general liability application · 2020-03-10 · 8 pricing non-member (usd) dan member (usd) general...

APPLICATIONGENERAL LIABILITY

n Backed by Lloyd’s of Londonn Program proceeds are reinvested in dive safetyn Customized coverage availablen Discounted rates for DAN members

Explore with DAN@diversalertnetwork DAN.org/LIABILITY

RISK RETENTION GROUP

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APPLICATION INSTRUCTIONS

STEP 1.

Fill out this application completely. Incomplete applications will delay processing times.

STEP 2.

Return the completed application to:

Email [email protected] Fax 1-919-490-2935

Mail Divers Alert Network Attn: Risk Retention Group 6 W. Colony Pl. Durham, NC 27705

FOR APPLICATION ASSISTANCE

Email [email protected]

Phone +1-919-490-2934 or 800-446-2671 ext 5009

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DAN General Liability Application

BUSINESS INFORMATION: (PRINT OR TYPE)

Legal Business Name _________________________________________________ DAN Business Member # ______________________

Doing Business As __________________________________________________________________________________________________

Business Mailing Address ____________________________________________________________________________________________

City _______________________ State/Province ________ Postal Code ______________Country ________________________________

Business Phone _____________________________________________________ Cell _________________________________________

Fax _______________________________________________________________________________________________________________

WEB Address ______________________________________________________________________________________________________

Primary Training Agency Affiliation ____________________________________________ Training Agency ID # ______________________

Primary Contact

Legal First Name _________________________ Last Name ______________________________Nickname ________________________

Title _________________________________________ Email _______________________________ Phone # ________________________

Is owner of Business? oYes o No

Secondary Contact

Given Name ____________________________Family Name ______________________________Nickname ________________________

Title _________________________________________ Email _______________________________ Phone # ________________________

Is owner of Business? oYes o No

GENERAL INFORMATION SECTION:

Business Type: o Corporation o Partnership o LLC o Proprietorship o Non-Profit o Other:

How long in business? ____________________________________________________________________________________

Owned business location(s) (Use another sheet if necessary)

1. Street Address _______________________________________________________________________________________

City ____________________ State/Province ________ Postal Code ______________Country ________________________________

Is primary location? o Yes o No

Location ownership: o Commercial Owned o Commercial Leased o Residential

2. Street Address _______________________________________________________________________________________




3. Street Address _______________________________________________________________________________________




* Use Additional Sheet if necessary.

Business Name ________________________ Customer ID # _________________

Renewal? oYes o No

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BUSINESS ACTIVITIES: (Please check all that apply)

o Air Fills o Hydrotesting o Rentals o Repairs

o Product Sales o Training o Tank Inspections o Local Trade Shows

o Pool on Premises o Travel (more than 100 miles) o Travel (less than 100 miles)

Description of business activities/operations:

________________________________________________________________________________________________________

________________________________________________________________________________________________________

________________________________________________________________________________________________________

________________________________________________________________________________________________________

Do you sell or rent products “other than scuba?” (Please describe) ______________________________________________

________________________________________________________________________________________________________

________________________________________________________________________________________________________



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KNOWN CLAIM/INCIDENT DECLARATION

Applicant must complete and sign one of the following claims/incident declarations. Read carefully and complete either 1 (No Claims/Incident Declaration) or 2 (Disclosure of Known Claim/Incident), not both.

NO CLAIMS/INCIDENT DECLARATION

I, ______________________________, have no knowledge of any incident, accident, occurrence, act, error, or omission (collectively “Event”) that might lead to, or has already led to, a legal action or claim except those matters already reported to DAN Services, Inc. I understand that I must report any known Event to my previous insurer and that this policy does not cover any Event known on or be-fore the effective date of this coverage. I also agree and understand that any Event which occurred prior to the effective date of this cov-erage which becomes a legal action or claim within 90 days of expiration of the previous policy must be reported and will be excluded under this policy. By applying for this insurance, I hereby authorize DAN Services, Inc. to release to the underwriters any information pertinent to the investigation of any Event, legal action or claim.

Signed _____________________________________________________ Date: _______________________________ (dd/mm/yyyy)

DISCLOSURE OF KNOWN CLAIM/INCIDENT

I, ______________________________, have knowledge of an incident, accident, occurrence, act, error, or omission (collectively “Event”) not previously reported to DAN Services, Inc., that might lead to, or has already led to, a legal action or claim against the Applicant and I have disclosed such Event(s) below. Other than the Event(s) disclosed below and those previously reported to DAN Services, Inc., I have no knowledge of any other Event that might lead to, or has already led to, a legal action or claim against the Ap-plicant. I understand that I must report any known Event to my previous insurer and that this policy does not cover any Event known on or before the effective date of this coverage. I also agree and understand that any Event which occurred prior to the effective date of this coverage which becomes a legal action or claim within 90 days of expiration of the previous policy must be reported and will be excluded under this policy. By applying for this insurance, I hereby authorize DAN Services, Inc. to release to the underwriters any information pertinent to the investigation of Event, legal action or claim.

