.
No other obligation or liability to pay sums or
perform acts or services is covered unless ex-
plicitly provided for under Supplementary Pay-
ments – Coverages A and B.
b. This insurance applies to "personal and adver-
tising injury" caused by an offense arising out
of your business but only if the offense was
committed in the "coverage territory" during the
policy period.
2. Exclusions
This insurance does not apply to:
a. Knowing Violation Of Rights Of Another
"Personal and advertising injury" caused by or
at the direction of the insured with the knowl-
edge that the act would violate the rights of an-
other and would inflict "personal and advertis-
ing injury".
b. Material Published With Knowledge Of
Falsity
"Personal and advertising injury" arising out of
oral or written publication of material, if done by
or at the direction of the insured with knowl-
edge of its falsity.
c. Material Published Prior To Policy Period
"Personal and advertising injury" arising out of
oral or written publication of material whose
first publication took place before the beginning
of the policy period.
d. Criminal Acts
"Personal and advertising injury" arising out of
a criminal act committed by or at the direction
of the insured.
e. Contractual Liability
"Personal and advertising injury" for which the
insured has assumed liab ility in a contract or
agreement. This exclusion does not apply to li-
ability for damages that the insured would have
in the absence of the contract or agreement.
f. Breach Of Contract
"Personal and advertising injury" arising out of
a breach of contract, except an implied con-
tract to use another's advertising idea in your
"advertisement".
g. Quality Or Performance Of Goods – Failure
To Conform To Statements
"Personal and advertising injury" arising out of
the failure of goods, products or services to
conform with any statement of quality or per-
formance made in your "advertisement".
h. Wrong Description Of Prices
"Personal and advertising injury" arising out of
the wrong description of the price of goods,
products or services stated in your "advertise-
ment".
i. Infringement Of Copyright, Patent,
Trademark Or Trade Secret
"Personal and advertising injury" arising out of
the infringement of copyright, patent, trade-
mark, trade secret or other intellectual property
rights. Under this exclusion, such other intellec-
tual property rights do not include the use of
another's advertising idea in your "advertise-
ment".
However, this exclusion does not apply to in-
fringement, in your "advertisement", of copy-
right, trade dress or slogan.
j. Insureds In Media And Internet Type
Businesses
"Personal and advertising injury" committed by
an insured whose business is:
(1) Advertising, broadcasting, publishing or
telecasting;
(2) Designing or determining content of web-
sites for others; or
CG 00 01 12 07 © ISO Properties, Inc., 2006 Page 7 of 16
(3) An Internet search, access, content or
service provider.
However, this exclusion does not apply to
Paragraphs 14.a., b. and c. of "personal and
advertising injury" under the Definitions Sec-
tion.
For the purposes of this exclusion, the placing
of frames, borders or links, or advertising, for
you or others anywhere on the Internet, is not
by itself, considered the business of advertis-
ing, broadcasting, publishing or telecasting.
k. Electronic Chatrooms Or Bulletin Boards
"Personal and advertising injury" arising out of
an electronic chatroom or bulletin board the in-
sured hosts, owns, or over which the insured
exercises control.
l. Unauthorized Use Of Another's Name Or
Product
"Personal and advertising injury" arising out of
the unauthorized use of another's name or
product in your e-mail address, domain name
or metatag, or any other similar tactics to mis-
lead another's potential customers.
m. Pollution
"Personal and advertising injury" arising out of
the actual, alleged or threatened discharge,
dispersal, seepage, migration, release or es-
cape of "pollutants" at any time.
n. Pollution-Related
Any loss, cost or expense arising out of any:
(1) Request, demand, order or statutory or
regulatory requirement that any insured or
others test for, monitor, clean up, remove,
contain, treat, detoxify or neutralize, or in
any way respond to, or assess the effects
of, "pollutants"; or
(2) Claim or suit by or on behalf of a govern-
mental authority for damages because of
testing for, monitoring, cleaning up, remov-
ing, containing, treating, detoxifying or neu-
tralizing, or in any way responding to, or
assessing the effects of, "pollutants".
o. War
"Personal and advertisi ng injury", however
caused, arising, directly or indirectly, out of:
(1) War, including undeclared or civil war;
(2) Warlike action by a m ilitary force, including
action in hindering or defending against an
actual or expected attack, by any govern-
ment, sovereign or other authority using
military personnel or other agents; or
(3) Insurrection, rebellion, revolution, usurped
power, or action taken by governmental au-
thority in hindering or defending against any
of these.
p. Distribution Of Material In Violation Of
Statutes
"Personal and advertising injury" arising di-
rectly or indirectly out of any action or omission
that violates or is alleged to violate:
(1) The Telephone Consumer Protection Act
(TCPA), including any amendment of or
addition to such law; or
(2) The CAN-SPAM Act of 2003, including any
amendment of or addition to such law; or
(3) Any statute, ordinance or regulation, other
than the TCPA or CAN-SPAM Act of 2003,
that prohibits or limits the sending, transmit-
ting, communicating or distribution of mate-
rial or information.
COVERAGE C MEDICAL PAYMENTS
1. Insuring Agreement
a. We will pay medical expenses as described
below for "bodily injury" caused by an accident:
(1) On premises you own or rent;
(2) On ways next to premises you own or rent;
or
(3) Because of your operations;
provided that:
(a) The accident takes place in the "cover-
age territory" and during the policy pe-
riod;
(b) The expenses are incurred and reported
to us within one year of the date of the
accident; and
(c) The injured person submits to examina-
tion, at our expense, by physicians of
our choice as often as we reasonably
require.
b. We will make these payments regardless of
fault. These payments will not exceed the ap-
plicable limit of insura nce. We will pay reason-
able expenses for:
(1) First aid administered at the time of an
accident;
(2) Necessary medical, surgical, x-ray and
dental services, including prosthetic de-
vices; and
(3) Necessary ambulance, hospital, profes-
sional nursing and funeral services.
2. Exclusions
We will not pay expenses for "bodily injury":
a. Any Insured
To any insured, except "volunteer workers".
b. Hired Person
To a person hired to do work for or on behalf of
any insured or a tenant of any insured.
c. Injury On Normally Occupied Premises
To a person injured on that part of premises
you own or rent that t he person normally occu-
pies.
d. Workers Compensation And Similar Laws
To a person, whether or not an "employee" of
any insured, if benefits for the "bodily injury"
are payable or must be provided under a work-
ers' compensation or disability benefits law or a
similar law.
e. Athletics Activities
To a person injured while practicing, instructing
or participating in any physical exercises or
games, sports, or athletic contests.
f. Products-Completed Operations Hazard
Included within the "products-completed opera-
tions hazard".
g. Coverage A Exclusions
Excluded under Coverage A.
SUPPLEMENTARY PAYMENTS – COVERAGES A
AND B
1. We will pay, with respect to any claim we investi-
gate or settle, or any "suit" against an insured we
defend:
a. All expenses we incur.
b. Up to $250 for cost of bail bonds required
because of accidents or traffic law violations
arising out of the use of any vehicle to which
the Bodily Injury Liability Coverage applies. We
do not have to furnish these bonds.
c. The cost of bonds to release attachments, but
only for bond amounts within the applicable
limit of insurance. We do not have to furnish
these bonds.
d. All reasonable expenses incurred by the in-
sured at our request to assist us in the investi-
gation or defense of the claim or "suit", includ-
ing actual loss of earnings up to $250 a day
because of time off from work.
e. All court costs taxed against the insured in the
"suit". However, these payments do not include
attorneys' fees or attorneys' expenses taxed
against the insured.
f. Prejudgment interest awarded against the
insured on that part of the judgment we pay. If
we make an offer to pay the applicable limit of
insurance, we will not pay any prejudgment in-
terest based on that period of time after the of-
fer.
g. All interest on the full amount of any judgment
that accrues after entry of the judgment and
before we have paid, offered to pay, or depos-
ited in court the part of the judgment that is
within the applicable limit of insurance.
These payments will not reduce the limits of insur-
ance.
2. If we defend an insured against a "suit" and an
indemnitee of the insured is also named as a party
to the "suit", we will defend that indemnitee if all of the following conditions are met:
a. The "suit" against the indemnitee seeks dam-
ages for which the insured has assumed the li-
ability of the indemnitee in a contract or agree-
ment that is an "insured contract";
b. This insurance applies to such liability as-
sumed by the insured;
c. The obligation to defend, or the cost of the
defense of, that indemnitee, has also been as-
sumed by the insured in the same "insured
contract";
d. The allegations in the "suit" and the information
we know about the "occurrence" are such that
no conflict appears to exist between the inter-
ests of the insured and the interests of the in-
demnitee;
e. The indemnitee and the insured ask us to
conduct and control the defense of that indem-
nitee against such "suit" and agree that we can
assign the same counsel to defend the insured
and the indemnitee; and
f. The indemnitee:
(1) Agrees in writing to:
(a) Cooperate with us in the investigation,
settlement or defense of the "suit";
(b) Immediately send us copies of any
demands, notices, summonses or legal
papers received in connection with the
"suit";
(c) Notify any other insurer whose coverage
is available to the indemnitee; and
(d) Cooperate with us with respect to coor-
dinating other applicable insurance
available to the indemnitee; and
(2) Provides us with written authorization to:
(a) Obtain records and other information
related to the "suit"; and
CG 00 01 12 07 © ISO Properties, Inc., 2006 Page 9 of 16
(b) Conduct and control the defense of the
indemnitee in such "suit".
So long as the above conditions are met, attor-
neys' fees incurred by us in the defense of that in-
demnitee, necessary litigation expenses incurred
by us and necessary litigation expenses incurred
by the indemnitee at our request will be paid as
Supplementary Payments. Notwithstanding the
provisions of Paragraph 2.b.(2) of Section I – Cov-
erage A – Bodily Injury And Property Damage Li-
ability, such payments wi ll not be deemed to be
damages for "bodily injury" and "property damage"
and will not reduce the limits of insurance.
Our obligation to defend an insured's indemnitee
and to pay for attorneys' fees and necessary litiga-
tion expenses as Supplementary Payments ends
when we have used up the applicable limit of in-
surance in the payment of judgments or settle-
ments or the conditions set forth above, or the
terms of the agreement described in Paragraph f.
above, are no longer met.
SECTION II – WHO IS AN INSURED
1. If you are designated in the Declarations as:
a. An individual, you and your spouse are insur-
eds, but only with respect to the conduct of a
business of which you are the sole owner.
b. A partnership or joint venture, you are an in-
sured. Your members, your partners, and their
spouses are also insureds, but only with re-
spect to the conduct of your business.
c. A limited liability company, you are an insured.
Your members are also insureds, but only with
respect to the conduct of your business. Your
managers are insureds, but only with respect
to their duties as your managers.
d. An organization other than a partnership, joint
venture or limited liab ility company, you are an
insured. Your "executive officers" and directors
are insureds, but only with respect to their du-
ties as your officers or directors. Your stock-
holders are also insureds, but only with respect
to their liability as stockholders.
e. A trust, you are an insured. Your trustees are
also insureds, but only with respect to their du-
ties as trustees.
