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Home My WebLink AboutCORRESPONDENCE - AGREEMENT MISC - FORT COLLINS ARCHERY ASSOCIATION FCAA (4)November 18, 2016 Fort Collins Archery Association Attn: Frank Buck guardian2825@gmail.com PO Box 270493 Fort Collins, CO 80527 RE: Renewal, Miscellaneous Agreement - Fort Collins Archery Association Dear Mr. Buck: The City of Fort Collins wishes to extend the agreement term for the above captioned proposal per the existing terms and conditions and the following: 1) The term will be extended for one (1) additional year, February 20, 2017 through February 19, 2018. If the renewal is acceptable to your firm, please sign this letter in the space provided and include a current copy of insurance certificate naming the City as an additional insured for General Liability within the next fifteen (15) days. If this extension is not agreeable with your firm, we ask that you send us a written notice stating that you do not wish to renew the contract and state the reason for non-renewal. Please contact Jill Wilson, Buyer at (970) 221-6216 if you have any questions regarding this matter. Sincerely, Gerry S. Paul Director of Purchasing __________________________________________ ________________ Signature Date (Please indicate your desire to renew Miscellaneous Agreement - FCAA by signing this letter and returning it to Purchasing Division within the next fifteen days.) GSP:jg Financial Services Purchasing Division 215 N. Mason St. 2nd Floor PO Box 580 Fort Collins, CO 80522 970.221.6775 970.221.6707- fax fcgov.com/purchasing DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 11/30/2016 The ACORD name and logo are registered marks of ACORD CERTIFICATE HOLDER © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) AUTHORIZED REPRESENTATIVE CANCELLATION CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) JECT LOC POLICY PRO- GEN'L AGGREGATE LIMIT APPLIES PER: CLAIMS-MADE OCCUR COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $ DAMAGE TO RENTED EACH OCCURRENCE $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ DED RETENTION $ CLAIMS-MADE OCCUR $ AGGREGATE $ UMBRELLA LIAB EACH OCCURRENCE $ EXCESS LIAB DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) INSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS PER STATUTE OTH- ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ $ ANY PROPRIETOR/PARTNER/EXECUTIVE If yes, describe under DESCRIPTION OF OPERATIONS below (Mandatory in NH) OFFICER/MEMBER EXCLUDED? WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED HIRED AUTOS NON-OWNED AUTOS AUTOS AUTOS COMBINED SINGLE LIMIT BODILY INJURY (Per person) BODILY INJURY (Per accident) CICG 174 (02-16) Page 1 of 1 Capitol Indemnity Corporation COMMON POLICY DECLARATIONS P.O. Box 5900, Madison, WI 53705 TRANSACTION TYPE: Renew ENDORSEMENT #: 000 CICG 174 02 16 POLICY NUMBER CP02250043-04 POLICY PERIOD 07/01/2016 - 07/01/2017 12:01 A.M. Standard Time at the address of the insured stated herein. AGENCY/PRODUCER CODE 02500 NAMED INSURED AND ADDRESS Fort Collins Archery Assoc PO Box 270493 Fort Collins, CO 80527-0493 AGENCY/PRODUCER Leavitt Recreation & Hospitality Insurance, Inc. 942 14th St Sturgis SD 57785-1347 FORM OF BUSINESS: Not for Profit Org BUSINESS DESCRIPTION: outdoor club IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY. THIS POLICY CONSISTS OF THE FOLLOWING COVERAGE PARTS FOR WHICH A PREMIUM IS INDICATED. THIS PREMIUM MAY BE SUBJECT TO ADJUSTMENT. Commercial General Liability Coverage Part Inland Marine Coverage Part $ 373.00 $ 365.00 TOTAL ADVANCE PREMIUM $ 738.00 TERRORISM RISK INSURANCE ACT OF 2015 $ 0.00 Premium shown as payable: $ 738.00 * THE LIABILITY PREMIUM BASIS OF THIS POLICY IS SUBJECT TO AN AUDIT. ADDITIONAL PREMIUM MAY BE DUE. FORMS APPLICABLE TO ALL COVERAGE PARTS: See Attached Policy Coverage Part Form Schedule CICG 179 Countersigned 05/16/2016 By (Authorized Representative) DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 CICG 176 (06-11) Page 1 of 1 Capitol Indemnity Corporation LOCATIONS SCHEDULE P.O. Box 5900, Madison, WI 53705 TRANSACTION TYPE: Renew ENDORSEMENT #: 000 CICG 176 06 11 POLICY NUMBER CP02250043-04 POLICY PERIOD 07/01/2016 - 07/01/2017 12:01 A.M. Standard Time at the address of the insured stated herein. AGENCY/PRODUCER CODE 02500 NAMED INSURED AND ADDRESS Fort Collins Archery Assoc PO Box 270493 Fort Collins, CO 80527-0493 AGENCY/PRODUCER Leavitt Recreation & Hospitality Insurance, Inc. 942 14th St Sturgis SD 57785-1347 Prems. No. Street City State ZIP 1 2825 SW Frontage Rd Fort Collins CO 80525-0493 DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 CICG 179 (02-09) Page 1 of 1 Capitol Indemnity Corporation POLICY COVERAGE PART FORM SCHEDULE P.O. Box 5900, Madison, WI 53705 TRANSACTION TYPE: Renew ENDORSEMENT #: 000 CICG 179 02 09 POLICY NUMBER CP02250043-04 POLICY PERIOD 07/01/2016 - 07/01/2017 12:01 A.M. Standard Time at the address of the insured stated herein. AGENCY/PRODUCER CODE 02500 NAMED INSURED AND ADDRESS Fort Collins Archery Assoc PO Box 270493 Fort Collins, CO 80527-0493 AGENCY/PRODUCER Leavitt Recreation & Hospitality Insurance, Inc. 942 14th St Sturgis SD 57785-1347 Forms and Endorsement apply to the Coverage Part and made a part of this policy at time of issue: FORMS APPLICABLE TO ALL PREMISES AND COVERAGES Form Description CICG 174 02 16 Common Policy Declarations CICG 176 06 11 Locations Schedule CGE 067 08 03 Additional Interest Schedule CGE 112 04 96 Important Notice CGE 215 04 96 Important Notice Non Payment Of Premium CGE 278 04 96 Policyholder Audit Information CGE 085 02 15 Policyholder Disclosure Notice Of Terrorism Insurance Coverage CGE 348 08 10 Policyholder Notice Flexibile Direct Bill Payment Plan Fee Sche IL 02 28 09 07 Colorado Changes Cancellation And Nonrenewal IL 01 25 11 13 Colorado Changes Civil Union IL 01 69 09 07 Colorado Changes Concealment Misrepresentation Or Fraud IL 00 17 11 98 Common Policy Conditions IL 09 95 01 07 Conditional Exclusion Of Terrorism Relating To Disp Of Fed CG 21 87 01 15 Conditional Exclusion Of Terrorism Relating To Disposition Of IL 09 35 07 02 Exclusion Of Certain Computer Related Losses CG 21 73 01 15 Exclusion of Certified Acts of Terrorism IL 09 53 01 15 Exclusion Of Certified Acts Of Terror IL 00 21 09 08 Nuclear Energy Liability Exclusion (Broad Form) CICG 258 11 93 Single Deductible BJP 190 08 14 Signature Page Countersigned 05/16/2016 By ___________________________________ Authorized Representative DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 CGE 067 (08-03) Page 1 of 1 Capitol Indemnity Corporation ADDITIONAL INTEREST SCHEDULE P.O. Box 5900, Madison, WI 53705 CGE 067 08 03 POLICY NUMBER CP02250043-04 POLICY PERIOD 07/01/2016 - 07/01/2017 12:01 A.M. Standard Time at the address of the insured stated herein. AGENCY/PRODUCER CODE 02500 NAMED INSURED AND ADDRESS Fort Collins Archery Assoc PO Box 270493 Fort Collins, CO 80527-0493 AGENCY/PRODUCER Leavitt Recreation & Hospitality Insurance, Inc. 942 14th St Sturgis SD 57785-1347 SCHEDULE Name of Person or Organization: City of Fort Collins Address: PO Box 580 Fort Collins CO 80522-0580 Larimer Insured Item: $ 25.00 - Additional Insured Interest: CG 20 26 - Additional Insured Designated Person or Organization Interest Type: Name Of Additional Insured Persons Or Organizations Description: Countersigned 05/16/2016 By ___________________________________ Authorized Representative DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 Capitol Indemnity Corporation P.O. Box 5900 Madison, WI 53705 CGE 112 (04-96) IMPORTANT NOTICE! This policy lists the first named insured on the declaration page. This party has specific rights and duties which are outlined in the common policy conditions. Please make certain that the first named insured, as listed, is correct. Advise us immediately if there is any change necessary. Please read this policy as there may be difference in coverages, rules and conditions from other insurance policies. DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 Capitol Indemnity Corporation P.O. Box 5900 Madison, WI 53705 CGE 215 (04-96) IMPORTANT NOTICE - NON PAYMENT OF PREMIUM Reinstatement of coverage after cancellation for non-payment of premium is at our option and may be denied. Absolutely no policy will be reinstated after a second cancellation for non-payment of premium. DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 Capitol Indemnity Corporation P.O. Box 5900 Madison, WI 53705 CGE 278 (04-96) POLICYHOLDER AUDIT INFORMATION Your commercial insurance policy may be audited. Your policy explains your rights and duties regarding an audit and this notice answers some common questions. WHY WOULD YOUR POLICY BE AUDITED? The premium charged when your policy was issued was an estimate based on the nature of your business and your exposures (payroll, sales, etc.) for the policy period. A review of your records at the end of the policy period allows us to adjust your premium based on actual operations during that time. HOW AND WHEN WILL AN AUDIT BE DONE? A premium auditor may either review your records in person or will send you a letter asking you to mail us the needed audit information. We will try to visit your business or contact you by mail as soon as we can after the end of our policy period. WHAT RECORDS ARE NEEDED FOR THE AUDIT? We will need to review your ledgers, journals, vouchers, contracts, tax reports, profit and loss statements and payroll and disbursement records. If you use subcontractors, we will need to see a Certificate of Insurance for each. Our premium auditor will let you know which of these items are specifically needed for your audit. WILL KEEPING DETAILED RECORDS HELP ME SAVE MONEY? You may be able to lower your final premium cost by keeping detailed records. A variety of insurance classifications may apply to your business, each having a different insurance rate. Detailed records should give us accurate payroll, sales and subcontracted costs allowing us to apply the appropriate classification to these exposures. DO I NEED A CERTIFICATE OF INSURANCE FOR EACH SUBCONTRACTOR I USE? You should always keep current Certificates of Insurance for all subcontractor you hire. Without these certificates, you may be charged as though the subcontractors' workers were your own employees - increasing your premium charge. WHY SHOULD I MAKE SURE THE PREMIUM BASIS (SUCH AS SALES OR PAYROLL) ARE REALISTIC ESTIMATES? Your initial policy premium is based on an estimate of your business operations for the policy period. The final policy premium is not determined until after your insurance audit. If your estimates are low, your deposit premium will be low and you will have to pay an additional premium after the audit. Likewise, overestimating your operations for the coming year will cause your deposit premium to be high, tying up your money until after the audit. Please contact your agent if you need more information or clarification on insurance premium audits. DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 CGE 085 (02-15) Page 1 of 2 © 2015 CapSpecialty, Inc. All rights reserved. POLICYHOLDER DISCLOSURE CGE 085 02 15 NOTICE OF TERRORISM INSURANCE COVERAGE You are hereby notified that under the Terrorism Risk Insurance Act of 2002, and the Terrorism Risk Insurance Program Reauthorization Act of 2015, that you have a right to purchase insurance coverage for losses arising out of acts of terrorism, as defined in Section 102(1) of the Act: The term “act of terrorism” means any act that is certified by the Secretary of the Treasury, in accordance with the provisions of the federal Terrorism Risk Insurance act, —to be an act of terrorism; to be a violent act or an act that is dangerous to human life, property; or infrastructure; to have resulted in damage within the United States, or outside the United States in the case of an air carrier or vessel or the premises of a United States mission; and to have been committed by an individual or individuals, as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion. Coverage under your existing policy may be affected as follows: IF THIS POLICY IS A RENEWAL OF A POLICY ON WHICH YOU PREVIOUSLY REJECTED TERRORISM COVERAGE, THEN THIS POLICY HAS BEEN ISSUED WITHOUT TERRORISM COVERAGE. YOU STILL HAVE AN OPPORTUNITY TO OBTAIN TERRORISM COVERAGE. ALL YOU HAVE TO DO IS NOTIFY YOUR AGENT OF YOUR DESIRE TO ACCEPT THIS OFFER AND PAY THE ADDITIONAL PREMIUM INDICATED BELOW. IF YOU ACCEPT THIS OFFER AND YOUR POLICY IS BILLED DIRECT TO YOU, WE WILL ADD THE ADDITIONAL PREMIUM DUE TO THE BALANCE OF YOUR DIRECT BILL STATEMENT. IF YOU DO NOT USE THE DIRECT BILL OPTION, YOU WILL RECEIVE A BILL FROM YOUR AGENT. DISCLOSURE OF FEDERAL PARTICIPATION IN PAYMENT OF TERRORISM LOSSES IF YOU ACCEPT THIS OFFER TO ADD TERRORISM COVERAGE TO YOUR POLICY, TERRORISM COVERAGE PROVIDED BY THE POLICY FOR LOSSES CAUSED BY CERTIFIED ACTS OF TERRORISM WILL BE PARTIALLY REIMBURSED BY THE UNITED STATES UNDER A FORMULA ESTABLISHED BY FEDERAL LAW. UNDER THIS FORMULA, IN 2015 THE UNITED STATES WILL PAY 85% OF COVERED TERRORISM LOSSES EXCEEDING THE STATUTORILY ESTABLISHED DEDUCTIBLE PAID BY THE INSURANCE COMPANY PROVIDING THE COVERAGE. THE FEDERAL SHARE WILL DECREASE BY 1% EACH YEAR AFTER 2015. THE PREMIUM CHARGED FOR THIS COVERAGE IS PROVIDED BELOW AND DOES NOT INCLUDE ANY CHARGES FOR THE PORTION OF LOSS COVERED BY THE FEDERAL GOVERNMENT UNDER THE ACT. HOWEVER, YOUR POLICY MAY CONTAIN OTHER EXCLUSIONS WHICH MIGHT AFFECT YOUR COVERAGE, (FOR EXAMPLE, NUCLEAR OR WAR EXCLUSIONS). THE TERRORISM RISK INSURANCE ACT, AS AMENDED IN 2015 CONTAINS A $100 BILLION CAP THAT LIMITS THE U.S.GOVERNMENT REIMBURSEMENT AS WELL AS INSURERS’ LIABLITY FOR LOSSES RESULTING FROM “CERTIFIED ACTS OF TERRORISM” WHEN THE AMOUNT OF SUCH LOSSES IN A CALENDAR YEAR (JANUARY 1 THROUGH DECEMBER 31) EXCEEDS $100 BILLION. IF THE AGGREGATE INSURED LOSSES FOR ALL INSURERS EXCEED $100 BILLION, YOUR COVERAGE MAY BE REDUCED. The United States Government, Department of the Treasury, will pay a share of terrorism losses insured under the federal program. The federal share equals the percentage of that portion of the amount of such insured losses that exceeds the applicable insurer retention for the calendar years shown as follows: o 2015 – The federal share of terrorism losses are 85%. o 2016 – The federal share of terrorism losses are 84%. o 2017 – The federal share of terrorism losses are 83%. o 2018 – The federal share of terrorism losses are 82%. o 2019 – The federal share of terrorism losses are 81%. o 2020 – The federal share of terrorism losses are 80%. DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 CGE 085 (02-15) Page 2 of 2 © 2015 CapSpecialty, Inc. All rights reserved. SELECTION OR REJECTION OF TERRORISM INSURANCE COVERAGE YOU HAVE THIRTY (30) DAYS FROM THE INCEPTION DATE OF YOUR POLICY TO CONSIDER THIS OFFER OF COVERAGE FOR TERRORIST ACTS. TERRORISM EXCLUSION WILL REMAIN ON YOUR POLICY AND YOU WILL NOT BE COVERED FOR LOSSES ARISING FROM TERRORIST ACTS IF WE DO NOT RECEIVE NOTICE OF YOUR ELECTION TO PURCHASE TERRORISM COVERAGE WITHIN THE TIMEFRAME STATED ABOVE. I hereby elect to purchase Terrorism coverage for a prospective premium of $(Please contact your agent for a quote). I hereby reject the terrorism coverage offer. I understand that I will have no coverage for losses arising from acts of terrorism as outlined in this Notice. ____________________________ Capitol Indemnity Corporation Policyholder/Applicant’s Signature Insurance Company ____________________________ CP02250043-04 Print Name Policy Number ____________________________ Date DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 CGE 348 (08-10) Page 1 of 1 Copyright 2010, Capitol Transamerica Corporation, Inc. Includes Material Copyrighted by Insurance Services Office, Inc., used with permission Policyholder Notice Flexible Direct Bill Payment Plan And Fee Schedule CGE This 348 08 10 policy is subject to the following premium payment plan with the due dates described below. You may pay the entire policy premium on the due date of the first installment or follow the payment schedule below. Each month thereafter you will receive an invoice requiring minimum payment, but will have the option of paying more if desired, until the total premium is paid. Each invoice will include the minimum payment required and the total balance due. If you pay more than the minimum required, the next invoice will be sent when the next premium is due. You may at any time pay the entire remaining premium amount due as indicated on the billing invoice to avoid paying future service charges. Installment Number Due Date of Payment Percentage of total Premium Due Cumulative Percentage Due Service Charge 1 On or before policy effective date 20% 20% -0- 2 One month after effective date 8% 28% $ 5.00 3 Two months after effective date 8% 36% $ 5.00 4 Three months after effective date 8% 44% $ 5.00 5 Four months after effective date 8% 52% $ 5.00 6 Five months after effective date 8% 60% $ 5.00 7 Six months after effective date 8% 68% $ 5.00 8 Seven months after effective date 8% 76% $ 5.00 9 Eight months after effective date 8% 84% $ 5.00 10 Nine months after effective date 8% 92% $ 5.00 11 Ten months after effective date 8% 100% $ 5.00 If your policy is endorsed and additional premium is generated, the additional premium will be spread over the remainder of the term. All return premium will be applied as a payment to current and future installments until the credit is fully applied. Non-payment of any premium or service charge, as of the due date indicated on the billing invoice, may result in cancellation due to non-payment. Having more than one check returned for non-sufficient funds will void the payment plan and full payment will be due. The payment due dates noted above are based on a one year policy term. If your policy is for a term longer than one year, the above payment schedule applies to each consecutive one year term until the expiration date shown on the policy. Fee Schedule 1. Installment Fee - A $5.00 fee will be charged for each installment billed (this does not apply to the first payment). 2. Reinstatement Fee - A $30.00 reinstatement fee will be charged if payment is received after the final cancellation and underwriting approves reinstating the policy. 3. Non-Sufficient Funds Fee - A $30.00 fee will be generated for any returned check including stop pay or non- sufficient funds. DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 IL 02 28 09 07 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. IL 02 28 09 07 © ISO Properties, Inc., 2006 Page 1 of 2 o IL 02 28 09 07 COLORADO CHANGES – CANCELLATION AND NONRENEWAL This endorsement modifies insurance provided under the following: CAPITAL ASSETS PROGRAM (OUTPUT POLICY) COVERAGE PART COMMERCIAL AUTOMOBILE COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL LIABILITY UMBRELLA COVERAGE PART COMMERCIAL PROPERTY COVERAGE PART CRIME AND FIDELITY COVERAGE PART EMPLOYMENT-RELATED PRACTICES LIABILITY COVERAGE PART EQUIPMENT BREAKDOWN COVERAGE PART FARM COVERAGE PART FARM UMBRELLA LIABILITY POLICY LIQUOR LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART A. Paragraph 2. of the Cancellation Common Policy Condition is replaced by the following: 2. If this policy has been in effect for less than 60 days, we may cancel this policy by mailing or delivering to the first Named Insured written notice of cancellation at least: a. 10 days before the effective date of cancellation if we cancel for nonpayment of premium; or b. 30 days before the effective date of cancellation if we cancel for any other reason. B. The following is added to the Cancellation Common Policy Condition: 7. Cancellation Of Policies In Effect For 60 Days Or More a. If this policy has been in effect for 60 days or more, or is a renewal of a policy we issued, we may cancel this policy by mailing through first-class mail to the first Named Insured written notice of cancellation: (1) Including the actual reason, at least 10 days before the effective date of cancellation, if we cancel for nonpayment of premium; or (2) At least 45 days before the effective date of cancellation if we cancel for any other reason. We may only cancel this policy based on one or more of the following reasons: (1) Nonpayment of premium; (2) A false statement knowingly made by the insured on the application for insurance; or (3) A substantial change in the exposure or risk other than that indicated in the application and underwritten as of the effective date of the policy unless the first Named Insured has notified us of the change and we accept such change. C. The following is added and supersedes any other Page 2 of 2 © ISO Properties, Inc., 2006 IL 02 28 09 07 o D. The following condition is added: INCREASE IN PREMIUM OR DECREASE IN COVERAGE We will not increase the premium unilaterally or decrease the coverage benefits on renewal of this policy unless we mail through first-class mail written notice of our intention, including the actual reason, to the first Named Insured's last mailing address known to us, at least 45 days before the effective date. Any decrease in coverage during the policy term must be based on one or more of the following reasons: 1. Nonpayment of premium; 2. A false statement knowingly made by the insured on the application for insurance; or 3. A substantial change in the exposure or risk other than that indicated in the application and underwritten as of the effective date of the policy unless the first Named Insured has notified us of the change and we accept such change. If notice is mailed, proof of mailing will be sufficient proof of notice. DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 IL 01 25 11 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. IL 01 25 11 13 © Insurance Services Office, Inc., 2013 Page 1 of 1 COLORADO CHANGES – CIVIL UNION IL 01 25 11 13 This endorsement modifies insurance provided under the following: COMMERCIAL AUTOMOBILE COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART COMMERCIAL LIABILITY UMBRELLA COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART FARM COVERAGE PART FARM UMBRELLA LIABILITY POLICY LIQUOR LIABILITY COVERAGE PART MEDICAL PROFESSIONAL LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCT WITHDRAWAL COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY A. The term "spouse" is replaced by the following: Spouse or party to a civil union recognized under Colorado law. B. Under the Commercial Automobile Coverage Part, the term "family member" is replaced by the following and supersedes any other provisions to the contrary: "Family member" means a person related to: 1. The individual Named Insured by blood, adoption, marriage or civil union recognized under Colorado law, who is a resident of such Named Insured's household, including a ward or foster child; 2. The individual named in the Schedule by blood, adoption, marriage or civil union recognized under Colorado law, who is a resident of the individual's household, including a ward or foster child, if the Drive Other Car Coverage – Broadened Coverage For Named Individuals endorsement is attached. C. With respect to coverage for the ownership, maintenance or use of "covered autos" provided under the Commercial Liability Umbrella Coverage Part, the term "family member" is replaced by the following: "Family member" means a person related to you by blood, adoption, marriage or civil union recognized under Colorado law, who is a resident of your household, including a ward or foster child. DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 IL 01 69 09 07 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. IL 01 69 09 07 © ISO Properties, Inc., 2006 Page 1 of 1 o COLORADO CHANGES – CONCEALMENT, MISREPRESENTATION OR FRAUD This endorsement modifies insurance provided under the following: CAPITAL ASSETS PROGRAM (OUTPUT POLICY) COVERAGE PART COMMERCIAL AUTOMOBILE COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL PROPERTY COVERAGE PART EQUIPMENT BREAKDOWN COVERAGE PART FARM COVERAGE PART – FARM PROPERTY – OTHER FARM PROVISIONS FORM – ADDITIONAL COVERAGES, CONDITIONS, DEFINITIONS FARM COVERAGE PART – LIVESTOCK COVERAGE FORM FARM COVERAGE PART – MOBILE AGRICULTURAL MACHINERY AND EQUIPMENT COVERAGE FORM The CONCEALMENT, MISREPRESENTATION OR FRAUD Condition is replaced by the following: CONCEALMENT, MISREPRESENTATION OR FRAUD We will not pay for any loss or damage in any case of: 1. Concealment or misrepresentation of a material fact; or 2. Fraud; committed by you or any other insured ("insured") at any time and relating to coverage under this policy. DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 IL 00 17 11 98 IL 00 17 11 98 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 o IL 00 17 11 98 COMMON POLICY CONDITIONS All Coverage Parts included in this policy are subject to the following conditions. A. Cancellation 1. The first Named Insured shown in the Declara- tions may cancel this policy by mailing or de- livering to us advance written notice of cancel- lation. 