Name of Any Person Injured: ________________________________________________________________________

Name of Staff/Employee Involved: _____________________________________________________________________

Date of Incident: ________________ Incident Report Filed: o Yes o No

If yes, please send copies of incident report or any other appropriate documentation to [email protected]

Fatality: o Yes o No Serious Injury: o Yes o No In Training: o Yes o No

Amount of Loss (with defense cost) ______________ Insurance Carrier______________________________________

Location of Incident _______________________________________________________________________________

Brief Summary of Incident __________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

Signed _____________________________________________________________ Date: __________________________ (dd/mm/yyyy)



Please send supporting claim/incident documentation to: [email protected] or fax to 919-490-2935

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SCHEDULE OF ADDITIONAL INSUREDS

Each Entity to be covered by this policy must be listed as an Additional Insured.

n There is no charge for Additional Insureds, but all must be listed to be coveredn Being listed as an Additional Insured does not create a contractual agreement with DAN Risk Retention Group.n Each legal entity such as retailers, resort dive operators, dive boats, educational institutions, hotels, motels, resorts, pool (facility)

owners, property owners, government entities and marinas must be listed to be covered. Show relationship between Insured and Additional Insureds.

n Legal entities other than those listed below, when listed, will be reviewed by the underwriter; inclusion on your Certificate of Insurance will indicate that coverage is in effect.

n List business relationship, not personal relationship: e.g., Paul Anderson (boat owner) not Paul Anderson (personal friend)


NAME _____________________________________________ADDRESS __________________________________________CITY/ST(Province) __________________________________ZIP(Postal)/COUNTRY _______________________________RELATIONSHIP _____________________________________EMAIL _____________________________________________PHONE ____________________________________________









* Use Additional Sheet if necessary.

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DECLARATION SECTION

Applicant must complete and sign this Declaration Section. Read carefully, check the boxes next to each statement and sign where indicated.

Your duty of disclosure information and the answers given by you to the specific questions in the Application form will be treated by the Underwriters as applying to each person or legal entity seeking coverage, including each principal, partner or director.

Please confirm the following with a check.

o I declare and warrant that I have read and understand the Application and that after full examination, all statements and particulars contained in the Application and any attachments are true and correct and that no information whatsoever has been withheld that might increase the risk of the Underwriters or influence the acceptance of this Application and should the above particulars change in any way, I will advise the Underwriters immediately.

o I understand that failure to disclose any material facts, which would be likely to influence the acceptance and assessment of the Application, may result in the Underwriters refusing to provide indemnity or cancelling the policy in every respect.

o I hereby agree and accept that this Declaration and the other parts of this Application shall be the basis of the contract between both parties if entered into.

o I hereby agree and accept that the Commercial General Liability policy is an Occurrence policy that I am required to provide immediate written notice to the party designated in the policy of any incident, accident, occurrence, act, error, or omission that might lead to a claim, and that failure to provide such written notice may result in a denial of coverage under the policy.

o I acknowledge and accept that this coverage is provided on an Excess and Surplus lines basis where the carrier is not required to be licensed in our State of domicile, but is allowed to do business in our State on a non-admitted and unlicensed basis.

o I hereby acknowledge and declare that I have never been declined general liability insurance, have never had a policy cancelled or non-renewed, and have never had special terms imposed.

o I acknowledge and declare that I have read, understand and accept the Exclusions as set forth on page 9 of the Application.

o I acknowledge and declare that I have read, understand and accept the Fraud Warning as set forth on page 8 of the Application.

**NOTICE**This policy is issued by your risk retention group. Your risk retention group may not be subject to all of the insurance laws and regulations of your State. State insurance insolvency guaranty funds are not available for your risk retention group.

Full Name of Applicant Signature Date (dd/mm/yyyy)



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PRICING Non-Member (USD) DAN Member (USD)General Liability o Revenues less than $50,000 $970 $923 o Revenues of $50,001 - $100,000 $1,301 $1,237 o Revenues of $100,001 - $200,000 $1,811 $1,722 o Revenues of $200,001 - $300,000 $2,347 $2,231 o Revenues of $300,001 - $400,000 $2,811 $2,672 o Revenues of $400,001 - $500,000 $3,090 $2,937 o Revenues of $500,001 - $750,000 $3,396 $3,228 o Revenues of $750,001 - $1,000,000 $3,649 $3,468 o Revenues of $1,000,001 - $1,500,000 $3,830 $3,640 o Revenues over $1,500,00 Call Call

