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05-2919
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION PRIME INSURANCE SYNDICATE, INC. 8722 South 300 West Sandy, Utah 84070 Plaintiff V. WEST SHORE REGIONAL TRANSPORTATION 50 Market Street Lemoyne, PA 17047 Defendant ECKERT & MELI PRAECIPE FOR SUMMONS TO THE PROTHONOTARY: Issue a Summons in Civil Action - Law in the above-captioned case. A Writ of Summons shall be issued and forwarded to Sheriff for service upon the above- named defendant. Service shall be made by Sheriff upon the defendant at the following address: West Shore Regional Transportation c/o John Paroda 196 Ashford Drive Enola, PA 17025 Dated: June 6. 2005 By: Docket No. OS -,.2919 [ 1;Mt 7P1J? ? Civil Action - Law CHERIN Identification No.: 70587 1515 Market Street, Ninth Floor Philadelphia, PA 19102 215-851-8481 Attorneys for Defendant, Prime Insurance Syndicate, Inc. C V 1._ C. 0 U T:. -o 3t N CO N a %M v? Y V03 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION PRIME INSURANCE SYNDICATE, INC. 8722 South 300 West Sandy, Utah 84070 Plaintiff v. WEST SHORE REGIONAL TRANSPORTATION 50 Market Street Lemoyne, PA 17047 Defendant Docket No. DS' C'«?1CtQ Civil Action - Law SUMMONS IN CIVIL ACTION TO: WEST SHORE REGIONAL TRANSPORTATION YOU ARE NOTIFIED THAT THE ABOVE-NAMED PLAINTIFF HAS COMMENCED AN ACTION AGAINST YOU. I) Prothonotary, Civil Division Dated: QQS NOTICE TO PLEAD To: Defendant, West Shore Regional Transportation: You are hereby notified to plead to the enclosed complaint within twenty (20) days from service er of or a judgment may be entered against You. 4-y for Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION PRIME INSURANCE SYNDICATE, INC. 8722 South 300 West Sandy, Utah 84070 Docket No. 05-2919 -Civil Term Plaintiff Civil Action - Law V. WEST SHORE REGIONAL TRANSPORTATION 50 Market Street Lemoyne, PA 17047 Defendant COMPLAINT 1. Plaintiff, Prime Insurance Syndicate, Inc. is a corporation with a business address of 8722 South 300 West, Sandy, Utah. 2. Defendant, West Shore Regional Transportation is a business located at 50 Market Street, Lemoyne, Pennsylvania. 3. On or about November 27, 2002, plaintiff and defendant entered into an agreement under which plaintiff would provide business automobile liability insurance coverage to defendant, and issued policy no. DOL253742, ("the policy"), to defendant, effective for the twelve month period commencing on the aforesaid date. 4. A true and correct copy of the policy is attached as Exhibit A. 5. In exchange for providing the aforesaid business automobile liability coverage, defendant agreed to pay $161,234.04, which includes endorsements added at defendant's request subsequent to the inception of the policy, policy fees and finance charges. 6. Defendant has failed to pay $130,252.43 of the aforesaid amount, despite demand for same. 7. In addition, pursuant to the terms of the policy, defendant agreed to a self insured retention. 8. Under the SIR provision of the policy, defendant owes plaintiff $2,062.42, which amount is or may continue to increase. 9. Defendant has failed to pay the $2,062.42 in SIR despite demand for same. 10. Under the terms of the policy, defendant agreed to pay plaintiff a total of $163,296.46, which includes premium, policy fees, finance charges and self insured retention. 11. Plaintiff has fully performed its obligations as set forth in the policy. 12. Defendant has failed to pay a total of $132,314.85. 13. Plaintiff has requested the balance owed under the terms of the policy. 14. Defendant has refused to pay the remaining balance of $132,314.85, which remains due and owing. 15. Defendant's refusal to pay the $132,314.85. balance constitutes a breach of contract. 1) WHEREFORE, Plaintiff, Prime Insurance Syndicate, Inc. requests entry of judgment in its favor and against Defendant, West Shore Regional Transportation in the amount of 5132,314.85. plus additional amounts owed under the policy SIR provision as that amount continues to grow, plus interest, costs of suit, attorneys fees and other costs as the Court deems j u St. ECKERT SEA-MANS CHERIN & MELLOTT, L DC By:? Kl Robert L. Sand, )quire Identification No.: 70587 1515 Market Street, Ninth Floor Philadelphia, PA 19102 Telephone: 215-851-8481 Attorneys for Defendant, Sears, Roebuck and Co. Dated: December 6, 2005 3 VERIFICATION I, Kelly Sisk, hereby verify that I am authorized to make this Verification on plaintiff's behalf; that the facts set forth in the foregoing Complaint are true and correct to the best of my knowledge and information; and that the statements made herein are subject to the penalties of the 18 Pa. C.S.A. § 4904 relating to unsworn falsification to authorities. Bw ' Dated: d ?4, 1 V m 6 INEX One Sc 1? ;r Drive, Suite 2720 - Chicago, Illinois 606, 312-372-4639 See Below for the risk bearing Syndicate(s) DECLARATIONS This Declaration Page is issued in conjunction with and forms a part of Coverage Contract Number: IIE# DOL 253742 SPTXA03030116 Item 1. Name of Insured and Address: West Shore Regional Transportation 50 Market Street Lemoyne, PA 17047 Item 2. Coverage Contract Period: From 03/17/2003 to 11/27/2003 (12:01 AM- Standard Time at the Address of the Insured) Retro Active Date: 11/27/2002 Item 3. Description of coverage afforded hereunder: Business Auto Liability Item 4. Limits of Liability: Commercial Auto Liability: $50,000 Per Person Rejected U.M. Per Person Rejected U.M. Property Damage $100,000 Per Accident Rejected U.M. Per Accident Rejected U.I.M. Per Accident Rejected U.I.M. Per Person Rejected U.I.M. Property Damage $5,000 Property Damage $5,000 PJ.P Per Person Property/Physical Damage Deductible: $0 Liability SIR: $1,250 Policy Liability Aggregate: $300,000 Item 5. Premium or Coverage Charge $31,177.00 Fee(s) Inspection/Policy $750.00 TOTAL $31,927.00 Item 6. Coverage Charge 301% Earned at Inception. Item 7. Endorsements and forms atta hed to this Coverage C/pntracC EX HANGE96-$S, PSI96-1, P195-1, PCA0195jj1A, PCA9?2. PS19 A, PJ-1,- -1, PSt94-6, PSI94-7, PSI B. P 5-11, PSI951-15, Pkd98-1, PS96-1. WRNT2epU-O6, PCp?5-8, PAErrr 5-3, P-PG2???000---95-6A, Application. CA 03 95 Item 8. Underwriting Syndicate: Prime Insurance Syndicate, Inc. INEX #029 Item 9. Exchange Broker: IEBS SL ??pp INEX # 327-B CJ1fe>'?'k. Authorized Representative INSURANCE COVERAGE HEREUNDER IS PROVIDED TO THE NAMED INSURED OR REINSURED THROUGH THE FACILITIES OF INEX (FORMERLY KNOWN AS THE ILLINOIS INSURANCE EXCHANGE) AND IS ISSUED IN ACCORDANCE WITH ARTICLE V112 OF THE ILLINOIS INSURANCE CODE AND THE INEX REGULATIONS. COVERAGE IS PROVIDED SOLELY BY THE UNDERWRITING SYNDICATE(S) LISTED HEREIN. INEX ITSELF IS NOT AN INSURER AND, ACCORDINGLY, IS NOT A PARTY TO THE CONTRACT AND HAS NO LIABILITY HEREUNDER. EACH UNDERWRIT ING SYNDICATE LISTED ACCEPTS INDIVIDUAL AND SEVERAL LIABILITY BUT HAS NO JOINT LIABILITY. 'THIS INSURANCE POLICY IS BEING ISSUED BY AN INSURER THAT MAY NOT BE LICENSED BY THE STATE INSURANCE DEPARTMENT IN THIS STATE AND MAY NOT BE SUBJECT TO THIS STATE'S SUPERVISION AND MAY NOT BE PROTECTED IN THE EVENT OF THE INSOLVENCY OF THE INSURER BY THIS STATE's GUARRANTEE OR SECURITY FUND. THIS POLICY ISSUED MAY NOT BE SUBJECT TO ANY OR ALL OF THE REGULATIONS OF THIS STATE'S INSURANCE DEPARTMENT PERTAINING TO POLICY FORM" Issue Office: Prime Insurance Syndicate, Inc. 8722 South 300 West, Sandy, UT 84070 Thurs&y, Endorsement PS 16-A Attached to and forming part of policy: DOL 253742 SPTYA03030116 Insured: West Shore Regional Transportation Carrier: INEX/Prime Insurance Syndicate, Inc. At its agency located in Salt Lake City, Utah Endorsement Effective date: 11/10/2003 Endorsement type date: 1/23/2004 It is hereby understood and agreed that the above policy is amended as follows: Amend Endorsement #20 to show ($12,896.00 in lieu of ($95,484.59), generating an additional premium. Additional Premium: $82,588.59 Total Premium: $82,588.59 All other terms and conditions of the policy remain unchanged. Endorsement: 21 nuuwunw ncpiwcumuvc of the Company BodorsememPSl&A- 10.2-01 Pape 1 of 1 Endorsement PS 16-A Attached to and forming part of policy: DOL 253742 SPTXA03030116 Insured: West Shore Regional Transportation Carrier: INEX/Prime Insurance Syndicate, Inc. At its agency located in Salt Lake City, Utah Endorsement Effective date: 11110/2003 Endorsement type date: 1/22/2004 It is hereby understood and agreed that the above policy is amended as follows: is cancelled, generating a return premium as follows. Return Premium: ($95,484.59) All other terms and conditions of the policy remain unchanged. Endorsement: 20 Authorized Representative of the Company T Y 4 Endorsement PS 16-A Attached to and forming part of policy: DOL 253742 SPTXA03030116 Insured: West Shore Regional Transportation Carrier: INEX/Prime Insurance Syndicate, Inc At its agency located in Salt Lake City, Utah Endorsement Effective date: 11/10/2003 Endorsement type date: 3/26/2004 It is hereby understood and agreed that the above policy is amended as follows: Amend Endorsement #20 to show ($12,896.00 in lieu of ($95,484.59), generating an $82,588.59 additional premium. EIB $0.00 4 Premium: $82,588.59 All other terms and conditions of the policy remain unchanged. Endorsement: 21 Authorized Representative of the Company t F mne SI&A- 10-M Attachment A Excluded Drivers List Name DL# David Adams 22420596 Kimberly Allen 24290046 Kenneth Arnett 23248998 Tonya Arter 23843513 Monerey Ayala 24649095 Clyde Bachert 18435983 Francis Bacon 17133483 Terry Ballent 18186800 David Bankes 20578531 Arnold Bell Jr. 26653224 Paul Beltz 14829287 George Bentzel IV 24903416 Kelby Berner 22525591 Richard Berry 17110557 Thomas Bethea 17400537 Amean Bey 20745716 Donald Bigelow 21580455 Christopher Blackwell 25758458 David Bookman 19804929 James Brennan 24487831 Charles Broadnox 111 18602718 Antonio Brown 24392186 Earl Brown 21815484 Garfield Burke 23708217 Toriano Burney 22507035 Dwayne Campbell 23745244 Maggie Cardona TBD David Carter 23424513 Brandy Carter 24038755 John Cassatt Jr. 18053311 Daniel Ciesnolevicz 21874491 Travis Clark 23741951 Donald Clark 22086275 Robert Coan 17005217 Anthony Cobbs 27075816 Troy Cole TBD Ronald Collier 19978266 Washington Collier 19832081 Mary Cope 19671082 Elton Corbin 22915936 Antonio Cordero 21871468 Alex Couch 25439800 Raymond Cristo 25693474 Gary Daniels 60019316 Avery Davis 19649391 Geraldine Davis 20377070 Carl Davis 19372043 Thomas Delozier 24488919 Tyrone Dorsey 25928357 Crystal Drake 21051990 Thomas Drake Jr. 23540834 Karen Easter 19680254 Duane Eggleston TBD Essadik Elhaddad 26573722 Peter Equere 23615445 Larry Evans 19833828 Shawte Evans 25073997 Jason Ewing 24344675 Sam Farmer 18210479 Joseph Fenn 19301161 Eddie Ferguson 22380349 Larry Fry 20778877 Michael Frye II 24421472 George Fulton 24689828 Fernando Garcia 19055327 Tamara Garlin 23004092 John Garrison 16545415 Brian Gates 22937378 Kareem George 23816329 Adel Ghamdugi 27105946 Jeffrey Gibson TBD Donald Gingrich 11695889 Dennis Green 24006232 Trevor Gunthorpe 2,4797700 Ernest Harper 18188307 Stephanie Hartman 25306029 Robert Hauser 16815606 Robert Heller 13441070 James Henderson Jr. 25392890 Almohammed Hiathams 26924142 Michele Highsmith 25324426 Martinet Hill 26115172 Gregory Hoffman 12857711 Carmen Holton 19193805 Cindy Humer 17347372 Arron Irvin 26620033 Steven Jackson 15246144 Jacoby Jackson 23940113 Arthur Jefferson 19500267 Michael Johnson 18854862 Runa Johnson 24806368 Tertius Johnson 25504259 Chris Jonas 24345246 Jeffrey Jones 19323742 Donzell Jones 27090724 Anthony Jones 22393054 Abdesselam Kamel 26086084 Johathan Kanyanga 26265725 Robert Kates K08046587101464 Jack Keck 18002928 Richard Kenee 11451347 Charles Koabel 23836407 Brian Kopera 23463870 James Lanza 19972031 Le Lawson 21719547 Jeffrey Lawyer 21625076 Joseph Long 23343103 Manuel Lopez 24065311 Mark Lopus 16919542 Robert Love TBD Johnny Lovejoy Jr. 19810133 Evans Lowery 22612053 Wayne Lowery 21098947 Carlos Luciano Jr. 20437851 Rashida Lyles 23691813 Mongi Mahjoub 27106004 Angel Malave 24369659 Paul Manning 07050249 Kenneth Marshall 27091222 Robert Martin 26925447 Jack Maxwell 04820175 Jack Maxwell 22134969 David McNaughton 13303307 Robert McCain 24337505 Fontaine McClure Sr. 24207527 Michael McEnry 16554659 Gasnel McFarlane 26921562 Trumaine McFarlane 25512197 George McFarlane 27484094 Allen McGill 24708337 Michael McKie 20661086 Abdelmonam Mensi 27166034 Anthony Mikula 60022960 George Miller III TBD Jennifer Miller 25563409 George Miller III TBD Stephanie Minium 23792105 Malcom Mirado 25111693 Douglas Mitchell 24203743 Mohomed Mohomed Idroos 27287408 Hector Monroig 19885321 Anthony Moore 27390123 Daniel Moore 25599124 Robert Moore Jr. 20787152 Crystal Moppin 23455314 Bruce Morris Sr. 22884324 David Mosley 22891422 Kirk Moyer 18644463 Brett Murray 22391767 Robert Myers Jr. 25920992 Terry Neal 02311313 William O'Malley 16203951 Brain Olson 60037888 Tammy Orsinger 22987703 Abdelhamid Ouassiai 27044153 Joe Pagano 24511525 Melanie Palm 23697188 Robert Parker 11727096 William Peters 23607694 Michael Plummer 19816348 Edwin Prescott 22965234 Edward Purdy 24251052 Jeffrey Putnam 25846067 Brian Quaid 20885745 Eric Rainey 20885745 Miguel Ramos 25616523 Joseph Rand 21400447 Leonard Randolph Jr. 02278574 Kenneth Randolph Jr. 24595300 Seth Reckert 27514793 Joseph Reid 23199806 Geoffrey Reynolds 21314165 Edward Riddle 12479836 Douglas Robinson 18187411 Carmelita Rohler 27290989 Eric Rossario TBD Edward Rose 13180005 Benjamin Santiago 22630376 James Saurs 21394473 Doreen Scott 26308946 John Sebastian 16204596 MichaelShambaugh 18176528 Larry Shanks 26658543 Treva Shenk 14752808 Brian Sheppler TBD Ronald Sherrick 24960168 Curtis Shiffer 22977555 Joseph Shuttz 15560492 Joshua Silva 26170964 Michael Simms 25301645 Leo Smith 15874053 David Smith 19042295 Daryl Smith 22142016 John Smyser 22898295 Jason Snively 24498861 Alberto Soto 24475350 Robert Sotter 15961735 Maurice Stafford 27671588 Jessie Stephenson 