2. We may cancel this policy by mailing or deliv- ering to the first Named Insured written notice of cancellation at least: a. 10 days before the effective date of cancel- lation if we cancel for nonpayment of pre- mium; or b. 30 days before the effective date of cancel- lation if we cancel for any other reason. 3. We will mail or deliver our notice to the first Named Insured's last mailing address known to us. 4. Notice of cancellation will state the effective date of cancellation. The policy period will end on that date. 5. If this policy is cancelled, we will send the first Named Insured any premium refund due. If we cancel, the refund will be pro rata. If the first Named Insured cancels, the refund may be less than pro rata. The cancellation will be ef- fective even if we have not made or offered a refund. 6. If notice is mailed, proof of mailing will be suf- ficient proof of notice. B. Changes This policy contains all the agreements between you and us concerning the insurance afforded. The first Named Insured shown in the Declarations is authorized to make changes in the terms of this policy with our consent. This policy's terms can be amended or waived only by endorsement issued by us and made a part of this policy. C. Examination Of Your Books And Records We may examine and audit your books and rec- ords as they relate to this policy at any time during the policy period and up to three years afterward. D. Inspections And Surveys 1. We have the right to: a. Make inspections and surveys at any time; b. Give you reports on the conditions we find; and c. Recommend changes. 2. We are not obligated to make any inspections, surveys, reports or recommendations and any such actions we do undertake relate only to in- surability and the premiums to be charged. We do not make safety inspections. We do not un- dertake to perform the duty of any person or organization to provide for the health or safety of workers or the public. And we do not warrant that conditions: a. Are safe or healthful; or POLICY NUMBER: CP02250043-04 IL 09 95 01 07 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. IL 09 95 01 07 © ISO Properties, Inc., 2005 Page 1 of 3 CONDITIONAL EXCLUSION OF TERRORISM (RELATING TO DISPOSITION OF FEDERAL TERRORISM RISK INSURANCE ACT) IL 09 95 01 07 This endorsement modifies insurance provided under the following: BOILER AND MACHINERY COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL PROPERTY COVERAGE PART EQUIPMENT BREAKDOWN PROTECTION COVERAGE FORM FARM COVERAGE PART STANDARD PROPERTY POLICY SCHEDULE The Exception Covering Certain Fire Losses (Paragraph D.) applies to property located in the following state(s), if covered under the indicated Coverage Form, Coverage Part or Policy: State(s) Coverage Form, Coverage Part Or Policy Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Applicability Of The Provisions Of This Endorsement 1. The provisions of this endorsement become applicable commencing on the date when any one or more of the following first occurs. But if your policy (meaning the policy period in which this endorsement applies) begins after such date, then the provisions of this endorsement become applicable on the date your policy begins. a. The federal Terrorism Risk Insurance Program ("Program"), established by the Terrorism Risk Insurance Act, has terminated with respect to the type of insurance provided under this Coverage Form, Coverage Part or Policy; or DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 Page 2 of 3 © ISO Properties, Inc., 2005 IL 09 95 01 07 b. A renewal, extension or replacement of the Program has become effective without a requirement to make terrorism coverage available to you and with revisions that: (1) Increase our statutory percentage deductible under the Program for terrorism losses. (That deductible determines the amount of all certified terrorism losses we must pay in a calendar year, before the federal government shares in subsequent payment of certified terrorism losses.); or (2) Decrease the federal government's statutory percentage share in potential terrorism losses above such deductible; or (3) Redefine terrorism or make insurance coverage for terrorism subject to provisions or requirements that differ from those that apply to other types of events or occurrences under this policy. 2. If the provisions of this endorsement become applicable, such provisions: a. Supersede any terrorism endorsement already endorsed to this policy that addresses "certified acts of terrorism" and/or "other acts of terrorism", but only with respect to loss or damage from an incident(s) of terrorism (however defined) that occurs on or after the date when the provisions of this endorsement become applicable; and b. Remain applicable unless we notify you of changes in these provisions, in response to federal law. 3. If the provisions of this endorsement do NOT become applicable, any terrorism endorsement already endorsed to this policy, that addresses "certified acts of terrorism" and/or "other acts of terrorism", will continue in effect unless we notify you of changes to that endorsement in response to federal law. B. The following definition is added and applies under this endorsement wherever the term terrorism is enclosed in quotation marks. "Terrorism" means activities against persons, organizations or property of any nature: 1. That involve the following or preparation for the following: a. Use or threat of force or violence; or b. Commission or threat of a dangerous act; or c. Commission or threat of an act that interferes with or disrupts an electronic, communication, information, or mechanical system; and IL 09 95 01 07 © ISO Properties, Inc., 2005 Page 3 of 3 5. The total of insured damage to all types of property in the United States, its territories and possessions, Puerto Rico and Canada exceeds $25,000,000. In determining whether the $25,000,000 threshold is exceeded, we will include all insured damage sustained by property of all persons and entities affected by the "terrorism" and business interruption losses sustained by owners or occupants of the damaged property. For the purpose of this provision, insured damage means damage that is covered by any insurance plus damage that would be covered by any insurance but for the application of any terrorism exclusions. Multiple incidents of "terrorism" which occur within a 72- hour period and appear to be carried out in concert or to have a related purpose or common leadership will be deemed to be one incident, for the purpose of determining whether the threshold is exceeded. With respect to this Item C.5., the immediately preceding paragraph describes the threshold used to measure the magnitude of an incident of "terrorism" and the circumstances in which the threshold will apply, for the purpose of determining whether this Exclusion will apply to that incident. When the Exclusion applies to an incident of "terrorism", there is no coverage under this Coverage Form, Coverage Part or Policy. D. Exception Covering Certain Fire Losses The following exception to the Exclusion Of Terrorism applies only if indicated and as indicated in the Schedule of this endorsement. If "terrorism" results in fire, we will pay for the loss or damage caused by that fire, subject to all applicable policy provisions including the Limit of Insurance on the affected property. Such coverage for fire applies only to direct loss or damage by fire to Covered Property. Therefore, for example, the coverage does not apply to insurance provided under Business Income and/or Extra Expense coverage forms or endorsements that apply to those coverage forms, or to the Legal Liability Coverage Form or the Leasehold Interest Coverage Form. E. Application Of Other Exclusions 1. When the Exclusion Of Terrorism applies in accordance with the terms of C.1. or C.2., such exclusion applies without regard to the Nuclear Hazard Exclusion in this Coverage Form, Coverage Part or Policy. 2. The terms and limitations of any terrorism exclusion, or the inapplicability or omission of a terrorism exclusion, do not serve to create coverage for any loss or damage which would otherwise be excluded under this Coverage Form, Coverage Part or Policy, such as losses excluded by the Nuclear Hazard Exclusion or COMMERCIAL GENERAL LIABILITY CG 21 87 01 15 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CG 21 87 01 15 © Insurance Services Office, Inc., 2015 Page 1 of 2 o CONDITIONAL EXCLUSION OF TERRORISM (RELATING TO DISPOSITION OF FEDERAL TERRORISM CG 21 87 01 15 RISK INSURANCE ACT) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY A. Applicability Of The Provisions Of This Endorsement 1. The provisions of this endorsement become applicable commencing on the date when any one or more of the following first occurs. But if your policy (meaning the policy period in which this endorsement applies) begins after such date, then the provisions of this endorsement become applicable on the date your policy begins. a. The federal Terrorism Risk Insurance Program ("Program"), established by the Terrorism Risk Insurance Act, has terminated with respect to the type of insurance provided under this Coverage Part or Policy; or b. A renewal, extension or replacement of the Program has become effective without a requirement to make terrorism coverage available to you and with revisions that: (1) Increase our statutory percentage deductible under the Program for terrorism losses. (That deductible determines the amount of all certified terrorism losses we must pay in a calendar year, before the federal government shares in subsequent payment of certified terrorism losses.); or (2) Decrease the federal government's statutory percentage share in potential terrorism losses above such deductible; or (3) Redefine terrorism or make insurance coverage for terrorism subject to provisions or requirements that differ from those that apply to other types of events or occurrences under this policy. 2. If the provisions of this endorsement become applicable, such provisions: a. Supersede any terrorism endorsement already endorsed to this policy that addresses "certified acts of terrorism" Page 2 of 2 © Insurance Services Office, Inc., 2015 CG 21 87 01 15 o B. The following definitions are added and apply under this endorsement wherever the term terrorism, or the phrase any injury or damage, are enclosed in quotation marks: 1. "Terrorism" means activities against persons, organizations or property of any nature: a. That involve the following or preparation for the following: (1) Use or threat of force or violence; or (2) Commission or threat of a dangerous act; or (3) Commission or threat of an act that interferes with or disrupts an electronic, communication, information, or mechanical system; and b. When one or both of the following applies: (1) The effect is to intimidate or coerce a government or the civilian population or any segment thereof, or to disrupt any segment of the economy; or (2) It appears that the intent is to intimidate or coerce a government, or to further political, ideological, religious, social or economic objectives or to express (or express opposition to) a philosophy or ideology. 2. "Any injury or damage" means any injury or damage covered under any Coverage Part or Policy to which this endorsement is applicable, and includes but is not limited to "bodily injury", "property damage", "personal and advertising injury", "injury" or "environmental damage" as may be defined in any applicable Coverage Part or Policy. C. The following exclusion is added: EXCLUSION OF TERRORISM We will not pay for "any injury or damage" caused directly or indirectly by "terrorism", including action in hindering or defending against an actual or expected incident of "terrorism". "Any injury or damage" is excluded regardless of any other cause or event that contributes concurrently or in any sequence to such injury or damage. But this exclusion applies only when one or more of the following are attributed to an incident of "terrorism": 1. The "terrorism" is carried out by means of the dispersal or application of radioactive material, or through the use of a nuclear weapon or device that involves or produces a nuclear reaction, nuclear radiation or radioactive contamination; or 2. Radioactive material is released, and it appears that one purpose of the "terrorism" was to release such material; or 3. The "terrorism" is carried out by means of the dispersal or application of pathogenic or poisonous biological or chemical materials; or 4. Pathogenic or poisonous biological or chemical IL 09 35 07 02 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. IL 09 35 07 02 © ISO Properties, Inc., 2001 Page 1 of 1 o EXCLUSION OF CERTAIN COMPUTER-RELATED LOSSES This endorsement modifies insurance provided under the following: COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL PROPERTY COVERAGE PART CRIME AND FIDELITY COVERAGE PART STANDARD PROPERTY POLICY A. We will not pay for loss ("loss") or damage caused directly or indirectly by the following. Such loss ("loss") or damage is excluded regardless of any other cause or event that contributes concurrently or in any sequence to the loss ("loss") or damage. 1. The failure, malfunction or inadequacy of: a. Any of the following, whether belonging to any insured or to others: (1) Computer hardware, including microprocessors; (2) Computer application software; (3) Computer operating systems and related software; (4) Computer networks; (5) Microprocessors (computer chips) not part of any computer system; or (6) Any other computerized or electronic equipment or components; or b. Any other products, and any services, data or functions that directly or indirectly use or rely upon, in any manner, any of the items listed in Paragraph A.1.a. of this endorsement; due to the inability to correctly recognize, process, distinguish, interpret or accept one or more dates or times. An example is the inability of computer software to recognize the year 2000. 2. Any advice, consultation, design, evaluation, inspection, installation, maintenance, repair, replacement or supervision provided or done by you or for you to determine, rectify or test for, any potential or actual problems described in Paragraph A.1. of this endorsement. B. If an excluded Cause of Loss as described in Paragraph A. of this endorsement results: 1. In a Covered Cause of Loss under the Crime and Fidelity Coverage Part, the Commercial Inland Marine Coverage Part or the Standard Property Policy; or 2. Under the Commercial Property Coverage Part: a. In a "Specified Cause of Loss", or in elevator collision resulting from mechanical breakdown, under the Causes of Loss – Special Form; or b. In a Covered Cause of Loss under the Causes Of Loss – Basic Form or the Causes Of Loss – Broad Form; we will pay only for the loss ("loss") or damage caused by such "Specified Cause of Loss", POLICY NUMBER: CP02250043-04 IL 09 53 01 15 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. IL 09 53 01 15 © Insurance Services Office, Inc., 2015 Page 1 of 2 o IL 09 53 01 15 EXCLUSION OF CERTIFIED ACTS OF TERRORISM This endorsement modifies insurance provided under the following: BOILER AND MACHINERY COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL PROPERTY COVERAGE PART CRIME AND FIDELITY COVERAGE PART EQUIPMENT BREAKDOWN COVERAGE PART FARM COVERAGE PART STANDARD PROPERTY POLICY SCHEDULE The Exception Covering Certain Fire Losses (Paragraph C) applies to property located in the following state(s), if covered under the indicated Coverage Form, Coverage Part or Policy: State(s) Coverage Form, Coverage Part Or Policy Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. The following definition is added with respect to the provisions of this endorsement: "Certified act of terrorism" means an act that is certified by the Secretary of the Treasury, in accordance with the provisions of the federal Terrorism Risk Insurance Act, to be an act of terrorism pursuant to such Act. The criteria contained in the Terrorism Risk Insurance Act for a "certified act of terrorism" include the following: 1. The act resulted in insured losses in excess of $5 million in the aggregate, attributable to all types of insurance subject to the Terrorism Risk Insurance Act; and 2. The act is a violent act or an act that is dangerous to human life, property or infrastructure and is committed by an individual or individuals as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion. B. The following exclusion is added: CERTIFIED ACT OF TERRORISM EXCLUSION We will not pay for loss or damage caused directly or indirectly by a "certified act of terrorism". Such loss or damage is excluded regardless of any other cause or event that contributes concurrently or in any sequence to the loss. C. Exception Covering Certain Fire Losses The following exception to the exclusion in Paragraph B. applies only if indicated and as indicated in the Schedule of this endorsement. If a "certified act of terrorism" results in fire, we will pay for the loss or damage caused by that fire. Such coverage for fire applies only to direct loss or damage by fire to Covered Property. Therefore, for example, the coverage does not apply to insurance provided under Business Income and/or Extra Expense coverage forms or endorsements which apply to those forms, or to the Legal Liability Coverage Form or the Leasehold Interest Coverage Form. DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 Page 2 of 2 © Insurance Services Office, Inc., 2015 IL 09 53 01 15 o If aggregate insured losses attributable to terrorist acts certified under the Terrorism Risk Insurance Act exceed $100 billion in a calendar year and we have met our insurer deductible under the Terrorism Risk Insurance Act, we shall not be liable for the payment of any portion of the amount of such losses that exceeds $100 billion, and in such case insured losses up to that amount are subject to pro rata allocation in accordance with procedures established by the Secretary of the Treasury. D. Application Of Other Exclusions The terms and limitations of any terrorism exclusion, or the inapplicability or omission of a terrorism exclusion, do not serve to create coverage for any loss which would otherwise be excluded under this Coverage Part or Policy, such as losses excluded by the Nuclear Hazard Exclusion or the War And Military Action Exclusion. DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 COMMERCIAL GENERAL LIABILITY CG 21 73 01 15 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CG 21 73 01 15 © Insurance Services Office, Inc., 2014 Page 1 of 1 o EXCLUSION OF CERTIFIED ACTS OF TERRORISM CG 21 73 01 15 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY A. The following exclusion is added: This insurance does not apply to: TERRORISM "Any injury or damage" arising, directly or indirectly, out of a "certified act of terrorism". B. The following definitions are added: 1. For the purposes of this endorsement, "any injury or damage" means any injury or damage covered under any Coverage Part to which this endorsement is applicable, and includes but is not limited to "bodily injury", "property damage", "personal and advertising injury", "injury" or "environmental damage" as may be defined in any applicable Coverage Part. 2. "Certified act of terrorism" means an act that is certified by the Secretary of the Treasury, in accordance with the provisions of the federal Terrorism Risk Insurance Act, to be an act of terrorism pursuant to such Act. The criteria contained in the Terrorism Risk Insurance Act for a "certified act of terrorism" include the following: a. The act resulted in insured losses in excess of $5 million in the aggregate, attributable to all types of insurance subject to the Terrorism Risk Insurance Act; and b. The act is a violent act or an act that is dangerous to human life, property or infrastructure and is committed by an individual or individuals as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion. C. The terms and limitations of any terrorism exclusion, or the inapplicability or omission of a terrorism exclusion, do not serve to create coverage for injury or damage that is otherwise excluded under this Coverage Part. DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 IL 00 21 09 08 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. IL 00 21 09 08 © ISO Properties, Inc., 2007 Page 1 of 2 o NUCLEAR ENERGY LIABILITY EXCLUSION ENDORSEMENT IL 00 21 09 08 (Broad Form) This endorsement modifies insurance provided under the following: COMMERCIAL AUTOMOBILE COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART FARM COVERAGE PART LIQUOR LIABILITY COVERAGE PART MEDICAL PROFESSIONAL LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY 1. The insurance does not apply: A. Under any Liability Coverage, to "bodily injury" or "property damage": (1) With respect to which an "insured" under the policy is also an insured under a nu- clear energy liability policy issued by Nu- clear Energy Liability Insurance Associa- tion, Mutual Atomic Energy Liability Underwriters, Nuclear Insurance Associa- tion of Canada or any of their successors, or would be an insured under any such pol- icy but for its termination upon exhaustion of its limit of liability; or (2) Resulting from the "hazardous properties" of "nuclear material" and with respect to which (a) any person or organization is re- quired to maintain financial protection pur- suant to the Atomic Energy Act of 1954, or any law amendatory thereof, or (b) the "in- sured" is, or had this policy not been issued would be, entitled to indemnity from the United States of America, or any agency thereof, under any agreement entered into by the United States of America, or any agency thereof, with any person or organi- zation. B. Under any Medical Payments coverage, to expenses incurred with respect to "bodily in- jury" resulting from the "hazardous properties" of "nuclear material" and arising out of the op- eration of a "nuclear facility" by any person or organization. C. Under any Liability Coverage, to "bodily injury" or "property damage" resulting from "hazard- ous properties" of "nuclear material", if: (1) The "nuclear material" (a) is at any "nuclear facility" owned by, or operated by or on be- half of, an "insured" or (b) has been dis- charged or dispersed therefrom; (2) The "nuclear material" is contained in "spent fuel" or "waste" at any time pos- sessed, handled, used, processed, stored, transported or disposed of, by or on