HomeMy WebLinkAbout95-03393
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JUN 23
CA)
2 ,G ['H '95
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,
JAMES O. BOWER INSURANCE/ INC
Plaintiff
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
VB.
NOI
JNFL, INC. tla NORTH STREET
GROCER , TRADING COMPANY I
Defendant. I
COMPLAINT
AND NOW comes/ Plaintiff, James O. Bower Insurance, Inc.,
by and through its attorney, Gregory J. Katshir, Esquire, with
the following Complaint and avers as followsl
1. Plaintiff, James O. Bower Insurance, Inc, is a
Pennsylvania corporation duly authorized to conduct business in
the Commonwealth of Pennsylvania, with a principle place of
business located at 2145 Market street, camp Hill PA 17011.
2. Defendant, JNFL, Inc. tla North street Grocer' Trading
Company (hereinafter IIJNFL") is a Pennsylvania corporation duly
authorized to conduct business in Pennsylvania, with its
corporate address at 617 North Second street/ Harrisburg,
Pennsylvania, and a mailing address of 231 North Second Street/
Harrisburg, Pennsylvania.
3. Plaintiff is a duly authorized agent for Norquard
Insurance Company and Amguard Insurance Company, Wilkes-Barre,
Pennsylvania.
4. Defendant is engaged in a delicatessen business,
located at 231 North Street, Harrisburg, pennuylvania 17101.
5. On or about May, 1993 at the instance and request of
Defendant , Plaintiff applied for and obtained fro~ the Norguard
Insurance Company, a policy of Workers Compensation Insurance
naming Defendant as insured.
6. The above policy, Number NOWC485746, had a policy
period of May 1, 1993 to May 1, 1994 at 12:01 a.m.
7.
$842.00.
estimated
Tho total annual estimated premium for
Defendant was billed, and subsequently
annual premium.
the policy was
paid, the
8. The aforesaid policy was in full force and effect for
the period described.
9. On or about June, 1994, Norguard Insurance company
performed a final audit upon Defendant relating to the total
estimated annual premium to be paid by Defendant for Workers
Compensation Insurance, pursuant to provisions of the policy and
applioable Pennsylvania law.
10. Pursuant to ~he final audit performed by Norguard
Insurance Company, Defendant was responsible to pay a total
estimated annual prem.um for the Workers Compensation insuranoe
of $3,260.00.
11. Defendant, pursuant to the policy, was responsible to
pay all premiums when ,'Ile, and specifically any balance due if
the final premium, afte" audit, is more than the estimated
premium paid. See attached copy of policy identified as "Exhibit
AU.
12. Plaintiff paid the sum of $2,418.00 to Norguard for
the policy described and billed Defendant therefor. Said sum
representing the difference between the total annual premium due
after the final audit and the amount of $842.00/ paid previously
by Defendant.
13. Defendant JNFL have failed, upon repeated requests to
pay all or any part of the sum owed Plaintiff.
14. Additionally, at the instance and request of
Defendants JNFL , Plaintiff applied for special business owners
liability insurance from Amguard Insurance Company for the
business trading as North street Grocer & Trading Company.
15. The above policy, Number NOGB402722, also had a policy
period from May 1, 1993 to May 1, 1994 at 12:01 a.m.
16. The total estimated annual premium for the property
and liability policy was $351.00. Defendant was billed for, and
subsequently paid, said amount.
17. Subsequently, on or about February, 1994, Defendant
JNFL , through Plaintiff as agent, obtained Property and
Liability Building coverage to be added to the above business
owners policy, covering the property at 231 North Street/
Harrisburg. See attached identified as II Exhibit B".
18. The amount due from Defendant for the additional
coverage was $284.00.
19. The aforesaid policy was in full forco and effect
during the policy period described.
20. Plaintiff paid $284.00 to Amguard for the policy
described and billed Defendant therefore.
