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HomeMy WebLinkAbout11-7259FILED-UFFIGF " THE P4C? I jqg. IeA ('' ANGINO & ROVNER, P.C. David L. Lutz, Esquire Attorney ID# : 35956 4503 North Front Street Harrisburg, PA 17110-1708 (717) 238-6791 FAX (717) 238-5610 Attorneys for Plaintiff(s) E-mail: dlutztrangino-rovner.com (7011 SEP 19 PM Z: 4 fir' CUMBERLAND COUNT' PENNSYLVANIA CRAIG HENRY and FRAN HENRY, Plaintiffs V. WESTFIELD INSURANCE CO., Defendant IN THE COURT OF CO CUMBERLAND COUN NO.Civi- CIVIL ACTION - LAW JURY TRIAL DEMAND NOTICE TO DEFEND You have been sued in court. If you wish to defend against the following pages, you must take action within twenty (20) days after this C served, by entering a written appearance personally or by attorney and fi Court your defenses or objections to the claims set forth against you. Yo fail to do so the case may proceed without you and judgment may be enl Court without further notice for any money claimed in the Complaint or for requested by the Plaintiff. You may lose money or property or other rights i LION PLEAS ,PA claims set forth in the mplaint and Notice are ng in writing with the are warned that if you red against you by the ny other claim or relief lportant to you. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER A ONCE. IF YOU DO NOT HAVE A LAWYER, GO TO OR TELEPHONE THE OFFICE ET FORTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER. RMf d a CkK S-S7da O464872 IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE. Pennsylvania Lawyer Referral Service Pennsylvania Bar Association, P.O. Box 186, Harrisburg, A 17108 TELEPHONE 1-800-692-7375 AVISO USTED HA SIDO DEMANDADO/A EN CORTE. Si usted esea defenderse de las demandas que se persentan mds adelante en las siguientes pdginas, debe tomar accion dentro de los pr6ximos veinte (20) dias despues de la notificacion de esta Dem da y Aviso radicando personalmente o por medio de un abogado una comparecencia escrita y r dicando en la Corte por escrito sus defensas de, y objecciones a , las demandas presentadas aqu en contra suya. Se le advierte de que si usted falla de tomar accion como se describe anteri rmente, el caso puede proceder sin usted y un fallo por cualquier suma de dinero reclamada en la demanda o cualquier otra reclamacion o remedio solicitado por el demandante puede ser dicta o en contra suya por la Corte sin mds aviso adicional. Used puede perder dinero o propi dad u otros derechos importantes para used. USTED DEBE LLEVAR ESTE DOCUMF,NTO SU ABOGADO INMEDIATAMENTE. SI USED NO TIENE UN ABOGADO, LL ME O VAYA A LA SIGUIENTE OFICINA. ESTA OFICINA PUEDE PROVEERLE INFO ACION A CERCA DE COMO CONSEGUIR UN ABOGADO. SI USED NO PUEDE PAGAR POR LOS SERVICIOS DE UN ABOGADO, ES POSIBLE QUE ESTA OFICINA LE PUEDA PROVEER INF RMACION SOBRE AGENCIAS QUE OFREZCAN SERVICIOS LEGALES SIN CARGO O BAJO COSTO A PERSONAS QUE CUALIFICAN. Pennsylvania Lawyer Referral Service Pennsylvania Bar Association, P.O. Box 186, Harrisburg, P A 17108 TELEFONO 1-800-692-7375 464872 ANGINO & ROVNER, P.C. David L. Lutz, Esquire Attorney ID# : 35956 4503 North Front Street Harrisburg, PA 17110-1708 (717) 238-6791 FAX (717) 238-5610 Attorneys for Plaintiff(s) E-mail: dlutz@angino-rovner.com CRAIG HENRY and FRAN HENRY, Plaintiffs V. WESTFIELD INSURANCE CO., Defendant ? - vv1Y1 Y1V1V 1 LLL"1U CUMBERLAND COUNT ', PA NO. CIVIL ACTION - LAW JURY TRIAL DEMANDE: COMPLAINT 1. Plaintiffs Craig and Fran Henry are adult individ Commonwealth of Pennsylvania. They reside in Mechanicsburg, Pennsylvania. 2. Defendant Westfield Insurance Co. (hereinafter We registered in Pennsylvania and provides automobile insurance to persol Pennsylvania. Westfield has a principal place of business located at 201 Box 3010, Lancaster, Lancaster County, Pennsylvania, 17604-3010. 3. Westfield regularly conducts business in Cumberland Cou 4. As part of the automobile insurance provided to pel Westfield provides underinsured motorist coverage (UIM) to policyhol coverage. 5. As of July 29, 2009, Westfield provided UIM benefits coverage to Craig and Fran Henry pursuant to policy no. BSP 4151561 is the applicable Westfield policy. and citizens of the Cumberland County, ) is a corporate duly operating vehicles in Oregon Road, P.O. , Pennsylvania. ns in Pennsylvania, 's that purchase said f at least $300,000 of Attached as Exhibit A 464872 6. Plaintiffs Craig and Fran Henry are the owners of Family Eye Care, the named insured on the applicable Westfield automobile insurance policy providing UIM coverage. 7. The facts and occurrences hereinafter related took plac e on or about July 29, 2009, on the Carlisle Pike, Hampden Township, Cumberland County, Per nsylvania. 8. At that time and place, Plaintiff Craig Henry was operating a 1996 Chrysler, traveling east on the Carlisle Pike. Mr. Henry entered the left turn lane o the Carlisle Pike as he planned to turn north onto Good Hope Road. 9. At the same time and place, Iram Amin was operating 1998 Toyota and was planning to enter the Carlisle Pike from a private parking lot befor , the subject collision. Defendant Amin was attempting to turn left onto the Carlisle Pik and thereafter travel westbound. 10. Iram Amin pulled from the private parking lot and attem ted to turn her vehicle left onto the Carlisle Pike, but she pulled directly into the path of C vehicle causing a collision. 11. The foregoing motor vehicle collision and all of the injurie herein sustained by Plaintiffs Craig and Fran Henry are the direct and negligent, careless, wanton, and reckless manner in which Iram Amin op( as follows: a. failure to keep alert and maintain a proper watch fe vehicles traveling on the Carlisle Pike; b. failure to yield the right-of-way to Craig Henry's Pike; g Henry's oncoming and damages set forth •oximate result of the ited her motor vehicle the presence of motor le on the Carlisle 464872 2 C. failure to see Craig Henry's vehicle on the Carlisl6 Pike before attempting to pull her vehicle from a private parking lot; d. driving her vehicle upon the road in a manner property and in a reckless manner with careless disregard to others and in violation of the Motor Vehicle Code of Pennsylvania. 12. It is averred and therefore believed that Iram Amin is 13. The provisions of Craig and Fran Henry's UIM polic arbitration and therefore, Craig and Fran Henry bring this claim for UIM persons and rights and safety of Commonwealth of does not provide for CLAIM I Craig Henry v. Westfield Insurance Co. 14. Paragraphs 1 through 13 of the Complaint are incorporate herein by reference. 15. Plaintiff Craig Henry sustained painful and severe injurie , which include but are not limited to cervical myelopathy, a central disc herniation at C4-5, increased symptoms of spasticity and stiffness of the cervical spine, persistent tenderness and pan in the lower thoracic spine, an aggravation of a pre-existing cervical spine condition, spasticit . and tightness over the left lower extremity, increased low back pain, increased spasticity of to left lower extremity, increased spasticity with regard to the left upper extremity, and an injury the lumbar spine. 16. By reason of the aforesaid injuries sustained by Craig H ,-nry, he was forced to incur liability for physical therapy, medical treatment, medications, an similar miscellaneous expenses in an effort to restore himself to health, and claim is made there r. 464872 3 17. Because of the nature of his injuries, Craig Henry has bees avers that he may be forced to incur similar expenses in the future, advised and, therefore, such as cervical spine surgery, and claim is made therefor. 18. Craig Henry has undergone and in the future may undergo physical and mental suffering, inconvenience in carrying out his daily activities, loss of life's pleasures and enjoyment, and claim is made therefor. 19. Craig Henry continues to be plagued by persistent p in therefore, avers that his injuries may be of a permanent nature, causing r si remainder of his lifetime, and claim is made therefor. 20. By reason of the aforesaid injuries sustained by Craig work loss, loss of earning capacity, and loss of opportunity as an optor therefor. 21. Craig Henry has undergone cervical spine surgery as a dii sustained in the subject motor vehicle accident and therefore, he has sust; because Dr. Henry's discs at C3-C4 and C6-C7 are showing bulging and car accident and future surgeries may be needed. CLAIM 11 Fran Henry v. Westfield Insurance Co. 22. Paragraphs 1 through 21 of the Complaint are incorporate( 23. As a result of the aforementioned injuries sustained by her Henry, Plaintiff Fran Henry has been and may in the future be deprived of and limitation and, problems for the , he has sustained and claim is made result of the injuries a surgical scar and oration due to the herein by reference. iusband, Plaintiff Craig ie care, companionship, 464872 4 consortium, and society of her husband, all of which will be to her made therefor. WHEREFORE, Plaintiffs Craig and Fran Henry demand j Westfield Insurance Co. in an amount in excess of Fifty Thousand of interest and costs and in excess of any jurisdictional amount requiring ANGINO & RO detriment, and claim is lent against Defendant ($50,000.00), exclusive 1pulsory arbitration. R. P.C. Date: q 1) I David L. Lutz PA I.D. No. 35956 4503 N. Front Street Harrisburg, PA 17110 (717) 238-6791 -phone (717) 238-5610 - fa dlutz@angino-rovnei.com Attorney for Plaintiffs 464872 5 VERIFICATION We, Craig and Fran Henry, Plaintiffs, have read the foregoing COTPLAINT and do hereby swear or affirm that the facts set forth in the foregoing are true and co?rect to the best of our knowledge, information and belief. We understand that this Verificatiar? is made subject to the penalties of 18 Pa. Cons. Stat. Ann. §4904, relating to unsworn falsification ?o authorities. 7 Craig Henry Fran Henry Dated: 9/iy ) 11 464872 WTTNF.R C Co erci Insurance Coverage Policy No.: BSP 4151561 Policy Period: 10/07/08 to 10/07/09 "I, Abby Weit, Supervisor -Administrative Services, of the Westfield Insurance Company, do hereby certify that the foregoing copy was prepared under my supervision and to the best of my knowledge and belief is a true and correct copy of the policy with an effective date of 10/07108-10/07/09." ti WEST IELD tIN URAN Sharing Knowledge, Building Trust® h'o- P- AD 1141 E Commercial Insurwice Coverage Policy THIS POLICY HAS BEEN ESPECIALLY DESIGNED FOR: FAMILY EYE CARE INC BY HENDERSON INSURANCE AGENCY INC THROUGH- WESTFIELD INSURANCE COMPAAY Westfield Companies INSURANCE SINCE 1848 P.O. Box 5001, Westfield Center, Ohio 44251-5001 ID 7004 (0893) IN WITNESS WHEREOF, this Company has caused this policy to be signed b its President and Sec- retary and countersigned by a duly authorized representative of the Company if equired by law. Secretary President i HENDERSON INSURANCE AGENCY INC 3820 WALNUT ST HARRISBURG. PA 17109-2532 717-652-8355 Policy Number: BSP 4151561 FAMILY EYE CARE I C 5012 CARLISLE PIKE MECHANICSBURG P 17050 Assembly Instructions These pages update your current policy. To keep it current, yo should: 1. Check the upper right hand corner of each page in this pa ket. a. If it says "Renewal or Rating Period Declarations", remove the expired declarations page from your current policy a rd replace it with the updated "Renewal or Rating Period Declarations" page. b. If it says "Amended Declarations", insert this amende page on top of the last declarations page you received. 2. Every time you receive a "Renewal or Rating Period Decl rations", remove all prior "Amended Declarations". 3. When you remove pages from your policy, retain them for la perma- nent record. Thank you for placing your business with Westfield Companies' 1 Westfield Companies INSURANCE SINCE 1848 P.O. Box 5001, Westfield Center, Ohio 44251-5001 CRP2117 (09-92) THIS PAGE INTENTIONALLY LEFT' BLANK PENNSYLVANIA LAW REQUIRES US TO NOTIFY YOU OF THE OOLLOWING Any person who knowingly and with intent to defraud any insurance comps y or other person files an application for insurance or statement of claim containing any materially fal a information or conceals for the purpose of misleading, information concerning any fact material theret commits a fraudulent in- surance act, which is a crime and subjects such person to criminal and civil nalties. AD 1075 (02-02) ADVISORY NOTICE TO POLICYHOL6ERS This is a summary of the major changes in your Business Auto Coverage Part No coverage is provided by this summary nor can it be construed to replace any provision of your poll y. You should read your policy and review your declarations page for complete information on the co erages you are provided. If there is any conflict between the policy and this summary, THE PROVISION OF THE POLICY SHALL PREVAIL. Some of the language of the new policy has been restated and repunctuated for clarity and readability but with no change in coverage intent. CA 0001 - Business Auto Coverage Form: Clarification Of Coverage 1) The Business Auto Coverage Form now defines "Employee", "Leased orker", and "Temporary Worker". i 2) The radar exclusion contained in the Business Auto Coverage Form includ s clarification to address changes in technology. Broadening Of Coverage I 1) The Coverage Extensions - Supplementary Payments - The maximum aily payment for loss of earnings is increased from $100 to $250. The limit provided for the cost f bail bonds is increased from $250 to $2,000. 2) Members of Limited Liability Companies are considered insureds under th? policy AD 82 49 10 97 THIS PAGE INTENTIONALLY LEFT' BLANK ADVISORY NOTICE TO POLICYHOLDER This is a summary of the major changes in your Commercial Automobile C verages. No coverage is provided by this summary nor can it be construed to replace any provision your policy. You should read your policy and review your declaration page for complete information n the coverages you are provided. If there is any conflict between the policy and this summary, THE PROVISIONS OF THIS POLICY SHALL PREVAIL. PLEASE READ YOUR POLICY, AND THE ENDORSEMENTS ATTACHED TO YO BROADENINGS OF COVERAGE - POLICY FORMS CA 00 01 - Business Auto Coverage Form CA 00 05 - Garage Coverage Form CA 00 10 - Business Auto Physical Damage Coverage Form CA 00 12 - Truckers Coverage Form CA 00 20 - Motor Carrier Coverage Form ¦ Coverage for transportation expenses and loss of use expenses under I are increased from $15 per day/$450 maximum to $20 per day/$600 maxi ¦ Coverage for covered pollution cost or expense is broadened to include a out of a statutory or regulatory requirement. CA 00 05 - Garage Coverage Form POLICY, CAREFULLY. sical Damage Coverage m cost or expense arising ¦ The pollution exclusion for Other Than Covered Autos has been revised t provide an exception for bodily injury sustained within a building caused by building heating equipment. ¦ The pollution exclusion in these coverage forms is also being revised to provide an exception for bodily injury sustained within a building and cause; by the release of gases, fumes, or vapors from materials brought into that building in connection with operations as a co tractor being performed by or on behalf of any insured. CLARIFICATIONS IN COVERAGE AND OTHER EDITORIAL REVISIONS - All Commercial Auto Coverage Forms contain minor editorial revisions to provi policies. Additionally, these coverage forms have been revised to include othe serve to clarify coverage. The changes to each coverage form are described b CA 00 01 - Business Auto Coverage Form CA 00 05 - Garage Coverage Form CA 00 10 - Business Auto Physical Damage Coverage Form CA 00 12 - Truckers Coverage Form CA 00 20 - Motor Carrier Coverage Form GE FORMS le for consistency among various revisions which glow: The Limits of Insurance provisions in the Physical Damage Coverage secti n have been revised to clarify the intent that loss payment for repair or replacement does not i clude any payment for betterment, and that adjustments will be made for depreciation and physical condition in determining actual cash value in the event of a total loss. (Not applicable in all states.) ¦ We have introduced a Diminution In Value exclusion to the Physical Damag Coverage to clarify that the Coverage Forms do not provide for payment of any loss in market value, as loss in market values is not a component of direct and accidental loss or damage as provided in the policy's definition of "loss". (Not applicable in all states.) ¦ All of the coverage forms have been revised to incorporate, where appro riate and with updated amounts for transportation and loss of use expenses, the provisions of man atory endorsements CA 00 22 - Changes in Commercial Auto Coverage Forms which has been with yawn. AD 8487 09 02 Page 1 of 2 ¦ All coverage forms have been revised to clarify that sales tax for a da considered part of the total loss settlement. CA 00 01 - Business Auto Coverage Form CA 00 05 - Garage Coverage