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Home My Public Portal AboutKorkat 4-15-20 COIf,-#iH,r sYft: T9KORKA ACORD., CERTIFICATE OF LIABTLITY INSURANCE COVERAGES CEBTIFICATE NUMBER FEVISION NUIVBEF 411612020 THIS CEFTIFICATE IS ISSUEO AS A MATTEB OF INFOFMATION ONLY AND CONFEBS NO RIGHTS UPON THE CEBTIFICATE HOLOER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OB NEGATIVELY AMENO, EXTENO OR ALTEB THE COVEBAGE AFFOBDEO BY THE POLICIES BELOW. THIS CEBTIFICATE OF INSUHANCE DOES NOT CONSTITUTE A CONTBACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED BEPFESENTATIVE OF PBOOUCER, AND TI-IE CERTIFICATE HOLDEB. IMPOBTANTI ll the certificate holdet is an AOOTTIONAL INSURED, the policy(ies) must have AODITIONAL INSUFED provisions or be endorstd. lf SUBBOGATION lS WA|VE0. subiecl to tho term6 and condltlona of the pollcy, certain polici6s may require an endorsement. A atatament on thig cerlificat€ does not contor any rightr to lho cortificatg holder in lieu ol such endorsemsntls). McGrltl lnsurance Sewlcos 741 W. Lanior Ave., Suite 10O Fayettevllle, GA 30214-cA 770 471-71@ fiRUIfcr cA Certiticate Team [ii13.*6 ',,,, rro azt -zt oo iil o, t ffi !ss, certif icatesga@mcgrifrinsurance.com tNsu RE AlS) AFFOFDT cCOVEAACE r sUFEhA : Burllngfton lnsurance Complny lNsuFEF B . Amerlcan Bulldrrs lnsurancc Company 77 657-1559 23620 1-1240 Lanler Plans lnc dba Korkat 221 Cable lndustrlal Way Carrollton, GA 30117 -!!q9FE Selectlve W6y lnsurance Company INSUBEF O 26301 Lr! A ADDLSUBB INSF \flVO POLICY I{UMAEB POLICY EFF POIICY EIP (lr ivoo/YYyl4 -0[/oo/YY!!) _LIMITS x cour/rEBcr.ALGE EFAL LTABTL|TY 435BW57462 04.l15l20m OU1 2O21 EACH occuEBE\cE s 1 ,oOOrqOO s100,0@ s5,000 CLA1M S.I,l AO E !(] *","DAMAGE TO RENTED PFEMISES tE rc!n6c.l !qE! ExP (anJ o!. p.Mn) PFRSONAI A AOV IN.IL]FY E;;i;"""*^;; x BUPD Ded:5 om s1,00O,000 GEN'L AGGREGATE L MIT APPL ES PEA s 2r09qpm $2,@,00 s $i,ooopoo $ t ___,- $ ; - "o.,"" [I i5.? f-,o" ---lor!!-AUTOIOE{.E LABI.ITY PBOOUCiS . COILI P/OP AGG 9237 5277 0!,t1st2ozo 04^ 12021 fE:HllE"?'i NGLE " ' x-l OWNEO fl ScHEDULEDL l Auros BOOILY INJUFY lPer pwonl BOOILY INJUFYtPa acciddi) 'FaoPEBrV D-AMAGE i lee q!sd!!ri) -- irl ffib%o*,.,. A -Et EXCESS LIAE f, occun CLA M$MAOE HFF0012559 Ul15l2om Ul1g2O21 EACH cccuFRENCE DED FETENTIo{$o B WOBKEBS COMPEiISATIOII AI{O EI/lPTOYEFS' LLABILTIY A'!Y PAOPFIETORPAB-IN EF/EXECUTIVE OFFICEB/MEMBER €XCLUDED' ll y6,d6cnb.unda DFSCFIPnoN oF oPFRATIoNS H.q utly2u?E o4/1t2021 X ESIr.urE - _P;i EL EAcri acc,DENr sl,O(x)romN ,E!_Dl9EAsE E.L, DISEASE Ea q',f!!olEE !1,@Q,00o eorrqlyq isl,O@,0QO 1 I OESC BIPTIOII OF oPE BAITONS / LOcAIlollS / VEHIC LES (AC OFO 1 0r , AddlloMl F.n.rt! Sch.du!., n.y b. .lt ch.d lr 6orc .p.6 h r.quko.l)*' Workers Comp Inlormatlon *' Other Stales Coverage Proprletors/PartnerdExecutivo OtliceryMombers Excluded: Shano Lanlet " See Atlachsd Forms ** (See Attached Oescriplions) CANCE T SHOULO At{Y OFTHE AAOVE DESCBIBED POLICIES BE CANCELLED BEFOBE THE EXPIBATION DATE THEBEOF. TIOfICE WILL BE DELIVEBEO II{ ACCOBOATICE \flITH THE POLICY PFOVISIOiIS, Ditl-> O)-- AUTHOFU EO REPFESENTATIVE Clty ot Tybee lsland P O Box 2749 Tybee lsland, GA 31328 149? ACOFIO 2s {2016/03) 1 ol2 #s25584337/M25584257 O l98&2015 ACOBD COBPOBATION. All rlghts r€€rved The ACORD name and logo ,ro regieter.d mrrks ol ACOBD CALA page 2 of 19 Cllent#:17a5271 IIISLJFED THIS IS TO CEPTIFY THAT THE POLICIES OF INSUBANCE USTED BELOW HAVE BEEN ISSUED TO THE INSUBEO NAMED ABOVE FON THE POLICY PEBIOD INDICATED, NOTWITHSTANOING AI,JY REQUIBEMENI. TERM OB CONDITION OF AMY CONTBACTOB OTHEB DOCUMENT W|TH NESPECT TO WHICH THIS CEBTIFICATE MAY AE ISSUED OB MAY PEBTAIN. THE INSUBANCE AFFORDED BY THE POLICIES DESCRIEED HEBEIN IS SUBJECT TO ALL THE TEBMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN BEDUCED BY PAID CLAIMS, s5,00O,@ . s5,0m,ogq s wcvl'1729710 ffi pago 3 of 19 CG 2404 0VO9 - Waiver ol Bights o, recovery CG 2010 07/04 - Additlonal lnsured - Owners, Lesssss or Contractors CG 2037 07/04 - Additional lnsured - Owners, Lessors and Contractors - Complotod OpErations CA 78OO 11/17 - ElllePac Commercial Adomoblle Extenslon IFGGOOg4 03/17 - Amendrnenl Other lnsurance (Primary and Non-Contrlbutory Coverage) WCOO313 (x/84 . Waivor ot Our Right To Rocover From Othqrs Endorsemenl SAGITTA 2s.3 (201d031 2 ol2 *s2558/357t 2558/257 1493 DESCRIPTIONS (Continued from Page 1) $ET'?J:ffi page 4 of 19 Lanier Plans lnc dba Xo.kat POLICY NUMBER: 4358Ws74@ COMMERCIAL GENERAL LIABILITY cc 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization:Anyperson or organrzatron br r(hom liou are requrred lo wave )mur nght ofreooveryon th1s Cove/age Part under a wntlen contracl or lnformation required to complete this Schedule, if not shown above, will be shown in the Declarations The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section lV - Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products- completed operations hazard'. This waiver applies only to the person or organization shown in the Schedule above. 1494 cG 24 04 05 09 O lnsurance Services Oftice, lnc., 2008 Pagel ofl O HTTHI;ffi page 5 of '19 This page has been left blank intentionally. 1495 $,-#-?i HflW page 6 ol 19 Lanier Plan6 lnc dba Korkat POLICY NUMBER 435BW574@ COMMERCIAL GENERAL LIABILITY cG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED. OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEOULE Name of Additional lnsured Person(s) or Location(s) Of Covered Operations Organization(s): Any person or organization for whom you are performing operalions when you and such person or organization have agreed in writing in a contract or agreement prior to the date of loss that such person or organization be added as an additional insured on your policy. lnformation requrred to complete this Schedule, if not shown above, will be shown rn the Deciarations A. Section ll - Who ls An lnsured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to ljability for "bodily injury', 'property damage" or "personal and advertising injury'' caused, in whole or in part, by: 1. Your acts or omrssions; or 2. The acts or omissions of those acling on your behalf: in the performance of your ongoing operations for the additional insured(s) at the location(s) desig- naled above. B. With respect lo the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to "bodily injury" or "property damage" occurring afler 1. All work. including materials. parts or equip- ment furnished in connection wilh such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additionai insured(s) at the location of the csvered operations has been completed; or 2. That portion of "your work' out of which lhe injury or damage arises has been put to its in- lended use by any person or organization other than another contractor or subcontractor en- gaged in perrorming operations tor a principal as a part of the same proJect 14S6 cG 20 10 07 04 Copyright, lnsurance SeTVices Office, lnc., 2004 Page 1 of 1 ffi This page has been left blank intentionally paoe 7 of 19 149/ Ergft HE!* page 8 of 19 Lanrer Plans lnc dba Ko.kal POLICY NUMBER: 4asBws746e COMMERCIAL GENERAL LIABILITY cG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Soction ll - Who ls An lnsured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for 'bodily injury" or 'property damage" caused, in whole or in part, by "your work" at the location designated and described in the schedule of this endorsement performed for thal additional insured and included in the 'products-completed operations hazard". Name Of Additional lnsured Person(s) Or Organization(s): Location And Description Of Completed Operations Any person or organizalion for whom you are performing operations when you and such person or organizalion have agreed in writing in a conlract or agreement prior to the date of loss that such person or organizalion be added as an additional insured on your policy. 