WORKERS COMPENSA liON AND
EMPLOYERS LIABILITY INSURANCE POLICY
In rulur" I,!r I'''.' P",fI'ljfll 01 th,' premlunl ""d subject 10 "" terms of Ihls policy, we agreo with YOiJ as follows:
GENERAL SECTION
A. The Policy
This pol,,;y ,,,eludes ilt,tS effedive date the Inlorma.
tion PaR'! and .111 ,,'ndorsements and SCll~dules li,t.
ed there. It,s a conu ;,~: uf 'nSlJrarlce between you
(tile employer nllmed ,n Item l of the Information
Page) and us Ithe insurer nJmed on the InfomlDtion
Pagel. The only agreements relJt,ng to th,s insurance
are stated In th,s policy. TIle terms of this policy may
not be changed or wa,ved except by endorsement
issued by us to be part of this policy.
B. Who Is Insured
You ~re Insured if you are an employer named in Item
1 of the Information Page. If that employer is a part.
nership. and if you arc one of its partners, YOIl are
insured, but only in your capacity as an employer of
the partnersh,p's employees.
C, Workers Compensation Law
Workers Compensation Law means the workers or
IVorkmen's compensation law Jnd occupational <Jis.
ease law of each state or territory named in Item 3.A.
of the InformJtion PaRe. It Includes any amendments
to ltl.lt law which arc in effect during the> policy peri.
ad. It <Joes not inclllde .Jny federaf workers or work.
men's compensation law, any feder;ll occupational
dlseasp.law or the provISions of any law that provide
nonoccupationJI d'sabilit, benefits.
0, Slale
StatIJ mcans any state of the United Stat(!s of Ameri.
ca, and the D,strict of Columbia.
E. Locations
This policy covers all of your workplaces listed In
Items 1 or 4 of tile Information Page; and it covers
all other workplaces in Item 3.A, states unless you
have otller Insurance or Jre self.insured tor such
workplaces.
PART ONE-WORKER:; COMPENSATION INSURANCE
A. How This Insurance Applies
This workers compensation insurance applies to
bodily Injury by accident or bodily injury by disease.
Bodily 'n!lHY II1cludes resulting death.
1. Bodily injury by accident must occur during the
poliCY period.
2. Bodily injury by disease must be caused or ag.
gravated by the conditions of your employment.
The employee's last day of last. exposure to the
conditions causing or aggra',atlllg such bodily in-
jury by disease must occur during tho policy
period.
B. We Will Pay
We will pay promptly when due the benefits required
of you by the workers compensation law.
C. We Will Defend
We have the light and duty to defend at our expense
any claim, proceeding or suit against you tor benefits
payable by this insurance. We have the right to in-
vest'gate and settl(! these claims, proceed,ngs or
su,ts.
We have no duty to defend a cI.),m, proceeding or
'Suit that IS not (0verecl by Hli'; inSLJrdnr:e,
D. We Will Also Pay
We will also pay these costs, in addition to other
amounts payable under this In5urance, as partof any
claim, proceeding or suit we defend:
1. reasonable expenses Incurred at our request, but
not loss of earnings;
2. premiums for bonds to release attachments and
tor appeal bonds in bond amounts up to the
amount payable under this insurance;
3. litigation costs taxed against you;
4. interest on a judgment as required by law until
we offer the amount due under this insurance:
and
5. expenses we Intur.
E. Olher Insurance
We will not pay more than our share of benefits and
costs covered by thi5 Insurance and othel' insurance
or self.insurance. Subject to any limits of liability that
may apply, all shares Will be equal until the toss IS
paid. It any ,nsurance or self.lnsurance is exhaust-
ed, the share, 01 all remall1l1lg insurance will be equal
Ilntll nlr 10<;', IS p~ic1.