20849703 Jimmie Stewart 19057639 Alfred Stewart 19647661 Patricia Stewart 19677534 Charles Stilo 16568225 Kenneth Stough 23665095 Chandre Summerford 22313702 Joseph Scada 23237190 Reginald Tabb 23935290 Troy Tate 22074880 Leandrew Tayler 17901145 Shawna Taylor 26807576 Elizabeth Thomas 19058141 Wilfredo Torres 24526698 James Turner 23108968 Alphonso Turner 22994493 Anthony Underwood 18864901 Leann Vajda 21050588 Lloyd Walker 23586457 Christopher Walker 23748049 Nakia Wallace 24445045 Donald Walters Jr. 26061047 Lonny Wanner 17618495 Danetta Washington 22976573 James Watford 24860260 David Watkins 08854785 Anthony Watson 22546092 Keith Watt 19507820 Patrica Watts 22550968 Armonda Weedon 23998354 Patrice Wells 25066608 Robert White 18334711 Rachel Wiley 23971502 Tanika Williams 25783797 Mildred Wittle 18194583 Ronald Zagrocki 21693101 Dennis Zellers 05140076 Michael Zigler 24949884 Bruce Zimmerman 17024797 Daneil Zufall TBD Endorsement PS 16-A Attached to and forming part of policy: DOL 253742 SPTXA03030116 Insured: West Shore Regional Transportation Carrier: INEX/Prime Insurance Syndicate, Inc. At its agency located in Salt Lake City, Utah Endorsement Effective date 11/6/2003 Endorsement type date: 11/11/2003 It is hereby understood and agreed that the above policy is amended as follows: Added Driver Driver # 71 Washington Collier Jr 4/21/1955 PA - # 19832081 Effective - 11/6/2003 Generating an additional premium of $0.00 Total Premium: $0.00 All other terms and conditions of the policy remain unchanged. Endorsement: 17 Authorized Representative of the Company EMors .OS16-A- 1a2-e1 Page 1 of 1 Endorsement PS 16-A Attached to and forming part of policy: DOL 253742 SPTXA03030116 Insured: West Shore Regional Transportation Carrier: INEX/Prime Insurance Syndicate, Inc. At its agency located in Salt Lake City, Utah Endorsement Effective date 11/6/2003 Endorsement type date: 11120/2003 It is hereby understood and agreed that the above policy is amended as follows: Added Driver Driver # 72 Cory Layton Sr 3/23/1977 PA - # 24848288 Effective - 11/6/2003 Generating an additional premium of $83.00 Total Premium: $83.00 All other terms and conditions of the policy remain unchanged. Endorsement: 18 Authorized Representative of the Company EMorscmemPSI&A- ]0.M Page I of I Endorsement PS 16-A Attached to and forming part of policy: DOL 253742 SPTXA03030116 Insured: West Shore Regional Transportation Carrier: INEX/Prime Insurance Syndicate, Inc. At its agency located in Salt Lake City, Utah Endorsement Effective date 11/6/2003 Endorsement type date: 12/5/2003 It is hereby understood and agreed that the above policy is amended as follows: Delete Drivers Driver # 71 Washington Collier Jr 4/21/1955 PA - 919832081 Effective -11/6/2003 Generating a return in premium of $0.00 Flat Cancel endorsement 917 Total Premium: $0.00 All other terms and conditions of the policy remain unchanged. Endorsement: 19 Authorized Representative of the Company P d.'..WSM-A- 10-2-01 Page 10(1 Endorsement PS 16-A Attached to and forming part of policy: DOL 253742 SPTXA03030116 Insured: West Shore Regional Transportation Carrier: INEX/Prime Insurance Syndicate, Inc. At its agency located in Salt Lake City, Utah Endorsement type date: 11/10/2003 Endorsement Effective date 10/31/2003 It is hereby understood and agreed that the above policy is amended as follows: Add Units Unit 98 1992 Chevrolet IGIBL5370NRI48702 Unit 99 1991 Chevrolet 1GIBL437XMW233420 Unit 100 1993 Chevrolet IGIBL537PWI47002 Unit 101 1992 Chevrolet IGIBL5370NRI48764 Unit 102 1994 Chevrolet IGIBL52PIRRI93431 Unit 103 1990 Chevrolet 1GNCU06D7LT166313 Unit 104 1994 Chevrolet 2C3ED56F9RH258159 Unit 105 1996 Chevrolet 2GIWL52M8T9184699 Unit 106 1990 Plymouth 1P4FH44ROLX168487 Unit 107 1994 Chevrolet IGIBL52P3RRI33280 Unit 108 1994 Chevrolet 1GIBL52P7RR134769 Unit 109 1991 Chevrolet IGIBL5372MW259221 Gene rating an addi tional premium of $3,024.00 Delete Units Unit # 21 1996 Chevrolet 2G I WL52MXT9308410 Unit #34 1991 Chevrolet IG1BN53EOMR145855 Unit #65 1994 Chevrolet IG1BL52P4RR134406 Unit # 78 1994 Chevrolet 1 G I BL52P6RRI36285 Unit #83 1991 Chevrolet IGIBL53EXMRI12707 Generating a return in premium of ($1,155.00) Total Premium: $1,869.00 All other terms and conditions of the policy remain unchanged. Endorsement: 16 Value: $0.00 Effective 10/3112003 Value: $0.00 Effective-10/31/2003 Value: $0.00 Effective-10/31/2003 Value: $0.00 Effective-10/31/2003 Value: $0.00 Effective-10/31/2003 Value: $0.00 Effective-10/31/2003 Value: $0.00 Effective.10/31/2003 Value: $0.00 Effective-10/31/2003 Value: $0.00 Effective-10/31/2003 Value: $0.00 Effective-10/31/2003 Value: $0.00 Effective-10/31/2003 Value: $0.00 Effective-10/31/2003 Effective - 10/31/2003 Effective- 1 0/3 12 003 Effective- 10/31/2003 Effective- 10/31/2003 Effective- 10/31/2003 Authorized Representative of the Company EidmeanrmPS16A - 10-M1 Page 1 A 7 Endorsement PS 16-A Attached to and forming part of policy: DOL 253742 SPTXA03030116 Insured: West Shore Regional Transportation Carrier: INEX/Prime Insurance Syndicate, Inc. At its agency located in Salt Lake City, Utah Endorsement Effective date: 10/22/2003 Endorsement type date: 10/23/2003 It is hereby understood and agreed that the above policy is amended as follows: Added Drivers Driver # 70 Vincent Headen 12/18/1960 PA - # 26678222 Generating an additional premium of $0.00 Total Premium: $0.00 All other terms and conditions of the policy remain unchanged. Endorsement: 15 Effective - 10/22/2003 Authorized Representative of the Company nMOMr IPSJbA-IM-01 Pagel oft Endorsement PS 16-A Attached to and forming part of policy: DOL 253742 SPTXA03030116 Insured: West Shore Regional Transportation Carrier: INEX/Prime Insurance Syndicate, Inc. At its agency located in Salt Lake City, Utah Endorsement Effective date 9/26/2003 Endorsement type date: 10/17/2003 It is hereby understood and agreed that the above policy is amended as follows: Add Units Unit 95 1992 Chevrolet IGIBL5375NRI47691 Value: $0.00 Effective-9/26/2003 Unit 96 1991 Lincoln ILNCM9844MY623332 Value: $0.00 Effective-9/26/2003 Unit 97 1994 Chevrolet 1GIBL52P4RR134406 Value: $0.00 Effective-9/26/2003 Generating an additional premium of $1,734.00 Total Premium: $1,734.00 All other terms and conditions of the policy remain unchanged. Endorsement: 14 C±OA1Oi-11 1 "f4A ? Authorized Representative of the Company EM?SM-A- 10.2-01 Pape 1 of I Endorsement PS 16-A Attached to and forming part of policy: DOL 253742 SPTXA03030116 Insured: West Shore Regional Transportation Carrier: INEX/Prime Insurance Syndicate, Inc. At its agency located in Salt Lake City, Utah Endorsement Effective date: 9/16/2003 Endorsement type date: 9/23/2003 It is hereby understood and agreed that the above policy is amended as follows: Add Units Unit 93 1991 Chevrolet IGIBL5371MW259212 Value: $0.00 Effective-9/16/2003 Unit 94 1992 Chevrolet IGIBL5375NW144971 Value: $0.00 Effective-9/16/2003 Generating an additional premium of $1,340.00 Delete Units Unit#9 1992 GMC 1GKDM19Z6NB535590 Unit # 70 1991 Dodge 284GK55R5MR262148 Generating a return in premium of ($1,228.00) Total Premium: $112.00 All other terms and conditions of the policy remain unchanged. Endorsement: 13 Effective - 9/16/2003 Effective - 9/16/2003 Authorized Representative of the Company EMO.PSWA- 1P2-01 Page t o(1 Endorsement PS 16-A Attached to and forming part of policy: DOL 253742 SPTXA03030116 Insured: West Shore Regional Transportation Carrier: INEX/Prime Insurance Syndicate, Inc. At its agency located in Salt Lake City, Utah Endorsement Effective date: 8/14/2003 Endorsement type date: 8/14/2003 It is hereby understood and agreed that the above policy is amended as follows: Added Drivers Driver # 51 Matthew Fine Driver # 52 Carl Harrison Driver # 53 Steven Jackson Jr Driver # 54 Lemarc Smith Driver # 55 Dennis Robinson Driver # 56 Mark Davison Driver # 57 Tony Sanders Driver # 58 Edward Sutliff Jr Driver # 59 Robert Holmes Jr Driver # 60 Robert Strong Driver# 61 Shelly Vaughn-Johnson Driver# 62 Steven Rapp Driver # 63 James Kibe Jr Driver # 64 Douglas Smith Driver # 65 Patrice Wells Driver # 66 Robin Carter Driver It 67 Michael Lyons Driver # 68 George Williams III Driver # 69 Oliver Johnson Jr Generating a n additional premium of $0.00 10/21/1976 PA - # 24094851 Effective - 8/14/2003 1/10/1948 PA - #13302218 Effective-8/14/2003 7/31/1978 PA - #24709280 Effective - 8/14/2003 7/19/1977 PA - #27893166 Effective - 8/1412003 10/29/1948 PA - # 25607508 Effective - 8/14/2003 9/17/1961 PA - # 22099222 Effective - 8/14/2003 9/8/1954 PA - # 16535796 Effective - 8/14/2003 7/8/1957 PA - # 27544457 Effective - 8/14/2003 11/24/1976 PA - #24298139 Effective-8/14/2003 2/9/1958 PA - # 2348386 Effective - 8/14/2003 12/5/1969 PA - # 25551949 Effective - 8/14/2003 4/25/1953 PA - # 16530511 Effective - 8/14/2003 8/16/1946 PA - # 12857546 Effective - 8/14/2003 2/27/1972 PA - #22974412 Effective-8/14/2003 7/31/1979 PA - # 25066608 Effective - 8/14/2003 8/26/1957 PA - #20476736 Effective - 8/14/2003 8/16/1962 PA - # 20753663 Effective - 8/14/2003 1/31/1969 PA - #22109652 Effective - 8/14/2003 8/5/1970 PA - # 22579945 Effective - 8/14/2003 Effective 811/03 Tina Barber PA DL# 24138637 is hereby excluded from the policy as a driver Total Premium: $0.00 All other terms and conditions of the policy remain unchanged. Endorsement: 11 Authorized Representative of [he Company Lnlnrxmml'tilb:\- W-2111 Pagel of 1 Endorsement PS 16-A Attached to and forming part of policy: DOL 253742 SPTXA03030116 Insured: West Shore Regional Transportation Carrier: INEX/Prime Insurance Syndicate, Inc. At its agency located in Salt Lake City, Utah Endorsement Effective date: 8/4/2003 Endorsement type date: 8/18/2003 It is hereby understood and agreed that the above policy is amended as follows Add Units Unit 90 1996 Chrysler 2C3HC56F1TH171640 Value: $0.00 Effective 8/4/2003 Unit 91 1994 Chevrolet 1G1BL52P2RR133030 Value: $0.00 Effective-8/4/2003 Unit 92 1994 Chevrolet IGIBL52PIRRI33665 Value: $0.00 Effective-8/4/2003 Generating an additional premium of $3,213.00 Delete Units Unit # 17 1991 Chevrolet 1G1BL83E5MW247869 Effective - 8/4/2003 Generating a return in premium of ($982.00) Total Premium: $2,231.00 All other terms and conditions of the policy remain unchanged. Endorsement: 11 Authorized Representative of the Company EudouemmtPS1&A- I0-2-01 Pape 1 011 Endorsement PS 16-A Attached to and forming part of policy: DOL 253742 SPTXA03030116 Insured: West Shore Regional Transportation Carrier: INEX/Prime Insurance Syndicate, Inc. At its agency located in Salt Lake City. Utah Endorsement Effective date: 8/1/2003 Endorsement type date: 8/29/2003 It is hereby understood and agreed that the above policy is amended as follows: Attached list of names are hereby excluded from the policy as drivers (see attachment B). Total Premium: $0.00 All other terms and conditions of the policy remain unchanged. Endorsement: 12 '?'uthorized Representative of the Company EM,1 mm.WSM A- 10.2-01 Page 1 of 1 Attachment B Excluded Drivers List Name DL# Denise Barrett 21968105 Shirley Clark 19317139 Anthony Corish 26045708 Theresa Gianquitto-Cannon 25018045 James Hymon Sr. 14818915 Michael Lucas Jr. 22476108 Steven Quickel 20840661 Nicholas Schaeffer 24696817 Clinton Sharpe 19515250 Lance Slaughter 27795701 Keith Troutman 19035352 Diane Warner 23607645 James Zulli 15712078 Endorsement PS 16-A Attached to and forming part of policy: DOL 253742 SPTXA03030116 Insured: West Shore Regional Transportation Carrier: INEX/Prime Insurance Syndicate, Inc. At its agency located in Salt Lake City, Utah Endorsement Effective date: 613/2003 Endorsement type date: 6/12/2003 It is hereby understood and agreed that the above policy is amended as follows: Add Units Unit 89 1993 Chevrolet IGIBL5376PWI4849 Value: $0.00 Effective-6/3/2003 Generating an additional premium of $1,512.00 Delete Units Unit #12 1987 Chevrolet IGIBL5IHIHX154715 Effective- 6/3/2003 Generating a return in premium of ($1,512.00) Total Premium: $0.00 All other terms and conditions of the policy remain unchanged. Endorsement: 10 At th nzntat? of the Company Edon nrPS16-A-M2-01 Page 1011 Endorsement PS 16-A Attached to and forming part of policy: DOL 253742 SPTXA03030116 Insured: West Shore Regional Transportation Carrier: INEX/Prime Insurance Syndicate, Inc. At its agency located in Salt Lake City, Utah Endorsement Effective date: 5/8/2003 Endorsement type date: 5/19/2003 It is hereby understood and agreed that the above policy is amended as follows: Add Units Unit 84 1987 Chevrolet 1G1BU51H7H9140092 Value: $0.00 Effective-5/8/2003 Unit 85 1991 Chevrolet 1GIBN53EIMWI04474 Value: $0.00 Effective-5/8/2003 Unit 86 1995 Chevrolet lGlBL52WXSR138280 Value: $0.00 Effective-5/8/2003 Unit 87 1995 Chevrolet lGlBL52PSR143370 Value: $0.00 Effective-5/8/2003 Generating an additional premium of $6,936.00 Delete Units Unit # 19 1992 Chevrolet IGIBL5370NRI47226 Effective - 5/8/2003 Unit #50 1995 Ford IFMCA1147SZA86371 Effective- 5/8/2003 Unit #51 1993 Chevrolet 1GIBL53E8PW146246 Effective- 5/8/2003 Unit #69 1995 Mercury 2MELM74W3DC676485 Effective- 5/8/2003 Generating a return in premium of ($6,936.00) Amend Unit #81 on endorsement #7 to read Unit #83 Total Premium: $0.00 All other terms and conditions of the policy remain unchanged. Endorsement: 9 'fiL.. V.6' Authorized Representative of the Company Pnd-e tPSWA- 10.2-01 Pape 7 d i Endorsement PS 16-A Attached to and forming part of policy: DOL 253742 SPTXA03030116 Insured: West Shore Regional Transportation Carrier: INEX/Prime Insurance Syndicate, Inc. At its agency located in Salt Lake City, Utah Endorsement Effective date: 4/21/2003 Endorsement type date: 4/2412003 It is hereby understood and agreed that the above policy is amended as follows: Add Units Unit ef-631991 Chevrolet 1G1BL53EXMR112707 Value: $0.00 Effective -4/21/2003 Unit 82 1994 Chevrolet 1G1BL52P1RR137165 Value: $0.00 Effective -4/21/2003 Generating an additional premium of $3,759.00 Delete Units Unit #26 1993 Chevrolet IGIBL5374PW147332 Unit #37 1996 Chrysler 2C3HC56F1TH171640 Generating a return in premium of ($3,759.00) Added Drivers Driver # 15 Driver # 16 Driver # 17 Driver # 18 Driver # 19 Driver # 20 Driver # 21 Driver # 22 Driver # 23 Driver # 24 Driver # 25 Driver # 26 Driver # 27 Driver # 28 Driver # 29 Driver # 30 Driver # 31 Driver # 32 Driver # 33 Driver # 34 Driver # 35 Driver # 36 Driver # 37 Driver # 38 Driver # 39 Driver # 40 Driver # 41 Driver # 42 Driver # 43 Driver # 44 Driver # 45 Driver # 46 Driver # 47 Driver # 48 nodarseneotP516A- 10,2-01 Anthony Alfred Michael Beardsley William Best Anthony Blanding Thomas Books James Brandt Jr. Manuel Cardona Barbara Crossland Edward Deitrick Donald Famer Jr. Wallace Fowler Jr. Dwayne Hassinger Terry Harman Dorothy Hill Calvin Johnson Jr. Charles Johnson Richard Lengjel Stanley Markowski Robert Maxwell Allen McCray Jeffrey Motter Samuel Ortenzio Jr James Paroda If Dawn Ridley Dale Roberts Jr. Matin Rothstein Kenneth Saunders Arthur Smith Victor Snyder III Joseph Sucec John Verrecchio Steven Wiest Dale Willey Robert Willis 11/3/1971 7/15/1962 1/15/1967 111411969 8/26/1942 7/30/1962 5/5/1947 12/16/1943 10/7/1941 9/24/1950 8/311958 5/19/1963 12/11/1965 2/6/1958 8/24/1977 3/27/1980 4/18/1960 4/25/1961 7/20/1949 10/611957 4/5/1958 7/5/1949 1/1/1972 2/28/1967 1077/1954 12/1/1965 9/23/1968 11/17/1953 1/30/1953 5/23/1961 8/3/1951 5/16/1962 3/23/1947 12/6/1972 Pape 1 012 Effective - 4/21/2003 Effective - 4/21/2003 PA - #22711483 PA - #25378508 PA - # 21207430 PA - #22609797 PA - # 11817360 PA - #19688175 PA - #19675794 PA - #12228155 PA - # 11022870 PA - #15955493 PA - #18208070 PA - #19961176 PA - # 20986030 PA - #18130614 PA - # 24739306 PA - # 25655559 PA - # 24487696 PA - # 19613921 PA - #13794578 PA - # 25477961 PA - #18130989 PA - #13546839 PA - #22631666 PA - # 22886827 PA - #22879583 PA - # 21016338 PA . # 21640278 PA - #16189166 PA - #16206692 PA - #22186776 PA - # 15383553 PA - #19947094 PA - #13542123 PA - #23137984 Effective - 4/15/2003 Effective - 411512003 Effective - 4/1512003 Effective - 4/15/2003 Effective - 4/15/2003 Effective - 4/15/2003 Effective - 4/15/2003 Effective - 4/15/2003 Effective - 411512003 Effective - 4/15/2003 Effective - 4115/2003 Effective - 4115/2003 Effective - 4115/2003 Effective - 4/1512003 Effective - 4/15/2003 Effective - 4/15/2003 Effective - 4/15/2003 Effective - 4115/2003 Effective - 4/15/2003 Effective - 4/15/2003 Effective - 4/15/2003 Effective - 4/15/2003 Effective - 4/ 1 51200 3 Effective - 4/15/2003 Effective - 4115/2003 Effective - 4/15/2003 Effective - 4/15/2003 Effective - 4/15/2003 Effective - 4/15/2003 Effective - 411512003 Effective - 4/15/2003 Effective - 411512003 Effective - 4/15/2003 Effective - 4/15/2003 Driver# 49 Barbara "';tson 413011953 PA - #21872°'5 Driver # 50 Richard ;on 9/27/1942 PA - # 1221, Generating an additional premium of $0.00 Total Premium: $0.00 All other terms and conditions of the policy remain unchanged. Endorsement: 7 Effective - 4/1512003 Effective - 4/15/2003 Authorized Representative of the Company nednRe WS16A. 162-01 Faye 2 d2 Endorsement PS 16-A Attached to and forming part of policy: DOL 253742 SPTY-A03030116 Insured: West Shore Regional Transportation Carrier: INEX/Prime Insurance Syndicate, Inc. At its agency located in Salt Lake City, Utah Endorsement Effective date: 4/1012003 Endorsement type date: 4/1712003 It is hereby understood and agreed that the above policy is amended as follows: Add Units Unit 81 1994 Chevrolet IGIBL52P8RRI91773 Value: $0.00 Effective 4/10/2003 Generating an additional premium of $1,974.00 Amend Unit #67 to read 1987 Mercury in lieu of 1987 Chevrolet Amend Vin # on Unit #2 to read 1G1BL52P8SR148492 Total Premium: $1,974.00 All other terms and conditions of the policy remain unchanged. Endorsement: 6 --410a? Authorized Representative of the Company Evdo.=o SI&A- M-01 Page 7 of f Endorsement PS 16-A Attached to and forming part of policy: DOL 253742 SPTXA03030116 Insured: West Shore Regional Transportation Carrier: INEX/Prime Insurance Syndicate, Inc. At its agency located in Salt Lake City, Utah Endorsement Effective date: 4/8/2003 Endorsement type date: 4/16/2003 It is hereby understood and agreed that the above policy is amended as follows: Add Units Unit 73 1994 Chevrolet 1G1BL52P3RR134431 Unit 74 1991 Chevrolet IGIBN53EMW224632 Unit 75 1989 Chevrolet 1G1BN51E7KR130981 Unit 76 1994 Chevrolet 1G1BL52P9RR134532 Unit 77 1993 Chevrolet IGIBL5378PWI46233 Unit 78 1994 Chevrolet 1GIBL52P6RR136285 Unit 79 1993 Chevrolet 1GIBL5375PW146139 Unit 80 1993 Chevrolet lGlBL5370PW148512 Generating an additional premium of $15,912.00 Delete Units Unit # 1 1991 Chevrolet IGIBL5373MW241214 Unit #41 1994 Chrysler 2C3ED56F9RH258159 Unit #43 1993 Chevrolet IGIBL5375PWI47002 Unit #45 1987 Chevrolet 1G1BU51H7H9140097 Unit #59 1992 Chevrolet IGIBL5372NRI46708 Unit #64 1992 Chevrolet IGIBL5376NRI46100 Generating a return in premium of ($11,934.00) Total Premium: $3,978.00 All other terms and conditions of the policy remain unchanged. Endorsement: 5 Value: $0.00 Effective-4/8/2003 Value: $0.00 Effective-418/2003 Value: $0.00 Effective-4/8/2003 Value: $0.00 Effective -4/8/2003 Value: $0.00 Effective -4/8/2003 Value: $0.00 Effective -4/8/2003 Value: $0.00 Effective-4/8/2003 Value: $0.00 Effective-4/8/2003 Effective - 4/8/2003 Effective - 4/8/2003 Effective - 402003 Effective - 4/8/2003 Effective - 41812003 Effective - 4/8/2003 44?SGu, Authorized Representative of the Company F,O.. PSI&A- 10-Ul Page 1 of 7 Endorsement PS 16-A Attached to and forming part of policy: DOL 253742 SPTXA03030116 Insured: West Shore Regional Transportation Carrier: INEX/Prime Insurance Syndicate, Inc. At its agency located in Salt Lake City, Utah Endorsement Effective date: 4/1/2003 Endorsement type date: 4/15/2003 It is hereby understood and agreed that the above policy is amended as follows: Add Units Unit 72 1994 Chevrolet IGIBL52PIRRI36274 Value: $0.00 Effective -4/1/2003 Generating an additional premium of $2,052.00 Daneil W. Zufall is hereby excluded as a driver from the policy effective 11/27/02 Total Premium: $2,052.00 All other terms and conditions of the policy remain unchanged. Endorsement: 4 Authorized Representative of the Company aoa .. SI&A- Wo- l Page 1 of t Endorsement PS 16-A Attached to and forming part of policy: DOL 253742 SPTXA03030116 Insured: West Shore Regional Transportation Carrier: INEX/Prime Insurance Syndicate, Inc At its agency located in Salt Lake City, Utah Endorsement Effective date: 3/31/2003 Endorsement type date: 4/14/2003 It is hereby understood and agreed that the above policy is amended as follows: Add Units Unit 66 1989 Chevrolet IGIBN51E5KR185798 Value: $0.00 Effective-3/31/2003 Unit 67 1987 Chevrolet 2NEBM75F7HX704534 Value: $0.00 Effective-3/31/2003 Unit 68 1995 Chevrolet 1GIBL52P85R145186 Value: $0.00 Effective-3/31/2003 Unit 69 1995 Mercury 2MELM74W3DC676485 Value: $0.00 Effective -3/31/2003 Unit 70 1991 Dodge 284GK55R5MR262148 Value: $0.00 Effective-3/31/2003 Unit 71 1995 Chevrolet 1GIBL52P7SR142635 Value: $0.00 Effective-3/31/2003 Generating an additional premium of $12,348.00 Total Premium: $12,348.00 All other terms and conditions of the policy remain unchanged. Endorsement: 3 Authorized Representative of the Company rwdms WP516A - 10.2-01 Page 1 of 1 Endorsement PS 16-A Attached to and forming part of policy: DOL 253742 SPTXA03030116 Insured: West Shore Regional Transportation Carrier: INEX/Prime Insurance Syndicate, Inc. At its agency located in Salt Lake City, Utah Endorsement Effective date: 3/25/2003 Endorsement type date: 4/11/2003 It is hereby understood and agreed that the above policy is amended as follows: Add Units Unit 60 1994 Chevrolet 1G1BL52P8RRI80756 Unit 61 1987 Chevrolet IGIBU51ZXH9163276 Unit 62 1994 Chevrolet IG1BL52P5RR136102 Unit 63 1992 Chevrolet IGIBL5374NR145379 Unit 64 1992 Chevrolet IGIBL5376NRI46100 Unit 65 1994 Chevrolet 1G1BL52P4RR134406 Generating an addi tional premium of $12,666.00 Total Premium: $12,666.00 All other terms and conditions of the policy remain unchanged. Endorsement: 2 Value: $0.00 Effective -3/25/2003 Value: $0.00 Effective -3/25/2003 Value: $0.00 Effective -3/25/2003 Value: $0.00 Effective -3/25/2003 Value: $0.00 Effective -3!2512003 Value: $0.00 Effective -3/25/2003 Authorized Representative of the Company t?.WS16A- W-01 Pape I Of I Endorsement PS 16-A Attached to and forming part of policy: DOL 253742 SPTXA03030116 Insured: West Shore Regional Transportation Carrier: INEX/Prime Insurance Syndicate, Inc. At its agency located in Salt Lake City, Utah Endorsement Effective date: 3/24/2003 Endorsement type date: 411012003 It is hereby understood and agreed that the above policy is amended as follows: Add Units Unit 11 1986 Lincoln ILNBP96FXGY742868 Value: $0.00 Effective -3/24/2003 Unit 12 1987 Chevrolet 1G1BL51H1HX154715 Value: $0.00 Effective-3/24/2003 Unit 13 1992 Chevrolet lGlBL837XNRI46987 Value: $0.00 Effective-3/24/2003 Unit 14 1995 Chevrolet IG1BL52P5SR145047 Value: $0.00 Effective-3/24/2003 Unit 15 1994 Chevrolet IGIBL52PORR133253 Value: $0.00 Effective-3/24/2003 Unit 16 1993 Chevrolet 1GIBL5376PWI48708 Value: $0.00 Effective-3/24/2003 Unit 17 1991 Chevrolet IGIBL93ESMW247869 Value: $0.00 Effective-3/24/2003 Unit 18 1995 Chevrolet lGlBL52PXSR144248 Value: $0.00 Effective-3/24/2003 Unit 19 1992 Chevrolet IGIBL5370NRI47226 Value: $0.00 Effective-3/24/2003 Unit 20 1992 Chevrolet IGIBL5375NW144971 Value: $0.00 Effective-3/24/2003 Unit 21 1996 Chevrolet 2G1WL52MXT9308410 Value: $0.00 Effective-3/24/2003 Unit 22 1995 Ford 2FALP71WISX157664 Value: $0.00 Effective-312412003 Unit 23 1994 Lincoln 1LNLM81W4RY742284 Value: $0.00 Effective-3/24/2003 Unit 24 1995 Chevrolet IGIBL52POSR143075 Value: $0.00 Effective-3/24/2003 Unit 25 1992 Chevrolet IGIBL5377NRI48406 Value: $0.00 Effective-3/24/2003 Unit 26 1993 Chevrolet IGIBL5374PWI47332 Value: $0.00 Effective-3/24/2003 Unit 27 1991 Chevrolet IGIBN53E8MW248734 Value: $0.00 Effective-3/24/2003 Unit 28 1996 Chevrolet 1GNDM19WOTBI78462 Value: $0.00 Effective - 3124/2003 Unit 29 1995 Chevrolet 1GIBL52PXSR146355 Value: $0.00 Effective-3/2472003 Unit 30 1991 Chevrolet IG1BL83E6MW211673 Value: $0.00 Effective -3/24/2003 Unit 31 1995 Pontiac IG2HX52K6S4283966 Value: $0.00 Effective-3/24/2003 Unit 32 1993 Chevrolet lGlBL53719WI43402 Value: $0.00 Effective-3/24/2003 Unit 33 1993 Chevrolet IGIBL5372PWI47393 Value: $0.00 Effective-3/24/2003 Unit 34 1991 Chevrolet IGIBN53EOMR145855 Value: $0.00 Effective -312412003 Unit 35 1990 Chevrolet 1GIBL5471LA156575 Value: $0.00 Effective -3/24/2003 Unit 36 2001 Chevrolet 2GIWF55E919696654 Value: $0.00 Effective-3/2412003 Unit 37 1996 Chrysler 2C3HC56F1TH171640 Value: $0.00 Effective-3/24/2003 Unit 38 1993 Chevrolet IGIBL5379PWI43275 Value: $0.00 Effective-3/24/2003 Unit 39 1996 Chrysler 201106177TH312839 Value: $0.00 Effective -3/24/2003 Unit 40 1991 Chevrolet 1GIBL537XMW258575 Value: $0.00 Effective -3/24/2003 Unit 41 1994 Chrysler 2C3ED56F9RH258159 Value: $0.00 Effective-3/2412003 Unit 42 1994 Chevrolet IGIBL5375PWI47033 Value: $0.00 Effective -3/24/2003 Unit 43 1993 Chevrolet IGIBL5375PWI47002 Value: $0.00 Effective-3/24/2003 Unit 44 1994 Chevrolet IGIBL52PXRRI33843 Value: $0.00 Effective-3/24/2003 Unit 45 1987 Chevrolet 1G1BU51H7H9140097 Value: $0.00 Effective-3/24/2003 Unit 46 1994 Chevrolet 1G1B252P9RRI33980 Value: $0.00 Effective-3/24/2003 Unit 47 1993 Ford 1FMCAIlU6PZB92253 Value: $0.00 Effective -3/24/2003 Unit 48 1991 Chevrolet IGIBL5371MW259212 Value: $0.00 Effective-3/24(2003 Unit 49 1994 Chevrolet IG1BL52P9RR136104 Value: $0.00 Effective-3/24/2003 Unit 50 1995 Ford IFMCA1147SZA96371 Value: $0.00 Effective-3/24/2003 Unit 51 1993 Chevrolet IG1BL53E8PW146246 Value: $0.00 Effective-3/24/2003 Unit 52 1992 Chevrolet 1GIBL5370NW143291 Value: $0.00 Effective-3/24/2003 Unit 53 1996 Ford 1FALP71W9TX133114 Value: $0.00 Effective-3/24/2003 Unit 54 1994 Chevrolet lGlBL52PORR134192 Value: $0.00 Effective -3/24/2003 Fndo.sv wPSI&A- 1o-2-01 Paget d2 Unit 55 1995 Ford 2FALP71WOSX157669 Unit 56 1994 Chevrolet 1GIBL52PIRRI34668 Unit 57 1993 Chevrolet IGIBLS373PW146639 Unit 58 1994 Chrysler 2C3HD56F9RH334993 Unit 59 1992 Chevrolet 1GIBL5372NR146708 Generating an addi tional premium of $103,733.00 Total Premium: $103,733.00 All other terms and conditions of the policy remain unchanged. Endorsement: 1 Value: $O.Ot Effective-3/2412003 Value: $0.0 Effective -3/24/2003 Value: $0.00 Effective -3/24/2003 Value: $0.00 Effective-3/24/2Q03 Value: $0.00 Effective -3/24/2003 .7 ? Authorized Representative of the Company Fndumeuxm Si6A- 142-01 Pete 2 d2 Endorsement PS 16-A Attached to and forming part of policy: DOL 253742 SPTXA03030116 Insured: West Shore Regional Transportation Carrier: INEX/Prime Insurance Syndicate, Inc. At its agency located in Salt Lake City, Utah Endorsement Effective date: 11/27/2002 Endorsement type date: 4125!2003 It is hereby understood and agreed that the above policy is amended as follows: Attached list of names are hereby excluded from the policy as drivers (see attachment A) Total Premium: $0.00 All other terms and conditions of the policy remain unchanged. Endorsement: 8 hLOSIOL Authorized Representative of the Company Fvdortu WSI&A- 10-2-01 page 1 of I POLICY NUMBER= DOL 25 2 COMMERCIAL AUTO CA 22 37 03 95 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PENNSYLVANIA BASIC FIRST PARTY BENEFIT For a covered 'auto' licensed or principally garaged in, or -garage operations' conducted in. Pennsylvania, Ibis 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 Coverage Form apply unless modified by the endorsement- This endorsement changes The policy effective on the inception date of the polity unless another date is in- dicated below- Endorsement effective 03/17/2003 Named Insured Countersigned by West Shore Regional Transportat n (Authorized Representative) SCHEDULE Benefits Limit of Liability (per insured) Medical Expense Benefits Up to 15,000 (11 no entry appears above, intormalion required to complete this endorsement wilt be shown in the Declara- tions as applicable to this endorsement.) A. COVERAGE We will pay the Basic First Party Benefit in ac- cordance with the 'Act- to or for an 'insured- who sustains 'bodily injury' caused by an -acci- dent arising out of the maintenance or use of an -auto-- BENEFITS Subject to the limit shown in the Schedule or Declarations, the Basic first Party Benefit con- sists of Medical Expense Benefits. These bene- fits consist of reasonable and necessary medical expenses incurred tot an'insured"s% 1_ Care; 2. Recovery; or Medical expenses will be paid it incurred within 19 months from the date of the -accident- caus- ing 'bodily injury'. If within 1S months from the dale of the 'accident- causing 'bodily injury' it is ascertainable with reasonable medical proba- bility that further expenses may be incurred as a result of the 'bodily injury. medical expenses will be paid without limitation as to the time such further expenses are incurred- B_ WHO IS AN INSURED 1. You_ 2_ If you are an individual, any -family member-_ 3. Any person while 'occupying' a covered -auto-. 