Continental Casualty Company v. Duyzend et al

Filing 1

COMPLAINT against defendant(s) Does 1-100, Kathryn Cox, Henri F. Duyzend, Sharon Duyzend, Cheryl Grant, Beverly Hawley, Richard Hawley, David Hubert, Jill Ortiz, Satoko Prigmore, Thomas Prigmore, William Mark Smith, Daryl Stuart, Laurel Stuart, Kristine Walla, Robert Wallace, Dale Hollingsworth, Ruth Hollingsworth, Sarah Hollingsworth, Thomas Huber, Daniel O'Neal, Patricia O'Neal, Chris Stuart, Cyndi Sundby, Douglas Sundby, Derry Tiedeman, Nicole Tiedeman, Megan Walla, Anne Welsh, Tom Welsh, Sandy Zickuhr, Tracy Zickuhr, Zoe Zickuhr (Receipt # 0981-3321765), filed by Continental Casualty Company . (Attachments: # 1 Civil Cover Sheet, # 2 Exhibit A, # 3 Exhibit B, # 4 Exhibit C, # 5 Exhibit D, # 6 Exhibit E, # 7 Exhibit F, # 8 Exhibit G, # 9 Exhibit H, # 10 Exhibit I, # 11 Exhibit J, # 12 Exhibit K, # 13 Summons, # 14 Summons, # 15 Summons, # 16 Summons, # 17 Summons, # 18 Summons, # 19 Summons, # 20 Summons, # 21 Summons, # 22 Summons, # 23 Summons, # 24 Summons, # 25 Summons, # 26 Summons, # 27 Summons, # 28 Summons, # 29 Summons, # 30 Summons, # 31 Summons, # 32 Summons, # 33 Summons, # 34 Summons, # 35 Summons, # 36 Summons, # 37 Summons, # 38 Summons, # 39 Summons, # 40 Summons, # 41 Summons, # 42 Summons, # 43 Summons, # 44 Summons, # 45 Summons)(Nelson, Justin) Modified on 8/23/2013 to edit capitalization and spelling of party names(PM).

EXHIBIT A

Claims-Made Declarations
NOTICE

CNA

for All the Commitments You Make'

YOUR PROFESSIONAL LIABILITY INSURANCE IS WRITTEN ON A "CLAIMS MADE"
BASIS AND PROVIDES COVERAGE FOR THOSE CLAIMS WHICH ARE THE RESULTS
OF DENTAL INCIDENTS OCCURRING SUBSEQUENT TO THE PRIOR ACTS DATE
STATED BELOW AND WHICH ARE FIRST MADE AGAINST YOU WHILE THIS
INSURANCE IS IN FORCE. PLEASE DISCUSS THIS WITH YOUR AGENT.
--- Policy Number---

DLP

~m

29fH7911

-

-T-

Policy Period

106/14/2667

----~~~~;~~e-ls-pr~VidedBY

To

06/14/20681-r

Named Insured and Address

Continental Casualty Company

'

---National Administrator

!

----'-

Henri Duyzend DDS
B & B Protector Plans Inc.
P.O. Box 15875
Tampa, FL 33684-5875

18528 Firland Way N.
Shoreline, WA 98133

State Administrator Number

970·05438-048487

I

Limits of Insurance
Each Claim .

$8,000,000

f ---

Aggregate

$5,000,000

I

Coverage

,

Professional Liability

. _--+

---------

: Personal Injury Liability & Advertising Injury Liability

Included
.

--j---.

$5,000

____ Each Person

$25,000
$25,000

- - - - Each
Aggregate

$4,352,00

--

-

-

- --'---

Policy Premium

I

First Aid _ _ _ _ _ _ _ ______ _

Cla~, EmpIoymen t Prac t'tces L'la b'I't Y Defense
11

I. ____

Printed Endorsements Attached At Policy Issuance - See Attached Schedule of Endorsements

This policy shall not be valid unless countersigned by a duly authorized representative of the company.
Countersigned 8y _ _ _ _ _ _ _ _ _ _ _ _ _ __
Authorized Representative

