Document JJNp5v4ROL0mGgB0QopRgX2Ea

The Travelers Insurance Companies Policy Jacket-- Edition January I, 1973 Th anclatad Dacloratient and Covarag* Parft (plus any neforaamant*) cuimplafayour policy. EMPLOYEE BENEFIT PLAN CONSULTANTS M WALL ST.. HEW YOU IMS . 'IflHfflB Policy Title Named Insured and Address: Policy Period: N11030 The Travelers Insurance Companies Hartford, Connecticut (Each a Stock Insurance Company) The member of The Travelers Insurance Companies designated in the declarations as the insurer (herein called the company), in consideration of the payment of the premium, in reliance upon the statements in the declarations made a part hereof and subject to all of the terms of this policy, agrees with the named insured as follows: Definitions AID 000168 IVhen used in this policy (including endorsements forming a part hereof): "automobile" means a land motor vehicle, trailer or semitrailer designed for travel on public roads Gncluding any machinery or apparatus attached thereto), but does not include mobik equipment; "bodily injury" means bodily injury, sickness or disease sustained by any person which occurs during the policy period, including death at any time resulting therefrom; "completed operations hazard" includes bodily injury and property damage arising out of operations or reliance upon a representation or warranty made at any time with respect thereto, but only if the bodily injury or property damage occurs after such operations have been com pleted or abandoned and occurs away from premises owned by or rented to the named insured. "Operations" include materials, parts or equipment furnished in connection therewith. Operations shall be deemed completed at the earliest of the following times: (1) when all operations to be performed by or on behalf of the named insured under the contract have been completed, (2) when ail operations to be performed by or on behalf of the named insured at the site of the operations have been completed, or (3) when the portion of the work out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in perform ing operations for a principal as a part of the same project. Iperations which may require further service or maintenance work, or Direction, repair or replacement because of any defect or deficiency, but hich are otherwise complete, shall be deemed completed. he completed operations hazard does not include bodily injury or property image arising out of (a) operations in connection with the transportation of property, unless the bodily injury or property damage arises out of a condition in or on a vehicle created by the loading or unloading thereof, (b) the existence of toots, uninstalled equipment or abandoned or unused "elevator" means any hoisting or lowering device to connect floors or landings, whether or not in service, and all appliances thereof including any car, platform, shaft, hoistway, stairway, runway, power equipment and machinery, but does not include an automobile servicing hoist, or a hoist without a platform outside a building if without mechanical power or if not attached to building wails, or a hod or material hoist used in alteration, construction or demolition operations, or an inclined conveyor used exclusively for carrying property or a dumbwaiter used exclusively for carrying property and having a compartment height not exceeding four feet; "incidental contract" means any written (I) lease of premises. (2) ease ment agreement, except in connection with construction or demolition operations on or adjacent to a railroad, (3) undertaking to indemnify a municipality required by municipal ordinance, except in connection with work for the municipality, (4) sidetrack agreement, or (5) elevator main tenance agreement; "insured" means any person or organization qualifying as an insured in the "Persons Insured" provision of the applicable insurance coverage. The insurance afforded applies separately to each insured against whom claim is made or suit is brought, except with respect to the limits of the company's liability; "mobile equipment" means a land vehicle (including any machinery or apparatus attached thereto), whether or not self-propelled, (1) not sub ject to motor vehicle registration, or (2) maintained for use exclusively on premises owned by or rented to the named insured, including the ways immediately adjoining, or (3) designed for use principally off public roads, or (4) designed or maintained for the sole purpose of affording mobility to equipment of the following types forming an integral part of or permanently attached to such vehicle: power cranes, shovels, loaders, diggers and drills: concrete mixers (pther than the mix-in-transit type); graders, scrapers, rollers and other road construction or repair equipment: air-compressors, pumps and generators, including spraying, welding and building cleaning equipment; and geophysical exploration and well servicing equipment; "named insured" means the person or organization named in Item 1. of the declarations of this policy; P*ge : but "named insured's products" shall not include a vending machine or ; any property other than such container, rented to or located for use ol j others but not sold: I "occurrence'' means an accident, including continuous or repeated ex- posure to conditions, which results in bodily injury or properly damage neither expected nor intended from the standpoint of the insured; "policy territory" means: (1) the United States of America, its territories or possessions, or Canada, or (2) international waters or air space, provided the bodily injury or property damage does not occur in the course of travel or transporta tion to or from any other country, state or nation, or (3) anywhere in the world with respect to damages because of bodily injury or property damage arising out of a productwhich was sold for use or consumption within the territory described in paragraph (1) above, provided the original suit for such damages is brought within such territory; "product! hazard" includes bodily injury and property damage arising out of the named insured's products or reliance upon a representation or warranty made at any time with respect thereto, but only if the bodily injury or property damage occurs away from premises owned by or rented to the named insured and after physical possession of such products has been relinquished to others; "property damage'' means (1) physical injury to or destruction of tangible property which occurs during the policy period, including the loss ol use thereof at any time resulting therefrom, or (2) loss of use of tangible property which has not been physically injured or destroyed provided sucn loss of use is caused by an occurrence during the policy period. Supplementary Payments The company will pay, in addition to the applicable limit of liability: (a) all expenses incurred by the; company, all costs taxed against the insured in any suit defended by the company and all interest on the entire amount of any judgment therein which accrues after entry of the judgment and before the company has paid or tendered or de posited in court that part of the judgment which does not exceed the limit of the company's liability thereon; (b) premiums on appeal bonds required in any such suit, premiums oil bonds to release attachments iin any such suit for an amount hot in excess of the applicable limit of liability of this policy, and the cost of bail bonds required of the insured because of accident or traffic law violation arising out of the use of any vehicle to which this policy applies, not to exceed $250 per bail bond, but the company shall have no obligation to apply for or furnish any such bonds; (c) expenses incurred by the insured for first aid to others at the time of an accident, for bodily injury to which this policy applies; (d) reasonable expenses incurred by the insured at the company's request in assisting the company in the investigation or defense of any claim or suit, including actual loss of earnings not to exceed $25 per day. Nuclear Energy Liability Exclusion (Broad Form) I. The policy does not apply: > A. Under any Liability Coverage, to bodily injury or property damage "nuclear material" means source material, special nuclear material or byproduct material; (1) with respect to which an insured under the policy is also an insured under a nuclear energy liability policy issued by Nuclear Energy Liability Insurance Association, Mutual Atomic Energy Liability Underwriters or Nuclear Insurance Association of Canada, or would be an insured under any such policy but for its termination upon exhaustion of its limit of liability; or ''source material", "special nuclear material", and "byproduct 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 component, solid or liquid, which has been used or exposed to radiation in a nuclear reactor; (2) resulting from the hazardous properties of nuclear material and with respect to which (a) any person or organization is required to maintain financial protection pursuant to the Atomic Energy Act of 1954, or any law amendatory thereof, or (b) the insured 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 organization. B. Under any Medical Payments Coverage, or under any Supple mentary Payments provision relating to first aid, to expenses in curred with respect to bodily injury resulting from the hazardous properties of nuclear material and arising out of the operation of a nuclear facility fay any person or organization. C. Under any Liability Coverage, to bodily injury or properly damage resulting from the hazardous properties ol nuclear material, if (1) the nuclear material (a) is at any nuclear facility owned by, or operated by or on behalf 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 possessed, 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 "waste" means any waste material (1) containing byproduct material and (2) resulting from the operation by any person or organization of any nuclear facility included within the definition of nuclear facility under paragraph (a) or (b) thereof; "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 packaging waste, (c) any equipment or device used for the processing, fabricating or; alloying pf special 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 plutonium 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 ol the foregoing is located, all operations conducted on such site and all premises used for such operations; f AID 000169 by an insured of services, materials, parts or equipment in connection with the planning, construction, maintenance, operation or use of any nuclear facility, but if such facility is located within the United States of America, its territories or possessions or Canada, this exclusion (3) applies only to property damage to such nuclear facility and any property thereat. \\ Aa used in thia exclusion: "huudowi properties; properties" include radioactive, toxic or explosive 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 radioactive contamination of property. III. This exclusion modifies the provisions of the policy relating to all Automobile Liability, General Liability and Medical Payments Insurance other than Comprehensive Persona! and Parmer's Com prehensive Personal Insurance. Conditions 1. Premium. All premiums for this policy shall be computed in accord- ance with the company's rules, rates, rating plans, premiums and minimum premiums applicable to the insurance afforded herein. Premium designated in this policy as "advance premium" is a deposit premium only which shall be credited to the amount of the earned premium due at the end of the policy period. At the dose of each period (or part thereof terminating with the end of the policy period) desig nated in the declarations as the audit period the earned premium shall be computed for such period and. upon notice thereof to the named insured, shall become due and payable. If the total earned premium for the policy period is less than the premium previously paid, the com pany shall return to the named insured the unearned portion paid by the named insured. The named insured shall maintain records of such information as is necessary for premium computation, and shall send copies of such records to the company at the end of the policy period and at such times during the policy period as the company may direct. 2. Inspection and Audit. The company shall be permitted but not ob ligated to, inspect the named insured's property and operations at any time. Neither the company's right to make inspections nor the making thereof nor any report thereon shall constitute an undertaking, on behalf of or for thebenefiti:inf the named insured or others, to deter mine or warrant that such property or operations are safe or healthful, or are in compliance with any law, rule or regulation. The company may examine and audit the named insured's books and records at any time during the policy period and extensions thereof and within three years after the final termination of this policy, as far as they relate to the subject matter of this insurance. 3. Financial Responsibility Laws. When this policy is certified as proof of financial responsibility for the future under the provisions of any motor vehicle financial responsibility law, such insurance as is afforded by this policy for bodily injury liability or for properly damage liability shall comply with the provisions of such law to the extent of the cover age and limits of liability required bv such law. The insured agrees to reimburse the company for any payment made by the company which it Vouid not have been obligated to make under the terms ofi this poh'py except for the agreement contained in this paragraph. 6. Other Insurance. The insurance afforded by this poiicv primarv insurance, except when stated to apply in excess of or contingent upon the absence of other insurance. When this insurance is primary and the insured has other insurance which is stated to be applicable to the loss on an excess or contingent basis, the amount of the company's liability under this policy shall not be reduced by the existence of such other insurance. When both this insurance and other insurance apply to the loss on the same basis, whether primary, excess or contingent, the company shall not be liable under this policy for a greater proportion of the loss than that stated in the applicable contribution provision below: (a) Contribution b; Equal Shares. If all of such other valid and collectible insurance provides for contribution by equal shares, the company shall not be liable for a greater proportion of such loss than would be payable if each insurer contributes an equal share until the share of each insurer equals the lowest applicable limit of liability under any one policy or the full amount of the loss is paid, and with respect to any amount of loss not so paid the remaining insurers then continue to contribute equal shares of the remaining amount of the loss until each such insurer has paid its limit in full or the full amount of the loss is paid. (b) Contribution by Limits. If any of such other insurance does not provide for contribution by equal shares; the company shall not be liable for a greater proportion of such loss than the applicable limit of liability under this policy for such loss bears to the total applicable limit of liability of all valid and collectible insurance against such loss. 7. Subrogation. In the event of any payment under this policy, the company shall be subrogated to all the insured's rights of recovery therefor against any person or organization and the insured shall execute and deliver instruments and papers and do whatever else is necessary to secure such rights. The insured shall do nothing after loss to prejudice such rights. 8. Change*. Notice to any agent or knowledge possessed by any agent or by any other person shall not effect a waiver or a change in any part of this policy or estop the company from asserting any right under the terms of this: policy; nor shall the terms of this policy be waived or changed, except by endorsement issued to form a part of this policy. 4. Insured's Duties in the Event of Occurrence, Claim or Suit. (a) In the event of an occurrence, written notice containing particulars sufficient to identify the insured and: also reasonably obtainable information with respect to the time, place and circumstances thereof, and the names and addresses of the injured and of available witnesses, shall be: given by or for the insured to the company or any of its authorized agents as soon as practicable. (b) If claim is madeior suit is brought against the insured, the insured shall immediately forward to the company every demand, notice, summons or other process received by him or his representative. (c) The insured shall cooperate with the company and, upon the com pany's request, assist in making settlements, in the conduct of suits and in enforcing any right of contribution or indemnity against any person or organization who may be liable to the insured because of injury or damage with respect to which insurance is afforded under this policy; and the insured shall attend hearings and trials and assist in securing and giving evidence and obtaining the attendance of witnesses. The insured shall not, except at his own cost, voluntarily make any payment, assume any obligation or incur any expense other than for first aid to others at the time of accidents 5. Action Against Company. So action shall lie against the company unless, as a condition precedent thereto, there shall have been full compliance with all of the terms of this policy, nor until the amount of the insured's obligation to pay shall have been finally determined either by judgment against the insured after actual trial or by written agreement of the insured, the claimant and the company. Any person or organization or the legal representative thereof who has securw such judgment or written agreement shall thereafter be entitled to recover under this policy to the extent of the insurance afforded by this policy. No person or organization shall have any right under this policy to join the company as a party to any action against the insured to determine the insured!! liability, nor shall the company be impleaded by the insured or his legal representative. Bankruptcy or insolvency of the insured or of the insured s estate shall not relieve the cbmpany of any of its obligations hereunder. 9. Assignment. Assignment of interest under this policy shall not bind the company until its consent is endorsed hereon; if, however, the named insured shall die, such insurance as is afforded by this policy shall apply (1) to the named insured's legal representative, as the named; insured, but only while acting within the scope of his duties as such, and (2) with respect to the property of the named insured, to the person having proper temporary custody thereof, as insured, but only until the appointment and qualification of the legal representative. 10. Three Year Policy. If this policy is issued for a period of three years any limit of the company's liability stated in this policy as "aggregate" shall apply separately to each consecutive annual period thereof. 11. Cancellation. This policy may be canceled by the named insured by mailing to the company written notice stating when thereafter the cancellation shall be effective. This policy may be canceled by the company by mailing to the named insured at the address shown in this policy, written notice stating when not less than ten days thereafter such cancellation shall be effective. The mailing of notice as aforesaid shall be sufficient proof of notice. The effective date and hour of can cellation stated in the notice shall become the end pf the policy period. Delivery of such written notice either by the named insured or by the company shall be equivalent to mailing. If the named insured cancels, earned premium shall be computed in accordance with the customary short rate table and procedure. If the company cancels, earned premium shall be computed pro rata. Pre mium adjustment may be made either at the time cancellation is effected or as Soon as practicable after cancellation becomes effective, but payment or tender of unearned premium is not a condition of cancellation. 12. Declarations. By acceptance of this policy, the named insured agrees that the statements in the declarations are his agreements and repre sentations. that this policy is issued in reliance upon the truth of such representations and that this policy embodies all agreements existing between himself and the company or any of its agents relating to this (continued on Pago 3) AID 000170 Page 3 New York Special Provision--If a Comprehensive Automobile Liability Insurance. Garage Insurance or Automobile Medical Pa\ meats Insurance Cover age Part forming a part of this poiicy insures premises located or automobiles principally garaged in New York, the Nuclear Energy Liability Exclusion (Broad Formi does not apply to such premises or automobiles. Puerto Rico Special Provision--11 is agreed that the Action Against Company Condition applicable to any liability coverage afforded by the policy with respect to occurrences which take place in Puerto Rico is amended to read: No action shall lie against the company unless as a condition precedent thereto, the insured shall have fully complied with all the terms of this policy. South Carolina Special Provision--If a Comprehensive General Liability, Manufacturers' and Contractors' Liability. Owners', Landlords' and Tenants' Liability, Druggists' Liability, Storekeeper's, Completed Operations and Products Liability, Contractual Liability, Premises Medical Payments or Garage Insurance Coverage Part forming a part of this policy insures premises located in South Carolina, it is agreed that with respect to such insurance that part of the alcoholic beverage exclusion which relates to the selling, serving or giving of any alcoholic beverage ta) to a person under the influence of alcohol or (b) which causes or contributes to the intoxication of any person, is deleted. Texas Special Provision--With respect to such insurance as may be afforded by this policy by The Charter Oak Fire Insurance Company for premises located or automobiles principally garaged in Texas, it is agreed as follows: Dividend Provision--Participating Companies. The named insured shall be entitled to participate in a distribution of the surplus of the company, as determined by its Board of Directors from time to time, after approval in accordance with the provisions of the Texas Insurance Code of 1951, as amended. Vermont Special Provisions-- 1. If thisipolicy affords a Liability Coverage with respect to a premises iocated or an automobile principally garaged in Vermont, it is agreed that the policy is amended in the following particulars with respect to such Coverage: The Bohcv lsnssued and delivered subject to the Laws of Vermont and particularly to Section 9242, Chapter 391 "The Vermont Statutes, Revision of 1947," including the following statutory requirements forming a part of such Laws: The company shall pay and satisfy any judgment that may be recovered against the insured upon any claim covered by this Policy to the extent and within the limits of liability assumed thereby, and shall protect the insured against the levy of any execution issued upon any such judicial judgment or claim against the insured. No limitation of liability in this Policy shall be valid if, after a judgment has been rendered against the insured in respect to his legal liability for damages in a particular instance, the company continues the litigation by an appeal or otherwise, unless the insured shall stipulate with the company, agreeing to continue such litigation. N'o action shall lie against the company to recover for any loss under this Pol.icv, unless brought within one year after the amount of such loss is made certain either by judgment against the insured after final determination of the litigation or by agreement between the parties with the written consent of the company. The insolvency or bankruptcy of the insured shall not release the company from the payment of damages for injury sustained or loss occasioned during the life of the Policy, and in case of such insolvency or bankruptcy an action may be maintained by the injured person or claimant against the company under the terms of the Policy for the amount of any judgment obtained against the insured not exceeding the limits of the Policy. Payment of any judicial judgment or claim by the insured for any of the company's liability hereunder shall not bar the insured from any action or right of action against the company. In case of payment of ioss or expense under this Policy, the company shall be subrogated to all rights of the insured against any piarty, as respects such loss or expanse, to the amount of such payment, and the insured shall execute all papers required and shall cooperate with the company to secure to the company such rights. 2. If a Comprehensive General Liability, Manufacturers'and Contractors' Liability, Owners' and Contractors' Protective Liability, Owners', Landlords' and Tenants' Liability, Premises Medical Payments or Storekeeper's Coverage Part forming a part of this policy insures premises located or operations conducted in Vermont, the exclusion relating to the operation or use of any snowmobile or trailer designed for use therewith applies only if the bodily injury or property damage occurs away from premises owned by, rented to or controlled by the named insured. (n witness whereof, the company'has caused this policy to be signed by its President and Secretary at Hartford, Connecticut, and counter signed on the declarations page by a duly authorized agent of the company. ' Secretary fifofk.lSUlctcPresident C-16216 Edition 1-1-73 B" in u.s.fc. K.S. (GA) AID 000171 The insurer for this Policy is that member of The Travelers Insurance Companies designated by an 'X' below: THE TRAVELERS INDEMNITY COMPANY THE CHARTER OAK FIRE INSURANCE COMPANY THE TRAVELERS INDEMNITY COMPANY OF AMERICA THE TRAVELERS INDEMNITY COMPANY OF ILLINOIS I THE TRAVELERS INDEMNITY COMPANY OF RHODE ISLAND THE TRAVELERS INSURANCE COMPANIES (Each A Sfocfc fimiranc, Company) HARTFORD CONNECTICUT POLICY NUMBER DECLARATIONS item 1* Named Insured Address (No., street, tows, county, state, zip code) COMPREHENSIVE AUTOMOBILE-GENERAL LIABILITY POLICY --L * " * *1 i ! * 1, . * /1 - * i". *: ' ` V V * V Item 2. Policy Period: From * : .} * /*. to Item Pern I Comprehensive Cevoragot Bodily Injury Liability Limits of Liability each each I person ;occurrence aggregate ' =I M 0 MS pSeneral Property Damage liability! = -.rit: m mj -- ;Comprehensive Bodily Injury Liability ! '.VAM1 I'Y'VT M J (Automobile Property Damage Uobilityj -- M ------- J Contractual Bodily Injury Liability | ==/ M=J Liability Property Damage Liability! M. M;J Premises each person Medical Payments M each acciiient it - Automobile Medical Payments it each person S Uninsured Motorists is : M each person (Damages for Bodily Injury) 1$ : M each accident t Comprehensive !$ t jAutomobile Collision i ACV Less S Deductible t {Physical Fire, lightning or Transportation t Damage Theft Combined Additional * s 1s Advance Premium j'j'S 7*7 'Wii -:v \ . ,i rv s 12:01 A.M.t The insurance afforded is only with respect to such of the Coverage Parts as are indicated by Symbol Number and the Coverages therein as are indicated byVtecific premium charge. The limit of the company's liability against each such Coverage shall be as stated herein, subject to all the term', of this policy having reference thereto. In any Limits of Liability space the letter "M" means "Thousands of Dollars" and the letters "ACV" mean "Actual Cash Value". 11 i rv $ Symbol numbers of Schedules, Endorsements, 1 and additional Coverage Parts forming a < part of this policy on its effective date, j s Totol Advance Premium Item 4. (a) The named insured is: individual Q; partnership ; corporation Q; joint venture Q: other: (b) Audit Period: Annual, unless otherwise stated: semi-annual ; quarterly ;______ monthly D_________ Item 5, During the past three years no insurer has canceled insurance, issued to the named insured, similar to that afforded hereunder, unless otherwise statet herein: General Liability Coverage Part*--The declarations are completed on an accompanying schedule designated "General Liability Hazards", Automobile Liability Coverage Parts--The declarations are completed on an accompanying schedule designated "Automobile Liability Hazards". tStaudard time at the address of the named insured as stated herein. Countersigned by_ AID 000172 Keep this declarations page in your "Policy Jacket--Edition January 1,1973", Form C-16216. These declarations and all Coverage Parts, Schedules and En dorsements issued to form a part hereof, together with your Policy Jacket, form your complete insurance policy. C-1<V243 Edition January 1. 1973 min t B" U.S.A. DECLARATIONS SCHEDULE--General Liability Hazards No----------------- Policy No.________________________ The letters "MP" wherever used in this schedule shall mean "Premium for Premises Medical Coverage". In the Rates and Advance Premie columns "BI" means "Bodily Injury Liability" and "PD" means "Property Damage Liability". Location of all premises owned by, rented to or controlled by the named insured (Enter "same" if same location as address shown in Item 1. declarations): Interest of named insured in such premises (Describe interest, such as "owner", "general lessee" or "tenant"): Part occupied by named insured: Comprehensive Genera! Liability Insurance. The following discloses all hazards insured hereunder known to exist at the effective date of this poli unless otherwise stated herein: Description of Hazards A--Premises --Operations B--'Elevators C--Escalators D--Independent Contractor? E--Completed Operation? F--Products ^XCI-SS LirtJT-5 S2S MDCftSKF.h7 3QC0'C} Code No. ?01 Premium Bases* j Rates BI PD A--Area B--Frontage C --Remuneration D--No. Insured E--No. Insured F --Cost G--Receipts H--Receipts I --Sales J --Admissions A--Per 100 Sq. Ft. of Area B --Per Linear Foot C--Per $100 of Remuner ation D--Each or units E--Per Landing F --Per $100 of Cost G--Per $1000 of Receipts H--Per $100 of Receipts I --Per $1000 of Sales J --Per 100 Admissions Advance Premium BI | PD c 4-- vr- c e.'S3AFTSHEN F'.EtfRiCM. CA3l E C*? iI-FRCCF rfCWK'HE-T ' 5y.ii 52?$!03 AID 000173 Minimum Premiums C-UlCIt 9.70 fHiKTto Independent Contractors BI PD Products BI PD s (C.c with Cert. Puts LI. 9,10,11,13,14,25) 'See over for Description of Premium Bases DECLARATIONS SCHEDULE--General Liability Hazards No.. Description of Hazards Code No. Premium Bases P..iic> N". Rates BI PD -STATS 0? LA THE Ai&COKJA CW.HY iRLSANS fARiSK A2**7350? ri Advance Premium BI PD T-MACQHDA W2RE AMD CA3LE CO ANACONDA WIRE CO HsSERNiA SANK BLOG MEW ORLEANS ORLEANS PARISH A-S2-752G7 '.fi ra-'.tv S02s0 vi0/0 e03'3 oC035 AID 000174 DECLARATIONS SCHEDULE--General Liability Hazards N'u._ Description of Hazards Code No. Premium Bases Pnlic> N. Rates BI PD A? HC. ;H? Cr-ifAfiY "HE AJiACOHDA :;SE -"AtLE 0 SOX *30 VARiiORO QSSC&4E C5 ' lJ * ^ *, > ; il A-52'7'^7 >52~3S4G3 **3.768 S-.C-C4Q .00! 8 < ,*V A soih .nr-A j-Bsa r-52"25.?20 >52-364)3 C-5W5220 .C:62 E.3I54 ,0033 34?233 3.0;SO , G 2 .0133 ,006 20,340 $<,0220 o0''62 .0154 ,0083 Advance Premium BI PD "* ; v: 05 *r AuiCO AHAHCONOA *NC m SWTH WALNUT CiHCUi 3f?Er:;.;sg0R0 STORES -VrfOLESA-2 *.-5 --7Y;0J 53-fOSf9 r* SoOCAO ,0035 eC0>8 -on; 8 rVs vA FLV ms .C'8 M i ,*r ^ >o C-11167 7-66 Pftitsreo >* ,, s * J266 AID 000175 88 DECLARATIONS SCHEDULE--"Central Liability Hazards Nn, Description of Hazards ->TAi E OF fX Code No. Premium Bases P..1.CV No. Rates BI PD "::7 AMCONDA COKrSii'r' i'A-JACOHOA :VJ!'-I -;.'5 r'EADUWS '-Ll-S tXPSHSSWAY AT HK7"' DALLAS 7S206 -'.'"S-":?)# ;a:o36 .-.V :V - '056 33 ,0030 *2,390 S.C50 ,0336 He 063 .0772 Advance Premium BI PD : , >6 20 ; ' AJvSiJTE D!\MS!0M'. 12!; MASSSTY DR :-'0 sox 35566 AiRLAWN STAT!OH DALLAS 75223 A-5;>7S507 C-52 '2.3220 73;536 32,350 s.ano ,0053 s.0138 -.0030 Sc 050 .0336 Sc 063 ,0172 i? 3' 16 20 * *5 A;W.CN0A WRS Al*sD CABle COMPANY '*ACC*SA WISE CtfPAKY !" 5 'ALLAS .;L~/ rc .^.s-WOUSALS 53-$jS) *V- ?-J, c-06 3:0'10 ,00.58 .0:33 .0030 A*3 .3*00 -035 5,25.9 -0*3 }1 = "i. :? #$C-l 1167 7-66 m K" .k u 5* 1266 All>000176 881 DECLARATIONS SCHEDULE--Automobile Liability Hazard* No- Policv No-- In the Rates and Advance Premium columns ' Bl" means "Bodily Injurv Lubihtv". "PD" means "Property Damage Liability" and "Med. Pa\> means "Division 1. Medical Payments". Comprehensive Commercial Automobile Insurance. (a) The schedules disclose all hazards insured hereunder known to exist at the effective date of this policy, and (b) the schedules contain a list of (1) all automobiles and trailers owned by the named insured at the effective date of this policv and the purpt" of use thereof, and (2) all persons within the'definition of Class 1 persons, at the effective date of this policy, unless otherwise stated herein. EFFs 'Jl-Oi-73 Description of Hazards 1. Owned Automobiles Premium Basis--Per Automobile See other Declarations Schedule(s)--Automobile Liability Hazards 50013(0 Bl 1$ 24207 E 22112 Adnac. Premium PD 16060 14897 3871(EXCEPT nc S- TX) S 1009 E 8C0 1026 211 NC S 527 E 209 444 91 IX $ 2178 2385 E 1251 405 Med. Pay. 74 73 S14 2. Hired Automobiles Premium Basis--Cost of Hiret Medical Payments. Type, Hind Location. Whero Automobii*, Will B Principally Osod Purpoaei j Estimated Rates per $100 Cost of Hire of Cost of i-- -.......... Use* Hire I Bl PD SEE END 3000(C) SEE SCHED 8841 (TX) INCLUDED INCLUDE0 3. Non-Owned Automobiles Cliu 1 Person*-- Name of Each Premium Basis--Class 1 Persons and Class 2 Employeest Location of Headquarter* of Persona Named Herein Rates per Person BI PD Med. Pays. SEE EHD 8000(C) SEE SCHED 8841(TX) Cla*a 2 Employee*-- Estimated Avera*e Number Location of Headquarter* of CUm 2 Employ*** SEE END 8000(C) SEE SCHED S841 (TX) Rate* per Employee BI PD iNCLUOiD i HCLUDi AID 000177 5tt Ll*.u j w u II M CP0923iEDI-74 CC 34A H " EE 386 !5 si yh'i M " 2066- It 23531 ?! 23700 31 ii 2il2,50 11 ! 25020 "The purposes oi use of the automobile are " Pleasure and Business" unless otherwise stated. The abbreviation "C" in the "Purposes of Use" coiuir 'hall mean "Commercial.' the abbreviation "C-U T" shall mean "Commercial^ Local Truckman)" and the abbreviation "C-I-HT" shall met 'Commercial-! Long Haul Truckman)." C-16786 Rev. 1-75 Pftmrco in u .S.a. tSee over for Description of Premium Bases 8*4 DESCRIPTION OF TERMS USED AS PREMIUM BASES: When used as a premium basis: A. "cost of hire" means the amount incurred for tal the hire of automobiles, including the entire remuneration of each emplovee of the named insurer! engaged in the operation of such automobiles subject to an average weekly maximum remuneration of $100, and for (b) pick-up, transportation or delivery service of property or passengers, other than such services performed by motor carriers which are subject to the security requirements of any motor carrier law or ordinance. The rates for each $100 of "cost of hire" shall be 5% of the applicable hired automobile rates, provided the owner of such hired automobile has purchased automobile Bodily Injury Liability and Property Damage Liability insurance covering the interest of the named insured on a direct primary basis as respects such automobile and submits evidence of such insurance to the named insured; B. "Class 1 persons" means the following persons, provided their usual duties in the business of the named insured include the use of non -owned automobiles: (a) all employees, including officers, of the named insured compensated for the use of such automobiles by salary, commission, terms of employment, or specific operating allowance of any sort; (b) all direct agents and representatives of the named insured; C. "Class 2 employees" means all employ ees, including officers, of the named insured, not included in Class 1 persons. The Travelers Conurarad Poiicn PERSONAL INJURY PROTECTION ENDORSEMENT TAH Symbol CC-384 P*Tt 3 of - 1. the maximum amount payable for medical expense* shall not exceed S2.000; 2. the maximum amount payable for work loss is (a) eighty five percent of any loss of gross income and earning capacity, not to exceed the total of $150 per week (b) $12 per day for inability to perform services for his household; 3. the maximum amount payablefor funeral expense* shall not exceed $1,000; 4. the amount payable for imvork>w is $2,000 and is payable only to natural person* who are the eligible injured person heirs; 5. any amount payable by The Travelers under the term* of this coverage shall be reduced by the amount paid, payable, c required to be provided on account of such bodily injury (a) under any workmen s compensation plan or any similar statutory plan, (b) by the United States or any of its agencies because of military enlistment, duty or service, or (c) under any applicable deductible (set forth in this endorsement or in the policy to which it is attached!1 - F. Condition* AID 000178 1. Action Against Company -- No action shall lie against The Travelers unless as a condition precedent tifereto, there shal have been full compliance with all the terms of this coverage. 2. Notice -- In the event of an accident, written notice containing particulars sufficient to identify the eligible injured per son, and also reasonably obtainable information respecting the time, place and circumstances of the accident shall b> given by or on behalf of each eligible injured person to The Travelers or any of its authorized agents as soon as practicable If any eligible injured person, his' legal representative or his survivors shall institute legal action to recover damages fo bodily injury against a person or organization who is or may be liable in tort therefor, a copy of the summons am complaint or other process served in connection with such legal action shall be forwarded as soon as practicable toTh< Travelers by such eligible injured person, his legal representative, or his survivors. 3. Medical Reports -- Proof of Claim -- As soon as practicable the eligible injured person or someone on his behalf shal give to The Travelers written proof of claim, under oath if required, including full particulars of the nature and extent o the injuries and treatment received and contemplated, and such other information as may assist The Travelers in de termining the amount due and payable. The eligible injured person shall submit to physical and mental examinations b\ physicians selected by The Travelers when and as often as The Travelers may reasonably require. 4. Subrogation -- In the event of any payment under this coverage, The Travelers is subrogated to the rights of the persor to whom or for whose benefit such payments were made, to the extent of such payments, and such person must executt and deliver instruments and papers and do whatever else is necessary to secure such rights. Such person shall do nothing after loss to prejudice such rights. 5. Reimbursement and Trust Agreement -- In the event of any payment to any person under this coverage: (a) The Travelers shall be entitled to the extent of such payment to the proceeds of any settlement or judgement that may result from the exercise of any rights of recovery of such person against any person or organization legaih responsible for the bodily injury because of which such payment is made; and The Travelers shall have a lien to th> extent of such payment, notice of which may be given to the person or organization causing such bodily injury his agent, his insurer or a court having jurisdiction in the matter; (b) such person shall hold in trust for the benefit of The Travelers all rights of recovery which he shall have against such other person or organization because of such bodily injury; (c) such person shall do whatever is proper to secure and shall do nothing after loss to prejudice such rights Th Tr*tJer CoBacatl Poliooi PERS AL INJ URY PROTECTION ENDORSEMENT - UTAH Symbol CG-384A Fife 4 of 4 (d) such person shall execute and deliver to The Travelers instruments and papers as may be appropriate to secure the rights and obligations of such person and The Travelers established by this provision. 6. Non-Duplication of Benefits-- Other Insurance -- No eligible injured person shall recover duplicate benefits for the same elements of loss under this or any similar insurance. In the event that an eligible injured person who is a Named Insured, a relative, or who is injured in an accident involving the use of an insured motor vehicle, has other similar insurance available and applicable to the.accident, the maximum recovery under- all such insurance shall not exceed the amount which would have been payable under the provisions of the insurance providing the highest dollar limit, and the Company shall not be liable for a greater proportion of any loss to which this coverage applies than the limit of liability hereunder bears to the sum of the applicable limits of liability of this coverage and such other insurance. In the event that an eligible injured person, other than a Named Insured, relative, or a person who is injured in an acci dent involving the use of an insured motor vehicle, has other similar insurance available and applicable to the accident, the coverage provided under this endorsement shall be excesB over such other insurance. PARTE In consideration of the coverage afforded under Section 1 and the adjustment of applicable rates: (a) any amount payable under the Uninsured Motorists Insurance Endorsement shall be reduced by the amount of any personal injury protection benefits paid or payable under this or any other automobile insurance policy be. cause of bodily injury sustained by an eligible injured person: * (b) any Automobile Medical Payments coverage afforded under this policy shall be excess insurance over any personal injury protection benefits paid or payable under this or any other automobile insurance policy because of bodily injury sustained by an eligible injured person. PART in The premium for the policy is based on rates which have been established in reliance upon the limitations on the right to recover damages imposed by the provisions of the Utah Automobile No-Fault Insurance Act. In the event a court of com petentjurisdiction declares, or enters ajudgement the effect of which is to render the provisions of such act invalid or un enforceable in whole or in part. The Travelers shall have the right to recompute the premium payable for the policy and the provisions of thi6 endorsement shall be voidable or subject to amendment at the option of The Travelers. AID 000179 The Traveler* Commercial Polia'e PERSONAL INJURY PROTECTION ENDORSEMENT ^TAH Symbol CC-384A Pi(e l a( 4 A. Insuring Agreements The Traveler* agree* with the Named Insured, subject to all of the provisions in this endorsement and to all of the provisionof the policy except as modified herein, as follows: PART I 1. Personal Injury Protection Coverage -- The Travelers will pay personal injury protection benefits for: (a) medical expenses, (b) work loss, (c) funeral expenses, and (d) survivor loss with respect to bodily injury sustained by an eligible injured person caused by an accident involving the use of a moto vehicle as a motor vehicle. B. Exclusions 1. This coverage does not apply; * i () to bodily injury sustained by any person while occupying a motor vehicle which kownedby ibtifTnnid .......... . and which is not an insured motor vehicle; (b) to bodily injury sustained by the Named Insured or any relative while occupying a motor vehicle which is ownec by a relative and for which the security required by the Utah Automobile No-Fault Insurance Act is not in effect (c) to bodily injury sustained by any person while operating the insured motor vehicle without the express or implied consent of the Named Insured or while not in lawful possession of the insured motor vehicle; (d) to bodily injury sustained by any person injured while occupying or, while a pedestrian through the use of an> motor vehicle, other than the insured motor vehide, for which the security required under the Utah Automobile No-Fault Insurance Act is in effect; (e) to bodily injury sustained by any person, if such person's conduct contributed to his injury under either of the following circumstances: (I) causing injury to himself intentionally, or (Zy while committing a felony; (f) to bodily injury sustained by any person arising out of the use of any motor vehicle while located for use as a resi dence or premises; (g) to bodily injury due to war, whether or not dedared, civil war, insurrection, rebellion or revolution, or to any act or condition incident to any of the foregoing; (h) to bodily injury resulting from the radioactive, toxic, explosive or other hazardous properties of nuclear material. C. Definitions When used in reference to this coverage: AID 000180 1. "Bodily Injury" means bodily injury, sickness or disease, including death resulting therefrom. CP-1686 11-74 Printed in li.S.A. m-2 The Traveler* Commercial Polide* PER? AL INJURY PROTECTION ENDORSEMENT - UTAH Svmboi CC-384A Page 2 ot 4 2. '`Eligible Injured Person" means (a) the Named Insured or any relative who sustains bodily injury caused by an accident involving the use of any motor vehicle; (b) any other person who sustains bodily injury caused by an accident while (I) occupying the insured motor vehicle with the consent of the Named Insured, or (2) occupying any other motor vehicle, other than a public or livery conveyance, operated by the Named In sured or a relative, or (3) a pedestrian if the accident involves the use of the insured motor vehicle and occurs within the State of Utah. 3. "Funeral Expenses" means funeral, burial or cremation expenses incurred. 4. "Insured Motor Vehicle" means a motor vehicle with respect to which (a) the bodily injury liability insurance of the policy applies and for which a specific premium is charged, and (b) the Named Insured is required to maintain security under the provisions of the Utah Automobile No-Fault Insur ance Act. 5. "Medical Expenses" means the reasonable expenses incurred for necessary medical, surgical, x-ray, dental and rehabili tation services, including prosthetic devices, necessary ambulance, hospital, and nursing services, and any nonmedical remedial care and treatment rendered in accordance with a recognized religious method of healing. 6. "Motor Vehicle" means any vehicle of a kind required to be registered under Tide 41, Utah Code Annotated 1953 but excluding motorcycles. 7. "Named Insured" means the person or organization named in the GENERAL DECLARATIONS. 8. "Occupying" means being in or upon a motor vehicle as a passenger or operator or engaged in the immediate acts of entering, boarding or alighting from a motor vehicle. 9. "Pedestrian" means any person not occupying or riding upon a motor vehicle. 10. "Relative" means a spouse or any other person related to the Named Insured by blood, marriage or adoption (including a ward or foster child) who is a resident of the same household as the Named Insured, or who usually makes his home in the same household but temporarily lives elsewhere. 11. "Survivor Loss" means compensation on account of the death of the eligible injured person. 12. "Work Loss" means (a) loss of income and loss of earning capacity by the eligible iiqured person during his lifetime, from inability to work during a period commencing three days after the date of the bodily injury and continuing for a maximum of 52 consecutive weeks thereafter, provided that ifsuch eligible injured person's inability to workshall so continue for in excess of a total of two consecutive weeks after the date of the bodily injury, this three day elimination period shall not be applicable; and (b) an allowance for services that, but for the bodily injury, the eligible injured person would have performed during his lifetime for his household commencing three days after the date of the bodily injury and continuing for a maximum of 365 consecutive days thereafter, provided that if such eligible injured person's inability to perform such services shall continue for in excess of 14 consecutive days after the date of the bodily injury, this three day elimination period shall not be applicable. D. Policy Period; Territory This coverage applies only to accidents which occur during the policy period and within the United States of America, its ter ritories or possessions, or Canada. E. Limits of Liability AID 000181 Regardless of the number of persons insured, policies or bonds applicable, claims made, or insured motor vehicles to which this coverage applies. The Travelers' liability for personal injury protection benefits with respect to bodily injury sustained by any one eligible injured person in any one motor vehicle accident, is limited as follows: The Travel Commercial Polict. MANDATORY PERSONAL INJURY PROTECTION ENDf ^MENT (New York) Symbol EE-386 P**e 3 of 4 (h) "use or operation" of a motor vehicle includes loading or unloading of such vehicle but does not include conduct with in the course of a business or repairing, servicing or otherwise maintaining motor vehicles unless the conduct occurs off the business premises. Conditions Action Against Company. No action shall lie against the Company unless as a condition precedent thereto there shall have been full compliance with the terms of this coverage. Notice. In the event of an accident, written notice setting forth details sufficient to identify the eligible injured person aJons with reasonably obtainable information regarding the time, place and circumstances of the accident shall be given by or on behalf of each eligible injured person to the Company or any of the Company's authorized agents as soon as reasonably practicable. If an eligible injured person or his legal representative institutes a proceeding to recover damages for personal injury under Section 673(2) of the New York Insurance Law, a copy of the summons and complaint or other process served in connection with such action shall be forwarded as soon as practicable to the Company or any of the Company's authorized agents by such eligible injured person or his legal representative. Proof of Claim Medical and Earnings Reports. As soon as reasonably practicable, the eligible injured person or someone on his behalf shall give to the Company written proof of claim, including full particulars of the nature and extent of the injuries and treat ment received and contemplated. Upon request by the Company the eligible injured person or someone on hiS behalf shall: (a) execute a written proof of claim under oath; * (b) provide authorization that will enable the Company to obtain medical records; and r- (c) provide any other pertinent information that may assist the Company in determining the amount-due and payable. The eligible injured person shall submit to medical examination by physicians selected by or acceptable to the Company when and as often as the Company may reasonably require. Arbitration. In the event any person makinga claim for first party benefits and the Company do not agree regarding any matter relating to the claim, such person shall have the option of submitting such disagreement to binding arbitration pursuant to pro cedures promulgated or approved by the Superintendent of Insurance. Reimbursement and Trust Agreement. To the extent that the Company pays first party benefits, the Company is entitled to the proceeds of any settlement or judgment resulting from the exercise of any right of recovery for damages for personal injury under Section 673(2) of the New York Insurance Law. The Company shall have a lien upon any such settlement or judgment to the extent that the Company has paid first party benefits. An eligible injured person shall: (a) hold in trust for the benefit of the Company all rights of recovery which he shall have for personal injury under Section 673(2) of the New York Insurance Law; (b) do whatever ia proper to secure and shall do nothing to prejudice such rights; and (c) execute and deliver to the Company instruments and papers as may be appropriate to secure the rights and obligations of such person and the Company established by this provision. Other Coverage. Where more than one source of first party benefits required by Article XVIII of the New York Insurance Law and Article VI or VIII of the New York Vehicle and Traffic Law is available and applicable to an eligible injured person in any one accident, this Company is liable to an eligible injured person only for an amount equal to the maximum amount that the eligible in jured person is entitled to recover under this coverage divided by the number of available and applicable sources of required first party benefits. Excess Insurance Provision. If medical payments coverage or any disability coverages are afforded under this policy, such cov erages shall be excess insurance over any mandatory or additional personal injury protection benefits paid or payable, or whicl would be paid or payable but for the application of a deductible, under this or any other automobile no-fault insurance policy AID 000182 The Traveler! Commercial Politic! MANDA RY PERSONAL INJURY PROTECTION ENDORSEMENT (New York) Symbol E&386 P**e 4 of 4 Constitutionality Provision. If it is conclusively determined by a court of competent jurisdiction that the limitations upon the right to recover damages for personal injury imposed by Section 673 of the Insurance Law are invalid or unenforceable in whole or in part, then, subject to the approval of the Superintendent of Insurance, the Company may amend this policy and/or recompute the premium for the existing or amended policy. These policy and/or premium changes will be effective retroactively to the date that such limitations are deemed to be invalid or unenforceable in whole or in part. CP 01 51 (Ed. 1-74) ' WiM&mcmMt modifies such insurant* as is afforded by the provisions of the policy relating to the following. %#:' COMPREHENSIVE AUTOMOBILE LIABILITY INSURANCE ^V- BASIC AUTOMOBILE LIABILITY INSURANCE a u t o mo b il e me d ic a l p a y me n t s in s u r a n c e UNINSURED MOTORISTS INSURANCE GARAGE INSURANCE AMENDATORY ENDORSEMENT--PUERTO RICO It is speed that 1. The insurance afforded under any bodily injury liability coverafi of the policy does not apply with respect to any accident occurring in the Commonwealth of Puerto Pico to the extent that the person or organization responsible for such injury is exempted from legal liability with respect thereto by reason of the Puerto Rico "Automobile Accident Social Protectipn Act". 2. The insurance afforded under any medical payments or medical expense insurance does not apply to any amount of expense which is paid or payable to or on behalf of the injured person under the Puerto Rico "Automobile Accident Social Protection Act" or which would have been payable under such Act but for the existence of this policy. 3. Neither such liability insurance nor such medial insurance shall be deemed to provide benefits or advantages from other insuranca program or other sources within the contemplation of such Act 4. If the policy affords protection against uninsured motorists, such insuranca does not apply with respect to any accident oceiimng in the Commonwealth of Puerto Rico. 5. The Action Against Company Condition applicable to any liability coverage afforded Rico is amended to read: No action shall lie against the company unless as a condition precedent thereto this policy. This endorsement must be attached to the Change Endorsement when issued after the policy is written. CP 01 51 (Ed. 1-74) AID 000183 The Traveler* Commercial Police. _ MANDATORY PERSONAL INJURY PROTECTION ENDOWMENT (New York) .. Symbol EE-366 Pa*e 1 of 4 The Company agrees with the named insured, as follows: Mandatory Personal Injury Protection The Company will pay first party benefits to reimburse for basic economic loss sustained by an eligible injured person on ar count of personal injuries caused by an accident arising out of the use or operation of a motor vehicle. This coverage applies onh to motor vehicle accidents which occur during the policy period and within the State of New York. First Party Benefits First party benefits are payments equal to basic economic loss, reduced by the following: (a) 20 percent of the eligible injured person's loss of earnings from work to die extent that an eligible injured person' base economic loss consists of such loss of earnings; . (b) amounts recovered or recoverable by an eligible injured person for any element of basic economic loss under State ant Federal laws providing social security disability or workmens compensation benefits; and (c) the amount of any applicable deductible, provided that such deductible shall apply to each accident, but only to th> total of first party benefits otherwise payable to the named insured and any relative aa a result of that accident Baac Economic Loss * V j' Basic economic loss shall consist of medical expense, work loss and other expense. Basic economic loss shall not include any loss sustained on account of death. Basic economic loss of each eligible injured person on account of any singleaceidentshall no exceed $50,000. Medical Expense Medical expense shall consist of reasonable and necessary expenses for: (a) medical, hospital, surgical, nursing, dental, ambulance, x-ray, prescription drug and prosthetic services; (b) psychiatric, physical and occupational therapy and rehabilitation; (c) any non-medical remedial care and treatment rendered in accordance with a religious method of healing recognized b> the laws of New York, and (d) any other professional health services. These medical expenses will not be subject to a time limitation, provided that within one year after the date of the acciden it is ascertainable that further medical expenses may be sustained as a result of the injury. Work Loss Work loss shall consist of the sum of the following losses and expenses up to $1,000 per month for a period of three year: from the date of the accident: (a) loss of earnings from work which the eligible injured person would have performed had such person not been injured and (b) reasonable and necessary expenses sustained by the eligible injured person in obtaining services in lieu of those whicl such person would have performed for income. Other Expenses AID 000184 Other expenses shall consist of all reasonable and. necessary expenses, other than medical expense and work loss, up to $2.r per day for a period of one year from the date of the accident causing injury. CP-1569 11-73 Printed m UAA. HI-2 The Tr*vehr Commercial Policies MANDA RY PERSONAL INJURY PROTECTION ENDORSEMENT (New York) Symbol EE-386 Pafe 2 of 4 Eligible Injured Person An eligible injured person is: (a) any person who sustains a personal injury arising out of the use or operation of the insured motor vehicle while not occupying another motor vehicle; or (b) the named insured or any relative who sustains a personal injury arising out of the use or operation of an uninsured motor vehicle while not occupying another motor vehicle with respect to which the requirements of Article VI or VIII of the New York Vehicle and Traffic Law have been satisfied, provided that: (i) in the case of a named insured, the uninsured motor vehicle is not owned by the named insured; and (ii) in the case of a relative, the uninsured motor vehicle is not owned by the named insured or such relative. Exclusions This coverage does not apply: (a) to a personal injury sustained by any person who intentionally causes his own personal injury; (b) to a personal injury sustained by any person as a result of operating a motor vehicle while in an intoxicated condition or while his ability to operate such vehicle is impaired by the use of a drug (within the meaning of Section 1192 of the New York Vehicle and Traffic Law); (c) to a personal injury sustained by any person while: (i) committing an act which would constitute a felony, or seeking to avoid lawful apprehension or arrest by a law enforcement officer; (ii) operating a motor vehicle in a race or speed test; or (iii) operating or occupying a motor vehicle known to him to be stolen. Other Definitions When used in reference to this coverage: (a) "the insured motor vehicle" means a motor vehicle owned by the named insured and to which the bodily injury liability insurance of the policy applies and for which a specific premium is charged; (b) "motor vehicle" means a motor vehicle as defined in Section 311 of the New York Vehicle and Traffic Law, except that it shall include fire and police vehicles, and it shall not include a motorcycle (as such term is defined in Section 123 of the New York Vehicle and Traffic Law); (c) "named insured" means the person or organization named in Item. 2. of the GENERAL DECLARATIONS; (d) "occupying" means in or upon or entering into or alighting from; (e) "personal injury" means bodily injury, sickness or disease; AID 000185 (f) "relative" means a spouse, child or other person related to the named insured by blood, marriage or adoption (includ ing a ward or foster child) who regularly resides in his household, including any such person who regularly resides in the household but is temporary living elsewhere; (g) "uninsured motor vehicle" means a motor vehicle, the owner of which is (a) a financially irresponsible motorist (as de fined in Section 601(j) of the New York Insurance Law); or (b) unknown and whose identity is unascertainable; DECLARATIONS SCHEDULE--Automobile (See reverse side for explanation of certain entries or absence thereof) Special Code: G'l/N O /tiC . UB Policy No. Fl^ 'Ni-JL-Schedule No. 12 /> Ph y s . DS mS / B RS B Ot h BS THAN COU. B" u K t 8D T h B" t I SICAL DAMAI Co l l is io n I Isl mi < mi ( "I t uni 1! . ui fei . i :8 *3 a2 jtei !S' sj 8" Si i ' if S 1 1 fi ! ' . j S i's3 khss>i. <S 1 o D *5 suili2 U>scJ>wZC S o "v aS W" X * W J* X 3 vO *T u 1 s *s O uI-*0 - JS `dJ is .Cf UJ 03 x <n wX ft o 88 t- b o b * Ow 38 s! 5S oz< &uf I* w tBil i is uC. .>* Ui .0 5:--i0 T! -c* rO <SI c< j I I s ! o BA 33 w> 3 *3 c ^3 c a S 3 jf o . j; A .'1 -o e ;< o s > a u. 2 : w e t a. 1 > u. $; T; ; le Si >-ik,e*.:,i' CL E <3 jl .4M93.'.iy. . : ' i 0~% o W\ u S iZ i 5 | : t>w ,:S lu :hi 1?' 1 18 1 iiimi t -J u U -a* W> *3 1| Ua 4fc rA w hU j K jf C O C- r>. o 2 3 3 s. Ui e CL aHlsh 3s li O fii S2 Q Si s< l*S r** sa- CL. sJ'II iui -C fi Is i Z" ^ O *rs o o^ s M >., B :i 3 :i >V dK II CO I--*. r^.vo 00 *~ 1^.0 t311 ij V? UJ V) Ui 3> 1 tn!j l|s *S4 cs 1i ii I. i 1 i v oo o o o B < -5o ; h. A E a > v `E a 4C v -- S' j b ^"r .fVt-. a c. tg M if: \%i 1. ' '1- ro X A> 15' o R a a -BV a j: i?i !c|\i -j,BW.. f <3 A> is i a ft ' Q ^Mttt o $ r >C Q w -u op *5/sr >*- b S C3 *"; f-- W' * -O D U\ -O V5 Ml n .>*1 ' 0 ,>* p~* S V5 .Lj jirl >JU '! , 09 O e? 1 -e w " v< 4j*. W' a CL CL kv. -o E a c % 60 rt 'lid. o 'o $ 2 < rs 5 I rt jiloS t j [ Explanation of Certain Entries or the Absence Thereof on Reverse Side The absence of an entry in premium spaces for a coverage shall mean that suth insurance is not afforded with respect to the designated automobile. The USE of the automobile is '`Pleasure and Business" unless otherwise stated. The abbreviation "C-LT" shall mean "Commercial--(Local Truckman)". The abbreviation "C-IT" shall mean "Commercial--(Intermediate Truckman)". The abbreviation "C-LHT" shall mean "Commercial--(Long-Haul Truckman)". The abbreviation "C" shall mean "Commercial". The abbreviation "ACV" in the "Limit of Liability" space shall mean "Actual Cash Value". : l|i The abbreviation "C AC" shall mean "Premium for Combined Additional Coverage". The abbreviation "FTCAC" shall mean "Premium for Fire, Theft, and Combined Additional Coverage". The abbreviation "TOW" shall mean "Premium for Towing and Labor Costs Coverage". The abbreviation "W" shall mean "Premium for Windstorm, Hail, Earthquake or Explosion Coverage". i:i[ ' | ,i The abbreviation "EPIP" shall mean "Premium for Excess Personal Injury Protection Coverage". The abbreviation "BDP" shall mean "Premium for Basic Damage to Property Coverage". The abbreviation "RR" shall mean "Premium for Rental Reimbursement Coverage". The abbreviation "BPP" shal| mean "Premium for Basic Property Protection Coverage". The abbreviation "SDP" shall mean "Premium for Supplemental Damage to Property Coverage". The abbreviation "PIP" shall mean "Premium for Personal Injury Protection Coverage". The abbreviation "I" shall mean "Deductible applies to the named insured only". The abbreviation "I/R" shall mean "Deductible applies to the named Insured and relatives". C-162S4 (BACK) AID 000187 DECLARATIONS SCHEDULE--Automobile (See reverse side ior explanation of certain entries or absence thereof) Special Code: ' ' / / i K '/M L Policy No. 4' Schedule No. &i' oS|' i, jail ia :? tai A. SC 6 si. 85 t e iJS5* ti*iZ jl= !xtgj *3 Wa. !fI "3 S:st gs 3 f'A-- 3 T 5 -C i- .1* -:-3 & \4m oa o -A o ax Ox V>A3 ~dba ^3 o oo o r^. CM CVC - 04 3N r- P's *~ 'O^ >4 3 A 3 > Th fvl II i! viN '/'N > w : * 3S C\ - . v\ iP. O* A HA V> IU SV At Vi tu II (Name and Address of Mortgagee 77ie number opposite each entry indicalcs the automobiteto which the entry applies, such automobile being identified by the same number Explanation of Certain Entries or the Absence Thereof on Reverse Side The absence of an entry in premium spaces for a coverage shall mean that such insurance is not afforded with respect to the designated automobile. The USE of the automobile is "Pleasure and Business" unless otherwise stated. The abbreviation "C-LT" shall mean "Commercial--(Local Truckman)". The abbreviation "C-IT" shall mean "Commercial--(Intermediate Truckman)". The abbreviation "C-LHT" shall mean "Commercial--(Long-Haiil Truckman)". The abbreviation "C" shall mean "Commercial". The abbreviation "ACV" in thte "Limit of Liability" space shall mean "Actual Cash Value". 1:1 '!l The abbreviation "CAC" shall mean "Premium for Combined Additional Coverage". The abbreviation "FTCAC" shall mean "Premium for Fire, Theft, and Combined Additional Coverage". The abbreviation "TOW" shall mean "Premium for Towing and Labor Costs Coverage". The abbreviation "W" shall mean "Premium for Windstorm, Hail, Earthquake or Explosion Coverage". The abbreviation "EPIP" shall mean "Premium for Excess Personal Injury Protection Coverage". The abbreviation "BDP" shall mean "Premium for Basic Damage to Property Coverage". The abbreviation "RR" shall rnean "Premium for Rental Reimbursement Coverage". The abbreviation "BPP" shall mean "Premium for Basic Property Protection Coverage". The abbreviation "SDP" shall mean "Premium for Supplemental Damage to Property Coverage". The abbreviation "PIP" shall mean "Premium for Personal Injury Protection Coverage". The abbreviation "I" shall mean "Deductible applies to the named injured only". The abbreviation "I/R" shall mean "Deductible applies to the named insured and relatives". C-16254 (BACK) DECLARATIONS SCHEDULE--Automobile (See reverse side for explanation of certain entries or absence thereof) Special Code: G V '/N l K t-/ Policy No. Schedule No. i i ' 11o Is Si SI 1 W i\' oi i'51*1'St., U 1 =5 3 fc 2Uc0J. .Ktws s ll ; i 1 sus>i O C 1 8 1 i i 1 $ ij j| I' 'c C1. I 'i- I'1 :zo mto3 :i=i-S 155 Ow j o. ui .!. ysS sit 2 3s ?s '3 i' re uO a ;} i--U Ui o a K\ O {*> r> * * >i ..V-v 3 K O N\ a ?* ll x an u e*\ c\S SO *-- >5 ;o o OX iS J. (9 - <3 >- O 3 s3 | i 3- IX ca. *>A <oWci"> ?! 11 <** 2|wo50><- v\ >A A ty ;\ A v% ,*s M'S \' s w p .?s *v 1 j\ ?-- -M * m tT- V* >* j\ rv U' N rM .V c b K V -c II -J' CoSJ *4* O ^ -S- o ^iO F^co 3 ^7 L_ T7 CM i-!|o UI S*O* UI 00 Ui J3 ui V> u j 17% |l. o, -COi 22 as oo o Q < Explanation of Certain Entries or the Absence Thereof on Reverse Side The absence of an entry in premium spaces for a coverage shall mean that such insurance is not afforded with respect to the designated automobile. The USE of the automobile is "Pleasure and Business" unless otherwise stated. The abbreviation "C-LT" shall mean "Commercial--(Local Truckman)*'. The abbreviation "C-IT" shall mean "Commercial--(Intermediate Truckman)". The abbreviation "C-LHT" shall mean "Commercial--(Long-Haul Truckman)". The abbreviation "C" shall mean "Commercial". The abbreviation "ACV" in the "Limit of Liability" space shall mean "Actual Cash Value". The abbreviation "CAC" shall mean "Premium for Combined Additional Coverage". The abbreviation "FTCAC" shall mean "Premium for Fire, Theft, and Combined Additional Coverage". The abbreviation "TOW" shall mean "Premium for Towing and Labor Costs Coverage". 1 Ij. ' !" The abbreviation "W" shall mean "Premium for Windstorm, Hail, Earthquake or Explosion Coverage". The abbreviation "EPlP" shall mean "Premium for Excess Personal Injury Protection Coverage". The abbreviation "BDP" shall mean "Premium for Basic Damage to Property Coverage". The abbreviation "RR" shall inean "Premium for Rental Reimbursement Coverage". The abbreviation "BPP" shall mean "Premium for Basic Property Protection Coverage". The abbreviation "SDP" shall mean "Premium for Supplemental Damage to Property Coverage". The abbreviation "PIP" shall 'mean "Premium for Personal Injury Protection Coverage". The abbreviation "I" shall mean "Deductible applies to the named insured only". The abbreviation "I/R" shall mean "Deductible applies tq the named insured and relatives". C.16254 (BACK) DECLARATIONS SCHEDULE--Automobile (Sec reverse side for explanation of certain entries or absence thereof) Special Code: p 0Ucy No. ifjC Schedule No. Explanation of Certain Entries or the Absence Thereof on Reverse Side The absence of an entry in premium spaces for a coverage shall mean that such insurance is not afforded with respect to the designated automobile. The USE of the automobile is "Pleasure and Business" unless otherwise stated. The abbreviation "C-LT" shall mean "Commercial--(Local Truckman)'" i The abbreviation "C-IT" shall mean "Commercial--(Intermediate Truckman)". The abbreviation "C-LHT" shall mean "Commercial--(Long-Haul Truckman)". The abbreviation "C" shall mean "Commercial". The abbreviation "ACV" in the;"Limit of Liability" space shall mean "Actual Cash Value". The abbreviation "CAC" shall mean "Premium for Combined Additional Coverage". The abbreviation "FTCAC" shall mean "Premium for Fire, Theft, and Combined Additional Coverage". The abbreviation "TOW" shall'jmean "Premium for Towing and Labor Costs Coverage". The abbreviation "W" shall mean "Premium for Windstorm, Hail, Earthquake or Explosion Coverage". The abbreviation "EPIP" shall mean "Premium for Excess Personal Injury Protection Coverage", : The abbreviation "BDl?" shall mean "Premium for Basic Damage to Property Coverage", The abbreviation "RR" shall rr ean "Premium for Rental Reimbursement Coverage". The abbreviation "BPP" shall mean "Premium for Basic Property Protection Coverage". The abbreviation "SDP" shall mean "Premium for Supplemental Damage to Property Coverage". The abbreviation "PIP" shall mean "Premium for Personal Injury Protection Coverage". The abbreviation "I" shall mean "Deductible applies to the named insured only". The abbreviation "I/R" shall mean "Deductible applies to the named insured and relatives". C-16254 (BACK) DECLARATIONS SCHEDULE--Automobile (See reverse side for explanation of certain entries or absence thereof) Special Code: iff/HC/ttC Policy No. TR-NSL-J 2316^3-3-7 Schedule N o . 8 le and Address of Mortgagee (The number opposite each entry indicalcs the automobile to which the entry applies, such automobile being identified by the same number P Explanation of Certain Entries or the Absence Thereof on Reverse Side The absence of an entry in premium spaces for a coverage shall mean that such insurance is not afforded with respect to the designated automobile. The USE of the automobile is "Pleasure and Business" unless otherwise stated. The abbreviation "C-LT" shall mean "Commercial--(Local Truckman)". The abbreviation "C-ITT shall mean "Commercial--(Intermediate Truckman)". The abbreviation "C-LHT" shall mean "Commercial--(Long-Haul Truckman)". The abbreviation "C" shall mean "Commercial". The abbreviation "ACV" in the "Limit of Liability" space shall mean "Actual Cash Value". The abbreviation "CAC" shall mean "Premium for Combined Additional Coverage". The abbreviation "FTCAC" shall mean "Premium for Fire, Theft, and Combined Additional Coverage". The abbreviation "TOW" shall mean "Premium for Towing and Labor Costs Coverage". The abbreviation "W" shall mean "Premium for Windstorm, Hail, Earthquake or Explosion Coverage". The abbreviation "EPIP" shall mean "Premium for Excess Personal Injury Protection Coverage". The abbreviation "BDP" shall mean "Premium for Basic Damage to Property Coverage". The abbreviation "RR" shall mean "Premium for Rental Reimbursement Coverage". The abbreviation "BPP" shall mean "Premium for Basic Property Protection Coverage". The abbreviation "SOP" shall mean "Premium for Supplemental Damage to Property Coverage". 'I i The abbreviation "PIP" shall! mean "Premium for Personal Injury Protection Coverage". The abbreviation "I" shaill mean "Deductible applies to the named insured only". The abbreviation "I/R" shall mean "Deductible applies to the named! insured and relatives". C-16254 (BACK) DECLARATIONS SCHEDULE--Automobile (See reverse side for explanation of certain entries or absence thereof) Special Code: 'j,V ''rtC /IJ C Policy No. Schedule No. 7 Explanation of Certain Entries or the Absence Thereof on Reverse Side The absence of an entry in premium spaces for a coverage shall mean that such insurance is not afforded with respect to the designated automobile. The USE of the automobile is "Pleasure and Business" unless otherwise stated. The abbreviation "C-LT" shall mean "Commercial--(Local Truckman)". The abbreviation "C-IT" shall mean "Commercial--(Intermediate Truckman)". The abbreviation "C-LHT" shall mean "Commercial--(Long-Haul Truckman)". The abbreviation "C" shrill mean "Commercial". The abbreviation "ACV" in the "Limit of Liability" space shall mean "Actual Cash Value". The abbreviation "CAC" shall mean "Premium for Combined Additional Coverage". The abbreviation "FTCAC" shall mean "Premium for Fire, Theft, and Combined Additional Coverage". The abbreviation "TOW" shall mean "Premium for Towing and Labor Costs Coverage". The abbreviation "W" shall mean "Premium for Windstorm, Hail, Earthquake or Explosion Coverage". The abbreviation "EPIP" shall mean "Premium for Excess Personal Injury Protection Coverage". The abbreviation "BDP" shall mean "Premium for Basic Damage to, Property Coverage". The abbreviation "RR" shall mean "Premium for Rental Reimbursement Coverage". The abbreviation "BPP" shall mean "Premium for Basic Property Protection Coverage". The abbreviation "SDP" shall mean "Premium for Supplemental Damage to Property Coverage". The abbreviation "PIP" shall mean "Premium for Personal Injury Protection Coverage". r The abbreviation "I" shall mean "Deductible applies to the named insured only". The abbreviation "I/R" shall mean "Deductible applies to the named insured and relatives". k r'xrs DECLARATIONS SCHEDULE--AutomobUe Lability Hzutrd* No.. - - 'C Polic\ No__ ' In the Rates and Advance Premium columns VBI" means "Bodily Injure Liabilitv "PD" means "Property Damage Liability" and "Med. Pa\means '`Division I. Medical Pavments". Comprehensive Commercial Automobile Insurance. (a) The schedules disclose all hazards insured hereunder known to exist at the effective date of this policv. and (b) the schedules contain a list of (l) all automobiles and trailers owned by the named insured at the effective date of this policv and the purpo- of use thereof, and (2) all persons within the definition of Class I persons* at the effective date of this policy, unless otherw ise stated herein Description of Hazards 1. Owned Automobiles Premium Basis--Per Automobile See other Declarations Schedule(s)--Automobile Liability Hazards 2371 (TX$ S 2*73 1251 Advance Premium PD______ Med. Peys 4335 405 i 2. Hired Automobiles Premium Basis--Cost of Hiret| Medical Payments_______________ % Type* Hired Locatiftu Where Automobiles Will Be Principally Used i-----------------Purposes Estimated ;Rates per SiOO Coet of Hire of Cost of Use* Hirt | BI 1 PD PSB C-CL-4 HOUSTON IX S3.703 3.174 IF El.527 .550 c ANY S13.75 6.017 E 4.18 5 .962 3. Noe-Owned AutomobilesPremium Basis--Class 1 Persons and Class 2 Emploveest Class I Persons-- Name of Each Location of Headquarters of Persona Named Herein Rates per Person BI PD Med. Pyi. r ANY HOUSTON IX >11.109 5.290 3.381 .916 Claaa 2 Employees-- Estimated Average Number iF ANY Location of Headquarters of Clasu 2 Employees HOUSTON TX Rates per Employee BI PD S.476 .145 E.265 -.046 INCLUDED INCLUDED INCLUDED UH SEE EHO 241 75 S 30! AID 000193 *Thc purposes ol use of the automobile are "Pleasure and Business" unless otherwise stated. The abbreviation "C" in the "Purposes of Use" colun <hall mean "Commercial." the abbreviation "C-UT" shall mean "Commercial-(Local Truckman)" and the abbreviation "C-UHT" shall me; ``Commercial-* Long Haul Truckman)." C-16786 Rev. 1-75 min t e d in d .-.a. tSee over for Description of Premium Bases Sfr DESCRIPTION OF TERMS USED AS PREMIUM BASES: When used as a premium basis: A. "cost of hire" means the amount incurred for ia> the hire of automobiles, including the entire remuneration of each emplovee <if the named insured encaged in the operation of such automobiles subject to an average weekly maximum remuneration of $100, and for (b) pick-up, transportation or delivery service of property or passengers, other than such services performed by motor carriers which are subject to the security requirements of any motor carrier law or ordinance. The rates for each $100 of "cost of hire" shall be 5% of the applicable hired automobile rates* provided the owner of such hired 'automobile has purchased automobile Bodily Injury Liability and Property Damage Liability insurance covering the interest of the named insured on a direct primary basis as respects such automobile and submits evidence of such insurance to the named insured: U. "Cits* 1 persons" means the following persons, provided their usual duties in the business of the named insured include the use of noil-owned automobiles: (a) all employees, including officers, of the named insured compensated for the use of such automobiles by salary. Commission, terms of employment, or specific operating allowance of any sort: (b) all direct agents and representatives of the named insured; C. "Claes 2 employees" means all employees, including officers, of the named insured, not included in Class 1 persons. <S> CP 04 64 (Ed. 1-7*) Thu endorsement modifies such insurance as is afforded by the provisions of the policy relating to the following: UNINSURED MOTORISTS INSURANCE UNINSURED MOTORISTS INSURANCE AMENDMENT ft Is agreed that the insured shall not be required to arbitrate disputed claims under Uninsured Motorists Insurance. This endorsement must be attached to the Change Endorsement when issued after the policy is written. CP 04 64 (Ed. i-74) % This endorsement modifies such insurance as is afforded by the provisions of the policy relating to the following: UNINSURED MOTORISTS INSURANCE CP 04 86 (Ed. 12-74) LOUISIANA AMENDMENT It is agreed that AID 000194 1. (a) The definition of "uninsured highway vehicle" shall also include a highway vehicle for which the owner or operator has a baddy injury liability bond or insurance policy applicable at the time of the accident but the limit* of such bond or policy are insufficient to pay the full amount the insured is legally entitled to recover for damages because of bodily infury caused by the accident (b) in the event the owner or operator has such a buddy injury liability bortd or insurance policy applicable to the accident this insurance shall apply as excess insurance over such liability bond or insurance policy, up to the amount the insured is legally entitled to recover for damages because of bodily injury caused by the accident subject to the limits specified for this insurance. 2. (a) Any amount payable under the terms of this insurance because of bodily injury sustained in an accident by a person who is an insured under this insurance shall not be reduced by any sums paid on account of such bodily injury by or on behalf of (i) the owner or operator of the uninsured highway vehide and (ii) any other person or organization jointly or severally liable together with such owner Or operator for such bodily injury including all sums paid under liability coverage; (b) that part of the "Limits of Liability" provision pertaining to such a reduction is amended accordingly. 3. The company shall not be obligated to make any payment because of bodily injury to which this insurance applies and which arises out of the ownership, maintenance or use of an uninsured highway vehicle until after the limits of liability under all bodily injury liability bonds or insurance policies applicable at the time of the accident have been exhausted by payment of judgments or settlements. This endorsement must be attached to the Change Endorsement when issued after the policy is written. CP 04 86 (Ed. 12-74) CP 04 60 (Ed 1-74) Thisandonoment modifies such insurance as is afforded by the provisions of the policy relating to the following: UNINSURED MOTORISTS INSURANCE OREGON AMENDMENT It is agreed that (1) Subject to provisions (a) and (b) thereof, the definition of "hit-and-run vehicle" is amended to include a highway vehicle or motor vehicle which without physical contact with the insured or with a vehicle which the insured is occupying at the time of the accident causes bodily injury to an insured arising out of a highway vehicle or motor vehicle accident, provided the facts of such accident can be corroborated by competent evidence other than the testimony of any person having a claim under this or any other similar insurance as the result of such accident. (2) Paragraph (d) of the limits of liability provision does not apply unless the named insured has employees who operate motor buses, motor trucks or taiicabs as defined in O.R.S. 481.030.481.035 and 481.050 artd such employees are covered for workmen's compensation. (3) The Arbitration condition is amended by the addition of the following two sentences: The company shall reimburse the insured for any costs of arbitration to the insured in excess of 8100. Costs shall not include attorney fees or expenses incurred in the production of evidence or witnesses or the making of transcripts of the arbitration proceedings. This endorsement must be attached to the Change Endorsement when issued after the policy is written. CP 04 60 (Ed. 1-74) T %r i # S " 000195 CP 04 51 (Ell -74) This endorsement modifies such insurance as is afforded by the provisions of the policy relating to the following: UNINSURED MOTORISTS INSURANCE CALIFORNIA AMENDMENT It is agreed that: 1. Exclusion (c) is amended to read as follows: so as to mure directly or indirectly to the benefit of any workmen's compensation or disability benefits carrier or any person or organi zation qualifying as a self-insurer under any workmen's compensa tion, disability benefits law or any similar law or directly to the benefit of the United States or any state or political subdivision thereof. 2. Subsections (b). (c) and (d) of the provision entitled "Limits of Lia bility" are replaced by the following: (b) Any loss payable under the terms of this insurance to or for any person shall be reduced by: (1) the amount paid and the present value of all amounts pay able to him under any workmen's compensation law. ex clusive of non-occupational disability benefits; (2) the amount the insured is entitled to recover from any other person insured under the bodily injury liability cov erage of the policy; and (3) all sums paid by or on behalf of the owner or operator of the uninsured highway vehid and any other person or organization jointly or severally liable together with such owner or operator for bodily injury to an insured. (c) The company shaft not be obligated to pay under this insurance that part of the damages which the insured may be entitled to recover from the owner or operator of an uninsured highway vehicle which represents expenses for medical services paid or payable under the Automobile Medical Payments Coverage of the policy. 3. Paragraph (a) of the definition of "uninsured highway vehicle'' is amended to read as follows: (a) a highway vehicle with respect to the ownership, maintenance or use of which there is. in at least the amounts specified by the financial responsibility law of the state in which the insured highway vehicle is principally garaged, no bodily injury liability bond or insurance policy applicable at the time of the accident with respect to any person or organization legally responsible for the use of such vehicle, or with respect to which there is a bodily injury liability bond or insurance policy applicable at the time of the accident but the company writing the same denies coverage thereunder or refuses to admit coverage thereunder except conditionally or with reservation or Such company is or becomes insolvent; or 4. The Condition entitled "Other Insurance" is replaced by the following; Other Insurance With respect to bodily injury to any insured occupying a highway vehicle (other than a highway vehicle which is owned by the named insured) to which the buddy injury liability coverage of the policy applies, the insurance hereunder shall not apply if the owner of such vehicle has insurance similar to that provided for herein. Subject to the preceding paragraph, if the insured has other similar insur ance available to him, any damages including damages for care and loss of services because of bodily injury shall be deemed not to exceed the higher of the applicable limits of the respective coverages and such damages in cluding damages for care and loss of services because of bodily injury shall be pro-rated between such coverages in such proportion as each coverage bears to the total of such limits. 5. The Condition entitled "Arbitration" is amended to read as follows." Arbitration :- If any person making claim hereunder and the company do not agri IMv such person is legally entitled to recover damages from the owner opr operator of an uninsured highway vehicle because of bodily injury4o tlwf-.,-,insured, or do not agree as to the amount of payment which may be owing- v under this insurance, then upon written demand of either, the matter or matters upon which such person and the company do not agree shall be settled by a smgie neutral arbitrator, and judgment upon the award ren dered by the arbitrator may be entered in any court having jurisdiction thereof- Such person and the company each agree to consider itself bound and to be bound by any award made by the arbitrator pursuant to this insurance. 