Form CA 00 12 - Truckers Coverage Form CA 00 20 - Motor Carrier Coverage Form The definition of "temporary worker" has been amended for consistency with Liability (CGL) policy. CA 00 05 - Garage Coverage Form Iged or stolen vehicle is ?he Commercial General i ¦ The insuring agreement for the Other Than Covered Auto section has been revised to clarify that the policy does not respond to injury or damage that is known by the insured prior to the policy period. The new language also addresses the applicability of this form in situatio s involving continuation, change or resumption of the same bodily injury or property damage during or after the policy period. Exclusion 8. Pollution Exclusion Applicable To "Garage Operations" - Other Tha?h Covered "Autos" of the Garage Coverage Form has been revised to: ¦ Break up this exclusion into two parts: one to exclude bodily injury and p perty damage; and one to exclude specified clean-up costs or expenses, similar to the format of he Commercial General Liability Pollution exclusion. As a result, the exclusion has been re-num ered and re-lettered ac- cordingly. ¦ Move the current exception for hostile fire, under new paragraph 8.a. ¦ Revise the former "loss, cost or expense" definition contained within this e6usion to: ¦ Add reference to "statutory or regulatory requirement"; and ¦ Provide an exception to clarify that this paragraph is not intended to 'xclude coverage for the third party property damage claims which are otherwise covered and of subject to paragraph a. of the exclusion. ¦ Section III - Garagekeepers has been revised to: ¦ Reference "customer's auto" instead of "covered auto" throughout thii section and add a defi- nition of this term in the Definitions section for consistency with Gara ekeepers endorsement CA 99 37. ¦ Add reference to "customer's auto" equipment in the lead-in to the Wh?j Is An Insured provision for clarity. ¦ Update the radar exclusion to track with the version found in the Phy?Isical Damage Coverage section. ¦ Add reference to an all perils deductible in paragraph C. Limit of Insu ance and Deductible to track with the Garage Declarations. CA 00 10 - Business Auto Physical Damage Coverage Form ¦ The quotes around the terms "insured", "suit" and "trailer" have been elimi Iated since these are not defined terms in this form. ¦ Definitions for "employee", "leased worker" and "temporary worker" have ben added. AD 8487 09 02 Page 2 of 2 ADVISORY NOTICE TO POLICYHOLDER CA 23 94 03 06 - Silica Or Silica-Related Dust Exclusion For Covered Autos I CA 25 39 03 06 - Silica Or Silica-Related Exclusion For Covered Autos Expos When this endorsement is attached to your policy, coverage is excluded for b, in whole or in part, out of the actual, alleged, threatened or suspected inhalatic or silica-related dust. In addition, coverage is excluded for property damage I in part, out of actual, alleged, threatened or suspected contact with, exposur( ence of, silica or silica-related dust. Coverage is also excluded for any loss, c whole or in part, out of the abating, testing for, monitoring, cleaning up, rem( detoxifying, neutralizing, remediating or disposing of, or in any way respondi fects of, silica or silica-related dust. - Garage Coverages Jily injury liability arising i of, or ingestion of, silica ability arising in whole or to, existance of, or pres- st or expense arising, in ,ing, containing, treating, 3 to or assessing the ef- AD 87 26 04 06 W E S T F I E L D INSURANCE IMPORTANT NOTICE TO OUR POLICYHOLDERS Westfield Insurance Fraud Hot-Line PLEASE READ THIS IMPORTANT INFORMATION ¦ Fraudulent insurance claims cost us all money. ¦ Call us if you have information concerning a fraudulent insu ¦ All information will be kept confidential. Sharing Knowledge. Building Trust., ce claim. ¦ Call and discuss your information with a trained investigator, for leave the informa- tion anonymously on a telephone answering machine. ¦ We can all help fight insurance fraud. AD 8522 01-03 Be a Fraud Buster 1-800-654-6482 Detach and retain information below for Fraud Hot-Line 1-800-654-6482 W E S T F I E L D `-?9 ' INSURANCE Sharing Knowledge. Building Trust.' Westfield Center, Ohio 44251 www. westfieldgrp. com Fraud 1-800- S I NS • Sharing Knn Westfield Cent( www.westfi use. It-Line 1-6482 FIELD R A N C E ige. Building Trust- , Ohio 44251 ldgrp.com THIS NOTICE DOES NOT GRANT ANY COVERAGE OR CHAN CONDITIONS OF ANY COVERAGE UNDER THE POLICY. CONFLICT BETWEEN YOUR POLICY AND THIS NOTICE, TH YOUR POLICY SHALL PREVAIL. POLICYHOLDER DISCLOSURE NOTICE OF TERRORISM INSURANCE COVERAGE and PREM On November 26, 2002, the Terrorism Risk Insurance Act of 2002 (hereafterthe by the President. The Act, as amended in 2007, defines an "act of terrorism" any act that is certified by the Secretary of the Treasury, in concurrence with t the Attorney General of the United States (1) to be an act of terrorism; (2) to be is dangerous to human life, property, or infrastructure; (3) to have resulted in States, or outside the United States in the case of certain air carriers or ves United States mission; and (4) to have been committed by an individual or indi, to coerce the civilian population of the United States or to influence the policy c United States Government by coercion. Coverage for acts of terrorism as defined by the Act, as amended, is includ and/or in any policy quoted for you. You should know that under your existing from certified acts of terrorism may be partially reimbursed by the United Sty formula established by federal law. Under this formula, the United States Go burses 85% of covered terrorism losses exceeding the statutorily established surance company providing the coverage. You should also know that the Act $100 billion cap that limits United States Government reimbursement as wel losses resulting from certified acts of terrorism when the amount of such lossi any one calendar year. If the aggregate insured losses for all insurers exceed $ may be reduced. Under the Act, as amended, this formula is currently effecti 2014. THE TERMS AND THERE IS ANY PROVISIONS OF IUM 'Act") was signed into law in Section 102(1) to mean ie Secretary of State, and a violent act or an act that famage within the United iels or the premises of a fiduals as part of an effort r affect the conduct of the d in your current policy overage losses resulting ies Government under a ernment generally reim- eductible paid by the in- as amended, contains a as insurers' liability for i exceeds $100 billion in 00 billion, your coverage e through December 31, The actual insurance coverage provided by your policy for acts of terrorism s defined in the Act, as amended, as is true for all coverages, is limited by the terms, conditions, ex lusions, limits, other pro- visions of your policy, any endorsements to the policy and generally applicabl rules of law. PREMIUM CHARGED During your current policy period, the portion, if any, of your premium that is attributable to coverage for acts of terrorism as defined in the Act is $ (refer to Common Policy De larations if blank). If you do not desire the coverage for acts of terrorism as defined in the Act, as mended, you may reject the coverage and instruct the insurance company to remove it and refund the p emium described above. To reject the coverage, you must: 1) advise the insurance company by letter (on your company letterhead), 2) signed by the owner, representative, or properly designated official of 1he named insured The insurance company must receive your letter within 60 days from the date own at the bottom right side of the forms titled "Common Policy Declarations". Please refer to "Commo Policy Declarations" for the mailing address of the insurance company. If your policy premium is $500, that may represent a minimum premium. In tha case, the portion that is attributable to acts of terrorism as defined in the Act, as amended, may be incl ded within that minimum and your total premium will not be reduced if you reject coverage for acts of errorism. The minimum premium will still apply. Should you have any question regarding this notice, please contact your insurance agent AD 85 84 01 08 51 ' WESTFIELD INSURANCE RENEWA Sharing Knowledge. Building Trust," COMMON POLICY DECLARATIONS COMPANY PROVIDING COVERAGE WESTFIELD INSUR NCE COMPANY NAMED INSURED AND MAILING ADDRESS AGENCY 37-0 203 PROD. 000 FAMILY EYE CARE INC HENDERSON INSURANCE AGENCY INC 5012 CARLISLE PIKE 3820 WALNUT ST MECHANICSBURG PA 17050 HARRISBURG PA 1710 -2532 TELEPHONE 717-652- 355 Policy Number: BSP 4 151 561 104? WIC Account Numbe : 3770082840 A Policy From 10/07/08 at 12:01 A.M. Stan Period To 10/07/09 mailin addr h and Time at your g ess s wn above. Business: EYE DOCTOR Named Insured i : Corporation In return for the payment of the premium, and subject to all terms of this policy, we agree with you to provide the insurance as stated in this policy. IF THIS POLICY AFFORDS PHYSICAL DAMAGE COLLISION COVERAGE AN A COVERED AUTO SYMBOL 1, 8, 21, 28, 41, OR 47 IS SHOWN NEXT TO THE PHYSICAL COVERAGE ON THE APPLICABLE AUTO DECLARATIONS, WE PROVIDE COL DAMAGE COLLISION ISION DAMAGE TO . RENTAL VEHICLES. IF NOT SHOWN, WE DO NOT AFFORD COLLISION D MAGE COVERAGE TO RENTAL VEHICLES. ANY SUCH INSURANCE PROVIDED IS EXCESS 0 ER ANY OTHER COLLECTABLE INSURANCE. THIS POLICY CONSISTS OF THE FOLLOWING COVERAG PARTS COMMERCIAL AUTO COVERAGE PART $ 2 295 00 TERRORISM INSURANCE COVERAGE , . $ 0.00 Policy Annual Premium $ 2,295.00 I i Total Advance Annual Policy Premium i i $ 2,295.00 The above is a summary of your coverages. For more please refer to the individual detail, coverage parts inside your policy. Forms and Endorsements applicable to all coverage parts: IL7002 0488*, IL0017 1198*, ID7004 0893 IL0003 0907'. IL0910 0702* .', IL0246 0907*, - COUNTERSIGNED: COUNTERSIGNED: BY Date ut orize epresentative PAGE 01 OF 01 IL 70 02 (04-88) n2zioen INTERLINE THIS ENDORSEMENT CHANGES THE POLICY. PLEASE R D IT CAREFULLY. CALCULATION OF PREMIUM 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 PROPERTY COVERAGE PART CRIME AND FIDELITY COVERAGE PART EMPLOYMENT - RELATED PRACTICES LIABILITY COVERAGE PART EQUIPMENT BREAKDOWN COVERAGE PART FARM COVERAGE PART LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART PROFESSIONAL LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART The following is added: r The premium shown in the Declarations was computed based on rates in a ct at the time the policy was issued. On each renewal, continuation, or anniversary of the effective d to of this policy, we will compute the premium in accordance with our rates and rules then in effect. O ISO Properties, Inc., 2006 11 IL 00 03 09 07 INTERLINE THIS ENDORSEMENT CHANGES THE POLICY. PLEASE RE? D IT CAREFULLY. PENNSYLVANIA CHANGES - CANCELLATION AND NONRENE 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 COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART A. The Cancellation Common Policy Condition is replaced by the following: CANCELLATION 1. The first Named Insured shown in the Declarations may cancel this policy by writing or giving notice of cancellation. 2. Cancellation Of Policies 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 30 days before the effective date of cancel- lation. 3. Cancellation Of Policies In Effect For 60 Days Or More If this policy has been in effect for 60 days or more or if this policy is a renewal of a policy we issued, we may cancel this policy only for one or more of the follow- ing reasons: a. You have made a material misrep- resentation which affects the in- surability of the risk. Notice of can- cellation will be mailed or delivered at least 15 days before the effective date of cancellation. b. You have failed to pay a premium when due, whether the premium is payable directly to us or our agents or indirectly under a premium fi- nance plan or extension of credit. Notice of a at least 15 date of can c A conditic ence mat changed s tial conditi ence mat become kr riod. Noti mailed or I before the tion. d Loss of reii decrease curred, wh the time c certified to sioner as policies. N be mailed days befor c:ancellatioi e. Material fail terms, cond ties. Notice mailed or d before the e tion. f. Other read Commissior of cancellati livered at It effective dat v ISO Properties, Inc., 2006 'AL ncellation will be mailed lays before the effective ellation. factor or loss experi- al to insurability has stantially or a substan- , factor or loss experi- al to insurability has vn during the policy pe- of cancellation will be livered at least 60 days fective date of cancella- surance or a substantial i reinsurance has oc- ;h loss or decrease, at cancellation, shall be the Insurance Commis- irectly affecting in-force >tice of cancellation will )r delivered at least 60 the effective date of re to comply with policy dons or contractual du- of cancellation will be livered at least 60 days ective date of cancella- ns that the Insurance er may approve. Notice )n will be mailed or Be- ast 60 days before the of cancellation. IL 02 46 09 07 Page 1 of 2 This policy may also be cancelled from in- ception upon discovery that the policy was obtained through fraudulent statements, omissions or concealment of facts material to B the acceptance of the risk or to the hazard assumed by us. 4. We will mail or deliver our notice to the first Named Insured's last mailing ad- dress known to us. Notice of cancellation will state the specific reasons for cancel- lation. 5. Notice of cancellation will state the ef- fective date of cancellation. The policy period will end on that date. 6. If this policy is cancelled, we will send the first Named Insured any premium re- fund due. If we cancel, the refund will be pro rata and will be returned within 10 business days after the effective date of cancellation. If the first Named Insured cancels, the refund may be less than pro rata and will be returned within 30 days after the effective date of cancellation. The cancellation will be effective even if we have not made or offered a refund. 7. If notice is mail d, it will be by registered or first class mail. Proof of mailing will be sufficient pr of of notice. The following are a ded and supersede any provisions to the co trary: 1. Nonrenewal If we decide no to renew this policy, we will mail or d liver written notice of nonrenewal, st ing the specific reasons for nonrenewal to the first Named In- sured at least 6 days before the expira- tion date of the olicy. 2. Increase Of Preinium If we increase your renewal premium, we will mail or deliver to the first Named Insured written otice of our intent to in- crease the premium at least 30 days be- fore the effecti a date of the premium increase. Any notice of nonr newal or renewal pre- mium increase will a mailed or delivered to the first Named Insu ed's last known address. If notice is mailed, i will be by registered or first class mail. Pro f of mailing will be suffi- cient proof of notice. IL 02 46 09 07 Page 2of2 PENNSYLVANIA NOTICE An Insurance Company, its agents, employees, or service contractors acting on its behalf, may pro- vide services to reduce the likelihood of injury, death or loss. These services may include any of the following or related services incident to the application for, issuance, renewal or continuation of, a policy of insurance. 1 surveys; 2. consultation or advice; or 3. inspections. furnishing of or the faiYure to furnish these ser- vices. III The Act does not 1 2 The "Insurance Consultation Services Exemption Act" of Pennsylvania provides that the Insurance 3 Company, its agents, employees or service con- tractors acting on its behalf, is not liable for dam- ages from injury, death or loss occurring as a result of any act or omission by any person in the if the injury, death r loss occurred during the actual performanc of the services and was caused by the ne ligence of the Insurance Company, its age s, employees or service contractors; to consultation se ices required to be per- formed under a written service contract not related to a policy f insurance; or if any acts or om ssions of the Insurance Company, its agents, employees or service contractors are jud cially determined to con- stitute a crime, ctual malice, or gross negligence. i O ISO Properties, Inc., 2001 11 IL 09 10 (Ed. 07 02) COMMON POLICY CONDITIO All Coverage Parts included in this policy are subject to the following conditio A. Cancellation 1. The first Named Insured shown in the Declarations may cancel this policy by mailing or delivering to us advance writ- ten notice of cancellation. 2. 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 non- payment of premium; or b. 30 days before the effective date of cancellation if we cancel for any other reason. 