'lnbrmation required to complets his Schsdule, ifnot sho,yn above, ryill be shown in the Declarations. r498 cG 20 37 07 04 @ ISO Properties, lnc., 2004 Page I ol 1 ffi This page has been left blanli intentioDally page 9 of 19 1499 E*THiffi page 10 of 19 v Plans lnc dba Korkal n23t5277 ElitePac' Gommercial Automobile Extension COIV[,4ERCIAL AUTO cA78 09 11 17 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Business Auto Coverage Form apply unless modified by the endorsement. AMENDMENTS TO SECTION II - LIABILITY COVER. AGE A lf this policy provides Auto Liability coverage for Owned Autos, the following extensions are applica- ble accordingly: NEWLY ACQUIREO OR FORMED ORGANIZA- TIONS The following is added to SECTION ll, A.1. - Who ls An lnsured: Any organization you newly acquire or form, other than a partnership, joint venture or limited liability company over which you maintain ownership or majority interest, will qualify as a Named lnsured if there as no similar insurance available to that organi- zation. However: 1. Coverage under this provision is afforded only until the 180th day aner you acquire or form the organization or the end of the policy period, whichever is earlier; 2. Coverage does not apply to "bodily injury" or "property damage" resulting from an "accident" that occurred before you acquired or formed the organization. No person or organization is an 'insured" with re- spect to the conducl of any current or past partner- ship, joint venture or limited liability company that is not shown as a Named lnsured in the Declarations EXPENSES FOR BAIL BONDS AND LOSS OF EARNINGS Paragraphs (2) and (4) of SECTION ll, A.z.a. - Supplementary Payments are deleted in their entirety and replaced with the following: (2) Up to the Limit of lnsurance shown on the ElitePac Schedule for the cost of bail bonds (in- cluding bonds for related traffic law violations) required because of an "accident" covered under this policy. We do not have to furnish these bonds. (4) All reasonable expenses incurred by the "insured" al our request. This includes actual loss of earnings because of time off from work. which we will pay up to the Limit of lnsurance shown on the ElilePac Schedule. EMPLOYEE INDEMNIFICATION AND EMPLOY. ER'S LIABILITY AMENOMENT The following is added to SECTION ll, 8.4. - Exclusions: This exclusion does not apply to a'volunleer work- er" who is not entitled lo workers compensalion, disabilily or unemployment compensation benefi ts FELLOW EMPLOYEE COVERAGE The Felloyv Employee Exclusion, SECTIoN ll, 8.5. - is deleled in its entirety. CARE, CUSTODY OR CONTROL AMENDMENT The following is added to SECTION ll, 8.6. - Exclusions: This exclusion does not apply to property owned by anyone other than an "insured", subjecl to the follow- ing: 1. The most we will pay under this exception for any one "accident" is the Limit of lnsurance stat ed in the ElilePac Schedule; and 2. A per "accident" deductible as stated in the ElitePac Schedule applies to this exception. B. lf this policy provides Auto Liability coverage for Owned Aulos or Non-Owned Autos, the following exlension is applicable accordingly. LIMITED LIABILITY COMPANIES The following is added to SECTIoN ll, A.1. - \rvho ls An lnsured: lf you are a limited liability company, your members and managers are "insureds" while using a covered "auto" you donl own, hire or borrow during the course of their duties for you. BLANKET ADDITIoNAL INSUREDS - As Required By Contract The following is added to sEcTloN ll, A.'1. - who ls An lnsured: cA78 09 11 17 Page 1 of 5 1500 Copyright,20lT Selective lnsurance Company of America. All rights reserved. lncludes copyrighted material of lnsurance Services Office, lnc , with ils permission ffi Any person or organization whom you have agreed in a written mntract. written agreement or written permil that such person or organization be added as an additional "insured" on your policy. Such person oI organization is an additional "lnsured" only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by your owner- ship, maintenance or use of a covered "auto". This coverage shall be primary and non-contributory with respect to