6. The Condition entitled "Action Against Company" is amended to read as follows: Action Against Company No action shall lie against the company unless, as a condition precedent thereto, the insured or his legal representative has fully complied with ail the tbrms of his policy nor unless within one year from the date of the accident (a) suit for bodily injury has been filed against the uninsured motor ists in a court of competent jurisdiction, or (b) agreement as to the amount due under this insurance has been concluded, or (c) the insured or his legal representative has formally instituted arbitration proceedings. This endorsement must be attached to the Change Endorsement when issued after the policy is written. CP 04 51 (Ed. 1-74) AID 000196 CANCELLATION CONDITION AMENDMENT--GEORGIA CP 02 84 (Ed. 8-74) It is agreed that the "Cancellation" Condition is replaced by the following: This policy may be cancelled by the named insured by surrender thereof to the company or any of its authorized agents or by mailing to the company written notice stating when thereafter the cancellation shall be effective. This policy may be cancelled by the company by mailing to the named insured and to any lienholder shown m the policy, at the last address of record, written notice stating when not less than thirty days thereafter such cancellation shall be effective: provided that this policy may be cancelled by the company by mailing to the named insured and to any lienholder shown m the policy, at the last address of record, written notice stating: 1. when not less than fifteen days thereafter such cancellation shall be effective, if the policy insures a commercial or industrial concern, or 2. when not less than ten days thereafter such cancellation shall be effective, if the named insured fails to discharge when due any of his obligations m connection with the payment of premium for this policy or any installment thereof, whether payable directly to the company or its agent or indirectly under any premium finance plan or extension of credit, or 3. when not less than ten days thereafter such cancellation shall be effective, if this policy has been in effect less than suty days at the time notice of cancellation is mailed and this is not a renewal policy. The mailing of notice as aforesaid shall be sufficient proof of notice. The time of surrender or the effective date and hour of cancellation stated m the notice shall become the end of the policy period. Delivery of such written notice either by the named insured or by the company shall be equivalent to mailing. If the named insured cancels, earned premium shall be computed in accordance with the customary short rate table and procedure. If the company cancels, earned premium shall be computed pro lata. Premium adjustments shall be made within fifteen days of notice of cancellation, unless an audit or rate investi gation is required in which case premium adjustment shall be made as soon as practicable: however, payment or tender of unearned premium is not a con dition of cancellation: This endorsement must be attached to the Change Endorsement when issued after the policy is written. CP 02 84 (Ed. 8-74) '1 AID 000197 CP 02 53 (Ed. i-ii) TERMINATION PROVISIONS AMENDMENT--MICHIGAN It is agreed that, with respect only to such insurance as is afforded by the policy for bodily injury lability or property dameg* liability arising out of the ownership, maintenance or use at automobiiei classified as private passenger autemuMcK A. The second sentence in the first paragraph of the "Cancellation" Con dition is replaced by the following: This policy may be cancelled by the company by mailing to the insured named in Item 1 of the declarations at his address last known to tlw company or its authorized agent, by certified mail, return receipt re quested, written notice stating when not less than twenty days there after such cancellation shall be effective: except that this policy may be cancelled by the company by mailing to the insurad named in Item! of the declarations at his address last known to the company or its authorized agent, by first class mail, written notice stating: 1. when not less than ten days thereafter such cancellation shall be effective, if the named insurad tails to discharge when due any of his obligations m connection with the payment of premium for this policy, or any installment thereof, whether payable di rectly to the company or his agent indirectly under any premium finance plan, or 2. when not less than twenty days thereafter such cancellation shall be effective, if this policy has been m effect less than fifty-five days at the time notice of cancellation is mailed and this is not a renewal policy. B. The following Condition is added or. ifi the policy contains a Condition so entitled, such Condition is replaced by the following: Cancellation by Company Limited Alter this policy has been in effect for fifty-five days or, if this policy is a renewal, effective immediately, the company shall not exercise its right to cancel the insurance unless: 1. during the fifty-five days following the date of original issue thereof the risk is unacceptable to the company; or 2. the named insured fails to discharge when due any of his obliga tions in connection with the payment of premium for this policy, or any installment thereof, whether payable directly to the com pany or its agent or indirectly under any premium finance plan; or 3. the named insurad or any other operator, either resident of the same household or who customarily operates an automuM* in sured under this policy has had his operator's license suspended during the policy period and the revocation or suspension has become final. This agreement shall apply to each successive policy period for which the company consents to renew or continue this policy but nothing herein shall obligate the company to renew or continue this policy beyond the expiration of any annual period commencing with its origi nal effective date: provided that, it this policy is written without a fixed expiration date or for a policy period longer than one year, this policy may be terminated by the company for other causes effective on the expiration of any such annual period by mailing to the insured named in Item 1 of the declarations at his address last known to the company or its authorized agent by first class mail, written notice of such ter mination not less than twenty days prior to the expiration of such an nual period. The mailing of notice as aforesaid shall be sufficient proof of notice. Delivery of such written notice by the company shall be equivalent to mailing. C. The following Condition is added: Renewal If the company elects not to renew this policy, it shall mail to the in sured named in Item 1 of the declarations, at his address last known to the company or its authorized agent by first class mail, written notice of such nonrenewal not less than twenty days prior to the ex piration date: provided that notwithstanding the failure of the com pany to comply with the foregoing provisions of this paragraph, this policy shall terminate on such expiration date, if - .L (a) the named inured fails to pay the premium is required by thr company for renewal or contjnuanca of this policy, or (b) the named inured has failed to discharge when due any of his obligation in connection with the payment of premium for this policy, or any installment thereof, whether payable directly tor the company or its agent indirectly under any premium finance plan. The mailing of notice as aforesaid shall be sufficient proof of notice. Delivery of such written notice by the company shall be equivalent to mailing: This endorsement must be attached to the Change Endorsement when issued after the policy is written. CP 02 53 (Ed. 1-74) AID 000198 I'i MARYLAND PERSONAL INJURY PROTECTION ENDORSEMENT The Company agrees with the named insured, subject to the provisions of this endorsement, and all provisions of the policy except where modified herein: SECTION I Coverage QQ -- PERSONAL INJURY PROTECTION The Company will pay the following benefits for I099 and expense incurred because of bodily injury caused by accident and involving a motor vehicle: (al medical expense benefits to or on behalf of each injured person: (bl income continuation benefits to or on behalf of each injured person who at the time of the accident was an income produc er; (cl essential services benefits to or on behalf of each injured person who at the time of the accident was not an income producer. Exclusions This insurance does not apply: (a) to bodily injury sustained by any person (1) who intentionally causes the motor vehicle accident; or (2) while operating of voluntarily riding in a motor vehicle known by him to be stolen; or (3) while in the commission of a felony or fleeing or attempting to elude a police officer; or (4) arising out of the ownership, maintenance, or use of a motorcycle or motorbike, by such person; (b> to bodily injury sustained by any person while occupying a motor vehicle which is located for use as a residence or premises; <c) to bodily injury sustained by the named insured or any relative while occupying, or while a pedestrian through being struck by any motor vehicle owned by the named insured or furnished or available for the named insured's regular use and which is not an insured motor vehicle; (d) to bodily injury sustained by any relative while occupying, or while a pedestrian through being struck by any motor vehicle owned by such relative or furnished or available for the relative's regular use; <e) to bodily injury sustained by any pedestrian, other than the named insured or a relative, if the motor vehicle accident occurs outside of Maryland; (f) with respect to income continuation benefits and essential services benefits, to bodily injury sustained by any person, other than the named insured or a relative, if the motor vehicle accident occurs outside of Maryland; (g) to bodily injury sustained by any person while occupying, or while a pedestrian through being struck by any motor vehicle other than an insured motor vehicle, for which the coverage required under Section 539, of Article 48A of the Annotated Code of Maryland is in effect; <h) to bodily injury due to war, declared or not, civil war, insurrection, rebellion, revolution, or to any act or condition in cident to any of the foregoing; (i) to bodily injury resulting from radioactive, toxic, explosive, or other hazardous properties of nuclear material. Definitions When used in reference to thi9 insurance; "bodily injury" means bodily injury, sickness or disease, including death resulting therefrom; / ! MEW 1-73 Pr in t B" in u S i. IISOI (Continued on Page 2) AID 000199 A991 "essential services benefits" means reimbursement for necessary and reasonable payments made to others, not members of the injured person's household, incurred within three years from the date of the accident for essential services ordinarily performed by the injured person, for care and maintenance of his family or family household; "funeral services" means funeral, burial, or cremation services; "income" means wages, salary, tips, commissions, professional fees, and other earnings from businesses or farms owned individually or jointly or in partnership with others, and to the extent that any such earnings are paid or payable tn property or services other than cash, income means the reasonable value of such property or services; "income continuotion benefits" means payment for loss of income incurred within three years from the date of the accident, "income producer" means a person who at the time of the accident was in an occupational status where he was earning or producing income; "injured person" means (a) the named insured or any relative who sustains bodily injury in any motor vehicle accident; <b> any other person who sustains bodily injury (1) while occupying the insured motor vehicle as a guest or passenger, or (2) while using the insured motor vehicle with the express or implied consent of the named insured, or (3) while a pedestrian through being struck by the insured motor vehicle; "insured motor vehicle" means a motor vehicle of which the named insured is the owner, to which the bodily injury liability insurance of the policy applies and for whicn a specific premium is charged; "medical expense benefits" means payment for all reasonable expenses arising from the accident and incurred within three years from the date of the accident for necessary medical, surgical, x-ray and dental services, including prosthetic devices, and necessary ambulance, hospital, and professional nursing sen-ices and funeral services; "motor vehicle" means an automobile and any other vehicle, including a trailer, operated or designed for operation upon a public road by any power other than animal or muscular power; "named insured" means the person or organization named in the declarations and if an individual, includes his spouse if a resident of the same household; "occupying" means in or upon or entering into or alighting from; "relative" means a person related to the named insured by blood, marriage or adoption who is a resident of the same house hold, and includes the named insured's unmarried and unemancipated children, while away from his household attending school or while in military service. Limits of Liability Regardless of the number of persons insured, policies or bonds applicable, claims made, or insured motor vehicles to which this insurance applies, the Company'3 liability for personal injury protection benefits is limited as follows: 1, The total aggregate amount payable by the Company to or on behalf of any one person who sustains bodily injury in any one motor vehicle accident shall not exceed *2500.00 for medical expense benefits, income continuation benefits and essential services benefits. 2. Benefits payable by the Company under the terms of this insurance to or on behalf of an injured person shall be reduced (a) to the extent that benefits therefor are paid, payable or required to be provided to or on behalf of the injurad parson under any workmen's compensation law of any state or the Federal Government; (b) by any amount received by or on behalf of such injured person from a person or organization who is liable in tort therefor or from such person's or organization's agent or insurer, to the extent that such amount would produce a duplication of payment or reimbursement for the same items of loss and expense for which benefits are available under this insurance. No person may recover benefits as prescribed by law and afforded under this insurance from more than one motor vehicle liability insurance policy on either a duplicative or supplemental basis. , . ICCSI rw i (Continued on Page 3) AID 000200 A991 P.lgv ' Policy Period: Territory This insurance applies only to accidents which occur during the policy period and within the United States of America, its territories or possessions, or Canada. CONDITIONS This insurance is subject to the following additional conditions: 1. Notice. In the event of an accident, written notice containing details sufficient to identify the injured persons, and also reasonably obtainable information respecting the time, place, and circumstances of the accident shall be given by or on behalf of each injured person to the Company or any of its authorized agents as soon as practicable. 2. Action Agoinst Compony. No action shall lie against the Company unless, as a condition precedent thereto, there shall have been full compliance with all the terms of this endorsement. 3. Medico! Reports; Proof of Claim. As soon as practicable, within a period not to exceed 6 months after the date of the accident, the injured person, or someone on his behalf, shall submit to the Company written proof of claim including full particulars of the nature and extent of the injuries and treatment received and contemplated and such other information as may assist the Company in determining the amount due and payable. If benefits for loss of wages or salary lor in the case of the self employed, their equivalent) are claimed, the person presenting such claim shall authorize the Company to obtain details of all wage or salary payments or their equivalent; paid to him by any employer or earned by him since the time of the bodily injury or during the year immediately preceding the date of the accident. The injured person shall sub mit to mental or physical examinations by physicians selected by the Company and at the Company's expense when and as often as the Company may reasonably require, and he or in the event of his death or incapacity, his legal representative shall upon each request by the Company execute authorization to enable the Company to obtain medical reports and copies of records. Proof of claim shall be made upon forms furnished by the Company unless the Company shall have failed to furnish such forms within 15 days after receiving notice of claim. The person making claim shall submit to examination under oath by any person named by the Company as often as reasonably required. If a lapse occurs in the period of disability or medical treatment of an injured person who has received benefits under this insurance and such person subsequently claims a recurrence of the bodily injury for which the original claim was made, such injured person or someone on his behalf shall be required to submit to the Company reasonable medical proof of such recurrence. 4. Prompt Poyment of Claims. Payments of personal injury protection benefits shall be made promptly and within thirty days after satisfactory proof of claim has been submitted to the Company. 5. Other Insurance. With respect to the named insured or any relative who sustains bodily injury while occupying, or while a pedestrian through being struck by a motor vehicle not insured as required under Article 48A. Section 539 and 541 of the Maryland Code: (1) If there is no other available personal injury protection coverage with respect to such bodily injury, the benefits pay able for such coverage under this policy with respect to such bodily injury shall be reduced to the extent of any medical or disability benefits coverage applicable to such motor vehicle and collectible from the insurer of such motor vehicle, or <21 if there is other personal injury protection coverage available with respect to such bodily injury, the aggregate max imum amount payable under this and all other policies as personal injury protection benefits shall not exceed the highest applicable limit of liability for such coverage under any one of such policies, provided that such aggregate maximum amount shall be reduced to the extent of any medical or disability benefits coverage applicable to such motor vehicle and collectible from the insurer of such motor vehicle. The company shall not be liable under this policy for a greater proportion of such benefits than the applicable limit of liability stated in this policy bears to the sum of the applicable limits of liability for such coverage under this policy and such other policies. It is further agreed that: SECTION II la) any amount payable as damages for economic loss under the Protection Against Uninsured Motorist Insurance shall be reduced by the amount of any basic personal injury protection coverage paid or payable under this or any other auto mobile insurance policy because of bodily injury to an injured person, and C-S6S2* NEW 1-73 (Continued on Page 4) AID 000201 A991 Page 4 <b> any Automobile Medical Payments Insurance afforded under the policy shall be excess insurance over any medical expense benefits paid or payable under this or any other automobile insurance policy because of bodily injury to an injured person. THE TRAVELERS INDEMNITY COMPANY THE CHARTER OAK FIRE INSURANCE COMPANY THE TRAVELERS INDEMNITY COMPANY OF ILLINOIS THE TRAVELERS INDEMNITY COMPANY OF RHODE ISLAND THE TRAVELERS INDEMNITY COMPANY OF AMERICA AID 000202 \OQ1 UNINSURED MOTORISTS INSURANCE COVERAGE PART ADDITIONAL DECLARATIONS Designated Insured Forming part of Policy No. Description of Injured Highway Vehicles (Check appropriate box) 2 .Any automobile owned by the named injured H Any private passenger automobile owned by the named insured Any highway vehicle to which are attached dealer's license plates issued to the named insured 0 Any highway vehicle for which a premium designated by the letters "UM" is included in the declarations of the policy and a highway vehicle ownership of which is acquired during the policy period by the named insured as a replacement therefor 0 Any mvhile equipment owned or leased by and registered in the name of the named insured ^ ---------------------:------------.------------------------- ------------ i:i' "i,!--':v' ' \ . .--:------------------------------------------ 1------------------- -------------------------- --- T Protection Against UNINSURED MOTORISTS INSURANCE I. Coverage U--Uninsured Motorists (Damages for Bodily Injury) The company will pay all sums Which the insured or his legal representative shall be legally entitled to recover as damages from the owner Or operator of an uninsured highway vehicle because of bodily injury sustained by the insured, caused by accident and arising out of the ownership, maintenance or use of such uninsured highway vehicle; provided, for the purposes of this coverage; determination as to whether the insured Or such representative is legally entitled to recover such damages, and if so the amount thereof; shall be made by agreement between the insured or such representative and the company or, if they fail to agree, by arbitration. s No judgment against any person or organization alleged to be legally responsible for the bodily injury shall be conclusive, as be tween the insured and the company, of the issues of liability of such person or organization or of the amount of damages to which the insured is legally entitled unless such judgment is entered pursuant to an action prosecuted by the insured with the written consent of the company. < Exclusions This insurance does not apply: (a) to bodily injury to an insured with respect to which such insured, his legal representative or any person entitled to payment under this insurance shall, without written con sent of the company, make any settlement with any person or organization who may be legally liable therefor; (b) to bodily injury to an insured while occupying * highway vehicle (other than an insured highway vehicle) Gwned by the named insured, any designated insured or any relative resident in the same household as the named or designated insured, or through being struck by such a vehicle, but this exclusion does not apply to the named insured or his relatives while occupying or if struck by a highway vehicle owned by a designated insured or his relatives; (c) so as to inure directly or indirectly to the benefit of any workmen's compensation or disability benefits earner or any person or organization qualifying as a self-insurer under any workmen's compensation or disability benefits law or any similar law. II. Persons Insured ! Each of the following is an insured under this insurance to the extent set forth below: (a) the named insured and any designated insured and; while resi dents of the same household, the spouse and i relatives of either!;!-: i.; 'i . ijV;' (b) any other person while occupying an insured highway vehicle; and "... :| (c) any person, with respect to damages he is entitled to recover because of bodily injury to which this insurance applies sus tained by an insured under (a) or (b) above. The insurance applies separately with respect to each insured, except with respect to the limits of the company's liability. III. Limits of Liability Regardless of the number of (1) persons or organizations who are insureds under this policy, (2) persons who sustain bodily injury, (3) claims made or suits brought on account of bodily injury, or (4) highway vehicles to which this policy applies, (a) The limit of liability stated in the declarations as appli cable to "each person'' is the limit of the company's liability for all damages because of bodily injury sustained by one person as the result of any one accident and, subject to the above provision respecting "each person", the limit of lia bility stated in the declarations as applicable to "each ac cident" is the total limit of the company's liability for all damages because of bodily injury sustained by two or more persons as the result of any one accident. (b) Any amount payable under the terms of this insurance be cause of bodily injury sustained in an accident by a person who is an insured under this coverage shall be reduced by (1) all sums paid on account of such bodily injury by or on behalf of (i) the owner or operator of the uninsured highway vehicle and (ii) any other person or organization jointly or severally liable together with such owner or operator for such bodily injury, including all sums paid under the bodily injury liability cov erage of the policy, and (2) the amount paid and the present value of all amounts payable on account of such bodily injury under any workmen's compensation law, disability benefits law or any similar law. (c) Any payment made under this insurance to or for any insured shall be applied in reduction of the amount of damages which he may be entitled to recover from any person or organization who is an insured under the bodily injury liability coverage of the policy. (d) The company shall not be obligated to pay under this in surance that part of the damages which the insured may be entitled to recover from the owner or operator of an unin sured highway vehicle which1 represents expenses for medical services, paid or payable under the medical payments cov erage of the policy. (Continued on Page 2) C-17844 Edition 1-74 *"#$B" in u.s S (LrM/CP 00 25) AID 000203 L 6B IV. Policy Period; Territory This insurance applies only to accidents which occur during the policy period and within the United States of America, its terri tories or possessions, or Canada. V. Additional Definitions When used m reference to this insurance (including endorsements forming a part of the policy): "designated insured'' means an individual named in the schedule under Designated Insured; "highway vehicle'' means a land motor vehicle or trailer other than (a) a farm type tractor or other equipment designed for use principally off public roads, while not upon public roads, (b) a vehicle operated on rails or crawler-treads, or (c) a vehicle while located for use as a residence or premises; "hit-and-run vehicle" means a highway vehicle which causes bodily injury to an insured arising out of physical contact of such vehicle with the insured or with a vehicle which the insured is occupying atthe time of the accident, provided: (a) there cannot be ascertained the identity of either the operator or owner of such highway vehicle; (b) the insured or someone on his behalf shall have reported the accident within 24 hours to a police, peace or judicial officer or to the Commissioner of Motor Vehicles, and shall have filed with the company within 30 days there after a statement under oath that the insured or his legal representative has a cause or causes of action arising out of such accident for damages against a person or persons whose identity is unascertainable, and setting forth the facts in support thereof; and (c) at the company's request, the insured or his legal repre sentative makes available for inspection the vehicle which the insured was occupying at the time of the accident; "insured highway vehicle" means a highway vehicle; la i described in the schedule as an insured highway vehicle to which the bodily injury liability coverage of the policy applies;;. i. (b) while temporarily used as a substitute for an insured highway vehicle as described in subparagraph (a) above, when withdrawn from normal use because of its break down, repair, servicing, loss or destruction; (c) while being operated by the named or designated insured or by the spouse of either if a resident of the same household; but the term "insured highway vehicle" shall not include: (i) a vehicle while used as; a public or livery conveyance, unless such use is specifically declared and described in this!'policyyi'T,ii.!!<tifr ' ; (ii) a vehicle while being used without the permission of the owner; (iii) under subparagraphs (b) and (c) above, a vehicle owned by the named insured, any designated insured Or any resident of the same household as the named or designated insured; or (iv) under subparagraphs (b) and (c) above, a vehicle fur nished for the regular use of the named insured or any resident of the Same household; but the term "uninsured highway vehicle'' shall not include: (ii an insured highway vehicle, iiij a highway vehicle which is owned or operated bv a selfinsurer within the meaning of any motor vehicle financial responsibility law, motor carrier law of any similar law, (iii) a highway vehicle which is owned by the United States of .America. Canada, a stale, a political sub-division of any such government or an agency of any of the foregoing. VI. Additional Conditions A. Premium. If during the policy period the number of insured highway vehicles owned by the named insured or spouse or the number of dealer's license plates issued to the named insured Changes, the named insured shall notify the companv during the policy period of any change and the premium shall be adjusted in accordance with the manuals in use by the company. If the earned premium thus computed exceeds the advance premium paid, the named insured shall pay the excess to the company ; it less, the company shall return to the named insured the un earned portion paid by such insured. B. Proof of Claim; Medical Reports. As soon as practicable, the insured or other person making claim shall give to the company written proof of claim, under oath if required, including full particulars of the nature and extent of the injuries, treatment, and other details entering into the determination of the amount payable hereunder. The insured and every other person making claim hereunder . shall submit to examinations under oath by any person named by the company >and subscribe the same, as often as1 may reasonably be required. Proof of claim shall be made upon forms furnished by the company unless the company shall have failed to furnish such forms within 15 days after receiving notice of claim The injured person shall submit to physical examinations by physiciansi selected by the company when and as often as the company may reasonably require and he, or in the event of his incapacity his legal representative, or in the event of his death his legal representative or the person or persons entitled to sue therefor, shall upon each request from the company execute authorization to enable the company to obtain medi cal reports and copies of records. C. Assistance and Cooperation of the Insured, After notice of claim under this insurance, the company may require the insured to take such action as may be necessary Or appropriate to preserve his right to recover damages from any person or organization alleged to be legally responsible for the bodily injury; and in any action against the company, the company may require the insured to join such person or organization as a party defendant. D. Notice of Legal Action. If, before the company makes payment of loss hereunder, the insured or his legal representative shall institute any legal action for bodily injury against any person or organization legally responsible for the use of a highway vehicle involved in the accident, a copy of the summons and complaint or other process served in connection with such legal action shall be forwarded immediately to the company by the insured or his legal representative. "occupying '' means in or upon or entering into or alighting from; 'm:!!' | "state'' includes the District of Columbia, a territory or pos session of the United States, and a province of Canada; "uninsured highway vehicle!'means: (a) a highway vehicle with respect to the ownership, main tenance or use of which there is, in at least the amounts specified by the financial responsibility law of the stale in which the insured highway vehicle is principally garaged; no bodily injury liability bond or insurance policy applicable at the time of the accident with respect to any person or organization legally responsible for the use ofsuch vehicle, or with respect to which there is a bodily injury liability bond or insurance policy applicable at the time of the accident but the company writing the same denies cover age thereunder or is or becomes insolvent; or (b) a hil-and-run-vehicle; E. Other Insurance; With respect to bodily injury to an insured while occupying a highway vehicle not owned by the named insured, this insurance shall apply only as excess insurance over any other similar insuranceI available to such insured and applicable to such vehicle as primary! insurance, and this insurance shall then apply only in the amount by which the limit of liability for this coverage exceeds the applicable limit of liability Of sUch other insurance. Except ;asn provided) in the foregoing paragraph, if the insured has otheriisimilar insurance available to him and applicable to the' accident, the damages shall be deemed not to exceed the higher of the applicable limits of liability of this insurance and suchj Other iinturance, and the company shall not) be liable for1 a greater 'proportion of any toss to which this cover age applies than the limit of liability hereunder bears to the sum of th'e applicable limits of liability of this insurance and such other insurance. (Continued on Page 3) AID 000204 L 6B EFFECTIVE: 01-01-76 DECLARATIONS SCHEDULE--General Liability Hazard* No------ ZL. P-ilicv No -J . v Die letters "MP" wherever used in this schedule shall mean "Premium for Premises Medical Coverage '. In the Rates and Advance Premie columns "BI" means "Bodily injury Liability" and "PD" means "Property Damage Liability". Location of all premises owned by, rented to or controlled by the named insured (Enter "same" if same location as address shown m Item !. declarations): Interest of named insured in such premises (Describe interest, such as "owner", "general lessee" or "tenant"): Part occupied by named insured: Comprehensive General Liability Insurance. The following discloses all hazards insured hereunder known to exist at the effective date of this poii unless otherwise stated herein: Description of Hazards Premises---Operations Independent Contractors Products--Completed Operations L.O.B.-Code No. 52-- 55-- ss- Premium Bases* Rates BI PD Ar--Are* B--Frontage C r--Remuneration DwNo. Insured E--No. Insured F ----Cost, G^rReceipts H---Receipts I --Sales J --Admission* A--Per 100 Sq. Ft. oi Ares B--Per Linear Foot C--Per $100 of Remuner ation D--Each or units E--Per Landing F --Per $100 of Cost G--Per $1000 of Receipts H-t-Per $100 of Receipts I --Per $1000 of Sales J r--Per 100 Admission* Advance Premium BI PD . 'I'ttr .'i- 66 LIMITS UDOSSEMarr 9000(c) niDcssaerr 26131 I'TIXEN T-S iffG-mSULATED ri iPJCAL CABLE .lUICOF i^(EFMEJT MFG *99901 52-71000 52-73907 52-36/403 52-25220 35 * 54,916 365 S' -' s 48,84! 32,5c.i 27 34 AID 000205 Minimum Premiums f Premises--Operations (BI S25 ' 3IPD SHE independent Contractors BI PD Products BI PD C-14101 Rev. 1-75 ..%&)Ko in ii.s.A. (U*e with Co t . Parts LI, 9t 10, II, 15 14 25) - -V- ' r;.:; m '~p 'See over for Description of Premium Bases DESCRIPTION OF TERMS USED AS PREMIUM BASES: When used as a premium basis: 1. "remuneration" means the entire remuneration earned during the policy period by proprietors and by all employees of the named insured, other than chauffeurs lexcept operators of mobile equipment) and aircraft pilots and co-pilots, subject to any overtime earnings or limitation of remuneration rule applicable in accordance with the manuals in use by the company; 2. "cost" means the total cost to the named insured with respect to operations performed for the named insured during the policy period by independent contractors of all work let or sub-let in connection with each specific project, including the cost of all labor, materials and equipment furnished, used or delivered fur use in the execution of such work, whether furnished by the owner, contractor or subcontractor, including all fees, allowances, bonuses or commissions made, paid or due; t. "receipt!" means the gross amount of money charged by the named insured for such operations by the named insured or by others during the policy period as are rated on a receipts basis other than receipts from telecasting, broadcasting or motion pictures, and includes taxes, other than taxes w hich the named insured collects as a separate item and remits directly to a govern mental! division; 4. "sales" means the gross amount of money charged by the named insured, by concessionaires of the named insured, or by others trading under his name for all goods and products sold or distributed during the policy period and charged during the policy period for installation, servicing or repair, and includes taxes, other than taxes which the named insured, concessionaires of the named insured and others trading under his name collect as a separate item and remit directly to a governmental division. The sales of tenants shall not be included. Any concessionaire who operates under his own trade name and whose premises are physically separated from the lessor's premises shall be considered a tenant. 5. "admissions" means the total number of persons, other than employees of the named insured, admitted to the event insured or to events conducted on the premises whether on paid admission tickets, complimentary tickets or passes. t" -14101 :R\CK' AID 000206  ECTT/I; Ol-Oi-76 DECLARATIONS SCHEDULE--General Liability Hazards N., Description of Hazards Code No. Premium Bases PuUcv Rates BI PD Advance Premium BI PD :iATE OF LA '.11 ANACONDA GOKPANY ORLEANS PARISH 52-73907 l- .CONDA WIRE AND CABLE CO " y yjimk w ir B co ''HERNIA BANK BLDG .- i-W ORLEANS ORLEANS PARISH 52-73907 IF ANY 1 !i C- 1 i is.0250 E,0313 -0024 j o0089| IF ANY 5,0250 ,0024 So0313 v0029 >-25-^6 CRfffiC/DP C-11167 7-66 min t B" in u .s .S . 1266 AID 000207 t 88 01-Oi-7u DECLARATIONS SCHEDULE-Mjeneral Liability Hazards No_____ 2. Description Of Hazards Code No. Premium Bases P..i.c. NV Rates BI PD "TATE OP HG .;u AHACGNM COMPANY . -\IIAG0HEA WIRE CABLE CO 490 ; CCSO TBt'iECCMBE CO 52-73907 >2-73907 52-36403 52-25220 010.336 c- 3cC040 ,0035 2.0028 ,0013 IF AST 687, 768 46,285 SaOClfi t0035 Ea0028 ,0013 3a0190 oGx2 E.0133 e006 3,0220 ,0162 E.0154 .0083 . TiCC NMAfXffIDA ZHC A.L L WALNUT CIIiCLE T-TflSBOEO " TA^SS-iiHOLSSALE 52-36403 52-25220 184,298 20,340 S01V0 ,012 2,0133 ,006 3,0220 ,0162 2,0154 ,0083 52-73907 53* 50991 3; 589 A759 OoCCliD ,0035 2,0028 ,0013 JU 3,200 2,070 .035 ,018 Advance Premium BI PD 131 92 i 10 -T 735 . 25 J-- 4i 3 MT7TH HIM 20 7 3 3-25-76 CBP/IK/DP *+,,-.0 1233 pr in t B" in u s *. 1266 D000208 881 "P'FS. A- ' r.I-Cl -75 DECLARATIONS SCHEDULE--General Liability Hazards No. Description of Hazards Code No. Premium Bases PollCV NU. Rates BI PD a. '-+T 12 Advance Premium BI PD - .grJCK2A iCKPStfl ALamnsi " 45is io n ) jrr: :.-6 6BS " K 78 8 9" / . ---:.?J.5'nAr AT MIL3C17 3 75206 52-73907 52-25220 -A" 73;G36 32,390 3.070 ,083 ^ W'J yX'(!; -CJJO -0370 --4. 23 2'i -nrioioN) - "A-jfsjTI EE 4. -XL 35566 i-".v;rl STATION ` J 73229 52---252IS `LlTEA V.TFE Al CA3L3 vOKFAHY "-/7GA WT22 XMP/JTY ---- J anew :;<s 8 9" / 52-7390? ' ;-is --ajciiavLE 53 * 50991 7S,636 3*01#) -0070 2,0175 ,0074 >-070 ,0350 2,CSS - 0370 l JL 14 2'3 7 M -2 :K " ANY A** JO, 606 JoOiw 007Q -0175 /Jo74 A- ' tUmQ ,019 oor:. Jr 118 -1::; :* C-U167 7-66 p*.Mreo .n u S S 1266 3^25^76 CSp /y e / 0? 0000 0 VO A] 88 BF5SJTI7E; 01-01*76 DECLARATIONS SCHEDULE--Automobile Liability Hazards c No____ -i_______ Polio N-'-' ______ In the Rate? and Advance Premium column? "BI" means "Bodih Injure Li.ibilnv ", "PD" me-m- "Property Uumace Li.ibihtv" anvl "Me ; Paxmeans "Division !. Medical Payments". Comprehensive Commercial Automobile Insurance. fa) The schedules disclose all hazards insured hereunder known to exi't at the effective dace of this policy, and fb) the schedules contain a. list of (1) all automobiles and trailers owned by the named insured at the effective date ul this police .md the p.:r;>. - of use thereof, and (2) all persons within the definition of Class 1 persons, at the elfective date of thi' policy, unless otherwise stated here:. Description of Hazards 1. Owned Automobiles : _________Premium Basis--Per Automobile See other Declarations Schedule(s)--Automobile Liability Hazards eooo(o) Advance Premium 3 25271 S 23034 Med. Pay; 887l(2XCEFT ItC & 12) S ll^s E 692 NC 3 1245 E 294 'EL S 2982 S 364 2. Hired Automobiles Premium Basis--Cost of Hire! Types Hired Locations Where Automobiles Will Be Principal!/ Used Purposes of Use* Medicat Payments________ % Estimated .Rates per $100 Cost of Hire Cost of -------------------------------------Hire BI PD 333 mo 3000(c) c3 SCHED 8341 (12) 3. Non-Owned AutomobilesPremium Basis--Class 1 Persons and Class 2 Employeest Clsss 1 Person*-- Name of Escb Location of Headquarters of Persons Named Herein Rates per Person BI PD Med. Pays. 553 SHD aOOO(G) aCHED (TX) EiULliDSD r-:Lt -uDEQ r:cL ,.K. L'-j L- -.J Clsss 2 Employees-- Estimated Average Number =BB Location of Headquarters of Clans 2 Employees aooo(c) SEE j j CHED 3841 Rates per Employee BI PD AID 000210 IECLT;;7ED rp;r r * -J - - .-r~ , 3EE 2ND 9950 OK E 96 n * 'CfC9S3(331-r' k) XE?CL " !r* EE 336 r IjiCL * KE" -399 JITS. r " ^rW? i08A Hid, ** *' =^2316 BiGI f 7? - *x-J4r-it*-jiii ETCL > r^ "The purpose? of n?e of the automobile are "Pleasure and Business" unless oth.Tw:.-.- sta::d. fhe abbrev iation "C" in the ''Purposes of l.'se" colun -hall mean "Commercial." the abbreviation "C-l.T" shall mean "Commercial-'Local Truckman)" and the abbreviation "C-I.IIT" shall mea "Coinniercial-i Long Haul Truckman I." >?@AC-167S6 Rev. 1-75 K o in u .s .S . 3^25"?6 0fiP/73/DF tSee over for Description of Premium Bases Ma DESCRIPTION OF TERMS USED AS PREMIUM BASES: When used as a premium basis: A. "cost of hire" means the amount incurred for sa> the hire of automobiles, including the entire remuneration of each empiovee of the named insured encased in the operation of such automobiles subject to an average weekly maximum remuneration of $100, ami tor tb> pick-up, transportation or delivery service of property or passengers, other than such services performed bv motor carriers which are subject to the security requirements of any motor carrier law or ordinance. The rates for each $100 of "cwst of hire" shall lie 5% of the applicable hired automobile rates, provided the owner of such hired automobile has purchased automobile Bodily Injury Liability and Property Damage Liability insurance covering the interest of the named insured on a direct primary basis as respects such automobile and submits evidence of such insurance to the named insured: . H. "Class 1 persons" means the following persons, provided their usual duties in the business of the named insured include the use of noil-owned automobiles: (a) all employees, including officer-, of the named insured compensated for the use of such automobiles by salary, commission, terms of employment, or specific operating allowance of any sort: (b) all direct agents and representatives of the named insured; C. "Class 2 employees" means all employees, including officers, of the named insured, not included in Class 1 persons. DECLARATIONS SCHEDULE--Automobile Liability Hazards No.. Pohc\ No. In the Rates .md Advance Premium columns "01" mean> "Bodilv lnjur\ Liability ", "PD ' means "Property Da mace Liability " and "Me-i. Pj v >. means "Division I. Medical Payments ' Comprehensive Commercial Automobile Insurance. (a) The schedules disclose all hazards insured hereunder known to exi**t nt the elective date of this policy, and (b) the schedules contain a list of M) all automobiles and trailers owned by the named injured at the effective date of thi* policv and the pi.rp.'- of use thereof, and (2) all persons within the demotion of Class l persons, at the effective date of thU policy, unle*-* otherwise Niated herein Description of Hazards 1. Owned Automobiles it _____ . - - ;Premium Basis--Per Automobile j See other DecIarations.;SchedLile(s)~Autornobile Liability Hazards Advance Premium BI PD Med. Pays * 2^ 2. Hired Automobiles Premium Basis--Cost of Hiret Types Hired Locations Where Automobiles Will Be Principally Used Purposes of Use* Medical Pavments_ Estimated Rates per S100 Cost of Hire Cost of Hire BI PD HOUSTON IX 35.26S 4.36; 13.0533 .345 i -M 315vO: 6 H 4.-.T, 7 7*5:4 o6-;' >1 3. Non-Owned Automobiles Class l Person*-- Name of Each Premium Basis---Class 1 Persons and Class 2 Employeest of Persona Named Herein Rates per Person BI PD Med. Ptys. HOniTICJI TX. 315*6 1 6,,47t 24.55c 1 .'50? i t 0LUDED Class 2 Employees-- Estimated Average Number Location of Headquarters of Clans 2 Employees Rates per Employee BZ PD y-Zf HOUSTON TI 3,692 5,201 'V243 . `->a..* IE liU *41 .1 . AID 000211 >-25-76 r^VYIt/DP J Pur;'OM-^--' Ii-r of the TmtomoHIo are "Pleasure and Business" ur.lc-. oth r-.v:-. s:a:.d. Hie ..'.b.-.-viatiuii "C" in the "Purposes of U,c" culun 'hall mean Cnimm-rria!. the abbreviation "C-l. I ' shall mean "Com-nercia!-' Local Truckman)" and the abbreviation "C-LHT" shall me: Commercial-1 Lone Haul Truckman)" C-16786 Rev. 1-75 B8 CDEK F ik u .s .S . tSee over for Description of Premium Bases DESCRIPTION OF TERMS USED AS PREMIUM BASES: When used as a premium basis: A. "cost of hire" mean' the amount incurred for -,a the hire of automobiles, including the entire remuneration of each employee of the named insured encaged in the operation of such automobiles subject to an average weekly maximum remuneration of S100. ami for d>) pick-up, transportation or delivery service of property or passengers, other than such services performed bv motor carriers which are subject to the security requirements of any motor carrier law or ordinance. The rates for each $100 of "cost of hire" shall be 5Tc of the applicable hired automobile rates, provided the owner of such hired automobile has purchased automobile Bodily Injury Liability and Property Damage Liability insurance covering the interest of the named insured on a direct primary Ixi'is as respects such automobile and submits evidence uf such insurance to the named insured; li. "Class I persons" means the following persons, provided their usual duties in the business of the named insured include the use of non-owned automobiles: (a) all employees, including officers; of the named insured compensated for the use of such automobiles by salary, commission, terms of employment, or specific operating allowance of any sort; (b) all direct agents and representatives of the named insured; C. "Class 2 employees" means all employees, including officers, of the named insured, not included in Class 1 persons. FUoTI/E; 01-01-V6 DECLARATIONS SCHEDULE--Automobile Liability Hazards No.. Policv No._ in the Rates and Advance Premium columns "Bl" means "Bodily Injury Liability ". "PD" means "Property Damage Liability" and "Med. Paw rpeans "Division 1. Medical Payments". Comprehensive Commercial Automobile Insurance. iaj The schedules disclose all hazards insured hereunder known to exist at the effective date of this policy, and bj the schedules contain a list of all automobiles and trailers owned'by the named insured at the effective date of this policy and the purpose^ use thereof ' Description of Hazards 1. Owned Automobiles premium Basis--Per Automobile See other Declarations chedule(s)--Automobile Liability Hazards $874 Advene* Premium BX ____;, PD_______ Med P*y 2 391 71 -TT 471 :< 2. Hired Automobiles Type* Hired RADIUS Premium Basis--Cost "of Hiret I Locations Where Automobile* WiXl Be Principally Used P.P. Q 0-200 miles O over 200 miles Estimated Rate* per $100 Cost of Hire "Colt of Hire BI PD Comm. 0-200 miles over 200 miles Truckmen 0-200 miles over 200 miles Public 3. Non-Owned Automobiles CUet Code Totel Humber of Employee! Premium Basis--Total Number of Person? Employed By The Insured Location of Headquarters of Employees C-18300 7.75 min t B" in u.S S . 44 AID 000212 fSee over for Description of Premium Basis 8 DESCRIPTION OF TERM USED AS PREMIUM BASIS: When used as a premium basis: "cost of hire" means the amount incurred for (a) the hire of automobiles, including the entire remuneration of each employee of the named insured engaged in the operation of such automobiles subject to an average weekly maximum remuneration of $100, and lor (b) pick-up, transportation or delivery service of property or passengers, other than such services performed by motor carriers which are subject to the security requirements of any motor carrier law or ordinance. The rates for each $100 of "cost of hire" shall be 5^ of the applicable hired automobile rates, provided the owner of such hired automobile has purchased automobile Bodily Injury Liability and'Property Damage Liability insurance covering the interest of the named insured on a direct primarv basis as respects such automobile and submits evidence of such insurance to the named insured. C-ISJOG (BACK) AID 000213 AMHTDZIG POLITY :K). T^;5L4L23/ -3 -75 UNINSURED MOTORISTS INSURANCE (Specified Car Bash) (North Carotin*) In consideration of the payment of the premium for this endorsement, the company agrees with the named insured, subject to the limits of liability, exclusions, conditions and other terms of this endorsement and to the applicable terms of the policy: Schedule limits of liability: SBodily Injury tllhPQQ each person: ;?2l222 each accident Property Damage S 5 >000 accident SThe additional premium for this endorsement is 14 Insuring Agreements I. Damages for Bodily Injury and Property Damage Caused by Unin sured Automobiles To pay all sums which the insured or his legal representative shall be legally entitled to recover as damages from the owner or operator of an uninsured automobile because of: (a) bodily injury, sickness or disease, including death resulting therefrom, hereinafter called "bodily injury", sustained by the insured: (b) injury to or destruction of the property of such insured, herein after called "property damage", with a limit in the aggregate for all insureds in aity one accident as set forth in the property dam age schedule of this endorsement, and subject for each insured, to an exclusion of the first One Hundred Dollars (J10Q) of such damages: caused by accident and arising out of the ownership, maintenance or use of such uninsured automobile. For the purposes of this endorsement determination as to whether the insured or such representative is legally entitled to recover such dam ages, and if so the amount thereof, shall be made by agreement between the insured or such representative and the company or, if they fail to agree and the insured so demands, by arbitration: but if the insured elects not to arbitrate, the liability of the company shall be determined only in an action against the company. In any action against the company, except an action to determine whether an automobile is an uninsured automobile, the com pany may require the insured to join such person or organization as a party defendant II. Definitions (a) Insured. With respect to the bodily injury coverage afforded under this endorsement the unqualified word "insured" means: (1) the named insured; (2) any person while occupying an insured automobile; and (3) any person, with respect to damages he is entitled to re' cover for care or loss of services because of bodily injury to which this endorsement applies. With respect to the property damage coverage afforded under this endorsement the unqualified word "insured" means: (1) the named insured: and (2) any other person using an insured automobile. The insurance applies separately with respect to each insured under this endorsement but neither this provision nor application of the insurance to more than one insured shall operate to increase the limits of the com pany's liability. (b) Insured Automobile. The term "insured automobile" means: (1) an automobile owned by the named insured which, as of the inception date of this endorsement is registered or principally garaged in North Carolina, or which has become registered or principally garaged in North Carolina during the policy period; (2) any automobile owned by the named insured to which is attached North Carolina dealers license plates issued to the named insured: and to which the liability coverage of the policy applies, while such automobile is being used by or with the permission of the named insured as stated in the policy but shall not include an automobile while used as a public or livery Conveyance unless such use is specifically declared and described in this endorse ment (c) Uninsured Automobile. The term "uninsured automobile" means: (1) with respect to damages for bodily injury and property dam age an automobile or other vehicle with respect to the owner ship. maintenance or use of which there is, in at least the amounts specified in Subsection (c) of Section 20-279.5 of the North Carolina Motor Vehicle Safety and Financial Responsibility Act neither (i) cash or securities on file with the North Carolina Commissioner of Motor Vehicles nor (ii) a bodily injury and property damage liability bond or insur ance policy, applicable to the accident with respect to any person or organization legally responsible for the use of such automobile or vehicle, or with respect to which there is a bodily injury and property damage liability insurance policy applicable at the time of the accident but the com pany writing the same either (a) denies coverage there under or (b) has became bankrupt or is unable to make payment because of insolvency occurring within three years after such accident (a written statement by the lia bility insurer whose name appears on the certification of financial responsibility made by the owner of any vehicle involved in an accident with the insured that such other motor vehicle is not covered by insurance at the time of the accident with the insured shall operate as a prima fame presumption that the operator of such other motor vehicle was uninsured at the time of the accident with the insured); or (2) with respect to damages for bodily injury only a hit-and-run automobile as defined; but the term "uninsured automobile" shall not include: (i) a vehicle owned by the named insured: (ii) a vehicle which is owned or operated by a self-insurer within the meaning of any motor vehicle financial responsibility law, motor carrier law or any similar law; (iii) a vehicle which is owned by the United States of America, Canada, a state, or any agency of any of the foregoing ex cluding political subdivisions thereof; (iv) a vehicle if operated on rails or crawler-treads or While located for use as a residence or premises and not as a vehi cle: or (v) a farm type tractor or equipment designed for use princi pally off public roads, except while actually upon public roads. (d) Hit-ind-Run Automobile. The term "hit-and-run automobile" means an automobile, other than one in which an insured is a passenger, which causes an accident resulting in bodily injury to an insured, arising out of physical contact of such vehicle with the insured or with a vehicle which the insured is occupying at the time of the accident provided: (i) there cannot be ascer tained the identity of either the operator or the owner of such "hit-and-run automobile"; (ii) the insured or someone on his .76 c iip /y k /d p This endorsement must be attached to the Change Endorsement when issued after the policy is written CP 04 73| (Ed. 1-74) (OVER) AID 000214 Ragalef 3 behalf shall have reported the accident within 24 hours dr as soon thereafter as may be practicable to a police, peace or judicial officer or to the Commissioner of Motor Vehicles, and shall within a reasonable time have given notice to the company of his injury, the extent thereof, and the time, date and place of such miury: and (ill) at the company's request, the insured or his legal representative makes available lor inspection any automobile which the insured was occupying at the time of the accident (e) Occupying. The word "occupying" means in or upon or entering into or alighting from. (f) State. The word "state" includes the District of Columbia, a ter ritory or possession Of the United States, and a province of Canada: III. Pelley Period, Territory This endorsement applies only to accidents which occur on and after the effective date hereof, during the policy period and within the United States Of America: its territories or possessions, or Canada. Exclusions This endorsement does not apply: (a) to bodily injury to an insured, care or loss of services recoverable by an insured or injury to or destruction of property of an insured, with respect to which such insured or his legal representative shall, without written consent of the company, make any settle ment with any person or organization who may be legally liable therefor: (b) so as to inure directly or indirectly to the benefit of any work men's compensation or disability benefits carrier or any person or organization qualifying as a self-insurer under any workmen's compensation or disability benefits law or any similar law; (c) so as to inure directly or indirectly to the benefit of any insurer of property; (d) to injury to or destruction of an automobile, or the contents thereof, other than an insured automobile as defined herein. Conditions A Policy Provisions. None of the Insuring Agreements, Exclusions. Conditions or Other Provi sions of the policy shall apply to the insurance afforded by this endorse ment except the Conditions "Notice" (or "Notice of the Insured's Duties in the Event of Occurrence, Claim or Suit"), "Changes", "Assignment". "Cancellation" and "Declarations". B. Premium. If during the policy period the number of automobiles owned by the named insured and registered or principally garaged in North Carolina or the number of North Carolina dealers license plates issued to the named insured changes, the named insured shall notify the company during the policy period of any change and the premium shall be adjusted in accor dance with the manuals in use by the company. If the earned premium thus computed exceeds the advance premium paid, the named insured shall pay the excess to the company; if less, the company shall return to the named insured the unearned portion paid by such insured. C. Proof of Claim. As soon as practicable, the insured or other person making claim shall give to the company written proof of claim, under oath if required, includ ing full particulars of the nature and extent of the injuries, treatment, and other details entering into the determination of the amount payable here under. Proof of claim shall be made upon forms furnished by the company unless the company shall have failed to furnish such forms within IS days after receiving notice of claim. The injured person shall submit to physical examinations, by physicians selected by the company when and as often as the company may reasonably require and he, or in the event of his incapacity his legal representative, or in the event of his death his legal representative or the person or persons entitled to sue therefor, shall upon each request from the company ex ecute authorization to enable the company to obtain medical reports and copies of records. The insured or other person maxing claim for damage to prooerty shall file proof of loss with the company within sixty days after the occurrence of loss, unless such time is extended m writing by the company, in the form of a sworn statement setting forth the interest of the insured and at all others m the property affected, any encumbrances thereon, the actual cash value thereof at time of loss, the amount, placa. time and causa of such loss, and the description and amounts of all other insurance covering such property. Upon the company's request the insured shall exhibrt tlw damaged property to the company. After notice of claim, the company may require the insured to take such action as may be necessary or appropriate to preserve his right to recover damages from any person or organization alleged to be legally responsible for the bodily injury or property damage. D. Notice of Legal Action Under North Carolma S.S. 20-279.21 (b) (3). No legal action for bodily miury or property damage against any person or organization alleged to be legally responsible for the use of an automo bile involved m the accident shall be initiated by the insured until 60 days following the posting of notice to the company at the address shown on the policy or after personal delivery of such notice to the company or its agent setting forth the belief of the insured that the prospective defendant or defendants are uninsured motorists. The company shall not be bound by a final judgment taken by the insured against an uninsured motorist unless the company has been served with copy of summons, complaint or other process against the uninsured motorist E. Limits of Liability. Regardless of the number of (l) persons or organizations who are insureds under this insurance. (2) persons or organizations who sustain bodily injury or property damage, (3) claims made or suits brought on account of bodily injury or property damage, or (4) automobiles to which this insurance applies. (a) The limit of bodily injury liability stated in the schedule as ap plicable to "each person" is the limit of the company's liability for all damages, including damages for cart or loss of services, because of bodily injury sustained by one persoi as the rtsuN of any one accident and. subject to the above promton respect ing each person, the limit of such liability stated in tha schedule as applicable to "each accident" is the total limit of the com pany's liability for all damages, including damages for care or loss of services, because of bodily injury sustained by two or more persons as the result of any one accident (b) The limit of property damage liability stated in the schedule as applicable to "each accident" is the total limit of the company's liability for all damages arising out of injury to or destruction of all property of one or more insureds as the result of anyone accident. (c) If claim is made under this endorsement and claim is also made against any person who is an insured under the Bodily Injury Liability or Property Damage Liability coverages of the policy because of bodily injury or property damage sustained in an accident by a person who is an insured under this endorsement (1) any payment made under this endorsement to or for any such person shall be applied in reduction Of any amount which He may be entitled to recover from any person who is an insured under the Bodily Injury Liability or Property Damage Liability coverages; and (2) any payment made under the Bodily Injury Liability or Property Damage Liability coverages to or for any such person shall be applied in reduction of any amount which he may be entitled to recover under this endorsement (d) Any amount payable to an insured under the terms of this en dorsement shall be reduced by (1) all sums paid to such insured for bodily injury or property damage by or on behalf of a person legally liable therefor. (2) the amount paid and the present value of all amounts payable to such an insured under any workmen's compensation law; exclusive of non-occupational disability benefits and (3) the amount paid or payable to such an insured under any policy of property insurance. F. Other Insurance. With respect to bodily injury to an insured, if the insured has other similar insurance available to him against a loss covered by this endorsement, the CP 04 73 (Ed. 1-74) AID 000215 Page 2 of 3 company shall not be liable under this endorsement tor a greater propor tion of such loss than the applicable limit of liability hereunder bears to the total applicable limits of liability of all valid and collectible insurance against such loss. 6. Arbitration. If any person making claim hereunder and the company do not agree that such person is legally entitled to recover damages from the owner or opera tor of an uninsured automobile because of bodily injury or property damage sustained by the insured, or do not agree as to the amount of pay ment which may be owing under this endorsement then, upon written demand of such person, the matter or matters upon which such person and the company do not agree shall be settled by arbitration in accordance with the rules of the American Arbitration Association, and judgment upon the award rendered by the arbitrators may be entered in any court having jurisdiction thereof. Such person and the company each agree to consider itself bound and to be bound by any award made by the arbitrators pur suant to this endorsement. H. Trust Agreement In the event of payment to any person under this endorsement: (a) the company shall be entitled to the extent of such payment to the proceeds of any settlement or judgment that may result from the exercise of any rights of recovery of Such person against any person or organization legally responsible for the bodily rniury or property damage because of which such payment ismade; (b) such person shall hold in trust for the benefit of the company all rights of recovery which he shall have against such other person or organization because of the damages which are the subject of claim made under this endorsement: (c) such person shall do whatever is proper to secure and shall do nothing after loss to prejudice such rights: CF 04 73 (Ed. 1-74) (d) if requested m writing by me company, such person shall take, through any representative designated by the company, such action as may be necessary or appropriate to recover such pay ment as damages from such other person or organization, such action to be taken m the name of such person: in the event of a recovery, the company Shall be reimbursed out of such recovery for expenses, costs and attorneys' fees incurred by it in connec tion therewith: (e) such person shall execute and deliver to the company such in struments and papers as may be appropriate to secure the rights and obligations of such person and the company established by this provision. I. Payment of Loss by ttw Company. Any amount due hereunder is payable (a) to the insured, or (b) if the insured be a minor to his parent or guardian, or (c) if the insured be deceased to his surviving spouse, otherwise (d) to a person authorized by law to receive such payment or to a person legally entitled to recover the damages which the payment represents; provided, the company may at its option pay any amount due hereunder in accordance with division (d) hereof. i. Action Against Company. No action shall lie against the company unless, as a condition precedent thereto, the insured or his legal representative has fully complied with ad the terms of this endorsement K. This endorsement replaces any other provisions of the policy, includ ing any endorsement aftached thereto, affording similar insuranct with respect to any damages arising out ot the ownership, maintenance or use of an uninsured automobile or a hit-and-run vehicle. Page3ef 3 T AID 000216 CM CM CM CM CM e- C- t^ cs o o 5J 2 " sp" ( j.utifo jji/tu n u jiu tn J iji /ig g ii/ilU J p l Xutjfij WHBaaglwp V-,Hf 'H ft4 4 ix 4 *U M M ffq J tM M & t ijtgojuoiH D j i/i s jp u ip m i i t u j g jv j jpyu44<` jjg iu n u jf p i) M S u i K CM K 35 H G Explanation of Certain Entries or the Absence Thereof on Reverse Side The absence of an entry in premium spaces for a coverage shall mean that such insurance is not afft the designated automobile. The USE of the automobile is "Pleasure and Business" unless otherwise stated. The abbreviation "C-LT" shall mean "Commercial--(Local Truckman)". The abbreviation "C-IT" shall mean "Commercial--(Intermediate Truckman)". The abbreviation "C-LHT" shall mean "Commercial--(Long-Haul Truckman)". The abbreviation "C" shall mean "Commercial". The abbreviation "ACV" in the "Limit of Liability" space shall mean "Actual Cash Value". jj The abbreviation "CAC" shall mean "Premium for Combined Additional Coverage". The abbreviation "FTCAC" shall mean "Premium for Fire, Theft, land Combined Additional Covet ii : | The abbreviation "TOW" shall mean "Premium for Towing and Labor Costs Coverage". The abbreviation "W" shall mean "Premium for Windstorm, Hail, Earthquake or Explosion Coven The abbreviation "EPIP" shall mean "Premium for Excess Personal Injury Protection Coverage". i: i The abbreviation "BDP" shall mean "Premium for Basic Damage to Property Coverage". The abbreviation "RR" shall mean "Premium for Rental Reimbursement Coverage". The abbreviation "BPP" shall mean "Premium for Basic Property Protection Coverage". The abbreviation "SDP" shall mean "Premium for Supplemental Damage to Property Coverage". The abbreviation "pIP" shall mean "Premium for Personal Injuiry [Protection Coverage". The abbreviation "I" shall mean "Deductible applies to the named insured only". The abbreviation "I/R" shall mean "Deductible applies to the named insured and relatives". C-16254 (BACK) S I" Explanation of Certain Entries or the Absence Thereof on Reverse Side The absence of an entry in premium spaces for a coverage shall mean that such insurance is not afforded with respect to the designated automobile. The USE of the automobile is "Pleasure and Business" unless otherwise stated. The abbreviation "C-LT" shall mean "Commercial--(Local Truckman)". The abbreviation "C-1T" shall mean "Commercial--(Intermediate Truckman)". The abbreviation "C-LHT" shall mean "Commercial--(Long-Haul Truckman)". The abbreviation "C" shall mean "Commercial". The abbreviation "ACV" in the "Limit of Liability" space shall mean "Actual Cash Value". The abbreviation "CAC" shall mean "Premium for Combined Additional Coverage". The abbreviation "FTCAC" shall mean "Premium for Fire, Theft, and Combined Additional Coverage". The abbreviation "TOW" shall mean "Premium for Towing and Labor Costs Coverage". The abbreviation "W" shall mean "Premium for Windstorm, Hail, Earthquake or Explosion Coverage". The abbreviation "EPIP" shall mean "Premium for Excess Personal Injury Protection Coverage". The abbreviation "BDP" shall mean "Premium for Basic Damage to Property Coverage". The abbreviation "RR" shall mean "Premium for Rental Reimbursement Coverage". The abbreviation "BPP" shall mean "Premium for Basic Property Protection Coverage". !i. 1 The abbreviation "SDP" shall mean "Premium for Supplemental Damage to Property Coverage". The abbreviation "PIP" shall mean "Premium for Personal Injiiry Protection Coverage". The abbreviation "I" shall mean "Deductible applies to the named insured only". 1 !l - The abbreviation "I/R" shall mean "Deductible applies to the named insured and relatives". C-16254 (BACK) Explanation of Certain Entries or the Absence Thereof on Reverse Side The absence of an entry in premium spaces for a coverage shall mean that such insurance is not afforded with respect to the designated automobile. The USE of the automobile is "Pleasure and Business" unless otherwise stated. The abbreviation "C-LT" shall mean "Commercial--(Local Truckman)". The abbreviation "C-IT" shall mean "Commercial--(Intermediate Truckman)". The abbreviation "C-LHT" shall mean "Commercial--(Long-Haul Truckman)". The abbreviation "C" shall mean "Commercial". The abbreviation "ACV" in the "Limit of Liability" space shall mean "Actual Cash Value". The abbreviation "CAC" shall mean "Premium for Combined Additional Coverage". The abbreviation "FTTCAC" shall mean "Premium for Fire, Theft, and Combined Additional Coverage" The abbreviation "TOW" shall mean "Premium for Towing and Labor Costs Coverage". The abbreviation "W" shall mean "Premium for Windstorm, Hail, Earthquake or Explosion Coverage". The abbreviation "EpIP" shall mean "Premium for Excess Persona! Injury Protection Coverage". The abbreviation "BDP" shall mean "Premium for Basic Damage to Property Coverage". The abbreviation "R1R" shall mean "Premium for Rental Reimbursement Coverage". The abbreviation "BIp P" shall mean "Premium for Basic Property Protection Coverage". The abbreviation "SDP" shall mean "Premium for Supplemental Damage to Property Coverage". The abbreviation "PIP" shall mean "Premium for Personal Injury Protection Coverage". The abbreviation^ "I" shall mean "Deductible applies to the named insured only". The abbreviation' "I/R" shall mean "Deductible applies to the named insured and relatives". C-16254 (BACK) cn Cj o. i/n A u DECLARATIONS SCHEDULE-- Automobile EFFECTIVE: 01-01-76 (Sec reverse side for explanation of certain entries or absence thereof) Special Code: Policy No. TT1-WSL- ' ISchedule No. Explanation of Certain Entries or the Absence Thereof on Reverse Side The absence of an entry in premium spaces for a coverage shall mean that such insurance is not afforded with respect to the designated automobile. The USE of the automobile is "Pleasure and Business" unless otherwise stated. The abbreviation "C-LT" shall mean "Commercial--(Local Truckman)". The abbreviation "C-IT" shall mean "Commercial--(Intermediate Truckman)". The abbreviation "C-LHT" shall mean "Commercial--(Long-Haul Truckman)". The abbreviation "C" shall mean "Commercial". The abbreviation "ACV" in the "Limit of Liability" space shall meah "Actual Cash Value". The abbreviation "CAC" shall mean "Premium for Combined Additional Coverage". .i The abbreviation "FTCAC" shall mean "Premium for Fire, Theft, and Combined Additional Coverage". The abbreviation "TOW" shall mean "Premium for Towing and: Labor Costs Coverage". The abbreviation "\V" shall mean "Premium for Windstorm, Hail, Earthquake or Explosion Coverage". The abbreviation "EPIP" shall mean "Premium for Excess Personal Injury Protection Coverage". The abbreviation "E1DP" shall mean "Premium for Basic Damage to Property Coverage". The abbreviation "RR" shall mean "Premium for Rental Reimbursement Coverage". The abbreviation "BPP" shall mean "Premium for Basic Property Protection Coverage". The abbreviation "SDP" shall mean "Premium for Supplemental Damage to Property Coverage". The abbreviation "PIP" shall mean "Premium for Personal Injury Protection Coverage". The abbreviation "I" shall mean "Deductible applies to the named insured only". The abbreviation "I/R" shall mean "Deductible applies to the named insured and relatives". C-16254 (BACK) Policy No. T rt4 J 3 L ~ 1 2 3 T 6 9 > *3 ~ 7 ') Schedule No. 1.7 gd I*sll ilE 013 ill ll.1s O *r *! c -fc 8- \ z rd CN <N O o Q l-M < Special Code DECLARATIONS SCHEDULE-- Automobile EFFECTIVE* ,1 ~ 0 ]~ 7 6 lS rr reverse side (or explanation o( certain entries or absence thereof) CL >< EOO "o. of, K ,i9 ,, vO II _ IT\ o<>o I 8Ol o N O O S<>o D< <Z iu Sf cv Cl rH U"v rH U"\ H u*\ lf\ * ir\ Rtf tcc~\ LT\ W of .tf RB ? Re? pH r"\ . to --< r\ ^ S' [> 1 t? f c. rv P-'. Explanation of Certain Entries or the Absence Thereof on Reverse Side The absence of an entry in premium spaces for a coverage shall mean that such insurance is not afforded with respect to the designated automobile. The USE of the automobile is "Pleasure and Business" unless otherwise stated. The abbreviation "C-LT" shall mean "Commercial--(Local Truckman)". The abbreviation "C-IT" shall mean "Commercial--(Intermediate Truckman)". The abbreviation "C-LHT" shall mean "Commercial--(Long-Haul Truckman)". The abbreviation "C" shall mean "Commercial". The abbreviation "ACV" in the "Limit of Liability" space shall mean "Actual Cash Value". The abbreviation "CAC" shall mean "Premium for Combined Additional Coverage". The abbreviation "FTCAC" shall mean "Premium for Fire, Theft, and Combined Additional Coverage". The abbreviation "TOW" shall mean "Premium for Towing and Labor Costs Coverage". The abbreviation "W" shall mean "Premium for Windstorm, Hail, Earthquake or Explosion Coverage". The abbreviation "EPIP" shall mean "Premium for Excess Personal Injury Protection Coverage". The abbreviation "BDP" shall mean "Premium for Basic Damage to Property Coverage". The abbreviation "RR" shall mean "Premium for Rental Reimbursement Coverage". The abbreviation "BPP" shall mean "Premium for Basic Property Protection Coverage". The abbreviation "SDP" shall mean "Premium for Supplemental Damage to Property Coverage". The abbreviation "PIP" shall mean "Premium for Personal Injury Protection Coverage". The abbreviation "I" shall mean "Deductible applies to the named insured only". The abbreviation "I/R" shall mean "Deductible applies to the named insured and relatives". C-16254 (BACK! HECLARATIONS SCHEDULE-- Automobile > fU U V iiJ 01~U ~70 Policy No. 'W - N S t- - 1 2 3 T 6 9 3 - > - 7 5 Schedule No. lSee rcxerse side for explanation of certain entries o r absence thereof) Special Code; ^ ' * -5joSZ5i < oi |C:S<?x5 r u o : Uu> !' zl i w Oj II O1 ; 1* '5 O r ** 1o : GiO &S< UlOE z r a |!Uo. " i!' </i,;! i :i i! ; .i 1i ! S !' i1 i i1 lis ii1 | |) i1 ii:: * 3 *---N < a C-<Lr cot<c .O35; o 5* Mil >>* o 8 O o 9 Co O V\ o Fig c- IS eS 88 1 11 ir\ cv V\ s| as rs OS, *A Q 8 hVaa-- ocv rH O 0 <esC sjS> Qi<>Oibo52E-El ' 1 | >z 1 1 IS i ^I K Q vO cv E S r-1 cv H C to rl O o ' ] *< *i N o s< Gi h- ' 3 Ik i UJ K ' S a- u ie . il' 2 O , S 3_<, S' u !> 1S ,2u I :W ' tt ;8: * j | i . ! i i r 1 i j i i i i j P R E M IU M 1 E na, r\ r\ bT\ irv IT- LT\ 1 nU i n s u r B" 1 M o t o r is t s ir\ U\ L*N LT- oUJ <> "'V vO p'N o ^ 1 ch i ; > E9 |f Q -1 i> r!--! C cv t-- r- r-l Cf\ !