G-15155-C (Ed. 07/2000)

~~~e~

03/28/2007 12:28:32 PM
MBONILLA

New Business

CNA

Declarations

For Alitho Commitmen1sYou Make'

j Fro~___ ,

Policy Number

DLP 297117911

, 06/14/2007

Policy Poriod

Coverage Is Provided By

To

----

---~

----

---

-----

Continontal Casualty Company

L4/2008

I

--~
Named Insured and Address

II--~-·-

Henri Duyzend DDS

B & B Protector Plans Inc.
P.O. Box 15875

l

18528 Firland Way N.
Shoreline, WA 98133

National AdminIstrator

___ _ _
Tampa, FL 33684·5875

! Slate AdminIstrator Number

Limits of Insurance

$5,000,000

Coverage
Each Occurrence
-Aggregate
' General Liability - Occurrence

----.-

$8,000.000
Included

--.
+'

, Personal Injury Liability & Advertising Injury Liability - Occurrence

$5,000,000

Aggregate

$5,000

--

$1,000,000

----

-------

-----

----

..

_------

----.-

Products Hazard/Completed Operations Hazard =Occurrence

"'

Each Person
----Each Occurrence

$10,000

Medical Payments - Occurrence

--

---

--

---

__ Per occurrenc;"-l Non-Owned or~irecJAutomobile Liability - Occurrence

$50,000

Per Suit
Aggregate

$50,000
$0

- - -1 Medical Waste Legal Expense Reimbursement - Occurrence

Each Claim
--Aggregate

-!

--

$0

INCLUDED

970·05438-048487

ERISA Fiduciary Liability - Claims-Made

I

--policy Premiu-m--

I

Printed Endorsements Attached At Policy Issuance ~ See Attachod Schedule of Endorsements

This policy shall not be valid unless countersigned by a duly authorized representative of the company.

»",,---vv\ 'tArl- "--'

Countersigned By _ _ _ _ _ _ _ _ _ _ _ _ _ __

Sl>crot"ry

Authorized Representative

G-135701-A (Ed. 06/2000)

Issue 03/28/2007 12:28:32 PM
Date:
MBONILLA

New Business

Declarations

CNA

fur Ailihe CommitmentsYou Make'

----:F;om

Policy Number

DLP 297117911

I

Policy Period

06/141200~7~

To:

Coverage Is Provided By

i --- 06/14/20oiIT~ Continental Casualty Company
I

i

I

I_

1 ___ _
Named Insured and Address

-~-

National Administrator

-I

Henri Duyzend DDS
B & B Protector Plans Inc.
P.O. Box 15875
Tampa, FL 33684·5875

18528 Firland Way N.
Shoreline, WA 98133

State Administrator Number 970.05438·048487
----------

Insured Location Address

______

18528 Firland Way N.

Shoreline

--~---

"'------

I
--+--- - ----

Limits of Insurance
$0

Inflation Guard Increase

$721,000

Limit of Insurance

0%

i

WA

I

98133

-----.L _ _ ~

__ _

Coverage

Limit of Insurance

0%

___

--------,------

~tate--J-ziP Code __

Inflation Guard Increase

, Blanket Dental Practice Personal Property

----,

----

$500

: Building

Deductible Amount

I

$3,000 Per Day@ 32.5 Days Valued Daily Limit
-12Mont;'-s Limit of Time
- $50,000--$0
$100,000
$15.000

Limit 01 Insurance
I. A. . Money/Securities
---

----

--

- ---- -

i

Actu~1 Loss Su~tainedl

Basic Cov;rage---- - -_

Building & Blanket Dental Practice Personal Property

-----+-

Practice Income

JDe~tist'sElectronic -Equipment
' Rents
-....; Employee Dishonesty (Applies Collectively To All Locations)

I. B .• Benelit Plans

Policy Premium

INCLUDED

L __ _

Printed Endorsements Attached At Policy Issuance - See Attached Schedule of Endorsements

This policy shall not be valid unless countersigned by a duly authorized representative 01 the company.
Countersigned By _ _ _ _ _ _ _ _ _ _ _ _ _ __
Authorized Representative

G·15156·B (Ed. 06/2000)

~:~~

03/28/2007 12:28:32 PM
MBONILLA

New Business

Issued by the Siock Insurance Company Herein called The Company

970-05438-048487
ST. ADM. NUMBER

==.!02:18462
PRODUCER NUMBER

Continental Casualty Company

IIfIIflIA

297117911
POLICY NUMBE-R

CNA Insurance Companies
CNA Plaza
Jbr AlitheCommilmEotsYou Maket Chicago, Illinois 60685

"'IVM.

CHANGE AND ATTACHING CLAUSE ENDORSEMENT
Named
Insured
And
Mailing
Address

Henri Duyzend DDS

Inception Dale

Expiration Date

18528 Firland Way N.
Shoreline, WA 98133

0611412007

0611412008

Endorsement
Effeclive
Dale

It is agreed that the following persons or organizations are named insureds and complete the Declarations.
Primary Location
18528 Firland Way N.
Shoreline, WA 98133

Name

Class: 1

PL Prior Acts Date

EPL Prior Acts Date

Henri Duyzend

80211

0611411988

0611411998

Risk Management Credit Applied

National Administrator, Name and Address
B & B Protector Plans Inc.
P.O. Box 15875
Tampa, FL 33684-5875
G-89548-A (ED. 02197)

Acct. No. 297117911
---------

Countersigned By _ _ _ _ _ _ _ _ _ _ _ _ _ __
Authorized Representative

Issue
Date:

0312812007 12:28:32 PM
MBONILLA

New Business

Issued by the Stock Insurance Company Herein called The Company

018462

Continental Casualty Company

IJfIAIA
'#II1'fI14.

970-05438-048487
ST. ADM. NUMBER

PRbDUCER~ NUMBER

CNA Insurance Companies

297117911

CNA Plaza

POLlCY"N~U"'M"B'ER

fbrAl!lbcCommilmentsYouMaJro~ Chicago, Illinois 60685

CHANGE AND ATTACHING CLAUSE ENDORSEMENT
Named
Insured
And
Mailing
Address

Henri Dllyzend DDS

Inception Dale

Expiration Dale

18528 Flrland Way N.
Shoreline, WA 98133

06/14/2007

06/14/2008

Endorsement
Effeelive
Date

Professional Corporation
Name

Class:

PL Prior Acts Date

EPL Prior Acts Date

HENRI F. DUYZEND, DDS PS

80999

06/14/1988

06/14/1998

Henri Duyzend DDS

National Administrator, Name and Address
B & B Protector Plans Inc,
P.O. Box 15875
Tampa, FL 33684·5875
G-89548-A (ED. 02/97)

Countersigned By _ _ _ _ _ _ _ _ _ _ _ _ _ __
Authorized Representative

~:~~
Accl. No. 297117911

03/28/2007 12:28:32 PM
MBONILLA

New Business

CNA

lbr Allthe CummitmelltsYou Me.ke'

ADDITIONAL INSURED - LEASED PREMISES - GL
Person(s) or Entity(ies)
Additional Insured

Designation of Premises
(Part Leased to You)

Mooers Clinic LLC
CIO Kelley Mooers
3625 50th Ave SW
Seattle, WA 98116

18528 Firland Way N.

We agree with you that the definition of you is changed to include the person(s) or entity(ies) named
above but only with respect to liability which results from the owning. using or taking care of that part of
the premises designated above which is leased to you.

We will not defend or pay for:
1. Any injury or damage which takes place after you ceased to be a tenant of said premises; or

2. Structural alterations, new construction or demolition operations performed by or for the owner of
the premises.

All other provisions of the policy remain unchanged.

Henri Duyzend

297117911

Insured Name

Policy Number

06/14/2007

Countersigned By _ _ _ _ _ _ _ _ _ __

Effective date of this endorsement
G-56427-E (Ed. 07/96)

Authorized Agent

Issue
Date:

03/28/2007 12:28:32 PM
MBONILLA

New Business

CNA

ibr All the C()mmitment.sYou Make'

For Attachment to Policy Number 297117911
WASHINGTON STOP-GAP EXTENSION
GENERAL LIABILITY INSURANCE

"It is agreed that this insurance covers your legal liability for injury of an employee of yours who sustains an injury
which arises out of and in the course of his employment, provided such employee is reported and declared under the
Worker's Compensation Fund of the State of Washington."
The insurance granted by this extension shall not apply to:
1. injury, disease or death suffered or caused by an employee whose renumeration has not been included in the
total
remuneration upon which this premium extension is based;
2. aircraft, operation or the performance of any duty in connection with aircraft while in flight;

3. any premium, assessment, penalty, fine, or other obligation imposed by any woker's compensation law;

4. any claim for injury, disease, or death with respect to which you are deprived of any defense or defenses or is
otherwise subject to penalty because of default in premium payment under, or any other failure to comply with the
provisions of the worker's compensation law or laws of the State of Washington.

The premium for the extension shall be computed upon the total payroll of the individual office.

Estimated Annual
Remuneration

Rate per $100
of Remuneration

Estimated
Annual Premium INCL.

$82,000

0.04

$80

All other provisions of the policy remain unchanged

Authorized Representative
AgenUBroker:
Address:

G-89678-046 (Ed. 05/05)

Issue
Date:

03/28/2007 12:28:32 PM
MBONILLA

New Business

Issued by the Siock Insurance Company Herein called The Company

970-05438-048487
ST. ADM. NUMBER

018462
PRODU-CER NUMBER

Continental Casualty Company

IJfJIA'A
..1V1I4.

297117911

CNA Insurance Companies
CNA Plaza
FbrAlIlheCommltmenl~\buMa1re$ Chicago, illinois 60685

POLICY NUMBER

CHANGE AND ATTACHING CLAUSE ENDORSEMENT
Named

Insured
And
Mailing
Address

Henri Duyzend DDS

Inception Date

Expiration Date

18528 Firland Way N.
Shoreline, WA 98133

06/14/2007

06/14/2008

Endorsement
Effective
Date

12/21/2007

This policy has been cancelled pro-rata.
Total Return Premium:

$2,042.00

National Administrator, Name and Address
B & B Protector Plans Inc.
P.O. Box 173569
Tampa, FL 33672
AccL No. 297117911

Countersigned By _______________
Authorized Represontative

issue
Date:

06/11/200804:15:15 PM

GiGO

Cancellation

Policy Change Endorsement
Professional Liability Coverage Part
Dentists/Oral Surgeons
HIPAA PROCEEDINGS ENDORSEMENT
Policy Continental Casualty Company
Issued·
By: '

A
Stock
Company

!

Policy No.:
297117911

,

1--

--,

"--,--

Producer's i Pacific Underwriters Corp
Name and; 12611 Des Moines Memorial Dr
Address: ! POBox 68787
; Seattle, WA 98168

Producer's
Code:

970-05438-048487

I

_ _ _L

When Is
Change
Effective:

Named . Henri Duyzend DDS
Insured: ' 18528 Firland Way N.
Shoreline, WA 98133

06/14/2007

at 12:01 a.m. hour and minute

----.L

______

HOW YOUR POLICY IS CHANGED:
In consideration of the premium paid, we agree with you as follows:
1.
A new section is added to the Policy as follows:
HIPAA PROCEEDING SUPPLEMENT:
In addition to the limits of liability, we will pay up to $10,000 for each of you for attorney fees
charged by an attorney selected by us, and other reasonable costs, expenses or fees resulting from
the investigation or defense of a HIPAA Proceeding. However, in no event shall the amount payable
hereunder exceed $30,000 per policy period regardless of the number of you insured hereunder
and regardless of the number of such proceedings.
Such HIPAA Proceeding must begin during the policy period and must be reported to us within
30 days after you receive notice of such HIPAA Proceeding but in no event later than the end of
the policy period.
2.

Section VI. DEFINTIONS is amended to add a new definition as follows:
"HIPAA Proceeding" means any federal proceeding alleging any breach of the responsibilities,
obligations or duties imposed upon you under the Health Insurance Portability and Accountability
Act of 1996 and any rules or regulations promulgated thereunder ("HIPAA").

All other terms and conditions remain the same.
This Endorsement is effective only when signed by our authorized representative.

(Authorized Representative)
G-145117-A (Ed. 06/03)

1

I>

Policy Change Endorsement
NATIONAL DENTAL POLICY
PROTECTED HEALTH INFORMATION/PRIVACY ENDORSEMENT
~ ~ ~ ~-r;~ ,--~~-

Policy
Issued
By:

Continental Casualty Company

Producer's
Name and
Address:

Pacific Underwriters Corp
12611 Des Moines Memorial Dr
POBox 68787
Seattle, WA 98168

Producer's
Code:

Henri Duyzend DDS
18528 Firland Way N.
Shoreline, WA 98133

When Is
Change
Effective:

Named
Insured:

A
Stock
Company

Policy No.:

297117911

970-05438-048487

06/14/2007
at 12:01 a.m. hour and minute

HOW YOUR POLICY IS CHANGED:
1.

As used in this Endorsement, the following terms are defined as follows:
Individual means the person who is the subject of Protected Health Information.
Individually Identifiable Health Information means information that is a subset of health information,
including demographic information collected from an individual, and
a.
b.

is created or received by you;
relates to the past, present or future physical or mental health condition of an individual; the provision
of health care to an individual; or the past, present or future payment for the provision of health care to
an individual, and
i. that identifies the individual; or
ii. with respect to which there is a reasonable basis to believe the information can be used to identify
the individual.

Privacy Rule means those requirements set forth in 45 CFR 160 and 164 pertaining to the protection of
Protected Health Information.
Protected Health Information means Individually Identifiable Health Information you give us:
a. transmitted by electronic media;
b. maintained in any medium described in the definition of electronic media at 45 CFR 162.103; or
c. transmitted or maintained in any other form or medium.
Required by Law shall have the meaning set out in 45 CFR 164.501 and shall include a mandate contained
in law that compels us to make a use or disclosure of protected health information and that is enforceable
in a court of law including a civil or an authorized investigative demand.

All other terms and conditions remain the same.
This Endorsement is effective only when signed by our authorized representalive.

(Authorized Repr<.sentative)
G-145118-A (Ed. 06/03)

Page 1 of 2

i

Policy Change Endorsement

2.

Subjecllo paragraph 3 below, il is agreed Ihal we may use or disclose Protected Health Information:
a. as Required By Law;
b. in performing our obligations under Ihis Policy, including bul nollimiled 10 Ihe proper defense,
investigation and settlemenl of claims;
c. 10 report violations of law 10 appropriale Federal and Slate aulhorities, consislent with § 164.502U)(1).

3.

In order 10 fulfill our obligations 10 You wilh respecllo Protected Health Information, we will:
a. use appropriale safeguards 10 mainlain Ihe securily of and prevenl use or disclosure of Ihe Protected
Health Information olher Ihan as provided for by this Endorsemenl
b.

promptly reporllo You any use or disclosure of Ihe Protected Health Information in violation of Ihe
requiremenls of Ihis Endorsemenl of which we become aware

c.

mitigale, 10 Ihe exlenl practicable, any harmful effecllhal is known 10 us of a use or disclosure of
Protected Health Information by us in violation of the requiremenls of Ihis Endorsement.

d.

oblain reasonable assurances from persons or entities to whom Protected Health Information is
disclosed Ihal it will remain confidential and used or furlher disclosed only as Required By Law or for
Ihe purpose for which il was disclosed 10 Ihe person or entity, and Ihallhe person or entity will notify
us of any ins lances of which il is aware in which Ihe confidentialily of Ihe information has been breached;
make available 10 Ihe Secrelary of Ihe United Slates Deparlmenl of Health and Human Services, or its
designee, inlernal practices, books, and records, including policies and procedures and Protected Health
Information, relating to Ihe use and disclosure of Prolecled Health Information, for purposes of said
Secrelary delermining Your compliance with the Privacy Rule, subject 10 all applicable legal privileges;
make available 10 You, al our offices during normal business hours, our inlernal practices, books, and
records, including policies and procedures and Protected Health Information, relating 10 Ihe use and
disclosure of Protected Health Information for purposes of Your delermining its compliance wilh the
Privacy Rute, provided You provides alleasl 7 days prior written request for such review.
within 45 days after request by You, we will provide to You documenlation of any disclosures of
Protected Heatth Information by us, and information retaled to such disclosures, as is required
for You 10 respond 10 a requesl by an Individual for an accounting of disclosures of Protected Health
Information in accordance with 45 CFR § 164.528

e.

f.

g.

4.

You agree Ihal You shall notify us of:
a. any limilalions in Your notice of privacy practices in accordance with 45 CFR § 164.520, to Ihe exlent
Ihal such limilation may affecl our use or disclosure of Prolecled Health Information.
b.

c.

5.
6.

7.

any changes in, or revocation of, permission by Individual to use or disclose Protected Health
Information, 10 Ihe exlenllhat such changes may affecl our use or disclosure of Protected Health
Information.
any reslriction to the use or disclosure of Protected Health Information Ihat You have agreed 10 in
accordance with 45 CFR § 164.522, 10 Ihe exlenllhal such restriction may affecl our use or disclosure of
Protected Health Information.

You shall nol requesl us 10 use or disclose Protected Health Information in any manner Ihal would nol be
permissible under Ihe Privacy Rule if done by You.
Excepl as provided in paragraph (2) of Ihis section, upon lermination of all of our obligations under this Policy,
we shall relurn or destroy all Protected Health Information received from You, or created or received by us
on Your behalf. This provision shall apply 10 Protected Health Information Ihal is in the possession of our
subconlraclors or agenls. We shall retain no copies of Ihe Protected Health Information.
In Ihe evenllhat we delermine Ihal relurning or deslroying the Protected Health Information is infeasible,
we shall provide 10 You notification of Ihe conditions thaI make relurn or deslruction infeasible. Upon such
notification, we shall extend Ihe prolections of Ihis Endorsemenllo such Protected Health Information and
limil further uses and disclosures of such Protected Health Information 10 those purposes thaI make Ihe
relurn or destruction infeasible.

All other provisions of the policy remain unchanged.
G-145118-A (Ed. 06/03)

Page 2 of 2

•

IMPORTANT INFORMATION
POLICYHOLDER DISCLOSURE
NOTICE OF INSURANCE COVERAGE
FOR ACTS OF TERRORISM

You are hereby notified that under, and in accordance with, the Terrorism Risk Insurance Act of 2002, effective
November 26, 2002, that you are entitled to insurance coverage for losses arising out of "Certified Acts of Terrorism"
subject to all applicable policy provisions.

You should know that under your policy, any covered losses caused by "Certified Acts of Terrorism" will be partially
reimbursed by the United States under a formula established by federal law. Under this formula, the United States
pays 90% of covered terrorism losses exceeding the statutorily established deductible paid by the insurance company
providing the coverage. The premium as of this date that is attributable to coverage for "Certified Acts of Terrorism" is
$~.

As used herein, "Certified Acts of Terrorism" means an act that is certified by the Secretary of the Treasury, in
concurrence with the Secretary of State and the Attorney General of the United States, to be an act of terrorism
pursuant to the federal Terrorism Risk Insurance Act of 2002.

The federal Terrorism Risk Insurance Act of 2002 sets forth the following criteria for a "Certified Act of Terrorism":

a. The act resulted in aggregate losses in excess of $5 million; and

b. The act is a violent act or an act that is dangerous to human life, property or infrastructure and is committed by an
individual or individuals acting on behalf of any foreign person or foreign interest, as part of an effort to coerce the
civilian population of the United States or to influence the policy or affect the conduct of the United States
Government by coercion.

Insured Name: Henri Duyzend
Insured Address: 18528 Firland Way N.
Shoreline, WA 98133

Policy Number: 297117911
Policy Effective Date: 14-JUN-07

G-144959-8 (Ed. 03/03)

COVERAGE OF AND CAP ON LOSSES FOR CERTIFIED ACTS OF TERRORISM
In consideration of the premium charge of $ __
0_, it is agreed as follows:

1. The DEFINITIONS section is amended by the addition of the following new term:
"Certified Act of Terrorism" means an act that is certified by the Secretary of the Treasury, in concurrence
with the Secretary of State and the Attorney General of the United States, to be an act of terrorism pursuant to
the federal Terrorism Risk Insurance Act of 2002.
The federal Terrorism Risk Insurance Act of 2002 sets forth the following criteria for a Certified Act of Terrorism:
a. The act resulted in aggregate losses in excess of $5 million; and
b. The act is a violent act or an act that is dangerous to human life, property or infrastructure and is committed
by an individual or individuals acting on behalf of any foreign person or foreign interest, as part of an effort to
coerce the civilian population of the United States or to influence the policy or affect the conduct of the United
States Government by coercion.

2.

This Policy provides coverage for losses arising from Certified Acts of Terrorism subject to all other terms and
conditions of this policy.

3.

Under the federal Terrorism Risk Insurance Act of 2002, any losses caused by Certified Acts of Terrorism will
be partially reimbursed by the United States under a formula established by federal law. Under this formula, the
United States pays 90% of covered terrorism losses exceeding the statutorily established deductible paid by the
insurance company providing the coverage.

4.

With respect to anyone or more Certified Acts of Terrorism, The Insurer will not pay any amounts for which
the Insurer is not responsible under the terms of the federal Terrorism Risk Insurance Act of 2002 (including
subsequent acts of Congress pursuant to the Act) due to the application of any clause in such law which results
in a cap on the Insurer's liability for payments for terrorism losses.

All other provisions of the Policy remain unchanged.

G-144872-A (Ed. 01/03)

Issued by the Stock Insurance Company Herein called The Company
Continental Casualty Company

018462

970-05438-048487
ST. ADM: NUMBER

PRODUCER NUMBER

""fAlA.

297117911
POLICY NUMBER

CNA Insuranco CompanIes
CNA Plaza
fQl'AlllheC.ommibnentsYouMake' Chicago, illinois 60685

"'RM.

CHANGE AND ATTACHING CLAUSE ENDORSEMENT
Named
Insured
And
Mailing
Address

Henri Duyzend DDS

tnception Date

Expiration Date

18528 Firland Way N.
Shoreline, WA 98133

0611412007

0611412008

Endorsement
Effective
Date

0611412007

It is understood and agreed that the following change(s) have been made to the policy:

Employee Practice Liability Defense and Indemnity (EPLI) has been amended to $250,000

All other provisions of the policy remain unchanged

National Administrator, Name and Address
B & B Protector Plans Inc.
P.O. Box 15875
Tampa, FL 33684-5875
G-89548-A (ED. 02/97)

Accl. No. 297117911

Countersigned By _ _ _ _ _ _ _ _ _ _ _ _ _ __
Authorized Representative

Issue
Date:

0512112007 08:52:33 PM
YMALDO

Endorsement

Issued by the Stock Insurance Company Herein caned The Company
Conlinental Casualty Company

IJIIIAla.
"''''14.

970-05438-048487
ST. ADM. NUMBER

018462
PRODUCER NUMBER

297117911
POLICY NUMBER -

CNA Insurance Companies

CNA Plaza

FbrAlllheCommitmel1tsYouMaket Chicago, IllInois 60685
---

CHANGE AND ATTACHING CLAUSE ENDORSEMENT
Named

Insured
And
Mailing
Address

Henri Duyzend DDS

Inception Date

Expiration Dale

16526 Firland Way N.

06/14/2007

06/14/2008

Shoreline, WA 96133

Endorsement
Effective
Date

06/14/2007

It is understood and agreed that the following change(s) have been made to the policy:

The EPUEPLI Coverage has been changed

All other provisions of the policy remain unchanged

National Administrator, Name and Address
B & B Protector Plans Inc.
P.O. Box 15875
Tampa, FL 33684-5875
G-89548-A (EO. 02/97)

Acc\' No. 297117911

Countersigned By _ _ _ _ _ _ _ _ _ _ _ _ _ __
Authorized Representative

~!~e~

05/21/200708:52:33 PM

YMALDO

Endorsement

Issued by tho Stock Insurance Company Herein called The Company
Continental Casually Company

018462

970-05438·048487
ST. ADM. NUMBER

PRODUCER NUMBER

IIfIIlIA

297117911
POLiCY NUMBER

CNA Insurance Companies
CNA Plaza
FbtAllthoCommitmenl.sYouMake' Chicago, illinois 60685

'tin"

CHANGE AND ATTACHING CLAUSE ENDORSEMENT
Named
Insured
And
Mailing
Address

Henri Duyzend DDS

Inception Date

Expiration Date

18528 Firland Way N.
Shoreline, WA 98133

0611412007

0611412008

Endorsement
Effective
Dale

0611412007

It is understood and agreed that the following change(s) have been made to the policy:

PC EPL has been deleted

All other provisions of the policy remain unchanged

National Administrator, Name and Address
B & B Protector Plans Inc.
P.O. Box 15875
Tampa, FL 33684-5875
G·89548-A (ED. 02/97)

Acct. No. 297117911

Countersigned By _ _ _ _ _ _ _ _ _ _ _ _ _ __
Authorized Representative

Issue
Date:

05/21/200708:52:33 PM

YMALDO

Endorsement

Issued by the Stock Insurance Company Herein called The Company

018462

Continental Casually Company

'sf''''"
IfIIA.'A

970·05438·048487
ST. ADM. NUMBER

PRODUCER NUMBER

297117911
rclucyNuMBER

CNA Insurance Companies

CNA Plaza
Fbr All IheC{lmmi\ments\ou !oIake' Chicago, Illinois 60685

CHANGE AND ATTACHING CLAUSE ENDORSEMENT
Named
Insured
And
Mailing
Address

Henri Duyzend DDS

Inception Date

Expiration Dale

18528 Firland Way N.
Shoreline, WA 98133

06/14/2007

06/14/2008

Endorsement
Effective
Date

06/14/2007

It is underslood and agreed that the following change(s) have been made to Ihe policy:

PC EPLI has been added

All other provisions of the policy remain unchanged

National Administrator, Name and Address
B & B Protector Plans Inc.
P.O. Box 15875
Tampa, FL 33684·5875
G·89548·A (ED. 02197)

Acc!. No. 297117911

Countersigned By _ _ _ _ _ _ _ _ _ _ _ _ _ __
Authorized Representative

Issue
Date:

051211200708:52:33 PM

YMALDO

Endorsement

Issued by the Slack Insurance Company Herein called The Company
Continental Casualty Company

018482

PRODUCER ~NUMBER

IJIIAIA

"''''M.

970-05438-048487
ST. ADM: NUMBER
297117911
POliCY NUMBER

CNA Insuranco Companies
CNA Plaza
FbrAlIthoCommitmelttsYouMakct Chicago, Illinois 60685
- -

CHANGE AND ATTACHING CLAUSE ENDORSEMENT
Named
Insured
And
Mailing
Address

Henri Duyzend DDS

Inception Dale

Expiration Dale

18528 Firland Way N.
Shoreline, WA 98133

06/14/2007

06/14/2008

Endorsement
Effeclive
Dale

06/14/2007

The following endorsement has been deleted as of 06/14/2007
0-30015-046 (Ed. 05/05) Washington Employment Practices Liability

Nalional Administrator, Name and Address
B & B Protector Plans Inc.
P.O. Box 15875
Tampa, FL 33684·5875
G-89548·A (ED. 02/97)

Accl. No. 297117911

Issued by lile Stock Insurance Company Herein called The Company

Countersigned By _ _ _ _ _ _ _ _ _ _ _ _ _ __
Authorized Representative

Issue
Dale:

05/21/200708:52:33 PM

Endorsement

YMALDO
970-05438-048487

Continental Casualty Company

018462

ST. ADM. NUMBER

PRODUCER NUMBER

PAIA.
'-1'1114

297117911
POLICY NUMBER

CNA Insurance Companies
CNA Plaza
FbrAlIthoCommitmentsYouMake' Chicago, Illinois 60685

CHANGE AND ATTACHING CLAUSE ENDORSEMENT
Named
Insured
And
Mailing
Address

Henri Duyzond DDS

tnceplion Dale

Expiration Date

18528 Firland Way N.
Shoreline, WA 98133

0611412007

0611412008

Endorsement
Effective
Date

0611412007

The following endorsement has been deleted as of 06/14/2007
EPL For Professional Corporation

HENRI F. DUYZEND, DDS PS

National Administrator, Name and Address
B & B Protector Plans Inc.
P.O. Box 15875
Tampa, FL 33684·5875
G·89548·A (ED. 02/97)

Ace!. No. 297117911

Countersigned By _ _ _ _ _ _ _ _ _ _ _ _ __
Authorized Representative

Issue
Date:

05/21/200708:52:33 PM

YMALDO

Endorsement

ISSLled by tho Stock Insurance Company Herein called The Company
Continental Casually Company

970-05438-048487
018462
PRODUCER NUMBER

If1IIAIA.
..IIfIM.

st. ADM. NUMBER
297117911

CNA Insurance Companies
CNA Plaza
fbrAJlthoCommitments\OuMake' Chicago, Illinois 60685

POLICY NuMBER

CHANGE AND ATTACHING CLAUSE ENDORSEMENT
Named
Insurod
And

Henri Duyzend DDS

Expiration Date

18528 Flrland Way N.
Shoreline, WA 98133

Mailing

Inception Date

06/14/2007

06/14/2008

Address

Endorsement
Effective
Date

06/14/2007

It is understood and agreed that the following change(s) have been made to the policy:

Henri Duyzend, DDS has been amended to:
Class

1

PL Prior Acts Date

06/14/1988

EPLI Prior Acts Date 06/14/1998

Liability Each Claim $5,000,000
Aggregate Each Consecutive Annual Period $8,000,000

Risk Management Credit Applied

Practice Location:
18528 Firland Way N.
Shoreline, WA 98133

All other provisions of the policy remain unchanged

National Administrator, Name and Address
B & B Protector Plans Inc.
P.O. Box 15875
Tampa, FL 33684·5875
G-89548-A (ED. 02/97)

Accl. No. 297117911

Countersigned By _ _ _ _ _ _ _ _ _ _ _ _ _ __
Authorized Representative

Issue
Date:

05/21/2007 08:52:33 PM
YMALDO

Endorsement

Issued by the Stock Insurance Company Herein called The Company
Continental CasuaUy Company

PAl.

"''''14..

018462

PRODUCER NtJMBE~R

970-05438-048487
ST. ADM. NUMBER
297117911
POLICY N(J"M~B~E~R~

CNA Insurance Companies

CNA Plaza
IbrAllthoCommitmel1tsYouMake' Chicago, Illinois 60685

CHANGE AND ATTACHING CLAUSE ENDORSEMENT
Named
Insured
And
Mailing
Address

Henri Duyzend DDS

Inception Date

Expiration Dale

18528 Firland Way N.
Shoreline, WA 98133

06/14/2007

06/14/2008

Endorsement
Effective
Dale

06/14/2007

It is understood and agreed that the following change(s) have been made to the policy:

The following P.C. is amended to:

Name:
HENRI F. DUYZEND, DDS PS

Henri Duyzend DDS

National Administrator, Name and Address
B & B Protector Plans Inc.
P.O. Box 15875
Tampa, FL 33684-5875
G-89548-A (ED. 02/97)

Accl. No. 297117911

Countersigned By _ _ _ _ _ _ _ _ _ _ _ _ _ __
Authorized Representative

~:~~

05/21/200708:52:33 PM

YMALDO

Endorsement

Issued by tile Stock Insurance Company Herein called The Company
Continental Casualty Company

".,A
""'14.

018462

970-05438-048487
ST. ADM. NUMBER

PRODUCER NUMBER

297117911
POLICY NUMBER

CNA Insurance Companies

CNA Plaza
~brAlllheCommilments'OuMake' Chicago, IllInois 60685

CHANGE AND ATTACHING CLAUSE ENDORSEMENT
Named
Insured
And
Mailing
Address

Henri Duyzend DDS

Inception Date

Expiration Dale

18528 Firland Way N.
Shoreline, WA 98133

06/14/2007

06/14/2008

Endorsement
Effeclive
Date

06/14/2007

The following endorsement has been deleted as of 06/14/2007
EPL Defense Only Prior Acls Dale

The above amendment pertains to

National Administrator, Name and Address
B & B Proleclor Plans Inc.
P.O. Box 15875
Tampa, FL 33684-5875
G-89548-A (ED. 02197)

Ace!. No. 297117911

Countersigned By _ _ _ _ _ _ _ _ _ _ _ _ __
Authorized Representative

~:~e~

05/21/200708:52:33 PM

YMALDO

Endorsement

Issued by the Stock Insurance Company Herein called The Company

018462
PRODUCER NUM8E-R

Continental Casualty Company

16UA.

taft"

970-05438-048487
ST. ADM. NUMBE-R
297117911
POLICY NUMBER

CNA Insurance Companies

CNA Plaza

fbrAlllheC<HnmilmenfsYouMIlke' Chicago. illinois 60685

CHANGE AND ATTACHING CLAUSE ENDORSEMENT
Named
Insured
And
Mailing
Address

Henri Duyzend DDS

Inception Dale

Expiration Date

18528 Flrland Way N.
Shoreline, WA 98133

06/14/2007

06/14/2008

Endorsement
Effeclive
Date

Total Policy Billed Premium:

$67.00

National Administrator, Name and Address

Countersigned By _ _ _ _ _ _ _ _ _ _ _ _ _ __

B & B Protector Plans Inc.

Authorized Representative

P.O. Box 15875
Tampa, FL 33684-5875
G-89548-A (ED. 02/97)

06/14/2007

~!~e~
Acc!. No. 297117911

05/21/200708:52:33 PM

YMALDO

Endorsement

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
COMPUTER VIRUS AND SYSTEM PENETRATION EXCLUSION

This endorsement modifies insurance provided under the following:
BUILDING BLANKET DENTAL PRACTICE PERSONAL PROPERTY AND INCOME
COVERAGE PART

I.

The following are added to Section II., EXCLUSIONS, paragraph A:.
A "Computer Virus";
"System Penetration ll

II.

The following paragraphs are added to Section IV. DEFINITIONS:
"Computer Virus" means any Electronic data introduced or implanted without authorization into
electronic data processing equipment or Electronic data which causes the corruption, distortion,
deletion, destruction, unauthorized copying or loss of functionality of Electronic data.
"Electronic Data" means information, programs or instructions that have been converted to a
form usable in electronic data processing systems.
"System Penetration" means the intentional and malicious use of a computer to obtain
unauthorized access to information and resources stored on electronic data processing
equipment in the form of Electronic data.

G-142813-A Ed. 02102

CNA

For All thn ConunitmC'1\1./; You )fake'

DEFENDANT'S REIMBURSEMENT COVERAGE PART

LIMITS OF LIABILITY

$ 500 per day
$5.000 per suit

I.

COVERAGE AGREEMENT
IV.
We will repay you for the necessary expenses and
loss of time you incur as a result of being a
defendant or co-defendant in a civil suit. These
amounts must result from your being required to
attend a trial of the suit. The suit must be caused
by an injury or damage covered by this policy.

II.

EXCLUSIONS
This coverage does not apply to trials of lawsuits if
an action for damages had been filed before the
effective date of this policy, and entered upon the
records of a court lawfully established to receive,
hear, or adjudicate such actions.

III.

LIMITS OF LIABILITY
This coverage applies separately to each insured
dentist. The Limit of Liability stated above as "per
day" is the maximum we will pay for each full day
you are required to appear in court. A full day
means your attendance during both the morning
and afternoon sessions of the trial. If you are
required to appear in court for only one-half day,
our liability shall only be one-half the per day limit.
Our liability for necessary expenses and loss of
time resulting from anyone or more trial(s) arising
out of the same alleged causes of actions,
regardless of the number of days you are required
to attend such trial(s), shall not exceed the "per
suit" limit stated above.

G-137664-A
(Ed. 06/2000)

SPECIAL CONDITIONS
You must give us, or any of our authorized agents,
written notice as soon as practicable following the
last date of expenses or loss of time you incur.
This notice shall contain details sufficient to
identify you and all reasonably obtainable
information regarding the time, place and
circumstances of the loss. Also included must be
the identity of the court and all parties to the action
before the court.
This coverage only applies to expenses and loss of
time which occur during the policy period.

CNA

For All tho Commitments You Malro1>

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
FUNGI, WET ROT, DRY ROT AND MICROBE EXCLUSION

This endorsement modifies insurance provided under the fol/owing:
BUILDING BLANKET DENTAL PRACTICE PERSONAL PROPERTY AND INCOME COVERAGE PART

The fol/owing is added to Section II, EXCLUSIONS, Paragraph A.:

I.

Fungi, Wet Rot, Dry Rot and Microbes
Presence, growih, prOliferation, spread or any activity of fungi, wet or dry rot or microbes.
This exclusion does not apply when fungi, wet or dry rot or microbes result from fire or lightning.

II.

A.

Subparagraphs 5 of Section II., EXCLUSIONS, Paragraph B., is deleted in its entirety and replaced by the
fol/owing:
5.

B.

Rust, or other corrosion, decay, deterioration, hidden or latent defect or any quality in property that
causes it to damage or destroy itself;

The fol/owing is added to Section II., EXCLUSIONS, Paragraph B.:
The fol/owing causes of :
(a) Dampness or dryness of atmosphere;
(b) Changes in or extremes of temperature; or
(c) Marring or scratching.

III.

Paragraph 11. of Section II., EXCLUSIONS, Part B., is deleted in its entirety and replaced by the fol/owing:
11. Continuous or repeated discharge, seepage or leakage of water, or the presence or condensation of
humidity, moisture or vapor, that occurs over a period of 14 days or more.

IV.

The fol/owing is added to Section IV., DEFINITIONS:
"Fungi" means any form of fungus, including but not limited to, yeast, mold, mildew, rust, smut or mushroom,
and including any spores, mycotoxins, odors, or any other substances, products, or byproducts produced by,
released by, or arising out of the current or past presence of fungi. But fungi does not include any fungi intended
by the insured for consumption.
"Microbe" means any non-fungal microorganism or non-fungal colony-form organism that causes infection or
disease. Microbe includes any spores, mycotoxins, odors, or any other substances, products, or byproducts
produced by, released by, or arising out of the current or past presence of microbes.

Page 1 of 1

G-142812-A
(ED. 02102)

Incorporates materials copyrighted by Insurance Services Offices, reprinted with their permission

Issued by Ihe Siock Insurance Company Herein called The Company

970·05438·048487
018462

Contlnental Casualty Company

ST. ADM-NUMBER

PRODUCER NUMBER

/IfI1l1.
flatllWl4.

CNA Insurance Companies
CNA Plaza
fbrAllibeCommitmentsYouMake' Chicago, illinois 60685

297117911
POLICY NUMBE~

CHANGE AND ATTACHING CLAUSE ENDORSEMENT
- - - - - -

Named
Insured
And
Mailing
Address

... - " " - - - -

Expiration Dale

06/14/2007

18528 Firland Way N.
Shoreline, WA 98133

---------_.--._-',

".".',

Inception Dale

Henri Duyzend DDS

06/14/2008

....

...

_

..

_ ...._ - - -

Endorsement
Effective
Date
------

SCHEDULE OF ENDORSEMENTS
G·89548-A (Ed. 02197) Change And AUaching Clause Endorsement
0·30015-046 (Ed. 05/05) Washington Employment Practices Liability
G-11715-E46 (Ed. 04/89) Washington State Provisions
G-135702-B46 (Ed. 05/05) General Liability Policy - Occurrence - WA
G·137664-A (Ed. 06/00) Defendants Reimbursement Coverage Part
G-140093-A46 (EiD. 01/01) Washington Amendatory Endorsement Cornman Cond!.
G·142812-A (Ed. 02102) Fungi, Wet Rot. Dry Rot and Microbe Exclusion
G·142813-A (Ed. 02102) Computer Virus and System Penetration Exclusion
G·142815-A46 (Ed.08103) FungVMold/Mildew/YeasVMicrobe Exclusion & Water
G-144156-A (Ed. 02102) Amendatory Endorsement - Cyber
G·144959-B (Ed. 03/03) Policyholder Disclosure Notice
G·145184-A (Ed. 06/03) Economic And Trade Sanctions Condition
G·147290A (Ed. 03/04) Exclusion - Silica
G·147309A (Ed. 03/04) Exclusion - Asbestos
G-15160-B (Ed. 06/00) Employee Dishonesty Coverage Part
G-15175·G46 (Ed. 12100) Washington State Provisions
G-16856-B99 (Ed. 02192) Special Extra Expense (HIV) Claims-Made
G·17739-B46 (Ed. 03/01) Washington Defense Coverage Amendatory Endorsement
G·41500-C (Ed. 01/90) Common Policy Conditions
G·58004-G46 (Ed. 01/01) Washington Amendatory Endorsement
EPL For Professional Corporation
G-124787-B (Ed. 02106) Professional Protector Plan Gold
G-144872-A (Ed. 01/03) Certified Acts of Terrorism
G·145117-A (Ed. 06/03) HIPAA Proceedings Endorsement
G-145118-A (Ed. 06/03) Protected Health InformationlPrivacy Endorsement
G·15158-E (Ed. 05/06) Professional tnsurance Policy Claims-Made
G-15159-E (Ed. 02106) Building, Blanket Dental Practice Personal Property
G·56427-E (Ed. 07/96) Additional Insured Leased Premises
G·89678-D46 (Ed. 05/05) Washington Stop Gap Extension
OFAC Policy Holder Notice For New Business

- - -..

.---

- - - - , .. _ . _ - - " , .

,------- -

National Administrator, Name and Address

Countersigned By _ _ _ _ _ _ _ _ _ _ _ _ _ __

B & B Protector Plans Inc.
P.O. Box 15875
Tampa, FL 33684-5875

Authorized Represenlative

~:~e~

G·89548·A (ED. 02197)
Accl. No. 297117911
- - - - - - " " , - - - - - - - - - - - - - - .. - - . _ - - -

03/28/2007 12:28:32 PM
MBONILLA

CNA

Fbr All tho Contmibnollts You Make'"

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
Amendatory Endorsement

This endorsement modifies insurance provided under the following:
COMMON POLICY CONDITIONS
GENERAL LIABILITY COVERAGE PART

I.

Section II, EXCLUSIONS of the General Liability Coverage Part is amended by the addition of the following:
We will not defend, or pay under this Coverage Part for:
Personal or advertising injury:

1.

arising out of the infringement of copyright, patent, trademark. trade secret or other intellectual property
rights.
However. this exclusion does not apply to infringement in your advertisement, of copyright, trade dress
or slogan.

2.

committed by an insured whose business is:
a.
b.
c.

advertising, broadcasting, publishing or telecasting;
designing or determining content of web-sites for others; or
an internet search, access, content or service provider.

However. this exclusion does not apply to items A.. B. and C. of the defintion of injury.
For the purposes of this exclusion, the placing of frame, borders or links, or advertising, for you or others
anywhere on the internet is not by iteself considered the business of advertising, broadcasting,
publishing or telecasting.

3.

4.

II.

arising out of an electronic chatroom or bulletin board the insured hosts, owns, or over which the insured
exercises control.
Arising out of the unauhorized use of another's name or product in your e-mail address, domain name or
metatag, or any other similar tactics to mislead another's potential customers.

Section IV., DEFINITIONS, of the General Liability Coverage Part is amended
following definitions:

by the addition of the

"Advertisement" means a notice that is broadcast or published to the general public or specific market
segments about your goods, products or services for the purpose of attracting customers or supporters. For
the purposes of this definition:
A.

Notices that are published include material placed on the internet or on similar electronic means of
communication; and
Page 1 of2

G-144156-A
(ED. 02102)

Incorporales materials copyrighted by Insurance Services Offices, reprinted with their permission

CNA

For All the Commihncnts You MalmG

B. Regarding web-sites, only that part of a web-site that is about your goods, products or services for the
purposes of attracting customers or supporters is considered an advertisement.
"Personal and Advertising Injury" means those offenses set forth in items A, B, C, 0, E, F and G of the
definition of injury.
III. Section IV., DEFINITIONS, of the General Liability Coverage Part, the definition of Damage is deleted and
replaced by the following:
"Damage" means:

A. physical injury to tangible property, including all resulting loss of use of that property. All such loss of
use shall be deemed to occur at the time of the physical injury that caused it.

B. Loss of use of tangible property that is not physically injured. All such loss of use shall be deemed to
occur at the time of the occurrence that caused it.
For the purposes of this insurance, electronic data is not tangible property.
As used in this definition, electronic data means information, facts or programs stored as or on, created or
used on, or transmitted to or from computer software, including systemsand applications software, hard or
floppy disks, CD-ROMS, tales, drives, cells, data processing devices or any other media which are used
with electronically controlled equipment.

IV. Section XVIII. DEFINITIONS, of the Common Policy Conditions, the definition of Coverage Territory is
deleted and replaced by the following:
"Coverage Territory" means:

A. the United States of America, including its territories and possessions;

B. Puerto Rico; and

c.

Canada

Coverage Territory includes Personal and Advertising Injury offenses that take place through the
internet or similar electronic means of communication provided the insured's responsibility to pay damages
is determined in a suit on the merits, in the territory described in A, B, or C above or in a settlement we
agree to.

Page 2 of2

G-144156-A

(ED. 02102)
Incorporates materials copyrighted by Insurance Services Offices, reprinted with their permission

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

ECONOMIC AND TRADE SANCTIONS CONDITION
The following condition is added to the Policy:
ECONOMIC AND TRADE SANCTIONS CONDITION
In accordance with laws and regulations of the United States concerning economic and trade embargoes,
this policy is void from its inception with respect to any term or condition of this policy that violates any
laws or regulations of the United States concerning economic and trade embargoes including, but not
limited to the following:
1. Any insured under this Policy, or any person or entity claiming the benefits of such insured, who is or
becomes a Specially Designated National or Blocked Person or who is otherwise subject to U.S.
economic or trade sanctions;
2. Any claim or suit that is brought in a Sanctioned Country or by a Sanctioned Country Government,
where any action in connection with such claim or suit is prohibited by U.S. economic or trade
sanctions;
3. Any claim or suit that is brought by any Specially Designated National or Blocked Person or any
person or entity who is otherwise subject to U.S. economic or trade sanctions;
4. Property that is located in a Sanctioned Country or that is owned by, rented to or in the care, custody
or control of a Sanctioned Country Government, where any activities related to such property are
prohibited by U.S. economic or trade sanctions; or
5. Property that is owned by, rented to or in the care, custody or control of a Specially Designated
National or Blocked Person, or any person or entity who is otherwise subject to U.S. economic or
trade sanctions.
As used in this endorsement a Specially Designated National or Blocked Person is any person or entity
that is on the list of Specially Designated Nationals and Blocked Persons issued by the U.S. Treasury
Department's Office of Foreign Asset Control (O.F.A.C.) as it may be from time to time amended.
As used in this endorsement a Sanctioned Country is any country that is the subject of trade or economic
embargoes imposed by the laws or regulations of the United States of America.

G-145184-A (Ed. 6/03)

CNA

fur An tlle Commitments You Make<3

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT
CAREFULLY.

EXCLUSION - SILICA
This endorsement modifies insurance provided under the following:
COMMON POLICY CONDITIONS
GENERAL LIABILITY COVERAGE PART

I.

THE GENERAL LIABILITY COVERAGE PART IS MODIFIED AS FOLLOWS:
The Following is added to Section II. EXCLUSIONS:
We will not defend. or pay under this Coverage Part for:
1.
2.

II.

injury arising in whole or in part out of the actual, alleged or threatened respiration or
ingestion at any time of silica; or
damage arising in whole or in part out of the actual. alleged or threatened presence of
silica.

THE COMMON POLICY CONDITIONS ARE MODIFIED AS FOLLOWS:
The following is added to Section XVIII., Definitions:
Silica means the chemical compound silicon dioxide (Si02) in any form. including dust which
contains silica.

G-147290-A
(Ed. 3/04)

Page 1 of 1

CNA

For All the CommitmentsYou Makeli>

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT
CAREFULLY.

EXCLUSION - ASBESTOS
This endorsement modifies insurance provided under the following:
COMMON POLICY CONDITIONS
GENERAL LIABILITY COVERAGE PART

I.

THE GENERAL LIABILITY COVERAGE PART IS MODIFIED AS FOLLOWS:
The Following is added to Section II. EXCLUSIONS:
We will not defend. or pay under this Coverage Part for:
1.

injury or damage arising in whole or in part out of the actual. alleged or threatened
exposure at any time to asbestos; or

2.

any loss. cost or expense that may be awarded or incurred:
a.
b.

II.

by reason of a claim or suit for any such injury or damage; or
in complying with a governmental direction or request to test for, monitor, clean-up,
remove, contain or dispose of asbestos.

THE COMMON POLICY CONDITIONS ARE MODIFIED AS FOLLOWS:
The following are added to Section XVIII., Definitions:
Asbestos means the mineral in any form whether or not the asbestos was at any time:

1.

airborne as a fiber, particle or dust;

2.

contained in or formed a part of a product, structure, or other real or personal property;

3.

carried on clothing;

4.

inhaled or ingested; or

5.

transmitted by any other means.

Suit means a civil proceeding in which damages because of injury or damage to which this
insurance applies are alleged. Suit includes:

1.

an arbitration proceeding in which such damages are claimed and to which you must
submit or does submit with our consent; or

2.

any other alternative dispute resolution proceeding in which such damages are
claimed and to which you submit with our consent.

G-147309-A
(Ed. 3/04)

Page 1 of 1

CNA

For All Ute Commitments You MakeliD

INDEX OF PROVISIONS
EMPLOYEE DISHONESTY
COVERAGE PART
TOPIC

PAGE

I.

Coverage Agreements

A. Money. Securities and Other Property
B. Welfare and Pension Plans
II.

Exclusions

A. Wrongful Acts by Partners
B. Governmental Authority
C. Indirect Damage
D. Legal Action Expenses
E. Nuclear
F. War
G. Previously cancelled Employees
H. Inventory shortage

III.

Limits of Insurance

A. Each Event
B.
IV.

Non-Cumulation

Definitions
Blanket Dental Practice Personal Property
Employee

Event

-

V.

Financial Interest
Money
Securities
Wrongful Act

Conditions

A. Policy Period
B. Duties in the Event of Damage
C. Damage Covered Under More than One Coverage
D. Legal Action Against Us
E. Consolidation/Merger
F. Discovery Period
G. Joint Insured
H. Loss Sustained During Prior Insurance
I. Loss Sustained During multiple Periods
J. Other Insurance
K. Records
L. Recoveries
M. Valuation - Settlement

G-15160-B
(ED 06/00)

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CRIME COVERAGE PART
EMPLOYEE DISHONESTY
Subject to all of the Common Policy Conditions, and the Definitions contained in the Property Coverage Part applicable to
Building, Blanket Dental Practice Personal Property and Income, we agree that:
I.

COVERAGE AGREEMENTS

2.

payment of damage of any type for which
you are legally liable. We will pay direct
compensatory
damage
arising
from
damage covered under this Coverage Part;
or

3.

payment of costs, fees or other expenses
you incur in establishing either the existence
or the amount of damage under this
insurance.

We will pay for damage to Covered Property caused
by or resulting from a Wrongful Act committed by
any of your employees engaged in your regular
service, acting alone or together with others.
Covered Property means the following types of
property for which a Limit of Insurance is shown on
the Declarations:
A. Money, Securities and Blanket Dental
Practice Personal Property. Such Covered
property may be:
1. owned or held by you; or
2.

for which you are legally liable.

D. that constitutes expenses related to any legal
action;
E. by nuclear reaction, radiation, contamination
however caused;
F.

This insurance is for your benefit only.
It
provides no rights or benefits to any other entity.
B. All Welfare and Pension plans requiring
employee dishonesty insurance in accordance
with Section 412 of the Employee Retirement
Income Security Act of 1974, commonly known
as ERISA.
We will pay for damage caused by any employee
while temporarily outside the Coverage Territory for
a period of not more than 90 days.
II.

EXCLUSIONS

G. caused by any emp loyee who has been
cancelled under similar prior insurance and not
reinstated since the last such cancellation; or
H. the proof of which is dependent upon:

1.

Profit and loss computation.

III. LIMITS OF INSURANCE
A. Each Event
The most we will pay for damage in anyone
Event is the Limit of Insurance shown on the
Declarations for:

A. resulting from any Wrongful Act committed by
you or any of your partners whether acting
alone or together with others;

1.

Money, Securities and Blanket Dental
Practice Personal Property; and

2.

an additional limit of $15,000 for Welfare and
Pension plans.

Such Limits of Insurance shall apply collectively
to Covered Property wherever located.
B. Non-Cumulation

B. resulting from seizure or destruction of property
by order of governmental authority;

Regardless of the number of years this
insurance remains in force or the number of
premiums paid, no Limit of Insurance cumulates
from year to year or period to period.

C. that is an indirect result of any act or Event
covered by this Coverage Part including but not
limited to damage resulting from:
1. your inability to realize income that you
would have realized had there been no
damage to Covered Property;

G-15160-B
(ED 06/00)

an inventory computation; or

2.

We will not pay for damage:

In the event of damage caused by a Wrongful
Act committed by any partner or in which a
partner is concerned or implicated, we will only
pay for damage in excess of the Financial
Interest in your partnership of the partner
involved in the damage.

resulting from war, whether or not declared,
warlike action, insurrection, rebellion or
revolution, or any related act or incident;

Page 1 of 4

IV. DEFINITIONS
"Blanket Dental Practice Personal Property"
means any tangible property other than Money and
Securities that has intrinsic value but does not
include any property listed in any other Coverage
Part as Property Not Covered.
"Employee" means:
Any natural person:

"Securities" means negotiable and non-negotiable
instruments or contracts representing either Money
or other property and includes:
A.

tokens, tickets, revenue and other stamps,
whether represented by actual stamps or unused
value in a meter, in current use; and

B. evidences of debt issued in connection with
credit or charge cards, which cards are not
issued by you;

A. while in your service, and for 30 days after
termination of such service; and

but does not include money.

B. whom you compensate directly by salary, wages
or commissions; and

"Wrongful Act" means a dishonest act committed
by an employee, whether identified or not, acting
alone or with others, other than you or a partner,
with the intent to:

C. whom you have the right to direct and control
while performing services for you;
D. employed by an employment contractor while
that person is subject to your direction and
control and performing services for you
excluding, however, any person while having
care, and custody of property outside your
premises.
E. while in the service of any Welfare or Pension
plan including as an insured under this Coverage
Part, as fiduciary, trustee, admin-istrator, officer
or employee and any other natural person while
performing acts normally performed by a
fiduciary, trustee, administrator, officer or
employee as defined in Title 1 of the Employee
Retirement Income Security Act of 1974 or any
of its amendments.

A. cause you to sustain damage; and also

B. obtain financial benefit, other than salaries,
commiSSions,
fees,
bonuses,
promotions,
awards, profit sharing, pensions or other
employee benefits earned in the normal course
of employment, for:

1. the employee; or
2.

V. CONDITIONS
A.

agent, broker, factor, commission merchant,
consignee,
independent
contractor
or
representative of the same general character; or

B. director or trustee except while performing acts

Subject to Emp[oyee Dishonesty Condition H.,
we will pay only for damage that you sustain
through Wrongful Acts occurring during the
policy period.

B. Duties in the event of Damage
Common Policy Condition III. is amended to
include the following:

coming within the scope of the usual duties of an
employee.

You must also:

"Event" means all damage caused by an employee or in which any employee is involved,
whether the result of a single, or series of, acts.
"Financial Interest" means the value of the
partner's interest in your partnership prior to
deducting the amount of damage caused by such
partner. Such value shall be determined as of the
close of business on the date of discovery of
damage.

1.

give us a detailed, sworn proof of damage
within 120 days;

C. Damage Covered
Coverage

under

more

than

One

Common Policy Condition XI., for the purpose of
this Coverage Part, is deleted and replaced by
the following:

currency, coins and bank notes in current use
and having a face value; and

[f 2 or more coverages of this insurance apply to
the same damage, we will pay the lesser of:

B. travelers checks, register checks and money
orders held for sale to the public.
G-15160-B
(ED 06/00)

submit to examination under oath at our
request and give us a signed statement of
your answers;

2.

"Money" means:
A.

Policy Period
Common Policy Condition I. is amended to
include the following:

Employee does not mean any:
A.

any entity intended by the employee to
receive that benefit.

Page 2 of 4

1.

the actual amount of damage; or

2.

1.

the sum of the Limits of Insurance applicable to those coverages.

D. Legal Action Against Us
Common Policy Condition XIII. is amended to
include the following:

a.

until 90 days after you have filed proof of
damage with us; and

2.

the damage would have been covered by
this insurance had it been in effect when
the Wrongful Act was committed or
happened.

unless brought within 2 years from the date
you discovered the damage.
2.

E. Consolidation/Merger
If through consolidation or merger with, or
purchase of assets of, some other entity:

1. any additional persons become employees;
2.

a.

Damage Covered Under This and Prior Insurance Issued by Us

1.

partly by this insurance; and

2.

partly by any prior cancelled or terminated
insurance that we or any affiliate had issued
to you or any predecessor in interest;

pay us an additional premium.

Discovery Period
1.

If this insurance or any of its coverages is
cancelled or terminated as to any of you,
damage sustained by that person is covered
only if discovered no later than 1 year from
the date of that cancellation or termination.

the most we will pay is the larger of the amount
recoverable under this insurance or the prior
insurance.

We will pay only for covered damage discovered no later than 1 year from the end of
the policy period.

2.

J.

If any of you or your partners or officers has
knowledge of any information relevant to this
insurance, that knowledge is considered
knowledge of all of you.

2.

We will not pay more for damage sustained
by more than one of you than the amount
we would pay if all the damage had been
sustained by one of you.

K.

An employee of any of you is considered to
be an employee of all of you.

3.

Records
You must keep records of all Covered Property
so we can verify the amount of any damage.

L.

Recoveries
1.

H. Damage Sustained During Prior Insurance

G-15160-B