2. Each of the following is also an insured:
a. Your "volunteer workers" only while performing
duties related to the conduct of your business,
or your "employees", other than either your
"executive officers" (if you are an organization
other than a partnership, joint venture or limited
liability company) or your managers (if you are
a limited liability company), but only for acts
within the scope of their employment by you or
while performing duties related to the conduct
of your business. However, none of these "em-
ployees" or "volunteer workers" are insureds
for:
(1) "Bodily injury" or "personal and advertising
injury":
(a) To you, to your partners or members (if
you are a partnership or joint venture),
to your members (if you are a limited li-
ability company), to a co-"employee"
while in the course of his or her em-
ployment or performing duties related to
the conduct of your business, or to your
other "volunteer workers" while perform-
ing duties related to the conduct of your
business;
(b) To the spouse, child, parent, brother or
sister of that co-"employee" or "volun-
teer worker" as a consequence of Para-
graph (1)(a) above;
(c) For which there is any obligation to
share damages with or repay someone
else who must pay damages because of
the injury described in Paragraphs (1)(a)
or (b) above; or
(d) Arising out of his or her providing or
failing to provide professional health
care services.
(2) "Property damage" to property:
(a) Owned, occupied or used by,
(b) Rented to, in the care, custody or con-
trol of, or over which physical control is
being exercised for any purpose by
you, any of your "employees", "volunteer
workers", any partner or member (if you are
a partnership or joint venture), or any mem-
ber (if you are a limited liability company).
b. Any person (other than your "employee" or
"volunteer worker"), or any organization while
acting as your real estate manager.
c. Any person or organization having proper
temporary custody of your property if you die,
but only:
(1) With respect to liabilit y arising out of the
maintenance or use of that property; and
(2) Until your legal representative has been
appointed.
d. Your legal representative if you die, but only
with respect to duties as such. That represen-
tative will have all your rights and duties under
this Coverage Part.
3. Any organization you newly acquire or form, other
than a partnership, joint venture or limited liability
company, and over which you maintain ownership
or majority interest, will qualify as a Named In-
sured if there is no othe r similar insurance avail-
able to that organization. However:
a. Coverage under this provision is afforded only
until the 90th day after you acquire or form the
organization or the end of the policy period,
whichever is earlier;
b. Coverage A does not apply to "bodily injury" or
"property damage" that occurred before you
acquired or formed the organization; and
c. Coverage B does not apply to "personal and
advertising injury" arising out of an offense
committed before you acquired or formed the
organization.
No person or organization is an insured with respect
to the conduct of any curren t or past partnership, joint venture or limited liability company that is not shown
as a Named Insured in the Declarations.
SECTION III – LIMITS OF INSURANCE
1. The Limits of Insurance shown in the Declarations
and the rules below fix the most we will pay re-
gardless of the number of:
a. Insureds;
b. Claims made or "suits" brought; or
c. Persons or organizations making claims or
bringing "suits".
2. The General Aggregate Limit is the most we will
pay for the sum of:
a. Medical expenses under Coverage C;
b. Damages under Coverage A, except damages
because of "bodily injury" or "property damage"
included in the "products-completed operations
hazard"; and
c. Damages under Coverage B.
3. The Products-Completed Operations Aggregate
Limit is the most we will pay under Coverage A for
damages because of "bodily injury" and "property
damage" included in the "products-completed op-
erations hazard".
4. Subject to Paragraph 2. above, the Personal and
Advertising Injury Limit is the most we will pay un-
der Coverage B for the sum of all damages be-
cause of all "personal and advertising injury" sus-
tained by any one person or organization.
5. Subject to
Paragraph 2. or 3. above, whichever
applies, the Each Occurrence Limit is the most we
will pay for the sum of:
a. Damages under Coverage A; and
b. Medical expenses under Coverage C
because of all "bodily injury" and "property dam-
age" arising out of any one "occurrence".
6. Subject to Paragraph 5. above, the Damage To
Premises Rented To You Limit is the most we will
pay under Coverage A for damages because of
"property damage" to any one premises, while
rented to you, or in the case of damage by fire,
while rented to you or temporarily occupied by you
with permission of the owner.
7. Subject to Paragraph 5. above, the Medical Ex-
pense Limit is the most we will pay under Cover-
age C for all medical expenses because of "bodily
injury" sustained by any one person.
The Limits of Insurance of this Coverage Part apply
separately to each consecutive annual period and to
any remaining period of less than 12 months, starting
with the beginning of the policy period shown in the
Declarations, unless the policy period is extended
after issuance for an additional period of less than 12 months. In that case, the additional period will be
deemed part of the last preceding period for purposes
of determining the Limits of Insurance.
SECTION IV – COMMERCIAL GENERAL LIABILITY
CONDITIONS
1. Bankruptcy
Bankruptcy or insolvency of the insured or of the
insured's estate will not relieve us of our obliga-
tions under this Coverage Part.
2. Duties In The Event Of Occurrence, Offense,
Claim Or Suit
a. You must see to it that we are notified as soon
as practicable of an "occurrence" or an offense
which may result in a claim. To the extent pos-
sible, notice should include:
(1) How, when and where the "occurrence" or
offense took place;
(2) The names and addresses of any injured
persons and witnesses; and
CG 00 01 12 07 © ISO Properties, Inc., 2006 Page 11 of 16
(3) The nature and location of any injury or
damage arising out of the "occurrence" or
offense.
b. If a claim is made or "suit" is brought against
any insured, you must:
(1) Immediately record the specifics of the
claim or "suit" and the date received; and
(2) Notify us as soon as practicable.
You must see to it that we receive written no-
tice of the claim or "suit" as soon as practica-
ble.
c. You and any other involved insured must:
(1) Immediately send us copies of any de-
mands, notices, summonses or legal pa-
pers received in connection with the claim
or "suit";
(2) Authorize us to obtain records and other
information;
(3) Cooperate with us in the investigation or
settlement of the claim or defense against
the "suit"; and
(4) Assist us, upon our request, in the en-
forcement of any right against any person
or organization which may be liable to the
insured because of injury or damage to
which this insurance may also apply.
d. No insured will, except at that insured's own
cost, voluntarily make a payment, assume any
obligation, or incur any expense, other than for
first aid, without our consent.
3. Legal Action Against Us
No person or organization has a right under this
Coverage Part:
a. To join us as a party or otherwise bring us into
a "suit" asking for damages from an insured; or
b. To sue us on this Coverage Part unless all of
its terms have been fully complied with.
A person or organization may sue us to recover on
an agreed settlement or on a final judgment
against an insured; but we will not be liable for
damages that are not payable under the terms of
this Coverage Part or that are in excess of the ap-
plicable limit of insurance. An agreed settlement
means a settlement and release of liability signed
by us, the insured and the claimant or the claim-
ant's legal representative.
4. Other Insurance
If other valid and collectible insurance is available
to the insured for a loss we cover under Cover-
ages A or B of this Coverage Part, our obligations
are limited as follows:
a. Primary Insurance
This insurance is primary except when Para-
graph b. below applies. If th is insurance is pri-
mary, our obligations are not affected unless
any of the other insurance is also primary.
Then, we will share with all that other insur-
ance by the method described in Paragraph c.
below.
b. Excess Insurance
(1) This insurance is excess over:
(a) Any of the other insurance, whether
primary, excess, contingent or on any
other basis:
(i) That is Fire, Extended Coverage,
Builder's Risk, Installation Risk or
similar coverage for "your work";
(ii) That is Fire insurance for premises
rented to you or temporarily occu-
pied by you with permission of the
owner;
(iii) That is insurance purchased by you
to cover your liability as a tenant for
"property damage" to premises
rented to you or temporarily occu-
pied by you with permission of the
owner; or
(iv) If the loss arises out of the mainte-
nance or use of aircraft, "autos" or
watercraft to the extent not subject to
Exclusion g. of Section I – Coverage
A – Bodily Injury And Property Dam-
age Liability.
(b) Any other primary insurance available to
you covering liability for damages aris-
ing out of the premises or operations, or
the products and completed operations,
for which you have been added as an
additional insured by attachment of an
endorsement.
(2) When this insurance is excess, we will have
no duty under Coverages A or B to defend
the insured against any "suit" if any other
insurer has a duty to defend the insured
against that "suit". If no other insurer de-
fends, we will undertake to do so, but we
will be entitled to the insured's rights
against all those other insurers.
(3) When this insurance is excess over other
insurance, we will pay only our share of the
amount of the loss, if any, that exceeds the
sum of:
(a) The total amount that all such other
insurance would pay for the loss in the
absence of this insurance; and
(b) The total of all deductible and self-
insured amounts under all that other in-
surance.
(4) We will share the remaining loss, if any,
with any other insurance that is not de-
scribed in this Excess Insurance provision
and was not bought specifically to apply in
excess of the Limits of Insurance shown in
the Declarations of this Coverage Part.
c. Method Of Sharing
If all of the other insurance permits contribution
by equal shares, we will follow this method
also. Under this approach each insurer con-
tributes equal amounts until it has paid its ap-
plicable limit of insurance or none of the loss
remains, whichever comes first.
If any of the other insurance does not permit
contribution by equal shares, we will contribute
by limits. Under this method, each insurer's
share is based on the ratio of its applicable
limit of insurance to the total applicable limits of
insurance of all insurers.
5. Premium Audit
a. We will compute all premiums for this Cover-
age Part in accordance with our rules and
rates.
b. Premium shown in this Coverage Part as ad-
vance premium is a deposit premium only. At
the close of each audit period we will compute
the earned premium for that period and send
notice to the first Named Insured. The due date
for audit and retrospective premiums is the
date shown as the due date on the bill. If the
sum of the advance and audit premiums paid
for the policy period is greater than the earned
premium, we will return the excess to the first
Named Insured.
c. The first Named Insured must keep records of
the information we need for premium computa-
tion, and send us copies at such times as we
may request.
6. Representations
By accepting this policy, you agree:
a. The statements in the Declarations are accu-
rate and complete;
b. Those statements are based upon representa-
tions you made to us; and
c. We have issued this policy in reliance upon
your representations.
7. Separation Of Insureds
Except with respect to the Limits of Insurance, and
any rights or duties specifically assigned in this
Coverage Part to the first Named Insured, this in-
surance applies:
a. As if each Named Insured were the only
Named Insured; and
b. Separately to each insured against whom claim
is made or "suit" is brought.
8. Transfer Of Rights Of Recovery Against Others
To Us
If the insured has rights to recover all or part of
any payment we have made under this Coverage
Part, those rights are transferred to us. The in-
sured must do nothing after loss to impair them. At
our request, the insured will bring "suit" or transfer
those rights to us and help us enforce them.
9. When We Do Not Renew
If we decide not to renew this Coverage Part, we
will mail or deliver to the first Named Insured
shown in the Declarations written notice of the
nonrenewal not less than 30 days before the expi-
ration date.
If notice is mailed, proof of mailing will be sufficient proof of notice.