>-rr-! CV CV I 1 tr y oi ur rN r* v ts tr\ --N no O rc-i lo y (V -" - :C f 1 r-7 o !.: : it-;- u jv; to IBn jo r*- -- 5^ c-l - . - * , Naim* am i Address of M n rl^ .i^ n * ( 'Hie num ber opposite n id i e n try inthrntes the autom obile to w h irh the entry, a p p lie s , s u d i autom nbtle b rin g id e n tifie d by the same num ber above.) rx Explanation of Certain Entries or the Absence Thereof on Reverse Side The absence of an entry in premium spaces for a coverage shall mean that such insurance is not afforded with respect to the designated automobile. The USE of the automobile is "Pleasure and Business" unless otherwise stated. The abbreviation "C-LT" shall mean "Commercial--(Local Truckman)". The abbreviation "C-IT" shall mean "Commercial--(Intermediate Truckman)". The abbreviation "C-LHT" shall mean "Commercial--(Long-Haul Truckman)". The abbreviation "C" shall mean "Commercial". The abbreviation "ACV" in the "Limit of Liability" space shall mean "Actual Cash Value". I The abbreviation "CAC" shall mean "Premium for Combined Additional Coverage". The abbreviation "FTCAC" shall mean "Premium for Fire, Theft, and Combined Additional Coverage". The abbreviation "TOW" shall mean "Premium for Towing and Labor Costs Coverage". The abbreviation "W" shall mean "Premium for Windstormj Hail, Earthquake or Explosion Coverage". The abbreviation "EPIP" shall mean "Premium for Excess Personal Injury Protection Coverage". The abbreviation "BDP" shall mean "Premium for Basic Damage to Property Coverage". The abbreviation "RR" shall mean "Premium for Rental Reimbursement Coverage". I , ,i The abbreviation "BPP" shall mean "Premium for Basic Property Protection Coverage". The abbreviation "SDP" shall mean "Premium for Supplemental Damage to Property Coverage". The abbreviation "Pip" shall mean "Premium for Personal injury Protection Coverage". The abbreviation "I" shall mean "Deductible applies to the Pained insured only". The abbreviation "I/R" shall mean "Deductible applies to the named insured and relatives". C-16254 (BACK r^, _ r-> o 6y E c l X V) ? pt u DECLARATIONS SCHEDULE-- Automobile r0-ii'; ;!7TTOt 0.1 01-'76 (.See reverse side for explanation of certain entries or absence thereof) /Special Coda: / '' Policy No. Schedule No. * Explanation of Certain Entries or the Absence Thereof on Reverse Side The absence of an entry in premium spaces for a coverage shall mean that such insurance is not afforded with respect to the designated automobile. The abbreviation "ACV" in the "Limit of Liability" space shall mean "Actual Cash Value". The abbreviation "CAC" shall mean "Premium for Combined Additional Coverage" The abbreviation "FTCAC" shall mean "Premium for Fire, Theft, and Combined Additional Coverage' "TOWING" Shall mean "Premium for Towing and Labor Costs Coverage". The abbreviation "W" shall mean "Premium for Windstorm, Hail, Earthquake or Explosion Coverage". The abbreviation "EPIP" shall mean "Premium for Excess Personal Injury Protection Coverage". The abbreviation "BDP" shall mean "Premium for Basic Damage to Property Coverage". The abbreviation "RR" shall mean "Premium for Rental Reimbursement Coverage". The abbreviation "BpP" shall mean "Premium for Basic Property Protection Coverage". The abbreviation "SDP" shall mean "Premium for Supplemental Damage to Property Coverage". The abbreviation "PIP" shall mean "Premium for Personal Injury Protection Coverage". i The abbreviation "PPI" shall mean "Property Protection Insurance Coverage". The abbreviation "I" shall mean "Deductible applies to the nained insured only". The abbreviation "I/R" shall mean "Deductible applies to the named insured and relatives". C-18299 (BACK) AUTOMOBILE MEDICAL PAYMENTS INSURANCE COVERAGE PART SCHEDULE_________ Designated Person Insured Forming pan of Policy No.'A*N ' -** =' $ ' ' Advance Premium SEE EKD CF 09 23(E0 l-?4) - Total INCLUDED Designation of Automobiler--Division 1 (1) O Any owned automobile (2) Any hired automobile (3 ) Q Any licensed owned private passenger automobile (4) Any automobile for which a premium is included in the declarations for Medical Payments (5) O Any non-ouined automobile (6) ' ------------ ----------------------- --------------------------------------- --------- --------------------------------------------------------------------- I. Coverage F--Automobile Medical Payments The company will pay all reasonable medical expense incurred within one year from the date of the accident: Division 1. to or for each person who sustains bodily injury, caused by accident, while occupying a designated auto mobile which is being used by a person for whom bodily injury liability insurance is afforded under this policy with respect to such use; Division 2. to or for each insured who sustains bodily injury, caused by accident, while occupying or, while a pedestrian, through being struck by a highway vehicle. Exclusions This insurance does not apply: (a) to bodily injury to any person or insured while employed or otherwise engaged in duties in connection with an automobile business, if benefits therefor are in whole or in part either payable or required tb be provided under any workmen's compensation law; (b) to bodily injury due to war, whether or not declared, civil war, insurrection, rebellion or revolution, or to any act or con dition incident to any of the foregoing; (c) under Division 1, to bodily injury to any employee of the named insured arising out of and in the course of employment by the named insured, but this exclusion does not apply to any such bodily injury arising out of and in the course of domestic employment by the named insured unless benefits therefor are in whole or in part either payable or required to be provided under any workmen's compensation law; (d) under Division 2, to bodily injury sustained while occupying a highway vehicle owned by any insured, or furnished for the regular use of any insured by any person or organization other than the named insured, II. Persons Insured--Division 2. Each of the following is un insured under this insurance to the extent set forth below: (a) any person designated as insured in the schedule; (b) while residents of the same household as such designated person, his spouse and the relatives of either; and if such designated person shall die, any person who was an insured at the time of such death shall continue to be an insured. III. Limit Of Liability Regardless of the number of (1) persons or organizations who are insureds under this policy, (2) persons who sustain bodily injury, (3) claims made or suits brought on account of bodily injury or (4) designated automobiles to which this policy applies, the limit of liability for medical payments stated in the declarations as appli cable to "each person" is the limit of the company's liability for all expenses incurred by or on behalf of each person who sustains bodily injury as the result of any one accident. When more than one medical payments coverage afforded by this policy applies to the loss, the company shall not be liable for more than the amount of the highest applicable limit of liability. IV. Additional Definitions The additional definitions applicable to automobile bodily injury liability insurance also apply to this insurance; and when used in reference to this insurance (including endorsements forming a Dart of the policy): 4 "designated automobile" means an automobile designated in the schedule and includes: (a) an automobile not owned by the named insured while tem porarily used as a substitute for an owned automobile desig nated in the additional declarations when withdrawn from normal use for servicing or repair or because of its breakdown, loss or destruction; and (b) a trailer designed for use with a private passenger automobile, if not being used for business purposes with another type automobile and if not a home, office, store, display or passenger trailer; "highway vehicle" means a land motor vehicle or trailer other than (a) a farm type tractor or other equipment designed for use principally off public roads, while not upon public roads, (b) a vehicle operated on rails or crawler-treads, or (c) a vehicle while located for use as a residence or premises; "medical expense" means expenses for necessary medical, surgical, X-ray and dental services, including prosthetic devices, and necessary ambulance, hospital, professional nursing and funeral services; "occupying" means in or upon or entering into or alighting from. V. Policy Period; Territory This insurance applies only to accidents which occur during the policy period within the territory described in paragraph (1) or (2) of the definition of policy territory. VI. Additional Conditions A. Medical Reports; Proof and Payment of Claim As soon as practicable the injured person or someone on his behalf shall give to the company written proof of claim, under oath if required, and shall, after each request from the company, execute authorization to enable the company to obtain medical reports and copies of records. The injured person shall submit to physical examination by physicians selected by the company when and as often as the company may reasonably require. The company, may pay the injured person or any person or organization rendering the services and such payment shall reduce the amount payable here under for such injury. Payment hereunder shall not con stitute an admission of liability of any person or, except hereunder, of the company. B. Excess Insurance Except with respect to an owned automobile, the insurance under Division 1 shall be excess insurance over any other valid and collectible automobile medical payments or auto mobile medical expense insurance. The insurance under Division 2 shall be excess insurance over any other valid and collectible automobile medical payments or automobile medical expense insurance available to the insured under any other policy. C. Non-Applicability of Subrogation Condition The Subrogation Condition does not apply to the Automobile Medical Payments Coverage. C-17843 Edition 1-74 miiiTEO m u.s.i. (AMP/CP 00 IS) L 5B AID 000225 COMPREHENSIVE AUTOMOBILE LIABILITY INSURANCE COVERAGE PART I. Coverage C--Bodily Injury liability Coverage D--Property Damage Liability The company will pav on behalf of the insured all sums which the insured shall become legally obligated to pay as damages because of Coverage C. bodily injury or Coverage, ,D. properly damage' ! [ to which this insurance applies, caused by an occurrence and arising out of the ownership, maintenance or use. including loading and unloading, of anv automobile, and the company shall have the right and duty to defend anv suit against the insured seeking damages on account of such bodily injury or properly darnage. even if any of the allegations of the suit are groundless, false or fraudulent, and may make such investigation and settlement of any claim or suit as it deems expedient, but the company shall not be obligated to pay any claim or judgment;, or, ton,defend,;:,!any:. suit! after the applicable limit of the company's! liability has been exhausted by payment of judgments or settlements Exclusions This insurance does not apply: (a) to liability assumed by the insured under any contract or agreement; (b) to any obligation for which the insured or any carrier as his insurer may be held liable under any workmen's compensa tion, unemployment compensation or disability benefits law, or Under any similar law; (c) to bodily injury to any employee of the insured arising out of and in the course of his employment by the insured or to any obligation of the insured to indemnify another because of damages arising out of such injury; but this exclusion does not apply to any such injury arising out of and in the course of domestic employment by the insured unless benefits therefor are in whole or in part either payable or required to be provided under any workmen's compensation law; (d) to property damage to (1) property owned or being transported by the insured, or (2) property rented to or in the care, custody or control of the insured. Or as to which the insured is for any purpose exercising physical control, other than property damage to a residence or private garage by a private passenger automobile covered by this insurance; (e) to bodily injury or property damage due to war, whether or not declared, civil war, insurrection, rebellion or revolution or to any act or condition incident to any of the foregoing, with respect to expenses for first aid under the Supple mentary Payments provision; (f) to bodily injury or property damage arising out of the dis charge, dispersal, release or escape of smoke, vapors, soot, fumes, acids, alkalis, toxic chemicals, liquids or gases, waste materials or other irritants, contaminants or pollu tants into or upon land, the atmosphere or any watercourse or body of water; but this exclusion does not apply if such discharge, dispersal, release or escape is sudden and ac cidental. II. Persons Insured Each of the following is an insured under this insurance to the extent set forth below: (a) the named insured; (b) any partner or executive officer thereof, but with respect to a non-owned automobile only while such automobile is being used in the business of the named insured; (c) any other person while using an owned automobile or a hired autompbile with the permission of the named insured, provided his actual operation or (if he is not operating) his other actual use thereof is within the scope of such per mission, but with respect to bodily injury or property damage arising out of the loading or unloading thereof, such other person shall be an insured only if he is: (1 i a lessee or borrower of the automobile, or (2) an employee of the named insured or of such lessee or borrower; <d) any other person or organization but only with respect to his or its liability because of acts or omissions of an insured under (a), (b) or (c) above. None of the following is an insured: (i) any person while engaged m the business of his employer with respect to bodily injury to any fellow employee of such person injured in the course of his employment; (ii) the owner or lessee (of whom the named insured is a sub lessee) of a hired automobile or the owner of a non-owned automobile; or any agent or employee of any such owner or lessee; (iii) an executive officer with respect to an automobile owned by him or by a member of his household ; (iv) any person or organization, other than the named insured, with respect to: (1) a motor vehicle while used with any trailer owned or hired by such person or organization and not covered by like insurance in the company (except a trailer designed for use with a private passenger automobile and not being used for business purposes with another type motor vehicle), or (2) a trailer while used with any motor vehicle owned or hired by such person or organization and not covered by like insurance in the company; (v) any person while, employed in or otherwise engaged in duties in: connection with an automobile business, other than an automobile business operated by the named insured. This insurance does not apply to bodily injury or property damage arising out of (1) a non-owned automobile used in the conduct of any partnership or joint venture of which the insured is a partner or member`and which is not designated in this policy as a named insured, or (2) if the named insured is a partnership, an automobile owned by or registered in the name of a partner thereof. III. Limits of Liability Regardless of the number of (1) insureds under this policy, (2) persons or organizations who sustain bodily injury or property damage, (3) claims made or suits brought on account of bodily injury or property damage or (4) automobiles to which this policy applies, the company's liability is limited as follows: Coverage C--The limit of bodily injury liability stated in the declarations as applicable to "each person" is the limit of the company's liability for all damages, including damages for care and loss of services, because of bodily injury sustained by one person as the result of any pne occurrence; but subject to the above provision respecting "each person", the total liability of the company for all damages, including damages for care and loss of services, because of bodily injury sustained by two or more persons as the result of any one occurrence shall not exceed the limit of bodily injury liability stated in the deciaratipns as applicable to "each occurrence". Coverage D--The total liability of the company for all damages because of all property damage sustained by one or more persons or organizations as the result of any one occurrence shall not exceed the limit of property damage liability stated in the declarations as applicable to "each occurrence". Coverages C and IV-For the purpose of determining the limit of the cbmpany's liability, all bodily injury and properly damage arising out of continuous or repeated exposure to substantially the same general conditions shall be considered as arising out of one occur rence. IV. Policy Territory AID 000226 This insurance applies only to bodily injury or property damage which occurs within the territory described in paragraph (1) or (2) of the definition of policy territory. (Continued on Page 2) L 2C Page 2 V. Additional Definition! When used in reference to this insurance (including endorsements forming a part of the policy ) : "automobile business" means the business or occupation of selling, repairing, servicing, storing or parking automobiles; j "hired automobile" means an automobile not owned by the named insured which is used under contract in behalf of, or loaned to, the named insuredprovided such automobile is not owned by or registered in the name of (a) a partner or executive officer of the named insured or (b) an emplovee or agent of the named insvred who is granted an operating allowance of any sort for the use of such automobile; `'son-owned automobile" means an automobile which is neither an owned automobile nor a hired automobile; "owned automobile" means an automobile owned by the named insured; "private passenger automobile" means a four wheel private passenger or station wagon type automobile; "trailer" includes semi-trailer but does not include mobile equipment. + VI. Additional Condition A. Excess Insurance--Hired and Non-Owned Automobiles With respect to a hired automobile or a non~cumed automobile, this insurance shall be excess insurance over any other valid and collectible insurance available to the insured. B. Out of State Insurance If. under the provisions of the motor vehicle financial responsi bility law or the motor vehicle compulsory insurance law or anv similar law of any state or province, a non-resident is required to maintain insurance with respect to the operation or use of a motor vehicle in such state or province and such insurance re quirements are greater than the insurance provided by the policy* the limits of the company's liability and: kinds of coverage afforded by the policy shall be as set forth in such law. m lieu of the insurance otherwise provided by the policy, but only to the extent .required: by such law and only with respect to the oper ation or use of a motor vehicle m such state or province, pro vided that the insurance under this provision shall be reduced to the extent that there is other valid and collectible insurance under this or any other motor vehicle insurance policy In no event shall any person be entitled to receive duplicate payments for the same elements of loss. C-17845 Edition 1-74 r r JKLKo n u .S.S (CAL/CP 00 10) AID 000227 L 2C COMPREHENSIVE GENERAL LIABILITY INSURANCE COVERAGE PART I. Coverage A--Bodily Injury Liability Coverage B--Property Damage Liability The company will pay on behalf of the insured all sums which the insured shall become legally obligated to pay as damages because of Coverage A. bodily injury or Coverage B. property damage to which this insurance applies, caused by an occurrence, and the company shall, have the right and duty to defend any suit against th,c insured seeking1 idamages* on account of such bodily injury or property damage, even if any of the allegations of the suit arc groundless, false or fraudulent, and may make such investiga tion and settlement of any claim or suit as it deems expedient, but the company shall not be obligated to pay any claim or judgment or to defend any suit after the applicable limit of the company's liability has been exhausted hy payment of judgments or settle ments. Exclusions This insurance does not apply: (a) to liability assumed by the insured under any contract or agreement except an incidental contract; but this exclusion does not apply to a warranty of fitness or quality of the named inured's products or a warranty that work performed by or on behalf of the named insured will be done in a work manlike manner; (b I to bodily injury or property damage arising out of the ownership, maintenance, operation, use, loading or unloading of (1) any automobile or aircraft owned or operated by or rented or loaned to any insured, or (2) any other automobile or aircraft operated by any person m the course of his employment by any insured; but this exclusion does not apply to the parking of an automobile on premises owned by, rented to or controlled by the named insured or the ways immediately adjoining, if Such automobile is not owned by or rented or loaned to any insured; (c) to bodily injury or properly damage arising put of (1) the ownership, maintenance, operation, use, loading or unload ing of any mobile equipment while being used in any pre- , arranged or organized racing, speed or demolition contest or in any stunting activity or in practice or preparation for any such contest or activity or (2) the operation or use of any snowmobile or trailer designed for use therewith; but this exclusion (f) {1) does not apply to property damage arising out of any emission, discharge, seepage, release or escape of petroleum or petroleum derivatives into any body of water; (2) to property damage arising out of any emission, discharge, seepage, release or escape of petroleum or petroleum derivatives into any body of water, but this exclusion (f)(2) does not apply to property damage mulling from fire or explosion arising out of any emission, discharge, seepage, release or escape which neither (i) is expected or intended from che standpoint of any insured or any person or organization for whose acts or omissions any insured is liable, nor (ii) results from or is contributed to by any condition in violation of or non-compliance with any govern mental rule, regulation or law applicable thereto. (g) to bodily injury or property damage due to war, whether or not declared, civil war; insurrection, rebellion or revolution or to any act or condition incident to any of the foregoing, with respect to (1) liability assumed by the insured under am incidental contract, or (2) expenses for first aid under the Supplementary Pay ments provision; (h) to bodily injury or property damage for which the insured or his indemnitee may be held liable (1) as a person or organization engaged in the business of manufacturing; distributing, selling or serving alcoholic beverages, or (2) if not so engaged; as an owner or lessor of premises used for such purposes; if such liability ii imposed (i) by, or because of the violation of, any statute, ordinance or regulation pertaining to the sale, gift, distribution or use of any alcoholic beverage, or (ii) by reason of the selling, serving or giving of any alcoholic beverage to a minor or to a person under the influence of alcohol or which causes or contributes to thei intoxication of any person ; but part (ii) of this exclusion does not apply with respect to liabilityi of.sche) .insured or hi indemnitee as an owner or lessor described in (2) above; (i) to any obligation for which the insured or any carrier as his insurer may be held liable under any workmen's compensa tion; unemployment compensation or disability benefits law, or under any similar law; (dA to bodily injury or property damage arising out of and in the course of the transportation of mobile equipment by an auto mobile owned or operated by or rented or loaned to any insured; , (e) to bodily injury ex property damage arising out of the ownership, maintenance, operation, use, loading or unloading of Ml any watercraft owned or operated by or rented or loaned to any insured, or (2) any other watercraft operated by any person in the course of his employment by any insured; but this exclusion does not apply to watercraft while ashore on premises owned by, rehted to or controlled by the named insured; i (f) (1) to bodily injury or property damage arising out of any emission, discharge, seepage, release or escape of any liquid, solid, gaseous or thermal waste or pollutant (i): if such emission, discharge, seepage, release or ^escape is either expected or intended from the ; standpoint of any insured or any person or organiza tion for whose acts or omissions any insured is !! liable, or (ii)j. resulting from or contributed to by any condition I in violation of or non-compliance With any govern1 mental rule, regulation or law applicable thereto; (j) to bodily injury to any employee of the insured arising out of and in the course of his employment by the insured or to any obligation ,01 the insured to indemnify another because of damages arising,out of such injury; but this exclusion does not apply to liability assumed by the insured under an incidental contrast; (k) to property damageto (1) property owned or occupied by or rented to the insured, (2) property used by the insured, or (3) property in the care, custody Or control of the insured or as 'to which the insured is for any purpose exercising physical control; but parts'1 (2) and (3) of this exclusion do not apply with respectito!liability under a written sidetrack agreement and part (3)' of this exclusion does not apply with respect to property damage ((other than to eleeatars) arising out of the use of am elevator at premises owned by, rented to or con trolled by the1 named insured; (l) to property damage to premises alienated by the named insured arising out of such premises or any part thereof; (m) to loss of use of tangible property which has not been physi cally injured or destroyed resulting from (1) a delay in or lack of performance by or on behalf of the named insured of any contract or agreement, or {Continued on Page 2) AID 000228 L IA Vt 1 6ZZ000aiv C*10D) f; ft uo-r WiQ \ y '/Cjoiiufj <Cnjo4 dtp aiqiiM unaoo qDiqM tSoutop /Ciwfojj 20 aifut fjtpoq os Ajao catfddt aacmanctn fnjj, Xjuiuzaj. Xaqoj S M 'iwinx aao jo ino 8u ir j e re paiapiruoa aq psqt suopipuoa jsjaaaS surei aqi AjfBuuBitqns 01 ajnsodxa pareadaj j o tnonuuuos jo jno Su ir j e thump <C/u 4o j 4 pint Onfut fjtpoq )[B 'Xiifiqsi) ,Xusdmos aqi JO ituii) oqi 8tnuiuijaiap jo asodjnd aqi j o j --g pm y b Iu ia o j j miiuut ptuivu aqi oj paiuai j o Xq pauno sasraiaad u io j j Xe me isauud qsea oi isadsaJ qiiA XpiEJEdas '(j) puE (t) sqdeiSBJsdqns japun pue `aAoqe (f) pun (z) *(i) tqdEjSejEoqns ui paqussap ilvwop Ku*ioi4 3i)l oi XpiEJEdas X|ddE ||e i)s iitui] aieSauaSc qsng paHty suouvutjo piiiftjuioi 3t)i uiqiiM papnpai tgvump (ut4oi4 ||e ptie pmiaq sitnppi4 sqi inqitM papnput thump i\u4oi4 jje () isajnisruis J3qio Jo tSuippnq Su iao u x j o j o azit aqi 8ut8treqa 3a[o au i io u op qsiqM tactuiaid qant ie taonEJ3i]it fEjniDruis j o ptmiui ptumu aqi oi pamaj Jo Xq paqMO tasiurajd ie ursdai j o 33UEU31U1EU1 io iiio Su ir j e ttsump (jajojJ apnjsui ipu saop (2) qdsJBEJBdqns inji inq 'suopBJado qsnt oi 8o iie[3j fjmttuot jotutpijui Xoc japan parnntss r Xiipqvi) qsiqm j o j thump <j o 4o i4 qans Xus Saipnpui `ptmiui ptumu 3t)i Xq joajaqi uoictAjadni fEjauaS pa> u o is ej iu o s luapuadapai Xq ptmiui ptumu aqi jqj pauuojiad tuonsjado jo aunos aql ut StniinsaO pus jo ino Su k u s thump <iu4oi4 )NB (z ) fMopq () qdEjSwjadqnt ui papnpur thump <ut4oi4 Smpnfsxa inq `suoiisjado j o satiuiaad qsnt oi 8u iie|3J ix iiu o i ptpapuui Xuv japan pamncre R Xiqiqsi) qaiqM j o j thump <u>4tU Sdipnpm "nreq ndtasaj uo paisj luauidmba s .j o is e j iu o s j o nntq aotisjaumbaj t ao psiEj ruoiiEjado j o tscimajd jo ino Santre tSmap (v*4oi4 tl* (I) :,,3i*8aj8 -8e ,, re suoiiBJEfsap aqi ui psisit Xiqiqvi) thump tuxfoid jo iiu iij aqi passxa iou ))Eqs MO]3q tqdEoSiiiidqnt pajaquina aqi jo Xu e u i paqusop pup E3))ddB 38j 3ao 3 rui qaiqM oi thump {ijxjouj IP* jo atneasq reSsarep ))E j o j Xaaaaioa'aqi jo XiipqEl) j eio i 31)1 '^ttutumx qSE3,, Sunsadcsj uoniAOjd 3AOqE^ aqi" oi Ijsafqng tl$tutUnix qora,, oi 3|qEoi[ddE re BuotiEJE)S3p aqi at psiEit Xii[tqsi| thump iiu&itj jo jiiui) sqi P333X3 iou f|Ei)t uuiuntx aao Xii* jo ipitaj aqi re raopazraeSjo j o tuosjsd ajoui j o 3ao Xq paoreiinc thump fimfotj ]jc jo 3tnE3sq caSEtirep ))E j o j Xasdoioa aqi jo XitpqEi) {not 3qj_--g 3Je j 3a o q ,,aw8aj88E,, re tuoiiEJEtsap aqi ui paicit XiixiqEt) tnOti fjtpoq jo Iitui) aqi paaaxa iou |)Eqs pmiuy tmpouf aqi oiqiiM papnpai (afut iCjtpeq [j e (Z) pas piBlop rummuh ptttj4uiet aqi rnqitM pspnpoi jWui tCjtpoq tp (i) jo asnssaq caSEtusp )re j o j Xooduioa aqi jo Xiijtqxii pioi aqi \jiutuntx qsE3,, Suiisadcaj uotnAOjd 3Aoqx aqi oi isafqng ,,ttututax q3E3,, oi a|qESi[ddE re taotiEJEjaap aqi ui paiBit XiipqEi) iaiCut (jipoq jo imn) aqi paaaxa iou p*qt ttutumx 3uo Xo e j o l|nJ aqi re raouad ajooi j o aao Xq paujiitnt OnCux iCppoq jo ssnssaq `EaslAjas jo no) po area j o j taSvaixp Suipnpui `taSEUixp )[E j o j Xuxduios aqi jo Xiipqaq )Eioi 3qj_--y alpjaAO^ :IMO[|OJ re paiiun) r XiipqEi) t^XuEdujos aqi `thump iCutrfouJ j o Kmtm (jtpotj jo lundass do jq8nojq nini jo apsui nnrxp () j o `thump <tu4oitj j o iCmfut iCjtpty areiRit oqM RioneziusSjo j o cdousd (z) `Xsijod ciqi japun sptmtui (t) jo jaquinu aqi jo a)pjE83-)} Xiiiqn J w.nnn 'III ptmiui ptumu re Xai)od tiqi ui paisu Sttap iou r qaiq/w pus jaquiaui j o jauuEd c r ptmiui aqi qaiqM jo ajnnisA luiof jo diquauind Xu e jo lanpuoa aqi jo mo So ir j e thump iCux/ottf j o .Onfut <}ipop oj X[ddE iou reop aadtjnRji nqj_ '(it ) qdBJSsjBdqnt ui paquarep uouad XOB j o jaXojd -ui3 aqi j o ptmiui ptumu aqi Xq paidnaao j o j o aSjsqa ui `oi paiuaj 'Xq paUMO Xuadojd oi thump f)u4at4 f~) j o 'iaauiXo|duia Rq jo aunoa aqi ui pajnfui uouad qant jo aaXofduia MOfjaj Xo e o i imCut J/ipcf (); :oi laadtaj qii (a) qdEjSx'jEd nqi japun ptmiui u e aq [jrqt o o pe eiu e Sj o j o uouad ou reqi papiAOjd 1 u o iie z iu e Sj o j o u o s -jad qan oi `tireq areaxa j o XjEujijd e u o Jaqua 'aiqs -ftEAE aaoEjntui aiqtiaaqoa pus prjEA jaqio ou n ajaqi j i X)UO inq `uojiBJado qant j o j a|qisuodtaj XqESa) u o iiez iu e8j o j o uouad Xu e puE ptmiui ptumu aqi jo aujsu aqi ui pajaitiSaj tuauidinba qant Xu e ptmiui ptumu aqi io aottciuuacl aqi qiiM SuiiEjado ajiqM uouad jaqio Xu e (u ) paE `luauXo(doia nq jo aunoa aqi ui luauidinba qant Xu e 8oiiEjado apqM ptmiui ptumu aqi jo aaXo[duia u e (i) *me [ uoiiEJitiSaj apiqjA j o io u i Xu e japan pajaitiSaj rutuidmbt tpqoiu jo `XEMqStq ai)qnd e uodn uoiioraoso) jo atodjnd aqi j o j 'uojiEjado aqi oi jaadrej qii/n (a) pus .`ptmiui ptumu aqi j o j jaSEUEUi aisire [E3J re 8u iis e a)iq u o iie z iu e 8j o j o [ptmiui ptumu aqi jo aaXo]duia Ue ueqi jaqio) Puouad X B (p) Iqant re reiinp tiq jo adoat aqi uiqiiM Su ime aftqM joajaqi jap)oqqao j'o joiaajip `jaaigo aAimsaxa Xo e pas paiEuSirep os u o iie z iu eSj o aqi `ajniaaA luiof j o diquauviEd `jEnpiAipui u e ireqi jaqio re tooiiEJEjaap aqi a; paiEuSirep n ptmiui ptumu aqi j i (a) !qsnt re XiinqElj siq oi isadtaa qiim Xjuo inq Qjoajaqi jaqoiaui j o jauuEd X B pas paiEuSirep' os ajniuaA loiof j o diquaousd aqi `ajniaaA luiof j o diqsjaauEd E re saoiiEJEiaap aqi ui paiEuSirep si ptmiui ptumu aqi j i (q) `.souisnq e qsnt jo lanpuos aqi oi laadsaj qM ptmiui ptumu aqi jo asnodt aqi pus `joiaud -ojd a)0S aqi R aq qaiqM jo treuitnq e j o isnpuos aqi oi laadrej qi) X[iio inq paiEuSirep os qouad aqi `JEnpiAipui os re iuonEJB)sap aqi oi paisuSiep a ptmiui ptumu aqi jj (e ) i :MO[aq quoj tas luaixa aqi oi aaUEJhSoi tiqi japun ptmiui ire si 8u imo )|o j aqi jo qseg pajnsnj raouaj -j j rnajaqi Xsuaisqap j o isajap paisadsnt j o o mo u i) Xu e j o asnssaq asn u io j j jo jaqjEui aqi mo^ UMEjpqiiM ajs Xuadojd j o qioM `sisnpojd qans ji `usd E uuoj qjOM j o sisnpojd qans qsiqM jo Xuadojd Xu e j o j o ptmiui ptumu aqi j o j j o Xq paia)duioa qjOM j o tjmpotrf tjamiui ptumu aqi jo asn jo ssoj j o `iuauiasE|daj `jiEdai `uoiisadsui '{EMBJpqiiM aqi j o j juuiiBja reSsuiep oi (d) IqitMajaqi uoiiaauuos ui paqtiujnj luamdinba jo susd `qEijaisui jo mo jo 'joajaqi uotiiod Xu e j o qjOM aqi jo ino Su is ij e ptmiui ptumu aqi jo jprqaq uo jo Xq pauuojjad qjOM oi thump <iu<fot4 oi (o) Itisnpojd qant jo usd Xu e j o sisnpojd qans jo ino Sulcus timpoi41ptmiui ptumu aqi oi thump <ta4oi4 oi (u) `.ptmiui u e usqi jaqio u o iie z iu e Sj o j o uouad Xu e Xq asn oi ind uaaq 3ABq qjoM j o sianppjd qans jaijB ptmiui ptumu aqi jo jpcqaq no j o Xq pauuojjad qjoM j o iitnpmij iptmiui ptumu aqi jo uonaiuosap ao oi Xjnfut [saisXqd [EiuappSE pus uappns aqi u io j j Smqnrej Xuadojd aiqiSusi jaqio jp asp jo sso| oi Xjdds iou saop uoisnpxa tiqi inq Sptoiiui ptumu aqi Xq paiuasajdaj j o p s iu ej j e m XiqtqBjnp jo tsauiq `Xiqsnb `asuanuopad in )3S 3| aqi laaui oi ptmiui ptumu aqi jo JfEqaq uo jo Xq pauuoj -jad J)JO j o ttmpoi4 sptmtui ptumu aqi jo ajnpBj aqi (j-) Z *J This endorsement modifies? such insurance as is ,afffertied-?b>1'the'[Sfo^isTdhs'ioF the policy relating to the following. COMPREHENSIVE AUTOMOBILE LIABILITY INSURANCE BASIC AUTOMOBILE LIABILITY INSURANCE DELETION OF FELLOW EMPLOYEE EXCLUSION - CONNECTICUT It is agreed that 1. Subdivision (i) of the "Persons Insured" provision is amended by adding the following thereto: "except any person who is an agent, representative or employee of the named insured"; 2. Exclusion (c) is amended by adding the following thereto: "or with respect to bodily injury to a fellow employee of any insured who is an agent, representative or employee of the named insured if such injury is caused by such insured while engaged in the business of his employer and if such injury to the follow- employee occurs in the course of his employment." AID 000230 This endorsement is issued by that member of The Travelers Insurance Companies which issued the policy of which this endorsement forms a part. C-1S105 NEW 1*75 PRINTED IN U.3.A. 26090 This endorsement modifies such insurance as is afforded by the provisions of the policy relating tv' the Ml.v.v;r.g; COMPREHENSIVE AUTOMOBILE LIABILITY INSURANCE BASIC AUTOMOBILE LIABILITY INSURANCE GARAGE INSURANCE POLLUTION EXCLUSION AMENDMENT - MICHIGAN With respect to bodily injury or property damage: (a) It is agreed that the insurance does not apply: (1) to bodily injury or property damage arising out of any emission, discharge, seepage, release or escape of any liquid, solid, gaseous, or thermal waste or pollutant (i) if such emission, discharge, seepage, release or escape is either expected or intended from the standpoint of any insured or any person or organization for whose acts or omissions any insured is liable, or (iil resulting from or contributed to by any condition in violation of or non-compliance with any Federal rule, regula tion or law applicable thereto: but this exclusion (1) does not apply to property damage arising out of any emission, discharge, seepage, release or escape of petroleum or petroleum derivatives into any body of water; (2) to property damage arising out of any emission, discharge, seepage, release or escape of petroleum or petroleum de rivatives into any body of water, but this exclusion (2) does not apply to property damage resulting from fire or explo sion arising out of any emission, discharge, seepage, release or escape which neither s <i) is expected or intended from the standpoint of any insured or any person or organization for whose acts or omis sions any insured is liable, nor (ii) results from or is contributed to by any condition in violation of or non-compliance with any Federal rule, regula tion or law applicable thereto. (b) the following exclusion is hereby deleted: it is agreed that the insurance does not apply to such bodily injury or property damage arising out of the discharge, dis persal. release or escape of smoke, vapors, soot, fumes, acids, alkalis, toxic chemicals, liquids or gases, waste materials or other irritants, contaminants or pollutants into or upon land, the atmosphere or any watercourse or body of water, but this exclusion does not apply if such discharge, dispersal, release or escape is sudden and accidental. AID 000231 This endorsement is issued by that member of The Travelers Insurance Companies which issued the policy of which this endorsement forms a part. C-17705 8-74 PRINTED IN U.S.A. 25550 This endorsement modifies such insurance as is afforded by the provisions of the oohcy relating to the following COMPREHENSIVE GENERAL LIABILITY INSURANCE COMPLETED OPERATIONS AND PRODUCTS LIABILITY INSURANCE CONTRACTUAL LIABILITY INSURANCE DRUGGISTS' LIABILITY INSURANCE FARMER'S COMPREHENSIVE PERSONAL INSURANCE MANUFACTURERS' AND CONTRACTORS' LIABILITY INSURANCE OWNERS' AND CONTRACTORS' PROTECTIVE LIABILITY INSURANCE OWNERS', LANDLORDS' AND TENANTS' LIABILITY INSURANCE STOREKEEPER'S INSURANCE COMPREHENSIVE AUTOMOBILE LIABILITY INSURANCE GARAGE INSURANCE LIMITATION OF COVERAGE FOR POLLUTION - MICHIGAN It ts agreed that the exclusions relating to any emission, discharge, seepage, release or escape of any liquid, solid, gaseous or thermal waste or pollutant is deleted and replaced by the following exclusions: (1) to bodily injury or property damage arising Out of any^mission, discharge, seepage, release or escape of any liquid, solid, gaseous or thermal waste or pollutant (0 if such emission, discharge, seepage, release or escape is either expected or intended from the standpoint of any insured or any person or organization for whose acts or omissions any insured is liable, or J <ii) resulting from or contributed to by any OanditioB-HYViolation of or non-compliance with any federal rule, regulation or law applicable thereto; !i but this exclusion <l) does not apply to prope\ly~iamage arising out of any emission, discharge, seepage, release or es cape of petroleum or petroleum derivative* injo any body o* water; (2) to property damage arising out of any emijwfon, discharge, seepage, release or escape of petroleum or petroleum deriva tives into any body of water, but this exclusion (2) does not apply to property damage resulting from fire or explosion arising out of any emission, discharge, seepage, release or escape which neither A<i> is ejected or intended from the standpoint |y insured or any person or organization for whose acts or omissions any tnxpred is liable, nor \ hi) results from or is cofitributed to by any co^ition in violation of or non-compliance with any federal rule, regulation or law applicabrb-thereto. v \ AID 000232 This endorsement is issued by that member of The Travelers Insurance Companies which issued the policy of which this endorsement forms a part. C-16323 1-73 PRINTED IN U.S.A 23490 This endorsement modifies such insurance as is afforded by the provisions of the policy relating to the Eoliowmg: COMPREHENSIVE GENERAL LIABILITY INSURANCE COMPLETED OPERATIONS AND PRODUCTS LIABILITY INSURANCE CONTRACTUAL LIABILITY INSURANCE DRUGGISTS' LIABILITY INSURANCE FARMER'S COMPREHENSIVE PERSONAL INSURANCE MANUFACTURERS' AND CONTRACTORS' LIABILITY INSURANCE OWNERS' AND CONTRACTORS' PROTECTIVE LIABILITY INSURANCE OWNERS', LANDLORDS' AND TENANTS' LIABILITY INSURANCE STOREKEEPER'S INSURANCE COMPREHENSIVE AUTOMOBILE LIABILITY INSURANCE GARAGE INSURANCE POLLUTION EXCLUSION AMENDMENT With respect to bodily injury or property damage occurring in Texas. Oklahoma and West Virginia: (a) it is agreed that the insurance does not apply to such bodily injury or property damage arising out of the discharge, dispersal, release or escape of smoke, vapors, soot, fumes, acids, alkalis, toxic chemicals, liquids or gases, waste materials or other irritants, contaminants or pollutants into or upon land, the atmosphere or any watercourse or body of water, but this exclusion does not apply if such discharge, dispersal, release or escape is sudden and accidental; and (b) the following exclusions are hereby deleted: (1) to bodily injury or property damage arising ouybf any emission, discharge, seepage, release or escape of any liquid, solid, gaseous, or thermal waste or pollutaMr (i) if such emission, discharge, seepattk release or escape is either expected or intended from the standpoint of any insured or any person or organization for whose aqrt or omissions any insured is liable, or -- - - J(ii) resulting from or contributed to by anyfcondiUTon in violation rf or non-compliance with any governmental rule, regulation or law applicable thereto; *- ___/ / but this exclusion (1) doei'not apply-to property damage arising out of any emission, discharge, seepage, release or escape of petroleum or pqfirofeum derivatives into any body of water; * / /\ (2) to property damage arising out of any jsmission, dischajse, Seepage, release or escape of petroleum or petroleum deriv- atj.vea-j.4t0 any body of water, tut this exclusion (2^ does no^ apply to property damage resulting from fire or explosion arising out of any emission, dicharge, seepage, re^ase or escape which neither \\ ! I\ (iK is expected,or intended fifcm the standpoint of an\ insured or any person or organization for whose acts or omis- ' sions any injured is liajne, nor \ \J \' (ii) Yesults fromjjAja^contnbuted to by any condition in violation of or non-compliance with any governmental rule, \sgulation or law applicable theretoA \ AID 000233 This endorsement is issued by that member of The Travelers Insurance Companies which issued the policy of which this endorsement forms a part. C-16343 1-73 PRINTED IN U.S.A. 23480 This endorsement modifies such insurance as is afforded by the provisions of the policy relating to the following: COMPREHENSIVE GENERAL LIABILITY INSURANCE 'IN REM" ACTIONS It is agreed that an action "in rem" against a vessel owned by, leased to or chartered by the named insured shall be treated as if it were an action "in personam" against the named insured; provided, however, this insurance shall not apply if there is any other insurance available to the insured under a protection and indemnity policy, whether such insurance is on a contributory, excess or escape basis or whether it is subject to a deductible or limitation of liability clause or any similar clause. THE TRAVELERS INDEMNITY COMPANY THE CHARTER OAK FIRE INSURANCE COMPANY CL. Secretary C-13410 7-69 RSTUVWX in U.S.A. 12520 0 AID 000234 PERSONAL INJURY LIABILITY INSURANCE COVERAGE PART ADDITIONAL DECLARATIONS__________________________________________ Forming part of Policy NQ .T^~j^knL^3T?3~3~75 Coverage Limits of Liability P. Personal Injury Liability The insurance afforded is only with respect to personal injury arising out of an offense included within such of the following groups of offenses as are indi cated by specific premium charge Or charges. $ 1 r000 j000 aggregate Insured's Participation---------- % Groups of Offenses A. False Arrest, Detention or Imprisonment, or Malicious Prosecution B. Libel, Slander, Defamation or Violation of Right of Privacy C. Wrongful Entry or Eviction or Other Invasion of Right of Private Occupancy __ $ ( j Advance Premium Minimum Premium $ Total Advance Premium t INCLUDED IN COMPOSITE The premium stated in the declarations is an estimated premium only. Upon termination of this policy, the earned premium for each group of offenses for which insurance is afforded shall be the following percentages of the basic limits "Owners', Landlords' and Tenants' " and "Manufacturers' and Contractors' " earned bodily injtiry liability premium. Group A_________ % Group B_________% Group C_________% The premium developed as per above shall be subject to an increased limits of liability factor of. I. Coverage P--Personal Injury liability The company will pay on behalf of the insured all sums which the insured shall become legally obligated to pay as damages because of injury (herein called "personal injury") sustained by any person or organization and arising out of one or more of the following offenses committed in the conduct of the named insured's business: (e) to personal injury arising out of a publication or. utterance described in Group B concerning any organization or busi ness enterprise, or its products or services, made by or at the direction of any insured with knowledge of the falsity thereof. II. Persons Insured Group A--false arrest, detention or imprisonment, or malicious prosecution ; Each of the following is an insured under this insurance to the extent set forth below: Group B--the publication or utterance of a libel or slander or of other defamatory or disparaging material, or a publication or utterance in violation of an indi vidual's right of privacy; except publications or utterances in the course of or related to advertising, broadcasting or telecasting activities conducted by or on behalf of the named insured; Group C--wrongful entry or eviction, or other invasion of the right of private occupancy; if such offense is Committed during the policy period within the United States of America, its territories or possessions, or Canada, and the company shall have the right and duty to defend any suit against the insured seeking damages on account of such personal injury even if any of the allegations of the suit are groundless, false or fraudulent, and may make such investigation and settle ment of any claim or suit as it deems expedient, but the company shall not be obligated to pay any claim or judgment or to defend any suit after the applicable limit of the company's liability has been exhausted by payment of judgments or settlements. Exclusions This insurance does not apply: (a) if the named insured is designated in the declarations as an individual, the person so designated and his spouse; (b) if the named insured is designated in the declarations as a partnership orjoint venture, the partnership or joint venture so designated and any partner or member thereof but only with respect to his liability as such; (c) if the named insured is designated in the declarations as other than an individual, partnership or joint venture, the organi zation so designated and any executive officer, director or stockholder thereof while acting within the scope of his duties as such. This insurance does not apply to personal injury arising out of the conduct of any partnership or joint venture of which the insured is a partner or member and which is not designated in this policy as a named insured. III. Limits of Liability--Insured's Participation Regardless of the number of (1) insureds under this policy, (2) persons or organizations who sustain personal injury, or (3) claims made or suits brought on account of personal injury, the total limit of the company's liability under this coverage lor all damages shall not exceed the limit ofpersonal injury liability stated in the declara tions as "aggregate". (a) to liability assumed by the insured under any contract or agreement; If a participation percentage is stated in the schedule for the insured, the company shall not be liable for a greater proportion of (b) to personal injury arising out of the wilful violation of a penal statute or ordinance committed by or with the knowledge or consent of any insured; any lost than the difference between such percentage and one hundred percent and the balance of the loss shall be borne by the insured; provided, the company may pay the insured's portion of a loss to effect settlement of the loss, and, upon notification of the (c) to personal injury sustained by any person as a result of an offense directly or indirectly related to the employment of action taken, the named insured shall promptly reimburse the com pany therefor. such person by the named insured; (d) to personal injury arising out of any publication or utterance described in Group B, if the first injurious publication or IV. Additional Definition AID 000235 When used in reference to this insurance. utterance of the same or similar material by or on behalf of "damages" means only those damages which are payable thej named insured was made prior to the effective date of because of personal injury arising out of an offense to which this this insurance; + insurance applies. C-I6169 Edition 11-73 min t B" in u.s.S . IT.3. (P.I.) L 15B CONNECTICUT BASIC REPARATIONS BENEFITS ENDORSEMENT The Company agrees with the named insured, subject to all of the provisions of this endorsement and to all of the provisions of the policy except as modified herein, as follows: Section I Coverage QQ.--'Basra Reparations Benefits The Company will pay, to or for the benefit of each eligible injured person, or his dependent survivors, basic reparations bene fits for economic loss consisting of: (a) allowable expense, (b) work loss and (c) survivors' loss resulting from bodily injury, accidentally caused and arising out of the ownership, maintenance or use, including loading or un loading, of a motor vehicle as a motor vehicle. Exclusions The insurance under this endorsement does not apply: (a) to bodily injury to any person intentionally causing or attempting to cause bodily injury to himself or another or toany survivors' loss he would otherwise be entitled to receive for bodily injury arising from hia acts; (b) to bodily injury to any converter of a motor vehiefe arising out of the maintenance or use, including loading or unloading, of such vehicle, but this exclusion does not apply to bodily injury to a basic reparations insured; (c) to bodily injury to any pedestrian, other than a basic reparations insured, if the accident occurs outside of Connecticut; (d) to bodily injury to any person, other than an individual who is a named insured or an employee of any named insured, who is required to provide security with respect to a motor vehicle under Connecticut Public Act 273, Laws of 1972; (e) to bodily injury to a basic reparations insured sustained while occupying a motor vehicle furnished by his employer, to the extent that benefits for allowable expense, work loss or survivors' loss are paid or payable by the insurer (including a selfinsurer) of such vehicle; (f) to bodily injury to a named insured sustained while occupying a motor vehicle with respect to which he is required to pro vide security under Connecticut Public Act 273, Laws of 1972, and which is not an insured automobile; (g) to bodily injury to any pereon sustained while occupying a motor vehicle, other than a private passenger automobile, if such motor vehicle is owned by or furnished or available for the regular use of any basic reparations insured; (h> to bodily injury to any person arising out of the ownership, maintenance or use including loading or unloading, of a parked motor vehicle unless (1) such bodily injury is sustained while the person is occupying the motor vehicle, (2) the vehicle is parked in such a way as to cause unreasonable risk of the bodily injury which occurred, or (3) such bodily injury is the direct result of physical contact with (i) equipment permanently mounted on the motor vehicle, while auch equipment is being operated or used, or (ii) property being lifted onto or lowered from such vehicle in the loading or unloading process; (i) to bodily injury due to war, whether or not declared, civil war, insurrection, rebellion or revolution, or to any act or condi tion incident to any of the foregoing; (j) to bodily injury resulting from the radioactive, toxic, explosive or other hazardous properties of nuclear material. C-16425 1-73 PRINTED IN U.S.A. (Continued on Page 21 AID 000236 23700 Defini tions When used in reference to this insurance: Page 2 allowable expense means reasonable charges incurred for reasonably needed products, services and accommodations, including, but not limited to, those for medical, surgical, dental and hospital care, nursing services, ambulance services, x-rays, prosthetic devices, laboratory fees and drugs, rehabilitation, rehabilitative occupational training, other health treatment and care, and reasonable charges for funeral and burial expenses; "basic reparations insured" means a named insured who is an individual and also includes, whether or not temporarily living elsewhere, (a) any person residing in the same household as the named insured and related to him by blood, marriage or adoption, and (b) any minor residing in the same household as the named insured and in the custody of the named insured or of any person described in < a> above; "bodily injury" means bodily injury, sickness or disease, including death resulting therefrom; "dependent survivors" means (a) the surviving spouse of the deceased eligible injured person if residing in the same household at the time of death, pro vided that the dependency of such spouse shall terminate upon remarriage; and (b) any other person who is, and so long as he remains, under the age of eighteen years or physically or mentally incapacitated from earning or engaged full-time in a formal program of academic or vocational education or training, who is receiving support from the deceased eligible injured person at the time of his death which would qualify such other person as a dependent of the deceased for federal income tax purposes under the Internal Revenue Code; "eligible injured person" means (a) a basic reparations insured who sustains bodily injury (l> while occupying a motor vehicle (other than a motorcycle), or (2) while a pedestrian, as a result of physical contact with a motor vehicle; or (b) any other person who sustains bodily injury (1) while occupying the insured automobile, (2) while occupying any other motor vehicle (other than a motorcycle or a vehicle while being used as a public or livery conveyance) if such motor vehicle is being operated by a basic reparations insured, or (3) while a pedestrian, as a result of physical contact with the insured automobile; "insured automobile" means a private passenger automobile with respect to which the named insured is required to provide security under Connecticut Public Act 273, Laws of 1972, to which the bodily injury liability insurance of the policy applies and for which a specific premium is charged; "motor vehicle" means a land motor vehicle or trailer but does not include (a) a vehicle operated on rails or crawler treads, (b) a vehicle or trailer while located for use as a residence or premises, or (c) a farm type tractor or other equipment designed for use principally off public roads, while not upon public roads; "named insured" means the person or organization named in Item 1. of the declarations; "occupying" means in or upon or entering into or alighting from; AID 000237 "private passenger automobile" means an automobile of the private passenger, station wagon or camper type, not used as a public or livery conveyance, or an automobile of the truck type with a load capacity of fifteen hundred pounds or less not used for commercial purposes other than fanning; "survivors' loss" means economic loss sustained after an eligible injured person's death by his dependent survivors during their dependency and consisting of (a) the loss of the contributions they would have received for their support from the deceased person out of income from work the deceased person would normally have performed had he not died, and Dn ifi* 91 23700 I P.ige 3 as the company may reasonably require and a1 cbjSy 'OT the Medical report will be forwarded to such ;<g:bU' -.inured person if requested. C. Multiple Policies Applicable to One Accident. Non-Duplication of Benefits: Priority of Complying Policies. Regard less of the number of automobiles insured for basic personal injury protection coverage pursuant to Section 4 of the New Jersey Automobile Reparation Reform Act, or the number of insurers or policies affording such coverage, there shall be no duplication of payment of basic personal injury protection benefits and the aggregate maximum amount payable under this and all applicable policies with respect to bodily injury to any one person as the result of any one accident shall not exceed the applicable amounts or limits specified in Section 4 of said Act. This insurance applies on a primary basis to bodily injury to the named insured and his relative and on a secondary basis to all other eligible injured persons. Similarly, the basic personal miury protection coverage provided by other complying policies applies on a primary basis to bodily injury to those persons who are named insureds under such policies and their relatives;. If an eligible injured person to whom this insurance applies on a secondary basis has other basic personal injury protection coverage under another complying policy applicable to his bodily injury on a primary basis, all claims for basic personal injury protection benefits shall first be made against the insurer issuing the other complying policy. No basic personal injury protection benefits shall be due and payable under this insurance unless the other insurer fails to pay such:benefits by reason of insolvency and the company has been given written notice by the claimant of such failure. "Complying policy" means a policy of automobile liability insurance main tained pursuant to the requirements of Section 3 of the New Jersey Automobile Reparation Reform Act and providing basic personal injury protection coverage as approved by the Commissioner of Insurance. D. Subrogation. In the event of any payment under this endorsement, the company is subrogated to the rights of the person for whose benefit such payments were made, to the extent of such payments, and such person must execute and1 deliver instruments and papers and do whatever else is necessary to secure such rights. Such person shall do nothing after loss to prejudice such rights. E. Reimbursement ahd Trust Agreement. Subject to any applicable limitations set forth in the New Jersey Automobile Reparation Reform Act, in the event of any payment to any person under this endorsement: (a) the company shall be entitled to the extent of such payment to the proceeds of any settlement or judgment Out , may result from the exercise of any rights of recovery of such person against any person or organization legally responsible for the bodily injury because of which such payment is made; and the company shall have a lieh to the extent of such payment notice of which may be given to the person or organization causing such bodily injury, his agent, his insurer or a court having jurisdiction in the matter, (b) such person shall hold in trust for the benefit of the company all rights of recovery which he shall have against such other person or organization because of such bodily injury; (c) such person shall do whatever is proper to secure and shall do nothing after loss to prejudice such rights, (d) such person shall execute and deliver to the company such instruments and papers as may be appropriate to secure the rights and obligations, of such person and the company established by this provision. F. Payment of Personal Injury Protection Benefits. Medical expense benefits and essential services benefits may be paid at the option of the company to the eligible injured person or the person or organization furnishing the products or services for which such benefits are due. In the event of the death of an eligible injured person any amounts payable, but unpaid prior to death, for medical expense benefits are payable to the eligible injured person's estate. Benefits payable under sub-division (l)of the definition of survivor benefits are payable to the eligible injured person's surviving spouse, pr if there is no surviving spouse, to his surviving children, or if there are no surviving spouse or surviving children, to the eligible injured person's estate. Benefits payable under sub-division (2> of the definition of survivor benefits are payable to the person who has in curred the expense of providing essential services. Funeral expense benefits are payable to the eligible injured person's estate. SECTION II Extended Medical Expense Benefits Coverage The company will pay medical expense benefits not to exceed the total aggregate amount of *1,000 with respect to bodily injury sustained by an insured person by an accident occurring during the policy period within the United States of America, its territories or possessions, or Canada and arising out of the ownership, maintenance or use, including loading and unload ing, of an insured automobile or of a highway vehicle not owned by or furnished or available for the regular use of the named insured or any relative of the named insured. Exdusions AID 000238 The insurance under Section II is subject to all of the exclusions applicable to Section I, except that the word "person" in exclusion (c) is replaced by the word "pedestrian." PL-1058 NEW 2-73 PRINTED IN U.S.A. 374 <Continued on Page 41 23581 18SSZ 6000aiv tLt 'VS-n Hi 'fcd EL-Z *3N SSOi-^o aousjnsup jo jauoissiuiuiOQ am Xq [BAOjddB oj joafqns ajs qoiqM saiBJ paspaj jo stssq aqi uo Xotpd aq) j o j ajqBAsd umiuiajd am ajnduiooaj oj jq8u aqj aABq [[Bqs XuBduioo aqj `usd ui io a[oq.w ut apBaojojuaun j o K YYZS 8 i joy aqj jo g uoijoag japuaj 01 si qoiqM jo joajja am JuauiSpnt a sjajua jo sajspap uoijoipsunf juaiaduioo jo jmoo 8 j j -joy pies jo g uoijoag Xq pasoduii saSBurop jaAOoaj oj jq8u aqj uo s u o i[8 [\]\i[ aqj joapjaj oj joy uuojajj uciiBJBday aiiqouiomy Xasjap Majq aqj jo gp uoijoag qjiM aouepjoooa ui paonpaj Uaaq aABq qoiqM sajBj uo paseq si Xoipd aqj j o j uiniuiajd aqx uonajnduiooay uimuiajg AI NOIX03S ajiqowolnD pawsut ^8 s i qoiqM a|iqouiojnB _8 o j joadsaj qjiM pajapp si Xoipd aqj japun papjojjs aSBjaAOo sjuauiXsd poipaui a(iqoiuojns X`8 (q> .`uoai3d painful ajqtitja a8 o j Xjnfui Sjtpoq jo asnsoaq Xoipod aouBJnsui apiqouicjnB Jaqjo Xa8 j o siqj japun apqsXBd jo piBd sjijauaq uoijoajojd Xinlui (Buosjad X`8 j o junouis am Xq paonpaj aq ppqs aSajaAOo sjsuojoui pajnsuiun j s u b8 S8 uoijoajojd am Japun sso[ oimouooa joj apqBXsd junouiB-Xtra <8 ) sajsj apqBotpddB jo juatujsnfps am pus `juauiasjopua siqj jo pp pus p suoijoag japun papjojjs aouBJnsui aqj jo uoijsjaipisuoo up IIIN0I1D3S 'aouBJnsui sjuauiXBd (BOipaui apiqouiojns jaqjo Xus japun jo c8 d jpnBj-ou apiqotuojns jaqjo X_8 japun j o j -ajaqj papiAOid aq oj pajinbBJ ajB j o apqsXsd ef8 sjijauaq jsqj juajxa am oj asuadxa j o ssop o j .X(dds jou saop aouBJnsui siqx joy uuojay uoijBJBday aptqouiojny Xasjap .viaiq aqj jo p uotjoag japun j o MBp psjapaj japun papiAOjd aJBOipapq j o Map uoijBSuaduioo s.uauiqjOM Xu b japun sjijauaq oj papjijua si uosiad pawsut u b qoiqM oj joadsaj qjiM asuadxa j o ssop oj XpddB jou saop aouBJnsui siqx 'sjuauag 10 aouBJnsup jaqjg :ip uoijoag japun saijdds uoijipuoo [Buoijipps auiMoppoj aqx `Uiajaqj sjsaddB ji jaAajaqM ,,uosiad painful ajqtStja,, j o j . .uosiad pawsut,, uuaj am 8uijnjijsqns `pp uoijoag oj X|dda j uoijoag jo <3 pus g `y suoijipuoQ SUOIJipUOQ pajnsui pauwu aqj jo uoissiouad aqj qjiM ajtqoui -oino pawsut qons 3uisn uosjad jaqjo Xg8 j o pawsut pauwu am J antwjai 8 j o pawsut pauwu am Xq pajBjado 8uiaq si aiiqouioino pawsut qons ji ajtqouiomo pawsut a8 8niXdnooo a[iqM liinfui Xj ipoq suiBjsns oqM uosjad jamo Xa8 po) `.painsut pauwu am jo uoissiuuad am qjtM ajatqan /CnmqStq qons 8utsn uosjad jaqjo Xa8 j o pawsut pauwu aqj jo animjai 8 j o pawsui pauwu am ^<1 pajBJado 8uiaq si ajatqan /inmqStq qons j i paouBXaAUOO Xh8 S hi j o oi[qnd B j8 pasn 8uiaq 3|tqM apiqaA B j o a(oXojojom B uoqj jamo) ajaiqan ,<vmqStq B 8uiXdnooo apiqM Sinful Sjtpoq suiBjsns oqM uosjad jaqjo Xg8 pq> .`ajatqan SomqStq 8 Xq pasnso `uvujsapad s apiqM (j) j o `.ajatqan SomqStq a u io j j SuijqSijB j o o j u i 8uuajua '8uisn `SuiXdnooo a|iqM (jj <infut <jtpoq suiBjsns antwjai j o pawsut pauwu aqj j i `pawsut pauwu am J antwjai X`8 j o pawsut pauwu 3qj (B) stiBaui "Uosiad painsut,' Isasiuiajd j o aouapisaj 8 k8 asn j o j pajsoo; ajiq* apoiqaA B (E) JO spBajj-ja[MBJO j o sjiBJ uo pajBjado apiqaA 8 (j) `spsoj otpqnd uodn jou apiqM `spBOj oipqnd j j o Xjpdiauud asn j o j pau8tsap juauidinba jaqjo jo lmlm8 ll adXj nn8 o 8 ip unqj jaqjo japiBjj jo apiqaA j o j o u i puaj 8 pq8 s u i ajatqan SomqStq,, : [| uoijoag japun puB g uoijoag oj X[dds p uoijoag japun suoijmijap aqx suoijiuyaa J- 38BJ MICHIGAN NO FAULT INSURANCE ENDORSEMENT The company agrees with the named insured, subject to all of the provisions of this endorsement and to ail of the provisions of the policy except as modified herein, as follows: SECTION 1 Coverage OQ --Personal Injury Protection Insurance (Personal Protection Insuronee) --PIP The company will pay, in accordance with Chapter 31 of the Michigan Insurance Code, to or on behalf of each eligible injured person or his dependent survivors, personal protection benefits consisting of (a) allowable expenses, (b> work loss, and (c) survivors' loss as a result of bodily injury caused by accident and arising out of the ownership, operation, maintenance or use. including loading or unloading, of a motor vehicle as a motor vehicle. Coverage 5S--Property Protection Insurance --BPP The company will pay, in accordance with Chapter 31 of the Michigan Insurance Code, for damage to tangible property caused by accident and arising out of the ownership, operation, maintenance or use, including loading and unloading, of-the insured motor vehicle as a motor vehicle. Definitions Under Section I: "allowable expenses'* means reasonable charges incurred for reasonably necessary products, services, and accommodations, for an eligible injured person's care, recovery or rehabilitation, including, but not limited to, expenses for medical, hospital, nursing, x-ray, dental, surgical, ambulance, funeral and burial services and prosthetic devices; "bodily injury'' means accidental bodily injury, sickness or disease, including death resulting therefrom; "damage" means accidental physical injury to or destruction of tangible property including the loss of use of such injured or destroyed property; "dependent survivors" means 1. the surviving spouse of the deceased eligible injured person if residing in the same household at the time of death, or if dependent upon such deceased at the time of death, provided that the dependency of such spouse shall terminate upon remarriage or death;2 2. any other person who was dependent upon the deceased eligible injured person at the time of such eligible injured per son's death, but only while such other person is a. under the age of 18 years, or b. physically or mentally incapacitated from earning, or c. engaged full-time in a formal program of academic or vocational education or training; "eligible injured person" means 1. the named insured or any relative who sustains bodily injury in an accident involving a motor vehicle; 2. any other person who sustains bodily injury a. while occupying the insured motor vehicle, or b. while not occupying any motor vehicle as a result of an accident involving the insured motor vehicle, or c. as the result of an accident involving any other motor vehicle (1) which is being operated by the named insured or a relative, and (2) to which the bodily injury liability insurance of the policy applies; r s tC-16910 B 8-73 p r in B" in u.s.A. (Continued on Page 2) AID 000240 24290 06ZVZ < aSoj uo pamnjuo3) U'l *3 N 0 169 i-3 JapiqaA j o io u j pajnsui u8 io u 9t qoiqM puB pajnsui paurau aqi Aq pajaisi8aj j o pau-wo apiqa.\ joioui Av8 `auiAdnooo ]ou ayqM Aq qoniis 8uiaq qanojqi JO '8uiAdnooo a[iq* pajnsui paureu aqi Aq pauiBisns Ajntui Aypoq oi -p :tiBSiqotft jo aiBi$ aqi apismo sjnooo luapioos aqi j i `apiqaA j o io u i Av8 SntAdnooo iou a[tq* `aAUBjaJ Aw8 j o pajnsui paurau aqj uuqi jaqjo 'uosjad Aua Aq pauiBisns .Cmtui Aypoq os -a lapiqaA j o io u i qons asn pus aipj oj payyua 8 8 m aq iBql pa.Aayaq Xpsuossaj aq ssapn `AynjMB(uu uaqBi paq aq qoiqM apiqaA j o io u j 8 8uisn ayq.vi uosjad xS 8 Aq pautBisns .Onrui A|ipoq oi -q `.jaqioire oi Jo jpsuiiq oi uuq Aq pasriBO A[[Buoiiuasut Ajntui Aypoq j o j japunajaq SAiaoaj oi papnua aq asiMjaqio ppow. uosjad Au b siyauaq Au b o i b ircooo aiv `BS 38 J3S yy Japufi y .... :A[ddB lou saop I uouoag japun aouBjn9Ui aqy suoisnpx^ saip uosjad pajntui ajqiSya aqi qoiqM uo aisp aqi z8 {z8 |8 }j Av8 apnpui sou saop sso[ spoM snq `juapuadap siq j o jpsunq jo njauaq aqi j o j inq auiooui j o j iou pauuojjad 3ABq p;noM uosjad pajntui a|qt8ya aqi `Ajntui Aypoq pauiBisns iou aq paq yaqi saapuas asoqi jo nay ui sjaqio u io j j saoiAjas Ajsssaoau pus Arauipjo 8uiuraiqo ui pajjnoui sasuadxa apBuossaj -g pun `Ajntui Aypoq pauiBisns iou aq paq paujBa aABq ppoM uosjad pajntui ajqi8i[a aqi auiooui jo ssof y jo 8U11SVSU00 juaptooB aqi jo aiBp aqi ~8 ~~8 sisaA g isjy aqi 8uunp pauiBisns sso[ stream ms s q [ 5(j o m,, '.qiaap 8utsnso AjnCui Aypoq aqi pauiBisns iou aq psq lyauaq jiaqi j o j pauuojjad aAsq pjnOM uosjad passaoap aqi wqi asoqi jo nay ui saotAJas AjBssaoau pus Ajsuipjo SuiuiBiqo ut Aouapuadap Jiaqi 8uunp sjOAtAjns juapuadap qons Aq pajjnoui Apsuossaj sasuadxa *3 pus `qiBap Sutsirao Ajntui Aypoq aqi pauiBisns iou aq psq passaoap aqi may Aouapuadap Jiaqi Sutmp uoddns j o j paAtaoaj aAsq pjnoM sjoAiAjns luapuadap qons isqi `saoiAjas 8tnpnput iou `anjBA oimouooa jo sSutqi aptSuBi jo suoiinqiiiuoo y jo 8UI1SISU00 pus uosjad pajntui ajqiSya us jo qiBap aqi jo aSnBoaq sjOAtAjns luapuadap Aq luapioos aqi jo aiBp aqi jayB sjsaA g isjy aqi 8uunp pauiBisns ssoj suBam^sso; .sjoAiAjns,, `.pajnsui pauisu aqi s b pjoqasnoq auras aqi jo luapisaj b s i oqM (pyqo Jaisoj j o pjBM 8 Suipnpui) uoiidops j o aSBuram `poojq Aq pajnsui paurau aqi 01 paiB(aj uosjad B suBaui (iaAtiBpj,, luiojj 8uiiq8ip j o oiui Suuaiua Jo uodn j o ut stream ^SuiAdnooo,, `suotiBJspap aqi jo x mail u' pauisu u o iib z iu b Sj o j o uosjad aqi stream ,,pajnsui pamau,, :sxaaqi o mi usqi ajom ssq qotqsv jaiwod reposnm Iraqi Jaqio jaMOd Aq AB*q8iq oyqnd 8 uodn uoiiBJado j o j pauSisap j o pajsjado `ja[tBJi a 8utpnput `apiqpA s stream ,,apiqaA j o io u j ,, isaydda Aoyod aqi jo aoiremsui AiytqBi] a8Burep Ayadcud aqi qoiqM 01 pus `aAtiBpj j o pajnsui paurau qons Aq pauMO iou si qoiqM aAiiBjaj Au b j o pajnsui paurau aqi Aq paisjado apiqaA j o io u j b -q j o `apoQ aouBrnsty usSiqoipi aqi jo xg jaidsqQ japun Aiunoas uiBiurem 01 pajmbaj si pamsui paurau aqi (g) pus `pa8raqo st mnimajd oyioads B qoiqM j o j pus saydds Aoyod aqi jo aouBjnsut Aiyiqsy aSBurep Auadcud aqi (X) qoiqM 01 loadsaj qipu pajnsui paurau aqi Aq patiMO apiqaA j o io u j b -b *9S aSBJSAOQ 0110ads aJ qiiM pasn uaq *3 .apoo aouBjnsux usSiquyu aqi jo xg JaidsqQ japun Aiunoas uisiutsm oi pajtnbaj si pajnsui paurau aqi -q pus *pa8jsqo si mnimajd oypads s qoiqM j o j ptra saydds Aoyod aqijo aouBJnsut Aiyicpy AJnfui Aypoq aqi -b qotqM 01 padsaj qiiM apiqaA j o io u j b `5ft aSBjaAOO 01 loadsaj qiiM pasn uaqM y stream ^apiqaA joiom pajnsui,, yuauiAo|dma j o qjOM mooj paAuap sSuiutsa jaqio pus `saaj `suoissiunnoo `sdy `s s S8 `Araps stream ,,auiooui,. Z Page 3 <b) expenses reasonably incurred by his dependent survivors in obtaining ordinary and necessary services from others not members of the deceased person's household in lieu of the services the deceased person would have performed for the bene fit of his household; work loss" means economic loss sustained during the life of the eligible injured person and consisting of (a> eighty-five percent of loss of income from work an eligible injured person who would normally be employed in gainful activ ity during the period of his disability would have performed had he not been injured, reduced by any income from substi tute work actually performed by such person or by income he would have earned in available appropriate substitute work which he was capable of performing but unreasonably failed to undertake, and (b) eighty-five percent of expenses reasonably incurred in obtaining ordinary and necessary services from others not members of the eligible injured person's household in lieu of those that such person would have performed had he not been injured, not for income but for the benefit of himself or his family. Limit of Liability The total aggregate amount payable by the Company for allowable expense, work loss and survivors' loss combined, because of bodily injury to any one person as a result of any one accident, shall not exceed *5,000; provided that (a) the maximum amount payable for all work loss and survivors' loss included therein shall not exceed *200 in any one week and such maximum shall apply pro rata to any period of leas than one week and (b) the maximum amount payable for funeral and burial expenses included therein shall not exceed *2.000. Any amount payable by the Company under the terms of this endorsement shall be reduced by the amount paid, payable or re quired to be provided _ t- (a) under any workmen's compensation or other similar medical or disability law, and <b> except with respect to a basic reparations insured, as direct benefits without regard to fault by an insurer (including a selfinsurer) of any vehicle other than an insured automobile. Policy Period; Territory The insurance afforded by this endorsement applies only to accidents which occur during the policy period and within the United States of America, its territories or possessions or Canada. Conditions The insurance afforded by this endorsement is subject to the following Conditions: A. Notice. In the event of an accident, written notice containing particulars sufficient to identify the eligible injured person, and also reasonably obtainable information respecting the time, place and circumstances of the accident shall be given by or on behalf of each eligible injured person to the Company or any of its authorized agents as soon as practicable. If any eligible injured person, his legal representative or dependent survivors shall institute legal action to recover damages for injury against a person or organization who is or may be liable in tort therefor, a copy of the summons and complaint or other process served in connection with such legal action shall be forwarded as soon as practicable to the Company by such eligible injured person, his legal representative or his dependent survivors. B. Medical Reports; Proof of Claim. As soon as practicable the eligible injured person or someone on his behalf shall give to the Company written proof of claim, under oath if required, including full particulars of the nature and extent of the in juries and treatment received and contemplated, and such other information as may assist the Company in determining the amount due and payable. The eligible injured person shall submit to physical examinations by physicians selected by the Company when and as often as the Company may reasonably require and a copy of the medical report will be forwarded to such eligible injured person if requested. C. Non-duplication of Benefits. Regardless of the number of motor vehicles insured or insurers (including self-insurers) pro viding security pursuant to the provisions of Connecticut Public Act 273, Laws of 1972, or the provisions of any other law providing for direct benefits without regard to fault for motor or any other vehicle accidents, no person shall recover duplicate benefits for the same elements of economic loss. No eligible injured person shall recover benefits under this endorsement to the extent that he is entitled to recover bene fits for the same elements of economic loss under the provisions of any other automobile policy providing such benefits to him as a named insured under such a policy or as a relative of such a named insured. If any eligible injured person is entitled to recover benefits under more than one policy the maximum recovery under all such policies shall not exceed the amount which would have been payable under the provisions of the policy providing the highest dollar limit of benefits payable. C-16425 1-73 (Continued on Page 41 AID 000242 23700 P.ige 4 D. Subrogation. Subject to any applicable limitations set forth in Section 7 of Connecticut Public Act 271. Laws of 1972. in the event of any payment under this endorsement, the Company is subrogated to the rights of the person to whom or for whose benefit such payments were made, to the extent of such payments, and such person must execute and deliver instru ments and papers and do whatever else is necessary to secure such rights. Such person shall do nothing after loss to pre judice such rights. E, Reimbursement and Trust Agreement. Subject to any applicable limitations set forth m Section 7 of Connecticut Public Act 273. Laws of 1972. in the event of any payment to any person under this endorsement; (a) the Company shall be entitled to the extent of such payment to the proceeds of any settlement or judgment that may result from the exercise of any rights of recovery of such person against any person or organization legally responsible for the bodily injury because of which such payment is made; and the Company shall have a lien to the extent of such payment notice of which may be given to the person or organization causing such bodily injury, his agent, his insurer or a court having jurisdiction in the matter, (b) such person shall hold in tru9t for the benefit of the-Company all rights of recovery which he shall have against such other person or organization because of such bodily injury, (c) such person shall do whatever is proper to secure and shall do nothing after loss to prejudice such rights. <d> such person shall execute and deliver to the company such instruments and papers as may be appropriate to secure the rights and obligations of such person and the Company established by this provision. Section 11 (n consideration of the reduction in premium for the protection against uninsured motorists coverage any amount payable for economic loss under the protection against uninsured motorists coverage shall be reduced by the amount of any basic reparations benefits paid or payable under this endorsement because of bodily injury to an eligible injured person. Section III Premium Recomputotion The premium for the policy is based on rates which have been reduced in accordance with Section 34 of Connecticut Public Act 273, Laws of 1972, to reflect the limitations on the right to recover for damages imposed by Section 5 of said Act. If a court of competent jurisdiction declares, or enters a judgment the effect of which is to render, Section 5 invalid or unenforce able in whole or in part,the Company shall have the right to recompute the premium payable for the policy on the basis of revised rates which are subject to review by the insurance commissioner. THE TRAVELERS INDEMNITY COMPANY THE CHARTER OAK FIRE INSURANCE COMPANY THE TRAVELERS INDEMNITY COMPANY OF ILLINOIS THE TRAVELERS INDEMNITY COMPANY OF RHODE ISLAND THE TRAVELERS INDEMNITY COMPANY OF AMERICA AID 000243 This endorsement modifies such insurance as is afforded by the provisions of the policy relating to the following" COMPREHENSIVE AUTOMOBILE LIABILITY INSURANCE AUTOMOBILE MEDICAL PAYMENTS INSURANCE MASSACHUSETTS COMPULSORY INSURANCE EXCLUSION It is agreed that the insurance does not apply with respect to any automobile with respect to which insurance is required of the named insured by the Massachusetts Compulsory Liability Security Act (Chapter 346, Acts of 1925) or by any act amendatory thereof or supplementary thereto, while such automobile is registered in Massachusetts under a certification of insurance re quired by said act. This exclusion is not applicable tocoverage!s). Amending Policy No. TR-NSL-123T693-3-75 AID 000244 This endorsement is issued by that member of The Travelers Insurance Companies which issued the policy of which this endorsement forms a part. C-11372 7-6 PKIKTCO IN U.S.A. 773 N.S. AOOOq THE TRAVELERS INSURANCE COMPANIES j NEW JERSEY BASIC PERSONAL INJURY PROTECTION ENDORSEMENT This endorsement provides coverage as required under the New Jersey Automobile Reparation Reform Act. commonly referred to as the "New Jersey No-Fault Law". All terms printed in italics are defined terms. For complete understanding of provisions containing these terms refer to the section entitled "Definitions". The company agrees with the named insured, subject to all of the provisions in this endorsement and to all of the provisions of the policy except as modified herein, as follows; SECTION I Coverage Q -- Basic Personal tnjury Protection Coverage The company will pay basic personal injury protection benefits consisting of (a) medical expense benefits, (b) income continuation benefits, (c> essential services benefits. Id) survivor benefits, and (e) funeral expense benefits with respect to bodily injury sustained by an eligible injured person, caused by accident and arising out of the ownership. maintenance or use, including loading or unloading, of a private passenger automobile as an automobile. Exclusions The insurance under this endorsement does not apply: __ - (a) to bodily injury; to a person whose conduct contributed to the injury in any of the following ways: 1 11 while committing a high misdemeanor or felony or seeking to avoid lawful apprehension or arrest by a police officer, or (2) while acting with specific intent to cause injury or damage to himself or others; (b) to bodily injury to the named insured of any relative of the named insured sustained while occupying, using or entering into Or alighting from a private passenger automobile which is not an insured automobile under this policy, if he is required to; maintain automobile liability insurance coverage with respect to the automobile under the New Jersey Automobile Reparation Reform Act; (c) to bodily injury to any person, other than the named insured or a relative of the named insured or a resident of New Jersey, if the accident occurs outside of New Jersey; (d) to bodily injury arising out of the ownership, maintenance or use, including loading or unloading, of any vehicle while located for use as a residence or premises other than for transitory recreational purposes; <e) to bodily injury due to war, whether or not declared, civil war, insurrection, rebellion or revolution, or to any act or condition incident to any of the foregoing; If) to bodily injury resulting from the radioactive, toxic, explosive or other hazardous properties of nuclear material. Definitions When used in reference to this insurance: "bodily injury" means bodily injury, sickness or disease, including death at any time resulting therefrom; "eligible injured person" means (a) the named insured or any relative of the named insured, if the named insured or relative sustains bodily injury < 1) while occupying, using, entering into or alighting from a private passenger automobile, or (2) while a pedestriaft, caused by a private passenger automobile or as a result of being struck by an object propelled by or from such an automobile; or (b) any other person who sustains bodily injury (1) while, with the permission of the named insured, occupying, using, entering into or alighting from the insured automobile, or (21) while a pedestrian, caused by the insured automobile or as a result of being struck by an object propelled by or from the insured automobile; "essential services benefits" means an amount not exceeding a limit of *12.00 per day and a total limit of *4,380 payable to an eligible injured person as reimbursement for payments made to others, for substitute essential services of the type actually rendered during his lifetime and which he would ordinarily have performed not for income but for the care and maintenance of himself anjd his relatives: "funeral expense benefits" means an amount not exceeding *1,000 for reasonable funeral, burial and cremation expenses incurred; IContinued on Page 21 PL-1058 HEW 2-73 PRINTED IN U.S.A. 37 AID 000245 23581 imz (< uo ,'uo J) - ^-Z <H3N <3 uaijo sn pue uaq.w sueuiSA'qd .\q uounmuiuxa [BOisXqd q i iiuiqtts H^qs u q s j j c I p,iifu'ui *>iqidijs ->qjL Ajqw\Vd uur np junuujH *qj auiuuujjup ui Xunduioo aqj istsse S 8 8 uoneuuojur jaqio qons pue 'paieiduidiuoo pun '|0puu -auniui oqi jo iuaixa pun ajnmu aqi jo sji>[nosynd [fnj Sutpnjoui *u iil jo jtuud Uduu.w .\ui:duioo aqi * \ -m:i (fnqs j[yqaq siq uo auoaoios; io uosjjd psjniui aqj aiquonotMd s h u o o s sy *uni'|j jo-jinny `^uoday siOAiAjns siq j o 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Aquisj u u bj b Aq paUwo si ajiqom -o/no pajnsui aqi j j `suoiiBJBpap atq jo \ uiaq ui pajnsui aqi s b pauisu u o iib ziu bSj o j o uosjad aqi suBaui ,,pamsut pamou,, :8uipaq jo poqiaui snoiSqaj paziu -Soaaj a qii.w aouBpjoooB ui pajapuaj juaunsaji pipauiaj poipaui-uou A8 j o j j o `onoBJdojtqo jo AaopqoAsd `Aja3jns `aupipaui aonosjd 01 pasuaoq suosjad Aq paquosajd luaunsaji j o j paunoui sasuadxa AJs9saoau pus ajqsuosBaj jaqio pus uoqBoipatu 'saot.\jas aouBfnquis `saoiAap onaqisojd `saotAjas oqsouSsip jaqio puB A8 -x `8 S uonsiiqqBqaj pus (Biidsoq `8uisjnu puoissajojd `luauiisaji (Biuap puB [BoiSjns `potpaui j o j paxinaui sasuadxa a[qeuoseaj qa suBaui ,,sujauaq asuadxa /oaipam,, `.paSjBqo si uimuiajd oijpads s qoiqM j o j pus saijddB Aoqod aqi jo aouajnsui AiiqqBq .iintui Aqpoq aqi qoiqAV 01 `iov uuojay uotiBJBday aqqouioiny Aasjap .wa^ aqi japun a8BJ3AOO aouajnsui Aiiqqsq aqqouioina u ibiu ibu i 01 pajinbaj si paansui pamou aqi qoiqM 01 padsaj qqM aqqouioinB u b suBaui ,,a]tqomo}nt> pajnsui,, !amoaui 8uionpojd j o SutujBa `sniais [Buoiisdnoao u b u i s b m `luappoB aqi jo auiq aqi IB `oqM uosjad b siream ,,jaanpoJd amoaui,, `.Aiiqqssip /Onfui Aqpoq jo ynsaj 8 8 `auiiiaJU siq 8uunp aaanpojd amoaui 8 j o amoaui jo sso[ aqi j o j ajqBABd OOS`9* jo liuiq pioi b puB qaaM lad 00t* J liuitl B 8uipaaoxa iou lunouia u b suaaui ,,sjijauaq uononutiuoa amoaui,, 'luauiAojduia j o qjOM u io j j paAuap sSuiujsa jaqio puB saaj `suotssiuiuioo `sdq `s b8b m 'Aj b j b s s u bb u i ,,amoaui,. Z a8Bd Page 3 e. lo bodily injury sustained by any relative while occupying, or through being struck by while not occupying, any motor vehicle if such relative is the owner or registrant of such motor vehicle and has failed to maintain security with respect thereto as required by Chapter 31 of the Michigan Insurance, Code; f. to bodily injury sustained by an owner or registrant of a motor vehicle involved in the accident with respect to which the security required by Chapter 31 of the Michigan Insurance Code is not in effect: g. to bodily injury sustained by any relative, if such relative is entitled to personal protection benefits as a named mi suredi under the terms of any other policy with respect to such coverage; h. to bodily injury sustained by any person, other than the named insured or any relative, if such person is entitled to personal protection benefits as a named insured or relative under the terms of any other policy with respect to such coverage; i. to bodily injury sustained by any person, other than the named insured or any relative, while occupying, or through being struck by while not occupying, any motor vehicle, other than an insured motor vehicle, which is being operated by the named insured! or relative if the owner or registrant of such motor vehicle has provided security with! respect thereto as required by Chapter 31 of the Michigan Insurance Code; j. to bodily injury sustained by any petBon arising out of the ownership, operation, maintenance or use, including loading or unloading, of a parked motor vehicle unless (1) the motor vehicle was parked in such a way as to cause unreasonable risk of the bodily injury which occurred, or (2) such bodily injury was a direct result of physical contact with (a) equipment permanently mounted on such motor vehicle while such equipment was being operated or used, or lb) property being lifted onto or lowered from such motor vehicle in the loading or unloading process, or (3) such bodily injury was sustained by a person while occupying such motor vehicle; k. to bodily injury sustained by any person while occupying a motor vehicle located for use as a residence or premises; l. to bodily injury sustained by any person while occupying a public or livery conveyance for which security is main tained as required by Chapter 31 of the Michigan Insurance Code, unless such conveyance is an insured motor vehi cle; m. to bodily injury sustained by the named insured or any relative while occupying a motor vehicle owned or registered by the employer of the named insured or such relative for which security is maintained as required by Chapter 31 of the Michigan Insurance Code; n. with respect to work loss and survivors' loss, to bodily injury sustained by any person, other than the named insured or any relative, while occupying any motor vehicle, other than the insured motor vehicle, which is being operated by the named insured or any relative outside the State of Michigan if neither the owner nor the registrant of such motor vehicle is required to provide security with respect thereto under Chapter 31 of the Michigan Insurance Code. 2. under Coverage SS, to damage to a. any property while the insured motor vehicle is located for use as a residence or premises; b. the property of any person while such person is using the insured motor vehicle without the express or implied con sent of the named insured; c. any property owned by the named insured or a relative if such named insured or relative was the owner, registrant or operator of a vehicle involved in the motor vehicle accident out of which the property damage arose; d. any vehicle or trailer, or the Contents of either, operated or designed for operation on a public highway by power other than muscular power, unless such vehicle or trailer is not an insured motor vehicle but is damaged by an insured motor vehicle and is parked in such a way as not to cause unreasonable risk of the damage which occurred; e. any property suffered or caused intentionally by the claimant; f. any property as a result of an accident involving a motor vehicle not owned by the named insured or any relative which is being operated by the named insured or any relative to the extent that security as required under Chapter 31 of the Michigan Insurance Code has been provided by or on behalf of the owner or registrant of such motor vehicle; C-1S910 NEW 8-73 PRINTED IN U.S.A. (Continued'on Page 4) AID 000247 24290 066*3 8wooo aiv iq JSod uo pamniuoji EL-8 3N 01691-; paouaunuoo s b* u o iio b aqi qotqM u o aiBp aqi ajojaq reaE j Iraqi aioui pajjnom ssoj aqi jo uotuod Eire j o j snjauaq jaAOoaj io u Esui luBtmep aqi `jaAamoH 'paunout uaaq seq S90[ pjOAtAins j o s s o j qjo.vv 'asuadxa aiqB.wO|p luaoaj isoui aqi jaije reaE j utqit* auiti /Cu b ib paouaunuoo aq Ebu i u o iio b aq} 'apem uaaq seq luauiEed B j o ua,\i8 uaaq seq aonou aqi Jl Ejnfut aqi j o j siyauaq uouoaioid [suosjad jo luauiEed b apsui E[snotAajd ssq EuBdtuoo aqi ssapin 10 luaptooe aqi jays reaE l utqitM Etraduioo aqi 01 u s a i8 uaaq 9sq utajaq paptAOJd s b Ejnfut jo aonou uauun ssapn Emtut aqi Su is u bo luaptoos jo aiap aqi jays reaE j usqi j b ib [ paouaunuoo aq iou Earn 38b j 3ao o stqi japun a[quEed siyauaq uotioaiojd puosjsd jo EjaAooai j o j u o iio b u b isqi jaqynj paptAOJd `luatuasjopua stqi jo suuai aqi |(B qit.w asuByduioo ynj uaaq oo afiojaAO^ aABq [pqs ajaqi 'oiaJaqi luapaoaid uotnpuoo B s b `ssapn Eusduioo aqi is u ib8b ay [iBqs u o iio b o .m -Euoduio^ tsuioGy uoyay 'S' 390 JO ssoi j o 30(ba aqi 'apBoyddB ajaqm `pus uoyeioaidap seal sisos luatuaoBldaj j o sisoo jtBdaj 3|qsU09B3J jo jassaj aqi paaoxa iou [[eqs siyauaq uotioaiojd Eyadojd j o j Ejt(tqBt| 9,Eireduioo aqi `8uioSaJOj aqi oi pafqng '000`000`t* paaoxa sou ipqs inaptooB auo u io j j Su is u b aSBurep ye j o j Eotpd stqi japun Eir[iqBi[ s,Eusduioo aqi jo inny pioi aqi 'sayddB SSBjaAOO stqi qotqM oi saptqaA j o io u i s$ s Bo j s a o ^ pajnsut j o `apeui s u iibj o a(qBpnddB epuoq j o satoyod 'pajnsut suosjad jo jaqtnnu aqi jo ssaipre8ay Etymon i ' SAiieiaj Eu b pus `pajnsut pautBU aqi oi Epo EjddB [pqs ajqyonpap qons isqi paptAOJd 'Eoyod stqi jo lied B Smrajoj puB oi paqoBiis luauiasjopua S' 8 u i j o A'ot[od stqi jo suoiisrepap aqi ut j o `luamasjopua stqi jo a[npaqo9 aqi ut qyoj ias aiqtionpap aAtioap Eu b (jr> tiuauiuiaAoS [Bjapaj aqi jo aiBis Eu b j o 9mB[ aqi (j) Japun paptAOJd aq oi pajtnbaj j o aiqB/Ead *ptBd lunoure aqi /Eq paonpaj aq [[Bqs aSBjaAOo stqi jo suuai aqi japun Suedmoo aqi Xq ajqs^Bd itmouiB Eu b -a :,Esp jad OZ* paaoxa iou qeqs s j o aiaj o s luapuadap s.uosjad pajnCut a{qt8t{a qons q paunout sasuadxa aiqBuosaaj jo asnsoaq ssoj ,9J0AtAjns j o j ajqBABd lunouiB ummixBUi aqi isqi paptAOJd `OQO`I< paaoxa iou [ioqs pouad ,Eap OE ai8uts .Eu b u i pautBisns `uosjad pajntui aiqtSya u b j o qisap aqi jo asnsoaq `sso; .s j o a iaj o s j o j a^qaEsd lunoure tunuiixBiu aqi -p `..Eep jad paaoxa iou Ijsqs uosjad pajnlut a(qt8qa aqi Eq paunout `auioout jo sso{ usqi jaqio `sso( qjoM j o j aiqaEed lunoure umuitxsui aqi (J) :E[ddB ipaqs anjBA aSsiuaojad jaisaj8 b asso qotq.w ut 'a8siuBApe x b i jauo[ e jo jocud a[qBuossaj Eusdutoo aqi oi siuasaJd uosjad pajnfut a[qt8t[a aqi ssa[un auioout jo sso[ qons.jo %gg paaoxa iou [[Bqs s9o( qjo jo asnsoaq auioout jo sso[ j o j a[qBEsd lunoure umuitxsui aqi (j) iBqi paptAOJd *sso[ j j j o m j o spouad jassa; Eus oj b ibj ojd E;dde ysqs lunoure qons puB apoQ aouBjnsul us8tqotM aqi jo IE Jaideqo jo <q> J.OIB uotioag japun paqstiqsisa st lunoure jaqio jaASisqM JO 000`IS paaoxa iou ueqs jaqia8oi 'pouad Eep o auras aqi utqiiM uosjad pajnfut afqtStja aqi Eq pauuojjad qjoM u io j j patusa auioout Eu b pus 'pouad EBp o ai8ut9 Eu b u i pautBisns ssoj qjOM ys j o j aiqaEed junouie uinuitxBui aqi 'o OOO'I* paaoxa iou nsqs sasuadxa (eunq pus isjaunj j o j aiqBEsd lunoure uinuitxBui aqi -q tares aAtsuaiut j o [stoads sajtnbaj uosjad pajnfut aiqt8tia aqi uaqtn idaoxa suotiepouiuioaoB aiEAUd-tuias j o j a3jeqo Ereuioisno pus a[qBuoseaj b j o ssaoxa ut uiooj iBjtdsoq b j o j saBreqo apnput iou UBIIS sasuadxa aiqBMOIfB `8 isMoyoj s b pajtuiti si luaptsos aptqaA j o j o u i auo Etre ut Ejnfut Eppoq sutsisns oqM uosjad auo Eu b j o jpqaq uo j o o j siyauaq uotjoaiojd (suosjad j o j Eilltqstl s.Etreduioo aqi `satldds aotrejnsut stqi <ioiqM oi saptqaA joioui q q aBojaxo^ pajnsut j o `apBtu stump `atqBotlddB spuoq j o saptpd 'pajnsut suosjad jo jaquinu aqi jo ssatpreSay -Euiiqoiq jo sjtuiiq 'ireStqstM jo aieig aqi ut `gg aSBjaAOQ japun -q .`BpeuBO j o `suotssassod j o sauoiujai sit 'eouatuv jo saiBig paituft aqi utqitM `65 aBejaAOQ japun -b pus pouad Eotpd aqi 8uunp pus Ei6I `I Jaqopo JaiJB j o u o jnooo qotqM siuappos oi Ejuo saijddB J uotisag Japun aotrejnsut aqi -Ejoiuiai .'pouay Eaigoj -j f-japunajaqi paiou saSsjaAoo aqi oi Epo Epds suotitpuoo Jaqio aqx -gg ptre 66 saSsjaAOO oi Ejddn oi PTM 6 `8 `I suotitpuoo) suoitipuo^ -aiqtionpap b j o uotisstlddB aqi j o j idaoxa paptAOJd aq ppoM j o Ejjadojd qons j o j paptAOJd si Ei -unoas Jaqio j o aousjnsut qonB ieqi luaixa aqi oi 'EiuoqinB EjoiBinSaj pjapaj j o aims `pool Eu b qit jatjreo j o io u i qons jo jjeqaq uo j o Eq pa(tj uaaq seq Eiunoas jo aouaptAa jaqio j o aotrejnsut jo aisotjtijao s jt `s ms '! panduioQ tre8tqstp] aqi jo gy, jaidsqo ut pautjap s b jaureo j o io u i b st oqM pajnsut paureu B Eq uotpiJOdsUBJl JOJ pajdaooB Ewadojd Eu b '8 * 388 Page 5 5. Action Against th Company. No action shall lie against the company unless, as a condition thereto, there shall have been Covarags SS full compliance with all terms of this endorsement, provided further that an action for recov ery of property protection benefits payable under this coverage may not be commenced later than 1 year after the date of accident. 6. Duties in Event of Loss. In the event of loss: Coverage SS (a) the property shall be protected and any further loss due to failure to protect shall not be recoverable under this cover age; however, reasonable expenses Incurred in affording such protection shall be deemed incurred at the company's re quest; (b> within a reasonable time after loss, sworn proof of loss in such form and including such information as the company may reasonably require shall be filed with the company and. upon the company's request, the damaged property shall be ex hibited and the owner or bailee thereof shall submit to examination under oath. 7. Medical Reports; Proof of Cloim. As soon as practicable the eligible injured person or someone on his behalf shall give Coverage QQ the company written proof of claim, under oath if required, including full particulars of the nature and extent of the injuries and treatment received and contemplated, and such other information as may assist the company in determining the amount due and payable. The eligible injured person shall submit to physical or mental exam inations by physicians selected by the company when and as often as the company may reasonably require. If requested by the company, such eligible injured person, someone on his behalf or his employer shall furnish a sworn statement of earnings by such eligible injured person since the date of the accident and for a reasonable time prior to-the accident. 8. Multiple Policies; Non-Duplication of Benefits. Regardless of the number of motor vehicles insured or insurers (including self insurers) providing security in accordance with Chapter 31 of the Michigan Insurance Code, or the provisions-of any other law providing for direct benefits without regard to fault for motor or any other vehicle accidents, no person shall recover duplicate benefits for the same expenses or loss. Coverage QQ If any eligible injured person is entitled to recover benefits under more than one policy, the maximum recov ery under all such policies shall not exceed the amount which would have been payable under the provisions of the policy providing the highest dollar limit of benefits payable. 9. Notice. In the event of an accident, written notice containing particulars sufficient to identify the eligible injured person and the damaged property, and also reasonably obtainable information respecting the time, place, and circumstances of the accident shall be given by or on behalf of the person who has sustained bodily injury or loss to the company or any of its authorized agents as soon as practicable. Coverage QQ If any eligible injured person, dependent survivor or the legal representative of either shall institute legal action to recover damages for injury against a person or organization who is or may be liable in tort therefore, a copy of the summons and complaint or other process served in connection with such legal action shall be forwarded as soon as prac ticable to the company by such eligible injured person, dependent survivor or legal representative. 