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COMMERCIAL INSURANCE
· A Custom Insurance Policy Prepared for:
CITY OF JEFFERSONVILLE
501 EAST COURT AVE.
JEFFERSONVILLE IN 47130
002361
One Tower Square, Harlford, Connecticut 06183
SEWAGE ~ISPOSAL PLANTS
COMMON ~DLICY DECLARATIONS
ISSUE DATE: 06/i4/02
POLICY NUMBER: BAd-BMG-?91X2292-TIL-02
1. NAMED INSURED AND MAILING ADDRESS:
CITY OF UEFFERSONVILLE
501 EAST COURT AVE.
UEFFERSONVILLE, IN 47120
2. POLICY PERIOD:
3. LOCATIONS
Premises Bldg.
Loc. No. No. Occupancy
ON FILE WITH COMPANY
From 08/06/02 to 08/06/03 12:01 A.M. Standard Time at
your mailing address.
Address
4. COVERAGE PARTS FORMING PART OF THIS POLICY AND INSURING COMPANIES:
BOILER AND MACHINERY COY PART DECLARATIONS BM TO 01 08 96 TIL
NUMBERS OF FORMS AND ENDORSEMENTS
FORMING A PART OF THIS POLICY: SEE IL'T8 01 10 93
SUPPLEMENTAL POLICIES: Each of the follqwing is a separate policy
containing its complete provisions:
Policy Policy No. Insuring Company
PREMIUM SUMMARY:
Provisional Premium $ 7,595
Due at Inception $ 7,595
Due at Each $
NAME AND ADDRESS OF AGENT OR BROKER:
KENRICK & ASSOCS INC (NT669)
1700 OPDYKE COURT
AUBURN HILLS, MI 48326
IL TO 02 11 89 PAGE 1 OF I
OFFICE: SOUTHFIELD
002362
POLICY NUMBER:
EFFECTIVE DATE
ISSUE DATE:
BAd-BMG-791 X2292-TI L-02
08-06-02
06-1 4-02
LISTING OF FORMS, ENDORSEMENTS AND SCHEDULE NUMBERS
THIS LISTING SHOWS THE NUMBER DF FORMS, SCHEDULES AND ENDORSEMENTS
BY LINE OF BUSINESS.
IL TO 02 11 89
IL T8 01 10 93
COMMON POLICY DECLARATIONS
FORMS, ENDORSEMENTS AND SCHEDULE NUMBERS
m
mm
m
m
mm
o~m
mm
m
m
BOILER AND MACHINERY
BM Ti 10 12 94
BM AO 15 08 96
PN Ti 89 06 99
BM T1 52 Ol 94
BM TI 50 01 93
BM T8 O0
BM T8 01
BM TS 27 08 95
BM TS 52 08 96
BM T3 80 02 O0
BM TB 40 04 91
BM T6 69 08 96
COMMON POLICY CONDITIONS
ENERGY MAX DEC
dURISDICTIONAL INSPECTIONS NOTICE
TABLE OF CONTENTS
COMP EQUIPMENT COVERAGE FORM
GENERAL PURPOSE ENDORSEMENT
GENERAL PURPOSE ENDORSEMENT
RBC EXCLUSION
CLAIM REPORTING
PERILS ELIMINATION ENDORSEMENT
PROPERTY NOT COVERED
SPECIAL LOCATION SCHEDULE
INTERLINE ENDORSEMENTS
IL O1 56 07 89
IL 01 86 07 96
IL 02 72 04 98
IL TS 55 08 98
IN CHANGES CONCEAL MISREPRESENT OR FRAUD
INDIANA CHANGES-RIGHTS OF'RECOVERY
IN CHANGES-CANCELLATION &;NONRENEWAL
EXCL OF CERTAIN COMPUTER ~EL LOSSES
IL T8 O1 i0 93
002363
PAGE:
I OF
BOILER AND MACHINERY
Travele~s?rop~rt~ C~a~
002364
(Each a Stock Insurance Company)
Hartford, CT 06183
BOILER AND MACHINERY
002365
COMMON POLICY CONDITIONS AND COMPANY
STATEMENT
coMpANY STATEMENT
In return for payment of the premium. The Travelers agrees with the Named Insured to provide the insurance
indicated. That insurance will be provided bY the company indicated in the declarations. References in this policy
to "The Travelers," "we," "us," or "our" means the company.
The companies listed below (each a stock company) have executed this policy, but it is valid only if countersigned
by our authorized representative.
The Traveleres Indemnity Company (IND)
The Pheonix Insurance Company (PHX)
The Charter Oak Fire Insurance Company (COF)
Secretary
The Travelers indemnity Company of Illinois (TIL)
The Travelers Indemnity Company of Connecticut (TCT)
The Travelers Indemnity Company of America (TIA)
The Travelers Insurance Company (INS)
Executive Vice President
COMMON POLICY CONDITIONS
A. CANCELLATION
'1. The first Named Insured shown in the Decla-
rations may cancel this policy by mailing or
delivering to us wdtten notice of cancellation
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 can-
cellation if we cancel for nonpayment of
premium; or
b. 30 days before the effective date of can-
cellation if we cancel for any other rea-
son.
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. If the policy is cancelled,
that date will become the end of the policy pe-
dod.
5, If this policy is cancelled, we will send the first
~lamed Insured any premium refund due. If
we cancel, the refund will be pre rata. If the
first Named Insured cancels, the refund may
be less than pro rata. The cancellation will be
effective 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 Declara-
tions 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 as 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 dur-
ing the policy period and up to three years after-
ward.
BM T1 10 '12 94
Includes copyrighted matedal of Insurance ServiceS Office, Inc., with its permission.
Copyright, Insurance Services Office, inc., 1983
Page 1 of 2
BOILER AND MACHINERY
D. INSPECTIONS AND SURVEYS
We have the right but are not obligated to:
1. Make inspections and surveys at any time;
2. Give you reports on the conditions we find;
and
3. Recommend changes.
Any inspections, surveys, reports or recommen-
dations relate only to insurability and the premi-
ums to be charged. We do not make safety in-
spections. We do not undertake 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:
1. Are safe or healthful; or
2. Comply with laws, regulations, codes or stan-
dards.
This condition applies not only to us, but also to
any rating, advisory, rate service or similar or-
ganization which makes insurance inspections,
surveys, reports or recommendations.
E. PREMIUMS
1. The first Named Insured shown in the Decla-
rations:
a. Is responsible for the payment of all pre-
miums; and
b. Will be the payee for any return premiums
we pay.
2. We compute all premiums for this policy in
accordance with our rules, rates, rating plans,
premiums and minimum premiums. The pre-
mium shown in the Declarations was com-
puted based on rates and rules in effect at the
time the policy was issued. On each renewal,
continuation or anniversary of the effective
date of this policy, we will compute the pre-
mium in accordance with our rates and rules
then in effect.
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 in-
sured. If you die, your dghts and duties will be
transferred to your legal representative but only
while acting within the scope of duties as your le-
gal representative. Until your legal representative
is appointed, anyone having proper temporary
custody of your property will have your rights and
duties but only with respect to that property.
Page 2 Of 2
BM T'I '10 '12 94
Includes copyrighted material of InSurance ServiCeS Office, InC.,with its permissiOn.
Copyright, Insurance Services Office, Inc., 1983
002366
One Tower Square, Hartford. Connecticut 06183
BOILER AND MACHINERY
COVERAGE PART DECLARATIONS
POLICY NUMBER: BAd -BMG-791 X2292-TI L-02
ISSUE DATE: 0B-14-02
ENERGYMAX
COMPREHENSIVE EQUIPMENT COVERAGE
EFFECTIVE DATE: Same as policy unless otherwise specified:
COVERAGES, LIMITS OF INSURANCE AND OPTIONS - insurance applies only to a coverage for which a limit
or 'Included is shown.
1. THESE DECLARATIONS APPLY TO ALL LOCATIONS COVERED BY THIS POLICY
EXCEPTIONS:
2. DEFINITION OF "OBJECT":
TNCLUDES PRODUCTION MACHINES
3. COVERAGES AND LIMITS:
COVERAGES
Limit Per Accident:
Expediting Expenses:
Business Income:
Extra Expense:
Spoilage:
Off Premises Service Interruption:
Ammonia Contamination:
Water Damage:
Hazardous Substances:
Ordinance or Law:
'Media":
Brands and Labels:
Newly Acquired Locations:
Error in Description:
LIMITS
40,849,110
100,000
100,000
COMBINED WITH BII
100,000
i 00,000
100,000
t O0 000
100,000
100,000
2,500
25 ,OO0
t 000,000
COI~BI NED WITH/PD
4. DEDUCTIBLES
Damage to Covered Property: $
Business Income: $
Extra Expense: $
Spoilage: $
Off Premises Service Interruption: $
Ammonia Contamination: $
Other Deductibles: $
SEE BM T8 00
SEE BM T8 O0
COMBINED WITH BII
IO % OF LOSS/ 2500 MIN
24 HOURS
COMBINED WITH/PD
SEE BM TB O0 AND BM T3 72
5. OTHER CONDITIONS
Notice of Cancellation: 30
Newly Acquired Locations:
Days
Up to a Maximum of 90 Days
6. NUMBERS OF FORMS, SCHEDULES AND ENDORSEMENTS FORMING PART OF THIS COVERAGE
PART ARE ATTACHED AS A SEPARATE LISTING.