the additional "insured". This provision only applies if: 1. lt is required in the written conlracl, written agreement or written permit identified in this sec- tion; 2, It is permitted by law; and 3. The written contract or written agreement has been executed (executed means signed by a named insured) or written permit issued prior to the 'bodily injury" or "properly damage" C. lf this policy provides Aulo Liability coverage for Non- Owned Autos, lhe following extension is applicable accordingly: EMPLOYEES AS INSUREDS lf this polacy provides Auto Liability coverage for Non-Owned Autos. the following is added to SECTION ll, A.1. - Who ls An lnsured: Any "employee" of yours is an "insured" while using a covered "auto" you don't own, hire or borrow in your business or your personal affairs. An "employee" of yours is an "insured" while operat- ing an "auto" hired or rented under a contracl or agreement in that "employee's" name with your per- mission, while periorming duties related to the con- duct of your business AMENDMENTS TO SECTION III . PHYSICAL DAIIIAGE COVERAGE lf thjs policy provides Comprehensive, Specified Causes of Loss or Collision coverage, the following extensions are applicable for lhose 'autos" for which Comprehen- sive. Specifred Causes of Loss or Collision coverage is purchased: TOWNG AND LABOR SECTION lll, A.2. - Towing is deleted in ats entirely and replaced with the following: We will pay all reasonable towing and labor costs up to the maximum Limit of lnsurance shown on the ElitePac Schedule per tow each lime a covered'Private Passen- ger Auto", "Social Service Van or Bus" or "Light Truck" is disabled and up lo the maximum Limit of lnsurance per tow each time a covered "lMedium Truck", 'Heavy Truck" or "Extra Heavy Truck" rs disabled. page 11 of 19 For labor charges to be eligible for reimbursement the labor must be performed at the place of disablement This coverage extension does not apply lo Emergency Services Organizations and Governmental Entities GLASS BREAKAGE DEDUCTIBLE The following is added to SECTION lll, A.3. - class Breakage - Hitting A Bird Or Animal - Falling Objects or Missiles: lf damaged glass is repaired rather than replaced, no deduclible will apply for such repair. This extension does not apply to Emergency Services Organizations and Governmental Entities ADDITIONAL TRANSPORTATION EXPENSES SEC. TION lll, A.4,a. - Transportation Expenses is deleted in its entirety and replaced with the following: We will pay up to the maximum Limit of lnsurance shown on the ElitePac Schedule for temporary transportation expenses that you incur because of any "loss" to a cov- ered "auto", but only if the covered "auto" carries the coverages and meels the requirements described in '1. or 2. below: '1. We wll pay temporary transporlation expenses for lotal thefl of a covered 'auto". We will only pay for such expenses incurred during the period beginning 24 hours after the thefr and ending, regardless of the policy's expiration, when the covered "auto" is re- turned to use or we pay for its "loss" 2. For'loss" other than total thefr of a covered'auto" under Comprehensive or Specified Causes of Loss Coverage, or for any "loss" under Collision Coverage to a covered "auto", we will only pay for those lem- porary lransportation expenses incurred during lhe policy period beginning 24 hours afrer the'loss" and ending, regardless of the policy's expiration. with the lesser of the number of days reasonably required to repair or replace the covered "auto" or 30 days Paragraph 2. of this extension does not apply while lhere are spare or reserve 'autos" available lo you for your operalions This coverage exlension does not apply to Emergency Services Organizations and Governmental Entities. HIREO AUTO PHYSICAL OAMAGE COVERAGE The following as added to SECTION lll, A.4. - Coverage Extensions: Physical Damage coverage is hereby extended to apply to Physical Damage "loss" to'autos" leased, hired, rent- ed or borrowed without a driver. We will provide