3. We will mail or deliver our notice to the first Named Insured's last mailing ad- dress known to us. 4. Notice of cancellation will state the ef- fective 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 re- fund due. If we cancel, the refund will be pro rata. If the first Named Insured can- cels, 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 sufficient proof of notice. B. Changes This policy contains all the agreements be- tween 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 records 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 Deports on the conditions we find; a c. Recommend changes. 2. We are not o spections, sur mendations an undertake rela the premiums make safety i undertake to person or orga health or safet, And we do not ligated to make any in- eys, reports or recom- any such actions we do only to insurability and be charged. We do not spections. We do not erform the duty of any ization to provide for the of workers or the public. varrant that conditions: a. Are safe of healthful; or b. Comply ith laws, regulations, codes or s andards. 3. Paragraphs 1. and 2. of this condition apply not only o us, but also to any rat- ing, advisory, to service or similar or- ganization w ich makes insurance inspections, su eys, reports or recom- mendations. 4. Paragraph 2. this condition does not apply to any nspections, surveys, re- ports or recommendations we may make relative to cer ification, under state or municipal stat es, ordinances or regu- lations, of boilers, pressure vessels or elevators. E. Premiums The first Named In red shown in the Decla- rations: 1. Is responsible r the payment of all pre- miums; and 2. Will be the p ums we pay. F. Transfer Of Your This Policy Your rights and du not be transferred 1 except in the case named insured. for any return premi- hts And Duties Under s under this policy may hout our written consent death of an individual If you die, your ri hts and duties will be transferred to your legal representative but only while acting thin the scope of duties as your legal representative. Until your legal representative is a )pointed, anyone having proper temporary ustody of your property will have your right and duties but only with respect to that prop rty. Copyright, Insurance Services Office, Inc., 1998 11 IL 00 17 11 98 A TO C V€ WESTFIELD 51 I N S U R A N RENEWA C E L BUSINESS AUTO C OVERA GE DECLARATIONS Sharing Knowledge. Building Trustm COMPANY PROVIDING COVERAGE WESTFIELD INSURA NCE COMPANY ITEM ONE-NAMED INSUR ED & MAILING ADDRESS AGENCY 37-04 203 PROD. 000 FAMILY EYE CARE INC HENDERSON INSURANCE AGENCY INC 5012 CARLISLE PIKE 3820 WALNUT ST MECHANICSBURG PA 17 050 HARRISBURG PA 17104 -2532 TELEPHONE 717-6524 355 Policy Number: BSP 4 151 561 1041 WIC Account Numbe : 3770082840 I A Policy From 10/07/08 at 12:01 A.M. Stan and Time at your Period To 10/07/09 mailing address sh wn above. ITEM TWO SCHEDULE OF COVERAGES AND COVERED AUT S Each Of These Coverages Will Apply Only To Those "Autos" Shoo n As Covered "Autos". "Autos" Are Shown As Covered "Autos" For A Particular Covera a By The Entry Of One Or More Of The Symbols From The Covered Auto Section Of The usiness Auto Coverage Form Next To The Name Of The Coverage. COVERED LIMIT COVERAGES AUTO THE MOST WE WILL PAY FOR A NY PREMIUM SYMBOLS ONE ACCIDENT OR LOSS Liability 01 Bodily Injury $1,021 and $1,000,000 Eac h Accident Property Damage Uninsured Motorists 07 Bodily Injury $300,000 Eac h Accident $69 Underins. Motorists 07 Bodily Injury $300,000 Eac h Accident $105 Physical Damage 07 Actual Cash Value or Cost of R ( pair $316 Comprehensive Whichever is Less Minus the Dec . for Each Coverage Covered Auto as Indicated in t l e Schedule for Covered Autos. No Deductib a Applies I to Loss Caused by Fire or Ligh ing. Physical Damage 07 Actual Cash Value or Cost of R ( pair $751 Collision Whichever is Less Minus the De ctible Coverage for Each Covered Auto as Indic ed in the Schedule for Covered Autos. First Party Benefit 07 See Endorsement CA2237 $33 TOTAL ADVANCE ANNUAL PRE MIUM $2,295 Audit Period (If Applies) F] Annual F Semi-Annual F-1 Quarterly Monthly Forms And Endorsements Attached To This Coverage Form: CA0001 0306*, CADS03 0306*, IL0021 0702*, CA0180 0997* 2394 0306* , CA2192 0806*, CA7070 0806*, CA2193 0806*, CA7007 1087*, 2237 0306%',, . WESTFIELD 51 RENEWA INSURANCE BUSINESS AUTO COVERA E DECLARATIONS Sharing Knowledge. Building Trust® (Cont inu d ) COMPANY PROVIDING COVERAGE WESTFIELD INSUR NCE COMPANY ITEM ONE-NAMED INSURED & MAILING ADDRESS AGENCY 37-O F203 PROD. 000 FAMILY EYE CARE INC HENDERSON INSURANC AGENCY INC 5012 CARLISLE PIKE 3820 WALNUT ST MECHANICSBURG PA 17050 HARRISBURG PA 1710 -2532 TELEPHONE 717-652- 8355 Policy Number: BSP 4 151 561 1041 WIC Account Numbe : 3770082840 I A Policy From 10/07/08 at 12:01 A.M. Stan and Time at your Period To 10/07/09 mailing address sh wn above. ITEM THREE SCHEDULE OF COVERED AUTOS YOU OWN The Insurance Afforded For Any One Automobile Is Only With R spect To Such And So Manx Of The Coverages As Are Indicated In Item Two Unless A Specific Limit Or Deductible Is Indicated In This Schedule Of Automobiles. COST STATED AUTO ST TER YR DESCRIPTION SERIAL NUMBER AGE SYM CLASS AMT GVW 001 PA 027 96 CHRY CONCORDE LXI 2C3HD56F6TH258091 6 1 739199 002 PA 027 00 BMW 740IL WBAGH8348YDPO9961 6 2 739199 003 PA 027 02 NSSN PATHFINDER S JN8DR09Y02W722430 6 1 739199 PREMIUMS- FPB/ NED UN-UD SPEC TOW & * DEDUCTIBLE TOTAL AUTO LIAB PIP PPI PY/EX MTRST COMP PERIL COLL LABOR ENDTS COMP COLL PREMIUM 001 309 ll 58 169 190 250 500 637 1 i 002 309 11 58 51 309 1 $ 1 250 500 8 8 003 309 11 58 252 $96 250 500 726 HIRED AUTO LIABILITY STATE ESTIMATED COST OF HIRE RATE PER $100 COST F HIRE PREMIUM PA IF ANY 1.403 Cost Of Hire Means The Total Amount You Incur For The Hire 0 Autos You Do Not Own (Not Including Autos You Borrow Or Rent From Your Partner s Or Employees Or Their Family Members). Cost Of Hire Does Not Include Charge For Services Performed By Motor Carriers Of Property Or Passengers. NON-OWNERSHIP LIABILITY RATING BASIS-NUMBER OF EMPLOYEES ESTIMATED NUMBER PREMIUM OF EMPLOYEES 0-25 $94 TOTAL ADVANCE ANNUAL AU 0 PREMIUM $2,295 PAGE 02 OF 03 CA DS 03 (03-06) nRl1RAR ur WESTFIELD 51 I N S U R A N C E RENEWA BUSINESS AUTO COVERA E DECLARATIONS Sharing Knowledge. BuildingTrust° (Continu d) COMPANY PROVIDING COVERAGE WESTFIELD INSURA NCE COMPANY ITEM ONE-NAMED INSURED & MAILING ADDRESS AGENCY 37-0 203 D. 000 FAMILY EYE CARE INC HENDERSON INSURANCE AGENCY INC 5012 CARLISLE PIKE 3820 WALNUT ST MECHANICSBURG PA 17050 HARRISBURG PA 1710' 1-2532 TELEPHONE 717-652-4 355 Policy Number: BSP 4 151 561 1041 WIC Account Numbe : 3770082840 A Policy From 10/07/08 at 12:01 A.M. Stand ard Time at your Period To 10/07/09 mailing address sho wn above. NOTICE TO INSURED (Invoice of Minimum Required Coverage ) The laws of the Commonwealth of Pennsylvania s enacted by the General Assembly, only require that you purcha e liability and First Party Medical Benefits Coverages. Any additional coveraes or coverages in exces required by law are provigded only at your request of the limits is enhancements to basic coverages. Bodily Injury and/or Property Damage: $35,000 Each Acc. $453 First Party Benefits: $5,000 Medical Benefits Only $33 YOUR TOTAL COST FOR MINIMUM REQUIRED COV RAGES $486 COMMERCIAL AUTO BUSINESS AUTO COVERAGE FORM Various provisions in this policy restrict coverage. SECTION I - COVERED UTOS Read the entire policy carefully to determine Item Two of the Decla tions shows the "autos" rights, duties and what is and is not covered. that are covered "auto " for each of your cover- Throughout this policy the words "you" and "your" ages. The following nu erica) symbols describe refer to the Named Insured shown in the Declara- the "autos" that may e covered "autos." The tions. The words "we," "us" and "our" refer to the symbols entered next t a coverage on the Dec- Company providing this insurance. larations designate the only "autos" that are cov- Other words and phrases that appear in quotation ered "autos." marks have special meaning. Refer to Section V A. Description Of C vered Auto Designation - Definitions. Symbols Symbol Description Of Covered Auto Designatio n Symbols 1 Any "Auto" 2 Owned "Autos" Only those "autos" you own (and for Liability Cove rage any "trailers" you Only don't own while attached to power units you own) This includes those "autos" you acquire ownership of after the policy egins. 3 Owned Private Only the private passenger "autos" you own. Thi includes those private Passenger passenger "autos" you acquire ownership of after the policy begins. "Autos" Only 4 Owned "Autos" Only those "autos" you own that are not of the pri ate passenger type Other Than (and for Liability Coverage any "trailers" you don' own while attached to Private power units you own). This includes those "autos ' not of the private Passenger passenger type you acquire ownership of after th policy begins. "Autos" Only 5 Owned "Autos" Only those "autos" you own that are required to h ve No-Fault benefits Subject to in the state where they are licensed or principally garaged. No-Fault This includes those "autos" you acquire ownershi of after the policy begins provided they are required to have No-Fau it benefits in the state where they are licensed or principally garaged. 6 Owned "Autos" Only those "autos" you own that because of the la w in the state where Subject To A they are licensed or principally garaged are requi ed to have and Compulsory cannot reject Uninsured Motorists Coverage. This includes Uninsured those "autos" you acquire ownership of after the olicy begins provided Motorists Law they are subject to the same state uninsured moto rists requirement. 7 Specifically Only those "autos" described in Item Three of the Declarations for which Described a premium charge is shown (and for Liability Cove rage any "trailers" "Autos" you don't own while attached to any power unit d scribed in Item Three). 8 Hired "Autos" Only those "autos" you lease, hire, rent or borrow This does not include Only any "auto" you lease, hire, rent, or borrow from a y of your "employees", partners (if you are a partnership), members (if y are a limited liability company) or members of their households. 9 Nonowned Only those "autos" you do not own, lease, hire, re t or borrow that are "Autos" Only used in connection with your business. This inclu es "autos" owned by your "employees", partners (if you are a partn ship), members (if you are a limited liability company), or member of their households but only while used in your business or your pers nal affairs. 19 Mobile Equip- Only those "autos" that are land vehicles and that would qualify under ment Subject To the definition of "mobile equipment" under this pol cy if they were not Compulsory Or subject to a compulsory or financial responsibility aw or other Financial Re- motor vehicle insurance law where they are licen d or principally sponsibility Or garaged. Other Motor Ve- hicle Insurance Law Only 16U rropernes, inc., 2005 CA 00 01 03 06 Page 1 of 12 B. Owned Autos You Acquire After The Policy caused by an "acci dent" and resulting from Begins the ownership, mai tenance or use of cov- 1. If Symbols 1 2 3 4 5 6 or 19 are entered ered "autos." Howe " ver, we will only pay for , , , , , next to a coverage in Item Two of the the covered pollut there is either "bo ion cost or expense" if ily injury" or "property Declarations, then you have coverage for " " damage" to which t is insurance applies that autos that you acquire of the type de- is caused by the sam e "accident". scribed for the remainder of the policy period. We have the right and duty to defend any "insured" against "suit" asking for such 2. But, if Symbol 7 is entered next to a cov- damages or a "cov red pollution cost or ex- erage in Item Two of the Declarations, an pense". However, a have no duty to defend "auto" you acquire will be a covered any "insured" again 3t a "suit" seeking dam- "auto" for that coverage only if: ages for "bodily inju " or "property damage" or a "covered pollu ion cost or expense" to a. We already cover all "autos" that you which this insurance does not apply. We may own for that coverage or it replaces investigate and settl e any claim or "suit" as an "auto" you previously owned that we consider approp iate. Our duty to defend had that coverage; and or settle ends when the Liability Coverage b. You tell us within 30 days after you Limit of Insurance as been exhausted by acquire it that you want us to cover payment of judgme or settlements. Id it for that coverage. 1. Who Is An Insu C. Certain Trailers, Mobile Equipment And Tem- porary Substitute Autos If Liability Coverage is provided by this Cov- erage Form, the following types of vehicles are also covered "autos" for Liability Cover- age: 1. "Trailers" with a load capacity of 2,000 pounds or less designed primarily for travel on public roads. 2. "Mobile equipment" while being carried or towed by a covered "auto." 3. Any "auto" you do not own while used with the permission of its owner as a temporary substitute for a covered "auto" you own that is out of service because of its: a. Breakdown; b. Repair; c. Servicing; d. "Loss;" or e. Destruction. SECTION II - LIABILITY COVERAGE A. Coverage We will pay all sums an "insured" legally must pay as damages because of "bodily in- jury" or "property damage" to which this in- surance applies, caused by an "accident" and resulting from the ownership, maintenance or use of a covered "auto." We will also pay all sums an "insured" legally must pay as a "covered pollution cost or ex- pense" to which this insurance applies, The following ar "insureds:" a. You for any covered "auto." b. Anyone els e while using with your permission a covered "auto" you own, hire o borrow except: (1) The ow er or anyone else from whom u hire or borrow a cov- ered uto." This exception does n t apply if the covered "auto" i a "trailer" connected to a cover d "auto" you own. (2) Your "e mployee" if the covered "auto" s owned by that "em- ployee" or a member of his or her hou ehold. (3) Someo a using a covered "auto" while he or she is work- ing in a business of selling, ser- vicing, repairing, parking or storing autos" unless that busi- ness is ours. (4) Anyone other than your "em- ployees ', partner (if you are a partner hip), members (if you are a li mited liability company), or a les see or borrower or any of thei "employees", while moving property to or from a covered "auto". (5) A partne r (if you are a partner- ship), o a member (if you are a limited iability company) for a covered "auto" owned by him or hero a member of his or her househ Id. c. Anyone liabl for the conduct of an "insured" d cribed above but only to the extent of that liability. CA 00 01 03 06 Page 2 of 12 2. Coverage Extensions a. Supplementary Payments b We will pay for the "insured:" (1) All expenses we incur. (2) Up to $2,000 for cost of bail bonds (including bonds for re- lated traffic law violations) re- quired because of an "accident" we cover. We do not have to furnish these bonds. (3) The cost of bonds to release at- tachments in any "suit" against the "insured" we defend, but only for bond amounts within our Limit of Insurance. (4) All reasonable expenses in- curred by the "insured" at our request, including actual loss of earnings up to $250 a day be- cause of time off from work. (5) All costs taxed against the "in- sured" in any "suit" against the "insured" we defend. (6) All interest on the full amount of any judgment that accrues after entry of the judgment in any "suit" against the "insured" we defend, but our duty to pay interest ends when we have paid, offered to pay or deposited in court the part of the judgment that is within our Limit of Insur- ance. These payments will not reduce the Limit of Insurance. Out-Of-State Coverage Extensions While a covered "auto" is away from the state where it is licensed we will: (1) Increase the Limit of Insurance for Liability Coverage to meet the limits specified by a com- pulsory or financial responsibil- ity law of the jurisdiction where the covered "auto" is being used. This extension does not apply to the limit or limits spec- ified by any law governing mo- tor carriers of passengers or property. (2) Provide the minimum amounts and types of other coverages, such as no-fault, required of out-of-state vehicles by the ju- risdictionwhere the covered "auto" is being used. We will n once for t becausec pay anyone more than same elements of loss these extensions. B. Exclusions This insurance doe not apply to any of the following: 1. Expected Or In*nded Injury "Bodily injury" r "property damage" ex- pected or inte ded from the standpoint of the "insured. 