Pale 1
1.11 dl~.
m 3A
Iments
y perl.
work.
ltlonal
rOVld"
f. Plyn",,11 You MUlt Makl
YI11/ .Ht! rl''}pl)rl'jlul.' tOf ,Jll, ~d:rnll,ll1h 111 11"':ll)') IJt
ttll~ htmellt:i r'!HlJl~Jrly prllVIlJl!d b, till! WmKt..'f'j (om-
pens.ll1on law 1f1ljUdl/lH tho')l! requlrl!lJ l)1!r:,llJ'iC:
1. ()I 'IOllf Serll)US ilnd wtlllulllllst.:onduc..:t,
2. Y"li knoWlrlHly employ .1<1 employee In vlo/atlon
t)t 1.1W;
3, )']" Idillo comply W'UI ,1 health or s.11ety law or
rl~gIlIJtlon, t)r
4. you d'scllJrge. coerce or otherwlsoe d,scrinllnate
,IBJ,nSI any employee In vlol.1tlon of the workers
(()lllpl.!nsatlon law
II we make any payments In excess of the beneflls
r.,gularly provided by the workers compensation law
en your behalf, you will reimburse uS promptly.
G. Recovery From Othen
We Ilave your rlgllts, and thoe rights of persons entl.
lied to the beneflls of thiS Insurance, to recover our
payments from anyone liable for the Injury. You wllf
do everything necessary to protect ttlOse rlglllS for
'JS and to Ilelp us enforce them,
H. Statutory Provlllons
These ~tatements apply where they are required by
law,
1. As between an injured worker and us, we have
n'ltlJ .' 'II tll.' '1'11,1'1 hlll'rl t' 'j' 11.1'/11 IlIHI!"jl
2. r';l,1 ,j,.Llllt II' II1t'I).IIlk(I'i.k', <Jr IW,lll....l!f)VI 1.11
jI'll'l/',';llr,l.t,lf,. ....lllr:lltt.'I,I'.'.'I.,'ll,Jllf'IIJIII!.i
unll,:'r till, 1I1',l/r.-1"':"'\ ,t!tPf HI 111111/'/ n(I'llr)
3. WI': drtJ Ulrl!l:tI, dlld ~Hlnlil/lly jhlOll! to IIfly ~wr.
~on twtlllt.'d to Uk' t),_lnehb Pd"ltJlc I)y Oll:i Ifltiur.
dflce, Those poro:;on') may C111010~ our dutu~s; 50
may all .1gency ,111ItIOrlle.<1 hy law. Enforcl?me.nt
may be 11~.lItl';t I.J~ lH ,1~,.ItI1'lt ,f',11 .Hld U')
4. JurisdICtion OV'Jr you IS IUrlsdlcl'on over us for
purp\lses olttle worker> cOOlpensatlonlaw. We
are hound by d'2';I"ons aR'I,"st you under thilt
law. sub/eetlo thl! rH'lV,sior1'i of IIns polley ilIa!
are not in eOrllllct With th,lt law
5. Th,s ,nsural1ce conforms to 1110' pdr!S of the work,
oer5 compensalion law that .lpply to
a. brrnellls pd,ablo by th,s Ir,suranee:
b. special taxes, payments Into secur'ty or other
speCial funds, and assessmonls payable by
us under that law.
6. Terms of this Insurance that conflict with the
workers compensation law are changed by this
staternentlo conform to that/aw,
Nothing In these paragraphs relieves you of your
duties uncler Ih,s poliCy.
PART TWO-EMPLOYERS LIABILITY INSURANCE
A. How Thll Insurance Applies
This employers liability Insurance applies to bodily
'"Jury by accident or bodily Injury by disease. Bodily
'"Jury Includes resulting death.
1. The bodily injury must arise out of and In the
course of the Injured emplo,ee's employment by
you.
2. The employment must be necessary or mciden.
tal to your work in a state or territory listed In Item
3.A. of the Information Page.
3. Bad", mjury by accident must occur during the
POI,cy period,
4. Bodily Injury by disease must be caused or ago
gravated by the conditions of your employment.
The employee's last day of last exposure to the
conditions causing or aggravating such bodily In.