cover- age equal to the broadest coverage available to any covered "aulo" shown in the Declaralions. But, the most we will pay for "loss" to each "auto" under this coverage extension is the lesser of: cA76 09 11 17 Page 2 of 5 1501 Copyright,2017 Selective lnsurance Company of America. All rights reserved lncludes copyrighted material of lnsurance Services Office. lnc, with its permission Fro{I/lr\rli r tr?.t4:JF '1. The Limit of lnsurance stated in the ElitePac Sched- ule; or 2. The actual cash value of the damaged or stolen property as of the time of the 'loss"; or 3. The aclual cost of repairing or replacing the dam- aged or stolen property with other property of like kind and quality. A part is of like kind and quality when il is of equal or better condition than the pre- accidenl part We will use the original equipment from the manufacturer when: (a) The operational safety of the vehicle might otherwise be impaired; (b) Reasonable and diligent efforts to locale the appropriate rebuilt, aflermarket or used part have been unsuccessful; or (c) A new original equipment part of like kind and quality is available and will result in the lowest overall repair cost For each leased, hired, rented or borrowed "auto" our obligation to pay "losses" will be reduced by a deductible equal to the highest deductible applicable to any owned "auto" for that coverage. No deductible will be applied lo "losses" caused by fire or lightning SECTION lV,8.5. Other lnsurance Condition, Para- graph 5.b. is deleted in its entirety and replaced by the following: For Hired Auto Physical Damage Coverage, the follow- ing are deemed to be covered "autos"' you own: 1. Any covered'auto" you lease. hire, renl, or borrow, and 2. Any covered "auto" hired or rented by your 'em- ployee" under a contract or agreement in that "employee's" name, with your permission, while performing duties related lo the conduct of your business. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". This coverage exlension does not apply to Emergency Services Organizalions and Governmental Enlities HIRED AUTO LOSS OF USE COVERAGE The following is added to SECTION lll, A.4. - Coverage Extensions: We will pay expenses for which you are legally responsi- ble to pay up lo the Limit of lnsurance shown on the ElitePac Schedule per "accident" for loss of use of a leased, hired, rented or borrowed "auto" if it resulls from an'accident". This coverage extension does not apply to Emergency Services Organizations, Governmental Entities, and Schools AUTO LOAN/LEASE GAP COVERAGE (Not Applica- ble in New York) The following is added to SECTION lll, A.4. - Coverage Extenaions: ln the event of a total "loss" to a covered'auto" we will pay any unpaid amount due on lhe lease or loan for a covered "auto", less: l. The amount paid under lhe Physical Oamage Cover- age Section of the policy, and 2. Any. a. Overdue lease/loan paymenls at the time of,loss',; b. Financial penalties imposed under a lease for excessive use, abnormal wear and tear, high mileage or similar charges, c. Security deposits not refunded by the lessor or financial institution; d. Costs for exlended warranlies, credit life, health. accident, or disability insurance purchased with the loan or lease; and e. Carry-over balances from previous leases or loans You are responsible for the deductible applicable to the 'loss" for the covered 'auto" PERSONAL EFFECTS The following as added to SECTION lll, A.4. - Coverage Extensions: lf this policy provides Comprehensive Coverage for a covered "auto" you own and that covered "auto" is stolen, we will pay up to the Limrt of lnsurance shown on the ElitePac Schedule, wilhout application of a deducti- ble, for lost personal effecls that were in the covered "auto" at the time of thefl Personal effects do not include jewelry, tools, money, or securities. This coverage is excess over any olher collectible insurance. AIRBAG COVERAGE The following is added to SECTION lll, 8.3.a. - Exclu- sions: Mechanical breakdown does not include the accidental discharge of an airbag. This coverage extension does not apply to Emergency Services Organizalions and Governmental Entities EXPANDED AUOIO, VISUAL, AND DATA ELEC. TRONIC EOUIPMENT COVERAGE SECTION lll, 8.4. - Exclusions This exclusion does not apply to the followingl 1. Global positioning systems; 2. 