2. Contractual Liability assum d under any contract or agreement. But this exclus on does not apply to li- ability for dama ges: a. Assumed i a contract or agreement that is an "insured contract" pro- vided the " bodily injury" or "property damage" curs subsequent to the execution f the contract or agree- ment; or b. That the "i sured" would have in the absence o the contract or agree- ment. 3. Workers' Any obligation f r which the "insured" or the "insured's" insurer may be held lia- ble under any workers' compensation, disability ben fits or unemployment compensation I w or any similar law. 4. Employee Inde l..nitication And Employ- er's Liability "Bodily injury" t a. An "emplo e" of the "insured" aris- ing out of a d in the course of: (1) Employment by the "insured"; or (2) Perfor ing the duties related to the co duct of the "insured's" busine s; or b. The spouse child, parent, brother or sister of th t "employee" as a con- sequence o Paragraph a. above. This exclusion abplies: (1) Whethe the "insured" may be liable a an employer or in any other ca pacity; and (2) To any bligation to share dam- ages ith or repay someone else w o must pay damages becaus of the injury. CA 00 01 03 06 Page 3 of 12 But this exclusion does not apply to 10. Completed Ope rations "bodily injury" to domestic "employees" "' not entitled to workers' compensation Bodily injury" or "property damage" benefits or to liability assumed by the arising out of our work after that work "insured" under an "insured contract." has been comp eted or abandoned. For the purposes of the Coverage Form, In this exclusio n, your work means: a domestic "employee" is a person en- gaged in household or domestic work a. Work or perations performed by performed principally in connection with you or on ur behalf; and a residence premises. b. Materials, arts or equipment fur- 5. Fellow Employee nished in c nnection with such work "Bodily injury" to any fellow "employee" or operatio is. of the "insured" arising out of and in the course of the fellow "employee's" em- Your work inc udes warranties or re- ployment or while performing duties re- presentations ade at any time with re- lated to the conduct of your business. spect to the fit ess, quality, durability or performance of any of the items included 6. Care, Custody Or Control in Paragraphs . or b. above. "Property damage" to or "covered pol- Your work will a deemed completed at lution cost or expense" involving prop- the earliest oft th e following times: erty owned or transported by the "insured" or in the "insured's" care, cus- (1) When all of the work called for tody or control. But this exclusion does in you contract has been com- not apply to liability assumed under a pleted. sidetrack agreement. (2) When II of the work to be done 7. Handling Of Property at the ite has been completed "Bodily injury" or "property damage" re- if your contract calls for work at sulting from the handling of property: more t han one site. a. Before it is moved from the place (3) When t at part of the work done where it is accepted by the "insured" at a jo b site has been put to its for movement into or onto the cov- intend E d use by any person or ered "auto;" or organi ation other than another contra or or subcontractor b. After it is moved from the covered workin on the same project. "auto" to the place where it is finally l delivered by the "insured." Work that ay need service, main- tenance, c orrection, repair or re- 8. Movement Of Property By Mechanical placement, but which is otherwise Device complete, will be treated as com- "Bodily injury" or "property damage" re- pleted. sulting from the movement of property 11. Pollution by a mechanical device (other than a hand truck) unless the device is attached "Bodily injury" or "property damage" to the covered "auto." arising out of the actual, alleged or threatened discharge, dispersal, 9. Operations seepage, migra tion, release or escape "Bodily injury" or "property damage" of "pollutants:" arising out of the operation of: a. That are, or that are contained in any a. Any equipment listed in Paragraphs property th t is: 6.b. and 6.c, of the definition of "mo- (1) Being ansported or towed by bile equipment"; or "mobile equip- handle , , or handled for move- ment"; or ment i to, onto or from, the b. Machinery or equipment that is on, covere "auto;" attached to, or part of, a land vehicle (2) Otherw se in the course of that would qualify under the defi- transit by or on behalf of the nition of "mobile equipment" if it "insure ;" or were not subject to a compulsory or financial responsibility law or other (3) Being stored, disposed of, motor vehicle insurance law where treated or processed in or upon it is licensed or principally garaged. the cov ered "auto;" CA 00 01 03 06 Page 4 of 12 b. Before the "pollutants" or any prop- erty in which the "pollutants" are contained are moved from the place where they are accepted by the "in- sured" for movement into or onto the covered "auto;" or c. After the "pollutants" or any property in which the "pollutants" are con- tained are moved from the covered "auto" to the place where they are finally delivered, disposed of or abandoned by the "insured." Paragraph a. above does not apply to fuels, lubricants, fluids, exhaust gases or other similar "pollutants" that are needed for or result from the normal electrical, hydraulic or me- chanical functioning of the covered "auto" or its parts, it (1) The "pollutants" escape, seep, migrate, or are discharged, dis- persed or released directly from an "auto" part designed by its manufacturer to hold, store, re- ceive or dispose of such "pollutants;" and (2) The "bodily injury," "property damage" or "covered pollution cost or expense" does not arise out of the operation of any equipment listed in Paragraphs 61. and 6.c. of the definition of "mobile equipment." Paragraphs b. and c. above of this exclusion do not apply to "accidents" that occur away from premises owned by or rented to an "insured" with respect to "pollutants" not in or upon a covered "auto" if: sovereign or other authority using military p rsonnel or other agents; or c. Insurrecti , rebellion, revolution, usurped p wer, or action taken by governme tal authority in hindering or defendi g against any of these. 13. Racing Covered "autos" while used in any pro- fessional or organized racing or demoli- tion contest or stunting activity, or while practicing for uch contest or activity. This insurance also does not apply while that covered "*to" is being prepared for such a contest r activity. C. Limit Of Insurance Regardless of the n "insureds," premiui vehicles involved ii we will pay for the "covered pollution bined, resulting frc the Limit of Insurai shown in the Declai mber of covered "autos," is paid, claims made or the "accident," the most otal of all damages and cost or expense" com- n any one "accident" is -e for Liability Coverage itions. All "bodily injury," and "property damage" and "covered pollu ion cost or expense" re- sulting from continuous or repeated exposure to substantially the same conditions will be considered as resul ing from one "accident." No one will be ent payments for the under this Coverag Payments Coverage Motorists Covera Underinsured Moto ment attached to thi SECTION III - PHYS (1) The "pollutants" or any property A in which the "pollutants" are contained are upset, overturned or damaged as a result of the maintenance or use of a cov- ered "auto;" and (2) The discharge, dispersal, seepage, migration, release or escape of the "pollutants" is caused directly by such upset, overturn or damage. 12. War "Bodily injury" or "property damage" arising directly or indirectly out of: a. War, including undeclared or civil war; b. Warlike action by a military force, including action in hindering or de- fending against an actual or ex- pected attack, by any government, led to receive duplicate 3me elements of "loss" Form and any Medical Endorsement, Uninsured le Endorsement or ists Coverage Endorse- Coverage Part. DAMAGE COVERAGE Coverage 1. We will pay for 'loss" to a covered "auto" or its equipmen under: a. Comprehen ive Coverage From any c use except: (1) The c ered "auto's" collision with an ther object; or (2) The cov ered "auto's" overturn. b. Specified C auses Of Loss Coverage Caused by: (1) Fire, li Ming or explosion; (2) Theft; (3) Windst rm, hail or earthquake; (4) Flood; (5) Mischie f or vandalism; or (6) The sin king, burning, collision or erailment of any conveya nce transporting the covere "auto." CA 00 01 03 06 Page 5 of 12 c. Collision Coverage Caused by: (1) The covered "auto's" collision with another object; or (2) The covered "auto's" overturn. 2. Towing We will pay up to the limit shown in the Declarations for towing and labor costs incurred each time a covered "auto" of the private passenger type is disabled. However, the labor must be performed at the place of disablement. 3. Glass Breakage - Hitting A Bird Or Ani- mal - Falling Objects Or Missiles If you carry Comprehensive Coverage for the damaged covered "auto," we will pay for the following under Comprehensive Coverage: a. Glass breakage; b. "Loss" caused by hitting a bird or animal; and c. "Loss" caused by falling objects or missiles. However, you have the option of having glass breakage caused by a covered "auto's" collision or overturn considered a "loss" under Collision Coverage. 4. Coverage Extension a. Transportation Expenses We will pay up to $20 per day to a maximum of $600 for temporary transportation expense incurred by you because of the total theft of a covered "auto" of the private pas- senger type. We will pay only for those covered "autos" for which you carry either Comprehensive or Specified Causes of Loss Coverage. We will pay for temporary transpor- tation expenses incurred during the period beginning 48 hours after the theft and ending, regardless of the policy's expiration, when the cov- ered "auto" is returned to use or we pay for its "loss." b. Loss of Use Expenses For Hired Auto Physical Damage, we will pay expenses for which an "in- sured" becomes legally responsible to pay for loss of use of a vehicle rented or hired without a driver, un- der a written rental contract or agreement. We will pay for loss of use expenses if caused by: (1) Other than collision only if the Declarations indicate that Com- prehensive Coverage is pro- vided for any covered "auto"; (2) Specifi if the I Specifi erage ered "< (3) Collisic indicat is prc "a uto". However, 1 any expen per day, to B. Exclusions ?d Causes Of Loss only eclarations indicate that rd Causes of Loss Cov- s provided for any cov- uto"; or only if the Declarations that Collision Coverage ded for any covered e most we will pay for ,s for loss of use is $20 i maximum of $600. 1. We will not pay for "loss" caused by or resulting from a y of the following. Such "loss" is excluded regardless of any other cause o event that contributes concurrently or in any sequence to the "loss." a. Nuclear Hazard (1) The explosion of any weapon employ ng atomic fission or fusion; or (2) Nuclea reaction or radiation, or radioac ive contamination, how- ever ca sed. b. War Or Mili rv Action (1) War, in cluding undeclared or civil wa ; (2) Warlike action by a military force, including action in hinderi g or defending against an actu I or expected attack, by any go ernment, sovereign or other a uthority using military person el or other agents; or (3) Insurre tion, rebellion, revo- lution, surped power or action taken b governmental authority in hin dering or defending against any of these. 2. We will not pay r "loss" to any covered "auto" while use in any professional or organized racing or demolition contest or stunting activi y, or while practicing for such contest or ctivity. We will also not pay for "loss" to ny covered "auto" while that covered "au o" is being prepared for such a contest o activity. 3. We will not pay for "loss" caused by or resulting from a of the following unless caused by other loss" that is covered by this insurance: a. Wear and to r, freezing, mechanical or electrical breakdown. b. Blowouts, p nctures or other road damage to tires. CA 00 01 03 06 Page 6of12 4. We will not pay for "loss" to any of the following: a. Tapes, records, discs or other simi- lar audio, visual or data electronic devices designed for use with audio, visual or data electronic equipment. b. Any device designed or used to de- tect speed measuring equipment such as radar or laser detectors and any jamming apparatus intended to elude or disrupt speed measurement equipment. c. Any electronic equipment, without regard to whether this equipment is permanently installed, that receives or transmits audio, visual or data signals and that is not designed solely for the reproduction of sound. d. Any accessories used with the elec- tronic equipment described in Para- graph c. above. Exclusions 4.c. and 4.d. do not apply to: a. Equipment designed solely for the reproduction of sound and accesso- ries used with such equipment, pro- vided such equipment is permanently installed in the covered "auto" at the time of the "loss" or such equipment is removable from a housing unit which is permanentiy installed in the covered "auto" at the time of the "loss", and such equip- ment is designed to be solely oper- ated by use of the power from the "auto's" electrical system, in or upon the covered "auto"; or b. Any other electronic equipment that is.. (1) Necessary for the normal oper- ation of the covered "auto" or the monitoring of the covered "auto's" operating system; or (2) An integral part of the same unit housing any sound reproducing equipment described in a. above and permanently in- stalled in the opening of the dash or console of the covered "auto" normally used by the manufacturer for installation of a radio. 5. We will not pay for "loss" to a covered "auto" due to "diminution in value". C. Limit Of Insurance 1. The most we will pay for "loss" in any one "accident" is the lesser of: a. The actua cash value of the dam- aged or s olen property as of the time of the "loss;" or b. The cost o repairing or replacing the damaged or stolen property with other property of like kind and qual- ity. 2. An adjustmer physical condit mining actual i a total "loss". 3. If a repair or r ter than like k pay for the am for depreciation and will be made in deter- h value in the event of )lacement results in bet- d or quality, we will not int of the betterment. D. Deductible For each covered for, repair, return of len property will be deductible shown i Comprehensive Co in the Declarations caused by fire or lic to," our obligation to pay replace damaged or sto- educed by the applicable the Declarations. Any erage deductible shown foes not apply to "loss" Ming. SECTION IV - BUSINE AUTO CONDITIONS The following conditionapply in addition to the Common Policy Conditi s: A. Loss Conditions 1. Appraisal For Poysical Damage Loss if you and we d sagree on the amount of "loss," either m ay demand an appraisal of the "loss." n this event, each party will select a co mpetent appraiser. The two appraisers will select a competent and impartial u mpire. The appraisers will state sep rately the actual cash value and amou nt of "loss." If they fail to agree, they will submit their differences to the umpire. decision agreed to by any two will be inding. Each party will: a. Pay its chogen appraiser; and b. Bear the oer expenses of the ap- praisal and umpire equally. If we submit to #n appraisal, we will still retain our right ? deny the claim. 2. Duties In The Suit Or Loss Of Accident, Claim, We have no d under this polio full compliance to provide coverage unless there has been th the following duties: a. In the eve t of "accident," claim, "suit" or "lo s," you must give us or our authorized representative prompt noti a of the "accident" or "loss." Incl de: (1) How, w en and where the "ac- cident" r "loss" occurred; CA 00 01 03 06 Page 7 of 12 (2) The "insured's" name and ad- dress; and (3) To the extent possible, the names and addresses of any in- jured persons and witnesses. b. Additionally, you and any other in- volved "insured" must: (1) Assume no obligation, make no payment or incur no expense without our consent, except at the "insured's" own cost. (2) Immediately send us copies of any request, demand, order, notice, summons or legal paper received concerning the claim or "suit." (3) Cooperate with us in the inves- tigation or settlement of the claim or defense against the "suit." (4) Authorize us to obtain medical records or other pertinent infor- mation. (5) Submit to examination, at our expense, by physicians of our choice, as often as we reason- ably require. c. If there is "loss" to a covered "auto" or its equipment you must also do the following: (1) Promptly notify the police if the covered "auto" or any of its equipment is stolen. (2) Take all reasonable steps to protect the covered "auto" from further damage. Also keep a record of your expenses for consideration in the settlement of the claim. (3) Permit us to inspect the covered "auto" and records proving the "loss" before its repair or dis- position. (4) Agree to examinations under oath at our request and give us a signed statement of your an- swers. 