10. Reimbursement and Trust Agreement. Subject to any applicable limitations set forth in Chapter 31 of the Michigan Insur ance Code, in the event of any payment to any person under Section I of this endorsement (a) the company shall be entitled to the extent of such payment to the proceeds of any settlement or judgment that may re sult from the exercise of any right of recovery of such person against any person or organization legally responsible for the bodily injury or property damage because of which such payment is made and the company shall have a lien to the extent of such payment, notice of which may be given to the person or organization causing such bodily injury or prop erty damage, his agent, his insurer, or a court having jurisdiction in the matter; (b) such person shall hold in trust for the benefit of the company all rights of recovery which he shall have againat such other person or organization because of such bodily injury or property damage; (c) such person shall do whatever is proper to secure and shall do nothing after loss to prejudice such rights; (d) such person shall execute and deliver to the company such instruments and papers as may be appropriate to secure the rights and obligations of such person and the company established by this provision; provided that this condition shall apply with respect to payment of benefits to any person under Coverage QQ only if such person isilegally entitled to recover such benefits. C-16910 NEWS-73 p r i B" in U.S.A. (Continued on Page 6) AID 000249 24290 06ZK 05^000 aiv ys'ft * QSiMititf Et*9 *3N Qt69*-3 OviiJMg VDIH31W 30 ANVdWOO AXINW3CINI SH333AVHX 3HI awTsi saoHH 30 ANVdwoo S n30n i s h 333S 3HX SIONmi 30 ANVdHOO AXINW3GNI SH333AVHX 3HX AMVdIVOO SDNVHnSNI 3313 HVO H3XHVH0 3HX ANVdWOD AXINW30NI SH3T3AVHX 3H1 apoo aoirejnsu] ireanpinj am jo xg jaidaqo Aq pajinbaj 9B siyauaq aoirejnsiq uonoaicuj Ayadojj japun apjaABd j o pied aja sujauaq jat[imis iaqi juapca aqi oi Ajdda iou aaop Aoyod siqi japun papjojjB siyauaq aSajaAOO luauiasjnqunaj paiuaj Aua (p> apoD aoirejnsiij uaStqoift aqi jo x jaidaqo Aq pajinbaj sa aiqsAad j o piad 8 8 siijauaq aoua -jnsux uouaajojd Ayadojj iaqi iuaixa aqi 01 Ajdda iou saop Adi[od siqi Japan papjojja aSBjaAOO aSaurep [BoisAqd Aua (3) apo^ aouajnaux uaSiqoijq aqi jo x jajdBqQ Aq pautaiuiaui aq 01 pajinbaj joa si Aiunaas qoiqM j o j apiqaA Aire 01 A(dda iou saop (q> uorpasqns siqi inq `paiapp si Aoipd 9tqi japun papjojjB aSajaAOO aiuaiuAed [Botpaui ajiqomoinB Atre (q> luoajad painful aiqtSip ua 01 Amtui Ajtpoq jo asnaoaq Aoijod aoirejnsui a(iqouioina jaqio A 8 j o aiqi japun aiqaAad j o piad siijauaq uotioaiojd puosjad Aua jo lunoure aqi Aq paonpaj aq jjaqa aSajaAOo aisuoioiu pajnautun jaureSa uoipaioid aqi Japun a[qnaAad mnoiire Aua (B> :saiBj aiqBOt[ddB jo luauijsntpa aqi pire luauiasjopua siqi jo I uotioag Japun papJOjjB aousjnaui aqi jo uoiiBjaptsuoo uj 9 aSBj it Noixoas CONTRACTUAL LIABILITY INSURANCE COVERAGE PART DECLARATIONS SCHEDULE ! ; . No. ''' ' ' '' . ' ' ' ' Designation of Contract* All written contracts (Blanket Coverage) Forming part of Policy No TR-HSL-123T&93-3-75 Code Premium Bases Rates 1 BJ\ P.D. Advance Premium B.I. P.D. (a) Cost (b) Sales (a) Per tl DO of Cost (b) Per SIC 00 of Sales Minimum Premiums B.I. l P.D. Total INCLUD :" IN COMPOS ITE I. Coverage Y--Contractual Bodily Injury liability Coverage Z--Contractual Property Damage liability The company will pay on behalf of the insured all sums which the insured, by reason of contractual liability assumed by Him under any written con tract of the type designated in the schedule for this insurance, shall become legally obligated to pay as damages because of Coverage Y--bodily injury or Coverage Z---property damage to which this insurance applies, caused by an occurrence, and the company shall have the right and duty to defend any suit against the insured seeking damages on account of such bodily injury or property damage, even if any of the allegations of the suit are groundless, false or fraudulent, and may make such investigation and settlement of any claim or suit aj it deems ex pedient, but the company shall not be obligated to pay any claim or judgment or to defend (1) any arbitration proceeding wherein the company is not entitled to exercise the insured's rights in the choice of arbitrators and in the conduct of such proceedings, or (2) any suit after the applicable limit of the company's liability has been exhausted by payment ofjudgments or settlements. Exclusions This insurance does not apply: (a) to liability assumed by the insured under any incidental contract; (b) (1) if the insured is an architect, engineer or surveyor, to bodily injury or property damage arising out of the rendering of or failure to render professional services by such insured, including (i) the preparation or approval of maps, drawings, opinions, reports, surveys, change orders, designs or specifications, and (ii) supervisory, inspection or engineering services; (2) if the indemnitee of the insured is an architect, engineer or surveyor, to the liability of the indemnitee, his agents or employees, arising out of (i) the preparation or approval of or failure to prepare or approve maps, drawings, opinions, reports, surveys, change orders, designs or specifications, or (ii) the giving of or the failure to give directions or instruc tions by the indemnitee, his agents or employees, provided such giving or failure to give is the primary cause of the bodily injury or property damage; (c) to bodily injury at property damage due to war, whether or not de clared, civil war, insurrection, rebellion or revolution or to any act or condition incident to any of the foregoing; (d) to bodily injury Or property damage for which the indemnitee may be held liable (1) as a person or organization engaged in the business of manu facturing, distributing, selling or serving alcoholic beverages, or (2) if not so engaged, as an owner or lessor of premises used for such purposes, if such liability is imposed (i) by, or because of the violation of, any statute, ordinance or regulation pertaining to the sale, gift, distribution or use of any alcoholic beverage or (ii) by reason of the selling, serving or giving of any alcoholic beverage to a minor or to a person under the influence of alcohol or which causes or contributes to the intoxication of any person; but part (ii) of this exclusion does not apply with respect to lia bility of the indemnitee as an owner or lessen' described in (2) above; (e) to any obligation for which the insured at any carrier as his insurer may be held liable under any workmen's compensation, unem ployment compensation or disability benefits law, or under any similar law; (0 to property damage to (1) property owned or occupied by or rented to the insured, (2) property used by the insured, or (3) property in the care, custody or control of the insured or as to which the insured is for any purpose exercising physical control; (g) to any obligation for which the insured may be held liable in an action on a contract by a third party beneficiary for bodily injury or property damage arising out of a project for a public authority; but this exclusion does not apply to an action by the public authority or any other person or organization engaged in the project; (h) to property damage to premises alienated by the named insured arising out of such premises or any part thereof; (i) to lorn of use of tangible property which has not been physically injured or destroyed resulting from (1) a delay in or lack of performance by or on behalf of the names insured of any contract or agreement, or (2) the failure of the named insured's products or work performed by or on behalf of the named insured to meet the level of per formance, quality, fitness or durability warranted or rep resented by the named insured; ( Continued an PageZj AID 000251 L26C 09 Z 1 (ffX) s i :i C--I-1 omp3 q :\v \-j uoisi.Mp yEiU3UiuJ3Ao3 ? oj XpsQjip uuj3J pint inaji avejvdas * n 133(]03 sjsqio tpns pins panrux pamvu aqi qasq>\ xei ireqi jaqio `S3TCJ sapnprn pue `jxedaj j o 2" S 3s 'uoiiEffBisui j o j pouad Xoqod aqi Suunp paEi^qa pire pouad Aaqod aqi Suunp painquisrp j o p|os sianpojd pire spooS j j ? j o j j u j B siq japun Sinpeji sjaqio Xq j o pjnrux ptuaru aqi Xq pa&nrqa Xauoui jo junouie s s o j S aqi sireaui ,4 s3[t,, pjoaqi . -$ ajnpaqas aqi ui papioA axe suoisnpxa qans ssajun \\|dde {<S) j o {O) suoisnpxa qaiqM. oi suoue-jado Xire jo is o " aqi ppnptn jouqpqs ij 3np j o pt*d *apBUi suoissuumoa j o sasnuoq `saaueMOfps *3j jp 2uipnpui saaqio j o `^twinpqj Xq paqsiujnj jaqwqM `ij j o m qansj o uonnaaxa aqi ui asn j o j pajaAipp j o pasn `paqsruinj juatudinba pu spuajBuj `JoqEj \\v jo isoa aqi sapnptfi j j -'piauui aqi Xq siaejiuoa qans japun pauinsse si XiniqBH Xire jaqiaqM jo sSajpjfeSai *uimuiajd jo sissq aqi si ,,j s o 39% qaiqM oi laadsaj qiiM aairejnsui siqi j o j ajnpaqas aqi in paieuSisap adXj aqi jo siaeuuoa jf? qiiM uouaauuoa ui ipoM ip j o isoa pioi aqi su*aui 14ioatJ pjoM aqi (p zszoooaiv astg mnraajj; ry pft stnjax i notidfossa : sissq inmuiajd e se pstn uaqv\ saijdde aairejnsui sn|l noit^M oi pouad Aaijod aip Saunp oiui pajama sjaejjuoa irauuM jaijio i|e jo Auedtuoa aijj Ajnoa ifeijs pimsut piuau aijx Aueduioa ai|i oi u mo u j j j o qiiM sjg uo aie re sjDBjjaoa uautJM nans jo junooae uo ainnn -jjd paieunio aijj st apipaqoi atjj ur psim uunrmajd aauBApc aijx otinnajj -9mpaaa -ojd uoijEjjiqjB Acre jo janpuoa aqi m ptre sjojBJJiqJB jo aaioqb aqi ui sjqSu sjiimtui aqi jo qs asiajaxa oi papnua aq qsqs Airedoioo aqj, aopBjjtqjv snoprpnoa [wnopippy 'i\ -jaasuoa s,Atredcuoa aqi qjiM pauiuiqns ssq ptmsex aqi qaiqM oi j o irmqns oi pajinbaj si ptjusui aqi qaiq oi Suipaaaojd uonBJiiqjB ire sapnput (litn,, Ijalitrein ajf![treiin(JOM 8 m auop aq ]qM pjjnrei pirnm aqi jo jjBqaq ao j o Aq pauuojjad ij j o m isqi A8 8 B j o nmposif stp>miut pimou aqi jo Aiipnb j o ssauiy aqi jo A8 8 8 japun AitjiqBtt 8atpnptn SB panjisuoo aq io u qsqs Oqifoi; pnirviruo} jBqi `jaAaMoq `papiAOJd fiuamaajSB JO laejiuoa uauUM 8 japan patnnssB Ajssajdxa Aiiqqsq stream ,, Aiqiqaq {Bntauiaoa,, : (Aaqod aqi jq ired 8 Sat -auoj siaauiauopua Sinpnpui) aatrejnsm sup oi aaiiajapjt at pasn aaq^\ noprajaa {Btsotiippy OoiLuii tbtpxf aqi ottptM pouad Aaqod aqi Sounp sjnaao qaiqM iSvutvp (u>4ouj jo (mfui Cfipeq oi A[UO saqddB aatrejnsui siqx Ajoiijjax ipouaj Aaqoj AI vnujj)u auo jo mo Su is u 8 8 pajapisuoa aq qBqs suoptpuoa jBJauaS auiBS aqi Aqepireisqns oi ajnsodxa pamadaj j o snoniipuoa jo mo Su is u 8 Souiop tCjjttfiud ptre OnCut iCftpoq qs `AitqqBif s/UBiiuioa aqi jo ituiq aqi Surinuijaiap jo asodjrid aqi j o j --2 A *3S*J3A0Q pjjnmt p>wmt aqi oi paiuaj j o Aq paUMO sasiutajd u io j j AB8 laafojd qaca oi laadsaj tptM ApjsjBdas saqddB AitqqBq jo ituiq aisSajSSs qang -^areSajSSB,, re suoUBJEfOap aqi ui paiBis AiqiqBif tSviuop (u iiIo m] jo Ituiq aqi paaaxa iou qsqs saqddB aSBjaAoa siqi qotqM oi j Sarnop tCtotfoxf ![B jo asnsaaq saSBtzrep ffE joj Atredtnoa aqi jo AiiqqEq (Bioi aqi \sxuurax qasa,, Sutiaadsaj uoisiAOid aAoqs aqi oi laaCqng \yjujjjfo50 qaBa,, oi ajqBaqddB 8 suopBJBpap aqi in paiBis Aiiqqsq iivutop tCtntfou)jo ituiq aqi paaaxa iou qBqs ijueuiux auo A8 j o ijnsaj aqi 8 s u o u 8 8 Sj o j o suosjad ajotu j o auo Aq paureisns iSoump iC)u<foi4 jo asrreaaq saSEurepjp j o j Aireduioa aqi jo AitqqBq 8 aqx--Z SS \p7uaiaax qaB3,, oi aiquaqddB 8 suopBJBpap aqi ui paiBis AiqiqBq Cmfut fppoq jo itmq aqi paaaxa iou qBqs j j iu j j j u j o auo A8 j o ipsaj e 8 suouad ajoui j o aub Aq paureisns Cmfut Cjtpoq jo asnsaaq `saatAjat jo sso( pus ajBa j o j saSEurep Sut -pnpui `saSBurep |p j o j AuBduioa aqi jo Aiqtqsq 8 aqx--A ?S*j3AOi : SAAoqoj 8 !| ' i- painnq si AitqqBq t,Atredtnoa aqi `tSouap CtatfoMf j o Cmfut C/ipoq jo lunoaas iio iqSnojq timi j o apEUi suirep () j o 'iivutop Cititfotif 'jo Cmfut Cjtpaq utBisns oqM 8 BSj o j o suosjad CZ) `Aaqod siqi japun spimmt ([) jo jbquinu aqi jo ssaquESa-g `Hi -qans re sapnp siq jo adoas aqi utqiiM SutiaE aqq jo -ajaqi japjoqipois j o joiaajip `jaaqjo aApnaaxa Atre pub paisiiSisap os 8 8 Sj o aqi `ajniuaA nnof j o dnpiauiJBd `pnpiAtpin 8 treqi jaqio re suopBJBfaap aqi ui'paiBuSisap si pimrut pituuu aqi jt (a) iipns SB AiiqqEq siq oi laadsaj qiiM Ajao mq joajaqi jaqmaui j o jainJBd A8 ptre paiBuSisap os ajniuaA unof j o diqsjauuBd aqi `ajniuaA iqiof j o diqsjauijsd e 8 suoiiejBpap aqi ut paiBuSisap n p>mtut pnuoti aqi ji (q) fssauisnq e qans jo lanpuoa aqi oi laadsaj qiiM pimsut pimou aqi jo asnods aqi pine `joiaudojd ajos aqi si aq qaiqM jo ssautsnq e jo isnpuoa aijj o> jaadtaj qii S mq pajeuSisap cw uosjad aqi `pjnpiAipui ire 8 suoiiBJBiaap aqj ui paiBuSisap si p>jnnii ptuinu aqj jt ( 8 ) :MOjaq quoj jas }uaixa aqj oj aauBjnsui siqi japan pajnsui ire si Su imo ([o j aqj jo ipe-j pajiisaj tiioJax n -Suissoja j o ssBdtapon `paani `spaq 8 `si(aBJi `apsaJi j o aSpuq peojqBJ Aire SiniaajjB `Auadojd PBOJJIBJ A8 jo taaj Aijq uiqiiM `suopsjado jo mo Su is u 8 eSamop fiotfoij j o iCmfut tppoq oi (d) Ijoajaqi 8uipBopm j o StnpBoj j o Bj o j B j o iiBdaj j o aatreu -aiutBoi `aopacuisaoa jo jno Su is u 8 itowvp n'lutfoid j o iatfm Kppoq oi (o) lAjdds iou saop aairejnsui stqx suonBJado uonaiuisaoa oi ScmEpj luatnaaoSB A8 japun pimi -ui aqi Aq pauinsss kitftqptj pmmttuoi oi A|dde 8 sooisnpxa SutMoqoj aqi `aiqBaqddB ion 8 aairejnsui snji j o j appaqas aqi ui paiBis isajuQ loiajaqi apBaqddB B [ j o uoiiBjnSaj `ajru pjuauiujaAoS A8 qiiM aaireqdmoa-uou j o j o BS u i uoptpuoa A8 Aq oi painquiuoa n j o u j o j j sipsaj (n) j o u `atqBt[ ti ptjnnit Aire suoissnno j o stas asoqM j o j uotiBznreSjo j o uouad Aire j o ptjnsut A8 j o itnodptreit aqi inog papuaiur j o paiaadxa n (;) jaqipu qaiqM adsao j o assapi `aSudaas `aSjBqasqi `uonstma A8 j o ino Su is u 8 uoiso{dxa j o ajij u io j j Supinsaj tSvuap iiojoitf oi AfddB loti saop (I) (a) uoitnpxa snp inq `8 m j o Apoq A8 oiin saAUBAijap umajojiad j o mnajojiad jo adsaca j o assapj `aSs dabs `aSjBqacip `uoisstuia A8 jo ino Su is u 8 iSmuap fiafaui oj (Z) .`jaiBM jo Apoq A8 oiut saAUBAijap umajojiad j o uinapjiad jo adeasa j o aseapj 'aSBdaas `aSreqasip `uotstnsa Acre jo mo Sdnuc iiouap Cu><fot4 oi A(dds iou saop ([) (u) uoisnpxa snp mq !oiajaqi aiqBaqddB 8 [ j o uopB{nSaj `ajru peiuaunuaAoS A8 qiiM aatreqduioa-uou j o j o uopsiotA m uoptpuoa A8 Aq o i pamqiJiaoa j o u io j j Stniinsaj (n) j o `a|qBq si pimsut Awe suoissnUo j o sias asoqM j o j 8 8 Sj o j o uo&iad A8 j o pimsut A8 jo imodptren aqi u io j j papuaiur j o paiaadxa jaqip si adBasa j o assapj `aSedaas `aSjEqastp `uoisstuia qans j i (t) nreinqod j o aiSBM puuaqi jo snoassS `pqos `pmbq A8 j o adBasa j o aseapj `aSedaas `aSjeqasip `uoisstuia A8 j o mo Su is t j 8 iivuap Ctutfostf Jo Cmfut Cppoq oi (i) (u) ; AS 38 j o isaiuoa qans Atre j o j uopejedaid j o aapaBJd ui j o AiiApaB Supunis A8 ut j o isaiuoa Uopqomap j o paads `Supu pazitreSjo j o pa8trejjBajd Aire ui pasn 8inaq aqqM luamdinba aqqbm Aire jo StnpBOjun j o 8utpB0[ `asn `uotiEjado `aaueuaiuretu `diqsjauMO aqi jo ino Su is 8 iivuap Ctixfaui j o Cmfut Cppoq ot (ui) ! inajaqi Aauaptpp j o laajap paiaadsns j o u mo u i| A8 j o asnsaaq asn tnojj j o laijrem aqi uiojj UMBjpqiiM 8 Auadoid j o ij j o m `sianpojd qans ji `ired B uupj qjOM j o ' sianpojd qans qaiqM jo Auadojd Aire jo j o pimsut piuaii aqi j o j j o Aq paia|dmoa ij j o m j o stmpostf tjimsut piutou aqi jo asn jo ssoj j o `iuauiaaE|d -aj `jtBdaj `uopaadsm `fBMBjpqiiM aqi j o j pamrep saSsuiEp oi (|) .`qiiMajaqi uopaauuoa ui paqsitunj luamdinba j o sired `sjBuainm jo mo j o `joajaqi uoiuod Atre j o ij j o m aqi jo mo Su is u 8 pimsut piutou aqi jo jpnpq no JO Aq pauuojjad ij j o m oi iivuap Cttufosi oi (ij) ! sianpojd qans jo ired A8 j o sianpojd qans jo ino Su is u 8 smpttttf sjptmsut piutou aqi oi iivuap Citiifouf oi (f) !pimsut 8 treqi jaqio 8 8 Sj o j o uosiad A8 Aq asn oi md uaaq aABq ij j o m j o sianpojd qans jams pimsut piutou aqi jo jpqaq uo j o Aq pauuojjad ij j o m j o sisnpotrf sjamsut piutou aqi jo uopatuisap j o o i Ajnrui paisAqd peiuapiaaB pus uappns aqi moJj Suiqnsaj Auadojd aiqtSuBi jaqio jo asn jo sso[ oi AjddB iou saop uoisnpxa snp inq 5*J Protection Against UNINSURED MOTORISTS INSURANCE COVERAGE PART Page 3 TR"HSL~12.3T69j"3"?5 F. Arbitration. If any person making claim hereunder and the company do not agree that such person is legally entitled to recover damages from the owner or operator of an uninsured highway vehicle because of bodily injury to the insured, or do not agree as to the amount of payment which may be owing under this insurance, then, upon written demand of cither, the matter or matters upon which such person and the company do not agree shall be settled by arbitration, which shall be conducted in accordance with the rules of the American Arbitration .Association unless other means of conducting the arbitration are agreed to between the insured and the company,, and judgment upon the award rendered by the arbitrators may be entered in any court having jurisdiction thereof. Such person and the company each agree to consider itself bound and to be bound by any award made by the arbitrators pursuant to this insurance. ; j [ , j G. Trust Agreement. In the event of payment to any person under this insurance: (a) the company shall be entitled to the extent of such payment to the proceeds of any settlement or judg ment that may result from the exercise of any rights of recovery of such person against any person or organi zation legally responsible for the bodily injury because of which such payment is made; (b) such person shall hold in trust for the benefit of the company all rights of recovery which he shall have against such other person or organization because of the damages which are the subject of claim made under this insurance; p (c) such person shall do whatever is proper to secure and shall do nothing after loss to prejudice such rights; (d) if requested in writing by the company, such person shall take, through any representative designated bv the company; such action as mav be necessarv or appropriate to recover such payment as damages from such other person or organization, such action to be taken in the name of such person; in the event of a recovery, the company shall be reimbursed out of such recovery for expenses: costs and attorneys' fees incurred by it in connection therewith; (e) such person shall execute and deliver to the company such instruments and papers as may be appropriate to secure the rights and obligations of:such person and the company established by this provision. . Payment of Lorn by the Company. Any amount due hertunder is payable (a) to the insured, or (b) if the insured be a minor to his parent or guardian, or (c) if the insured be deceased to his surviving spouse, other wise (d) to a person authorized by law to receive such payment or to a person legally entitled to recover the damages which the payment represents; provided; the company may at its option pay any amount due hereunder in accordance with division (d) hereof. State Exception--Texas As respects coverage applicable to an insured highway vehicle principally garaged in Texas, it is agreed that the insurance afforded hereunder with respect to accidents occurring either in Texas or while the insured is occupying an insured highway vehicle registered in Texas shall be amended as follows: 1. The first paragraph of 1. Coverage D--Uninsured Motorists (Damage for Bodily Injury) is replaced by the following: The company will pay ail sums which the insured or his legal representative shall be legally entitled to recover as damages from the owner or operator of an uninsured highway vehicle because of bodily injury sustained by the insured, caused by accident and arising out of the ownership, maintenance or use of such uninsured highway vehicle; provided, for the purposes of this coverage, determination as to whether the insured or such representative is legally entitled to recover such damages, and if so, the amount thereof, may be made by agreement between the insured or such representative and the company or, if they fail to agree, by arbitration in accordance with the arbitration provision of this policy, or by judicial determination. 2. Additional Condition F is replaced by the following: If any person making claim hereunder and the company do not agree that such person is legally entitled to recover damages from the owner or operator of an uninsured highway vehicle because of bodily injury to the insured, or do not agree as to the amount of payment which may be owing under this insurance, then, upon written demand of either, the matter or matters upon which such person and the company do not agree may, by agreement, be settled by arbitration, which shall be conducted in accordance with the rules of the American Arbitration Association unless other means of conducting the arbitration are agreed to between the insured and the company, and judgment upon the award rendered by the arbitrators may be entered in any court having jurisdiction thereof. Such person and the company each agree to consider itself bound and to be bound by any award made by the arbitrators pursuant to this insurance. AID 000253 T CR  AMENDATORY ENDORSEMENT-- B YORK Effective from Issued to. At 12:01 A.M. Standard Time Amending Policv numbered. The additional premium for this endorsement is $------------------ (The information provided for above is required to be stated only when this endorsement is issued for attachment to the policy subsequent co its effective date.) 1. NEW YORK AUTOMOBILE ACCIDENT INDEMNIFICATION ENDORSEMENT The company, agrees with the named insured, in consideration of the payment of the premium for this endorsement and subject to all terms of this endorsement: INSURING AGREEMENTS I. Damages for Bodily Injury Caused by Uninsured Automobiles The company will pay all sums which the insured or his legal representative shall be legally entitled to recover as damages from the owner or operator of an uninsured automobile because of bodily injury, sickness or disease, including death resulting there from. hereinafter called "bodily injury", sustained by the insured, caused by accident arising out of the ownership, maintenance or use of such uninsured automobile: provided, for the purposes of this endorsement, determination as to whether the insured or such representative is legally entitled to recover such damages; and if so the amount thereof, shall be made by agreement between the insured or such representative and the company or, if they fail to agree, by arbitration. n. Definitions (a) "t Insured. The:unqualified word "insured" means: (1) the named insured and, while residents of the same household, his spouse and the relatives of either; (2) any other person while occupying (i) an automobile owned by the named insured or, if the named insured is an individual, such spouse and used by or with the permission of either, or (li) any other automobile while being operated by the named insured or such spouse, except a person occupying an automobile not registered in the State of New York, while used as a public or livery conveyance, and (3) any person, with respect to damages he is entitled to recover because of bodily injury to which this endorsement applies sustained, by an insured under (1) or (2) above. (b) Uninsured'Automobile. The term "uninsured automobile" means: (1) an automobile with respect to the ownership, maintenance or use of which there is, in the amounts specified in the New York Motor Vehicle Financial Security Act, neither (i) cash or securities on deposit with the New York Commissioner-of Motor Vehicles nor (ii) a bodily injury liability bond or insurance policy applicable at the time of the accident with respect to any person or organization legally responsible for the use of such automobile, or with respect to which there is it bodily injury liability bond or insurance policy applicable at the time of the accident but the com pany writing the same disclaims liability or denies coverage thereunder, or (2) a hit-and-run automobile as defined; but the term "uninsured automobile" shall not include: (i) an autompbiIe;|oyined by the named insured or spouse; (ii) an automobile; which is owned or operated by a self-insurer within the meaning of any motor vehicle financial re sponsibility law, 'motor carrier law, or any similar law; (iii) an automobilejwnich is owned by the United States of America, Canada, a state, a political sub-division of any such government oY[ an agency of any of the foregoing; Civ) a land motor vehicle or trailer, if operated on rails or crawler-treads or while located for use as a residence or premises and not as a vehicle; or (v) a farm type tractor or equipment designed for use principally off public roads, except while actually upon public roads. | (c) Hit-and-Run Automobile. The term "hit-and-run automobile" means an automobile which causes bodily injury to an insured arising jout of physical contact of such automobile with the insured or with an automobile which the insured is occupying at|the time of the accident, provided; (1) there cannot be ascertained the identity of either the operator or the owner of such `{hit-and-run automobile"; (2) the insured or someone on his behalf shall have reported the accident within 24 hours orjas soon.as reasonably possible to a police, peace or judicial officer or to the Commissioner of Motor Vehicles, mid .shall> have (filed jvith the company within 90 days thereafter a statement under oath that the insured or his legal represeiitativeiihajsja cause,or1 causes of action arising out of such accident for damages against a person or persons whose identity is ,unascertainable. and setting forth the facts in support thereof; and (3) at the request of the company, the insured or his legal representative makes available for inspection the automobile which the insured was occupying at the time of the accidelnt., i .......... . in i 'i , i, ' (d) Occupying. The word "occupying" means in or upon or entering into or alighting from. (e) State.1 The word "state" includes the District of Columbia, a territory or possession of the United States, and a province of Canada. 1 m. Territory This endorsement applies:only to accidents which occur within the State of New York. (Continued on page 2) AID 000254 for Company Um Only 0ATE OF EXPIRATION MODE OF ADJUSTMENT LOCATION OF RISK OFFICE AND NAME OF AGENT C-10910 7-65 PAiNTco in u.s.A. N.8. 4193C ocett sszooo aiv (Z slot# ua pmutjaoj) -sSuipaaoojd jegaj S B ;o lonpuoo aqi ui puE sassauitM jo aouepuane aqi Suiuieiqo `aouaptAa 8S 3 pue Suunoas ui isisse pue sjeij} pue s8uueaq puane peqs `Xueduioo aqi jo isanbaj uodn `puE uoisiAojd siqi ,\q paq'sijqeisa Xueduioo aqi puE uosiad 'qons jo suoiiESijqo puE siqiiii aqi amoas 01 aieudojdde aq Xeui sesjaded pus sjuauinJisui qons Xueduioo aqi oi jaAijap pus amoaxa peqs uosjad qons (a> iqijAvajaqi uoiioauuoo ui n Xq paunoui saaj sXaujoiie pue sisoo`sasuadxa j o j XjaAOoaj qons jo ino pasjnqunaj aq jjeqs XuEduioa aqi `XjaAOoaj B j o juaAO aqi ui : uosjad qons jo auieti aqi ui uaijei aq oi u o u o 8 qons `u o iBB Sj o j o uosjad jaqio qons u j o j j saBeuiep B mauiXed qons jaXooaj oi aieudojdde j o Ajessaoau aq S B B uouoe qons Xiieduioo aqi Aq paieu2;sap aAiieiuasajdaJ Xue qSnojqi `ajjei peqs uosjad qons `Xueduioo aqi Xq gmiij.vi u; paisanbaj j i ip; :siqSu qons aoipntajd 01 ssoj jaijs Suiqiou op peqs pue ajnoas 01 Jadojd si jaAaieq.u op peqs uosjad qons (X>) :Xmtui Xppoq qons jo asneoaq u o iiBB Sj o j o uosjad jaqio qons B SB aAEq peqs aq qoiq.M XjaAoaaj j o siqSu |]E Xueduiooaqi jo lijauaq aqi j o j isnji ui pjoq |jeqs uosjad qons (q) lapeui si juauiXed qons qoiq.si jo asneoaq Xjntui Xppoq aqi j o j ajqisuodsaJ XpeSaj u o u pB 3j o j o uosjad X1B B 2B uosjad qons jo XjaAoaaj jo siqSu X1B jo asojaxa'aqi u j o j j l|nsaj XB jeqi luauiipnt j o luauiajuas XB jo spaaoojd aqi oi luauiXed qons jo juaixa aqi oi pa(iiiua aq peqs Xueduioo aqi (c) iiuauiasjopua siqi japun uosjad X1B oi luauiXEd jo iuaA3 aqi uj *iuauxaai3y ismx -luauiasjopua siqi oi lusnsjnd sjoiejitqje aqi Xq apsui pje*e XB Xq punoq aq oi pus punoq jjasu japjsuoo oi aai3e qoea XuEduioa aqi pue uosjad qon joajaqi uon oipsijnf 2uiAEq uno^ XB u i pajaiua aq XBi sjoiejiiqjy aHl Xq pajapuaj pjE*s aqi uodn luauiapnC pue -uojieioossy uoueJliqjy ueotiauiy aqi josajnj aqi qip& aouepjoooe ut uoiiejijqje Xq pajuas aq peqs aaj2e io u op Xueduioo aqj pue uosjad qons qoiqM uodn sjaiiEui j o jaiiEui aqi `Jaqiia jo puEuiap uaiiijA uodn `uaqi `luauiasjopua siqi Japun 8ui.o aq XB qoiq luauiXed jo lunouie aqi oi 9B aajSs iou op jp `pajnsui aqi oi XjnCui Xjipoq jo asnuoaq a|iqouioinE pamsuiun B j o joiEjado j o jau.wo aqi u io j j saSEuiEp jaAOoaj oi pajiiiua X||B3a[ s i uosjad qons lEqi aajSs iou op XuEduioo aqi puE japuiiajaq Bj o auiqBui' uosjad X1B j j -nopEUiqJV aouBlnsui jaqio qons puE aouEjnsui siqi jo XiqiqEij jo siiuiq ajqEoqddE aqi jo uins aqi oi sjEaq japunajaq XiqiqEii jo iiuiq aqi usqi saqddE a8EJ3A03 siqi qoiqui oi ssoj XB j o uoiuodojd jaiEajg B j o j a|qEi[ aq iou ||Bqs XuEduioa aqi puE `aauEjnsui jaqio qons pup aouEjnsui siqi jo XiqiqEq jo s iiu iij ajqEoqddE aqi |o jaqSiq aqi paaoxa oi iou pauiaap aq ||Eqs saSEUiEp aqi 'luapioos aqi oi ajqEoqddE puE uiiq oi a(qE]iEAE aouEjnsui Bj iu -is ^aqio suq pajnsui aqi ji `qdsjSEjEd 3uio2ajoj aqi ui papmojd se idabx3 -aouejnsui Jaqio qons jo \iqiqei| jo nuiq ajqEoqddE aqi spaaoxa aSejaAOo siqi j o j XiiijqEii jo iiiuq aqi qoiqjE Xq lunocue aqi ui X|uo \[dde naqi [[uqs aouejnsui siqi pue `aouejnsui ijeiuud se ajiqoiuoine qons oi a|qeoi|ddE pue pajnsui qons oi aiqejtEAE aouejnsui jejimis jaqio \ue ja\o aouejnsui ssaoxa se \juo Xgdde [jeqs aouejnsui siqi `pajnsui paiueu aqi Xq pauAio iou apqoiuoine ueSuiXdnooo a|iq pajnsui ue oi \jntui \ppoq oi loadsaj qn.\\ -aouEjnsui jaqio '8 'l '9 siqauaq Xiqiqesip [euouednooo-uou jo asisnjoxa `uq uoiiEsuaduioo s,uaui -qjOM Xue japun Xjnfut Xppoq qons jo junoooe uo aiqeAed siunouie (|E j o an|e\ luasajd aqi pue pied lunoiue aqi (f) pue iuaui -asjopua siqi Xq papiXoid ieqi oi jejiuiis iqauaq Xjoineis j o aouejnsui \ue japun luapiooe auies aqi ui pauieisns Xjntui Xppoq JO lunoooe u'o spainsui ajoui j o auo oi pied sums ||E (z ) ` unlui xppoq qons j o j joiejado j o jauMO qons quit jaqiaSoi a[qeij XqejaAas j o Xj iu io C suosjad j o uosjad jaqio Xue (q) pue a|iqouioine pamsuiun aqi jo joiejado j o jausio aqi re) jo jjeqaq uo j o Xq .Ontni Xppoq qons jo lunoooe uo spajnsui ajoui j o auo oi pied sums j|e 11) Xq paonpaj aq qeqs `uosjad auo Xq pauieisns Xjntui X|tpoq jo'asneoaq `saoiAjas jo ssoj j o ajeo joj ajqeXed siunouie 3utpnpui `luauiasjopua siqi jo suuai aqi japun a|qeXed lunouic Xuy (q) 000`0?t juapme auo \u p j o ijnsaj aqi se `*ej uoilEJOdJQ3 uoiieo -qiuuiapuj luapiooy apiqay\ joiojq qjo^ Map] aqi japun suosjad paqqenb j o spajnsui jaqiaqm `suosjad ajoui j o 6i Xq pauieisns Xjhfui Xppoq jo'asneoaq `saoiAjas jo ssoj j o ajeo j o j saSeuiep Suipnpui `saSetuep pe j o j -ueduioo aqi jo Xiqiqeij jo iiuiq jeioi aqi `uoisiAojd 3AOqe aqi oi loaCqns `pue OOO'OHs! luapiooe auo vue jo i|nsaj aqi se uosjad auo Xq pauieisns Ximui Xppoq jo asneoaq `saoi.uas jo sso| j o ajeo j o j sa8eiuep 2uipnpui IsaSeuiep pe j o j sueduioo aqi jo Mipqeq jo nuiq aqx (e) Xipiqei'x jo sinm'i aAiieiuasaidaj jeSaj siq j o pajnsui aqi \q A'nxiiuoo aqi oi Apieipauiuii papje.njoj aq peqs uopoe {ESaj qons qii.w uonoauuoo ui paAjas ssaoojd jaqio j o luiejduioo pue suouiums aqi jo \doo e 'luapiooe aqi ui paA|OAUi apqouioine ue jo asn aqi j o j ajqisuodsaj XpeSaj B B Sj o j o uosjad !xue is u 8 SB unfui xppoq j o j uouoe [e8a[ Xue aimiisui peqs aAiieiuasajdaj jeSaj siq jo pajnsui aqi `japunajsq ssoj jo luauixed saqeui xueduioo aqi ajojaq `j j nopoyipSwi jo aoijojj i> spjooaj jo saidoo pue suodai jeoipauj uieiqo oi Xueduioo aqi ajqeua oi uofiezijoqine ainoaxa Xueduioo aqi u io j j isanbaj qoea uodn pqs `jojajaqi ans oi papiiua suosjad j o uosjad aqi j o aAiieiuas -ajdai jeSaj stq qieap siq jo iuaA3 aqi ur jo `aAjieiuasajdaj [ESaj siq Xuoedeoui siq jo iuaA3 aqi ui j o `aq pue ajinbaj XjqEuosBaj XB Xueduioo aqi se pue uaq*x Xueduioo aqi Xq paioaps sueioisxqd xq suoneuiuiexa jeoisxqd oi uuiqns jpqs uosjad pajntui aqx `uuep jo aonou Smuaoaj jaije sXep j uiqiiw stujoj qons qsiuiinjeoi papej aAEq peqs XuEduioo aqi ssapn Xueduioo aqi Xq paqsiujnj s u ij o j uodn apeui aq peqs unep jo j o o j j auies aqi aqijosqns pue Xueduioo aqi Xq pauieu uosjad Xue Xq qieo japun suoueuiuiexa oi uuiqns pajinbaj aq A|qeuoseaj S B@" #B peqs japunajaq $%%B&o Sunjeui uosjad jaqio XjaAa pue pajnsui aqx japunajaq ajqEAed lunouie aqi jo uoiieuiuuaiap aqi oiui iujjaiua speiap jaqio pue `luauneaji `saimfui aqi jo luaixa piie ajnieu aqi jo sjejnoiiJEd pnj Suipnjoui `paunbaj p qieo japun ''((B)0 jo joojd uauiJA Xueduioo aqi oi 3S 28 jjeqs '((B)0 Supjeui uosjad jaqio jo pajnsui aqi' xueduioo aqi Aq isanbaj uanuxx jaije ajqeoiioejd se uoos sy `luauiasjopua siqi japun iuie|0 jo ao'iou uaiiu.ni XuFdiuuo aqi oi 9S 23 peqs u iiB34 3upjeui uosjad jaqio j o jjamsui aqi`ajqeoiioEjd 5B uoos se j i sxrp (y, uiqu\\ suodaji jrapafq unejj jo j o o j x pue aopojj jiajnsut qons Xq pied uoiuod paujeaun aqi pajnsui pauieu aqi oi umiaj peqs Xueduioo aqi `ssaj j i ` Xueduioo aqi oi ssaoxa aqi Xed peqs pamsui patueu aqi `pied uiniuiaid aouEApe aqi spaaoxa painduioo snqi uiniuiaid paujea aqi j j xueduioo aqi Xq asn ui s|enueui aqi qnxx aouejuoooe ui aSueqo qons jo aiep aqi jo se joaisnfpe aq peqs uiniuiajd aqi pue aSueqo xue jo pouad Aoqod aqi Suunp xueduioo aqi Xjtiou peqs pamsui pauieu aqi `saSueqo pamsui pauieu aqi oi panssi saiejd jaijodsuen j o saiejd asuaoq s jajcap qjo ^ xvajq jo jaquinu aqi j o ij j o x .najq ui pajaisiSaj pue asnods j o pajnsui |uieu aqi Xq pausio sajiqouioine jo jaquinu aqi pouad xoqod aqi Suunp )j `umimajd -s 'V `f 'Z ..suoiiejejoaQ,, pue ..luapiooy jo aoiio^j,, j o ..aoiio^j,, suotiipuo^ aqi idaoxa luauiasjopua.siqi Xq papJOJB aouejnsui aqi oi Xjdde peqs Xoijod aqi jo suoiiipuo^ io suoisnjoxg `siuauiaaiSy Sutmsuj aqi jo auoxj ntoisuojj Xopoj [ SJIOIXiaHOD 6B ] 7B78A8BC XB j o D8 E siqauaq XiijiqEsip j o uoiiEsuaduioo s.uaunjjo* X1B japun jajnsui-jjas e se 2uiXp|Enb FFGFFBHFIB Sj o j o uosjad Xue j o jaijjeo sigauaq Xiijiqesip jo uoiiEsuaduioo s uaunjjo/A Xue jo iqauaq aqi oi XjioajjpU! j o Xjioajjp ajnui oi se os (o) : jopjaqi ajqeij XpeHaj aq Xeui oqM uo|ie2iue8jo j o uosjad Xue isuie2e uoiioe Xue iuaui2pnf oi ainoasojd j o qiiM luauiajiias Xue aqeui `Xued -uioo aqi ;o luasuoo uanuM inoqiiM `peqs luauiasjopua siqi japun luauixed oi pajiuua uosjad Xue j o saAiieiuasajdaj jE8aj siq 'pajnsui qons qoiq.xx oi loadsaj qijM `pajnsui ue Xq ajqejaAoaaj saoiAjas jo ssoj j o ajeo j o `fiajnsui ue oi XjnCui Xppoq oi (q) : pauieisns os Xmfui Xjtpoq qons ;o asneoaq pamsui ue Xq aiqejaAooaj saoiAjas jo ssoj jo ajeo oi jo :u o iiBPPS 3J j o uoisuadsns jo japjo ue jo uoiiejoiA ui apqouioine ue Sunejado ajiq.xi jjajnsui ue oi Xjntui Xjipoq oi (e) :X|dde iou saop luauiasjopua siqx SHOisnioxa jaSej 9. Payment of Loss by Company., ,.^ny amount^due-he^eundetystpavable .,u to the injured, or b n the soured be a :v -'nr :. h parent or guardian, or *c.` if the insured beJdecea*ed to his surviving spou>e. otherwise id* to a per>ou authorizes ov law t,i receive such payment or to a person legally entitled to recover the damages which the pj\ ment represent"; provided, the com pany: may at its option pay auy amount due hereunder m accordance with sub-division id; hereof. 10. Action Against Company. No action shall lie against the company unless, as a condition precedent therein. the injured or h<legal representative has fully complied with all the terms of this endorsement. 11. Changes. This; endorsement embodies all agreements existing between the insured and the company relating to rhi* insurance. Notice to or knowledge possessed by the company, any agent or any other person shall not effect a waiver or a change m thiendorsement or estop the company from asserting any right under the terms of this endorsement. 12. Assignment. Assignment of interest under this endorsement shall not bind the company until its consent is endorsed hereon; if, however, the named insured or his spouse if a resident of the same household, shall die. this endorsement shall cover l ? the survivor as named insured. i2j hss legal representative as named insured but only while acting w ithin the -cope nl his duties as such, and (3; any relative who was an insured at the time of such death. 13. Policy Period^-Termination. This endorsement applies only to accidents which occur on and after the effective date hereof and during the policy period and shall terminate upon (1) termination of the policy of which it forms a part or 121 termination of New York registration on all automobiles owned by the named insured or spouse. 2. LIMITATION OF FAMILY PROTECTION COVERAGE--NEW YORK It is agreed that such insurance as is afforded by the policy or by any endorsement used therewith, other than the New York Auto mobile Accident Indemnification Coverage, with respect to damages which the insured shall become legally entitled to recover from the owner or operator of an uninsured automobile, does not apply to any accident occurring within the State of New York. 3. AMENDMENT OF CANCELLATION CONDITION--NEW YORK It is agreed that in the second; sentence of the Cancellation Condition, the word "ten" is replaced by "twenty" and the following is added thereto: " '`provided in the event of non-payment of premium, such notice shall state when not less than ten days thereafter such cancellation shall be effective". THE CHARTER OAK FIRE INSURANCE COMPANY THE TRAVELERS INDEMNITY COMPANY C-10910 7-65 PRINTED IN U.S.A. N.S. 4193C AID 000256 HOSPITAL PROFESSIONAL LIABILITY INSURANCE COVERAGE PART ADDITIONAL PECULATIONSTerming part e* fellcy N. TR-NSL-123T693-3-75 CwiNII Limit* DcUllty Tu#*l Atfvmn fnMtivm O. Hospital Professional Liability $ 1 P000 9000 $ 1 gOOO jOOO each claim $ INCLUDED IN COMPOSITE aggregate General liability Hninrdx Deter!pHen ef Hexerdt (Slate Nenini whether ep trend nct-ter-preth; Kind et ceies cved fen Scheel et Medicine In charge) Cede Ne. Premium Bam A-Beds B-Out-Patients Visits Rtwi A-Each B-Per 100 Out- Patients Visits Arfvun Premium* Minimum Premium Per Location per Annum $ (Continued on Page 2) AID 000257 122 t&s> There is a gap between and ooozSS AMENDING POLICY NO.TR-NSL-123T693-3-75 TlwijH|lQnjpsflt modifies such insurance as is afforded by the provisions of the policy relating to the following: '-Hr* COMPREHENSIVE AUTOMOBILE LIABILITY INSURANCE - BASIC AUTOMOBILE LIABILITY INSURANCE AUTOMOBILE MEDICAL PAYMENTS INSURANCE HIRED AUTOMOBILE LIMITATION SCHEDULE CA 09 10 (Ed. 1 74) 1. Description tf Automobile:. ALL AUTOMOBILES OWNED BY: 2. All automobiles owned by _ CONSOLIDATED LEASING CORP, 507 S FLOWER ST 3. All hired automobiles for which the "purposes of use" are stated in the policy as. LOS ANGELES CA 90017 It is agreed that, with respect to hired automobiles for which the premium basis is "cost of hire", (a) the insurance does not apply with respect to any such automobile which is described or designated in the Schedule of this endorsement, unless otherwise indicated by issuance of the "Hired Automobiles--Specified Car Basis" endorsement to form a part of the policy: and (b) the cost of hire of any such described or designated automobile is inapplicable with respect thereto. This endorsement must be attached to the Change Endorsement when issued after the policy is written. CA 09 10 (Ed. 1-74) t : S 3" 000259 '? ' . AMTOIHS POLICY HO. Tfti'WSL'"!23T693->3-7 L-JS TMffi8^ament modifies such insurance as is afforded by the provisions of the policy relating to the following: COMPREHENSIVE AUTOMOBILE LIABILITY INSURANCE r " AUTOMOBILE MEDICAL PAYMENTS INSURANCE Description of Automobile HIRED AUTOMOBILES--SPECIFIED CAR BASIS ALL HIRED AUTOMOBILES CA 09 11 (El l-74> It is agreed that the insurance with respect to the hired automihie described herein or designated in the policy as subject te this i subject to the following additional provisions: 1. The insurance applies to the named insured, as rentes of such automobile, in the same manner as if he were the owner thereof; and, whew; in reference to the insurance afforded by this endorsement, "named insured" includes an iadMduat earned inaraA - - ' 2. Subject otherwise to the "Persons Insured" provision, the insurance'covers as an inured the owner, any fossae (of wham the m is a sub-lessee) and any agent or employee of such owner or lessee, but only while such ntimabii is being used in the business i insured, or by or on behalf of the named insured for personal or pleasure purposes, and subdivision (ii) of the sentence banning "i following is an insurad:,' in such provision is amended accordingly. 3. The insurance applies as primary insurance. This endorsement must be attached to the Change Endorsement when issued after the policy is written CA 09 12 (Ed. 1-74) . r-jpr rrma >tBfg hrifed AID 000260 m AMENDING POLICY N0.TR-HSL-i23T693-3~7? UNINSURED MOTORISTS INSURANCE', QZ (fieorgia) CPW 67 (Ed. 8-70 *- -t ti* - l * 1|*t * In consideration-of the pejniwnt of premium md subject to all of the pre visions of this endorsement and to the applicable provisions of the policy, the company agrees with the named insured as follows.' Schedule Oesignated I Limits of UabilitF Bodily Injury stMSSL each person *2QiBXL each accident ( Property Damage $J5l i2QQ- each accident . Advance Premium $INCL IN COMPOSITE Description of Insured Highway Vehicle,. ,, Any highway vehict* registered er principally garaged in Georgia which is (check appropriate-twr) S3 An owned automobile under Part I of the policy G A private passenger automobile owned by the named insured * ' G Owned by the Ramnd insure! ` G * ! *w Designated in the declarations of the-policy end any highway d of the same type ownership of which is acquired during till policy period by the named insurtd as a replacement therefqjv -a AaymoMe equipment owned by the natped insured,* . -. B I. COVERAGE UNINSURED MOTORISTS* -v t i .7 (Demegee fw Bndly Injury end Property Damage Caused by Unto- Sm VN|mnf IVIRCmI/ ' The company will pay all sums which the insured er his legal fepresenhk tive shall be legally entitled to recover as damages from the owset or operator of an uninsured highway vehicle because of bodily injury or prqp< erty damage, caused by accident and arising out of the ownership, miiate>. nance or use of such uninsured highway vehicle. No default judgment against any knew* person or orgamztfiea alleged tr be legally responsible, for the bodily injury or property damage-shell beconclusive, as between the insured, end the company, as to the eefibltshtmerit of legal liability or of. the amount of damages towhich the-iqsured legally entitled. ' . Exchraiovw .. . This insurance does not apply; (a) to bodily injury or property dimage with respect to which the, insured, bis legal representativCbf any parson entitled to pay-, ment under this insurance shad,' without written consent of the . company, make any settlement ritiLMf person or organization who may be leefl/JjaW* ttiarnforr^TL,' (b) to bodily injury to aw insured: whit* accupying ihtgkweyveiiici* (other than apinaund> highway vehicle) owned: try the named insured, any desigMtad meured or any relative resident in the same household a the namedor designated insured;^, (c). so as to inure, directly or indirectly.to the benefit of any wockr ' men's compensation or disability benefits carrier or any persop ' or organization qualifying as.a self-insurer under any workmen's. compensation or disability benefits law or any similar law^ . . (d) to the first $250 of the amount of property damage to tpe prop-, erty of each insured as the result pf any one accident (el so as to inure djrectfy or indirectly to the benefit ofarty insurer, of property:. , . . , "; - (1) to property daniagi for which the insured has been compensated! by other property or physical damage insurenarv . IL PERSONS INSURED Each of the following is an insured under this insurance to the extent set forth below; (a) the named insured and any designated insured and, white resi dents of the same household, the spouse and relatives of either; (b) any other person while occupying an insured highway vehicle * * \ -. (c) any person, with respect to damages he is entitled to recover .because of bodily injury, to which this insurance applies, sus- 5 fained by an insured under (a) or (b) above. The insurance applies separately with respect to each insuad. ixceptwrttr respe^tto the limib otthe company's liability. . .. Ilkf LIMT9 0P LIRBURY* Regardless of t& number of (1) persons or organizations who tra insured* under $il'Insurance, (2) person or orgamzation who sustain bodily injur? of property' damage, (3) claims made er suits brought on account of bodily Injury or property damage, or (Q,bigfoQjmhida^tQ,]riNcft tin insurant* applies, (aj,.tfii lir^jf.be^mj4ry W^y'rtat*d.ir( tlmssbeAnasa^ ' pliable to "each person' is. the. limit of the compaatfa liibitpv' - for all damages because of bodily injury sustained by an | as the result tit*u).oneteccideiriraat; subjectitwh , visjqa respaciingj'eacli peof", the. limit* luqb the Sihedulf as*#'aNe to'each icodenT ktr ' of the compter! lability m ell deeagn becauggij jury sustaiaed by two or men perms as the i `v*, ' accidtnW* a ' - = "`' (hi The. limit qf'arcwrty iladflga'liah ,, ,, the total liitirTof the company's liebiiRy far til r of property damage to all property of one or men insureds as the result of any enraeeideiit ' -) - Vl* (c) (f dim is i mi under this insurance end daim is al against any person or organization when an insufed*Unddt tile bodily injury liability or property damage lability overage of the policy beause of bodily injury or property damage sustained in an accidant by a person wbo is an insured under this insurance (1) any payment made under thie insurancefeer for any such person shall be applied in rtducliaa of aoy.ameunt wtrich- he may ba entitled to recover from aRy person or organism tion who is an insured under, the bodily injury liability or property damage liability: coverage; and (2) any payment made under the bodily injury lability or prop erty damage liability coverage to or for luif such1 gWRli slaR be applied in reduction* any aihaunt'vrMjh HemuBPbe entrttedto recover under Wis insurancm-''TM (d) Any amount payable to an insured under the terms ottljia I8 4u k ana shall be reduced by (1) all sums paid to such insureafbr bodily injury or property damage by or on behalf of the pdfifM or organization legally liable therefor and (2) the amountyaf# and the present value of all amounts payable to each an-imuz# under any workmen's compensation law, exclusive, of non-occupetienii disability benefits: - IV. POUCT PERIOD; TERMTORV- < --- This insurance-applies only to accidents which- occur during 8 policy period amt-within the UmtaHtatas of Ameria, its tefrftorie*% pass**siom or Cenedfc v. Roonwitti otniiiiioiir-. v. Whevusadtit nfarena to (hit wtsurana fincMding endorsements fearing apirtetthepBey)r : -' - * : " 'J \r.C' This endorsement must be attached to the Chugs Endorienwnf when issued after the policy is writtam CP 04 67 (Er*. 8-74) AID 000261 y r ' Jff) <to f w O. m ? w metis bodily injury, sickness or disease, indudirif death, sustained by an insured under (a) er (b) of the Persons Insurtd provision; "designated insured" metis an individual name# iff the'ttehedufo osder ^ Designated insured;. "highway vehiefe" means a land motor vehicle or trailer other than (a) a farm type tractor or other equipment designed for use princi pally Off public roads^wbile not upon public roads, CP 04Tf7 (Ed. 8-74) notice of the pendency of any legal procaaoing against such in solvent company d which he may hava knowledge, withm a rea sonably, top* and before he enters into any negotiation or arrangement with such insolvent company and before the company is prejudiced by any action or nonaction of his with respect to the determination of the insolvency of such company; or (b) a hit-and-run vehicle; (b) a vehicle operated on rails or crawler-treads, or but the term"uninsured highway vehicle" shall not include: (c) a vehicle while located for use as a residence or premises; (i) an insured highway vehicle, "Wt-and-nm vehicle" means a highway vehicle which causes an accident resulting in bodily injury to an insured or property damage arising out of physical contact of such vehicle (1) with the insured or (2) with an insured higftwiy vehicle; provide* - (a) there cannot be ascertained the identity pf either the operator or owner of such highway vehicle; (bP the insured or someone on his behalf shall hava reported the accident within 10 days or as soon as practicable to the Georgia Director of Public Safety, and shall haw filed with the compaey within 30 days thereafter a statement under oath that the m-; . sured hr his, legal representative has a cause or causes of action '5 arising out of such accident for damages against a person or persons whose identity is unascertainabiti and setting fqrtji ....... the fiSts m support thereof; and /ri (c) at the company s request the insured or his legal representative makes available-for inspection the vehicle which the insured was occupying at the time of tha accident -- "inured higteHg vehicle? means highway vehicle; (a)* described in the schedule as an insured highway vehicle to which the bodily injury and property damage liability coverage of the policy appfm?-' (b) while temporarily used as a substitute for an insured highway vehicle as described in subparagraph (a) above when withdrawn from normal use because of in breakdown, repair, .servicing, loss or destruction; (c) while being operated by the named or designated insired or by the spouse of either if a resident of the same household; but tha term "insured highway vehicle" shall not include:; (i) under subparagraphs (a) and (b) above, a vehicle unless being used by-or with the permission of the named or desig nated! insured or of the spouse of either if t resident of the same household er (ii) under subparagraphs (b) and (c) above, a vehicle owned by the named insured, any designated insured or any resident of the same household as the named or designated insured; "occupying" means in or upon or entering into or sighting from; "property damage" means injury te ar destructiMii(i) an insured high way- vehicle owned by the namadiraured otha TftWiiTr/* a resident of the same household, and (2} any property owned-bjfcpdinsured under (a) or (b) of the Persons Insured provision while contained in such insured highway vehicle; "stata" includes the- District it Columbia, a territory qr possession of tlw United States, wd a prownceef Canada;, "unbound highway vehicle" meerts* (af ra highway vehicle with respect to the ownership, maintenance or use of which there is, in at least the amounts specified in Sec tion 56-407A of the Georgia Insurance Code, neither (i) cash or securities on file with tha Georgia Director of Public Safety nor (ii) a bodily injury and property damage liability-bond or insur ance policy, applicable at the time of the accident with respact to airy person or organisation legally responsible for the use of such vehicle, or with respect to which 1here is a bodily injury -and- proparty damage liability bond dr insurance policy appli cable at the time of the accident but the company writing tha, same either (a) has legally denied coverage thereunder, or (b) is or becomes insolvent provided the insured gives the company CP 04 67 (Ed. 8-74) . ta: sjaT (ii) a highway vehicle which is owned-by or furnished for the regularise of the named insured, ha spouse, or a relative of eittewbo a resident of the same household. VI. ADDITIONAL COJUntySS / Ti.'-'iii - > A. PolicyProvision*. r- s -jn- ' None of the Insuring Agreements, Exclusions, Conditions or other provi sions of the policy shall apply to tha insurance afforded by this endorse' merit except the CooditwjmvNetiet" (or "Insured's Duties in the Event of Occurrence, Claim or Suit"). "Subrogation". "Changes", "Assignment", "Cancellation" and "Dedafatiops'E I B. Premia*........ If during the policy period the numtae-of insured highway vehicles owned by the named insured or spoilt and registyred or principally garaged ia Georgir or the number of Gkqrgty) state's' license plates issued to the naipeo insured1 changes, the ngpedirtsprli stuff notifytbe company durihg the policy period or any changt'and the premium'shad be adjusted i* accordance with-the-manhart in esdbfth* company! Ifthe earned pn thus computed exceeds theAdvifici premium pai4.the.nmed iosuri pay the excess to the company; if less, the company shall return.! named insured the unearned portionpj^.by.$uch ipsutyd, C. Proofef-Cfatyt , . ,, ' "... bos ..-i ->i -j . ,, As soon as practicable, the insured or other pensa.makinrxIain-sMf'. give to the company written proof id claim, under oath if required, include mg fun particulars of the nature and extant of the injuries, treatment aft# other details (entering into Hit determination of the amount payable hens1 under. Proof "of claim shaltbe made Cipon forme furnished by the company unless thetornpnry shall hem fate#to fbrnish sucIHorms within IS day# after receiving notice of clainf.* - ' The injured lperaorshalKstibmi(>to physical examinations by physiciadg selected by the company when and-as often as the company may reasonably require and he. or in the event of his incapacity his legal representative, or =. m the eventiof his death-his legaf representative or the person e( pensdfc entitled tolsue therefor, shall upon each request from the compafty'fcraot* authorization to enable the company to obtiin medical reports anftcopMl of records; The insured or other person making claim for damage to property shaft file proof of; loss with the company withm sixty days after the occurrence of loss, unless such time is extended in writing by the company, in the form of a sworn statement setting forth the interest of the insured and of alt others in the property affected, any encumbrances thereon, the actual cash value thereof at time of loss, the amount; place, time end cause-of such loss, and the-description and amounts id all other insurance covering such, property. Upon the company's request, the insured shaft exhibit the damaged property to the company, D. Auixtim* ind Ceeperaban et the Insured. After notice of claim under this insurance, the company may require the insured to take such action as may be necessary or appropriate to pre serve his right to recover damages from any person or organization alleged to be legally responsible for the bodily injury or property damage. E. Notice efLegal Action . If. before the company makes payment of loss hereunder, the insured er his legal representative shall institute any legaf action for bodily injury or property damage against any person or organization legally' responsible for the use-of a bighmy vehicle involved in the accident, a copy of the summons and complaint or otter process served'in connection with such legal action shall be forwarded immediately to the company by the insured or his legal representative. ,. ... ,-r 1 ! , -.- Pag*2elJ 5i S >40 AID 000262 / / F. Otter Insurance. With respect to bodily injury to an insured while occupying a highway vehicle not owned by the named insured, this insurance shall apply only as excess insurance over any other similar insurance available to such insured and applicable to such vehicle as primary insurance, and this insurance shall then apply only in the amount by which the limit of liability for this coverage exceeds the applicable limit of liability of such other insurance. Except as provided in the foregoing paragraph, if the insured has other similar bodily injury insurance available to him and applicable to the acci dent the damages for bodily injury shall be deemed not to exceed the higher of the applicable limits of liability of this insurance and such other insur ance, and the company shall not be liable for a greater proportion of any loss to which this coverage applies than the limit of liability hereunder bears (Ed. 8-74) to the sum of the applicable limits of liability of this insurance and such other insurance. S. Payment of Lou by tte Company. Any amount due hereunder is payable to the insured or his legal represen tative. Hi Action Against Company. No action shall lie against the company unless, as a condition precedent thereto, the insured or his legal representative has fully complied with all the terms of the policy applicable to this coverage. I. This endorsement replaces any other provisions of the policy, includ ing any endorsement forming a part thereof, affording similar insurance with respect to any damages arising out of the ownership, maintenance or use of an uninsured vehicle or a hit-and-run vehicle. CP 04 67 (Ed. 8-74) Page 3ef3 AID 000263 6 AMEND;MG POLICY r.Co T?,-hJi-i2:T.Vj3-3-75 UNINSURED MOfORISTS INSURANCE (Xn Jersey) if CP 04 70 (Ed. 1 74} In consideration of the payment of premium and subject to all of the pro visions of this endorsement and to the applicable provisions of the policy, the company agrees with the named insured as follows; Schedule Designated Insured:_________ ______________ ___________________ ____ Limits of Liability; Bodily Injury SlS.QOOeath person S30.000 each accident Property Damage S 5,000 each accident Advance Premium $ IRCL IN COMPOS ITE Description of Insured Highway Vehicles: Any highway vehicle registered or principally garaged in New Jersey which is; (check appropriate bos) E An owned automobile under Part I of the policy G A private passenger automobile owned by the named-insured G Owned by the-named insured G Designated- in the declarations of the policy and any highway vehicle of the same type ownership of which is acquired during the policy period by the named insured as a replacement therefor G Any mobile equipment owned by the named insured G __________________ I. COVERAGE UNINSURED MOTORISTS (Damages for Bodily Injury iMI Property Damage Caused by Uni*.sured Highway Vehicles) The company will pay alt sums which the insured or his legal representa tive shall be legally entitled to recover as damages from the owner or operator of an uninsured highway vehicle because of bodily injury or prop erty damage, caused by accident and arising out of the ownership, mainte nance or use of such uninsured highway vehicle; provided, for the purposes' of this coverage, determination as to whether the insured or such represen tative is legally entitled to recover such damages, and if so the amount thereof, shall be made by agreement between the insured or such represen tative and the company or, if they fail to agree, by arbitration. No judgment against any person or organization alleged to be legally re sponsible for the bodily injury or property damage shad be conclusive, as between the insured and the company, of the issues of liability of such person or organization or of the amount of damages to which tha insurad is legally entitled unless such judgment.# entered pursuant to. an action prosecuted by the insured with the written consent of the company. Exclusions This insurance does not apply: (a) to bodily injury or property damage with respact to which tlw insured, his legal representative or any person entitled to pay ment under this insurance staff, without written consent of the company, make any settlement with any person or organization who may be laglliy liable therefor; (b) to bodily injury to an insured while occupying a highway vehicle (other than an insured highway vehicle) owned by the named insured, any designated insured or any native resident in tlw same household as the named or designated insured, or through being struck by such a vehicle, but this exclusion does not apply to the named insured or his relatives while occupying or if struck by a highway vehicle owned by a designated insured or his relatives; (c) to property contained in or struck by a highway vehicle (other than an insured highway vehicle) owned by the named insured, any designated insured or any relative resident in the same house hold as the named or designated insured, but this exclusion does not apply to property of the named insured or his relatives while contained in or struck by a highway vehicle owned by a designated insured or his relatives; (d) so as to mure directly or indirectly to the benefit of any work mens compensation or disability benefits carrier or any person or organization qualifying as a self-insurer under any workmen s compensation or disability benefits law or any similar law; (e) to the first {100 of the amount of property damage to the prop erty of each insured as the result of any one accident: (f) so as to inure directly or indirectly to the benefit of any insurer of property; (g) to property damage arising out of the ownership, maintenance or . use of a hit-and-run vehicle: II. PERSONS INSURED Each oi the following is an insured under this insurance to the extent set forth below:, (a) the named insured and any designated insured and. while resi dents of tlw same household, the spouse and relatives of either (b) any other person while occupying an insured highway vehicle; and (c) any pena-n. with respect to damages Iw is entitled to recover because of bodily injury to which this insurance applies sus tained by an insured under (a) or (b) above. The insurance applies separately with respect to each insured, except with respect to the limits of the company's fiability. III. LIMITS OF LIABILITY- Regardless of the immbef of (1) persons or organizations who are imuredd under this insurance, (2) persons or organizations who sustain bodily injury or property damage, (3) claims made or suits brought on account of bodily injury-or property damage, or (4) highway vehicles to which this insurance applies (a) The limit of bodily injury liability stated in the schedule as ap plicable to "etch person" is the limit of the company's liability for alldamages because of bodily injury sustained by one person as the result of any. one accident and, subject to the above pre vision respecting "each person", the limit of liability stated in the schedule as applicable to "each accident" is the total limit of the company's liability for all damages because of bodily inlury sustained by two or more person* as the result of any one accident: (b) The limit of property damage liability stated in the schedule is the total limit of the company's liability for all damages because of prpperty damage to all property of one or more insureds as the result of any one accident (c) Any amount payable under the terms of this insurance because of bodily injury or property damage sustained in an accident by a person who is an insured shall be reduced by . (1) all sums paid on account of such bodily injury or property damage by or on behalf of' (i) the owner or operator of the uninsured highway vehicle and (ii) any other person or organization jointly or severally liable together with such owner or operator for such bodily injury or property damage. including all sums paid under the bodily injury or property dam age liability coverage of the poliey, and (2) the amount paid and the present value of all amounts pay able on account of such bodily injury under any workmen's compensation law. disability benefits law or any similar lave (d) Any payment made under this insurance to or for any insured shall be applied in reduction of the amount of damages which he may be entitled to recover from any person insured under the bodily injpry or property dimage liability coverage of the policy. (e) The company shall not be obligated to pay under this insurance that part of the damages which the insured may be entitled w cover fro* the owner or operator of an uninsured higher This endorsement must be attached to the Change Endorsement when issued after fhe policy is written. CP 04 70 (Ed. 1-74) AID 000264 which represents expenses for medical services paid or payable under the medical payments or medical expense coverage of the policy or which represents toss paid or payable to the insured under any automobile physical damage insurance of the policy Ilf. POLICY PERIOD; TERRITORY This insurance applies only to accidents which occur during the policy period and within the United States of America, its territories or posses sions, or Canada. V. RDOITIOMU. DEFINITIONS When used in reference to this insurance (including endorsements forming a part of the policy): "bodily injury" means bodily injury, sickness or disease, including death, sustained by an insured under (a) or (b) of the Persons Insured provision; "designated Insured" means an individual named in the schedule under Designated Insured and also includes his spouse, if a resident of the same household: "Idgbwy veKeta" means a land motor vehicle or trailer other than (a) a farm type tractor or-othar equipment designad for use princi pally off public roads, while not upon public roads, (b) a vehicle operated on rails or crawler-treads, or (c) a vehicle while located for use as a residence or premises; "Wt-Md-nm vehicle" means (i) a highway vehicle which causes an acci dent resulting in bodily injury to in insured arising out :bf physical contact of such vehicle with the insured or with a vehicle which the insured is oc cupying at the time of the accident or (ii) a highway vehicle which without physical contact with the insured or with a vehicle which the insured is occupying at the time of the accident causes bodily injury to an insured arising out of an accident in New Jersey, provided; (a) there cannot be ascertained the identity of either the operator or owner of such highway vehicle: and (b) the insured or someone on his behalf shall have reported the accident within 48 hours to a police, peace or judicial officer or to the ConmtKSMner of Motor Vehicles, and shall have filed with the company within 30 days thereafter a statement under oath that the insured or his legal representative has a cause or causes v of action arising out of such accident for damages against a per son or parson:' whose identity is unatcertainabje, and setting . forth the facts m support thereof; and (c) at the company's request, the insured or. his-legal representative makes available for inspection the vehicle which the insured was occupying at the time of the accident; and (d) with respect to subdivision (ii) thelabts of such accident can be corroborated by competent evidence other than the testimony of any person having a claim under this or any other similar in surance as the result of such accident; "mured highway vehicle'* means a highway vehicle: (a) described in the schedule as an insured highway vehicle to which the bodily injury and property damage liability coverage of the policy applies; (b) while temporarily used as a substitute for in insured highway vehicle ,as described in subparagraph (a) above, when withdrawn from normal use because of its breakdown, repair, servicing, loss or destruction; (c) while being operated by the named or designated insured or by the spouse of either if a resident of the same household; but the term "insured highway vehicle" shall not indude: (i) a vehicle while used as a public or livery conveyance, unless such use is specifically declared and described in the policy; (ii) a vehicle while being used without the permission of the owner; (iii) under subparagraphs (b) and (c) above, a vehicle owned by the named insured, any designated insured or any resident of |the same household as the named or designated insured; or i (iv) under subparagraphs (b) and (c) above, a vehicle furnished for the regular use of the named insured or any resident of the same household; "named insured" means the individual named in item 1 of the declarations and also includes his spouse. If a resident of the same household: "occupying" means in or upon or entering into or alighting from; "property damage" means injury to or destruction of (i) an insured high way vehicle owned by the named insured or his spouse, if ( resident of the same households (n) any property owned by an insured under (a) or (b) of the Persons Insured provision while contained in such insured highway vehicle and (in) any property owned by an insured under (a) of the Persons Insured provision while contained in any insured highway vehicle; "state" includes the District of Columbia, a territory or possession of the United States, and a provmce of Canada; "uninssred highway vttode" mains. (a) a highway whid* with respect to IJm owwrafcip. sidaaaoci or na at *Mt thare a. at toad tha MwMts ipecihed by tha financial raanwaiWIity law el tha stati m which tha i--red high way vahrda ta principally garaged, no bodily injury and property damage lability bond or insurance policy applicable at the time of the accident with respect to any person or organintion legally responsible for the use of such vehicle, or with respect ta which there is a bodily injury and property damage liability bond or in surance policy applicable at the time of the accident but the com pany writing the same denies coverage thereunder or is or becomes insolvent; or (b) a hit-and-run vehicle, but only with respect to bodily injury caused thereby; but the term "uninsured highway vehicle" shall not include: (0 an insured highway vehicle, (u) a highway vehicle which is owned or operated by a self-in surer within the meaning of any vehicle financial responsi bility taw. motor carrier law or any similar law, (Hi) a highway vehicle which is owned by the United States of America. Canada, a state, a political subdivision of any such government or an agency of any of the foregoing. VI. ' ADDITIONAL CONDITIONS A. Policy Provisions, None -nf the Insuring Agreements. Exclusions. Conditions or dther pro visions-of the policy shell apply to the insurance afforded by this endorse ment except the Conditions "Notice" (or "Insured's Duties in the Event of Occurrence. Claim or Suit"), "Changes". "Assignment", "Cancellation" and "Declarations". B. Premium. If during the policy period the number of insured highway vehicles owned by the named insured or spouse or the number of dealer's license plates issued to the named insured changes, the named insured shall notify the company during the policy period of any change and the premium shall be adjusted in accordance with the manuals in use by the company. If the earned premium thus computed exceeds the advance premium paid, the named insured shall pay the excess to the company; if less, the company shall return to the named insured the unearned portion paid by such in sured. C. Proof of Claim. As soon as practicable, the insured or other person making claim shall give to the company written proof of claim, under oath if required, includ ing full particulars of the nature and extent of the injuries, treatment and other details entering into the determination of the amount payable here under. The insured and every other person making claim hereunder shall submit to examinations under oath by any person named by the company and subscribe the same, as often as may reasonably be required. Proof of claim stall be made upon forms furnished by the company unless the company shall have failed to furnish such forms within IS days liter re ceiving notice of claim. The injured person shall submit to physical examinations by physicians selected by the company when and as often as the company may reason- CP 04 70 (Ed. AID 000265 r2ii 3 ably require and he. flm event of ha incapacity his legal representa tive or in the event of his death his legal representative or the person or persons entitled to sue therefor, shall upon each request from the company execute authorization to enable the company to obtain medical reports and copies of records. The insured or other person making claim for damage to property shall file proof of loss with the company withm sixty days after the occurrence of loss; unless such time is extended m writing by the company, m the form of a sworn statement setting forth the interest of the insured and of all others in the property affected, any encumbrances thereon, the actual cash value thereof at time of loss, the amount place, time and cause of such loss, and the description and amounts of all other insurance covering such property. Upon the company's request the insured shall exhibit the damaged property to the company. 0: Assistance and Cooperation of the insured. After notice of claim under this insurance, the company may require the insured to take such action as may be necessary or appropriate to pre serve his right to recover damages from any person or organization alleged to be legally responsible for the bodily inyury or property damage; and in any action against the company, the company may require the in sured to join such person or organization1 as a party defendant L he*ice at Legal Adieu. If. before the company makes payment of loss hereunder, the insured or his legal representative shall institute any legal action tor bodily injury or property damage against any person or organization legally responsible for thf>u$c of)/a highway vehicle involved in the accident a copy of the summons and complaint or other process served in connection with such legal action shdll be forwarded immediately to the company by the insured or his legal representative. F. Other Imuranet. With respect to bodily iniury to an insured while occupying a highway vehicle not owned by the named insured, this insurance shall apply only as excess insurance over any other similar insurance available to such insured ,and ^applicable to such vehicle as primary insurance, and this insurance shall then apply only m the amount by which the limit of liability for this cove'iage exceeds the applicable limit of liability of such other insurance. Except as provided in the foregoing paragraph, if the insured has other similar insurance available to him and applicable to the accident the dam ages shill be deemed not to exceed the higher of the applicable limits of liabil ty of this insurance and such other insurance, and the company shall not te liable for a greater proportion of any loss to which this coverage appi'ss than the limit of liability hereunder bears to the sum of the applica ble limits of lability of this insurance and such other insurance. Witr. respect to property damage, the insurance hereunder shall apply only as z .K 67 insurance over any other valid and collectible insurance of. any kind appliczbfe to such property damage, and this insurance shall apply only in the amountiby which the limit of liability for this coverage exceeds the.amount recoverable under such other insurance. 6. ArbitritlM. If any person making claim hereunder and the company do not agree that such person is legally entitled to recover damages from the owner or opera tor of an uninsured highway vehicle because of bodily injury or property damage to the insured, or do not agree as to the amount of payment which may be owing under this insurance, then, upon written demand ot either. CP 04 70 (Ed. 1-74) the matter or matters upon whic. . Jch person and the company do not agree shall be settled by arbitration, which shall be conducted m accor dance with the rules of the American Arbitration Association unless other means of conducting the arbitration are agreed to between the insured and the company, and judgment upon the award rendered by the arbitrators may be entered in any court having jurisdiction thereof. Such person and the company each agree to consider itself bound and to be bound by any award made by the arbitrators pursuant to this insurance. H. Trust Agreement In the event of payment to any person under this insurance: (a) the company shall be entitled to the extent of such payment to the proceeds of any settlement or judgment that may result from the exercise of any rights of recovery of such person against any person or organization legally responsible for the bodily injury or property damage because of which such payment is made: (b) such person shall hold m trust for the benefit of the company all rights of recovery which he shall have against such other person or organization because of the damages which are the subject of claim made under this insurance; (c) such person shall do whatever is proper to secure and shall do nothing after loss to prejudice such rights: (d) if requested in writing by the company, such person shall take, through any representative designated by the company, such action as may be necessary or appropriate to recover such pay ment as damages from such other person or organization, such action to be taken in the name of such person; in the event of a recovery, the company shall be reimbursed out of such recovery for expenses, costs and attorneys' fees mcurredJby it in connec tion therewith; (t) such person shall execute and deliver to the company such in struments and papers, as may be appropriate to secure the rights and obligations of such person and the company established by this provision. f. Payment of Loss by the Company. Any amount due hereunder is payable (a) to the insured, or (b) if the insured be a minor to his parent or guardian, or (c) if the insured be deceased to his surviving spouse, otherwise (d) to a person authorized by law to receive such payment or to a person legally entitled to recover the damages which the payment represents; provided, the company may at its option pay any amount due hereunder in accordance with division (d) hereof. J. Action Against Company. No action shall lie against the company unless, as a condition precedent thereto, the insured or his legal representative has fully complied with all the terms of the policy applicable to this coverage. K. This endorsement replaces any other provisions of the policy, indud. ing any endorsement forming a part thereof, affording similar insurance with respect to any damages arising out of the ownership, maintenance or use of an uninsured vehicle or a hit-and-run vehicle. Page 3 of 3 AID 000266 AMENDING POLICY NO. TR-NSL-7 23T693-W5 UNINSURED MOTORISTS INSURANCE (Maryland) CP 04 69 (Ed. 1-74) In consideration of the payment of premium and subiect to all of the pro visions of this endorsement and to the applicable provisions of the policy, the company agrees with the named insured as follows: Schedule Designated Insured: Limits of liability: Bodily Injury % 21J7&OT each person 4U7O0U $ each accident t t oot Property Damage $ each accident Advance Premium $ IMCL IN COMPOS ITE Description of Insured Highway Vehicle: Any highway vehicle registered in Maryland which is: (check ap propriate box.) & An owned automobile under Part I of the policy O A private passenger automobile owned by the named insured Owned by the named insured G Designated in the declarations of the policy and any highway vehicle of the same type ownership of which is acquired during the policy period by the named insured as a replacement therefor G Any mobile equipment owned by the named insured G_ I. C0VEM6E UNINSURED MOTORISTS (Damages for Bodily Injury and Property Damage Caused by Unin sured Highway Vehicles) The company will pay all sums which the. insured or his legal representa tive shall be legally entitled to recover as damages from the owner or operator of an uninsured highway vehicle because of bodily injury or prop erty damage, caused by accident and arising out of the ownership, mainte nance or use of such uninsured highway vehicle; provided, for the purposes of this coverage, determination as to whether the insured or such represen tative is legalljf entitled to recover such damages, and if so the amount thereof, shall be made by agreement between the insured or such represen tative and the bbmpany or, if they fail to agree, by arbitration. No default judgment against any known person or organization alleged to be legally responsible for the bodily injury or property damage shall be conclusive, as between the insured and the company, as to the establish ment of legal liability or of the amount of damages to which the insured is legally entitled. Exclusions This insurance does not apply: (a) to bodily injury or property damage- with respect to which the insured, his legal representative or any person entitled to pay ment under this insurance shall, without written consent of the company, make any settlement with any person or organization who may be legally liable therefor; (b) to bodily injury to an insured while occupying a highway vehicle (other than an insured highway vehicle) owned by the named insured, any designated insured or any relative resident in the same household as the named or designated insured: (c) so as to inure directly or indirectly to the benefit of any work men's compensation or disability benefits carrier or any person or organization qualifying as a self-insurer under any workmen's compensation or disability benefits law or any similar lave (d) to the first $100 of the amount of property damage to the prop erty of each insured as the result of any one accident (e) so as to inure directly or indirectly to the benefit of any insurer of property; (f) to property damage for which the insured has been compensated by ottjhr property or physical damage insurance: fl. PERSONS INSURED Each of the fallowing is an insured under this insurance to the extent set forth below: (a) the named insured and any designated insured and. while resi dents of the same household, the spouse and relatives of either: (b) any other person while occupying an insured highway vehicle: and (c) any person, with respect to damages he is entitled to recover because of bodily injury to which this insurance applies sus tained by an insured under (a) or (b) above. The insurance applies separately with respect to each insured, except with respect to the limits of the company's liability. III. LIMITS OF LIABILITY Regardless of the number of (1) persons or organizations who are insureds under this insurance, (2) persons or organizations who sustain bodily injury or property damage, (3) claims made or suits brought on account of bodily injury or property damage, or (4) highway vehicles to which this insurance applies, (a) The limit of bodily injury liability stated in the schedule as ap plicable to "each person" is the limit of the company's liability for all damages because id bodily injury sustained by one person as the result of any one accident and, subject to the above pro vision respecting "each person", the limit of liability stab* is the schedule as applicable to "each accident" is the total limit of the company's liability for all damages because of bodilfji*- jury sustained by two or mors persons as the result of arqpm accident f (b) The limit of property damage lability stated in the schedule a the total limit of the company's liability for all damages because of property damage to all property of one or more insureds as the result of any one accident (c) If claim is made under this insurance and claim is also madt against any person or organization who is an insured under the bodily injury liability or property damage liability coverage of the policy because of bodily injury or property damage sustained in an accident by a person who is an insured under this insurance (1) any payment made under this insurance to or for any such person shall he applied in reduction of any amount which he may be entitled td recover from any person or organization who is an insured under the bodily injury liability or prop erty damage liability coverage; and (2) any payment made under the bodily injury liability or prop erty damage liability coverage to or for any such person shall be applied in reduction of any amount which he may be entitled to recover under this insurance. (d) Any amount payable to an insured under the terms of this insur ance shall be reduced by (1) all sums paid to such insured for bodily injury or property damage by or on behalf of the person or organization legally liable therefor and (2) the amount paid and the present value of all amounts payable to such an insured under any workmen's compensation law, exclusive of non-oecupational disability benefits. IV. POLICY PERIOD; TERRITORY This insurance applies only to Occidents which occur during the polity period and within the United States of America, its territories or posses sions, or Canada. V. ADDITIONAL DEFINITIONS When used in reference to this insurance (including endorsements forming a part of the policy): "bodily injury" mans bodily injury, sickness or disease, including death, sustained by an insured under (a) or (b) of the Persons Insured provision; "designated insured" means an individual named in the schedule under Designated Insured; This endorsement must be attached to the Change Endorsement when issued after the policy is written. CP 04 69 (Ed. 1-74) (OVER) AID 000267 Page 1 if 3 i i "highway vWd*" means a land motor vehicle or trailer other than (a) a farm type tractor or other equipment designed tor use princi pally off public roads, while not upon public roads, (b) a vehicle operated on rails of crawler-treads, or (c) a vehicle while located for use as a residence or premises; "Irit-afwS-fHn vehicle" means a highway vehicle which causes an accident resulting in bodily injury to an insured or property damage arising out of physics! contact of such vehicle (1) with the insured or (2) with an insured nighmy vehicle, provided: insolvent company and before the company 15 oreiud'ced by any action or nonaction ot his with respect to the determination of the insolvency of such company; or (b) a hit-and-run vehicle: but the term "uninsured highway vehicle" shall not include: (1) an insured highway vehicle, (ii) a highway vehicle which is owned by or furnished for the regular use of the named insured, his spouse, or a relative of either who is a resident of the same household, (a) there cannot be ascertained the identity of either the operator or owner of such highway vehicle: (b) the insured or someone on his behalf shall have reported the accident within 24 hours to a police, peace or judicial officer or to the Commissioner of Motor Vehicles, and shall have filed with the company within 30 days thereafter a statement under oath that the insured or Ins legal representative has a cause or causes of action arising out of such accident for damages against a per son or persons whose identity is unascertained^ and setting forth the facts in support thereof: and (c) at the company's request, the insured or his legal representative makes available for inspection the vehicle which the insured was occupying at the time of the accident "Insured highway vehicle" means a highway vehicle: (a) described m the schedule as an insured highway vehicle to which the bodily injury and property damage liability coverage of the policy applies: (b) wbUt temporarily used as a substitute for an insured highway vehicle as described in subparagraph (a) above, when withdrawn from normal use because of its breakdown, repair, servicing,, loss or destruction; (c) while being operated by the named or designated insured or by the spouse of either if a resident of the same household; (iii) a highway vehicle which is owned or operated by a self-in surer within the meaning of any motor vehicle financial responsibility law. motor carrier law or any similar law, (iv) a highway vehicle which ts owned by the United States of America. Canada, a state, a political subdivision of any such government or an agency of any of the foregoing. ADDITIONAL CONDITIONS A. Nicy Prevision. None of the Insuring Agreements, Exclusions. Conditions or other pre visions of the policy shall apply to the insurance afforded by this endorse ment except the Conditions "Notice" (or "Insured's Duties in the Event of Occurrence, Claim or Suit"). "Changes", "Assignment", "Cancellation" and "Declarations". 