'Telematic devices"; or 3. Electronic equipment that reproduces, receives or transmits visual or data signals and accessories used with such equipmenl, provided such equipment is: cA78 09 11 17 Page 3 of 5 1502 Copyright. 2017 Selective lnsurance Company of America All rights reserved. lncludes copyrighted material of lnsurance Services Office, lnc., with its permission page '12 of 19 Fls4; Hrlfi a. Permanently installed in or upon the covered 'auto" at the time of the "loss"; b. Removable from a housing unit that is perma- nently installed in the covered "auto" at the time of the 'loss", c. Designed to be solely operated by use of power from the "auto's" electrical system; or d. Designed to be used solely in or upon the covered "aulo". For each covered "loss" to such equipment, a deductible of $50 shall apply, unless the deductible otherwise appli- cable to such equipment is less than $50, at which point lhe lower deductible, if any, will apply. COMPREHENSIVE DEOUCTIBLE . LOCATION TRACKING DEVICE The following is added to SECTION lll, D. - Deductible: Any Comprehensive Coverage Deductible shown in the Declarations wall be reduced by 50% for any'loss" caused by thei if the covered "auto" is equipped with a location tracking devrce and lhat device was the sole method used to recover the'auto". PHYSICAL DAMAGE LIilIIT OF INSURANCE SECTION lll, C. - Limit Of lnsurance is deleted in its entirety and replaced with lhe foliowing: The most we will pay for a "loss" in any one "accident" is the lesser of: l. The actual cash value of the damaged or stolen property as of the time of lhe 'loss"; or 2. The cost of repairing or replacing the damaged or stolen property with other prope(y of like kind and quality. This coverage extension does not apply to Emergency Services Organizations and Governmental Entities. AIIENDIIIENTS TO SECTION lV - BUSINESS AUTO CONDITIONS DUTIES IN THE EVENT OF ACCIDENT, CLAIilI, SUIT OR LOSS The following is added to SECTIoN lV, A2.a. - Outies ln The Event Of Accident, Claim, Suit Or Loss: The notice requirements for reporting "accidenl" claim, "suil" or "loss" informataon to us, including provisions related lo the subsequent investigation of such 'acci- dent". claim. "suit" or "loss" do not apply until the "accident", claim. "suit" or "loss" is known to: l. You, if you are an individual; 2. A partner, if you are a partnership; page 13 of 19 3. An executive officer or insurance manager. if you are a corporation; 4. Your members, managers or rnsurance manager, if you are a limited liability company; 5. Your elected or appointed officials, trustees. board members or your insurance manager, if you are an organization other than a partnership, joinl venture or limited liability company. But, this section does not amend the provisaons relating to notification of police or protection or examination of the property that was sub.iect to the "loss". WAIVER OF SUBROGATION SECTION lV, A.5. - Iransfer Of Ri9ht6 Ot Recovery Against Others To Us is deleted in its entirety and replaced with the following: We waive any right of recovery we may have against any person or organizalion because of payments we make for 'bodily injury" or "property damage" resulting from the ownership, mainlenance or use of a covered "auto" but only when you have assumed liability for such "bodily injury" or'properly damage" in an "insured con- tract" ln all olher circumstances, rf a person or organiza- lion to or for whom we make payment under this Cover- age Form has rights to recover damages from another, those rights are lransferred to us I,lULTIPLE DEDUCTIBLES The following is added to SECTION lV, A. - Loss Conditions: lf a "loss" from one event involves lwo or more covered "autos" and coverage under Comprehensive or Specifed Causes of Loss applies, only the highest applicable deductible will be applied. CONCEALMENT, MISREPRESENTATION OR FRAUD The following is added to SECTION lV, 8.2. - Conceal- ment, Misrepresentation Or Fraud: lf you should unintentionally fail to disclose any existing hazards in your representations lo us prior to the incep- tion date of the policy or during the policy period in connection with any newly discovered hazards. we will not deny coverage under lhis Coverage Form based uPon such failure. POLICY PERIOD, COVERAGE TERRITORY SECTION lV, 8.7. - Policy Period, Coverage Territory is deleted in its entirety and replaced with the following: Under this Coverage Form, we cover "accidents" and "losses" occurring: a. During the policy period shown in lhe Declarations, and b. Within the "Coverage Territory". cA78 09 11 17 Page 4 of 5 Copyright. 20'17 Selective lnsurance Company of America. All rights reserved lncludes copyrighted malerial of lnsurance Services Office, lnc., with its permission 1503 tp:]r"H# We also cover "loss" lo or "accidents" involving a cov- ered "auto" while being transported belween any of these places. TWO OR MORE COVERAGE FORMS OR POLICIES ISSUED BY US . DEDUCTIBLES The following is added to SECTION lV, 8.8. - Two Or More Coverage Forms Or Policies lssued By Us: lf a "loss" covered under this Coverage Form also in- volves a "loss" lo other property resulting from the same "accidenl" that is covered under this policy or another policy issued by us or any member company of ours, only the highest applicable deductible will be applied. AMENOMENTS TO SECTION V - DEFINITIONS BODILY INJURY INCLUDING tIENTAL ANGUISH (Not Applicable in New York) The definition of bodily injury is deleted in its entirety and replaced by the following: "Bodily injury" means bodily injury, sickness, or disease sustained by a person, including death resulling from any of these. "Bodily injury" includes mental anguish resulting from bodily inlury, sickness or disease sus- lained by a person. ADDITIONS TO SECTION V. DEFINITIONS COVERAGE TERRITORY 'Coverage Terratory" means: '1. The United States of America (including its territories and possessions), Canada and Puerto Rico; and 2. Anywhere in the world. except for any country or jurisdiction that is subject lo trade or other economic sanction or embargo by the United States ot America, if a covered "auto" is leased, hired, rented, or borrowed withoul a driver for a period of 30 days or less, and the insured's responsibility lo pay "dam- ages" is determined in a'suit" on the merits in and under lhe substanlive law of the United States of America (including its territories and possessions). Puerlo Rico, or Canada, or in a settlemenl we agree lo. lf we are prevented by law, or olherwise, from defending the "insured" in a "suit" brought in a localion described in Paragraph 2. above, the insured will conduct a defense of that 'suit" We will reimburse the 'insured" for the rea- sonable and necessary expenses incurred for the de- fense of any such "suit" seeking damages to which this insurance applies, and that we would have paid had we been able to exercis€ our right and duty to defend page 14 of 19 EXIRA HEAVY TRUCK "Extra Heavy Truck" means a truck with a gross vehicle weight rating of 45,00'l pounds or more. HEAVY TRUCK "Heavy Truck" means a lruck with a gross vehicle weight rating of 20,001 pounds to 45,000 pounds. LIGHT TRUCK 'Light Truck" means a truck with a gross vehicle weight rating of 10,000 pounds or less. MEDIUM TRUCK "Medium Truck" means a truck with a gross vehicle weight rating of 10,001 pounds lo 20,000 pounds. PRIVATE PASSENGER AUTO "Private Passenger Aulo" means a four-wheel 'auto" of the private passenger or station wagon type. A pickup, panel truck or van not used for business is lncluded within the definilion of a "private passenger aulo" SOCIAL SERVICE VAN OR BUS "Social Service Van or Bus" means a van or bus used by a government entity, civic, charitable