3. Legal Action Against Us No one may bring a legal action against us under this Coverage Form until: a. There has been full compliance with all the terms of this Coverage Form; and b. Under Liability Coverage, we agree in writing that the "insured" has an obligation t pay or until the amount of that obl gation has finally been determined by judgment after trial. No one has the right under this pol- icy to bring us into an action to de- termine the "insured's" liability. 4. Loss Payment - Physical Damage Cover- ages At our option w may.. a. Pay for, re air or replace damaged or stolen p perty; b. Return the stolen property, at our expense. V ie will pay for any dam- age that r ults to the "auto" from the theft; or c. Take all or any part of the damaged or stolen p operty at an agreed or appraised v alue. If we pay for the "loss", our payment will include the ap icable sales tax for the damaged or sto n property. 5. Transfer Of Rig Others To Us Of Recovery Against If any person c whom we make erage Form ha, ages from an( transferred to u ization must do secure our righ after "accident" B. General Conditions 1. Bankruptcy Bankruptcy or in or the "insured'i us of any oblige age Form. organization to or for ayment under this Cov- rights to recover dam- her, those rights are That person or organ- verything necessary to and must do nothing "loss" to impair them, olvencyof the "insured" estate will not relieve ions under this Cover- 2. Concealment, Fraud Misrepresentation Or This Coverage F rm is void in any case of fraud by you at any time as it relates to this Coverage Form. It is also void if you or any othe "insured," at any time, intentionally con ceal or misrepresent a material fact co erning: a. This Coverag e Form; b. The covered "auto;" c. Your interes t in the covered "auto;" or d. A claim and r this Coverage Form. 3. Liberalization If we revise this Coverage Form to pro- vide more cove age without additional premium charge your policy will auto- matically provide the additional coverage as of the day the revision is effective in your state. CA 00 01 03 06 Page 8of12 4. No Benefit To Bailee - Physical Damage date on the bill. If the estimated total Coverages premium a ceeds the final premium We will not recognize any assignment or due, the fi t Named Insured will get grant any coverage for the benefit of any a refund. person or organization holding, storing b. If this poli is issued for more than or transporting property for a fee re- one year, he premium for this Cov- gardless of any other provision of this erage For will be computed annu- Coverage Form. ally based n our rates or premiums 5. Other Insurance in effect the beginning of each year of the policy. a. For any covered "auto" you own, this 7. Policy Period, overage Territory Coverage Form provides primary in- surance. For any covered "auto" you Under this Co verage Form, we cover don't own, the insurance provided "accidents" an "losses" occurring: by this Coverage Form is excess over any other collectible insurance. a. During the policy period shown in However, while a covered "auto" the Declara tions; and which is a "trailer" is connected to b. Within the overage territory. another vehicle, the Liability Cover- this Coverage Form provides for age coverage t erritory the "trailer" is: a. The United States of America; (1) Excess while it is connected to b. The territo ries and possessions of a motor vehicle you do not own. the United States of America; (2) Primary while it is connected to c. Puerto Ric ; and a covered "auto" you own. d. Canada-lar d b. For Hired Auto Physical Damage e. Anywhere n the world, if: Coverage, any covered "auto" you lease, hire, rent or borrow is (1) A cov red "auto" of the private deemed to be a covered "auto" you passe ger type is leased, hired, own. However, any "auto" that is rented or borrowed without a leased, hired, rented or borrowed driver or a period of 30 days or with a driver is not a covered "auto". less; a id c. Regardless of the provisions of Par- (2) The "i sured's" responsibility to agraph a. above, this Coverage pay d mages is determined in Form's Liability Coverage is primary a "sui " on the merits, in the for any liability assumed under an United States of America, "insured contract." Puerto Rico or Canada or in a settle ent we agree to. d. When this Coverage Form and any other Coverage Form or policy cov- We also cover "loss" to, or "accidents" ers on the same basis, either excess involving, a co /ered "auto" while being or primary, we will pay only our transported bet een any of these places. share. Our share is the proportion that the Limit of Insurance of our 8. Two Or More overage Forms Or Poli- Coverage Form bears to the total of cies Issued By s the limits of all the Coverage Forms If this Coverag e Form and any other and policies covering on the same Coverage For or policy issued to you basis. by us or any c mpany affiliated with us 6. Premium Audit apply to the sa a "accident," the aggre- gate maximum Limit of Insurance under a. The estimated premium for this all the Coverag e Forms or policies shall Coverage Form is based on the ex- not exceed the highest applicable Limit posures you told us you would have of Insurance u nder any one Coverage when this policy began. We will Form or policy. This condition does not compute the final premium due apply to any C erage Form or policy is- when we determine your actual ex- sued by us or a n affiliated company spe- posures. The estimated total pre- cifically to ap ly as excess insurance mium will be credited against the over this Cover age Form. final premium due and the first SECTION V - DEFINITIO NS Named Insured will be billed for the balance, if any. The due date for the A. "Accident" includes continuous or repeated final premium or retrospective pre- exposure to the sa a conditions resulting in mium is the date shown as the due "bodily injury" or "p roperty damage." CA 00 01 03 06 Page 9 of 12 B. "Auto" means: els, lubrica s, fluids, exhaust gases or other si ilar "pollutants" that are 1. A land motor vehicle, "trailer" or semi- needed for r result from the normal trailer designed for travel on public electrical, ydraulic or mechanical roads; or functioning f the covered "auto" or its parts, if: 2. Any other land vehicle that is subject to a compulsory or financial responsibility (1) The "po llutants' escape, seep, law or other motor vehicle insurance law migrate , or are discharged, dis- where it is licensed or principally ga- persed r released directly from raged. an "au 1 c)" part designed by its manufa turer to hold, store, re- However, "auto" does not include "mobile ceive or dispose of such equipment". "pollut nts-," and C. "Bodily injury" means bodily injury, sickness l2) The "property d injury or disease sustained by a person including damage o e " or r "covered pollution death resulting from any of these. cost or expense" does not arise D. "Covered pollution cost or expense" means out of the operation of any d i P h any cost or expense arising out of: equipm 6.b. or ent liste n aragrap s 6.c, of the definition of 1. Any request, demand, order or statutory "mobil equipment." or regulatory requirement that any "in- " Paragraphs b. and c. above do not or others test for, monitor, clean sured apply to "ac cidents" that occur away up, remove, contain, treat, detoxify or from premis es owned by or rented neutralize, or in any way respond to, or " " to an "ins ured" with respect to ; or assess the effects of pollutants "pollutants" not in or upon a covered 2. Any claim or "suit" by or on behalf of a "auto" if: governmental authority for damages be- cause of testing for, monitoring, cleaning (1) The "p Ilutants" or any property up, removing, containing, treating, in whi h the "pollutants" are detoxifying or neutralizing, or in any way contain ed are upset, overturned responding to or assessing the effects of or dam aged as a result of the "pollutants". mainte ance or use of a cov- "Covered pollution cost or expense" does not ered "a uto,' and include any cost or expense arising out of the (2) The discharge, dispersal, actual, alleged or threatened discharge, dis- seepag e, migration, release or persal, seepage, migration, release or es- escape of the "pollutants" is cape of "pollutants:" caused directly by such upset, overtu or damage. a. That are, or that are contained in any property that is: (1) Being transported or towed by, E. "Diminution in valu " means the actual or handled, or handled for move- perceived loss in arket value or resale ment into, onto or from the cov- value which results from a direct and acci- ered "auto;" dental "loss". (2) Otherwise in the course of transit by or on behalf of the "insured;" (3) Being stored, disposed of, treated or processed in or upon the covered "auto;" or b. Before the "pollutants" or any prop- erty in which the "pollutants" are contained are moved from the place where they are accepted by the "in- sured" for movement into or onto the covered "auto;" or c. After the "pollutants" or any property in which the "pollutants" are con- tained are moved from the covered "auto" to the place where they are finally delivered, disposed of or abandoned by the "insured." Para- graph a. above does not apply to fu- F. "Employee" includ s a "leased worker". "Employee" does n t include a "temporary worker". G. "Insured" means an qualifying as an ins sured provision of Except with respect the coverage afford each insured who against whom a clai H. "Insured contract" rr 1. A lease of prer 2. A sidetrack agi 3. Any easement cept in connei demolition ope of a railroad; . person or organization red in the Who Is An In- ie applicable coverage. o the Limit of Insurance, d applies separately to s seeking coverage or n or "suit" is brought. ans: ses; ement; r license agreement, ex- on with construction or tions on or within 50 feet CA 00 01 03 06 Page 10 of 12 4. An obligation, as required by ordinance, 1. Bulldozers, far machinery, forklifts and to indemnify a municipality, except in other vehicles designed for use princi- connection with work for a municipality; pally off public oads; 5. That part of any other contract or agree- 2. Vehicles mainta ined for use solely on or ment pertaining to your business (in- next to premise s you own or rent; eluding an indemnification of a municipality in connection with work 3. Vehicles that tr avel on crawler treads; performed for a municipality) under which you assume the tort liability of an- 4. Vehicles, whet er self-propelled or not, other to pay for "bodily injury" or "prop- maintained pri marily to provide mobility erty damage" to a third party or to permanently mounted: organization. Tort liability means a li- a. Power cra nes, shovels loaders ability that would be imposed by law in diggers or , , rills; or the absence of any contract or agree- ment. b. Road cons truction or resurfacing 6. That part of any contract or agreement equipment such as graders, entered into, as part of your business, scrapers o rollers. pertaining to the rental or lease, by you " " 5. Vehicles not d scribed in Paragraph 1. or any of your employees , of any " 2., 3. or 4. a , ove that are not self- auto." However, such contract or propelled and re maintained primarily agreement shall not be considered an " " to provide mob ility to permanently at- insured contract to the extent that it tached equipm nt of the following types: obligates you or any of your "employees" to pay for "property damage" to any a. Air compre sors, pumps and gener- "auto" rented or leased by you or any of auors, incl ding spraying, welding, your "employees". building cl aning, geophysical ex- An "insured contract" does not include ploration, li hting and well servicing that part of any contract or agreement: equipment; or a. That indemnifies a railroad for "bod- b. Cherry pic ers and similar devices ily injury" or "property damage" used to rai a or lower workers. arising out of construction or demo- 6. Vehicles not de scribed in Paragraph 1., lition operations, within 50 feet of 2., 3. or 4. abov maintained primarily for any railroad property and affecting purposes other than the transportation any railroad bridge or trestle, tracks, of persons or cargo. However, self- roadbeds, tunnel, underpass or propelled vehi les with the following crossing; or types of perman ntly attached equipment are not "mobil equipment" but will be b. That pertains to the loan, lease or considered "aut s:" rental of an "auto" to you or any of your "employees", if the "auto" is a. Equipment esigned primarily for: loaned, leased or rented with a (1) Snow r emoval; driver; or c. That holds a person or organization (2) Road m aintenance, but not con- engaged in the business of trans- structi or resurfacing; or porting property by "auto" for hire (3) Street leaning; harmless for your use of a covered "auto" over a route or territory that b. Cherry pick ers and similar devices person or organization is authorized mounted automobile or truck to serve by public authority. chassis an used to raise or lower workers; an I. "Leased worker" means a person leased to you by a labor leasing firm under an agree- ment between you and the labor leasing firm, to perform duties related to the conduct of your business. "Leased worker" does not in- clude a "temporary worker". J. "Loss" means direct and accidental loss or damage. K. "Mobile equipment" means any of the follow- ing types of land vehicles, including any at- tached machinery or equipment: c. Air compre sors, pumps and gener- ators, inclu ing spraying, welding, building cl aning, geophysical ex- ploration, lighting or well servicing equipment. However, "mobile e elude land vehicles compulsory or finan other motor vehicle i licensed or principal cles subject to a coi sponsibility law or insurance law are cc tuipment" does not in- that are subject to a ial responsibility law or isurance law where it is y garaged. Land vehi- ipulsory or financial re- other motor vehicle isidered "autos". CA 00 01 03 06 Page 11 of 12 L M N "Pollutants" means any solid, liquid, gaseous or thermal irritant or contaminant, including smoke, vapor, soot, fumes, acids, alkalis, chemicals and waste. Waste includes mate- rials to be recycled, reconditioned or re- claimed. "Property damage" means damage to or loss of use of tangible property. "Suit" means a civil proceeding in which: 1. Damages because of "bodily injury," or "property damage"; or 2. A "covered pollution cost or expense", to which this insurance applies, are alleged. "Suit" includes: a. An arbitrate n proceeding in which such dama es or "covered pollution costs or exp enses" are claimed and to which th "insured" must submit or does sub mit with our consent; or b. Any other Iternative dispute resol- ution proc eding in which such damages o "covered pollution costs or expense s- are claimed and to which the i sured submits with our consent. 0. "Temporary worker" means a person who is furnished to you to s bstitute for a permanent "employee" on leav or to meet seasonal or short-term workload onditions. P. "Trailer" includes selnitrailer CA 00 01 03 06 Page 12 of 12 INTERLINE THIS ENDORSEMENT CHANGES THE POLICY. PLEASE RE NUCLEAR ENERGY LIABILITY EXCL ENDORSEMENT (Broad Form) This endorsement modifies insurance provided under the following COMMERCIAL AUTO MOBILE COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART FARM COVERAGE PART LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PA POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART PROFESSIONAL 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 nuclear energy liability pol- icy issued by Nuclear Energy Liabil- ity Insurance Association, Mutual Atomic Energy Liability Underwrit- ers, Nuclear Insurance Association of Canada or any of their succes- sors, or would be an insured under any such policy but for its termi- nation upon exhaustion of its limit of liability; or (2) Resulting from the "hazardous prop- erties" of "nuclear material" and with respect to which (a) any person or organization is required to maintain financial protection pursuant to the Atomic Energy Act of 1954, or any law amendatory thereof, or (b) the "insured" is, or had this policy not been issued would be, entitled to indemnity from the United States of America, or any agency thereof, un- der any agreement entered into by the United States of America, or any agency thereof, with any person or organization. B. Under any Medical Payments coverage, to expenses incurred with respect to "bodily injury" resulting from the "haz- ardous properties" of "nuclear material" and arising out of the operation of a "nu- clear facility" by any person or organiza- tion. C. Under any Liab injury" or "pro from "hazardou material", if: IT CAREFULLY. ON lity Coverage, to "bodily )erty damage" resulting properties" of "nuclear (1) The "nucle r material" (a) is at any "nuclear' fa ility" owned by, or oper- ated by or n behalf of, an "insured" or (b) has een discharged or dis- persed the from; (2) 'The "nucle r material" is contained in "spent fuel" or "waste" at any time possessed, handled, used, proc- essed, stored, transported or dis- posed of, y or on behalf of an "insured;" (3) The "bodil injury" or "property damage" a ses out of the furnishing by an "insu ed" of services, materi- als, parts or equipment in con- nection ith the planning, constructio , maintenance, opera- tion or use of any "nuclear facility," but if such facility is located within the United tates of America, its ter- ritories or ossessions or Canada, this exclusion (3) applies only to "property damage" to such "nuclear facility" and any property thereat. 