SECTION V – DEFINITIONS
1. "Advertisement" means a not ice that is broadcast
or published to the general public or specific mar-
ket segments about your goods, products or ser-
vices for the purpose of attracting customers or
supporters. For the purposes of this definition:
a. Notices that are published include material
placed on the Internet or on similar electronic
means of communication; and
b. Regarding web-sites, only that part of a web-
site that is about your goods, products or ser-
vices for the purposes of attracting customers
or supporters is considered an advertisement.
2. "Auto" means:
a. A land motor vehicle, trailer or semitrailer de-
signed for travel on public roads, including any
attached machinery or equipment; or
b. Any other land vehicle that is subject to a com-
pulsory or financial resp onsibility law or other
motor vehicle insurance law in the state where
it is licensed or principally garaged.
However, "auto" does not include "mobile equip-
ment".
CG 00 01 12 07 © ISO Properties, Inc., 2006 Page 13 of 16
3. "Bodily injury" means bod ily injury, sickness or
disease sustained by a person, including death re-
sulting from any of these at any time.
4. "Coverage territory" means:
a. The United States of America (including its
territories and possessions), Puerto Rico and
Canada;
b. International waters or airspace, but only if the
injury or damage occurs in the course of travel
or transportation between any places included
in Paragraph a. above; or
c. All other parts of the world if the injury or dam-
age arises out of:
(1) Goods or products made or sold by you in
the territory described in Paragraph a.
above;
(2) The activities of a person whose home is in
the territory described in Paragraph a.
above, but is away for a short time on your
business; or
(3) "Personal and advertising injury" offenses
that take place through the Internet or simi-
lar electronic means of communication
provided the insured's re sponsibility to pay dam-
ages is determined in a "suit" on the merits, in the
territory described in Paragraph a. above or in a
settlement we agree to.
5. "Employee" includes a "leased worker". "Em-
ployee" does not include a "temporary worker".
6. "Executive officer" means a person holding any of
the officer positions created by your charter, con-
stitution, by-laws or any other similar governing
document.
7. "Hostile fire" means one which becomes uncon-
trollable or breaks out from where it was intended
to be.
8. "Impaired property" means tangible property, other
than "your product" or "your work", that cannot be
used or is less useful because:
a. It incorporates "your product" or "your work"
that is known or thought to be defective, defi-
cient, inadequate or dangerous; or
b. You have failed to fulfill the terms of a contract
or agreement;
if such property can be restored to use by the re-
pair, replacement, adjustment or removal of "your
product" or "your work" or your fulfilling the terms
of the contract or agreement.
9. "Insured contract" means:
a. A contract for a lease of premises. However,
that portion of the contract for a lease of prem-
ises that indemnifies any person or organiza-
tion for damage by fire to premises while
rented to you or temporarily occupied by you
with permission of the owner is not an "insured
contract";
b. A sidetrack agreement;
c. Any easement or license agreement, except in
connection with construction or demolition op-
erations on or within 50 feet of a railroad;
d. An obligation, as required by ordinance, to
indemnify a municipality, except in connection
with work for a municipality;
e. An elevator maintenance agreement;
f.
That part of any other contract or agreement
pertaining to your business (including an in-
demnification of a municipality in connection
with work performed for a municipality) under
which you assume the tort liability of another
party to pay for "bodily injury" or "property dam-
age" to a third person or organization. Tort li-
ability means a liability that would be imposed
by law in the absence of any contract or
agreement.
Paragraph f. does not include that part of any
contract or agreement:
(1) That indemnifies a railroad for "bodily injury"
or "property damage" arising out of con-
struction or demolition operations, within 50
feet of any railroad property and affecting
any railroad bridge or trestle, tracks, road-
beds, tunnel, underpass or crossing;
(2) That indemnifies an architect, engineer or
surveyor for injury or damage arising out of:
(a) Preparing, approving, or failing to pre-
pare or approve, maps, shop drawings,
opinions, reports, su rveys, field orders,
change orders or drawings and specifi-
cations; or
(b) Giving directions or instructions, or
failing to give them, if that is the primary
cause of the injury or damage; or
(3) Under which the insured, if an architect,
engineer or surveyor, assumes liability for
an injury or damage arising out of the in-
sured's rendering or failure to render pro-
fessional services, including those listed in
(2) above and supervisory, inspection, ar-
chitectural or engineering activities.
10. "Leased worker" means a person leased to you by
a labor leasing firm under an agreement between
you and the labor leasing firm, to perform duties
related to the conduct of your business. "Leased
worker" does not include a "temporary worker".
11. "Loading or unloading" means the handling of
property:
a. After it is moved from the place where it is
accepted for movement into or onto an aircraft,
watercraft or "auto";
b. While it is in or on an aircraft, watercraft or
"auto"; or
c. While it is being moved from an aircraft, water-
craft or "auto" to the place where it is finally de-
livered;
but "loading or unloading" does not include the
movement of property by means of a mechanical
device, other than a hand tr uck, that is not at-
tached to the aircraft, watercraft or "auto".
12. "Mobile equipment" means any of the following
types of land vehicles, including any attached ma-
chinery or equipment:
a. Bulldozers, farm machinery, forklifts and other
vehicles designed for use principally off public
roads;
b. Vehicles maintained for use solely on or next to
premises you own or rent;
c. Vehicles that travel on crawler treads;
d. Vehicles, whether self-propelled or not, main-
tained primarily to provide mobility to perma-
nently mounted:
(1) Power cranes, shovels, loaders, diggers or
drills; or
(2) Road construction or resurfacing equipment
such as graders, scrapers or rollers;
e. Vehicles not described in Paragraph a., b., c.
or d. above that are not self-propelled and are
maintained primarily to provide mobility to per-
manently attached equipment of the following
types:
(1) Air compressors, pumps and generators,
including spraying, welding, building clean-
ing, geophysical exploration, lighting and
well servicing equipment; or
(2) Cherry pickers and similar devices used to
raise or lower workers;
f. Vehicles not described in Paragraph a., b., c.
or d. above maintained primarily for purposes
other than the transportation of persons or
cargo.
However, self-propelled vehicles with the fol-
lowing types of permanently attached equip-
ment are not "mobile equipment" but will be
considered "autos":
(1) Equipment designed primarily for:
(a) Snow removal;
(b) Road maintenance, but not construction
or resurfacing; or
(c) Street cleaning;
(2) Cherry pickers and similar devices mounted
on automobile or truck chassis and used to
raise or lower workers; and
(3) Air compressors, pumps and generators,
including spraying, welding, building clean-
ing, geophysical exploration, lighting and
well servicing equipment.
However, "mobile equipment" does not include
any land vehicles that are subject to a compulsory
or financial responsibility law or other motor vehi-
cle insurance law in the st ate where it is licensed
or principally garaged. Land vehicles subject to a
compulsory or financial re sponsibility law or other
motor vehicle insurance law are considered
"autos".
13. "Occurrence" means an accident, including con-
tinuous or repeated exposure to substantially the
same general harmful conditions.
14. "Personal and advertising injury" means injury,
including consequential "bodily injury", arising out
of one or more of the following offenses:
a. False arrest, detention or imprisonment;
b. Malicious prosecution;
c. The wrongful eviction from, wrongful entry into,
or invasion of the right of private occupancy of
a room, dwelling or premises that a person oc-
cupies, committed by or on behalf of its owner,
landlord or lessor;
d. Oral or written publication, in any manner, of
material that slanders or libels a person or or-
ganization or disparages a person's or organi-
zation's goods, products or services;
e. Oral or written publication, in any manner, of
material that violates a person's right of pri-
vacy;
f. The use of another's advertising idea in your
"advertisement"; or
g. Infringing upon another's copyright, trade dress
or slogan in your "advertisement".
CG 00 01 12 07 © ISO Properties, Inc., 2006 Page 15 of 16
15. "Pollutants" mean any solid, liquid, gaseous or
thermal irritant or contaminant, including smoke,
vapor, soot, fumes, acids, alkalis, chemicals and
waste. Waste includes materials to be recycled,
reconditioned or reclaimed.
16. "Products-completed operations hazard":
a. Includes all "bodily injury" and "property dam-
age" occurring away from premises you own or
rent and arising out of "your product" or "your
work" except:
(1) Products that are still in your physical pos-
session; or
(2) Work that has not yet been completed or
abandoned. However, "your work" will be
deemed completed at the earliest of the fol-
lowing times:
(a) When all of the work called for in your
contract has been completed.
(b) When all of the work to be done at the
job site has been completed if your con-
tract calls for work at more than one job
site.
(c) When that part of the work done at a job
site has been put to its intended use by
any person or organization other than
another contractor or subcontractor
working on the same project.
Work that may need service, maintenance,
correction, repair or replacement, but which
is otherwise complete, will be treated as
completed.
b. Does not include "bodily injury" or "property
damage" arising out of:
(1) The transportation of property, unless the
injury or damage arises out of a condition in
or on a vehicle not owned or operated by
you, and that condition was created by the
"loading or unloading" of that vehicle by any
insured;
(2) The existence of tools, uninstalled equip-
ment or abandoned or unused materials; or
(3) Products or operations for which the classi-
fication, listed in the Declarations or in a
policy schedule, states that products-
completed operations are subject to the
General Aggregate Limit.
17. "Property damage" means:
a. Physical injury to tang ible property, including
all resulting loss of use of that property. All
such loss of use shall be deemed to occur at
the time of the physical injury that caused it; or
b. Loss of use of tangible property that is not
physically injured. All such loss of use shall be
deemed to occur at the time of the "occur-
rence" that caused it.
For the purposes of this insurance, electronic data
is not tangible property.
As used in this definition, electronic data means
information, facts or programs stored as or on,
created or used on, or transmitted to or from com-
puter software, including systems and applications
software, hard or floppy disks, CD-ROMS, tapes,
drives, cells, data proces sing devices or any other
media which are used with electronically controlled
equipment.
18. "Suit" means a civil proceeding in which damages
because of "bodily injury ", "property damage" or
"personal and advertising injury" to which this in-
surance applies are alleged. "Suit" includes:
a. An arbitration proceeding in which such dam-
ages are claimed and to which the insured
must submit or does submit with our consent;
or
b. Any other alternative dispute resolution pro-
ceeding in which such damages are claimed
and to which the insured submits with our con-
sent.
19. "Temporary worker" means a person who is fur-
nished to you to substitute for a permanent "em-
ployee" on leave or to meet seasonal or short-term
workload conditions.
20. "Volunteer worker" means a person who is not
your "employee", and who donates his or her work
and acts at the direction of and within the scope of
duties determined by you, and is not paid a fee,
salary or other compensation by you or anyone
else for their work performed for you.
21. "Your product":
a. Means:
(1) Any goods or products, other than real
property, manufactured, sold, handled, dis-
tributed or disposed of by:
(a) You;
(b) Others trading under your name; or
(c) A person or organization whose busi-
ness or assets you have acquired; and
(2) Containers (other than vehicles), materials,
parts or equipment furnished in connection
with such goods or products.
b. Includes:
(1) Warranties or representations made at any
time with respect to the fitness, quality, du-
rability, performance or use of "your prod-
uct"; and
6 © ISO Properties, Inc., 2006 CG 00 01 12 07
(2) The providing of or failure to provide warn-
ings or instructions.
c. Doe
s not include vending machines or othe r
prop
erty rented to or located for the use of oth-
ers but not sold.