1. Premium. If during the policy period the number of insured highway vehicles owned by the named insured or spouse and registered or principally garaged in Maryland or the number of Maryland dealer's license plates issued to the named insured changes, the named insured shad notify the company dur ing the policy period of any changi and the premium shall be adjusted in accordance with the manuals in usa by the company. It the tamed pre mium thus computed exceeds the advtnce premium paid, thd named in sured shall pay the excess to the company; if less, the company shell return to the named insured the unearned portion paid by such insuredw but the term "insured highway vehicle" shall not include: C. Proof ef Clad*. . (i) under subparagraphs (a) and (b) above, a vehicle unless being used by or with the permission of the named or designated insured or of the spouse of either if a resident of the same household; or (ii) under subparagraphs (b) and (c) above, a vehicle owned by the named insured, any designated insured or any resident of the same household as the named or designated insured; "occupying" means in or upon or entering into or alighting from: "property damage" means injury to or destruction of (1) an insured high way vehicle owned by the named insured or his spouse, if a resident of the same household, and (2) any property owned by an insured under (a) or (b) of the Persons Insured provision while contained in such insured highway vehicle; As soon as practicable, the insured or other person making claim shaft give to the company written proof pf claim, under oath if required, includ ing full particulars of the nature and extent of the injuries, treatment and other details entering into the determination of the amount payable here under. Proof pf claim shall be mada upon forms furnished by the company unless the company shall have failed to furnish such forms within 15 days after receiving notice of claim. The injured person shall submit to physical examinations by physicists selected by the company when and as often as the company may reason ably require and he, or in the event of his incapacity his legal representa tive, or in the event of his death his legal representative or the person or persons entitled to sue therefor, shall upon each request from the company execute authorization to enable the company to obtain medical reports and copies of records. "state" includes the Oistrict of Columbia, a territory or possession of the United States, and a province of Canada; "uninsured highway vehicle" means: (a) a highway vehicle with respect to the ownership, maintenance or use of which there is, in at least the amounts specified in Sec tion 7-101 of Article 66 1/2 of the Annotated Code of Maryland, neither (i) cash or securities on file with the Administrator of the Department of Motor Vehicles of the State of Maryland nor (ii) a bodily injury and property damage liability bond or insur ance policy, applicable at the time of the accident with respect to any person or organization legally responsible for the use of such vehicle, or with respect to which there is a bodily injury and prop erty damage liability bond or insurance policy applicable at the time of the accident but the company writing the same either (a) has legally denied coverage thereunder, or (b) is or becomes in solvent provided the insured gives the company notice of the pendency of any legal proceeding against such insolvent company of which he may have knowledge, within a reasonable time and before he enters into any negotiation or arrangement with such The insured qr other person making claim for damage to property shall file proof of loss with the company within sixty days after the occurrence of loss, unless such time is extended in writing by the company, in the form of a sworn statement setting forth the interest of the insured and of all others in the property affected, any encumbrances thereon, the actual cash value thereof at time of loss, the amount place, time and cause of such loss, and the description and amounts of all other insurance covering such; property. Upon the company's request the insured shall exhibit the damaged property to the company. D. Assistance and Cooperation of the Insured. After notice of claim under this insurance, the company may require the insured to takje such action as may be necessary or appropriate to pre serve his right to recover damages from any person or srpnization alleged to be legally responsible for the bodily injury or property damage. L Notice f legal Action. If. beforp the {company makes payment of loss hereunder, the insured or his legal representative shall institute any legal action for bodily injury or property daoujge against any person or organization legally responsible mvu. 1-74) AID 000268 Pmiets* . .. ' .- c _ ''. - ,. "" at . -.I. r .-:,j ?tpl actios sfs'l Sm '.QFiGuCit 'itnuediats'y is the corasi'y by ite msoraf f b tepi rwrtsffristiw. F. : Wfetr fresrsiw. ' ,, i ; ,, * ' r: .. :c: , - ............... , " s ", ss sxces .nsuranw over an? other smviar insurance available !c $i,ch insured snd apaiicrtble to such vetiicii ss primary .nsurjncc, anti tins irsyrsocs stiali than rspiy only in the amount by which the* iirmt of liab.lity for tfns cov-ifinje eicesbs the npD'icot.a limit of liability of such other s-- . Erccpt as nrev 6,.i t the fcrogoirg pzragrao.i. ? tils nsaryj has ether ' ' ; I . - - >,, ,v ;!. t ' ii , Vl- . i.. . wV"., i, s io. i,, ,,.`.. ,'vgi;' cl' ills applicable limits of liability of Shis insurance and such ciSu ii - r : ' t ,, Mi.iucny s.isl. 'ct b,, ir:f f;r ? r ..ft o.. r. ..,1'.. to .. cico -r"\.:'rili,,i: i ii',. ,ii tci I' V, i; .v. : bears to tha sum of tbs applicable limits of liability of this insarrncs onri sjch eiber insimnes. 7 '1 ii i. .. .. ,i.y ~-.io j i! in. i.r.i-i i.r >s ccycj tatiws. . ..,. to tr* "S.,r_.-j ; i-j leg;! ri-Or.s. i in .'Ci o,i i il 'i., lust i... co. o'.'i. u 'I'^Sj * co.iii.uoi. r.c.' tt-^r^i.i !i. it,.--r or 'o I r,,.ir^s.. i'fr. ,-ss`oil, co'.'ni'.r. it1 ,-ii the terms o? the policy aoplicablc to this coverage. ! 'in.- j jcr;..ii.i.i r.nl'c.s any ati._r irovsio.is o' tu. nolir,, iiic!,,ii- i- ; :ori,,ir'i *, vr. tiM^r rliO'''',' ; S'v'r- '.i rr. i . . j ua of an uninsured vehicle or a hit-and-run vehicle - J. Ktimb*rc*mM mi Trwi %Mit 1 ..w 1 ' . J ` - . 1 C'S. . 1 . .1............: the cocs-eos of j t ; settlement iv judgment tM my resu t srocr* tho msrciss of sny rights o' recovery of sac* parson *pstst nary person or ofp<iat!Cts lirully rospoosibls for the btx'iiy injury bacauss o{ s^ich such poymsc'; is mads: ?m; the compcry sMi ^ 1 ti.: ' o*..c. 1 - .o i-o..-.. j1 c- s- si: ,-- . i j ' .re ' - ;:1,. :r . , .- ..7 s,.c.".-r'i !i 1 r -- of ;1 S'l__. ; ri ;.-q >-iUt.'. r. ., .: ... s - J ., -.1 Si'-., i.w . .: -s1 ro;.' io s.-. notfurg -fte? lass io prejudice such rights. ,'o M ii.. 1 s'1 io f'. cc,.p ... s ic1 . Sir- '..'.c ... , I.'vr t.tc..'"' 1 anil ebliptions of such person rird tha compEny established by this provision. :. ; .. i. i-' ci -i, .... ".I.1 .-il.;. > ....... L t , -! it.. Suorcjt.a ia *'! ti ir.s- " r l < ' r.-;.-.ry t.:,,rfc' " . so.i or K :"",.'1'..i-'l -h i. i . i,.-"-, i ;u ..!: i.jin . .-r 1 ro.rs rm do t.- . .L. . -.c^v ry s.c' s- r.i ri ,. . f i'-'V.i ; 1 ' . 11 a....... ", ' j *ec . ri"-.'. (Fii 1-? ) /zzy^ I AMENDING f'OLICY NO. TTMCL-1237693-W5 UNINSURED MOTORISTS INSURANCE (Kansas) CP 04 68 (Ed. 8-74) THIS FORM PROTECTS INSUREDS WHO ARE NOT CONTRIBUTORS NEGLIGENT AGAINST BODILY INJURY CAUSED BY NEGLIGENT UNINSURED AND HIT-AND-RUN MOTORISTS. Schedule Designation of named insured for purposes of this endorsement (2) while temporarily used as a substitute for an insured auto mobile as described in subparagraph (1) above, when with drawn from normal use because of its breakdown, repair, servicing, loss or destruction: 3Q+DQQLimits of Liability: S 1 g,nnn each person: $ each accident. The advance premium for this endorsement is S INCL_IN COMPOS! < - Description of Insured Automobiles: Check appropriate boi 0 Any automobile owned by the principal named insured (3) while being operated by a named insured or by his spouse it a resident of the same household: but the term "insured automobile" shall not include: (i) an automobile while used as a public or livery conveyance, unless such use is specifically declared and described m the policy: Q Any private passenger type automobile owned by the principal named insured (h ) an automobile while being used without the permission of the owner: Any automobile to which are attached Dealer's Automobile Registration Plates issued in the name of the principal named insured CD Any automobile designated in the declarations of the policy and an automobile ownership of which is acquired during the policy period by the principal named insured as a replacement therefor. In consideration of the payment of the premium for this endorsement and' subject to all: of the terms of this endorsement, the company agrees with the named insured as follows: Insuring Agreements I. Damages for Bodily Injury Caused by Uninsured Motor Vehicles. (lii) under subparagraphs (2) and (3) above, an automobile owned by the principal named insured or by any named insured: designated in the schedule or by any resident of the same household as such insured: or (iv) under subparagraphs (2) and (3) above, an automobile furnished for the regular use of the principal named in sured or any resident of the same household. (c) "uninsured motor vehicle" means: , (1) a motor vehicle with respect to the ownership maintenance or use of which there is. in at least the amebnts specified by the financial responsibility law of the stafrio which the insured automobile is principally garaged, nt bodily injury liability bond or insurance policy applicable at the time oif The company will pay all sums which the insured or his legal representa tive shall be legally entitled to recover as damages from the owner or op erator of an uninsured motor vehicle because of bodily injury, sickness or disease, including death resulting therefrom, hereinafter called "bodily injury", sustained by the insured, caused by accident and arising out of the ownership, maintenance or use of such uninsured motor vehicle: pro vided. for the purposes of this endorsement, determination as to whether the insured or such representative is legally entitled to recover such dam ages. and if so the amount thereof, shall be made by agreement between the insured or such representative and the company or. if they fail to agree, by arbitration. No judgment against any person or organization alleged to be legally re sponsible for the bodily injury shall be conclusive, as between the insured and the company, of the issues of liability of such person or organization or of the amount of damages to which the insured is legally entitled unless such judgment is entered pursuant to an action prosecuted by the insured with the written consent of the company. the accident with respect to any person or organization legally responsible for the use of such vehicle, or-with respect to which there is a bodily injury liability bond or insurance policy applicable at the time of the accident but the company writing the same denies coverage thereunder or is or: becomes insolvent; or (2) a hit-and-run vehicle as defined: but the term "uninsured motor vehicle" shall not include: (i) an insured automobile, (ii) a motor vehicle which is owned or operated by a self-in surer within the meaning of any motor vehicle financial responsibility law. motor carrier law or any similar law. (iii) a motor vehicle which is owned by the United States of America. Canada, a state, a political subdivision of any such government or an agency of any of the foregoing, II. Definitions (a) "insured" means: (1) the named insured as stated in the policy (herein also re ferred to as the "principal named insured") and any person designated as named insured in the schedule and. while residents of the same household, the spouse of any such named insured and relatives of either: (2) any other person while occupying an insured automobile; and (3) any person, with respect to damages he is entitled to re cover because of bodily injury to which this endorsement applies sustained by an insured under (l) or (2) above. The insurance applies separately with respect to each insured, but the application of the insurance to more than one insured shall not operate to increase the limits of the company's liability. (b) "insured automobile" means an automobile: (l) described in the schedule as an insured automobile to which the bodily injury liability coverage of the policy applies: (iv) a land motor vehicle or trailer if operated on rails or crawler-treads or while located for use as a residence or premises and not as a vehicle, or D O O O (v) a farm type tractor or equipment designed for use princi pally off public roads, except while actually upon public roads, (d) "hit-and-run vehicle" means a vehicle which causes bodily injury to an insured arising nut nf physical contact of such vehicle with the insured or with an automobile which the insured is occupy ing at the time of the accident, provided: (1) there cannot be ascertained the identity of either the operator or owner of such "hit-and-run vehicle": (2) the insured or someone on his behalf shall have reported the accident within 24 hours to a police. peace or judicial officer or to the Commissioner of Motor Vehicles. and shill have filed with the company within 30 days there- after a statement under oath that the insured or his legal representative has a cause or causes of action arising out of such accident for damages against a person or persons whose identity is unaseertainable. and setting forth the facts in sup port thereof: and (3) at the company's request, the insured or his legal representative makes available for inspection the auto mobile which the insured was occupying at the time of the accident. This endorsement must be attached to the Chai Endorsement when issued after the policy is written. CP 04 68 (Ed. 8-74) . Page 1 of 2 ; There is a gap between and yggKfe. fab G 003-71 AMENDING POLICY HG > T3-frSi - \ 3T6y $-3-7 S UNINSURED MOTORISTS INSURANCE (NewMexiee) CP 04 71 (Ed. 1-71) In consideration of the payment of premium and subiect to all of the provi sions of this endorsement and to the applicable provisions of the policy, the company agrees with the named insured as follows: Schedule Designated Insured: Limits of Liability: ------------------------ r ~vo:poe ~--~ Bodily Iniury $ __L__each person Property Damage 5 VoE**""** S ueach accident Advance Premium $ INCL IN COMPOSITE Description of Insured Highway Vehicles: 3 Any highway vehicle registered or principally garaged in New Mexico which is: (check appropriate box) [23 An owned automobile under Part I of the policy A private passenger automobile owned by the named insured 0 Owned by the named insured 0 Designated in the declarations of the policy and any highway vehicle of the same type ownership of which is acquired during the policy period by the named insured as a replacement therefor 0 Any mobile equipment qwned by the named insured 0 _____ _______________ I. CQVERA6E UNINSURED MOTORISTS (Damages for Bodily Injury and Property Damage Caused by Unin sured Highway Vehicles) The company will pay all sums which the insured or his legal representa tive shall be legally entitled to recover as damages from the owner or operator of an uninsured highway vehicle because of bodity injury or prop erty damage, caused by accident and arising out of the ownership, mainte nance or use of such uninsured highway vehicle: provided, for the purposes of this coverage, determination as to whether the insured or such represen tative is legally: entitled to recover such damages, and if so the amount thereof, shall be made by agreement between the insured or such represen tative and the company or. if they fail to agree, by arbitration. No judgment against any person or organization alleged to be legally re sponsible for the bodily injury or property damage shall be conclusive, as between the insured and the company, of the issues of liability of such person or organization or of the amount of damages to which the insured is legally entitled unless such judgment is entered pursuant to an actioa prosecuted by the insured with the written consent of the company. Exclusions This insurance does not apply. (a) to bodily injury or property damage with respect to which the insured, his legal representative or any person entitled to pay ment under this insurance shall, without written consent of the company, maki any settlement with any person or organization who may be legally liable therefor; (b) to bodily injury to an insured while occupying a highway vehicle (other than an insured highway vehicle) owned by the named insured: any designated insured or any relative resident in the same household as the named or designated insured, or through being struck by such a vehicle, but this exclusion does not apply to the named insured or his relatives while occupying or if struck by a highway vehicle owned by a designated insured or his rela tives; (c) to property contained in or struck by a highway vehicle (other than an insured highway vehicle) owned by the named insured, any designated insured or any relative resident in the same household as the named or designated insured, but this exclu sion does not apply to property of the named insured or his relatives while contained in or struck by a highway vehicle owned by a designated insured or his relatives; (d) so as to inure directly or indirectly to the benefit of any work men's compensation or disability benefits carrier or any person or organization qualifying as a sett-insurer under any workmen's compensation or disability benefits law or any similar law; (e) to the first S250 of the amount of property damage to the prop erty of each insured as the result of any one accident: (f) so as to inure directly or indirectly to the benefit of any insurer of property. II. PERSONS INSURED Each of the following is an insured under this insurance to the extent set forth below: (a) the named insured and any designated insured and. while resi dents of the same household, the spouse and relatives of either (b) any other person while .occupying an insured highway vehicle: and (c) any person, with respect to damages he is entitled to recover because of bodity iniury to which this insurance applies sus tained by an insured under (a) or (b) above. The insurance applies separately with respect to each insured, except with respect to the limits of the company's liability, III. LIMITS OF LIABILITY Regardless of the number of (1) persons or organizations who are insureds under this insurance, (2) persons or organizations who sustain bodily injury or property damage, (3) claims made or suits brought os accousb of bodily injury or property damage, or (4) highway vehicles to wtuch this insurance applies, (a) The limit of bodily injury liability stated in tlw Schedule as ap* plieabte to "each person" is the limit of the company's liabilityfor all damages because of bodily injury sustained by one person as the result of any onr accident and. subject to the above pro vision respecting "each person", the limit of liability stated in the schedule as applicable to "each accident" is the total limit of the company's liability for all damages because of bodily in iury sustained by two or more persons as the result of any on* accident. (b) The limit of property damage liability stated in the schedule is the total limit of the company's liability for all damages because of property damage to all property of one or more insureds as the result of any one accident (c) Any amount payable under the terms of this insurance because of bodily injury or property damage sustained in an accident by a person who is an insured shall be reduced by (1) all sums paid on account of such bodily injury or property damage by or on behalf of (i) the owner or operator of the uninsured highway vehicle and (ii) any other person or organization jointly or severalty liable together with such owner or operator for such bodily injury or property damage. including all sums paid under the bodily injury or property dam age liability coverage of the policy, and (2) the amount paid and the present value of all amounts pay able on account of such bodily injury under any workmen's compensation law. disability benefits law or any similar law. (d) Any payment made under this insurance to or for any insured shall be applied in reduction of the amount of damages which be ' may be entitled to recover from any person insured under the bodily injury or property damage liability coverage of the policy. (e) The company shall not be obligated to pay under this insurance that part of the damages which the insured may be entitled to recover from the owner or operator of an insured highway vehicle which represents expenses for medical services paid or payable This endorsement must be attached to the Change Endorsement when issued after the policy is written. CP 04 71 (Ed. 1-74) (OVER) AID 000272 Ragelef 3 under the medicai payments or medical expense coverage of the policy or wtncn represents loss said or oayaDie to the insured under any automotnie physical damage insurance of the policy. IV. POLICY PERiOO: TERRITORY This insurance applies only to accidents which occur during the policy period and within the United States ot America, its territories or posses sions. or Canada. V. ADDITIONAL DEFINITIONS When used in reference to this insurance (including endorsements forming a part of the policy): "bodily injury" means bodily injury, sickness or disease, including death, sustained by an insured under (a) or (b) of the Persons Insured provision: "designated insured" means an individual named in the schedule under Designated Insured: "highway vehicle" means a land motor vehicle or trailer other than (a) a farm type tractor or other equipment designed for use princi pally off public roads, while not upon public roads. (b) a vehicle operated on rails or crawler-treads, or (c) a vehicle while located for use as a residence or premises; "hit-and-run vehicle" means a highway vehicle which causes an accident resulting in bodily injury to an insured or property damage arising out of physical contact of such vehicle with the person or property of the insured or with a vehicle which the insured is occupying at the time of the accident provided: (a) there cannot be ascertained the identity of either the operator or owner of such highway vehicle: (b) the insured or someone on his behalf shall have reported the accident within 24 hours to a police, peace or judicial officer or to the Commissioner of Motor Vehicles, and shall have filed with the company within 30 days thereafter a statement under oath that the insured or his legal representative has a cause &r causes of action arising out of such accident for damages against a per son or persons whose identity is unascertainable. and setting forth the facts in support thereof; and (c) at the company's request, the insured or his legal representative makes available for inspection the vehicle which the insured was occupying at the time of the accident; "insured highway vehicle'' means a highway vehicle: (a) described in the schedule as an insured highway vehicle to which the bodily injury and property damage liability coverage of the policy applies; (b) while temporarily used as a substitute for an insured highway vehicle as described in subparagraph (a) above when withdrawn from normal use because of its breakdown, repair, servicing, loss or destruction: (c) while being operated by the named or designated insured or by the spouse of either if a resident of the same household; but the term "insured highway vehicle" shall not include: (i) a vehicle while used as a public or livery conveyance, unless such use is specifically declared and described in the policy; (ii) a vehicle while being used without the permission of the owner: (iii) under subparagraphs (b) and (c) above, a vehicle owned by the named insured, any designated insured or any resident of the same household as the named or designated insured; or (iv) under subparagraphs (b) and (c) above, a vehicle furnished for the regular use of the named insured or any resident of the same household: "occupying" means in or upon or entering into or alighting from: "property damage" means injury to or destruction of (i) an insured high way vehicle owned by the named insured or his spouse, if a resident of the same household, (ii) any property owned by an insured under (a) or (b) ol the Persons Insured provision while contained n sue* ensured highway vehicle and (m) any property owned by an insured uncer tai of the Persons Insured provision while contained m any insured highway vehicle: "state" includes the District ot Columbia, a territory or possession ot the United States, and a province ot Canada: "uninsured highway vehicle" means: (a) a highway vehicle with respect to the ownership, maintenance or use of which there is. m at least the amounts specified by the financial responsibility law ol the state m which the insured highway vehicle is principally garaged, no bodily injury and prop erty damage liability bond or insurance policy applicable at the time ot the accident with respect to any person or organisation legally responsible for the use of such vehicle, or with respect to which there is a bodily injury and property damage liability bond or insurance policy applicable at the time of the accident but the company writing the same denies coverage thereunder or is or becomes insolvent; or (b) a hit-and-run vehicle: but the term "uninsured highway vehicle", shall not include: (i) an insured highway vehicle. (ii) a highway vehicle which is owned or operated by a self-in surer withia the meaning of any motor vehicle financial responsibility law. motor carrier law or any simitar law. (iii) a highway vehicle which is owned by the United States of America. Canada, a state, a political subdivision of any such government or an agency of any of the foregoing. VI. ADDITIONAL CONDITIONS A. Policy Provision*. None of the Insuring Agreements. Exclusions. Conditions or other pro visions of the policy shall apply to the insurance afforded by this endorse ment except the Conditions "Notice" (or "Insured's Duties in the Event of Occurrence. Claim or Suit"), "Changes". "Assignment". ,<CaaceHatii" and "Declarations". B. Premium. r If during the policy period the number of insured highway vehicles owned by the named insured or spouse or the number af dealer's license plates issued to the named insured changes, the named insured shall notify the company during the policy period of any change and the premium shall be adjusted in accordance with the manuals in use by the company. If the earned premium thus computed exceeds the advance premium paid, the named insured shall pay the excess to the company; if less, the company shall return to the named insured the unearned portion paid by such in sured. C. Proof of Claim. As soon as practicable, the insured or other person making claim shall gjve to the company written proof of claim, under oath if required, includ ing full particulars of the nature and extent of the injuries, treatment, and other details entering into the determination of the amount payable here under. The insured and every other person malting claim hereunder shall submit to examinations under oath by any person named by the company and subscribe the same, as often as may reasonably be required. Proof of claim shall be made upon forms furnished by the company unless the com pany shall have failed to furnish such forms within 15 days after receiving notice of claim. The injured person shall submit to physical examinations by physicians selected by the company when and as often as the company may reasonably require and he. or in the event of his incapacity his legal representative, or m the event of his death his legal representative or the person or persons entitled to sue therefor, shall upon each request from the company execute authorization to enable the company to obtain medical reports and copies of records. The insured or other person making claim for damage to property shall file proof of loss with the company within sixty days after the occurrence of loss, unless such time is extended in writing by the company, in the form of a sworn statement setting forth the interest of the insured and of all others in the property affected, any encumbrances thereon, the actual cash value thereof at time of loss, the amount, place, time and CP 04 71 (Ed. 1-74) AID 000273 Pafe2rf3 cause of such loss, and tne description and amounts of all other insurance covering such property. Upon the company's request, the insured shall exhibit the damaged property to the company. D. Assistance and Cooperation of the Insured. After notice of claim under this insurance, the company may require the insured to take such action as may be necessary or appropriate to pre serve his ngnt to recover damages from any person or organization alleged to be legally responsible for the bodily miury or property damage: and in any action against the company, the company may require the in sured to join such person or organization as a party defendant. L Notice of Legal Action. If. before the company makes payment of loss hereunder, the insured or his legal representative shall institute any legal action for bodily injury or property damage against any person or organization legally responsible for the use of a highway vehicle involved in the accident, a copy of the summons and complaint or other process served in connection with such legal action shall be forwarded immediately to the company by the insured or his legal representative F. Other Insurance. With respect to bodily miury to an insured while occupying a highway vehicle not owned by the named insured, this insurance shall apply only as excess insurance over any other similar insurance available to such insured and .applicable to such vehicle as primary insurance, -and this insurance shalliithen apply only in the amount by which the limit of liability for this coverage exceeds the applicable limit of liability of such other insurance. Except as provided m the foregoing paragraph, if the insured has other similar bodily miury insurance available to him and applicable to the accident, the damages shall be deemed not to exceed the higher of the applicable limits of liability of this insurance and such other insurance, and the company shall not be liable for a greater proportion of any loss to which this coverage applies than the limit of liability hereunder bears to the sum of the applicable limits Of liability of this insurance and such other insurance. With respect to property damage, the insurance hereunder shall apply only as excess insurance over any other valid and collectible insurance of any kind applicable to such property damage, and this insurance shall apply only in the amount by which the limit of liability for this coverage exceeds the amount recoverable under such other insurance. G. Arbitration. If any person making claim hereunder and the company do not agree that such person is legally entitled to recover damages from the owner or opera tor of an uninsured highway vehicle because of bodily injury or property damage to the insured, or do not agree as to the amount of payment which may be owing under this insurance, then, upon written demand of either, the matter or matters upon which Such person and the company do not agree shall be settled by arbitration, which shall be conducted in accor dance with the rules of the American Arbitration Association unless other means of conducting the arbitration are agreed to between the insured and the company, and judgment upon the award rendered by the arbitrators CP 04 71 (Ed. 1-74) may be entered in any court having jurisdiction thereof Such person and the company each agree to consider itself bound and to be bound by any award made by the arbitrators pursuant to this insurance. H. Trust Agreement In the event of payment to any person under this insurance: (a) the company shall be entitled to the extent of such payment to the proceeds of any settlement or iudgment that may result from the exercise of any rights of recovery of such person against any person or organization legally responsible for the bodily miury or property damage because of which such payment is made: (b) such person shall hold in trust for the benefit of the company all rights of recovery which he shall have against such other person or organization because of the damages which are the subject of claim made under this insurance: (c) such person shall do whatever is proper to secure and shall do nothing after loss to preiudice Such rights: (d) if requested in writing by the company, such person shall take, through any representative designated by the company, such action as may be necessary or appropriate to recover such pay ment as damages from such other person or organization, such action to be taken in the name of such person; in the event of a recovery, the company shall be reimbursed out of such recovery for expenses, costs and attorneys' fees incurred by It in connec tion therewith; (e) such person shall execute and deliver to the company such in struments and papers as may be appropriate to Secure the rights and obligations of such person and the company established by this provision. I. Payment of Loss by the Company. Any amount due hereunder is payable (a) to the insured, or (b) if the insured be a minor to his parent or guardian, pr (c) if the insured be deceased to his surviving spouse, otherwise (d) to a person authorized by law to receive such payment or to a person legally entitled to recover the damages which the payment represents: provided, the company may at its option pay any amount due hereunder in accordance with division (d) hereof. 1. Action Against Company. No action shall lie against the company unless, as a condition precedent thereto, the insured or his legal representative has fully complied with all the terms of the policy applicable to this coverage. K. This endorsement replaces any other provisions of the policy, includ ing any endorsement forming a part thereof, affording similar insurance with respect to any damages arising out of the ownership, maintenance or use of an uninsured vehicle or a hit-and-run vehicle. Page 3 of 3 AID 000274 company shall not be liable under this endorsement for a greater propor tion of such loss than the applicable limit of liability hereunder bears to the total applicable limits of iiaoility of all valid and collectible insurance against such loss. G. Arbitration. If any person making claim hereunder and the company do not agree that such person is legally entitled to recover damages from the owner or opera tor; of an uninsured automobile because of bodily injury or property damage sustained by the insured, or do not agree as to the amount of pay ment which may be owing under this endorsement, then, upon written demand of such person, the mattei or matters upon which such person and the company do not agree snail be settled by arbitration m accordance with the rules of the American Arbitration Association, and judgment upon the award rendered by the arbitrators may be entered m any court having jurisdiction thereof. Such person and the company each agree to consider itself bound and to be bound by any award made by the arbitrators pur suant to this endorsement. H. Trust Agreement In the event of payment to any person under this endorsement: (a) the company shall be entitled to the extent of Such payment to the proceeds of any settlement or lodgment that may result from the exercise of any rights of recovery of such person against any person or organization legally responsible for the bodily injury or property damage because of which such payment is made: (b) such person shall hold in trust for the benefit of the company all rights of recovery which he shall have against such other person or organization because of the damages which are the subject . of claim made under this endorsement: (c) such person shill do whatever is proper to secure and shall do nothing after loss to prejudice such rights; CP 04 73 (Ed. 1-74) CP 04 73 (Ed. 1-74) (d) if requested in writing by the company, such person shall take, through any representative designated by the company, such action as may be necessary or appropriate to recover such pay ment as damages from such other person or organization, such action to be taken in the name of such person: in the event of a recovery, the company shall be reimbursed out of such recovery for expenses, costs and attorneys' fees incurred by it in connec tion therewith: (e> such person shall eiecute and deliver to the company such in struments and papers as may be appropriate to secure the rights and obligations of such person and the company established by this provision. I. Payment of toss by the Company. Any amount due hereunder is payable (a) to the insured, or (bj if the insured be a minor to his parent or guardian, or (c) if the insured be deceased to his surviving spouse, otherwise (d) to a person authorized by law to receive such payment or to a person legally entitled to recover the damages which the payment represents: provided, the company may at its option pay any amount due hereunder in accordance with division (d) hereof. J. Action Against Company. No action shall lie against the company unless, as a condition precedent thereto, the insured or his legal representative has fully complied with all the terms of this endorsement K. This endorsement replaces any other provisions ofthe policy, includ ing any endorsement attached thereto, affording similar insurance with respect to any damages arising out of the ownership, maintenance or use of an uninsured automobile or a hit-and-run vehicle P*C* 3 f 3 AID 000275 behalf shall have reported the accident within 24 hours or as soon thereafter as may be practicable te a police, peace or judicial officer or to the Commissioner of Motor Vehicles, and shall within a reasonable time have given notice to the company of his miury. the extent thereof, and the time, date and place of such injury: and (m) at the company's request the insured or his legal representative makes available for inspection any automobile which the insured was occupying at the time of the accident (e) Occupying. The word "occupying" means in or upon or entering into or alighting fro*. (f) State. The word "state" includes the District of Columbia, a ter ritory or possession of the United States, and a province of Canda. Ilf. Pdicy Period. Territory This endorsement applies only to accidents which occur on and after the effective date hereof, dunng the policy period and within the United States of America, its territories or possessions, or Canada. Exclusions This endorsement does not apply: (a) to bodily injury to an insured, care or loss of services recoverable by an insured or injury to or destruction of property of an insured, with respect to which such insured or his legal representative shall, without written consent of the company, make any settle ment with any person or organization who may be legally liable therefor (b) so as to inure directly or indirectly, to the benefit of any work men's compensation or disability benefits carrier or any person cr organization qualifying as a self-insurer under any workmen's compensation or disability benefits law or any simitar law; (c) so as to mure directty or indirectly to the benefit of any insurer of property; (d) to injury to or destruction of an automobile, or the contents thereof, other than an insured automobile as defined herein. CondSews A. Petiey PrtyisieK. None of the Insuring Agreements. Exclusions, Conditions or Other Provi sions of the policy shall apply to the insurance afforded by this endorse ment except the Conditions "Notice" (or "Notice of the Insured's Duties in the Event of Occurrence. Claim or Suit"). "Changes". "Assignment". "Cancellation" and "Declarations '. B. Premium. If during the policy period the number of automobiles owned by the named insured and registered or principally garaged m North Carolina or the number of North Carolina dealers license plates sand to the named insured changes, the named insured shall notify the company during the policy period of any change and the premium shall be adjusted in accor dance with the manuals in use by the company. If the earned premium thus computed exceeds the advance premium paid, the named insured shall pay the excess to the company; if less, the company shaN return to the named insured the unearned portion paid by such insured. C. Praei f Claim. As soon as practicable, the insured or other person making claim shall give to the company written proof of claim, under oath if required, includ ing full particulars of the nature and extent of the injuries, treatment, and . other details, entering into the determination of the amount payable here under. Proof ,of claim shall be made upon forms furnished by the company unless the company shall have failed to furnish such forms withia 15 days after receivings notice of claim. The injured person shah submit to physical examinations by physicians selected by the company when and as often as the company may reasonably require and he. or in the event of his incapacity his legal representative, or in the event of his death his legal representative or the person or persons entitled to sue therefor, shall upon each request from the company ex ecute authorization to enable the company to obtain medical reports and copies of records CP 04 73 (Ed. 1-74) The insured or other person making claim for damage to property shall file proof of loss with the company within sixty days after the occurrence of loss, unless such time is extended in writing by the company, in the form of a sworn statement setting forth the interest of the insured and of aH others m the property affected, any encumbrances thereon, the actual cash value thereof at time of loss, the amount, place, time and cause of such loss, and the description and amounts of all other insurance covering such property. Upon the company's request, the insured shall exhibit the damaged property to the company. After notice of claim, the company may require the insured to take such action as may be necessary or appropriate to preserve his right to recover damages from any person or organization alleged to be legally responsible for ttiei bodily injury or property damage. D. Nwttce ef legal Aetna Undwr North Carwfini S.S. 20-279.21 (b) (3). No legal action for bodily injury or property damage against any person or organization alleged to be legally responsible for the use of an automo bile involved in the accident shall be initiated by the insured until GO days following the posting of notice to the company at the address shown on the policy or after personal delivery of such notice to the company or its agent setting forth the belief of the insured that the prospective defendant or defendants are uninsured motorists. The company shall not be bound by a final judgment taken by the insured against an uninsured motorist unless the company las been served with copy of summons, complaint or. other process against the uninsured motorist E. Limits d liabifty. Regardless of the number of (1) persons or organizations who are insureds under this insurance. (2) persons or organizations who sustain bodily injury or property damage. (3) claims made or suits brought on account of bodily ntjtiry or property damage, or (4) automobiles te which-tfcs insurance wnfies (a) The limit of bodily injury lability stated m the schedule as ap plicable to "each person" is the limit of the company's lability for all damages, including damages for are or loss of services, because of bodily injury sustained by one person as the result of any o k accident and, subject to the above provisions respect ing each person, the limit of such lability stated m the schedule as applicable to "each accident" is the total limit of the com pany's liability for all damages, including damages for are or loss of services, because of bodily miury sustained by two or more persons as the result of any o k acmirwt. (b) The limit of property damage liabdfty stated in the schedule as appliable to 'each accident" is the total limit of the company's liability.for.all damages arising out of injury to or destruction' of ad prupertyof o k or more insureds as the result of any o k accident (c) If claim is made under this endorsement and claim is also made against any person who is an insured under the Bodily Injury liability or Property Damage Liability coverages of the policy because of bodily injury or property damage sustained m an accident (by a person who is an insured under this endorsement: (1) any oayment made under this endorsement to or for any such person shall be applied 8" reduction of any amouirt which ha may be entitled to recover from any person who is an insured under the Bodily injury liability or Property Damage Liability coverages; and (2) any payment made under the Bodily Injury Liability or Property Damage Liability coverages to or for any such person shall be applied in reduction of any amount which he may be entitled to recover under this endorsement (d) Any amount payable to an insured under the terms of this en dorsement shall be reduced by (1) alt sums paid to such insured for bodily injury or property damage iby or on behalf of a person legally liable therefor. (2) the amount paid and the present value of all amounts payable to such an insured under any workmen's compensation law. exclusive of non-oceupationil disability benefits and (3) the amount paid or (payable to such an insured under any policy of property insurance. F. Other Insurance. With respect to bodily injury to an insured, i! the insured has other simitar insurance available to him against a loss covered by this endorsement the A ID 000276 CP '04? 73 (Ed. 1-74) Page 2 ef 3 AMENDING POLICY HO. TR-NSL-t2^1693-3-7$ CP 04 73 (Ed. i 7*1 UNINSURED MOTORISTS INSURANCE (Specified Cj t Boa) (North Carolina) In consideration of the payment of the premium for this endorsement the company agrees with the named insured, subject to the limits of liability, exclusions, conditions and other terms of this endorsement and to the applicable terms of the policy: Schedule Limits of Liability: Bodily Injury S 151Wrench person; g30y000 each accident Property Damage S .-5.jfi9Peach accident The additional premium for this endorsement is S 14 Insuring Agreements I. Damages for Bodily Injury and Property Damage Caused by Unin sured Automobile* To pay all sums which the insured or his legal representative shall be legally entitled to recover as damages front the owner or operator of an uninsured automobile because of: (a) bodily injury, sickness or disease, including death resulting, therefrom, hereinafter called "bodily injury", sustained by the insured; (b) injury to or destruction of the property of such insured, herein-, after called "property damage", with a limit in the aggregate for all insureds in any one accident as set forth in the property dam age schedule of this endorsement, and subject for each insured, to an exclusion of the first One Hundred Dollars ($100) of such damages; caused by accident and arising out of the ownership, maintenance or use of such uninsured automobile. For the purposes of this endorsement, determination as to whether the insured or such representative is legally entitled to recover such dam ages. and if so the amount thereof, shall be made by agreement between the insured or such representative and the company or, if they fail to agree and the insured so demands, by arbitration; but if the insured elects not to arbitrate, the liability of the company shall be determined only in an action against the company. In any action against the company, except an action to determine Whether an automobile is an uninsured automobile, the com pany may require the insured to join such person or organization as a party defendant II. Definitient (a) Insured. With respect to the bodily injury coverage afforded under this endorsement the unqualified word "insured" means; (1) the named insured; (2) any person while occupying an insured automobile; and (3) any- person, with respect to damages he is entitled to re cover for care or loss of services because of bodily injury to which this endorsement applies. With respect to the property damage coverage afforded under this endorsement, the unqualified word "insured" means: (1) the named insured; and (2) any other person using an insured automobile. The insurance applies separately with respect to each insured under this endorsement, but neither this provision nor application of the insurance to more than one insured shall operate to increase the limits of the com pany's liability. (b) Insured Automobile. The term "insured automobile" means; (l) an automobile owned by the named insured which, as of the inception date of this endorsement, is registered or principally garaged in North Carolina, or which has become registered or principally garaged in North Carolina during the policy period: (2) any automobile owned by the named insured to which is attached North Carolina dealers license plates issued to the named insured; and to which the liability coverage of the policy applies, while such automobile is being used by or with the permission of the named insured as stated ip the policy but shall not include an automobile while used as a public or livery conveyance unless such use is specifically declared and described m this endorse ment (c) Uninsured Automobile. The term "uninsured automobile" means; (1) with respect to damages for bodily injury and property dam age an automobile or other vehicfe with respect to the owner ship, maintenance or use of which there is. in at least the amounts specified in Subsection (c) of Section 20-279.5 of the North Carolina Motor Vehicle Safety and. Financial Responsibility Act. neither (i) cash or securities on file with the North Carolina Commissioner of Motor Vehicles nor (ii) a bodily injury and property damage liability bond or insur ance policy, applicable to the accident with respect to any person or organization legally responsibft- for the use of such automobile or velucle, or with respect to which there is a bodily injury and property damage Rabiiity insurance policy applicable at the time of the acetdh'nt but the com pany writing the same either (a) denies coverage there under or (b) has become bankrupt or is unable to make payment because of insolvency occurring within three years after such accident (a written statement by the lia bility insurer whose name appears on the certification of financial responsibility made by the owner of any vehicle involved m an accident with the insured that such othet motor vehicle is not covered by insurance at the time of the accident with the insured shall operate as a prima facie presumption that the operator of such other motor vehicle was uninsured at the time of the accident with the insured):, or (2) with respect to damages for bodily injury only a hit-and-run automobile as defined; but the term "unmsored automobile" shall not include: (i) a vehicle owned by the named insured; (ii) a vehicle which is owned or operated by a self-insurer within the meaning of any motor vehicle financial responsibility law. motor earner law or any similar law; (iii) a vehicle which is owned by the United States of America, Canada, a state, or any agency of any of the foregoing ex cluding political subdivisions thereof; (iv) a vehicle if operated on rails or crawler-treads or while located for use as a residence or premises and not as a vehi cle; or (v) a farm type tractor or equipment designed for use princi pally off public roads, except while actually upon public roads. (d) HK-ind-Run Automobile. The term "hit-and-run automobile" means an automobile, other than one in which an insured is a passenger, which causes an accident resulting in bodily injury to an insured, arising out of physical contact of such vehicle with the insured or with a vehicle which the insured is occupying at the time of the accident, provided: (i) there cannot be ascer tained the identity of either the operator or the owner of such "hit-and-run automobile"; (ii) the insured or someone on his This endorsement must be attached to the Change Endorsement when issued after the policy is written. CP 04 73 (Ed. 1-74) AID 000277 Page 1 of 3 Except *s provided in . .oregoing paragraph, if the insured has other similar insurance available to him and applicable to the accident the dam ages shall be deemed not to exceed the higher of the applicable limits of liability of this insurance and such other insurance, and the company shad not be liable for a greater proportion of any loss to which this coverage applies than the limit of liability hereunder bears to the sum of the applica ble limits of liability of this insurance and such other insurance. S. Arbitration. If any person making claim hereunder and the company do not agree that such person is legally entitled to recover damages from the owner or opera tor of an uninsured highway vehicle because of bodily miury to the insured, or do not agree as to the amount of payment which may be owing under this msuranceithen. upon written demand of either, the matter or matters upon which such person and the company do not agree shall be settled by arbitration, which shall be conducted m accordance with the rules of the American Arbitration Association unless other means of conducting the arbitration are agreed to between the insured and the company, and judg ment upon the award rendered by the arbitrators may be entered in any court having jurisdiction thereof. Such person and the company each agree to consider itself bound and to be bound by any award made by the arbi trators pursuant to this insurance. If agreement by arbitration is not reached within three months from date of demand, the insured or his legal representative may institute any legal action for bodily injury against any person or organization legally responsible for the use of a highway vehicle involved mthei accident H. Trust Agreement. In the event of payment to any person under this insurance: (a) the company shall be entitled to the extent of such payment to the proceeds of any settlement or judgment that may result from the exercise of any rights of recovery of such person against any person or organization legally responsible for the bodily injury because of which such payment is made: (b) such person shall hold in trust for the benefit of the company all rights of recovery which he shall have against such other person or organization because of the damages which are the subject of claim made under this insurance: CP 04 74 (Ed. 1-74) (c) such person shall do wlu is proper to secure and shall ao nothing after loss to prejudice such rights: (d) if requested in writing by the company, such person shall take, through any representative designated by the company, such action as may be necessary or appropriate to recover such pay ment as damages from such other person or organization, such action to be taken in the name of such person: in the event of a recovery, the company shall be reimbursed out of such recovery for expenses, costs and attorneys' fees incurred by it in connec tion therewith: (e) such person shall execute and deliver to the company such in struments and papers as may be appropriate to secure the rights and obligations of such person and the company established by this provision. I. Payment of Loss by the Company. Any amount due hereunder is payable (a) to the insured, or (b) if the insured be a minor to his parent or guardian, or (c) if the insured be deceased to his surviving spouse, otherwise (d) to a person authorized by law to receive such payment or to a person legally entitled to recover the damages which the payment represents: provided, the company may at its option pay any amount due hereunder in accordance with division (d) hereof. i. Action Against Company. No action shall lie against the company unless, as a condition precedent thereto, the insured or his legal representative las fully complied with aH the terms of the policy applicable to this insurance. K. This endorsement replaces any other provisions of the policy, includ ing any endorsement forming a part thereof, affording similar iuunnca with respect to any damages arising out of the ownership, maintenance or use of an uninsured vehicle or a hit-and-run vehicle. Page 3 ef 3 # AID 000278 insured" means an individual named in the schedule under Desifnated Insured and also includes his spouse, if a resident of the same household; "highway vohieJt" means a sett-propelled land mptor vehicle or trailer, other than (a) a farm type tractor or other equipment designed for use princi pally off public roads, while not upon public roads. (b) a vehicle operated on rails or crawler-treads, or (c) a vehide while located for use as a residence or premises; "Mt-and-run vehicle" means a highway vehicle which causes bodily injury arising out of physical contact of such vehicle with the insured or with a vehicle which the insured is occupying at the time of the accident. provided: (a) there cannot be ascertained the identity of either the Operator or owner of such highway vehicle: (b) the insured or someone on his behalf shall have reported the accident within U hours to a police, peace or judicial officer or to the Commissioner of Motor Vehicles, and shall have filed with the company within 30 days thereafter a statement under oath that the insured or his legal representative has a cause or causes of action arising out of such accident for damages against a per son or persons whose identity is unascertamabie, and setting forth the facts in support thereof; and (c) at the company's request, the insured or his legal representative makes available for inspection the vehicle which the insured was occupying at the time of the accident; "bund highway vehide" means a highway vehide to which the bodily injury liability coverage of the policy applies and which is: (a) described in the schedule as an insured highway vehicle; (b) being used temporarily as a substitute for an insured highway vehicle as described in subparagraph (a) above, when withdrawn from normal use because of its breakdown, repair, servicing, loss or destruction; or (c) being operated by the named or designated insured or, if a resi dent of the same household, a relative of either; hut the term "insured highway vehicle" shall not include; (i) a vehide while used as a public or livery conveyance, un- less such use is specifically dedared and described in the . policy; (ii) a vehicle while being used without the permission of the ` owner; (iii) under subparagraphs (b) and (c) above, a vehicle owned by the named insured, any designated insured or any resi dent of the same household as the named or designated insured: or (iv) under subparagraphs (b) and (c) above, a vehicle furnished for the regular use of the named insured or any resident of the same household; "named insured" means the individual named in Item 1 of the declarations and also includes his spouse, if a resident of the same household; "occupying" means in or upon or entering into or alighting from; "state" includes the District of Columbia, a territory or possession of the United States, arid a province of Canada; "uninsured highway vehicle" means: (a) a highway vehicle with respect to the Ownership, maintenance or use of which there is. in at least the amounts specified by the financial responsibility law of the state in which the insured highway vehicle is principally garaged, no bodily injury liability bond or insurance policy applicable at the time of the accident with respect to any person or organization legally responsible tor the use of such vehicle, or with respect to which there is a bodily injury liability bond or insurance policy applicable at the time of the accident but the company writing the same denies coverage thereunder or is or becomes insolvent: or (b) a hit-and-run vehicle; but the term "uninsured highway vehicle" shall not include: (i) an insured highway vehicle. (ii) a highway vehicle which is owned or operated by a self-in surer within the meaning of any motor vehicle financial responsibility law, motor carrier law or any similar law. (iii) a highway vehicle which is owned by the United States of America. Canada, a state, a political subdivision of any such government or an agency of iny of the foregoing. VI. ADDITIONAL CONDITIONS A. Policy Premium. None of the Insuring Agreements. Exclusions. Conditions or other pre visions of the policy shall apply to the insurance afforded by this endorse ment except the Conditions "Notice" (or "Insured's Duties in the Event of Occurrence. Claim or Suit"). "Changes", "Assignment", "Cancellation" and "Declarations". B. Prtmium. If during the policy period the number of insured highway vehicles owned by the named insured or the number of dealer's license plates issued to the named insured changes, the named insured shall notify the company during the policy period of any change and the premium shall be adjusted in accordance with the manuals in use by the company. If the earned pre mium thus computed exceeds the advance premium paid, the named in sured shall pay the excess to the company; if less, the company shall return to the named insured the unearned portion paid by such insured. C. Proof of Claim. As soon as practicable, the insured or other person making claim shaU give to the company written proof of claim, under oath if required, includ ing full particulars of the nature and extent of the injuries, treatment and other details entering into the determination of the amount payable here under. The insured and every other person making claim hereunder shall submit to examinations under oath by any person named by the company and subscribe the same, as often as may reasonably be required. Proof of claim shall; be made upon forms furnished by the company unless the company shall have failed to furnish such forms within 15 days after re ceiving notice of claim. The injured person shall submit to physical examinations by physicians selected by the company when and as often as the company may reason ably require and he, or in the event of his incapacity his legal representa tive, or in the event of his death his legal representative or the person or persons entitled to sue therefor, shall upon each request from the company execute authorization to enable the company to obtain medical reports and copies of records. D. Assistant* and Caoporition af the Intorod. After notice of claim under this insurance, the company may require the insured to take such action as may be necessary or appropriate to pre serve his right to recover damages from any person or organization alleged to be legally responsible for the bodily injury; and in any action against the company, the company may require the insured to join such person or organization as a party defendant. E. Notice of Legal Action. If, before the company makes payment of loss hereunder, the insured or his legal representative shall institute any legal action for bodily injury against any person or organization legally responsible for the use of a highway vehicle involved in the accident, a copy of the summons end com plaint or other process served in connection with such legal action shall be forwarded immediately to the company by the insured or his legal represen tative; F. Other Insurance. With respect to bodily injury to an insured while occupying a highway vehicle not owned by the named insured, this insurance shall apply only as excess insurance over any other similar insurance available to such insured and applicable to such vehicle is primary insurance, and this insurance shall then apply only in the amount by which the limit of liability for this coverage exceeds the applicable limit -of liability of such other insurance. CP 04 74 (Ed. 1-74) AID 000279 Page Z of 3 a /flPv V|i|/ AKENDittG POL!';' NO.TP-ii.jL- 17^693-?-Li UNINSURED MOTORISTS INSURANCE (Oklahoma) CP 04 74 (Ed 174) In consideration of the payment of premium and subiect to all of the pro visions of this endorsement and to the applicable prolusions of the policy, the company stress with the named insured as follows; Schedule Designatad Insured: Limits of Liability; Bodily Injury; j . .f999 each person Advance Premium $ I' NCL IN COMPOSITE pjrh accident Description of Insured Highway Vehicles; Any highway vehicle registered or principally garaged in Okla homa which is; (check appropriate boa) An owned automobile under Part I of the policy G A private passenger automobile owned by the named insured G byOwned the named insured G Designated in the declarations of the policy and any highway vehicle of the same type ownership of which is acouired during the pohcy period by the named insured as a replacement therefor G Any mobile equipment owned by the named insured G --:--------------------------------------------;----------------------------------- I. C0VERA6E UNINSURED MOTORISTS (Damages for Bodily Injury Caused by Uninsured Highway Vehicles) The company will pay in accordance with Title 36 Oklahoma Statutes 1961 all sums which the insured or his legal representative shall be legally en titled to recover as damages from the owner or operator of an uninsured highway vehicle because of bodily injury caused by accident and arising out of the ownership, maintenance or use of such uninsured highway vehicle: provided, for the purposes of this coverage, determination as to whether the insured or such representative is legally entitled to recover such damages, and if so the amount thereof, shall be made by agreement between the insured or such representative and the company or. if they fail to agree, by arbitration. No judgment against any person or organization alleged to be legally re sponsible for the bodily injury shall be conclusive, as between the insured and the company, of the issues of liability of such person or organization or of the sAbunt of damages to which the insured is legally entitled unless such judgment is entered pursuant to an action prosecuted by the insured with the written consent of the company. Exclusions This insurance does not apply. (a) to bodily injury with respect to which the insured, his legal rep resentative or any person entitled to paymenbunder this insur ance shall, without written consent of the company, make any settlement with any person or organization who may be legally liable therefor (b) to bodily injurpAo as insured while occupying a highway vehicle (other than an insured highway vehicle) owned by the named insured, any designated insured or any relative resident in the same household as the named or designated insured, or through being struck by such a vehicle, but this exclusion does not apply to the named insured or his relatives while occupying or it struck by a highway vehicle owned by a designated insured or his rela tives; (c) so as to inure directly or indirectly to the benefit of any work men's compensation or disability benefits carrier or any person or organization qualifying as a satf-insurer under any workmen's compensation or disability benefits law or any similar law. II. PERSONS INSURED Each of the following is an insured under this insurance to the extent sat forth below; (a) the named insured and any designated insured and. while resi dents of the same household, the spouse and relatives of either. (b) any other person while occupying an insured lughwty vehicle; and (c) any person, with respect to damages he is entitled to recover because of bodily miury to which this insurance applies sus tained by an insured under (a) or (b) above. The insurance applies separately with respect to each insured, except with respect to the limits.of the company's liability. , III. LIMITS OF LIABILITY Regardless of the number of (1) persons or organizations who are insureds under this insurance; (2) persons who sustain bodily injury. (3) claims made or suits brought on account of bodily injury, or (4) highway vehicles to which this insurance applies. (a) The limit of bodily injury liability stated in the schedule as ap plicable to 'leach person" is the limit of the company's liability for all damages because of bodily injury sustained by one person as the result of any one accident arid, subject to the above pre vision respecting "etch person", the limit of liability stated in the schedule as applicable to "each accident" is the total limit of the company's liability for all damages because of bodily in jury sustained by two or more persons as the result aFany one accident - (b) Any amount payable under the terms of this insurant*btcauea of bodily injury sustained in an accident by a person-who is an insured shall be reduced by (1) all sums paid on account of such bodily injury by or on behalf of (i) the owner or operator of the uninsured highway vehi cle and (ii) any other person or organization jointly or severaUy liable together with such owner or operator for such bodily injury. including all sums paid under the bodily injury liability coverage of the policy and (2) the amount paid and the present value of all amounts pay able on account of such bodUy injury under any workmen's compensation law. disability benefits law or any similar law. (c) Any payment made under this insurance to or for any insured shall be applied in reduction of the amount of damages which he may be entitled to recover from any person or organization insured under the bodily injury liability coverage of the policy. (d) Any payment made under this insurance to or for any insured which represents expenses for medical services shall be applied in reduction of the amount of expenses to which the medical payments of medical expense coverage of the policy applies IV. POLICY PERIOD; TERRITORY This insurance applies only to accidents which occur during the pelrcy period and within the United States of America, its territories or posses sions or Canada. V. ADDITIONAL DEFINITIONS When used in reference to this insurance (including endorsements forming a part of the policy): "bodily injury" means bodily injury, sickness or disease, including death, sustained by an insured under (a) or (b) of the Persons Insured provision; This endorsement must be attached to the Change Endorsement when issued after the policy is writtea CP 04 74 (Ed. 1-74) (OVER) AID 000280 Pagelf3 <s> UNINSURED MOTORISTS INSURANCE (Specified Car Bash) (Virginia) CP 04 76 (Ed. 1-74). In consideration of the payment of the premium for this endorsement, the company agrees with the named insured, subject to the limits of liability, exclusions, conditions and other terms of this endorsement and to the applicable terms of the policy: Limits of Liability: Bodily Injury t Schedule Property Damage i The additional premium for this endorsement is J Mfh permit each irnrlrnt each accident Insuring Agreements I. Damages far Bedffy Injury and Proparty Damage Caused by (In sured Meter tfcMdcs To pay. in accordance with Section 38.1-381 of the Code of Virginia and ail -Acts amendatory thereof or supplementary thereto, all sums which the insured or his legal representative shall be legally entitled to recover as damages from- the owner or operator of an uninsured motor vehicle be cause of: (a) bodily injury, sickness or disease, including death resulting therefrom, hereinafter called "bodily injury", sustained by the insured: (b) injury to or destruction of (1) an insured automobile and its contents and (2) any other property (except an automobile) owned by an insured and located in Virginia, hereinafter called "property damage"; caused by accident and arising out of the ownership, maintenance or use of such uninsured motor vehicle. II. DefhdtiMi (a) Insured. The unqualified word "insured" means: (1) the named insured: (2) any other person while occupying an insured automobile: and (3) any person, with respect to damages he is entitled to re cover tor care or loss of services because of bodily injury to which this endorsement applies. The insurance applies separately with respect to each insured hereunder, but neither this provision nor application of the insurance to more than one insured shall operate to increase the limits of the company's liability. (b) Insured Automobile. The term "insured automobile" means: (1) an automobile owned by the named insured and registered in Virginia: (2) any automobile owned by the named insured to which is attached Virginia dealer's license plates issued to the named insured; with respect to which the bodily injury and property damage lia bility coverages of the policy apply. (c) Uninsured Meter Vehicle. The term "uninsured motor vehicle" means: (1) a motor vehicle with respect to the ownership, mainte nance or use of which there is, in at least the amounts specified in the Virginia Motor Vehicle Safety Responsi bility Act. neither (i) cash or securities on fils with the Virginia Commissioner of Motor Vehicles nor (ii) a bodily injury and property damage liability bond or insurance policy, applicable at the time of the accident with respect to any person or organization legally responsible for the use of such vehicle, or with respect to which there is such a bond or insurance policy applicable at the time of the accident but the company writing the same is or becomes insolvent or denies coverage thereunder: or (2) a hit-and-run vehicle as defined; but the term "uninsured motor vehicle" shall not include: (i) a motor vehicle which is owned or operated by a self-in surer within the meaning of the Virginia Motor Vehicle Safety Responsibility Act or any motor carrier law or similar law; (ii) a motor vehicle which is owned by the United States of America, the State of Virginia, a political subdivision there of, or an agency of any of the foregoing; (iii) a vehicle operated on rails or while located for use as a residence or premises and not as a vehicle; 9" (iv) a vehicle or other equipment designed for use principally offi public roads, except while actually upon public roads. (d) HR-and-Ren Vehicle. The term "hit-and-run vehicle" means a vehicle which causes an accident resulting m bodily injury to an insured or property damage, provided; (i) there cannot be ascer tained the identity of either the operator or the owner of such "hit-and-run vehicle": and (h ) the insured or someont-oq his behalf shall have reported the accident within 5 days or as soon as practicable to the Commissioner of Motor Vehicles. (e) Occupying. The word "occupying" mans in or upon or edtering into or alighting from. III. Policy Period; Territory This endorsement applies only to accidents which occur on and after tbs effective date hejreof. during the policy period and within the United States of America, its territories or possessions, or Canada. Eielurions This endorsement does not apply: (a) to bodily injury to an insured, care or loss of services recover able by an insured or injury to or destruction of property of an insured, with respect to which such insured, or his legal repre sentative shall, without written consent of the company, make any settlement with any person or organization who may be legally liable therefor; (b) to the first two hundred dollars of the total amount of all prop erty damage as the result of any one accident: (c) so as to inure directly or indirectly to the benefit of any insurer of property. Conditions A. Policy Provisions. None of the Insuring Agreements, Exclusions. Conditions or other provi sions of the policy shall apply to the insurance afforded by this endorse ment except the Conditions "Notice" (or "Insured's Duties in the Event of Occurrence, Claim or Suit). "Subrogation", "Changes", "Assignment", ''Cancellation" and "Declarations '. B. Premium. If during the policy period the number of automobiles owned by the named insured and registered in Virginia or the number of Virginia dealer's license plates issued to the named insured changes, the named insured shall notify the company jluring the policy period of any change and the premium shall be adjusted in accordance with the manuals in use by the company. If the earned premium thus computed exceeds the advance premium paid, the This endorsement must be attached to the Change Endorsement when issued after the policy Is written. CP 04 76 (Ed. 1-74) (OVER) 0 AID 000281 Pagelef2 named insured shall pay the excess to the company; if less, the company shall return to the named insured the unearned portion paid by such in sured. C. Proof of Claim. As soon as practicable, the insured or other person making claim shall give to the company written proof of claim, under oath if required, including full particulars of the nature and extent of the miurtes. treatment, and other details entering into the determination of the amount payable here under. Proof of claim shall be made upon forms furnished by the company unless the company shall have failed to furnish such forms within 15 days after receiving notice of claim. The injured person shall submit to physical examinations by physicians selected by the company when and as often as the company may reason ably require and he, or in the event of his incapacity his legal representa tive; or in the event of his death his legal representative or the person or persons entitled to sue therefor, shall upon each request from the com pany execute authorization to enable the company to obtain medical re ports and copies of records. The insured or other person making claim for damage to property shall file proof of loss with the company within sixty days after the occurrence of loss, unless such time is extended in writing by the company, in the form of a sworn statement setting forth the interest of the insured and of all others in the property affected, any encumbrances thereon, the actual cash value thereof at time of loss, the amount, place, time and cause of such loss, and the description and amounts of all other insurance covering Such property. Upon theeompany's request, the insured shall exhibit the dam aged property to the company. With respect to claims alleged to have arisen out of the ownership, mainte nance or use of a hit-and-run automobile if the insured has not obtained a judgment against John Doe, the liability of the uninsured motorist may be established, as between the insured and the company, by filing with the company within a reasonable time after the accident a statement under oath that the .insured1 or his legal representative has a cause or caused of action arising out of such accident for damages against a person or per sons .whose'Jdentity is unascertainable, setting forth the facts in support thereof, and shall present clear and convincing evidence that there was a hit-and-run automobile involved in the accident. Ds Notice of Legal Action. If. before the company makes payment of loss hereunder, the insured or his legal representative shall institute any legal action for bodily injury or property damage against any person or organization legally responsible for the use of. an automobile involved in the accident, a copy of the sum mons and complaint or other process served in connection with such legal action shall be forwarded immediately to the company by the insured or his legal representative E. LMttmiliy. Regardless of the number of (1) persons or organizations who are insureds under this insurance, (2) persons or organizations who sustain bodily miury or property damage, (3) claims made or suits brought on account of buddy -mury or property damage, or (4) automobiles to which this insurance applies. (a) The limit of bodily injury liability stated in the schedule as ap plicable to "each person" is the limit of the company's liability CP 04 76 (Ed. 1-74) CP 04 76 (Ed. 1-74) for all damages. including damages for can or loss of services, because of bodily injury sustained by one person as the result of any one accident and. subject to tntabovi provision respect ing each person, tbe limit of suck tabrlity stated in the schedule as applicable to "etch accident" is the total limit of the com pany's liability tor all damages, inctqtfng damages for care or loss of services, because of bodily injury sustained by two or more persons as tin result of any one accident. , (b) The limit of property damage lability stated in the schedule as applicable to "each accident" is the total limit pf the company's liability for aft damages arising out ofonjury to dr destruction of all property of ene or more insured* ma result of any one accident. (c) If claim is made hereunder tod t&ffi is atei made Igainst any person who is an Insured under the .Noddy. Injury Liability or Property Damage LMfcty coverages of the policy because of bodily injury or property daauga sustained in ee accident by a pereon who is an insured herewder. any paymatt trade here under to or for. any such ptaauhafl bs applied in reduction of eny amount which brvhty Mrettitled to recover from any per son, who is an insured udder the jMiff Injury-LmbiUty er Prop erty Damage liability coverages. (d) Any amount payable bermtadto heemrsu of Wd% injury or prop erty dmregt sustaiMd -in*0 Midtid bp a pereow'who is an insured under tins coverage shalf-fce-rodcad by-all sums paid on account of such iujury or damage by or on behalf of the owner or oparetor of the-uninsured autombbile. (e) Any amount recoverable is damages because Of bodHy injury or property damage sustained in at aeddgflt by a pereon who is an insured under this cgwtagr shall M rwfaewf by all sums paid on account ef such injury or damage by or an behalf of any pereon or pereon jomgly or teeinfly fabtetogether with the owner or operator of the-uaiwufod mdomabife for Such injury or damage.minding ait-sums paid odder the Bodily In jury Liability- or Property Damage liability coverages of the policy. F. Other iMsrauct. With respect to bodily injury to an hsured whilt occupying at^automobile not owned by the named inured, tha'inuraoea fMjrjoMtr shall apply only as excess insurance overlay attar tawarmurance available to such inured and applicable to such auto*obdogs.primary insurance Except as provided in the foregoing paragraph. IUhe insured'has otter similar bodily injury insurance avaitobS to him andapplicable to the acci dent the company shall not (reliable for 1 greater proportion of any loss to which this coverage applies than Urn (unit of liability heroundarbears to the urn of the applicable limits of liability, of J3w insurarwe and uch other insurance. \. With respect to property damage,the hounded hereuOder.shall apply only as excess insurance over atqr othar v*id arid eoffectlbie insurance of any kind applicable tomb property damage. . G. Payment eflaas by the Company. ' Any amount due hereunder is payable tothtutaoftd or bo-legal represen tative ' ^ ' :^Pagt2o<2 .. * ' ; AID 000282 *` . AMENDING POLICY NO. TS-NSL-12TT633-3-75 NOT APPLICABLE TO TX This endorsement modifies such insurance as is afforded by the provisions of the policy relating to the following: COMPREHENSIVE AUTOMOBILE LIABILITY INSURANCE BASIC AUTOMOBILE LIABILITY INSURANCE AUTOMOBILE MEDICAL PAYMENTS INSURANCE CP 09 23 (Ed 1-74) USE OF OTHER AUTOMOBILES COVERAGE--LIMITED FORM SCHEDULE The insurance afforded because of the naming below of any individual or partnership is only with respect to such and so many of the following coverages as are indicated by specific premium charge or charges for such individual or partnership. Name of Individual or Partnership: Bodily Injury Liability Premium Property Damage Liability Automobile Medical Payments SEE END 8000(0) INCLUDED IN COMPOSITE Total Premium S It is agreed that such insurance as is afforded by the policy, under the bodily injury liability and property damage liability coverages and division 1 of the Automobile Medical Payments coverage, with respect to any owned private passenger automobile covered under the policy also applies with respect to any other automobile, subject to the following additional provisions: 1. Persons Insured With respect to the insurance afforded by this endorsement for bodily injury liability and for property damage liability the "Persons insured" provision policy is replaced by the following: Each of the following is an insured under this insurance to the extent set forth below: (a) each individual named m the schedule of this endorsement and while a resident of the same household, the spouse of such individual, and (b) any other person or organization, not owning or hiring the automobile, but only with respect to his or its liability because of acts or omissions of an insured under (a) above. 2. Exclusions This insurance does not apply: (a) to any insured while engaged in the business of his employer with respect to bodily injury to a fellow employee of such insured injured in the course of his employment: (b) to any insured while employed in or otherwise engaged in duties in connection with an automobile business; (c) if the individual named in the schedule of this endorsement is an employee, to the employer of such individual; (d) if the individual named in the schedule of this endorsement is a partner, to the partnership of which such individual is a member, unless such partnership is designated in the schedule of this endorsement: (e) to any afitomobiit owned by or furnished or available for the regular use of such named individual, his spouse or any resident of the same household other than a private chauffeur or domestic servant of such named individual or spouse: (f) to any automobile while used in the business or occupation of the named individual or spouse except a private passenger automobile operated or occupied by such named individual, spouse, or a private chauffeur or domestic servant of such named individual or spouse: (g) to any automobile while used by any insured as a public or livery conveyance: but this exclusion does not apply to bodily injury or property damage which results from the insured's occupancy of such automobile other than as the operator thereof. 3. Excess Insurance. The insurance afforded by this endorsement for Bodily Injury liability and Property Damage liability shall be excess over any over valid and collectible insurance, whether primary, excess or contingent, available to the insured. The insurance afforded by this endorsement for Automobile Medical Payments shall be excess over any other valid and collectible automobile medical payments or automobile medical expense insurance, whether primary, excess or contingent. This endorsement must be attached to the Change Endorsement when issued after the policy is written. CP 09 23 (Ed. 1-74) AID 000283 rue uu Cela. Perm t--INS t < IHI The Public Utilities Commission of the Bute of Colorado UNITOEM PUBLIC LIABILITY AND PROPERTY DAMAGE ENDORSEMENT The policy to which this endorsement is attached is written in pursuance of, and is to be construed in accordance with, any pne or more of the following laws of the State of Colorado: Chapter 115-9-10--C.R.S. 1963 Chapter 115-11-9--C.R.S. 1963 Chapter 115-10-6--C.R.S. 1963 and the Rules and Regulations of the Public Utilities Commission of the State of Colorado adopted there under and applicable to the Insured. In consideration of the premium stated in the policy to which this endorsement is attached, the Insurer hereby waives a description of the motor vehicle or motor vehicles to be insured thereunder, and agrees to pay any final judgment within the limits set forth in the policy or endorsements attached thereto, for injury to, and/or death of persons (with the exception of any employee of the Assured) and damage to property (excluding property of the Assured or property which is rented or leased by the Assured or property other than the baggage of passengers in the custody of the Assured or carried in or upon any automobile of the Assured) resulting from the ownership, mainte nance or use of any and all motor vehicles and/or trailers, pursuant to a Certificate of Public Convenience and Necessity or a Permit issued by the Public Utilities Commission of the State of Colorado, and further agrees that upon the failure of the Insurer to pay any such final judgment, such judgment creditor may maintain an action in any court of competent jurisdiction to compel such payment. It is understood and agreed by and between the Insurer and the Assured that the right of any person to recover hereunder shall not be affected by any act or omission of the Assured or of any employee of the Assured with regard to any condition or requirement of said policy, but all the terms and conditions of the policy shall remain in full forcc and be binding as between the Insurer and the Assured; and the Insurer shall be reimbursed by the Assured for auy ahd all loss, costs or expenses paid or incurred by the Insurer which the Insurer would not be obligated to pay under the provisions of the policy independently of this endorsement. MINIMUM SCHEDULE On each motor vehicle used for the transportation of persons and/or property: Passenger Capacity Not to Exceed for Death or Injury to: Any One Person Ail Persona 12 or less........................... .......................... $25,000 13 to 18, inclusive...................................... 25,000 $ 50,000 70,000 19 to 24, inclusive ...................................... More than 24 . ...................................... 