(ED 06/00)

Other Insurance
This insurance does not apply to damage
recoverable or recovered under other insurance
or indemnity. However, if the limit of the other
insurance or indemnity is insufficient to cover the
entire amount of the damage, this insurance will
apply to that part of the damage not recoverable
or recovered under the other insurance or
indemnity but not for more than the Limit of
Insurance.

G. Joint Insured
1.

the prior insurance had it remained in
effect.

If any damage is covered:

give us written notice within 90 days
thereafter; and

b.

I.

this insurance as of its effective date; or

b.

you acquire the use and control of any
additional premises;

any insurance afforded for employees or
premises also applies to those additional
employees and premises, but only if you:

The insurance under this Condition is part
of, not in addition to, the Limits of Insurance
applying to this insurance and is limited to
the lesser of the amount recoverable under:
a.

or

F.

this insurance became effective at the
time of cancellation or termination of the
prior insurance; and

b.

You may not bring any legal action against us
involving damage:

1.

If you, or any predecessor in interest,
sustained damage during the period of any
prior insurance that you could have
recovered under that insurance except that
the time within Which to discover damage
had expired, we will pay for it under this
insurance, provided:

Page 3 of 4

Any recoveries, less the cost of obtaining
them, made after settlement of damage
covered by this insurance will be distributed
as follows:

a.

b.
2.

c.

to you, until you are reimbursed for any
damage that you sustain that exceeds
the Limit of Insurance;
then to us, until we are reimbursed for
the settlement made.

(1) actual cash value of the property on
the day the damage was discovered;

Recoveries do not include any recovery:
a.

b.

(2) cost of repairing the property or
premises; or

from insurance, suretyship, reinsurance,
security or indemnity taken for our
benefit; or

(3) cost of replacing the property with
property of like kind and quality.

of original securities after duplicates of
them have been issued.

We may, at our option, pay the actual
cash value of the property or repair or
replace it.

M. Valuation - Settlement

1.

Subject to the applicable Limit of Insurance
provision we will pay for:
a.

b.

If we cannot agree with you upon the
actual cash value or the cost of repair or
replacement, the value or cost will be
determined by arbitration.

damage to Money for not more than its
face value. In the event of damage to
Money before the amount has been
counted and recorded by you, payment
shall not exceed such amount as is
corroborated by reasonable estimates
satisfactory to us.

2.

We may, at our option, pay for damage:
a.

damage of Securities for not more than
their value at the close of business on the
day the damage was discovered. We
may, at our option:

in the Money of the country in which the
damage occurred; or

b.

in the United States of America dollar
equivalent of the Money of the country in
which the damage occurred determined
by the rate of exchange on the day the
damage was discovered.

3.

In compliance with Title 1 of the Employee
Retirement Income Security Act of 1974, or
any of its amendments, payment by us
under this Coverage Part to the first named
insured shall be held for the use and benefit
of any Welfare or Pension plans sustaining
damage. If Money, Securities or Blanket
Dental Practice Personal Property of two
or more Welfare or Pension plans are
commingled, recovery under this Coverage
Part for damage to such Money, Securities
or Blanket Dental Practice Personal
Property shall be shared by such plans on a
pro rata basis in accordance with the
amount of coverage each plan is required to
carry by the act.

4.

(1) pay the value of such Securities or
replace them in kind, in which event
you must assign to us all your rights,
title and interest in and to those
Securities;

Any property that we pay for or replace
becomes our property.

(2) pay the cost of any Lost Securities
Bond required in connection with
issuing duplicates of the Securities.
However, we will be liable only for the
payment of so much of the cost of
the bond as would be charged for a
bond having a penalty not exceed-ing
the lesser of the
(a) value of the Securities at the
close of business on the day the
damage was discovered; or
(b) Limit of Insurance.

G-15160-B
(ED 06/00)

damage to Blanket Dental
Practice Personal Property other than
Money and Securities or damage to the
premises for not more than the:

Page 4 of 4

CNA

FOT All the. Conunitmcntli You }lako~

CLAIMS MADE
SPECIAL EXTRA EXPENSE COVERAGE ENDORSEMENT
HEALTH CARE PROVIDER
IMPORTANT NOTICE
COVERAGE UNDER THIS ENDORSEMENT ONLY APPLIES IF (1) YOU FIRST TEST HIV
POSITIVE DURING THIS COVERAGE PERIOD, (2) THE CLAIM IS REPORTED TO US DURING
YOUR LIFETIME AND (3) THE CLAIM IS ALSO REPORTED TO US DURING THIS COVERAGE
PERIOD, UNLESS THE CLAIM REPORTING PERIOD HAS BEEN EXTENDED UNDER
CONDITION VI. B.

PLEASE READ THIS ENDORSEMENT CAREFULLY TO SEE WHAT OTHER
LIMITATIONS AND CONDITIONS MAY APPLY TO YOUR CLAIM.
I.

COVERAGE AGREEMENT
We agree with You to pay the Amount of Extra Expense Coverage as a result of You as a Named
Insured testing positive for Human Immunodeficiency Virus, hereinafter referred to as "HIV", during
the Coverage Period subject to the following terms and conditions. This must be the first time
You tested positive for HIV.

II.

AMOUNT OF EXTRA EXPENSE COVERAGE
The amount we will pay You under this endorsement shall be as follows:

Physicians, Surgeons & Dentists named on
the Declarations

$150,000 per named insured

All other health care providers named on the
Declarations

$ 25,000 per named insured

The payment of this amount shall exhaust coverage under this endorsement, and no further
amounts shall be recovered.
Upon receipt of proof of loss and verification by us, we shall pay the applicable sum due to You.
III.

ENDORSEMENT EXCLUSIONS
We will not pay, under this Coverage for any claim arising out of:

A. Clinical Testing with a positive result for HIV prior to the effective date of this endorsement.
B. Any act by You where You intentionally infect yourself with HIV.
C. Taking drugs or narcotics that are not lawfully available unless prescribed by a qualified
practitioner other than yourself and taken in accordance with the prescription.

G-16856-899 (Ed. 02/92)

1

CLAIMS MADE

IV.

ADDITIONAL POLICY EXCLUSIONS
We agree with You that when a claim is reported under this endorsement or under any Special
Extra Expense Coverage Endorsement on a preceding policy, the policy to which this endorsement
is attached is amended to include the following additional exclusion:
We will not defend or pay under this Coverage Part for injury or damage resulting from the
transmission by You of the Human Immunodeficiency Virus, "HIV", or any sickness, illness,
disease or death at any time resulting therefrom which is contributed to, caused or exacerbated
by the HIV.

V.

DEFINITIONS

A. "You" for purposes of this endorsement means the Health Care Provider specifically named in
the Declarations. "You" does not mean any locum tenens.
"You" does not include anyone for whose professional acts or omissions You are legally
responsible unless specifically named in the Declarations.
B.

"Coverage Period" for purposes of this endorsement is the Policy Term or Period shown in
the Declarations. If this endorsement is issued after the inception of the Policy Term or Period,
the effective date of this endorsement shall be the effective date stated at the end of this
endorsement.

C.

"Clinical Testing" shall mean a blood specimen drawn from You by a qualified laboratory
during the Coverage Period, the results of which shall be determined by accepted clinical
practice prevailing at the time of diagnosis.
A positive result for HIV must be established by a double positive enzyme-linked
immunosorbent assay test and confirmed by a positive Food and Drug Administration approved
Western Blot assay test, or by a positive result under an HIV test that is considered reliable by
the Federal Centers for Disease Control.

VI.

CONDITIONS

A. A claim under this endorsement is considered reported when You give written notice to us by
registered or certified mail during Your lifetime of the positive result of a Clinical Testing
diagnosing HIV during the Coverage Period, and supply a copy of the diagnosis and test
results. This notice must be received by us within sixty (60) days of the date of the Clinicat
Testing. You must also complete the Special Extra Expense Coverage Questionnaire supplied
by us.
B. Any claim reported to us outside of this Coverage Period will not be valid under this
endorsement, except in the event that You have sent a blood specimen, drawn before or on the
expiration date, for Clinical Testing, and such results of this Clinical Testing are unknown at
the expiration date of coverage under this endorsement. In such an event You shall have thirty
(30) days after the expiration date in which to report a claim under this endorsement in writing
to us.
C. Reporting a claim under this endorsement shall give us the right of access to all Your personal
medical records, tests and reports, wherever located. Failure to provide access to this
information shall be deemed a waiver of right to benefits under this endorsement.
G-16856-B99 (Ed. 02/92)

2

CLAIMS MADE
D.

If a claim is reported under this endorsement, we shall have the right to require such further Clinical
Testing as may be necessary, at a qualified laboratory of our choice, to confirm the diagnosis, such tests
to commence within a reasonable period of time after the claim is reported. If the HIV diagnosis is
confirmed, the Amount of Extra Expense Coverage will be paid to You by us after receipt of such
confirmation.

E. When a claim is reported under this endorsement and the policy to which this endorsement is attached is
amended by Section IV, ADDITIONAL POLICY EXCLUSION, an unlimited extension of the claim
reporting period is provided for HIV claims arising out of medical professional services rendered prior to
the date a claim is reported under this endorsement and subsequent to the Prior Acts date stated on the
Declarations.
The Limits of Liability applicable to this claim reporting period shall be equal to the Limits of Liability
stated on the Declarations.
VII.

CANCELLATION OR NON-RENEWAL
If the policy to which this endorsement is attached is canceled or non-renewed then the coverage under this
endorsement shall terminate at the same date as the policy non-renewal or termination date. In such
circumstance, in the event that the results of a Clinical Testing on blood drawn during the Coverage Period
and before the cancellation or non-renewal date are unknown at the cancellation or non-renewal date of this
endorsement, You shall have an additional thirty (30) days after the cancellation or non-renewal date of this
endorsement, You shall have an additional thirty (30) days after the cancellation or non-renewal date of this
endorsement in which to make a written report of a claim to us.
Any blood drawn from You for Clinical Testing after the cancellation or non-renewal date is excluded as the
basis of a claim under this endorsement.

This endorsement is a part of your policy and takes effect on the effective date of your policy, unless another
effective date is shown below.

Must Be Completed
ENDT. NO.

POLICY NO.

Complete Only When This Endorsement Is Not Prepared wi h the PoliayOr Is Not to be
Effective with the Policy
ISSUED TO
EFFECTIVE DATE OF
THIS ENDORSEMENT

Countersigned by _ _~~~~~_~~_ __
Authorized Representative

CNA

For AlitheCornmitmentsYou Makc~

Washington Amendatory Endorsement
PROFESSIONAL LIABILITY COVERAGE PART
Dentists/Oral Surgeons

We agree with you that Section I. COVERAGE AGREEMENTS, is amended as follows:
1.

The last paragraph of sub-item 4., is deleted and replaced with the following:
The duty to defend ends by payment of the policy limits pursuant to, or in furtherance of, a judgement
or settlement with, or on behalf of, the injured party, or by consent of the insured. We have no duty to
and will not defend any claims not covered by this Coverage Part.

2.

Sub-item 5., is amended to include the following:

5.

We will also provide defense coverage if you become subject to a state regulatory "civil"
investigation. This investigation must be the outcome of injury or damage resulting from a
dental incident otherwise covered under this policy. In such case, we will pay your attorney
fees, costs, expenses and select legal counsel.
You must provide us with written notice of any state regulatory authority investigation:
a.

within the current policy period, plus five (5) days mailing time; and

b.

within 30 days after you have received notice of any investigation by the state regulatory
authority.

Your failure to comply with the above reporting conditions will make this endorsement voidable at
our sole option.

All other provisions of this policy remain unchanged.

Insured Name

Policy Number

Effective date of this endorsement

Countersigned By: _ _-:-c:---:--;--;---;-_ _
Authorized Agent

G-17739-B46
(ED 03/01)

CNA

For All the Commitments You Malw~

INSURANCE COVERAGE
COMMON POLICY CONDITIONS
I.

C. immediately forward all documents
which you receive in connection with
the claim to us;
D. fully cooperate with us or our
designee
in
the
making
of
settlements, the conduct of suits or
other proceedings, enforcing any
right of contribution or indemnity
against another who may be liable to
you because of injury or damage.
You shall attend hearings and trials,
assist in securing and giving
evidence,
and
obtaining
the
attendance of witnesses; and
E. refuse, except at your own cost to
voluntarily make any payment,
assume any obligation or incur any
expense other than reasonable
medical expenses incurred at the
time of the event.

Policy Period; Coverage Territory
We are providing insurance under this
policy:
A. beginning at 12:01 A.M. and ending
at 12:01 A.M. during the policy
period shown on the Declarations;
and
B. including any prior acts period if
stated on the Declarations as
applicable;
C. within the coverage territory.

II.

Your Duties As The First Named On
The Declarations
When there are more than one of you
named in this policy, the first of you
named, on behalf of all others, will be:
A. authorized to make changes in the
terms of this policy with our consent;
B. the payee of any premiums we
refund;
C. responsible for:
1. the payment of all premiums
due;
2. keeping
records
of
the
information we need for premium
computation, and sending us
copies at such times as we may
request; and
3. notifying us that you want to
cancel this policy.

III.

IV.

Separation of Insureds
This policy applies separately to each of
you against whom a claim is brought
except with respect to:
A. the limits of liability; and
B. any of your duties as the first named
on the Declarations

V.

Inspections and Surveys
We have the right but are not obligated
to:
A. make inspections and surveys at any
time;
B. Give you reports on the conditions
we find;
C. recommend changes; or
D. conduct loss control and prevention
activity.

Your Duties
If there is a claim or you reasonably
think there will be, you must do the
following:
A. notify us and your insurance agent in
writing as soon as possible;
B. specify the names and addresses of
the
injured
people
and
any
witnesses.
Provide
us
with
information on the time, place and
nature
of
the
event;

Any inspections, surveys, reports, or
relate
only
to
recommendations
insurability and the premiums to be
charged. We do not:
A. make safety inspections;

G·41500·C
(ED 01/90)

Page 1

B. undertake to perform the duty of any
entity to provide for the health and
safety of workers or the public; nor
C. warrant that conditions:
1. are safe or healthful; or
2. comply with laws, regulations,
codes or standards.
This provision applies not only to us, but
also to any rating, advisory, rate service,
or similar organization which makes
insurance inspections, surveys, reports,
recommendations, or gives loss control
or prevention advice.

VI.

Examination
Records

of

Your

Books

VIII.

XI.

XII.

Under More

Than

One

Transfer Of Rig his Of Recovery
If any entity for whom we make payment
under this policy has rights to recover
amounts from another, those rights are
transferred to us to the extent of our
payment. That entity must do everything
necessary to secure our rights and must
do nothing after injury or damage to
impair them.

XIII.

Legal Action Limitation
You may not bring any legal action
against us concerning this policy until:

Transfer of Interest

A. you have fully complied with all the

You must first obtain our written consent
to transfer or assign this policy. If you
die, the policy will continue for the
remaining part of the policy period; first,
for the benefit of your legal representative
while acting within their duties as such,
and second, for the benefit of anyone
having proper temporary custody of your
property until a legal representative is
appointed.
IX.

Insurance
Coverage

If more than one of this policy's
coverages apply to the same injury or
damage, we will not pay more than the
limit of liability applicable to the most
specifically described coverage, or, the
actual amount of the injury or damage,
whichever is less.

Changes
Notice to any of our agents or knowledge
possessed by any such agent or any
other person shall not act as a waiver or
change in any part of this policy. It also
will not prevent us from asserting any
rights under the provisions of this policy.
None of the provisions of this policy will
be waived, changed or modified except
by written endorsement issued to form a
part of this policy.

Other Insurance
If you have other insurance which applies
to the loss, the other insurance must pay
first. It is the intent d this policy to apply
to the amount of loss which is more than
the limit of liability of the other insurance.
We will not pay more than our limit of
liability.

and

We may examine and audit your books
and records as they relate to this policy
at any time during the policy period and
up to 3 years afterward.
VII.

X.

Concealment,
Fraud

provisions of this policy; and
B. the amount of your obligation to pay
has been decided. Such amount can
be set by judgment against you after
actual trial or by written agreement
between you, us and the claimant.

Misrepresentation,

This policy is void in any case of fraud by
you relating to it. It is also void if you
intentionally conceal or misrepresent a
material fact or circumstance concerning:
A. this policy;
B. any covered property; or
C. your interest in the covered property
or this insurance.

XiV.
Page 2

Any entity, or their legal representative, is
entitled to recover under this policy after
they have secured a judgment or written
agreement. Recovery is limited to the
extent of the insurance afforded by this
policy. No entity has any right under this
policy to include us in any action against
you to determine your liability, nor will
we be brought into such an action by you
or your representative. If you or your
estate becomes bankrupt or insolvent, it
does not change any of our obligations
under this policy.
Premium

All premium charges under this policy will
be computed according to our rules and
rating plans which apply at the inception
of the current policy period. Premiums for
this policy are payable to us in advance.
They may be paid to us or our authorized
representative. The first premium is due
on the inception date of the policy.

E. If notice is mailed, proof of mailing
will be sufficient proof of notice.
XVII.

We will provide you with the following
information relating to this and any
preceding policy we have issued to you
during the previous three years:

You must keep accurate records of the
information we will need to compute your
premium. You agree to send us these
records at the end of each policy period,
or any other time we request them.
XV.

A. A list or other record of each claim,
not previously reported to any other
insurer, of which we were notified in
accordance
with
these
policy
Condilions. We will include the date
and brief description of the claim if
that information was in the notice we
received.
B. A summary by policy year, of
payments
made and
amounts
reserved, stated separately, for each
Aggregate Limit of Liability shown on
the Declarations.

Non-renewal
We can non-renew this policy by giving
written notice to the first of you named
on the Declarations, at your last known
address, at least 30 days before the
expiration date.
If notice is mailed, proof of mailing will be
sufficient proof of notice.

XVI.

Amounts reserved are based on our
judgment. They are subject to change
and should not be regarded as ultimate
settlement values.

Cancellation
This policy can be canceled by either the
first of you named on the Declarations or
us.
A. The first of you named can cancel
this policy at any time. To do so,
you must:
1. return the policy to us or any of
our authorized representatives; or
2. mail a written notice to us. telling
when the cancellation is to be
effective.
We must receive the policy or written
notice before the cancellation date.
B. We can cancel this policy by giving
written notice to the first of you
named on the Declarations, at your
last known address at least:
1. 10 days, if we cancel for nonpayment of premium; or
2. 30 days, if we cancel for any
other reason;
before
the
effective
date
of
cancellation.
C. Notice of cancellation will state the
effective date of cancellation. This
policy will end on that date.
D. If we cancel, the refund will be prorata. If you cancel, the refund may
be
less
than
pro-rata.
The
cancellation will be effective even if
we have not made or offered a refund.

Your Right to Claim Information

You must not disclose this information to
any claimant or their representative
without our written consent.
If we cancel or elect not to renew this
policy for any reason other than nonpayment of premium, we will provide such
information no later than 30 days before
the date of policy termination. In other
circumstances, we will provide this
information only if we receive a written
request from you within 60 days after the
end of the policy period. In this case, we
will provide this information within 45
days of receipt of the request.
We compile claim information for our
own business purposes and exercise
reasonable care in doing so. In providing
this information to you we make no
representations or warranties to insureds,
insurers, or others to whom this
information is furnished by or on your
behalf. Cancellation or non-renewal will
be effective even if we inadvertently
provide inaccurate information.
XVIII.

Page 3

Definitions

If any of the following terms are used in
this policy, they will only have the
meaning shown.

A. physical injury to tangible property,
including all resulting loss of Lise of
that property; or
B. loss of use of tangible property that
is not physically injured.

"Advertising Injury" means injury
arising out of one or more of the following:

"Hazardous
Properties"
includes
radioactive, toxic or explosive properties.

A. oral or written publication of material
that:
1. slanders or libels an entity or
disparages an entity's goods,
products or services; or
2. violates an entity's right of
privacy;
B. misappropriation of advertising ideas
or style of doing business; or
C. infringement of copyright, title or
slogan.

"Hostile Fire" means one which
becomes uncontrollable or breaks out
from where it was intended to be.
"Impaired Property" means tangible
property other than your product or your
work that cannot be used or is less
useful because:
A. it incorporates your product or your
work that is known or thought to be
defective, deficient, inadequate or
dangerous; or
B. you have failed to fulfill the terms of a
contract or agreement;
if such property can be restored to use
by:
A. the repair, replacement, adjustment
or removal of your product or your
work; or
B. your fulfilling the terms of the
contract or agreement.

"Anti -trust law" means those laws listed
in:

A. Title 15, Section 12, of the United
States Code;
B. the Federal Trade Commission Act;
and
C. any similar state law.
"Auto" means a land motor vehicle, trailer
or semi-trailer designed for use on public
roads. Any attached apparatus or
machinery is included. Mobile equipment
is not included.

"Injury" means bodily injury, sickness,
disease, mental or emotional distress
sustained by a person. Also included is
death at any time as a result.

"Claim Expenses" means:

A. fees charged by an attorney we
designate; and
B. all other fees, costs and expenses
which result from the investigation,
adjustment, defense and appeal of a
claim.

"Insured Contract" means:

A. a lease of premises;
B. a sidetrack agreement;
C. an easement or license agreement
except
in
connection
with
construction or demolition operations
on or within 50 feet of a railroad;
D. an obligation, as required by
ordinance,
to
indemnify
a
municipality, except in connection
with work for a municipality.
E. an elevator maintenance agreement;
or
F. the part of any other contract or
agreement
pertaining
to your
business,
including
an
indemnification of a municipality in
connection with work performed for a
municipality, under which you
assume the tort liability of another
party to pay for injury or damage to
a third party if the contract or
agreement is made prior to the
injury or damage.

These expenses must be incurred by us
or by you with our prior written consent.
"Claim Expenses" does not include:

A. salary charges of our regular
employees or Company officials; or
B.
fees and expenses of
independent adjusters.

"Coverage Territory" means:
A. the United States of America,
including
its
territories
and
possessions;
B. Puerto Rico; and
C. Canada.
"Damage" means:
Page 4

"Insured Contract" does not mean that
part of any contract or agreement:

D. maintained primarily to provide
mobility to:
1. road construction or resurfacing,
or other construction equipment,
whether or not sel~propelled; or
2. air compressors, pumps and
generators, including spraying,
welding,
building
cleaning,
geophysical exploration, lighting
and well servicing equipment, or
devices used to raise or lower
workers, if not self-propelled; or
E. not described in A. through D.1
maintained primarily for purposes
other than to carry persons or cargo.

A. that indemnifies an entity for injury
or
damage
arising
out
of
or
demolition
construction
operations, within 50 feet of any
railroad property and affecting any
railroad bridge or trestle, tracks, road
beds, tunnel, underpass or crossing;
B. that
indemnifies
an
architect,
engineer or surveyor for injury or
damage arising out of:
1. preparing, approving or failing to
prepare
or approve
maps,
drawings,
OpiniOnS,
reports,
surveys, change orders, designs
or speCifications; or
2. giving directions or instructions,
or failing to give them, if that is
the primary cause of the injury
or damage;
C. under which you, if an architect,
engineer or surveyor, assumes
liability for an injury or damage
arising out of your rendering or failure
to render professional services,
including those listed above and
supervisory,
inspection
or
engineering services; or
D. that indemnifies any entity for
damage by fire to premises rented or
loaned to you.

"Mobile Equipment" does not mean
self-propelled vehicles:
A. described in subparagraph D.2 of the
definition of mobile equipment; nor
B. equipment designed primarily for:
1. snow removal;
2. road maintenance, other than
construction or resurfacing; or
3. street cleaning;
"Named Insured" means the entity
named on the Declarations of this policy
as the named insured.
"Non-owned Auto" means an auto not
owned, registered, hired, leased or
loaned to you.
"Nuclear Facility" means:

"Loading or unloading" means the
handling of property:

A. any nuclear reactor;
B. any equipment or device designed or
used for:
1. separating the isotopes of
uranium or plutonium,
2. processing or utilizing spent fuel,

A. after it is moved from the place where
it is accepted for movement into or
onto an aircraft, watercraft or auto;
B. while it is in or on an aircraft,
watercraft or auto; or
C. while it is being moved from an
aircraft, watercraft or auto to the
place where it is finally delivered.

ar
3.

handling,
processing
or
packaging waste;
C. any equipment or device used for the
processing, fabricating or alloying of
special nuclear material if at any
time the total amount of such
material in your custody at the
premises where such equipment or
device is located consists of or
contains more than 25 grams of
plutonium or uranium 233 or any
combination thereof, or more than
250 grams of uranium 235;