22. "Your work":
a. Mean
s:
(1) Work or operations pe rformed by you or on
your behalf; and
(2) Materials, parts or equipment furnished in
connection with such work or operations.
b.
Includ
es:
(1) Warranties or representations made at any
time with respect to the fitness, quality, du-
rability, performance or use of "your work",
and
(2) The providing of or failure to provide warn-
ings or instructions.
Endorsements
Hiscox Insurance Company Inc.
Policy Number:
Named Insured:
Endorsement Number:
Endorsement Effective:
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CGL E5401 CW (03/10) Page 1 of 1
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
DEFINITION OF EMPLOYEE
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
In Section V – DEFINITIONS , Definition 5.
“Employee” is deleted and replaced with the
following:
5. “Employee” includes a “leased worker” and a
“temporary worker”.
P102.176.827.1
Healing Spot Counseling Center Inc.
1 07/28/2023
Hiscox Insurance Company Inc.
Policy Number:
Named Insured:
Endorsement Number:
Endorsement Effective:
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CGL E5403 CW (03/10) Page 1 of 1
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
NOTICE INFORMATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Where To Send Notice
Phone: 866-424-8508
Email: [email protected]
Mail: Hiscox
5 Concourse Parkway, Suite 2150
Attn: Direct Claims
Atlanta GA, 30328
Subparagraph 2. Duties In The Event Of Occur-
rence, Offense, Claim Or Suit in Section IV –
COMMERCIAL GENERAL LIABILITY CONDI-
TIONS is amended to include the following:
Any notification required by this policy shall be pro-
vided to us at the address listed in the above
SCHEDULE.
P102.176.827.1
Healing Spot Counseling Center Inc.
2 07/28/2023
Hiscox Insurance Company Inc.
Policy Number:
Named Insured:
Endorsement Number:
Endorsement Effective:
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CGL E5404 CW (03/10) Page 1 of 1
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
EXCLUSION – PERSONAL INFORMATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
Paragraph 2. Exclusions under Section I – COV-
ERAGE A – BODILY INJURY AND PROPERTY
DAMAGE LIABILITY, COVERAGE B – PERSONAL
AND ADVERTISING INJURY LIABILITY , and
COVERAGE C – MEDICAL PAYMENTS is
amended to include the following exclusion:
Personal Information
“Bodily injury”, “property damage” or “personal and
advertising injury” caused by the insured’s failure to
protect any non-public, personally identifiable infor-
mation in the insured’s care, custody or control.
P102.176.827.1
Healing Spot Counseling Center Inc.
3 07/28/2023
Hiscox Insurance Company Inc.
Policy Number:
Named Insured:
Endorsement Number:
Endorsement Effective:
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CGL E5407 CW (03/10) Page 1 of 1
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
EXCLUSION – PROFESSIONAL SERVICES
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
Paragraph 2. Exclusions under Section I –
COVERAGE A – BODILY INJURY AND PROPER-
TY DAMAGE LIABILITY , and COVERAGE B –
PERSONAL AND ADVERTISING INJURY
LIABILITY, is amended to include the following
exclusion:
Professional Services
“Bodily injury”, “property damage” or “personal and
advertising injury” caused by the rendering or failure
to render any professional service.
This exclusion applies even if the claims allege neg-
ligence or other wrongdoing in the supervision, hir-
ing, employment, training or monitoring of others by
an insured, if the “occurrence” which caused the
“bodily injury” or “property damage”, or the offense
which caused the “personal and advertising injury”,
involved the rendering or failure to render any pro-
fessional service.
P102.176.827.1
Healing Spot Counseling Center Inc.
4 07/28/2023
Hiscox Insurance Company Inc.
Policy Number:
Named Insured:
Endorsement Number:
Endorsement Effective:
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CGL E5408 CW (03/10) Page 1 of 1
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
CANCELLATION PROVISION
(14 DAY FULL REFUND)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
All Coverage Parts included in this policy are subject to the following condition:
Notwithstanding anything in the “COMMON POLICY
CONDITIONS” or any other cancellation provision to
the contrary, if the first Named Insured cancels
within 14 days of the inception of the policy period
shown in the Declarations without there having
been: (i) an “occurrence” that caused “bodily in-
jury” or “property damage”; (ii) an offense arising
out of your business that caused a “personal and
advertising injury”; or (iii) an accident that caused
“bodily injury”; then we shall return in full any pre-
mium amount actually paid to us. In such event,
the effective date of cancellation shall be deemed
to be the inception date of the policy period shown
in the Declarations.
P102.176.827.1
Healing Spot Counseling Center Inc.
5 07/28/2023
Hiscox Insurance Company Inc.
Policy Number:
Named Insured:
Endorsement Number:
Endorsement Effective:
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CGL E5409 CW (03/10) Page 1 of 1
RIGHT AND DUTY TO SELECT DEFENSE COUNSEL
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
In regard to any covered “suit” seeking damages
under Section I – COVERAGE A – BODILY IN-
JURY AND PROPERTY DAMAGE LIABILITY or
COVERAGE B – PERSONAL AND ADVERTISING
INJURY LIABILITY , our right and duty to defend
shall include the right to select defense counsel.
P102.176.827.1
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6 07/28/2023
Hiscox Insurance Company Inc.
Policy Number:
Named Insured:
Endorsement Number:
Endorsement Effective:
THIS ENDORSEMENT CHANGES THE POLICY. PL EASE READ IT CAREFULLY.
CGL E5421 CW (02/14) Includes copyrighted material of Insurance Services Office, Inc., with its permission.
ADDITIONAL INSURED – AUTOMATIC STATUS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
A. Section II – Who Is An Insured is amended
to include as an additional insured any per-
son(s) or organization(s) for whom you are
performing operations or leasing a premises
when you and such person(s) or organiz a-
tion(s) have agreed in writing in a contract or
agreement that such person(s) or organiz a-
tion(s) be added as an additional insured on
your policy. Such person or organization is
an additional insured only with respect to li a-
bility for "bodily injury", "property damage" or
"personal and advertising injury" caused, in
whole or in part , by your acts or omissions or
the acts or omissions of those acting on your
behalf:
1. In the performance of your ongoing oper a-
tions; or
2. In connection with your premises owned by or
rented to you.
A person's or organization's status as an add i-
tional insured under this endorsement ends
when your operations or lease agreement for
that additional insured are completed.
P102.176.827.1
Healing Spot Counseling Center Inc.
7 07/28/2023
Hiscox Insurance Company Inc.
Policy Number:
Named Insured:
Endorsement Number:
Endorsement Effective:
IL 00 17 11 98 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 2
COMMON POLICY CONDITIONS
All Coverage Parts included in this policy are subject to the following conditions.
A. Cancellation
1. The first Named Insured shown in the Declar a-
tions may cancel this policy by mailing or del i-
vering to us advance written notice of cancella-
tion.
2. We may cancel this policy by mailing or deliver-
ing to the first Named Insured written notice of
cancellation at least:
a. 10 days before the effective date of cance l-
lation if we cancel for nonpayment of pr e-
mium; or
b. 30 days before the effective date of cance l-
lation if we cancel for any other reason.
3. We will mail or deliver our notice to the first
Named Insured's last mailing address known to
us.
4. Notice of cancellation will state the effective
date of cancellation . The policy period will end
on that date.
5. If this policy is cancelled, we will send the first
Named Insured any premium refund due. If we
cancel, the refund will be pro rata. If the first
Named Insured cancels, the refund may be
less than pro rata. T he cancellation will be e f-
fective even if we have not made or offered a
refund.
6. If notice is mailed, proof of mailing will be suff i- cient proof of notice.
B. Changes
This policy contains all the agreements between
you and us concerning the insurance afforded.
The first Named Insured shown in the Declar ations
is authorized to make changes in the terms of this
policy with our consent. This policy's terms can be
amended or waived only by endorsement issued
by us and made a part of this policy.
C. Examination Of Your Books And Records
We may examine and audit your books and
records as they relate to this policy at any time dur-
ing the policy period and up to three years afte r-
ward.
D. Inspections And Surveys
1. We have the right to:
a. Make inspections and surveys at any time;
b. Give you reports on the conditions we find;
and
c. Recommend changes.
2. We are not obligated to make any inspections,
surveys, reports or recommendations and any
such actions we do undertake relate only to i n-
surability and the premiums to be charged. We
do not make safety inspections. We do not u n-
dertake to perform the duty of any person or
organization to provide for the health or safety
of workers or the public. And we do not warrant
that conditions:
a. Are safe or healthful; or
b. Comply with laws, regulations, codes or
standards.
3. Paragraphs 1. and 2. of this condition apply not
only to us, but also to any rating, advisory, rate
service or similar organization which makes i n-
surance inspections, surveys, re ports or re c-
ommendations.
4. Paragraph 2. of this condition does not apply to
any inspections, surveys, reports or reco m-
mendations we may make relative to certific a-
tion, under state or municipal statutes, ord in-
ances or regulations, of boilers, pressure v es-
sels or elevators.
E. Premiums
The first Named Insured shown in the Declar a-
tions:
1. Is responsible for the payment of all premiums;
and
2. Will be the payee for any return premiums we
pay.
P102.176.827.1
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8 07/28/2023
F. Transfer Of Your Rights And Duties Under This
Policy
Your rights and duties under this policy may not be
transferred without our written consent except in
the case of death of an individual named insured.
If you die, your rights and duties will be tran sferred to your legal representative but only while ac ting
within the scope of duties as your legal representa-
tive. Until your legal representative is appointed,
anyone having proper temporary custody of your
property will have your rights and duties but only
with respect to that property.
Hiscox Insurance Company Inc.
Policy Number:
Named Insured:
Endorsement Number:
Endorsement Effective:
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
IL 00 21 09 08 © ISO Properties, Inc., 2007 Page 1 of 2
NUCLEAR ENERGY LIABILITY EXCLUSION
ENDORSEMENT
(Broad Form)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
1. The insurance does not apply:
A. Under any Liability Coverage, to "bodily injury"
or "property damage":
(1) With respect to which an "insured" under
the policy is also an insured under a nuc-
lear energy liability policy issued by Nuclear
Energy Liability Insurance Association, Mu-
tual Atomic Energy Liability Underwriters,
Nuclear Insurance Association of Canada
or any of their successors, or would be an
insured under any such policy but for its
termination upon exhaustion of its limit of
liability; or
(2) Resulting from the "hazardous properties"
of "nuclear material" and with respect to
which (a) any person or organization is re-
quired to maintain financial protection pur-
suant to the Atomic Energy Act of 1954, or
any law amendatory thereof, or (b) the "in-
sured" is, or had this policy not been issued
would be, entitled to indemnity from the
United States of America, or any agency
thereof, under any agreement entered into
by the United States of America, or any
agency thereof, with any person or organi-
zation.
B. Under any Medical Payments coverage, to
expenses incurred with respect to "bodily in-
jury" resulting from the "hazardous properties"
of "nuclear material" and arising out of the op-
eration of a "nuclear facility" by any person or
organization.