25,000 25,000 90,000 100,000 Property Damage $5,000 5,000 5,000 5,000 On vehicles used for the transportation of property -. For death or injury to any one person, $25,000; all persons, $50,000; property damage, $5,000. All conditions and provisions of this policy, and any statements or agreements contained therein or endorsed thereon in conflict with this endorsement are, by agreement of all parties hereto, held null and void insofar as they are in conflict herewith. The policy to which this endorsement is attached shall not be cancelled until after ten days notice in writing shall have first been given by the Insurance Company or its authorized agent to the Public Utilities Commission of the State of Colorado, at its office at Denver, Colorado, said ten days notice to commence to run from the date the date notice is actually received at the office of the Commission AND TO BE ON PAPER 8% INCHES BY 11 INCHES. ATTACHED TO AND FORMING A PART OF POLICY NO....._______________________________ issued by the.........TRAVELERS CCMPAHV............... tm AHACOSBA COHP-NY STAL PER SN5 8000(A) A ID 000284 reference to transportation of pustsftn when endorsement Is attached to poller issued to n property carrier only. `'Eliminate reference to transportstio;a of property when endorsement fa attached to policy issued to a passenger carrier only. Pull schedule appllee to carrier of both pemongers and property. THIS FORM OP ENDORSEMENT IS REQUIRED TO BE ATTACHED TO THE POLICY OP PUBLIC LIABILITY AND PROPERTY DAMAGE INSURANCE BUT NOT TO THE CRRTIPICATR OP INSURANCE AND MUST BE GIVEN TO THE INSURED AND NOT PILED* WITH THE COMMISSION. IRB IX33C OREGON PUBLIC UTILITIES COMMISSIONER Endorsement for Motor Carrier Policies of Insurance for Bodily Injury Liability and Property Damage Liability -- Automatic Coverage The policy to which this endonement is attached ii an Automobile Bodily Injury Liability and Property Damage Liability Policy, and ia hereby amended to assure compliance by the named insured, as a motor carrier of passenger* or property with appropriate provisions of the Motor Transportation Code of Oregon, as amended, and the pertinent rule* and regulations of the Public Utilities Commissioner of Oregon, promulgated in accordance with the proviaions of the Motor Transportation Code of Oregon. In consideration of the premium stated in the policy to which this endorsement is sttached, or becomes a part, when duly countersigned, the company hereby agrees to pay any final judgment recovered against the named insured for bodily injury to or the death of any persons or loss of or damage to property of others (excluding injury to or death of the named insured's employees while engaged in the courae of their employment, and loaa of or damage to property owned or operated by or in the care, custody or control of the named insured, end property transported by the named insured, designated as cargo, and to any obligation for which the named insured may be held liable under any Work men's Compensation Law), resulting from the negligent operation, maintenance, ownership, or use of motor vehicles under permit issued to the named insured by the Public Utilities Commissioner of Oregon, or otherwise under the Oregon Motor Transportation Code, within the limits of liability hereinafter provided, regardless of whether such motor vehicles are specifically described in the policy or nut It is understood and agreed that upon failure of the company to pay any such final judgment recovered against the named insured, the judgment creditor may maintain an action in any court of competent jurisdiction against the company to compel such payment The bankruptcy or insolvency of the named) insured shall not relieve the company of any of its obligations hereunder. The liability of the company extends to such looses, damages, injuria, or deaths whether occurring on the route or in the territory authorized to be served by the named insured or elsewhere, within the State of Oregon, but as respects this endorsement only while operating under the provisions of the Motor Transportation Code of Oregon. The liability of the company on each motor vehicle for the following limits shall be a continuing one notwithstand ing any recovery hereunder, in the following minimum amounts: ' PROPERTY BODILY INJURY LIABILITY DAMAGE TYPE OF MOTOR VEHICLE Limit for Each Person Limit for Each Accident Limit for Each Accident Each motor vehicle authorised for use in tho transportation of property or persons --------------- ---....--------- --------- --------- 110,000 $20,000 $10,000 In the event the policy to which this endorsement is sttached is issued for limits greater than those prescribed herein, the terms and conditions of this endorsement shall apply only to the minimum limits set forth in this endorsement. Nothing contained in the policy or any endorsements thereon, nor the violation of any of the provisions of the policy or of any endorsement thereon by the named insured, shall relieve the company from liability hereunder or from the payment of any auch final judgment, but as respects any equipment of the named insured while being operated by others under an interchange of equipment agreement or requirement, the insurance afforded by this policy shall be w over any other valid and collectible insurance available to the named insured. The named insured agrees to reimburse the company for any payment made by the company on account of any accident, daim, or suit involving a breach of the terms of the policy, and for any payment that the company would not have been obligated to make under the proviaions of the policy, except for the agreement contained in this endorsement. Cancellation of this endorsement or of the policy to which it is sttached may be effected by the company or the named insured giving not feae than IS days' notice in writing to the Public Utilities Commissioner of Oregon at his office in Salem, Oregon, said notice to commence to run from the date notice is actually received at the office of said Commissioner. Attached to and forming part of Policy No. ............ issued by the .....TRAVELERS................ ....... `.^RERRITV............................... (herein called company) of ............... HARTfORD CT ................ To . ..T^ WIAC.QHaA...COMPAMY,.ETAL...............................of........... HEW...Y0SK..M.....10.004................. PER ENQ 3000(A) Dated at..................................................................this.................. day of........................................................ , 19.............. 1 04 6 71MC S (Ed. * ) UNIFORM PRINTING ft SUPPLY " :; . Authorisad Company Representative S3A S <" 000285 KMU-1444 BavM IRB 2SB7-C PREMIUM DISCOUNT ENDORSEMENT--TEX/ AUTOMOBILE LIABILITY INSURANCE _- *' > . / This endorsemsnt forms a part of Policy No. --........................~............................ issued to ........................................ by the sTUMSlCJS T" (Name of Insurance Company) ___ at its Agency located (city and state) ... and is effective from........... ..... .......... ............ ................ (12:01 A. M. Standard Time) (The information above Is required only when this endorsement is issued subsequent to preparation of the policyJ This endorsement forms, a part of the policy to which attached, effective from its date of issue unless otherwise stated herein. It is agreed that the premium pertaining to Texas for Automobile Liability and Medical Payments insurance is subiect to discount in accordanct with the following procedure: 1. Texas Automobile Liability Standard Premium. Such premium pertaining to Texas computed in accordance with the provisions of the poUc-.edesignated m paragraph 4 hereof, other than this endorsement and exclusive of the application ol any retrospective rating plan, shall b known as the Texas Automobile Liability Standard Premium. 2. Total Standard Premium for All States. The Automobile Liability and Medical Payments Premium computed m accordance with the prcv. stons of the policies designated in paragraph 4 hereof, other than this endorsement and exclusive of the application of any retrospective rating plan, any Automatic Premium Adjustment Endorsement, any Premium Return Plan Endorsement, or other Premium Discount Endorse ment. shall be knd^n as the Total Standard Premium. 3. Premium Discount--Texas (a) For policy periods of on# yoar or leu--The Texas Automobile Liability Standard Premium shall be subject to the applicable dtscour percentages for the Total Standard Premium obtained from the "Table of Texas Premium Discount Percentages (Automobile Liability) set out On the reverse side hereof. (b) For policy periods of mere them one yoar--The Texas Automobile Liability Siandard Premium for each annual period or portion therec during the policy period shall be subiect to the applicable discount percentages stated in said 'Table of Texas Premium Discount Per centages (Automobile Liability)" opposite the Total Standard. Premium for the policies for each such period or portion thereof durinq th policy period. (c) If retrospective ratmg is applicable to a part of the premium pertaining to Texas, the amount of premium discount applicable to th. Texas Automobile Liability Standard Premium, exclusive of any premium subiect to any Retrospective Ratmg Plan, shall be the difference between (!) the discount determined by applyinq to the Texas Automobile Liability Standard Premium the applicable percentages stated i: said Table opposite the Total Standard Premium, and (2) the discount determined by applying to that portion of the Texas Automobile Liability Standard Premium which is subject to retrospective ratmg the applicable percentage stated in said Table opposite so much c the Total Standard Premium as is subject to retrospective rating. 4. Policy Numbers ___________Estimated Standard Premium Total Applicable premium percentages based on total estimated advance standard premium: Taxicabs. Livery. Buses and Long Haul Truckmen ...................... % Garage Liability ...................... % All other, including School Buses ...................... 7. SEE REVERSE SIDE FOR FURTHER PROVISIONS FORM 25--PREMIUM DISCOUNT ENDORSEMENT--TEXAS Texas Standard Automobile Endorsement Revised November 1. 1959 Sy (Duly Authorized Representative) AID 000286 TX '-69. AMENDATORY ENDORSEMENT--NOTIC' ^ TR--NSL- 1231693-3-75 This endorsement forms a part of Policy No.......................................... issued to .................................. ........................................................... TRAVELERS INDEMNITY COMPANY by the.......... ......................... ..... ............................................................................................ ...................................................................... at its Agency (Name of Insurance Company) located (city and state) ..................................................................... ................................and is effective from ...................................................... (12:01 A.M. Standard Time) (The information above is required only when this endorsement is issued subsequent to preparation of the policy.) This endorsement forms a part of the policy to which attached, effective from its date of issue unless otherwise stated herein. I This endorsement modifies such insurance as is afforded by the provisions of the policy relat ing to the following: COMPREHENSIVE AUTOMOBILE LIABILITY INSURANCE BASIC AUTOMOBILE LIABILITY INSURANCE GARAGE INSURANCE As respects bodily injury liability and property damage liability, unless the company is prejudiced by the insured's failure to comply with the requirement, any provision of this policy requiring the insured to give notice of action, occurrence or loss, or re quiring the insured to forward demands, notices, summons or other legal process, shall not bar liability under this policy. (Duly Authorized Representative) FORM TX-03-69.--AMENDATORY ENDORSEMENT--NOTICE Texas Standard Automobile Endorsement Prescribed October 1, 1974 0 AID 000288 This endorsement modifies such insurance as is afforded by the provisions of the policy relating to the following COMPREHENSIVE GENERAL LIABILITY INSURANCE MANUFACTURERS' AND CONTRACTORS' LIABILITY INSURANCE OWNERS', LANDLORDS' AND TENANTS' LIABILITY INSURANCE STOREKEEPER'S INSURANCE REAL PROPERTY - LIABILITY - FIRE It is agreed that the Property Damage Liability Coverage applies to property damage to structures or portions thereof rented to or occupied by the named insured and described in this endorsement, including fixtures permanently attached thereto, if such property damage arises out of fire, subject to the following additional provisions: 1. With respect to the insurance provided by this endorsement all of the exclusions of the policy, other than the Nuclear Energy Liability Exclusion (Broad Form*. are deleted and replaced by the following: This insurance does not apply to liability assumed by the insured under any contract or agreement. 2. The limit of liability stated in this endorsement applies separately to the insurance under this endorsement and is in lieu of any other limit of liability stated in the policy. Description of Property 283 EAST IONA AVE MUSKEGON Ml 233 NORTH LEMON ST CHANGE CA 10,000 50,000 each occurrence Rote (per $100 of Limit) INCLUDED IN COMPOSITE Premium Amending Policy No. TR-NSL-! 231693-3' r AID 000289 This endorsement is issued by that member of The Travelers Insurance Companies which issued the policy of which this endorsement forms a part. O. i r non S PREMIUM DISCOUNT ENDORSEMENT--NORTH CAROLINA Page 1 (Automobile and General Liability Insurance) The premium pertaining to North Carolina for Liability and Medical Payments insurance is subject to discount in accordance with the following procedure: 1. North Carolina Standard Premium. Such premium pertaining to North Carolina computed in accordance with the provisions of the policies designated in paragraph 5 hereof, other than this endorsement and exclusive of the applica tion of any retrospective rating plan and exclusive of any premium under any Automobile Liability Policy appli cable with respect to automobiles classified as "Livery," "Buses other than School Buses" and "Long Haul Truckmen" shall be known as the North Carolina Standard Premium. 2. Total Standard Premium for All States. The Liability and Medical Payments premium computed in accordance with the provisions of the policies designated in paragraph 5 hereof, other than this endorsement and exclusive of the application of arty retrospective rating plan, any Automatic Premium Adjustment Endorsement, any Premium Return Plan Endorsement, or other Premium Discount Endorsement, shall be known as the Total Standard Premium. 3. Premium Discount--North Carolina (a) For policy periods of one year or less--The North Carolina Standard Premium, exclusive of any premium subject to any retrospective rating plan, shall be subject to the applicable discount percentages for the Total Standard Premium obtained from the Table of "North Carolina Premium Discount Percentages." (b) For policy periods of more than one year--The North'Carolina Standard Premium for each annual period or portion thereof during the policy period shall be subject to the applicable discount percentages stated in said Table of "North Carolina Premium Discount Percentages" opposite the Total Standard Premium for the policies for each such period or portion thereof during the policy period. (c) If retrospective rating is applicable to a part of the premium pertaining to North Carolina, the amount of premium discount applicable to the North Carolina Standard Premium, exclusive of any premium subject to any retrospective rating plan, shall be the difference between (1) the discount determined by applying to the North Carolina Standard Premium the applicable percentages stated in said Table opposite the Total Standard Premium, and (2) the discount determined by applying to that portion of the North Carolina Standard Pre mium which is subject to retrospective rating the applicable percentages stated in said Table opposite so much of the Total Standard Premium as is subject to retrospective rating. 4. Table--North Carolina Premium Discount Percentages. Stated on Pages 2 and 3 of this endorsement. 5. Policy Numbers Estimated Standard Premium TR-r!5L=123T5$3~`/ * ~ Total Applicable Premium Discount Percentages based on Total Estimated Advance Standard Premium: General Liability__________% Automobile Liability--Garages_________ % Taxis_________ % All Other Automobile Liability Except Livery, Buses other than School Buses, andLong Haul Truckmen_________ % Amending Policy \r> ' -** - AID 000290 Th is endorsement is executed by The Travelers Insurance Company as respects insurance afforded by that company only; it is executed by The Travelers Indemnity Company as respects insurance afforded by that company only. =T B >T S ?B@B>A IBCDES BK B CFGHS IJ K L M N P QP RTUT B T S B Br s I " B it y C S ny 4080A ' Secretary Secretary :'R-N5L-r North Carolina Premium Discount Percentages (Continu&u) Page 3 Total Standard 1 Premium {See Note) (i) $75,000 80,000 85.000 90.000 95.000 100,000 105.000 110.000 115.000 120.000 125.000 130.000 135.000 140.000 145.000 150.000 162.500 175.000 187.500 200.000 212.500 225.000 237.500 250.000 262.500 275.000 287.500 300.000 312.500 325.000 337.500 35o;ooo 362.500 375.000 387.500 400.000 412.500 425.000 437.500 450.000 462.500 475.000 487.500 500,000 and Over General Liability (2) 22.2% 22.3 22.4 22.5 22.6 22.7 23.0 23.3 23.5 23.7 23.9 24.0 24.2 24.4 24.5 24.7 25.0 25.2 25.5 25.6 25.8 25.9 26.1 26.2 26.3 26.4 26.5 26.6 26.6 26.7 26.8 26.8 26.9 27.0 27.0 27.0 27.1 27.1 27.2 27.2 27.2 27.3 27.3 * Automobile Liability-- Garages (3) 14.6% 14.7 14.7 14.8 14.9 15.0 15.2 15,4 15.6 15.7 15.9 16,0 16.2 16.3 16,4 16.6 16.8 17.0 17.1 17.3 . 17.4 17.5 17.6 17.7 17.8 17.9 1,7.9 ljB.O 18.1 1M 18.2 18.2 18.3 18.3 18.3 18.4 18.4 18.4 18.5 18.5 18.5 18.5 18.6 * Taxis (4) 8.9% 9.0 9.1 9.2 9.2 94 9,6 9.8 10.0 10:1 10.3 10.4 10.6 10.7 10-8 11.0 11.2 11.4 11.6 11.7 11.8 12.0 12.1 12.2 12.2 12.3 12.4 12.5 12.5 12.6 12.6 12.7 12.7 12.8 12.8 12.8 12.9 12.9 12.9 13.0 13.0 13.0 13.0 * A.; Ot::er Auto mobile Liability Lxcept Lsverv, Buses outer tbar, iiTltcoi Buse*. and Lon^ Huus Truckmen (5) 14.1% 14.2 14.2 14.3 14.4 14.5 14.7 14.9 15.1 15.2 15.4 15.5 15.7 15.8 15.9 16.1 16.3 16.5 16.6 16.8 16.9 17.0 17.1 17.2 17.3 17.4 17.4 17.5 17.6 17.6 17.7 17.7 17.8 17.8 17.8 17.9 17.9 17.9 18.0 18.0 18.0 18.0 18.1 * Note: If the Total Standard Premium is between two of the amounts shown in Column (1), the premium discount percentage applicable is that shown for the lower of such amounts. If the Total Standard Premium is $500,000 or over, the discount percentage applicable for each kind of insurance shall be determined as the weighted average of the percentage shown in (b) for the first S500.000 of Total Standard Premium and the percentage shown in (c) for the portion of the Total Standard Premium over $500i000: Kind of Insurance General Liability (a) Automobile Liability--Garages Taxis All Other Automobile Liability except Livery, Buses other than School Buses, and Long Haul Truckmen : IS00.000 (b) 27.3% 18.6 13.1 18.1 Portion Over $500,000 (O 28.5%-. 19.5 14.0 19.0 4080A AID 000291 Total Standard Premium (i) $1,000 or less 1,050 l'lOO 1,150 1,200 1,250 M00 U50 1,400 1,450 1,500 1,550 1,600 1,650 1,700 1,750 1,800 l'8S0 1,900 1,950 2,000 2,100 2,20l - 2,300 2,400 2,500 2,600 2,700 2,800 2,900 3,000 3,100 3,200 3.300 3,400 3,500 3,600 3,700 3.800 3,900 4,000 4,200 4,400 4,600 4,800 5,000 5,200 5,400 5.600 5,800 6,000 6,200 6.400 6.600 6.800 General Liability (2) o.o% 0.7 1.2 1.6 1.9 2.3 2.6 2.9 3.1 3.4 3.6 3.8 4.0 4.2 4.4 4.6 4.7 4.9 5.0 5.2 5.4 5.6 5.8 6.0 6.2 6.4 6.5 6.7 6.8 6.9 7.1 7.2 7.3 7.4 7.5 7.5 7.6 7.7 7.8 7.8 7.9 8.1 8.2 8.3 8.4 8.7 9.1 9.6 10.0 10.4 10.8 11.1 11.4 11.7 12.0 Automobile Liability- Garages (3) 0.0% 0.3 0.6 0.7 0.9 1.1 1.2 1.4 1.5 1.6 1.7 1.8 1.9 2.0 2.1 2.2 2.3 2.3 2.4 2.5 2.6 2.7 2.8 2.9 3.0 3.0 3.1 3.2 3.2 3.3 3.4 3.4 3.5 3.5 3.6 3.6 3.6 3.7 3.7 3.7 3.8 3.8 3.9 3.9 4.0 4.2 4.6 4.9 5.2 5.5 5.8 6.1 6.3 6.5 6.8 North Carolina Premium Discount Percentages (Forming a Part of Endorsement 4080A) Taxi] (4) 0.0%, 0.1 0.1 0.1 0.2 0.2 0.2 0.3 0.3 0.3 0.3 0.4 0.4 0.4 0.4 0.4 0.5 0.5 0.5 0.5 0.5 0.5 0.6 0.6 0.6 0.6 0.6 0.6 0.6 0.7 0.7 0.7 0.7 0.7 0.7 0.7 0.7 0.7 0.7 0.7 0.8 0.8 0.8 0.8 0.8 0.9 1.2 1.4 1.6 1.8 2.0 12. 2.3 2.5 2.6 Ail Other Auto mobile Liability Except Livery, Buses other than School Buses, and Long Haul Truckmen (5) Total Standard Premium (See Note) \ (D General Liability (2) 0.0%, 0.3 0.5 0.7 0.8 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 2.0 2.0 2.1 2.2 2.2 2.3 2.4 2.5 2.6 2.7 2.7 2.8 2.9 2.9 3.0 3.0 3.1 3.1 3.2 3.2 3.2 3.3 3.3 3.3 3.4 3.4 3.5 3.5 3.5 3.6 3.8 4.2 4.5 4.8 5.1 5.4 5.6 5.9 6.1 6.3 S7.000 7,200 7,400 7,600 7,S00 8,000 8,200 8,400 8,600 8,800 9,000 9,200 9,400 9,600 9,800 10,000 10,500 11,000 11,500 12,000 12,500 13,000 13,500 14,000 14,500 15,000 16,000 17,000 18,000 19,000 20,000 21,000 22,000 23,000 24,000 25,000 27,500 30,000 32,500 35,000 37,500 40,000 42,500 45,000 47,500 50,000 52,500 55.000 57.500 60,000 62,500 65,000 67,500 70,000 72,500 12.3%, 12.5 12.8 13.0 13.2 13.4 13.6 13.8 14.0 14.1 14.3 14.5 14.6 14.7 14.9 15.1 15.4 15.7 15.9 16.2 16.4 16.6 16.7 16.9 17.1 17.3 17.5 17.8 18.0 18.1 18.3 18.5 18.6 18.7 18.8 19.0 19.2 19.5 19.8 20.1 20.4 20.6 20.8 21.0 21.1 21.3 21.4 21.5 21.6 21.7 21.8 21.9 22.0 22.0 22.1 (Continued on reverse side) Automobile Liability-- Oarages (3) 7-0%, 7.2 7.3 7.5 7.7 7.8 8.0 S.l 8.3 8.4 8.5 8.6 8.7 8.8 8.9 9.1 9.3 9.6 9.7 9.9 10.1 10.2 10.4 10.5 10.6 10.8 11.0 11.1 11.3 11.4 11.6 11.7 11.8 11.9 12.0 12.1 12.3 12.5 12.7 13.0 13.2 13.3 13.5 13,6 13.7 13.9 14.0 14.0 14.1 14.2 14.3 14.3 14.4 14.5 14.5 Page 2 Taxis (4) 2 8%, 2.9 3.0 3.1 3,3 3.4 3.5 3.6 3.6 3.7 3i8 319 4.0 4.0 4,1 4.2 4.4 4.5 4.6 4.8 4.9 5.0 5.1 5.1 5,2 5.3 5.5 5.6 5.7 5.8 5.9 5.9 6.0 6.1 6.1 6.2 6.3 6.5 6.8 7.1 7.3 7.5 7.7 7.8 8.0 8.1 8.2 8.3 8.4 8.5 8.6 8.6 8.7 8.8 8.8 All Other Auto mobile Liability Except Livery, Buses ether than School Buses, and Long Haul Truckmen (5) 6.5% 6.7 6.9 7.1 7.2 7.4 1 .3 7.7 7.8 7.9 8.1 8.2 8.3 8.4 8.5 8.7 8.9 - 9.1 9.3 9.5 9.6 9.8 9.9 10.0 10.1 10.3 10.5 10.7 10.8 11.0 11.1 11.2 11.3 11.4 11.5 11.6 11.8 12.0 12.3 12.5 12.7 12.8 13.0 13.1 13.3 13.4 13.5 13.6 13.6 13.7 13.8 13.8 13.9 14-0 14.0 A ID 000292 PREMIUM DISCOUNT ENDORSEMENT--TEXAS (General Liability Insurance) It is agreed that the premium pertaining to Texas for General Liability and Medical Payments insurance i' 'object to di'count m ac cordance with the following procedure; 1. Texas General Liability Standard Premium. Such premium pertaining to Texas computed in accordance with the provisions of the policies designated in paragraph 5 hereof, other than this endorsement and exclusive of the application of anv retrospective rating plan, shall be known as the Texas Genernl'Liability Standard Premium. 2. Total Standard Premium For All States. The General Liability and Medical Pus meats Premium computed in accordance with the provisions of the policies designated in paragraph! 5 hereof, other than this endorsement and exclusive of the application of any retrospective rating pian, any Automatic Premium Adjustment Endorsement, any Premium Return Plan Endorsement, or other Premium Discount Endorsement, 'hall he known as the Total Standard Premium. 3. Premium Discount--Texas (a) For policy periods of one year or less--The Texas General Liability Standard Premium shall be subject to the applicable dis count percentages for the Total Standard Premium obtained from the Table of "Texas Premium Discounts (General Liability) '. ........ For policy periods of more than one year--The Texas General Liability Standard Premium for each annual period or portion thereof during the policy period shall be subject to the applicable discount percentages stated in said Table of "Texas Premium Discounts fGeneral Liability)" opposite the Total Standard Premium for the policies for each such period or portion thereof during the policy period. (c) If retrospective rating is applicable to a part of the premium pertaining to Texas, the amount of premium discount applicable to the Texas General Liability Standard Premium, exclusive of any premium subject to any Retrospective Rating Plan, shall be the difference between (1) the discount determined by applying to the Texas General Liability Standard Premium the applicable percentages stated in said Table opposite the Total Standard Premium, and (2) the discount determined by applying to that portion of the Texas General Liability Standard Premium which is subject to retrospective rating the applicable percentage stated in sxid Table opposite so much of the Total Standard Premium as is subject to retrospective rating. 4. Table of Texas Premium Discount Percentages---Slated below and on Page 2 of this endorsement. 5. Policy Numbers Estimated Standard Premium TR-NSL-t 23T693-3-75 Total Applicable premium discount percentage based on total estimated advance standard premiums TABLE OF TEXAS PREMIUM DISCOUNT PERCENTAGES (General Liability) Total General Liability Standard Premium (See N'ote 1) (1) Premium Discount Percentages Applicable to Texas General Liability Standard Premium (2) $1,000 or less 1,007 1,021 1,035 1,049 .0% .1 .2 .3 .4 1,064 1,080 1,095 1,112 1,128 .5 .6 .7 .8 .9 1,146 1,163 1,182 1,200 1,220 1.0 1.1 1.2 1.3 1.4 1,240 1,261 1,283 1,305 1,328 1.5 1.6 1.7 1.8 1.9 Total General Liability Standard Premium (See Note 1) (U Premium Discount Percentages Applicable to Texas General Liability Standard Premium (2) 1,352 1,377 1,402 1,429 1,457 2.0 2.1 2.2 2.3 2.4 1,486 1,516 1,547 1,579 1,613 2.5 2.6 2.7 2.8 2.9 1,649 1,688 1,725 1,765 1,808 3.0 3.1 3.2 3.3 3.4 1,852 1,899 1,949 2,000 2,055 3.5 3.6 3.7 3.8 3.9 Tout General Liability Standard Premium (See N'ote 1) (i) Premium Discount Percentages ADDlicable bihty Standard Premium (2) 2,113 2,174 2,239 2,308 2,381 4.0 4.1 4.2 4.3 4.4 2,460 2,543 2,632 2,728 2,831 4.5 4.6 4.7 4.8 4.9 2,942 3,062 3,192 3,334 3,489 5.0 5.1 5.2 5.3 5.4 3,659 3,847 4,055 4,286 4,546 5.5 5.6 5.7 5.8 5.9 C-14085 7-70 **c3 u s * 373 (Continued on Page 2) AID 000293 4128B S8ZI* ' ' q ; : isoti .1 urd B sunoj juauiasjopua siqj qjiq.w jo A3t;od aqj pansst qo.q.* saiueduico aauEjnsui sjaiaAEJj. aqj. jo Jaquiaui lEq^ Xq panssi si juauiasjopua siqj. 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(panmjnoo) (Xjipqsn ino) S30VIN33H3d IttnODSia WOIW3Hd SVX31 30 31SVi ENDORSEMENT *pjSir' iSsf*V~ ; THE TRAVELERS INSURANCE COMPANIES This endorsement is issued by that member of The Travelers Insurance Companies which issued the policy of which this endorsement forms a part. If any additional premium is noted below, this endorsement is issued in consideration thereof. If any return premium is noted below, the receipt thereof is acknowledged upon acceptance of this endorsement. Effective from Issued to____ Date of Issue wVon/fc. Day. Year) Asv -S A .siM Amending .............. .... ,. at the time of day the policy becomes effective. Policy Nc___'. " *-' -MS Additional Premium $ Return Premium $ (The information provided for above, except the policy number, is required to be stated only when this endorsement is issued for attachment to the policy subsequent to its effective date.) It is agreed that as of the effective date hereof the policy is amended in the following particulars: -NOT TO TX" loya as P.*te ~sr Eaplcyec &3Xt ever 5.000 3 jCOO 10.00--' Izzyipz TICOUDc.) *Ji : r C. Ecployae Benefit PrograasB Ptier 2haa lAoje -Zcs^.Pr.ed ic. 'Saragrejfc. 17 Islcv $ *.,000,200 * l,0005000 a.S K\. raployee ag^re^ate ]C-17820 New 8-"4 *K **t j o * * s * (continued on Page f2) i Countersigned By fStm9 AID 000295 SrMSOL No. ft-oco ENDORSEMENT THE TRAVELERS INSURANCE COMPANIES This endorsement is issued by that member of The Travelers Insurance Companies which issued the policy of which this endorsement forms a part. If any additional premium is noted below, this endorsement is issued in consideration thereof. If any return premium is noted below, the receipt thereof is acknowledged upon acceptance of this endorsement. Effective from____ 2-Lritlrx5--------- {Month, Day. Year) Amending ...( > _at the time of day the policy becomes effective. Policy Nc__ Issued - TH AMACOHDA COMPANY ET AL ?E3 uiiS g-OOCfA: Date of Issue: 3"5"*/5 01/LWM Additional Premium $ Return Premium $ (The information provided for above, except the policy number, is required to be stated only when this endorsement is issued for attachment to the policy subsequent to its effective date.) It is agreed that as of the effective date hereof the policy is amended in the following particulars: DjJLuctibla < 1,000 r GO each rdasloyee "usuring Agreement - .r.rac.i. ma-uJ-A . The ccapsny will psy on bahalf Of the insured all -naas vhich tha isavrcd shall bs-tcae legally obligated tc psy damages because of any negligent aas or ojaiuaica of ihe insured- or of any ether person her \x>si acts "he is legally liable , if auen negligent act or ori--;sicn ie ucxcitted i_ v.p -dsiniatri-tion of the nens-i insured's sqplcyea benefit program- sad vie ccsi.-e.ay -Jhel.1 sure the right and. aafcy. to defend -uv suit ar.iinat the ir-suifid seeking damages on account cl such loss-, eras if any of the alleg-atl^aa of the 3uit sre grenadlesa, fhlae ox fraudrlaat. uad aay -sake such investigation aad ssttlawsQt of any cl&in or suit 33 it deems erpsdicn;has the cexpany shall not be obligated to pay any cihim or .Judgment or to dafend aixr .suit after the applicable limit of the cc.-'pany's liability has t2sn e:haU5ted by peynent of judgments or settle-neat 3 = rblUU3iOE3 This insurance does net ruxi- - AID 000296 r-I7R20 VewR.74 (a) to less arising out of any dishonest. fre.udi.Usnt, cruioaCi. :r xtslicious act or emission, ccucdtted by ray insure:;.; (c- to tidily injury, prr-psrty damage c? parse-si iajtry; (c1 to load arising out of failure of perferEsncs of contract by any insurer; (i) tc leas srieing cut of *n insufficiency of funds to x;2t any obligation under any plan included in the- employee benefit program; *(: * . > r A.mTArcionfrH (continued on Page #3) SruaOL NO. SCGO ENDORSEMENT i i : THE TRAVELERS INSURANCE COMPANIES This endorsement is issued by that member of The Travelers Insurance Companies which issued the policy of which this endorsement forms a part. If any additional premium is noted below, this endorsement is issued in consideration thereof. If any return premium is noted below, the receipt thereof is acknowledged upon acceptance of this endorsement. Effective from______ iHllrZS____ [Month. Day. \/ear) -at the time of day the policy becomes effective. issued THE "KAGQMPA COMPAHY ET It PER EM3 SCOOfAi Date of Issue: J 'j)~75 QL./LirJ-l Additional Premium $ Amending --, Policy Nr. ' 1 -it Oy;-.:- Return Premium i (The information provided for above, except the policy number, is required to be stated only when this endorsement is issued for attachment to the policy subsequent to its effective date.) It is agreed that as of the effective date hereof the policy is amended in the following particulars: 's) :o aey claim or suit b&eed upcr. <l) failure of any investznent to perfo.na as represented by any insured, or * Z) advice given to :iay person to participate or not participate in ary plan incir.dei in uhe ^splcyse benefit program; vfi to loss arising cat cf tits failure of the aacad insured to ecugply \i.th the .crndstory provisions c-f any lav concerning voz&ers coEpecsaticn, A'neaployxenc inanracca, social security or Usability benefits II. ?&t 3^8 3 Insured 2ac.h of the follcving is sc insured to the extent set .torcth oalev? : z.) the z.aaad insured: 'b' -ich oxasutive officer end employee of tie njuusd insured who in authorized to administer the naased insurer.* e es^Ioyce benefit pregreaa, III Limits cf Liability fle^ardlesa of the number of (l; infursds under this policy, acts or omissions vhieh result in .1033, 3} r,i?uis included in :he n.rmsd iasnred/E =nployee benefit program, {'i* w '*ho Tust-aia osa: or *5) ol^iar- .sale cr suits vroit^rt on account, of loss. 'she ccapaEy'3 liability is iisitsd '.lie total liability of the co-rpsny for ail ^_8 &s s s to vhich this insurance applies shall not exceed sue adroit of employee :aesf.lt liability stated in the Schedule 9.3 "jv^gragate7'; aabject to the foregoing provision respecting s the limit of liability stated in the Schedule as applicable C-17820 N>w-74 *>.'13 j5 {continued ce Page fl; Sfr&Srfrimii Countersigned Bv. AID 000297 Srmmot. No. 30C0 ENDORSEMENT THE TRAVELERS INSURANCE COMPANIES This endorsement is issued by that member of The Travelers Insurance Companies which issued the policy of which this endorsement forms a part. If any additional premium is noted below, this endorsement is issued in consideration thereof. If any return premium is noted below, the receipt thereof is acknowledged upon acceptance of this endorsement. Effective from. 01-75 (Monih. Day. Year) _at the time of day the policy becomes effective. THE JWACOHPA CCHP&HY TTAL P5R EHD 8000(A) Issued to. Date of Issue: DL/LWH Additional Premium $ Amending Policy Nc__LL'Hl -4V 7 .3T*S95-l-7^ Return Premium $ (The information provided for above, except the policy number, is required to be stated only when this endorsement is issued for attachment to the policy subsequent to its effective date.) It is agreed that as of the effective date hereof the policy is amended in the following particulars: in ;,saeh employee" is the total limit of the eo-spany: 3 liability lor rli damages for loss to vkion this insurance applies sustained by say one employee, including such person's dependents and beneficiaries, If the policy period i3 for a tera in excess of one year, the aggregate licit"of liability shall apply .s^par.-ctely to each consecutive annual period thereof, Diductible Subject to the foregoing, the liability of the company -srith respect tc rojiCh eiijn.loyee' shall he -only for the amount. o ` 3ftca .-ci'-h less that is hi oxceae cf the deductible ixcvut stated in t: ychtanle as Applicable to "inch esrloyae". Tha terms ox' this insurance, including these aith respect to notice cf claim or suit, the company:a right to investigate, negotiate and settle any claiia or'suit, and the co&pany's right and duty to defend, upply raspectira of ths application of the deductible amount. Z.a company 7^07 psy any part or all of the deductible r-noimt to effect i.-itlervsut of say claim or suit and, upon notification of the action token, the named insured shall promptly re?j.o:xse the oerspsny for such part cf v/ue deductible siaount as has been, -aid bv the -;.-,333ziy. IV. Additional Definitions Then used in rtf-irence isuranas AID 000298 `:etplovae benefit program13 .assas the folloving plans; (a) -'roup lire insurance, group accident or ncelth insuranceprofit sharing plans, pension plans end stock subscription plans, provided that no one other than &n employee aey sub' scribe to sucb iasur&aee cr plans; <"*17820 New 8-74 a* w'c (continued on Fage *5; Countersigned Bv. Sv ms o l No . sooc ENDORSEMENT THE TRAVELERS INSURANCE COMPANIES This endorsement is issued by that member of The Travelers Insurance Companies which issued the policy of which this endorsement forms a part. If any additional premium is noted below, this endorsement is issued in consideration thereof. If any return premium is noted below, the receipt thereof is acknowledged upon acceptance of this endorsement. Effective from 01 --01 --75at the time of day the policy becomes effective. (Month. Day. Year) Issued THE ASACOHEA COMPANY STAL PER HS 8000(A)_________ Date of Issue; S--5--/ 5 OL/LWM Additional Premium $ Amending Policy Nc TR-aSL-1.23' Return Premium $ -a sfj 93-.3..V j (The information provided for above, except the policy number, is required to be stated only when this endorsement is issued for attachment to the policy subsequent to its effective date.) It is agreed that as of the effective date hereof the policy is amended in the following particulars: (b) unemployment; insurance, social security benefits, vorker's compensa tion and disability benefits; (c) eay other similar plan designated in the Schedule or added thereto by endorsement; ' `administration11 means (<a) counseling employees, including their dependents and beneficiaries, with respect to the eaployes benefit program; (b) handling records in connection vith tea scplcyae benefit program; or (c) effecting or terminating any employee's participation in a plea in cluded in the employee benefit program; ''employee" mesas officers and employees of the named insured, vhether i-ctivsly employed, disabled or retired; ''perscnal injury" men3 injury arising out of one or core of the following offenses: (a) false arrest-, detention or imprisonment or aej.icici.is pro3-:cut.icn; \b) the publication or utterance of a libel or slander cr other defama tory cr disparaging material, or a publication or utterance in vio lation of en individual's right of privacy; (c) wrongful entry or eviction, or ether invasion of the righu of private occupancy: or (d) discrimination; (continued on Page #6} AID 000299 C-I7820 New 8-74 >n s * Countersigned By_________________ _________________ ______________ _______________ _________ Svwot NO. 2300 ENDORSEMENT THE TRAVELERS INSURANCE COMPANIES This endorsement is issued by that member of The Travelers Insurance Companies which issued the policy of which this endorsement forms a part. If any additional premium is noted below, this endorsement is issued in consideration thereof. If any return premium is noted below, the receipt thereof is acknowledged upon acceptance of this endorsement. Effective from. J1-01-75 (Month. Day. Ytat) Amending -at the time of day the policy becomes effective. Policy N'c----- '***' ^ *-'J * V-Z_ /%'J J Issued fME A?!AC0PA COMPANY ETAL PaR.SHD 8000(A) Date of Issue: 3-- 5--75 Additional Premium $ Return Premium $ (The information provided for above, except the policy number, is required to be stated only when this endorsement is issued for attachment to the policy subsequent to its effective date.) It is agreed that as of the effective date hereof the policy is amended in the following particulars: V.- .Sndorseaict Period and Territory This insurance applies csi'-y to claims first brought against the insured during the policy period vithin tbs United States of America, its territories or possessions or Canada, provided the insured, at the effective date of this endorsement, had no Isnovisdga cf any act or omission which sight result in such claim-. 71 Additional Condition 'Joeice - Upon the insured's becoming svara of nay ict or omission vhich jay give rise to a loss coversd hereunder. written notice shall bo 31Ten ly ;r on behalf of the insured in accordance vith the condition cf the policy describ ing the insured7s duties in the event of sn occurrence, claim r.v suit `a bCM7820 New 8*74 K . K *%S Countersigned By. AID 000300 Scd8 ef No . 6000 ENDORSEMENT THE TRAVELERS INSURANCE COMPANIES This endorsement is issued by that member of The Travelers Insurance Companies which issued the policy of which this endorsement forms a part. If any additional premium is noted below, this endorsement is issued in consideration thereof. If any return premium is noted below, the receipt thereof is acknowledged upon acceptance of this endorsement. Effective from_____ 01*01-76-- (Month. Day. Year) at the time of day the policy becomes effective. issued ANJICONDA CCMPAN3T ET AL PER MD 8000(A) Date of Issue: 3-25-76 CRiyYlGEF Additional Premium $ Amending Policy No TR-fISL-123T69>=3 - rj Return Premium $ (The information provided for above, except the policy number, is required to be stated only when this endorsement is issued for attachment to the policy subsequent to its effective date.) It is agreed that as of the effective date hereof the policy is amended in the following particulars: This endorsement modifies such insurance as is afforded by the provisions of the policy relating to the following: COMPREHENSIVE GENERAL LIABILITY INSURANCE Employee Benefits Liability Insurance Endorsement This Insurance is on a~" Cl aims Made" Basis Schedule Premium Computation Estimated No of Employees Rate per Employee Estimated Premium Minimum ?*<emlum first 5,000 next 5,000 over 10,000 Total $ $ $ $ I3CLUDSD IN COMPOSITE Employee Benefit Programs Other Than Those Specified in Paragraph IV below. 3. Limits of Liability 5 1,000,0C0 % 1,000,000 each employee aggregate (continued on Page #2) C-I7S20 REV. S-73 M..TC0 > u S-. Countersigned By. AID 000301 Srwoc No. 132U ENDORSEMENT I THE TRAVELERS INSURANCE COMPANIES This endorsement is issued by that member of The Travelers Insurance Companies which issued the policy of which this endorsement forms a part. If any additional premium is noted below, this endorsement is issued in consideration thereof. If any return premium is noted below, the receipt thereof is acknowledged upon acceptance of this endorsement. Effective from. 01-01-76 {Month. Day. Year) at the time of day the policy becomes effective. *;EE ANACONDA COMPANY ST AL FUR 3H5 3000(A) Issued to. Date of Issue: 3^ CRPflX/DP Additional Premium $ Page #2 Return Premium $ (The information provided for above, except the policy number, is required to be stated only when this endorsement is issued for attachment to the policy subsequent to its effective date.) It is agreed that as of the effective date hereof the policy is amended in the following particulars: 4, Deductible % !,000,00 each employee insuring Agreement The company will pay on behalf of the insured all sums -which the Insured shall become legally obligated to pay as damages because of any negligent set or omission of the insured, or of any other person for hose acts the iisured is legally liable, if such negligent act or omission is committsu n The administration of the named insured's employee benefit program, 2nd :he company shall have the right and duty to defend any suit against the insured seeking damages on account of such loss, even if any of the allege tlons of the suit are groundless, false or fraudulent, and may make such investigation and settlement of any claim or suit as it deems expedient, but the co.npany shall not be obligated to pay ?ny claim or judgment or to c-tend any suit after the applicable limit of the company's lisoility has oeen exhausted by payment of judgments o* settlements. Exclusions Th1s insurance does not apply: (a) to loss arising out. cf any dishonest, fraudulent, criminal or mail cions act or omission, ccmlttsd by any insured; lb) tc ' .oiiy injury, property carnage or personal '.Jury; ic) ro *oss arising cue of failure of performance ;*' contract by any Insurer; (d) to loss arising out of an Insufficiency of funds to moat any obligation under any plan included in the employee benefit program; STMgQL NO. (cc'irlnued on P*ge #3 i AID 000302 *? 52/. 1 C-I7A20 REV. S-75 ,,.,,gK" u,* Countersigned B> ENDORSEMENT THE TRAVELERS INSURANCE COMPANIES This endorsement is issued by that member of The Travelers Insurance Companies which issued the policy of which this endorsement forms a part. If any additional premium is noted below, this endorsement is issued in consideration thereof. If any return premium is noted below, the receipt thereof is acknowledged upon acceptance of this endorsement. Effective from. 01-01--76 --i------- at the time of day the policy becomes effective. {Month. Day. Ytar) . . SB AHACONDA COMPART ET AL PEE 2m aOOO(A) STrfta.: >25-76 W/BL/BP uur<..r Amending Policy No. TBp4I5L^123T693375 Page #3 Return Premium $ (The information provided for above, except the policy number, is required to be stated only when this endorsement is issued for attachment to the policy subsequent to its effective date.) It is agreed that as of the effective date hereof the policy is amended in the following particulars: (e) to any claim or suit based upon (1) failure of any Investment to perform as represented by any insured, or (2) advice given to any person to participate or not participate in any plan Included In the employee benefit program; (f) to loss arising out of the failure of the named Insured to comply with the mandatory provisions of any law concerning workers' compensation, unemployment Insurance, social security or disability benefits. i1, Persons Insured Each of the following is an insured to the extent set forth below: (a) the named Insured; (b) each executive officer and employee of the named insured who Is authorized to administer the named Insured's employee benefit program. III. Limits of Liability Regardless of the number of (1) insureds under this policy, (2) acts or omissions which result In loss, (3) plans included In the named insured's employee benefit program, (4) persons who sustain loss, or (5) claims .?<aie or suits brought on account of loss, the company's liability Is limited as follows: The total liability of the company for all damages to which this insurance applies shall not exceed the limit of employee benefit liability stated in the Schedule as "aggregate*, subject to the foregoing provision respecting (continued on Page #4} AID 000303 St mu o l No . i^ i 17*20 REV. 1.75 ..,hKi u , . Countersigned By. 4 ENDORSEMENT THE TRAVELERS INSURANCE COMPANIES This endorsement is issued by that member of The Travelers Insurance Companies which issued the policy of which this endorsement forms a part. If any additional premium is noted below, this endorsement is issued in consideration thereof. If any return premium is noted below, the receipt thereof is acknowledged upon acceptance of this endorsement. Effective from. 01-01-76 (Month. Day, Keep) .at the time of day the policy becomes effective. Issued to_ THE ANACONDA COMPANY ET AL PER END 8000(A) Date of Issue: 3-25-76 / jk /x k /" l Additional Premium $ Amending Policy No.. 1S-MSL-123T693-3-75 Page #4 Return Premium $ (The information provided for above, except the policy number, is required to be stated only when this endorsement is issued for attachment to the policy subsequent to its effective date.) It is agreed that as of the effective date hereof the policy is amended in the following particulars: "aggregate", the Unit of liability stated In the Schedule as applicable to "each employee" Is the total limit of the company's liability for all damages for loss to which this insurance applies sustained by any one employee. Including such person's dependents and beneficiaries. If the policy period is for a term In excess of one year, the aggregate limit of liability shall apply separately to each consecutive annual period thereof. Deductible Subject to the foregoing, the liability of the company with respect to "each employee" shall be only for the amount of each such loss that Is In excess of the deductible amount stated In the Schedule as applicable to "each employee". The terms of this Insurance, including those with respect to notice of claim or suit, the company's right to Investigate, negotiate and settle any claim or suit, and the company's right and duty to defend, apply irrespective of the application of the deductible amount. The company may pay any part or all of the deductible amount to effect settlement of any claim or suit and, upon notification of the action taken, the named Insured shall promptly reimburse the company for such part of the deductible amount as has been paid by the company* IV. Additional Definitions When used In reference to this Insurance: AID 000304 "employee benefit program" means the following plans: (a) group life Insurance, group accident or health Insurance, profit sharing plans, pension plans and stock subscription plans, provided that no one other than an employee may suoscribe Srm>OLNO to such Insurance or plans; 1 (continued on Page #5) 13241 C-17,20 REV. S-75 **l*TCO * U.S A. Countersigned By. 1 lf_, ^ ENDORSEMENT THE TRAVELERS INSURANCE COMPANIES This endorsement is issued by that member of The Travelers Insurance Companies which issued the policy of which this endorsement forms a part. If any additional premium is noted below, this endorsement is issued in consideration thereof. If any return premium is noted below, the receipt thereof is acknowledged upon acceptance of this endorsement. Effective from 01-^01-76 {Month. Day. Year) at the time of day the policy becomes effective. Issued - -3i5 ANACONDA COMPACT EX AL FES SHD SODOM PnHryd\n TB^ISL-123T69Vi^75 Page #5 Date of Issue: 3-25-76 CRP/XK/DP Additional Premium $ Return Premium % (The information provided for above, except the policy number, is required to be stated only when this endorsement is issued for attachment to the policy subsequent to its effective date.) It is agreed that as of the effective date hereof the policy is amended in the following particulars: (b) unemployment Insurance, social security benefits, writers* compensa tion and disability benefits; {c) any other similar plan designated in the Schedule or added thereto by endorsement; "administration" means (a) counseling employees. Including their dependants and beneficiaries, with respect to the employee benefit program; (b) handling records in connection with the employee benefit program; :. (c) effecting or terminating any employee's participation In a p==an in cluded in the employee benefit program; "employee" means officers and employees of the named Insured, whether actlyely employed, disabled or retired. "personal injury" means Injury arising out of one or more of the following offenses: (a) false arrest, detention or imprisonment or malicious prosecution', (b) the publication or utterance of a libel or slander or other c;e &:- tory or disparaging material, or a publication or utterance vr latlon of an individual's right of privacy; (c) wrongful entry or eviction, or other invasion of the right of private occupancy; or (d) discrimination. AID 000305 (continued on -age ?S) SrmeOL No. C-17320 REV. S-7S ...n t io .. u . Countersigned By__:_____________ / ENDORSEMENT THE TRAVELERS INSURANCE COMPANIES This endorsement is issued by that member of The Travelers Insurance Companies which issued the policy of which this endorsement forms a part. If any additional premium is noted below, this endorsement is issued in consideration thereof. If any return premium is noted below, the receipt thereof is acknowledged upon acceptance of this endorsement. Effective from C1---01-76 (.Month. Day. Ytor) at the time of day the policy becomes effective. L AHA30r*DA COMPANY ET .4L I'SP. 5S3 33CO(Aj Issued to---ii. Date of Issue: GRtyYK/DP Additional Premium t Amending } Policy No________________ _______!_________ Return Premium $ (The information provided for above, except the policy number, is required to be stated only when this endorsement is issued for attachment to the policy subsequent to its effective date.) It is agreed that as of the effective date hereof the policy is amended in the following particulars: irocrsement Period and Territory 'i.VIs Jnsur^ca applies only to claims first brought against ins insured dur doiIcy period within the United States of *3*5*1 ca, `its sr'rctorias t-ssessiena or Canada, provided the '-,$*reds vt the effect-1*** *M- '.dcrseent, had no knowledge of or omission which -vsi5. C 3J'B Condition Totic-s - Vton :ha insured'? btc .-sing ,%44r* of :j cct p-s -*v::s ii** Hse *o loss covered h-ar'jnser> written :i :s s':if i V ; n of the insured In accordance with the iti-jn -of i-scr...-- ;-* -i^-ur^d's duties In the of in o- /Mi. AID 000306 SrrnOL No, C-17S20 REV. 8-75 min u o u u .i .*. Countersigned By_________--_________________________________________ ENDORSEMENT THE TRAVELERS INSURANCE COMPANIES This endorsement is issued by that member of The Travelers Insurance Companies which issued the policy of which this endorsement forms a part. If any additional premium is noted below, this endorsement is issued in consideration thereof. If any return premium is noted below, the receipt thereof is acknowledged upon acceptance of this endorsement. Effective from________*r/X`~*0*"70,, , (Mom*. Day. Year) at the time of day the policy becomes effective. issued - 'THE ANACONDA COMPANY BTAL PER EKD 8000(A) Date of Issue: 3^5"76 CRP/YK/DP Additional Premium $ Amending Policy No ,iSMK5L-I23T6975. Return Premium S (The information provided for above, except the policy number, is required to be stated only when this endorsement is issued for attachment to the policy subsequent to its effective date.) It is agreed that as of the effective date hereof the policy is amended in the following particulars: iris ENDORSEMENT MODIFIES SUCH INSURANCE AS IS HJOVIBED BY THE PROVISIONS OF THE EMPLOYEE BENEFITS LIAB3UTT INSURANCE ENDORSEMENT* EMPLOYEE BENEFITS LIABIT.TTY - NEW YORK AMENDATORY ENDORSEMENT IT IS AGREED THAT WITH RESPECT TO THE EMPLOYEE BENEFIT LIABILITI INSURANCE ENDORSEES.:; TIE FOLLOWING PROVISIONS APPLY: lo THE DEFTNITIQN OF "EMPLOYEE BENEFIT PROGRAM" UNDER 17, ADDITIONAL DEFINITIONS IS REPLACED BY THE FOLLOWING: 4 "EMPLOYEE BENEFIT PRCCEAM" MEANS THE FOLLOWING PLANS: (A) (SOUP LIFE INSURANCE, (SOUP ACCIDENT OR HEALTH INSURANCE, PROFIT SHARING ELANS, PENSION PLANS AND STOCK SUBSCRIPTION PLANS, PROVIDED THAT NO CHE OTHER THAN AN EMPLOYEE MAY SUBSCRIBE TO SUCH INSURANCE OR PLANS; (B) ANY OTHER SIMILAR PLAN DESIGNATED HI TIES SCHEDULE OR ADDED THERETO BY ENDORSEMENT; ' 2. THE FOLLOWING ADDITIONAL CCHDITION IS ADDED UNDER VI*, ADDITIONAL CONDITIONS, DISCOVERY PERIOD AID 000307 IF THE COMPANY CANCELS OR DOES NOT RENEW OR IF THE INSURED CANCELS THIS COVERAGE, THE INSURED SHALL HAVE THE OPTION OF HAVING THIS INSURANCE ALSO APPLY TO LOSS TO WHICH THIS INSURANCE APPLIES FOR WHICH CLAIM IS FIRST SrmOL NO. (CONTINUED ON PAGE #2) 26620 C-17S20 REV. A-75 *i.rcD i* u *.*. f/vy //k i , Countersigned By ENDORSEMENT THE TRAVELERS INSURANCE COMPANIES This endorsement is issued by that member of The Travelers Insurance Companies which issued the policy of which this endorsement forms a part. If any additional premium is noted below, this endorsement is issued in consideration thereof. If any return premium is noted below, the receipt thereof is acknowledged upon acceptance of this endorsement. Effective from. Issued Date of Issue: 01-01-76________ at the time of day the policy becomes effective. {Month. Day. V`ar) k mn o3-25-76 K /y k /" mo... saooU) Additional Premium $ TR-M5L-123T6931 PACE #2 Return Premium $ (The information provided for above, except the policy number, is required to be stated only when this endorsement is issued for attachment to the policy subsequent to its effective date.) It is agreed that as of the effective date hereof the policy is amended in the following particulars: MADE AGAINST THE INSURED WITHIN SIX MONTHS FIRST FOLLOWING THE EFFECTIVE DATE OF SUCH CANCELLATION OR NOHREEHAL, PROVIDED THAT: (A) WRITTEN NOTICE OF THE EXERCISE OF THIS OPTION IS GIVEN TO THE COMPANY BI THE EFFECTIVE DATE OF CANCELLATION OR WITHIN TEN DAIS OF THE EFFECTIVE DATE OF NONHENEWAL* (B) THE PREMIUM, AS DETERMINED BY THE COMPANY, SHALL BE 'PAID PROMPTLY WHEN DUE, AND (C) THE LOSS ARISES OUT OF AN ACT OR OMISSION WHICH OCCURRED ON OR AFTER THE EFFECTIVE DATE OF THIS ENDORSEMENT STATED IN THE SCHEDULE OF THIS ENDORSEMENT BUT BEFORE THE EFFECTIVE DATE OF CANCEZLATTGN OS NDNEENEWAL OF THIS COVERAGE* FAILURE OF THE COMPANY TO OFFER TO RENEW THIS COVERAGE UPON THE SAME RATES AND FORMS AS IS NOW PROVIDED SHALL BE DEEMED. FOR FURPQSES OF THIS DISCOVER PERIOD PROVISION, NOT TO BE CANCELLATION OR NONHENEWAL BY THE COMPANY, C-1T820 REV. 8-7S .rcsi. u.s... Countersigned Bv_ AID 000308 4* Svwot. No. 26620 THE TRAVELERS INSURANCE COMPANIES This endorsement is issued by that member of The Travelers Insurance Companies which issued the policy of which this endorsement forms a part. If any additional premium is noted below, this endorsement is issued in consideration thereof. If any return premium is noted below, the receipt thereof is acknowledged upon acceptance of this endorsement. Effective from________Ql`tQI=`Z&________at the time of day the policy becomes effective. T^e4SI^123T693~>-75 {Month. Day. Ytar) issued m CHE ANACONDA COMPANY SEAL PER DID 8000(A)______________________________________________________________ Date of Issue: >-25-76 CRP/YK/DP Additional Premium $ Return Premium $ (The information provided for above, except the policy number, is required to be stated only when this endorsement is issued for attachment to the policy subsequent to its effective date.) It is agreed that as of the effective date hereof the policy is amended in the following particulars: THIS HIDORSHEHT MODIFIES SUCH INSURANCE AS IS PROVIDED BY THE PROVISIONS OF THE POLICY RELATING TO THE FOLLOWING: aULOYES BENEFITS LIABILITY INSURANCE EMPLOYEE BENEFITS LIABILITY - HEW JERSEY AMENDATORY ENpoararoiT THE EMPLOYEE BENEFITS LIABILITY ENDORSEMENT IS AMENDED AS FOLLOWS: THE FOLLOWING CONDITION IS ADDED: " pqK rsBtu H^rop - v" wxB K yz{S n y K S |K B}s o r " ~B n o t BB CR IF THE INSURED CANCELS THIS COVERAGE, THE INSURED SHALL HAVE THE OPTION OF HAVING THIS INSURANCE ALSO APPLY TO LOSS TO WHICH THIS INSURANCE APPLIES FOR WHICH CLAIM IS FIRST MADE AGAINST THE INSURED WITHIN ONE YEAR FIRST FOLLOWING THE EFFECTIVE DATE OF SUCK CANCELLATION OR NONHENEWAL FROTHED THAT: ( ) vffirmaiS K B " B BBK B " t h is o p t io n i s GIVEN TO THE COMPANY BY THE EFFECTIVE DATE OF CANCELLATION OB WITHIN 30 DAYS OF THE EFFECTIVE DATE OF NONHENEWAL; (S') THE PREMIUM, AS DETERMINED BY THE COMPANY, SHALL BE PAID PROMPTLY WHEN DUE, AND C-I7R20 REV. *-7J M..IID...I1 CCONTHIUED ON PAGE &) _ jr/A/Aa -- Countersigned By______________ AID 000309 >WCs 2S9U= ENDORSEMENT THE TRAVELERS INSURANCE COMPANIES This endorsement is issued by that member of The Travelers Insurance Companies which issued the policy of which this endorsement forms a part. If any additional premium is noted below, this endorsement is issued in consideration thereof. If any return premium is noted below, the receipt thereof is acknowledged upon acceptance of this endorsement. Effective from _____ Ql"01"76______ at the time of day the policy becomes effective. Policy No____TS^tISL^123T693--3^75_______ (Month. Day. Ytar) PAGE #2 lssued THE ANACONDA COMPANY ETAL PER END aOOO(A)______________________________ ________________________________ Date of Issue: 3-25-76 CRP/YK/DP Additional Premium $ Return Premium $ (The information provided for above, except the policy number, is required to be stated only when this endorsement is issued for attachment to the policy subsequent to its effective date.) It is agreed that as of the effective date hereof the policy is amended in the following particulars: (c) THE LOSS ARISES OUT OF AN ACT OR OMISSION WHICH OCCURRED: (l) DURING THE LAST TWELVE MONTHS THIS ENDORSEMENT WAS IN EFFECT, BUT IF THIS END0RSEM3JT HAS NOT BEEN IN EFFECT FOB AT LEAST TWELVE MONTHS, SUCH ACT OR OMISSION MUST HAVE OCCURRED CN CE AFTER THE EFFECTIVE BATE OF THIS ENDORSEMENT; AND (2) BEFORE THE EFFECTIVE DATE OF CANCELLATION OR NCKEENEWAL OF THIS COVERAGE* FAILURE OF THE COMPANY TO OFFER TO RENEW THIS COVERAGE UPON THE SAME RATES AND F0S1-B AS IS NOW PROVIDED SHALL BE DEEMED, FOE PURPOSES OF t u t s DISCOVERY PERIOD PROVISION, NOT TO BE CANCELLATION OR NQHRENEWAL BY THE COMPANY* 0-17*20 REV. 8-73 i,i i Di.u m Countersigned By AID 000310 SvMtOC NO. 26940 / i \ ENDORSEMENT THE TRAVELERS INSURANCE COMPANIES This endorsement is issued by that member of The Travelers Insurance Companies which issued the policy of which this endorsement forms a part. If any additional premium is noted below, this endorsement is issued in consideration thereof. If any return premium is noted below, the receipt thereof is acknowledged upon acceptance of this endorsement. Effective from. 01-01-76 (MoiUk. Day. Ytar) .at the time of day the policy becomes effective. IDssauteedoftoI_ssu.eH!IE ANACONDA 3"25"7& COMPANY BT AL GRP/YKj /DP FSB END 5000(A) Additional Premium $ Amending Policy N'o TB-SSM23T69T Return Premium $ (The information provided for above, except the policy number, is required to be stated only when this endorsement is issued for attachment to the policy subsequent to its effective date.) It is agreed that as of the effective date hereof the policy is amended in the following particulars: THIS INDORSEMENT MODIFIES SUCH INSURANCE AS IS AFFORDED BT THE FR07ISICHSOF THE POLICY EZLAHKr TO THE KJLLOWIHGs EMPLOYEE BENEFITS LIABILITY INSURANCE EMPLOYEE BENEFITS LIABILITY - MICHIGAN AMENDATORY ENDORSEMENT THE FOLLOWING C0NDII1GN IS ADDED TO THE EMPLOYEE BENEFITS LIABILITY IN DORSEMENT: DI5C0VE3Y PERIOD - IF THE COMPANY CANCELS CE REFUSES TO RENEW BUS COVERAGE, THE INSURED SHALL HAVE THE OPTION OF HAVING THIS INSURANCE ALSO APPLY TO LOSS TO WHICH THIS INSURANCE APPLIES FOR WHICH CLAIM IS FIRST MADE AGAINST THE INSURED WITHIN SH MOTHS FIRST FOLLOWING THE EFFECTIVE DATE OF SUCH CANCESLATIQN OB NQNEESEUAL PROVIDED THAT: (A) WRITTEN NOTICE OF THE EXERCISE OF THIS OPTION IS GIVEN TO THE COMPANY BY THE EFFECTIVE DATE OF CANCELLATION OR WITHIN TEN DAYS OF THE EFFECTIVE DATE OF NC3I3EHEKAL; (3) THE EREMItM, AS DETERMINED 3Y THE COMPANY, SHALL EE PAID FROMPTLI WHEN DUE; AND (C) THE LOSS ARISES OUT OF AN ACT OR OMISSION WHICH OCCURRED CN CR AFTER THE EFFECTIVE DATE OF THIS ENDORSEMENT BUT BEFORE THE EFFECTIVE DATS C? (CANCELLATION OR MCNRENEWAL OF THIS COVERAGE, (CONTINUED ON PAGE #2). . . _ AID 000311 S8 No . 26960 C-17820 REV. 8-7S Mn.no " u s * Countersign^ Ry __ , r^- ________________________ I tit WttO,Bl,VI i THE TRAVELERS INSURANCE COMPANIES This endorsement is issued by that member of The Travelers Insurance Companies which issued the policy of which this endorsement forms a part. If any additional premium is noted below, this endorsement is issued in consideration thereof. If any return premium is noted below, the receipt thereof is acknowledged upon acceptance of this endorsement. Effective from. 01-01-76 (Month. Day. Year) .at the time of day the policy becomes effective. i\E ANACONDA COMPANY ET AL PER END 8000(A) Issued to- Date of Issu--e: >25-76 CSP/WttF Additional Premium t Amending T&-MSL-123T69>>75 PAGE #2 Return Premium $ (The information provided for above, except the policy number, is required to be stated only when this endorsement is issued for attachment to the policy subsequent to its effective date.) It is agreed that as of the effective date hereof the policy is amended in the following particulars: FAILURE OF THE CCMPAHI TO OFFER TO RHEH THIS COVERAGE UPCN THE SAME RATES h MD FOftE AS IS MOW PROVIDED SHALL BE DEEMED, FOR PURPOSES OF THIS DISCOVER! PERIOD HtOVXSIGH, MOT BE CANCELLATXGR OR HGKEESEUAL ET THE COMPANY. C-17A20 REV. t-7S it k o u .s .S . Countersigned By AID 000312 St ms o K NO. 26960 * ENDORSEMENT THE TRAVELERS INSURANCE COMPANIES J This endorsement is issued by that member of The Travelers Insurance Companies which issued the policy of which this endorsement forms a part. If any additional premium is noted below, this endorsement is issued in consideration thereof. If any return premium is noted below, the receipt thereof is acknowledged upon acceptance of this endorsement. Effective from________ _;________ __ _________ at the time of day the policy becomes effective. {Month, Day, Year) Issued TS ANACONDA COMPANY ET AL F3 END 8000(A) Amending Policy NY 2,,7<* ' '*- ________ Date of Issue: d=,?.i-75 DL/LM Additional Premium $ Return Premium % (The information provided for above, except the policy number, is required to be stated only when this endorsement is issued for attachment to the policy subsequent to its effective date.) It is agreed that as of the effective date hereof the policy is amended in the following particulars: THE PATHS FOR THE FOLLOWING CLASSIFICATIONS ARE AMENDED TO READ AS FOLLOWS* 3CHS3UL5 *2 STATE GF LA 7,2 .-ViACCNDA COMPANY ORLEANS PARISH *>ACC-NDA WIRE AND CABLE CO AHAC.OMDA WIRE CO HI5ERN5A BANK BUILDING *EV *?.;, rARSSH RATES Bl 3 0J40 E .0175 S *0140 *0175 REM SUM ADJUSTMENT AT AUDIT AID 000313 CJ7I20 New 8-74 nkiwrco < u s a Countersigned By______________ SrmOL No. 3W;'v U SJ ENDORSEMENT THE TRAVELERS INSURANCE COMPANIES This endorsement is issued by that member of The Travelers Insurance Companies which issued the policy of. which this endorsement forms a part. If any additional premium is noted below, this endorsement is issued in consideration thereof. If any return premium is noted below, the receipt thereof is acknowledged upon acceptance of this endorsement. Effective from. Issued to. Date of Issue: *3-0 W5 (Afoul*. Day. Year) at the time of day the policy becomes effective. -/ncaao1- K S :-sa B " sacota) DL'L./M Additional Premium $ Amending Policy Xc_ Return Premium $ (The information provided for above, except the policy number, is required to be stated only when this endorsement is issued for attachment to the policy subsequent to its effective date.) It is agreed that as of the effective date hereof the policy is amended in the following particulars: ST 1$ UNDERSTOOD AMD AGREED THAT, A-S RESPECTS THE FOLLOWS LOCATION ONLY* THE BODILY IHJURY UNIT OF LIABILITY IS $100,000 PER OCCURRENCEr THORTON BUILDING AND THORTON ANNEX - APARTMENTS BUTTE, MONTANA PREMIUM ADJUSTMENT AT AUDIT C-I7S20 NewS><4 - u s * Countersigned By. t<411 AID 000314 S 8 KNo . i C./v\* ENDORSEMENT | | THE TRAVELERS INSURANCE COMPANIES jJ ! This endorsement is issued by that member of The Travelers Insurance Companies which issued the policy of which this endorsement forms a part. If any additional premium is noted below, this endorsement is issued in consideration thereof. If any return premium is noted below, the receipt thereof is acknowledged upon acceptance of this endorsement. Amending Effective fromat the time of day the policy becomes effective. Policy N'c_ TR-NSL-U3T693-3-75 (Month. Day. Year} Issued to___________________________________________________ Date of Issue: Additional Premium $ Return Premium $ (The information provided for above, except the policy number, is required to be stated only when this endorsement is issued for attachment to the policy subsequent to its effective date.) It is agreed that as of the effective date hereof the policy is amended in the following particulars: ITEM 1NAMED INSURED TO READ: NAMED INSURED MEANS THE ORGANIZATION, INCLUDING ANY SUBSIDIARY' THEREOF, NAMED IN ITEM 1 OF THE DECLARATIONS AND ALSO INCLUDES ANY OTHErt COMPANY WHICH IS ACQUIRED OR FORMED BY THE NAMED INSURED DURING THE POLICY PERIOD AND OVER WHICH THE NAMED INSURED MAINTAINS OWNERSHIP OR FINANCIAL CONTROL. C-17820 New 8-74 K Ks . j s * Countersigned By_____ ________ S " 000315 S 8 o l No. 8000(A) ENDORSEMENT O THE TRAVELERS INSURANCE COMPANIES This endorsement is issued by that member of The Travelers Insurance Companies which issued the policy of which this endorsement forms a part. If any additional premium is noted below, this endorsement is issued in consideration thereof. If any return premium is noted below, the receipt thereof is acknowledged upon acceptance of this endorsement. Effective from_________0__1-01-76_____,, {Month. Day. Year) '-.z mjxsm KS z t Issued to------------------------- --------- .... . .............. Date of Issue: CR- /YK/PD ,i,,t day ,h. policy b-- dte*.. S B " K oof S ) Additional Premium t+S 105,125 Return Premium $ -75 B 84,795 (The information provided for above, except the policy number, is required to be stated only when this endorsement is issued for attachment to the policy subsequent to its effective date.) It is agreed that as of the effective date hereof the policy is amended in the following particulars: ITTMATED TOTAL ADVANCE PREMIUM FOR THE FIRftT ANOTV2K3ARY 15 AMENDED TO READ: ..i : .:jZDULET> AMD ENDORSEMENTS KSC? 04 73(SD 1-74) -399 H&-3308A vr.io.331s YY-33<-I 241 8000(c) seij/.z; 9342 38:1(6) 88^4 9950 *502 8310(3) G525 26131 J 3241 .'6620 26940 26960 fO>-399 *&-3308A WS*-3318 YY-3321 C-535 1324I 26131 r~6ZC 26940 25560 CC 34A C? 04 63('ED 3-74) CP 04 c?(2T 1-74; CP 04 7'-'ED 1-74) C.' 0ir ?4(ED 1-74) C? 04 76(ED 1--74) 206cZ 23561 23~X) 342C3G 2502C 300) (EMPLOYEE BENEFITS HID) O ->U.STEED ON.>8 VFB *03947 C-17820 REV. 8-75 min t io in u .$.S . Countersigned By. AID 000316 Sr--o l No. <!K. 241. PERSONAL INJURY PROTECTION ENDORSEME (Basic AutomoMa Liability Insurants, Comprehensive AutomoMe Liability Insurants, Garage Insurants) This endorsement forms a part of Policy No. issued to by the (Name of Insurants Company) . at its Agent located (city and state) and is effective from . (12:01 A M. Standard Time) (The information above is required only when this endorsement is issued subsequent to preparation of the policy.) This endorsement forms a part of the policy to which attached, effective from its date of issue unless otherwise stated herein. SCHEDULE Coverage Personal Injury Protection Coverage Limits of liability $ TS-' each person Description of Insured Motor Vehicles (Check appropriate block) Advance Premium $ ' Any automobile owned by the named insured. Any private passenger automobile owned by the named insured. Any motor vehicle to which are attached dealer's license plates issued to the named insured. Any motor vehicle designated in the Declarations of the policy by the letters P.I.P. and a motor vehicle ownership of which is acquired during the policy period by the named insured as a replacement therefor. ............................................................................................................................. ..................... *...................... In consideration of the premium for this endorsement, the Company agrees with the nemed insured, subject to all of the provisions of this endorsemi and all of the provisions of the policy except as modified herein, as follows: PERSONAL INJURY PROTECTION INSURING AGREEMENT In accordance with the provision of Article 5.06-3 of the Insurance Code of Texas and all Acts amendatory or supplementary thereto, the Company v pay: (1) the named insured or any member of the insured's household who sustains bodily injury, caused by accident, in a motor vehicle accident anc (2) any other person who sustains bodily injury, caused by accident, (a) while occupying the insured motor vehicle, or (b) while using such vehicle with the permission of the named insured, or the spouse of the insured if a resident of the same household, for losses incurred by such injured person within three years of the date of such accident for: (1) all reasonable and necessary medical expenses incurred for services furnished, and (2) (a) if the person sustaining such bodily injury is an income or wage producer at the time of such accident, benefits for loss of income sustair by such person, while living, as a direct and proximate result of such accident, and (b) if the person sustaining such bodily injury is not an income or wage producer at the time of such accident, benefits in reimbursement for m essary and reasonable expenses incurred for essential services ordinarily performed by such injured person for the care and maintenance the family or family household, during the period of such injured person's disability. EXCLUSIONS This insurance does not apply: (a) to any person who: (1) intentionally causes the accident resulting in the bodily injury of such person, or (2) sustains bodily injury while in the commission of a felony or while seeking to elude lawful apprehension or arrest by a law enforeem official. (b) to the named insured or any member of the insured's household who sustains bodily injury while occupying or through being struck b) motor vehicle owned by such named insured or any member of the insured's household which is not an insured motor vehicle. LIMITS OF LIABILITY Regardless of the number of persons insured, policies or bonds applicable, vehicles involved or claims made, the total aggregate limit of liability all benefits of every kind for loss or expense incurred by or on behalf of any one person who sustains bodily injury as the result of any one accident s not exceed the limit of liability set out in the schedule of this endorsement. If the person receiving payment under this coverage is also making a cl against the insured under bodily injury liability coverage of this policy or against the Company under family protection or uninsured motorists coverage this policy, such insured and the Company shall be entitled to an offset, credit or deduction ageinst any award made to such guest or passenger in an amc of money equal to the amounts paid by the owner, operator or the Company under "personal injury protection" to such guest or passenger and the bo injury liability and family protection or uninsured motorists coverages of this policy are hereby amended accordingly; provided, however, nothing he shall be construed to authorize a direct action against the Company. DEFINITIONS AID 000317 I ___ .. i,.e<iiui"ig uiiMm on me aaie u. atuaem as ;o>n>s. (a) if income is a salary or fixed remuneration. Oy the monthly rate of income being 'earned oh "the date of accident: (b) otherwise, by the average monthly income actually earned during the twelve month period immediately preceding me date of accident, or if the insured has been engaged m his occupation as of the date of accident for a period of less than twelve months. Dy the average monthly income actually earned during that period; "benefits for loss of income" means eighty (80%) per cent of actual Income lost because of disability resulting from insured bodily miury which pre vents the injured person from performing the substantial duties of his usual occupation; "bodily injury" means bodily injury, sickness, or disease, including death at any time resulting therefrom; "income" means wages, salary, tips, commissions, professional fees, and other earnings from work or employment; "income or wage producer" means a person who at the time of an accident was in an occupational status where such person was earningorproducing mccme; "insured motor vehicle" means an automobile owned or leased by the named insured which is described in the schedule as an insured motor vehicle to which bodily injury liability coverage of the policy applies; "medical expenses" means expenses for necessary medical, surgical, x-ray and dental services, including prosthetic devices, and necessary ambulance, hospital, professional nursing and funeral services; "member cf the insured's household" means a relative of the individual named insured who is a resident of the same household; "motor vehicle'! means an automobile and any other vehicle, including a trailer, operated or designed for operation upon a public road by anypower other than animal or muscular power; "named insured'' means the person or organization named in the declarations; "occupying" means in or upon or entering into or alighting from: "person" means a natural person and not a corporation, partnership, association or business name. CONDITIONS 1. Policy Provisions. None of the insuring agreements, exclusions or conditions of the policy shall apply to the insurance afforded by this endorsement except the conditions "Notice." "Assistance and Cooperation of the Insured," "Changes," "Assignment" "Cancellation" and "Declarations." 2. Premium. If during the policy period the number of insured motor vehicles owned by the named insured or spouse or the'number of dealer's license plates issued to the named insured changes, the named insured shall notify the Company during the policy period of any change and the premium shall be ad justed m accordance with the manuals in use by the Company. If the earned premium thus computed exceeds the advance premium paid, the named insured shall pay the excess to the Company; if less, the Company shall return to the named insured the unearned portion paid by such insured. 3. Proof of Claim end Medical Reports. As soon as practicable, and no later than six months after the date of accident, the person making claim shall give to the Company written proof of claims, including full particulars of the nature and extent of the injuries and treatment received and contemplated and medical expenses incurred, the nature and extent of actual income lost, all such instruments and papers relating to income as the Company may rea sonably require to establish benefits for loss of income, and such other information as may assist the Company in determining the amount due and payable. The injured person shall submit to mental or physical examinations by physicians selected by the Company and at the Company's expense when and as often as the Company may reasonably require and such person or. in the event of disability, incapacity or death, the legal representative, shall upon each request by the Company execute authorization to enable the Company to obtain medical reports and copies of records. Proof of claim shall be made upon forms furnished by the Company unless the Company shall have failed to furnish such forms within fifteen days after receiving notice of Claim. The person making claim shall submit to examination under oath by any person named by the Company, and subscribe the same, as often as may reasonably be required. 4. Other Insurance. If there is other personal injury protection insurance against a loss covered by the previsions of this endorsement, the Company shall not be liable under this policy for a greater proportion of such loss than the applicable limit of liability stated in this endorsement bears to the total applicable limit of liability of all valid and collectible personal injury protection insurance; provided, however, the insurance afforded hereunder shall be.excess over any other valid and collectible personal injury protection insurance available to the named insured or any member of the insured's household. 5. Payment cf Loss. Any payment under this coverage, including benefits for loss of income, are payable to the person who is disabled or. if the disabled person is an unemancipated minor, to the parent or guardian who has custody of such minor, within thirty days after satisfactory proof thereof is received by the Company. Subject to proof of claim: (a) accrued medical expenses and benefits for loss of Income are payable every two weeks; (b) any benefits for a period of less than two weeks for which the Company is liable are payable at termination of the disability period. , 6. Action Against Company. No action shall lie against the Company unless as a condition precedent thereto there shall have been full compliance with all the terms of the policy and of this endorsement and until thirty days after the required notice of accident and proof of loss have been filed with the Company. 7. Policy Period, Territory. This insurance applies only to accidents which occur during the policy period of the policy to which the endorsement is at tached, in the United States of America, its territories and possessions, or Canada, or while the motor vehicle is being transported between ports thereof. FORM 241.--PERSONAL INJURY PROTECTION ENDORSEMENT Texas Standard Automobile Endorsement Prescribed August 27, 1373 By.......................... A' (Duly Authorized Representative) ' - r r |. ; i - ; . -r- i ,,.-. 4 -j r* * t;;*i ill > A ) ') AID 000318 This endorsement modifies such insurance as is afforded by the provisions of the policy relating to the following: COMPREHENSIVE GENERAL LIABILITY INSURANCE MANUFACTURERS' AND CONTRACTORS' LIABILITY INSURANCE OWNERS' AND CONTRACTORS' PROTECTIVE LIABILITY INSURANCE OWNERS', LANDLORDS' AND TENANTS' LIABILITY INSURANCE ADDITIONAL INSURED (Employm,s ) It is agreed that the "Persons Insured* provision is amended to include any employee of the named insured while acting within the scope of his duties as such, but the insurance afforded to such employee does not apply: 1. to bodily injury to (a) another employee of the named insured arising out of or in the course of his employment or (b) the named insured or, if the named insured is a partnership or joint venture, any partner or member thereof: 2. to property damage to property owned, occupied or used by. rented to. in the care, custody or control of. or over which physical control is being exercised for any purpose by (a) another employee of the named insured or (b) the named insured, or. if the named insured is a partnership or joint venture, any partner or member thereof. INCLUDED IN COMPOSITE This endorsement is issued by that member of The Travelers Insurance Companies which issued the policy of which this endorsement forms a part. C-H9J2 4-67 PPINTtD IH U.S.A. N.S. 173 AID 000319 G106A 241. PERSONAL INJURY PROTECTION ENDORSEMENT (Buie Automobile liability Insurance, Comprehensive Automobile Liability Insurance, Garage Insurance) This endorsement forms a part of Policy No. issued to by the (Name of Insurance Company) at its Agency located (city and state)........................................... ............ ...................... ............................................. and is effective from ................................... (12:01 A.M. Standard Time) (The information above is required only when this endorsement is issued subsequent to preparation of the policy.) This endorsement forms a part of the policy to which attached, effective from its date of issue unless otherwise stated herein. SCHEDULE Coverage Personal Injury Protection Coverage Limits of Liability $ ; each person Advance Premium $ Description of Insured Motor Vehicles (Check appropriate block) Any automobile owned by the named insured. Any private passenger automobile owned by the named insured. Any motor vehicle to which are attached dealer's license plates issued to the named insured. P Any motor vehicle designated in the Declarations of the policy by the letters P.I.P. and a motor vehicle ownership of which is acquired' during the policy period by the named insured as a replacement therefor. ........................................................... ............................................................................................................ In consideration of the premium for this endorsement, the Company agrees with the named insured, subject to all of the provisions of this endorsement and all of the provisions of the policy except as modified herein, as follows: PERSONAL INJURY PROTECTION INSURING AGREEMENT In accordance with the provision of Article 5.06-3 of the Insurance Code of Texas and all Acts amendatory or supplementary thereto, the Company will pay: (1) the named insured or any member of the insured's household who sustains bodily injury, caused by accident, in a motor vehicle accident, and (2) any other person who sustains bodily injury, caused by accident, (a) while occupying the insured motor vehicle, or (b) while using such vehicle with the permission of the named insured, or the spouse of the insured if a resident of the same household, for losses incurred by such injured person within three years of the date of such accident for: (1) all reasonable and necessary medical expenses incurred for services furnished, and (2) (a) if the person sustaining such bodily injury is an income or wage producer at the time of such accident, benefits for loss of income sustained by such person, while living, as a direct and proximate result of such accident, and (b) if the person sustaining such bodily injury is not an income or wage producer at the time of such accident, benefits in reimbursement for nec essary and reasonable expenses incurred for essential services ordinarily performed by such injured person for the care and maintenance of the family or family household, during the period of such injured person's disability. EXCLUSIONS This insurance does not apply: (a) to any person who: (1) intentionally causes the accident resulting in the bodily injury of such person, or (2) sustains bodily injury while in the commission of a felony or while seeking to elude lawful apprehension or arrest by a law enforcement official. (b) to the named insured or any member of the insured's household who sustains bodily injury while occupying or through being struck by a motor vehicle owned by such named insured or any member of the insured's household which is not an insured motor vehicle. LIMITS OF LIABILITY Regardless of the number of persons insured, policies or bonds applicable, vehicles involved or claims made, the total aggregate limit of liability for all benefits of every fund for loss or expense incurred by or on behalf of any one person who sustains bodily injury as the result of any one accident shall not exceed the limit of habilitv set out in the schedule of this endorsement. If the person receiving payment under this coverage is also making a claim AID 000320 of money equal to the amounts paid by the owner, operator or the Company under ' personal*-'lOfury protection. to such'guest or passenger ana tne oo2y injury liability and family protection or uninsured motorists coverages of this polity are hereby amended accordingly: provided, however, nothing nerem shall be construed to authorize a direct action against the Company. DEFINITIONS 'actual income lost" means the difference between the monthly rate of income being earned bn the date of accident and income received during the period of disability, measuring income on the date of accident as follows: (a) if income is a salary or fixed remuneration, by the monthly rate of income being earned on the date of accident: (b) otherwise, by the average monthly income actually earned during the twelve month period immediately preceding the date of accident, or if the insured has been engaged in his occupation as of the date of accident for a period of less than twelve months, by the average monthly income actually earned during that period; "benefits tor loss of income" means eighty (80%) per cent of actual income lost because of disability resulting from insured bodily iniury which pre vents the injured person from performing the substantial duties of his usual occupation; "bodily injury" means bodily injury, sickness, or disease, including death at any time resulting therelrom; "income" means wages, salary, tips, commissions, professional fees, and other earnings from work or employment; "income or wage producer" means a person who at the time of an accident was in an occupational status where such person was earning or producing inccme; "insured motor vehicle" means an automobile owned or leased by the named insured which is described in the schedule as an insured motor vehicle to which bodily injury liability coverage of the policy: applies; "medical expenses" means expenses for necessary medical, surgical, x-ray and dental services, including prosthetic devices, and necessary ambulance, hospital, professional nursing and funeral services; "member of the insured's household" means a relative of the individual named insured who is a resident of the same household; "motor vehicle" means an automobile and any other vehicle, including a trailer, operated or designed for operation upon a public road by any power other than animal or muscular power; "named insured" means the person or organization named in the declarations; "occupying" means in or upon or entering into or alighting from; "person" means a natural person and not a corporation, partnership, association or business name. CONDITIONS 1. Policy Provisions. None of the insuring agreements, exclusions or conditions of the policy shall apply to the insurance afforded by thisendorsement except the conditions "Notice," "Assistance and Cooperation of the Insured," "Changes," "Assignment" "Cancellation" and "Declarations." 2. Premium. If during the policy period the number of insured motor vehicles owned by the named insured or spouse or the number of dealer's license plates issued to the named insured changes, the named insured shall notify the Company during the policy period of any change and the premium shall be ad justed in accordance with the manuals in use by the Company. If the earned premium thus computed exceeds the advance premium paid, the named insured shall pay the excess to the Company; if less, the Company shall return to the named insured the unearned portion paid by such insured. 3. Proof of Claim and Medical Reports. As soon as practicable, and no later than six months after the date of accident, the person making claim shall give to the Company written proof of claims, including full particulars of the nature and extent of the injuries and treatment received and contemplated and medical expenses incurred, the nature and extent of actual income lost, all such instruments and papers relating to income as the Company may rea sonably require to establish benefits for loss of income, and such other information as may assist the Company in determining the amount due and payable. The injured person shall submit to mental or physical examinations by physicians selected by the Company and at the Company's expense when and as often as the Company may reasonably require and such person or. in the event of disability, incapacity or death, the legal representative, shall upon each request by the Company execute authorization to enable the Company to obtain medical reports and copies of records. Proof of claim shall be made upon forms furnished by the Company unless the Company shall have failed to furnish such forms within fifteen days after receiving notice of claim. The person making claim shall submit to examination under oath by any person named by the Company, and subscribe the same, as often as may reasonably be required. 