behalf Page 2 of 2 © ISO Properties, Inc., 2007 IL 00 21 09 08 o "Source material", "special nuclear material", and "by-product material" have the meanings given them in the Atomic Energy Act of 1954 or in any law amendatory thereof. "Spent fuel" means any fuel element or fuel com- ponent, solid or liquid, which has been used or ex- posed to radiation in a "nuclear reactor". "Waste" means any waste material (a) containing "by-product material" other than the tailings or wastes produced by the extraction or concentra- tion of uranium or thorium from any ore processed primarily for its "source material" content, and (b) resulting from the operation by any person or or- ganization of any "nuclear facility" included under the first two paragraphs of the definition of "nu- clear facility". "Nuclear facility" means: (a) Any "nuclear reactor"; (b) Any equipment or device designed or used for (1) separating the isotopes of uranium or plutonium, (2) processing or utilizing "spent fuel", or (3) handling, processing or packag- ing "waste"; (c) Any equipment or device used for the proc- essing, fabricating or alloying of "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 pluto- nium or uranium 233 or any combination thereof, or more than 250 grams of uranium 235; (d) Any structure, basin, excavation, premises or place prepared or used for the storage or disposal of "waste"; and includes the site on which any of the foregoing is located, all operations conducted on such site and all premises used for such operations. "Nuclear reactor" means any apparatus designed or used to sustain nuclear fission in a self-support- ing chain reaction or to contain a critical mass of fissionable material. "Property damage" includes all forms of radioac- tive contamination of property. DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 Capitol Indemnity Corporation P.O. Box 5900, Madison, WI 53705 CICG 258 (11-93) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SINGLE DEDUCTIBLE This endorsement modifies insurance provided under the following: COMMERCIAL PROPERTY COMMERCIAL INLAND MARINE COMMERCIAL CRIME Whenever an occurrence involves more than one coverage part, only one deductible will apply. The deductible applicable will be the highest deductible amount of all the coverage parts involved. DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 CICL 042 (05-15) Page 1 of 1 Capitol Indemnity Corporation COMMERCIAL GENERAL LIABILITY P.O. Box 5900, Madison, WI 53705 COVERAGE PART DECLARATIONS TRANSACTION TYPE: Renew ENDORSEMENT #: 000 CICL 042 05 15 POLICY NUMBER CP02250043-04 POLICY PERIOD 07/01/2016 - 07/01/2017 12:01 A.M. Standard Time at the address of the insured stated herein. AGENCY/PRODUCER CODE 02500 NAMED INSURED AND ADDRESS Fort Collins Archery Assoc PO Box 270493 Fort Collins, CO 80527-0493 AGENCY/PRODUCER Leavitt Recreation & Hospitality Insurance, Inc. 942 14th St Sturgis SD 57785-1347 Form of Business: Not for Profit Org Business Description: outdoor club General Aggregate Limit (Other Than Products-Completed Operations) $ 2,000,000 Products-Completed Operations Aggregate Limit $ 2,000,000 Personal And Advertising Injury Limit $ 1,000,000 Each Occurrence Limit $ 1,000,000 Damage To Premises Rented To You Limit $ 100,000 Any One Fire Medical Expense Limit $ 5,000 Any One Person Location of all Premises You Own, Rent or Occupy: SEE ATTACHED LOCATION FORM SCHEDULE CICG 176 Classification Code No. Premium Basis Rate Pr/Co Advance Pr/Co Premium Other SEE ATTACHED COMMERCIAL GENERAL LIABILITY SCHEDULE CICL 043 Balance To Meet Minimum $ 0.00 TOTAL ADVANCE PREMIUM $ 373.00 THE LIABILITY PREMIUM BASIS OF THIS POLICY IS SUBJECT TO AN AUDIT. ADDITIONAL PREMIUM MAY BE DUE. FORMS AND ENDORSEMENTS: SEE COMMERCIAL GENERAL LIABILITY COVERAGE PART FORM SCHEDULE CICL 044 COUNTERSIGNED 05/16/2016 By _________________________________ Authorized Representative DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 CICL 043 (05-15) Page 1 of 1. Capitol Indemnity Corporation COMMERCIAL GENERAL LIABILITY SCHEDULE P.O. Box 5900, Madison, WI 53705 TRANSACTION TYPE: Renew ENDORSEMENT #: 000 CICL POLICY 043 05 15 NUMBER CP02250043-04 POLICY PERIOD 07/01/2016 - 07/01/2017 12:01 A.M. Standard Time at the address of the insured stated herein. AGENCY/PRODUCER CODE 02500 NAMED INSURED AND ADDRESS Fort Collins Archery Assoc PO Box 270493 Fort Collins, CO 80527-0493 AGENCY/PRODUCER Leavitt Recreation & Hospitality Insurance, Inc. 942 14th St Sturgis SD 57785-1347 Prems No. Classification Code No. Premium Basis Rate Pr/Co Other Advance Pr/Co Premium Other 1 Clubs - Civic- service or social - No buildings or premises owned or leased except for office purposes - Other than not-for-profit 41669 300 Members 1.105 $ 0.00 $ 331.00 1 Archery ranges - indoor 00371 1 Each 16.708 $ 0.00 $ 17.00 Damage To Property of Others 00038 0 Payroll $ 0.00 CG 20 26 - Additional Insured Designated Person or Organization 49950 1 Each $ 25.00 Balance To Meet Minimum Premium $ 0.00 Total Advance Premium $ 373.00 Minimum Earned Premium N/A DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 CICL 044 (10-93) Page 1 of 1 Copyright 2008, Capitol Transamerica Corporation, Inc. Capitol Indemnity Corporation COMMERCIAL GENERAL LIABILITY P.O. Box 5900, Madison, WI 53705 COVERAGE PART FORM SCHEDULE CICL 044 10 93 POLICY NUMBER CP02250043-04 POLICY PERIOD 07/01/2016 - 07/01/2017 12:01 A.M. Standard Time at the address of the insured stated herein. AGENCY/PRODUCER CODE 02500 NAMED INSURED AND ADDRESS Fort Collins Archery Assoc PO Box 270493 Fort Collins, CO 80527-0493 AGENCY/PRODUCER Leavitt Recreation & Hospitality Insurance, Inc. 942 14th St Sturgis SD 57785-1347 Forms and Endorsements applying to this Coverage Part and made a part of this policy at time of issue: FORMS APPLICABLE TO ALL PREMISES AND COVERAGES Form Description CICL 042 05 15 General Liability Coverage Part Declaration CICL 043 05 15 General Liability Schedule CGE 509 06 15 General Liability Unmanned Aircraft Endorsements Advisory Notic CG 20 02 11 85 Additional Insured Club Members CG 20 26 04 13 Additional Insured Designated Person Or Organization CG 00 01 04 13 Commercial General Liability Coverage Form CGL 123 05 13 Damage To Property Of Others CG 21 47 12 07 Employment Related Practices Exclusion CG 21 06 05 14 Exclusion Access Or Disclosure Of Confidential Or Personal Info CG 21 01 11 85 Exclusion Athletic or Sports Participants CGL 135 01 13 Exclusion Lead Liability CGL 187 01 13 Exclusion Tree Stand Or Raised Platform CG 21 09 06 15 Exclusion Unmanned Aircraft CG 21 67 12 04 Fungi or Bacteria Exclusion CG 21 96 03 05 Silica or Silica Related Dust Exclusion CGL 453 07 13 Total Asbestos Exclusion CGL 030 04 13 Total Liquor Liability Exclusion COUNTERSIGNED 05/16/2016 BY _________________________________ Authorized Representative DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 CGE 509 (06-15) Page 1 of 2 © 2015 CapSpecialty, Inc. All rights reserved. Contains Copyrighted Material of Insurance Services Offices, Inc. used with permission GENERAL LIABILITY UNMANNED AIRCRAFT ENDORSEMENTS ADVISORY NOTICE TO POLICYHOLDERS CGE 509 06 15 This Notice does not form part of your policy. No coverage is provided by this Notice nor can it be construed to replace any provision of your policy. You should read your policy and review your Declarations page for complete information on the coverages you are provided. If there is any conflict between the Policy and this Notice, THE PROVISIONS OF THE POLICY SHALL PREVAIL. Carefully read your policy, including the endorsements attached to your policy. This Notice provides information concerning the following new and revised endorsements, which applies to your renewal policy being issued by us: FOR USE WITH THE COMMERCIAL GENERAL LIABILITY COVERAGE PART: CG 21 09 – Exclusion – Unmanned Aircraft When this endorsement is attached to your policy, coverage is excluded with respect to bodily injury and property damage arising out of the ownership, maintenance, use or entrustment to others of any unmanned aircraft. The attachment of this endorsement will result in a reduction in coverage under Coverage A – Bodily Injury And Property Damage Liability to the extent that: 1. An exposure exists with respect to unmanned aircraft that are not owned or operated by or rented or loaned to any insured; or 2. Liability is assumed under any insured contract for the ownership, maintenance or use of unmanned aircraft. In addition, this endorsement excludes coverage with respect to personal and advertising injury arising out of the ownership, maintenance, use or entrustment to others of any unmanned aircraft, with certain exceptions. The attachment of this endorsement will result in a reduction in coverage under Coverage B – Personal And Advertising Injury Liability, to the extent that an exposure exists with respect to unmanned aircraft. However, the attachment of this endorsement would not result in a reduction of coverage with respect to the use of another's advertising idea in your advertisement or to infringing upon another's copyright, trade dress or slogan in your advertisement. CG 24 50 – Limited Coverage For Designated Unmanned Aircraft When this endorsement is attached to your policy, coverage is excluded with respect to bodily injury and property damage arising out of the ownership, maintenance, use or entrustment to others of any unmanned aircraft, with the exception of unmanned aircraft that are designated in the Schedule of the endorsement, but only related to operations or projects that are also designated in the Schedule. The attachment of this endorsement will result in a broadening of coverage under Coverage A – Bodily Injury And Property Damage Liability with respect to designated unmanned aircraft that are owned or operated by or rented or loaned to any insured, but only with respect to designated operations or projects. However, the attachment of this endorsement will result in a reduction in coverage under Coverage A to the extent that: l An exposure exists with respect to unmanned aircraft that are not owned or operated by or rented or loaned to any insured; or l Liability is assumed under any insured contract for the ownership, maintenance or use of unmanned aircraft; with respect to unmanned aircraft that are: l Not designated in the Schedule of the endorsement; or l Designated in the Schedule of the endorsement, with respect to operations or projects that are not designated in the Schedule of the endorsement. DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 CGE 509 (06-15) Page 2 of 2 © 2015 CapSpecialty, Inc. All rights reserved. Contains Copyrighted Material of Insurance Services Offices, Inc. used with permission In addition, this endorsement excludes coverage with respect to personal and advertising injury arising out of the ownership, maintenance, use or entrustment to others of any unmanned aircraft, with certain exceptions. The attachment of this endorsement will result in a reduction in coverage under Coverage B – Personal And Advertising Injury Liability, to the extent that an exposure exists with respect to unmanned aircraft, but only if such unmanned aircraft are: l Not designated in the Schedule of the endorsement; or l Designated in the Schedule of the endorsement, with respect to operations or projects that are not designated in the Schedule of the endorsement. However, the attachment of this endorsement would not result in a reduction of coverage with respect to the use of another's advertising idea in your advertisement or to infringing upon another's copyright, trade dress or slogan in your advertisement. This endorsement contains an optional Unmanned Aircraft Liability Aggregate Limit. If a limit is shown in the Schedule, any coverage provided under the endorsement is subject to that aggregate limit. The Unmanned Aircraft Liability Aggregate Limit will be subject to the General Aggregate Limit or the Products-Completed Operations Aggregate Limit, whichever applies. All other limits continue to apply if and to the extent that the Unmanned Aircraft Liability Aggregate Limit has not been used up. DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CG 20 02 11 85 Copyright, Insurance Services Office, Inc., 1984 Page 1 of 1 o ADDITIONAL INSURED – CLUB MEMBERS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. WHO IS AN INSURED (Section II) is amended to include as an insured any of your members, but only with respect to their liability for your activities or activities they perform on your behalf. DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 POLICY NUMBER: CP02250043-04 COMMERCIAL GENERAL LIABILITY CG 20 26 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CG 20 26 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 ADDITIONAL INSURED – DESIGNATED PERSON OR ORGANIZATION CG 20 26 04 13 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II – Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 COMMERCIAL GENERAL LIABILITY CG 00 01 04 13 CG 00 01 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 16 CG 00 01 04 13 COMMERCIAL GENERAL LIABILITY COVERAGE FORM Various provisions in this policy restrict coverage. Read the entire policy carefully to determine rights, duties and what is and is not covered. Throughout this policy the words "you" and "your" refer to the Named Insured shown in the Declarations, and any other person or organization qualifying as a Named Insured under this policy. The words "we", "us" and "our" refer to the company providing this insurance. The word "insured" means any person or organization qualifying as such under Section II – Who Is An Insured. Other words and phrases that appear in quotation marks have special meaning. Refer to Section V –Definitions. SECTION I – COVERAGES COVERAGE A – BODILY INJURY AND PROPERTY DAMAGE LIABILITY 1. Insuring Agreement a. We will pay those sums that the insured becomes legally obligated to pay as damages because of "bodily injury" or "property damage" to which this insurance applies. We will have the right and duty to defend the insured against any "suit" seeking those damages. However, we will have no duty to defend the insured against any "suit" seeking damages for "bodily injury" or "property damage" to which this insurance does not apply. We may, at our discretion, investigate any "occurrence" and settle any claim or "suit" that may result. But: (1) The amount we will pay for damages is limited as described in Section III – Limits Of Insurance; and (2) Our right and duty to defend ends when we have used up the applicable limit of insurance in the payment of judgments or settlements under Coverages A or B or medical expenses under Coverage C. No other obligation or liability to pay sums or perform acts or services is covered unless explicitly provided for under Supplementary Payments – Coverages A and B. b. This insurance applies to "bodily injury" and "property damage" only if: (1) The "bodily injury" or "property damage" is caused by an "occurrence" that takes place in the "coverage territory"; (2) The "bodily injury" or "property damage" occurs during the policy period; and (3) Prior to the policy period, no insured listed under Paragraph 1. of Section II – Who Is An Insured and no "employee" authorized by you to give or receive notice of an "occurrence" or claim, knew that the "bodily injury" or "property damage" had occurred, Page 2 of 16 © Insurance Services Office, Inc., 2012 CG 00 01 04 13 2. Exclusions This insurance does not apply to: a. Expected Or Intended Injury "Bodily injury" or "property damage" expected or intended from the standpoint of the insured. This exclusion does not apply to "bodily injury" resulting from the use of reasonable force to protect persons or property. b. Contractual Liability "Bodily injury" or "property damage" for which the insured is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages: (1) That the insured would have in the absence of the contract or agreement; or (2) Assumed in a contract or agreement that is an "insured contract", provided the "bodily injury" or "property damage" occurs subsequent to the execution of the contract or agreement. Solely for the purposes of liability assumed in an "insured contract", reasonable attorneys' fees and necessary litigation expenses incurred by or for a party other than an insured are deemed to be damages because of "bodily injury" or "property damage", provided: (a) Liability to such party for, or for the cost of, that party's defense has also been assumed in the same "insured contract"; and (b) Such attorneys' fees and litigation expenses are for defense of that party against a civil or alternative dispute resolution proceeding in which damages to which this insurance applies are alleged. c. Liquor Liability "Bodily injury" or "property damage" for which any insured may be held liable by reason of: (1) Causing or contributing to the intoxication of any person; (2) The furnishing of alcoholic beverages to a person under the legal drinking age or under the influence of alcohol; or (3) Any statute, ordinance or regulation relating to the sale, gift, distribution or use of alcoholic beverages. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in: (a) The supervision, hiring, employment, training or monitoring of others by that insured; or (b) Providing or failing to provide transportation with respect to any person that may be under the influence of alcohol; if the "occurrence" which caused the "bodily CG 00 01 04 13 © Insurance Services Office, Inc., 2012 Page 3 of 16 f. Pollution (1) "Bodily injury" or "property damage" arising out of the actual, alleged or threatened discharge, dispersal, seepage, migration, release or escape of "pollutants": (a) At or from any premises, site or location which is or was at any time owned or occupied by, or rented or loaned to, any insured. However, this subparagraph does not apply to: (i) "Bodily injury" if sustained within a building and caused by smoke, fumes, vapor or soot produced by or originating from equipment that is used to heat, cool or dehumidify the building, or equipment that is used to heat water for personal use, by the building's occupants or their guests; (ii) "Bodily injury" or "property damage" for which you may be held liable, if you are a contractor and the owner or lessee of such premises, site or location has been added to your policy as an additional insured with respect to your ongoing operations performed for that additional insured at that premises, site or location and such premises, site or location is not and never was owned or occupied by, or rented or loaned to, any insured, other than that additional insured; or (iii) "Bodily injury" or "property damage" arising out of heat, smoke or fumes from a "hostile fire"; (b) At or from any premises, site or location which is or was at any time used by or for any insured or others for the handling, storage, disposal, processing or treatment of waste; (c) Which are or were at any time transported, handled, stored, treated, disposed of, or processed as waste by or for: (i) Any insured; or (ii) Any person or organization for whom you may be legally responsible; or (d) At or from any premises, site or location on which any insured or any contractors or subcontractors working directly or indirectly on any insured's behalf are performing operations if the "pollutants" are brought on or to the premises, site or location in connection with such operations by such insured, contractor or subcontractor. However, this subparagraph does not apply to: (i) "Bodily injury" or "property damage" arising out of the escape of fuels, Page 4 of 16 © Insurance Services Office, Inc., 2012 CG 00 01 04 13 (2) Any loss, cost or expense arising out of any: (a) Request, demand, order or statutory or regulatory requirement that any insured or others test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of, "pollutants"; or (b) Claim or suit by or on behalf of a governmental authority for damages because of testing for, monitoring, cleaning up, removing, containing, treating, detoxifying or neutralizing, or in any way responding to, or assessing the effects of, "pollutants". However, this paragraph does not apply to liability for damages because of "property damage" that the insured would have in the absence of such request, demand, order or statutory or regulatory requirement, or such claim or "suit" by or on behalf of a governmental authority. g. Aircraft, Auto Or Watercraft "Bodily injury" or "property damage" arising out of the ownership, maintenance, use or entrustment to others of any aircraft, "auto" or watercraft owned or operated by or rented or loaned to any insured. Use includes operation and "loading or unloading". This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage" involved the ownership, maintenance, use or entrustment to others of any aircraft, "auto" or watercraft that is owned or operated by or rented or loaned to any insured. This exclusion does not apply to: (1) A watercraft while ashore on premises you own or rent; (2) A watercraft you do not own that is: (a) Less than 26 feet long; and (b) Not being used to carry persons or property for a charge; (3) Parking an "auto" on, or on the ways next to, premises you own or rent, provided the "auto" is not owned by or rented or loaned to you or the insured; (4) Liability assumed under any "insured contract" for the ownership, maintenance or use of aircraft or watercraft; or (5) "Bodily injury" or "property damage" arising out of: (a) The operation of machinery or equipment that is attached to, or part of, a land vehicle that would qualify under the definition of "mobile equipment" if it CG 00 01 04 13 © Insurance Services Office, Inc., 2012 Page 5 of 16 (4) Personal property in the care, custody or control of the insured; (5) That particular part of real property on which you or any contractors or subcontractors working directly or indirectly on your behalf are performing operations, if the "property damage" arises out of those operations; or (6) That particular part of any property that must be restored, repaired or replaced because "your work" was incorrectly performed on it. Paragraphs (1), (3) and (4) of this exclusion do not apply to "property damage" (other than damage by fire) to premises, including the contents of such premises, rented to you for a period of seven or fewer consecutive days. A separate limit of insurance applies to Damage To Premises Rented To You as described in Section III – Limits Of Insurance. Paragraph (2) of this exclusion does not apply if the premises are "your work" and were never occupied, rented or held for rental by you. Paragraphs (3), (4), (5) and (6) of this exclusion do not apply to liability assumed under a sidetrack agreement. Paragraph (6) of this exclusion does not apply to "property damage" included in the "products- completed operations hazard". k. Damage To Your Product "Property damage" to "your product" arising out of it or any part of it. l. Damage To Your Work "Property damage" to "your work" arising out of it or any part of it and included in the "products- completed operations hazard". This exclusion does not apply if the damaged work or the work out of which the damage arises was performed on your behalf by a subcontractor. m. Damage To Impaired Property Or Property Not Physically Injured "Property damage" to "impaired property" or property that has not been physically injured, arising out of: (1) A defect, deficiency, inadequacy or dangerous condition in "your product" or "your work"; or (2) A delay or failure by you or anyone acting on your behalf to perform a contract or agreement in accordance with its terms. This exclusion does not apply to the loss of use of other property arising out of sudden and accidental physical injury to "your product" or "your work" after it has been put to its intended use. n. Recall Of Products, Work Or Impaired Property Damages claimed for any loss, cost or Page 6 of 16 © Insurance Services Office, Inc., 2012 CG 00 01 04 13 (4) Any federal, state or local statute, ordinance or regulation, other than the TCPA, CAN-SPAM Act of 2003 or FCRA and their amendments and additions, that addresses, prohibits, or limits the printing, dissemination, disposal, collecting, recording, sending, transmitting, communicating or distribution of material or information. Exclusions c. through n. do not apply to damage by fire to premises while rented to you or temporarily occupied by you with permission of the owner. A separate limit of insurance applies to this coverage as described in Section III – Limits Of Insurance. COVERAGE B – PERSONAL AND ADVERTISING INJURY LIABILITY 1. Insuring Agreement a. We will pay those sums that the insured becomes legally obligated to pay as damages because of "personal and advertising injury" to which this insurance applies. We will have the right and duty to defend the insured against any "suit" seeking those damages. However, we will have no duty to defend the insured against any "suit" seeking damages for "personal and advertising injury" to which this insurance does not apply. We may, at our discretion, investigate any offense and settle any claim or "suit" that may result. But: (1) The amount we will pay for damages is limited as described in Section III – Limits Of Insurance; and (2) Our right and duty to defend end when we have used up the applicable limit of insurance in the payment of judgments or settlements under Coverages A or B or medical expenses under Coverage C. No other obligation or liability to pay sums or perform acts or services is covered unless explicitly provided for under Supplementary Payments – Coverages A and B. b. This insurance applies to "personal and advertising injury" caused by an offense arising out of your business but only if the offense was committed in the "coverage territory" during the policy period. 