D. any structure, basin, excavation,
premises or place prepared or used
for the storage or disposal of waste.

"Loading or unloading" does not mean
the movement of property by means of a
mechanical device, other than a hand
truck, that is not attached to the aircraft,
watercraft or auto.
"Mobile Equipment" means any land
vehicles,
including
any
attached
machinery or equipment:
A. designed for use primarily off public
roads;
B. maintained for use solely on or next
to premises you own or rent;
C. that travels on crawler treads;
Page 5

Nuclear Facility also includes the site
on which any of the foregoing is located,
all operations conducted on such site
and all premises used for such
operations.

by or for any of you or anyone for
which
you
may
be
legally
responsible.
"Pollution" does not mean heat, smoke
or fumes from a hostile fire.

"Nuclear Reactor" means any apparatus
designed or used to sustain nuclear
fission in a self-supporting chain reaction
or to contain a critical mass of fissionable
material;
With respect to injury to or
of property, the word
"destruction" includes all
radioactive contamination of
loss of use.

"Products/Completed
Operations
Hazard" means injury or damage that
happens away from premises you own or
rent and arising out of your products or
your work, except:

destruction
injury or
forms of
property or

A. products that are still in
physical possession; or
B. work that has not yet
completed or abandoned.

your
been

"Source Material", "Special Nuclear
Material", and "By-product Material"
have the meanings given them in the
Atomic Energy Act of 1954 or any or its
amendments.

"Pollutants" means any solid, liquid,
gaseous
or
thermal
irritant
or
contaminant, including smoke, vapor,
soot, fumes, acids, alkalis, chemicals
and waste. Waste includes materials to
be recycled, reconditioned or reclaimed.

"Spent fuel" means any fuel element or
fuel component, solid or liquid, which has
been used or exposed to radiation in a
nuclear reactor.

"Pollution" means the actual, alleged or
threatened
discharge,
dispersal,
seepage, migration, release or escape of
pollutants;

"Tort liability" means a liability that
would be imposed by law in the absence
of any contract or agreement.

A. at or from any premises, site or
location;
1. which is or was at any time:
a. owned, occupied, rented or
loaned to you; or
b. used by or for any of you or
others for the handling,
storage,
disposal,
processing or treatment of
waste.
2. on which any of you or any
contractors or subcontractors
working directly or indirectly on
your behalf are performing
operations:
a. if the pollutants are brought
on or to the premises, site or
location in connection with
such operations by you, any
contractor or subcontractor;
or
b. if the operations are to test
for, monitor, clean up,

"Waste" means any waste material:
A. containing
by-product material
other than the tailings or wastes
produced by the extraction or
concentration of uranium or thorium
from any ore processed primarily for
its source material content; and
B. resulting from the operation by an
entity of any nuclear facility
included under the first two
paragraphs of the definition of
nuclear facility.

"Your Premises" means
A. the location described on the
Declarations of this policy;
B. any additional premises, used for
business purposes, which may
become insured under this policy, up
to a maximum of 30 days;
C. approaches immediately adjoining
such premises.

remove,
contain,
treat,
detoxify or neutralize or in
any way respond to , or
assess
the
effects
of
pollutants;
B. which are or were at any time
transported, handled, stored, treated,
disposed of, or processed as waste

"Your product" means:
A.

Page 6

any goods or products, other than
real property, manufactured, sold,
handled, distributed or disposed of
by;

1.

you;
others trading under your name;
or
3. an entity whose business or
assets you have acquired; and
B. containers, other than vehicles,
materials, parts, or equipment
furnished in connection with such
goods or products;
C. warranties or representations made
at any time with respect to the
fitness,
quality,
durability
or
performance of any of the items
listed above; or
D. the providing of or failure to provide
warnings or instructions.

"Your work" will be considered
completed, when, at the earliest of the
following times:

2.

A. all of the work called for in your
contract has been completed;
B. all of the work to be done at the site
has been completed if your contract
calls for work at more than one site;
or
C. that part of the work to be done at a
job site has been put to its intended
use by any entity other than another
contractor or subcontractor working
on the same project.

Work
that
may
need
service,
maintenance,
correction,
repair or
replacement, but which is otherwise
complete, will be treated as completed.

'Your product" does not include vending
machines or other property rented to or
located for the use of others but not sold.

This hazard does not include injury or
damage arising out of:

'Your work" means:
A. work or operations performed by you
or on your behalf; and
B. materials, parts
or equipment
furnished in connection with such
work or operations;
C. warranties or representations made
at any time with respect to the
fitness,
quality,
durability
or
performance of any of the items
listed above; or
D. the providing of or failure to provide
warnings or instructions.

A. the transportation of property, unless
the injury or damage arises out of a
condition in or on a \ehicle created
by its loading or unloading;
B. the existence of tools, uninstalled
equipment or abandoned or unused
materials; or

C. products or operations for which the
classification in this Coverage Part or
in our manual of rules, includes
products or completed operations.

Page 7

CNA

For All theConunitments You Make~

PROFESSIONAL LIABILITY COVERAGE PART
DENTISTS/ORAL SURGEONS
CLAIMS-MADE

YOUR PROFESSIONAL LIABILITY INSURANCE IS WRITTEN ON A "CLAIMS-MADE" BASIS AND
PROVIDES COVERAGE FOR THOSE CLAIMS WHICH ARE THE RESULT OF DENTAL INCIDENTS
HAPPENING SUBSEQUENT TO THE PRIOR ACTS DATE, IF ANY, STATED ON THE
DECLARATIONS AND WHICH ARE FIRST MADE AGAINST YOU WHILE THIS INSURANCE IS IN
FORCE. NO COVERAGE EXISTS FOR CLAIMS FIRST MADE AGAINST YOU AFTER THE END OF
THE POLICY PERIOD UNLESS, AND TO THE EXTENT, AN EXTENDED REPORTING PERIOD
APPLIES.

We are the stock insurance company named on the Declarations. Throughout this policy the words we,
us and our refer to the company providing this insurance. We agree with you as follows:

I.

consent is being withheld, at our
expense, we may request that a
neutral Arbitrator decide
whether your consent has been
unreasonably withheld. The decision
of the Arbitrator shall be binding.
The selection of the Arbitrator, and
the rules governing the arbitration,
shall be determined according to
rules promulgated by the American
Arbitration Association. A finding
by the arbitrator that consent has
been unreasonably withheld will
authorize the company to settle the
claim.

COVERAGE AGREEMENTS
We will pay all amounts up to the limit of
liability, which you become legally obligated
to pay as a result of injury or damage. We
will also pay claim expenses. The injury
or damage must be caused by a dental
incident arising out of the supplying of or
failure to supply professional services by
you or anyone for whose professional acts
or omissions you are legally responsible.
The dental incident as described above
must happen on or after the prior acts date
and claim therefore must be first made
before the end of the policy period stated on
the Declarations of this policy.

Our payment of the limit of liability ends our
duty to defend or settle.

We have the right and will defend any
claim. We will:

We have no duty to and will not defend any
claims not covered by this Coverage Part.

1.

do this even if any of the charges of
the claim are groundless, false or
fraudulent;

2.

investigate any claim as we feel
appropriate;

3.

negotiate and settle any claim; and

4.

not settle any claim without your
consent, which will not be
unreasonably withheld. If your

G-15158-E
(Ed. 05/2006)

Page 1 of 8

5.

We will also provide defense

coverage if you become subject to a
state regulatory "civil" investigation.
This investigation must be the
outcome of injury or damage
resulting from a dental incident
otherwise covered under this policy.
In such case, we will pay your
attorney fees, costs, expenses and we
will select legal counsel.

You must provide us with written
notice of any state regulatory authority
investigation:

1.

liability that you would have in
the absence of the contract or
agreement;

1.

wilhin the current policy period;
and

2.

liability you assume in a
contract with:

2.

within 30 days after you have
received notice of any
investigation by the state
regulatory authority.

a.
b.
c.

II.

EXCLUSIONS
d.
We will not defend, or pay, under this
Coverage Part for:

A.

but only as respects
professional services
provided by you;

injury to:

1.

2.

an employee of yours arising
out of and in the course of
employment by you; or

3.

4.

the spouse, child, parent,
brother, or sister of that
employee as a consequence of
1. above.

professional services
rendered as a dentist under
contract or agreement with a
dentist or a provider of dental
professional services; or
a warranty of fitness or quality
of any therapeutic agents or
supplies you have furnished
or supplied in connection with
treatment you have performed;

This exclusion applies:

1.

2.

Health Maintenance
Organizations;
Preferred Provider
Organizations;
Independent Practice
Associations; or
Any other similar
organization;

whether you may be liable as
an employer or in any other
capacity; and

D.

to any obligation you have to
indemnify some other entity
because of such injury.

injury or damage resulting from a
dental incident which is also a
willful violation of a statute,
ordinance or regulation imposing
criminal penallies;
We will defend any civil suit against
you seeking amounts which would be
covered if this exclusion did not apply.
In such case, we will pay only the fees,
costs, and expenses of such defense;

This exclusion does not apply:

1.

to liability you assume under
an insured contract; or

2.

to a claim resulting from
immediate dental care given to
an employee after the injury
andlor to a dental incident
arising from your professional
services to any employee.

E.

any liability you have as a
proprietor, superintendent, director,
administrative or executive officer of
any:

1.
B.

C.

any liability you assume under any
contract or agreement. This
exclusion does not apply to:

G-15158-E
(Ed. 05/2006)

hospital, nursing home or
sanitarium;

2.

clinic with bed and board
facilities; or

3.

any amounts you or any entity must
pay under any unemployment or
Workers' Compensation, disability
benefits, or other similar law;

laboratory or business.

This exclusion does not apply to
Page 2 of 8

your professional liability arising out
of laboratory facilities:
2,

1,

you maintain for testing of your
own patients; or

2,

necessary to the practice of
your specialty;

3,

F,

any injury, sickness, disease, death
or destruction:

1,

with respect to which you are
also an insured under a
Nuclear Energy Liability Policy
issued by:
a,
b,
c,

b,

Nuclear Energy Liability
Insurance Association;
Mutual Atomic Energy
Liability Underwriters; or
Nuclear Insurance
Association of Canada,

or would be an insured under any
such policy if it had not terminated
due to eXhaustion of its limit of
liability; or

2,

resulting from the hazardous
properties of nuclear material
and with respect to which:

operated by or on
your behalf;
has been discharged
or dispersed
therefrom;
is contained in spent
fuel or waste at
anytime possessed,
handled, used,
processed, stored,
transported or
disposed of by or on
your behalf; or

the injury, sickness,
disease, death or
destruction arises out of
the furnishing by you of
services, materials, parts
or equipment in
connection with the
planning, construction,
maintenance, operation or
use of any nuclear
facility, If such facility is
within the coverage
territory, this
subparagraph 3,b, applies
only to injury to or
destruction of property at
such nuclear facility;

G,

b,

3,

any entity is required to
maintain financial
protection pursuant to the
Atomic Energy Act of 1954
or any of its amendments;
or
you are, or had this policy
not been issued would be,
entitled to indemnity from
the United States of
America or any of its
agencies, under any
agreement entered into
by the United States of
America or any of its
agencies with any entity;

resulting from the hazardous
properties of nuclear material
if:
a,

G-15158-E
(Ed, 05/2006)

H,

a dental incident resulting
from professional services by
any dentist who is not an
insured dentist. This
exclusion does not apply,
however, to any liability you
may have as a result of such
dental incident;
injury or damage you
expected or intended, or which
a reasonable person could
have expected;
This exclusion does not apply
to injury resulting from the use
of reasonable force to protect
persons or property,

the nuclear material:
1,

any fines, penalties, sanctions,
government payments or the
return or withdrawal of fees for
patient treatment or any
multiplication of amounts
payable under this policy
imposed by law;

I.

a,

is at any nuclear
facility owned or
Page 3 of 8

J.

any claim arising out of actual
or alleged involvement in any:
1.

anti-trust law violation; or

2.

date if, on the
inception date of this
policy, you knew or
had been told that it
would result in a
claim; or

agreement or conspiracy
to restrain trade;
2.

This exclusion does not apply to
claims arising from your activity
at our request as a member of
any committee, panel, or board
which provides underwriting or
claims advice or
recommendations to us, provided
your activity is within the scope of
the committee's, panel's or
board's established guidelines.
K.

which on the inception
date of this policy is the
subject of a:
a.
b.
c.

M.

injury or damage arising out of
pollution or pollutants;

reported dental
incident;
pending claim or
proceeding; or
which is a paid claim.

injury or damage for which you
may be held liable as a result of loss
of use of tangible property which
has not been physically injured or
destroyed if:

This exclusion also applies to:
1.
1.

a.

b.

l.

arising out of a dental
incident which happened:
a.
b.

G-15158-E
(Ed. 05/2006)

request, demand or
order that you 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
claim by or on behalf
of a governmental
authority for amounts
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;

any claim:
1.

a delay in or lack of
performance has been caused
by or on your behalf under any
contract or agreement; or

2.

your products or work
completed on your behalf do
not meet the standards you have
warranted or represented;

Any loss, cost or expense
arising out of any:

prior to the prior acts
date of this policy;
after the prior acts
Page 4 of8

We will cover loss of use of other
tangible property if:
1.

2.

N.

the loss results from a sudden
and accidental physical
damage or destruction of your
products or work completed by
or on your behalf; and
the products or work has been
put to use by an entity other
than you;

amounts claimed as a result of the
withdrawal, inspection, repair,
replacement, or loss of use of your
products. This also applies to work
completed by or for you, and any
property of which your products
form a part. This exclusion only
applies if the withdrawal from the
market or use is due to a known or
suspected defect or deficiency;

O.

any claim made against you, or any
person for whose acts or omissions
you are legally responsible, for any
act of sexual intimacy, sexual
molestation or sexual assault or any
act similarly defined.

C.

Claim expenses are in addition to our
limit of liability.
D.

All claims whenever made, shall be
considered first made during the
policy period in which the earliest
claim arising out of such same or
related dental incident was made,
and all such claims shall be subject
to the same limit of liability.

E.

The limits of liability shall apply
separately to each of you.

We will defend any civil suit against
you seeking amounts which would be
covered if this exclusion did not apply.
In such case, we will pay only the fees,
costs and expenses of such defense.

P.

a dental incident involving:
1.

2.

Claim Expenses

you, if at the time of the dental
incident, you knew your state
license (permanent or
provisional) was
suspended, revoked,
terminated, not issued or
fraudulently obtained, or
restricted or on probationary
status with respect to the specific
professional services upon
which the claim is based; or
the prescribing or dispensing of
controlled substances by you
or anyone for whose acts
you are legally responsible
if the required license or
registration to prescribe or
dispense such controlled
substances was not in effect.

IV.

DEFINITIONS
"Claim" means the receipt of a demand for
money or services, naming you and
alleging a dental incident.
"Claim" also means a dental incident
which you report to us during the policy
period which might result in a claim. The
report of such dental incident must
include:
the date, time and place of the
incident;

B.

what happened and what
professional services you
performed;

C.

the type of claim you anticipate;
and

Each Claim

D.

The limit of liability stated for each
claim is the limit of our liability for all
injury or damage arising out of, or in
connection with, the same or related
dental incident.

III.

A.

the name and address of the injured
party, and of any witnesses.

All claims arising out of the same dental
incident will be considered as having been
made at the time the first report was made.

LIMITS OF LIABILITY

A.

B.

"Damage" means:

Aggregate
Subject to provision A. above, the total
limit of our liability for all injury or
damage shall not exceed the limit of
liability stated as aggregate. All dental
incidents for which claims are made
during the policy period are included.
The aggregate limit of liability applies
to each annual policy period.

G-15158-E
(Ed. 0512006)

Page 5 of 8

A.

partial or total physical damage to
tangible property. Such damage
must happen on or after the prior
acts date and during the policy
period prior to expiration. Loss of
use of damaged property is also
included;

B.

loss of use of undamaged property.
This loss of use must be caused by
a dental incident during the policy

period.

"Insured Dentist" means the dentist
named on the Declarations.

"Dental Incident" means any act, error
or omission in the supplying of or failure to
supply professional services by you. This
includes your responsibility for anyone
acting under your direction or control, or for
whose acts you are legally liable. We also
include your professional services as a
member of a formal accreditation,
standards review or other professional
board or committee related only to a
professional dental society or a hospital.

"Nuclear Material" means source
material, special nuclear material or byproduct material.
"Prior Acts date" means the date stated
on the Declarations that is either:

"Independent Contractor" means a
person or entity who would be classified as
such under the IRS definition.
"Injury" as defined in the General
Conditions, shall also include the following:

A.

malicious prosecution;

B.

false arrest, detention,
imprisonment;

a date concurrent with the effective
date of the policy; or

B.
"Extended Reporting Period" means the
time after the policy period, for reporting
claims due to a dental incident. The
dental incident must occur on or after the
prior acts date and before the end of the
policy period.

A.

a particular date other than the
effective date of the policy upon
which we and you ag ree that
policy coverage will be applicable.

"Professional Services" means those
services for which you are licensed, trained
and qualified to perform in your profession
as a dentist. Professional Services also
includes your activities as a member of a
formal accreditation, standards review or
other professional board or committee
related only to a professional society or
hospital.
"Retire" means the complete withdrawal
from the practice of dentistry.
"Totally and permanently disabled"
means that you have become so disabled,
as a result of injury or disease, as to be
wholly prevented from performing work or
engaging in your own occupation for
remuneration or profit. Such a condition
must have existed continuously for not less
than six months and must be expected to
be continuous and permanent.

C.

wrongful entry or eviction or other
invasion of the right of private
occupancy;

D.

a violation of an individual's right
to privacy;

E.

oral or written publication of material
that:

"You" or "Your" means:

1.

slanders or libels an entity or
disparages an entity's goods,
products or services; or

A.

the entity named on the
Declarations of this policy as the
named insured;

2.

violates a person's right of
privacy;

B.

any dentist who becomes a partner,
stockholder, or employee during the
policy period provided that within 30
days after becoming a stockholder,
partner, or employee:

F.

the performance of or failure to
perform autopsies;

G.

testimony given at or arising out of
inquests; and

H.

advertising injury.
Page 6 of 8

you notify us of such
appointment, election,
ownership, or employment;

2.
G-15158-E
(Ed. 0512006)

1.

on the date you notify us, all

other dentists who are partners,
officers, shareholders, or
employees are named in this
policy; and

3.

such dentist immediately
submits a completed
application to us which we
approve;

we will give you this extended
reporting period coverage at no
charge.

c.

You or your estate must within 60
days after the end of this policy write to
us telling us the coverage is wanted.
We also require:

any of your employees other than a
dentist, but only while acting within
the scope of their duties as such; or

D.

V.

and are 55 years or older and
have been continuously insured
by us for at least the immediately
preceding 5 years.

any independent contractor dental
hygienist of a named insured, but
only while acting within the scope of
one's duties related to the practice of
your profession under sole direction
or supervision of the named
insured.

1.

written proof of the date of your
death; or

2.

written proof of your total and
permanent disability, including
the date it occurred,
certified by your attending
physician.

EXTENDED REPORTING PERIOD

A.

You agree to submit to medical
examination(s) by any physician(s) we
designate if requested.

Termination
If this policy is terminated for any
reason other than failure to pay the
premium, if such unpaid premium is
paid in full and extended reporting
period premium is paid in advance,
you have the right to an extended
reporting period, except those
defined under you, C. and D. above.

C.

A prior acts date once established
cannot be changed except at your
written request approved by us in
writing prior to that change being
effective.

To use this right, you must:

1.

2.

B.

write to us within 60 days of the
termination telling us you want
the extension; and
pay the premium to us promptly
when due. The premiums will
be developed from the rules,
rates, and rating plans in effect
at the inception of the last
policy period.

VI.

FIRST AID SUPPLEMENT

A.

If you:
die or become totally and
permanently disabled during
the policy period; or

Coverage

We will reimburse you up to $5,000
each person for reasonable first aid
expenses incurred by your patients
and paid by you, for emergency
medical care caused by a dental
incident. We will not make any
payment under this supplement
without your consent.

Death, Disability, or Retirement

1.

The limits of liability stated under
this policy at the time of termination,
death, disability, or retirement will
be the limits of liability applying to
the extended reporting period.

B.

Exclusions
We will not pay for first aid expenses:

2.

retire during the policy period
1.

G-15158-E
(Ed. 05/2006)

Page 7 of 8

for services provided by:

VII. SPECIAL CONDITIONS
a.
b.

you; or
any entity under contract
with you, to provide such
services.

The following Conditions apply in addition to
the Common Policy Conditions.

A.
2.

3.

C.

for any obligation you or any
entity has under any
unemployment or Worker's
Compensation, Disability
Benefits, or other similar law; or
caused by the failure to render
professional services.

This policy applies to dental incidents
taking place anywhere in the world;
provided, however, that claim is made
and suit is brought against you in the
coverage territory.
B.

Special Conditions/Definitions
1.

As soon as practicable, the
injured person, or someone on
their behalf, shall give us
written proof of claim for first
aid expenses, under oath if
required. If we request, the
injured person shall execute
authorization to enable us to
obtain medical reports and
copies of records. The injured
person will also submit to
physical examinations by
physicians selected by us. The
examinations will be made
when, and as often as we
may reasonably require.

2.

We may pay the injured person,
or any entity rendering the
services. However, payment
will not imply an admission of
liability.

3.

First aid expenses means
medical aid at the time of the
accident, and, if incurred within
12 months of the accident,
necessary:
a.

b.

G-15158-E
(Ed. OS/2006)

medical, surgical, x-ray
and dental services,
drugs, medical and
surgical supplies,
including prosthetic
devices; and
ambulance, hospital,
professional nursing and
funeral services.

Page 8 of 8

Territory

Your Duty
A claim for injury or damage is
considered first made when you first
receive notice of the claim. The notice
must be given to us immediately and
within the policy period or within 10
days after its expiration or termination.
All claims arising out of the same
dental incident will be considered as
having been made at the time the first
claim is made.

C.

Liberalization
If we make any revision that would
broaden the coverage under this
Coverage Part without additional
premium within 60 days prior to or
during the policy period, the broadened
coverage will immediately apply to this
Coverage Part.

CNA

For A U the Commlt.ments You ~Iake·

Attached to Policy Number: _ _ _ __
WASHINGTON EMPLOYMENT PRACTICES LIABILITY
DEFENSE COVERAGE AMENDATORY ENDORSEMENT

IMPORTANT NOTICE: THIS AMENDATORY ENDORSEMENT IS WRITTEN ON A
"CLAIMS MADE" BASIS AND, WITH RESPECT TO CLAIMS WHICH ARE FIRST
MADE AGAINST YOU WHILE THIS POLICY IS IN FORCE OR DURING ANY
EXTENDED REPORTING PERIOD, ALLEGING
WRONGFUL
APPLICABLE
EMPLOYMENT PRACTICES, PROVIDES COVERAGE ONLY FOR CERTAIN
DEFENSE COSTS. NO COVERAGE IS PROVIDED FOR AWARDS, JUDGMENTS,
SETTLEMENTS OR OTHER MONETARY SUMS RELATED TO SUCH CLAIMS. READ
ALL TERMS OF THIS AMENDATORY ENDORSEMENT CAREFULLY.

Prior Acts Date of this Amendatory Endorsement:

(See Attached Dentist Schedule)

Limits of Defense Coverage
Payable By Us:

$25,000

Each Claim

$25,000

Annual Aggregate

Per schedule
under II. C.

Each Claim

Co·Payment:

As a condition precedent to the availability of any defense coverage under this amendatory endorsement,
the payment of the premium must be made when due. Subject to the terms of this amendatory
endorsement, and the terms and conditions of the policy to which this endorsement is attached, we agree
with you as follows:
I.

amendatory endorsement you did not
know, or could not have reasonably
foreseen that such wrongful
employment practice would give rise
to a claim. In such case, we will pay,
subject to the limits of defense
coverage stated above, and your copayment obligations described herein,
and all other terms of this amendatory
endorsement, the fees, costs and
expenses of such defense. We will
also select and assign defense
counsel to defend the claim made
against you.

COVERAGE AGREEMENTS
A. We have the right to and will defend
you and we will pay claim expenses
incurred on your behalf in the defense
of any claim not otherwise excluded
under this coverage part, alleging a
wrongful employment practice
against you which has been asserted
by an employee as a result of a
wrongful employment practice,
even if the claim is groundless, false
or fraudulent, provided that at or prior
to the prior acts date of this

0-30015-046 (Ed. 05/05)

Page 1 of 8

B. The wrongful employment practice

1. allow the attorney assigned by us

must begin on or after the prior acts
date of this amendatory endorsement
and a claim must be first made
against you after the prior acts date
of this amendatory endorsement and
reported to us prior to the end of the
policy period stated on the policy
Declarations and any applicable
extended reporting period.