3. Rehabilitation. 4. Any person while not 'occupying- an 'auto' if injured as a result of an 'accident- in This includes remedial care and treatment ren- Pennsylvania involving a covered 'auto. dered in accordance with a recognized religious method of healing. If a covered 'auto' is parked and unoccupied, it is not an 'auto` involved in an 'accident- unless it was parked in a manner as to create an unreasonable risk of injury- CA 22 37 03 95 Copyright, Insurance Services Office, Inc., 1994 Page 1 of 3 ? EXCLUSIONS 1Ve will not pay First Party Benefits for -bodily injury: 1. Sustained by any person injured while inten- tionally causing or attempting to cause injury to himself or herself or any other person- 2. Sustained by any person while committing a felony. 3. Sustained by any person while seeking to elude lawful apprehension or arrest by a law enforcement official. 4. Sustained by any person while maintaining or using an 'auto" knowingly converted by that person. However, this exclusion does not apply to: a. You; or b. Any 'family member-_ 5. Sustained by any person who, at the time of the "accident": a- Is the owner of one or more currently registered -autos' and none of those 'autos" is covered by the financial re- sponsibility required by the 'Act'; or b. Is "occupying- an 'aulo owned by that person for which the financial responsibil- ity required by the -Act- is not in effect. 6. Sustained by any person maintaining or using an "auto" while located for use as a resi- dence or premises. 7. Sustained by a pedestrian if the 'accident' occurs outside of Pennsylvania- This exclu- sion does not apply lo: a. You; or b. Any -family member-_ d. Sustained by any person while "occupying': a. A recreational vehicle designed for use off public roads; or b. A motorcycle, moped or similar type vehi- cle- 9. Caused by or as a consequence of a. Discharge of a nuclear weapon (even if accidental); b. War (declared or undeclared), c. Civil war; d. Insurrection: or e. Rebellion or revolution. 10. From or as a consequence of the following whether controlled or uncontrolled or how- ever caused: a. Nuclear reaction; b. Radiation; or c. Radioactive contamination. D. LIMIT OF INSURANCE 1. Regardless of the number of covered 'autos premiums paid, claims made, 'autos' in- volved in the 'accident" or insurers providing First Party Benefits. the most we will pay to or for an 'insured' as the result of any one "accident' is the limil shown in the Schedule or in the Declaraliions- 2. Any amount payable under First Party Bene- fits shall be excess over any sums paid, pay- able or required to be provided under any workers' compensation law or similar law- E. CHANGES IN CONDITIONS The CONDITIONS are changed for FIRST PARTY BENEFITS as follows: 1- TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US does not apply. 2. The following CONDITIONS are added- NON-DUPLICATION OF BENEFITS No person may recover dupl"le benefits for the same expenses or loss under this or any other similar automobile coverage including sell-insurance- age 2 of 3 Copyright, Insurance Services Office, Inc., 1994 CA 22 37 03 95 0 PRIORITIES OF POLICIES We will pay First Party Benefits in accordance with the order of priority set forth by the'Act'. We will not pay if there is another insurer at a higher level of priority. The -First- category listed below is the highest level of priority and the 'Fourth- category listed below is the low- est level of priority- The priority order is: First The insurer providing benefits to the "insured" as a named insured. Second The insurer providing benefits to the 'insured- as a family member 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. It two or more policies have equal priority within the highest applicable number in the priority order 1. The insurer against whom the claim is first made shaft process and pay the claim as it 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 applica- ble limit shown in the Schedule or Decla- rations-. 3--The insurer thereafter is entitled to re- cover pro rata contribution from any other insurer for the benefits paid and the costs of processing the claim- If contribution is sought among insurers under the Fourth priority, proration shall be based on the number of involved motor vehicles; and 4. The maximum recovery under all policies shall not exceed the amount payable un- der the policy with the highest dollar limits of benefits, F. ADDITIONAL DEFINITIONS As used in this endorsement: 1. "Auto' means a self-propelled motor vehicle, or trailer required to be registered, operated or designed for use on public roads- How- ever, 'auto' does not include a vehicle oper- ated: a- By muscular power, or b. On rails or tracks. 2- The 'Act" means the Pennsylvania Motor ve- hicle Financial Responsibility Law- 3. -Family member means a resident of your household who is: a. Related to you by blood., marriage or adoption; or b_ A minor in your custody or in the custody of any other "family member-- 4- "Occupying- means in, upon, getting in, on, out or oft CA 22 37 03 95 Copyright. Insurance Services Once, Inc., 1994 Page 3 of 3 0 INEXlt RIME INSURANCE SYNDICA. c INC. SERVICE OF SUIT ENDORSEMENT INEX INSURANCE EXCHANGE-96SS It is agreed that in the event of the failure of any Syndicate(s) participating in the insurance afforded hereunder to pay their proportional share of any amount claimed to be due hereunder, such Syndicate(s) at the request of the Insured, will submit to the jurisdiction of any court of competent jurisdiction within the United States and will comply with all requirements necessary to give such count jurisdiction, and all matters arising hereunder shall be determined with the law and practice of such court. Service of process in such suit may be made upon the Director of Insurance of the State of Illinois, 320 West Washington Street, Springfield, IL 62767. Syndicate(s) participating in the insurance afforded hereunder agree, in the event of any suit instituted against any one or more, of them with respect to insurance afforded or alleged to be afforded under this Coverage Contract, to abide by the final decision of such court or of any Appellate Court in the event of subsequent appeal. The Director of Insurance of the State of Illinois is authorized and directed to accept service of process on behalf of any Syndicate(s) participating hereunder in any such suit and upon the request of the Insured, to give a written undertaking to the Insured that he will enter a general appearance on behalf of such Syndicate(s) in the event that such suit shall be instituted. Further, pursuant to any statue of any state of the United States which makes provision therefor, the Syndicate(s) hereby designate the Superintendent, Commissioner or Director of Insurance or other officer specified for the purpose in the statute, as their true and lawful attorney upon whom may be served any lawful process in any suit instituted by or on behalf of the insured or any beneficiary hereunder arising Out of this Contract of Insurance, and hereby designate the Secretary of the INEX Insurance Exchange, One South Wacker Drive, Ste. 2720 Chicago, IL 60606 as the person to whom said officer is authorized to mail such process or a true copy thereof. INEX/tRIME INSURANCE SYNDICA%INC. TERRITORIAL RESTRICTION ENDORSEMENT ENDORSEMENT PSI96-1 This Endorsement changes the Policy issued. Please read it carefully! Coverage is not available for residents of Alaska, Arizona, California, Colorado, Connecticut, Florida, Maine, Minnesota, Nevada, New Hampshire, New Mexico, New York, Rhode Island, Texas, Virginia, Vermont, and Washington. INEN/PnmeTerribrial Rest fiction version 03062002 Page 1 of T Thurstlay. April 10, 2003 COVERED AUTOS LIMITATION OF USE RADIUS OF OPERATION, SAFETY INSPECTION ENDORSEMENT PCA95-1 This Endorsement changes the Policy. Please read it carefully! In consideration of the premium paid, it is understood and agreed that this policy applies only to those autos scheduled on the policy per attached form PCA0195-1 A while operated within the radius indicated for each covered auto. Only specifically described autos originally scheduled on the policy or added by subsequent endorsement shall be a covered auto under the policy issued to the Insured. It is further understood and agreed that the radius is measured from the garage location indicated on the Automobile Schedule for each covered auto and that no vehicle is covered beyond its scheduled radius, regardless of whether it is used as a substitute for another scheduled covered auto described herein. All Covered autos are required to pass an annual saftey inspection performed by an independent service garage. A copy of the inspection form is required to be submitted to the insurer, and is considered a part of the policy documentation. PCA05-2 Schedule Dnv Endorsement Wrsim 03-062102 1 Of l Q Q a O z 0 c W W O d L Q? a U 0 d d Tu^ V, a Q O T S 8 o o S o o S S ? S O O O O O O O O O 0 o c o 0 0 0 0 0 0 0 0 0 0 0 o g o 0 0 0 0 0 0 0 0 0 0 0 c c o o c o 0 0 o c w w .n w .a w w .n d+ vs I 0 0 0 0 0 0 0 0 0 0 ` 0 0 0 0 0 0 0 0 0 0 6 6 6 6 6 6 G. 6 6 d 7 U a U U . a s> > U 1 4 d < 6 S S a 1 Q i G . O . U ti V U Y N T L T N N T L Y T ? T . T T o . y J yy J V .-1 . y y .1 J y .-i J y y .J yy J ? V 1 O P N `O ? m P Nl a ? P Vl v? h- N y ? m M S N v l r? N d N ? N V O? ? N x N " ? m Z a K i ? K a Z ?o r . v, p S j n x z z m m x m m u .? m ? N U U ? z U U C 7 U i V U U - N ll 7 m y O V U _ L 6 O 9 U C m U U > N I A c c 4 ? _ U _ V U r _ d O Q ? O 6 O Q L L L ? 9 U V U O a 'J' m U R U [i (r$ U F U - > % - ? - a C 0 a v ?I .3 7 7 b m vi N_ A T !' o E u n? m° v U U m ? m U iO L O t x„ =s o? U 0 0 z T T O N 0 3 m c 6 R 0 F a? _v e .2-S 0 0 E m 0 5 a T ? C 9 O O A u 4 y m 9 U ?s m E 3 a ? o ? m U N T O 6 SCHEDULE DRIVERS ENDORSEMENT SCHEDULE DRIVER ENDORSEMENT PCA95-2 This Endorsement changes the Policy. Please read it carefully! No Coverage shall be provided under this Policy for any covered auto, which is being used or operated by anyone other than the driver(s) or operator(s) named below. The Insured hereby warrants that each and every person named below is over the age of 23 or under the age of 65. No coverage shall be provided to any person under this Policy for any covered aut,o which is being used by anyone who is under the age of 23 or over the age of 65. New drivers and operators shall be deemed to be added to this Schedule Driver Endorsement provided the Insured reports in writing the driver's name, date of birth, and drivers's license number to the Insurer within two days from the eff ective date of use of the auto, and provides the Insurer with current Motor Vehicle Record from each driver or operator to be insured. Named Driver or Operator Listing: No. Name D.O.B. License Number State Notes 1 Wayne Matson 4/14/1943 12209625 PA 2 Dennis Zeuers 4/29/1948 19958918 PA 3 Kevin Enders 12/2011968 22404147 PA 4 Darryl Hassinger 61311960 60029371 PA 5 Richard Johnson 9124/1943 12176972 PA 6 Craig Richardson 11/26/1958 18319620 PA 7 Randy Young 8/28/1962 60022824 PA 8 Howard Brandt 12/28/1966 23025355 PA 9 Al Dowart 8120/1956 17538287 PA 10 Martin Stauffer 112711965 21963741 PA 11 Laura Henry 6/23/1968 22848622 PA 12 Karen Sprenkle 212311969 22053024 PA 13 Jerry Shinault 9/27/1951 17634980 PA 14 Sue Juan Mosley 6/4/1969 203547482 PA Special Note: All Other Drivers Excluded. Schedule Drivers ErgorseroenrP0A95-2 version 03-03-2003 Paw 1 of 1 Thursdav. Aadl 10. 2003 LIABILITY SELF-INSURANCE ENDORSEMENT ENDORSEMENT PS194-56A This Endorsement changes the Policy. Please read it carefully. SCHEDULE OF SELF-INSURED RETENTION: PER DECLARATION PAGE SELF-INSURED RETENTION (SIR) is the amount the Insured will pay on each and every claim for damages and/or claim expenses to which this policy applies. The Insured will pay 100% of the Self-Insured Retention on each and every claim before any payment is due pursuant to the terms of this policy. The SIR applies to each and every claim regardless of whether a claimant presents multiple claims. IT IS AGREED THAT: 1. Unless the Insurer elects otherwise, the Insured will be solely responsible for the investigation, defense, settlement and final disposition of any claim made or suit brought or proceeding instituted against the Insured which, together with claim expenses, does not exceed the amount of SIR. This shall not affect the Insured's duty to give notice to the Insurer of accidents, claims or suits, or to forward demands, notices, summonses or legal papers received in connection with the claim or suit. It shall not relieve the Insured of any other duty which it is required to perform by the terms of the policy. 