C. Under any Liability Coverage, to "bodily injury"
or "property damage" resulting from "hazard-
ous properties" of "nuclear material", if:
(1) The "nuclear material" (a) is at any "nuclear
facility" owned by, or operated by or on be-
half of, an "insured" or (b) has been dis-
charged or dispersed therefrom;
(2) The "nuclear material" is contained in
"spent fuel" or "waste" at any time pos-
sessed, handled, used, processed, stored,
transported or disposed of, by or on behalf
of an "insured"; or
(3) The "bodily injury" or "property damage"
arises out of the furnishing by an "insured"
of services, materials, parts or equipment in
connection with the planning, construction,
maintenance, operation or use of any "nuc-
lear facility", but if such facility is located
within the United States of America, its terri-
tories or possessions or Canada, this ex-
clusion (3) applies only to "property dam-
age" to such "nuclear facility" and any
property thereat.
2. As used in this endorsement:
P102.176.827.1
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9 07/28/2023
"Hazardous properties" includes radioactive, toxic
or explosive properties.
"Nuclear material" means "source material", "spe-
cial nuclear material" or "by-product material".
"Source material", "special nuclear material", and
"by-product material" have the meanings given
them in the Atomic Energy Act of 1954 or in any
law amendatory thereof.
"Spent fuel" means any fuel element or fuel com-
ponent, solid or liquid, which has been used or ex-
posed to radiation in a "nuclear reactor".
"Waste" means any waste material (a) containing
"by-product material" other than the tailings or
wastes produced by the extraction or concentra-
tion of uranium or thorium from any ore processed
primarily for its "source material" content, and (b)
resulting from the operation by any person or or-
ganization of any "nuclear facility" included under
the first two paragraphs of the definition of "nuc-
lear facility".
"Nuclear facility" means:
(a) Any "nuclear reactor";
(b) Any equipment or device designed or used
for (1) separating the isotopes of uranium or
plutonium, (2) processing or utilizing "spent
fuel", or (3) handling, processing or packag-
ing "waste";
(c) Any equipment or device used for the
processing, fabricating or alloying of "spe-
cial nuclear material" if at any time the total
amount of such material in the custody of
the "insured" at the premises where such
equipment or device is located consists of
or contains more than 25 grams of pluto-
nium or uranium 233 or any combination
thereof, or more than 250 grams of uranium
235;
(d) Any structure, basin, excavation, premises
or place prepared or used for the storage or
disposal of "waste";
and includes the site on which any of the foregoing
is located, all operations conducted on such site
and all premises used for such operations.
"Nuclear reactor" means any apparatus designed
or used to sustain nuclear fission in a self-
supporting chain reaction or to contain a critical
mass of fissionable material.
"Property damage" includes all forms of radioac-
tive contamination of property.
Hiscox Insurance Company Inc.
Policy Number:
Named Insured:
Endorsement Number:
Endorsement Effective:
CG 00 68 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1
RECORDING AND DISTRIBUTION OF MATERIAL OR
INFORMATION IN VIOLATION OF LAW EXCLUSION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
A. Exclusion q. of Paragraph 2. Exclusions of Sec-
tion I – Coverage A – Bodily Injury And Proper-
ty Damage Liability is replaced by the following:
2. Exclusions
This insurance does not apply to:
q. Recording And Distribution Of Material
Or Information In Violation Of Law
"Bodily injury" or "property damage" arising
directly or indirectly out of any action or
omission that violates or is alleged to vi-
olate:
(1) The Telephone Consumer Protection
Act (TCPA), including any amendment
of or addition to such law;
(2) The CAN-SPAM Act of 2003, including
any amendment of or addition to such
law;
(3) The Fair Credit Reporting Act (FCRA),
and any amendment of or addition to
such law, including the Fair and Accu-
rate Credit Transaction Act (FACTA); or
(4) Any federal, state or local statute, ordin-
ance or regulation, other than the TCPA,
CAN-SPAM Act of 2003 or FCRA and
their amendments and additions, that
addresses, prohibits, or limits the print-
ing, dissemination, disposal, collecting,
recording, sending, transmitting, com-
municating or distribution of material or
information.
B. Exclusion p. of Paragraph 2. Exclusions of Sec-
tion I – Coverage B – Personal And Advertising
Injury Liability is replaced by the following:
2. Exclusions
This insurance does not apply to:
p. Recording And Distribution Of Material
Or Information In Violation Of Law
"Personal and advertising injury" arising di-
rectly or indirectly out of any action or omis-
sion that violates or is alleged to violate:
(1) The Telephone Consumer Protection
Act (TCPA), including any amendment
of or addition to such law;
(2) The CAN-SPAM Act of 2003, including
any amendment of or addition to such
law;
(3) The Fair Credit Reporting Act (FCRA),
and any amendment of or addition to
such law, including the Fair and Accu-
rate Credit Transaction Act (FACTA); or
(4) Any federal, state or local statute, ordin-
ance or regulation, other than the TCPA,
CAN-SPAM Act of 2003 or FCRA and
their amendments and additions, that
addresses, prohibits, or limits the print-
ing, dissemination, disposal, collecting,
recording, sending, transmitting, com-
municating or distribution of material or
information.
P102.176.827.1
Healing Spot Counseling Center Inc.
10 07/28/2023
Hiscox Insurance Company Inc.
Policy Number:
Named Insured:
Endorsement Number:
Endorsement Effective:
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CG 21 41 11 85 Copyright, Insurance Services Office, Inc., 1984 Page 1 of 1 EXCLUSION – INTERCOMPANY PRODUCTS SUITS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
This insurance does not apply to any claim for dam-
ages by any Named Insured against another Named
Insured because of "bodily injury" or "property dam-
age" arising out of "your products" and included
within the "products-completed operations hazard."
P102.176.827.1
Healing Spot Counseling Center Inc.
11 07/28/2023
Hiscox Insurance Company Inc.
Policy Number:
Named Insured:
Endorsement Number:
Endorsement Effective:
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CG 21 46 07 98 Copyright, Insurance Services Office, Inc., 1997 Page 1 of 1
ABUSE OR MOLESTATION EXCLUSION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
The following exclusion is added to Paragraph 2.,
Exclusions of Section I – Coverage A – Bodily
Injury And Property Damage Liability and Para-
graph 2., Exclusions of Section I – Coverage B –
Personal And Advertising Injury Liability:
This insurance does not apply to "bodily injury",
"property damage" or "personal and advertising
injury" arising out of:
1. The actual or threatened abuse or molestation by
anyone of any person while in the care, custody
or control of any insured, or
2. The negligent:
a. Employment;
b. Investigation;
c. Supervision;
d. Reporting to the proper authorities, or failure
to so report; or
e. Retention;
of a person for whom any insured is or ever was
legally responsible and whose conduct would be
excluded by Paragraph 1. above.
P102.176.827.1
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Hiscox Insurance Company Inc.
Policy Number:
Named Insured:
Endorsement Number:
Endorsement Effective:
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CG 22 44 07 98 Copyright, Insurance Services Office, Inc., 1997 Page 1 of 1
EXCLUSION – SERVICES FURNISHED BY
HEALTH CARE PROVIDERS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Description Of Operations:
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.)
The following exclusion is added to Paragraph 2.,
Exclusions of Section I – Coverage A – Bodily
Injury And Property Damage Liability and Para-
graph 2., Exclusions of Section I – Coverage B –
Personal And Advertising Injury Liability:
With respect to any operation shown in the Schedule,
this insurance does not apply to "bodily injury", "prop- erty damage" or "personal and advertising injury"
arising out of:
1. The rendering or failure to render:
a. Medical, surgical, dental, x-ray or nursing ser-
vice, treatment, advice or instruction, or the re-
lated furnishing of food or beverages;
b. Any health or therapeutic service, treatment,
advice or instruction; or
c. Any service, treatment, advice or instruction for
the purpose of appearance or skin enhance-
ment, hair removal or replacement or personal
grooming.
2. The furnishing or dispensing of drugs or medical,
dental or surgical supplies or appliances; or
3. The handling or treatment of dead bodies, includ-
ing autopsies, organ donation or other procedures.
P102.176.827.1
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13 07/28/2023
Social work services
Hiscox Insurance Company Inc.
Policy Number:
Named Insured:
Endorsement Number:
Endorsement Effective:
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CG 21 57 07 98 Copyright, Insurance Services Office, Inc., 1997 Page 1 of 1
EXCLUSION – COUNSELING SERVICES
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
The following exclusion is added to Paragraph 2.,
Exclusions of Section I – Coverage A – Bodily
Injury And Property Damage Liability and Para-
graph 2., Exclusions of Section I – Coverage B –
Personal And Advertising Injury Liability:
This insurance does not apply to "bodily injury",
"property damage" or "personal and advertising
injury" arising out of advisory services or counseling
with respect to such issues as mental health, crisis
prevention, social services or drug and alcohol re-
habilitation or similar subjects.
P102.176.827.1
Healing Spot Counseling Center Inc.
14 07/28/2023
Hiscox Insurance Company Inc.
Policy Number:
Named Insured:
Endorsement Number:
Endorsement Effective:
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
IL 02 70 09 08 © ISO Properties, Inc., 2007 Page 1 of 4 CALIFORNIA CHANGES – CANCELLATION
AND NONRENEWAL
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
A. Paragraphs 2. and 3. of the Cancellation Com-
mon Policy Condition are replaced by the follow-
ing:
2. All Policies In Effect For 60 Days Or Less
If this policy has been in effect for 60 days or
less, and is not a renewal of a policy we have
previously issued, we may cancel this policy by
mailing or delivering to the first Named Insured
at the mailing address shown in the policy and
to the producer of record, advance written no-
tice of cancellation, stating the reason for can-
cellation, at least:
a. 10 days before the effective date of cancel-
lation if we cancel for:
(1) Nonpayment of premium; or
(2) Discovery of fraud by:
(a) Any insured or his or her representa-
tive in obtaining this insurance; or
(b) You or your representative in pur-
suing a claim under this policy.
b. 30 days before the effective date of cancel-
lation if we cancel for any other reason.
3. All Policies In Effect For More Than 60 Days
a. If this policy has been in effect for more
than 60 days, or is a renewal of a policy we
issued, we may cancel this policy only upon
the occurrence, after the effective date of
the policy, of one or more of the following:
(1) Nonpayment of premium, including
payment due on a prior policy we issued
and due during the current policy term
covering the same risks.
(2) Discovery of fraud or material misrepre-
sentation by:
(a) Any insured or his or her representa-
tive in obtaining this insurance; or
(b) You or your representative in pur-
suing a claim under this policy.
(3) A judgment by a court or an administra-
tive tribunal that you have violated a
California or Federal law, having as one
of its necessary elements an act which
materially increases any of the risks in-
sured against.
P102.176.827.1
Healing Spot Counseling Center Inc.
15 07/28/2023
(4) Discovery of willful or grossly negligent
acts or omissions, or of any violations of
state laws or regulations establishing
safety standards, by you or your repre-
sentative, which materially increase any
of the risks insured against.
