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HomeMy WebLinkAbout02-2024 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA AMERICAN COUNTRY INSURANCE CO. Plaintiff V$ WEST SHORE REGIONAL TRANSPORTATION : NO. O-~. : CIVIL ACTION - LAW : JURY TRIAL DEMANDED NOTICE You have been sued in Court. If you wish to defend against the claims set forth in the following pages, you must take action within twenty (20) days after this notice and complaint are served, by entering a written appearance personally or by attorney and filing in writing with the Court your defenses or objections to the claims set forth against you. You are warned that if you fail to do so the case may proceed without you and a judgment may be entered against you by the Court without further notice for any money claimed in the complaint or for any other claim or relief requested by the Plaintiff. You may lose money or property or other rights important to you. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. Cumberland County Court Administrator 4th Floor, Cumberland County Court House Carlisle, PA 17013 (717) 240-6200 GRIEST, HIMES, HERROLD, SCHAUMANN, LLP By: M~ Anderson, Esuire Supreme Court ID 85539 Attoney for Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA AMERICAN COUNTRY INSURANCE CO. Plaintiff VS WEST SHORE REGIONAL TRANSPORTATION : CIVIL ACTION - LAW : JURY TRIAL DEMANDED COMPLAINT AND NOW, TO WIT, on the~ ~ D'~ay of ~ , 2002, comes the Plaintiff, American Country Insurance Co., by its counsel, Griest, Himes, Herrold, Schaumann, LLP by Michael C. Anderson, Esquire and files this Complaint of which the following is a statement: 1. The Plaintiff, American Country Insurance Co., is an Illinois Corporation authorized and otherwise licensed to sell insurance in the State of Pennsylvania with principal offices located at 222 North LaSalle Street, Suite, Chicago, Illinois 60601. 2. The Defendant, West Shore Regional Transportation is a Pennsylvania taxi service business with a principal place of business at 50 Market Street Lamoyne, Pennsylvania 17043. 3. On or about April 19, 2000, Plaintiff and Defendant entered into a contract wherein Plaintiff would provide insurance to the Defendant in accordance with the terms of the insurance policy in return for the payment of the premium by Defendant. A copy of the insurance policy is attached hereto and incorporated by reference thereto as Exhibit "A'. 4. Plaintiff did at all times relevant hereto provide Defendant with insurance in accordance with the terms of said insurance policy. 5. Defendant failed to pay the insurance premiums that were properly billed to Defendant by Plaintiff. 6. On September 22, 2000, Plaintiff sent Defendant notice that Plaintiff had not received Defendant's premium payment. Said letter also advised Defendant that if payment to the past due amounts was not received before October 25, 2000, at 12:01 A.M., Plaintiff would cancel Defendant's insurance policy. A copy of said letter is attached hereto and incorporated by reference thereto as Exhibit "B". 7. Defendant failed to pay the past due amount indicated in the September 22, 2000, letter, and, therefore, Plaintiff canceled Defendant's insurance. 8. As a result of the cancellation of the policy, the policy period was from April 19, 2000, to October 25, 2000. 9. Based on a proration of the insurance premium calculated using the policy period of April $11,880.00. 10. 11. Plaintiff. 19, 2000, to October 25, 2000, Plaintiff earned a total premium of Of the $11,880.00 earned by Plaintiff, Defendam has only paid $6,120.00. Defendant still owes Plaintiff $5,760.00 for the insurance premium earned by 12. Despite Plaintiff's repeated and continued demands for payment of the same, Defendant has refused and continues to refuse payment of the same. 13. The amount in controversy is for an amount less than $30,000.00 and, therefore, is a proper matter for arbitration. WHEREFORE, Plaintiff demands judgment against Defendant in the amount of $5,760.00 together with interest, costs of suit, and attorneys' fees. Respectfully submitted, GRIEST, HIMES, HERROLD, SCHAUMANN, LLP Michael. An~terson~ Esquire Attontey for Plaintiff Supreme Court ID 85539 129 E. Market Street York, PA 17401 (717) 846-8856 VERIFICATION I verify that the statements made in this foregoing Complaint are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C. S. Section 4904 relating to unsworn falsification to authorities. COl~' "ON POLICY DECLARATION" Policy No. TCAO002685 AMERICAN COUNTRYINSURANCE COMPANY RESEARCH UNDERWRITERS 222 NORTH LASALLE STREET CHICAGO, ILLINOIS 60601 4240 GREENSBURG PIKE PITTSBURGH PA 15221 NAMED INSURED: WEST SHORE REGIONAL TRANSPORTATION MAILING ADDRESS: 50 MARKET STREET LEMOYNE PA 17043 POLICY PERIOD: From 04/19/2000 To 04/19/2001 at 12:01 A.M. standard time at your mailing address shown above. BUSINESS DESCRIPTION: TAXI SERVICE IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY. THIS POLICY CONSISTS OF THE FOLLOWING COVERAGE PARTS FOR WHICH A PREMIUM IS INDICATED. THIS PREMIUM MAY BE SUBJECT TO ADJUSTMENT. Commercial Property Coverage Part Commercial General Liability Coverage Part Commercial Crime Coverage Part Commercial Inland Marine Coverage Part Boiler and Machinery Coverage Part Commercial Auto Coverage Part TOTAL PREMIUM PREMIUM NOT COVERED NOTCOVERED NOT COVERED NOT COVERED NOT COVERED 21,600.00 $ 21,600.00 Premium shown is payable:$ at inception Fom~s applicable to all Coverage Parts: IL 00 03 11 85 IL 00 17 11 98 IL 09 10 01 81 IL 00 21 11 94 IL 02 46 09 96 COUNTERSIGNED (Date) BY (Authorized Representative) IL 00 19 11 8S ~1. ~T. 06/29/2000 Copyright, Insurance Services Office, Inc., 1983, 1984 Company Copy BU~ !ESS AUTO DECLARATION~ POLICY NO. TCA0002685 AMERICAN COUNTRY INSURANCE COMPANY 222 NORTH LASALLE STREET CHICAGO, ILLINOIS 60601 RESEARCH UNDERWRITERS 4240 GREENSBURG PIKE PITTSBURGH PA 15221 ITEM ONE NAMED INSURED: MAILING ADDRESS: WEST SHORE REGIONAL TRANSPORTATION 50 MARKET STREET LEMOYNE PA 17043 POLICY PERIOD: From 04/19/2000 to 04/19/2001 at 12:Ol A.M. Standard Time at your mailing address shown above. FORM OF BUSINESS: [] CORPORATION [] PARTNERSHIP [] INDIVIDUAL [] OTHER_ IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY. ITEM TWO SCHEDULE OF COVERAGES AND COVERED AUTOS This policy provides only those coverages where a charge is shown in the premium column below. Each of these coverages will apply only to those "autos" shown as covered "autos." "Autos" are shown as covered "autos" for a particular coverage by the entry of one or more of the symbols from the COVERED AUTO Section of the Business Auto Coverage Form next to the name of the coverage. CA 00 03 12 93 Copyright, Insurance Services Office, Inc., 1993 Company Copy PAGE 1 OF 7 BUSINESS AUTO DECLARATIONS (Continued) COVERED AUTOS (Entry of one or more of the symbols from LIMIT the COVERED COVERAGES AUTOS Section of PREMIUM the Business Auto THE MOST WI~ WILL PAY FOR ANY ONE Coverage Form ACCIDENT OR LOSS shows which autos are covered autos) LIABILITY 7 $ 100,000 [;20,808.00 PERSONAL INJURY SEPARATELY STATED IN EACH PIP PROTECTION (or equivalent ENDORSEMENT MINUS $ NONE Ded. No-fault coverage) 7 ;624.00 ADDED PERSONAL INJURY SEPARATELY STATED IN EACH ADDED PIP PROTECTION (or equivalent added ENDORSEMENT No-fault Coverage) PROPERTY PROTECTION SEPARATELY STATED IN THE P.P.I. INSURANCE ENDORSEMENT MINUS $ DED FOR (Michigan only) EACH ACCIDENT AUTO MEDICAL PAYMENTS UNINSURED MOTORISTS 7 ; 35 · In Thousands ;168.00 UNDERINSURED MOTORISTS ~; 35 *In Thousands (When not included in Uninsured Motorists Coverage) 7 INCLUDED PHYSICAL DAMAGE ~,CTUAL CASH VALUE OR COST OF REPAIR COMPREHENSIVE COVERAGE WHICHEVER IS LESS MINUS $ DED. FOR EACH COVERED AUTO. BUT NO DEDUCTIBLE APPUES TO LOSS CAUSED BY FIRE OR LIGHTNING. See ITEM FOUR for hired or borrowed "autos." PHYSICAL DAMAGE e~CTUAL CASH VALUE OR COST OF REPAIR SPECIFIED CAUSES OF WHICHEVER IS LESS MINUS $25 DED. LOSS COVERAGE FOR EACH COVERED AUTO FOR LOSS CAUSED BY MISCHIEF OR VANDALISM. See ITEM FOUR for hired or borrowed autos." PHYSICAL DAMAGE %CTUAL CASH VALUE OR COST OF REPAIR COLLISION COVERAGE WHICHEVER IS LESS MINUS $ DED. FOR EACH COVERED AUTO. See ITEM FOUR for hired or boffowed "autos." PHYSICAL DAMAGE I; FOR EACH DISABLEMENT OF A PRIVATE TOVVING AND LABOR PASSENGER "AUTO" Not available in Califomia) I PRI~IUM FOR EN[X~S~EN'I'~ ESTIMATED TOTAL PREMIUM ~;21,600.00 PAGE 2 OF 7 Copyright, Insurance Sen/ices Office, Inc., 1993 CA 00 03 12 93 BUSINESS AUTO DECLARATIONS (Continued) Premium shown is payable: $ at inception. ENDORSEMENTS ATTACHED TO THIS POLICY: IL 09 21 - Broad Form Nuclear Exclusion (Not applicable in New York) AC 3-102 AUTOtD CA 00 01 07 97 CA 0180 09/97 CA 21 92 09 97 CA 21 93 09 97 CA 22 37 03 95 CA 22 38 03 95 CA 24 02 12 93 MC1632 06 71 UA 104 05/90 UA 105 05/90 COUNTERSIGNED (Date) BY: (Authorized Representative) NOTE: OFFICERS' FACSIMILE SIGNATURES MAY BE INSERTED HERE, ON THE POLICY COVER OR ELSE- WHERE AT THE COMPANY'S OPTION CA O0 03 12 93 Copyright, Insurance Services Office, Inc., 1993 Company Copy PAGE 3 OF 7 BUSINESS AUTO DECLARATIONS (Continued) ITEM THREE SCHEDULE OF COVERED AUTOS YOU OVVN DESCRIPTION TERRITORY PURCHASED Covered Year, Model, Trade Name, Body Type Original Actual Town & State where the Auto Serial Number(S) Vehicle Identification Number(VIN) Cost New Cost & Covered Auto will he No. NEVV (N) principally garaged USED (U) I 89 CHEVY #05 IGIBL51EXKRI21181 $0.00 ~07-HARRISBURG iPA 2 88 CHEV #27 IGIBNSIZSJAI21495 ;0.00 ~07-CUMBERLAND CITY 3 95 JEEP #35 I J4FJ28S2SL588021 ;0.00 307-HARRISBURG !PA 4 89 CHEV #31 IGIBN51E6KRI06316 $0.00 D07-CUMBERLANDCITY ?A 5 87 CHEV #50 IGIBN51ZXH91355295 ;0.00 D07-CUMBERLANDCITY ?A CL~ SSIFI CATIOI~ Radius of Business Size GVVV, Age Pdmary Secondary Code Except for towing, all Covered Operation Use GCW or GrOul: Rating Rating physical damage loss s = service Vehicle Factor Factor is payable to you and Auto r = retail Seating Liab. Phy. the loss payee named No. c = Corem Capacity Dam. below as interasts may appear at the time of the loss I bDIST-PFL LIGHT 5 1.00 ! .00 O.O0 4 i 89 2 LDIST-PFL LIGHT 5 i.00 1.00 0.00 4189 3 LD1ST-PFL LIGHT 5 ! .00 1.00 0.00 4189 4 LDIST-PFL bIGHT 5 .00 1.00 0.00 4189 5 LDIST-PFL LIGHT fi 1.00 !.00 0.00 1189 COVERAGES - PREMIUMS, LIMITS & DEDUCTIBLES (Absence of a deductible or limit entry in any column below means that the limit or deductible entry in the corresponding ITEM TVVO column applies instead.) LIABILITY PERSONAL INJURY ADDED P.I.P. PROP. PROT. (Mich. only) Covered PROTECTION Limit Premium Limit stated Premium Limit stated in each Limit stated Premium Auto in each Added P.I.P. End. in P.P.I. end. No. P.I.P. End. Premium minus minus deductible deducible shown below shown below t $1,734.00 $52.00 2 $1,734.00 ~52.00 3 $1,734.00 :52.00 4 $1,734.00 ;52.00 5 $1,734.00 ;52.00 rotal $2o,8o8.o0 g624.00 Premium PAGE 4 OF 7 Copyright, Insurance Sendces Office, Inc., 1993 CA 00 03 12 93 BUSINESS AUTO DECLARATIONS (Continued) COVERAGES - PREMIUMS, LIMITS & DEDUCTIBLES (Absence of a deductible or limit entry in any column Covered below means that the limit or deductible entry in the corresponding ITEM TVVO column applies instead) Auto AUTO MED PAY No. Limit Premium TOTAL COVERAGES - PREMIUMS, LIMITS & DEDUCTIBLES (Absence of a deductible or limit entry in any column below means that the limit or deductible entry in the correspondin~l ITEM TVVO column applies instead) COMPREHENSIVE SPECIFIED CAUSES COLLISION TOVMNG & LABOR Covered OFLOSS Auto Limit stated Premium Limit stated in Limit stated Premium Limit Per Premium NO. in ITEM ITEM TWO in ITEM DL~.-~nent TVVO minus Premium TVVO minus deductible deductible TOTAL ITEM FOUR SCHEDULE OF HIRED OR BORROWED COVERED AUTO COVERAGE AND PREMIUMS. LIABILITY COVERAGE - RATING BASIS, COST OF HIRE STATE ESTIMATED COST RATE PER EACH $100 FACTOR (if liab PREMIUM OF HIRE FOR COST OF HIRE Cov. is primary) EACH STATE TOTAL PREMIUM Cost of hire means the total amount you incur for the hire of "autos" you don't own (not including "autos" you borrow or rent from your partners or employees or their family members). Cost of hire does not include charges for services performed by motor carriers of property or passengers. CA 00 03 12 93 Copyright, Insurance Services Office, Inc., 11 993 PAGE $ OF 7 BUSINESS AUTO DECLARATIONS (Continued) SICAL DAMAGE COVERAGE LIMIT OF INSURANCE ESTIMATED RATE PER COVERAGES THE MOST WE WILL PAY ANNUAL EACH $100 PREMIUM DEDUCTIBLE COST OF ~,NNUAL COST HIRE OF HIRE ~CTUAL CASH VALUE, COST OF REPAIRS OR $ WHICHEVER IS LESS, MINUS COMPREHENSIVE $ Ded. FOR EACH COVERED AUTO BUT NO DEDUCTIBLE APPLIES TO LOSS CAUSED BY FIRE OR LIGHTNING. SPECIFIED ~,CTUAL CASH VALUE, COST OF REPAIRS OR CAUSES OF LOSS [ WHICHEVER IS LESS MINUS 125 Ded. FOR EACH COVERED AUTO FOR .OSS CAUSED BY MISCHIEF OR VANDALISM .COLLISION ACTUAL CASH VALUE, COST OF REPAIRS OR $ WHICHEVER IS LESS MINUS $ Ded. FOR EACH COVERED AUTO TOTAL PREMIUM ITEM FIVE SCHEDULE FOR NON-OWNERSHIP LIABILITY Other~cy L Number o! _Em. lo ees Social Serwce,agency Premium PAGE 6 OF 7 Copyright, Insurance Services Office, Inc., 1993 Company Copy CA 00 03 12 93 BUSINESS AUTO DECLARATIONS (Continued) ITEM SIX SCHEDULE FOR GROSS RECEIPTS OR MILEAGE BASIS - LIABILITY COVERAGE - PUBLIC AUTO OR LEAS- ING RENTAL CONCERNS RATES ESTIMATED [ ] Per $100 of Gross Receipts PREMIUMS YEARLY [ ] Per Mile [ ] Gross Receipts LIABILITY AUTO MEDICAL LIABILITY AUTO MEDICAL [ ] Mileage COVERAGE PAYMENTS [_. COVERAGE PAYMENTS I TOTAL PREMIUMS MINIMUM PREMIUMS When used as a premium basis: FOR PUBLIC AUTOS Gross Receipts means the total amount to which you are entitled for transporting passengers, mail or merchandise during the policy period regardless of whether you or any other carrier originate the transportation. Gross receipts does not include: A. Amounts you pay to railoads, steamship lines, airlines and other motor carriers operating under their own ICC or PUC permits. B. Advertising revenue. C. Taxes which you collect as a separate item and remit directly to a government division. D. C.O.D. collections for cost of mail or merchandise including collection fees. Mileage means the total live and dead mileage of all revenue producing units operated during the policy period. FOR RENTAL OR LEASING CONCERNS Gross Receipts means the total amount to which you are entitled for the leasing or rental of "autos" during the policy period and includes taxes except those taxes which you collect as a separate item and remit directly to a governmental division. Mileage means the total of all live and dead mileage developed by all the "autos" you leased or rented to others during the policy period. CA 00 03 12 93 Copyright, Insurance Services Office, Inc., 1993 Company Copy PAGE 7 OF 7 SCHEDUL . OF COVERED AUTOS YOU WN EXTENSION OF DECLARATIONS ITEM THREE kUTOS YOU OWN (CONT.) ~ -- ~ ' PURCHASED TERRITORY Covered Original Actual New(N) town & State where the Covered Year Model; Trade Name; Body Type, Auto Cost New Cost & Used(U) ~ No. ~icte Identification Number IN ~ ~ )07-CUMBEP, L^ND CITY PA ~ 1GABL5371 MW256424 6 91 CHEV #5~~~ ~ ~ ~HEV #54 ~ 7 IGIBL5378NRI45059 ~ ~ )07-CUMBERLAND CITY )A ~ }1 FORD #60 ~ 8 2FACP72F4MXI76971 ~ ~ )07-CUMBERLANDCITY ~ I G I BN51E5KA 106872 ) )07-HARRISBURG ?A 9 39 CHEVY #77 ~ ~ ~ ?A ~ )4 CHEVY #2 ~ l0 IGIBL52PXRRI35544 )==~.