PRODUCER:KENRZCK & ASSOCS [NC
BM TO 01 08 96
Order No. BM A0150896
NT669
OFFICE: SOUTHFIELD
057
NOTICE TO POLICYHOLDERS
JURISDICTIONAL INSPECTIONS
Dear Policyholder;
Many states and some cities issue certificates permitting the continued operation of certain equipment such as
boilers, water heaters, pressure vessels, etc. Periodic inspections are normally required to renew these certifi-
cares. In most jurisdictions, insurance company employees who have been licensed are authorized to perform
these inspections.
If:
· You own or operate equipment that requires a certificate from a state or city to operate legally, and
· We Insure that equipment under this Policy, and
· You would like us to perform the next required inspection;
Then;
Call this toll-free number - 1-800-425-4119
When you call this number, our representative will ask you for the following information!
· Name of your business (as shown on this Policy)
· Policy Number
· Location where the equipment is located. Including Zip Code.
· Person to contact and phone number for scheduling of inspection
· Type of equipment requiring inspection
· Certificate inspection date and cedificate number
Or;
Fill in the form on the reverse side of this notice and fax it to the toll-free number indicated on that form.
Please note the following:
· Your jurisdiction may charge you a fee for renewing a certificate, tt is your responsibility to pay such a fee.
· All the provisions of the INSPECTIONS AND SURVEYS Condition apply to the inspections described in this
notice.
REMINDER
If new equipment is installed or old equipment replaced that requires a jurisdictional inspection please let us
know by calling our toll-free number listed above.
PN T'I 89 06 99 Page 1 of 2
REQUEST FOR JURISDICTIONAL INSPECTION
Name of
Business:
(As Shown on Policy)
Policy
Number:
Location of Equipment:
City State Zip Code
Person to Contact for Scheduling Inspection:
Telephone Number of Person to Contact:
Equipment Type Certificate Number Certificate Expiration Date
Fax Form to 1-877-764-9535
Completed by:
Phone Number:
Page 2 of 2 PN T1 89 06 99
ENERGYMAX
COMPREHENSIVE EQUIPMENT COVERAGE FORM TABLE OF CONTENTS
Declarations and Endorsements that may also be attached to ybur policy are not included in this Table of
Contents.
ITEM PAGE NUMBER
COVERAGE ........................................................................... :..........~..........¢ .......................................................... 1
Oovered Property ............................................................................. : .... 1
Oovered Cause of Loss ....................................... 1
Defense and Supplementary Payments ............................................................................................................................................. 1
COVERAGE EXTENSIONS ............................... 1
Expediting Expenses ............................................................................................................................................................................. i .......... 1
Business Income 1
Extended Business income ......... .............................. 2
Extra Expense ............................................ 2
Spoilage .................................................................................................................................. ................................................................................. 2
Off Premises Service interruption ........................................................................................................................................................... 2
Ammonia Contamination .............................................................................................................................................................................. 3
Water Damage .................................................................................................................................................. 3
Hazardous Substances .......... , ....................... 3
Ordinance or Law (Including Demolition
and Increase Cost of Construction) ....................................................................................................................................................... 3
"Med a" ~ ~ 3
Brands and Labels ...................................... , ............... 3
New y Acquired Locations .................................................................. 3
Error n Description .............................................................. 4
EXCLUSIONS . .......................... 4
Ordinance or Law . 4
Nuclear Hazard 4
War and Military Action ............................................................................................... -~ ..................................................... ,.?..., ..................... 4
Earth Movement 4
Other Exclusions 4
LIMITS OF NSURANOE .................................................................... 5
Limit Per Accident 6
Coverage Extension Limits ....................................................................... 6
DEDUCTIBLE. ............................................................................................................................................................................................................... 6
Damage to Covered Property ................................................................................. : .......................................................... : ................ , ...... 6
Business Income ............................................................................................................. .............................................................................. ..... 6
Extra Expense .................................................................................................................... i ...................................... ' ............................... :'": ....... 6
Spoilage ................................................................................................................................................................................................................... 7
Off Premises Service interruption ..................................................................................................................................................... ,-..- 7
Ammonia Contamination ......................................................................................... .'. ........................................................ , ......................... 7
BM T1 52 01 94
Page 1 of 2
002368
ENERGYMAX
COMPREHENSIVE EQUIPMENT COVERAGE FORM TABLE OF CONTENTS
(Continued)
ITEM
PAGE NUMBER
LOSS COND TIONS .............................................................................................................................................................................................. 7
Abandonment ..................................................................................................................................................................................................... 7
Appraisal ............................................................................................................. 7
Duties in the Event of Loss or Damage ............................................................................................................................................ 7
Reducing Your Loss ...................................................................................................................................................................................... 8
Loss Payment ..................................................................................................................................................................................................... 8
Valuation 8
Spoilage Coverage Valuation 9
"Media" Valuation 9
Business Income Report of Values 9
Business Income Coinsurance 9
Conditional Suspension of Coinsurance 10
Joint Loss .............................................................................................................................................................................................................. 10
ADDITIONAL CONDITIONS 11
Cancellation 11
Concealment, Misrepresentation and Fraud ................................................................................................................................ 11
Legal Action Against Us .............................................................................................................................................................................. 11
Adjustment of Premium .............................................................................................................................................................................. 11
Liberalization 11
Other Insurance ................................................................................................................................................................................................ 11
Policy Period, Coverage Territory ........................................................................................................................................................ 12
Transfer of Rights of Recovery Against Others to Us 12
Additional Insured 12
Bankruptcy ........................................................................................................................................................................................................... 12
Suspension. .......................................................................................................................................................................................................... 12
Mortgage Holders ............................................................................................................................................................................................ 12
DEFINITIONS 13
Page 2 of 2 BM T1 52 01 94
BOILER AND MACHINERY
COMPREHENSIVE EQUIPMENT COVERAGE E ORM
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. The
words "we," "us" and "our" refer to the Company identified on the Declarations which is providing this insurance.
Other words and phrases that appear in quotation marks have special meaning. Refer to Section G-DEFINI-
TIONS.
A. COVERAGE
We will pay for direct damage to Covered (5)
Property caused by a Covered Cause of Loss.
1. CoVered Property
Covered Property, as used in this Coverage
Part, means any property that:
a. You own; or
b. Is in your care, custody or control and (6)
for whiCh you are liable
while at a location described in the Declara-
tions.
2. Covered Cause of Loss
A Covered Cause of Loss is an "accident" to 4.
an "object."
f"~"~' 3. DefenSe and Supplementary Payments
a. If a claim or "suit" is brought against you
alleging that you are liable for damage to
~'~" property of another in your care, custody
~ or control, that was directly caused by
nE an "accident" to an "object," we will
~'~ either:
(1) Settle the claim or "suit," or
oX (2) Defend you against the claim or
"suit" but keep for ourselves the right
to settle it at any point.
o~ b. We will pay, with respect to any claim or
o...,, any "suit" we defend:
~ (1) All expenses we incur;
~ (2) The cost of bonds to release attach-
~.~, mentS. We do not have to furnish
o5 these bonds;
~ (3) All reasonable expenses incurred by
you 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;
(4) All costs taxed against you in any ~ (3)
"suit" we defend;
Pre-judgment interest awarded a-
gainst you on that part of the judg-
ment we pay. If we make an offer to
pay the applicable limits, we will not
pay any pre-judgment interest based
on that period of time after the offer;
and
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 limits.
Coverage Extensions
YOU may extend the insurance provided by
this Coverage Part as follows:
a. Expediting Expenses
With respect to your damaged Covered
Property, we will pay the reasonable
extra cost to:
(1) Make temporary repairs; and
(2) Expedite permanent repairs or re-
placement.
b'. Business Income
(1) We will pay your actual loss of "busi-
ness income" from a total or partial
interruption of business caused sole-
ly by an "accident" to an "object" as
described in (3) below.
(2) We will also pay any necessary ex-
penses you incur to reduce the
amount of loss under this Coverage
Extension. We will pay for such ex-
penses to the extent that they do not
exceed the amount of loss that other-
wise would have been payable under
this Coverage Extension.
The "object'~ must either be Covered
Property or be property of others
BM T1 50 01 93 Page 1 of 15
002369
BOILER AND MACHINERY
that is:
(a) located on or within 500 feet of a
location insured under this Cov-
erage Part; and
(b) Used to supply electrical power,
communications services, air con-
ditioning, heating, gas, water or
steam to the described premises.
(4) The "accident" must occur during the
Policy Period, but expiration of the
policy does not limit our liability
under this coverage.