Options (please select any additional endorsement options) o Additional Location N/C N/C o Lakes/Quarries $2,841 $2,700 o Tour and Travel Agent Liability $131 $125 o Terrorism $58 $55 o Employee Benefit $290 $275

PREMIUM CALCULATION INFORMATION FOR GENERAL LIABILITYGROSS BUSINESS REVENUES (Before Expenses)

Average Annual Sales (Excluding Travel, Water Instruction and Activities) _____________


Please indicate the preferred effective date ___________________ Policy Period Dates will be determined effective by U.S. East Coast Time. (dd/mm/yyyy)

PREMIUM TOTALSA. General Liability $ ____________________________ Options a. Lakes/Quarries $ ____________________________ b. Tour and Travel Agent Liability $ ____________________________ c. Terrorism $ ____________________________ d. Employee Benefit $ ____________________________

Total Premium Due $ ____________________________

Costs and FeesCost of insurance includes Premium, Filing Fees and Applicable Taxes, each of which will be itemized on the Declara-tions page provided to each insured. All Premium, Filing Fees and Taxes are fully earned. There is no refund of earned premium, fees or taxes if an insured wishes to cancel coverage.

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PAYMENT OPTIONSo Check or Money Order # ______________ Total (USD) $ ___________________________________ Make checks payable to: DAN Services. Send to: DAN Liability Insurance, 6 W. Colony Place, Durham, NC 27705-9030 USA o Premium Financing Federal Tax ID # or FEIN # ___________________________________ Contact DAN Liability Insurance at [email protected] or +1 (919)684-2934 for more information.

Credit Card Card Holder Information: (Print or Type)

Card Holder Name __________________________________________________________________________________

Billing Address ____________________________________________________________________________________

City ________________ State/Province ______Zip/Postal _________________Country __________________________

FAX ________________________________________ E-mail _____________________________________________

Card Type: (Check only one) o MasterCard o VISA o AMEX o Discover

Card # |____|____|____|____|____|____|____|____|____|____|____|____|____|____|____|____|

Expires: |____|____|____|____| CVC: |____|____|____|____| Month/Year

Total (USD) $ ___________________________________


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FRAUD WARNING

GENERAL STATEMENT: Any person who, with the intent to defraud or knowingly facilitates a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement, or conceals information for the purpose of misleading may be guilty of insurance fraud and subject to criminal and/or civil penalties.

AK, AL, AR, CA, CT, DC, DE, GA, IA, ID, IN, IL, MA, MO, MS, MT, NC, ND, NE, NJ, NH, NM, ND, OK, PA, RI, TN, TX, WI (GROUP) - Fraud Warning: Any person who knowingly and with intent, defrauds or deceives any insurance company by submitting an application or filing a claim that contains any false or incomplete information, or conceals information for the purpose of misleading, is guilty of insurance fraud, which is a felony and subject to criminal and/or civil penalties

MD, ME, WA, NY, MN, SD, UT (INDEPENDENTLY) – Fraud Warning: Any person who knowingly and with intent, defrauds or deceives any insurance company by submitting an application or filing a claim that contains any false or incomplete information, or conceals information for the purpose of misleading, maybe guilty of insurance fraud, which is a felony and maybe subject to criminal and/or civil penalties.

Notice to Colorado: It is unlawful to knowingly provide false, incomplete, or misleading information to an insurance company for the purpose of defrauding or attempting to defraud the company. Penalties may include imprisonment, fines, denial of insurance and civil damages. Any insurance company or agent of an insurance company who knowingly provides false, incomplete, or misleading facts or information to a policy holder or claimant for the purpose of defrauding or attempting to defraud the policy holder or claimant with regard to a settlement or aware payable from insurance proceeds shall be reported to the Colorado Division of Insurance within the Department of Regulatory Agencies.

Notice to Florida: Any person who knowingly and with intent to injure, defraud or deceive any insurer, files a statement of claim or an application containing any false, incomplete, or misleading information is guilty of a felony of the third degree.

Notice to Hawaii: For your protection, Hawaii law requires you to be informed that presenting a fraudulent claim for payment of a loss or benefit is a crime punishable by fines or imprisonment or both.

Notice to Idaho: Any person who knowingly and with intent to defraud or deceive any insurance company, files a statement or claim containing a false, incomplete or misleading information is guilty of a felony.

Notice to Indiana: Any person who knowingly makes any false or fraudulent statement or presentation in or with reference to any application for life insurance or for the purpose of obtaining any fee, omission, money or benefit from or in any company transacting business under this article, commits a class A misdemeanor.

Notice to Kentucky: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties.

Notice to Louisiana: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison.

Notice to New York: Any person who knowingly and with intent to defraud an insurance company or other person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime and shall also be subject to a civil penalty not to exceed five thousand dollars and the stated value of the claim for each such violation.

Notice to Ohio: Any person who, with intent to defraud or knowing that he is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement is guilty of insurance fraud.