2. As used in this endorsement: s" includes radioactive, "Hazardous properti1perties. toxic or explosive pr "Nuclear material" eans "source material," "Special nuclear terial" or "by-product material." Copyright, Insurance Services Office, Inc., 2001 IL 00 21 07 02 Page 1 of 2 "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 component, solid or liquid, which has been used or exposed to radiation in a "nuclear reactor." "Waste" means any waste material (a) con- taining "by-product material" other than the tailings or wastes produced by the extraction or concentration of uranium or thorium from any ore processed primarily for its "source material" content, and (b) resulting from the operation by any person or organization of any "nuclear facility" included under the first two paragraphs of the definition of "nuclear 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 p ckaging "waste:" (c) Any equipment processing, fat Ispec_ial nuclear the total amoun custody of the " where such eqi cated consists ( 25 grams of plul any combinatioi 250 grams of un or device used for the 'icating or alloying of material' if at any time of such material in the isured" at the premises ipment or device is lo- or contains more than )nium or uranium 233 or thereof, or more than nium 235, (d) Any structure, asin, excavation, prem- ises or place p epared or used for the storage or disp al of "waste;" and includes the si foregoing is located, on such site and all operations. "Nuclear reactor" rr signed or used to su self-supporting chair critical mass of fissic "Property damage" i dioactive contaminat e on which any of the ill operations conducted premises used for such ans any apparatus de- tain nuclear fission in a reaction or to contain a cable material. cludes all forms of ra- n of property. IL 00 21 07 02 Page 2 of 2 POLICY NUMBER: BSP 4151561 1 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SILICA OR SILICA-RELATED DUST EXCLU ION FOR COVERED AUTOS EXPOSURE This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the overage Form apply un- less modified by the endorsement. A. The following exclusion is added to Para- 3. Any loss, cost or expense arising, in graph B. Exclusions of Section II - Liability whole or in pa , out of the abating, test- Coverage in the Business Auto, Motor Carrier ing for, monito ing, cleaning up, remov- and Truckers Coverage Forms and for "Ga- ing, containing , treating, detoxifying, rage Operations" - Covered "Autos" in the neutralizing, re ediating or disposing of, Garage Coverage Form: or in any way re sponding to or assessing SILICA OR SILICA-RELATED DUST the effects of, silica" or "silica-related EXCLUSION FOR COVERED AUTOS dust", by any " nsured" or by any other EXPOSURE person or entit . This insurance does not apply to: B. Additional Definitio 1. "Bodily injury" arising, in whole or in part. out of the actual, alleged, threat- ened or suspected inhalation of, or ingestion of, "silica" or "silica-related d ust". 2. "Property damage" arising, in whole or in part, out of the actual, alleged, threat- ened or suspected contact with, expo- sure to, existence of, or presence of, "silica" or "sillica-related dust". As used in this endorsement: 1. "Silica" means ilicon dioxide (occurring in crystaline, morphous and impure forms), silica articles, silica dust or silica compoun s. 2. "Silica-related lust" means a mixture or combination of silica and other dust or particles. O ISO Properties, Inc., 2005 1 CA 23 94 03 06 POLICY NUMBER: BSP 4151561 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PENNSYLVANIA UNINSURED MOTORISTS COVERAGE - NONSTACKED For a covered "motor vehicle" licensed or principally garaged in, or "garage perations" conducted in, Pennsylvania, this endorsement modifies insurance provided under the followi g: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the overage Form apply un- less modified by the endorsement. This endorsement changes the policy effective on the inception date of the pol cy unless another date is indicated below: Named Insured: Endorsement Effective Date: SCHEDULE Limit Of Insurance: $ Each "Accident" Information required to complete this Schedule, if not shown above, will be s wn in the Declarations. A. Coverage b. Anyone et a "occupying" a covered "motor veh icle" or a temporary sub- 1. We will pay all sums the "insured" is le- stitute for covered "motor vehicle." gally entitled to recover as compensatory The covere d "motor vehicle" must damages from the owner or driver of an be out of service because of its "uninsured motor vehicle". The damages breakdown repair, servicing, "loss" must result from "bodily injury" sustained or destruct on. by the "insured" caused by an "accident". The owner's or driver's liability for these c. Anyone fo damages he or she is damages must result from the owner- entitled to ecover because of "bod- ship, maintenance or use of an ily injury" ustained by another "in- "uninsured motor vehicle". sured." 2. No judgment for damages arising out of 2. A partnership, limited liability company, a "suit" brought against the owner or corporation or ny other form of organ- operator of an "uninsured motor vehicle" ization, then th following are "insureds": is binding on us unless we: a. Anyone "o cupying" a covered "mo- a. Received reasonable notice of the for vehicle or a temporary substi- pendency of the "suit" resulting in tute fora covered "motor vehicle." the judgment; and The covere d "motor vehicle" must b. Had a reasonable opportunity to be out of service because of its protect our interests in the "suit". breakdown repair, servicing, "loss" or destruct on. S. Who Is An Insured b. Anyone fo damages he or she is If the Named Insured is designated in the entitled to ecover because of "bod- Declarations as: ily injury" ustained by another "in- sured." 1. An individual, then the following are "in- sureds": C. Exclusions a. The Named Insured and any "family This insurance doe not apply to any of the members". following: O ISO Properties, Inc., 2005 CA 21 92 08 06 Page 1 of 4 1. Any claim settled without our consent. 2. Any amount pad However, this exclusion does not apply this coverage if such settlement does not adversely af- sums paid by or fect our rights of recovery under this responsible. Th coverage. for the same da age Form's Liab 2. The direct or indirect benefit of any includes all surf insurer or self-insurer under any work- attorney either ers' compensation, disability benefits or amount paid to 1 similar law. 3. No one will be 3. Anyone using a vehicle without a rea- cate payments f sonable belief that the person is entitled under this Cov( to do so. ability Coverag ments CoverE 4. Punitive or exemplary damages. Underinsured endorsement at 5. "Bodily injury" sustained by: Part. a. An individual Named Insured while We will not ma "occupying" or when struck by any under this Cove vehicle owned by that Named In- "loss" for which sured that is not a covered "auto" for by or for anyone Uninsured Motorists Coverage under ble. this Coverage Form; We will not pay b. Any "family member" while "occu- if a person is en pying" or when struck by any vehicle for the same ele owned by that "family member" that workers' compe is not a covered "auto" for Uninsured fits or similar la, Motorists Coverage under this Cov- E. Changes In Conditioi erage Form; or c. Any "family member" while "occu- pying" or when struck by any vehicle owned by the Named Insured that is insured for Uninsured Motorists Coverage on a primary basis under any other Coverage Form or policy. 6. "Bodily injury" arising directly or indi- rectly out of: a. War, including undeclared or civil war; b. Warlike action by a military force, including action in hindering or de- fending against an actual or ex- pected attack, by any government, sovereign or other authority using military personnel or other agents; or c. Insurrection, rebellion, revolution, usurped power, or action taken by governmental authority in hindering or defending against any of these. D. Limit Of Insurance 1. Regardless of the number of covered "motor vehicles", "insureds", premiums paid, claims made or vehicles involved in the "accident", the most we will pay for all damages resulting from any one "ac- cident" is the Limit Of Insurance for Uninsured Motorists Coverage shown in the Schedule or Declarations. able for damages under hall be reduced by all for anyone who is legally s includes all sums paid nages under this Cover- lity Coverage. This also paid for an "insured's" irectly or as part of the he "insured". entitled to receive dupli- )r the elements of "loss" rage Form and any Li- Form, Medical Pay- ge endorsement or Motorists Coverage ached to this Coverage :e a duplicate payment -age for any element of )ayment has been made who is legally responsi- ar any element of "loss" itled to receive payment vent of "loss" under any isation, disability bene- s The Conditions are ganged for Pennsylvania Uninsured Motorists I Coverage - Nonstacked as follows: 1. Duties In The E ent Of Accident, Claim, Suit Or Loss is changed by adding the following: a. Promptly n tify the police if a hit- and-run dri er is involved, and b. Promptly send us copies of the legal papers if a suit" is brought. 2. Legal Action A ainst Us is replaced by the following: a. No one m y bring a legal action against us under this Coverage Form until there as been full compliance with all the terms of this Coverage Form. b. Any legal this Covera within four "accident". b. does not within four "accident", made a w tration in a visions of tt ction against us under e Form must be brought mrs after the date of the iowever, this Paragraph apply to an "insured" if, gars after the date of the re or the "insured" have tten demand for arbi- cordance with the pro- s endorsement. 3. Transfer Of R Others To Us following: is Of Recovery Against changed by adding the CA 21 92 08 06 Page 2 of 4 If we make any payment due to an "acci- dent" involving an "uninsured motor ve- hicle" and the "insured" recovers from another party in a separate claim or "suit", the "insured" shall hold the pro- ceeds in trust for us and pay us back the amount we have paid less reasonable attorneys' fees, costs and expenses in- curred by the "insured" to the extent such payment duplicates any amount we have paid under this coverage. 4. Other Insurance in the Business Auto and Garage Coverage Forms and Other Insurance - Primary And Excess Insur- ance Provisions in the Truckers and Mo- tor Carrier Coverage Forms are replaced by the following: a. If there is other applicable similar insurance available under more than one Coverage Form or policy, the following priorities of recovery apply: First The Uninsured Motorists Coverage ap- plicable to the vehicle the "insured" was "occupying" at the time of the "acci- dent". Second The Coverage Form or policy affording Uninsured Motorists Coverage to the "insured" as an individual Named In- sured or "family member". b. Where there is no applicable insur- ance available under the first prior- ity, the maximum recovery under all Coverage Forms or policies in the second priority shall not exceed the highest applicable limit for any one vehicle under any one Coverage Form or policy. c. Where there is applicable insurance available under the first priority: (1) The Limit Of Insurance applica- ble to the vehicle the "insured" was "occupying" under the Cov- erage Form or policy in the first priority, shall first be exhausted; and d. If two or more Coverage Forms or policies have equal priority: (1) The in urer against whom the claim i first made shall process and p y the claim as if wholly respon ible for all insurers with equal priority; (2) The in urer thereafter is entitled to rec er pro rata contribution from any other insurer on the same evel of priority for the benefit paid and the costs of proces ing the claim; and (3) If we are the insurer against whom he claim is first made, we wil pay, subject to the limit of insu ance for Uninsured Mo- torists Coverage shown in the Declarations, after all contribut- ing ins rers agree as to: (a) W ether the "insured" is le- ga ly entitled to recover da ages from the owner or driver of an "uninsured mo- tor. vehicle"; and (b) Thy amount of damages 5. The following Condition is added: ARBITRATION a. If we and an "insured" disagree whether the "insured" is legally en- titled to re over damages from the owner or river of an "uninsured motor vehi le" or do not agree as to the amount of damages that are re- coverable y that "insured", then the matter may be arbitrated. However, disputes co cerning coverage under this endor ment may not be arbi- trated. Bo h parties must agree to arbitration. If so agreed, each party will select an arbitrator. The two arbitrators Will select a third. If they cannot agree within 30 days, either may reque t that selection be made by a judge of a court having juris- diction. Ea h party will pay the ex- penses it incurs and bear the expenses f the third arbitrator equally. (2) The maximum recovery under b. Unless both parties agree otherwise, all Coverage Forms or policies arbitration will take place in the in the second priority shall not county in hich the "insured" lives. exceed the amount by which the Local rules of law as to arbitration highest limit for any one vehicle procedure and evidence will apply. under any one Coverage Form A decision greed to by two of the or policy in the second priority arbitrators ill be binding. exceeds the limit applicable un- F. Additional Definition der the Coverage Form or policy in the first priority. As used in this end Bement: CA 21 92 08 06 Page 3 of 4 1 2. 