2. The Insured will use due diligence and prudence to settle all claims and suits which, in the exercise of sound judgment, should be settled; provided, however, that the Insured will not make or agree to any settlement for any sum which, together with claim expenses, would exceed the amount of the SIR without the prior written approval of the Insurer. 3. The Insurer has no obligation to participate in or to assume charge of the investigation, defense or settlement of any claim made, suit brought or proceedings instituted against the Insured prior to the full payment ("exhaustion") of the SIR by the Insured; but, the Insurer has the right, in its sole discretion, to associate with the Insured and/or its defense counsel in the defense and control of any claim, suit, or proceedings. 4. The Insurer, in its sole discretion, may elect to assume control and defense of any or all claims, suits and proceedings which, in its opinion, may involve this policy. Such assumption of the control and defense of any claim, suit or proceeding by the Insurer, including the selection and/or appointment of defense counsel by the Insurer, shall not affect the Insured's responsibility for payment of the SIR, 5. The Insurer, in its sole discretion and without the consent of the Insured, may agree to the payment of all or any part of the SIR in satisfaction of claim expenses, settlement(s) or judgment(s); 6. The Insurer, in its sole discretion, may direct the Insured to pay all or any part of the SIR to a third party in satisfaction of claim expenses incurred or of settlement(s) or judgment(s). The Insured shall make such payment within 15 days of direction by the Insurer. 7. The Insurer, in its sole discretion, may pay the amount of the SIR from its own funds in satisfaction of claim expenses, settlement(s) or judgment(s). In the event the Insurer chooses to make such payment the Insured shall reimburse the Insurer within 15 days of the mailing of a demand by the Insurer. 8. In the event the insured fails to reimburse the Insurer pursuant to paragraph 7, and expenses in collection efforts are incurred by the Insurer or its designated representative, the Insured agrees to pay all reasonable attorney fees and costs of collection to the extent permitted by law. 9. Pursuant to the COVERAGE section of the policy, the Insurer has the right, but not the duty, to settle any covered claim for which the proposed amount to be paid in damages and claim expenses does not exceed the applicable limit of liability. Such settlements are binding on the insured and do not require the insured's prior consent or ratification. A. Any settlement agreed to by the Insurer pursuant to this right shall be contingent upon payment by the Insured of the SIR. B. If any settlement agreed to by the Insurer is not concluded due to the failure of the Insured to pay the SIR for any reason, the liability of the Insurer for all claim expenses, settlement(s) andjudgment(s) shall be limited to the amount for which the claim could have been settled but for the Insureds failure to tender the SIR. 10. The policy shall have available at the option of the Insurer, medical benefits payable for expenses in excess of any other collectible insurance or benefit available to any injured third parry. The maximum benefit payable is $1,000 per person, with an aggregate limit of $5,000 per policy period. 11. This policy shall not apply to any claim first reported to the Insurer while the Insured is in default in the payment of the SIR under paragraphs 6, 7, or 9 of this Endorsement. PSAa %A UatmVitq Sall bnuianma fa W 03-Or 20 Page } of t PBA-1 COMMERCIAL BUSINESS AUTO POLICY THIS POLICY DIFFERS SIGNIFICANTLY FROM POLICIES OF OTHER INSURERS. IT IS A MANUSCRIPT POLICY WITH VERY STRICT REPORTING REQUIREMENTS. PLEASE READ THE POLICY TO DETERMINE WHAT IS AND WHAT IS NOT COVERED, THE "APPLICATION" AND "WARRANTY-PRIOR CLAIMS" FORMS ARE PART OF THE POLICY, AND CONSTITUTE WARRANTIES. COVERAGE IS PROVIDED ONLY FOR OTHERWISE COVERED CLAIMS: (1) WHICH ARE FIRST MADE AGAINST YOU DURING THE POLICY PERIOD; AND (2) WHICH RESULT FROM AN ACCIDENT OCCURRING DURING THE POLICY PERIOD; AND (3) FOR WHICH WRITTEN NOTICE IS GIVEN TO THE INSURER DURING THE POLICY PERIOD. IN ADDITION, COVERAGE IS STRICTLY LIMITED TO THOSE AUTOS AND DRIVERS, AND AT THOSE LOCATIONS, LISTED AND DESCRIBED. VARIOUS OTHER PROVISIONS OF THIS POLICY RESTRICT AND LIMIT THE COVERAGE PROVIDED. CLAIM EXPENSES SHALL REDUCE THE AVAILABLE LIMIT OF LIABILITY. Coverage is only provided for scheduled Autos operated by approved drivers identified on the Scheduled Driver Endorsement. Throughout the POLICY and its endorsements the words you, your and Insured refer to the Insured named in the Declarations, and any person or organization qualifying as an Insured under Section II of the Policy, The words we, us, our, Insurer and Company refer to the Insurance Company providing this coverage. Section IX-DEFINITIONS tells you about other words and phrases that appear and have special meaning. The terms of this Policy are contractual; not merely recitals and the Policy shall be construed as a whole including all paragraphs, sections, conditions, provisions, exclusions, and endorsements. SECTION 1- COVERED AUTOS A. COVERED AUTOS LIMITATION OF USE ENDORSEMENT - (PCA95-1) Identifies the Autos that are covered Autos for each of your coverages. Autos must be listed, with a premium shown, on the Endorsement for coverage to be afforded. B. OWNED AUTOS YOU ACQUIRE AFTER THE POLICY BEGINS 1. An Auto you acquire after the coverage effective date will be a covered Auto under this Policy only if: a. It replaces an Auto you previously owned that was a covered Auto under this Policy or is an additional Auto; and b. You inform us within 2 days after you acquire the Auto that you want us to cover it under the Policy. C. CERTAIN TRAILERS AND MOBILE EQUIPMENT The following types of vehicles are covered AUTOS for liability coverage: 1. Trailers primarily for travel on public roads, while being towed by a covered AUTO. 2. Mobile equipment while being carried or towed by a covered AUTO. SECTION 11- WHO IS AN INSURED The Following are Insureds: A. You for business use of any covered AUTO; B. Any other person who is an approved driver identified on the Scheduled Driver Endorsement for any business use of a covered AUTO. SECTION 111- LIABILITY COVERAGE A. INSURING AGREEMENT 1. Subject to the Self-Insured Retention (SIR) and all other terms and conditions of this Policy, we will pay all sums the Insured becomes legally obligated to pay as Damages because of Bodily Injury or Property Damage to which this Policy applies, caused by an Accident and resulting from the ownership, maintenance or use of a covered Auto operated by an approved driver identified on the Scheduled Driver a. The Accident occurs during the Policy period stated in the Declaration Policy; and b. The Accident occurs within the radius of operation set forth in the COVERED AUTOS LIMITATION OF USE ENDORSEMENT, and within the United States of America; and PBA-1 Commercial Business Auto Policy version 03106102 Pam I Of 9 c. If the vehicle was being operated in Commercial Business Use in the course of your business; and d. If the Claim arising out of the Accident is first made against you and reported to us in writing during the Policy period. 2. We have both the right and the duty to provide for your defense with respect to a Claim covered by this Policy. We have the exclusive right to designate and appoint legal counsel to represent you and to otherwise control such defense. Notwithstanding anything to the contrary, our duty to provide for such defense will immediately terminate: a. When the applicable limit of liability of the Policy is exhausted by payment of Damages and/ or Claim Expenses; b. If you fail to pay any Self-Insured Retention (SIR) obligation imposed by this Policy in a timely manner; c. If the Application attached hereto and forming a part hereof, including any Supplemental Questionnaire thereto, is discovered by us to contain any material misrepresentation of fact; or d. If you violate any of the CONDITIONS set forth in the Policy. 3. We shall have the sole right, but not the duty, under this Policy to settle those covered Claims for which the proposed amount to be paid as Damages does not exceed the applicable limit of liability. Any such settlement shall be binding upon the Insured and shall not require the Insureds prior consent or ratification. Such a settlement shall not effect your duty to make timely payment of any applicable Self- Insured Retention. B. EXCLUSIONS THIS POLICY DOES NOT APPLY TO: 1. Any obligation for which the insured or the insured's insurer may be held liable under any workers' compensation, disability benefits or unemployment compensation law or any similar law. 2. Bodily Injury to any fellow employee of the insured arising out of and in the course of the fellow employee's employment or while performing duties related to the conduct of your business. 3. Bodily Injury to: a. An employee of an insured arising out of, and in the course of: (1 Employment by the Insured; or (2 Performing duties related to the conduct of the insured's business; or b. The spouse, child, parent, brother or sister of that employee as a consequence of (a) above. This Exclusion applies: (1 whether or not the insured may be liable as an employer or in any other capacity; (2 Performing duties related to the conduct of the insureds business; or to any obligation to share Damages with or repay someone else who must pay Damages because of the injury, including Damages awarded for contribution or indemnity. 4. Claims arising out of: a. Employment policies or practices of an insured including discrimination, termination, discharge or harassment; or b. Employment benefit laws affecting an insured. 5. Property damage to property owned or transported by the insured or in the insured's care, custody or control or property loaned to you. 6. Bodily Injury or Property Damage resulting from the handling of property: a. Before it is moved from the place where it is accepted by the insured for movement into or onto the covered Auto; or b. After it is moved from the covered Auto to the place where it is finally delivered by the Insured. 7. Bodily Injury or Property Damage resulting from the movement of property by a mechanical device (other than a hand truck) unless the device is attached to the covered Auto. 8. Claims for Bodily Injury or Property Damage caused directly or indirectly by war, whether or not declared, and including but not limited to civil war, insurrection, rebellion, revolution, warlike act by a military force or military personnel, destruction or seizure or use for a military purpose, and any consequence, whether direct or indirect of any of these, or from any act of terrorism. PBA-1 commercial Business Auto Poficv version 03106102 Paw 2 of 9 9. Bodily Injury or Property Da. cage caused by: a. The explosion of any weapon employing atomic fission or fusion; or b. Nuclear reaction or radiation, or radioactive contamination, however caused. 10 Bodily Injury or Property Damage arising out of the acts of an Insured's employee or agent outside the scope of his or her employment or duties. 11 Bodily Injury or Property Damage arising out of the willful violation of a penal statute or ordinance. 12 Bodily Injury or Property Damage expected or intended from the standpoint of any Insured. 13 Pollution a. Bodily Injury or Property Damage arising out of the actual, alleged or threatened discharge, dispersal, seepage, migration, release or escape of pollutants at anytime. b. Any Loss, cost or expense arising out of any: (1) Request, demand or order (including consent decrees, consent orders or administrative procedures) that any insured or others test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of pollutants; or (2) Claim or Suit by or on behalf of any person for Damages because of testing for, monitoring, cleaning up, removing, containing, treating, detoxifying or neutralizing, or in any way responding to, or assessing the effects of pollutants. Pollutants means any solid, liquid, gaseous, or thermal irritant or contaminant including smoke, vapor, soot, fumes, acid, alkalis, chemicals and waste. Waste includes material to be recycled, reconditioned or reclaimed. 14 Liability assumed under any contract or agreement, but this exclusion does not apply to liability for Damages that the insured would have in the absence of the contract or agreement 15. Covered Autos while used in any professional or organized racing or demolition contest or stunting activity, or while practicing for such contest or activity. This Policy also does not apply while that covered Auto is being prepared for such a contest or activity. 