Notice to Oklahoma: Any person who knowingly, and with intent to injure, defraud or deceive any insurer makes any claim for the proceeds of an insurance policy containing any false, incomplete, or misleading information is guilty of a felony.

Notice to Oregon: Any person who knowingly and with intent, defrauds or deceives any insurance company by submitting an application or filing a claim that contains any false or incomplete information, or conceals information for the purpose of misleading, may be guilty of insurance fraud, which may be a crime and may be subject to criminal and/or civil penalties.

Notice to Pennsylvania: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties.

Notice to Virginia: It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the purpose of defrauding the company. Penalties include imprisonment, fines and denial of insurance benefits.


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EXCLUSIONS

COVERAGE ABODILY INJURY AND PROPERTY DAMAGE LIABILITY

This insurance does not cover:

a. Expected or Intended injury - “Bodily injury” or “property damage” expected of intended from the standpoint of the insured. This exclusion does not apply to “bodily injury” resulting from the use of reasonable force to protect persons or property.

b. Contractual Liability - Bodily injury” or “property damage” for which the insured is obligated to pay damages by reason of the assumption of liability in a contract or agreement.

c. Liquor Liability - “Bodily injury” or “property damage” for which any insured may be held liable by reason of: (i) Causing or contributing to the intoxication of any person; (ii) The furnishing of alcoholic beverages to a person under the legal drinking age of under the influence of alcohol; or (iii) Any statute, ordinance or relating to the sale, gift, distribution or use of alcoholic beverages.

d. Workers’ Compensation and Similar Laws - Any obligation of the insured under a workers’ compensation, disability benefits or unemployment compensation law of any similar law.

e. Employer’s Liability - “Bodily injury” to (i) An “employee” of the insured arising out of and in the course of Employment by the insured; or performing duties related to the conduct of the insured’s business; or (ii) The spouse, child, parent, brother or sister of that “employee” as a consequence of Paragraph i. above.

f. Pollution - “Bodily injury” or “property damage” which would not have occurred in whole or part but for the actual, alleged or threatened, discharge, dispersal, seepage, migration, release or escape of pollutants at any time; or, Any loss, cost or expense arising out of any (i) request, demand or order that any insured or others test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of pollutants; or (ii) claim or suit by or on behalf of a governmental authority for damages because of testing for, monitoring, cleaning up, removing, containing, treating, detoxifying or neutralizing, or in any way responding to, or assessing the effects of pollutants. Pollutants mean any solid, liquid, gaseous, or thermal irritant or contaminant including smoke, vapor, soot, fumes, acid alkalis, chemicals and waste. Waste includes material to be recycled, reconditioned or reclaimed.

g. Aircraft, Auto or Watercraft - “Bodily injury” or “property damage” arising out of the ownership, maintenance, use or entrustment to others of any aircraft, “auto” or watercraft that is (i) owned or operated by or rented or loaned to any insured; or (ii) operated by any “volunteer worker” in the course of his or her employment by the insured or while performing duties related to the conduct of the insured’s business.

h. Mobile Equipment - “Bodily injury” or “property damage” arising out of (i) the transportation of “mobile equipment” by an “auto” owned or operated by or rented or loaned to any insured; or (ii) the use of “mobile equipment” in, or while in practice for, or while being prepared for, any prearranged racing, speed, demolition, or stunting activity.

i. War - “Bodily injury” or “property damage”, however caused, arising, directly or indirectly, out of (i) war, including undeclared or civil war; (ii) warlike action by a military force, including action in hindering or defending against an actual or expected attack, by any government, sovereign or other authority using military personnel or other agents; or (iii) insurrection, rebellion, revolution, usurped power, or action taken by governmental authority in hindering or defending against any of these.

j. Damage to Property - “Property damage” to: i. Property you own, rent or occupy, including any costs or expenses incurred by you, or any other person, organization

or entity, for repair, replacement, enhancement, restoration or maintenance of such property for any reason, including prevention of injury to a person or damage to another’s property.

ii. Premises you sell, give away or abandon, if the “property damage” arises out of any part of those premises;

iii. Property loaned to you;

iv. Personal property in the care, custody or control of the insured;


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v. That particular part of real property on which you or any contractors or subcontractors working directly or indirectly on your behalf are performing operations, if the “property damage” arises out of those operations; or

vi. That particular part of any property that must be restored, repaired or replaced because “your work” was incorrectly performed on it.

k. Damage to Your Product - “Property damage” to “your product” arising out of it or any part of it.

l. Damage to Your Work - “Property damage” to “your work” arising out of it or any part of it and included in the “products-completed operations hazard”.