~== ~ ~07-HARRISBURG Primary Rating damage loss is payable to you and '=='='"'~"~'1 Business use Size ' Secondary the loss payee named below as Covered Radius of ' s = se~ca GVVV Age Facto~ Auto Operation ' = retail or C-.-.-.-.-.-.-.-.-.~p ~ ~ Rating Code Interests may appear at the time No. : = co. ,-¢~adal GCW Factor of the loss. ~ ~ ~ ~ ~-- ).00 1189 6 LDIST-PFL LIGHT $ 1.00 1.00 7 LDIST-PFL LIGHT 6 1.00 [.00 ).00 1189 8 LDIST-PFL ~IGHT 6 i.00 1.00 ).00 ~i89 9 LDIST-PFL ~ ~iGHT I0 ~ LIGHT ~ 1.00 ).00 4189 COVERAGES - PREMIUMS, LIMITS & DEDUCTIBLES (Absence of a deductible or limit entry in any column ~ondin ITE. M ? colu~ Covered below means that the lirnit or deductible en ~ ~ ~ ~=~' .... Auto ~ ~~l~&~ Premium Limit*' Pref~ura No. Limit~ Premium Deductible* Pren'ium Premium Deductible* TOTA& PREMIUM ~20t808 ;624 COVERAGES - PREMIUMS, UMITS & DEDUCTIBLES {Absence of a deductible or limit entry in an~ column . ' ' deduc'dble ~nt in the corresponding ITI=M 'BNO column applies in~tead.) below means that the hm,t or deau~me en~ t~__~.n_t_n~ . _ ......... ~ ............ .~overed ~ ~ ~ Limit Per Auto Limit** minus Limit** Deductible Premium Disablement Premium No. Deductible Premium Premium ____.._.._,.,-- TOT, N. .......... ~, .... k ...tr..kl. D ! P Added P. I- P. or P. P. L · Limit stated in each app "Limit stated In ITEM TWO. CA t90 SCHEDUL OF CovERED AUTOS YOU INN EXTENSION OF DECLARATIONS ITEM THREE ,~ONT.) SCHEDULE OF COVERED AU IU~ TLJU vvv~[ ....... Covered Original Actual New(N) Town & State where the Covered Auto Year Model; Trade Name; Body Type, Cost New Cost & Used(U) No. ~cle Identification Number N ~ D07-HARRISBURG PA ~ ~8 CHEVY #4 IGIBNSI21.1RI45025 ~ 007-HARRISBURG PA ~y #3 IG1BLSI6XJRI75166 damage loss is payable to you and '--~ '"'"'~'--~ Business use ng ~o,,, ~ the loss payee named below., as Operation I r = retail , -., .... Interests may appear at the t~ne ~,uto Liability Damage Factor of the loss. c = comme~iat GCW No. 1.00 ].00 0.00 4159 ! 1 LDIST-PFL ..---------. LIGHT 1:2 bDIST-PFL ~ LIGHT COVERAGES - PREMIUMS, LIMITS & DEDUCTIBLES (Absence of a deductible or limit entry in any column c~r~ below means that the limit o{.d.ed~ in the correspondi iTE_M _ .TV~O. colu~nstead.~ No~ Limit..,~ Premium Deductible* Pmmi~ Premium Deductible* Premiu....~...m Limit' Premium ;52 ~ --''"'--'-"' ~ '----'" 12 $1 73~4 ._.__..._._. TOTAL >REMlUM ~;20r808 ;624 COVERAGES - PREMIUMS, LIMITS & DEDUCTIBLES (Absence of a deductible or limit entry in any column below means that the limit or deductible entry in the corresponding ITEM TVVO column applies instead.) Auto Limit-- minus Limit" Premium No. Deductible Premium Premium Deductible Premium Disablement *, **Limit stated In ITEM TWO. CA 190 MANUSCRIPT ENDORSEMENT A THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Endorsement Effective Named Inusred WEST SHORE REGIONAL TRANSPORTATION IPolicy Number TCA0002685 Countersigned By PENNSYLVANIA ADDED FIRST PARTY BENEFITS LIMIT OF LIABILITY ENDORSEMENT form CA 22 38 03 95 is amended to read: The Schedule of Benefits specified in Endorsement No. BASIC FIRST PARTY BENEFIT is changed as follows: SCHEDULE As indicated below, Added First Party Benefits apply instead of the Basic First Party Benefit. The limits of liability shown for the benefits selected below replace the limits of liability shown in the Schedule for Basic First Parbj Benefit. Benefits Limit of Liability (per insured) [] Added First Party Benefits Applicable only to an insured who is the operator of the covered "auto" at the time of the "accident" Medical Expense Benefits Work Loss Benefits Funeral Expense Benefits Accidental Death Benefits 2. Applicable only to an insured who is not the operator of the covered "auto" at the time of the "accident" Medical Expense Benefits Work Loss Benefits Funeral Expense Beneffis Accidental Death Benefits Up to $ 10,000. Up to $ N/A. subject to a maximum Up to $ NOT COVERED $ NOT COVERED Up to $ 25,000. Up to $ 10,000. subject to a maximum of $ 1,000. per month Up to $ NOT COVERED $ NOT COVERED AC3-102 POLICY NUMBER: TCA0002685 COMMERCIAL AUTO CA 21 92 09 97 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PENNSYLVANIA UNINSURED MOTORISTS COVERAGE - NONSTACKED For a covered "motor vehicle" licensed or principally garaged in, or "garage operations" conducted in, Pennsyl- vania, this endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indi- cated below: Named Insured: _ I WEST SHORE REGIONAL TRANSPORTATION Countersigned By: SCHEDULE (Authorized Representative) $ 35 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. Coverage 1. We will pay all sums the "insured" is legally entitled to recover as compensatory damages from the owner or ddver of an "uninsured mo- tor vehicle". The damages must result from "bodily injury" sustained by the "insured" caused by an "accident". The owner's or driver's liability for these damages must result from the ownership, maintenance or use of an "uninsured motor vehicle". 2. No judgment for damages arising out of a "suit" brought against the owner or operator of an "uninsured motor vehicle" is binding on us unless we: a. Received reasonable notice of the pen- dency of the "suit" resulting in the judg- ment; and b. Had a reasonable opportunity to protect our interests in the "suit". B. Who Is An Insured 1. You. 2. If you are an individual, any "family member". 3. Anyone else "occupying" a covered "motor vehicle" or a temporary substitute for a cov- ered "motor vehicle". The covered "motor ve- hicle" must be out of service because of its breakdown, repair, servicing, "loss" or destruc- tion. 4. Anyone for damages he or she is entitled to recover because of "bodily injury" sustained by another "insured". C. Exclusions This insurance does not apply to any of the follow- ing: 1. Any claim settled without our consent. How- ever, this exclusion does not apply if such set- tlement does not adversely affect our fights of recovery under this coverage. CA 21 92 09 97 Copyright, Insurance Services Office, Inc., 1997 Page t of 3 The direct or indirect benefit of any insurer or self-insurer under any workers' compensation, disability benefits or similar law. Anyone using a vehicle without a reasonable belief that the person is entitled to do so. Punitive or exemplary damages. "Bodily injury" sustained by: a. You while "occupying" or when struck by any vehicle owned by you that is not a cov- ered "auto" for Uninsured Motorists Cover- age under this Coverage Form; b. Any "family member' while "occupying" or when struck by any vehicle owned by that "family member' that is not a covered "auto" for Uninsured Motorists Coverage under this Coverage Form; or c. Any "family member" while "occupying" or when struck by any vehicle owned by you that is insured for Uninsured Motorists Coverage on a pdmary basis under any other Coverage Form or policy. Of Insurance Regardless of the number of covered "motor vehicles", "insureds", premiums paid, claims made or vehicles involved in the "accident", the most we will pay for all damages resulting from any one "accident" is the Limit Of Insur- ance for Uninsured Motorists Coverage shown in the Schedule or Declarations. Any amount payable for damages under this coverage shall be reduced by all sums paid by or for anyone who is legally responsible. This includes all sums paid for the same damages under this Coverage Form's Liability Cover- age. This also includes all sums paid for an "insured's" attorney either directly or as part of the amount paid to the "insured". No one will be entitled to receive duplicate payments for the same elements of "loss' un- der this Coverage Form and any Liability Cov- erage Form, Medical Payments Coverage en- dorsement or Underinsured Motorists Cover- age endorsement attached to this Coverage Part. We will not make. a duplicate payment under this Coverage for any element of "loss" for which payment has been made by or for any- one who is legally responsible. We will not pay for any element of "loss" if a person is entitled to receive payment for the same element of "loss" under any wod~ers' compensation, disability benefits or similar law. D. Umit 1. E. Changes In Conditions The Conditions are changed for Pennsylvania Uninsured Motorists Coverage - Nonstacked as follows: 1. Duties In The Event Of Accident, Claim, Suit Or Loss is changed by adding the follow- ing: a. Promptly notify the police if a hit-and-run driver is involved, and b. Promptly send us copies of the legal papers if a "suit" is brought. 