Jury by disease must occur during the policy
period.
5. If you are sued, the original suit and any related
legal actions for damages for bodily Injury by ac.
cldent or by disease must be brought In the Un,t.
ed Stales of America. its territories or pos~es.
slons. or Canada.
B. We Will Pay
We will pay all sums ,au legally must pay as damages
because of bodily Injury to your employees. provld.
ed the bodll, injury is covered by this Employers Lia.
billty Insurance.
The damages we will pay, where recovery Is permit.
ted by law. Include damages:
1. for which you are liable to a third party by rea.
son of a claim or suit agamst you by that third
party to recover the clamages claimed against
such third party as a result of Injury to your em.
ployee:
2. for CMe. and loss of so)rvlces: and
3. for consequential bodily In/ury to a spouse, child,
parent, brother or sister of the injured employee:
provided that ttlese damages arc the direct conse.
quence of bodily mjury that arises out of and In the
course of tile injured emfJlo,ee'~ employment by you:
and
4. becaus,) of bodily injury to your employee that
arise,. (Jut (JI and In !lie course 01 employment.
cld"ned dBd"btlou ,n a capacity other than as
!_~rnf;ll)Jf!r
Pa.e 2
C. Exclullonl
fhl'i InSLJr~lJll:l! dotJ'i tlot COVi!r
1. IIJtllllty ,1,)~UII1I!J ~lIhh:r d l)lfltrac:;t. fIlI'i I!Aclu-
,1(111 dOll, lIell olppl,IO ,1 Wolrr"nt,111,]t Y\JUr work
will bu done in a workmanlike mannur;
2. P'II1ItlW or exemplary damagus bec:ausu qf bodIly
InJur, 10 an employee employed III vIolation 01
law;
3. bodily InJury 10 an employr.e whilQ employed In
violation 01 law with your aclual knowledge or the
actual knowledgu of any of your uxecutlve
officers;
4. any obligation Imposed by a /lorkers compensa.
lion, occupational dlseasc, unemployment com.
pensatlon, or disability benelits law, or any
Similar law;
15. bodily Iniltry 'ntentlonaily causcd or aggravated
by you;
6. bodily injury occurring outside the United States
of America, Its territories or possessions, and
Canada, This exclusion does not apply to bodily
injury to a citizen or resident of the United States
of America or Canada who is temporarily outside
these countries;
7. damages arising oul of coerc,on, critiCism, de.
motion, evaluation, reassignment, discipline,
defamat,on, harassment, humiliation, dlscriml.
nation agalllsl or termination 01 any employee,
or any personnel pradccs, policies, act, or
omissions;
8. bodily injury to any person in work subject to Ihe
Longshore and Harbor Workers' Compensation
Act (33 USC Sedans 901.9501, the Nonap.
propriated Fund Instrumentalities Act (5 USC
Sections 8171.81731, the Outer Continental Shelf
Lands Act (43 use Sect,ons 1331.1356), the De-
lense Base Act (42 USC Sections 165l-16541,
the Federal Coai Mine Health and Safely Act of
1969 (30 USC Secllons 901.942), any ott1Cr fed.
eral workers or workmen's compensation law or
other federal occupational iJiscase law, or any
amendments to these laws;
9. bodily injury to any person In work subJect to the
Federal Employers' Liability Act (45 use Sections
51.601, any other federal laws obllgilting an um.
player to pay damages to an employee d\Je to
bodily Injury arising out of or in the course of em.
ployment, or any amendments to those laws;
10. bodily injury to a master or membol of Ihe crew
of any vessel:
11. fint~S or ptlnaltitJs Imp0s(~cllor Violation of flJl.k:r.
,-lIIJr st.H!! 1;)',11: ,lllll
12, 11,1"1.11\"', I." I' 1111.: lInd. 'f Illl1 ~'/lIWd/lt drHJ ~jea'il)n.