m. Damage to Impaired Property or Property Not Physically Injured - “Property damage” to “impaired property” or property that has not been physically injured, arising out of (i) a defect deficiency, inadequacy or dangerous condition in “your product” or “your work”; or (ii) a delay or failure by you or anyone acting on your behalf to perform a contract or agreement in accordance with its terms.

n. Recall of Products, Work or Impaired Property - Damages claimed for any loss, cost or expense incurred by you or others for the loss of use, withdrawal, recall, inspection, repair, replacement, adjustment, removal or disposal of (i) “Your product”; (ii) “Your work”; or (iii) “Impaired property”, provided; such product, work, or property is withdrawn or recalled from the market or from use by any person or organization because of a known or suspected defect, deficiency, inadequacy or dangerous condition in it.

o. Personal and Advertising Injury - “Bodily injury” arising out of “personal and advertising injury”.

p. Electronic Data - Damages arising out of the loss of, loss of use of, damage to, corruption of, inability to access, or inability to manipulate electronic data.

q. Fungi or Bacteria - “Bodily injury” or “property damage” which would not have occurred, in whole or in part, but for the actual, alleged or threatened inhalation of, ingestion of, contact with, exposure to, existence of, or presence of, any “fungi” or bacteria on or within a building or structure, including its contents, regardless of whether any other cause, event, material or product contributed concurrently or in any sequence to such injury or damage. Any loss, cost or expenses arising out of the abating, testing for, monitoring, cleaning up, removing, containing, treating, detoxifying, neutralizing, remediating or disposing of, or in any way responding to, or assessing the effects of, “fungi” or bacteria, by an insured or by any other person or entity.

r. Employment Related Practices - “Bodily Injury” to:

i. A person arising out of any: a. Refusal to employ that person; b. Termination of that person’s employment; or c. Employment-related practices, policies, acts or omissions, such as coercion, demotion, evaluation, reassignment,

discipline, defamation, harassment, humiliation, discrimination or malicious prosecution directed at that person; or

ii. The spouse, child, parent, brother or sister of that person as a consequence of “bodily injury” to that person at whom any of the employment related practices described in Paragraphs a, b, or c above is directed.

s. Infringement, Misappropriation, Interference with Privacy and Unfair Competition - “Bodily injury” or “property damage” arising directly or indirectly out of:

i. Any infringement upon or dilution of copyright, trademark, patent, title, slogan, service mark, service name, trade name, trade dress, trade secret, or other intellectual property rights;

ii. Any invasion or infringement of or interference with the right of privacy or publicity including, but not limited to, intrusion, public disclosure or private facts, unwarranted or wrongful publicity, false light or the use of name or likeness for profit;

iii. Plagiarism or misappropriation of information, trade secrets, ideas or style of doing business; iv. “Unfair competition” as defined by statute or common law, both state and federal, whether or not pertaining to and

alleged in conjunction with a claim of plagiarism, misappropriation of information or ideas, “piracy”, infringement or dilution of copyright, title, slogan, trademark, trade name, trade dress, trade secret, patent, service mark, service name, or other intellectual property rights;

v. Any acts of the insured pertaining to the internet, web site(s), domain name(s), metatag(s), linking, framing or chatrooms the insured hosts, owns, or over which the insured exercises control.


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t. Professional Liability - The Commercial General Liability Policy does not apply to “bodily injury” or “property damage” or “personal and advertising injury” that arises out of the rendering of or failure to render advice, instruction or direction in connection with a training program for either recreational or certification purposes; including, but not limited to, instruction in the activity of water skiing, jet skiing, operation of a boat, parasailing, hang gliding, paragliding, ultra-light flying, kite boarding, kite surfing, snow kiting, surfing, wake boarding, scuba diving, skin diving, swimming or any other recreational activities; and, the claim occurs:

i. Any time after the conclusion of the student/trainee’s instructional program. Conclusion is not limited to the successful completion of the program. Failure to successfully complete the program,

or the student/trainee voluntarily or involuntarily discontinues lessons also constitutes conclusion of the instructional program;

ii. Off the insured’s premises, while the student/trainee is not engaged in an instructional program facilitated by the insured; or iii. On the insured’s premises, while the student/trainee is not engaged in an instructional program facilitated by the insured.

u. Abuse or Molestation - This insurance does not apply to “bodily injury” or “property damage”, “personal injury”, “personal and advertising injury” or any injury arising out of:

i. The actual or threatened abuse or molestation or licentious, immoral or sexual behavior whether or not intended to lead to, or culminating in any sexual act, of any person, whether caused by, or at the instigation of, or at the direction of, or omission by, any insured, his employees, or any other person, or

ii. The actual or alleged transmission of any communicable disease, or iii. Charges or allegations of negligent hiring, employment, investigation, supervision, reporting to the proper authorities, or

failure to so report; or retention of a person for whom any insured is or ever was legally responsible and whose conduct would be excluded by paragraph i. above.