(5) Failure by you or your representative to
implement reasonable loss control re-
quirements, agreed to by you as a con-
dition of policy issuance, or which were
conditions precedent to our use of a par-
ticular rate or rating plan, if that failure
materially increases any of the risks in-
sured against.
(6) A determination by the Commissioner of
Insurance that the:
(a) Loss of, or changes in, our reinsur-
ance covering all or part of the risk
would threaten our financial integrity
or solvency; or
(b) Continuation of the policy coverage
would:
(i) Place us in violation of California
law or the laws of the state where
we are domiciled; or
(ii) Threaten our solvency.
(7) A change by you or your representative
in the activities or property of the com-
mercial or industrial enterprise, which
results in a materially added, increased
or changed risk, unless the added, in-
creased or changed risk is included in
the policy.
b. We will mail or deliver advance written
notice of cancellation, stating the reason for
cancellation, to the first Named Insured, at
the mailing address shown in the policy,
and to the producer of record, at least:
(1) 10 days before the effective date of
cancellation if we cancel for nonpay-
ment of premium or discovery of fraud;
or
(2) 30 days before the effective date of
cancellation if we cancel for any other
reason listed in Paragraph 3.a.
B. The following provision is added to the Cancella-
tion Common Policy Condition:
7. Residential Property
This provision applies to coverage on real
property which is used predominantly for resi-
dential purposes and consisting of not more
than four dwelling units, and to coverage on
tenants' household personal property in a resi-
dential unit, if such coverage is written under
one of the following:
Commercial Property Coverage Part
Farm Coverage Part – Farm Property – Farm
Dwellings, Appurtenant Structures And House-
hold Personal Property Coverage Form
a. If such coverage has been in effect for 60
days or less, and is not a renewal of cover-
age we previously issued, we may cancel
this coverage for any reason, except as
provided in b. and c. below.
b. We may not cancel this policy solely be-
cause the first Named Insured has:
(1) Accepted an offer of earthquake cover-
age; or
(2) Cancelled or did not renew a policy
issued by the California Earthquake Au-
thority (CEA) that included an earth-
quake policy premium surcharge.
However, we shall cancel this policy if the
first Named Insured has accepted a new or
renewal policy issued by the CEA that in-
cludes an earthquake policy premium sur-
charge but fails to pay the earthquake poli-
cy premium surcharge authorized by the
CEA.
c. We may not cancel such coverage solely
because corrosive soil conditions exist on
the premises. This Restriction (c.) applies
only if coverage is subject to one of the fol-
lowing, which exclude loss or damage
caused by or resulting from corrosive soil
conditions:
(1) Capital Assets Program Coverage Form
(Output Policy);
(2) Commercial Property Coverage Part –
Causes Of Loss – Special Form; or
(3) Farm Coverage Part – Causes Of Loss
Form – Farm Property, Paragraph D.
Covered Causes Of Loss – Special.
IL 02 70 09 08 © ISO Properties, Inc., 2007 Page 3 of 4 C. The following is added and supersedes any provi-
sions to the contrary:
NONRENEWAL
1. Subject to the provisions of Paragraphs C.2.
and C.3. below, if we elect not to renew this
policy, we will mail or deliver written notice stat-
ing the reason for nonrenewal to the first
Named Insured shown in the Declarations and
to the producer of record, at least 60 days, but
not more than 120 days, before the expiration
or anniversary date.
We will mail or deliver our notice to the first
Named Insured, and to the producer of record,
at the mailing address shown in the policy.
2. Residential Property
This provision applies to coverage on real
property used predominantly for residential
purposes and consisting of not more than four
dwelling units, and to coverage on tenants'
household property contained in a residential
unit, if such coverage is written under one of
the following:
Capital Assets Program (Output Policy) Cover-
age Part
Commercial Property Coverage Part
Farm Coverage Part – Farm Property – Farm
Dwellings, Appurtenant Structures And House-
hold Personal Property Coverage Form
a. We may elect not to renew such coverage
for any reason, except as provided in b., c.
and d. below:
b. We will not refuse to renew such coverage
solely because the first Named Insured has
accepted an offer of earthquake coverage.
However, the following applies only to in-
surers who are associate participating in-
surers as established by Cal. Ins. Code
Section 10089.16. We may elect not to re-
new such coverage after the first Named
Insured has accepted an offer of earth-
quake coverage, if one or more of the fol-
lowing reasons applies:
(1) The nonrenewal is based on sound
underwriting principles that relate to the
coverages provided by this policy and
that are consistent with the approved
rating plan and related documents filed
with the Department of Insurance as re-
quired by existing law;
(2) The Commissioner of Insurance finds
that the exposure to potential losses will
threaten our solvency or place us in a
hazardous condition. A hazardous con-
dition includes, but is not limited to, a
condition in which we make claims
payments for losses resulting from an
earthquake that occurred within the pre-
ceding two years and that required a re-
duction in policyholder surplus of at
least 25% for payment of those claims;
or
(3) We have:
(a) Lost or experienced a substantial
reduction in the availability or scope
of reinsurance coverage; or
(b) Experienced a substantial increase
in the premium charged for reinsur-
ance coverage of our residential
property insurance policies; and
the Commissioner has approved a plan
for the nonrenewals that is fair and
equitable, and that is responsive to the
changes in our reinsurance position.
c. We will not refuse to renew such coverage
solely because the first Named Insured has
cancelled or did not renew a policy, issued
by the California Earthquake Authority that
included an earthquake policy premium
surcharge.
d. We will not refuse to renew such coverage
solely because corrosive soil conditions ex-
ist on the premises. This Restriction (d.)
applies only if coverage is subject to one of
the following, which exclude loss or dam-
age caused by or resulting from corrosive
soil conditions:
(1) Capital Assets Program Coverage Form
(Output Policy);
(2) Commercial Property Coverage Part –
Causes Of Loss – Special Form; or
(3) Farm Coverage Part – Causes Of Loss
Form – Farm Property, Paragraph D.
Covered Causes Of Loss – Special.
3. We are not required to send notice of nonre-
newal in the following situations:
a. If the transfer or renewal of a policy, without
any changes in terms, conditions, or rates,
is between us and a member of our insur-
ance group.
b. If the policy has been extended for 90 days
or less, provided that notice has been given
in accordance with Paragraph C.1.
c. If you have obtained replacement coverage,
or if the first Named Insured has agreed, in
writing, within 60 days of the termination of
the policy, to obtain that coverage.
d. If the policy is for a period of no more than
60 days and you are notified at the time of
issuance that it will not be renewed.
e. If the first Named Insured requests a
change in the terms or conditions or risks
covered by the policy within 60 days of the
end of the policy period.
f. If we have made a written offer to the first
Named Insured, in accordance with the
timeframes shown in Paragraph C.1., to re-
new the policy under changed terms or
conditions or at an increased premium rate,
when the increase exceeds 25%.
Hiscox Insurance Company Inc.
Policy Number:
Named Insured:
Endorsement Number:
Endorsement Effective:
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CG 32 34 01 05 © ISO Properties, Inc., 2004 Page 1 of 1
CALIFORNIA CHANGES
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
The term "spouse" is replaced by the following:
Spouse or registered domestic partner under Califor-
nia law.
P102.176.827.1
Healing Spot Counseling Center Inc.
16 07/28/2023
Hiscox Insurance Company Inc.
Policy Number:
Named Insured:
Endorsement Number:
Endorsement Effective:
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CGL E5402 CW (03/10) Page 1 of 1
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
MODIFIED WAIVER OF TRANSFER OF RIGHTS OF
RECOVERY AGAINST OTHERS TO US
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
The following is added to Paragraph 8. Transfer Of
Rights Of Recovery Against Others To Us of
Section IV – Conditions:
You may waive your rights against another party so
long as you do so in writing prior to: (i) an offense
arising out of your business that caused a “personal
and advertising injury”; or (ii) an “occurrence” that
caused “bodily injury” or “property damage”.
P102.176.827.1
Healing Spot Counseling Center Inc.
17 07/28/2023
Hiscox Insurance Company Inc.
Policy Number:
Named Insured:
Endorsement Number:
Endorsement Effective:
THIS ENDORSEMENT CHANGES THE POLICY. PL EASE READ IT CAREFULLY.
CG 21 73 01 15 © Insurance Services Office, Inc., 2014 Page 1 of 1
EXCLUSION OF CERTIFIED ACTS OF TERRORISM
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
A. The following exclusion is added:
This insurance does not apply to:
TERRORISM
"Any injury or damage " arising, directly or indirec t- ly, out of a "certified act of terrorism".
B. The following definitions are added:
1. For the purposes of this endorsement, "any
injury or damage" means any injury or damage
covered under any Coverage Part to which this
endorsement is applicable, and includes but is
not limited to "bodily injury", "property da m-
age", "personal and advertising injury", "injury"
or "environmental damage" as may be defined
in any applicable Coverage Part.
2. "Certified act of terrorism" means an act that is
certified by the Secretary of the Treasury, in
accordance with the provisions of the fe deral
Terrorism Risk Insu rance Act, to be an act of
terrorism pu rsuant to such Act. The criteria
contained in the Terrorism Risk Insurance Act
for a "cert ified act of terrorism" include the fo l-
lowing:
a. The act resulted in insured losses in excess
of $5 million in the aggregate, attributable to
all types of insurance subject to the Terro r-
ism Risk Insurance Act; and
b. The act is a violent act or an act that is
dangerous to human life, property or infr a-
structure and is committed by an individual
or individuals as part of an effort to coerce
the civilian population of the United States
or to influence the policy or affect the co n-
duct of the United States Government by
coercion.
C. The terms and limitations of any terrorism excl u-
sion, or the inapplicability or omission of a terro r-
ism exclusion, do not serve to create coverage for
injury or damage that is otherwise excluded u nder
this Coverage Part.
P102.176.827.1
Healing Spot Counseling Center Inc.
18 07/28/2023
Hiscox Insurance Company Inc.
Policy Number:
Named Insured:
Endorsement Number:
Endorsement Effective:
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
Includes copyrighted material of Insurance
CGL E1954 CW (05/20) Services Offices, Inc., with its permission Page 1 of 1
EXCLUSION - ASBESTOS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
The following exclusion is added to both SECTION I – COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, 2. Exclusions, and SECTION I – COVERAGES, COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY, 2. Exclusions:
AS-A. Asbestos “Bodily injury”, “property damage”, or “personal and advertising injury” based upon or arising out of any actual or alleged:
(1) mining, processing, manufacturing, use, testing, ownership, sale, or removal of asbestos, asbestos fibers, or material containing asbestos; (2) exposure to asbestos, asbestos fibers, or materials containing asbestos; or
(3) provision of instructions, recommendations, notices, warnings, supervision, or advice given, or which should have been given, in connection with asbestos, asbestos fibers, or structures or materials containing asbestos.
P102.176.827.1
Healing Spot Counseling Center Inc.
19 07/28/2023
Hiscox Insurance Company Inc.