2. Exclusions This insurance does not apply to: a. Knowing Violation Of Rights Of Another "Personal and advertising injury" caused by or at the direction of the insured with the knowledge that the act would violate the rights of another and would inflict "personal and advertising injury". b. Material Published With Knowledge Of Falsity "Personal and advertising injury" arising out of oral or written publication, in any manner, of CG 00 01 04 13 © Insurance Services Office, Inc., 2012 Page 7 of 16 i. Infringement Of Copyright, Patent, Trademark Or Trade Secret "Personal and advertising injury" arising out of the infringement of copyright, patent, trademark, trade secret or other intellectual property rights. Under this exclusion, such other intellectual property rights do not include the use of another's advertising idea in your "advertisement". However, this exclusion does not apply to infringement, in your "advertisement", of copyright, trade dress or slogan. j. Insureds In Media And Internet Type Businesses "Personal and advertising injury" committed by an insured whose business is: (1) Advertising, broadcasting, publishing or telecasting; (2) Designing or determining content of web sites for others; or (3) An Internet search, access, content or service provider. However, this exclusion does not apply to Paragraphs 14.a., b. and c. of "personal and advertising injury" under the Definitions section. For the purposes of this exclusion, the placing of frames, borders or links, or advertising, for you or others anywhere on the Internet, is not by itself, considered the business of advertising, broadcasting, publishing or telecasting. k. Electronic Chatrooms Or Bulletin Boards "Personal and advertising injury" arising out of an electronic chatroom or bulletin board the insured hosts, owns, or over which the insured exercises control. l. Unauthorized Use Of Another's Name Or Product "Personal and advertising injury" arising out of the unauthorized use of another's name or product in your e-mail address, domain name or metatag, or any other similar tactics to mislead another's potential customers. m. Pollution "Personal and advertising injury" arising out of the actual, alleged or threatened discharge, dispersal, seepage, migration, release or escape of "pollutants" at any time. n. Pollution-related Any loss, cost or expense arising out of any: (1) Request, demand, order or statutory or regulatory requirement that any insured or others test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of, "pollutants"; or (2) Claim or suit by or on behalf of a governmental authority for damages Page 8 of 16 © Insurance Services Office, Inc., 2012 CG 00 01 04 13 COVERAGE C – MEDICAL PAYMENTS 1. Insuring Agreement a. We will pay medical expenses as described below for "bodily injury" caused by an accident: (1) On premises you own or rent; (2) On ways next to premises you own or rent; or (3) Because of your operations; provided that: (a) The accident takes place in the "coverage territory" and during the policy period; (b) The expenses are incurred and reported to us within one year of the date of the accident; and (c) The injured person submits to examination, at our expense, by physicians of our choice as often as we reasonably require. b. We will make these payments regardless of fault. These payments will not exceed the applicable limit of insurance. We will pay reasonable expenses for: (1) First aid administered at the time of an accident; (2) Necessary medical, surgical, X-ray and dental services, including prosthetic devices; and (3) Necessary ambulance, hospital, professional nursing and funeral services. 2. Exclusions We will not pay expenses for "bodily injury": a. Any Insured To any insured, except "volunteer workers". b. Hired Person To a person hired to do work for or on behalf of any insured or a tenant of any insured. c. Injury On Normally Occupied Premises To a person injured on that part of premises you own or rent that the person normally occupies. d. Workers' Compensation And Similar Laws To a person, whether or not an "employee" of any insured, if benefits for the "bodily injury" are payable or must be provided under a workers' compensation or disability benefits law or a similar law. e. Athletics Activities To a person injured while practicing, instructing or participating in any physical exercises or games, sports, or athletic contests. f. Products-Completed Operations Hazard Included within the "products-completed operations hazard". g. Coverage A Exclusions Excluded under Coverage A. SUPPLEMENTARY PAYMENTS – COVERAGES A AND B 1. We will pay, with respect to any claim we CG 00 01 04 13 © Insurance Services Office, Inc., 2012 Page 9 of 16 g. All interest on the full amount of any judgment that accrues after entry of the judgment and before we have paid, offered to pay, or deposited in court the part of the judgment that is within the applicable limit of insurance. These payments will not reduce the limits of insurance. 2. If we defend an insured against a "suit" and an indemnitee of the insured is also named as a party to the "suit", we will defend that indemnitee if all of the following conditions are met: a. The "suit" against the indemnitee seeks damages for which the insured has assumed the liability of the indemnitee in a contract or agreement that is an "insured contract"; b. This insurance applies to such liability assumed by the insured; c. The obligation to defend, or the cost of the defense of, that indemnitee, has also been assumed by the insured in the same "insured contract"; d. The allegations in the "suit" and the information we know about the "occurrence" are such that no conflict appears to exist between the interests of the insured and the interests of the indemnitee; e. The indemnitee and the insured ask us to conduct and control the defense of that indemnitee against such "suit" and agree that we can assign the same counsel to defend the insured and the indemnitee; and f. The indemnitee: (1) Agrees in writing to: (a) Cooperate with us in the investigation, settlement or defense of the "suit"; (b) Immediately send us copies of any demands, notices, summonses or legal papers received in connection with the "suit"; (c) Notify any other insurer whose coverage is available to the indemnitee; and (d) Cooperate with us with respect to coordinating other applicable insurance available to the indemnitee; and (2) Provides us with written authorization to: (a) Obtain records and other information related to the "suit"; and (b) Conduct and control the defense of the indemnitee in such "suit". So long as the above conditions are met, attorneys' fees incurred by us in the defense of that indemnitee, necessary litigation expenses incurred by us and necessary litigation expenses incurred by the indemnitee at our request will be paid as Supplementary Payments. Notwithstanding the provisions of Paragraph 2.b.(2) of Section I – Coverage A – Bodily Injury And Property Damage Liability, such payments will not be deemed to be damages for "bodily injury" Page 10 of 16 © Insurance Services Office, Inc., 2012 CG 00 01 04 13 2. Each of the following is also an insured: a. Your "volunteer workers" only while performing duties related to the conduct of your business, or your "employees", other than either your "executive officers" (if you are an organization other than a partnership, joint venture or limited liability company) or your managers (if you are a limited liability company), but only for acts within the scope of their employment by you or while performing duties related to the conduct of your business. However, none of these "employees" or "volunteer workers" are insureds for: (1) "Bodily injury" or "personal and advertising injury": (a) To you, to your partners or members (if you are a partnership or joint venture), to your members (if you are a limited liability company), to a co-"employee" while in the course of his or her employment or performing duties related to the conduct of your business, or to your other "volunteer workers" while performing duties related to the conduct of your business; (b) To the spouse, child, parent, brother or sister of that co-"employee" or "volunteer worker" as a consequence of Paragraph (1)(a) above; (c) For which there is any obligation to share damages with or repay someone else who must pay damages because of the injury described in Paragraph (1)(a) or (b) above; or (d) Arising out of his or her providing or failing to provide professional health care services. (2) "Property damage" to property: (a) Owned, occupied or used by; (b) Rented to, in the care, custody or control of, or over which physical control is being exercised for any purpose by; you, any of your "employees", "volunteer workers", any partner or member (if you are a partnership or joint venture), or any member (if you are a limited liability company). b. Any person (other than your "employee" or "volunteer worker"), or any organization while acting as your real estate manager. c. Any person or organization having proper temporary custody of your property if you die, but only: (1) With respect to liability arising out of the maintenance or use of that property; and (2) Until your legal representative has been appointed. d. Your legal representative if you die, but only with respect to duties as such. That CG 00 01 04 13 © Insurance Services Office, Inc., 2012 Page 11 of 16 3. The Products-Completed Operations Aggregate Limit is the most we will pay under Coverage A for damages because of "bodily injury" and "property damage" included in the "products-completed operations hazard". 4. Subject to Paragraph 2. above, the Personal And Advertising Injury Limit is the most we will pay under Coverage B for the sum of all damages because of all "personal and advertising injury" sustained by any one person or organization. 5. Subject to Paragraph 2. or 3. above, whichever applies, the Each Occurrence Limit is the most we will pay for the sum of: a. Damages under Coverage A; and b. Medical expenses under Coverage C because of all "bodily injury" and "property damage" arising out of any one "occurrence". 6. Subject to Paragraph 5. above, the Damage To Premises Rented To You Limit is the most we will pay under Coverage A for damages because of "property damage" to any one premises, while rented to you, or in the case of damage by fire, while rented to you or temporarily occupied by you with permission of the owner. 7. Subject to Paragraph 5. above, the Medical Expense Limit is the most we will pay under Coverage C for all medical expenses because of "bodily injury" sustained by any one person. The Limits of Insurance of this Coverage Part apply separately to each consecutive annual period and to any remaining period of less than 12 months, starting with the beginning of the policy period shown in the Declarations, unless the policy period is extended after issuance for an additional period of less than 12 months. In that case, the additional period will be deemed part of the last preceding period for purposes of determining the Limits of Insurance. SECTION IV – COMMERCIAL GENERAL LIABILITY CONDITIONS 1. Bankruptcy Bankruptcy or insolvency of the insured or of the insured's estate will not relieve us of our obligations under this Coverage Part. 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit a. You must see to it that we are notified as soon as practicable of an "occurrence" or an offense which may result in a claim. To the extent possible, notice should include: (1) How, when and where the "occurrence" or offense took place; (2) The names and addresses of any injured persons and witnesses; and (3) The nature and location of any injury or damage arising out of the "occurrence" or offense. b. If a claim is made or "suit" is brought against any insured, you must: (1) Immediately record the specifics of the Page 12 of 16 © Insurance Services Office, Inc., 2012 CG 00 01 04 13 4. Other Insurance If other valid and collectible insurance is available to the insured for a loss we cover under Coverages A or B of this Coverage Part, our obligations are limited as follows: a. Primary Insurance This insurance is primary except when Paragraph b. below applies. If this insurance is primary, our obligations are not affected unless any of the other insurance is also primary. Then, we will share with all that other insurance by the method described in Paragraph c. below. b. Excess Insurance (1) This insurance is excess over: (a) Any of the other insurance, whether primary, excess, contingent or on any other basis: (i) That is Fire, Extended Coverage, Builder's Risk, Installation Risk or similar coverage for "your work"; (ii) That is Fire insurance for premises rented to you or temporarily occupied by you with permission of the owner; (iii) That is insurance purchased by you to cover your liability as a tenant for "property damage" to premises rented to you or temporarily occupied by you with permission of the owner; or (iv) If the loss arises out of the maintenance or use of aircraft, "autos" or watercraft to the extent not subject to Exclusion g. of Section I – Coverage A – Bodily Injury And Property Damage Liability. (b) Any other primary insurance available to you covering liability for damages arising out of the premises or operations, or the products and completed operations, for which you have been added as an additional insured. (2) When this insurance is excess, we will have no duty under Coverages A or B to defend the insured against any "suit" if any other insurer has a duty to defend the insured against that "suit". If no other insurer defends, we will undertake to do so, but we will be entitled to the insured's rights against all those other insurers. (3) When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of: (a) The total amount that all such other insurance would pay for the loss in the absence of this insurance; and CG 00 01 04 13 © Insurance Services Office, Inc., 2012 Page 13 of 16 b. Those statements are based upon representations you made to us; and c. We have issued this policy in reliance upon your representations. 7. Separation Of Insureds Except with respect to the Limits of Insurance, and any rights or duties specifically assigned in this Coverage Part to the first Named Insured, this insurance applies: a. As if each Named Insured were the only Named Insured; and b. Separately to each insured against whom claim is made or "suit" is brought. 8. Transfer Of Rights Of Recovery Against Others To Us If the insured has rights to recover all or part of any payment we have made under this Coverage Part, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request, the insured will bring "suit" or transfer those rights to us and help us enforce them. 9. When We Do Not Renew If we decide not to renew this Coverage Part, we will mail or deliver to the first Named Insured shown in the Declarations written notice of the nonrenewal not less than 30 days before the expiration date. If notice is mailed, proof of mailing will be sufficient proof of notice. SECTION V – DEFINITIONS 1. "Advertisement" means a notice that is broadcast or published to the general public or specific market segments about your goods, products or services for the purpose of attracting customers or supporters. For the purposes of this definition: a. Notices that are published include material placed on the Internet or on similar electronic means of communication; and b. Regarding web sites, only that part of a web site that is about your goods, products or services for the purposes of attracting customers or supporters is considered an advertisement. 2. "Auto" means: a. A land motor vehicle, trailer or semitrailer designed for travel on public roads, including any attached machinery or equipment; or b. Any other land vehicle that is subject to a compulsory or financial responsibility law or other motor vehicle insurance law where it is licensed or principally garaged. However, "auto" does not include "mobile equipment". 3. "Bodily injury" means bodily injury, sickness or disease sustained by a person, including death resulting from any of these at any time. 4. "Coverage territory" means: a. The United States of America (including its Page 14 of 16 © Insurance Services Office, Inc., 2012 CG 00 01 04 13 9. "Insured contract" means: a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire to premises while rented to you or temporarily occupied by you with permission of the owner is not an "insured contract"; b. A sidetrack agreement; c. Any easement or license agreement, except in connection with construction or demolition operations on or within 50 feet of a railroad; d. An obligation, as required by ordinance, to indemnify a municipality, except in connection with work for a municipality; e. An elevator maintenance agreement; f. That part of any other contract or agreement pertaining to your business (including an indemnification of a municipality in connection with work performed for a municipality) under which you assume the tort liability of another party to pay for "bodily injury" or "property damage" to a third person or organization. Tort liability means a liability that would be imposed by law in the absence of any contract or agreement. Paragraph f. does not include that part of any contract or agreement: (1) That indemnifies a railroad for "bodily injury" or "property damage" arising out of construction or demolition operations, within 50 feet of any railroad property and affecting any railroad bridge or trestle, tracks, road-beds, tunnel, underpass or crossing; (2) That indemnifies an architect, engineer or surveyor for injury or damage arising out of: (a) Preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (b) Giving directions or instructions, or failing to give them, if that is the primary cause of the injury or damage; or (3) Under which the insured, if an architect, engineer or surveyor, assumes liability for an injury or damage arising out of the insured's rendering or failure to render professional services, including those listed in (2) above and supervisory, inspection, architectural or engineering activities. 10."Leased worker" means a person leased to you by a labor leasing firm under an agreement between you and the labor leasing firm, to perform duties related to the conduct of your business. "Leased worker" does not include a "temporary worker". 11."Loading or unloading" means the handling of property: CG 00 01 04 13 © Insurance Services Office, Inc., 2012 Page 15 of 16 However, self-propelled vehicles with the following types of permanently attached equipment are not "mobile equipment" but will be considered "autos": (1) Equipment designed primarily for: (a) Snow removal; (b) Road maintenance, but not construction or resurfacing; or (c) Street cleaning; (2) Cherry pickers and similar devices mounted on automobile or truck chassis and used to raise or lower workers; and (3) Air compressors, pumps and generators, including spraying, welding, building cleaning, geophysical exploration, lighting and well servicing equipment. However, "mobile equipment" does not include any land vehicles that are subject to a compulsory or financial responsibility law or other motor vehicle insurance law where it is licensed or principally garaged. Land vehicles subject to a compulsory or financial responsibility law or other motor vehicle insurance law are considered "autos". 13."Occurrence" means an accident, including continuous or repeated exposure to substantially the same general harmful conditions. 14."Personal and advertising injury" means injury, including consequential "bodily injury", arising out of one or more of the following offenses: a. False arrest, detention or imprisonment; b. Malicious prosecution; c. The wrongful eviction from, wrongful entry into, or invasion of the right of private occupancy of a room, dwelling or premises that a person occupies, committed by or on behalf of its owner, landlord or lessor; d. Oral or written publication, in any manner, of material that slanders or libels a person or organization or disparages a person's or organization's goods, products or services; e. Oral or written publication, in any manner, of material that violates a person's right of privacy; f. The use of another's advertising idea in your "advertisement"; or g. Infringing upon another's copyright, trade dress or slogan in your "advertisement". 15."Pollutants" mean any solid, liquid, gaseous or thermal irritant or contaminant, including smoke, vapor, soot, fumes, acids, alkalis, chemicals and waste. Waste includes materials to be recycled, reconditioned or reclaimed. 16."Products-completed operations hazard": a. Includes all "bodily injury" and "property damage" occurring away from premises you own or rent and arising out of "your product" or "your work" except: (1) Products that are still in your physical Page 16 of 16 © Insurance Services Office, Inc., 2012 CG 00 01 04 13 As used in this definition, electronic data means information, facts or programs stored as or on, created or used on, or transmitted to or from computer software, including systems and applications software, hard or floppy disks, CD- ROMs, tapes, drives, cells, data processing devices or any other media which are used with electronically controlled equipment. 18."Suit" means a civil proceeding in which damages because of "bodily injury", "property damage" or "personal and advertising injury" to which this insurance applies are alleged. "Suit" includes: a. An arbitration proceeding in which such damages are claimed and to which the insured must submit or does submit with our consent; or b. Any other alternative dispute resolution proceeding in which such damages are claimed and to which the insured submits with our consent. 