Abuse includes, but is not limited to, negligent or intentional infliction of physical, emotional or psychological injury/harm.

v. Asbestos -

i. “Bodily injury” in any way arising out of the use by any person or organization of or exposure to asbestos, asbestos products, asbestos fibers or asbestos dust;

ii. “Property damage” to real property arising out of the use by any person or organization of asbestos, asbestos products, asbestos fibers or asbestos dust, including, without limitation, the costs incurred with respect to the removal or abatement of asbestos, asbestos products, asbestos fibers or asbestos dust from or in such real property;

iii. Any obligation of the insured to indemnify any party because of damage arising out of such “property damage”, “bodily injury”, sickness, disease, occupational disease, disability, shock, death, mental anguish or mental injury, at any time as a result of the manufacture of, mining of, use of, sale of, removal of, distribution of, or exposure to asbestos, asbestos products, asbestos fibers or asbestos dust; or

iv. Any obligation to defend any “suit” or claim against the insured alleging “bodily injury”, sickness, disease, occupational disease, disability, shock, death, mental anguish or mental injury or “property damage” resulting from or contributed to, by any and all manufacture of, mining of, use of, sale of, removal of, distribution of, or exposure to asbestos, asbestos products, asbestos fibers or asbestos dust.

w. Lead i. “Bodily injury” or “property damage”, for past, present or future claims arising in whole or in part, either directly or

indirectly, out of the manufacture, distribution, sale, resale, re-branding, installation, repair, removal, encapsulation, abatement, replacement or handling of, explore to, ingestion of or testing for, lead whether or not the lead is or was at any time airborne as a particle, contained in a product, carried on clothing, inhaled, transmitted in any fashion or found in any form whatsoever;

ii. The costs of clean up or removal of lead or products and materials containing lead; iii. The costs of such actions as may be necessary to monitor, assess and evaluate the release or threat of same, or lead

or products and material containing lead; iv. The cost of disposal of lead substances or the taking of such other action as may be necessary to temporarily or

permanently prevent, minimize or mitigate damage to the public health or welfare or to the environment, which may otherwise result;

v. The cost of compliance with any law or regulation regarding lead.


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x. Securities and Financial Interest i. Any violation of any securities law or similar law or any regulation promulgated thereunder; ii. The purchase, sale, offer of sale or solicitation of any security, debt, insurance policy, bank deposit or financial interest

or instrument; iii. Any representation made at any time in relation to the price or value of any security, debt, insurance policy, bank deposit

or financial interest or instrument; or iv. Any depreciation or decline in price or value of any security, debt, insurance policy, bank deposit or financial interest

or instrument.

y. Silica i. “Bodily injury” or “property damage” or any other loss, cost or expense arising out of the presence, ingestion, inhalation,

or absorption, of or exposure to silica products, silica fibers, silica dust or silica in any form; or. ii. Any obligation of the insured to defend and/or indemnify any party because of damages arising out of such “bodily

injury” or “property damage” arising out of the presence, ingestion, inhalation, or absorption, of or exposure to silica products, silica fibers, silica dust or silica in any form.

z. Violation of Statutes in Connection with Sending, Transmitting, or Communicating Any Material or Information - Any loss, injury, damage, claim, “suit”, cost or expense arising out of or resulting from, caused directly or indirectly, in whole or in part by, any act that violates any statute, ordinance or regulation of any federal, state or local government including, any amendment of or addition to such laws, that includes, addresses or applies to the sending, transmitting or communicating of any material or information, by any means whatsoever.

aa. Nuclear Reaction / Nuclear Radiation or Radioactive Contamination - Any loss, injury, damage, claim, Suit, cost or expense arising out of or resulting from, caused directly or indirectly, in whole or in part by, nuclear reaction, nuclear radiation or radioactive contamination.

COVERAGE B

PERSONAL AND ADVERTISING INJURY LIABILITY

This insurance does not cover:

a. Knowing Violation of Rights of Another - “Personal and advertising injury” caused by or at the direction of the insured with the knowledge that the act would violate the rights of another and would inflict “personal and advertising injury”;

b. Material Published with Knowledge of Falsity - “Personal and advertising injury” arising out of oral or written publication of material, if done by or at the direction of the insured with knowledge of its falsity;

c. Material Published Prior to Policy Period - “Personal and advertising injury” rising out of oral or written publication of material whose first publication took place before the beginning of the policy period;

d. Criminal Acts - “Personal and advertising injury” arising out of a criminal act committed by or at the direction of any insured;

e. Contractual Liability - “Personal and advertising injury” for which the insured has assumed liability in a contract or agreement.

f. Breach of Contract - “Personal and advertising injury” arising out of a breach of contract, except an implied contract to use another’s advertising idea in you “advertisement”;

g. Quality of Performance of Goods – Failure to Conform to Statements - “Personal and advertising injury” arising out of the failure of goods, products or services to conform with any statement of quality or performance made in your “advertisement”;

h. Wrong Description of Prices - “Personal and advertising” arising out of the wrong description of the price of good, products or services stated in you “advertisement”;

i. Infringement of Copyright, Patent, Trademark or Trade Secret - “Personal and advertising injury” arising out of the infringement of copyright, patent, trademark, trade secret or other intellectual property rights.

j. Insureds in Media and Internet Type Businesses - “Personal and advertising injury” committed by an insured whose business is: i. Advertising, broadcasting, publishing or telecasting: ii. Designing or determining content of we-sites for others; or iii. An Internet search, access, content or service provider.