to represent you to withdraw from
representing you;

C. All claims, whenever made, arising
out of, or in connection with, the same
or related wrongful employment
practices, shall be considered to have
been first made during the policy
period in which the earliest claim
arising out of such wrongful
employment practice was made, and
all such claims shall be subject to the
same limits of defense coverage.

2. do nothing to impede or prohibit
that attorney from withdrawing
from your representation; and

3. cooperate with us and with that
attorney to facilitate the
withdrawal.

II.

LIMITS OF DEFENSE COVERAGE

A. Each Claim
The "each claim" limit of defense
coverage stated above is the
maximum we will pay for all claim
expenses arising out of, or in
connection with, the same or related
wrongful employment practices,
regardless of the number of you,
claims or claimants. The limit of
defense coverage applicable to "each
claim" applies collectively to all
persons or entities covered under the
definition of you. The "each claim"
limit of defense coverage applies
regardless of the number of persons
or entities who are covered under this
policy.

D. We have no duty to defend you or to
pay claim expenses which are
excluded from coverage under this
amendatory endorsement.

E. After you report a claim to us alleging
a wrongful employment practice,
and subject to all other terms of this
amendatory endorsement, we will
appoint an attorney to defend you.
The attorney assigned by us to defend
you will continue to be paid by us,
subject to your co-payment
obligations described herein, until our
payment of claim expenses equals
the limits of defense coverage.

F.

Once our payment of claim expenses
equals the limits of defense coverage,
you will be responsible for the
payment of all further fees and
expenses, including those of any
attorney who thereafter may represent
you. If you choose either not to
continue to be represented by the
attorney we originally assigned to
represent you or you fail to agree with
that attorney on the payment of future
fees and expenses, you will:

B. Annual Aggregate
The total limit of our liability for all
claim expenses for which claims are
made during the policy period shall not
exceed the "annual aggregate" limit of
defense coverage. The "annual
aggregate" limit applies to each annual
policy period. The "annual aggregate"
limit of defense coverage applies
collectively to all persons or entities
covered under the definition of you,
regardless of the number of persons
or entities who are covered under the
policy.
C. Co-Payment
You will share with us in the payment of all
claim expenses, up to the applicable limits
of defense coverage as follows:

D-30015-D46 (Ed. 05/05)

Page 2 of 8

Claim Expenses

Your Co-payment

Our Payment

% of each $ of the

0%

First $5000

~O

% of each $ of the
Next $30 000

$10,000

$20,000

Total ffi35,000

ffi10,000

state or local governmental body
whose purpose is to address
wrongful employment practices.

§25,000

33.33%

100'%
~5,000

"Claim" does not include criminal:

66.67%

You shall be billed directly for your
co-payment and you agree to pay
those amounts when due. You shall
reimburse us within 30 days of notice
of payment on your behalf by us for
any amounts we have paid which are
your co-payment obligation.

1.

2.

indictments;

3.

investigations; or

4.

proceedings of any kind or nature.

B. "Claim Expenses" means:
1. fees charged by an attorney

Failure to satisfy your co-payment
obligation under this provision may
result in cancellation of your coverage.

III.

charges;

selected and assigned by us to
defend you; and

2.

SPECIAL DEFINITIONS
The definitions set forlh below, in addition
to those definitions set forth in the policy,
are applicable to this amendatory
endorsement. To the extent there is any
inconsistency between the definitions in
the policy and the definitions of this
amendatory endorsement, the definitions
set forth below control, but only with
respect to the coverage provided under
this amendatory endorsement and for no
other purposes whatsoever.

"Claim Expenses" shall not include:

1. any awards, judgments,
settlements or other monetary
sums, including, but not limited to,
court costs or attorneys' fees, paid
or payable to an employee in
connection with or on account of a
claim;

A. "Claim" means any:
1.

2.

3.

all other reasonable fees, costs
and expenses incurred or
authorized by the attorney we
select and assign to defend you,
related to the investigation,
adjustment and defense of a
claim.

demand for money or other relief
by an employee naming you and
alleging a wrongful employment
practice;

2.

proceeding initiated against you
by an employee alleging a
wrongful employment practice
before any court, governmental
body, or arbitrator or arbitration
panel, which is legally authorized
to render an enforceable civil
judgment, award or order for
money damages; or

payment of insurance plan
benefits claimed by or on behalf of
retired employees, or that a
claimant would have been entitled
to as an employee had you provided the claimant with a
continuation of insurance;

3.

any fees, costs or expenses
incurred or authorized by you, or
anyone acting on your behalf,
without our prior written consent;
or

4.

any claim expenses charged by
an attorney who we did not assign
to defend a claim asserted

proceeding initiated against you
by an employee before the United
States Equal Employment
Opportunity Commission or other

D-30015-D46 (Ed. 05/05)

Page 3 of 8

1. submission to such conduct is

against you, unless we agreed in
writing to pay these claim
expenses before they were
incurred.

either implied or stated to be a
term or condition of employment,
or a factor in evaluating the
individual's job performance,
eligibility for promotion, eligibility
for an increase in compensation or
any other component of
employment; or

C. "Discrimination" means a termination
of an employment relationship, a
demotion, a failure or a refusal to hire
or to promote, a payment of wages
and/or of benefits, an assignment of
job duties, of job responsibilities
and/or of hours of work, or an
assignment of supervisor(s), and/or an
application of your employment
policies or procedures which is
motivated in whole or in part by the
employee's color, race, sex, national
origin, sexual orientation or
preference, age, religion, creed, status
as an individual with a disability (as
defined in the Americans with
Disabilities Act of 1990 including any
amendments thereto or as determined
by any court ruling), and/or pregnancy.
D. "Employee" means an individual
whose service or work is or was
engaged and directed on a daily basis
by you. This includes current or
former full-time or part-time
employees, current or former
supervisory employees, and
applicants for employment.

2. such conduct interferes either
directly or indirectly with an
individual's work performance by
creating a hostile, offensive or
intimidating environment.

G.

"Retire" means the complete
cessation of performing work or
engaging in your own occupation.

H. "Supervisory Employees" means any
employee of yours who has the
authority to employ, promote, demote,
terminate employment, grant salary
increases, direct the work of,
discipline, and/or evaluate the
performance of other employees of
yours.

I.

"Employee" does not mean seasonal
or temporary workers, volunteers,
owners, partners, shareholders or
members of the named insured.

"Totally and permanently disabled"
means that you have become so
disabled, as a result of injury or
disease, as to be wholly prevented
from performing work or engaging in
your own occupation. Such a
condition must have existed
continuously for not less than six
months and must be expected to be
continuous and permanent.

E. "Extended Reporting Period"
means the time after the policy period
for reporting claims due to an alleged
wrongful employment practice. The
claim must occur on or after the prior
acts date and before the end of the
policy period, and coverage is
otherwise subject to all limitations and
exclusions of this amendatory
endorsement.

J. "Wrongful Employment Practice"
means one or more of the following
alleged acts, insofar as they arise out
of an employee's employment with
you: discrimination, sexual
harassment, wrongful termination,
breach of any employment agreement,
breach of the implied covenant of
good faith and fair dealing,
misrepresentation, equal pay
violations, invasion of privacy,
defamation, negligent or intentional
infliction of emotional
distress,retaliation, and/or any other
violation of any federal, state or local

F. "Sexual Harassment" means
unwelcome sexual advances,
requests for sexual favors, or verbal
conduct or physical contact of a sexual
nature when:

0-30015-046 (Ed. 05/05)

Page 4 of 8

statute or ordinance relating to the
above types of claims.

K.

"Wrongful Termination" means
termination of an employment
relationship in a manner which is in
violation of any law or in breach of any
employment agreement.

C. alleging any wrongful employment
practice which began before the prior
acts date of this amendatory
endorsement;

D. of which you gave written notice, or
were required to have given written
notice, before the issuance of this
amendatory endorsement to any
insurer under any other policy in force
prior to this policy;

l. "You" or "Yours" means:
1. the named insured;

2. if the named insured is an
individual, the person designated,
but only with respect to the
conduct of a business of which
that individual is a sole proprietor;
and
3.

IV.

any of the named insured's
owners, executive officers,
partners, shareholders of
professional corporations,
members of limited liability
corporations, supervisory
employees or members of the
board of directors, trustees or
governors, but only while acting
within the scope of their duties as
such.

EXCLUSIONS
We will not pay under this amendatory
endorsement any awards, judgments,
settlements, or monetary sums paid or
payable to an employee on account of a
claim or any fees, costs or expenses
resulting from compliance with nonmonetary relief.
In addition, we will not pay claim
expenses incurred as a result of any
claim:

E. arising from facts, situations or
circumstances which, as of the prior
acts date of this amendatory
endorsement, you knew or could have
reasonably foreseen, or which a
reasonable person could have
foreseen, might be the basis of a
claim against you alleging a wrongful
employment practice;
F. whose sole allegations seek the
recovery of judgments or awards
which are deemed uninsurable by law;

G. alleging any wrongful employment
practices for which you are liable as
an administrator, executor,
conservator, guardian, or any similar
fiduciary capacity;

H. under the Employee Retirement
Income Security Act of 1974, Public
Law 93-406, including amendments
thereto, commonly referred to as
"ERISA" or the Pension Reform Act of
1974;

i.

for unemployment compensation, or
Workers' Compensation, disability
benefits and/or other similar claims;

J. under the Worker Adjustment and
Retraining Notification Act, Public Law
100-379, (1988), including
amendments thereto and/or other
similar laws;

A. brought by your spouse, child or other
dependent;
brought by any former or present
director or officer, owner, shareholder,
member, partner, predecessor or
successor firm;

0-30015·046 (Ed. 05105)

K.

under the Family and Medical Leave
Act, Public Law 103-3, (1993),
including amendments thereto, and/or
other similar laws;

l.

B.

under any federal, state or local
statutory law or common law or any of

Page 5 of 8

their amendments which are similar to
the statutes referred to in Sections IV.
H. through IV. K. of this amendatory
endorsement;

M.

under any government or
administrative order or regulation
relating to employment practices
under which you have either implicitly
or explicitly consented to be bound;

applicable to this amendatory
endorsement. To the extent there is any
inconsistency between the conditions in
the policy and the conditions of this
amendatory endorsement, the conditions
set forth below control, but only with
respect to the coverage provided under
this amendatory endorsement and for no
other purposes whatsoever.

A. Notice and Cooperation
N. alleging any wrongful employment
practices based on an alleged failure
to pay wages and/or benefits due or
payable to an employee, except
where the alleged failure to pay wages
and/or benefits is caused by
discrimination;

If a claim is made against you during
the policy period for an alleged
wrongful employment practice that
happened after the prior acts date
date of this amendatory endorsement,
you must give written notice to us as
soon as reasonably possible.

O. alleging any wrongful employment
Notice given by or on your behalf, or
notice given by or on behalf of any
claimant, to any of our licensed agents
authorized by us to sell this
amendatory endorsement in this state,
with particulars sufficient to identify
you, shall be deemed notice to us.

practices committed by you or at
your direction with actual or alleged
dishonest, fraudulent, and/or criminal
purpose;
P. arising out of injury to any person, with
the exception of a claim of wrongful
employment practices;

To the extent possible, notice should
include:

Q. arising out of or in connection with
labor disputes or labor negotiations,
including but not limited to the
replacement of employees, lockouts,
strikes, picket line violence, boycotts,
union organizations, unfair labor
practices or other similar actions;

R.

1.

the identity of the claimant(s)
alleging the wrongful
employment practice;

2. the identity of the person(s) who
allegedly committed the wrongful
employment practice and any
witnesses;

seeking damages, costs or expenses
incurred by you pursuant to the
Americans with Disabilities Act of
1990, including any amendments
thereto or as determined by any court
ruling with the exception of a claim for
wrongful employment practices; or

3. the date(s) the alleged wrongful
employment practice took place;
and

4. a copy of any written complaint,
S. arising out of the conduct of any
partnership, joint venture, corporation
or other entity of which you are a
partner, owner, shareholder or
member and which is not designated
in this policy as a named insured.
V.

charge or demand.
In addition to the above, you agree to
immediately:
1.

SPECIAL CONDITIONS
The conditions set forth below, in addition
to those set forth in the policy, are

D-30015-D46 (Ed. 05/05)

Page 6 of 8

fully cooperate with us or our
designee in the investigation, the
conduct of suits or other
proceedings, or enforcing any right
of contribution or indemnity
against another who may be liable

to you because of such alleged
wrongful employment practice;
2.

3.

from your conduct will be paid by
you and will not be reimbursed by
us.

forward copies of all documents
received in connection with the
claim to us; and

2.

3.

B. Other Insurance
With respect to this amendatory
endorsement only, the following
provision replaces paragraph XI.
("Insurance Under More Than One
Coverage") of the "Common Policy
Conditions" to which this amendatory
endorsement is attached:
With respect to any claim or claims to
which this amendatory endorsement
applies, no coverage shall be available
under any other part of this policy or
any other insurance policy issued by
us.

VII.

EXTENDED REPORTING PERIOD
Extended reporting period coverage applicable
to claims ariSing from wrongful employment
practices is available to you under the following
conditions:

AWARD OF COURT COSTS ANDIOR
ATTORNEYS' OR OTHER FEES

A. Awards to you andlor to us
In the event that you, us, andlor the
attorney assigned by us to represent
you, are awarded court costs,
attorneys' fees or other fees, the
award shall be distributed to you and
to us based on the percentage of total
payment made by you and by us in
defense of the claim up to the time
the award is made.

B. Sanctions
1.

Unless otherwise prohibited by
law, you will reimburse us or the
attorney assigned by us to
represent you, for any costs,
attorneys' fees andlor fines that
are assessed against us or the
attorney assigned by us to
represent you, and which result
from conduct attributable to you.

attend hearings and trials, assist
in securing and giving evidence,
completing narrative reports and
in obtaining the attendance of
witnesses.

No one is authorized, except at your own
cost, to voluntarily make any payment,
assume any obligaton or incur any
expense without our consent.

VI.

Any costs, attorneys' fees or fines
ordered by a court or government
agency to be paid to the court or
government agency by us or the
attorney assigned by us to
represent you, resulting from our
conduct or the conduct of the
attorney assigned by us to
represent you, will be paid by us.

Any costs, attorneys' fees or fines
ordered by a court or government
agency to be paid by you resulting

D-30015-D46 (Ed. 05/05)

Page 7 018

A.

Termination

1.

die or become totally and permanently
disabled during the policy period, or

An extended reporting period is available for
a period of one year upon termination of this
policy. To exercise this right, you must:

2.

retire during the policy period and
are 55 years or older and have
been continuously insured by us
for at least the immediately
preceding 5 years.

1.

write to us within 60 days of the
termination requesting to purchase the
extended reporting period; and

2.

pay the premium to us promptly when due.
The premiums will be developed from the
rules, rates, and rating plans in effect at
the inception of the last policy period.

we will provide this extended reporting
period coverage at no charge.
You or your estate must, within 60 days after
the end of this policy, write to us telling us the
coverage is wanted. We also require:

However, if this policy is terminated for
your non-payment of premium, the right is
waived by you unless the unpaid premium
is paid in full and the extended reporting
period premium is paid in advance.

3.

2.

any pending claim or proceedings.

you to submit to medical examination(s)
by any physician(s) we designate if
requested.

any paid claim; or

b.

written proof of your total and permanent
disability, including the date it occurred,
certified by your attending physician; or

3.

Such extension for the reporting of
wrongful employment practices shall
not apply to:
a.

B.

1. written proof of the date of your death; or

Death, Disability, or Retirement

C. The limits of liability stated under this policy at
the time of termination, death, disability, or
retirement will be the limits of liability applying
to the extended reporting period.

If you:

All other provisions of this policy remain unchanged.

Countersigned by: _ _ _ _ _ _ _ __
Authorized Representative

D-30015-D46 (Ed. 05/05)

Page 8 018

CNA

For AU the Commitments You Ma1m~

WASHINGTON AMENDATORY ENDORSEMENT
INSURANCE COVERAGE COMMON POLICY CONDITIONS

We agree with you that the Insurance Coverage Common Policy Conditions is amended as follows:
Condition XII., Transfer Of Rights Of Recovery, is deleted and replaced with the following:
In the event of any payment under this policy, we shall be subrogated to all of your rights of
recovery against any person or entity to the extent of payment. After you have first recovered
amounts paid, you must transfer to us your rights of recovery against any other party. You shall
execute and deliver instruments and papers and do whatever else is necessary to secure such
rights. You shall do nothing after loss to prejudice such rights.
All other provisions of the policy remain unchanged.

This endorsement is a part of your policy and takes effect on the policy effective date, unless a different
date is specified below:

Named Insured

Policy Number

Effective date of this endorsement

Countersigned By: ---;;-""7-;--~--:---­
Authorized Agent

G-140093-A46
(Ed. 01/01)

CNA

For All the Commitments YOu Make'

MEDICAL PAYMENTS COVERAGE

LIMITS OF LIABILITY

$ 5,000 each person
$10.000 each occurrence
I.

COVERAGE AGREEMENTS
We will pay, regardless of fault, all Medical Expenses up to the stated Limit of Liability
for "each person" and "each occurrence" due to an accident:

1. arising out of a condition in premises you own or rent; or
2.

II.

any immediately adjoining approaches.

EXCLUSIONS
We will not pay for medical expenses:
A. for services provided by:

1. you;
2. any entity under contract with you, to provide such services.

B. which are also included within the Products/Completed Operations Hazard;
C. resulting from operations performed for you by independent contractors except for maintenance and
repair of your premises or structural alterations at your premises which do not change the size of or
involve the moving of buildings or other structures;
D. to any person while engaged in maintenance, repair, alteration, demolition or new construction at your
premises;

E. to any person included in the definition of you while on your premises;
F. to any other tenant if the injury occurs on that part of the premises rented from you;
G. to your employees or the employees of your tenants or residents of your premises
if the injury arises out of and in the course of employment;
H. arising out of the owning, taking care of, operation, leasing, renting, entrusting to others, loading or
unloading of any auto, non-owned auto, mobile equipment, watercraft or aircraft;
I.

resulting from selling, serving or giving any alcoholic beverage unless the injury occurs
on your premises;

J. to any person if any benefits for such injury are payable or required to be provided
under any unemployment or Worker's Compensation, Disability Benefits, or other
similar law;

K. to any person practiCing, instructing or participating in any physical training, sports,
athletic activity or contest whether on a formal or informal basis;

0-135702-B46
(Ed. 05/05)

1

L.
III.

caused by the failure to render professional services.

SPECIAL CONDITIONS/DEFINITIONS

A. As soon as practicable, the injured person, or someone on his behalf, shall give us
written proof of claim for medical expenses, under oath if required. If we request, the injured person
shall execute authorization to enable us to obtain medical reports and copies of records. The injured
person will also submit to physical examinations by physicians selected by us. The examinations will
be made when, and as often as we may reasonably require.
B. We may pay the injured person, or any entity rendering the services. However, payment will not imply
an admission of liability.

c.

Medical expenses means first aid at the time of the accident, and if incurred within 12 months of the
accident, necessary:
1. medical, surgical, x-ray and dental services, drugs, medical and surgical supplies, including
prosthetic devices; and
2. ambulance, hospital, professional nursing and funeral services.

G-135702-B46
(Ed. 05/05)

2

NON-OWNED OR HIRED AUTOMOBILE LIABILITY
COVERAGE

LIMITS OF LIABILITY
$1,000,000 per occurrence

I,

COVERAGE AGREEMENTS
We will pay all amounts, up to the limit of liability, which you become legally obligated to pay as a result of
injury or damage. We will also pay claim expenses. The injury or damage must be caused by an
occurrence during the policy period, and arise out of using, taking care of, loading or unloading of any
non-owned or hired auto.
We have the right and will defend any claim. We will:
A. do this even if any of the charges of the claim are groundless, false or fraudulent;
B. investigate and settle any claim as we feel appropriate;
The duty to defend ends by payment of the policy limits pursuant to, or in furtherance of, a judgement or
settlement with, or on behalf of, the injured party, or by consent of the insured .. We have no duty to defend
any claims not covered by this Coverage Part.

II,

EXCLUSIONS
We will not defend, or pay, under this Coverage Part for:
A. liability which you have assumed under any contract or agreement, except liability assumed under any
short term contract or agreement of 6 months or less for a hired auto;
B. any amounts you or any entity must pay under any unemployment or Worker's Compensation, Disability
Benefits, or other similar law;
C. injury to:
1.

an employee of yours arising out of and in the course of employment by you; or

2.

the spouse, child, parent, brother, or sister of that employee as a consequence of 1. above.

D. damage to property which is:
1.

owned or being transported by you; or

2.

in your care, custody or control or rented to you, or over which you are exercising physical control;

This exclusion does not apply to a residence or private garage damaged by a private auto covered by
this Coverage Part.
E. loss, under any circumstance, due to nuclear reaction, radiation, or contamination, regardless of cause;

G-135702-B46
(Ed. 05/05)

3

F.

injury or damage arising out of the actual, alleged or threatened discharge, dispersal, seepage,
migration, release or escape of pollutants:

1.

that are, or that are contained in any property that is:
a.

being transported or towed by, handled, or handled for movement into, onto or from the
non-owned or hired auto;

b.

otherwise in the course of transit by or on behalf of you; or

c.

being stored, disposed of, treated or processed in or upon the non-owned or hired auto.

This does not apply to fuels, lubricants, fluids, exhaust gases or other similar pollutants that are
needed for or result from the normal electrical, hydraulic or mechanical functioning of the
non-owned or hired auto or its parts, if:
a. pollutants escape, seep, migrate, or are discharged, dispersed or released directly from an auto
part designed by its manufacturer to hold, store, receive or dispose of such pollutants; and
b.the injury or damage or covered pollution cost or expense does not arise out of the operation
of
1) cherry pickers and similar devices mounted on automobile or truck chassis and used to raise
or lower workers; or

2) air compressors, pumps and generators, including spraying, welding, building cleaning,
geophysical exploration, lighting or well servicing equipment.

2. before the pollutants or any property in which the pollutants are contained are moved from the
place where they are accepted by you for movement into or onto the non-owned or hired auto;
or
3.

after the pollutants or any property in which the pollutants are contained are moved from the
non-owned or hired auto to the place where they are finally delivered, disposed of or abandoned
by you.

2. and 3. above do not apply to occurrences that occur away from premises owned by or rented to you
with respect to pollutants not in or upon a non-owned or hired auto if:
1.

the pollutants or any property in which the pollutants are contained are upset,
overturned or damaged as a result of the maintenance or use of a non-owned or hired auto; and

2.

the discharge, dispersal, seepage, migration, release or escape of the pollutants is caused directly
by such upset, overturn or damage;

G. injury or damage arising out of a non-owned auto used in the conduct of any partnership or joint
venture of which you are a member and is not designated in this policy as a named insured;
H. the liability of your partner arising out of an auto owned or registered in their name, if the named
insured is a partnership;

I. injury or damage due to war, whether or not declared, civil war, insurrection, rebellion, or revolution or
to any act or condition incidental to any of the foregoing, with respect to liability you have assumed
under an insured contract;

G-135702-B46
(Ed. 05/05)

4

J. injury or damage resulting from the handling of property:
before it is moved from the place where it is accepted by the person using a non-owned auto or a
hired auto for movement into or onto the auto;

1.

2. after it is moved from a non-owned auto or hired auto to the place where it is finally delivered by
the person using the auto;

K. Injury resulting from the movement of property by a mechanical device, other than a hand truck, not
attached to the non-owned auto or hired auto;

L. injury or damage you expected or intended. This exclusion does not apply to injury resulting from the
use of reasonable force to protect persons or property.

III.

LIMITS OF LIABILITY
A.

The limit of liability stated for "each occurrence" is the limit of our liability for all injury or damage
arising out of, or in connection with, the same or related occurrence. This limit applies regardless
of the number of you who are covered under this policy.

B. Subject to the above, the total limit of our liability for all injury or damage shall not exceed the limit of
liability stated as "aggregate", if applicable. All occurrences which happen during the policy period are
included. The aggregate limit of liability applies to each annual policy period. This limit applies