.11 "I-S'IIIjIlIJI.tI 'II'H\~t:1 Prl):I~(:tIlJr1 ^r.t (;?') use
'-).~r:tll;Il'1 t:~l}l l,'~;,n ,ll1d Ul1dl~r ,WI I.}HlfJf ff]d-
.~rdl Id'N ,.1N.!r.jlr,~t d,Jfll,lgl!'llnr 'fIOI,ltllJn of tho";l.'
1.1'1I'l ()f n:~IJI,J!i'JI1') 1';LJIJI~d tlll_1r('lJllrjf~r, and .]n,
.1fll(lndnllJnt'l to thll')l! 1,1W'i
D. Wd Will Defend
We 11JVe ttw ngllt dno dut, lo dtJlend, at Qur 1!.-:pHnse,
any (laim, proce'ldlng or ".Jlt ,Jgalnst you lor damages
payable by this InSlJra,1(e. Wu have the light to In.
vestlgate and sullie these claims, proceedings and
suits.
Wu have nc duty to delend a claIm. proceeding or
SUit that" not covered by ItliS insurancu We have
no duty to <Jefe:!nd or continue:! dufendll'll Jfter we
have pal<l our appl,cabh! IIn1lt of I'ablllty under tt1lE
Insurance
E. We Will Allo Pay
We will also pay these costs, In addition to other
amounts payable under this insurance, as part of any
claim, proceed,ng, or suit we defend:
1. reasonable expensuslllcurred at our requust, but
riot loss of earnings:
2. premiums for bonds to release attacllments and
lor appeal bonds in bond amounts up to the 1,m.
It of our l,abll,ly under this insurance:
3. litigation costs taxed against you:
4. interest on a Judgment as reqUIred by law until
we offer tl1u amount due under this insurance:
and
5. expenses we incur.
F. Other Insurance
We /1111 IIot pay more than our share of damages and
costs covured by this insurance and other inslJlance
or self.lnsurance. Subject to any limits 01 liability that
apply, all shares will be equal until the loss is paid.
If any Insurance or self.insurance is exhausted, ltle
S11c1ft1S 01 (111 remaining insurance and self.insuran(c
will be equa, unlll the loss is paid.
G. Limits of Liability
Our liabillt,to pJy for damages is limited, Our 1,,11IIs
01 liability Jre sl10wn in Item 3.B, of the Information
Page. They apply as explained below.
1. Bodll,lnJury by Accident. The limit shown for
"bodily inpJry by accident-each accident" is the
most we Will pay for all damages covered by this
Insurance because of bodily Injury to one or more
employees In anyone accident.
;\ d:'iCtl'Je I') nut bodily injury by accident unlt~ss
It r,I')lllh ,Jlr,xl1y !r(H" bodil'l IrlJIH'J l)'j cl((IChJnl
Pa.e 3
t.J Sl'.l')()I1-
12') USC
,)ltllJr ff~d-
" u( ttlf)St1
,.1I1d JrlY
)wn for
"is the
by thiS
)rmore
Jnless
:,dt;nt.
2, .lhdilj IIljlHj tJ'j (}1')t),I')I~ III!' ilrlllt )tlf)W', 11'/
"tJodll/ IflJIUY 1)'1 dlV'.I'lll '1)11111"'1 1111111" I'i tlhl
fllthl ',"11',,"1111..1'1 "'r III c L If II.jW~') lIlYll,.',j IJY 1III'l
I! 1')IJr.Jlll.l) ,Ind ,HI~lrl~ <.Jut I)f !.Jud.ljlll;IHY IlY dls-
1!.I:il', rc~.lrdltJs~) 01 tllv IlU/lltJer lIt IJlI1JjloyC!l't!
'.'1111) '.iIJ~t,)In DOl1ll'1llljW'j ll'l JIJt~,I'iU, TIll' 1IIIllt
SIHlWfl lor "lH.)Uliy IlljlHY Oy JI~iedSl'- -tJrldl ern.
pk)Yf!t.~" Ii ltll! mc~t ".~ will ~,j'f hJf illl d,l/flaw_";
u('eJuse r.Jt uoJdj injury llj JI'5e':l~(l to tiny l)/ll!
employee.