19."Temporary worker" means a person who is furnished to you to substitute for a permanent "employee" on leave or to meet seasonal or short- term workload conditions. 20."Volunteer worker" means a person who is not your "employee", and who donates his or her work and acts at the direction of and within the scope of duties determined by you, and is not paid a fee, salary or other compensation by you or anyone else for their work performed for you. 21."Your product": a. Means: (1) Any goods or products, other than real property, manufactured, sold, handled, distributed or disposed of by: (a) You; (b) Others trading under your name; or (c) A person or organization whose business or assets you have acquired; and (2) Containers (other than vehicles), materials, parts or equipment furnished in connection with such goods or products. b. Includes: (1) Warranties or representations made at any time with respect to the fitness, quality, durability, performance or use of "your product"; and (2) The providing of or failure to provide warnings or instructions. c. Does not include vending machines or other property rented to or located for the use of others but not sold. 22."Your work": a. Means: (1) Work or operations performed by you or on your behalf; and (2) Materials, parts or equipment furnished in connection with such work or operations. CGL 123 (05-13) Page 1 of 1 Copyright 2013, Capitol Transamerica Corporation Includes material copyrighted by Insurance Services Office, Inc., used with permission. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DAMAGE TO PROPERTY OF OTHERS CGL 123 05 13 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE Damage To Property Of Others Limits of Insurance: $ 5,000 Per Occurrence Limit $ 25,000 Aggregate Limit A. SECTION I – COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, 2. Exclusions, j. Damage to Property paragraph (4) is replaced with the following: We will pay, on the basis of actual cash value (not on the basis of replacement cost), up to the limits of insurance shown in the schedule above for “property damage” to property of others caused by any insured. We will not pay for “property damage”: 1. To property covered under the Commercial Property Coverage part of this policy; 2. Caused intentionally by any insured; 3. To property owned by or rented to any insured; 4. To property owned by or rented to a tenant of any insured or a resident in your household; or 5. Arising out of: a. any act or omission in connection with premises owned, rented or controlled by any insured, other than the insured location; or b. the ownership, maintenance or use of aircraft, watercraft, or motor vehicles or any other motorized land conveyances. The exclusion does not apply to a motorized land conveyance designed for recreational use off public roads, not subject to motor vehicle registration and not owned by any insured. The coverage available under this endorsement is included in the liability limits of insurance shown in the declarations page. Also, any property damage deductible for liability claims which may be included in this policy applies to the coverage available under this endorsement. All Other Terms And Conditions Of This Policy Remain Unchanged. DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 COMMERCIAL GENERAL LIABILITY CG 21 47 12 07 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CG 21 47 12 07 © ISO Properties, Inc., 2006 Page 1 of 1 o EMPLOYMENT-RELATED PRACTICES EXCLUSION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. The following exclusion is added to Paragraph 2., Exclusions of Section I – Coverage A – Bodily Injury And Property Damage Liability: This insurance does not apply to: "Bodily injury" to: (1) A person arising out of any: (a) Refusal to employ that person; (b) Termination of that person's employment; or (c) Employment-related practices, policies, acts or omissions, such as coercion, demotion, evaluation, reassignment, discipline, defamation, harassment, humiliation, discrimination or malicious prosecution directed at that person; or (2) The spouse, child, parent, brother or sister of that person as a consequence of "bodily injury" to that person at whom any of the employment- related practices described in Paragraphs (a), (b), or (c) above is directed. This exclusion applies: (1) Whether the injury-causing event described in Paragraphs (a), (b) or (c) above occurs before employment, during employment or after employment of that person; (2) Whether the insured may be liable as an employer or in any other capacity; and (3) To any obligation to share damages with or repay someone else who must pay damages because of the injury. B. The following exclusion is added to Paragraph 2., Exclusions of Section I – Coverage B – Personal And Advertising Injury Liability: This insurance does not apply to: "Personal and advertising injury" to: (1) A person arising out of any: (a) Refusal to employ that person; (b) Termination of that person's employment; or (c) Employment-related practices, policies, acts or omissions, such as coercion, demotion, evaluation, reassignment, discipline, defamation, harassment, humiliation, discrimination or malicious prosecution directed at that person; or (2) The spouse, child, parent, brother or sister of that person as a consequence of "personal and advertising injury" to that person at whom any of the employment-related practices described in Paragraphs (a), (b), or (c) above is directed. This exclusion applies: (1) Whether the injury-causing event described in Paragraphs (a), (b) or (c) above occurs before COMMERCIAL GENERAL LIABILITY CG 21 06 05 14 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CG 21 06 05 14 © Insurance Services Office, Inc., 2013 Page 1 of 1 EXCLUSION – ACCESS OR DISCLOSURE OF CONFIDENTIAL OR PERSONAL INFORMATION AND DATA-RELATED LIABILITY – WITH CG 21 06 05 14 LIMITED BODILY INJURY EXCEPTION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Exclusion 2.p. of Section I – Coverage A – Bodily Injury And Property Damage Liability is replaced by the following: 2. Exclusions This insurance does not apply to: p. Access Or Disclosure Of Confidential Or Personal Information And Data-related Liability Damages arising out of: (1) Any access to or disclosure of any person's or organization's confidential or personal information, including patents, trade secrets, processing methods, customer lists, financial information, credit card information, health information or any other type of nonpublic information; or (2) The loss of, loss of use of, damage to, corruption of, inability to access, or inability to manipulate electronic data. This exclusion applies even if damages are claimed for notification costs, credit monitoring expenses, forensic expenses, public relations expenses or any other loss, cost or expense incurred by you or others arising out of that which is described in Paragraph (1) or (2) above. However, unless Paragraph (1) above applies, this exclusion does not apply to damages because of "bodily injury". As used in this exclusion, electronic data means information, facts or programs stored as or on, created or used on, or transmitted to or from computer software, including systems and applications software, hard or floppy disks, CD-ROMs, tapes, drives, cells, data processing devices or any other media which are used with electronically controlled equipment. B. The following is added to Paragraph 2. Exclusions of Section I – Coverage B – Personal And Advertising Injury Liability: 2. Exclusions This insurance does not apply to: Access Or Disclosure Of Confidential Or Personal Information "Personal and advertising injury" arising out of any access to or disclosure of any person's or organization's confidential or personal information, including patents, trade secrets, POLICY NUMBER: CP02250043-04 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CG 21 01 11 85 Copyright, Insurance Services Office, Inc., 1984 Page 1 of 1 o EXCLUSION – ATHLETIC OR SPORTS PARTICIPANTS CG 21 01 11 85 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE Description of Operations: All classifications appearing on the policy, form CICL 043 and any endorsed to the policy. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) With respect to any operations shown in the Schedule, this insurance does not apply to "bodily injury" to any person while practicing for or participating in any sports or athletic contest or exhibition that you sponsor. DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 CGL 135 (01-13) Page 1 of 1 Copyright 2013, Capitol Transamerica Corporation Includes material copyrighted by Insurance Services Office, Inc., used with permission. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION – LEAD LIABILITY CGL 135 01 13 This endorsement modifies insurance under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM The following exclusions are added to SECTION I – COVERAGES, COVERAGE A – BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Paragraph 2. Exclusions and SECTION I – COVERAGES, COVERAGE B – PERSONAL AND ADVERTISING INJURY LIABIITY Paragraph 2. Exclusions. Lead Liability “Bodily injury” or “property damage” or “personal and advertising injury” arising out of: (1) The ingestion, inhalation or absorption of lead in any form; (2) Actual or alleged damage of any kind arising out of any form of lead; Any loss, cost or expense arising out of any: (1) Request, demand or order that any insured or others test for, monitor, clean up, remove, contain, treat, detoxify or neutralize or in any way respond to or assess the effects of lead; or (2) Claim or “suit” by or on behalf of any governmental authority or any claimant for damages, statutory penalties, abatement or any form of injunctive relief resulting from testing for, monitoring, cleaning up, removing, containing, treating, detoxifying or neutralizing or in any way responding to or assessing the effects of lead. All Other Terms And Conditions Of This Policy Remain Unchanged. DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 CGL 187 (01-13) Page 1 of 1 Copyright 2013, Capitol Transamerica Corporation Includes material copyrighted by Insurance Services Office, Inc., used with permission. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY EXCLUSION – TREE STAND OR RAISED PLATFORM CGL 187 01 13 This endorsement modifies insurance under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM The following exclusion is added to SECTION I – COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY Paragraph 2. Exclusions, and COVERAGE C – MEDICAL PAYMENTS Paragraph 2. Exclusions: Tree Stand Or Raised Platform This insurance does not apply to “bodily injury”, “property damage”, or medical expense arising out of the existence or use of any tree stand or raised platform. All Other Terms And Conditions Of This Policy Remain Unchanged. DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 COMMERCIAL GENERAL LIABILITY CG 21 09 06 15 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CG 21 09 06 15 © Insurance Services Office, Inc., 2014 Page 1 of 2 EXCLUSION – UNMANNED AIRCRAFT CG 21 09 06 15 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Exclusion 2.g. Aircraft, Auto Or Watercraft under Section I – Coverage A – Bodily Injury And Property Damage Liability is replaced by the following: 2. Exclusions This insurance does not apply to: g. Aircraft, Auto Or Watercraft (1) Unmanned Aircraft "Bodily injury" or "property damage" arising out of the ownership, maintenance, use or entrustment to others of any aircraft that is an "unmanned aircraft". Use includes operation and "loading or unloading". This Paragraph g.(1) applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage" involved the ownership, maintenance, use or entrustment to others of any aircraft that is an "unmanned aircraft". (2) Aircraft (Other Than Unmanned Aircraft), Auto Or Watercraft "Bodily injury" or "property damage" arising out of the ownership, maintenance, use or entrustment to others of any aircraft (other than "unmanned aircraft"), "auto" or watercraft owned or operated by or rented or loaned to any insured. Use includes operation and "loading or unloading". This Paragraph g.(2) applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage" involved the ownership, maintenance, use or entrustment to others of any aircraft (other than "unmanned aircraft"), "auto" or watercraft that is owned or operated by or rented or loaned to any insured. This Paragraph g.(2) does not apply to: (a) A watercraft while ashore on premises you own or rent; (b) A watercraft you do not own that is: Page 2 of 2 © Insurance Services Office, Inc., 2014 CG 21 09 06 15 (e) "Bodily injury" or "property damage" arising out of: (i) The operation of machinery or equipment that is attached to, or part of, a land vehicle that would qualify under the definition of "mobile equipment" if it were not subject to a compulsory or financial responsibility law or other motor vehicle insurance law where it is licensed or principally garaged; or (ii) The operation of any of the machinery or equipment listed in Paragraph f.(2) or f.(3) of the definition of "mobile equipment". B. The following exclusion is added to Paragraph 2. Exclusions of Coverage B – Personal And Advertising Injury Liability: 2. Exclusions This insurance does not apply to: Unmanned Aircraft "Personal and advertising injury" arising out of the ownership, maintenance, use or entrustment to others of any aircraft that is an "unmanned aircraft". Use includes operation and "loading or unloading". This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the offense which caused the "personal and advertising injury" involved the ownership, maintenance, use or entrustment to others of any aircraft that is an "unmanned aircraft". This exclusion does not apply to: a. The use of another's advertising idea in your "advertisement"; or b. Infringing upon another's copyright, trade dress or slogan in your "advertisement". C. The following definition is added to the Definitions section: "Unmanned aircraft" means an aircraft that is not: 1. Designed; 2. Manufactured; or 3. Modified after manufacture; to be controlled directly by a person from within or on the aircraft. DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 COMMERCIAL GENERAL LIABILITY CG 21 67 12 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CG 21 67 12 04 © ISO Properties, Inc., 2003 Page 1 of 1 o FUNGI OR BACTERIA EXCLUSION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. The following exclusion is added to Paragraph 2. Exclusions of Section I – Coverage A – Bodily Injury and Property Damage Liability: 2. Exclusions This insurance does not apply to: Fungi or Bacteria a. "Bodily injury" or "property damage" which would not have occurred, in whole or in part, but for the actual, alleged or threatened inhalation of, ingestion of, contact with, exposure to, existence of, or presence of, any "fungi" or bacteria on or within a building or structure, including its contents, regardless of whether any other cause, event, material or product contributed concurrently or in any sequence to such injury or damage. b. Any loss, cost or expenses arising out of the abating, testing for, monitoring, cleaning up, removing, containing, treating, detoxifying, neutralizing, remediating or disposing of, or in any way responding to, or assessing the effects of, "fungi" or bacteria, by any insured or by any other person or entity. This exclusion does not apply to any "fungi" or bacteria that are, are on, or are contained in, a good or product intended for bodily consumption. B. The following exclusion is added to Paragraph 2. Exclusions of Section I – Coverage B – Personal and Advertising Injury Liability: 2. Exclusions This insurance does not apply to: Fungi or Bacteria a. "Personal and advertising injury" which would not have taken place, in whole or in part, but for the actual, alleged or threatened inhalation of, ingestion of, contact with, exposure to, existence of, or presence of any "fungi" or bacteria on or within a building or structure, including its contents, regardless of whether any other cause, event, material or product contributed concurrently or in any sequence to such injury. b. Any loss, cost or expense arising out of the abating, testing for, monitoring, cleaning up, removing, containing, treating, detoxifying, neutralizing, remediating or disposing of, or in any way responding to, or assessing the effects of, "fungi" or bacteria, by any insured or by any other person or entity. COMMERCIAL GENERAL LIABILITY CG 21 96 03 05 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CG 21 96 03 05 © ISO Properties, Inc., 2004 Page 1 of 1 o SILICA OR SILICA-RELATED DUST EXCLUSION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. The following exclusion is added to Paragraph 2., Exclusions of Section I – Coverage A – Bodily Injury And Property Damage Liability: 2. Exclusions This insurance does not apply to: Silica or Silica-Related Dust a. "Bodily injury" arising, in whole or in part, out of the actual, alleged, threatened or suspected inhalation of, or ingestion of, "silica" or "silica-related dust". b. "Property damage" arising, in whole or in part, out of the actual, alleged, threatened or suspected contact with, exposure to, existence of, or presence of, "silica" or "silica-related dust". c. Any loss, cost or expense arising, in whole or in part, out of the abating, testing for, monitoring, cleaning up, removing, containing, treating, detoxifying, neutralizing, remediating or disposing of, or in any way responding to or assessing the effects of, "silica" or "silica-related dust", by any insured or by any other person or entity. B. The following exclusion is added to Paragraph 2., Exclusions of Section I – Coverage B – Personal And Advertising Injury Liability: 2. Exclusions This insurance does not apply to: Silica or Silica-Related Dust a. "Personal and advertising injury" arising, in whole or in part, out of the actual, alleged, threatened or suspected inhalation of, ingestion of, contact with, exposure to, existence of, or presence of, "silica" or "silica-related dust". b. Any loss, cost or expense arising, in whole or in part, out of the abating, testing for, monitoring, cleaning up, removing, containing, treating, detoxifying, neutralizing, remediating or disposing of, or in any way responding to or assessing the effects of, "silica" or "silica-related dust", by any insured or by any other person or entity. C. The following definitions are added to the Definitions Section: 1. "Silica" means silicon dioxide (occurring in crystalline, amorphous and impure forms), silica particles, silica dust or silica compounds. 2. "Silica-related dust" means a mixture or combination of silica and other dust or particles. CGL 453 (07-13) Page 1 of 1 Copyright 2013, Capitol Transamerica Corporation Includes material copyrighted by Insurance Services Office, Inc., used with permission. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. TOTAL ASBESTOS EXCLUSION CGL 453 07 13 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM A. The following exclusion is added to Paragraph 2. Exclusions of SECTION I – COVERAGES, COVERAGE A – BODILY INJURY AND PROPERTY DAMAGE LIABILITY: Asbestos Or Asbestos-Related Dust (1) “Bodily Injury” arising, in whole or in part, out of the actual, alleged, threatened or suspected inhalation of, or ingestion of, asbestos or asbestos-related dust particles. (2) “Property damage” arising , in whole or in part, out of the actual alleged, threatened or suspected contact with, exposure to, existence of, or presence of, asbestos or asbestos-related dust. B. Any loss, cost or expense arising, in whole or in part, out of the abating, testing for, monitoring, cleaning up, removing, containing, treating, detoxifying, neutralizing, remediating or disposing of, or in any way responding to or assessing the effects of, asbestos or asbestos dust, by any insured or by any other person or entity whether it was done knowingly or unknowingly or by accident. C. The following exclusion is added to Paragraph 2. Exclusions of SECTION I – COVERAGES, COVERAGE B – PERSONAL AND ADVERTISING INJURY LIABILITY: Asbestos Or Asbestos-Related Dust (1) “Personal and advertising injury” arising, in whole or in part, out of the actual, alleged, threatened or suspected inhalation of ingestion of contact with, exposure to, existence of, or presence of, “asbestos” or “asbestos-related dust”. (2) Any loss, cost or expense arising, in whole or part, out of the abating, testing for, monitoring cleaning up, removing, containing, treating, detoxifying, neutralizing, remediating of disposing of, or in any way responding to or assessing the effects of, “asbestos” or “asbestos-related CGL 030 (04-13) Page 1 of 1 Copyright 2013, Capitol Transamerica Corporation Includes material copyrighted by Insurance Services Office, Inc., used with permission. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. TOTAL LIQUOR LIABILITY EXCLUSION CGL 030 04 13 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SECTION I – COVERAGE A – BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Paragraph 2. Exclusions, Exclusion c. Liquor Liability is replaced by the following: 1. Exclusions This insurance does not apply to: a. Liquor Liability "Bodily injury" or "property damage" for which any insured may be held liable by reason of: (1) Causing or contributing to the intoxication of any person, including causing or contributing to the intoxication of any person because alcoholic beverages were permitted to be brought on your premises, for consumption on your premises; (2) The furnishing of alcoholic beverages to a person under the legal drinking age or under the influence of alcohol; or (3) Any statute, ordinance or regulation relating to the sale, gift, distribution or use of alcoholic beverages. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in: (a) The supervision, hiring, employment, training or monitoring of others by that insured; or (b) Providing or failing to provide transportation with respect to any person that may be under the influence of alcohol. All Other Terms And Conditions Of This Policy Remain Unchanged. DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 CICIM 004 (05-15) Page 1 of 10 Capitol Indemnity Corporation INLAND MARINE COVERAGE PART P.O. Box 5900, Madison, WI 53705 SUPPLEMENTAL DECLARATIONS TRANSACTION TYPE: Renew ENDORSEMENT #: 000 CICIM 004 05 15 POLICY NUMBER CP02250043 POLICY PERIOD 07/01/2016 - 07/01/2017 12:01 A.M. Standard Time at the address of the insured stated herein. AGENCY/PRODUCER CODE 02500 NAMED INSURED AND ADDRESS Fort Collins Archery Assoc PO Box 270493 Fort Collins, CO 80527-0493 AGENCY/PRODUCER Leavitt Recreation & Hospitality Insurance, Inc. 942 14th St Sturgis SD 57785-1347 FORMS AND ENDORSEMENTS: SEE INLAND MARINE COVERAGE PART FORM SCHEDULE CICIM 033 Coverage Part Premium Accounts Receivable NOT COVERED Bailee’s Customer’s Property NOT COVERED Builder’s Risk NOT COVERED Equipment and Mobile Property $ 365.00 Golf Greens, Bridges & Culverts Property NOT COVERED Hole In One NOT COVERED Installation Floater NOT COVERED Minicomputer NOT COVERED Tagged Fish Indemnification (see form CICIM 036) NOT COVERED Valuable Papers and Records NOT COVERED Warehouseman’s Legal Liability NOT COVERED Balance To Meet Minimum Premium $ 0.00 Total Advance Premium $ 365.00 Minimum Earned Premium N/A Countersigned 05/16/2016 By ___________________________________ Authorized Representative DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 CICIM 004 (05-15) Page 2 of 10 EQUIPMENT AND MOBILE PROPERTY Schedule Item Number: 1 Covered Property: 1 Crouching cougar McKenzie target Description: , 1 Crouching cougar McKenzie target Limit: $ 450 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 2 Covered Property: Standing small black bear McKenzie target Description: , Standing small black bear McKenzie target Limit: $ 410 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 3 Covered Property: Hyena McKenzie target Description: , Hyena McKenzie target Limit: $ 400 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 4 Covered Property: Armadillo McKenzie target CICIM 004 (05-15) Page 3 of 10 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 11 Covered Property: Baboon Rinehart target Description: , Baboon Rinehart target Limit: $ 199 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 12 Covered Property: Stegasaurus Rinehart target Description: , Stegasaurus Rinehart target Limit: $ 180 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 13 Covered Property: Small buck Rinehart target Description: , Small buck Rinehart target Limit: $ 220 Deductible: $ 500 Coinsurance: 100 % CICIM 004 (05-15) Page 4 of 10 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 21 Covered Property: Bobcat Rinehart target Description: , Bobcat Rinehart target Limit: $ 179 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 22 Covered Property: Bedded elk Rinehart target Description: , Bedded elk Rinehart target Limit: $ 850 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 23 Covered Property: Dahl Sheep Rinehart target Description: , Dahl Sheep Rinehart target Limit: $ 425 Deductible: $ 500 Coinsurance: 100 % CICIM 004 (05-15) Page 5 of 10 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 31 Covered Property: Feeding doe Rinehart statue Description: , Feeding doe Rinehart statue Limit: $ 235 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 32 Covered Property: Wolverine Rinehart target Description: , Wolverine Rinehart target Limit: $ 180 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 33 Covered Property: Standing stone sheep Rinehart target Description: , Standing stone sheep Rinehart target Limit: $ 399 Deductible: $ 500 CICIM 004 (05-15) Page 6 of 10 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 41 Covered Property: Stone sheep inserts Description: , Stone sheep inserts Limit: $ 237 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 42 Covered Property: 2 bedded dahl sheep inserts Description: , 2 bedded dahl sheep inserts Limit: $ 172 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 43 Covered Property: 2 Antelope/alert deer inserts Description: , 2 Antelope/alert deer inserts Limit: $ 158 Deductible: $ 500 Coinsurance: 100 % CICIM 004 (05-15) Page 7 of 10 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 51 Covered Property: 2 Wolverine inserts Description: , 2 Wolverine inserts Limit: $ 112 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 52 Covered Property: 2 strutting turkey inserts Description: , 2 strutting turkey inserts Limit: $ 126 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 53 Covered Property: 3 Howling wolf inserts Description: , 3 Howling wolf inserts Limit: $ 213 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV CICIM 004 (05-15) Page 8 of 10 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 61 Covered Property: Jackalope insert Description: , Jackalope insert Limit: $ 43 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 62 Covered Property: Feeding deer insert Description: , Feeding deer insert Limit: $ 63 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 63 Covered Property: standing bear insert Description: , standing bear insert Limit: $ 126 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: CICIM 004 (05-15) Page 9 of 10 LH Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 71 Covered Property: 9 PSE "Scamp" Recurve Bow 46" 8-RH 1-LH Description: , 9 PSE "Scamp" Recurve Bow 46" 8-RH 1-LH Limit: $ 800 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 72 Covered Property: 6 GreatTree "Mohegan" Recurve Bows 62" 5-RH 1-LH Description: , 6 GreatTree "Mohegan" Recurve Bows 62" 5-RH 1-LH Limit: $ 660 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 73 Covered Property: 6 GreatTree "Mohegan" Recurve Bow 54" 5-RH 1- LH Description: , 6 GreatTree "Mohegan" Recurve Bow 54" 5-RH 1-LH CICIM 004 (05-15) Page 10 of 10 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 80 Covered Property: 300 arrows (wood, fiberglass, aluminum) Various lengths Description: , 300 arrows (wood, fiberglass, aluminum) Various lengths Limit: $ 1,500 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 81 Covered Property: Howling wolf Rinehart target Description: , Howling wolf Rinehart target Limit: $ 395 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum TOTAL PREMIUM THIS COVERAGE PART: $ 365.00 DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 CICIM 033 (01-08) Page 1 of 1 Capitol Indemnity Corporation INLAND MARINE P.O. Box 5900, Madison, WI 53705 COVERAGE PART FORM SCHEDULE TRANSACTION TYPE: Renew ENDORSEMENT #: 000 CICIM 033 01 08 POLICY NUMBER CP02250043-04 POLICY PERIOD 07/01/2016 - 07/01/2017 12:01 A.M. Standard Time at the address of the insured stated herein. AGENCY/PRODUCER CODE 02500 NAMED INSURED AND ADDRESS Fort Collins Archery Assoc PO Box 270493 Fort Collins, CO 80527-0493 AGENCY/PRODUCER Leavitt Recreation & Hospitality Insurance, Inc. 942 14th St Sturgis SD 57785-1347 Forms and Endorsements applying to this Coverage Part and made a part of this policy at time of issue: Form Description CICIM 004 05 15 Inland Marine Coverage Part Declaration CIM 085 10 07 Equipment And Mobile Property Coverage Form Countersigned 05/16/2016 By ___________________________________ Authorized Representative DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 CIM 085 (10-07) Page 1 of 8 Copyright 2009, Capitol Transamerica Corporation Includes material copyrighted by ISO, used with permission THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EQUIPMENT AND MOBILE PROPERTY COVERAGE FORM Various provisions in this Coverage Form restrict coverage. Please read the entire form carefully to determine rights, duties and what is and is not covered. Throughout this form the words “you” and “your” refer to the Named Insured shown in the Declarations. The words “we,” “us” and “our” refer to the Company providing this insurance. Other words and phrases that appear in quotation marks have special meaning. Please refer to the SECTION V - DEFINITIONS section of this form. SECTION I – COVERAGE A. Coverage Provided We will pay for direct physical loss to Covered Property that you use in your business. The loss must occur during the policy period shown in the Declarations, within the Coverage Territory, and be caused by or result from a Covered Cause of Loss. Coverage Territory, as used in this Coverage Form, means the United States of America (including its territories and possessions), Puerto Rico, and Canada. 1. Covered Property Covered Property means property for which there is a Limit of Insurance and description in the Declarations. 2. Property Not Covered Unless specifically described as covered in the Declarations, Covered Property does not include: a. Accounts, bills, deeds, evidences of debt, currency, money, notes, securities, plans, blueprints, designs, drawings, tracings, specifications or any similar property; b. Aircraft, watercraft or marine vessels; c. Automobiles, motorcycles, trucks, trailers, semi-trailers or other vehicles used to transport people or property on public roads; d. Contraband, or property in the course of illegal transportation or trade; e. Cranes; f. Electronic data processing equipment or media, including but not limited to programs, records or data made a part of any electronic data processing systems; g. Property that has become a part of any building, structure or installation; CIM 085 (10-07) Page 2 of 8 Copyright 2009, Capitol Transamerica Corporation Includes material copyrighted by ISO, used with permission (2) Powerboats 20’ in length or smaller with an engine of no more than 50 horsepower; and (3) Boats powered only by human effort. 3. Debris Removal a. We will pay your expense to remove debris of Covered Property caused by or resulting from a Covered Cause of Loss. This coverage does not apply to expenses to: (1) Extract “pollutants” from land or water; or (2) Remove, restore, or replace polluted land or water. If the sum of loss and debris removal expense exceeds the applicable Limits of Insurance, then we will pay up to an additional $5,000, or the Debris Removal Limit of insurance shown in the Declarations, for each occurrence of loss for debris removal. This amount is in addition to any other Limit of Insurance. b. We will pay the expenses for debris removal only if they are reported to us in writing within 180 days or the earlier of: (1) The date of direct physical loss; or (2) The end of the policy period. 4. Rental Expense a. If a loss covered by this insurance occurs to Covered Property we will pay your expense to rent equipment or property to replace that Covered Property that was damaged or destroyed. b. This rented equipment or property must be used in your business operations for the same or similar purpose as the lost or damaged property and be of similar kind and quality. c. The most we will pay is $250 per day up to a maximum of $2,500, regardless of the actual cost of rental or number of items lost or damaged. B. Covered Causes of Loss Unless otherwise shown in the Declarations, Covered Cause of Loss means risks of direct physical loss unless the loss is excluded below or payment is limited by other provisions in this CIM 085 (10-07) Page 3 of 8 Copyright 2009, Capitol Transamerica Corporation Includes material copyrighted by ISO, used with permission or dry rot or bacteria results in fire; lightning; explosion; smoke; aircraft or vehicle damage; riot or civil commotion; vandalism; leakage from fire extinguishing equipment or plumbing systems. As used in this Exclusion, Fungus means any type or form of fungus, including mold or mildew, and any mycotoxins, spores, scents or by- products produced or released by fungi. c. Governmental Action Seizure or destruction of property by order of governmental authority. But we will pay for loss or damage caused by or resulting from acts of destruction ordered by governmental authority and taken at the time of a fire to prevent its spread, if the fire would be covered under this Coverage Part. d. Nuclear Hazard Nuclear reaction or radiation, or radioactive contamination, however caused. But if nuclear reaction or radiation, or radioactive contamination, results in fire, we will pay for the loss or damage caused by that fire. e. War And Military Action (1) War, including undeclared or civil war; (2) Warlike action by a military force, including action in hindering or defending against an actual or expected attack, by any government, sovereign or other authority using military personnel or other agents; or (3) Insurrection, rebellion, revolution, usurped power, or action taken by governmental authority in hindering or defending against any of these. f. Water (1) Flood, surface water, waves, tides, tidal waves, overflow of any body of water, or their spray, all whether driven by wind or not; (2) Mudslide or mudflow; (3) Water that backs up or overflows from a sewer, drain or sump; or CIM 085 (10-07) Page 4 of 8 Copyright 2009, Capitol Transamerica Corporation Includes material copyrighted by ISO, used with permission But this exclusion does not apply to a carrier for hire; e. Unauthorized instructions to transfer property to any person or to any place; f. Voluntary parting with any property by you or anyone entrusted with the property if induced to do so by any fraudulent scheme, trick, device or false pretense; g. Electric arcing, short circuit, blowout, or other electrical disturbance or damage by artificially generated electricity. But if loss by fire results we will pay for that resulting loss; h. Exceeding the manufacturer’s rated capacity of the equipment; i. Mechanical breakdown or failure. But if loss by fire results we will pay for that resulting loss; j. Processing, repairing, adjusting, servicing, maintaining or similar work upon Covered Property. But if loss by fire results we will pay for that resulting loss; k. Rain, snow, ice, sleet or sand, all whether driven by wind or not; l. Loss that solely depends on any audit of records or any inventory computation to prove its factual existence; m. Subsidence of or breaking through ice, or sinking in permafrost or muskeg; n. Wear and tear, gradual deterioration, depreciation, hidden or latent defect, or any quality in the property that causes it to damage or destroy itself. SECTION II - LIMITS OF INSURANCE The most we will pay for loss or damage in any one occurrence is the applicable Limit(s) of Insurance shown in the Declarations. SECTION III - DEDUCTIBLE 1. In any one occurrence of loss, we will first reduce the amount of loss, if required, by the Coinsurance Condition. If the adjusted amount of loss is less than or equal to the Deductible, we will not pay for that loss. If the adjusted amount of loss exceeds the Deductible, we will then subtract the Deductible from the adjusted amount of loss, and will pay the resulting amount up to the Limit of Insurance. An occurrence means accidental loss CIM 085 (10-07) Page 5 of 8 Copyright 2009, Capitol Transamerica Corporation Includes material copyrighted by ISO, used with permission b. Bear the other expenses of the appraisal and umpire equally. If there is an appraisal, we will still retain our right to deny the claim. 3. Coinsurance If a Coinsurance percentage is shown in the Declarations, the following applies. We will not pay the full amount of any loss if the value of Covered Property at the time of loss times the Coinsurance percentage shown for it in the Declarations is greater than the Limit of Insurance for the property. Instead, we will determine the most we will pay using the following steps: Step 1: Multiply the value of Covered Property at the time of loss by the Coinsurance percentage; Step 2: Divide the Limit of Insurance of the property by the figure determined in Step 1; Step 3: Multiply the total amount of loss, before the application of any deductible, by the figure determined in Step (2); and Step 4: Subtract the deductible from the figure determined in Step 3. We will pay the amount determined in Step 4 or the Limit of Insurance, whichever is less. For the remainder, you will either have to rely on other insurance or absorb the loss yourself. 4. Duties In The Event Of Loss You must see that the following are done in the event of loss or damage to Covered Property: a. Notify the police if a law may have been broken. b. Give us prompt notice of the loss. Include a description of the property involved. c. As soon as possible, give us a description of how, when and where the loss occurred. d. Take all reasonable steps to protect the Covered Property from further damage, and keep a record of your expenses necessary to protect the Covered Property, for consideration in the settlement of the claim. This will not increase the Limit of Insurance. However, we will not pay for any subsequent loss resulting from a cause of loss that is not a Covered Cause of Loss. Also, if feasible, set the damaged property aside and in the best CIM 085 (10-07) Page 6 of 8 Copyright 2009, Capitol Transamerica Corporation Includes material copyrighted by ISO, used with permission an examination, an insured's answers must be signed. k. You will not, except at your own cost, voluntarily make a payment, assume any obligation, or incur any expense without our consent. l. Immediately send us copies of any demands, notices, summonses or legal papers received in connection with the claim or suit. 5. Loss Payment and Valuation a. We will determine the value of lost or damaged property sold to others based on the net selling price after all allowances and discounts. For all other property we will determine the value of lost or damaged property based on the actual cash value at the time of the loss unless a different valuation is shown in the Declarations. If Replacement Cost is shown we will value the lost or damaged property without deduction for depreciation. However, unless otherwise shown in the Declarations, Replacement Cost does not apply to personal property of others or works of art, antiques or rare articles including but not limited to etchings, pictures, statuary, marbles, bronzes, porcelains and bric-a-brac. You may make a claim for loss or damage covered by this insurance on an actual cash value basis instead of on a replacement cost basis. In the event you elect to have loss or damage settled on an actual cash value basis, you may still make a claim for the additional coverage this Optional Coverage provides if you notify us of your intent to do so within 180 days after the loss or damage. We will not pay on a replacement cost basis for any loss or damage: (1) Until the lost or damaged property is actually repaired or replaced; and (2) Unless the repairs or replacement are made as soon as reasonably possible after the loss or damage. We will not pay more for loss or damage on a replacement cost basis than the least of: CIM 085 (10-07) Page 7 of 8 Copyright 2009, Capitol Transamerica Corporation Includes material copyrighted by ISO, used with permission d. In case of loss to any part of a pair, set or collection we may, at our option: (1) Repair or replace any part to restore the pair or set to its value before the loss; or (2) Pay the difference between the value of the pair or set before and after the loss. e. We will give notice of our intentions within 30 days after we receive the sworn proof of loss. f. We will not pay you more than your financial interest in the Covered Property. g. We may adjust losses with the owners of lost or damaged property if other than you. If we pay the owners, such payments will satisfy your claim against us for the owners; property. We will not pay the owners more than their financial interest in the Covered Property. h. We may elect to defend you against suits arising from claims of owners of property. We will do this at our expense. i. We will not be liable for any part of a loss that has been paid or made good by others. 6. Other Insurance a. You may have other insurance subject to the same plan, terms, conditions and provisions as the insurance under this Coverage Part. If you do, we will pay our share of the covered loss or damage. Our share is the proportion that the applicable Limit of Insurance under this Coverage Part bears to the Limits of Insurance of all insurance covering on the same basis. b. If there is other insurance covering the same loss or damage, other than that described in 1. above, we will pay only for the amount of covered loss or damage in excess of the amount due from that other insurance, whether you can collect on it or not. But we will not pay more than the applicable Limit of Insurance. 7. Recovered Property If either you or we recover any property after loss settlement, that party must give CIM 085 (10-07) Page 8 of 8 Copyright 2009, Capitol Transamerica Corporation Includes material copyrighted by ISO, used with permission (a) Owned or controlled by you; or (b) That owns or controls you. This will not restrict your insurance B. General Conditions 1. Concealment, Misrepresentation Or Fraud This Coverage Part is void in any case of fraud, intentional concealment or misrepresentation of a material fact, by you or any other insured, at any time, concerning: a. This Coverage Part; b. The Covered Property; c. Your interest in the Covered Property; or d. A claim under this Coverage Part. 2. Control Of Property Any act or neglect of any person other than you beyond your direction or control will not affect this insurance. The breach of any condition of this Coverage Part at any one or more locations will not affect coverage at any location where, at the time of loss or damage, the breach of condition does not exist. 3. Legal Action Against Us No one may bring a legal action against us under this Coverage Part unless: a. There has been full compliance with all the terms of this Coverage Part; and b. The action is brought within 2 years after you first have knowledge of the direct loss or damage. 4. No Benefit To Bailee No person or organization, other than you, having custody of Covered Property will benefit from this insurance. SECTION V – DEFINITIONS “Pollutants” means any solid, liquid, gaseous or thermal irritant or contaminant, including smoke, vapor, soot, fumes, acids, alkalis, chemicals and waste. Waste includes materials to be recycled, reconditioned or reclaimed. All Other Terms And Conditions Of This Policy Remain Unchanged. DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 BJP 190 (08-14) Page 1 of 1 A Stock Company Capitol Indemnity Corporation P.O. Box 5900 Madison WI 53705-0900 Toll Free (800) 475-4450 BJP 190 01 14 In Witness Whereof, we have caused this policy to be executed and attested, and, if required by state law, this policy shall not be valid unless countersigned by our authorized representative. Secretary President DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 the other prompt notice. At your option, the property will be returned to you. You must then return to us the amount we paid to you for the property. We will pay recovery expenses and the expenses to repair the recovered property, subject to the Limit of Insurance. 8. Reinstatement of Limit After Loss The Limit of Insurance will not be reduced by the payment of any claim, except for total loss or damage of a scheduled item, in which event we will refund the unearned premium on that item. 9. Transfer Of Rights Of Recovery Against Others To Us If any person or organization to or for whom we make payment under this Coverage Part has rights to recover damages from another, those rights are transferred to us to the extent of our payment. That person or organization must do everything necessary to secure our rights and must do nothing after loss to impair them. But you may waive your rights against another party in writing: a. Prior to a loss to your Covered Property. b. After a loss to your Covered Property only if, at time of loss, that party is one of the following: (1) Someone insured by this insurance; or (2) A business firm: DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 (3) The Limit of Insurance applicable to the lost or damaged property; (4) The cost to replace the lost or damaged property with other property of comparable material and quality and used for the same purpose; or (5) The amount actually spent that is necessary to repair or replace the lost or damaged property. b. In the event of loss covered by this Coverage Form, at our option, we will either: (1) Pay the value of lost or damaged property; (2) Pay the cost of repairing or replacing the lost or damaged property, subject to c. below; (3) Take all or any part of the property at an agreed or appraised value; or (4) Repair, rebuild or replace the property with other property of like kind and quality, subject to c. below. c. The cost to repair, rebuild or replace does not include the increased cost attributable to enforcement of any ordinance or law regulating the construction, use or repair of any property. DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 possible order for examination. e. At our request, give us complete inventories of the damaged and undamaged property. Include quantities, costs, values and amount of loss claimed. f. As often as may be reasonably required, permit us to inspect the property proving the loss and examine your books and records. g. Permit us to take samples of damaged and undamaged property for inspection, testing and analysis, and permit us to make copies from your books and records. h. Send us a signed, sworn proof of loss containing the information we request to investigate the claim. You must do this within 60 days after our request. We will supply you with the necessary forms. i. Cooperate with us in the investigation or settlement of the claim. j. We may examine any insured under oath, while not in the presence of any other insured and at such times as may be reasonably required, about any matter relating to this insurance or the claim, including an insured's books and records. In the event of DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 caused by a Covered Cause of Loss as described in this policy and includes all loss or damage from continuous or repeated exposure to the same general harmful conditions. 