regardless of the number of you who are covered under this policy.

C. Claim expenses are in addition to our limit of liability. All claims whenever made, shall be considered
first made during the policy period in which the earliest claim ariSing out of such same or related
occurrence was made, and all such claims shall be subject to the same limit of liability.
IV.

DEFINITIONS
"Auto Business" means the business or occupation of selling, servicing, repairing, storing or parking of
autos.
"Covered pollution cost or expense" means any cost or expense arising out of any:

A. Request, demand or order; or

B. Claim by or on behalf of a governmental authority demanding,
that you 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.
Covered pollution cost or expense does not include any cost or expense arising out of the actual, alleged
or threatened discharge, dispersal, seepage, migration, release or escape of pollutants:

1. that are, or that are contained in any property that is:
a.

being transported or towed by, handled, or handled for movement into, onto or from the
non-owned or hired auto;

b.

otherwise in the course of transit by or on behalf of you; or

c.

being stored, disposed of, treated or processed in or upon the non-owned or hired auto.

G-135702-B46
(Ed. 05/05)

5

This does not apply to fuels, lubricants, fluids, exhaust gases or other similar pollutants that are needed for
or result from the normal electrical, hydraulic or mechanical functioning of the non-owned or hired auto or
its parts, if:
a.

pollutants escape, seep, migrate, or are discharged, dispersed or released directly from an auto part
designed by its manufacturer to hold, store, receive or dispose of such pollutants; and

b.

the injury or damage or covered pollution cost or expense does not arise out of the operation of
1) cherry pickers and similar devices mounted on automobile or truck chassis and used to raise or
lower workers; or
2) air compressors, pumps and generators, including spraying, welding, building cleaning, geophysical
exploration, lighting or well servicing equipment.

2.

before the pollutants or any property in which the pollutants are contained are moved from the place
where they are accepted by you for movement into or onto the non-owned or hired auto; or

3.

after the pollutants or any property in which the pollutants are contained are moved from the
non-owned or hired auto to the place where they are finally delivered, disposed of or abandoned by
you.

2. and 3. above do not apply to occurrences that occur away from premises owned by or rented to you with
respect to pollutants not in or upon a non-owned or hired auto if:
a.

the pollutants or any property in which the pollutants are contained are upset, overturned or damaged
as a result of the maintenance or use of a non-owned or hired auto; and

b.

the discharge, dispersal, seepage, migration, release or escape of the pollutants is caused directly by
such upset, overturn or damage.

"Hired Auto" means an auto not owned by you which is used under contract on behalf of, or loaned to
you. Such auto also shall not be owned by or registered in the name of:

A. a partner or executive officer of yours; or
B. an employee or agent of yours who is granted allowance of any sort for the use of such auto.
"Occurrence" means an accident, including continuous or repeated exposure to conditions which result in
injury and/or damage.
Injury and damage arising from exposure to substantially the same general conditions shall be considered
one occurrence.

"You" or "Your" means:
A. the named insured;
B. any partner or executive officer of yours, but only while the non-owned auto is being used in your
business;
C. any other person while using an owned or hired auto with your permission, provided that the actual
operation or other use, if not operating, is within the scope of your permission. With respect to injury or
damage arising out of the loading or unloading of the auto, such other person shall only meet the
definition of you if they are:

G-135702-B46
(Ed. 05/05)

6

1.

a lessee or borrower of the auto; or

2.

an employee of yours or such lessee or borrower.

D. any other entity, but only with respect to their liability because of acts or omissions
of an insured under (A.) or (B.) above.
You or Your does not include:

A. any person while engaged in the business of this employer with respect to injury to any fellow employee
of such person injured in the course of his employment;
B. the owner or lessee, of whom you are sub-lessee, of a hired auto or the owner of a non-owned auto,
or any agent or employee of any such owner or lessee;
C. an executive officer with respect to an auto owned by that person or a member of their household;
D. any entity, other than you, with respect to:
1.

a motor vehicle while used with any trailer owned or hired by such entity and not covered by like
insurance by us, except a trailer designed for use with a private passenger auto and not being used
for business purposes with another type of motor vehicle; or

2.

a trailer while used with any motor vehicle owned or hired by such entity and not covered by like
insurance by us;

E. any person while employed in or otherwise engaged in duties in connection with an auto business,
other than an auto business operated by you.

G-135702-B46
(Ed. 05/05)

7

MEDICAL WASTE LEGAL EXPENSE
REIMBURSEMENT COVERAGE
LIMIT OF LIABILITY:

Per Suit: $50,000

Annual Aggregate: $50,000

We agree with you that Legal Expense Reimbursement Coverage will be provided as follows:
I.

COVERAGE AGREEMENT
We will reimburse you for the necessary legal expenses incurred by you resulting from your
being a defendant or co-defendant in a civil suit alleging violation of a law or regulation
governing disposal of medical wastes.
Such civil suit must be brought after the effective date of this policy.
We have neither the right nor the duty to defend any claim arising from a defined incident.
This coverage does not apply to any civil suit for any incident that happened prior to the
effective date of this policy, nor to any incident which we are obligated to defend under the
policy form to which this endorsement is attached.

11. LIMITS OF LIABILITY
A. Per Suit
The limit of liability stated above as "Per Suit" is the limit of liability for all legal expenses
arising out of, or in connection with, the same or related civil suit.
B. Annual Aggregate
Subject to provision A. above, the total limit of liability for all legal expenses shall not
exceed the limit of liability stated as "Annual Aggregate". This limit applies regardless of
the number of civil suits filed against you during each annual policy period.
The limits applicable to "Per Suit" and "Annual Aggregate" apply collectively for the entity
named as the named insured, including such other entities who qualify for coverage under
the definition of you.
All civil suits whenever filed, including any and all appeals, shall be considered first filed
during the policy period in which the earliest civil suit arising out of the same or related
incident was filed, and all such civil suits shall be subject to the same limit of liability.

111. ADDITIONAL DEFINITIONS
Civil suit includes administrative proceedings brought by the Federal or State Environmental
Protection Agency as well as law suits brought in civil court.
Incident means the actual or alleged improper disposing of any medical waste material that
results in a civil suit being filed against you.
Legal expenses means fees charged by the legal counsel you select and all other fees,
costs and expenses, other than loss of income, which result from the investigation, defense
and appeal of a civil suit.

G-135702-B46
(Ed. 05/05)

8

IV. YOUR DUTIES
You shall give us, or any of our authorized representatives, written notice as soon as
practicable after you receive notice of the civil suit covered by this policy. Such notice shall
contain details sufficient to identify you and all reasonably obtainable information regarding
the time, place and circumstances of the civil suit, and shall identify the court and all parties
to the action before the court.

All other terms and condition of the policy remain unchanged.

G-135702-B46
(Ed. 05/05)

9

CNA

Th. AIlIh., Comruihnellts You. Makes

DENTIST'S INSURANCE COVERAGE INDEX· OCCURRENCE

1. Your General Liability Policy is made up of the following items:
Your Declarations Page·
The Declarations Page summarizes specific information regarding your
coverage.
Common Policy Conditions·
The items contained in the Common Conditions apply to every Coverage
Part and Endorsement that make up your policy, unless a different or
additional condition is mentioned in the respective Coverage Part.
The Coverage Part(s) applicable to your policy·
These are specific coverage agreements which detail the type of coverage
afforded by this policy. Your policy may contain more than one Coverage
Part, each providing a different, specific coverage.
Endorsements·
Most often, a policy will contain Endorsements which make the entire
contract more complete. Endorsements are often added to aI/ow the policy
to conform to individual state requirements, or may be used at the direction
of the company, or may be used due to the specific nature of the risk
insured. Endorsements attached to your policy at inception are listed on the
Declarations Page.
2. To make your policy complete, you must have a Declarations Page, the Common
Policy Conditions, and various Coverage Parts.

3. For ease in reviewing and locating information contained in the Coverage Parts, you
can find the topics below on the page indicated.
General Liability
COVerage Agreements
Exclusions
Limits Of Liability
Definitions
Special Conditions
Other Coverages
Medical Payments
Non-Owned or Hired Automobile Liability
Medical Waste Legal Expense Reimbursement

G-135702·B46
(Ed. 05105)

Beginning
on Page

1
1
5
6
8
Beginning
on Paoe

1
1
1

CNA

lbr All the CommUmelllsYou Make"

GENERAL LIABILITY COVERAGE PART

We are the stock insurance company named on the Declarations. Throughout this policy the words we, us and
our refer to the company providing this insurance. We agree with you as follows:

I.

COVERAGE AGREEMENTS
We will pay all amounts, up to the limit of liability, which you become legally obligated to pay as a result of
Injury or damage. We will also pay claim expenses. The injury or damage must be caused by an
occurrence during the policy period.
We have the right and will defend any claim. We will:
A. do this even if any of the charges of the claim are groundless, false or fraudulent; and
B. investigate and settle any claim as we feel appropriate.
The duty to defend ends by payment of the policy limits pursuant to, or in furtherance of, a judgement or
settlement with, or on behalf of, the injured party, or by consent of the insured. We have no duty to defend
any claims not covered by this Coverage Part.

II,

EXCLUSIONS
We will not defend, or pay, under this Coverage Part for:
A. injury to:
1.

an employee of yours arising out of and in the course of employment by
you; or

2.

the spouse, child, parent, brother, or sister of that employee as a consequence of 1. above.

This exclusion applies:
1.

whether you may be liable as an employer or in any other capacity; and

2.

to any obligation you have to indemnify some other entity because of such injury.

This exclusion does not apply to liability you assume under an insured contract.
B. any amounts you or any entity must pay under any unemployment or Workers' Compensation, disability
benefits, or other similar law;
C. loss of use of tangible property which has not been physically damaged if:
1.

a delay in or lack of performance has been caused by or on your behalf
under any contract or agreement;

2.

your products or work completed on your behalf do not meet the standards
you have warranted or represented.

We will cover loss of use of other tangible property if:
G-135702-B46
(Ed. 05105)

Page 1 of 8

1.

the loss results from a sudden and accidental physical damage or destruction of your products
or work completed by or on your behalf; and

2.

the products or work has been put to use by an entity other than you;

D. amounts claimed as a result of the withdrawal, inspection, repair, replacement,
or loss of use of your products. This also applies to work completed by or for you,
and any property of which your products form a part. This exclusion only applies if
the withdrawal from the market or use is due to a known or suspected defect or
deficiency;
E. liability which you have assumed under any contract or agreement, other than an
insured contract.
This exclusion does not apply to a warranty:
1.

of fitness or quality of your products; or

2.

that work performed by or on your behalf will be done in a workmanlike manner;

F. damage to:
1.

your products which arises out of such products or any of its parts;

2.

work performed by or on your behalf arising out of:
a.

the work;

b.

any part of the work; or

c.

material, parts or equipment furnished in connection with the work;

3.

property which is:
a.

owned, occupied or rented to you;

b.

used by you;

c.

in your care, custody or control, or over which you are exercising physical control;

There are exceptions to this subsection 3. Subitems b. and c. do not apply to liability under a
sidetrack agreement. Subitem c. does not apply to damage, other than to elevators, arising out of
the use of an elevator at premises you own, rent, or control.
We will pay up to $500,000 for each occurrence for your legal liability for damage to a premises in
which you do not have a financial interest, or own, caused by:

a.
b.

discharge, leakage or overflow of water or steam from a plumbing, heating, refrigeration
or air conditioning system; or

c.

G-135702-B46
(Ed. 05/05)

fire;

rain which enters directly into the building through open doors, windows, skylights,
transoms or ventilators.

Page 2 of 8

4.

premises you no longer own, rent, control or use, which arise out of such premises or any of its
parts;

G. injury or damage arising out of or resulting from the rendering of or failure to render any SCientific,
professional, consulting or technical services;
H. injury or damage for which you may be held liable as a result of:
1.

causing or contributing to the alcoholic beverage intoxication of any person;

2.

furnishing of alcoholic beverages to a person under the legal drinking age or under the influence
of alcohol;

3.

any statute, ordinance or regulalion relaling to the sale, gift, distribution or use of alcoholic
beverages.

This exclusion only applies if you:

1.

manufacture, sell or distribute alcoholic beverages;

2.

serve or furnish alcoholic beverages for a charge whether or not such activity:
a.
b.

3.

requires a license;
is for the purpose of financial gain or livelihood; or

serve or furnish alcoholic beverages without a charge, if a license is required for such activity.

I. an auto, non-owned auto, mobile equipment, watercraft, or aircraft which:
1.

you own, use, take care of, operate, load or unload, lease or rent, or entrust to others;

2.

is loaned to you or is operated, loaded or unloaded, for you by an employee in the course of
employment by you;

There are some exceptions. Coverage will apply on premises which you own, rent, or control to:
1.

the parking of a non-owned auto;

2.

watercraft while ashore;

This exclusion does not apply to self-propelled lawn care or snow removal equipment of 10 horsepower
or less.

J. mobile equipment in, or while in practice or preparation for:
1.
2.

K.

any prearranged or organized racing, speed or demolition contest, or
any stunling activity;

the transporting of mobile equipment by an auto which you own, operate or rent, or which is loaned to

you;

l. the operation or use, loading or unloading, of any snowmobile or trailer designed for
use with a snowmobile;
G-135702-B46
(Ed. 05105)

Page 3 of 8

M. war, whether or not declared, or any civil war, insurrection, rebellion or revolution, or any incidental act or
condition, with regard to:
1. liability you have assumed under a contract or agreement; or

2. expenses for first aid.
N. the conduct of any partnership or joint venture of which you are a partner or member and which is not
designated in this policy as a named Insured;

O. any injury, sickness, disease, death or destruction:

1. with respect to which you are also an insured under a Nuclear Energy
Liability Policy issued by:
a. Nuclear Energy Liability Insurance Association;
b. Mutual Atomic Energy Liability Underwriters; or
c. Nuclear Insurance Association of Canada,

or would be an insured under any such policy if it had not terminated due to exhaustion of its limit of
liability; or
2. resulting from the hazardous properties of nuclear material and with respect to which:
a. any entity is required to maintain financial protection pursuant to the Atomic Energy Act of 1954 or
any of its amendments, or
b. you are, or had this policy not been issued would be, entitled to indemnity from the United States
of America or any of its agencies, under any agreement entered into by the United States of
America or any of its agencies with any entity;
3. resulting from the hazardous properties of nuclear material if:
a. the nuclear material:

1. is at any nuclear facility owned or operated by or on your behalf; or
2. has been discharged or dispersed therefrom; or
3. is contained in spent fuel or waste at anytime possessed, handled, used, processed, stored,
transported or disposed of by or on your behalf; or
b. the injury, sickness, disease, death or destruction arises out of the furnishing by you of services,
materials, parts or equipment in connection with the planning, construction, maintenance,
operation or use of any nuclear facility. If such facility is within the coverage territory, this
subparagraph 3.b. applies only to injury to or destruction of property at such nuclear facility.
P. any fines, penalties, or the return or withdrawal of fees or government payments;
Q. injury or damage you expected or intended, or which a reasonable person could have expected.

G-135702-B46
(Ed. 05105)

Page 4 of 8

This exclusion does not apply to injury resulting from the use of reasonable force to protect
persons or property;
R. any multiplication of amounts payable under this policy, imposed by law;
S. any claim arising out of actual or alleged involvement in any:
1. anti-trust law violation; or
2. agreement or conspiracy to restrain trade.
T. injury or damage arising out of pollution or pollutants:
This exclusion also applies to:
1. Any loss, cost or expense arising out of any:
a. request, demand or order that you 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
b. claim by or on behalf of a governmental authority for amounts 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.
U. any claim made against you, or any person for whose acts or omissions you are legally
responsible for, any act of sexual intimacy, sexual molestation or sexual assault or any act
similarly defined.
We will defend any civil suit against you seeking amounts which would be covered if this
exclusion did not apply. In such case, we will pay only the fees, costs and expenses of such
defense;
V. any injury or damage arising from any profession or business other than your practice of
dentistry, which shall be defined by the applicable statutes and licensing laws of the jurisdiction in
which you practice; or
W. any direct or consequential injury or damage arising out of any:
1.
2.

termination of employment; or

3.

III.

refusal to employ;

coercion, demotion, reassignment, defamation, harassment, humiliation, discrimination
or other employment related practices, policies, acts or omissions.

LIMITS OF LIABILITY
We will pay all amounts, up to the stated limits of liability, including amounts:
A. EACH OCCURRENCE

G-135702-646
(Ed. 05105)

Page 5 of 8

The limit of liability stated for "each occurrence" is the limit of our liability for all injury or damage
arising out of, or in connection with, the same or related occurrence. This limit applies
regardless of the number of persons or organizations who are covered under this policy.

B. AGGREGATE

1.

The General Liability Aggregate Limit is the most we will pay, regardless of the number of
occurrences, for all amounts payable under the Coverage Part due to injury or damage
except injury or damage included in the Products/Completed Operations Hazard. The
General Aggregate Limit of Liability applies to each annual policy period.

2.

The Products/Completed Operations Aggregate Limit is the most we will pay, regardless
of the number of occurrences, for all amounts payable under the Coverage Part due to
injury or damage included within the Products/Completed Operations Hazard. The
Products/Completed Operations Aggregate Limit applies to each annual policy period.

The limits of this Coverage Part apply separately to each consecutive annual period and to any
remaining period of less than 12 months, starting with the beginning of the policy period shown
in the Declarations, unless the policy period is extended after issuance for an additional period
of less than 12 months. In that case, the additional period will be deemed part of the last
preceding period for purposes of determining the limits of insurance.
C. The "each occurrence" limit and the aggregate limit apply collectively regardless of the number
of you who are covered under this policy.
D. Claim Expense
Claim expenses are in addition to the limit of liability.

IV.

DEFINITIONS
"Claim" means the receipt of a demand for money or services, naming you and alleging injury and damage.

"Damage" means:
A. partial or total physical damage to tangible property. Such damage must happen during the policy
period. Loss of use of damaged property is also included;

B. loss of use of undamaged tangible property. This loss of use must be caused by an
occurrence during the policy period.
"Hostile Fire" means fire which escapes from its intended confines at or from premises you own, rent or
occupy.
"Injury" as defined in the General Conditions, shall also include the following:
A. malicious prosecution;

B. false arrest, detention, imprisonment;
C. wrongful entry, or eviction, or other invasion of the right of private occupancy;
D. a violation of an individual's right to privacy;
G-135702-B46
(Ed. 05105)

Page 6 of 8

E. oral or written publication of material that:
a.

slanders or libels an entity or disparages an entity's goods, products or services; or

b.

violates a person's right of privacy;

F. assault, battery, mental anguish, mental shock, humiliation or hallucination; or
G. advertising Injury.
"Insured contract" as defined in the General Conditions, shall also mean business equipment contracts
necessary to the practice of dentistry.
"Loading or Unloading" means, with respect to any vehicle:
A. the handling of property after it is moved from the place where it is accepted for
movement into or onto a vehicle;
B. while it is in or on a vehicle;
C. while it is being moved from a vehicle to the place where it is finally delivered.
Movement of property by mechanical device, other than a handtruck, which is not
attached to the vehicle is not included.
For purposes of this definition only, vehicle means auto, aircraft, mobile equipment or watercraft.
"Nuclear Material" means Source Material, SpeCial Nuclear Material or By-product Material.
"Occurrence" means an accident, including continuous or repeated exposure to conditions which:
A. results in Injury and/or damage; and
B. was not expected nor intended by you.
Injury and damage arising from exposure to substantially the same general conditions shall be considered
one occurrence.

"You" or "Your" means:
A. the named insured;
B. if the named insured is an individual, the person designated, but only with respect to
the conduct of a business of which that individual is a sole proprietor and the
spouse of the named Insured with respect to the conduct of such business;
C. any of your employees, executive officers, partners, stockholders or members of the
board of directors, trustees or governors, but only while acting within the scope of
their duties as such;
D. any person, other than an employee, or organization while acting as real estate
manager for you; and
E. as respects the operation, for the purpose of movement upon a public highway, of mobile
equipment registered under any motor vehicle registration law:
1.
G-135702-B46
(Ed. 05105)

an employee of yours while operating any such equipment in the course of
Page 7 of 8

their employment, and
2.

any other person while operating any such equipment registered in your
name with your permission. This includes any entity legally responsible
for such operation. This only applies if there is no other valid and collectible
insurance available, either on a primary or excess basis, to such entity.

No entity shall be an insured under this Definition E. with respect to:

1.

2.

V.

injury to any fellow employee of such person injured in the course of their
employment; or
damage to property you or the employer of any person described in
above subparagraph E. 2. own, rent, occupy, or for which you or the
employer are responsible.

SPECIAL CONDITIONS
The following Conditions apply in addition to the Common Policy Conditions.

A. Financial Responsibility Laws
If this policy is certified as proof of financial responsibility for the future under the provisions of any motor
vehicle financial responsibility law, we agree that the coverage and limits of liability provided by this
policy for Injury or damage shall comply with such law. In return, you agree to reimburse us for any
payment we make which we would not have been obligated to make except for the agreement contained
in this Condition.

B. Territory
This Coverage Part applies to injury or damage which occurs:

1.

within the coverage territory;

2.

within international waters or air space, provided the injury or damage does
not occur in the course of travel to or from any other country, nation or state;
or

3.

anywhere in the world with respect to injury or damage ariSing out of your
products sold within the coverage territory.

Any claim must be made and suit must be brought within the coverage territory.

G-135702-846
(Ed. 05/05)

Page 8 of 8

CNA

For All too Commitments You Make'

PROFESSIONAL PROTECTOR PLAN
GOLD
This endorsement modifies insurance provided under the following:

BUILDING BLANKET DENTAL PRACTICE PERSONAL PROPERTY AND INCOME COVERAGE PART

I.

Fine Arts - Increase in Limits
Section I. COVERAGE AGREEMENTS, Paragraph A. Covered Property is amended as follows:
•

Item 2.d.(2) of Your Blanket Dental Practice Personal Property is deleted in its entirety and replaced
as follows:
(2) the most we will pay is $25,000 at each described premises with no more than $5,000 per item.

II.

Dentist's Electronic Equipment - Increase in Limits and Off-Premises added; Contingent Business
Interruption added
Section I. COVERAGE AGREEMENTS, Paragraph B. Covered Related Expenses is amended as follows:
A.

Item 16. Dentist's Electronic Equipment is amended as follows:
1.
2.

the $25,000 limit is deleted and replaced with a $50,000 limit;
Subject to a $15,000 sub-limit, this Covered Related Expense applies off-premises, anywhere
in the world. This sub-limit is part of and not in addition to the limit shown in A.1. above.

B. Contingent Business Interruption is added as follows:
We will pay up to $500 per day, not exceeding a maximum of $15,000 for practice income you
actually lose during the period of restoration following direct physical loss at the premises operated
by others upon whom you depend to:
1.
2.
3.

deliver materials or services to you, or others for your account;
accept your product or services; or
attract customers to your business.

The damage must occur at such premises and be caused by or resulting from a covered cause of
toss under this policy.

III.

LIMITATIONS deleted for interior of any building; gutters and downspouts; outdoor radio or television
antennas; and stamps, tickets and letters of credit
Section II. EXCLUStONS, Paragraph E. LIMITATIONS is amended as follows:
•

G-124787-B
(ED. 02106)

Items 1.a., 1.d., 1.1. and 2.c. are deleted in their entirety.
Page 1 of 2

IV.

Employee Dishonesty - Increase in Limits
The following additional change applies:
The limit of liabilily as stated in the Declarations for Employee Dishonesty is increased by $15,000. The
total employee dishonesty limit of liability is determined by adding the above referenced $15,000 to the limil
of liability stated on the Declarations. That new limit is the most we will pay for employee dishonesty.

All other terms, condition and exclusions apply and remain unchanged.

G-124787-8

(ED. 02106)

Page 2 of 2

CNA

For All tho COOllllitmentsYou Makcll:

INDEX OF PROVISIONS
BUILDING, BLANKET DENTAL PRACTICE PERSONAL PROPERTY AND INCOME