Extended Business Income
We will pay your actual loss of "business
income'~ from a total or partial interrup-
tion of business caused solely by an "ac-
cident'' to an "object" and incurred
during the period that:
(1) Begins on the date property is ac-
tually repaired, rebuilt or replaced
and operations are resumed; and
(2) Ends on the earlier of:
(a) The date you could restore your
operations with reasonable speed,
to the condition that would have
existed if no direct physical loss or
damage had occurred; or
(b) Unless otherwise stated in the
Declarations, 30 consecutive days
after the date determined in (1)
above.
Extra Expense
(1) We will pay the reasonable "extra ex-
pense'' to operate your business
during a total or partial interruption
of business caused solely by an "ac-
cident'~ to an "object" as described in
(2) below.
(2) The "object" must either be Covered
Property or be property of others
that is:
(a) located on or within 500 feet of a
location insured under this Cov-
erage Part; and
(b) Used to supply electrical power,
communications services, air con-
ditioningl heating, gas, water or
steam to the described premises.
(3) The "accident" must occur during the
Policy Period, but expiration of the
policy does not limit our liability
under this coverage.
e. Spoilage
(1) We will pay for your loss of perish~
able goods due to spoilage resulting
from lack of power, light, heat, steam
or refrigeration caused solely by an
"accident" to an "object" as described
in (3) below.
(2) We will also pay any necessary ex-
penses you incur to reduce the
amount of loss under this Coverage
Extension. We will pay for such ex-
penses to the extent that they do not
exceed the amount of loss that other-
wise would have been payable under
this Coverage Extension.
(3) The "object" must either be Covered
Property or be property of others
that is:
(a) located on or within 500 feet of a
location insured under this Cov-
erage Part; and
(b) Used to supply electrical power,
communications services, air con-
ditioning, heating, gas, water or
steam to the described premises.
(4) The "accident" must occur during the
Policy Period, but expiration of the
policy does not limit our liability
under this coverage.
f. Off Premises Service Interruption
(1) You may extend the insurance
provided by the Coverage Exten-
sions-Business Income, Extra Ex-
pense and Spoilage to loss caused
solely by an "accident" to an "object''
as described in (2) below.
(2) The "object" must be:
(a) Located more than 500 feet from a
location insured under this
Coverage Part; and
(b) Used to supply electrical power,
communications services, air con-
ditioning, heating, gas, water or
steam to the described premises.
(3) The "accident" must occur during the
Page 2 of 15 BM T1 50 01 93
~,"-~.~ Policy Period, but expiration of the
policy does not limit our liability
under this coverage.
g. Ammonia Contamination
We will pay for direct damage to Covered
Property contaminated by ammonia as a
result of an "accident" to an "object."
h. Water Damage
We will pay for direct damage to Covered
Property by water as a result of an "acci-
dent'' to an "object" that is part of an air
conditioning system.
i. Hazardous Substances
We will pay for direct damage to build-
ings and personal property that are
Covered Property and are contaminated
by a Hazardous Substance as a result of
an "accident" to an "object/'
If applicable, we will also pay for loss
under the Coverage Extensions-Busi-
ness Income and Extra Expense caused
by such contamination.
As used above, Hazardous Substance
~ shall mean any substance other than
' ammonia that has been declared to be
hazardous to health by a governmental
*---- agency.
°~--'~ j. Ordinance or Law (Including Demoli-
"'Z tion and Increased Cost of Construc-
t-__. tion)
~'-- The following applies despite the opera-
°~ tion of the Ordinance or Law Exclusion.
If an "accident" to an "object" damages a
__ building that is Covered Property, we will
-- pay:
o~ (1) For loss or damage caused by enfor-
o5 cement of any ordinance or law that:
-- (a) Requires the demolition of parts of
~'---- the same property not damaged
~------ by the "accident";
o~---- (b) Regulates the construction or
o~ repair of buildings, or establishes
.~ zoning or land use requirements
-- at the described premises; and
'--- (c) Is in force at the time of the "acci-
dent.''
r~' (2) The increased cost to repair, rebuild
. or construct the property caused by
BOILER AND MACHINERY
enforcement of building, zoning or
land use ordinance or law. If the
property is repaired or rebuilt, it
must be intended for similar use or
occupancy as the current property,
unless otherwise required by zoning
or land use ordinance or law.
(3) The cost to demolish and clear the
site of undamaged parts of the prop-
erty caused by enforcement of the
building, zoning, or land use ordi-
nance or law.
This extension of coverage does not
apply to any increase in loss due to a
substance declared to be hazardous to
health by a governmental agency.
We will not pay for increased construc-
tion costs until the property is actually
repaired or replaced.
"Media"
We will pay for "media" directly damaged
by an "accident" to an "object."
Brands and Labels
If branded or labeled merchandise that is
Covered Property is damaged by an "ac-
cident'' to an "object," but retains a sal-
vage value, you may, at your expense:
(1) Stamp the word SALVAGE on the
merchandise or its containers if the
stamp will not physically damage the
merchandise; or
{2) Remove the brands or labels, if
doing so will not physically damage
the merchandise. You must m-label
the merchandise or its containers to
comply with the law.
We will pay for any reduction in value of
the salvage merchandise resulting from
either of these two actions.
Newly Acquired Locations
You may extend the insurance provided
by this Coverage Part to a newly ac-
quired location that you have purchased
or leased. This automatic coverage
begins at the time you acquire the
property and is subject to the following
conditions:
(1) You agree to pay an additional
premium as determined by us. Such
BMT1 5001 93 Page 3 of 15
002370
BOILER AND MACHINERY
additional premium will be computed
from the date of acquisition.
(2) Insurance under this Coverage Ex-
tension for each newly acquired
location will end when any of the fol-
lowing first occurs:
(a) This Policy expires;
(b) The number of days specified in
the Declarations for this coverage
expire after you acquire the loca-
tion;
(c) You report the location to us; or
(d)The location is more specifically
insured.
(3) Insurance under this Coverage Part
for such locations will be subject to
the same conditions, exclusions and
limitations as other insured locations.
If deductibles vary by location, the
highest deductibles will apply.
n. Error in Description
We will pay your loss covered by this
Coverage Part if such loss is otherwise
not payable solely because of any unin-
tentional error or omission in the descrip-
tion of a location as insured under this
Coverage Part.
You agree to give us prompt notice of
any correction or addition to the descrip-
tion of a location insured under this
Coverage Part.
B. 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. Ordinance or Law
Any increase in loss caused by or result-
ing from enforcement of any ordinance,
law, regulation, rule or ruling regulating
or restricting repair, replacement, altera-
tion, use, operation, construction or in-
stallation, except as provided under the
Coverage Extensions-Ordinance or Law
(Including Demolition and Increased
Cost of Construction) and Hazardous
Substances.
b. Nuclear Hazard
Loss caused by or resulting from nuclear
reaction or radiation, or radioactive con-
tamination, however caused.
c. War and Military Action
(1) War, including undeclared or civil
war;
(2) Warlike action by a military force, in-
cluding action in hindering or
defending against an actual or ex-
pected attack, by any government,
sovereign or other authority using
military personnel or other agents; or
(3) Insurrection, rebellion, revolution, u-
surped power or action taken by
governmental authority in hindering
or defending against any of these.
d. Earth Movement
Earth movement, including but not
limited to earthquake, mine subsidence,
landslide, mudslide or volcanic eruption.
We will not pay for loss or damage caused
by or resulting from any of the following:
a. An explosion. However, we will pay for
loss Caused by or resulting from an ex-
plosion of an "object" of a kind described
below:
Explosion of any:
(1) Steam boiler;
(2) Electric steam generator;
(3) Steam piping;
(4) Steam turbine;
(5) Steam engine;
(6) Gas turbine; or
(7) Moving or rotating machinery when
such explosion is caused by centri-
fugal force or mechanical break-
down;
b. Fire or explosion that occurs at the same
time as an "accident" or that ensues from
an "accident.'r With respect to any electri-
cai equipment forming a part of an "ob-
ject,'~ this exclusion is changed to read:
Fire or explosion outside the "object" that
occurs at the same time as an "accident"
or ensues from an "accident."
c. Explosion of gas or unconsumed fuel
Page 4 of 15 BM T1 50 01 93
within the furnace of any boiler or fired
vessel or within the gas passages from
that furnace to the atmosphere;
d. An "accident" that is the direct or indirect
result of an explosion or fire;
e. An "accident" that is the direct or indirect
result of the following, if such loss is
covered by another policy of insurance
in force at the time of the loss:
(1) Lightning;
(2) Wind, Hail, Weight of Snow, ice or
Sleet, Riot, Civil Commotion, Van-
dalism, Vehicles, Falling Objects, Air-
craft, Smoke, Collapse, Water
Damage, Rising Water or Flood;
(3) Freeze arising from weather condi-
tions;
f. Water or other means used to extinguish
a fire, even when such an attempt is un-
successful;
g. Lack of power, light, heat, steam or
refrigeration, except as provided in the
Coverage Extensions-Business Income,
Extra Expense, Off Premises Service In-
terruption and Spoilage;
h. Damage to property contaminated by
Ammonia, except as provided in the
Coverage Extension-Ammonia Contam-
ination;
i. Damage to property by water as a result
of an "accident" to an an "object" that is
part of an air conditioning system, ex-
cept as provided in the Coverage Exten-
sion-Water Damage;
j. Loss to "media,'~ however caused, except
as provided in the Coverage Extension-
''Media'';
k. Any of the following tests:
(1) A hydrostatic, pneumatic or gas
pressure test of any boiler, fired yes-
scl or electrical steam generator; or
(2) An insulation breakdown test of any
type of electrical or electronic "ob-
ject."