2. Unless otherwise shown in the Declarations, when more than one Deductible applies to a loss only the highest applicable deductible will be applied. SECTION IV – CONDITIONS A. Loss Conditions 1. Abandonment There can be no abandonment of any property to us. 2. Appraisal If there is disagreement on the value of the property or the amount of loss, either you or we may make written demand for an appraisal of the loss. In this event, each party will select a competent and impartial appraiser. The two appraisers will select an umpire. If they cannot agree, either may request that selection be made by a judge of a court having jurisdiction. The appraisers will state separately the value of the property and amount of loss. If they fail to agree, they will submit their differences to the umpire. A decision agreed to by any two will be binding. Each party will: a. Pay its chosen appraiser; and DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 (4) Water under the ground surface pressing on, or flowing or seeping through: (a) Foundations, walls, floors or paved surfaces; (b) Basements, whether paved or not; or (c) Doors, windows or other openings. But if Water, as described above, results in fire, explosion or sprinkler leakage, we will pay for the loss caused by that fire, explosion or sprinkler leakage. 2. We will not pay for loss caused by or resulting from any of the following: a. Corrosion, rust or decay; b. Dampness or dryness of atmosphere, or extremes of or changes in temperature; c. Delay, loss of use, loss of market, loss of occupancy, interruption of your business, or consequential loss of any kind; d. Dishonest or criminal acts by you, or any of your partners, employees, directors, trustees, authorized representatives, or anyone to whom you entrust property, whether or not acting alone or in collusion with others or occurring during the hours of employment. DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 Coverage Form. C. Exclusions 1. We will not pay for loss or damage caused directly or indirectly by any of the following. Such loss or damage is excluded regardless of any other cause or event that contributes concurrently or in any sequence to the loss. a. Earth Movement (1) Any earth movement (other than sinkhole collapse), such as an earthquake, landslide, mine subsidence or earth sinking, rising or shifting. But if loss by fire or explosion results, we will pay for that resulting loss. (2) Volcanic eruption, explosion or effusion. But if loss by fire results, we will pay for that resulting loss. b. Fungus, Wet Rot, Dry Rot And Bacteria Presence, growth, proliferation, spread or any activity of Fungus, wet or dry rot or bacteria. This exclusion does not apply when Fungus, wet or dry rot or bacteria results from fire or lightning. But we will pay for loss if Fungus, wet DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 h. Property you own or borrow that is leased or rented to others; i. Property that you lease, rent or borrow from others unless you are legally liable for that property; j. Property that you are building or installing; k. Property more than 10 feet underground, except while in transit on public or private roads; l. Property while waterborne, except while in transit. However, while waterborne Covered Property does include: (1) Sailboats 26’ in length and smaller; DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 Limit: $ 600 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 74 Covered Property: 6 GreatTree "Mohegan" Recurve Bows 48" 5-RH 1-LH Description: , 6 GreatTree "Mohegan" Recurve Bows 48" 5-RH 1-LH Limit: $ 600 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 75 Covered Property: 2 Intermature "bullseye" Recurve bow 62" 1-RH 1- LH Description: , 2 Intermature "bullseye" Recurve bow 62" 1-RH 1-LH Limit: $ 220 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 76 Covered Property: Internature "Warrior" Recurve Bow 48" 1-LH Description: , Internature "Warrior" Recurve Bow 48" 1-LH Limit: $ 100 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 77 Covered Property: 2 Bear Recurve Bows 60" 2-RH Description: , 2 Bear Recurve Bows 60" 2-RH Limit: $ 220 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 78 Covered Property: 2 JoJan Fletching jigs 6-arrow Description: , 2 JoJan Fletching jigs 6- arrow Limit: $ 240 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 79 Covered Property: 30 unknown brand armguards Description: , 30 unknown brand armguards Limit: $ 210 DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 64 Covered Property: target trailer with target stands Description: , target trailer with target stands Limit: $ 3,550 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 65 Covered Property: Numbered target stakes for traditional and sighted bows Description: , Numbered target stakes for traditional and sighted bows Limit: $ 300 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 66 Covered Property: Bailing machine Description: , Bailing machine Limit: $ 929 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 67 Covered Property: Hand tools Description: , Hand tools Limit: $ 200 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 68 Covered Property: 2 gas weedwackers Description: , 2 gas weedwackers Limit: $ 150 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 69 Covered Property: 3 lawnmowers Description: , 3 lawnmowers Limit: $ 450 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 70 Covered Property: 18 Mathews "Genesis" Compound Bows 13-RH 5- Description: , 18 Mathews "Genesis" Compound Bows 13-RH 5-LH Limit: $ 2,700 DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 54 Covered Property: 2 Caribou inserts Description: , 2 Caribou inserts Limit: $ 362 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 55 Covered Property: 5 Dahl sheep inserts Description: , 5 Dahl sheep inserts Limit: $ 430 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 56 Covered Property: 2 Javelina/pecary inserts Description: , 2 Javelina/pecary inserts Limit: $ 90 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 57 Covered Property: 2 Fallow deer inserts Description: , 2 Fallow deer inserts Limit: $ 148 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 58 Covered Property: Catalina insert Description: , Catalina insert Limit: $ 61 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 59 Covered Property: Baboon insert Description: , Baboon insert Limit: $ 45 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 60 Covered Property: 2 stegasaurus inserts Description: , 2 stegasaurus inserts Limit: $ 96 DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 44 Covered Property: Buck deer (800) Mule & WT Description: , Buck deer (800) Mule & WT Limit: $ 553 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 45 Covered Property: Spike buck inserts Description: , Spike buck inserts Limit: $ 56 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 46 Covered Property: 4 Black bear inserts Description: , 4 Black bear inserts Limit: $ 136 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 47 Covered Property: 1 Cinamon bear insert Description: , 1 Cinamon bear insert Limit: $ 90 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 48 Covered Property: 2 Razorback inserts Description: , 2 Razorback inserts Limit: $ 148 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 49 Covered Property: 2 standing cinamon bear Description: , 2 standing cinamon bear Limit: $ 180 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 50 Covered Property: 2 Cougar inserts Description: , 2 Cougar inserts Limit: $ 148 DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 34 Covered Property: Giant mule deer buck Rinehart target Description: , Giant mule deer buck Rinehart target Limit: $ 515 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 35 Covered Property: Standing elk Rinehart target Description: , Standing elk Rinehart target Limit: $ 1,095 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 36 Covered Property: Standing caribou Rinehart target Description: , Standing caribou Rinehart target Limit: $ 990 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 37 Covered Property: Javelina Rinehart target Description: , Javelina Rinehart target Limit: $ 150 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 38 Covered Property: 2 Standing elk inserts Description: , 2 Standing elk inserts Limit: $ 362 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 39 Covered Property: 2 Bedded elk inserts Description: , 2 Bedded elk inserts Limit: $ 410 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 40 Covered Property: Mountain goat insert Description: , Mountain goat insert Limit: $ 101 DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 24 Covered Property: Strutting turkey Rinehart target Description: , Strutting turkey Rinehart target Limit: $ 350 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 25 Covered Property: Snarling wolf Rinehart target Description: , Snarling wolf Rinehart target Limit: $ 395 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 26 Covered Property: Razorback Rinehart target Description: , Razorback Rinehart target Limit: $ 310 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 27 Covered Property: Bedded dahl sheep Rinehart target Description: , Bedded dahl sheep Rinehart target Limit: $ 425 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 28 Covered Property: Swiping cougar Rinehart target Description: , Swiping cougar Rinehart target Limit: $ 360 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 29 Covered Property: Walking black bear Rinehart target Description: , Walking black bear Rinehart target Limit: $ 395 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 30 Covered Property: Standing pronghorn Rinehart target Description: , Standing pronghorn Rinehart target Limit: $ 375 DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 14 Covered Property: Jackalope Rinehart target Description: , Jackalope Rinehart target Limit: $ 189 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 15 Covered Property: Carp Rinehart target Description: , Carp Rinehart target Limit: $ 160 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 16 Covered Property: Fallow deer Rinehart target Description: , Fallow deer Rinehart target Limit: $ 325 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 17 Covered Property: Green frog Rinehart target Description: , Green frog Rinehart target Limit: $ 149 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 18 Covered Property: Standing bear Rinehart target Description: , Standing bear Rinehart target Limit: $ 550 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 19 Covered Property: 2 10pt standing deer Rinehart target Description: , 2 10pt standing deer Rinehart target Limit: $ 980 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 20 Covered Property: 30 pt standing deer Rinehart target Description: , 30 pt standing deer Rinehart target Limit: $ 515 DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 Description: , Armadillo McKenzie target Limit: $ 140 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 5 Covered Property: 2 Big horn sheep McKenzie targets Description: , 2 Big horn sheep McKenzie targets Limit: $ 1,100 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 6 Covered Property: Wolf McKenzie target Description: , Wolf McKenzie target Limit: $ 360 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 7 Covered Property: Coyote McKenzie target Description: , Coyote McKenzie target Limit: $ 350 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 8 Covered Property: Lion McKenzie target Description: , Lion McKenzie target Limit: $ 980 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 9 Covered Property: Caribou McKenzie target Description: , Caribou McKenzie target Limit: $ 1,160 Deductible: $ 500 Coinsurance: 100 % Cause of Loss: Special Valuation: RCV Debris Removal: 5,000 Rental Expense: $ 250 per day / $ 2,500 maximum Item Number: 10 Covered Property: Buffalo McKenzie target Description: , Buffalo McKenzie target Limit: $ 1,600 DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 dust”, by any insured or by any person or entity whether it was done knowingly or unknowingly or by accident. D. The following definitions are added to the DEFINITIONS Section: 1. “Asbestos” means naturally occurring hydrated fibrous mineral silicates that possess a unique crystalline structure and are incombustible in air, including chrysotile, amosite, crocidolite, tremolite, anthophylite, acinolite, and any material which contains “asbestos” 2. “Asbestos-related dust,” means a mixture or combination of “asbestos” and other dust or particles. All Other Terms And Conditions Of This Policy Remain Unchanged. DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 C. The following definition is added to the Definitions Section: "Fungi" means any type or form of fungus, including mold or mildew and any mycotoxins, spores, scents or byproducts produced or released by fungi. DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 (i) Less than 26 feet long; and (ii) Not being used to carry persons or property for a charge; (c) Parking an "auto" on, or on the ways next to, premises you own or rent, provided the "auto" is not owned by or rented or loaned to you or the insured; (d) Liability assumed under any "insured contract" for the ownership, maintenance or use of aircraft or watercraft; or DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 processing methods, customer lists, financial information, credit card information, health information or any other type of nonpublic information. This exclusion applies even if damages are claimed for notification costs, credit monitoring expenses, forensic expenses, public relations expenses or any other loss, cost or expense incurred by you or others arising out of any access to or disclosure of any person's or organization's confidential or personal information. DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 employment, during employment or after employment of that person; (2) Whether the insured may be liable as an employer or in any other capacity; and (3) To any obligation to share damages with or repay someone else who must pay damages because of the injury. DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 b. Includes: (1) Warranties or representations made at any time with respect to the fitness, quality, durability, performance or use of "your work"; and (2) The providing of or failure to provide warnings or instructions. DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 possession; or (2) Work that has not yet been completed or abandoned. However, "your work" will be deemed completed at the earliest of the following times: (a) When all of the work called for in your contract has been completed. (b) When all of the work to be done at the job site has been completed if your contract calls for work at more than one job site. (c) When that part of the work done at a job site has been put to its intended use by any person or organization other than another contractor or subcontractor working on the same project. Work that may need service, maintenance, correction, repair or replacement, but which is otherwise complete, will be treated as completed. b. Does not include "bodily injury" or "property damage" arising out of: (1) The transportation of property, unless the injury or damage arises out of a condition in or on a vehicle not owned or operated by you, and that condition was created by the "loading or unloading" of that vehicle by any insured; (2) The existence of tools, uninstalled equipment or abandoned or unused materials; or (3) Products or operations for which the classification, listed in the Declarations or in a policy Schedule, states that products- completed operations are subject to the General Aggregate Limit. 17."Property damage" means: a. Physical injury to tangible property, including all resulting loss of use of that property. All such loss of use shall be deemed to occur at the time of the physical injury that caused it; or b. Loss of use of tangible property that is not physically injured. All such loss of use shall be deemed to occur at the time of the "occurrence" that caused it. For the purposes of this insurance, electronic data is not tangible property. DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 a. After it is moved from the place where it is accepted for movement into or onto an aircraft, watercraft or "auto"; b. While it is in or on an aircraft, watercraft or "auto"; or c. While it is being moved from an aircraft, watercraft or "auto" to the place where it is finally delivered; but "loading or unloading" does not include the movement of property by means of a mechanical device, other than a hand truck, that is not attached to the aircraft, watercraft or "auto". 12."Mobile equipment" means any of the following types of land vehicles, including any attached machinery or equipment: a. Bulldozers, farm machinery, forklifts and other vehicles designed for use principally off public roads; b. Vehicles maintained for use solely on or next to premises you own or rent; c. Vehicles that travel on crawler treads; d. Vehicles, whether self-propelled or not, maintained primarily to provide mobility to permanently mounted: (1) Power cranes, shovels, loaders, diggers or drills; or (2) Road construction or resurfacing equipment such as graders, scrapers or rollers; e. Vehicles not described in Paragraph a., b., c. or d. above that are not self-propelled and are maintained primarily to provide mobility to permanently attached equipment of the following types: (1) Air compressors, pumps and generators, including spraying, welding, building cleaning, geophysical exploration, lighting and well servicing equipment; or (2) Cherry pickers and similar devices used to raise or lower workers; f. Vehicles not described in Paragraph a., b., c. or d. above maintained primarily for purposes other than the transportation of persons or cargo. DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 territories and possessions), Puerto Rico and Canada; b. International waters or airspace, but only if the injury or damage occurs in the course of travel or transportation between any places included in Paragraph a. above; or c. All other parts of the world if the injury or damage arises out of: (1) Goods or products made or sold by you in the territory described in Paragraph a. above; (2) The activities of a person whose home is in the territory described in Paragraph a. above, but is away for a short time on your business; or (3) "Personal and advertising injury" offenses that take place through the Internet or similar electronic means of communication; provided the insured's responsibility to pay damages is determined in a "suit" on the merits, in the territory described in Paragraph a. above or in a settlement we agree to. 5. "Employee" includes a "leased worker". "Employee" does not include a "temporary worker". 6. "Executive officer" means a person holding any of the officer positions created by your charter, constitution, bylaws or any other similar governing document. 7. "Hostile fire" means one which becomes uncontrollable or breaks out from where it was intended to be. 8. "Impaired property" means tangible property, other than "your product" or "your work", that cannot be used or is less useful because: a. It incorporates "your product" or "your work" that is known or thought to be defective, deficient, inadequate or dangerous; or b. You have failed to fulfill the terms of a contract or agreement; if such property can be restored to use by the repair, replacement, adjustment or removal of "your product" or "your work" or your fulfilling the terms of the contract or agreement. DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 (b) The total of all deductible and self- insured amounts under all that other insurance. (4) We will share the remaining loss, if any, with any other insurance that is not described in this Excess Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this Coverage Part. c. Method Of Sharing If all of the other insurance permits contribution by equal shares, we will follow this method also. Under this approach each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. If any of the other insurance does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. 5. Premium Audit a. We will compute all premiums for this Coverage Part in accordance with our rules and rates. b. Premium shown in this Coverage Part as advance premium is a deposit premium only. At the close of each audit period we will compute the earned premium for that period and send notice to the first Named Insured. The due date for audit and retrospective premiums is the date shown as the due date on the bill. If the sum of the advance and audit premiums paid for the policy period is greater than the earned premium, we will return the excess to the first Named Insured. c. The first Named Insured must keep records of the information we need for premium computation, and send us copies at such times as we may request. 6. Representations By accepting this policy, you agree: a. The statements in the Declarations are accurate and complete; DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 claim or "suit" and the date received; and (2) Notify us as soon as practicable. You must see to it that we receive written notice of the claim or "suit" as soon as practicable. c. You and any other involved insured must: (1) Immediately send us copies of any demands, notices, summonses or legal papers received in connection with the claim or "suit"; (2) Authorize us to obtain records and other information; (3) Cooperate with us in the investigation or settlement of the claim or defense against the "suit"; and (4) Assist us, upon our request, in the enforcement of any right against any person or organization which may be liable to the insured because of injury or damage to which this insurance may also apply. d. No insured will, except at that insured's own cost, voluntarily make a payment, assume any obligation, or incur any expense, other than for first aid, without our consent. 