4. Other Insurance. If there is other personal injury protection insurance against a loss covered by the provisions of this endorsement, the Company shall not be liable under this policy for a greater proportion of such loss than the applicable limit of liability stated in this endorsement bears to the total applicable limit of liability of all valid and collectible personal injury protection insurance; provided, however, the insurance afforded hereunder shall be excess over any other valid and collectible personal injury protection insurance available to the named insured or any member of the insured's household. 5. Payment cf Loss. Any payment under this coverage, including benefits for loss of income, are payable to the person who is disabled or, if the disabled person is an unemancipated minor, to the parent or guardian who has custody of such minor, within thirty days after satisfactory proof thereof is received by the Company. Subject to proof of claim: (a) accrued medical expenses and benefits for loss of income are payable every two weeks; (b) any benefits for a period of less than two weeks for which the Company is liable are payable at termination of the disability period. 6. Action Against Company. No action shall lie against the Company unless as a condition precedent thereto there shall have been full compliance with all the terms of the policy and of this endorsement and until thirty days after the required notice of accident and proof of loss have been filed with the Company. 7. Policy Period, Territory. This insurance applies only to accidents which occur during the policy period of the policy to which the endorsement is at tached, in the United States of America, its territories and possessions, or Canada, or while the motor vehicle is being transported between ports thereof. FORM 241.--PERSONAL INJURY PROTECTION ENDORSEMENT^-- ---------------Tens Standard Automobile Endorsement Prescribed August 27,1973 (Duly Authorized Representative) AID 000321 COMPREHENSIVE GENERAL LIABILITY INSURANCE MANUFACTURERS' AND CONTRACTORS' LIABILITY INSURANCE OWNERS'. LANDLORDS' AND TENANTS' LIABILITY INSURANCE STOREKEEPER'S INSURANCE ADDITIONAL INSURED (Premises Leased to the Named insured) It is agreed that the "Per--ins Insured" provision is amended to inelude as an insure./ the person >r orgnm/ation designated below, but only with respect to liability arising out of the ownership, mainlen.ince or use of that part of the premises designated below leased to the nano! insured, and subject to the following additional exclusions- The insurance does not apply: 1. to any occurrence which takes place after the named insured censes to la- a tenant in said premises; 2. to structural alterations, new construction or demolition operations performed by or on behalf of the person or organi zation designated below. Designation of Premises (Part Leased to Named Insured) * A r * r'' A SCHEDULE Name of Person or Organization (Additional Insured) 'i c'SACH s ^ r*M *.`i 1 a .. Premiums Bodily Injury Liability Property Oamoge Liability . 4I iy*u I'.! Amending Policy No. AID 000322 This endorsement is issued by that member of The Travelers Insurance Companies which issued the policy of which this endorsement forms a part. 173C-M2S9 7-6$ p o in t B" in u .S.A. N.S. G109 This <.*!!*: k >: COMPREHENSIVE GENERAL LIABILITY INSURANCE MANUFACTURERS' AND CONTRACTORS' LIABILITY INSURANCE OWNERS'. LANDLORDS' AND TENANTS' LIABILITY INSURANCE STOREKEEPER'S INSURANCE ADDITIONAL INSURED (Premises Leased to the Named Insured) ft m .(greed that the "Per-->ns Injured" provision is amended to include an .m red the person ir orc.im/ation designated below, but only with respect to liability arising out of the ownership, maintenance or use of that part of the premises designated below leased to the named nsured. and subject to the following additional exclusions: The insurance does not apply: 1. to any occurrence which takes place after the named insured ceases to be a tenant in said premises: 2. to structural alterations, new construction or demolition operations performed hy or on behalf of the person or organi zation designated below. Designation of Premises (Part Leased to Named insured) SCHEDULE Name of Person or Organization (Additional Insured) OCHLAii CORPORATION Premiums Bodily Property injury Liability .Damage Liability INCLUDED Amending Policy No. TR-NSL-123T693-3-75 AID 000323 This endorsement is issued by that member of The Travelers Insurance Companies which issued the policy of which this endorsement forms a part. C-H2S9 7-66 OftIMTCO IN U.5.A. N.S. 173 G109 iUJ-lEG EX~.-J Thi~ enrt'jr !i!"ie- ~w:; m-ur inv -.* :> .iff -rdf: > .it- pr- f rn- p COMPREHENSIVE GENERAL LIABILITY INSURANCE MANUFACTURERS' AND CONTRACTORS' LIABILITY INSURANCE OWNERS'. LANDLORDS' AND TENANTS' LIABILITY INSURANCE STOREKEEPER'S INSURANCE ADDITIONAL INSURED (Premises Leased to die Named Insured) It is agreed that the "Per--ms Insured" provision is amended to include n~ in insure! the person or organization de-ign.ued below, but only with respect to liability arising out of the ownership, mamu-n.ir.ee or use of that part of the premises designated below- leased to the named insured, and subject to the following additional ewlusions- The insurance does not apply: 1. to any occurrence which takes place after the named insured ceases to be a tenant in said premises. 2. to structural alterations, new construction or demolition operations performed by or on behalf of the person or organi zation designated below. ' SCHEDULE Designation of Premises {Part Leased to Named Insured) Name of Person or Organisation (Additional Insured) FEDERICO COSTA SVREET Hh TO REY '3DUSTEIAL BEVELC?< r'EHT H/'.TC .-iSY PR VAN fViGMJNCFF Premiums Bodily Property Injury Liability .Damage Liability INCLUDED : *.* Amending Policy No---------- id? -MSL--1 ? iTb AID 000324 This endorsement is issued by that member of The Travelers Insurance Companies which issued the policy of which this endorsement forms a part. C-U259 7*66 PRINTED IN u.S.A. N.S. 173 G109 tHjjuRatmtn 1 THE TRAVELERS INSURANCE COMPANIES This endorsement is issued by that member of The Travelers Insurance Companies which issued the policy of which this endorsement forms a part. If any additional premium is noted below, this endorsement is issued in consideration thereof. If any return premium is noted below, the receipt thereof is acknowledged upon acceptance of this endorsement. Effective from I'ued to IX.tv of Issue: Month, Day, Year Amending at the time of day the policy becomes effective. Policy Nc j R-- '.SL--> `'AGE .>! Additional Premium $ Return Premium $ -> The information pro-, ded for above, except the policy number, is required to be stated onh when this endorsement is issued for attachment ti the policy subsequent to its effective date.) I: : agreed that as 01 'he effective date hereof the p-.licy is amended in the fell-"-wing particulars: THIS ENDORSEMENT MODIFIES THE PREMIUM CCHDU 'ON AND j$ APPLICABLE TO ALL INSURANCE AFFORDED 9Y THE POLICY MOT SPECIFICALLY EXCEPTE0,, COMPOSITE RATE ENDORSEMENT TiE PREMIUM FOR THIS POLICY EXCEPT WITH RESPECT TO LA, NC & TX COVERAGE SHALL HF COMPUTED !N ACCORDANCE WITH TE PREMIUM 3AS IS AMO RATES DESIGNATED IN THE SCHEDULE 3EL0W. yNE CREM!,J*. rCR LA, NC 5 TX COVERAGE SHALL BE COMPUTED !H ACCORDANCE WITH THE PROVISIONS'OF THE POLICY EXCLUSIVE CF THIS ENDORSEMENT* A DISCOUNT WHERE APPLICABLE BASED UPON THE NUMBER CF AUTOMOBILES OWNED 8Y THE NAMED INSURED !S INCLUDED !H THE COMPUTATION OF THE RATES STATED IN THIS EN DORSEMENT AMO SUCH DISCOUNT DOES NOT OTHERWISE APPLY. THE .ADVANCE PREMIUM STATED 3EL0W IS AN ESTIMATED PREMIUM ?CR THE FIRST ANNUAL PERIOD. cPON TERMINATION OF THIS ANNULI t-ERIOD, THE EARNED PREMIUM SHALL 3E COMPUTED in ACCORDANCE WITH THE POLICY "HD THIS ENOGSSL-F.NT, IF THE EARNED ?REM:UM THUS CCHPi/TEO EXCEEDS THE ESTIMATED ADVANCE FREMUX PAID, THE NAMED INSURED SHALL PAY THE EXCESS TO THE COMPANY* <F LESS, "HE COMPANY SHALL RETURN TO THE NAMED INSURED THE UNEARNED POPTIOM -AI0 3Y THE INSURED,- RATES AND PRE MIUMS FOR THE SECOND ANNUAL PERIOD SHALL BE DETERMINED AT -.HE INCEPTION SATE OF EACH PERIOD AND SHALL BE SPECIFIED IN AN ENDORSEMENT ^0 3E ADDED T) TIE POLICY. AFTER TERMINATION OF THIS PERIOD, THE EARNED PREMIUM SHALL BE COMPUTED IN ACCOR DANCE WITH THE POLICY AND THIS ENDORSEMENT C-17S20 NewB-Ti AID 000325 (CONTINUED ON PAGE #2) Countersigned B\________________________________________________ SvMftOL No. 8000 ><*.: ENDORSEMENT THE TRAVELERS INSURANCE COMPANIES This endorsement is issued by that member of The Travelers Insurance Companies which issued the policy of which this endorsement forms a part. If any additional premium is noted below, this endorsement is issued in consideration thereof. If any return premium is noted below, the receipt thereof is acknowledged upon acceptance of this endorsement. Effective from---------------------------------- Monin. Day. Year U-.,ied to D.ar of Issue: Amending .at the time of day the policy becomes effective. Policy N'c I2iiL_LLl i .] i Additional Premium $ Return Premium $ ' The information pro\ ded for above except the policy number, i~ required to be 'tated only when this endorsement is issued for attachment to the policy subsequent to its effective date.) It .greed that as oi he effective date hereof the j. icy is amended in the fulkaving particulars: SfPkCULE 1. 0EFINITJ3H Or `OM C0'J3R^E AUTCMQB *l L'AS'vJTV CCOE 5140 -:STI.MATp fiEHUNERAnOH -- - -222,759,000 CuMPEf-SATi ON 3EHUHERAT RATES PE.? $ 100 OF REMUNERATION " 0 N ESTIMATED ANNUA;. ADVANCE PREMIUM PQ S>0104 E-005T5 -20*9 -':nS4 24207 2211? 14897 GflMERAL j j ^ | v*y 43 ".*0050 ?.}2,753,000 3,0226 Er0201 -Os';! -O' 34 52-603 ^6 f?B4 J5,?4A 31*190 C-IT82U N`ewS-T4 s K -- --v Cotmier^igned B\_______________ 4/0 000326 Sy w COC NO. 6G00C A THE TRAVELERS INSURANCE COMPANIES This endorsement is issued by that member of The Travelers Insurance Companies which issued the policy of which this endorsement forms a part. If any additional premium is noted below, this endorsement is issued in consideration thereof. If any return premium is noted below, the receipt thereof is acknowledged upon acceptance of this endorsement. Effective from ?-i -o i-76 (Month. Day. Ytar) .at the time of day the policy becomes effective. : -u-AOUMBA COMPANY S? AL PER END 3C-00(A) Issued to--------- 30SF/5K7DF Date of Issue: Additional Premium I Amending vIPT T' Policy W ~ ' Return Premium $ (The information provided for above, except the policy number, is required to be stated only when this endorsement is issued for attachment to the policy subsequent to its effective date.) It is agreed that as of the effective date hereof the policy is amended in the following particulars: SCHEDULE ITTION OP PREMIUM BASIS: SALE ESTIMATES RETJERATTON RATES $100 or EEHmoRATic:: 31 H)a.r> 'OEILE LIABILITY Csi; 2A2?991r012 3 .,010c E ,0095 :o 69 I.-L STABILITY /+3=Jj C050 2ft2991t012 S ,0226 E ,0201 -0134 ESTIMATED -VSUAI AS'TAN'TE PEETL:u.-f 31 L.. 25-271 23,004 1> 14 91c 3S,:=: 32. 35 . cT> C-ir0 REV. S-7S MlKTIt K !M.t. Countersigned By. AID 000327 SK Wo . ~ -\trxsj , " This endorsement modifies such insurance as is afforded by the provisions of the policy relating to the following: UNINSURED MOTORISTS INSURANCE ECTIV5: 01-01-76 UNINSURED MOTORISTS INSURANCE COVERAGE PART-SPECIFIED CAR BASIS It is agreed that this part applies only to the automobiles designated below: Automobiles and State of Principal Garaging . .VJ TiroiLES . 'TI7. Ll I IAP7GED "I ATAXIc Limits of Liability Each Person Each Accident Premium S EQUAL TQs Hmi'T'!! j 3FI FuIAAOIAL 333B0K3I3ILiair l :.i u .t s o ? r~ CC'TASIT LTx>?sn-2ca Sr.- JE i'ZTtE THE \AAA- 8C^'Q) IS C-AriCSD 7.-CLY 1,-JOG ,000 19.CCO 10,000 5 -COO l,i:G0:C00 20 000 2CLCCC ;o..oc;c l:k 14 tr 04 75(ED Amending Policy No. I^?SL"123T69j-3"7 tf 5''5 Vo 0Kl/*iS-DP THE TRAVELERS INDEMNITY COMPANY C-1 2701 * 68 PRINTED IN U.S.A. AID 000328 THE CHARTER OAK FIRE INSURANCE COMPANY Secretary 9950 ENDORSEMENT THE TRAVELERS INSURANCE COMPANIES V. This endorsement is issued by that member of The Travelers Insurance Companies which issued the policy of which this endorsement forms a part. If any additional premium is noted below, this endorsement is issued in consideration thereof. If any return premium is noted below, the receipt thereof is acknowledged upon acceptance of this endorsement. Effective from Month. Day. Yean Amending T',lsaL]23 at the time of day the policy becomes effective. Policy Nc____ ________ ..r___ ___ c____Z. h-ued to________________________________________________________________________________________________________________________ p-ite of Issue: Additional Premium S Return Premium $ The information pro-.-ded for above, except the policv number, is required to be stated or.K when this endorsement is issued for attachment tc the policy subsequent to its effective date, i It i- .<reed that as oi the effective date hereof the p*.licy is amended in the following particulars: ADDITIONAL INSURED (ENGINEERING MANAGEMENT INC) IT IS AGREED THAT WITH RESPECT TO SUCH INSURANCE AS IS AFF0R0E0 BY THE POLICY FOR BODILY INJURY AND PROPERTY DAMAGE* THE PERSONS INSURED PROVISION IS AMENDED BY ADDING THERETO ENGINEERING MANAGEMENT, INC., BUT ONLY WITH RESPECT TO OPERATIONS CONDUCTED ON PREMISES OWNED 8Y THE NAMED INSURED, AND SUBJECT TO THE FOLLOWING ADDITIONAL PROVISIONS. SUCH INSURANCE AS IS AFFORDED BY THIS ENDORSEMENT DOES NOT APPLY* 1) TO "001LY INJURY OR PROPERTY DAMAGE ARISING OUT OF THE OWNERSHIP, MAINTENANCE, OPERATION, USE, LOADING 98 UNLOADING OF ANY AUTOMOBILE. Z\ TO BODILY INJURY TO ANY OFFICER OR EMPLOYEE SF THE MAMED INSURED) 3) TO 300JLY INJURY OR PROPERTY DAMAGE INCLUDED IN PRODUCTS HAZARD OR THE COMPLETED OPERATIONS HAZARD) 4) TO PROPERTY DAMAGE TO PROPERTY OWNED 3Y, LEASED C8 RENTED TO THE NAMED INSURED) THE INCLUSION HEREIN OF THE ADDITIONAL INSURED SHALL HOT OPERATE TO INCREASE THE LIMITS OF THE COMPANY'S LIMITS. C-17820 \tw 8-74 Co m nter*ig tied By_________ ' Jt -4^** AJD 000329 Stwoi No. 3000{E , J. JL------ iJ<J i'W* mm\.n i\J ruwv* INST FACT Co mp (n o o p Si % PO To t DS 8 DBS I" Bit y Un 'n s mq t K BBB COi.v S-DN F pE.T-,E^-A'NC Tj * .*1 OU is Si 3 n j1 0 < u6 y* Owu Of s?!i K * a* ** 3 X c: *6. SI S . B! PD MED. Bi <K - Mca.i GB , LS . S 'l B PREM. I RET. PREM F F p AOO*C PREM. 0 RET. PREU. F F A A A A TcTAk. OFFICE & CODE J . ... ' /' PROO. COOS , * PROO. . ` * *' i. j POUCT . | EXPIRES . N- \ WOO OF | AOJUST; If any additional premium is noted below, this endorsement is issued in consideration thereof. If any return premium is noted below, the receipt thereof is acknowledged upon acceptance of this endorsement. Effective from \ Month. Day. Year) at the time of day the policy becomes effective. Amending Policy N'o. Issued to______ Zi____________________________________________________________________________________________________________ ___ Date of Issue: T*. _ Additional Premium J Return Premium $ (The information provided for above, except the policy number, is required to be stated only when this endorsement is issued for attachment to the policy subsequent to its effective date.) It is agreed that as of the effective date hereof the policy is amended in the following particulars: -- -- :U. The Travelers Insurance Companies C-l 7520B NEW 8-74 PRINTED IN U.S.*. 575 S " 000330 Srtno l No. This endorsement is issued by that member of The Travelers Insurance Companies which issued the policy of which this endorsement forms a part. .n u u xta & in,n i THE TRAVELERS INSURANCE COMPANIES This endorsement is issued by that member of The Travelers Insurance Companies which issued the policy of which this endorsement forms a part. If anv additional premium is noted below, this endorsement is issued in consideration thereof. If any return premium is noted below, the receipt thereof is acknowledged upon acceptance of this endorsement. Effective from____ Month. Day, Ytar A mending at the time of day the policy becomes effective. Policy Nc___ : 3 Issued to____________________________________________________________________________________________________ ___ Date of Issue: Additional Premium $ Return Premium $ v-7S i The information pro-. :ded for above, except tlie policy number. i> required to be stated only when this endorsement is issued for attachment tthe policy subsequent to its effe<-rive date.) It i- .greed that as ot he effective date hereof the p' icy i- amended in the following particulars: HOT APPLICABLE ~Q TX CONDITION 6 OF THE POLICY JACKET IS TENDED TO READ AS FOLLOWS; -? SUCH OTHER INSURER SHALL, ?0R ANY REASON, REFUSE CR FAIL TO DEFEND AND rlCEMNJFY TH!S THURSO THEN rj.E C3H9ANV WILL TAKE OVER AND DEFEND AND ` MOEMNiFY IN ACCCR? UfCC WITH THE * - iMG AGREEMENTS* TERMS AND CONDITIONS OF ^H)S POLICY, AS r.'SUGH SUCH OTHER POLICY DID NOT EXIST, C-17820 New 8 -4 <;( aS- Countersigned Bv AID 000331 Srwftot. No. ~3QUQ(F' ENDORSEMENT THE TRAVELERS INSURANCE COMPANIES This endorsement is issued by that member of The Travelers insurance Companies which issued the policy of which this endorsement forms a part. If any additional premium is noted below, this endorsement is issued in consideration thereof, if any return premium is noted below, the receipt thereof is acknowledged upon acceptance of this endorsement. Effective from______________________ . Mor:r. Day, Year fsiued to_____ Date of Is-ue: at the time of day the policy becomes effective. Additional Premium $ fR~NSL-l 23T69?-3-7-> Return Premium $ i The information pro ded for above, except tiie police number, b required to be stated only when thb endorsement is issued for Attachment to the policy subsequent to its elective date.) It : agreed that a= of he effective date hereof the p lice b amended in the foil <u mg particulars: CONDITION 4; INSUREDS OUT'ES \H THE EVENT OF OCCURRENCE CLAIM OR SUIT IS AMENDED AS FOLLOWS; NOTICE SHALL 3E DEEMED GIVEN AS SOON AS PRACTICABLE, AS RESPECTS THE NAMED INSURED, ;F GIVEN WiTHIN 30 DAYS AFTER THE INSURANCE MANAGER OF THE NAMED INSURED BECOMES AWARE OF SUCH OCCURRENCE Oft OFFENSE. 01*820 **r*rc; a5 Cumitersi^ned Bv. AJD 000332 Sv*fOL NO, *000(G- ! ;J THE TRAVELERS INSURANCE COMPANIES This endorsement is issued by that member of The Travelers Insurance Companies which issued the policy of which this endorsement forms a part. If any additional premium is noted below, this endorsement is issued in consideration thereof. If any return premium is noted belOWv the receipt thereof is acknowledged upon acceptance of this endorsement. Effective fromat the time of day the policy becomes effective. Policv N Month. Day. Year. 1 .{-N5L-! ij i I>Mied to Date of fi*ue: Additional Premium $ Return Premium $ l he information pn- -ded for above, except the pviict number. U required to be stated onlt when this endorsement is issued for attachment t. the policy subsequent to its effective date.) It > .greed that as tf he effective date hereof the ; act i~ amended in the following particulars: NOT APPU CABLE 70 TX CONDITION 7-SUBROGATION OF THE POLICY JACKET TO READ: IN THE EVENT OF ANY PAYMENT UNOER THIS POLICY, THE COMPANY SHALL BE SUBROGATED TO THE EXTENT OF SUCH PAYMENT, TO ALL THE INSURED'S RIGHTS OF RECOVERY THEREFOR AND THE INSURED SHALL EXECUTE ALL PAPERS REQUIRED AND SHALL DO EVERYTHING THAT MAY BE NECESSARY TO SECURE SUCH RIGHTS, PUT THE COMPANY SHALL HAVE NO RIGHTS OF SUBROGATION AGAINST ANY OWNED OR CONTROLLED, SUBSIDIARY COMPANIES OF THE NAMED INSURED. THE COMPANY WILL ACT IN CONCERT WITH ALL OTHER INTERESTS CONCERNED {INCLUDING THE INSURED) IN THE EXERCISE OF SUCH RIGHTS OF RECOVERY. IF ANY AMOUNT IS RECOVERED AS A RESULT OF SUCH PROCEEDINGS SUCH AMOUNT SHALL BE APPORTIONED AS FOLLOWS* FIRST, ANY INTEREST (INCLUDING THE INSURED) THAT SHALL HAVE PAID AN AMOUNT OVER AND ABOVE ANY PAYMENT MADE UNOER THIS POLICY SHALL BE REIMBURSED UP TO THE AMOUNT PAID BY SUCH INTEREST. SECOND, THE COM PANY SHALL BE REIMBURSEO OUT OF THE BALANCE THEN REMAINING, UP TO THE AMOUNT PAID UNDER THIS POLICY; THIRD, THE INSURED IS ENTITLED TO THE RESIDUE. THE EXPENSE OF ALL PROCEEDINGS NECE$SARV TO THE RECOVERY OF ANY SUCH AMOUNT SHALL BE APPORTIONED BETWEEN THE INTERESTS CONCERNED (INCLUDING THE INSURED) IN THE RATIO OF THEIR RESPECTIVE RECOVERIES AS FINALLY SETTLED. IF THERE SHOULD BE NO RECOVERY IN PROCEEDINGS IN STITUTED SOLELY ON THE INITIATIVE OF THE COMPANY, THE EXPENSES THERQF SHALL BE BORNE BY THE COMPANY. C-I'SZO \'ew8-"4 Hrnti; a i - Countersigned By. AJD 000333 Sr--oi Nq , 8000(H) THE TRAVELERS INSURANCE COMPANIES This endorsement is issued by that member of The Travelers Insurance Companies which issued the policy of which this endorsement forms a part. If any additional premium is noted below, this endorsement is issued in consideration thereof. If any return premium is noted below, the receipt thereof is acknowledged upon acceptance of this endorsement. Effective from______________________ Month Day. Veer United to_____ Date of Issue: at the time of day the policy becomes effective. fediv.g TR-HSL-123T693-W5 Additional Premium $ Return Premium $ ( The information prov ded for above, except the policy number, i- required to be stated only when this endorsement is issued for attachment tv the policy subsequent to its erertive date.) It igreed that as at the elective date hereof the policy is amended in the fi-wing particulars; AS RESPECTS COVERAGE PART L5B AUTOMOBILE MEDICAL PAYMENTS LIMITS OF LIABILITY TO READ: TX 32500 EACH PERSON A/0 $2000 EACH PERSON C-17820 N'cw 8-"4 *i*rcc j s * Countersigned By. AID 000334 SrwftOC No. 8000(1} ENDORSEMENT i THE TRAVELERS INSURANCE COMPANIES J This endorsement is issued by that member of The Travelers insurance Companies which issued the policy of which this endorsement forms a part. If anv additional premium is noted below, this endorsement is issued in consideration thereof. If any return premium is noted below, the receipt thereof is acknowledged upon acceptance of this endorsement. Effective from________________________ Month. Day. Issued to D..tv jf Issue: Amending .at the time of day the policy becomes effective. Policy Nc____ ! ? gT^.y'-a j.- Additional Premium $ Return Premium $ "~e information prv ded for above, except the policy number. required to be stated emit who:: this endorsement is issued for attachment to the policy subsequent to its effective date. 1 It .greed that as oi he effective date hereof t*-e t .icy i> amended in the ft -.wing particulars: NOT APPLICABLE TO TX SUCH INSURANCE AS IS AFFORDED BY THIS POLICY SHALL APPLY TO ALL SPORT, ATHLETIC, SOCIAL OR RECREATIONAL ACTIVITIES SPONSORED 3Y "HE NAMED N$URE0 IN WHICH THE EMPLOYEES OF THE INSURED ARE PARTICIPANTS. C-IT820 New 8-74 Countersigned By. AID 000335 St ms o l No . 6000 O tlWUKStMtn i THE TRAVELERS INSURANCE COMPANIES j This endorsement is issued by that member of The Travelers Insurance Companies which issued the policy of which this endorsement forms a part. If any additional premium is noted below, this endorsement is issued in consideration thereof. If any return premium is noted below, the receipt thereof is acknowledged upon acceptance of this endorsement. Effective from---------------------------------- Mvntit. Day. Year Amending ,.el at the time of day the policy becomes effective. Policy Nc------ I-ucd to____________________________________________________________ -- -....................-.................... - ,. Pof U-ue: Additional Premium $ ..........- ... -.........-- - Return Premium $ ... -- !`he information pr.e. ded for above, xcep' the police number, i- required to be stated onl> when this endorsement is issued for attachment o the policy subsequent to its elective date.) is ..greed that a= ei he elective date h-.n-jf the t :cy i- amended in the ! -at ing particulars: if IS HEREBV S / BB" dUili MATED. S B K s io n <h ) " in s u r S K B K BS / B S it S is P-"1 0* C-17820 New8-`4 mti: . s t Countersigned B> AID 000336 Srwaoc No. 8000{K THE TRAVELERS INSURANCE COMPANIES J This endorsement is issued by that member of The Travelers Insurance Companies which issued the policy of which this endorsement forms a part. If any additional premium is noted below, this endorsement is issued in consideration thereof. If any return premium is noted below, the receipt thereof is acknowledged upon acceptance of this endorsement. Effective from______________________ Month. Day. i'tar Amendine at the time of day the policy becomes effective. Policy N'v. Is-uod to_________________________________________________________________________________________________________________ D.ae of Issue: Additional Premium $ Return Premium $ . information pro de<f for above exert the p->1 icy number, is. required to be stated onh hi;:: this endorsement is issued for attachment t> the policy subsequent to its effective date.; It : .greed that as of he en'ective date hen of th<- t .icy i- amended :r. the fi-iipving particulars: ASSAULT 5- BATTERY CCHMITTEO FOR THE PURPOSE OF PREVENTING OR ELIMINATING OAMGER IN THc OPERATION OF AIRCRAFT OR FOR THE PURPOSE OF PRCTECTING r<*i PROPERTY CF THE JNSUPEO OS THE PERSON OR PROPERTY OF OTHERS SHALL -F OCCURRENCE C-17820 New 8-`4 - Countersigned By r*-A 000337 SriMOL WO. SCCO'.L * ENDORSEMENT THE TRAVELERS INSURANCE COMPANIES This endorsement is issued by that member of The Travelers Insurance Companies which issued the policy of which this endorsement forms a part. If any additional premium is noted below, this endorsement is issued in consideration thereof. If any return premium is noted belbw, the receipt thereof is acknowledged upon acceptance of this endorsement. Effective from---------------------------------- Mown. Day. Fear, Ir-ued to____ Date of Is^ue: Amending .at the time of day the policy becomes effective. Policy Ne. TR^SL-1 ?.3T^93 Additional Premium $ Return Premium $ ;'he information pr^ ded for above exccp' police number, i-. required to be -tuted only when thi> endorsement i~ issued for attachment tc the policy subsequent to its effective date. I It i- .greed that a- o; he elective date hereof the | .icy is amended in the f"" .'aing particulars: SUCH INSURANCE AS IS AFFORDED BY THE POLICY FOR BODILY INJURY LIABILITY AND FOR PROPERTY DAMAGE LIABILITY APPLIES SUBJECT TO THE FOLLOWING PROVISIONS: 1, THE UNQUALIFIED WORD "INSURED" ALSO INCLUDES ANY PERSON, TRUSTEE, ESTATE OR ORGAN?ZAT3ON WHO LEASES OR RENTS PREMISES TO THE NAMED INSURED, 3UT ONLY WITH RESPECT TO HIS LIABILITY ARISING OUT OF SUCH PREMISES WHILE LEASED TO, OCCUPIED OR USED BY THE NAMED INSURED; 2a THE INSURED WITH RESPECT TC SUCH PERSON, TRUSTEE, ESTATE OR ORGAN- `ZATION SHALL APPLY ONLY TC SUCH r** EXTENT AMO FOR SUCH LIMITS OF LIABILITY AS THE NAMED INSURED- JiDER ITS OPERATING PROCESSES, AS AGREED IN WRITING TO PROVIDE INSURANCE FOR SUCH INTEREST, PROVIDED THE COMPANY SHALL NOT BE LIABLE *0R ANY AMOUNT ASREEO TO 8Y THE NAMED INSURED WHICH IS IN EXCESS OF THE LIMITS OF LIABILITY AFFORDED BY THE POLICY. PREMIUM INCLUDED IN COMPOSITE RATE C-17820 New 8-74 Rtwrii Countersigned By. AID 000338 SvMtOC No. 0000 <*i> ENDORSEMENT THE TRAVELERS INSURANCE COMPANIES u This endorsement is issued by that member of The Travelers Insurance Companies which issued the policy of which this endorsement forms a part. If any additional premium is noted below, this endorsement is issued in consideration thereof. If any return premium is noted below, the receipt thereof is acknowledged upon acceptance of this endorsement. Amending t o _l!^l Effective fromat the time of day the policy becomes effective. Policy Nc______J1 Manih. Day. Year- Issued to Da'.. ,f Is^ne: Additional Premium $ Return Premium S ~J ' ; '. he information pro- ded for above, ex-apt the po!ic\ number, i- required to be stated only she- this endorsement is issued for attachment t< the policy subsequent to its effective date.) I: : ..freed that as he elective date hi-.-v-jf the : :c\ i' amended in the- fei! "air.g particulars: SUCH INSURANCE AS IS AFFORDED BY THE POLICY UNDER THE PROPERTY DAMAGE LIABILITY COVERAGE THEREOF SHALL ALSO APPLY TO LIABILITY IMPOSED UPON THE INSURED BY AHY FOREST FIRE PREVENTION ACT OR BY ANY SIMILAR ACT FOR THE COST OF CONTROLLING OR EXTINGUISHING FIRES, WHETHER OR NOT SUCH FIRES OCCUR ON PREMISES OWNED 3Y, OCCUPIED BY, RENTED TO, OR !N THE CARE, CUSTODY AND CONTROL OF THE INSURED, SUBJECT TO THE FOLLOWING ADDITIONAL PROVISIONS* 0) THE LIMITS OF LIABILITY AS STATED BELOW AS APPLICABLE TO -EACH OCCURRENCE" IS THE TOTAL LIMIT OF THE COMPANY5S LIABILITY UNDER COVERAGE S FOR ALL DA*5.4GES ARISING OUT OF DAMAGE TO OR DESTRUCTION Or ALL PROPERTY OF ONE "R MORE rSSSsJNS OR ORGANIZATIONS, I SILOING THE LOSS 2F USE THEREOF AS THE RESULT OF ANY ONE ACCiOENT. (2) LIMITS OF LIABILITY $500-000 EACH OCCURRENCE- C-17820 New 8.74 *rcc Countersigned By AID 000339 S8 o l No . 8000'N B " BBt THE TRAVELERS INSURANCE COMPANIES This endorsement is issued by that member of The Travelers Insurance Companies which issued the policy of which this endorsement forms a part. If any additional premium is noted below, this endorsement is issued in consideration thereof. If any return premium is noted below, the receipt thereof is acknowledged upon acceptance of this endorsement. Effective from----------------------------------.Uonj/t. Day, Vtar Issued to_____________________________ P..v of Ii'ue: at the time of day the policy becomes effective. Amending Policy NY. re-SSL^ 23T693~V- ? r Additional Premium S Return Premium $ . : information pro-, -ded for above. e\ccpt the policy number. is required to be stated onl> when this endorsement i~ issued for attachment r the policy subsequent to its effective date.; It : ..greed that as he effective date hereof the ; ,;cy i- amend'd ir. the fc: .'.cin? particulars; "APPLICABLE TO TX ITEM 1-NAMED INSURED TO READ: THE ANACONDA C3MPAHY C-17820 Sew 8-4 curt; j i * Countersigned By. AID 000340 SrMOL NO. Soon < o ENDORSEMENT THE TRAVELERS INSURANCE COMPANIES This endorsement is issued by that member of The Travelers Insurance Companies which issued the policy of which this endorsement forms a part. If any additional premium is noted below, this endorsement is issued in consideration thereof. If any return premium is noted below, the receipt thereof is acknowledged upon acceptance of this endorsement. Effective from______________________ Month. Day. Year Amending at the time of day the policy becomes effective. Poiicv Nc VR~NSL-123T6933~ Is-UL'd to_________ ---- f1 a- jt Is-ue: ............... ........ ............--................................................................ Additional Premium $ .............. Return Premium S . i hv information pro-, ded for above, vx.tct the pu'icv number, i- required to be stated onl\ une:. this endorsement is issued ior attachment tthe policy subsequent to its effective date.) it . .greed that a: he effective date h-. r-.-of the ; dr> A amend>d in the i- ii tving particular-: WITH RESPECT TO OPERATIONS AT CERTAIN MINING PROPERTIES IN WASATCH AND SUMMIT COUNTIES, UTAH THE POLICY IS EXTENDED TO COVER THE ADDITIONAL INTEREST OF (*) PARK CITY VENTURES - LESSEE AND (2) UNITED PARK CITY MINES COMPANY - OWNER IT IS FURTHER AGREED THAT SUCH INSURANCE AS !S AFFORDED BY THE POLICY ANO THIS ENDORSEMENT DOES HOT APPLY TO BODILY INJURY TO ANY EMPLOYEE OF PARK CITY VENTURES OR UNITED PARK CITY HffJES COMPANY ARISING OUT OF AND IN THE COURSE OF HIS EMPLOYMENT WHILE UNDERGROUND* C-J7820 New 8-.*4 - -s* Countersigned By AID 000341 S8 o l n o . 5ono(P- ENDORSEMENT THE TRAVELERS INSURANCE COMPANIES U This endorsement is issued by that member of The Travelers Insurance Companies which issued the policy of which this endorsement forms a part. If any additional premium is noted below, this endorsement is issued in consideration thereof. If any return premium is noted below, the receipt thereof is acknowledged upon acceptance of this endorsement. Effective from Is.-ued to_____ P.i' of Issue: Manat. Day. Year) Amending at the time of day the policy becomes effective. Policy Xc. Additional Premium $ Return Premium $ The information pn>- :ded for above, flap: 'he policy number, i- required to be <t.ited or.h hv:: this endorsement i< issued for attachment t the policv subsequent to its etterrive date. > 1: : ..greed that as of 'he elective date he-cof the ;. ,:cy > amended in the k : .-wing particulars: POLLUTION EXCLUSION {BROAD FORM) IT IS AGREED THAT SUCH INSURANCE AS IS AFFORDED SY THE POLICY FOR BODILY IN-IURY AND PROPERTY DAMAGE DOES NOT APPLY TO POLLUTION OF flJE A3R9 LAND OR WATER, NOR TO 3CD!LY INJURY OR PROPERTY DAMAGE RESULTING FROM SUCH POLLl/HCN. C-17S20 Newg.T* *Kn*Tt: % , i * Countersigned By- AID 000342 SrwgQt. No, OQOGfQ.i ENDORSEMENT THE TRAVELERS INSURANCE COMPANIES This endorsement is issued by that member of The Travelers Insurance Companies which issued the policy of which this endorsement forms a part. If anv additional premium is noted below, this endorsement is issued in consideration thereof. If any return premium is noted below, the receipt thereof is acknowledged upon acceptance of this endorsement. Effective from_______________________ Monte,. Day. Year Amending .at the time of day the policy becomes effective. Policy Nc TR-HSkii 1T6S3- 0 Issued to______________________________________________________________________________________________________________________________________________ Dof Issue: Additional Premium $ Return Premium $ TV information provided for above, except the po!ic\ number, is required to be stated onh when this endorsement is issued for ittachment to the policy subsequent to its effective date.) It:- .greed that a.- ot he effective date her: of the ; .icy is amended in the to:' .wing particulars: SUBSIDENCE OF SOIL SUCH INSURANCE AS IS AFFORDED BY INSURANCE PART L!A UNDER COVERAGE B SHALL NOT APPLY TO INJURY TO CR DESTRUCTION INCLUDING THE LOSS OF USE OF PROPERTY RESULTING FROM OR ATTRIBUTABLE TO THE SUBSIDENCE OF SOIL AT ANY LOCALITY WHERE MINING OPERATIONS HAVE BEEN OR ARE BEING CONDUCTED OR THE DEPOSITION OF SILT. C-17820 New 1.74 Countersigned By. AID 000343 S8 o l No . 8CO0<-$ ENDORSEMENT THE TRAVELERS INSURANCE COMPANIES This endorsement is issued by that member of The Travelers Insurance Companies which issued the policy of which this endorsement forms a part. If any additional premium is noted below, this endorsement is issued in consideration thereof. If any return premium is noted below, the receipt thereof is acknowledged upon acceptance of this endorsement. Effective from Month. Day. V tar; Amending at the time of dav the policy becomes effective. Policy Nc. TR-HSL-*23T69M-7S Issued to----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------- Pate of Issue: Additional Premium S Return Premium $ The information pro- :derf for above ccci-pt the policy number. Is required to be ' t.-.'ed only wrtm: this endorsement is issued for attachment tc the policy subsequent to its r,v.'r-n\e date.) It:- .greed that a: -f ' he effective dale hereof the ; .icy is amended in the f. owing particulars: THE LIMITS OF LIABILITY OF THIS POLICY ARE INCLUSIVE OF AND NOT IN ADDITION TO THE LIMITS OF LIABILITY AFFORDED BY ANY OTHER LIABILITY POLICY ISSUED TO THE NAMED INSURED BY THE COMPANY AS EVIDENCE OF THIS INSURANCE. C*17820 New 8-74 K K -s j % m Countersigned By. AID 000344 S8 n o , 8000 ( fcWUUKSliMfcK l THE TRAVELERS INSURANCE CO ANIES u This endorsement is issued by- that member of The Travelers Insurance Companies which issued the policy of which this endorsement forms a part. If any additional premium is noted below, this endorsement is issued in consideration thereof. If any return premium is noted belcnv, the receipt thereof is acknowledged upon acceptance of this endorsement. Effective from______________________ Montn. Day, Year I--ued to_____ of Issue: .Amending .at the time of day the policy becomes effective. Policy NY.. TR i 23T69?." 7 5 Additional Premium $ Return Premium $ i'hc inforaunon pro", ded for above r-sct.pt t'ne policy number, is required to be stated im when this endorsement is i.--ued for .irrnrhment to the policy subsequent to irs e'-V-cs' e date..! It : ..greed that a= ci he elective date hereof the , .icy is amended in the fui-v-hig particulars: INSURANCE COVERAGE PART - L1A - SECTION ii - PERSONS INSURED PARAGRAPH "C" DELETED AND THE FOLLOWING SUBSTITUTED iN LIEU THEREOFi "IF THE NAMED INSURED IS DESIGNATED IN THE DECLARATIONS AS OTHER THAN AN INDIVIDUAL PARTNERSHIP OR JOINT VENTURE THE ORGANIZATION SO DESIGNATED AND ANY EXECUTIVE OFFICER, DIRECTOR, STOCKHOLDER, OR OTHER EMPLOYEE OF THE NAMED INSURED WHILE ACTING WITHIN THE SCOPE OF HIS DUTIES AS AN OFFICER OR AS A DIRECTOR OF THE A.C.M. CLUB} AND, ANY ATTORNEY, GEOLOGIST, ENGINEER OR OTHER EMPLOYEE AS NOMINEE FOR THE MAMED INSURED WHILE ACTING WITHIN THE SCOPE OF HIS DUTIES .AS SUCH OR WHILE ACTING AS AGENT FOR ANY NAMED INSURED UNDER THIS POLICY," INSURANCE COVERAGE PART L!A - SECTION IV ~ POLICY TERRITORY DELETED AND THE FOLLOWING SUBSTITUTED JN LIEU THEREOF; THIS POLICY APPLIES ONLY TO OCCURRENCES WHICH HAPPEN DURING THE POLICY PERIOD ANYWHERE IN THE WORLD, PROVIDED THE CLAIMS ARE MACE SR THE SUITS ARE BROUGHT WITHIN THE UNITED STATES OF AMERICA OR THE DOMINION OF CANAOA, BUT SHALL NOT APPLY TO ANY MINING PREMISES, PUNTS, WAREHOUSE BUILDINGS OR OTHER PREMISES OR WORK PLACES OUTSiOE OF THE UNITED STATES 07 AMERICA OR THE DOMINION OF CANAOA. WATERCRAFT WHILE AWAY FROM THE PREMISES; EXCLUSION (E) OF INSURANCE PART L'A SHALL NOT APPLY UNDER COVERAGES A AND B TO OWNERSHIP, MAINTENANCE, OR USE OF ANY BARGE, SCOW, OR LIGHTER OWNED OR HIRED BY AND USED IN THE BUSINESS OF THE HAM,ED INSURED. SUCH INSURANCE AS IS AFFORDED HEREUNDER SHALL BE EXCESS COVERAGE OVER ANY OTHER VALID AND COLLECTIBLE INSURANCE N FORCE AS RESPECTS THIS EXPOSURE. EXCLUSION (t) OF INSURANCE PART L1A SHALL HOT APPLY TO WATERCRAFT OF THE PLEASURE TtPE USED BY THE NAMED INSURED PROVIDED (1) THE WATERCRAFT IS NOT OWNED BY THE NAMED INSURED OR LEASED OR HIRED BY THE NAMED INSURED (2) THE WATERCRAFT IS NOT USED BY THE NAMED INSURED TO CARRY PASSENGERS FOR A CONSIDERATION OR IN TRANSPOSTATI ON OF CARGO. AID 000345 S8 o l No . C-l`820 New8*T* Countersigned By. ENDORSEMENT THE TRAVELERS INSURANCE COMPANIES This endorsement is issued by that member of The Travelers Insurance Companies which issued the policy of which this endorsement forms a part. If any additional premium is noted below, this endorsement is issued in consideration thereof. If any return premium is noted below, the receipt thereof is acknowledged Upon acceptance of this endorsement. Effective from________________________ Month. Day. Year Amending .at the time of day the policy becomes effective. Policy Nc rR-WSL-12Tr6:-3-7-> PAGE #1 Is.-ued to______________________________________________________________ ________________________________________________________________________________________ Date if Issue: Additional Premium $ Return Premium $ The information pro- ded for above, except the pe'icv ".umber. required to be stated or.K hi- this endorsement is issued for attachment to rhe policy subsequent to its ctrecrive date.) 1'. ..greed that a- ui he c"active date her-.-a the ; .icx > amended in the !\.lhusing particulars: ASVERTISIHG INJURY LIABILITY COVERAGE LiMITS OF LIABILITY ADVERTISING INJURY $ 1,000,000 ADVERTISING INJURY $ 1,030,000 GENERAL AGGREGATE .MINIMUM PRENHJH ADVANCE PREMIUM $ $ INCLUDED IN COMPOSITE -HE ADVANCE PREMIUM STATED IN THESE DECLARATIONS IS AN ESTIMATED PREMIUM ONLY, U COVERAGE - ADVERTISING INJURY LIABILITY, THE COMPANY WILL PAY ON BEHALF Cr THE INSURED ALL SUMS WHICH THE INJURED SHALL BECOME LEGALLY OBLIGATED '!0 PAY AS DAMAGES BECAUSE OF INJURY (HEREINAFTER CALLED ADVERTISING INJURY) SUSTAINED BY ANY PERSON OR ORGANIZATION AND ARISING OUT OF ONE CR MORE OF THE FOLLOWING OFFENSESj A. THE PUBLICATION OR UTTERANCE OF A LIBEL OR SLANDER OR OTHER DEFAMATORY OR DISPARAGING MATERIAL OR A PUBLICATION OR UTTER ANCE IN VIOLATION OF AN INDIVIDUAL'S RIGHT OF PRIVACY,* B. ANY INFRINGEMENT OF COPYRIGHT, TITLE, OR SLOGAN; AID 000346 C. PIRACY OR UNFAIR COMPETITION OR JOEA MISAPPROPRIATION UNOER AN IMPLIED CONTRACT; C-l*S20 Newft.U IF SUCH OFFENSE JS COMMITTED DURING THE POLICY PERIOD WITHIN THE UNITEO STATES OF AMERICA, ITS TERRITORIES OR POSSESSIONS, DR CANADA IN THE CONDUCT OF THE INSURED?S ADVERTISING, PROMOTIONAL OR PUBLICITY ACTIVITIES, AND THE COMPANY SHALL HAVE THE RIGHT AND DUTY TO DEFEND ANY SUIT AGAINST THE 'HSUSEO SEEKING DAMAGES ON ACCOUNT OF SUCH INJURY (CONTINUED ON PAGE #2) Countersigned By :% SK . No . 3000fU B " BBt THE TRAVELERS INSURANCE COMPANIES u This endorsement is issued by that member of The Travelers Insurance Companies which issued the policy of which this endorsement forms a part. If any additional premium is noted below, this endorsement is issued in consideration thereof. If any return premium is noted below, the receipt thereof is acknowledged upon acceptance of this endorsement. Effective from_______ Month, Day. Year rn __________ D..'-t of Is.'ue: Amending 't-j'yjror,-1-"' P,'UE ^2at the time of day the policy becomes effective. Policy Nc' ' * /~ Additional Premium $ Return Premium $ -- The information pr-- ded for above, except the pu'iee number. required to be stated nni> when this endorsement i> issued for attachment t\ the policy subsequent to its effective dace.! It .freed that a? i : ae effective date hereof the ; .:cy is amended in the following particulars: EVEN IF ANY OF THE ALLEGATIONS OF THE SUIT ARE GROUNDLESS, FALSE, OR FRAUDULENT, AND MAY .HAKE SUCK INVESTIGATION AND SETTLEMENT OF ANT CLAIM OR SUIT AS IT DEEMS EXPEDIENT, BUT THE COMPANY SHALL NOT BE OSLiGATED TO PAY A?!Y CuAlfi' OR JUDGMENT OR TO DEFEND ANY SUIT AFTER THE APPLICABLE LIMIT OF THE COMPANY'S LIABILITY HAS BEEN EXHAUSTED BY PAY MENT OF JUDGMENTS 01? SETTLEMENTS* IN THE EVENT THAT, cM ANY SUIT WHICH THE COMPANY HAS .AGREED TO DEFEND AS PROVIDED FOR iN "HE PARAGRAPH ABOVE, ANY APPLICATION FOR AS INJUNC TION OR INJUNCTIVE ?11SF SHALL BE MADE SY THE PLAINTIFF, THE COMPANY AGREES TO DEFEND 'N THE NAME AND ON 3EHALF OF THE INSURED AGAINST SUCH APPLICATION FOR "AN ^JUNCTION OR INJUNCTIVE r-iEUEF; BUT THE OBLIGATION OF TI E COMPANY 33 TO DEFEND, AGAINST SUCH APPLICATION FOR AN INJUNCTION 3* INJUNCTIVE REuiEr SMALL HOT EXTEND CSYO&D THE DETERMINATION OF THE COURT OF FIRST INSTANCE* EXCLUSIONS. THIS INSURANCE DOES NOT APPLY* A. TO FAILURE OF PERFORMANCE OF CONTRACT, 3UT fHJS SHALL NOT APPLY t q CLAisi FOR THE UNAUTHORIZED APPROPRIATION OF ;0EAS BASED UPON THE ALLEGED BREACH OF Ail IMPLIED CONTRACTj B. TO INFRINGEMENT OF REGISTERED TRADE MARK, SERVICE MARK OR TRADE NAME BY USE THEREOF AS THE TRADE MARK, SERVICE MARK OR TRADE NAME OF GOODS OR SERVICES SOLD, OFFERED FOR SALE OR ADVERTISED, BUT THIS SHALL MOT RELATE TO TITLES OS SLOGANSj C. TO BODILY INJURY OR PROPERTY DAMAGE; AID 000347 Do TC INCORRECT DESCRIPTION, OR MISTAKE IN ADVERTISED PRICE, OF AMY ARTICLE OR COMMODITY; E. TO LIABILITY ASSUMED BY THE INSURED UNDER ANY CONTRACT OR AGREEMENT; C*I7620 New Ml K K ; j s * (CONTINUED ON PAGE #3} Cmmter-ncued By. S 8 no. 8000 (i; ENDORSEMENT THE TRAVELERS INSURANCE COMPANIES J! This endorsement is issued by that member of The Travelers Insurance Companies which issued the policy of which this endorsement forms a part. If anv additional premium is noted below, this endorsement is issued in consideration thereof. If any return premium is noted below, the receipt thereof is acknowledged upon acceptance of this endorsement. Effective from---------------------------------- Momh. Day. Year Amending .at the time of day the policy becomes effective. Policy Nt_____ ` - ? 'I IsMied to.________________________________________________________________________________________________________________________ I of Issue: Additional Premium $ Return Premium $ i The information pro', ided for above except the policy number, i- required to be sr.ited only when this endorsement t= issued for itta-'hment n the policy subsequent to its effective date.) !: ..greed that a= of 'he elective date hereof the ; icy amended in the foil.using particulars: F. TO ANY OFFENSE COHHiTTED CURING THE POLICY PER 100 WHICH WAS A 'ONTINUATUj N CR RPE71TI0?{ OF THE SAME CR SIMILAR OFFENSE (EMITTED ?ft?DR TO THE EFFECTIVE GATE OF THIS INSURANCE} fi. T0 ADVERT`SING INJURY EITHER EXPECTED OR INTENDED FROM THE . STANDPOINT CF THE " KSL'RED. Me PERSONS INSURED. EACH OF THE FOLLOW!HQ IS AN INSURED UNDER THIS iNsl'RANCE TO THE EXTENT 3ET FORTH DFLOW* F "HE TAMED iNSL'PED IS 0S 1GMATED \H THE DECLARATIONS AS AN JNDiVfC'.'AL THE FZRSC* SO DESIGNATED; J 3 F V!i NAMED INSURED io DESIGNATED IN THE DECLARATIONS A3 A PARTNEPSH-P OR wDINT VENTURE, THE PARTNERSHIP OR UOrNT VENTURE SO DESIGNATED ANDT-ir PARTNER OR .MEMBER THEREOF RUT ONLY WITH RESPECT TO HIS LIABILITY As SUCH; / r THE NAMED INSURED IS DESIGNATED KM " E DECLARATIONS AS OTHER *H.Mi aji i>01V4DUAL9 PARTNERSHIP OR JOINT VENTURI: .r THE ORGANISATION SO '0ESICNAT5 AND ANY EXECUTIVE OFFICER, 0iRECTOS OR . TDC;<HCLD?.R THEREOF WHILE ACTING WITHIN THE SCOPE OF HIS DUTIES AS SUCH. THIS INSURANCE DOES NOT APPLY ?0 ADVERT'S!HQ INJURY AP S1 KG OT OF THE CCN- DUCT OF ANY PARTNERSHIP OR JOINT VENTURE " CM THE HSURED * S A PASTNFP OR MEMBER AND WHICH `S H'jT DESIGNATED 5-H : -v .1 \ NAMED SNSUREO, 11 LIMITS OF L,A8IUTY. REGARDLESS OF THE -iUHSER Or (i) INSUREDS UNDER TW'S POLICY, <2`` PERSONS iX ORGANIZATIONS WHO SUSTAIN ADVERTISING 'NJUPY j M3) CLAIMS MADE CR SUITS DROUGHT ON ACCOUNT Or ADVERTISING NJURV, T~v TOTAL Ll.AfliUTY OF THE COMPANY FOR .ALL DAMAGES RESULTING FROM. THE SAMS INJURIOUS MATERIAL,- ACT CR OMISSION (REGARDLESS C*F THE NUMBER CR KIND OF MEDIA USED 09 TriE FREQUENCY OF REPETITION THEREOF) SHALL HO* EXCEED THE L;MIT OF ADVERTISING INJURY LIABILITY STATED :N THE 3ECLARATiCHS AS 1`ADVERTISING INJURY*" C-i"$20 NewS-T4 * . s * {K K HUEO o n S KB #4) .f . J Countersigned By. AID 000348 Sywaou No. Sc#. ryi.- ENDORSEMENT THE TRAVELERS INSURANCE COMPANIES This endorsement is issued by that member of The Travelers Insurance Companies which issued the policy of which this endorsement forms a part. If any additional premium is noted below, this endorsement is issued in consideration thereof. If any return premium is noted below, the receipt thereof is acknowledged upon acceptance of this endorsement. Effective from---------------------------------- Slonin. Day. Y*ar at the time of day the policy becomes effective. Amendine ~ Policy N't____ HSU123t 693-3- I PAGE U.'iied to-------------------------------------------------------------- ------ ----------------------------------------------------------------------------------------- D i" of Is-ue: Additional Premium $ Return Premium $ , The information pr.' ded for above, except the policy number, is required to be stated onh when this endorsement is issued for attachment t. the policy subsequent to its effective date.) It : .^reed that as 11 ne effective date hereof the p `icy is amended in the following particulars: SUBJECT TO THE ABOVE PROVISION RESPECTING ''ADVERTISING INJURY," THE TOTAL LIMIT OF THE COMPANY'S LIABILITY UNDER THIS COVERAGE FOR ALL DAMAGES SHALL NOT EXCEED THE LIMIT OF ADVERTISING INJURY LIABILITY STATED IN TOE ADDITIONAL DECLARATIONS AS "GENERAL AGGREGATE." IV. AMENDED DEFINITION. WHEN USED IN REFERENCES TO THIS INSURANCE: "DAMAGES" KEANS THOSE DAMAGES WHICH ARE PAYABLE BECAUSE OF ADVERTISING iNJURY ARISING OUT OF AN OFFENSE TO WHICH THIS INSURANCE APPLIES. C-1782G \ew8'T4 c>*rc CotmcerMgned By- AID 000349 SYhH>CK8CQO\U B " 9BB THE TRAVELERS INSURANCE COMPANIES This endorsement is issued bv that member of The Travelers Insurance Companies which issued the policy of which this endorsement forms a part. If any additional premium is noted below, this endorsement is issued in consideration thereof. If any return premium is noted below, the receipt thereof is acknowledged upon acceptance of this endorsement. Effective from---------------------------------- Month. Day. Year; Amending at the time of day the policy becomes effective. Policy N<_. [--lied to------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------- ... P.itv of Is-ue: Additional Premium $ Return Premium S ; The information pr.>\ ded for above, except the policy number, i- required to be stated onlt whe-t this endorsement is issued lor attachment to the policv subsequent to its elective date.) It -greed that a- :' me effective date hereof the ; .icy is amended in the tV.' suing particulars: THIS ENDORSEMENT MODIFIES SUCH IHSUSANCE AS IS AFFORDED BY THE PROVISIONS OF THE POLICY RELATING TO THE FOLLOWINGS COMPREHENSIVE GENERAL LIABILITY INSURANCE COMPLETED OPERATIONS AND PRODUCTS LIABILITY INSURANCE ADDITIONAL INSURED (VENDORS > 3ROA0 FORM) IT ,$ AGREED THAT THE ''PERSONS INSURED" PROVISION IS HERDED TO INCLUDE ANY PERSON OR ORGANIZATION (HEREIN REFERRED TO AS "VENDOR1'), AS AN INSURED, BUT ONLY WiTH RESPECT TO THE DITfRiBUTiOH OR SALE IN THE REGULAR COURSE CF THE VENDOR'S BUSINESS OF THE HV0 iNSUREOJS PRODUCTS SUBJECT TO THE FOLLOWING ADDITIONAL PROVISIONS? THE INSURANCE WITH RESPECT TO THE VENDOR DOES NOT APPLY TO? (A) ANY EXPRESS WARRANTY UNAUTHORIZED 3Y THE NAMED INSURED? <35 3001LY INJURY OR PROPERTY DAMAGE ARISING OUT OF (I) (I!) ANY PHYSICAL OR CHEMICAL CHANGE :N THE FORM OF THE PRODUCT MADE INTENTIONALLY BY THE VENDOR* REPACKING, UNLESS UNPACKED SOLELY FOR THE PURPOSE OF INSPECTIOH, DEMONSTRATION, TESTING OR THE SUDSTiTUlION OF PARTS UNDER INSTRUCTION FROM THE MANUFACTURER AMO THEN REPACKED IN THE ORIGINAL CONTAINER, (III) DEMONSTRATION, INSTALLATION, SERVICING OR REPAIR OPERATIONS, EXCEPT SUCH OPERATIONS PERFORMED AT THE VENDOR'S PREMISES 3N CONNECTION WITH THE SALE OF THE PRODUCT. OR (V) PRODUCTS WHICH AFTER DISTRIBUTION OR SALE S THE NAMED INSURED HAVE BEEN LABELED OR RELABELED OR USED .AS A CONTAINER, PART OR INGREDIENT OF ANY OTHER THING OR SUBSTANCE BY OR FOR THE VENDOR. 2. THE INSURANCE DOES HOT APPLY TO ANY PERSON OR ORGANIZATION, AS IMSUREO, FROM WHOM THc NAMED INSURED HAS ACQUIRED OUCH PRODUCTS OR ANY INGREDIENT, PART OP. CONTAINER, ENTERING INTO, ACCOMPANYING OR CONTAINING SUCH PRODUCTS* INCLUDED 8H COMPOSITE @S " 000350 Svmoc No. sooo(y C-17S20 New 8-"4 CumiterMgned By. This endorsement modifies such insurance as is dtYorded By the provisions ol the policy relating to the t-alloivmg: UNINSURED MOTORISTS INSURANCE UNINSURED MOTORISTS INSURANCE COVERAGE PART-SPECIFIED CAR BASIS It is agreed that this part applies only to the automobiles designated below. Automobiles and State of Principal Garaging ii-L tV'K'.WXi vA^FO ~A .>11 -i*1 .** Limits of Liability Each Person Each Accident s Premium $ .'V 'JIT 3 rne ^vrg >?;; TV* VuTC" K-58ILE IS R'?C{iAi.i.Y s'Jtf&rKS ' T7. :K`l oAC'KC i :CE?7 5 ft j r } 1 'l rT,` fQ0QvC00 i'VJCO 2s'JC`.'> '! sOOvyCCO 20,500 'o;:oo i D50C0 35 75 jt ou 73;SD Amending Policy No. : -1 \ izi. THE TRAVELERS INDEMNITY COMPANY C't2?0f 4-64 PRINTED (N U.S.A. THE CHARTER OAK FIRE INSURANCE COMPANY AID 000351 9950 V r ENDORSEMENT iI 1| ;i THE TRAVELERS INSURANCE COMPANIES This endorsement is issued by that member of The Travelers Insurance Companies which issued the policy of which this endorsement forms a part. If any additional premium is noted below, this endorsement is issued in consideration thereof. If any return premium is noted below, the receipt thereof is acknowledged upon acceptance of this endorsement. Effective from____________________ `Montis. Day. Years I='ued to____ Date of Issue: Amending .at the time of day the policy becomes effective. Policy Nc. rR-RSL-i23T6q^.V7T Additional Premium $ Return Premium $ i The information pro-, ided for above, except the policv number, i- required to be stated only when this endorsement is issued for attachment t the policy subsequent to its effective date.) it agreed that as of - he effective date hereof the ; .icy is amended in the following particulars: NOT APPLICABLE TO TX THIS ENDORSEMENT MODIFIES SUCH INSURANCE AS IS AFFORDED BY THE PROVISIONS OF THE POLICY RELATING TO THE FOLLOWINGS COMPREHENSIVE AUTOMOBILE LIABILITY INSURANCE AUTOMOBILE PHYSICAL DAMAGE INSURANCE COVERAGE IN HEX I CO - SO DAYS THIS INSURANCE ALSO APPLIES TO BODILY INJURY AND PROPERTY DAMAGE OR LOSS WHICH OCCURS DURING THE POLICY PERIOD WITHIN THE REPUBLIC OF MEXICO SU8JECT TO THE FOLLOWING ADDITIONAL PROVISIONS! Io THIS INSURANCE APPLIES ONLY DURING A TEMPORARY VISIT FCR A PERIOD OF NOT MORE THAN NINETY <9C) CONSECUTIVE DAYS. 2, IN THE EVENT OF A LOSS TO A COVERED AUTOMOBILE WHICH MAXES NECESSARY THE REPAIR OF SUCH AUTOMOBILE CR THE REPLACEMENT OF ANY PART OR PARTS THEREOF WHILE SUCH AUTOMOBILE IS WITHIN SUCH MEXICAN TERRITORY, THE LIMIT OF THE COMPANY'S LIABILITY FCR SUCH REPAIRS OR REPLACEMENTS SHALL NOT EXCEEO THE COST OF SUCH REPAIRS OR REPLACEMENTS AT THE NEAREST POINT IN THE UNITED STATES OF AMERICA WhERE SUCH REPAIRS OR REPLACEMENTS CAN BE MADE. 017820 New 8-74 *ircz j s * Countersigned By. AID 000352 SrMflOi NO. 11f90 SYMBOL NUMBERS OF ENDORSEMENTS Amending Policy No. TR-NSL-123T693-3-75 It is agreed that endorsements with the following symbol numbers form a port of this policy on its effective date: S106A G109(3) G209A 41288 9380(2) 12520 19950 20541 23480 23490 24910 8802 8810(3} T7B TS BB IS K B CQS T7B TS BB I!" B"!it y C#$%S n y T&B C'S (0B( OS 1 F23B I4568S 4K B CABCS Dy C-10925 1-66 PRINTED IN U.S.A. n - 9380 NOTICE OF CANCELLATION It is agreed that no limitation or cancellation of this policy shall become effective until the number of days' written notice specified :n Item 2 of the Schedule shall have been given to the person or organization designated in Item 1 of the Schedule at the address there designated. Schedule 1. Name: Address: DEPARTMENT OF THE NAVY OFFICE OF NAVAL MATERIAL INSURANCE BRANCH WASHINGTON DC 20360 2. Number of Days' Notice: 30 Amending Policy No. TR-NSL-123T693-3-7S THE TRAVELERS INSURANCE COMPANY THE TRAVELERS INDEMNITY COMPANY C-12301 12-67 PRINTED IN U.S A AID 000353 8221 SYMBOL NUMBERS OF ENDORSEMENTS Amending Policy N'o. Tft-NSl-123T693-3-75 It is agreed that endorsements with the following symbol numbers form a part of this policy on its effective date: A991 A0008 CA 09 10(E0 1-74} CA 09 12(D 1-74) CC 384A CP 01 SUED 1-74) CP 02 53(ED1-74) CP 02 84(E0 1-74) CP 04 51(ED 1-74) CP 04 6G(0 5-74} CP 04 64<ED1-74) CP 04 67{D 3-74) CP 04 68(ED 1-74) C? 04 69(ED 7-74) CP 04 70(EO1-74) CP 04 71(ED 1-74) CP 04 73(ED 1-74) CP 04 ?4(ED 1-74) CP 04 76(E01-74) CP 04 86{ED 1-74) CP 09 23(E0 1-74) EE-386 M7C M63A TX-03-69 25 241 4080A 4193C 80QG(A-V) 8221 8841(2) 8871(6) 9950 11190 11260 11310 18230 20230 20661 23581 23700 24290 24830 25020 25550 25670 26090 T-B T.S /B0B.1 I2456S 2K B Co mpS 78 T-B T9S :B;B9< I=" B>=it y C?@AS BC TDB CES FGBF OS H FIJB IKLMNS KKB Co mpS 78 C-10925 1-66 PAINTED in u .S.A. i AID 000354 bmjuKstMtn i THE TRAVELERS INSURANCE COMPANIES j i This endorsement is issued by that member of The Travelers Insurance Companies which issued the policy of which this endorsement forms a part. If any additional premium is noted below, this endorsement is issued in consideration thereof. If any return premium is noted below, the receipt thereof is acknowledged upon acceptance of this endorsement. Effective from_____ ____________________ at the time of day the policy becomes effective. Amending Policv Nc_ TR-NSL-123T693-3-7E {.Month, Day. Year) Issued to_________________________________ Date of Issue: Additional Premium * Return Premium $ (The information provided for above, except the policy number, is required to be stated only when this endorsement is issued for attachment tc the policy subsequent to its effective date.) It is agreed that as of the effective date hereof the policy is amended in the following particulars: THIS ENDORSEMENT MODIFIES SUCH INSURANCE AS IS AFFORDED BY THE PROVISIONS OF THE POLICY RELATING TO THE FOLLOWING* UNINSURED MOTORISTS INSURANCE, LIMITATION OF UNINSURED MOTORISTS INSURANCE COVERAGE PART__________________________ NEW JERSEY THE COVERAGE WITH RESPECT TO AN INSURED HIGHWAY VEHICLE PRINCIPALLY GARAGED IN THE STATE OF NEW JERSEY, DOES NOT APPLY TO ANY ACC1QENT OCCURRING IN THE STATE OF NEW JERSEY. r C-17&20 New E-74 * y *S Countersigned By___________ AID 000355 Sv mx x . No. 11260 II 'J t THE TRAVELERS INSURANCE COMPANIES i This endorsement is issued by that member of The Travelers Insurance Companies which issued the policy of which this endorsement forms a part. If any additional premium is noted below, this endorsement is issued in consideration thereof. If any return premium is noted below, the receipt thereof is acknowledged upon acceptance of this endorsement. Amending Effective from----- ---------------------------------- at the time of day the policy becomes effective. Policy Nc_ TR-NSL-125T693-3-75 (Month. Dot. Ycor) Issued to------------------------------------------------- ------ Date of Issue: Additional Premium ( Return Premium $ (The information provided for above, except the policy number, is required to be stated only when this endorsement is issued for attachment ti the policy subsequent to its effective date.) It is agreed that as of the effective date hereof the policy is amended in the following particulars: NOT APPLICABLE TO TX THIS ENDORSEMENT MODIFIES SUCH INSURANCE AS.IS AFFORDED BY THE PROVISIONS OF THE POLICY RELATINO TO THE FOLLOWINGS COMPREHENSIVE AUTOMOBILE LIABILITY INSURANCE EXCLUSION OF AUTOMOBILES IN CANADA THIS POLICY DOES NOT APPLY TO THE OWNERSHIP, MAINTENANCE, OPERATION, USE, LOADING OR UNLOADING OF AUTOMOBILES PRINCIPALLY GARAGED IN CANADA. C-I7B20 NewS-74 min t io s *. Countersigned By. AID 000356 St mu x n o . 11310 UNIFORM MOTOR CARRIER BODILY INJURY AND PROPERTY DAMAGE LIABILITY INSURANCE ENDORSEMENT-FORM F Effective from At 12:01 A.M. Standard Time Amending Policy No. Issued to Date of Issue: FOP COJ use OFFICE & CODE POL. EXP! WES ONOO. CODE MODE OF ADJUST. PROO. (The information provided for above, except the policy number, is required to be stated only when this endorsement is issued for attach ment to the policy subsequent to its effective date.' It is agreed that: 1. The certification of the policy, as proof of financial responsibility under the provisions of any state motor earner law or regulation^ promulgated by any State Commission having jurisdiction with respect thereto, amends the policy to provide insurance for automo bile bodily injury and property damage liability in accordance with the provisions of such law or regulations to the extent of the coverage and the limits of liability required thereby; provided only that the insured agrees to reimburse the company for any pay ment made by the company which it would not have been obligated to make under the terms of this policy except by reason of the obligation assumed in making such certification. 2. The Uniform Motor Carrier Bodily Injury and Property Damage Liability Certificate of Insurance has been filed with the State Commissions indicated below. 3. This endorsement may not be canceled without cancellation of the policy to which it is attached. Such cancellation may be effector by the company or the insured giving thirty (30) days' notice in writing to the State Commission with which such certificate has been filed, such thirty (30) days' notice to commence to run from the date the notice is actually received in the office of such Commission. X-INDICATES STATE COMMISSIONS WITH WHOM UNIFORM MOTOR CARRIER BODILY INJURY AND PROPERTY DAMAGE LIABILITY CERTIFICATE OF INSURANCE HAS BEEN FILED ALABAMA ILLINOIS MONTANA RHODE ISLAND 1 ALASKA INDIANA NEBRASKA SOUTH CAROLINA ARIZONA IOWA NEVADA SOUTH DAKOTA ARKANSAS KANSAS NEW HAMPSHIRE TENNESSEE CALIFORNIA KENTUCKY NEW JERSEY TEXAS COLORADO CONNECTICUT LOUISIANA MAINE NEW MEXICO NEW YORK UTAH VERMONT DELAWARE DISTRICT OF COLUMBIA FLORIDA MARYLAND MASSACHUSETTS MICHIGAN NORTH CAROLINA NORTH DAKOTA OHIO VIRGINIA WASHINGTON WEST VIRGINIA GEORGIA HAWAII IDAHO MINNESOTA MISSISSIPPI MISSOURI OKLAHOMA OREGON PENNSYLVANIA WISCONSIN WYOMING THE TRAVELERS INDEMNITY COMPANY , ,,,,,, AID 000357 THE CHARTER OAK FIRE INSURANCE COMPAN" Countersigned fry C-12630 6-66 SRINTCO IN u.l.A. N.S. 1RB 3S38A 472 1823C I Effective (ram. .at the 6mm of day ti* poBey Ai--di| Policy No------ Iuued to. o*ng KW e*. Ml NQL. mom** mm. (The information p.ovkfcd for above, except the policy omtr, -required VJ** *l TM'r ****" *** r tta poticy BUNeqMent to iu ffetiv> d*te.) It h agreed that** of the elective data fcefwl the policy ia amended in the follow-ia* particular*: i. immd for attachment to THIS ENDORSEMENT MODIFIES SUCH INSURANCE /IS IS AFFORDED BT THE PROVISIONS OF THE POLICT RELATINQ TO THE FOLLOWING: CONTRA'/TUAL LIABILITY INSURANCE (BLANKET COVERAOE) jueanrarr o f "per s o n s in s u r e d * p r o v is io n IT IS AGREED THAT THE "PERSONS INSURED" PROVISION IS AMENDED TO INCLUDE A SECOND PARAGRAPH AS FOLLOWS: "THIS INSURANCE DOES NOT APPLY TO BODILY INJURY OR PROPERTY DAMAGE ARISING OUT OF THE CONDUCT OF ANY PARTNERSHIP OR JOINT VENTURE OF WHICH THE INSURED IS A PARTNER OR MEMBER AND WHICH IS NOT DESIGNATED IN THIS POLICT AS A NAMED INSURED." T** TKS OPQPR ImvaAMc* CSTUVS WX T*B Tutsuu Immmmt t CYZ[S K [ AID 000358 19950 Tu Ouurrva OS \ Fats IMtiaafccr C]^_S K_ c-iarw (Urmi a-at > .**, m Cowevaigaed by. r ILLINOIS INSURANCE IN THE TRAVELERS INDEMNITY COMPANY OF ILLINOIS Amending Policy Numbered It is agreed that the obligations expressed in the policy as obligations of The Travelers Insurance Com pany or The Travelers Indemnity Company, subject to the exclusions, conditions and other terms thereof, are the obligations of The Travelers Indemnity Company of Illinois to the extent that such obligations are with respect to risks located in Illinois and that the policy to such extent is a contract between the insured and The Travelers Indemnity Company of Illinois and no other. THE TRAVELERS INSURANCE COMPANY THE TRAVELERS INDEMNITY COMPANY ' THE TRAVELERS INDEMNITY COMPANY OF ILLINOIS Secretary C-l 4946 B-7! PAINTED in U.5.A. AID 000359 20230 ENDORSEMENT THE TRAVELERS INSURANCE COMPANIES This endorsement is issued by that member of The Travelers Insurance Companies which issued the policy of which this endorsement forms a part. If any additional premium is noted below, this endorsement is issued in consideration thereof. If any return premium is noted below, the receipt thereof is acknowledged upon acceptance of this endorsement. Effective fromat the time of day the policy becomes effective. ftSSrig TR"NSL-?2TT&?3~3->y5 (Month. Day. VJr) Issued to------ ------------------------------------------- ----------------- Date of Issue: Additional Premium $ Return Premium $ (The information provided for above, except the policy number, is required to be stated only when this endorsement is issued for attachment to the policy subsequent to its effective date.) It is agreed that as of the effective date hereof the policy is amended in the following particulars: APPLICABLE TO ENGINEERING MANAGEMENT INC THIS ENDORSEMENT MODIFIES THE PROVISIONS OF THE POLICY RELATING TO ALL LIABILITY INSURANCE OTHER 'HAN PERSONAL INJURY LIABILITY INSURANCE AND SUCH INSURANCE AS IS AFFORDED BY THE POLICY WITH RESPECT TO THE OWNERSHIP, MAINTENANCE OR USE, INCLUDING LOADING OR UNLOADING, OF ANY AUTOMOBILE. EXCLUSION (ENGINEERS, ARCHITECTS OR SURVEYORS PROFESSIONAL LIABILITY) THIS INSURANCE DOES HOT APPLY TO BODILY INJURY 0P. PROPERTY DAMAGE ARISING OUT OF THE RENDERING OF OR THE FAILURE TO RENDER SERVICES BY OR ON DEHALF QP THE NAMED INSURED PURSUANT TO ANY ARCHITECTURAL OR ENGINEER IHG SERVICES CONTRACT! 4UT THIS EXCLUSION ROES NOT APPLY TO SOOILY INJURY OR PROPERTY DAMAGE OCCURRING AT PREMISES OWNED BY OR LEASED TO THE NAMED INSURED. C*l7S20 Ne*rft-?4 u%* Countersigned Bv___ AID 000360 Sr--o l No. 2054? AUTOMOBILE PERSONAL INJURY PROTECTION ENDORSEMENT OREGON C, .!> The Company agrees with the named insured, subject to all of the provisions of this endorsement and to ail of the provisions of the policy except as modified herein, as follows: AUTOMOBILE PERSONAL INJURY PROTECTION The Company will provide in accordance with Chapter 523 of Oregon Laws 1971. the following benefits for loss and expense incurred because of bodily injury caused by accident and arising out of the ownership, maintenance or use of an automobile: (a) medical and hospital benefits, including funeral expenses, to or on behalf of each injured person; (b) income continuation benefits to or on behalf of each injured person who at the time of the accident was usually engaged in a remunerative occupation; (c) loss of services benefits to or on behalf of each injured person who at the time of the accident was not usually engaged in a remunerative occupation. Exclusions This insurance does not apply: (a) to or on behalf of any person (1) who intentionally causes injury to himself; or (2) who is injured while participating in any prearranged or organized racing or speed contest or in practice or prepa ration for any such contest; (b) to income continuation benefits to or on behalf of any person who sustains bodily injury in an accident which occurs outside the State of Oregon, but this exclusion does not apply (1) to the named insured or a relative, or (2) to any other person while occupying the insured automobile as a guest passenger or while using the insured automobile with the per mission of the named insured; (c) to bodily injury due to war, whether or not declared, civil war, insurrection, rebellion or revolution, or to any act or con dition incident to any of the foregoing; (d) to bodily injury resulting from the radioactive, toxic, explosive or other hazardous properties of nuclear material; (e) to the named insured or any relative while occupying any automobile owned by the named insured or furnished for the named insured's regular use and not insured for AUTOMOBILE PERSONAL INJURY PROTECTION; (f) to a relative while occupying any automobile owned by such relative or furnished for the relative's regular use and not insured for AUTOMOBILE PERSONAL INJURY PROTECTION; (g) with respect to any injured person who is not the named insured or a relative, to the extent that amounts are paid or payable to or on behalf of such injured person under any collateral benefits, including but not limited to insurance bene fits under anlother policy issued by this or any other insurer, governmental benefits or gratuitous benefits. Definitions When used in reference to this insurance: "injured person" means (a) the named insured or any relative who sustains bodily injury caused by accident while occupying, or while a pedestrian, through being struck by an automobile; (b) any person, other than the named insured or a relative, who sustains bodily injury caused by accident (X) while occupy ing the insured automobile as a guest passenger, or (2) while using the insured automobile with the permission of the named insured, or (3) while a pedestrian, through being struck by the insured automobile; "named insured" means the individual named in Item 1 of the declarations of the policy and includes his spouse if a resident of the samejhousehold; .. ! "relative ` means a relative of the named insured who is a resident of the same household; AID 000361 "bodily injury" means bodily injury, sickness or disease, including death at any time resulting therefrom; C-15191 (Continued on page 2) 20661 C990S (f aSod uo panutjuoj 161^10 `aepeueo j o 'suoissassod j o sauo;iJJa; s i; '8 s u iv jo sa; paiiu^ aq; uiqjq* `pouad Xoqod aq; 3uunp inooo qoiqM siuappoe o; X[uo `(q) uoisnpxa Aq paquiq AqEoijpads bB idaoxa 'saqdds aoueinsui siqj. Ajojiuax ` pouaj Aaqoj s;suo;oui painsuiun j s u i8 S8 uot;oa;oid j o AjinqBii Ajnfui Xqpoq jaq;ia j o j cpapiojjB aowjnsut japun Jainsui iaq;o A 8 j o AueduiOQ aqi u io j j jaAOoai o; pa|;i;ua aq Asm uosjad pamtui qons `;uappoB adeBs aq; ui pauiEjsns Ajnfui Aqpoq jo asnsoaq `qotqAA saSBiwp jo junouie aq; jO uoipnpaj ut paqddB aq [|Eqs ;i Aq pied fghi js;tjauaq qons j o j Bz iu 8 Sj o j o jajnsui Jaqjo A 8 o ; 'I/.6I SAABq uoSaio jo ggg ia;deqo o; ;wnsjnd `juamasjnquiiaj k lse j o uosjad pajnfui A 8 j o jpqaq uo j o o ; sqjauaq 8 jaqip aouBjnsui siq; Japun Auaduioo aq; Aq apBUi s;uamABd Any g Aoi|od Jaq;o qons japun uosjad painful qons o; a[qB[iBAB s;ijauaq saoiAjas jo sso[ j o uo;;Bnui;uoo auiooui `[Bjidsoq pus [Boipam Ac8 j o ;unouis aq; jo ;ua;xa aq; o; `Aoqod aouBjnsui aqqouio;nB jaq;ow japun papiAOJd si s;ijauaq uoi;oa;ojd Amfui [Buosjad j o j aouBjnsui jBpuiis j i m n o p: 8 sjijauaq A;qtqBsip j o [soipaui 8 |iu iis iaq;o A 8 qj o uoijBsuaduioo s.uatu^JOM A 8 japun uosjad pajnfui qons jo jpqaq uo j o o; a[qeAsd j o piBd ;unouiB aq; Aq (q) (8 ) paonpaj aq ({Bqs aAi;Bjai 8 j o pajnsui paiwu aq; s| oqM uosjad pajnfui q8 j o j[Eqaq uo j o o; aowjnsui siq; jo suua; aq; japun AwdrnoQ aq; Aq aiqsAsd junoure Auy z9eooocnv o;ajaq; ajqBonddB bB s;ijauaq qons jo qosa jo uoyiuyap ui pajBjs suoijEjiuiq aq; o; asiauaqjo ;oafqng `.s;ijauaq saoiAjas jo sso[ j o j Asp Jad jxS (a) Z :s;ijauaq uoi;Bnui;uoo auiooui j o j q;upui jad QOSS (q) !000`ES Pj8 ;unouiB a[qi;onpap qons uaaM;aq aouaiajjip aq; aq uaq; ||Bqs s;ijauaq qons j o j AuBduioQ aq; Aq aiqBAsd os ;unouiB [8 ;o ; aq; `;unouiB a[qi;onpap qons spaaoxa sums qons [[s jo ;unouiB r|8 ;o ; aq; j i `pus ;uapiooB auo A 8 u i uiiq Aq pauiB;sns Amfui Aqpoq jo asnsoaq uosjad pajnfui qons jo jpqaq uo j o o; s;tjauaq qons j o j AusduioQ aq; Aq a[qBAsd asiAuaq;o sums ||B j o ;unouiB pr;o; aq; u io j j pa;onpap aq |[sqs ;unouiB qons `A[ddB o; ;uauiasjopua siq; jo ainpaqog aq; ui pa;B;s si Aj8 j i ;unouiB a|qi;onpap 8 uioqM o; uosjad pajnfui qosa o; padsaJ q;iis ;sqj jaq;jnj papiAOJd pus `-0001 IS paaoxa ;uaAa ou ut nq> sasuadxa [Bjaunj qons j o j ;uautAsd ;sq; *jaAa/Aoq ` papiAOJd `.sasuadxa pjaunj guipnpui s;tjauaq jBjidtoq pus (Boipaui j o j 000`St . ( ) jo urns aq; paaoxa ;ou |[Bqs ;uappoB auo Aj8 ui uosjad pajnfui qons Aq pauiBjsns Ajnfui Aqpoq jo asnsoaq uosjad pajnfui ipsa jo jpqaq uo j o o ; Auaduioo aq; Aq aiqBABd ;unouie p;o; aqj, j s: s/ttoqoj 8 pa;iuii| si s;yauaq NOLLOaiOHd AHflfNI IVNOSHad 31130WOLflV j o j A;qiqBq s, Auaduioo aq; `saqddB aouBjnsui siq; qoiqM o; sa|iqouio;n8 pajnsui j o apsui suiiep jo jaquinu aq; jo ssaipjBSa^ AjqiqBiq jo s;^^ Asp tppx qons u io j j sqaajs z<5 usq; ajoui ;ou jo uoi;BJidxa aq; j o saoiAjas qons uuojjad o; a(qs AiqBuosBaj si uosjad pajnfui qons qoiqjs uo a;sp aq; jaq;ia jo t8 Suipua puB ;uappos aq; jo a;ap aq; ja;jB sAsp Supuaui -moo pouad aq; 8uunp pajapuaj A[pn;oB 8 u8 saoiAjas qons papiAOJd `auiooui ;noq;ut pauuojjad aABq ppoM uosjad painful aq; asoq; jo naq ui saoiAjas |Bi;uassa j o j pajmaui AjqBUOSBaj sasuadxa j o j `;uauiasjnquiiaj swain ..sjyauaq saoiAjas jo sso[,, : Asp q;^x qons u io j j sqaa* bjg usq; ajoui io u jo uoi;Bjidxa aq; j o uoi;Bdnooo pnsn siq o; um;aj o; a|qs si uosjad qons qoiqis uo a;sp aq; jaq;ia jo 8 8uipua puB ;uappaB qons jo a;ap aq; ja;jB sABp yx Supuauiuioo pouad aq; Suimp `;uappoB aq; ui uiiq Aq paun^ns Amfui Aqpoq jo asnsoaq`qjOAA u io j j auiooui jo sso| s,uosjad pajnfui aq; jo %0i J ;uauiAsd swaui ,.s;[jauaq uoi;enui;uoo auiooui,, `.saoiAjas (Bjaunj puB oi;aq;sojd `aauB|nquiB v`(BoiSins `p;uap `^idsoq `prnipam j o j ;uappos qons jo qnsaj e 8 uosjad pajnfui aq; jo jpqaq uo j o Aq ;uappos aq; jo a;Bp aq; u io j j jsaA auo uiq;iM paunoui sasuadxa Ajsssaoau puB ajqBuosBaj |[B j o j sjuauiAsd swaui ,,s;ijauaq |s;idsoq pus [Boipam,, wx x`.Suiqowj j o Su iu 8 wq; iaq;o `aAi;E|aj 8 j o pajnsui pauisu aq; jo ssauisnq j o uoissajojd `uoi;8dnooo aq; ut A[iJBUiud pasn ;ou si cpiqM adA; spni; [ausd j o AiaAipp uspas Apoq dnqoid `Ajiqin aq; jo a[iqouio;ns [aaqAA y jaq;o Aw sapnpui puB `sjaq;o o; pa;uai j o u aousAaAUOo AyzS {{ |j o oi[qnd s 8 pasn ;ou apqouiojnB adA; u o S8 S S u o i;8 ;s j o jaBuassBd a;BAud [aaqA y 8 swam ,,a[iqomo;nB jaSuassad ajBAud,, `.saqdds A3i(od aq; jo aouBjnsui A;i[!qBi[ Ainf ui Aqpoq aq; qoiqM o; `jauAno aq; si pajnsui pamsu aq; qoiqM jo a[iqomo;n8 ja8uasssd a;BAud 8 susam ,,a|iqomo;nB pajnsui,, }Isasimajd j o aouapisaj 8 8 asn j o j pa;soo[ apiqaA s (g) jo `spsaj; ~ j 3|S Bj o j o S|I8 uo pa;sjado apiqaA 8 (j ) `spsoj aqqnd uodn ;ou aqqM `spBOJ oqqnd j j o AqBdpuud asn j o j pauSisap ;uamdinba paqadojd-jias Jaqjo j o j o ; 8 ; adA; 8 j 8 (j ) wq; jaq;o jaqsj; j o ap;qaA jo;om pw[ pa[[adojd-j[as s suBam ,,a[iqomo;nB,, Z aed :u io j j Sui;q8ipi j o o;ui 8uua;ua j o uodn j o u i susam ,,8uiAdnooo,, CONDITIONS Page 3 This insurance is subject to the following additional Conditions: A. Notice. In the event of an accident, written notice containing particulars sufficient to identify the injured persons, and also reasonably obtainable information respecting the time, place and circumstances of the accident shall be given by or on behalf of each injured person to the Company or any of its authorized agents as soon as practicable. If any injured person or his legal respresentative shall institute legal action to recover damages for bodily injury against a person or or ganization who is or may be liable in tort therefor, a copy of the summons and complaint Or other process served in con nection with such legal action shall be forwarded as soon as practicable to the Company by such injured person or his legal representative. B. Action Against Company. No action shall lie against the Company, unless, as a condition precedent thereto, there shall have been full compliance with all the terms of this endorsement. C. Medical Reports; Proof of Claim. As soon as practicable the injured person or someone on his behalf shall give to the Company written proof of claim, under oath if required, including full particulars of the nature and extent of the injuries and treatment received and contemplated, and such other information as may assist the Company in determining the amount due and payable. The injured person shall submit to physical examinations by physicians selected by the Com pany at the expense of the Company when and as often as the Company may reasonably require. The injured person, or in the event of his incapacity or death his legal representative, shall upon each request from the Company execute authorization to enable the Company to obtain medical reports, copies of records and information with respect to loss of income. The Company may require that the injured person, as a condition for receiving income continu ation benefits, cooperate in furnishing the Company reasonable medical proof of his inability to work. D. Trust Agreement. In the event of payment to any person of any benefits under this endorsement: (a) the Company shall be entitled to the proceeds of any settlement or judgment that may result from the exercise of any rights of recovery of such person against any person or organization legally responsible for the bodily injury because of which such payment is made, to the extent the damages recovered include any expense, amount or pay ment for which such benefits were paid; (b) such person shall hold in trust for the benefit of the Company all rights of recovery which he shall have against such other person or organization because of any expense, amount or payment which is the subject of claim made here under; (c) such person shall do whatever is proper to secure and shall do nothing after loss to prejudice such rights; (d) if requested in writing by the Company, such person shall take, through any representative, not in conflict in in terest with such person designated by the Company, such action as may be necessary or appropriate to recover such payment as damages from such other person or organization, such action to be taken in the name of such person; in the event of a recovery, the Company shall be reimbursed out of such recovery for expenses, costs and attorney's fees incurred by it in connection therewith; (e) such person shall execute and deliver to the Company such instruments and papers as may be appropriate to secure the rights and obligations of such person and the Company established by this provision. E. Subrogation. In the event of any payment under this endorsement, the Company shall be entitled to reimbursement pur suant to Section 7 (1) of Chapter 523 Oregon Laws 1971, and subrogated, to the extent of such payment, to all the rights of recovery therefor which the person to or on behalf of whom such payment is made may have against any person or or ganization, and such person shall execute and deliver instruments and papers and do whatever else is necessary to secure rights. Such person shall do nothing after loss to prejudice such rights. F. Arbitration. If any person making claim and the Company do not agree as to the amount payable hereunder, then each party shall, upon the written demand of either, select a competent and disinterested arbitrator. The two arbitrators so named shall select a third arbitrator, or if unable to agree thereon within 30 days then, upon the request of such person or the Company, such third arbitrator shall be selected by a judge of a court of record in the County and State in which such arbitration is pending. The arbitrators shall then hear and determine the question or questions so in dispute, and the decision in writing of any two arbitrators shall be binding upon the person and the Company, each of whom shall pay his or its chosen arbitrator and shall bear equally the expense of the third arbitrator and all other expenses of the arbitration. provided that attorney fees and fees paid to medical or other expert witnesses are not deemed to be expenses of arbi tration but are to be borne by the party incurring them. Unless the parties otherwise agree the arbitration shall be con ducted in the County and State in which the person resides and in accordance with the usual rules governing procedure and admission of evidence in courts of law. Cl 5191 iContinued on Page -it AID 000363 20663 19902 ANVdWOD 30NVHHSNI 3HI3 MVO H3XHVH3 3HX jV}2JM AKVdtWOD AXINW3QNI SH333AVHA 3HX -y;. o n A" j Suipuauiv -3S )8 |9j ipsa puE pamsut pauisu tpea <-- pajnsui pauieu qaca -- :oj aiqeaqdde------------~------------------- S } aiqijanpap B o j goafqns aq pcqs s;ijauaq [Ejidsoq pue |E3ipaui 10} asuemsut aqj, t aS^d 3ina3HDS Effective from. -at the time of day the policy becomes effective. Amending Policy No. Issued to_ Date of Issue: uFCOsOeK. OFFICE FcOxft.ia' ci McoOoOt . MAOOOACisOr.F MOO. tOC- OF (The information provided for above, except the policy number, is required to be stated only when this endorsement is issued for attachment to the policy subsequent to its effective date.) It is agreed that as of the effective date hereof the policy is amended in the following particulars: MICHIGAN NO-FAULT INSURANCE AMENDATORY ENDORSEMENT It is agreed that the endorsement entitled "Michigan No-Fault Insurance Endorsement (Personal Protection Insurance)" forming a part of the policy is amended by the addition of the following Section: Premium Recomputation The premium for the policy is based on rates which have been established in reliance upon the limitations on the right to recover for dsaages under the provisions of Chapter 31 of the Michigan Insurance Code. If a court of competent jurisdiction de clares or enters a judgment from which there is no appeal the effect of which is to render the provisions of such Act invalid or unenforceable in whole or in part, the Company shall have the right to recompute the premium payable for the policy on the basis of revised rates which are subject to review by the Coonlssioner of Insurance. In the event the named insured elects to delete any coverage as a result of such declaration or judgment, any resulting refund of premium shall be computed on a pro rata basis. TB TS Bm Imu h S Kk CS K Stcriitry C-10747 (Lr*t) 3-A3 .ti.rto * *71 Th * Tunuu I" Bt y CS K Countersigned by. S*ertUry AID 000364 24830 TB C S B BB OS Fiu In s u r S K B C S n y Stcrttmry FLORIDA AUTOMOBILE REPARATIONS REFORM ACT ENDORSEMENT The company agrees with the named insured,, subject to all of the provisions of this endorsement and to all of the provisions of the policy except as modified herein, as follows: SECTION I PERSONAL INJURY PROTECTION The company will pay, in accordance with the Florida Automobile Reparations Reform Act. to or for the benefit of the injured person: (a) all reasonable medical expenses, and (b) with respect to the period of disability of the injured person, any loss of income and earning capacity from inability to work proximately caused by the injury sustained by the injured person and all expenses reasonably incurred in obtaining from others Ordinary and necessary services in lieu of those that, but for such injury, the injured person would have per formed without income for the benefit of his household, and (c) funeral, burial or cremation expenses, incurred as a result of bodily injury, caused by on accident arising out of the ownership, maintenance or use of a motor vehicle and sustained by: (1) the named insured or any relative while occupying a motor vehicle or, while a pedestrian, through being struck by a motor vehicle; or (2) any other person while occupying the insured motor vehicle or, while a pedestrian, through being struck by the insured motor vehicle. Exclusions This insurance does not apply: (a) to the named insured or any relative while occupying a motor vehicle of which the named insured is the owner and which is not an insured motor vehicle under this insurance; (b) to any person while operating the insured motor vehicle without the express or implied consent of the named insured; (c) to any person, if such person's conduct contributed to his bodily injury under any of the following circumstances: lil causing bodily injury to himself intentionally; (ii) convicted of driving while under the influence of alcohol or narcotic drugs to the extent that his driving faculties are impaired; or (iii) while committing a felony; (d) to the extent that benefits are paid or payable under any workmen's compensation law; (e) to any pedestrian, other than the named insured or any relative, not a legal resident of the State of Florida; tf> to any person, other than the named insured, if such person is the owner of a motor vehicle with respect to which security is required under the Florida Automobile Reparations Reform Act; (g) to any person, other than the named insured or any relative, who is entitled to personal injury protection benefits from the owner of a motor vehicle which is not an insured motor vehicle under this insurance or from the owner's insurer; (h) to any person who sustains bodily injury while occupying a motor vehicle located for use as a residence or premises. Limit of Liobility; Application of Deductible; Other Insurance Regardless of the number of persons insured, policies or bonds applicable, vehicles involved or claims made, the total aggre gate limit of personal injury protection benefits available under the Florida Automobile Reparations Reform Act from all sources combined, including this policy, for all loss and expense incurred by or on behalf of any one person who sustains bodily injury as the result of any one accident shall be *5,000: provided that payment for funeral, cremation or burial expenses included in the foregoing shall in no event exceed *1,000. If workmen's compensation benefits have been received for the same items of loss and expense under any workmen's compensation law, the total aggregate limit of personal injury protection benefits available with respect to such bodily injury shall be reduced by the amount of workmen's compensation benefits received. If benefits have been received under the Florida Automobile Reparations Reform Act from any insurer for the same items of loss and expense for which benefits are available under this policy, the company shall not be liable to make duplicate pay ments to or for the benefit of the injured person, but the insurer paying such benefits shall be entitled to recover from the com pany its equitable pro rata share of the benefits paid and expenses incurred in processing the claim. C-I7SS7 HEW 2-7* MINTED IN U.S.A. (Continued on page 2i AID 000365 25020 Page 2 The amount of any deductible stated in the schedule of this endorsement shall be deducted from the total amount of all sums otherwise payable by the company with respect to all loss and expense incurred by or on behalf of each person to whom the deductible applies and who sustains bodily injury as the result of any one accident, and if the total amount of such loss and expense exceeds such deductible, the total limit of benefits the company is obligated to pay shall then be the difference between such deductible amount and the applicable limit of the company's liability. Definitions When used in reference to this Section: "bodily injury" means bodily injury, sickness or disease, including death at any time resulting therefrom; "medical expenses" means expenses for necessary medical, surgical, x-ray. dental, ambulance, hospital, professional nursing and rehabilitative services, for prosthetic devices and for necessary remedial treatment and services recognized and permitted under the laws of the state for an injured person who relies upon spiritual means through prayer alone for healing in accordance with his religious beliefs; "motor vehicle" means a 4 wheel self-propelled vehicle of a type required to be registered and licensed under Florida law, which is not used as a public or livery conveyance, and which is one of the following types: (a) a private passenger vehicle, such as a sedan, station wagon or jeep-type vehicle,^ (b) a pick-up or panel truck not used primarily in the occupation, business or profession of the owner, (c) a utility automobile designed for personal use, as a camper or motor home or for family recreational purposes but a utility automobile does not include any such automobile used primarily (1) in the occupation, profession or business of the owner or (2) for the transportation of passengers. A "motor vehicle" does not include a vehicle owned by the State of Florida, any political subdivision or municipality thereof, or the Federal Government; "named insured" means the person or organization named in the declarations of the policy, and if an individual, shall include the spouse if a resident of the same household; "occupying" means in or upon or entering into or alighting from; "insured motor vehicle" means a motor vehicle of which the named insured is the owner and with respect to which (a) the bodily injury liability insurance of the policy applies and (b) security is required to be maintained under the Florida Automo bile Reparations Reform Act; "relative" means a person related to the named insured by blood, marriage or adoption (including a ward or foster child) who is a resident of the same household as the named insured; "pedestrian" means a person while not an occupant of any self-propelled vehicle; "owner" means a person or organization who holds the legal title to a motor vehicle, and also includes: (a) a debtor having the right to possession, in the event a motor vehicle is the subject of a security agreement, and (b) a lessee having the right to possession, in the event a motor vehicle is the subject of a lease with option to purchase and such lease agreement is for a period of six months or more, and (c) a lessee having the right to possession, in the event a motor vehicle is the subject of a lease without option to purchase, and such lease agreement is for a period of six months or more, and the lease agreement provides that the lessee shall be responsible for securing insurance. Policy Period; Territory The insurance under this Section applies only to accidents which occur during the policy period (a) in the State of Florida, and (b) as respects the named insured or a relative, while occupying the insured motor vehicle outside the State of Florida but within the United States of America, its territories or possessions or Canada, and (c) as respects the named insured, while occupying a motor vehicle of which a relative is the owner and for which security is maintained under the Florida Automobile Reparations Reform Act, outside the State of Florida but within the United States of America, its teiritories or possessions or Canada. Conditions (l) Notice. In the event of an accident, written notice of the loss must be given to the company or any of its authorized agents as soon as practicable. If any injured person or his legal representative shall institute legal action to recover damages for bodily injury against a third party, a copy of the summons and complaint or other process served in connection with such legal action shall be forwarded as soon as practicable to the company by such injured person or his legal representative. C-17*67 HEW 2-7* (Continued on page 31 AID 000366 25020 (2) Action AgoinsT The Company. V* .t'.