2. Transfer Of Rights Of Recovery Against Others To Us is changed by adding the follow- ing: If we make any payment due to an "accident" involving an "uninsured motor vehicle" and the "insured" recovers from another party in a separate claim or "suit", the "insured" shall hold the proceeds in trust for us and pay us back the amount we have paid less reasonable attorneys' fees, costs and expenses incurred by the "insured" to the extent such payment duplicates any amount we have paid under this coverage. 3. Other Insurance in the Business Auto and Garage Coverage Forms and Other Insur- ance - Primary And Excess Insurance Pro- visions in the Truckers and Motor Carrier Coverage Forms is replaced by the following: a. If there is other applicable similar insurance available under more than one Coverage Form or policy, the following priorities of recovery apply: First Second The Uninsured Motorists Coverage applicable to the vehicle the "insured" was "occupying" at the time of the "accident". The Coverage Form or policy affording Uninsured Motorists Coverage to the "insured" as a named insured or family member. b. Where there is no applicable insurance available under the first priority, the maxi- mum recovery under all Coverage Forms or policies in the second priority shall not exceed the high~st applicable limit for any one vehicle under any one Coverage Form or policy c. Where there is applicable insurance avail- able under the first priority: (1) The Limit Of Insurance applicable to the vehicle the "insured" was "occupying" under the Coverage Form or policy in the first priority, shall first be exhausted; and Page 2 of 3 CopyrigM, Insurance Services Office, Inc., 1997 CA 21 92 09 97 [] (2) The maximum recovery under all Cov- erage Forms or policies in the second priority shall not exceed the amount by which the highest limit for any one ve- hicle under any one Coverage Form or policy in the second priority exceeds the limit applicable under the Coverage Form or policy in the first priority. d. If two or more Coverage Forms or policies have equal priority: (1) The insurer against whom the claim is first made shall process and pay the claim as if wholly responsible for all in- surers with equal priority; (2) The insurer thereafter is entitled to recover pro rata contribution from any other insurer on the same level of prior- ity for the benefits paid and the costs of processing the claim; and (3) If we are the insurer against whom the claim is first made, we will pay, subject to the limit of insurance for Uninsured Motorists Coverage shown in the Decla- rations, after all contributing insurers agree as to: (a) Whether the "insured" is legally entitled to recover damages from the owner or driver of an "uninsured motor vehicle"; and (b) The amount of damages. 4. The following condition is added: ARBITRATION a. If we and an "insured" disagree whether the "insured" is legally entitled to recover dam- ages from the owner or driver of an "uninsured motor vehicle" or do not agree as to the amount of damages that are re- coverable by that "insured", then the matter may be arbitrated. Either party may make a written demand for arbitration. In this event, each party will select an arbitrator. The two arbitrators will select a third. If they cannot agree within 30 days, either may request that selection be made by a judge of a court having jurisdiction. Each party will pay the expenses it incurs and bear the ex- penses of the third arbitrator equally. b. Arbitration shall be conducted in accor- dance with the Pennsylvania Uniform Arbi- tration Act. Unless both parties agree oth- erwise, arbitration will take place in the county in which the "insured" lives. Local roles of law as to arbitration procedure and evidence will apply. A decision agreed to by two of the arbitrators will be binding. F. Additional Definitions As used in this endorsement: 1. "Family member" means a person related to you by blood, marriage or adoption who is a resident of your household, including a ward or foster child. 2. "Occupying" means in, upon, getting in, on, out or off. 3. "Uninsured motor vehicle" means a land motor vehicle or trailer: a. For which no liability bond or policy applies at the time of an "accident". b. For which an insudng or bonding compan.y: (1) Denies coverage; (2) Is or becomes insolvent; or (3) Is or becomes involved, in' insolvency proceedings. c. That is a hit-and-mn vehicle and neither the driver nor owner can be identified. The ve- hicle must: (1) Hit an "insured", a covered "motor ve- hicle" or a vehicle an "insured" is "occupying"; or (2) Cause an "accident" resulting in "bodily injury" to an "insured" without hitting an "insured", a covered "motor vehicle" or a vehicle an "insured" is "occupying". If there is no physical contact with the hit- and-mn vehicle, the facts of the "accident" must be proved. However, an "uninsured motor vehicle" does not include any vehicle: a. Owned or operated by a self-insurer under any applicable motor' vehicle law, except a self-insurer who is or who becomes insol- vent and cannot provide the amounts re- quired by that motor vehicle law; b. Owned by a governmental unit or agency; or c. Designed for use mainly off public roads while not on public roads. 4. "Motor vehicle" means a vehicle which is self- propelled except one which is propelled solely by human power or by electdc power obtained from overhead trolley wires, but does not mean a vehicle operated upon tellS. CA 21 92 09 97 Copyright, Insurance Services Office, Inc., 1997 Page 3 of 3 POLICY NUMBER: TCA0002085 COMMERCIAL AUTO CA 21 93 09 97 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PENNSYLVANIA UNDERINSURED MOTORISTS COVERAGE - NONSTACKED For a covered "motor vehicle" licensed or principally garaged in, or "garage operations" conducted in, Pennsyl- vania, this endorsement modifies insurance provided under the follOwing: BUSINESS AUTO COVERAGE FORM "' GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM' TRUCKERS COVERAGE FORM .-.- With respect to coverage provided by this endorsement, the provlsibns of the Coverage Form apply unless modified by the endorsement. - This endorsement changes the policy effective'on the inception date of the policy unless another date is indi- cated below: (Authorized Representative Countersigned By: IEndorsement Effective: _ Named Insured: WEST SHORE REGIONAL TRANSPORTATION SCHEDULE LIMff OFINSURANCE $35 ,. Each "Accident" (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) · A. Coverage ; ':',' 1. We will pay all sums the "ins[~red* is' legally entitled to recover as C°mpansa._.t~_. ~! .a...m,.., ages from the owner or driver of an undednsured motor vehicle". The damages 'must result from 'bodily ihjury" sustained by the ."ins. ured' caused by an "accident". The owner's or driver's liability for these damages must result from the ownership.'maintenance Or use of an "underinsured motor vehicle". 