Bodily ulJury by dISt!.l~'~ Joe:; not Iflt.:luue dl~)f].l~it!
that results directly 110111 a noddy IIllury by ac.
(Id.~nt
3. Wt~ ''''III 'wt p.1y any c(alfll'i II)r d,Hllages aftt!r Wf1
I,ave paid the ,1ppl'GllJli' '"n,t"f our Ilabil,ty un.
der thi~ insur.H1Ul.
H. Recovery From Others
Wt~ tl.1Y0 /01" (I~ht~, to rCCOY'\r IJW pr1/,nlt~rlt 'rorn any.
tilt' IldUII! kIf dl1lfljlH'I (.<(;.!rf'!J Of nll:1In'jljriJllf..!, Y/1U
w,1I ,j'l ";I'f ,It',ln~ IIt'I:'!'j'"II/ 't) prrJt.t!d ttll)lll~ fllltlh
r", Ij'l ,Hid \. 111;lp Ij'J 1'(IIo)(I;I} 011:111.
I. Acllons Alalnst Us
Hlc'" WillI),) n0 r,gt't 01 ar.tlon ;JHamst u~ under thl5
Insuranc;e unless.
1. You ha'le C1/J1pllcd W,tll all tile tcrm) 01 thIs pal,.
cy; and
2. Tho amount you owe has been determined with
our consent e1r by ar.tualtllal ar,d final Judgmp.nt.
fhls msuranr.e does not Hive anyone the right to add
us as n defendant in an ,Kllon against you to deter.
nllne your I,abillty n,P. n~nkrLJptcy or insolvency of
,au or your estate WIll not relieve us of our obliga.
t'OIlS under this Part,
PART THREE-OTHER STATES INSURANCE
A. How This Insurance Applies
1. This other slates insurallce applies only if one
or more states are shown in Item 3.e, of the In.
formation Page.
2. If ynu begin work in anyone of those states aller
tile elfer.live date of this policy and are not,n.
5ured (I are not self.lllsured Inr such work, all
prOViS'on, ell the policy w,ll apply as though Ulat
state 'IlfH'l listed In Item 3.A. of ttle Information
Page.
3. We will re,mlJurse you for the lJeneflts required
by Ihe workers compensation law of that state
if we Jre not permitted to pay the benelits directly
to persons entitled to them.
4. If you have work on the effective date of this pOli.
cy In any state not listed in Item 3.A. of the In.
formatloll Page, coverage will not be afforded for
that state ullless we are notified within tllirty
d.1YS.
B. Nollce
Tell uS at once ,f ,au begin work in any state listed
I" Item 3.(;. of the Information Page.
PART FOUR-YOUR OUTlES IF INJURY Or.CURS
TBllus at once ,I,njury occurs that may be Govered by
thiS polic/,. Your otller duties are listed here.
1. Provide for immediate medical and other services It,.
Quired by the workers compensation law.
2. Give us or our agent the names and addresses of the
mjured persons and of witnesses, and other informa,
tion we may need.
3. Promptly give us all notices. demands and legal pa.
pers related to the injury, claim, proceeding or suit.
4. Cooperate w,th us and assist US, as we may request,
'1'1 I"" Investigation. settlement or defense of any
cl",m, proceedmg or suit.
5. Do nottling after an mJury occurs that would Inter.
fere with our right to recover from others.
6, Do not voluntallly make payments, assume obliga.
('ons or mcur expenses, except at your own cost.
PART FIVE-PREMIUM
A. Our Manuals
All premium for this policy will be delerrnmed by our
manuals of rules. rates, ratmp nlans and classified'
tlons. We may change our manuals and apply the
changes to th,s policy If authomed by law or a gov.
ernm~ntal agency regulating this insurance.