3. With respect to the Coverage Extensions-
Business Income, Extra Expense and Off
Premises Service Interruption, we will not
pay for:
BOILER AND MACHINERY
a. The interruption of business that would
not or could not have been carried on if
the "accident" had not occurred;
b. Your failure to use due diligence and dis-
patch and all reasonable means to
resume business at the described
premises;
c. That part of any loss or expense that is
due solely to the suspension, lapse or
. cancellation of a contract following an
"accident" extending beyond the time
business could have resumed if the con-
tract had not lapsed, been suspended or
cancelled;
d. Delay in rebuilding, repairing or replac-
ing the property or resuming operations
due to interference at the location of the
rebuilding, repair or replacement by
strikers or other persons;
e. Delay in resuming operations due to the
need to reconstruct or reinput data or
programs on "media"; or
f. Any continuing loss extending beyond
the date the damaged property is
repaired or replaced, except as provided
in the Coverage Extension-Extended
Business Income.
4. With respect to the Coverage Extension-
Spoilage, we will not pay for loss or damage
as a result of your failure to use all
reasonable means to protect the perishable
goods from damage following an "accident."
5. With respect to the Coverage Extension-Off
P~'emises Service Interruption, we will not
pay for loss caused by or resulting from:
a. An "accident" caused by Lightning, Wind,
Hail, Weight of Snow, Ice or Sleet, Riot,
Civil Commotion, Vandalism, Vehicles,
Falling Objects, Aircraft, Smoke, Col-
lapse, Water Damage, Rising Water or
Flood;
b. Any interruption of service lasting less
than 8 hours; or
c. A deliberate act or acts by a supplying
utility to shed Icad to maintain system
integrity.
C. LIMITS OF INSURANCE
Any payment made under this Coverage Part will
not be increased if more than (~ne insured is
BM T1 50 01 93 Page 5 of 15
002371
BOILER AND MACHINERY
shown in the Declarations.
1. Limit Per Accident
The most we will pay for loss and expense
arising from any "one accident" is the
amount shown as the Limit Per Accident in
the Declarations. This limit applies to all
coverages under this Coverage Part, includ-
ing Coverage Extensions. However, costs we
incur under the Defense and Supplemental
Payments coverage shall not reduce the
available Limit Per Accident.
2. Coverage Extension Limits
The limit of your insurance under each of the
Coverage Extensions from loss or expense
arising from any "one accident" is the
amount shown in the Declarations for that
Coverage Extension. If an amount of time is
shown, coverage under that Coverage Exten-
sion will continue for that amount of time im-
mediately following the "accident."
If two or more limits apply to the same por-
tion of a loss, we will only pay the smaller
limit.
D. DEDUCTIBLE
Unless otherwise indicated in the Declarations,
these deductibles apply separately for each ap-
plicable coverage.
1. Damage to Covered Property
We will not pay for loss or damage resulting
from any "one accident" until the amount of
loss or damage exceeds the Damage to
Covered Property Deductible shown in the
Declarations. We will then pay the amount of
loss or damage in excess of the Damage to
Covered Property Deductible, up to the ap-
plicable Limit of Insurance shown in the Dec-
larations.
This Deductible applies to all coverages, in-
cluding Coverage Extensions, except as
otherwise specified in the Deductible provi-
sions for Business Income, Extra Expense,
Spoilage and Off Premises Service Interrup-
tion.
2. Business Income
The Business Income Deductible applies to
any loss of "business income," except as
provided in the Coverage Extension-Off
Premises Service Interruption.
If a Business Income hour deductible is
shown in the Declarations, we will not be li-
able for any loss of "business income" occur-
ring during the specified number of hours
immediately following the "accident."
If a Business Income dollar deductible is
shown in the Declarations, we will first sub-
tract that amount from the amount of "busi-
ness income" we would otherwise pay arising
from any "one accident." We will then pay the
amount of loss or expense in excess of the
Deductib[e, up to the applicable Limit of In-
surance shown in the Declarations.
If the Business Income dollar deductible is
expressed as a number times ADV, that
amount will be calculated as follows:
The ADV will be the "business income"
for the entire location that would have
been earned had no "accident" occurred
during the period of interruption of busi-
ness divided by the number of working
days in that period. No reduction shall
be made for the "business income" not
being earned, or in the number of work-
ing days, because of the "accident" or
any other scheduled or unscheduled
shutdowns during the period of interrup-
tion.
The number indicated in the Declarations
will be multiplied by the ADV as deter-
mined above. The result will be used as a
Business Income dollar deductible
EXAMPLE
Business is interrupted for 10 days. If there
had been no "accident," the total "business
income" for those 10 days would have been
$5,000. The Business Income Deductible is 3
X ADV.
$5,000 / 10 = $500 ADV
3 X $500 = $1,500 Business Income Deduct-
ible
Extra Expense
If an Extra Expense dollar deductible is
shown in the Declarations, we will first sub-
tract that amount from the amount of loss or
expense we would otherwise pay with regard
to insurance under the Coverage Exten-
sion- Extra Expense arising from any "one
accident.'r We will then pay the amount of
loss or expense in excess of the Extra Ex-
pense Deductible, up to the applicable Limit
Page 6 of 15 BM T1 50 01 93
of Insurance shown in the Declarations.
If an Extra ExpenSe dOlla~ dedUCtible is ex-
pressed as a number times ADV, that
amount will be calculated as described in
D.2. above.
If an Extra Expense hour deductible is shown
in the Declarations, we will not be liable for
any loss or expense with regard to insurance
under the Coverage Extension-Extra Ex-
pense occurring during the specified number
of hours immediately following the "acci-
dent."
4. Spoilage
With regard to insurance under the Coverage
Extension-Spoilage, we will not pay for loss
or damage resulting from any "one accident"
until the amount of loss or damage exceeds
the Spoilage Deductible shown in the Decla-
rations. We will then pay the amount of loss
or damage in excess of the Spoilage Deduct-
ible, up to the applicable Limit of Insurance
shown in the Declarations.
5. Off Premises Service Interruption
If an Off Premises Service Interruption dollar
deductible is shown in the Declarations, we
will first subtract that amount from the
amount of loss or expense we would other-
wise pay with regard to insurance under the
Coverage Extension-Off Premises Service
Interruption arising from any "one accident."
We will then pay the amount of loss or ex-
pense in excess of the Off Premises Service
Interruption Deductible, up to the applicable
Limit of Insurance shown in the Declarations.
If an Off Premises Service Interruption dollar
deductible is expressed as a number times
ADV, that amount will be calculated as
described in D.2. above.
If an Off Premises Service Interruption hour
deductible is shown in the Declarations, we
will not be liable for any loss or expense with
regard to insurance under the Coverage Ex-
tension-Off Premises Service Interruption
occurring during the specified number of
hours immediately following the "accident."
Exclusion B.5.b. applies without regard to
the Off Premises Service Interruption Deduct-
ible.
6. Ammonia Contamination
With regard to insurance unde~ the Coverage
BOILER AND MACHINERY
Extension-Ammonia Contamination, we will
not pay for loss or damage resulting from
any "one accident" until the amount of loss or
damage exceeds the Ammonia Contamina-
tion Deductible shown in the Declarations.
We will then pay the amount of loss or
damage in excess of the Ammonia Con-
tamination Deductible, up to the applicable
Limit of Insurance shown in the Declarations.
If an Ammonia Contamination Deductible is
expressed as a percentage of Loss, we will
not be liable for the indicated percentage of
the loss or damage insured under the
Coverage Extension-Ammonia Contamina-
tion. If the dollar amount of such percentage
is less than the indicated Minimum Deduct-
ible, the Minimum Deductible will be the Am-
monia Contamination Deductible.
E. LOSS CONDITIONS
The following conditions apply in addition to the
Common Policy Conditions:
1. Abandonment
There can be no abandonment of any
property to us.