2. We will pay under this coverage only if a. or b. below applies: a. The limits of any applicable liability bonds or policies have been-exhausted' by judg- ments or payments; or b. A tentative settlement has been made between an "insured" and the insurer of the. "underin.sured motor vehicle" and?e:? : (1) Have been given prompt w~ittee notice of such tentative settlement; and (2) Advance payment to the "iqS~J~ed" in an amount equal to the tentativp settlement within 30 days after receipt of no~tifica- tion.. 3. No judgment for damages adsL.ng out of a "suit" brought against the owner, or '_operator of an "u_ndednsured motor vehicle is binding on us unless we: a. Received reasonable notice of the pen- dency of the "suit" resulting in the judg- ment; and - - b. Had a reasonable opportunity to protect our interests in the "suit". CA 21 93 09 97 Copyright, Insurance Services Office, Inc., 1997 Page I of 4' B. Who Is An Insured 1. You. 2. If you are an individual, any "family member". 3. Anyone else "occupying" a covered "motor vehicle", or a temporary substitute for a cov- ered "motor vehicle". The covered "motor ve- hicle'' must be out of service because of its breakdown, repair, servicing, "loss" or dest~'uc- tion. ~ Anyone for damages he or she is entitled 'to recover because of "bodily injury" sustained by another "insured". C. Exclusions This insurance does not apply to any of the follow- ing: 1. The direct or indirect benefit of any insurer or --.-. self-insurer- under any workers' compensat!on, disability benefits or similar law. 2. Anyone using a vehicle without a reasonable belief that the person is entitled to do so. 3. Punitive or exemplary damages. 4'-:- "Bodily'injury" sustained by: a. You while "occupying" or when struck by any vehicle owned by you that is not a cov- ered "auto" for Underinsured Motorists ".._ _ Coverage under this Coverage Form; . b. Any "family member" while "occupying" or when struck by any vehicle owned by that 3. No one will be entitled to receive duplicate payments for the same elements of "loss" un- der this Coverage Form and any Liability Coy- era(j~ Form, Medical Payments Coverage en- dorsement or Uninsured Motorists Coverage endorsem, ent attached to this Coverage Part. · ,We will. not make a duplicate payment under "thi~ COverage for any element of "loss" for which payment has been made by or for any- .. one.who is legally responsible. We will not pay for any element of "loss" if a person is entitled to receive payment for the same element of "loss" under any workers' compensation, disability benefits or similar law. E. Changes In Conditions The Conditions are Changed fOr 15ennSylvania Un- derinsured Motorists Coverage - Nonstacked as follows:...: 1. Duties In The Event O! Accident, Claim, Suit Or Loss is changed by adding the follow- ing: a. Promptly send us copies of the legal papers if a "suit" is brought. b. A person seeking Underinsured Motorists . Coverage must also promptly notify us, in writing, of a tentative settlement between .the ,insured" and the insurer of the - -- '- "underinsured motor vehicle" and allow- us 30 days to advance payment to the "insured" in an amount equal to the tenta- "auto" for Undednsured Motorists Coverage _..under this Coverage Form; or c. Any "family member while "occupying" or ........ when struck by any. vehicle owned by you _ :;,.:.;.::~ ,that is insured for Undednsured Motorists Coverage on a primary basis under any .;: .~ o~_er Coverage .,Form or policy. D. UmitOf Insurance 1. Re~iess of the number of' COvered "motor "~"-'vehicles", "insureds", premiums paid, claims made or vehicles ~ involved in the "accident", -- - the most we will pay for all damages resulting . ..: fro..m~ any one accident is the Limit Of Insur- ~ ance for UndedpsUred Motorists Coverage .... ~hOwn in the SChedule or Declarations. ~ 2, The Limit of Insurance under, this coverage :e .;.shail. be' reduced by ali sums paid by or for · ? } any'6he who is legally responsible. This in- ' cludes all sums paid fOr the s.ame damages under this Coverage Form's Liability Cover- ~;~:~ ~ge. This also includes all sums paid for an '~' ~ "insured's" attorney either directly or as part of the amount paid to the "insured". __."family member" that is not a .covered .... tive_ settlement to preserve our rights against the insurer, owner or operator of _such "un_derinsured motor vehicle".. 2, Transfer Of Rights Of Recovery Against . - · Others To Us is changed by adding the follow- · Lng: _ If we make any payment due to an *accident" involving an "underinsured motor vehicle" and . the "insured~' recovers from another party in a .'seParate'claim.°r "suit", the "insured" shall hSid the proceeds in trust for us and pay us beck the amount we have paid less reasonable attorneys' fees, costs and expenses incurred by the "insured" to the extent such payment .. ~ duplicates anyamount we have paid under this cov. erage. Our rights do not apply .under this provision : * with .ras. p.e.c.t to Underinsured Motorists Cover- age if we! . ...a. Have been given prompt written notice of a · :, tentative settlement between an "insured" ~ ** and the insurer of an "underinsured motor vehicle"; and page 2 of 4 Copyright, Insurance Services Office, Inc., 1997 CA 21 93 09 97 E! b. Fail to advance payment to the "insured" in an amount equal to the tentative settlement within 30 days after receipt of notification. If we advance payment to the "insured" in an amount equal to the tentative settlement within 30 days after receipt of notification: a. That payment will be separate from any amount the "insured" is entitled to recover under the provisions of Undednsured Mo- torists Coverage; and .- , b. We also have a right to recover the ad- vanced payment. · . 3. Other Insurance in the Business Auto and Garage Coverage Forms and Other Insur- ance - Primal/And Excess Insurance Pro- visions in the Truckers and Motor Carrier Coverage Forms is replaced by the following: a. If there is other applicable similar insurance available under more than one Coverage Form or policy, the following priorities of recovery apply: First Second The Underinsured Motorists Coverage applicable to the Vehicle the "insured" was "occupying" at the time of the "accident". The Coverage Form or policy affording Underinsured Motorists Coverage to the "insured" as a named insured or family member. b. Where there is no applicable insurance available under the first priority, the maxi- mum recovery under all Coverage Forms or policies in the second priodty shall not exceed the highest applicable limit for any one vehicle under any one Coverage Form or policy. c. Where there is applicable insurance avail- able under the first priority: (1) The Limit Of Insurance applicable to the vehicle the "insured" was "occupyir~" under the Coverage Form or policy in the first priority, shall first be exhausted; and (2) The maximum recovery under all Cov- erage Forms or policies in the second priority shall not exceed the amount by which the highest limit for any one ve- hicle under any one Coverage Form or policy in the second pdority exceeds the limit apl)lie, able under the Coverage Form or policy in the first priority. d. If two or more Coverage Forms or policies have equal priority: (1) The insurer against whom the claim is first made shall process and pay the claim as if wholly responsible for all in- surers with equal priority; (2) The insu[er thereafter is entitled to recover pro rata contribution from any other insurer for the benefits .paid and the costs of processing the claim; and (3) If we are the insurer against whom the claim is first made, we will pay, subject tO the limit of insurance for Underin- sured Motorists Coverage. shown in the Declarations, after all contributing insur- ers agree as to: (a) Whether the "insured" is legally entitled to recover damages from the owner or driver of an "underinsured motor vehicle"; and (b) The amount of damages. 