B. Classifications
Item 4 of the Information Page shows the rate and
premium baSIS for certall1 buslI1ess or work classlf,.
cati0ns, n1eSt..' cl'}'i'Sdl(;:ltions were aSSigned based
on an ~'itlll'att! ')f n~~~ ';'lpo')urf~:; ,t;U '''''fluid 1l,1';,!; dur-
ing the pOI,(y per,od. If your actual exposures are not
properly descllbed by those classifications, we will
assign proper CI<lssiflcations, rates and premium ba.
sis by endorsement to this policy.
C. Remuneration
Premium for each work classification Is determined
by multiplying a rate times a premium basis.
Remuneration Is the most common premium basis.
TillS prem,um basis inCludes payroll and all other
rem'.mcratlon pa'd or payable dUllng the policy peri.
od 10r U1t~ "'~l,\;icr.') ot:
Pale 4
.._._-,_.~..
,
.~II 'l'HH IJf",",!r') .Ind "fllpl.)"""", '~I1,J,J~/l.'IIIf\.'I,tk
,(I)\wr'fd Of tll"l PI:,III', lI1d
2. ,lll 'lttlt!t p'~r'inn" rllll~.lK"'1 ,11 'h'Hk tll.Jf 'JJIJlrJ
II1~lke LJ'i ll.!bl.! (JI'd,'r P,ltt Une tWqrkCfS (om.
P/!fPi,JtItJrl Ifl')ur,lnCt~) Ilf tlll'j 111)11('1 II lOil do not
t1.:Jye payroll tt?E:Ord'i tor tllI~'i'! p'!r')r)f1'i, the (on
tt,lt:t fJrlt:'~ 10' tl'lt.'lt ',t_"'jll:Wi dnd milterldls 11101,
I)~~ USf!d tiS th(l pt~\mlljll1 1},1'il'i T111~ p.lrawaph
2, will .10t ,1f)ply II yo'lI ~I'I" 'I, prnol tll,ltlllP 0.",.
plf)YFJr'i rJI ttlt:'~r! CI!fo;,W'; I,l,'/Iully ';/!':I/tI!'1 tlll,llr
"",,;,I+.cr::) Compel1::i.ltlurl nl'llg,Jtlons
D. Premium Payments
You will pay .111 prelTIIlun Nnen tllIe. You Will pay the
premium even II p,lrt or .111 at Jliorker, compen,a.
t,on law" not v,II,d.
E. Final Premium
Th,} promium sllown on n10 In'(ml1~ltlon Po;lg,~, '1cht:d.
IJI~s, Jnd endorSt2lllcnts IS ,W c5tlmatc, TtlC final
prem,um will be determJtlcd alter th,s POlICY end~ by
using the actual, not the estlm.lted. premium basIs
and the prope.r cla~s,(icaticns .1nd rates that lawll.Jlly
apply to the business and work covered by thiS poli-
cy. If the final premium 15 more than t~le premium
you paid to us. you must pay us the balance. /I It 15
less, we will relund the balance to you. The final
premium will not be less than the highest minimum
pren1lum tor the class,ficatlons covered by thiS policy.
11 1111'1 pljl'(,I'i 1..1/1(1:/.'1/, 1111111 P'l!/Ill1lrn will be df}.
II '! I nHltl, IIIl Itlt; h :llfJVw'lnp, 'lv.l'lIHllf~ii our manuals prf).
,11j/IIJ!l1f;rWI'it!
1. 11 WI.ll:olnc,ll, Illldl pr~rnlurn 'Nill b/) ':':,llc'ulafed pm
(,If,j bd'J\cJ nn t/lA tlfml thl"i pnlir:y wtl'1ln force
F In 01 I preml'llI1 '.'I'" not b,) less tlLln the pro rata
itl,l(/! 0' H'I: n1lnnnum prl?tnlum.