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k. Electronic Chatrooms or Bulletin Boards - “Personal and advertising injury” arising out of an electronic chatroom or bulletin board the insured hosts, owns, or over which the insured exercises control.

l. Unauthorized Use of Another’s Name or Product - ”Personal and advertising injury” arising out of the unauthorized use of another’s name or product in your email address, domain name or metatag, or any other similar tactics to mislead another’s potential customers.

m. Pollution - “Personal and advertising injury” arising out of the actual, alleged or threatened discharge, dispersal, seepage, migration, release or escape of “pollutants” at any time.

n. Pollution-Related - Any loss, cost or expense arising out of any: i. Request, demand, order or statutory or regulatory requirement that nay insured or others test for, monitor, clean up,

remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of, “pollutants”, or ii. Claim or suit by or on behalf of a governmental authority for damages because of testing for, monitoring, cleaning up,

removing, containing, treating, detoxifying or neutralizing, or in any way responding to, or assessing the effects of, “pollutants”.

o. War - “Personal and advertising injury”, however caused, arising, directly or indirectly, out of: i. War, including undeclared or civil war; ii. Warlike action by a military force, including action in hindering or defending against an actual or expected attack,

by any government, sovereign or other authority using military personnel or other agents; or iii. Insurrection, rebellion, revolution, usurped power, or action taken by governmental authority in hindering or defending

against any of these.

p. Fungi or Bacteria - “Personal and advertising injury” which would not have taken place, in whole or in part, but for the actual, alleged or threatened inhalation of, ingestion of, ingestion of, contact with, exposure to, existence of, or presence of any “fungi” or bacteria on or within a building or structure, including its contents, regardless of whether any other cause, event, material or product contributed concurrently or in any sequence to such injury; and, any loss, cost or expenses arising out of the abating, testing for, monitoring, cleaning up, removing, containing, treating, detoxifying, neutralizing, remediating or disposing of, or in any way responding to, or assessing the effects of, “fungi” or bacteria, by an insured or by any other person or entity.

q. Employment Related Practices i. A person arising out of any: a. Refusal to employ that person; b. Termination of that person’s employment; or c. Employment-related practices, policies, acts or omissions, such as coercion, demotion, evaluation, reassignment,

discipline, defamation, harassment, humiliation, discrimination or malicious prosecution directed at that person; or ii. The spouse, child, parent, brother or sister of that person as a consequence of “personal and advertising injury” to that

person at whom any of the employment-related practices described in Paragraphs a, b, or c above is directed.

r. Infringement, Misappropriation, Interference with Privacy and Unfair Competition - “Personal and advertising injury” arising directly or indirectly out of:

i. Any infringement upon or dilution of copyright, trademark, patent, title, slogan, service mark, service name, trade name, trade dress, trade secret, or other intellectual property rights;

ii. Any invasion or infringement of or interference with the right of privacy or publicity including, but not limited to, intrusion, public disclosure or private facts, unwarranted or wrongful publicity, false light or the use of name or likeness for profit;

iii. Plagiarism or misappropriation of information, trade secrets, ideas or style of doing business; “Unfair competition” as defined by statute or common law, both state and federal, whether or not pertaining to and alleged in conjunction with a claim of plagiarism, misappropriation of information or ideas, “piracy”, infringement or dilution of copyright, title, slogan, trademark, trade name, trade dress, trade secret, patent, service mark, service name, or other intellectual property rights.