2. Appraisal
If we and you disagree on the value of the
property, the amount of "business income" or
the amount of loss, either 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 ap-
praisers will state separately the value of the
property, the amount of "business income" or
amount of loss. If they fail to agree, they will
submit their differences to the umpire. A
decision agreed to by any two wiii be bind-
ing. Each party will:
a. Pay its chosen appraiser; and
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. Duties In the Event of Loss or Damage
You must see that the following are done in
the event of loss or damage:
a. Give Us prompt notice of the loss or
BM T1 50 01 93 Page 7 of 15
002372
BOILER AND MACHINERY
damage. Include a description of the
property involved;
b. As soon as possible, give us a descrip-
tion of how, when and where the loss or
damage occurred;
c. Allow us a reasonable time and oppor-
tunity to examine the property and prem-
ises before repairs are undertaken or
physical evidence of the "accident" is re-
moved. But you must take whatever
measures are necessary for protection
from further damage;
d. Permit us to inspect the property and
records. Also permit us to take samples
of damaged and undamaged property
for inspection, testing and analysis.
e. If requested, permit us to question you
under oath, at such times as may be
reasonably required about any matter
relating to this insurance or your claim
including your books and records, tn
such event, your answers must be
signed;
f. Send us a signed, sworn statement of
loss containing the information we re-
quest to settle the claim. You must do
this within 60 days after our request;
g. Cooperate with us in the investigation
and settlement of the claim;
h. Promptly send us any legal papers or
notices received concerning the loss or
damage; and
i. Make no statement that will assume any
obligation or admit any liability, for any
loss or damage for which we may be
liable, without our consent.
We may examine any insured under oath,
while not in the presence of any other in-
sured and at such times as may be
reasonably required, about any matter relat-
ing to this insurance or the claim, including
an insured's books and records. In the event
of an examination, an insured's answers
must be signed.
Reducing Your Loss
With respect to Coverage Extensions-Busi-
ness Income, Extra Expense, Off Premises
Service Interruption and Spoilage, you must
reduce your loss, if possible, by:
a. Resuming business, partially or com-
pletely;
b. Using merchandise or other property
available to you; or
c. Using the property or services of others.
5. Loss Payment
a. In the event of loss or damage 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;
(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.
b. We will give notice of our intentions
within 30 days after we receive the proof
of loss.
c. We will not pay you more than your
financial interest in the Covered Proper-
ty.
d, We may adjust losses with the owners of
lost or damaged property if other than
you. If we pay the owners, such pay-
ments will satisfy your claims against us
for the owner's property. We will not pay
the owners more than their financial in-
terest in the Covered Property.
e. We will pay for covered loss or damage
within 30 days after we receive the sworn
proof of loss, if:
(1) You have complied with all of the
terms of this Coverage Part; and
(2) We have reached agreement with
you on the amount of loss or an ap-
praisal award has been made and
we have not denied the claim.
6. Valuation
a. We will pay you the amount you spend
to repair or replace Covered Property
directly damaged by an 'raccident~' to an
'~object." Our payment will be the smallest
of:
(1) The cost to repair the damaged
property;
Page 8 of 15 BM T1 50 01 93
(2) The cost to replace the damaged
,/'""" property; or
(3) The amount you actually spend that
is necessary to repair or replace the
damaged property.
b. If the cost of repairing or replacing a part
of an "object" is greater than:
(1) The cost of repairing the entire "ob-
ject''; or
(2) The cost of replacing the entire "ob-
ject'';
We will pay only the smallest amount.
c. If an "object" cannot be repaired or the
cost of repairing is more than the cost to
replace, and the damage to the "object"
equals or exceeds 100% of the actual
cash value of the "object," you may
choose to apply the following provision.
New Generation Coverage-If you want
to replace a damaged "object" with a
newer generation "object" of the same
capacity, we will pay up to 25% more
than an "object" of like kind, quality and
capacity would have cost at the time of
~ the "accident."
d. Except for New Generation Coverage,
· "'-- you must pay the extra cost of replacing
~ damaged property with property of a
~-~ better kind or quality or of a larger
~_... capacity.
....-- e. We will not pay you if the loss or damage
o~ is to property that is obsolete or useless
o~ to you.
°~ f. If you do not repair or replace the dam-
®~ aged property within 18 months after the
~ date of the "accident," then we will pay
o~ only the smaller of the:
o~ (1) Cost it would have taken to repair; or
°~ (2) Actual cash value;
~ at the time of the "accident."
o--..... 7. Spoilage CoVerage Valuation
o5 With regard to insurance under the Coverage
~ Extension-Spoilage, We will pay for perish-
, ,~ able goods on the basis of:
· ~ a. The selling price at the time of the '~acci-
dent" as if no loss or damage had oc-
~ curred; and
~' b. Less any discounts and expenses you
BOILER AND MACHINERY
otherwise would have had.
8. "Media" Valuation
With regard to insurance under the Coverage
Extension-"Media," we will pay for "media"
on the following basis:
a. For "media" that are mass-produced and
commercially available, at the replace-
ment cost.
b. For all other"media," at the cost of:
(1) Blank material for reproducing the
records; and
(2) Labor to transcribe or copy the
records when there is a duplicate.
9. Business Income Report of Values
You must report to us each year the "busi-
ness income annual value" for all locations to
which the Coverage Extension-Business in-
come applies.
10, Business Income Coinsurance
We will not pay the full amount of any "busi-
ness income" loss if the "business income
actual annual value" is greater than the "busi-
ness income estimated annual value" shown
in your latest report, instead,' We Will deter-
mine the most we will pay using the following
steps:
a. Divide the "business income estimated
annual value" last reported to us by the
"business income actual annual value" at
the time of the "accident";
b. Multiply the total amount of the covered
loss of "business income" by the figure
determined in paragraph a. above;
c; Subtract the applicable Deductible from
the amount determined in paragraph b.
above;
The resUlting amount, or the the Business
Income Limit, whichever is less, is the most
we will pay. We will not pay for the remainder
of the loss.
This provision apPlies separately to each in-
sured location,
EXAMPLE 1 (Underinsurance)
When:
The "business income actual annual value" at
the location of loss at the time of the "acci-
dent'' is $400,000.
BM T1 50 01 93 Page 9 of 15
002373
BOILER AND MACHINERY
The "business income estimated annual
value" in your latest report for the location of
loss is $200,000.
The actual loss of "business income" result-
ing from the "accident'~ is $80,000.
The Business Income Limit is $1,000,000.
The Business Income Deductible is $5,000.
Step 1:$200,000 / $400,000 = .5
Step 2:$80,000 x .5 = $40,000
Step 3:$40,000 - $5,000 = $35,000
The total "business income" loss recovery,
after deductible, would be $35,000. For the
remainder, you will either have to rely on
other insurance or absorb the loss yourself.
EXAMPLE 2 (Adequate insurance)
When:
The "business income actual annual value" at
the location of loss at the time of the "acci-
dent'' is $400,000.
The "business income estimated annual
value" in your latest report for the location of
loss is $400,000.
The actual loss of "business income'r result-
ing from the ~'accident" is $80,000.
The Business Income Limit is $1,000,000.
The Business Income Deductible is $5,000.
Step 1:$400,000 / $400,000 = 1
Step 2:$80,000 x 1 = $80,000
Step 3:$80,000 - $5,000 = $75,000
The total "business income" loss recovery,
after deductible, would be $75,000,
11. Conditional Suspension of Coinsurance
The Business Income Coinsurance provision
is suspended if we have received from you a
Business Income Report of Values as follows:
a. The report must provide a "business in-
come estimated annual value" for the
location or locations affected by the "ac-
cident"; and
b. The "business income estimated annual
value" must apply to an annual period
ending no later than 90 days before the
date of the "accident."
12. Joint Loss
a. In the event of loss or damage insured
under this Coverage Part and also under
a Commercial Property Policy(les) or
Coverage Part(s) that is not part of this
Policy, and there is a disagreement be-
tween the insurers with respect to:
(1) Whether such damage or destruction
was caused by an "accident" insured
against bythis Coverage Part or by a
peril insured against by such Com-
mercial Property Policy(les) or
Coverage Part(s); or
(2) The extent of participation of this
Coverage Part and of such Commer-
cial Property Policy(les) or Coverage
Part(s) in a loss which is insured
against, partially or wholly, by any or
all of said Policies or Coverage Parts.
shall, upon written request from you,
pay to you one-half of the amount of the
loss which is in disagreement, but in no
event more than we would have paid if
there had been no Commercial Property
Policy(les) or Coverage Part(s) in effect,
subject to the following conditions:
(1) The amount of the loss which is in
disagreement, after making provi-
sions for any undisputed claims pay-
able under the Policies or Coverage
Parts and after the amount of the
loss is agreed upon by you, us, and
the provider of Commercial Property
insurance, is limited to the minimum
amount remaining payable under
either this Coverage Part or the Com-
mercial Property Policy(les) or
Coverage Part(s);
(2) The Commercial Property insurer(s)
shall simultaneously pay to you one-
half of the amount which is in dis-
agreement;
(3) The payments by us and the Com-
mercial Property insurer(s) here-
under and acceptance of those sums
by you signify the agreement of us
and the agreement of us and the
commercial property with arbitration
within 90 days of such payment;
The arbitrators shall be three in num-
ber, one of whom shall be appointed
by us and one of whom shall be ap-
pointed by the commercial property
insurer(s) and the third appointed by
consent of the other two, and the
decision by the arbitrators shall be
b. We
Page 10 of 15 BM T1 50 01 93
BOILER AND MACHINERY
binding on us and the Commercial
Property insurer(s) and that judg-
ment upon such award may be
entered in any court of competent
jurisdiction;
(4) You agree to cooperate in connec-
tion with sUch arbitration but not to
intervene therein;
(5) The provisions of this condition shall
not apply unless such other Pol-
icy(les) or Coverage Part(s) issued
by the Commercial Property in-
surer(s) is similarly endorsed; and
(6) Acceptance by you of any payment
pursuant to the provisions of this
condition, including any arbitration
award, shall not operate to alter,
waive or surrender or in any way af-
fect the rights you have against us or
the commercial property insurer(s).