4. The following Condition is added: ARBITRATION a. If we and an "insured" disagree whether the "insured" is legally entitled to recover dam- ages from the owner or driver of an "underinsured motor vehicle" or do not agree as to the amount of damages that are recoverable by that "insured", then the matter may be arbitrated. Either party may make a wdtten demand for arbitratiOn. In this event, each party will select an arbitra- tor. The two arbitrators will select a third. If they cannot agree within 30 days, either may request that selection be made by a judge of a court having jurisdiction. Each party will pay the expenses it incurs and bear the expenses of the third arbitrator equally. b. Arbitration shall be conducted in accor- dance with the Pennsylvania Uniform Arbi- tration Act. Unless both parties agree oth- enNise, arbitration will take place in the county in which the "insured" lives. Local rules of law as to arbitration procedure and evidence will apply. A decision agreed to by two o! th.e arbitrators will be binding. -- CA 21 93 09 9'7 Copyright; Insbi'a~nc, e Services Office; Inc:,' ;1997 Page 3 of 4 F. Additional Definitions As used in this endorsement: 1: "FamilY member" means a person related to you b~': blood, marriage or adoption who is a resident of ybur househo!d, including a ward or foster child. 2. "Occupying" means in, upon, getting in, on, out or off. 3. "LJnderinsured motor vehicle" means a vehicle for which the sum of all liability bonds or poli- 'cies that apply at the time of an "accident" do ',: not P~0vide at least the*amount, an "insured" is ' '"leg,allY entitled to reCOVer as damages. However, an i'undefinsured motor vehicle" does not include any vehicle: a. Owned'or operated by a self-insurer under any applicable motor vehicle law;- b. Owned'by a governmehtal unit or agency; or c. Designed for use mainly off public· roads while not'On public roads: "MOi0r vehicle" means a vehicle which is self- propelled except one which is propelled solely by human power or by electric' power obtained from overhead trolley wires, bbt~:does not mean a vehicle operated upon rails. · :~..~. _,..'-: ~.'.: . Page 4 of 4 Copyright, Insurance Sewices Office, Inc., 1997 CA 2193 09 97 1:3 POLICY NUMBER: TCA0002685 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, this endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below: Endorsement effective Named Insured Countersigned by WEST SHORE REGIONAL (Authorized Representative) SCHEDULE IBenefits Limits of Liability (per insured) Medical Expense Benefits Up to $5,000 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations 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'' adsing 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 for an "insured's": 1. Care; 2. Recovery; or 3. Rehabilitation. This includes remedial care and treatment ren- dered in accordance with a recognized religious method of healing. Medical expenses will be paid if incurred within 18 months from the date of the "accident" caus- ing "bodily injury". If within 18 months from the date 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". 4. Any person while not "occupying" an "auto" if injured as a result of an "accident" in Pennsylvania involving a covered "auto". 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 dsk of in jury. CA 22 37 03 95 Copyright, Insurance Services Office, Inc., 1994 Page I of 3 C. EXCLUSIONS We 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". $. 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 "auto" 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 residence or premises. 7. Sustained by a pedestrian if the"accident" occurs outside of Pennsylvania. This exclu- sion does not apply to: a. You; or b. Any"family member". 8. Sustained by any person while "occupying": a. A recreational vehicle designed for use off public roads; or b. A motorcycle, moped or similar type vehicle. 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 limit shown in the Schedule or in the Declarations. 2. Any amount payable under First Party Bene- fits shall be excess over any sums paid, payable 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-DUPMCATION OF BENEFITS No person may recover duplicate benefits for the same expenses or loss under this or any other similar automobile coverage including self-insurance. Page 2 of 3 Copyright, Insurance Services Office, Inc., 1994 CA 22 37 03 95 First Second Third Fourth 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 Iow- est level of priority. The priodty order is: The insurer providing benefits to the "insured" as a named insured. 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". The insurer of the "auto" which the "insured" is "occupying" at the time of the "accident". The insurer providing beneffis on any "auto" involved in the "accident" if the "insured" is: a. Not "occupying" an "auto"; and b. Not provided First Party Benefffs under any other policy. If two or more policies have equal pdority within the highest applicable number in the pdority order: 1. The insurer against whom the claim is first made shall process and pay the claim as if wholly responsible; 2. If we are the insurer against whom the claim is first made, our payment to or for an "insured" will not exceed the applica- ble limit shown in the Schedule or Declarations; Fo 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. 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 Vehicle 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 off. CA 22 37 O3 95 Copyright, Insurance Services Office, Inc., 1994 Page 3 of 3 POLICY NUMBER: TCA0002685 COMMERCIAL AUTO CA 22 38 03 95 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PENNSYLVANIA ADDED AND COMBINATION FIRST PARTY BENEFITS ENDORSEMENT This endorsement modifies insurance provided under the following: PENNSYLVANIA BASIC FIRST PARTY BENEFIT 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 policy unless another date is indicated below: IEndorsement effective Named Insured WEST SHORE REGIONAL Countersigned by (Authorized Representative) BASIC FIRST PARTY BENEFIT is changed as follows: SCHEDULE As indicated below, Added First Party Benefits or Combination First Party Benefits apply instead of the Basic First Party Benefit. The limits of liability shown for the benefits selected below replace the limits of liability shown in the Schedule for the Basic First Party Benefit. Benefits Limit of Liability (per insured) [] Added First Party Benefits Medical Expense Benefits Work Loss Benefits Funeral Expense Benefits Accidental Death Benefits Upto $ 10,000 Up to $ subject to a maximum of $ Up to $ $ per month [] Combination First Party Benefits Maximum Total Limit for All Benefits Subject to the following individual limits: Medical Expense Benefits Work Loss Benefits Funeral Expense Benefits Accidental Benefits Up to $ No specific dollar amount No specific dollar amount Up to $ 2,500 Up to $ (If no entry appears above, informatiOn required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) CA 22 38 03 95 Copyright, Insurance Services Office, Inc., 1994 Page 1 of 2 COVERAGE We will pay Added First Party Benefits or Com- bination First Party Benefits in accordance with the "Act" up to the limits stated in the Schedule or Declarations to or for an "insured" who sus- tains "bodily injury" caused by an "accident" and arising out of the maintenance or use of an "auto". We will only pay Combination First Party Benefits for expenses or loss incurred within 3 years from the date of the "accident". In addition to the Medical Expense Benefits de- scribed in the Basic First Party Benefit endorse- ment, Added First Party Benefits and Combination First Party Benefits also consist of: 1. Work Loss Benefits consisting of: a. Loss of income. Up to 80% of the gross income actually lost by an "insured". b. Reasonable expenses actually incurred to reduce loss of income by hiring: (1) Special help, thereby enabling the "in- sured'' to work; or (2) A substitute to pedorm the work a self-employed "insured" would have performed. However, Work Loss Benefits do not include: a. Loss of expected inco .me for any period following the death of an "insured"; or b. Expenses incurred for services performed following the death of an "insured"; or c. Any loss of income, or expenses incurred for services performed, during the first 5 working days the "insured" did not work after the "accident" because of the "bodily injury". 