3. "Family member" means a person re- lated to an individual Named Insured by blood, marriage or adoption who is a resident of such Named Insured's household, including a ward or foster child. "Occupying" means in, upon, getting in, on, out or off. "Uninsured motor vehicle" means a land motor vehicle or "trailer": a. For which no liability bond or policy applies at the time of an "accident". b. For which an insuring or bonding company: (1) Denies coverage, (2) Is or becomes insolvent; or (3) Is or becomes involved in insolvency proceedings. c. For which neither the driver nor owner can be identified. The vehicle or "trailer" must: (1) Hit an "insured", a covered "motor vehicle" or a vehicle an "insured" is "occupying"; or 4 (2) Cause n "accident" resulting in "bodily injury" to an "insured" without hitting an "insured", a covere "motor vehicle" or a vehicle an "insured" is "occupy- ing". I If there is o physical contact with the hit-and- un vehicle, the facts of the "accide t" must be proved. However, an u insured motor vehicle" does not includ any vehicle: a. Owned or o erated by a self-insurer under any Applicable motor vehicle law, except a self-insurer who is or who becom s insolvent and cannot provide the mounts required by that motor vehicle law: or b. Designed fqr use mainly off public roads while not on public roads. "Motor vehicle" means a vehicle which is self-propelle except one which is propelled solely by human power or by electric power obtained from overhead trolley wires, bu does not mean a vehi- cle operated up n rails. CA 21 92 08 06 Page 4 of 4 POLICY NUMBER: BSP 4151561 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE RE PENNSYLVANIA UNDERINSURED MOTORI NONSTACKED For a covered "motor vehicle" licensed or principally garaged in, or "garage Pennsylvania, this endorsement modifies insurance provided under the follows BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the less modified by the endorsement. This endorsement changes the policy effective on the inception date of the pol indicated below: Named Insured: Endorsement Effective Date: SCHEDULE COMMERCIAL AUTO IT CAREFULLY. COVERAGE - Iperations" conducted in, g: rage Form apply un- unless another date is Limit Of Insurance: $ Each "Accident" Information required to complete this Schedule, if not shown above, will be sh own in the Declarations. A. Coverage 3. No judgment fo damages arising out of a "suit" broug t against the owner or 1. We will pay all sums the "insured" is le- operator of an "underinsured motor ve- gally entitled to recover as compensatory hicle" is binding on us unless we: damages from the owner or driver of an "underinsured motor vehicle". The dam- a. Received asonable notice of the ages must result from "bodily injury" pendency f the "suit" resulting in sustained by the "insured" caused by an the judgme t; and "accident". The owner's or driver's li- ability for these damages must result b. Had a rea sonable opportunity to from the ownership, maintenance or use protect our interests in the "suit". of an "underinsured motor vehicle". B. Who Is An Insured 2. We will pay under this coverage only if Paragraph a. or b. below applies: If the Named Insur d is designated in the Declarations as: a. The limits of any applicable liability bonds or policies have been ex- 1. An individual, t en the following are "in- hausted by payment of judgments or sureds": settlements; or a. The Named Insured and any "family b. A tentative settlement has been members". made between an "insured" and the insurer of the "underinsured motor b. Anyone els "occupying" a covered vehicle" and we: "motor vehi le" or a temporary sub- stitute for a covered "motor vehicle." (1) Have been given prompt written The cover "motor vehicle" must notice of such tentative settle- be out of service because of its ment; and breakdown, repair, servicing, "loss" or destructi on. (2) Advance payment to the "in- sured" in an amount equal to c. Anyone for damages he or she is the tentative settlement within entitled to cover because of "bod- 30 days after receipt of notifica- ily injury" s ustained by another "in- tion. sured." O ISO Properties, Inc., 2005 CA 21 93 08 06 Page 1 of 4 2. A partnership, limited liability company, c. !nsurrectio , rebellion, revolution, corporation or any other form of organ- usurped po wer, or action taken by ization, then the following are "insureds": governmen at authority in hindering or defendin against any of these. a. Anyone "occupying" a covered "mo- tor vehicle" or a temporary substi- D. Limit Of Insurance tute for a covered "motor vehicle." The covered "motor vehicle" must 1. Regardless of he number of covered be out of service because of its "motor vehicles ', "insureds", premiums breakdown, repair, servicing, "loss" paid, claims ma de or vehicles involved or destruction. in the "accident' , the most we will pay for all damages re ulting from any one "ac- b. Anyone for damages he or she is cident" is the Limit Of Insurance for entitled to recover because of "bod- Underinsured M torists Coverage shown ily injury" sustained by another "in- in the Schedule or Declarations. sured." 2. No one will be entitled to receive dupli- C. Exclusions cate payments r the same elements of "loss" under thi Coverage Form and any This insurance does not apply to any of the Liability Covera ge Form, Medical Pay- following: ments Cover ge Endorsement or Uninsured Moto rists Coverage Endorse- 1. The direct or indirect benefit of any ment attached t this Coverage Part. insurer or self-insurer under any work- ers' compensation disability benefits or We will not ma ke a duplicate payment , similar law. under this Cov rage for any element of "loss" for which payment has been made 2. Anyone using a vehicle without a rea- by or for anyon who is legally responsi- sonable belief that the person is entitled ble. to do so. We will not pay or any element of "loss" 3. Punitive or exemplary damages. if a person is en itled to receive payment for the same ele ment of "loss" under any 4. "Bodily injury" sustained by: workers' compe nsation, disability bene- fits or similar la w. a. An individual Named Insured while "occupying" or when struck by any E. Changes In Conditio s vehicle owned by that Named In- sured that is not a covered "auto" for The conditions are c anged for Pennsylvania Underinsured Motorists Coverage Underinsured Moto fists Coverage - Non- under this Coverage Form; stacked as follows: b. Any "family member" while "occu- pying" or when struck by any vehicle owned by that "family member" that is not a covered "auto" for Underinsured Motorists Coverage under this Coverage Form; or c. Any "family member" while "occu- pying" or when struck by any vehicle owned by the Named Insured that is insured for Underinsured Motorists Coverage on a primary basis under any other Coverage Form or policy. 5. "Bodily injury" arising directly or indi- rectly out of: a. War, including undeclared or civil war; b. Warlike action by a military force, including action in hindering or de- fending against an actual or ex- pected attack, by any government, sovereign or other authority using military personnel or other agents; or 1. Duties In The E ent Of Accident, Claim, Suit Or Loss is changed by adding the following: a. Promptly sed us copies of the legal papers if a suit" is brought. b. A person sf torists Cove notify us, i settlement and the inst motor vehic to advance in an amou settlement against the for of such hicle". 2. Legal Action the following: eking Underinsured Mo- rage must also promptly writing, of a tentative between the "insured" rer of the "underinsured e" and allow us 30 days iayment to the "insured" it equal to the tentative o preserve our rights nsurer, owner or opera- underinsured motor ve- Us is replaced by a. No one may bring a legal action against us u der this Coverage Form until there as been full compliance with all the terms of this Coverage Form. CA 21 93 08 06 Page 2 of 4 b. Any legal action against us under settlement with n 30 days after receipt of this Coverage Form must be brought notification: within four years after the date of the "accident". a. That paym ent will be separate from any amoun the "insured" is entitled c. Paragraph 2.b. above of this condi- to recover under the provisions of tion does not apply if, within four Underinsur d Motorists Coverage; years after the date of the "acci- and dent": b. We also h ve a right to recover the (1) We or the "insured" have made advanced ayment. a written demand for arbitration 4. Other Insuranc e in the Business Auto in accordance with the pro- and Garage Co verage Forms and Other visions of this endorsement; or Insurance - Pri mary And Excess Insur- (2) The "insured" has filed an action ance Provision in the Truckers and Mo- for "bodily injury" against the for Carrier Cove rage Forms are replaced owner or operator of the by the following "underinsured motor vehicle" a. If there is other applicable similar and such action is: insurance vailable under more than (a) Filed in a court of compe- one Cover age Form or policy, the following p iorities of recovery apply: tent jurisdiction; and (b) Not barred by the applica- ble state statute of limita- tions. In the event that the four year time limi- tation identified in this condition does not Second apply, the applicable state statute of lim- itations will govern legal action against us under this Coverage Form. 3. Transfer Of Rights Of Recovery Against Others To Us is changed by adding the following: If we make any payment due to an "acci- dent" involving an "underinsured motor vehicle" and the "insured" recovers from another party in a separate claim or "suit", the "insured" shall hold the pro- ceeds in trust for us and pay us back the amount we have paid less reasonable attorneys' fees, costs and expenses in- curred by the "insured" to the extent such payment duplicates any amount we have paid under this coverage. Our rights do not apply under this pro- vision with respect to Underinsured Mo- torists Coverage if we: a. Have been given prompt written no- tice of a tentative settlement be- tween an "insured" and the insurer of an "underinsured motor vehicle"; and b. Fail to advance payment to the "in- sured" in an amount equal to the tentative settlement within 30 days after receipt of notification. If we advance payment to the "insured" in an amount equal to the tentative The Underins red Motorists Coverage applicable to he vehicle the "insured" was "occupyin " at the time of the "ac- cident". The Coverage Form or policy affording Underinsured otorists Coverage to the "insured" as n individual Named In- sured or "fami member". b. Where the is no applicable insur- ance availa ble under the first prior- ity, the ma imum recovery under all Coverage F orms or policies in the second pri rity shall not exceed the highest app licable limit for any one vehicle un er any one Coverage Form or pol icy. c. Where ther is applicable insurance available u der the first priority: (1) The Li mit Of Insurance applica- ble to he vehicle the "insured" was "o cupying" under the Cov- erage orm or policy in the first priority shall first be exhausted; and (2) The m ximum recovery under all Cov erage Forms or policies in the econd priority shall not exceed the amount by which the highest limit for any one vehicle under y one Coverage Form or pol in the second priority excee the limit applicable un- i der th overage Form or policy in the spriority. t d. If two or more Coverage Forms or policies ha\Je equal priority: CA 21 93 08 06 Page 3 of 4 (1) The insurer against whom the claim is first made shall process and pay the claim as if wholly responsible for all insurers with equal priority; (2) The insurer thereafter is entitled to recover pro rata contribution from any other insurer for the benefits paid and the costs of processing the claim; and (3) If we are the insurer against whom the claim is first made, we will pay, subject to the limit of insurance for Underinsured Motorists Coverage shown in the Declarations, after all con- tributing insurers agree as to: (a) Whether the "insured" is le- gally entitled to recover damages from the owner or driver of an "underinsured motor vehicle and (b) The amount of damages 5. The following Condition is added: ARBITRATION a. If we and an "insured" disagree whether the "insured" is legally en- titled to recover damages from the owner or driver of an "underinsured motor vehicle" or do not agree as to the amount of damages that are re- coverable by that "insured", then the matter may be arbitrated. However, disputes concerning coverage under this endorsement may not be arbi- trated. Both parties must agree to arbitration. If so agreed, each party will select an arbitrator. The two arbitrators will select a third. If they cannot agree within 30 days, either may request that selection be made by a judge of a court having juris- diction. Each party will pay the ex- penses it incurs and bear the expenses f the third arbitrator equally, b. Unless both parties agree otherwise, arbitration will take place in the county in hich the "insured" lives. Local rules of law as to arbitration procedure nd evidence will apply. A decision greed to by two of the arbitrators ill be binding. F. Additional Defin As used in this ends 1. "Family membe lated to an indh blood, marriage resident of s household, incl child ement: means a person re- dual Named Insured by or adoption who is a ch Named Insured's ding a ward or foster 2. "Occupying" m ?ns in, upon, getting in, on, out or off. 3. "Underinsured vehicle for whip bonds or polici of an "accident the amount an tied to recover 4. otor vehicle" means a the sum of all liability that apply at the time do not provide at least nsured" is legally enti- damages. HowEwer, an "u derinsured motor vehi- cle" does not in Jude any vehicle: a. Owned or o orated by a self insurer under any applicable motor vehicle law; or , b. Designed fqr use mainly off public roads while not on public roads. "Motor vehicle" means a vehicle which is self-propelle except one which is propelled solely by human power or by electric power obtained from overhead trolley wires, bu does not mean a vehi- cle operated up n rails. CA 21 93 08 06 Page 4of4 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PENNSYLVANIA UNINSURED AND UNDERINSURED MOTORISTS ARBITRATION AMENDMENT For a covered "motor vehicle" licensed or principally garaged in, or "garage perations" conducted in, Pennsylvania, this endorsement modifies insurance provided under the followi g: PENNSYLVANIA UNINSURED MOTORISTS COVERAGE - STACKED - CA 21 6 PENNSYLVANIA UNDERINSURED MOTORISTS COVERAGE - STACKED - C 21 91 PENNSYLVANIA UNINSURED MOTORISTS COVERAGE - NONSTACKED - C 21 92 PENNSYLVANIA UNDERINSURED MOTORISTS COVERAGE - NONSTACKE - CA 21 93 With respect to coverage provided by this endorsement, the provisions of the C verage form apply unless modified by the endorsement. E. Changes in Conditions ARBITRATION is deleted and replaced with the following: ARBITRATION A. Subject to paragraph D. below, if we and an "insured" do not agree: 1. Whether the owner of an "uninsured motor vehicle" or "underinsured motor vehicle" is liable for the acci- dent; or 2. On the amount of damages suffered by that "insured" as a result of tale liability of an operator of an "uninsured motor vehicle" or "underinsured motor vehicle": these questions, and these questions only, may be arbitrated if we and the "insured" mutually agree to submit these questions to arbitration. Either party may express its desire to proceed to arbi- tration on these issues by appointing an arbitrator. The other party may then ap- point its arbitrator and the parties must then select a mutually agreeable third arbitrator. These is no agreement to ar- bitrate unless the parties mutually agree in writing upon the third arbitrator. To the extent the parties mutually agree to proceed to arbitration, such arbitration shall be conducted in accordance with the provisions of the Pennsylvania Arbi- tration Act of 1927. In the event that we or the "insured" do not agree to arbitrate the matters de- scribed in A.1 & A.2, then either party seeking enforcement of its rights under this endorsement may commence a law suit in, and only in, a trial court for the county in which the "insured" lives. Ei- ther party to th law suit shall be entitled to a jury trial o the dispute at issue and may demand s uch and each party shall be responsible or its own costs and fees. B. If the parties gree to arbitrate, then each part will: 1. Pay the exp enses it incurs; and 2. Bear the expenses of the third arbitrator e qually. C. Unless both pa ies agree otherwise, ar- bitration will ta e place in the county in which the "ins red" lives. Local rules as to procedur and evidence will apply. The arbitrator's authority to award dam- ages is limited the amount of available uninsured mot rists coverage as shown in the declaratio ns. Subject to paragraph D. below, a dec Sion agreed to by at least two of the arbit ators will be binding only as to: 1. Whether th e owner of an "uninsured motor ve icle" or "underinsured motor vehi cle" is liable for the acci- dent; and 2. The amoun t of damages suffered by that "insur d" as a result of the li- ability of an operator of an "uninsured motor vehicle: or "underinsu ed motor vehicle". D. Any and all cov rage disputes, including, but not limited o, all questions involving whether there i coverage available un- der this policy or the claims of the "in- sured", and al questions involving or concerning the amount of coverage available to the "insured" are not subject to arbitration a nd shall be decided by, and only by, a t ial court for the county in which the "insu ed" lives. CA 70 70 08 06 POLICY NUMBER: COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE RE D IT CAREFULLY. PENNSYLVANIA BASIC FIRST PAR BENEFIT For a covered "auto" licensed or principally garaged in, or "garage o erations" conducted in, Pennsylvania, this endorsement modifies insurance provided under the followi g: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the overage Form apply un- less modified by the endorsement. This endorsement changes the policy effective on the inception date of the pol y unless another date is indicated below. Named Insured: Endorsement Effective Date: Countersignature Of Authorized Representative Name: Title: Signature: Date: SCHEDULE Benefits Limit o Insurance Medical Expense Benefits Up to $ ,000 per insured Information required to complete this schedule, if not shown above, will be sh wn in the Declarations. A. Coverage We will pay the Basic First Party Benefit in accordance with the "Act" to or for an "in- sured" who sustains "bodily injury" caused by an "accident" arising out of the mainte- nance or use of an "auto." Benefits Subject to the limit shown in the Schedule or Declarations, the Basic First Party Benefit consists of Medical Expense Benefits. These benefits consist of reasonable and necessary medical expenses incurred for an "insured's": Medical expenses ill be paid if incurred within 18 months from the date of the "acci- dent" causing "bodily injury." If within 18 months from the da a of the "accident" caus- ing "bodily injury" it is ascertainable with reasonable medica probability that further expenses may be incurred as a result of the "bodily injury," med cal expenses will be paid without limitation a to the time such further expenses are incurred. B. Who Is An Insured 1. You. 1. Care: 2. Recovery; or 3. Rehabilitation This includes remedial care and treatment rendered in accordance with a recognized religious method of healing. 