F. ADDITIONAL CONDITIONS
The following conditions apply in addition to the
Common Policy Conditions:
1. Cancellation
~'~' As respects this Coverage Part, part 2
of
the
"Cancellation" Condition of this Policy is re-
~'-"- placed by the following:
· ~ We may cancel this Coverage Part by mail-
~ lng or delivering to the first Named Insured
~ written notice of cancellation at least:
~'~ a. 10 days before the effective date of can-
o~ celiation if we cancel for nonpayment of
o~ premium; or
°~__ b. The number of days indicated in the
~ Declarations for Notice of Cancellation
~ before the effective date of cancellation
o~ for any other reason.
°~ 2. Concealment, Misrepresentation or Fraud
~'---- This Coverage Part is void in any case of
~ fraud by you relating to it. It is also void if
~ you or any other Named Insured at any time
o~--- intentionally conceal or misrepresent a
o~ material fact concerning:
'~ (1) This Coverage Part;
%--- (2) The Covered Property;
(3) Your interest in the Covered Property; or
t,~-~, (4) A claim under this Coverage Part.
3. Legal Action Against Us
No one may bring a legal action against us
under this Policy unless:
a. There has been full compliance with all
the terms of this Policy; and
b. The action is brought within two years
and one day next after the date of the
"accident"; or
c. We agree in writing that you have an
obligation to pay for damag~ to Covered
Property of others or until the amount of
that obligation has been determined by
final judgment or arbitration award. No
one has the right under this Policy to
bring us into an action to determine your
liability.
4. Adjustment of Premium
a, The premium charged at the inception of
each policy year is an advance premium.
We will determine an adjusted premium
for this insurance based on your reports
of value.
b~ If the adjusted premium is less than the
advance premium, we will return the ex-
cass premium to you. Such excess
premium will not exceed 75% of the ad-
vance premium.
c. If the adjusted premium is greater than
the advance premium, we will charge the
additional premium.
5. Liberalization
If we adopt any revision that would broaden
the coverage under this Coverage Part
without additional premium within 45 days
prior to or during the policy period, the
broadened coverage will immediately apply
tO this Coverage Part.
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 ap-
plicable limits under this Coverage Part
bear to the Limits of Insurance of all in-
surance covering on the same basis.
(b) If there is other insurance covering the
same loss or damage, other than that
BM T1 50 01 93 Page 11 of 15
002374
BOILER AND MACHINERY
described in (a) above, we will pay only
the amount of covered loss or damaged
in excess of the amount due from that
other insurance, whether you can collect
on it or not.
In no case will we pay more than the ap-
plicable limits.
7. Policy Period, Coverage Territory
Under this Coverage Part:
a. The"accident" must occur:
(1) During the Policy Period shown in
the Declarations; and
(2) Within the Coverage Territory.
b. The Coverage Territory is:
(1) The United States of America (includ-
ing its territories and possessions);
(2) Puerto Rico; and
(3) Canada.
8. 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 ex-
tent of our payment. That person or organi-
zation 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 bythis insurance;
(2) A business firm:
(a) Owned or controlled by you; or
(b) That owns or controls you; or
(3) Your tenant.
This will not restrict your insurance.
9. Additional Insured
If a person or organization is designated in
this Coverage Part as an additional insured,
we will consider them to be an insured under
this Coverage Part only to the extent of their
interest:
10.
11.
12.
Bankruptcy
The bankruptcy or insolvency of you or your
estate will not relieve us of any obligation
under this Coverage Part.
Suspension
Whenever an "object" is found to be in, or
exposed to, a dangerous condition, any of
our representatives may immediately sus-
pend the insurance against loss from an "ac-
cident' to that "object.'r This can be done by
delivering or mailing a written notice of
suspension to:
a. Your last known address; or
b. The address where the "object" is lo-
cated.
Once suspended in this way, your insurance
can be reinstated only by an endorsement
for that "object."
Mortgage Holders
a. The term mortgage holder includes trus-
tee.
b. We will pay for direct damage to Covered
Property due to an "accident" to an "ob-
ject'' to each mortgage holder shown in
the Declarations in their order of prece-
dence, as interests may appear.
c. The mortgage holder has the right to re-
ceive loss payment even if the mortgage
holder has started foreclosure or similar
action on the Covered Property.
d. If we deny your claim because of your
acts or because you have failed to comp-
iy with the terms of this Coverage Part,
the mortgage holder will still have the
right to receive loss payment if the
mortgage holder:
(1) Pays any premium due under this
Coverage Part at our request if you
have failed to do so;
(2) Submits a signed, sworn proof of
loss within 60 days after receiving
notice from us of your failure to do
so; and
(3) Has notified us of any change in
ownership or occupancy or substan-
tial change in risk known to the
mortgage hotder.
All of the terms of this Coverage Part will
Page 12 of 15 BM T1 5001 93
then apply directly to the mortgage
holder.
e. If we pay the mortgage holder for any
loss and deny payment to you because
of your acts or because you have failed
to comply with the terms of this
Coverage Part:
(1) The mortgage holder's right under
the mortgage will be transferred to us
to the extent of the amount we pay;
and
(2) The mortgage holder's right to
recover the full amount of the mort-
gage holder's claim will not be im-
paired.
At our option, we may pay to the mort-
gage holder the whole principal on the
mortgage plus any accrued interest. In
this event, your mortgage and note will
be transferred to us and you will pay
your remaining mortgage debt to us.
f. If we cancel this policy, we will give writ-
ten notice to the mortgage holder at
least:
("'--'~ (1) 10 days before the effective date of
cancellation if we cancel for your
nonpayment of premium; or
~ (2) 30 days before the effective date of
,.~ cancellation if we cancel for any
-- other reason.
~,~- g. If we elect not to renew this policy, we
o~______ will give written notice to the mortgage
o~. holder at least 10 days before the expira-
tion date of this policy.
~ G. DEFINITIONS
~ 1. "Accident" means a sudden and accidental
o~ breakdown of the "object" or part of the '~ob-
~ ject." At the time the breakdown occurs, it
~ must become apparent by physical damage
that requires repair or replacement of the
~~ "object" or part of the "object."
o~------. None of the following is an "accident":
o~-----' a. Depletion, deterioration, corrosion, ero-
~ sion, or wear and tear, unless a sudden
~ and accidental breakdown ensues;
· ~ b. The breakdown of any structure or foun-
dation; or
c. The functioning of any Safety or protec-
tive device.
BOILER AND MACHINERY
2. "Business Income" means the sum of:
a;! The Net Income (net profit or loss before
income taxes) that would have been
earned or incurred; and
b. Continuing normal operating expenses
incurred, including payroll.
3. "Business Income Actual Annual Value"
means the "business income" for the current
fiscal year that would have been earned had
no "accident" occurred.
In calculating the "business income actual
annual value," we will take into account the
actual experience of your business before
the "accident" and the probable experience
you would have had without the "accident."
4. "Business Income Estimated Annual
Value" means the "business income" as es-
timated by you in the most recent Business
Income Report of Values we have on file.
5. "Extra Expense" means:
The additional cost you incur to operate your
business during the interruption over and
above the cost that normally would have
been incurred to operate the business during
the same period had no "accident'' occurred.
6. "Media" means all forms of electronic and
magnetic tapes and discs, converted data,
program or instruction for use in any elec-
tronic computer or electronic data process-
ing equipment.
7. "Object" means:
a. Any of the following, unless otherwise ex-
cluded:
(1) Boiler, fired vessel, unfired vessel
normally subject to vacuum or inter-
nal pressure other than weight of its
contents, refrigerating and air con-
ditioning vessels, and any metal
piping and its accessory equipment;
(2) Mechanical or electrical machine or
apparatus used for the generation,
transmission or utilization of mech-
anical or electrical power.
(3) Any of the following vessels listed
below are included within the pro-
visions of this section when used
with an "object":
(a) Condensate return tank;
BM T1 50 01 93 Page 13 of 15
BOILER AND MACHINERY
(b) Cushion or expansion tank used
with a hot water heating boiler,
(4) Fiber optic cable.
b. "Object" does not mean any:
(1) Part of a boiler, fired vessel or elec-
tric steam generator that does not
contain steam or water;
(2) Insulating or refractory material;
(3) Non-metallic vessel, unless it is con-
structed and used in accordance
with the American Society of Mech-
anical Engineers Code; (A.S,M.E.)