2. Funeral Expense Benefits. Actual expenses incurred for an "insured's" funeral or burial if "bodily injury" resulting from the "accident" causes his or her death within 24 months from the date of the "accident". 3. Accidental Death Benefits. A death benefit paid if "bodily injury" resulting from an "acci- dent" causes the death of you or any "family member" within 24 months from the date of the "accident". B. EXCLUSIONS In addition to the exclusions in the Basic First Party Benefit endorsement, the following exclu- sion also applies. We will not pay: Accidental Death Benefits on behalf of any per- son who intentionally caused or attempted to cause "bodily injury" to himself, herself or any other person. C. 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 limit shown in the Schedule or the Declarations. Combination First Party Benefits are subject to a maximum total sin- gle limit of liability with individual limits for specific benefits as shown in the Schedule or Declarations. 2. If Combination First Party Benefits are af- forded, we will make available at least the minimum limit required by the "ACt" for the Basic First Party Benefit. This provision will not change our total limit of liability. D. CHANGES IN CONDITIONS In addition to the CONDITIONS applicable to the Basic First Party Benefit endorsement, the fol- lowing CONDITION also applies: PAYMENT OF ACCIDENTAL DEATH BENEFITS The Accidental Death Benefit under this policy will paid to the executor or administrator of the deceased "insured's" estate. If there is no executor or administrator, benefits shall be paid to: 1. The deceased "insured's" surviving spouse; or 2. If there is no surviving spouse, the deceased "insured's" surviving children; or 3. If there is no surviving spouse or surviving children, the d~ce'ased "insured's" estate. Page 2 of 2 Copyright, Insurance Services Office, Inc., 1994 CA 22 38 03 95 COMMERCIAL AUTO CA 24 02 12 93 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PUBLIC TRANSPORTATION AUTOS This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. LIABILITY COVERAGE for a covered "auto" licensed or used to transport the public is changed as fOllows: The CARE, CUSTODY OR CONTROL exclusion does not apply to "property damage" to or "covered pollution cost or expense" involving property of the "insured's" passengers while such property is carded by the covered "auto". CA 24 02 12 93 Copyright, Insurance Services Office, Inc., 1993 FORM F UNIFORM MOTOR CARRIER BODILY INJURY AND PROPERTY DAMAGE LIABILITY INSURANCE ENDORSEMENT It is agreed that: 1. The certification of the policy, as proof of financial responsibility under the provisions of any State motor carrier law or regulations promulgated by any State Commission having jurisdiction with respect thereto, amends the policy to pro- vide insurance for automobile bodily injury and property damage liability in accordance with the provisions of such law or regulations to the extent of the coverage and limits of liability required thereby; provided only that the insured agrees to reimburse the company for any payment made by the company which it would not have been obligated to make under the terms of this policy except by reason of the obligation assumed in making such certification. 2. The Uniform Motor Carrier Bodily Injury and Property Damage Liability Certificate of Insurance has been filed with the State Commissions indicated on the reverse side hereof. 3 This endorsement may not be canceled without cancellation of the policy to which it is attached. Such cancellation may · _ ......... ,.A: ...... '~ 4yin- thi'~'~' t30~ da~,s' notice in writing to the State Commission with which ~ etxecteo Dy me company or u]~ i.~u ~ s :? '- ' : ...... the notice is actuall" re such certificate has been filed, such thirty (30) days not,ce to commence to run irom tne oate y -. ceived in the office of such Commission, Attached to and forming part of policy No. TCAO002685 issuedby , herein called Company, of to Dated at of. this day of Countersigned by 20 O0 Authorized Representative IRB 3538 A M(~1632 (E(L ~-71) ~/~--INDICATES STATE COMMISSIONS WITH WHOM UNIFORM MOTOR CARRIER BODILY INJURY AND PROPERTY DAMAGE LIABILITY CERTIFICATE OF INSURANCE HAS BEEN FILED ALABAMA ILLINOIS ~IONTANA RHODE ISLAND ALASKA INDIANA ~ NEBRASKA SOUTH CAROLINA ~RIZONA IOWA NEVADA SOUTH DAKOTA ARKANSAS KANSAS NEW HAMPSHIRE TENNESSEE CALIFORNIA KENTUCKY NEW JERSEY TEXAS COLORADO LOUISIANA NEW MEXICO UTAH CONNECTICUT MAINE qEW YORK VERMONT DELAWARE MARYLAND NORTH CAROLINA VIRGINIA DISTRICT OF COLUMBIA MASSACHUSETTS NORTH DAKOTA WASHINGTON FLORIDA MICHIGAN OHIO WEST VIRGINIA GEORGIA MINNESOTA OKLAHOMA WISCONSIN HAWAII MISSISSIPPI OREGON WYOMING IDAHO MISSOURI [ PENNSYL V ANIA Rejection of Uninsured Motorist Protection A. By signing this waiver, I am rejecting uninsured motorist coverage under this policy, for myself and all relatives residing in my household. Uninsured coverage protects me and relatives living in my household for losses and damages suffered if injury is caused by the negligence of a driver who does not have any insurance to pay for losses and damages. I knowingly and voluntarily reject this co~,erage. Signature of First Named Insured Date Bo Rejection of Stacked Uninsured Coverage Limits By signing this waiver,-i'am rejecting stacked limits of uninsured motorist coverage under the policy for myself and members Of my bous~h°ld under which the limits of coverage available would be the sum of Hmits for each motor vehicle insured under the policy. Instead the limits of coverage that I am purchasing shall be reduced to tho limits statod ill the policy. I knowingly and voluntarily rejec~ the stacked limits :- of coverage. I understaad that my prem~-m-~ will be reduced if I reject this coverage. ' . ..-..:~ ?"-..t $:; :'-" ' - :.-,. * .. , Signature of Firs~ Named Insured · ·:. '7 "!?'";~-';~: c"t:~;' - _ , _-- · : . ih., Dale : ~.. '.~'".--,-~.'- (Blue Sheet) · UA 104 (E=, 5-90) UNIF0~M I~RINTING & ~UPP~Y. INC, _- Rejection of Underinsured Motorist Protection A. By signing this waiver, I am rejecting underinsured motorist coverage under this policy, for myself and all relatives residing in my household. Underinsured coverage protects me and relatives living in my house- hold for losses and damages suffered if injury is caused by the negligence of a driver who does not have enough insurance to pay for all losses and damages. I knowingly and voluntarily reject this coverage. Signature of First Named Insured Date Rejection of Stacked Underinsured Coverage Limits B. By signing this waiver, I am rejecting stacked limits of underinSured motorist coverage under the policy for myself and members of my household under which the limits of coverage available would be the sum ofllmits for each motor vehicle insured under the policy. Instead the ]imlts of coverage that I am purehas- ing shall be reduced to the limits stated in the policy. I knowingly and voluntarily reject the stacked limits of coverage. I understand that my premium will be reduced if I reject this coverage. Signature of First Named Insured Date UA lOS {Id. ~-°o0) UNIFORM pRINTING AND SUP~LY. INC. (Green Sheet) NOTICE OF CANCELLATION DUE TO NONPAYMENT OF PREMIUM AMERICAN COUNTRY INSURANCE CO. 222 N. ,.