Policy Number:
Named Insured:
Endorsement Number:
Endorsement Effective:
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
Includes copyrighted material of Insurance
CGL E1975 CW (05/20) Services Offices, Inc., with its permission. Page 1 of 1
LIMITATION OF COVERAGE TO BUSINESS OPERATIONS
DESCRIPTION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
I. SECTION I – COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, 1.
Insuring Agreement, b. is deleted in its entirety and replaced with the following:
b. This insurance applies to “bodily injury” and “property damage” only if:
(1) the “bodily injury” or “property damage” is caused by an “occurrence” that takes place in the “coverage territory”;
(2) the “bodily injury” or “property damage” occurs during the policy period; (3) prior to the policy period, no insured listed under Paragraph 1. of Section II – Who is an Insured and no “employee” authorized by you to give or receive notice of an “occurrence” or claim, knew that the “bodily injury” or “property damage” had occurred, in whole or in part. If such a listed insured or authorized “employee” knew, prior to the policy period, that the “bodily injury” or “property damage” occurred, then any continuation, change, or resumption of such “bodily injury” or “property damage” during or after the policy period will be deemed to have been known prior to the policy period; and (4) the “bodily injury” or “property damage” is caused by or results from the performance of the specified business operations described in the insured’s application for this policy during the policy period.
II. SECTION I – COVERAGES, COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY, 1. Insuring Agreement, b. is deleted in its entirety and replaced with the following:
b. This insurance applies to “personal and advertising injury” caused by an offense arising out of your business but only if:
(1) the offense was committed in the “coverage territory” during the policy period; and (2) the “personal and advertising injury” is caused by or results from the performance of the specified business operations described in the insured’s application for this policy during the policy period.
P102.176.827.1
Healing Spot Counseling Center Inc.
20 07/28/2023
Hiscox Insurance Company Inc.
Policy Number:
Named Insured:
Endorsement Number:
Endorsement Effective:
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CG 21 32 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1
COMMUNICABLE DISEASE EXCLUSION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
A. The following exclusion is added to Par agraph 2.
Exclusions of Section I – Coverage A – Bodily
Injury And Property Damage Liability:
2. Exclusions
This insurance does not apply to:
Communicable Disease
"Bodily injury" or "property damage" arising out
of the actual or alleged transmission of a co m-
municable disease.
This exclusion applies even if the claims
against any insured allege negligence or other
wrongdoing in the:
a. Supervising, hiring, employ ing, trai ning or
monitoring of others that may be infected
with and spread a communicable disease;
b. Testing for a communicable disease;
c. Failure to prevent the spread of the di s-
ease; or
d. Failure to report the disease to authorities.
B. The following exclusion is added to Paragraph 2.
Exclusions of Section I – Coverage B – Person-
al And Advertising Injury Liability:
2. Exclusions
This insurance does not apply to:
Communicable Disease
"Personal and advertising injury " arising out of
the actual or alleged transmission of a co m-
municable disease.
This exclusion applies even if the claims
against any insured allege negligence or other
wrongdoing in the:
a. Supervising, hiring, employ ing, trai ning or
monitoring of others that may be infected
with and spread a communicable disease;
b. Testing for a communicable disease;
c. Failure to prevent the spread of the di s-
ease; or
d. Failure to report the disease to authorities.
P102.176.827.1
Healing Spot Counseling Center Inc.
21 07/28/2023
Notices
Policyholder Notice
Electronic Delivery
INT N003 CW (01/19)
If you received your insurance policy by email, it is because you have chosen electronic delivery of your policy documents and important notices, including cancellation and nonrenewal notices where permitted by law. We also will send any renewal policy documents to you by email at the address you have provided.
If you are currently receiving paper documents and would like to have ease of retrieval and access and save on storage space, you will need to contact us and update your preferences. Most documents can be sent electronically within minutes. For electronic documents, you will need a computer or mobile device with Internet access and the ability to receive external emails. You also will need software such as Adobe Reader® that allows you to view and save PDF documents, and a printer to create paper copies.
At any time you may request a paper copy of your policy, or you may withdraw your consent to receive documents by email. We will then send documents to you by US mail at no added cost.
You must notify us if your email or street address changes. To update your email or street address, or to request paper documents, please contact us at 888-202-3007.
Hiscox Insurance Company Inc.
ECONOMIC AND TRADE SANCTIONS POLICYHOLDER NOTICE
INT N001 CW 01 09 Page 1 of 1
Hiscox is committed to complying with the U.S. Department of Treasury Office of Foreign Assets Control (OFAC) requirements. OFAC administers and enforces economic sanctions policy based on Presidential declarations of national emergency. OFAC has identified and listed numerous foreign agents, front organizations, terrorists, and narcotics traffickers as Specially Designated Nationals (SDN’s) and Blocked Persons. OFAC has also identified Sanctioned Countries. A list of Specially Designated Nationals, Blocked Persons and Sanctioned Countries may be found on the United States Treasury’s web site http://www.treas.gov/offices/enforcement/ofac/.
Economic sanctions prohibit all United States citizens (including corporations and other entities) and permanent resident aliens from engaging in transactions with Specially Designated Nationals, Blocked Persons and Sanctioned Countries. Hiscox may not accept premium from or issue a policy to insure property of or make a claim payment to a Specially Designated National or Blocked Person. Hiscox may not engage in business transactions with a Sanctioned Country.
A Specially Designated National or Blocked Person is any person who is determined as such by the Secretary of Treasury.
A Sanctioned Country is any country that is the subject of trade or economic embargoes imposed by the laws or regulations of the United States.
In accordance with laws and regulations of the United States concerning economic and trade embargoes, this policy may be rendered void from its inception with respect to any term or condition of this policy that violates any laws or regulations of the United States concerning economic and trade embargoes including, but not limited to the following:
(1) Any insured under this Policy, or any person or entity claiming the benefits of such insured, who is or becomes a Specially Designated National or Blocked Person or who is otherwise subject to US economic trade sanctions;
(2) Any claim or suit that is brought in a Sanction ed Country or by a Sanctioned Country government, where any action in connection with such claim or suit is prohibited by US economic or trade sanctions;
(3) Any claim or suit that is brought by any Specia lly Designated National or Blocked Person or any person or entity who is otherwise subject to US economic or trade sanctions;
(4) Property that is located in a Sanctioned Countr y or that is owned by, rented to or in the care, custody or control of a Sanctioned Country government, where any activities related to such property are prohibited by US economic or trade sanctions; or
(5) Property that is owned by, rented to or in the care, custody or control of a Specially Designated National or Blocked Person, or any person or entity who is otherwise subject to US economic or trade sanctions.
Please read your Policy carefully and discuss with your broker/agent or insurance professional. You may also visit the US Treasury’s website at
http://www.treas.gov/offices/enforcement/ofac/ .
Application Summary
Hiscox Insurance Company Inc.
Application Summary
© Hiscox Inc. 2010 Page 1
The following outlines the details you have given us about your business. We have relied on the accuracy of this information in order to issue your policy. If any of the items below are incorrect or have changed, please call us at so that we can update your policy details.
Your policy
Policy number: P102.176.827.1
Quote reference number: Q102.176.827.001
Product: Commercial General Liability
Business name: Healing Spot Counseling Center Inc.
Business address: 5065 Deer Valley Road
City: Antioch
State: CA
Zip code: 94531
County: Contra Costa
Name: Miya Moore-Felton
Email address: [email protected]
Telephone number: 925-434-8506
Per occurrence limit of liability: $2,000,000
Aggregate limit of liability: $2,000,000
Deductible: $0
Revenue: $65,000
When would you like your policy to start? July 28, 2023 Locations
Covered Location 1: 5065 Deer Valley Road
Antioch
CA
94531
Revenue: $65,000
Sq footage: 1,400
Hiscox Insurance Company Inc.
© Hiscox Inc. 2010 Page 2
Your business
Class of Business: Social work services
Your business's ownership structure Not for profit Corporation Is your business operated out of your home? No
Do you currently have an insurance policy in effect for the coverage requested? No Social work services
Does your business perform any design, construction, installation, removal, or physical repair of any property or tangible good?
No
Do you or your business supply, manufacture, distribute any tangible goods or products?
No
Statements About Your Business
As the individual completing this transaction, you are authorized to purchase and bind this insurance on behalf of the entity applying for coverage.
Agree
Your business is not controlled or owned by any other firm, corporation, or entity. Agree For the entire period of time that you have owned and controlled the business, you have not sold, purchased or acquired, discontinued, merged into or consolidated with another business.
Agree
Your business has never had any commercial insurance cancelled or rescinded. Agree Business Activities
Your business does not conduct any of the following activities: Agree - Automotive repair or sales
- Food service/restaurant operations
- Medical Services
- Retail Operations
Note: This does not include the activities of your clients in any of these industries.
Hiscox Insurance Company Inc.
© Hiscox Inc. 2010 Page 3
Claims and Loss History
Based upon your knowledge and the knowledge of your business's current and past partners, officers, directors and employees, during the last five years a third party has never made a claim against your business and you do not know of any reason why someone may make a claim.
Agree
General Liability
The limits of liability represent the total amount available to pay judgments and settlements for any claims. We are not liable for any amounts that exceed these limits.
If coverage is provided, it shall apply only to occurrences that take place during the policy period.
Judgments, settlements and claims expenses incurred are subject to a deductible amount. The deductible is the amount you must pay before we will make any payments under the policy. Some coverage may not be subject to a deductible, in which case you are not required to make payments before any payments are made under the policy.
Please consult the policy language for details.
If you have knowledge of any circumstance that may lead to a loss or a claim being made against you, coverage will be excluded if such loss occurs or claim is made.
Occurrences that took place prior to the inception of the policy are excluded.
Fraud Warning
For your protection California law requires the following to appear on this form:
Any person who knowingly presents false or fraudulent information to obtain or amend insurance coverage or to make a claim for the payment of a loss is guilty of a crime and may be subject to fines and confinement in state prison.
Policy Cancellation Statement
You have 14 days from inception of your policy/policies to review your documents. If you have no losses or reported claims, you have the right to cancel back to inception for a full refund.
Other General Confirmation Statements
Optional Terrorism
You have declined to purchase optional terrorism coverage.
Yes
Optional Business Personal Property Coverage
You have declined to purchase optional business personal property and equipment coverage.
Yes
● You can receive your policy documents and important notices, including cancellation and nonrenewal notices, in electronic or paper form.
Agree to receive policy
documents by email
Hiscox Insurance Company Inc.
© Hiscox Inc. 2010 Page 4
Other General Confirmation Statements
● We will send documents by email or US mail to the address you have provided.
You must notify us if your email or street address changes. ● For electronic documents, you will need a computer with Internet access and the ability to receive external emails; software such as Adobe Reader® to view and save PDF documents; and a printer to create paper copies. ● You can always withdraw your consent to receive documents by email. We will then send documents to you by US mail at no added cost. ● To update your email or street address, or to request paper documents, you can contact us at .
Agree to receive important notices
by email
The information you provided is accurate and complete and has been used to accept your application and determine the terms and conditions your policy/policies.