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s. Professional Liability - The Commercial General Liability Policy does not “Bodily injury” or “property damage” or “personal and advertising injury” that arises out of the rendering of or failure to render advice, instruction or direction in connection with a training program for either recreational or certification purposes; including, but not limited to, instruction in the activity of water skiing, jet skiing, operation of a boat, parasailing, hang gliding, paragliding, ultra-light flying, kite board-ing, kite surfing, snow kiting, surfing, wake boarding, scuba diving, skin diving, swimming or any other recreational activities; and, the claim occurs:

i. Any time after the conclusion of the student/trainee’s instructional program. Conclusion is not limited to the successful completion of the program. Failure to successfully complete the program,

or the student/trainee voluntarily or involuntarily discontinues lessons also constitutes conclusion of the instructional program;

ii. Off the insured’s premises, while the student/trainee is not engaged in an instructional program facilitated by the insured; or

iii. On the insured’s premises, while the student/trainee is not engaged in an instructional program facilitated by the insured.

t. Abuse or Molestation - “Bodily injury” or “property damage”, personal injury”, “personal and advertising injury” or any injury arising out of:

i. The actual or threatened abuse or molestation or licentious, immoral or sexual behavior whether or not intended to lead to, or culminating in any sexual act, of any person, whether caused by, or at the instigation of, or at the direction of, or omission by, any insured, his employees, or any other person, or

ii. The actual or alleged transmission of any communicable disease, or iii. Charges or allegations of negligent hiring, employment, investigation, supervision, reporting to the proper authorities,

or failure to so report; or retention of a person for whom any insured is or ever was legally responsible and whose conduct would be excluded by paragraph i. above.

COVERAGE C

MEDICAL PAYMENTS

This insurance does not cover “bodily injury” to:

a. Any Insured - To any insured.

b. Hired Person - To a person hired to do work for or on behalf of any insured or a tenant of any insured.

c. Injury on Normally Occupied Premises - To a person injured on that part of premises you own or rent that the person normally occupies.

d. Worker’s Compensation and Similar Laws - To a person, whether or not an ‘employee” of any insured, if benefits for the “bodily injury” are payable or must be provided under a worker’s compensation law, unemployment compensation insurance, social security, or disability benefits law, or under any similar or related law (including occupational disease and cumulative trauma) including but not limited to the Jones Act, the Longshoremen and Harbor Workers Act, the Americans with Disabili-ties Act, and any civil rights laws or legislation..

e. Athletics Activities - To a person injured while practicing, instructing or participating in any physical exercises or games, sports, or athletic contests.

f. Products-Completed Operations Hazard - Included within the “products-completed operations hazard”.

g. Coverage A Exclusions - “Bodily injury” or “property damage” arising directly or indirectly from any of the circumstances described as excluded under Coverage A.


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The following exclusions apply to all section of this policy

1. No (re)insurer shall be deemed to provide cover and no (re)insurer shall be liable to pay any claim or provide any benefit here-under to the extent that the provision of such cover, payment of such claim or provision of such benefit would expose that (re)insurer to any sanction, prohibition or restriction under United Nations resolutions or the trade or economic sanctions, laws or regulations of the European Union, United Kingdom or United States of America.

2. This insurance excludes loss, damage, cost or expense of whatsoever nature directly or indirectly caused by, resulting from or in connection with:

a. the actual or threatened malicious use of pathogenic or poisonous biological or chemical materials regardless of any other cause or event contributing concurrently or in any other sequence thereto;

b. the ownership, maintenance, handling, igniting, operation, sponsorship, set-up or take-down or other use by any Insured, or by any person for which any Insured may be held liable in any capacity, of:

i. Firearms, including handguns, revolvers, pistols, rifles, shotguns, air guns, semi-automatic weapons and similar devices; ii. Fireworks, including firecrackers, Roman Candles, flash powder, explosive compositions or combustible substances, pin

wheels, skyrockets, ground displays, flares, smoke bombs, and similar devices that produce, when ignited or activated, sound, smoke, motion or a combination of these;

c. the hazardous properties of nuclear material (for more details refer to the Exclusion Clause – Nuclear Incident Liability);

d. ionizing radiations or contamination by radioactivity from any nuclear fuel or from any nuclear waste from the combustion of nuclear fuel;

e. the radioactive, toxic, explosive or other hazardous properties of any explosive nuclear assembly or nuclear component thereof.

f. any kind of seepage or any kind of pollution and/or contamination, or threat thereof, whether or not caused by or resulting from a Peril insured, or from steps or measures taken in connection with the avoidance, prevention, abatement, mitigation, remediation, clean-up or removal of such seepage or pollution and/or contamination or threat thereof (for more details refer to the Exclusion Clause – Seepage and/or Pollution and/or Contamination);

g. any act of terrorism regardless of any other cause or event contributing concurrently or in any other sequence to the loss (for more details refer to the Exclusion Clause – Terrorism);

h. any act of terrorism involving the use or release or the threat thereof of any nuclear weapon or device or chemical, biological or radioactive agent, material device or weapon (for more details refer to the Exclusion Clause – Nuclear / Chemical / Biological / Radioactive Terrorism);

i. war, invasion, acts of foreign enemies, hostilities (whether war be declared or not), civil war, rebellion, revolution, insurrection, military or usurped power or confiscation or nationalization or requisition or destruction of or damage to property by or under the order of any government or public or local authority.


general liability application · 2020-03-10 · 8 pricing non-member (usd) dan member (usd) general...

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