16 Mold and Fungi - a. Any sums which any Insured becomes legally obligated to pay as damages because of Bodily Injury, Property Damage, Personal Injury, Advertising Injury or Medical Payments directly or indirectly relating to the actual, potential, alleged or threatened presence of mold, mildew or fungi of any kind whatsoever, or any materials containing them at any time. b. Any loss, cost or expense: (1) Any Insured or any other person or organization my incur in testing for, monitoring, removing, treating or in any way responding to the actual, potential, alleged or threatened presence of mold, mildew or fungi of any kind whatsoever, or any materials containing them, whether as a result of a request, demand, statutory or regulatory requirement or otherwise; or (2) Any Insured or any other person or organization may incur in connection with any claim or "suit" on behalf of any governmental authority or any person or organization relating to the actual, potential, alleged or threatened presence of mold, mildew or fungi of any kind whatsoever, or any materials containing them. c. Any Insured or any other person or organization may incur in connection with any claim or "suit" on behalf of any governmental authority or any person or organization relating to the actual, potential, alleged or threatened presence of mold, mildew or fungi of any kind whatsoever, or any materials containing them. SECTION IV - LIMITS OF LIABILITY A. The Limits of Liability shown on the Declaration Page and the conditions set forth below fix the most we will pay regardless of the number of: 1. Insureds; 2. Claims made or suits brought; 3. Persons or organizations making claim or bringing suits, or, 4. Claims arising out of any one accident. B. The Each Accident Limit of Liability listed on the Declaration Policy is the most we will pay for Damages and/or Claim Expenses because of all Bodily Injury and Property Damage arising out of anyone Accident. Claim Expenses shall reduce the available limit of liability. PBA-1 commercial Business Auto Policv maim 03/06/02 Pam 3 of 9 C. The Per Person Limit of Liability listed on the Declaration Policy is the most we will pay for Damages and/or Claim Expenses because of all Bodily Injury and Property Damage sustained by any one person arising out of any one Accident. Claim Expenses shall reduce the available limit of liability. D. Notwithstanding anything contained in this Policy to the contrary, the Insurer's financial obligation imposed by the coverage with respect to all Claims hereunder shall not exceed the amount specified on the Declaration Policy as the Aggregate Limit of Liability. E. Such amounts payable under B. and C. above shall directly diminish the respective Limits of Liability as stated in the Declaration Policy. F. Our obligation to make any payments under this Policy shall only be in excess of any SIR amount for Damages and/or Claim Expenses specif ied on the Declaration Page. The SIR amount shall apply separately to each and every Claim and to each and every insured. SECTION V - PHYSICAL DAMAGE COVERAGE A. Coverage If premium is paid, and shown in the Declarations: 1. We will pay for Loss to a covered Auto or its equipment under: a. Comprehensive Coverage From any cause except: (1 The covered Auto's collision with another object; or (2 The covered Auto's overturn- b. Specified Causes of Loss Coverage Caused by: (1 Fire, lightning or explosion; (2 Theft; (3 Windstorm, hail or earthquake; (4 Flood; (5 Mischief or vandalism; or (6 The sinking, burning, collision or derailment of any conveyance transporting the covered Auto. c. Collision Coverage Caused by: (1 The covered Auto's collision with another object; or (2 The covered Auto's overturn; (3 Glass breakage. 2. If you carry Comprehensive Coverage for the damaged covered Auto, we will pay for glass breakage under Comprehensive Coverage. However, you have the option of having glass breakage caused by a covered Auto's collision or overturn considered a Loss under Collision Coverage. 3. Need for Adequate Insurance-Coinsurance Penalty We will not pay a greater share of any Loss than the proportion that the Stated Value of each insured vehicle, described in the Schedule, bears to the actual cash value of the respective vehicle at the time of Loss. Coverage of the Loss will be reduced, as a coinsurance penalty, by the same proportion that the Stated Value has to the Will actual cash value of the respective vehicle. Each item or vehicle on the schedule is deemed to be separately insured. In order to avoid a coinsurance penalty in the event of a Claim, this clause requires that each vehicle be 100 percent insured to its respective actual cash value. B. Exclusions 1. We will not pay for Loss caused by or resulting from any of the following. Such Loss is excluded regardless of any other cause or event that contributes concurrently or in any sequence to the Loss. a. Nuclear hazard (1) The explosion of any weapon employing atomic fission or fusion; or (2) Nuclear reaction or radiation, or radioactive contamination however caused. b. War and Terrorism - it is agreed that this insurance excludes loss, damage, cost or expense of whatsoever nature directly or indirectly caused by, resulting from or in connection with any of the following regardless of any other cause or event contributing concurrently or in any other sequence to the loss; PBA-1 Commercial Business Auto Policv (1) War, invasion, acts of faaign enemies, hostilities or warlike operatiol,? (whether war be declared or not), civil war, rebellion revolution, insurrection, civil commotion assuming the proportions of or amounting to an uprising, military or usurped power; or (2) Any act of terrorism. For the purpose of this exclusion an act of terrorism means an act, including but not limited to the use of force or violence and/or the threat thereof, of any person or group(s) of persons, whether acting alone or on behalf of or in connection with any organization(s) or government(s), committed for political, religious, ideological or similar purposes including the intention to influence any government and/or to put the public, or any section of the public, in fear. This exclusion also excludes loss, damage, cost or expense of whatsoever nature directly or indirectly caused by, resulting from or in connection with any action taken in controlling, preventing, suppressing or in any way relating (1) and/or (2) above. If the Company alleges that by reason of this exclusion, any loss, damage, cost or expense is not covered by this insurance the burden of proving the contrary shall be upon the Insured. In the event any portion of this exclusion is found to be invalid or unenforceable, the remainder shall remain in full force and effect. & We will not pay for Loss to any covered Auto while used in any professional or organized racing or demolition contest or stunting activity, or while practicing for such contest or activity. We will also not pay for Loss to any covered Auto while that covered Auto is being prepared for such a contest or activity. 4. We will not pay for Loss caused by or resulting from any of the following unless caused by other Loss that is covered by this insurance: a. Wear and tear, freezing, mechanical or electrical breakdown; b. Blowouts, punctures or other road damage to tires. 5. We will not pay for Loss to any of the following: a. Tapes, records, discs or other similar audio, visual or data electronic devices designed for use with audio, visual or date electronic equipment. b. Any device designed or used to detect 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 electronic equipment described in Paragraph c, above. Exclusions 4.c. and 4.d. do not apply to: a. Equipment designed solely for the reproduction of sound and accessories used with such equipment, provided 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 permanently installed in the covered Auto at the time of Loss, and such equipment is designed to be solely operated 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 operation 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 installed in the opening of the dash or console of the covered Auto normally used by the manufacturer for installation of a radio. 6. Mold and Fungi - To any loss or damage involving in any way the actual or potential presence of mold, mildew or fungi of any kind whatsoever, whether or not directly or indirectly caused by or resulting from any peril insured under this Policy. C. Limit of Insurance The most we will pay for Loss in any one Accident is the lesser of: 1. The actual cash value of the damaged or stolen property as of the time of the Loss; or 2. The cost of repairing or replacing the damaged or stolen property with other property of like kind and quality. D Deductible PBA-7 Commercial Business Auto Poliev version 03106/02 Paw 5 of 9 For each covered Auto, our obligation to pay for, repair, return or replace damaged or stolen property will be reduced by the applicable deductible shown in the Declarations. SECTION VI - LOSS CONDITIONS A. NOTICE OF ACCIDENT, CLAIM OR SUIT We have no duty to provide coverage under this Policy unless there has been full compliance with the following duties: 1. In the event of an Accident or any occurrence, event or incident likely to give rise to a Claim under this Policy, or of a Claim or Suit, you must give us immediate written notice within fourteen (14) days. Notice within fourteen (14) days is a condition precedent to coverage under this Policy. Notice must be sent to Claims Direct Access ("CDA"), PO Box 4439, Sandy, UT 84091-4439, toll-free telephone 867-585-2849 Fax 887-452-6909. Notice to the broker and/or agent does not comply with this requirement of the Policy. Notice is to include: a. How, when and where the Accident took place; b. The names and addresses of any injured persons and witnesses; and c. The nature and location of any injury or damage arising out of the Accident. 2. Additionally, you and any other involved insured must: a. Immediately send us copies of any request, demand, order, notice, summons or legal paper received concerning the Claim or Suit; b. Cooperate with us in the investigation or settlement of the Claim or defense against the Suit; c. Authorize us to obtain medical records or other pertinent information; d. Submit to examination, at our expense, by physicians of our choice, as often as we reasonably require. 3. If there is a covered Loss to a covered Auto or its equipment you must also do the following: a. Promptly notify the police if the covered Auto or any of its equipment is stolen; b. 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; c. Permit us to inspect the covered Auto and records proving the Loss before its repair or disposition; d. Agree to examinations under oath at our request and give us a signed statement of your answers. 4. No insured will make any payment, or incur any expense, except at its own cost, without our prior written consent. 5. No insured will admit any liability. B. LEGAL ACTION AGAINST US No one may bring a legal action against us under this Policy until: 1. There has been full compliance with all the terms of this Policy, and 2. Under Liability Coverage, we agree in writing that the insured has an obligation to pay or until the amount of that obligation has finally been determined by judgment after trial. No one has the right under this Policy to bring us into an action to determine the insured's liability. C. APPRAISAL FOR PHYSICAL DAMAGE LOSS If you and we disagree on the value of the Auto or the, amount of Loss, either may make written demand for an appraisal of the value of the Auto or the amount of Loss. In this event, each parry has the option to either: 1. Select an independent, competent and impartial appraiser, or 2. Use as their appraiser, the adjuster or other party they initially retained to adjust the Loss. The two appraisers will select an umpire. If they cannot agree on the selection of the umpire, either may request that a judge of a court having jurisdiction make the selection. The appraisers will state separately the value of the Auto or the amount of Loss. If the appraisers submit a written report of an agreement to us, the amount agreed upon will be the amount of Loss. If they fail to agree, they will submit their differences to the umpire. A decision agreed to by any two will be binding. Each party will: 1. Pay its chosen appraiser; and 2. Bear the other expenses of the appraisal and umpire equally. D. LOSS PAYMENT - PHYSICAL DAMAGE COVERAGES At our option we may: 1. Pay for, repair or replace damaged or stolen property; PBA-1 Commercial Business Auto Pollev version 03/06/02 Paae 6 of 9 2. Return the stolen prope. ty, at our expense. We will pay for any dam.ye that results to the Auto from theft 3. Take all or any part of the damaged or stolen property at an agreed or appraised value. E. TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US If any person or organization to or for whom we make payment under this Policy has rights to recover Damages from another, those rights are transferred to us. That person or organization must do everything necessary to secure our rights and must do nothing after Accident or Loss to impair them. SECTION VII - GENERAL CONDITIONS A. OTHER INSURANCE t. If other valid and collectible insurance, including any form of self-insurance or Self-Insured Retention, is available to an insured for a Loss covered under this Policy then: a. This Coverage is excess over any other insurance, including any form of self-insurance or Self-Insured Retention, whether primary, excess, or contingent on the existence, collectibility or recoverability of any other insurance, or on any other basis. b. We will have no duty to defend any Claim or Suit. If other Insurers or Self-Insurers provide any concurrent coverage but decline to provide indemnity or defense, we may undertake at our discretion to do so. However, we will in that case be entitled to assignment of the Insured's legal rights against the other carriers or self-insurers. 