I have read the information above and confirm it is correct. I understand that by checking this box and providing the premium payment I agree that I am entering into a binding agreement with Hiscox Insurance Company Inc.
HEALTHCARE PROVIDERS SERVICE
ORGANIZATION PURCHASING GROUP HPSO
Qtertificate of 3f nsurance
OCCURRENCE PROFESSIONAL LIABILITY POLICY FORM
Print Date: 7/09/2023
The application for the Policy and any and allsupplementary information, materials, and statements submitted therewith shall be maintained on file by us or our Program Administrator and will be deemed attached to and incorporated into the Policy as if physically attached.
PRODUCER BRANCH PREFIX POLICY NUMBER POLICY PERIOD
018098 970
Named Insured and Address:
HPG 0678526751 From: 07/08/23 to 07/08/24 at 12:01 AM Standard Time Program Administered by:
Healing Spot Counseling Center
c/o Miya Moore Felton
5179 Lone Tree Way Antioch, CA
94531-8689
Medical Specialty: Code:
Healthcare Providers Service Organization
1100 Virginia Drive, Suite 250
Fort Washington, PA 19034
1-800-982-9491
www.hpso.com
Insurance Provided by:
Clinical Counselor/LPCC
Marriage/Family Counselor
80723
80723
American Casualty Company of Reading, Pennsylvania
151 N. Franklin Street
Chicago, IL 60606
Professional liability $ 1,000,000 each claim $ 3,000,000 Your professional liability limits shown above include the following:
* Good Samaritan Liability * Malplacement Liability * Personal Injury Liability aggregate
* Sexual Misconduct Included in the PL limit shown above subject to $ 25,000 aggregate sublimit Coverage Extensions
License Protection $25,000 per proceeding $25,000 aggregate Defendant Expense Benefit $1,000 per day limit $25,000 aggregate Deposition Representation $10,000 per deposition $10,000 aggregate Assault $25,000 per incident $25,000 aggregate
Includes Workplace Violence Counseling
Medical Payments $25,000 per person $100,000 aggregate
First Aid $10,000 per incident $10,000 aggregate
Damage to Property of others $10,000 per incident $10,000 aggregate Information Privacy (HIPAA) Fines and Penalties $25,000 per incident $25,000 aggregate Media Expense $ 25,000 per incident $ 25,000 aggregate
Workplace liability
Workplace Liability Included in Professional Liability Limit shown above Fire & Water Legal Liability
Personal Liability
Included in the PL limit shown above subject to $150,000 aggregate sublimit $1,000,000 aggregate
Total$ 100.00
Base Premium $100.00
Premium reflects Employed , Full Time
Policy Forms and Endorsements (Please see attached list of policy forms and endorsements) ��1//
Chairman of the
1 Board Secretary
Keep this Certificate of Insurance in a safe place. It and proof of payment are your proof of coverage. There is no coverage in force unless the premium is paid in full. To activate your coverage, please remit premium in full by the effective date of this Certificate of Insurance.
Coverage Change Date: 7/08/2023
CNA93692 (11-2018)
Endorsement Date: 7/08/2023
© Copyright CNA All Rights Reserved.
Master Policy: 188711433
POLICY FORMS & ENDORSEMENTS
The following are the policy forms and endorsements that apply to your current professional liability policy.
COMMON POLICY FORMS&ENDORSEMENTS
FORM#
G-121500-D (04-08)
G-121503-C (07-01)
G-121501-C1 (07-01)
CNA94164 (11-18)
G-145184-A (06-03)
G-147292-A (03-04)
GSL 15563 (02-10)
GSL 15564 (10-09)
GSL 15565 (03-10)
GSL 17101 (02-10)
GSL 13424 (05-09)
CNA80051 (09-14)
CNA80052 (09-14)
G-123846-D04 (07-01)
CNA81753 (03-15)
CNA81758 (01-21)
CNA82011 (04-15)
CNA89027 (10-17)
G-121487-B (07-01)
CNA89026 (05-17)
FORM NAME
Common Policy Conditions
Workplace Liability Form
Occurrence Policy Form - California
Amendment Definition of Claim Endorsement
Policyholder Notice - OFAC Compliance Notice
Policyholder Notice - Silica, Mold & Asbestos Disclosure Information Privacy Coverage Endorsement HIPAA Fines, Penalties & Notification Costs Sexual Misconduct Sublimits of Liability Professional Liability & Sexual Misconduct Exclusion Healthcare Providers Professional Liability Assault Coverage Exclusion of Specified Activities Reuse of Parenteral Devices and Supplies Services to Animals
Amended Definition of Personal Injury Endorsement
Distribution or Recording of Material or Information in Violation of Law Exclusion Endorsement California Cancellation and Non-Renewal
Coverage & Cap on Losses from Certified Acts Terrorism
Notice - Offer of Terrorism Coverage & Disclosure of Premium Related Claims Endorsement
Entity Exclusion Endorsement
Amendment to Certificate
Media Expense Coverage
PLEASE REFER TO YOUR CERTIFICATE OF INSURANCE FOR THE POLICY FORMS & ENDORSEMENTS SPECIFIC TO YOUR STATE AND YOUR POLICY PERIOD.
For NJ residents: The PLIGA surcharge shown on the Certificate of Insurance is the NJ Property & Liability Insurance Guaranty Association.
For KY residents: The Surcharge shown on the Certificate of Insurance is the KY Firefighters and Law Enforcement Foundation Program Fund and the Local Tax is the KY Local Government Premium Tax.
As required by 806 Ky. Admin Regs. 2:100, this Notice is to advise you that a surcharge has been applied to your insurance premium and is separately itemized on the Declarations page or billing instrument attached to your policy, as required KRS. §136.392.
For WV residents: The surcharge shown on the Certificate of Insurance is the WV Premium Surcharge.
For FL residents: The FIGA Assessment shown on the Certificate of Insurance is the FL Insurance Guaranty Association - 2022 Regular Assessment.
Form #:CNA93692 (11-2018)
Master Policy#: 188711433
Named Insured: Healing Spot Counseling
Center/Miya Moore Felton
Policy#: 0678526751
© Copyright CNA All Rights Reserved.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
INSURER(S) AFFORDING COVERAGE
INSURER F :
INSURER E :
INSURER D :
INSURER C :
INSURER B :
INSURER A :
NAIC #
NAME:
CONTACT
(A/C, No):
FAX
E-MAIL
ADDRESS:
PRODUCER
(A/C, No, Ext):
PHONE
INSURED
REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES
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).
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.
OTHER:
(Per accident)
(Ea accident)
$
$
N / A
SUBR
WVD
ADDL
INSD
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. $ $
$
$PROPERTY DAMAGE
BODILY INJURY (Per accident)
BODILY INJURY (Per person)
COMBINED SINGLE LIMIT
AUTOS ONLY
AUTOSAUTOS ONLY
NON-OWNED
SCHEDULEDOWNED
ANY AUTO
AUTOMOBILE LIABILITY
Y / N
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
DESCRIPTION OF OPERATIONS below
If yes, describe under
ANY PROPRIETOR/PARTNER/EXECUTIVE
$
$
$
E.L. DISEASE - POLICY LIMIT
E.L. DISEASE - EA EMPLOYEE
E.L. EACH ACCIDENT
ER
OTH-
STATUTE
PER
LIMITS(MM/DD/YYYY)
POLICY EXP
(MM/DD/YYYY)
POLICY EFF
POLICY NUMBERTYPE OF INSURANCELTR
INSR
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
EXCESS LIAB
UMBRELLA LIAB $EACH OCCURRENCE
$AGGREGATE
$
OCCUR
CLAIMS-MADE
DED RETENTION $
$PRODUCTS - COMP/OP AGG
$GENERAL AGGREGATE
$PERSONAL & ADV INJURY
$MED EXP (Any one person)
$EACH OCCURRENCE
DAMAGE TO RENTED
$PREMISES (Ea occurrence)
COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRO-
JECT LOC
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
CANCELLATION
AUTHORIZED REPRESENTATIVE
ACORD 25 (2016/03)
© 1988-2015 ACORD CORPORATION. All rights reserved.
CERTIFICATE HOLDER
The ACORD name and logo are registered marks of ACORD
HIRED
AUTOS ONLY
Contractor Release of Liability
For Workers’ Compensation Coverage
TO: City of Richmond
City Department: _______________________________________ Contractor’sName: _______________________________________ Scope of Services: _______________________________________ I, ________________________, declare under penalty of perjury, that I am a sole proprietor, doing business as Healing Spot Counseling Center Inc. As such, I do not employ any employees.
I fully understand that if I hire any employees during the term of this contract, that I must abide by the laws and regulations of the State of California regarding Workers’ Compensation insurance. At such time, I will provide the City of Richmond evidence of such Workers’ Compensation coverage in compliance with the terms of this contract.
Should I fail to secure Workers’ Compensation coverage as required by the State of California, I will defend and indemnify the City of Richmond for any damage resulting to it from my failure to take out or maintain such insurance.
It is further understood and agreed that this release and assumption of risk is to be binding on my heirs and assigns.
Print Name:________________________________________________ Signature:______________________________ Date:________________
Letter 947 (Rev. 2-2020)
Catalog Number 35152P
Department of the Treasury Internal Revenue ServiceTax Exempt and Government EntitiesP.O. Box 2508Cincinnati, OH45201 THE HEALING SPOT COUNSELING CENTER INC5179 LONE TREE WAYANTIOCH, CA94531 Date:
03/21/2023
Employer ID number:
92-2866360
Person to contact:
Name: Customer Service
ID number: 31954
Telephone: 877-829-5500
Accounting period ending:
December 31
Public charity status:
170(b)(1)(A)(vi)
Form 990 / 990-EZ / 990-N required:
Yes
Effective date of exemption:
March 7, 2023
Contribution deductibility:
Yes
Addendum applies:
No
DLN:
26053476003733
DearApplicant:
We're pleased to tell you we determined you're exempt from federal income tax under Internal Revenue Code (IRC) Section 501(c)(3). Donors can deduct contributions they make to you under IRC Section 170. You're also qualified to receive tax deductible bequests, devises, transfers or gifts under Section 2055, 2106, or 2522. This letter could help resolve questions on your exempt status. Please keep it for your records.
Organizations exempt under IRC Section 501(c)(3) are further classified as either public charities or private foundations. We determined you're a public charity under the IRC Section listed at the top of this letter.
If we indicated at the top of this letter that you're required to file Form 990/990-EZ/990-N, our records show you're required to file an annual information return (Form 990 or Form 990-EZ) or electronic notice (Form 990-N, the e-Postcard). If you don't file a required return or notice for three consecutive years, your exempt status will be automatically revoked.
If we indicated at the top of this letter that an addendum applies, the enclosed addendum is an integral part of this letter.
For important information about your responsibilities as a tax-exempt organization, go to www.irs.gov/charities.
Enter "4221-PC" in the search bar to view Publication 4221-PC, Compliance Guide for 501(c)(3) Public Charities, which describes your recordkeeping, reporting, and disclosure requirements.
Sincerely,
Stephen A. Martin
Director, Exempt Organizations
Rulings and Agreements