3. Legal Action Against Us No person or organization has a right under this Coverage Part: a. To join us as a party or otherwise bring us into a "suit" asking for damages from an insured; or b. To sue us on this Coverage Part unless all of its terms have been fully complied with. A person or organization may sue us to recover on an agreed settlement or on a final judgment against an insured; but we will not be liable for damages that are not payable under the terms of this Coverage Part or that are in excess of the applicable limit of insurance. An agreed settlement means a settlement and release of liability signed by us, the insured and the claimant or the claimant's legal representative. DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 representative will have all your rights and duties under this Coverage Part. 3. Any organization you newly acquire or form, other than a partnership, joint venture or limited liability company, and over which you maintain ownership or majority interest, will qualify as a Named Insured if there is no other similar insurance available to that organization. However: a. Coverage under this provision is afforded only until the 90th day after you acquire or form the organization or the end of the policy period, whichever is earlier; b. Coverage A does not apply to "bodily injury" or "property damage" that occurred before you acquired or formed the organization; and c. Coverage B does not apply to "personal and advertising injury" arising out of an offense committed before you acquired or formed the organization. No person or organization is an insured with respect to the conduct of any current or past partnership, joint venture or limited liability company that is not shown as a Named Insured in the Declarations. SECTION III – LIMITS OF INSURANCE 1. The Limits of Insurance shown in the Declarations and the rules below fix the most we will pay regardless of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits". 2. The General Aggregate Limit is the most we will pay for the sum of: a. Medical expenses under Coverage C; b. Damages under Coverage A, except damages because of "bodily injury" or "property damage" included in the "products-completed operations hazard"; and c. Damages under Coverage B. DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 and "property damage" and will not reduce the limits of insurance. Our obligation to defend an insured's indemnitee and to pay for attorneys' fees and necessary litigation expenses as Supplementary Payments ends when we have used up the applicable limit of insurance in the payment of judgments or settlements or the conditions set forth above, or the terms of the agreement described in Paragraph f. above, are no longer met. SECTION II – WHO IS AN INSURED 1. If you are designated in the Declarations as: a. An individual, you and your spouse are insureds, but only with respect to the conduct of a business of which you are the sole owner. b. A partnership or joint venture, you are an insured. Your members, your partners, and their spouses are also insureds, but only with respect to the conduct of your business. c. A limited liability company, you are an insured. Your members are also insureds, but only with respect to the conduct of your business. Your managers are insureds, but only with respect to their duties as your managers. d. An organization other than a partnership, joint venture or limited liability company, you are an insured. Your "executive officers" and directors are insureds, but only with respect to their duties as your officers or directors. Your stockholders are also insureds, but only with respect to their liability as stockholders. e. A trust, you are an insured. Your trustees are also insureds, but only with respect to their duties as trustees. DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 investigate or settle, or any "suit" against an insured we defend: a. All expenses we incur. b. Up to $250 for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these bonds. c. The cost of bonds to release attachments, but only for bond amounts within the applicable limit of insurance. We do not have to furnish these bonds. d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or "suit", including actual loss of earnings up to $250 a day because of time off from work. e. All court costs taxed against the insured in the "suit". However, these payments do not include attorneys' fees or attorneys' expenses taxed against the insured. f. Prejudgment interest awarded against the insured on that part of the judgment we pay. If we make an offer to pay the applicable limit of insurance, we will not pay any prejudgment interest based on that period of time after the offer. DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 because of testing for, monitoring, cleaning up, removing, containing, treating, detoxifying or neutralizing, or in any way responding to, or assessing the effects of, "pollutants". o. War "Personal and advertising injury", however caused, arising, directly or indirectly, out of: (1) War, including undeclared or civil war; (2) Warlike action by a military force, including action in hindering or defending against an actual or expected attack, by any government, sovereign or other authority using military personnel or other agents; or (3) Insurrection, rebellion, revolution, usurped power, or action taken by governmental authority in hindering or defending against any of these. p. Recording And Distribution Of Material Or Information In Violation Of Law "Personal and advertising injury" arising directly or indirectly out of any action or omission that violates or is alleged to violate: (1) The Telephone Consumer Protection Act (TCPA), including any amendment of or addition to such law; (2) The CAN-SPAM Act of 2003, including any amendment of or addition to such law; (3) The Fair Credit Reporting Act (FCRA), and any amendment of or addition to such law, including the Fair and Accurate Credit Transactions Act (FACTA); or (4) Any federal, state or local statute, ordinance or regulation, other than the TCPA, CAN-SPAM Act of 2003 or FCRA and their amendments and additions, that addresses, prohibits, or limits the printing, dissemination, disposal, collecting, recording, sending, transmitting, communicating or distribution of material or information. DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 material, if done by or at the direction of the insured with knowledge of its falsity. c. Material Published Prior To Policy Period "Personal and advertising injury" arising out of oral or written publication, in any manner, of material whose first publication took place before the beginning of the policy period. d. Criminal Acts "Personal and advertising injury" arising out of a criminal act committed by or at the direction of the insured. e. Contractual Liability "Personal and advertising injury" for which the insured has assumed liability in a contract or agreement. This exclusion does not apply to liability for damages that the insured would have in the absence of the contract or agreement. f. Breach Of Contract "Personal and advertising injury" arising out of a breach of contract, except an implied contract to use another's advertising idea in your "advertisement". g. Quality Or Performance Of Goods – Failure To Conform To Statements "Personal and advertising injury" arising out of the failure of goods, products or services to conform with any statement of quality or performance made in your "advertisement". h. Wrong Description Of Prices "Personal and advertising injury" arising out of the wrong description of the price of goods, products or services stated in your "advertisement". DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 expense incurred by you or others for the loss of use, withdrawal, recall, inspection, repair, replacement, adjustment, removal or disposal of: (1) "Your product"; (2) "Your work"; or (3) "Impaired property"; if such product, work, or property is withdrawn or recalled from the market or from use by any person or organization because of a known or suspected defect, deficiency, inadequacy or dangerous condition in it. o. Personal And Advertising Injury "Bodily injury" arising out of "personal and advertising injury". p. Electronic Data Damages arising out of the loss of, loss of use of, damage to, corruption of, inability to access, or inability to manipulate electronic data. However, this exclusion does not apply to liability for damages because of "bodily injury". As used in this exclusion, electronic data means information, facts or programs stored as or on, created or used on, or transmitted to or from computer software, including systems and applications software, hard or floppy disks, CD- ROMs, tapes, drives, cells, data processing devices or any other media which are used with electronically controlled equipment. q. Recording And Distribution Of Material Or Information In Violation Of Law "Bodily injury" or "property damage" arising directly or indirectly out of any action or omission that violates or is alleged to violate: (1) The Telephone Consumer Protection Act (TCPA), including any amendment of or addition to such law; (2) The CAN-SPAM Act of 2003, including any amendment of or addition to such law; (3) The Fair Credit Reporting Act (FCRA), and any amendment of or addition to such law, including the Fair and Accurate Credit Transactions Act (FACTA); or DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 were not subject to a compulsory or financial responsibility law or other motor vehicle insurance law where it is licensed or principally garaged; or (b) The operation of any of the machinery or equipment listed in Paragraph f.(2) or f.(3) of the definition of "mobile equipment". h. Mobile Equipment "Bodily injury" or "property damage" arising out of: (1) The transportation of "mobile equipment" by an "auto" owned or operated by or rented or loaned to any insured; or (2) The use of "mobile equipment" in, or while in practice for, or while being prepared for, any prearranged racing, speed, demolition, or stunting activity. i. War "Bodily injury" or "property damage", however caused, arising, directly or indirectly, out of: (1) War, including undeclared or civil war; (2) Warlike action by a military force, including action in hindering or defending against an actual or expected attack, by any government, sovereign or other authority using military personnel or other agents; or (3) Insurrection, rebellion, revolution, usurped power, or action taken by governmental authority in hindering or defending against any of these. j. Damage To Property "Property damage" to: (1) Property you own, rent, or occupy, including any costs or expenses incurred by you, or any other person, organization or entity, for repair, replacement, enhancement, restoration or maintenance of such property for any reason, including prevention of injury to a person or damage to another's property; (2) Premises you sell, give away or abandon, if the "property damage" arises out of any part of those premises; (3) Property loaned to you; DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 lubricants or other operating fluids which are needed to perform the normal electrical, hydraulic or mechanical functions necessary for the operation of "mobile equipment" or its parts, if such fuels, lubricants or other operating fluids escape from a vehicle part designed to hold, store or receive them. This exception does not apply if the "bodily injury" or "property damage" arises out of the intentional discharge, dispersal or release of the fuels, lubricants or other operating fluids, or if such fuels, lubricants or other operating fluids are brought on or to the premises, site or location with the intent that they be discharged, dispersed or released as part of the operations being performed by such insured, contractor or subcontractor; (ii) "Bodily injury" or "property damage" sustained within a building and caused by the release of gases, fumes or vapors from materials brought into that building in connection with operations being performed by you or on your behalf by a contractor or subcontractor; or (iii) "Bodily injury" or "property damage" arising out of heat, smoke or fumes from a "hostile fire". (e) At or from any premises, site or location on which any insured or any contractors or subcontractors working directly or indirectly on any insured's behalf are performing operations if the operations are to test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of, "pollutants". DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 injury" or "property damage", involved that which is described in Paragraph (1), (2) or (3) above. However, this exclusion applies only if you are in the business of manufacturing, distributing, selling, serving or furnishing alcoholic beverages. For the purposes of this exclusion, permitting a person to bring alcoholic beverages on your premises, for consumption on your premises, whether or not a fee is charged or a license is required for such activity, is not by itself considered the business of selling, serving or furnishing alcoholic beverages. d. Workers' Compensation And Similar Laws Any obligation of the insured under a workers' compensation, disability benefits or unemployment compensation law or any similar law. e. Employer's Liability "Bodily injury" to: (1) An "employee" of the insured arising out of and in the course of: (a) Employment by the insured; or (b) Performing duties related to the conduct of the insured's business; or (2) The spouse, child, parent, brother or sister of that "employee" as a consequence of Paragraph (1) above. This exclusion applies whether the insured may be liable as an employer or in any other capacity and to any obligation to share damages with or repay someone else who must pay damages because of the injury. This exclusion does not apply to liability assumed by the insured under an "insured contract". DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 in whole or in part. If such a listed insured or authorized "employee" knew, prior to the policy period, that the "bodily injury" or "property damage" occurred, then any continuation, change or resumption of such "bodily injury" or "property damage" during or after the policy period will be deemed to have been known prior to the policy period. c. "Bodily injury" or "property damage" which occurs during the policy period and was not, prior to the policy period, known to have occurred by any insured listed under Paragraph 1. of Section II – Who Is An Insured or any "employee" authorized by you to give or receive notice of an "occurrence" or claim, includes any continuation, change or resumption of that "bodily injury" or "property damage" after the end of the policy period. d. "Bodily injury" or "property damage" will be deemed to have been known to have occurred at the earliest time when any insured listed under Paragraph 1. of Section II – Who Is An Insured or any "employee" authorized by you to give or receive notice of an "occurrence" or claim: (1) Reports all, or any part, of the "bodily injury" or "property damage" to us or any other insurer; (2) Receives a written or verbal demand or claim for damages because of the "bodily injury" or "property damage"; or (3) Becomes aware by any other means that "bodily injury" or "property damage" has occurred or has begun to occur. e. Damages because of "bodily injury" include damages claimed by any person or organization for care, loss of services or death resulting at any time from the "bodily injury". DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 of an "insured"; or (3) The "bodily injury" or "property damage" arises out of the furnishing by an "insured" of services, materials, parts or equipment in connection with the planning, construction, maintenance, operation or use of any "nu- clear facility", but if such facility is located within the United States of America, its terri- tories or possessions or Canada, this ex- clusion (3) applies only to "property dam- age" to such "nuclear facility" and any property thereat. 2. As used in this endorsement: "Hazardous properties" includes radioactive, toxic or explosive properties. "Nuclear material" means "source material", "spe- cial General Liability nuclear material" or "by-product material". Commercial Auto Farm Umbrella Liability (Ed. 9-08) DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 elevator collision, or Covered Cause of Loss. C. We will not pay for repair, replacement or modification of any items in Paragraphs A.1.a. and A.1.b. of this endorsement to correct any deficiencies or change any features. DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 materials are released, and it appears that one purpose of the "terrorism" was to release such materials; or 5. The total of insured damage to all types of property exceeds $25,000,000. In determining whether the $25,000,000 threshold is exceeded, we will include all insured damage sustained by property of all persons and entities affected by the "terrorism" and business interruption losses sustained by owners or occupants of the damaged property. For the purpose of this provision, insured damage means damage that is covered by any insurance plus damage that would be covered by any insurance but for the application of any terrorism exclusions; or 6. Fifty or more persons sustain death or serious physical injury. For the purposes of this provision, serious physical injury means: a. Physical injury that involves a substantial risk of death; or b. Protracted and obvious physical disfigurement; or c. Protracted loss of or impairment of the function of a bodily member or organ. Multiple incidents of "terrorism" which occur within a 72-hour period and appear to be carried out in concert or to have a related purpose or common leadership will be deemed to be one incident, for the purpose of determining whether the thresholds in Paragraphs C.5. or C.6. are exceeded. With respect to this Exclusion, Paragraphs C.5. and C.6. describe the threshold used to measure the magnitude of an incident of "terrorism" and the circumstances in which the threshold will apply, for the purpose of determining whether this Exclusion will apply to that incident. When the Exclusion applies to an incident of "terrorism", there is no coverage under this Coverage Part or Policy. The terms and limitations of any terrorism exclusion, or the inapplicability or omission of a terrorism exclusion, do not serve to create coverage for injury or damage that is otherwise excluded under this Coverage Part. DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 and/or "other acts of terrorism", but only with respect to an incident(s) of terrorism (however defined) which results in injury or damage that occurs on or after the date when the provisions of this endorsement become applicable (for claims made policies, such an endorsement is superseded only with respect to an incident of terrorism (however defined) that results in a claim for injury or damage first being made on or after the date when the provisions of this endorsement become applicable); and b. Remain applicable unless we notify you of changes in these provisions, in response to federal law. 3. If the provisions of this endorsement do NOT become applicable, any terrorism endorsement already endorsed to this policy, that addresses "certified acts of terrorism" and/or "other acts of terrorism", will continue in effect unless we notify you of changes to that endorsement in response to federal law. DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 the War And Military Action Exclusion. DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 2. When one or both of the following applies: a. The effect is to intimidate or coerce a government or the civilian population or any segment thereof, or to disrupt any segment of the economy; or b. It appears that the intent is to intimidate or coerce a government, or to further political, ideological, religious, social or economic objectives or to express (or express opposition to) a philosophy or ideology. C. The following exclusion is added: EXCLUSION OF TERRORISM We will not pay for loss or damage caused directly or indirectly by "terrorism", including action in hindering or defending against an actual or expected incident of "terrorism". Such loss or damage is excluded regardless of any other cause or event that contributes concurrently or in any sequence to the loss. But this exclusion applies only when one or more of the following are attributed to an incident of "terrorism": 1. The "terrorism" is carried out by means of the dispersal or application of radioactive material, or through the use of a nuclear weapon or device that involves or produces a nuclear reaction, nuclear radiation or radioactive contamination; or 2. Radioactive material is released, and it appears that one purpose of the "terrorism" was to release such material; or 3. The "terrorism" is carried out by means of the dispersal or application of pathogenic or poisonous biological or chemical materials; or 4. Pathogenic or poisonous biological or chemical materials are released, and it appears that one purpose of the "terrorism" was to release such materials; or DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 b. Comply with laws, regulations, codes or standards. 3. Paragraphs 1. and 2. of this condition apply not only to us, but also to any rating, advisory, rate service or similar organization which makes insurance inspections, surveys, reports or recommendations. 4. Paragraph 2. of this condition does not apply to any inspections, surveys, reports or recom- mendations we may make relative to certifica- tion, under state or municipal statutes, ordi- nances or regulations, of boilers, pressure ves- sels or elevators. E. Premiums The first Named Insured shown in the Declara- tions: 1. Is responsible for the payment of all premiums; and 2. Will be the payee for any return premiums we pay. F. Transfer Of Your Rights And Duties Under This Policy Your rights and duties under this policy may not be transferred without our written consent except in the case of death of an individual named insured. If you die, your rights and duties will be trans- ferred to your legal representative but only while acting within the scope of duties as your legal rep- resentative. Until your legal representative is ap- pointed, anyone having proper temporary custody of your property will have your rights and duties Farm Umbrella Liability but only with respect to that property. Commercial Auto Crime and Fidelity General Liability Commercial Property Commercial Umbrella Equipment Breakdown Commercial Inland Marine Employment-Related Practices (Ed. 11-98) DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 provision to the contrary: NONRENEWAL If we decide not to renew this policy, we will mail through first-class mail to the first Named Insured shown in the Declarations written notice of the nonrenewal at least 45 days before the expiration date, or its anniversary date if it is a policy written for a term of more than one year or with no fixed expiration date. If notice is mailed, proof of mailing will be sufficient proof of notice. DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1 PROPERTY DAMAGE $ $ $ $ THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSD ADDL WVD SUBR N / A $ $ (Ea accident) (Per accident) OTHER: THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: INSURED PHONE (A/C, No, Ext): PRODUCER ADDRESS: E-MAIL FAX (A/C, No): CONTACT NAME: NAIC # INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : INSURER(S) AFFORDING COVERAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INS025 (201401) 6/27/2016 Leavitt Recreation & Hospitality Insurance 942 14th Street Sturgis SD 57785 Kelly Jones (800)525-2060 (866)465-2797 kelly-jones@leavitt.com Fort Collins Archery Associati P.O. Box 270493 Matt Dworak Fort Collins CO 80525 Capitol Indemnity Corporation 10472 CL1662702179 A X CP02250043 7/1/2016 7/1/2017 1,000,000 100,000 5,000 1,000,000 2,000,000 2,000,000 IT IS UNDERSTOOD AND AGREED THAT THE CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED, BUT ONLY WITH RESPECT TO ITS LIABILITY ARISING OUT OF THE ACTIVITIES OF THE NAMED INSURED. Chris Hipple/KEJONE City of Fort Collins P.O. Box 580 413 Bryan Ave. Fort Collins, CO 80521 DocuSign Envelope ID: 11F2D030-F7DD-4D40-8209-9F2BE3F5ECC1