2. When both this insurance and other insurance, whether primary, excess or contingent or on any other basis, including any form of self-insurance or Self-Insured Retention, apply to the Loss on the same basis, we shall not be liable under this Policy for a greater proportion of the Loss than that stated in the applicable contribution provision below: a. Contribution by Equal Shares- it all such other insurance provides for contribution by equal shares, we shall not be liable for a greater proportion of such Loss than that which would be payable if each insurer or self-insured entity contributes an equal share until the share of each insurer or self-insured entity equals the lowest applicable limit of liability under any one Policy, or the full amount of the Loss is paid. With respect to any amount of the Loss not so paid, the remaining insurers or self-insured entity will then contribute an equal share of the remaining amount of the Loss until each such insurer has paid its limit in full or the full amount of the Loss is paid. b. Contribution by Limits - if all such other insurance does not provide for contribution by equal shares, the Insurer shall not be liable for a greater proportion of such Loss than the applicable limit of liability under this Policy, bears to the total applicable limit of liability of all other valid and collectible insurance applicable to such Loss. 3. Two or more Policy issued by us - If this Policy and any other Policy or coverage contract issued to you by us or any company affiliated with us apply to the same Accident the aggregate maximum limit of liability under all of the policies and Coverage Contracts shall not exceed the highest applicable limit of liability under any one Policy or Coverage Contract. This condition does not apply to any Policy or Coverage Contract issued by us or an affiliated company specifically to apply as excess insurance over this Coverage Contract. B. BANKRUPTCY Bankruptcy or insolvency of the insured or the insured's estate will not relieve us of any obligations under this Policy. C. CONCEALMENT, MISREPRESENTATION OR FRAUD This Policy is void in any case of fraud by you at any time as it relates to this Policy. It is also void if you or any other insured, at any time, intentionally conceal or misrepresent a material fact concerning: 1. This Policy; 2. The covered Auto; 3. Your interest in the covered Auto; 4. A Claim under this Policy. D. NO BENEFIT TO BAILEE - PHYSICAL DAMAGE COVERAGES We will not recognize any assignment or grant any coverage for the benefit of any person or organization holding, storing or transporting property for a fee regardless of any other provision of this Policy. E. INSURED'S REPRESENTATION By accepting this Policy you agree: PBA-1 Commercial Business Auto Policv version 03/06/02 Paw 7 of 9 1. The statements in the Declaration, attached Application, and any Supplemental Questionnaire for coverage are accurate and complete; 2. Those statements are based upon representations you made to us; 3. We have issued this Policy in reliance upon the submitted Application and Supplemental Questionnaire; and 4. You are subject to all the Policy provisions. F PREMIUM AUDIT The estimated premium for this Policy is based on the exposures you told us you would have when this Policy began. We will compute the final premium due when we determine your actual exposures. The estimated total premium will be credited against the final premium due and the insured will be billed for the balance, if any. If the estimated total premium exceeds the final premium due, the insured will get a refund. G POLICY PERIOD, COVERAGE TERRITORY Under this Policy, we cover Accidents and Losses occurring: 1. During the Policy period shown in the Declarations, for which Claims are first made against you during the Policy period or any extended reporting period we may provide; and 2. Within the coverage territory, which is the United States of America. SECTION VIII - ADDITIONAL CONDITIONS A. NON-ASSIGNABLE: The interest of the Insured under this Policy cannot be assigned without prior written cons B. CANCELLATION AND NON-RENEWAL: 1. The Insured shown in the Declaration Page may cancel this Policy by mailing its request to cancel to the Insurer. 2. The Insurer may cancel this Policy by mailing first class or by hand delivery to the Insured written notice of cancellation at least: a Ten (10) days before the effective date of cancellation, if we cancel for nonpayment of the premium or your failure to pay any SIR due; or b Thirty (30) days before the effective date of cancellation, if we cancel for any other reasons. 3. The Insurer will mail or deliver any notice of cancellation to the Insureds last mailing address known to us. 4. Notice of cancellation will state the effective date of cancellation. The Policy period will end on that date. 5. If this Policy is canceled, the refund will be short-rate. The premium will be fully earned in the event of a Loss that exceeds the premium amount shown in the Declarations. The cancellation will be effective even 4 we have not made or offered a refund. 6. If notice is mailed, a prepaid proof of mailing is sufficient proof of notice to the Insured. Notice deposited in the mail in the manner described above shall be effective when so deposited. 7. If the Insurer decides not to renew this Policy, the Insurer is not required to send any notice of such nonrenewal. C. CHANGES This Policy contains all of the agreements between you and us concerning the coverage provided by the Policy, except as may be identified by endorsement to this Policy. The coverage terms can be amended or waived only by endorsement issued by us and made a part of the Declaration Page. Notice to any agent, broker, service provider or knowledge possessed by any agent, broker or service provider, or by any other person, shall not effect, waive or change any part of the coverage provided the Insured or preclude the Insurer and/ or the Insurance Company from asserting any right under the terms of the Policy and coverage issued. SECTION IX - DEFINITIONS A. Accident means an incident, event, or circumstance which is unexpected or unintended from the standpoint of any Insured. B. Auto means a land motorized vehicle, a trailer or semi-trailer designated for travel on public roads. C. Bodily Injury means physical injury to a person's body, including death, but shall exclude: 1. Sickness or disease sustained by any person or death resulting therefrom; 2. Mental or emotional distress, mental anguish, humiliation, embarrassment, mental anxiety or other emotional, psychological or mental injury, or any physical manifestation thereof. D. Claim means any written notice to the Insured or any Insured from any person that asserts that the Insured should pay that person's expenses or Losses resulting from Bodily Injury or Property Damage. PBA-1 Co emlal Business Auto Poliov version 03/06/02 Pace 8 of 9 E. Claim Expenses means fees, costs and expenses incurred in the investigation, adjustment and defense of a Claim. F Claims Reporting Period means the period of time during which a Claim must be reported to us. Please see the Claims Reporting Period Endorsement, forming a part of this Policy, which specifies the Claims Reporting Period provided by this Policy. G Commercial Business Use means any use of a covered Auto by an approved driver who is using the covered Auto within the course of his/her employment with the insured and which use is within the scope of operation as permitted by the Insured. H Damages means a monetary judgment, award or settlement, but does not include fines or statutory penalties, sanctions, whether imposed by law or otherwise, punitive, exemplary or treble Damages, or any multiplied portion of a compensatory award, nor the return or restitution of legal fees, costs, and expenses. 1. Loss(es) means direct and accidental damage(s). J. Policy means the Policy issued by the insurer to the insured including all endorsements thereto. K Property Damage means physical damage to tangible property, including all resulting loss of use of that property. All such loss of use shall be deemed to occur at the time of the Accident. L Self-Insured Retention ("SIR") is the amount which the Insured will pay for Damages and/ or Claim Expenses otherwise covered under this Policy. The Insured will pay 100% of the Self-Insured Retention before any payment is due pursuant to the terms of this Policy. M Suit means a civil proceeding in which damage because of Bodily Injury or Property Damage, to which this Insurance applies, is alleged. Suit includes: 1. An arbitration proceeding in which such Damages are claimed and to which you must submit or do submit with our consent; or 2. Any other alternative dispute resolution proceeding in which such Damages are claimed and to which you submit with our consent. SECTION X - SEVERABILITY If any provision of this Policy is void or otherwise determined to be unenforceable, all other provisions shall nonetheless be deemed valid. SECTION XI - MUTUAL AFFIRMATION By unqualifiedly accepting this Policy upon receipt, the Insured affirms that all provisions serve to embody and articulate the entire agreement of the parties. SECTION XII - CHOICE OF LAW The provisions of this Policy are to be construed in accordance with the laws of the State of Illinois, as the state in which thePolicy has been entered. PBA-1 Commercial Business Auto Poiicv version 03106102 Paw 9 ULTIMATE NET LOSS ENDORSEMENT PSI94-1 This Endorsement changes the Policy. Please read it carefully. All claim settlement costs, defense costs and related costs (claim expenses) are included expenses within the maximum limit of liability shown on the Insureds Declaration Page, and not in addition to such maximum limit of liability. The maximum limit of liability applies to the total sum which the insured, or the insurer, become legally obligated to pay by reason of any injury or damage for which coverage is provided by the coverage contract, including any supplementary payment either through adjudication or compromise, and shall also include any hospital, medical, or funeral charges, and sums paid or payable as salaries, wages, compensation, fee charges, interest, or expenses for doctors, nurses, investigators, attorneys, and other persons, relating to any settlement, adjustment, investigation or defenses of any claim. Claim expenses shall not include any charges for the insurer's personnel salary or any part of the normal operating overhead of the insurer. PSI941 Ultimate Net Lass version 03-06-2002 Page 1 of 1 LROSS LIABILITY EXCLUSION ENDORSEMENT PS194-6 This Endorsement changes the Policy. Please read it carefully. This insurance does not apply to liability arising from claims or suits brought by: t- One insured against another insured; or 2. Any parent company or corporation of any insured member, or any subsidiary company, or corporation or any insured member; or 3. Any other company or corporation owned by any of the entities described in 1 or 2 above; or 4. Any division or department of any of the entities described in 1, 2 or 3 above; or 5. Any officer, director or employee of any of the entities described in 1, 2, 3 or 4 above. PSI94-6 Cross Liability Exclusion version 0306-2002 Pagel d t REINSTATEMENT OF LIABILITY LIMITS ENDORSEMENT PSI94-7 This Endorsement changes the Policy. Please read it carefully. The Insured herein understands and agrees to the following additional provisions: A. General Exclusions We will not pay for loss as specified below: A single accident, or the accumulation of more than one accident during the policy period, may cause the per accident limit and/or the annual aggregate maximum limit to be exhausted, at which time the Insured will have no further benefits under the policy. 2. The Insured may request the Insurer to reinstate the original limit of liability for the remainder of the policy period for an additional coverage charge as may be calculated and offered by the Insurer on the policy issued. The Insurer is under no obligation to accept the Insured's request. 4. It is understood and agreed that the Insurer has no obligation under the coverage provided by the policy to notify the Insured of the possibility that the maximum coverage payable may be exhausted by any accident or combination of accidents which may occur during the policy period. It is the sole responsibility of the Insured to determine if additional coverage should be purchased. It expressly is not the obligation of the Insurer to make a determination or advise the Insured concerning additional coverage. It is understood and agreed that the Insurer is herein released and relieved from any and all responsibility to notify the Insured of the possible reduction in limits. The Insured herein assumes the sole and individual responsibility to evaluate, consider and initiate a request for additional coverage or reinstatement of the annual aggregate limit which may be exhausted by any single accident or combination of accidents during the policy period. PS19W7 Ralnslelemeol of Liability LimBS version 030&2002 Page 1 of 1 MINI[ViJM EARNED COVERAGE CHNRGE ENDORSEMENT PSI94-8 This Endorsement changes the Policy. Please read it carefully. In consideration of the coverage charges made and the mutual covenants contained in the policy, it is mutually agreed and declared that in the event of any claim, the minimum earned coverage charge for the policy is one hundred percent (100%) of the Total coverage charge stated on the Insured Declaration Page, and that such minimum earned coverage is not subject to short rate or pro rata adjustment. P5194-8 Mm rnurh Earned Coverage Charge version 03-0 2002 Page 1 of 1 INDEPeNDENT CONTRACTOR EXCLUSION ENDORSEMENT PSI95-11 This Endorsement changes the Policy. Please read it carefully. This policy does not apply to bodily injury or property damage arising out of the acts of any Independent Contractor including but not limited to, the negligent hiring of any subcontractor, failure to contract with any subcontractor, negligent supervision of any subcontractor, or any other liability relating to any independent contractor service or failure to provide service. This policy does not apply to bodily injury or property damage sustained by an independent contractor or any employee of an independent contractor. PS*511 IndependW Ca radon Ex Usron version 0306-2002 Page 1 of 1 GENERAL CHANGE ENDORSEMtiIT ACCIDENT DATE ENDORSEMENT PSI95-15 This Endorsement changes the Policy. Please read it carefully. The loss or the accident date will be considered to have occurred on the day the insured provided and completed the service which resulted in bodily injury or property damage, regardless of when the bodily injury or property damage is first discovered, first manifest or reported. Coverage is excluded for bodily injury or property damage which directly or indirectly is the result of acts, treatments, services, lack of services, errors or omissions or other actions (hereinafter referred to as "services") which were provided by the Insured prior to the effective coverage date of this policy. Bodily injury or property damage which first manifests itself or is first discovered while this policy is in effect, but is the result of services provided prior to the effective coverage date or retroactive date shown on the policy is not a benefit under this policy. PSI95-15 General Change Endorsement Accident Dale wrsm 0&ef> Page 1 of 1 EXCLUSION RE: FIREARMS, ANIMALS ENDORSEMENT PS198-1 This Endorsement changes the Policy. Please read it carefully. This insurance does not apply to bodily injury or property damage arising out of: t. The use of firearms by, or on behalf of, or at the direction of any insured; 2. The ownership, boarding or use of any kind of animal whether or not domesticated. P5190-1 Evdwion. Re: Fire ..AnimWs version 03.06.2002 Page 7 W 1 GE .