or social service organization to provide transportation to clients inci- dental to the social services sponsored by the organiza- tron. rncluding special tnps and oultngs TELEMATIC DEVICE "Telematic Device" includes devices designed for the collection and dissemination of data tor the purpose ot monitoring vehicle and/or driver performance. This in- cludes Global Positioning System technology, wireless safety communications and automahc driving assistance systems, all integrated wilh computers and mobile com- munications technology in automotive navigation sys- tems VOLUNTEER WORKER "Volunteer worker" means a person who performs busi- ness duties for you, for no fnancial or other compensa- tion cA 78 09 11 17 Page 5 of 5 1504 Copyright, 2017 Selective lnsurance Company of America. All righls reserved. lncludes copyrighted malerial of lnsurance Services Office, lnc , with ils permission This page has been left blank intentio.ally r 505 HffiIIffi page 15 of 19 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an iniury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent thal you perform wo* under a written contract that requires you to obtain this agresllent from us.) This agreement shall not operate directly or indirectly to benefit anyone not nemed in the Schedule. Schedule page 16 of 19 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY wc 00 03 13 (Ed.4a4) ,ALL WRITTEN CONTRACTS THAT REQUIRE A WAIVER OF SUBROGATION" This endo6ement dtano€s th€ policy to which it b attached and is effe.ctive on the dale issued Unl€ss otherwise sbted. (Tb lntoniatron berow b requi'gd onry whoh thrs endo,renpnt b r..rEd 3ub3equent to p.Eprr.tron ot the poricy.) Endorsement Effedive Policy No. WCV11729710 Endo6enEnt No. lrlsured Lanier Plahs Inc dba Kd,kat premium $ lnsurance Cornpany CounleNigned by wc 00 03 13 (Ed.4€4) I506 Copyright 19a3 National Council on Compensation tnsurance. F#+ EEiF*lhrE! pffi#ffi page 17 of 19 150 / This page has been left blar i intentionally. A. Paragraph C. of this endors€ment replaces paragraph 4. Other lnsurance of Section lV- Commercial General Liability Condition3. but only with respect to the insurance afforded to the additional insured(s) scheduled above. B. Paragraph C. of this endorsemenl replaces paragraph 4. Other lnsurance of Section lV- Products-Completed Operations Liability Conditions, but only with respect to the insurance afforded to the additional insured(s) scheduled above. C. Other lnsurancs Nolwithstanding other valid and colleclible insurance available to the insured for a loss we cover under the applicable Coverage Part to which this endorsement is modifying, this insurance is primary and non-conlributory. page 18 of 19 However, this endorsement: 1. Applies only when you are required by conlract. agreement or permit to provide primary and non.contributory coverage for the additional insured, provided such written contract, agreement or permit is fully executed prior to an "occurrence" in which coverage is sought under this policy, and 2. Does not apply to any claim. toss or liability due to the sole negligence of the additional insured. All other terms and conditions of this remain unchanged. Policy rnier Plans lnc dba Korkat 4358W5745e THIS ENOORSEMENT CHANGESTHE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT - OTHER !NSURANCE (PRTMARY AND NON-CONTRTBUTORY COVERAGE) This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART Schedule of Additional lnsured(s) Any person or organization named in an Additional lnsured endorsement attached to this policy with whom you have agreed, in a written contract, that such person or organization should be provided primary and non-contributory coverage, but only when such written contract is fully executed prior to an "occurrence" in which coverage is sought under this policy. lncludes copyrighted material of ISO Properties. lnc. wilh its permissron t)08 rFG-c.0094 03 17 Page 1 of 1 F#4k H-ffii ffi{++ This page has been left blan-k intentionally page 19 ol 19 1509