(4) Catalyst;
(5) Buried vessel or piping;
(6) Sewer piping, piping forming a part
of a fire protection system or water
piping other than:
(a) Feed water piping between any
boiler and its feed pump or injec-
tor; or
(b) Boiler condensate return piping;
or
(c) Water piping forming a part of
refrigerating and air conditioning
vessels and piping used for cool-
ing, humidifying or space heating
purposes;
(7) Part of a vessel that is not under;
(a) Pressure of the contents of the
vessel; or
(b) Internal vacuum;
(8) Oven, stove, furnace, incinerator, pot
or kiln;
(9) Structure, foundation, cabinet or
compartment containing the object;
(10) Power shovel, dragline, excavator,
vehicle, aircraft, floating vessel or
structure, penstock, draft tube or
well-casing;
(11) Conveyor, crane, elevator, escalator
or hoist, but not excluding any
electrical machine or electrical ap-
paratus mounted on or used with
this equipment;
(12) "Media" used with any electronic
computer or electronic data process-
ing equipment;
(13) Machine or apparatus that is used
for research, medical, diagnostic,
surgical, dental or pathological pur-
poses;
(14) Felt, wire, screen, die, extrusion
plate, swing hammer, grinding disc,
cutting blade, cable, chain, belt,
rope, clutch plate, brake pad, non-
metallic part or any part or tool sub-
ject to frequent, periodic replace-
ment;
(15) "Object" manufactured by you for
sale.
c. For any boiler or fired vessel, the furnace
of the "object" and the gas passages
from there to the atmosphere will be
considered as outside the "object."
d. When a vesset uses a heat transfer
medium other than water or steam, we
will consider the medium or its vapor as
substitutes for the words-water or steam.
e. For any gas turbine, "accident" does not
include the cracking of any part of the
object exposed to the products of com-
bustion.
f. If Production Machines are shown as Ex-
cluded in the Declarations, "object" does
not mean any production or process
machine or apparatus that processes,
forms, cuts, shapes, grinds, or conveys
raw materials, materials in process or
finished products. But '~object" does
mean any:
(1) Pressure vessel or vacuum vessel,
described in Paragraph a. above,
other than any cylinder containing a
movable plunger or piston;
(2) Pump, compressor, fan, or blower
that conveys raw materials, materials
in process or finished products;
(3) Separate enclosed gear set con-
nected by a coupling, clutch or belt;
or
(4) Separate driving electrical or mech-
anical machine connected by a cou-
pling clutch or belt.
"One Accident" means:
If an initial "accident" causes other "acci-
dents,r' all will be considered "one accident."
Page 14 of 15 BM T1 50 01 93
All "accidents" at any one location that
manifest themselves at the same time and
are the result of the same cause will be con-
sidered "one accident."
"Suit" means a civil proceeding to which this
insurance applies and includes:
a. An arbitration proceeding in which dam-
BOILER AND MACHINERY
ages are claimed and to which you must
submit or do submit with our consent; or
Any other alternative dispute resolution
proceeding in which damages are
claimed and to which you submit with
our consent.
BM T1 50 01 93 Page 15 of 15
002376
POLICY NUMBER: BAd-BMG-791X2292-TI L-02
BOILER AND MACHINERY
GENERAL PURPOSE ENDORSEMENT
PROPERTY DAMAGE AND BUSINESS INTERRUPTION DEDUCTIBLES
IT IS AGREED THE DEDUCTIBLES FOR THE POLICY WILL BE AS FOLLOWS:
PROPERTY DAMAGE:
$2,500 ALL COVERED OBdECTS EXCEPT:
$25,000 APPLIES TO SEWAGE/WATER TREATMENT PLANTS
WITH VALUES OF $500,000 AND OVER
SEE BM TS 72 FOR AIR CONDITIONING AND REFRIGERATION
DEDUCTIBLES
BUSINESS INTERRUPTION:
48 HOURS ALL COVERED DBdECTS EXCEPT:
72 HOURS APPLIES TO SEWAGE/WATER TREATMENT PLANTS
WITH VALUES OF $500,000 AND OVER
IF MORE THAN ONE "OBdECT" IS INVOLVED IN "ONE ACCIDENT", THEN ONLY ONE
DEDUCTIBLE, THE HIGHEST, SHALL APPLY FOR EACH OF THE APPLICABLE COVERAGES.
BM T8 O0 Page 1
POLICY NUMBER: BAd-BMG-791X2292-TIL-02
BOILER AND MACHINERY
GENERAL PURPOSE ENDORSEMENT
POWER GENERATING EQUIPMENT EXCLUSION
IT IS AGREED THAT THE FOLLOWING IS ADDED TO PARAGRAPH G. DEFINITIONS 7,b
"OBdECT" DOES NOT MEAN:
(16)
ANY PRESSURE, MECHANICAL OR ELECTRIC EQUIPMENT, MACHINERY
OR APPARATUS USED IN, OR ASSOCIATED WITH, THE GENERATION
OF ELECTRIC POWER; BUT NOT EXCLUDING EMERGENCY POWER GENERATION
EQUIPMENT LESS THAN OR EQUAL TO 1000 KW.
BM T8 01 Page I
002377
BOILER AND MACHINERY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
RBC Exclusion
The definition of "object~ is amended to exclude any Rotating Biological Contactor (RBC), including any shaft,
cylinder, disk or support forming a part of an RBC.
However, "object" will include any motor or gear set used to drive an RBC.
BM T3 27 08 95 Page 1 of 1
BOILER AND MACHINERY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CLAIM REPORTING
This endorsement modifies insurance provided under the following:
BOILER AND MACHINERY COVERAGE FORM
To report a Boiler and Machinery loss, contact your agent directly or phone our Home Office Claim Department
at 800-835-1291 during business hours EST, or 800-243-3840 after hours.
BM T3 52 08 96 Page 1 of 1
002378
BOILER AND MACHINERY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
PERILS ELIMINATION ENDORSEMENT
(Lightning, Extended Coverage Property Perils,
Freeze and FloOd)
This endorsement modifies insurance provided under the following
BOILER AND MACHINERY COVERAGE PART
We will not pay under any coverage provided by this
policy for loss caused by or resulting from an "acd-
dent" that is the direct or indirect result of:
a. Lightning;
b. Windstorm or Hail (not including rain, snow,
sand or dust within a building or structure, unless
the building or structure first sustains wind or hail
damage to its roof or walls through which the rain,
snow, sand or dust enters);
c. Smoke (not including smoke from agricultural
smudging or industrial operations);
d. Aircraft or Vehicles, meaning physical contact of
an aircraft, a spacecraft, a self-propelled missile,
a vehicle or an object thrown up by a vehicle or
objects falling from aircraft or spacecraft;
e. Riot or Civil Commotion, including:
(1) Acts of striking employees; and
(2) Looting occurring at the time and place of a
riot or civil commotion;
f. Vandalism, meaning willful and malicious dam-
age to, or destruction of, the described property;
g. Sprinkler Leakage, meaning leakage or dis-
charge of any substance from an Automatic
Sprinkler System, including collapse of a tank that
is part of the system.
Automatic Sprinkler System Means:
('1) Any automatic fire protective or extinguishing
system, including connected:
jo
(a) Sprinklers and discharge nozzles;
(b) Ducts, pipes, valves and fittings;
(c) Tanks, their component parts and sup-
ports; and
(d) Pumps and private fire protection mains.
(2) When supplied from an automatic fire protec-
tive system:
(a) Non-automatic fire protective systems;
and
(b) Hydrants, standpipes and outlets.
Collapse of a building or any part of a building;
Falling Objects (not including objects that fall
within a building or structure unless the roof or an
outside wall of the building or structure is first
damaged by the falling object);
Discharge of Molten Material;
Weight of Snow, Ice or Sleet;
Freeze arising out of weather conditions;
Flood, meaning:
(1) Surface water, underground 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) Release of water impounded by a dam; or
(4) Water which backs up through sewers, drains
or sumps.
BM T3 80 02 00 Page 1 of 1
POLICY NUMBER:BAd-BMG-791 x2292-T'r L-02
BOILER AND MACHINERY
ISSUE DATE:06-14-02
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
PROPERTY NOT COVERED
The following property is not insured by this policy. If the stated property is an "object," damage to other
property resulting from an "accident" to that "object" is also excluded.
Property Description
ALL GEAR SETS AND ELECTRIC MOTORS.
002379 BM T8 40 0491 Page 1 of 1
BOILER AND MACHINERY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
SPECIAL LOCATION SCHEDULE
This endorsement modifies insurance provided under the following:
BOILER AND MACHINERY COVERAGE FORM
The following is being used on this policy instead of
a specific schedule of "locations" attached to the
policy.
All "locations" owned, operated or under the care,
custody or control of the Named Insured, that are
located in the United States of America (including its
territories and possessions), Puerto Rico and
Canada and are on file with us, are considered as
individually inserted in any "location" entry area of
any Declarations or Endorsement, unless specifically
changed by endorsement.
At each anniversary of the policy:
1. You must submit an updated list of all "locations'~
to be covered under the policy for the upcoming
policy year; and
2. The "Automatic Coverage~' extension ceases to
apply at any "location'~ acquired prior to that an-
niversary date and not on the most current list
filed with us.
