©2017 Philadelphia Consolidated Holding Corp.
Includes copyrighted material of Insurance Services Office, Inc. with permission.
ABUSIVE CONDUCT LIABILITY COVERAGE FORM – CLAIMS MADE
DEFENSE WITHIN LIMITS
POLICY DECLARATIONS
THIS IS A CLAIMS MADE POLICY WHICH INCLUDES DEFENSE COSTS WITHIN THE LIMITS.
PLEASE READ THIS POLICY CAREFULLY.
THIS POLICY ONLY COVERS THOSE CLAIMS FIRST MADE AGAINST THE INSURED DURING THE POLICY PERIOD.
THE LIMIT OF INSURANCE AVAILABLE TO PAY "DAMAGES" SHALL BE REDUCED BY AMOUNTS INCURRED FOR "DEFENSE COSTS."
Policy Number: ____________________________ Effective date: __________________________ 12:01 A.M. Standard Time
LIMITS OF INSURANCE:
AGGREGATE LIMIT $_________________
EACH ABUSIVE CONDUCT LIMIT $_________________
DEDUCTIBLE: $ _________________
RETROACTIVE DATE:
This insurance does not apply to “Damages” or “Defense Costs” resulting from "Abusive Conduct" which occurred before the Retroactive Date, if any, shown here ________________________
(Enter Date or “None” if No Retroactive Date Applies)
PRIOR AND PENDING DATE: _________________________
BUSINESS DESCRIPTION:
Form of Business:
Business Description:
PREMIUM:
FORMS AND ENDORSEMENTS (Other than Applicable Forms and Endorsements Shown Elsewhere in the Policy) Forms and Endorsements Applying to this Coverage Part and Made Part of this Policy at Time of Issue:
SEE SCHEDULE ATTACHED
PHPK2558355-003
NON PROFIT ORGANIZATION
Non Profit Organization
07/15/2024
1,000,000
1,000,000
$ 1,045.00
09/04/2016
07/15/2021
NONE
EXHIBIT 3
EXHIBIT 3
POLICY NUMBER: COMMERCIAL GENERAL LIABILITY
CG 24 04 05 09
CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US
This endorsem
ent modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
SCHEDULE
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
The following is added to
Paragraph 8. Transfer Of
Rights Of Recovery Against Others To Us of
Section IV – Conditions:
We waive any right of recovery we may have against
the person or organization shown in the Schedule
above because of payments we make for injury or
damage arising out of your ongoing operations or
"your work" done under a contract with that person
or organization and included in the "products-
completed operations hazard". This waiver applies
only to the person or or ganization shown in the
Schedule above.
PHPK2558355-003
Name Of Person Or Organization:
City of Santa Ana, its City Council, its officers, officials, employees, agents, and volunteers
EXHIBIT 3
POLICY NUMBER: COMMERCIAL GENERAL LIABILITY
CG 20 26 04 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CG 20 26 04 13 © Insuran
ce Services Office, Inc., 2012 Page of
ADDITIONAL INSURED – DESIGNATED
PERSON OR ORGANIZATION
This endorsem
ent modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section II – Who Is An Insured is amended to
include as an additional insured the person(s) or
organization(s) shown in the Schedule, but only
with respect to liability for "bodily injury", "property damage" or "personal and advertising injury"
caused, in whole or in part, by your acts or
omissions or the acts or omissions of those acting
on your behalf:
1. In the performance of your ongoing operations;
or
2. In connection with your premises owned by or
rented to you.
However:
1. The insurance afforded to such additional
insured only applies to the extent permitted by
law; and
2. If coverage provided to the additional insured is
required by a contract or agreement, the
insurance afforded to such additional insured
will not be broader than that which you are
required by the contract or agreement to
provide for such additional insured.
B. With respect to the insurance afforded to these
additional insureds, the following is added to
Section III – Limits Of Insurance:
If coverage provided to the additional insured is
required by a contract or agreement, the most we
will pay on behalf of the additional insured is the
amount of insurance:
1. Required by the contract or agreement; or
2. Available under the applicable Limits of
Insurance shown in the Declarations;
whichever is less.
This endorsement shall not increase the
applicable Limits of Insurance shown in the
Declarations.
PHPK2558355-003
Name Of Additional Insured Person(s) Or Organization(s):
City of Santa Ana, its City Council, its officers, officials, employees, agents, and volunteers
4 7
EXHIBIT 3
PI-GL-005 (07/12)
Page of
Includes copy
righted material of Insurance Services Office, Inc., with its permission.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED
PRIMARY AND NON-CONTRIBUTORY INSURANCE
This endorsem
ent modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
SECTION II – WHO IS AN INSURED is amended to include as an additional insured the person(s) or organization(s) shown in the endorsement Schedule, but only with respect to liability for “bodily injury,” “property damage” or “personal and advertising injury” arising out of or relating to your negligence in the performance of “your work” for such person(s) or organization(s) that occurs on or after the effective date shown in the endorsement Schedule.
This insurance is primary to and non-contributory with any other insurance maintained by the person or organization (Additional Insured), except for loss resulting from the sole negligence of that person or organization.
This condition applies even if other valid and collectible insurance is available to the Additional Insured for a loss or ”occurrence” we cover for this Additional Insured.
The Additional Insured’s limits of insurance do not increase our limits of insurance, as described in SECTION III – LIMITS OF INSURANCE.
All other terms, conditions, and exclusions under the policy are applicable to this endorsement and remain unchanged.
1 1
Effective Date: 07//2024
Name of Person or Organization (Additional Insured):
City of Santa Ana, its City Council, its officers, officials, employees, agents, and volunteers Policy Number: PHPK-003
EXHIBIT 3