~s~ S~RE~, su~ 1~oo ~O¢~a CHic~o, ~ ~0~01-1105 ~12-~-2000 9/22/00 NailTo: WEST SHORE REGIONAL TRANSPORTATION 50 M3%RKET STREET LEMOYNE PA 17043 T.~rec]Z~me anc]~a'~''ess WEST SHORE REGIONAL TRANSPORTATION 50 MARKET STREET I~lq~-E PA 17043 TCA0002685 4/19/00 at 12:01 a.m. BUSINESS Ab-TO POLICY 10/25/00 at 12:01 a.m. $ 10,024.00 We have not received your Premium Payment. If payment of the amount past due is received before the cancellation date above and approved by the company, you will receive notification that your policy will be reinstated with no lapse in coverage. You are a valued customer and we hope to receive your pay- ment so that coverage will continue without interruption. If your payment has been paid, thank you and please disregard this notice. ~t ~ ~ ~SS 10250 RESEARCH UNDERWRITERS 4240 GREENSBURG PIK~ P I~'~SBURG PA 15221 INSURED'S COPY SHERIFF'S RETURN CASE NO: 2002-02024 P COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND AMERICAN COUNTRY INSURANCE CO VS WEST SHORE REGIONAL TR3LNSPORT - REGULAR CPL. MICHAEL BARRICK , Sheriff or Deputy Sheriff of Cumberland County,Pennsylvania, who being duly sworn according to law, says, the within COMPLAINT & NOTICE was served upon WEST SHORE REGIONAL TRANSPORTATION the DEFENDANT , at 1218:00 HOURS, at 50 MARKET STREET LEMOYNE, PA 17043 on the 29th day of April , 2002 by handing to CLYDE BACHENT, OWNER a true and attested copy of COMPLAINT & NOTICE together with and at the same time directing His attention to the contents thereof. Sheriff's Costs: Docketing 18.00 Service 11.04 Affidavit .00 Surcharge 10.00 .00 39.04 Sworn and Subscribed to before me this /Y ~ day of  L~ ~.L~ A.D. ~r6thonotary · ' So Answers: R. Thomas Kline ~/ 05/02/2002 _ ,,// GRIEST HIMES HER~ y/ / F~/', Deputy ~%~riff ~ ~- IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA AMERICAN COUNTRY INSURANCE CO. Plaintiff V$ WEST SHORE REGIONAL TRANSPORTATION : NO. 02-2024 Civil Term : : CIVIL ACTION - LAW : JURY TRIAL DEMANDED TO: West Shore Regional Transportation 50 Market Street Lamoyne, PA 17043 Date of Notice: May 29, 2002 IMPORTANT NOTICE YOU ARE IN DEFAULT BECAUSE YOU HAVE FAILED TO ENTER A WRITTEN APPEARANCE PERSONALLY OR BY ATTORNEY AND FILE IN WRITING WITH THE COURT YOUR DEFENSES OR OBJECTIONS TO THE CLAIMS SET FORTH AGAINST YOU. UNLESS YOU ACT WITHIN TEN (10) DAYS OF THE DATE OF THIS NOTICE, A JUDGMENT MAY BE ENTERED AGAINST YOU WITHOUT A HEARING AND YOU MAY LOSE YOUR PROPERTY OR OTHER IMPORTANT RIGHTS. YOU SHOULD TAKE THIS NOTICE TO A LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE FOLLOWING OFFICE TO FIND OUT WHERE YOU CAN GET LEGAL HELP. Cumberland County Court Administrator 4th Floor, Cumberland County Court House Carlisle, PA 17013 (717) 240-6200 GRIEST, HIMES,HERROLD, SCHAUMANN, LLP ~lC~e. 1 C.'?And3rson~ Esqu' Sup. Ct. I.D. No. 85539 129 East Market Street York PA 17401 (717) 846-8856 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA AMERICAN COUNTRY INSURANCE CO. Plaintiff VS WEST SHORE REGIONAL TRANSPORTATION : NO. 02-2024 Civil Term : _. : : CIVIL ACTION - LAW : JURY TRIAL DEMANDED CERTIFICATE OF SERVICE I, Michael C. Anderson, Esquire, a member of the law firm of Griest, Himes, Herrold, Schaumann, LLP, Esquires, hereby certify that a copy of the foregoing Default Notice was served upon the following on the date shown below by United States first class mail, postage prepaid: West Shore Regional Transportation 50 Market Street Lamoyne, PA 17043 GRIEST, HIMES,HERROLD, SCHAUMANN, LLP Mich~, C.~ Anderson, Esquire Sup. Ct. I.D. No. 85539 129 East Market Street York PA 17401 (717) 846-8856 Dated: May 29, 2002 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA AMERICAN COUNTRY INSURANCE CO. Plaintiff vs WEST SHORE REGIONAL TRANSPORTATION : NO. 02-2024 Civil Term : : _. : CIVIL ACTION - LAW _. : : JURY TRIAL DEMANDED pRAECIPE FOR DEFAULT JUDGMENT TO THE PROTHONOTARY OF CUMBERLAND COUNTY: ENTER JUDGMENT in the above case for enter, an answer or appearance against TRANSPORTATION, Defendant, and in favor INSURANCE CO., Plaintiff, for the sum of: failure to file, or WEST SHORE REGIONAL of AMERICAN COUNTRY Amount requested per Complaint Interest from October 25, 2001, to July 1, 2002 $5,760.00 728.60 TOTAL $6,488.60 together with interest In addition, this will certify that the required 10-day notice was given to the Defendants by first class, postage pre- paid mail on May 29, 2002. ~re Attorney for Plaintiff, Sup Ct. ID No. 85539 J ~4~/ ~ ,2002, judgment entered by Prothonot%ry this day according to the tenor of the/~ove statement. Prothonot~ry~ the IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA AMERICAN COUNTRY INSURANCE CO. Plaintiff V$ WEST SHORE REGIONAL TRANSPORTATION TO: West Shore Regional Transportation 50 Market Street Lamoyne, PA 17043 : NO. 02-2024 Civil Term ._ : CIVIL ACTION - LAW JuRY Tmn Date of Notice: May 29, 2002 YOU AR~: .YN DEFAULT BECAUSE YOU HAVE FAILED TO ENTFR A WRITTEN APPEAiLa3qCE PERSONALLY OR BY ATTORNEY ANO FILE 1N WRITING WITH THE COURT YOUR DEFENSES OR OBJECTIONS TO THE CLAIMS SET FORTH AGAINST YOU. UNLESS YOU ACT WITHIN TEN (10) DAYS OF THE DATE OF THIS NOTICE, A JUDGMENT MAY BE ENTERED AGAINST YOU WITHOUT A HEARING AND YOU MAY LOSE YOUR PROPERTY OR OTHER IMPORTANT RIGHTS. YOU SHOULD TAKE THIS NOTICE TO A LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE FOLLOWING OFFICE TO FIND OUT WHERE YOU CAN GET LEGAL HELP. Cumberland County Court Administrator 4th Floor, Cumberland County Court House Carlisle, PA 17013 (717) 240-6200 GRIEST, HIMES,HERROLD, SCHAUMANN, LLP Mic~l C. Anderson, Esquire Stip. Ct. I.D. No. 85539 129 East Market Street York PA 17401 (717) 846-8856 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA AMERICAN COUNTRY INSURANCE CO. Plaintiff VS WEST SHORE REGIONAL TRANSPORTATION NO. 02-2024 Civil Term CIVIL ACTION - LAW JURY TRIAL DEMANDED CERTIFICATE OF SERVICE I, Michael C. Anderson, Esquire, a member of the law firm of Griest, Himes, Herrold, Schaumann, LLP, Esquires, hereby certify that a copy of the foregoing Default Notice was served upon the following on the date shovm below by United States first class mail, postage prepaid: West Shore Regional Transportation 50 Market Street Lamoyne, PA 17043 GRIEST, HIMES,HERROLD, SCHAUMANN, LLP Mich~ C.~ Anderson, Esquire Sup~. Ct. I.D. No. 85539 129 East Market Street York PA 17401 (717) 846-8856 Dated: May 29, 2002 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA AMERICAN COUNTRy INSURANCE CO. Plaintiff vs WEST SHORE REGIONAL TRANSPORTATION : NO. 02-2024 ; ; ; ~ CIVIL ACTION _ LAW JURY TRIAL DEMANDED NOtice is hereby given that a JUDGMENT in the abOVe. ca~tioned matter has been entered against you in the amount of $6,488.60 on ~ (x) A co~y of · 2002. all documents filed With the Prothonotary in su~ort of the Within Jud~nent /S/are enc ed. If you have any question~ the filing ~)arty: regarding this NOtice, ~lease Contact Michael C. Anderson, Esquire GRIEST, HIMES, ~ERROLD, SCHAUMANN, LLP 129 East Market Street (This NOtice is given in h 46-8856 NOTICE SENT TO: aCCordance with Pa.R.C.p. 236.) NAME West ShOre Regional TranspOrtation 50 Market Street Lamoyne, PA 17043