BM T8 69 08 96 Page 1 of 1
INTERLINE
ENDORSEMENTS
INTERLINE
ENDORSEMENTS
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
INDIANA CHANGES - CONCEALMENT,
MISREPRESENTATION OR FRAUD
This endorsement modifies insurance provided under the following:
BOILER AND MACHINERY COVERAGE PART
BUSINESSOWNERS POLICY
COMMERCIAL AUTO COVERAGE PART
COMMERCIAL INLAND MARINE COVERAGE PART
COMMERCIAL PROPERTY COVERAGE PART
FARM COVERAGE PART
The CONCEALMENT, MISREPRESENTATION OR FRAUD condition is replaced by the following:
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 an insured at any time and relating to a claim under this policy.
Page 1 of 1
IL 01 56 07 89 Copyright, Insurance Services Office, Inc., 1989
00238~ Copyright, ISO Commercial Risk Services, Inc., 1989
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
INDIANA CHANGES - RIGHTS OF RECOVERY
This endorsement modifies insurance provided under the following:
BOILER AND MACHINERY COVERAGE PART
COMMERCIAL CRIME COVERAGE PART
COMMERCIAL INLAND MARINE COVERAGE PART
The TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US Condition is replaced by
the following:
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
cover damages from another, those rights are trans-
fen'ed to us to the extent of our payment. Our right to
recover damages from another may be enforced even
if the person or organization to or for whom we make
payment has not been fully compensated for dam-
ages.
The person or organization to or for whom we make
payment must do everything necessary to secure our
rights and must do nothing after loss to impair them.
IL 01 86 07 96 Copyright, Insurance Services Office, Inc~, 1996 Page 1 of 1
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
INDIANA CHANGES - CANCELLATION
AND NONRENEWAL
This endorsement modifies insurance provided under the following:
BOILER AND MACHINERY COVERAGE PART
BUSINESSOWNERS POLICY
COMMERCIAL AUTO COVERAGE PART
COMMERCIAL CRIME COVERAGE PART*
COMMERCIAL GENERAL LIABILITY COVERAGE PART
COMMERCIAL INLAND MARINE COVERAGE PART
COMMERCIAL PROPERTY COVERAGE PART
FARM COVERAGE PART
EMPLOYMENT-RELATED PRACTICES LIABILITY COVERAGE PART
LIQUOR LIABILITY COVERAGE PART
POLLUTION LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
* This endorsement does not apply to coverage provided for employee dishonesty (Coverage Form A), forgery or
alteration (Coverage Form B), or public employee dishonesty (Coverage Forms O and P).
A. Paragraph 2. of the CANCELLATION Common
Policy Condition is replaced by the following:
2. a. Cancellation of Policies in Effect for 90
¢/'-'" Days or Less
If this policy has been in effect for 90 days
~ or less, we may cancel this policy by mail-
~,~ lng or delivering to the first Named In-
~ sured written notice of cancellation at
~ least:
~ (1) 10 days before the effective date of
~ cancellation if we cancel for nonpay-
ment of premium;
o~ (2) 20 days before the effective date of
-- cancellation if you have perpetrated a
~----- fraud or material misrepresentation
o~ (3) 30 days before the effective date of
cancellation if we cancel for any other
~,- reason.
~ b. Cancellation of Policies in Effect for More
Than 90 Days
If this policy has been in effect for more
than 90 days, or is a renewal of a policy
'---- we issued, we may cancel this policy, only
"'__. for one or more of the reasons listed be-
*~ Iow, by mailing or delivering to the first
Named Insured wdtten notice of cancella-
tion at least:
(f) 10 days before the effective date of
cancellation if we cancel for nonpay-
merit of premium;
(2) 20 days before the effective date of
cancellation if you have perpetrated a
fraud or material misrepresentation
on us; or
{3) 45 days before the effective date of
cancellation if:
(a) There has been a substantial
change in the scale of dsk cov-
ered by this policy; or
{b) Reinsurance of the dsk associ-
ated with this policy has been
cancelled.
B. The following is added to the Common Policy
Conditions and supersedes any prevision to the
contrary.
NONRENEWAL
1. If we elect not to renew this policy, we will
mail or deliver to the first Named Insured writ-
ten notice of nonrenewal at least 45 days be-
fore:
a. The expiration date of this policy, if the
policy is wdtten for a term of one year or
less; or
Page 1 of 2
IL 02 72 04 98 Copyright, Insurance Services Office, Inc., 1997
The anniversary date of this policy, if the
policy is wdtten for a term of more than
one year.
We will mail or deliver our notice to the first
Named Insured's last mailing address known
to us. If notice is mailed, proof of mailing will
be sufficient proof of notice.
Page 2 of 2 Copyright, Insurance Services Office, Inc., 1997 IL 02 72 04 98
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
EXCLUSION OF CERTAIN COMPUTER-RELATED LOSSES
DUE TO DATES OR TIMES
This endorsement modifies insurance provided under the following:
BOILER AND MACHINERY COVERAGE PART
COMMERCIAL CRIME COVERAGE PART
COMMERCIAL INLAND MARINE COVERAGE PART
COMMERCIAL PROPERTY COVERAGE PART
DELUXE PROPERTY COVERAGE PART
We will not pay for loss ("loss") or damage
caused directly or indirectly by any of the follow-
ing. 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 mi-
croprooessors;
(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 elec-
tronic equipment or components; or
b. Any other products, and any services,
data or functions that directly or indi-
rectly use or rely upon, in any manner,
any of the items listed in Paragraph
A.l.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, evalua-
lion, 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.I. 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
Boiler and Machinery Coverage Part, the
Commercial Crime Coverage Part or the
Commercial Inland Marine Coverage Part;
or
2. Under the Commercial Property Coverage
Part:
a. In a "Specified Cause of Loss", in eleva-
tor collision resulting from mechanical
breakdown, or from theft (if insured) un-
der 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; or
3. In a "Specified Cause of Loss", in e~evator
collision resulting from mechanical break-
down, or from theft under the Deluxe Prop-
erty Coverage Part;
we will pay only for the loss ("loss") or damage
caused by such "Specified Cause of Loss", ele-
valor collision, theft, or a Covered Cause of
Loss.
C. We will not pay for repair, replacement or
modification of any items in Paragraphs A.l.a.
and A.l.b. of this endomement to correct any
deficiencies or change any features.
IL T3 55 08 98
Incl ~des Material Copyrighted by Insurance Services Office
Page 1 of 1
002383
Specialty National Insurance Company
A ~'PlIIP~R. COMPANY
ENDORSEMENT NO. I
ATTACHED TO AND ENDORSEMENT EFFECTIVE
FORMING A PART OF (Standard Time) INSURED AGENCY AND CODE
POLICY NUMBER MO. DAY YR. 12:01 NOON
A.M.
3XZ12057001 08 06 2002 X CITY OF JEFFERSONVILLE 430034
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
In consideration for the premium charged it is hereby understood and agreed the following change (s) are
made to the INLAND MARINE section (s) of this policy.
AMEND: Aquatic Center and State Park value to $130,000 in Lieu of $100,000.
NO PREMIUM ADJUSTMENT DUE:
ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED
AUTHORIZED REPRESENTATIVE
Agent: Clark General Insurance
9~03~02
sp
ZC 25166 (8/99)
Specialty National Insurance Company
A ~.~EPER, COMPANY
ENDORSEMENT NO. 4
A~rTACHED TO AND ENDORSEMENT EFFECTIVE
FORMING A PART OF (Standard Time) INSURED AGENCY AND CODE
POLICY NUMBER MO, DAY YR. 12:01 NOON
A.M. ;
3XZ12057001 08 06 2002 X CITY OF JEFFERSONVILLE 430034
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
In consideration for the premium charged it is hereby understood.and agreed the following change (s) are
made to the ADDITIONAL INSURED/LOSS PAYEE section (s) of this policy.
ADD: ADDITIONAL INSURED/LOSS PAYEE AS THEIR INTEREST MA~Y APPEAR IN COMPUTER
HARDWARE FOR CITY OF JEFFERSONVILLE.
Fifth Third Bank Indiana ~
251 N Illinois St., Suite 1000
Mail Drop 8490A2 ~
Indpls, IN 46204
ADDITIONAL INSURED/LOSS PAYEE AS THEIR INTEREST MAY APPEAR IN A COMPUTER NET
SYSTEM.
Indiana Bond Bank
:...,~,,. ,.: ....... 10W market St. Suite 2980
Indpls, IN 46204
ADDITIONAL INSURED/LOSS PAYEE AS THEIR INTEREST MAY APPEAR IN TWO 1997 PIERCE
FIRE TRUCKS.
Maxus Leasing Group
31300 Bainbridge Rd.
Cleveland. OH 44139
ADDITIONAL INSURED AS THEIR INTEREST MAY APPEAR IN BUILDING OWNER LOCATION #12.
U.S. Army & INAAP Reuse Authori~
6200 Highway 62. Suite 650
Jeffersonville. IN 47130
NO PREMIUM ADJUSTMENT DUE:
ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHA,NGED
AUTHORIZED REPRESENTATIVE
f-~, Agent: Clark General Insurance ,'
· 9/06/02
sp
ZC 25166 (8~99)'' : ': ~'''::~""
' DAT/E