-I;'-" -mill iv igai;.'.' ;nl. . i' .t - shall have been full compliance with .iii 'i'mu !' un- :n-ir mo . ' cr.i.i in -ins - utter and reasonable proof of claim has been film! with the . r,-.1- < r.quir. -t i. .u . `.vat 1 3.1 Medical Reports; Proof and Payment of C'.oim. As >>. .n i- wi . the p--r---r ". A,:, written proof at'claim, under oath if rc-i-nred. which m.iy ;:-.ci..-te :'.... part . -r- :: .re .nd .-\tent c t{u. m. an.} treatment received and contemplated, and mi h other intorr..,it . '. r.. i> as-.'t lb-.- . :r.pan> .a -letermining (ho . '.a:.! due anil poj able. slich prisrvn "hall -.uhnut to mental >r physe' il e an.itKcts a rhi- ' > p.in\'.- ocpeii'o v.hen and ,i' oPor, i> the company may re.is- f. illi v require uvd a copy of the .aed. . 1 r-:;r: 'hall for".arc i to such per' if requested. <41 Reimbursement and Subrogation. In the vent of payment to ..r t r benefit of are injured person uad r ::-..s insurance; (at The cpmp.ihy shqU be reimbursed tn the extent of such pay::.-:;!, ev `usive of roasi a ihie at t< .'new -" fee- and oth- r reasonable expenses, out of the jir weeds of any settlement or ; u-nt that .n.i> result fro.-.-, -he ex,-re ise of .an rights of recovery of such person against, any person nr -irg.mig.iti>>:. .cg.illy .--'sp.-n'iblc for the l-od-iy injury because f which such payment ts made and the company shall have a !t.-n >n such proceeds to such extent; ihi if the injured person or his legal representative fails to bring '.at against a person or organic cion '-gaily responsible for such bodily injury within one year after the 1 i-a payment inv '>..-nefit' under 'his tn-urar. v. the eomp.my. upon giving 30 d t> s written notice to the injured person >r hi- -g.>. -;.re~eruativn, shall h.tve the right to bring suit agam-t stwh person or org.intg.itiva, in is .. in name or ;n the nut;.- >f ` a injured person or V.s {. gal representative, to re cover the amount of such p ' wvVi'.s, provided, hoaec-.-r. that tli. pr-.-vcution or settlement of such suit w-ithout the consent of the injured person or his legal representative shall he without prejudice to such person or his legal rep resentative. SECTION II MODIFICATION OF POLICY COVERAGES Any automobile medical payments insurance and any protection against uninsured motorists insurance afforded by the policy shaii be excess over any benefits available, or which would be iv.ulable but for the application of a deductible, under the Florida Automobile Reparations Reform Act. SECTION 111 FINANCIAL RESPONSIBILITY With respect only , to any motor vehicle for which security is required to be maim .lined under the Florida Automobile Repara tions Reform Act and for which insurance is afforded under the policy, the limit' ..``the company's liability under the insurance for bodily injury ,md property damage liability shall comply with the limits of liability required by any other applicable motor vehicle financial responsibility or compulsory insurance law. SECTION IV PROVISIONAL PREMIUM It is agreed that in the event of any change in the rules, rates, rating plans, premiums or minimum premiums applicable to the insurance afforded, because of an adverse judicial finding as to the constitutionality of any provisions of the Florida Automo bile Reparations Reform Act providing for the exemption of persons from iort liability, the premium stated in the declarations for any automobile bodily injury liability, automobile property damage liability, automobile medical payments and protection against uninsured motorists insurance shall be deemed provisional and subject to recomputation. If this policy is a renewal policy or continuation, such recomputation shall also include a determination of the amount of any return premium previously credited or refunded to the named insured pursuant to Section 12<2Hei of the Florida Automobile Reparations Reform Act with respect to insurance afforded under a previous policy. If the final premium thus recomputed exceeds the premium stated in the declarations, the named insured shall pay to the comp.inv the excess as well as the amount of any return premium previously credited or refunded. SCHEDULE The insurance for PERSONAL INJURY PROTECTION is subject to a deductible of S________ _____________________ applicable to __, the following named insured only; _________ __ each named insured and each relative. Amending Policy No. rR~NSi.-1 _____________ AID 000367 This endorsement is issued by that memijer of The Trtwelei? Insurance Companies which issued the policy of which this endorsement forms a part. C-CMST NEW 2-74 PS'MTED IN U-S.A 25020 t. J-.,rm B.M.C. ->0 F\!>nRSEMF\T PRi Full MOTOR CARRIER 1'oLIClES oF INSLRAV.E FoR RTA DAMACE LIABILITY l NDER SECTION 215 OF THE 1NTE. wiMuMLF. HolMI.'l 1MI KA \TF. i.ilAIMFRCE V I AM) The policy to which this endorsement is attached is an automobile bodilv injurs and property damagr lubilitx pohcs and > lirrrbv amended to assurr rompliance by the insured, as a motor earner of passengers or property, with >ertion 21.) ot the Interstate i.ommerce Vet and the pertinent rules and regulations of the Interstate < Commerce Commission. In consideration of the premium stated in the policy to which this endorsement is attached, the Company hrrrbv agrees to pay. within the limits of liabilitv hereinafter provided, any final judgment recovered against the insured for bodily injury to or death of am per-on. or loss ot or damage to property of others (excluding injury to or death of the insured s employ ee while engaged in the course of their emplov merit, and propertv transported by the insured, designated as cargol. resulting from negligence in the operation, maintenance, or use ot motor vehicles under certituatr of public convenience and necessity or permit issued to the insured by the Interstate Commerce Commission, or otherwise m transportation in mlerstate or foreign commerce subject to part II of the Interstate Commerce Act. regardless of whether such motor vehicles are specifically described in the policy or not. The liabilitv of the Company extends to such bodily injuries and deaths and losses and damages whether occurring on the route or m thr territory authorized to be served by the insured or elsewhere. Within the limits of liability hereinafter provided it is further understood and agreed that no condition, provision, stipulation, or limitation contained in the policy, or any other endorsement thereon or violation thereof, or of this endorsement, bv the insured, shall relieve the Cumpany from liabilitv hereunder or from the payment of any such final judgment, irrespective of the financial responsibility or lack thereof or iiw>lvrnry or bankniptcy of the insured. However, all terms, conditions, and limitations in the policy to which this endorsement is attached are to remain in full force and effect as binding between the insured and the Company, and the insured agrees to reimburse the Company for any payment made bv the Company on arrount of any accident, claim, or suit involving a breach of the terms of the policy, and for any payment that the Company would not have been obligated to make under the provisions of the policy except for the agreement contained in this endorsement. It is understood and agreed that, upon failure of the Company to pay any final judgment recovered against the insured as provided herein, the judgment creditor may maintain an action in any court of competent jurisdiction against the Company to compel such payment. The limits of the Company's liability for the amounts provided in this endorsement apply separately to each accident and anv'payment under the policy because of any one accident shall not operate to reduce the liability of the Company for the payment of final judgments resulting from any other accident. The Company shall not be liable for amounts in excess of the following for each accident: SCHEDULE OF LIMITS Motor Carriers--Bodily Injury Liability--Property Damage Liability <1> (2> Kind of Equipment Passenger Equipment (seating capacity) Seven passengers or less....................................................................... 8 to 12 passengers, inclusive.................................................................... 13 to 20 passengers, inclusive...................................................................... 21 to 30 passengers, inclusive...................................................................... 31 passengers or more......................................................... .. Freight Equipment AH motor vehicles used in the transportation of property........................ Limit for bodily injuries to or death of one person Limit for bodily injuries to or death of all persons injured or killed in any one accident (subject to a maximum of $100,000 for bodily injuries to or death of one person) SI00.000 100.000 100.000 100.000 100.000 $300,000 300.000 500.000 500i000 500.000 100.000 300.000 W Limit for loss or damage in any one accident to property of others (ex cluding cargo) $50,000 50.000 50.000 50.000 50.000 50.000 Whenever required by the Commission, the Company agrees to furnish to the Commission a duplicate original of said policy and all endorse ments thereon. This endorsement may not be canceled without cancellation of the policy to which it is attached. Such cancellation may be effected by the Company or (he insured giving thirty (30) days' notice in writing to the Interstate Commerce Commission at its office in Washington. D.C., said thirty (30) days' notice to commence to run from the <Jate notice is actually received in the office of said Commission. : : Y- A : :. -V ; v-'. Issued to ..... ..............................................................of Dated at.............. ..................................... ,........................................ this ... Amending Policy Nn .......... * ".y- day of......................................................... 19. This endorsement is issued by that member of The Travelers Insurance Companies which issued the policy of which this endorsement forms a part. C-1T836 8-74 Printed in U.S.A. Countersigned by Authorized Company Representative. AID 000368 25670 i c.ftUUKatMfcff 1 i! 0 THE TRAVELERS INSURANCE COMPANIES This endorsement is issued by that member of The Travelers Insurance Companies which issued the policy of which this endorsement forms a part. If any additional premium is noted l>elow, this endorsement is issued in consideration thereof. If any return premium is noted below, the receipt thereof is acknowledged upon acceptance of this endorsement. Effective iruni ~ - r.i. Amending -L ~ / -.it the time ui d.iy the policy becomes elfective. Policy No-------------------- U---- 'JL------------------------------------ i Mount. Da: l tor' Issued to: Date of Issue: ----------------------------------------------------------- --------------------------------------- 5*s- C?.'~i`CK/Additional Premium $ Return Premium $ (The information provided for above, except the police number, is required to be stated onlv when this endorsement i' is-ued I nr .uuchinent to the policy subsequent to its effective date.) It is agreed that as of the elfective date hereof the policy is amended in the following particulars: APPLICABLE TO LOUISIANA This endorsement modifies such insurance as is afforded by the provisions of the policy relating to the followings Manufacturers and Contractors Liability Insurance Owners Landlords and Tenants Liability Insurance Personal Injury Liability Insurance Comprehensive General Liability Insurance Bodily Injury Exclusion Endorsement (Officers and Employees of the Named Insured) The insurance does not apply to bodily injury sustained by any employee or executive officer of the named insured arising out of and in the course of his employment by the named insured, or to any obligation of the insured to indemnify another because of damages arising out of such injury; but this exclusion does not apply (1) to the insureds, if any, designated in the Schedule below, or (2) to liability assumed by the named insured under a written contract, executed prior to loss, other than a written contract between the named insured and any employee or executive officer thereof. Schedule 1. Titlet / 2. Premium Computation Rate - % of Annual Workers* Compensation Premium - Louisiana Provisional Premium $ 3 ;? Premium for this endorsement is to be increased by T 'yj (M&C Table A Increased Limits Factor) .20 :: 26 AID 000369 SBi n o . 26131 i I RfcA ifit ____ 0 Thi' endorsement modifies such insurance as is aiforded in the previsions of nn\ tieneral Liability insurance AMENDATORY ENDORSEMENT - NOTICE TEXAS As respects bodily injury liability coverage and property damage liability coverage, unless the company is prejudiced by the insured's failure to comply with the requirement, any provision of this policy requiring the insured to give notice of action. occurrence or loss, or requiring the insured to forward demands, notices, summons or other legal process, shall not bar liability under thu* policy. This endorsement is issued by that member of The Travelers Insurance Companies which issued the policy of which this endorsement forms a part. C-I6S00 S-73 PAINTEO IN u.S.A. N.S. AID 000370 G525 The Traveler! Commercial Policies MICHIGAN NO-FAULT INSURANCE S'mbol KK .W Page l oi 7 A. Insuring Agreements The Company agrees with the Named Insured, subject to all of the provisions of this endorsement and t*> all <>l tie provision? of the policy except as modified herein, as follows: PART I B. Coverages 1. Personal Injury Protection Insurance (Personal Protection Insurance) -- PIP The Company will pav. in accordance with Chapter 31 of the Michigan Insurance Code, to or on behalt ol curb eligible injured person or his dependent survivors, personal protection benefits consisting of (a) allowable expenses; (b) work loss; and (c) survivors' loss as a result of bodily injury caused by accident and arising out of the ownership, operation, maintenance or u?<-. including loading or unloading, of a motor vehicle as a motor vehicle. 2. Property Protection Insurance -- BPP The Company will pay, in accordance with Chapter 31 of the Michigan Insurance Code, for damage to tangible property caused by accident and arising out of the ownership, operation, maintenance or use. including loading and unloading, of Un insured motor vehicle as a motor vehicle. C. Definitions Under Part I: allowable expenses means reasonable charges incurred for reasonably necessary products, service?, and accommodation?, for an eligible injured person's care, recovery or rehabilitation, including, but not limited to. expense? for medical. ho?pital. nursing, x-ray, dental, surgical, ambulance, funeral and burial services and prosthetic devices: bodily injury means accidental bodily injury, sickness or disease, including death resulting therefrom: damage means accidental physical injury to or destruction of tangible property including the loss of use of such injured or de stroyed property; dependent survivors means 1. the surviving spouse of the deceased eligible injured person if residing in the same household at the time ol death, or if dependent upon such deceased at the time, of death, provided that the dependency of such spouse shall terminate upon remarriage or death; 2. any other person who was dependent upon the deceased eligible injured person at the time of such eligible injured person's death, but only while such other person is (a) under the age of 18 years: or (b) physically or mentally incapacitated from earning: or AID 000371 (0 engaged full-time in a formal program of academic or vocational education or training: CP-1647 7-74 Printed in U.S.A. HI-2 The Travelers Commercial Policies MICHIGAN NO-FAULT INSURANCE Symbol KK-390 Page 2 of 7 eligible injured person nieuu.- 1. the Named Insured or any relative who sustains bodily injury in an accident involving a motor vehicle; 2. anv other person who sustains bodily injury (a) while occupying the insured motor vehicle: or (b) while not occupying any motor vehicle as a result of an accident involving the insured motor vehicle; or (e) a? the result of an accident involving any other motor vehicle (1) which is being operated by the Named Insured or a relative, and (2) to which the bodily injury liability insurance of the policy applies; income means salary, wages, tips, commissions, fees, and other earnings derived from work or employment; insured motor vehicle means 1. when used with respect to Personal Injury Protection Insurance, a motor vehicle with respect to which (a) the bodily injury liability insurance of the policy applies and for which a specific premium is charged, and (b) the Named Insured is required to maintain security under Chapter 31 of the Michigan Insurance Code; 2. when used with respect to Property Protection Insurance, (a) a motor vehicle owned by the Named Insured with respect to which (1) the property damage liability insurance of the policy applies and for which a specific premium is charged; and (2) the Named Insured is required to maintain security under Chapter 31 of the Michigan Insurance Code, or (b) a motor vehicle operated by the Named Insured or any relative which is not owned by such Named Insured or relative, and to which the property damage liability' insurance of the policy applies; motor vehicle means a vehicle, including a trailer, operated or designed for operation upon a public highway by power other than muscular power which has more than two wheels; Named Insured means the person or organization named in Item 2 of the General Declarations; occupying means in or upon or entering into or alighting from; a id 000372 relative means a person related to the Named Insured by blood, marriage or adoption (including a ward or foster child) who is a resident of the same household as the Named Insured; survivors' loss means loss sustained during the first 3 years after the date of the accident by dependent survivors because of the death of an eligible injured person and consisting of 1. contributions of tangible things of economic value, not including services, that such dependent survivors would have received for support during their dependency from the deceased had he not sustained the bodily injury causing death, and 2. expenses reasonably incurred by such dependent survivors during their dependency in obtaining ordinary and nec essary service in lieu of those that the deceased person would have performed for their benefit had he not sustained the bodily injury causing death; The Trawlers Commercial Policies MICHIGAN NO-FAfJLT INSURANCE 5 Symbol KK-399 Page 3 oi 7 work loss means loss sustained during the first 3 years after the date of the accident consisting of 1. loss of income the eligible injured person would have earned had he not sustained bodily injury, and 2. reasonable expenses incurred in obtaining ordinary and necessary services from others in lieu of those -ervices that. had he not sustained bodily injury, the eligible injured person would have performed not for income but for the benefit of himself or his dependent, but work loss does not include any loss after the date on which the eligible injured person dies. D. Exclusions The insurance under Part I does not apply: 1. Under Personal Injury Protection Insurance, (a) to any benefits any person would otherwise be entitled to receive hereunder for bodily injury intentionally caused by him tohimself or to another; (b) to bodily injury sustained by any person while using a motor vehicle which he had taken unlawfully, unless he reasonably believed that he was entitled to take and use such motor vehicle; (c) to bodily injury sustained by any person, other than the Named Insured or any relative, while not occupying any motor vehicle, if the accident occurs outside the State of Michigan; (d) to bodily injury sustained by the Named Insured while occupying, or through being struck by while not oc cupying, any motor vehicle owned or registered by the Named Insured and which is not an insured motor vehicle; (e) to bodily injury sustained by any relative while occupying, or through being struck by while not occupying, any motor vehicle if such relative is the owner or registrant of such motor vehicle and has failed to maintain security with respect thereto as required by Chapter 31 of the Michigan Insurance Code; (f) to bodily injury sustained by an owner or registrant of a motor vehicle involved in the accident with respect to which the security required by Chapter 31 of Michigan Insurance Code is not in effect; (g) to bodily injury sustained by any relative, if such relative is entitled to personal protection benefits as a Named Insured under the terms of any other policy with respect to such coverage; (h) to bodily injury sustained by any person, other than the Named Insured or any relative, if such person is en titled to personal protection benefits as a Named Insured or relative under the terms of any other policy with respect to such coverage; (i) to bodily injury sustained by any person, other than the Named Insured or any relative, while occupying, or through being struck by while not occupying, any motor vehicle, other than an insured motor vehicle, which is being operated by .the Named Insured or relative if the owner or registrant of such motor vehicle has pro vided security with respect thereto as required by Chapter 31 of the Michigan Insurance Code; (j) to bodily injury sustained by any person arising out of the ownership, operation, maintenance or use, in cluding loading or unloading, of a parked motor vehicle unless (1) the motor vehicle was parked in such a way as to cause unreasonable risk of the bodily injury which occurred, or (2) such bodily injury was a direct result of physical contact with AID 000373 (a) equipment permanently mounted on such motor vehicle while such equipment was being operated or used, or The Travelers Commercial Policies MICHIGAN NO-FAULT INSURANCE Symbol KK-399 Pa*e 4 of 7 (b) property being lifted onto or lowered from such motor vehicle in the loading or unloading proc ess, or (3) such bodily injury was sustained by a person while occupying such motor vehicle; (k) to bodily injury sustained by any person while occupying a motor vehicle located for use as a residence or premises; (l) to bodily injury sustained by any person while occupying a public or livery conveyance for which security is maintained as required by Chapter 31 of the Michigan Insurance Code, unless such conveyance is an in sured motor vehicle; (m) to bodily injury sustained by the Named Insured or any relative while occupying a motor vehicle owned or registered by the employer of the Named Insured or such relative for which security is maintained as re quired by Chapter 31 of the Michigan Insurance Code; (n) with respect to work lossand survivors'loss, to bodily injury sustained by any person, other than the Named Insured or any relative, while occupying any motor vehicle, other than the insured motor vehicle, which is being operated by the Named Insured or any relative outside the State of Michigan if neither the owner nor the registrant of such motor vehicle is required to provide security with respect thereto under Chapter 31 of the Michigan Insurance Code. 2. under Property Protection Insurance, to damage to (a) any property while the insured motor vehicle is located for use as a residence or premises; (b) the property of any person while such person is using the insured motor vehicle without the express or im plied consent of the Named Insured; (c) any property owned by the Named Insured or a relative if such Named Insured or relative was the owner, registrant or operator of a vehicle involved in the motor vehicle accident out of which the property damage arose; (d) any vehicle or trailer, or the contents of either, operated or designed for operation on a public highway by power other than muscular power, unless such vehicle or trailer is not an insured motor vehicle but is dam aged by an insured motor vehicle and is parked in such a way as not to cause unreasonable risk of the damage which occurred; (e) any property suffered or caused intentionally by the claimant; (f) any property as a result of an accident involving a motor vehicle not owned by the Named Insured or any relative which is being operated by the Named Insured or any relative to the extent that security as required under Chapter 31 of the Michigan Insurance Code has been provided by or on behalf of the owner or registrant of such motor vehicle; (g) any property accepted for transportation by a Named Insured who is a motor carrier as defined in Chapter 475 of the Michigan Compiled Laws, if a certificate of insurance or other evidence of security has been filed by or on behalf of such motor carrier with any local, state or federal regulatory authority, to the extent that such insurance or other security is provided for such property or would be provided except for the ap plication of a deductible. E. Conditions AID 000374 (Conditions 1. 8, 9 and 10 apply to Personal Injury Protection Insurance and Property Protection Insurance. The other con ditions apply only to the coverages noted thereunder.) 1. Policy Period; Territory. The insurance under Part I applies only to accidents which occur during the policy period and ] a. The Travelers Commercial Policies MICHIGAN NO-FAULT INSURANCE Symbol KK-39<J Page 5 of 7 (a) under Personal Injury Protection Insurance, within the United States of America, its territories or possession?, or Canada: (b) under Property Protection Insurance, in the ?tate of Michigan. 2. Limits of Liability - Personal Injury Protection Insurance. Regardless of the number of persons insured, policies or bonds applicable, claims made, or insured motor vehicles to which this insurance applies, the Company s liability for personal protection benefits to or on behalf of any one person who Sustains bodily injury in any one motor vehicle accident is limited as follows: (a) allowable expenses shall not include charges for a hospital room in excess of a reasonable and customary charge for semi-private accommodations except when the eligible injured person requires special or intensive care; (b) the maximum amount payable for funeral and burial expenses shall not exceed $1,000: (c) the maximum amount payable for all work loss sustained in any single 30 day period, and any income earned from work performed by the eligible injured person within the same 30 day period, together shall not ex ceed $1,000 or whatever other amount is established under Section 3107 (b) of Chapter 31 of the Michigan Insurance Code and such amount shall apply pro rata to any lesser periods of work loss, provided that (1) the maximum amount payable for loss of income because of work loss shall not exceed 85% of such loss of income, unless the eligible injured person presents to the Company reasonable proof of a lower tax advantage, in which case a greater percentage value shall apply; (2) the maximum amount payable for work loss, other than loss of income, incurred by the eligible in jured person shall not exceed $20 per day; (d) the maximum amount payable for survivors' loss, because of the death of an eligible injured person, sustained in any single 30 day period shall not exceed $1,000, provided that the maximum amount payable for survivors' loss because of reasonable expenses incurred by such eligible injured person's dependent survivors shall not exceed $20 per day; (e) any amount payable by the Company under the terms of this coverage shall be reduced by the amount paid, payable or required to be provided under (1) the laws of any state or the federal government; (2) any elective deductible set forth in the declarations of this endorsement, or in the declarations of this policy or in any endorsement attached to and forming a part of this policy, provided that such de ductible shall apply only to the Named Insured, and any relative. 3. Limits of Liability -- Property Protection Insurance. Regardless of the number of persons insured, policies or bonds applicable, claims made, or insured motor vehicles to which this coverage applies, the total limit of the Company's liability under this policy for all damage arising from one accident shall not exceed $1,000,000. Subject to the foregoing, the Company's liability for property protection benefits shall not exceed the lesser of reasonable repair costs or replacement costs less depreciation and, where applicable, the value of loss of use. 4. Action Against Company -- Personal Injury Protection Insurance. No action dial! lie against the Company unless, as a condition precedent thereto, there shall have been full compliance with all the terms of this endorsement', provided further that an action for recovery of personal protection benefits payable under this coverage may not be commenced later than 1 year after the date of accident causing the injury unless written notice of injury as pro vided herein has been given to the Company within l year after the accident or unless the Company has previously made a payment of personal protection benefits for the injury. If the notice has been given or a payment has been made, the action may be commenced at any time within 1 year after most recent allowable expense, work loss or survivors' loss has been incurred. However, the claimant may not recover benefits for any portion of the loss incurred more than 1 year before the date on which the action was commenced. AID 000375 The Travelers Commercial Policies MICHIGAN NO-FAULT INSURANCE Symbol KK-3*W Page 6 ol 7 5. Action Against the Company -- Property Protection Insurance. No action shall lie against the Company units.. a. a condition thereto, there shall have been full compliance with all terms of this endorsement, provided further that an action for recovery of property protection benefit- payable under this coverage may not he commenced later than 1 year after the date of accident. 6. Duties in Event of Loss -- Property Protection Insurance. In the event of loss. (a) the property shall be protected and any further loss due to failure to protect shall not be recoverable under this coverage: however, reasonable expenses incurred in affording such protection shall be deemed incurred at the Company's request: (b) within a reasonable time after loss, sworn proof of loss in such form and including such information as the Company may reasonably require shall be filed with the Company and, upon the Company's request, the damaged property shall be exhibited and the owner or bailee thereof shall submit to examination under oath. 7. Medical Reports; Proof of Claim -- Personal Injury Protection Insurance. As soon as practicable the eligible in jured person or someone on his behalf shall give, the Company written proof of claim, under oath if required, in cluding full particulars of the nature and extent of the injuries and treatment received and contemplated, and such other information as may assist the Company in determining the amount due and payable. The eligible injured per son shall submit to physical or mental examinations by physicians selected by the Company when and as often as the Company may reasonable require. If requested by the Company, such eligible injured person, someone on his behalf or his employer shall furnish a sworn statement of earnings by such eligible injured person since the date of the accident and for a reasonable time prior to the accident. 8. Multiple Policies; Non-Duplication of Benefits. Regardless of the number of motor vehicles insured or insurers (in cluding self insurers) providing security in accordance with Chapter 31 of the Michigan Insurance Code, or the provisions of any other law providing for direct benefits without regard to fault for motor or any other vehicle ac cidents, no person shall recover duplicate benefits for the same expenses or loss. Personal Injury Protection Insurance. If any eligible injured person is entitled to recover benefits under more than one pdlicy, the maximum recovery under all such policies shall not exceed the amount which would have been payable under the provisions of the policy providing the highest dollar limit of benefits payable. 9. Notice. In the event of an accident, written notice containing particulars sufficient to identify the eligible injured person and the damaged property, and also reasonably obtainable information respecting the time, place, and circumstances of the accident shall be given by or on behalf of the person who has sustained bodily injury or loss to the Company or any of its authorized agents as soon as practicable. Personal Injury Protection Insurance. If any eligible injured person, dependent survivor or the legal representative of either shall institute legal action to recover damages for injury against a person or organization who is or may be liable in tort therefore, a copy of the summons and complaint or other process served in connection with such legal action shall be forwarded as soon as practicable to the Company by such eligible injured person, dependent survivor or legal representative. 10. Reimbursement and Trust Agreement. Subject to any applicable limitations set forth in Chapter 31 of the Michigan Insurance Code, in the event of any payment to any person under Part I of this endorsement (a) the Company shall be entitled to the extent of such payment to the proceeds of any settlement or judg ment.that may result from the exercise of any right of recovery of such person against any person or organiza tion legally responsible for the bodily injury or property damage because of which such payment is made and the Company shall have a lien to the extent of such payment, notice of which may be given to the per son or organization causing such bodily injury or property damage, his agent, his insurer, or a court having jurisdiction in the matter; (b) such person shall hold in trust for the benefit of the Company all rights of recovery which he shall have against such other person or organization because of such bodily injury or property damage; A ID 000376 The Travelers Commercial Policies MICHIGAN' VO-FAlLT INSURANCE Symbol KK-39Q Page 7 of 7 (c) such person shall do whatever is proper to secure and shall do nothing after loss to prejudice such right-. (d) such person shall execute and deliver to the Company such instruments and papers as may be appropriate to secure the rights and obligations of such person and the Company established by this provision. provided that this condition shall apply with respect to payment of benefits to any person under Personal Injurv Protection Insurance only if such person is legally entitled to recover such benefits. PART II In consideration of the insurance afforded under Part I of this endorsement and the adjustment of applicable rates: (a) any amount payable under the protection against uninsured motorists coverage shall be reduced by the amount of any personal protection benefits paid or payable under this or any other automobile insurance policy because of bodily in jury to an eligible injured person; (b) anv automobile medical payments coverage afforded under this policy is deleted, but this subsection (b) does not apply to any vehicle for which security is not required to be maintained by Chapter 31 of the Michigan Insurance Code: (c) any physical damage coverage afforded under this policy does not apply to the extent that Property Protection Insur ance benefits are paid or payable as required by Chapter 31 of the Michigan Insurance Code; (d) any rental reimbursement coverage benefit afforded under this policy does not apply to the extent that similar bene fits are paid or payable under Property Protection Insurance benefits as required by Chapter 31 of the Michigan Insur ance Code. PART III The premium for the policy is based on rates which have been established in reliance upon the limitations on the right to recover for damages under the provisions of Chapter 31 of the Michigan^ Insurance Code. If a court of competent jurisdiction declares or enters a judgment from which there is no appeal the effect of which is to render the provisions of such Act invalid or unenforce able in whole or in part, the Company shall have the right to recoitipute the premium payable for the policy on the basis of revised rates which are subject to review by the Commissioner of Insurance. In the event the Named Insured elects to delete any coverage as a result of such declaration or judgment, any resulting refund of premium shall be computed on a pro rata basis. i AID 000377 1 The Travelers Commercial Policies BASIC PERSONAL INJURY PROTECTION ENDORSEMENT (Georgia) Symoof RR-3308A Page 1 of 3 A. INSURING AGREEMENTS The Travelers agrees with the Named Insured, subject to all of the provisions in this endorsement and to all of the provisions of the policy except as modified herein, as follows: SECTION I 1. PERSONAL INJURY PROTECTION COVERAGE -- The Travelers will pay personal injury protection benefits for: (a) medical expenses, (b) work loss, (c) essential services expenses, (d) funeral expenses, and (e) survivors' loss, incurred with respect to bodily injury sustained by an eligible injured person and caused by an accident arising out of the operation, mainte nance or use of a motor vehicle as a vehicle. B. EXCLUSIONS 1. This insurance does not apply: (a) to bodily injury sustained by a person while occupying a motor vehicle which is owned by such person with respect to which the security required by the Georgia Motor Vehicle Accident Reparations Act is not in effect; (b) to bodily injury sustained by any person while using the insured motor vehicle without the express or implied permission of the Named In sured or his spouse, if residing in the same household, or while voluntarily occupying a motor vehicle known by such person to be stolen; (c) to bodily injury sustained by any person while occupying, or while a pedestrian as a result of being struck by, any motor vehicle, other than the insured motor vehicle, with respect to which the security required under the Georgia Motor Vehicle Accident Reparations Act is in effect; - (d) to any benefits any person would otherwise be entitled to receive hereunder for bodily injury sustained intentionally by the person injured or caused intentionally by the claimant; (e) to bodily injury sustained by any pedestrian, other than the Named Insured or any relative, as a result of being struck by a motor vehicle outside the State of Georgia; (f) to bodily injury sustained by any person if such injury arises from conduct within the course of a business of repairing, servicing or other wise maintaining vehicles unless such conduct involves the actual operation of a motor vehicle as a vehicle on the business premises or unless such conduct occurs off the business premises; (g) to bodily injury sustained by any person if such injury arises from conduct in the course of loading or unloading any motor vehicle unless the conduct occurs while such person is occupying such motor vehicle; Ih) to bodily injury sustained by any person arising out of the maintenance or use of any motor vehicle when such motor vehicle is not used as a vehicle; (i) to bodily injury sustained by any person due to war, whether or not declared, civil war, insurrection, rebellion or revolution or to any acts or condition incident to any of the foregoing; (j) to bodily injury sustained by any person resulting from the explosion of any nuclear device. c. DEFINITIONS When used in reference to this coverap: AID 000378 1. "bodily injury" means bodily injury, sickness or disease, including death at any time resulting therefrom; 2. "disability" means any period of time during the eligible injured person's lifetime in which he is unable to either (a) perform substantially all the duties required by his usual occupation, or (b! engage in his principal activity if such person is not employed on at least a full time basis, provided the disability commences within twenty four (24) months from the date on which the motor vehicle accident occurs; 3. "eligible, injured person" means (a! the- Named Insured or any relative who sustains bodily injury while occupying, or while a pedestrian as a result of being struck by, any motor vehicle; (b) any other parson who sustains bodily injury while occupying, or while a pedestrian as a result of being struck by. the insured motor vehicle; 4. "essential services expenses" means expenses reasonably incurred during the period of the eligible injured person's disability for ordinary and necessary services from others, excluding members of the eligible injured person's household, in lieu of services that had he not been injured, he would have performed not for income, but for the benefit of his household; 5. "funeral expenses" means any reasonable and necessary expenses normally incurred by the survivors of a deceased, eligible injured person or by the estate of such person for funeral services, preparation for burial, and burial including but not limited to payments for any lands, services. Supples and equipment incidental to such funeral services, preparation for burial, and burial; CP 1896 10-75 U.S.A. (CP 0592) The Travelers Commercial Policies BASIC PERSONAL INJURY PROTECTION ENDORSEMENT (Georgia) Symool RR 330SA Page 2 of 3 6. "insured motor vehicle" means a motor vehicle with respect to which (a) the bodily injury liability insurance of the policy applies and for which a specific premium is charged, and fb) the Named Insured maintains the security required under the provisions of the Georgia Motor Vehicle Accident Reparations Act; 7. "medical expenses" means all necessary medical expenses including necessary medicine, drugs, surgical, dental, x-ray and rehabilitative services, including prosthetic devices, and necessary ambulance, hospital, and nursing services, all as prescribed, authorized, approved or rendered by an attending physician, including any person licensed to practice a healing art and any remedial treatment and care rendered in accordance with a recognized religious healing method; 8. "motor vehicle" means a vehicle having more than three load bearing wheels, of a kind required to be registered under the laws of this State relating to motor vehicles designed primarily for operation upon the public streets, roads and highways, and driven by power other than mus cular power, and includes a trailer drawn by or attached to such a vehicle; 9. "Named Insured" means the person or organization named in the Declarations; 10. "occupying" means in or upon, or engaged in the immediate act of entering into or alighting from; 11. "pedestrian" means any person not occupying a motor vehicle or a motorcycle or any other motor driven vehicle designed primarily for opera tion upon the public streets, roads and highways, or not in or upon a vehicle operated on stationary rails, or tracks, or aircraft; 12. "relative" means the spouse or any other person related to the Named Insured by blood, marriage or adoption (including a ward or foster child) who is a resident of the tame household as the Named Insured, whether or not temporarily residing elsewhere; 13. "survivors'loss" means compensation in the event of the death of an eligible injured person, survived by a spouse Or dependent children, pay able after such death as though the deceased were alive but totally disabled, such payment to be made to the spouse, if alive, otherwise to the children or the person having legal custody of such children as though awarded as a year's support as provided by law, and the maximum amount payable shall be the amount of work loss and the amount of essential services expenses, that would have been payable to the deceased eligible injured person; 14. "usual occupation" means a person's principal activity or vocation; 15. "work loss" means 85% of the loss of income or earnings of the eligible injured person incurred during his disability. D. POLICY PERIOD; TERRITORY This coverage applies only to accidents which occur during the policy period and within the United States of America, its territories or possessions, or Canada.; ; E. LIMIT OF LIABILITY Regardless of the number of persons insured, policies or bonds applicable, claims made or insured motor vehicles to which this coverage applies. The Travelers liability for personal injury protection benefits with respect to bodily injury sustained by any one eligible injured person in any one motor vehicle accident shall not exceed Five Thousand ($5,000) Dollars in the aggregate, and subject to such aggregate: 1. the maximum amount payable for medical expenses shall not exceed $2,500; 2. the maximum amount payable for work loss shall not exceed $200 per week; 3. the maximum amount payable for essential services expenses shall not exceed $20 per day; 4. the maximum amount payable for funeral expenses shall not exceed $1,500. A.ID 000379 F. CONDITIONS 1. Action Against Company. No action shall lie against The Travelers unless as a condition precedent thereto, there shall have been full compliance with all terms of this coverage. 2. Notice. In the event of an accident, written notice containing particulars sufficient to identify the eligible injured person, and also reasonably obtainable information respecting the time, place and circumstances of the accident shall be given by or on behalf of each eligible injured per son to The Traveters or any of its authorized agents as soon as practicable. If an eligible injured person, his legal representative or his survivors shall institute legal action to recover damages for bodily injury against a person or organization who is or may be liable in tort therefor, a copy of the summons anff complaints or other process served in connection with such legal action shall be forwarded as soon as practicable to The Traveiers by such eligible injured person, his legal representatives or his survivors. 3. Medical Reports; Proof of Claim. As soon as practicable, the eligible injured person or someone on his behalf shall give to The Travelers written proof of claim, under oath if required, including full particulars of the nature and extent of the bodily injury, treatment and rehabilitation re ceived and contemplated, and such other information as may assist The Travelers in determining the amount due and payable. The eligible in jured person shall submit to physical and mental examination by physicians selected by The Travelers when and as often as The Travelers may reasonably require at The Traveiers expense. 4. Subrogation. Subject to any applicable limitations set forth in the Georgia Motor Vehicle Accident Reparations Act, in the event of any pay ment under this coverage, The Travelers is subrogated to the rights of the person to whom or whose benefit such payments were made, to the extent of such payments, and such person shall execute and deliver instruments and papers and do whatever else is necessary to secure such rights. Such person shall do nothing to prejudice such rights. 5. Non-duplication of Benefits; Priority of Payments; Othar Insurance. No eligible injured person shall recover duplicate benefits for the same elements of loss under this policy or any other policy of motor vehicle liability insurance or approved plan of self-insurance. In the event an eligible injured person has such duplicate coverage available and applicable to the accident, the maximum amount of recovery shall not exceed Th Travelers Commercial Policies BASIC PERSONAL INJURY PROTECTION ENDORSEMENT (Georgia) Symbol RR 3308A Page 3 of 3 that amount which would have been payable under the provisions of this insurance policy or such other policy of motor vehicle liability insur ance or approved plan of sefMnsurance providing the highest dollar amount, and The Travelers shall not be liable for a greater portion of any loss to which this coverage applies than the limit of liability hereunder bears to the sum of the applicable limits of liability of this coverage ano such other duplicate coverage. 6. Conformance to Statute. Notwithstanding any of the other terms and conditions of the policy, the coverage afforded shall be at least as exten sive as the minimum coverage required by the Georgia Motor Vehicle Accident Reparations Act, and notwithstanding the terms and conditions of this policy all provisions of this policy shall conform to the laws of this State. SECTION II Modification of Policy Coverages In consideration of the coverage afforded under Section I and the adjustment of applicable rates any amount payable under uninsured motorists cover age or automobile medical payments coverage afforded under this policy shall be excess insurance over any personal injury protection benefits paid or payable under this or any other automobile insurance policy because of bodily injury sustained by an eligible injured person. SECTION III Constitutionality Clause The premium f;or and the coverages of the policy have been established in reliance upon the provisions of the Georgia Motor Vehicle Accident Repara tions Act In the event a court of competent jurisdiction declares, or enters a judgment the effect of which is to render, the provisions of such act in valid or unenforceable in whole or in part. The Travelers shall have the right to recompute the premium payable for the policy and the provisions of this endorsement shall be voidable or subject to amendment at the option of The Travelers in accordance with such declaration of judgment AID 000380 Th, Tr.vrt.rs Commarci.i Poi,c, KENTUCKY BASIC PERSONAL INJURY PROTECTION (Amendatory Endorsement) Symhol VY-3321 P*9* 1 of 4 The Travelers agrees with the Named Insured, subject to all of the provisions of this endorsement and to all of the provisions of the policy except as modified herein, as follows: PARTI A. PERSONAL INJURY PROTECTION COVERAGE The Travelers will pay, in accordance with Kentucky Revised Statutes Chapter 304, Sub Title 39. personal injury protection benefits for: 1. medical expense, 2. work loss, 3. replacement services loss, 4. survivor's economic loss, 5. survivor's replacement services loss, and . S. funeral expense incurred with respect to bodily injury sustained by an eligible injuredperson and caused by an accident arising out of the operation, maintenance or use of a motor vehicle as a vehicle. B. EXCLUSIONS 1. This coverage does not apply: a. to bodily injury sustained by the Named Insured or any relative while occupying any motor vehicle owned by the Named Insured which is not an insured motor vehicle; b. to bodily injury sustained by any relative while occupying any motor vehicle owned by such relative with respect to which the security required by the Kentucky Revised Statutes Chapter 304, Sub Title 33, is not in effect; c. to bodily injury sustained by the Named Insured or any relative, who has not rejected his tort limitation pursuant to Kentucky Revised Statutes Chapter 304, Sub Title 39, while occupying or while a pedestrian through being struck by, any motor vehicle, other than the insured motor vehicle, with respect to which the security required under the Kentucky Revised Statutes Chapter 304, Sub Title 39, is in effect unless the provider of Such security fails to make payment for loss within 30 days of reasonable proof of the fact and the amount of loss sustained; d. to bodily injury sustained by any person if such injury arises from his conduct within the course of a business of repairing, servicing or other wise maintaining motor vehicles unless such conduct occurs off the business premises; e. to bodily injury sustained by any person arising from conduct in the course of loading or unloading any motor vehicle unless such conduct occurs while occupying such motor vehicle; f. to bodily injury sustained by any person other than the Named Insured or any relative which arises from the operation, maintenance or use of a motor vehicle without a good faith belief that he is legally entitled to do so; g. to any benefits any person would otherwise be entitled to receive hereunder for bodily injury intentionally caused by such person or arising out of his intentionally attempting to cause bodily injury, and, if any person dies as a result of intentionally causing or attempting to cause bodily injury to himself, his survivors are not entitled to any survivor's economic loss or survivor's replacement services loss benefits; h. to bodily injury sustained by any pedestrian, other than the Named Insured Or any relative, outside the Commonwealth of Kentucky; i. to bodily injury sustained by any person, other than the Named Insured or any relative while occupying a motor vehicle which is regularly used ini the course of the business of transporting persons or property and which is one of five or more motor vehicles under common owner ship, or a motor vehicle owned by a government other than the Commonwealth of Kentucky, its political subdivisions, municipal corpora tions, or public agencies, if the accident occurs outside the Commonwealth of Kentucky; j. to bodily injury sustained by any person arising out of the use of any motor vehicle while located as a residence or premises; k. to bodily injury due to war, whether or not declared, civil war, insurrection, rebellion or revolution, or to any act or condition incident to any of the foregoing; l . to bodily injury resulting from the radioactive, toxic, explosive or other hazardous properties of nuclear material. C. DEFINITIONS When used in reference to this coverage: 1. "bodily injury" means bodily harm, sickness, disease, or death; 2. "eligible injured person" means AID 000381 a. the Named Insured or any relative who sustains bodily injury while occupying or while a pedestrian through being struck by any motor vehicle provided that, if such person has rejected the limitation upon his tort rights pursuant to Kentucky Revised Statutes Chapter 304, {Sub Title 39, he shall not be an eligible injured person, unless basic personal injury protection coverage has subsequently been purchased . for such person under this policy, or b. j any other person who sustains bodily injury whila occupying or while a pedestrian through being struck by, the insured motor vehicle, pro| vided that, if such person has rejected the limitation upon his tort rights pursuant to Kentucky Revised Statutes Chapter 304, Sub Title 39, he shell not be an eligible injured person. CP 1791 6 75 Prmtta in U.S.A. (CP 05 101) Th Trawlari Commarcial Policies KENTUCKY BASIC PERSONAL INJURY PROTECTION (Amendatory Endorsement) Symbol YY 3321 PV* 2 of 4 however, any rejection of tort limitations applicable solely to motorcycles shall not affect the status of any person as an eligible injured person with respect to any motor vehicle other than a motorcycle; 3. "funeral expense" means reasonable charges incurred for expenses in any way related to funeral, cremation or burial; 4. "insured motor vehicle" means a motor vehicle with respect to which: a. the bodily injury liability insurance of the policy applies and for which a specific premium is charged, and b. the Named Insured is required to maintain security under the provisions of Kentucky Revised Statutes Chapter 304, Sub Title 39; 5. "medical expense" means reasonable charges incurred for reasonably needed products, services, and accommodations, including those for medical care, physical rehabilitation, rehabilitative occupational training, and other remedial treatment and care, any nonmadical remedial treatment rendered in accordance with a recognized religious method of healing, and any healing arts professions of a type licensed by the Commonwealth of Kentucky, provided that medical expense shall not include that portion of a charge for a room in a hospital, clinic, con valescent or nursing home, or any other institution engaged in providing nursing care and related services, in excess of a reasonable and cus tomary charge for semi-private accommodations, unless intensive care is medically required; 6. "motor vehicle" means a vehicle of a kind registered or required to be registered under Kentucky Revised Statutes; 7. "Named Insured" means the person or organization named in the declarations; 8. "occupying" means in or upon, entering into or alighting from; 9. "pedestrian" means a person who is not occupying a motor vehicle at the time the injury occurs; 10. "relative" means the spouse and any person related to the Named Insured by blood, marriage, or adoption including a minor in the custody of the Named Insured, spouse or such related person who is a resident of the same household as the Named Insured, whether or not temporarily residing elsewhere, but does not include any such person wjip is a Named Insured under any other policy providing the security under Ken tucky Revised Statutes Chapter 304, Sub Title 39; 11. "replacement services loss" means expenses reasonably incurred in obtaining ordinary and necessary services in lieu of those the eligible injured person would have performed, not for income, but for the benefit of himself or his family if he had not been injured; 12. "survivor" means a person identified in Kentucky Revised Statutes Section 411.130 as one entitled to receive benefits by reaspn of the death of another person; 13. "survivor's economic loss" means loss after the eligible injured person's death of contributions of things of economic value to his survivors, not including services they would have received from the eligible injured person had he not suffered the fatal injury, less expenses of the survivors avoided by reason of eligible injured person's death; 14. "survivor's replacement services loss" means expenses reasonably incurred by surivivorsafter the eligible injured person's death in obtaining ordinary and necessary services in lieu of those the eligible injured person would have performed for their benefit had he not suffered the fatal injury, less expenses of the survivors avoided by reason of the eligible injured person's death and not subtracted in calculating survivor's economic loss; 15. "work toss" means loss of income from work the eligible injured person would probably have performed if he had not been injured, and expenses reasonably incurred by him in obtaining services in lieu of those he would have performed for income, reduced by any income from substitute work actually performed by him. D. POLICY PERIOD; TERRITORY This coverage applies only to accidents which occur during the policy period and within the United States of America, its territories or possessions, or Canada; E. LIMITS OF LIABILITY Regardless of the number of persons insured, policies or approved plans of self-insurance applicable, claims made or insured motor vehicles to which this coverage applies. The Travelers' liability for personal injury protection benefits with respect to bodily injury sustained by any one eligible injured person in any one motor vehicle accident shall not exceed $10,000 in the aggregate, and subject to such aggregate limit: 1. the maximum amount payable for work loss, replacement services loss, survivor's economic loss, and survivor's replacement services loss shall not exceed S200 per week in the aggregate prorated for any lesser period, provided that if the eligible injured person's earnings or work are seasonal or irregular, tile weekly limit shall be equitably adjusted or apportioned on an annual basis; 2. the maximum amount payable for funeral expense shall not exceed $1,000. Any amount payable by The Travelers under the terms of this coverage shall be reduced by any applicable deductible set forth in the declarations, but only with respect to bodily injury sustained by the Named Insured or any relative, provided that, if two or more such persons sustain bodily injury in the same motor vehicle accident, such deductible applicable to all of them shall not exceed such deductible amount and such amount shall be allocated equally among them. Provided further that, a Nemed Insured or relative is entitled to receive under this coverage the difference between this deductible and a greater deductible applicable under another policy applying to personal injury protection coverage pursuant to Ken tucky Revised Statutes Chapter 304, Sub Title 39. In calculating loss or expense for which personal injury protection benefits are payable under this coverage, a reduction shall be made in the amount of: 1. all benefits or advantages a person receives or is entitled to receive from social security and workmen's compensation, unless these benefits or advantages have not been received before personal injury protection benefits are overdue or the claim is paid: AID 000382 Th Traveler* Commercial Policies KENTUCKY BASIC PERSONAL INJURY PROTECTION (Amendatory Endorsement) Symbol YY-33Z1 p** 3 0 2. any income tax saving resulting from benefits or advantages received for loss of income under this coverage or from like benefits or advantages received under social security or workmen's compensation which are not considered taxable income, provided that the maximum reduction may not exceed 15% of the loss of income and shall be in lesser amount if the claimant furnishes to The Travelers reasonable proof of a lower value of the income tax advantage, F. CONDITIONS 1. Action Against The Travelers. No action shall lie against The Travelers unless as a condition precedent thereto, there shall have been full com pliance with all the terms of this coverage. 2. Notice. In the event of an accident, written notice containing particulars sufficient to identify the eligible injuredperson, and also reasonably obtainable information respecting the time, place and circumstances of the accident shall be given by or on behalf of each eligible injured per son to The Travelers or any of its authorized agents as soon as practicable. 3. Medical Reports; Proof of Claim. As soon as practicable, the eligible injured person of someone on his behalf shall give to The Travelers written proof of claim, undei oath if required, including full particulars of the nature and extant of the bodily injury, treatment and rehabilitation re ceived and contemplated, and such other information as may assist The Travelers in determining the amount due and payable. The eligible injured person shall submit to physical and mental examination by physicians selected by The Travelers when and as often as The Travelers may reasonably require. 4. Subrogation. Sublet to the provisions of the Kentucky Revised Statutes Chapter 304, Sub Title 39, in the event of any payment under this coverage, The "revelers is subrogated to the rights of the person to whom or for whose benefit such payments were made to the extent of such payments. Such person shall execute and deliver the instruments and papers and do whatever else is necessary to secure such rights. Such person shall do nothmq after loss to prejudice such rights. 5. Reimbursement and Trust. Agreamant. Subject to the provisions of the Kentucky Revised Statutes Chapter 304, Sub Title 39, in the event of the payment to any person under this coverage: a. The Travelers shall be entitled to the extent of such payment to the proceeds of any settlement or judgment that may result from the exer cise of any rights of recovery of such person against any person or organization legally responsible for the bodily injury because of which such payment is made, and The Trevelers shall have a lien to the extent of such payment, notice of which may be given to the person or organization causing such bodily injury, his agent, his insurer or a court having jurisdiction in the matter; b. such person shall hold in trust for the benefit of The Travelers all rights of recovery which he shall have against such other person or organi zation because of such bodily injury; c. such person shall do whatever is proper to secure and shall do nothing after loss to prejudice such rights; and d. such person shall execute and deliver to The Travelers instruments and papers as may be appropriate to secure the rights and obligations of such person and The Travelers established by this provision. 6. Non-Duplication of Benefits; Priority of Payments; Other Insurance. No eligible injured person shall recover duplicate benefits for the same elements of loss under this or any similar insurance, including approved self-insurance plans. In the event an eligible injured person has other similar insurance, including approved self-insurance plans, available and applicable to the,accident, the maximum recovery under all such insurance shall not exceed the amount which would have been payable under the provisions of the insurance providing the highest dollar limit, and The Travelers shall not be liable for a greater proportion of any loss to which this coverage applies than the limit of liability hereunder bears to the sum of the applicable limit of liability of this coverage and such other insurance. PART II A. In consideration of the coverage afforded under PART I and the adjustment of applicable rates: 1. any amount payable under tha uninsured motorists insurance coverage shall be reduced by the amount of any personal injury protection bene fits paid or payable under this or any other automobile insurance policy because of bodily injury sustained by an eligible injuredperson; 2. any automobile medical payments insurance afforded under this policy shall be excess insurance over any personal injury protection benefits paid or payable but for the application of a deductible under this or any other automobile insurance policy because of bodily injury sustained by an eligible injured person. PART III A. Constitutionality Clausa The premium for and the coverages of the policy have been established in reliance upon the provisions of the Kentucky Revised Statutes Chapter 304, Sub Title 39. In the event a court of competent jurisdiction declares, or enters a judgment the effect of which is to render, the provisions of such statutes invalid or unenforceable in whole or in part. The Travelers shall have the right to recompute the premium payable for the policy and the provisions of this endorsement shall ba voidable or subject to amendment at tha option of The Travelers. AID 000383 Th Travalars Commercial Policies KENTUCKY BASIC PERSONAL INJURY PROTECTION (Amendatory Endorsement) Symbol YY 3321 Pag* 4 of 4 B. Notice to Policyholders Acceptance of the coverage described in Kentucky Revised Statutes Chapter 304, Sub Title 39, places some limitations on your right to bring suit for bodily injury, KRS 304.39-060 reads in part: "(1) Any person who registers, operates, maintains or uses a motor vehicle on the public roadways of this Commonwealth shall, as a condition of such registration, operation, maintenance or use of such motor vehicle and use of the public roadways, be deemed to have accepted the provisions of this act, and in particular those provisions which are contained in this section. (2) (a) Ton liability with respect to accidents occurring in this Commonwealth and arising from the ownership, maintenance, or use of a motor vehicle is 'abolished' for damages because of bodily injury, sickness or disease to the extent the basic reparation benefits provided in this Act are payable therefor, or that would be payable but for any deductible authorized by this Act, under any insurance policy or other method of security complying with the requirements of this Act, except to the extent non-economic detriment qualifies under subsection (2) (b) hereof. (b) In any action of tort brought against the owner, registrant, operator or occupant of a motor vehicle with respect to which security has been provided as required in this Act, or against any person or organization legally responsible for his acts or omissions, a plaintiff may recover damages in tort for pain, suffering, mental anguish and inconvenience because of bodily injury, sickness or disease arising out of the ownership, maintenance, operation or use of such motor vehicle only in the event that the benefits which are payable for such injury as "medical expense" or which would be payable but for any exclusion or deductible authorized by this Act exceed $1,000.00 or the injury or disease consists in whole or in part of permanent disfigurement, a fracture to a weight-bearing bone, a compound, comminuted, displaced or compressed fracture, loss of a body member, permanent injury within reasonable medical probability, permanent loss of bodily function or death. Any person who is entitled to receive free medical and surgical benefits shall be deemed in compliance with the requirements of this subjection upon a showing that the medical treatment received has an equivalent value of at least $1,000. (c) Tort liability is not so limited for injury to a person who is not an owner, operator: maintainer or user of a motor vehicle within sub section (1) of this section. (4) Any person may refuse to consent to the limitations of his tort rights and liabilities as contained in this section. Such rejection must be in writing in a form to be prescribed by the Department of Insurance and must have been executed and filed with the Department eta time prior to ^ny motor vehicle accident for which such rejection is to apply These are some of the exceptions to the limitations on your right to sue and are not intended to comprise a complete enumeration of all circum stances under which suit may be brought for bodily injury. AID 000384 Th. t rav*i*r> Commercul Policies NEW JERSEY BASIC PERSONAL INJURY PROTECTION ENDORSEMENT svmbo. wvw3is a This endorsement provides coverage as required under the New Jersey Automobile Reparation Reform Act, commonly referred to as the "New Jersey No-Fault Law". All terms printed in italics, other than section headings or titles, are defined terms. For a complete understanding of provisions containing these terms refer to the section entitled "Definitions". The Company agrees with the Named Insured, subject to all of the provisions in this endorsement and to all of the provisions of the policy except as modified herein, as follows: PARTI Basic Personal Injury Protection Coverage The Company will pay basic personal injury protection benefits consisting of: {a) medical expense benefits, (b) income continuation benefits, (c) essential services benefits, (d) survivor benefits, and (e) funeral expense benefits with respect tp bodily injury sustained by an eligible injured person, caused by accident and arising out of the ownership, maintenance or use/including loading or unloading, of a private passenger automobile as an automobile. Exclusions The insurance? under this endorsement does not apply: (a) to bodily injury to a person whose conduct contributed to the injury in any of the following ways: (1) while committinga high misdemeanor or felony or seeking to avoid lawful apprehension or arrest by a police officer, or (2) while acting with specific intent to cause injury or damage to himself or others; (b) to bodily injury to the Named Insured or any relative of the Named Insured sustained while occupying, using or entering into or alighting from a private passenger automobile which is not an insured automobile under this policy, if he is required to maintain automobile liability insurance cov erage with respect to the automobile under the New Jersey Automobile Reparation Reform Act; (c) to boclily injury to any person, other than the Named Insured or a relative of the Named Insured or a resident of New Jersey, if the accident occurs outside of New Jersey; (d) to bodilylinjury arising out of the ownership, maintenance, or use, including loading or unloading, of any vehicle while located for use as a resi dence or premises other than for transitory recreational purposes; (e) to bodily injury due to war, whether or not declared, civil war, insurrection, rebellion or revolution, or to any act or condition incident to any of the foregoing; or (f) to bodily injury resulting from the radioactive, toxic, explosive or other hazardous properties of nuclear material. Definitions! When used in reference to this insurance: "bodily injury" means bodily injury, sickness or disease, including death at any time resulting therefrom; AID 000385 "eligible injuredperson" means: la) the Named Insured or any relative of the Named Insured, if the Named Insured or relative sustains bodily injury (1) while occupying, using, entering into or alighting from a private passenger automobile, or (2) while a pedestrian, caused by a private passenger automobile or as a result of being struck by an object propelled by or from such an automobile; or (b) any other person who sustains bodily injury (1) while, with the permission of the Named Insured, occupying, using, entering into or alighting from the insured automobile, or (2) while a pedestrian, caused by the insured automobile or as a result of being struck by an object propelled by or from the insured automobile: "essential services benefits" means an amount not exceeding a limit of $12.00 per day and a total limit of $4,380 payable to an eligible injured person as reimbursement for payments made to others, for substitute essential services of the type actually rendered during his lifetime and which he would ordinarily have performed not for income but for the care and maintenance of himself and his relatives; "funeral expense benefits" means an amount not exceeding $1,000 for reasonable funeral, burial and cremation expenses incurred; "income" means salary, wagjes, tips, commissions, fees and other earnings derived from work or employment; "income continuation benefits" means an amount not exceeding a limit of $100 per Week and a total limit of $5,200 payable for the loss of income of an income producer during his lifetime, as a result of bodily injury disability; CP-1837 7r75 Printed in U.S.A. sitsEarn'd The Travelers Commercial Policies NEW JERSEY BASIC PERSONAL INJURY PROTECTION ENDORSEMENT Svmool WW-3318 Page 2 of 4 "income producer" means a person who, at the time of the accident, was in an occupational status, earning or producing income; "insured automobile" means an automobile with respect to which the Named Insured is required to maintain automobile liability insurance coverage under the New jersey Automobile Reparation Reform Act, to which the bodily injury liability insurance of the policy applies and for which a specific premium is charged; "medical expense benefits" means all reasonable expenses incurred for medical, surgical and dental treatment, professional nursing, hospital and re habilitation services, x-ray and other diagnostic services, prosthetic devices, ambulance services, medication and other reasonable and necessary ex penses incurred for treatment prescribed by persons licensed to practice medicine, surgery, psychology or chiropracticj or for any nonmedical remedial treatment rendered in accordance with a recognized religious method of healing; "Named Insured" means the person or organization named as the insured in the declarations. If the insured automobile is owned by a farm family co-partnership or corporation, the term "Named Insured"also includes the head of the household of each family designated in the policy as having a working interest in the farm; "pedestrian" means any person who is not occupying a vehicle propelled by other than muscular power and designed primarily for use on highways, rails and tracks and includes any person who is entering into or alighting from such a vehicle; "private passenger automobile" means a self-propelled vehicle designed for use principally on public roads and which is one of the following types: (1) a private passenger or station wagon type automobile, (2) a pick-up or panel truck or delivery sedan, or (3) a utility automobile designed for personal use as a camper or motor home or for family recreational purposes; but a private passenger automobile does not include a motorcycle, an automobile used as a public or livery conveyance for passengers, a pick-up or panel truck, delivery sedan or utility automobile customarily used for business, occupational or professional purposes other than farming or ranching or a utility automobile customarily used for the transportation of passengers other than members of the user's family or their guests; "relative" means a person related to the Named Insured by blood, marriage or adoption (including a ward or foster child) who is a resident of the same household as the Named Insured; "survivor benefits" means the amount or amounts payable in the event of the death of an eligible injuredperson as determined in subdivision (J) or (2) hereof, as appropriate: (D if the eligible injured person was an income producer at the time of the accident, an amount equal to the difference between $5,200 and all basic income continuation benefits paid for any loss of income resulting from his injury prior to his death; (2) if the eligible injured person ordinarily performed essential services for the care and maintenance of himself, his family or family household, an amount not to exceed the difference between $4,380 and all basic essential services benefits paid with respect to his injury prior to death. Limit of Liability Any amount payable by the Company as personal injury protection benefits with respect to bodily injury shall be reduced by all amounts paid, paya ble or required to be provided under any workmen's compensation or employees temporary disability law, or under Medicare provided under federal law. The applicable limit on income continuation benefits applies separately to each full regular and customary work week of an eligible injured person. If his disability from work or employment consists of or includes only a part of such a week, the Company shall be liable for only that proportion of such weekly limit that the number of days lost from work or employment during the part week bears to the number of days in his full work week. Policy Period; Territory This insurance applies only to accidents which occur during the policy period and within the United States of America, its territories or possessions or Canada. Conditions 1. Notice. In the event of an accident, written notice containing particulars sufficient to identify the eligible injured person, and also reasonably obtainable information respecting the time, place and circumstances of the accident shall be given by or on behalf of each eligible injured person to the Company or any of its authorized agents as soon as practicable. If any eligible injured person, his legal representative or survivors shall institute legal action to recover damages for injury against a person or organization who is or may be liable in tort therefor, a copy of the summons and complaint or other process served in connection with such legal action shall be forwarded as soon as practicable to the Company by such eligible injured person, his legal representative or his survivors. 2. Medical Reports; Proof of Claim. As soon as practicable the eligible injured person or someone on his behalf shall give to the Company written proof of claim, including full particulars of the nature and extent of the injuries and treatment received and contemplated, and such other infor mation as may assist the Company in determining the amount due and payable. The eligible injuredperson shall submit to physical examination by physicians when and as often as the Company may reasonably require and a copy of the medical report will be forwarded to such eligible in jured person if requested. 3. Multiple Policies Applicable to One Accident; Non-duplication of Benefits; Priority of Complying Policies. Regardless of the number of automo biles insured for basic personal injury protection coverage pursuant to Section 4 of the New Jersey Automobile Reparation Reform Act, or the number of insurers or policies affording such coverage, there shall be no duplication of payment of basic personal injury protection benefits and the aggregate maximum amount payable under this and all applicable policies with respect to bodily injury to any one person as the result of any one accident shall not exceed the applicable amounts or limits specified in Section 4 of said Act. AID 000386 Th. Travi*rs Commrctl Policies NEW JERSEY BASIC PERSONAL INJURY PROTECTION ENDORSEMENT Symbol ww;33i8 p9* 3 of 4 This insurance applies on a primary basis to bodily injury to the Named insured and his relative and on a secondary basis to all other eligible in jured persons. ' Similarly, the basic personal injury protection coverage provided by other complying policies applies on a primary basis to boddy injury to those persons Who are named insureds under such policies and their relatives. If an eligible injured person to whom this insurance applies on a secondary basis has Other basic personal injury protection coverage under another complying policy applicable to his bodily injury on a pn mary basis, all claims for basic personal injury protection benefits shall first be made against the insurer issuing the other complying policy. No basic personal injury protection benefits shall be due and payable under this insurance unless the other insurer fails to pay such benefits by reason of insolvency and the Company has been given written notice by the claimant of such failure. "Complying Policy" means a policy of automobile liability insurance maintained pursuant to the requirements of Section 3 of the New Jersey Automobile Reparation Reform Act and providing basic personal injury protection coverage as approved by the Commissioner of Insurance. 4. Reimbursement and Trust Agreement Subject to any applicable limitations set forth in the New Jersey Automobile Reparation Reform Act. in the event of any payment to any person under this endorsement; (a) the Company shall be entitled to the extent of such payment to the proceeds of any settlement or judgment that may result from the exercise of any rights of recovery of such person against any person or organization legally responsible for the bodily injury because of which such pay ment is made; and the Company shall have a lien to the extent of such payment notiea of which may be given to the person or Organization causing such bodily injury, his agent, his insurer or a court having jurisdiction in tha matter; (b) such person shall hold in trust for the benefit of the Company all rights of recovery which he shall have against such other person or organiza tion because of such bodily injury; (c) such person shall do whatever is proper to secure and shall do nothing after loss to prejudice suih rights; (d) such person shall execute and deliver to the Company such instruments and papers as may bt appropriate to secure the rights and obligations of such person and the Company established by this provision. 5. Payment of Personal Injury Protection Benefits. Medical expense benefits and essential services benefits may b paid at tha option of the Compa ny to the eligible m/urad person or the person or organization furnishing the products or services for which sets benefits are due. In the event of the death of an eligible injured person any amounts payable, but unpaid prior to death, for medical expense benefits are payabla to the eligible in jured person's estate. Benefits payable under subdivision (1) of the definition of survivor benefits are payable to the eligible injuredperson's surviving spouse, or if there is no surviving spouse, to his surviving children, or if there are no surviving spouse or surviving children, to the eligible injuredperson's estata. Benefits payable under subdivision (2) of the definition of survivor benefits are payable to the person who has incurred the expat to of pudding essential services. Funeral expense benefits are payable to the eligible injured person's estate. 6. Whenever this endorsement is used with a policy consisting of more than one Section, this Form shall be a part of Section III, Automobile Lia bility, of such policy. PART II Extended Medical Expense Benefits Coverage The Company will pay medical expense benefits not to exceed the total aggregate amount of $1000 and funeral expense benefits with respect to bodily injury sustained by an insured person, caused by an accident occurring during the policy period within the United States of America, its terri tories or possessions or Canada and arising out of the ownership, maintenance or use, including loading and unloading, of an insured automobile or of a highway vehicle not owned by or furnished or available for the regular use of the Named Insured or any relative of the Named Insured. Exclusions The insurance junder Part II is subject to all of the exclusions applicable to Pan I, except that the word "person" in exclusion (c) is replaced by the word ''pedestrian". Definitions The definitions under Pan I apply to Pan II and under Pan II: "highway vehicle" means a land motor vehicle or trailer other than: (1) a farm type tractor or other equipment designed for use principally off public roads, while not upon public roads, (2) a vehicle operated on rails or crawler-treads or (3) a vehicle while located for use as a residence or premises: "insuredperson" means: (a) the Named insured or any relative of the Named insured, if the Named Insured or relative sustains bodily injury: (1) while occupying, using, entering into or alighting from a highway vehicle; or 12) while aj;pedestrian, caused by a highway vehicle; (b) any other jperson who sustains bodily injury while occupying a highway vehicle (other than a motorcycle or a vehicle while being used as a public or livery conveyance) if such highway vehicle is being operated by the Named insured or a relative of tha Named insured or any other person using such highway vehicle with the permission of the Named insured; or (c) any other person who sustains bodily injury while occupying an insured automobile if such insured automobile is being operated by the Named in sured or a relative of the Named Insured or any other person using such insured automobile with the permission of the Named insured. AID 000387 Tht Trawlers Commercial Policies NEW JERSEY BASIC PERSONAL INJURY PROTECTION ENDORSEMENT Symbol WW-3318 Pag 4 of 4 Conditions Conditions 1, 2 and 4 of Part I apply to Part II, substituting the term "insured person" for "eligible injured person" wherever it appears therein. The following additional condition applies under Part II: Other Insurance or Benefits. This insurance does not apply to loss or expense with respect to which an insured person is entitled to benefits under any workmen's compensation law or Medicare provided under federal law or under Section 4 of the New Jersey Automobile Reparation Reform Act. This insurance does not apply to loss or expense to the extent that benefits are payable or are required to be provided)therefor under any other auto mobile no-fault law or under any other automobile medical payments insurance. PART HI In consideration of the insurance afforded under Parts I and II of this endorsement, and the adjustment of applicable rates: (a) any amount payable for economic loss under the Protection Against Uninsured Motorists Coverage shall be reduced by the amount of any personal injury protection benefits paid or payable under this or any other automobile insurance policy because of bodily injury to an eligible injured per son; (b> any Automobile Medical Payments Coverage afforded under the policy is deleted with respect to an automobile which is an insured automobile. PART IV Premium Recomputation The premium for the policy is based un rates which have been reduced in accordance with Section 18 of the New Jersey Automobile Reparation Re form Act to reflect the limitations un tha right to recover damages imposed by Section 8 of said Act. If a court of competent jurisdiction declares, or enters a judgment tha effact of which is to render. Section 8 of the Act invalid or unenforceable in whole or in part, the Company shall have the right to recompute tha premium payable for the policy on the basis of revised rates which are subject to approval by the Commissioner of Insurance. AID 000388