-RAL CHANGE ENDORSEM 4T NUCLEAR ENERGY LIABILITY EXCLUSION ENDORSEMENT (BROAD FORM) ENDORSEMENT PS96-1 This Endorsement changes the Policy. Please read it carefully. It is agreed that: 1. This Policy does not apply: A. Under any liability coverage, to bodily injury, sickness, disease, death, or property damage; 1. With respect to which an insured under this Policy is also an insured under a nuclear energy liability policy issued by the Nuclear Energy Liability Insurance Association, the Mutual Atomic Energy Liability Insurance Association, the Mutual Atomic Energy Liability Underwriters or Nuclear Insurance Association of Canada, or would be an insured under any such Policy but for its termination upon exhaustion of its limit of liability; or 2. Resulting from hazardous nuclear material and with respect to which (a) any person or organization is required to maintain financial protection pursuant to the Atomic Energy Act of 1954 or any law amendatory thereof, or (b) the Insured is, or had this Policy not been issued would be, entitled to indemnity from the United States of America, or any agency thereof, under any agreement entered into by the United States of America or any agency thereof with any person or organization. B. Under any medical payments coverage, or under any Supplementary Payments Provision relating to first aid, to expenses incurred for bodily injury, sickness, disease or death resulting from the hazardous properties of nuclear material and arising out of the operation of a nuclear facility by any person or organization. C. Under any liability coverage, to bodily injury, sickness, disease, death or property damage resulting from the hazardous nuclear material, if; 1. The nuclear material (a) is at any nuclear facility owned or operated by, or on behalf of, a Insured, or (b) has been discharged, dispersed, seeped, released or leaked therefrom; 2. The nuclear material is contained in spent fuel or waste at anytime possessed, handled, used, processed, stored, transported or disposed of, by or on behalf of a Insured; or 1 The bodily injury, sickness, disease, death or property damage arises out of the furnishing by a Insured of services, materials, parts or equipment in connection with the planning, construction, maintenance, operation or use of any nuclear facility; but, if such facility is located within the United States of America, its territories or possessions or Canada, this exclusion (3) applies only to property damage to such nuclear facility. II Definitions: As used in this Endorsement: A. 'Hazardous" includes radioactive, toxic or explosive properties of a material or substance; B. "Nuclear material" means source material, special nuclear material or by-product material; C "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; D. "Spent fuel" means any fuel element or fuel component, solid or liquid, which has been used or exposed to radiation in a nuclear reactor, E. "Waste" means any material or substance (1) containing by-product material and (2) resulting from the operation by any person or organization of any nuclear facility included within the definition of nuclear facility under paragraph (1) or (11) thereof; 1 of 2 F. "Nuclear facility" means 1. Any nuclear reactor; 2. Any equipment or device designed or used for (a) separating the isotopes of uranium or plutonium, (b) processing or utilizing spent fuel, or (c) handling, processing or packaging waste; 3. Any equipment or device used for the processing, fabricating or alloying of special nuclear material If at any time the total amount of such material in the custody of the insured at the premises where such equipment or device is located consists of or contains more than 25 grams of plutonium or uranium 233 or any combination thereof, or more than 250 grams of uranium 235; 4. Any structure, basin, excavation, premises or place prepared or used for the storage or disposal of waste, including the site on which any of the foregoing is located and all operations conducted on such site and all premises used for such operations; G. "Nuclear reactor" means any apparatus, device or facility designed or used to sustain nuclear fission in a self-supporting chain reaction or to contain a critical mass of fissionable material; H. "Property damage" includes all forms of radioactive contamination of property. It s understood and agreed that, except as specifically provided in the foregoing to the contrary, this clause is subject to the terms, exclusions, conditions and limitations of the Policy to which it is attached. P596.1 Nuclear Energy Liability E=lusim version 03.06-2002 2 of 2 CLAIMS WARRAN„ .i AND COVERAGE STATEM__tIT ENDORSEMENT WRNT -2000-06 This Endorsement changes the policy/certificate issued. Please read it carefully! Coverage provided under the policy/certificate is contingent on the following warranty, requirements and acknowledgements as evidenced by the named insured's signature: WARRANTY STATEMENT The undersigned applicant warrants that all the information provided by him is true and correct to the best of his knowledge and belief and agrees and understands that the policy/certificate may be voided if the undersigned applicant provides any false or misleading information to the insurance company in connection with the subnutted application. It is hereby agreed that the issuance of the policy/certificate and coverage to be provided hereunder for the undersigned applicant, is subject to the truthfulness and accuracy of the loss history provided by the applicant. The undersigned applicant, agrees that the application discloses all losses, claims, incidents, occurrences, events or circumstances which the undersigned applicant, knows about or should have known about and that no accident or incident has taken place which has not been revealed which could reasonably be expected to result in a claim, and further, that the loss history provided herein is true, correct and complete. The undersigned applicant, and for anyone sought to be insured under the policy/certificate, warrants that all statements contained in this Application for Insurance are true and correct and understands and agrees that this insurance may be voided at the insureds sole discretion, due to any misstatement or omission of a material fact, intentional or otherwise, made by the undersigned. FUTURE CLAIM INCIDENT/REPORTING REOUIREMENT In case of any incident, event, occurrence, loss, or accident which could reasonably be expected to result in a claim or suit covered by this insurance, you must provide us IMMEDIATE written notice no later than 14 days from the incident, event, occurrence, loss or accident which could result in a claim or suit covered by this insurance. Written notice should be provided to: Claims - PO Box 4439, Sandy, UT 84091-0439 e-mail: CDA@primeis.com Phone/FAX: Phone: (877) 585-2849 or (801) 304-5530 11 Fax: (801) 304-5536 ACKNOWLDGEMENT OF RESTRICTIVE SURPLUS LINES COVERAGES By signing this Warranty, and by accepting the contract of insurance, the undersigned applicant, hereby accepts and acknowledges that the coverage provided in this policy/certificate may not necessarily conform to the type or amount of coverage requested in the Application for Insurance. The coverage, as ultimately provided in the policy/certificate, was negotiated and agreed to by the applicant and the Insurer. The undersigned applicant, also hereby accepts and acknowledges that this contract is delivered as a surplus lines coverage and that it may be different from contracts issued by insurers in admitted markets and, accordingly, it may, depending upon the circumstances, be more or less favorable to an insured than a contract from an admitted carrier might be. The insurer issuing this policy/certificate does not hold a certificate of authority to do business in this state and thus is not fully subject to regulation by the State's Insurance Commissioner. This contract receives no protection from any state guaranty funds set up for admitted carriers under any state regulatory provision, including chapter 28. Accept Decline ? ? LIMITED WAR AND TERRORISM COVERAGE (20% increase in premium if accepted) ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. Insured's Signature and Date Signature of Broker/Agent of Insured Print Insured's Name Date CWCS01-0102 PROHIBITED USE ENDORSEMENT PCA 95-8 This Endorsement changes the Policy Please read it carefully! No coverage shall be provided under this policy for any covered auto which is being used or operated by anyone under the influence of alcohol, other intoxicants or narcotics, unless administered on the advice of a physician. If for any reason, a court of competent jurisdiction determines this policy provides liability for a covered auto which is being used by anyone under the influence of alcohol, other intoxicants or narcotics, then the Insurer has the right to amend and reduce the liability limits identified on the Insured Declaration Page to an amount no greater than $50.,000. The Insurer has the right to recompute the premium charged for such coverage. P-PCA95A Pmhbled Use version 03-06-2002 Page 1 of 1 1EX/PRIME SYNDICATE INC ACKNOWLEDGEMENT OF EXCLUDED COVERAGE ENDORSEMENT ENDORSEMENT PAEC95-3 This Endorsement changes the Policy issued. Please read it carefully! The Business Auto Coverage Contract only includes the coverages marked "Yes". No insurance is provided for the coverages marked "No". 1. Commercial Auto Liability Coverage 2. Uninsured Motorist Coverage - Bodily Injury Uninsured Motorist Coverage - Property Damage 3. Increased Limit of Uninsured Motorist Coverage 4. Underinsured Motorist Coverage - Bodily Injury Underinsured Motorist Coverage - Property Damage 5. Personal Injury Protection Coverage 6. Contractual Liability Physical Damage Coverage 7. Non-owned Vehicle Coverage 8. Hired Vehicle Coverage © Yes ? No ? Yes © No ? Yes © No ? Yes W No ? Yes © No ? Yes © No © Yes ? No ? Yes © No ? Yes © No ? Yes © No If the state in which the Insured resides has a mandatory minimum automobile insurance coverage requirements, then the Insurer will obtain sufficient coverage to satisfy those requirements and will provide the necessary minimum coverage elements to each Insured residing in that state. The Insured has reviewed the coverages which the Insured has procured from and understands the Insurer has affirmatively rejected the coverages marked "No". The Insured, by accepting the terms of this Coverage Contract and by paying the coverage charges applicable to the Coverage Contract, agrees that it is specifically and voluntarily rejected the coverages marked "No". Uninsured Motorist Coverage (Number 2, above) applies only to covered autos you own, that because of the law in the state where they are licensed or principally garaged are required to have, and cannot reject, Uninsured Motorist Coverage. The limit of liability, will be no greater than the minimum limit required by the Financial Responsibility laws of the state where the accident occurs. Personal Injury Protection Coverage (Number 5, above) applies only to covered autos you own, that are required to have Personal Injury Protection Coverage, or No-Fault Benefits in the state where they are licensed or principally garaged. The limit of liability will be no greater than the minimum liability limit required by the laws of the state where the autos are licensed or principally garaged. BE REMINDED: Liability coverage is provided only for those Named Operator Drivers and scheduled under the coverage contract issued. For a person to be insured as a named operator driver, a driver questionnaire must be provided and a physical exam completed, within ten (10) days of receipt of the coverage contract issued to the Insured. No coverage will be provided for accidents involving any driver not named as an authorized named operator driver within the coverage contract issued. Liability coverage is only provided for the business use of insured vehicles. Personal use of insured vehicles is excluded and not insured. PAEC95-3 Acknoviwdgement of Excluded coverage version 0346-02 Page r or 1 COVERED AUTO PASSENGER ENDORSEMENT ENDORSEMENT PG2000-95-6A This Endorsement changes the Insurance Policy. Please read it carefully. This Endorsement modifies the Policy to remove the exclusion for liability coverage for passengers of covered autos if the covered autos are classified as one of the following 1 Taxicabs, 2. Shuttle vans, 3. Non-Emergency Medical Transportation Vehicles, a. Public Livery Vehicles, or 5. Ambulances. All other terms and conditions of the Policy remain in eff ect. P-PG200Q956A Covered Auto Passenger version 060&2002 Page 1 of 1 _? ` ' ?. ; , _, ?:.. Curtis R. Long Prothonotary office of the i3rotbonotarp Cumberfanb Countp Renee K. Simpson Deputy Prothonotary John E. Slike Solicitor (? •• Q 9 CIVIL TERM ORDER OF TERMINATION OF COURT CASES AND NOW THIS 29TH DAY OF OCTOBER 2008 AFTER MAILING NOTICE OF INTENTION TO PROCEED AND RECEIVING NO RESPONSE - THE ABOVE CASE IS HEREBY TERMINATED WITH PREJUDICE IN ACCORDANCE WITH PA R C P 230.2 BY THE COURT, CURTIS R. LONG PROTHONOTARY One Courthouse Square • Carlisle, Pennsylvania 17013 • (717) 240-6195 • Fax (717) 240-6573