2. If you are an member." 3. Any person wh? "auto." individual, any "family "occupying" a covered 4. Any person wile not "occupying" an "auto" if injure as a result of an "acci- dent" in Penn Ivania involving a cov- ered "auto." O ISO Properties, Inc., 2005 CA 22 37 03 06 Page 1 of 3 If a covered "auto" is parked and unoc- b. War, includ ng undeclared or civil cupied, it is not an "auto" involved in an war: "accident" unless it was parked in a manner as to create an unreasonable c. Warlike acti on by a military force, risk of injury. including ac tion in hindering or de- fending ag inst an actual or ex- C. Exclusions pected atta ck, by any government, We will not pay First Party Benefits for "bodily sovereign r other authority using in1urY ?? military per onnel or other agents; or 1. Sustained by any person injured while intentionally causing or attempting to d. Insurrection rebellion, revolution, cause injury to himself or herself or any usurped po wer, or action taken by other person. government 3l authority in hindering or defending against any of these. 2. Sustained by any person while commit- ting a felony. 10. From or as a c sequence of the follow- ing whether con rolled or uncontrolled or 3. Sustained by any person while seeking however caused to elude lawful apprehension or arrest by a law enforcement official. a. Nuclear rea tion; 4. Sustained by any person while maintain- b. Radiation; ing or using an "auto" knowingly con- verted by that person. However, this c. Radioactive contamination. exclusion does not apply to: D. Limit Of Insurance a. You; or 1. Regardless of he number of covered b. Any "family member." "autos," premiu ms paid, claims made, "autos" involve in the "accident" or 5. Sustained by any person who, at the time insurers providi ng First Party Benefits, of the "accident:" the most we w II pay to or for an "in- sured" as the re ult of any one "accident" a. Is the owner of one or more cur- is the limit show n in the Schedule or in rently registered "autos" and none the Declaration of those "autos" is covered by the fi- nancial responsibility required by 2. Any amount pa yable under First Party the "Act;" or Benefits shall b excess over any sums paid, payable o required to be provided b. Is "occupying" an "auto" owned by under any worke rs' compensation law or that person for which the financial similar law. responsibility required by the "Act" is not in effect. E. Changes In Conditio s 6. Sustained by any person maintaining or The Conditions are changed for First Party using an "auto" while located for use as Benefits as follows: a residence or premises. 1. Transfer Of Rig is Of Recovery Against 7. Sustained by a pedestrian if the "acci- Others To Us d s not apply. dent" occurs outside of Pennsylvania. 2. The following Co nditions are added: This exclusion does not apply to: NON-DUPLICAT ON OF BENEFITS a. You; or No person may recover duplicate bene- b. Any "family member." fits for the sam expenses or loss under this or any othe similar automobile cov- 8. Sustained by any person while "occupy- erage including elf-insurance. PRIORITIES OF POLICIES a. A recreational vehicle designed for We will pay Fir st Party Benefits in ac- use off public roads; or cordance with he order of priority set b. A motorcycle, moped or similar type forth by the "Act " We will not pay if there vehicle. is another insu er at a higher level of priority. The "Fi st" category listed below 9. Arising directly or indirectly out of: is the highest evel of priority and the "Fourth" categ ry listed below is the a. A discharge of a nuclear weapon lowest level of p riority. The priority order (even if accidental); is: CA 22 37 03 06 Page 2 of 3 F First The insurer providing benefits to the "insured" as a named in- sured. Second The insurer providing benefits to the "insured"-as -a-family- mem- ber who is not a named insured under another policy providing coverage under the "Act." Third The insurer of the "auto" which the "insured" is "occupying" at the time of the "accident." Fourth The insurer providing benefits on any "auto" involved in the "accident" if the "insured" is: a. Not "occupying" an "auto;" and b. Not provided First Party Benefits under any other policy. If two or more policies have equal prior- ity within the highest applicable number in the priority order: 1. The insurer against whom the claim is first made shall process and pay the claim as if wholly responsible; 2. If we are the insurer against whom the claim is first made, our payment to or for an "insured" will not exceed the applicable limit shown in the Schedule or Declarations; 3. The insurer thereafter is entitled to recover pro rata contribution from any other insurer for the benefits paid and th costs of processing the claim. If contribution is sought among ins rers under the Fourth priority, pr ration shall be based on the numbe of involved motor vehi- cles-, and 4. The maxi um recovery under all policies sh II not exceed the amount payable u der the policy with the highest dol ar limits of benefits. F. Additional Defi tions As used in this ndorsement: 1. "Auto" me s a self-propelled motor vehicle, o trailer required to be registered, operated or designed for use on p blic roads. However, "auto" doe not include a vehicle operated: a. By mus cular power; or b. On rail or tracks. 2. The "Act" eans the Pennsylvania Motor Vehi le Financial Responsibil- ity Law. 3. "Family m E mber" means a resident of your hou sehold who is: a. Relate to you by blood, mar- riage r adoption; or b. A mino r in your custody or in the cu tody of any other "family membe r." 4. "Occupying ' means in, upon, getting in. on. out r off. CA 22 37 03 06 Page 3 of 3 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE RE14D IT CAREFULLY. PENNSYLVANIA CHANGES This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the less modified by the endorsement. A. Changes in Liability Coverage 2. The following is added to Supplementary Payments: Prejudgment interest awarded against the "insured" on the part of the judgment we pay. Any prejudgment interest awarded against the "insured" is subject to the applicable Pennsylvania Rules of Civil Procedure. B. Changes In Conditions 1. The following is added to the Loss Con- ditions Section: Paragraph A.2.b.(5) of the Duties In The Event Of An Accident, Claim, Suit Or Loss Condition is replaced by the following: After we show good cause, submit to ex- amination at our expense, by physicians of our choice. The following is added to the Transfer Of Rights of Recovery Against Others To Us Condition: If we make any payment due to an "acci- dent" and the "insured" recovers from another party "suit", the inst ceeds in trust fc amount we ha attorneys' fees curred by the such payment c have paid unde erage Form apply un- n a separate claim or red shall hold the pro- r us and pay us back the e paid less reasonable costs and expenses in- "insured" to the extent uplicates any amount we this coverage. 2. The following ?S added to the General Conditions Sec on: CONSTITUTIONALITY CLAUSE The premium f r, and the coverages of, this Coverage Form have been estab- lished in reliance upon the provisions of the Pennsylvania Motor Vehicle Financial Responsibility Law. In the event a court, from which there is no appeal, de tares or enters a judg- ment, the effect of which is to render the provisions of such statute invalid or unenforceable n whole or in part, we shall have the right to recompute the premium payable for the Coverage Form and void or amend the provisions of the Coverage For subject to the approval of the Insurance Commissioner. Copyright, Insurance Services Office, Inc., 1997 1 CA 01 80 09 97 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF COLLISION DEDUCTIBLE - NOT AT FAULT ACCIDENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM TRUCKERS COVERAGE FORM BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM The deductible amount shall not apply to loss caused by collision between your overed auto and another automobile, provided: (a) The loss to the covered auto is greater than the deductible amount; and (b) The owner or operator of such other automobile has been identified; and (c) The owner or operator of such other automobile is legally liable for the loss to your covered auto; and (d) There is a valid Property Damage Liability Insurance Policy applicable at the time of the accident with respect to the person or organization legally responsible for such loss to the covered auto. CA 70 07 10 87 HENDERSON INSURANCE AGENCY INC 3820 WALNUT ST HARRISBURG. PA 17109-2532 717-652-8355 Policy Number: BSP X151561 FAMILY EYE CARE I NC 5012 CARLISLE PIKE MECHANICSBURG P 17050 Assembly Instructions These pages update your current policy. To keep it current, yo' should: 1. Check the upper right hand corner of each page in this pa 'ket. a. If it says "Renewal or Rating Period Declarations", r move the expired declarations page from your current policy a rd replace it with the updated "Renewal or Rating Period De ?arations" page. b. If it says "Amended Declarations", insert this amende , page on top of the last declarations page you received. 2. Every time you receive a "Renewal or Rating Period Declarations", remove all prior "Amended Declarations". 3. When you remove pages from your policy, retain them for '.a perma- nent record. Thank you for placing your business with Westfield Compa' ies± Westfield Companies INSURANCE SINCE 1848 P.O. Box 5001, Westfield Center, Ohio 44251-5001 CRP2117 (09-92) THIS PAGE INTENTIONALL Ir LEFT BLANK sl WESTFIELD INSURANCE AMENDE COMMON POLICY D CLARATIONS Sharing Knowledge. Building TrusO COMPANY PROVIDING COVERAGE WESTFIELD INSURA NCE COMPANY NAMED INSURED AND MAILING ADDRESS AGENCY 37-0 203 PROD. 000 FAMILY EYE CARE INC HENDERSON INSURANCE AGENCY INC 5012 CARLISLE PIKE 3820 WALNUT ST MECHANICSBURG PA 17050 HARRISBURG PA 1710 -2532 TELEPHONE 717-652-E 355 Policy Number: BSP 4 151 561 1041 WIC Account Numbe : 3770082840 ( A Policy From 10/07/08 at 12:01 A.M. Stan and Time at your Period To 10/07/09 mailing address sho wn above. x* Effective 09/01/09 this Common Policy declarations amends all prior ss x* Common Policy declarations and endorses this policy as sho wn below. ss Business: EYE DOCTOR Named Insured i : Corporation In return for the payment of the premium, and subject to all terms of this policy, we agree with you to provide the insurance as stated in this policy. IF THIS POLICY AFFORDS PHYSICAL DAMAGE COLLISION COVERAGE AN A COVERED AUTO SYMBOL 1, 8, 21, 28, 41, OR 47 IS SHOWN NEXT TO THE PHYSICAL DAMAGE COLLISION COVERAGE ON THE APPLICABLE AUTO DECLARATIONS, WE PROVIDE COL ISION DAMAGE TO RENTAL VEHICLES. IF NOT SHOWN, WE DO NOT AFFORD COLLISION DA MAGE COVERAGE TO RENTAL VEHICLES. ANY SUCH INSURANCE PROVIDED IS EXCESS OV ER ANY OTHER COLLECTABLE INSURANCE. THE COVERAGE PARTS BELOW HAVE BEEN ENDORSED AS ,FOLLOWS: COMMERCIAL AUTO COVERAGE PART ENDORSEMENT Return $ 63.00 CR Net Returned Premium $ 63.00 CR AUTO COVERAGE PART ENDORSEMENT 1. DELETED AUTO 001 - 96 CHRY CONCORDE LXI 8091 - STATE WAS PENNSYLVANIA This endorsement changes your policy. Pl ase •• attach it to your original policy. Forms and Endorsements applicable to all coverage parts: IL7002 0488 IL0017 1198 ID7004 0893 IL0003 090 IL0246 0907 IL0910 0702 . , COUNTERSIGNED: BY Date ut orize epresentative PAGE 01 OF 01 IL 70 02 (04-88) 09/1709 HF t,.IONO TA, R `;. L T _6 ar -1 OERLAND COUNTY EF NSYLVANIA THOMAS, THOMAS & HAFER, LLP Kevin C. McNamara, Esquire Identification Number: 72668 P.O. Box 999 Harrisburg, PA 17108-0999 717/237-7132 kmcnamara@tthlaw.com Attorneys for Defendant Westfield Insurance Co. CRAIG HENRY and FRAN HENRY, Plaintiffs V. WESTFIELD INSURANCE CO., Defendant NO. 11-7259 CIVIL CIVIL TERM JURY TRIAL DEMANDED PRAECIPE FOR ENTRY OF APPEARANCE TO THE PROTHONOTARY: Please enter the appearance of the undersigned as attorneys for Defendant Westfield Insurance Co. in the above matter. Respectfully submitted, THOMAS, HOMAS & HAFER, LLP By: C m / Kevin C. McNamara, Esquire Attorneys for Defendant Westfield Insurance Co. DATE: IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA 960317.2 CERTIFICATE OF SERVICE I, Kevin C. McNamara, Esquire, hereby certify that I have served a true and correct copy of the foregoing document on the following persons by placing same in the United States mail, postage prepaid, on the day of L ? [jz4/- , 2011: David L. Lutz, Esquire Angino & Rovner, P.C. 4503 North Front Street Harrisburg, PA 17110-1708 THOMAS, THOMAS & HAFER, LLP By: ` C Kevin C. McNamara, Esquire 960317.2 . ``3, I aCT ?6 PM 12? ??_ Z?1 ANGINO & ROVNER, P.C. David L. Lutz, Esquire Attorney ID# : 35956 4503 North Front Street Harrisburg, PA 171 i 0-1708 (717) 238-6791 FAX (717) 238-5610 Attorneys for Plaintiff(s) E-mail: dlutz@angino-rovner.com CRAIG HENRY and FRAN HENRY, Plaintiffs IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA V. WESTFIELD INSURANCE CO., Defendant NO. 11-7259 Civil CIVIL ACTION - LAW JURY TRIAL DEMANDED ACCEPTANCE OF SERVICE I, Kevin C. McNamara, Esquire, counsel for Defendant Westfield Insurance Co., hereby accepts service of the attached Complaint filed in this action on behalf of Defendant Westfield Insurance Co. and hereby verify that i am authorized by my client to accept service of the Complaint. Kevin C. McNamara, Esquire Thomas, Thomas & Hafer, LLP P.O. Box 999 Harrisburg, PA 17108-0999 Dated: (] 3 ORIGINAL 48021 • - CERTIFICATE OF SERVICE I, Mary T. Geraets, an employee of the law firm of Angino & Rovner, P.C., do hereby certify that I am this day serving a true and correct copy of the ACCEPTANCE OF SERVICE upon all counsel of record via postage prepaid first class United States mail addressed as follows: Kevin C. McNamara, Esquire Thomas, Thomas & Hafer, LLP P.O. Box 999 Harrisburg, PA 17108-0999 Attorney for Defendant Mary T. eraets Dated: `u ; ? , W 480520 ? ? rn ? Z 4 c:) o - ?p -0 n n =0 3 r' fV ca ? W ANGINO & ROVNER, P.C. David L. Lutz, Esquire Attorney IDP : 35956 4503 North Front Street Harrisburg, PA 17110-1708 (717) 238-6791 FAX (717) 238-5610 Attorneys for Plaintiff(s) E-mail: dlutz c angino-rovner.com CRAIG HENRY and FRAN HENRY, IN THE COURT OF COMMON PLEAS Plaintiffs CUMBERLAND COUNTY, PA V. NO. 11-7259 Civil WESTFIELD INSURANCE CO., CIVIL ACTION - LAW Defendant JURY TRIAL DEMANDED PLAINTIFFS' REPLY TO THE DEFENDANT'S NEW MATTER 24. through 27. The Defendant's New Matter, paragraphs 24 through 27, fails to set forth factual allegations that require the Plaintiffs to admit and/or deny said allegations. The factual allegations contained in the Plaintiffs' Complaint are incorporated herein by reference. The Defendant's New Matter are all conclusions of law to which no response is necessary. 484709 WHEREFORE, the Plaintiffs respectfully request that the Defendant's New Matter be dismissed. Date: I 1 , ?"\\ ANGINO & ROVNER, P.C. Davi . Lutz PA I.D. No. 35956 4503 N. Front Street Harrisburg, PA 17110 (717) 238-6791 -phone (717) 238-5610 - fax dl utz@angino-ro vnen com Attorney for Plaintiffs 484708 CERTIFICATE OF SERVICE I, Mary T. Geraets, an employee of the law firm of Angino & Rovner, P.C., do hereby certify that I am this day serving a true and correct copy of the PLAINTIFFS' REPLY TO THE DEFENDANT'S NEW MATTER upon all counsel of record via postage prepaid first class United States mail addressed as follows: Kevin C. McNamara, Esquire Thomas, Thomas & Hafer, LLP P.O. Box 999 Harrisburg, PA 17108-0999 Attorney for Defendant 4w d4-11 Mary T. eraets Dated: 484708 1., `'n 12 F 1G= ENNSl`I-V° N1 r, ANGINO & ROVNER, P.C. David L. Lutz, Esquire Attorney ID# : 35956 4503 North Front Street Harrisburg, PA 17110-1708 (717) 238-6791 FAX (717) 238-5610 Attorneys for Plaintiff(s) E-mail: dlutz t angino-rovner.com CRAIG HENRY and FRAN HENRY, Plaintiffs V. WESTFIELD INSURANCE CO., Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA NO. 11-7259 Civil CIVIL ACTION - LAW JURY TRIAL DEMANDED PRAECIPE To the Prothonotary of Cumberland County: Please mark the above-captioned action settled, satisfied, and discontinued. ANGINO & ROVNER, P.C. Date: 480520 David L. Lutz PA I.D. No. 35956 4503 N. Front Street Harrisburg, PA 17110 (717) 238-6791 -phone (717) 238-5610 - fax dlutz@angino-rovner.com Attorney for Plaintiffs o'R\got CERTIFICATE OF SERVICE 1, Mary T. Geraets, an employee of the law firm of Angino & Rovner, P.C., do hereby certify that I am this day serving a true and correct copy of the PRAECIPE upon all counsel of record via postage prepaid first class United States mail addressed as follows: Kevin C. McNamara, Esquire Thomas, Thomas & Hafer, LLP P.O. Box 999 Harrisburg, PA 17108-0999 Attorney for Defendant Dated: 480520