2. II jOlj (.,lfl(f!!, final pretnlwn WII! tJP' rno'~ than
pro rata; ,t will be based on the time this poliCY
lias ,n lor(e., and Increased hy Qur short rate
cancelilt,on table and procedure F'n~1 premium
will not be less than thu m,nlmum premium.
F, Records
You Will keep records of inlormation needed to com.
pule pr~mium. You will ~rovlde us with caples of
tllI)~') record, when we ask for them,
G, Audit
YQU w,lIlet us eX,1rn,n'l .1nd Judlt .111 ,our records that
r'llJte to th,s POli(y, These records Include ledgers.
lourn~ls. reg'sters, vouchers, contracts, tax reports.
payroll and d,sbur,ement records, and programs tor
storing and retrieVing data, We may conduct the al..
dlts during reglJlar busln~ss hours during the policy
period and w,thin three yedrS after the policy period
ends. Information developed by audit will be used
to determine final premium, Insurance rate service
organizations have the sa.ne rights we have under
thiS proviSion,
PART SIX-CONDITIONS
A. Inspection
We have the right, but are not obliged to inspect your
workplaces at any time. Our Inspections are not safety
inspections. They relate only to toe insurability at the
workpl~ces and the premiums to be Charged. We
may give you reports on the conditions we find, We
may also recommend changes. While they may help
reduce losses, we do not undertake to perform the
duty of any person to provide (or the health or safety
at you/' employees or the public. We do not warrant
that your workplaces are sate or healthtul or that they
comply with laws, regulations, codes or standards.
Insurance rate service organizations hav~ the same
rights we have 'Jnd~r thiS proviSion.
B. Lona Term Polley
If the policy period is longer than one year and six.
teen days, all provi,lons of this policy '.'1111 apply as
though a new pOlicy were issued on each annual an.
niversary that this pol,cy is in force.
C. Trans'er Of Your R1ahh And Dulles
Your rights or duties under this poliCY may not be
:ransferred without our written consent.
If you die and we receive nOI,(e w,th,n thirty days after
your death, we will cover your legal representative
as insured.
D. Cancelation
1. You may cancel this policy, You must mail or de.
li'ler advance written notice to us stating when
the cancelation is to take effect.
2. We may cancel this policy. We must mall or de.
I'ver to you not less than ten days advance writ.
ten notice statlns when the cancelation Is to take
ettect. Mailing that notice to you at your mallins
address shown In item I of the Intormation Page
will be sufticient to prove notice,
3. The policy periOd will end on the dal' and hour
staled in the cancelat'on notice.
4. Any of these provls'ons that conflict with a law
that controls the cancelation of the Insurance In
thiS policy is changed by this statement to com.
ply with the law.
E. Sole Representative
The Insured (liSt named in Item I of the Information
Page will act on behalf ot all insureds to change this
POliCY, receive return premium, and give or receive
not,ce ot cancelation.
.
Paal 5
'GUARD" ..
INSU1~ANCE
GROUP
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NOROUARO INSURANC~ COMPANY
POLICY MID 1IllWC4a:l746
This vndoraement torma a part of po11cy nu~b&r NOWC48~746
~..u.d by NORGUARD INSURANCE COMPANY to NORTH ST. GROCER & TRADING CO..
f:!tvc'.lvlP 12101 A. M. on 0~/011199J,
-~-=-2-~-.-:-3-.-.-"-~-~.#-.-Z_D_._~_a_._~_
TYPE DUE GROSS
TRANS DATE PREMIUM ~.f
FINAL AUD 0:3/0./93 2,418.00 I ~
2/418.00 --1'
Agency I JA"ES O. BOWER INSURANCE
CoIllItll'lillNtulW
FP 1283
Peg" -:]-
ImJlAL USE MY
IliA 1 _48'-'46
OIt, I 16/21/1994
P.O, BOX A.H, W'LKES.BAAAE, PENNSYLVANIA 18103
AQINCY COl'Y
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