COVERAGE PART
TOPIC
I.

PAGE
Coverage Agreements

1/6

A. Covered Property
1. Building
2. Blanket Dental Practice Personal Property
- Contents Inside the Building
- Off-premises
- Accounts Receivable; Valuable Papers including x-ray records and patient
charts
Fine Arts
- Money and Securities
- Glass
- Temporary Relocation
3. Practice Income
4. Extra Expense
5. Extended Practice Income
6. Rents
B. Covered Related Expenses
1. Backup of Sewer or Drain Water Damage
2. Debris Removal
3. Preservation of Property
4. Fire Department Service Charges
5. Fire Extinguisher Recharge
6. Arson Reward
7. Cost of Research - Valuable Papers
8. Off Premises Power Failure
9. Condominium Property
10. Pollution Cleanup and Removal
11. Lawns, Trees, Shrubs, Plants, Signs
12. Personal Effects; Property of Others
13. Expenses to Reduce Income Loss; Income Loss Due to Civil Authority; Income
Loss Related to Alterations and New Buildings
14. Money Orders and Counterfeit Paper Currency
15. Forgery and Alteration
16. Dentist's Electronic Equipment
17. Claim Data Expense

1
1/2

2
2
2
2
213

3
3
3
3
3
3
3
3
3
4
4
4
4
4
4/5
5
5
5

5/6
6

6/7

C. New Acquired or Constructed Property
D. Property Not Covered

G-15159-E, ED. 02106

1
1
1
1
1
1

7

Pagei

INDEX OF PROVISIONS-CONTINUED
BUILDING, BLANKET DENTAL PRACTICE PERSONAL PROPERTY AND INCOME
COVERAGE PART
TOPIC

II.

III.

Exclusions/Restrictions
A. Concurrent Causes
1. Ordinance or Law
2. Earth Movement
3. Volcanic Eruption
4. Government Aclion
5. Nuclear
6. War; Military Action
7. Water
B. 1. Artificial Electric Current
2. Delay, Loss of Use or Market
3. Smoke
4. Wear, Tear
5. Rust, Corrosion,
6. Smog
7. Contaminants or Pollutants
8. Settling, Cracking
9. Insects
10. Mechanical Breakdown
11. Seepage, Leakage
12. Frozen Plumbing, Heating, Air Conditioning Equipment
13. Dishonest or Criminal Acts
14. Fraudulent Scheme or False Pretense
15. Property in the Open
16. Cerlain Causes of Collapse
C. 1. Weather Conditions
2. Indecision
3. Construction Related
D. Special Exclusions
1. Finished Stock
2. Outdoor Television Equipment
3. Interference by Strikers
4. Any other consequential damage
E. Limitations
1. Limitations
2. Limitation of Theft damage

8
8
8
8
8
8
8
8
8

8
8
8
8
8
8/9
9
9
9
9

9
9
9

9
9
9
9
9
9
10

10/11

LIMITS OF INSURANCE
A. Maximum Amount Payable
B. Praclice Income, Extra Expense and Extended Practice Income
C. Covered Related Expenses
D. Deductible
E. Inflation Guard
F. Valuation
1. Building/Dental Practice Personal Property
2. Siock
3. Glass
4. Tenanl's Improvements and Betterments
5. Valuable Papers and Records

G-15159-E, ED. 02106

7/10
7
7
7
7
7
7

Page ii

10
10
10
10
10
10
10/11
11
11
11
11

INDEX OF PROVISIONS-CONTINUED
BUILDING, BLANKET DENTAL PRACTICE PERSONAL PROPERTY AND INCOME
COVERAGE PART
PAGE
6.

7.
8.
IV.

-

-

Accounts Receivable Records
Blanket Dental Practice Personal Property
Building
Covered Causes of Loss
Damage
Electronic Media and records
Elevator
Falling Objects
Fine Arts
Finished Stock
Period of Restoration
Practice Income
Rents
Sinkhole Collapse
Specified Causes of Loss
Stock
Valuable Papers and Records
Volcanic Action
Water Damage

E.
F.
G.
H.
I.

J.
K.
L.
M.

G·15159·E, ED. 02106

11
11
11
11

11/12
12
12
12/13

13
13
13
13
13
13
13
13
13
13
14
14
14
14
14
14/17

Conditions
A.
B.
C.
D.

11
11

11/14

Definitions
-

V.

Practice Income
a. Actual Loss Sustained
b. Valued Daily Limit
c. Actual Loss Sustained during period of restoration
Rents
Actual Cash Value

14
14
14
14
14
14

Control of Property
Legal Action Against Us
Liberalization
No Benefit to Bailee
Other Insurance
Transfer of Rights of Recovery
Abandonment
Appraisal
Duties In the Event of Damage
Payment for Damage
Recovered Property
Vacancy
Mortgage Holders

15
15
15
15/16

16
16
16/17

Page iii

CNA

For All the Commitments You Make'

BUILDING, BLANKET DENTAL PRACTICE PERSONAL
PROPERTY AND INCOME COVERAGE PART
Various provisions in this policy restrict coverage. Read
the entire policy carefully to determine rights, duties and
what is and is not covered.

(1) the damage is caused by a covered
cause of loss; and
(2) the most we will pay is $10,000 at
each described premises with no
more than $1,000 per item.

Throughout this policy, the words you and your refer to
the named insured and anyone having a financial
interest in your property as named in this policy. The
words we, us and our refer to the Company providing this
Insurance.

Items valued at $1,000 or less are not
considered fine arts. The limits of
insurance for fine arts are in addition to
the limits of insurance shown in the
declarations.

Words and phrases that appear in bold facing have
special meaning.
Refer to DEFINITIONS in the
Common Policy Conditions and in this Coverage Part.
I.

e.

COVERAGE AGREEMENTS

A. Covered Property
We will pay for all direct physical damage to
Covered Property at the premises described on
the Declarations caused by or resulting from any
covered cause of loss.

(1) theft, meaning any act of stealing;

Covered Property means the following types of
property for which a Limit of Insurance is shown
on the Declarations or which is shown below:

(2) disappearance; or
(3) destruction.

1.

Building;

2.

Your Blanket Dental Practice Personal
Property:
a.

We will not pay for damage:
(1) resulting
from
accounting
arithmetical errors or omissions;

located:

(2) in the open, or in a vehicle, within
1000 feet of the described premises.

c.

(3) to property contained in any moneyoriented device unless the amount
of money deposited in it is recorded
by
a
continuous
recording
instrument in the device

off-premises, anywhere in the world.
The most we will pay for damage when
caused by or resulting from a covered
cause of loss is $25,000. However, this
coverage does not apply if the damage
is covered under 2.g. below.

The most we will pay for damage in any
one event is:
(1) $15,000 inside the premises for
money and securities while:

including accounts receivable records
and other valuable papers and records
including x-ray negatives and prints and
patient's charts;

(a) in or on the described premises;
or
(b) within a bank
institution; and

This coverage does not apply to your
accounts receivable records or
valuable papers and records in excess
of 10 years of age.
d.

including fine
following:

G-15159-E, ED. 02/06

arts,

or

(2) due to the giving or surrendering of
property in any exchange or
purchase; or

(1) in or on the building; or

b.

and money and securities used in your
practice while at a bank or savings
institution, within your living quarters or
the living quarters of your partners or
any employees having use and custody
of the property, at the described
premises, or in transit between any of
these places, resulting directly from:

or

savings

(2) $10,000 outside the premises for
and
securities
while
money
anywhere else.

subject to the

All damage:
Page 1 of 17

(1) caused by one or more persons; or

(a) the stored property is more
specifically insured; or

(2) involving a single act or series of
related acts;

(b) the damage is covered under
2.b. above.

is considered one event.
3.

You must keep records of all money and
securities so we can verify the amount of
any damage.
In the event of damage we
determine the value as follows:

We will pay for the actual loss of practice
Income you sustain, or the Valued Daily
Limit, as described under Limits of Insurance
prOVision III.F.6., due to the necessary
suspension of your practice during the
The suspension
period of restoration.
must be caused by direct physical damage
to the building or blanket dental practice
personal property at the described
premises caused by or resulting from a
Covered Cause of Loss or power failure as
described under paragraph I.B.8.

will

(1) money at its face value; and
(2) securities at their value at the close
of practice on the day the damage is
discovered.
f.

Glass
(1) We will pay for all glass other than
art glass windows, including all
lettering and ornamentation, located
at the described premises:

We will only pay for loss of practice income
that occurs within 12 consecutive months
after the date of direct physical damage or
power failure as described under paragraph
I.B.8. Practice income coverage shall apply
separately to each location affected by such
suspension of practice.

(a) owned by you; or
(b) owned by others but in your
care, custody or control
(2) We will also pay for necessary:

4.

(a) expenses incurred to put up
temporary plates or board up
openings;
(b) repair
or
replacement
encasing frames; and

of

including temporary relocation of Your
Blanket Dental Practice Personal
Property subject to the following:

We will only pay for extra expenses that you
incur within 12 consecutive months after the
date of direct physical damage or power
failure as described under paragraph I.B.8.

(1) If Your Blanket Dental Practice
Personal Property is removed from
the described premises and stored
temporarily at a location you own,
lease or operate while the described
premises is being renovated or
remodeled, we will pay for damage
to that stored property caused by or
resulting from a covered cause of
loss:

5.

Extended Practice Income
We will pay for the actual loss of practice
income you incur during the period that:
a.

(b) during the storage period of up
to 90 consecutive days but not
beyond expiration of this policy.

begins on the date property, except
finished stock, is actually repaired,
rebuilt or replaced and your practice is
resumed; and

b.

(a) up to $50,000 at each temporary
location; and

ends on the earlier of:
(1) the date you could restore your
practice with reasonable speed, to
the condition that would have
existed if no direct physical damage
happened; or

(2) This coverage does not apply if:

G-15159-E, ED. 02106

Extra Expense
Extra expense means the extra expenses
necessarily incurred by you during the
Period of Restoration to continue normal
services
and
operations
which
are
interrupted due to damage by a Covered
Cause of Loss to the premises described,
or power failure as described under
You will exercise due
paragraph I.B.8.
diligence and dispatch to restore normal
practice services.

(c) expenses incurred to remove or
replace obstructions.
g.

Practice Income

Page 2 of 17

If it is necessary to move covered property
from the described premises to preserve it
from, or for repair of, damage by a covered
cause of loss, we will pay for any direct
physical damage to that property:

(2) 12 consecutive months after the
date determined in (1) above.
Loss of practice income must be caused by
direct physical damage at the described
premises caused by or resulting from any
covered cause of loss.
6.

a.

Rents
The actual loss of rents or other income you
sustain due to direct physical damage
caused by or resulting from a Covered
Cause of Loss to your building at the
described premises, whether rented or not,
for the length of time which is required to
rebuild, repair, or replace it, beginning with
the date of damage during the policy period,
but not limited by its expiration.

while it is being moved or while
temporarily stored at another location;
and

b. only if the damage happens within 60
days after the property is first moved.
4.

Fire Department Service Charge
When the fire department is called to save
or protect covered property from a covered
cause of loss, we will pay up to $15,000 for
your liability for fire department service
charges:

B. Covered Related Expenses

a.

assumed by contract or agreement prior
to damage; or

Back Up of Sewer or Drain

b.

required by local ordinance.

We will pay up to $25,000 for damage to
covered property caused by water that backs
up from a sewer or drain. However, we will
not provide coverage for damage due to
water emanating from a sump pump well or
similar device designed to prevent overflow,
seepage or leakage of subsurface water.

No deductible applies to this covered related
expense.

We will also pay for the following expenses:
1.

2.

5.

We will pay up to an amount not exceeding
$2,500 in anyone event for the cost of
recharging your Underwriters Laboratories
listed or Factory Mutual approved type ABC
(multipurpose) fire extinguishers or dry
chemical fixed pipe fire extinguishing
systems after being used in fighting a fire on
your premises on or adjoining premises.

Debris Removal
We will pay up to 25% of:
a.

b.

the amount we pay for the direct
physical damage to covered property;
plus

6.

for expense to remove debris of covered
property caused by or resulting from a
covered cause of loss that happens during
the policy period. The expenses will be paid
only if they are reported to us in writing within
180 days of the earlier of:

7.

the date of direct physical damage; or

b.

Arson Reward
We will pay up to $10,000 for information
which leads to an arson conviction in
connection with damage caused by fire
Part.
covered under this Coverage
Regardless of the number of persons
involved in providing information our liability
will not be increased.

the deductible in this policy applicable to
that damage;

a.

Fire Extinguisher Recharge

the end of the policy period.

Valuable Papers and Records - Cost of
Research
a.

We will pay your costs to research,
replace or restore the lost information on
damaged
valuable
papers
and
records, x-ray negatives and prints and
patient charts including those which
exist on electronic media and records,
for which duplicates do not exist.

b.

This coverage does not apply to your
valuable papers and records in excess
of 10 years of age.

This limitation does not apply to any
additional debris removal limit provided in
the Limits of Insurance section.
This coverage does not apply to costs to:
a.
b.
3.

extract pollutants from land or water; or
remove, restore or replace polluted land
or water.

Preservation of Property

G-15159-E, ED. 02106

Page 3 of 17

8.

We will pay for your signs other than signs
attached to your buildings, lawns, trees,
shrubs and plants including debris removal
expenses.

Power Failure
We will pay for damage to covered property
caused by the failure of power or other utility
service supplied to the described premises,
resulting from direct physical damage which
happens away from the described premises
caused by a covered cause of loss. The
interruption must result from a covered
cause of loss to the following types of
property not on the described premises, but
supplying electricity, water, steam or gas to
the described premises:
a.

c.

b.

switching stations;
substations;

The most we will pay for damage by a
covered cause of loss is $10,000 at
each described premises for lawns,
trees, shrubs and plants, but not more
than $ 2,500 for anyone tree, shrub or
plant.

We will not pay for damage to trees, shrubs,
and plants resulting from the following
causes of damage: windstorm or hail;
vehicles; vandalism; disease or growth
failure.

d. transformers; or
e.

transmission lines.

12. Personal Effects and Property of Others

If damage by a covered cause of loss
results, we will pay for that resulting
damage.

a.

Personal effects owned by you, your
officers, your partners or your
employees. The most we will pay for
damage is $25,000 at each described
premises.

b.

We will not pay for damage you sustain
during the 24 hours immediately following
direct physical damage to the power or other
utility service.
9.

The most we will pay for damage to
signs by a covered cause of loss is
$10,000 at each described premises.

utility generating plants;

b.

a.

Personal property of others in your care,
custody or control located in or on the
building or in the open, or in a vehicle,
within 1000 feet of the described
premises. The most we will pay for
damage is $25,000 at each described
premises. Our payment for damage to
personal property of others will only be
for the account of the owner of the
property.

Condominium Property

If you are a condominium unit owner at a
location insured under this policy, we will pay
for damage to walls, floors, ceilings, floor
coverings or any other property required by
your condominium association agreement to
be insured by you.
However, we will not pay for damage to
such walls, floors, ceilings, floor coverings or
any other property if someone other than
you pays to repair or replace it.

13. As respects practice income:
a.

We will pay any necessary expenses
you incur, except the cost of
extinguishing a fire:

10. Pollution Clean Up and Removal
We will pay your expense up to $10,000 for
the sum of all such expenses arising out of
covered causes of loss happening during
each separate 12 month period of the policy,
to extract pollutants from land or water at
the described premises if the release,
discharge or dispersal of the pollutants is
caused by or results from a covered cause
of loss that happens during the policy
period. The expenses will be paid only if
they are reported to us in writing within 180
days of the earlier of:
a.

(1) to reduce the amount of damage;
(2) to the extent that they do not exceed
the amount of damage that
otherwise would have Deen payable;
under this Coverage Part.
b.

the end of the policy period.

11. Lawns, Trees, Shrubs, Plants and Signs
G-15159-E, ED. 02106

Civil Authority
We will pay for the actual loss of
practice income and rents you sustain
caused by action of civil· authority that
prohibits access to the described
premises due to the direct physical
damage to property, other than at the
described premises, caused by or

the date of direct physical damage; or

b.

Expenses to Reduce Damage.

Page 4 of 17

We will pay for the actual loss of
practice income you sustain due to
direct physical damage at the described
premises caused by or resulting from
any covered cause of loss to:

If you are sued for refusing to pay the
covered instrument on the grounds that
it has been forged or altered, and you
have our written consent to defend
against the suit, we will pay any
reasonable legal expenses that you
incur in that defense. The amount we
will pay for these legal expenses will be
a part of and not in addition to the limit of
insurance applicable to the Forgery and
Alteration coverage.

(1) new buildings, whether complete or
under construction;

The most we will pay for any loss and legal
defense is $10,000.

b.

resulting from any covered cause of
loss. This coverage will apply for a
period of up to 30 consecutive days from
the time of that action.
c.

Alterations and New Buildings

16. Dentist's Electronic Equipment

(2) alterations or additions to existing
buildings; and

We will pay for direct damage to
covered
dentist's
electronic
equipment (including extra expense),
located on or within 1000 feet of the
described premises, caused by or
resulting from a covered electronic
equipment cause of loss as defined
below.
The most we will pay for
damage and extra expense covered by
this covered related expense is $25,000.

(3) machinery, equipment, supplies or
building materials located on or
within 1000 feet of the described
premises and;
(a) used
in the construction,
alterations or additions; or
(b) incidental to the occupancy of
new buildings.
If such direct physical damage delays
the start of your practice, the period of
restoration will begin on the date your
practice would have begun if the direct
physical damage had not happened.
14. Money Orders
Currency

and

Counterfeit

For purposes of this coverage, dentist's
electronic equipment means any
electronic dental equipment, computers,
dental chair, x-ray equipment or other
components capable of accepting
information, processing it according to a
plan and producing the desired results.
This
includes
any
telephone
components or equipment, telephone
switchgear, operating programs, related
software,
facsimile
transmission
equipment, telex equipment and other
related
hardware
used
for
the
transmission of communications. It also
includes software for electronic data
processing, recording or storage media
such as films, tapes, cards, discs, drums
or cells.

Paper

We will pay for loss due to:
a.

the acceptance in good faith, in
exchange for merchandise, money or
services, of any post office or express
money order, issued or claiming to have
been issued by any post office or
express company, if the money order is
not paid upon presentation; or

b. the acceptance in good faith in the
regular course of business of counterfeit
United States or Canadian paper
currency.

Covered electronic equipment cause
of loss means risk of direct physical
loss to dentist's electronic eqUipment
except as excluded or limited below.
The covered electronic eqUipment
cause of loss also includes electrical
disturbance.

The most we will pay for any loss is $10,000.
15. Forgery and Alteration
a.

We will pay for loss resulting directly
from forgery or alteration of, on or in any
check, draft, promissory note, or similar
written promise, order or direction to pay
a sum certain in money, made or drawn
by or drawn upon you or made or drawn
by one acting as your agent or claiming
to have been so made or drawn.

G-15159-E, ED. 02106

We will not pay for loss or damage
caused by or resulting from the
exclusions as indicated below. Only the
following exclusions as stated in this
Coverage Part, Section iI. Exclusions
Page 5 of 17

apply
to
equipment:
a.
b.
c.
d.
e.
f.
g.
h.

dentist's

taking inventories, making appraisals,
preparing income statements and
preparing other documentation.

electronic

exclusion
A.4.,
Governmental
Action;
exclusion A.5., Nuclear Hazard;
exclusion A.6., War and Military
Action;
exclusion B.2., Delay, loss of use or
loss of market;
exclusion BA., Wear and tear;
exclusion B.5., Rust, corrosion;
exclusion B.7., seepage, migration;
exclusion B.13.,dishonest or criminal
acts,

b.

(1) Any expenses incurred, directed or
billed by or payable to attorneys,
or
their
insurance
adjusters
associates or subsidiaries;
(2) Any costs in connection with the
Appraisal Condition as set forth in
Section V. CONDITIONS; or
(3) Any expenses incurred, directed or
billed by or payable to insurance
brokers or agents,
or their
associates or subsidiaries, without
our written consent prior to such
expenses being incurred.

The following additional exclusions shall
also apply:
i.

j.

k.

depreciation,
obsolescence,
dampness or dryness, cold or heat
or any other cause of consequential
loss or damage.
error,
omission
in
machine
or
incorrect
programming
instructions to a machine;
errors, omissions or deficiencies in
design, specification, materials or
workmanship.

c.

Except as otherwise provided, the following
provisions apply to property located in or on the
building or in the open, or in a vehicle, within
1000 feet of the described premises.
1.

You may extend the insurance provided by
this Coverage Part as fallows:
a.

to apply to:
(1) your new buildings while being
built on the described premises; and
(2) buildings you acquire at locations,
other than the described premises,
intended for similar use as the
building
described
on
the
Declarations;

The most we will pay for practice
income as provided elsewhere in this
Coverage Part for loss or damage
covered by this covered related expense
is $2,500. This is part of and not in
addition to the $25,000 limit stated
above for this coverage. The Valued
Daily Limit as stated in the declarations
will be used to determine the amount of
the practice income loss. The Actual
Loss Sustained provision of Practice
Income Coverage does not apply and is
not available for loss or damage to
Dentist's Electronic Equipment.

(3) your blanket dental practice
personal property at any location
you acquire.
b.

The most we will pay for damage under
this Coverage Extension is:
(1) $500,000 on each newly acquired
Building;
(2) $250,000 on Your Blanket Dental
Practice Personal Property, at
each newly acquired location,
whether owned, leased, occupied or
controlled by you.

17. Claim Data Expense
We will pay the reasonable expenses
you incur in preparing claim data when
we require such data to show the extent
of damage. This includes the cost of

G-15159-E, ED. 02106

The most we will pay for preparation of
claim data under this Covered Related
Expense in anyone occurrence is
$5,000 regardless of the number of
premises involved.

C. Newly Acquired or Constructed Property

For purposes of this coverage electrical
disturbance means electrical injury,
magnetic
injury,
disturbance
of
electronic recordings or erasure of
electronic recordings including damage
caused by interruption of an electrical
power supply, power surge, blackout or
brownout.

a.

Under this Covered Related Expense,
we will not pay for:

Page 6 of 17

14. vehicles
or
sell-propelled
machines,
including aircraft or watercraft, that:

c. You may extend your practice income
coverage to apply at any location you
acquire.

a.

2.

Insurance for each newly acquired location
will end when any of the following first
happens:
a.

This exclusion does not apply to:
a.

you report values to us.

We will charge you additional premium for
values reported from the date you acquire the
property.
D. Property Not Covered
Covered property does not include:
1. accounts, bills, currency, deeds, evidence of
debt, money, notes or securities, except as
provided in paragraphs I.A.2.c., and I.A.2.e;
2.

rowboats or canoes out of water at the
described premises;

3.

that you own.

II.

EXCLUSIONS

A. We will not pay for damage caused directly or
indirectly by any of the following. Such damage
is excluded regardless of any other cause or
event that contributes concurrently in any
sequence to the damage.
1.

automobiles;

a.

contraband, or property in the course of
illegal transportation or trade;

6.

the cost of excavations, grading, backfilling
or filling;

7.

fine arts with a value exceeding $1,000 per
item except as provided in paragraph
I.A.2.d.;

8.

foundations of buildings, machinery or
boilers if their foundations are below:

2.

requiring the tearing down of any
property, including the cost of removing
its debris.

Earth Movement
Any earth movement other than sinkhole
collapse, such as an earthquake, landslide,
mine subsidence or earth sinking, rising or
shifting. If damage by fire or explosion
results, we will pay for that resulting
damage.

a. the lowest basement floor; or

3.

b. the surface of the ground, if there is no
basement;

Volcanic Eruption
Any volcanic eruption, explosion or effusion.
If damage by fire, building glass breakage
or volcanic action results, we will pay for
that resulting damage.

land, including land on which the property is
located, or water;
4.

10. pilings, piers, wharves or docks;

Governmental Action
Seizure or destruction of property by order of
governmental authority.

11. property that is covered under another
coverage part of this or any other policy in
which it is more specifically described,
except for the excess of the amount due,
whether you can collect on it or not, from
that other insurance.

We will pay for acts of destruction ordered
by governmental authority and taken at the
time of a fire to prevent its spread, if the fire
would be covered under this coverage part.

12. retaining walls that are not part of the
building;

5.

Nuclear Hazard
Nuclear reaction or radiation, or radioactive
contamination, however caused.

13. underground pipes, flues or drains; or
G-15159-E, ED. 02106

regulating the construction, use or repair
of any property; or

b.

4. bridges, roadways, walks, patios or other
paved surfaces;
5.

Ordinance or Law
The enforcement of any ordinance or law:

animals;

9.

snow removal or lawn care equipment of
less than 20 horsepower; or

b.

90 days expire after you acquire or
begin to construct the property; or

c.

are operated principally away from the
described premises;

this policy expires; or

b.

are licensed for use on public roads; or

b.

The most we will pay for loss is
$100,000 at each location.

Page 7 of 17

If damage by fire results, we will pay for that
resulting damage.

property that causes it to damag e or destroy
itself;
6.

smog;

war, including undeclared or civil war;

7.

b.

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

c.

7.

War And Military Action
a.

6.

insurrection,
rebellion,
revolution,
usurped power, or action taken by
governmental authority in hindering or
defending against any of these.

seepage, migration, escape, release,
discharge or dispersal of contaminants or
pollutants unless the seepage, migration,
escape, release, discharge or dispersal is
itself caused by any of the specified causes
of loss. But if damage by the specified
causes of loss results, we will pay for the
resulting damage by the Specified Causes
of Loss;

8.

settling, cracking, shrinking or expansion;

9.

nesting or infestation, or discharge or
release of waste products or secretions, by
insects, birds, rodents, or other animals;

Water
a.

Flood, surface water, waves, tides, tidal
waves, overflow of any body of water, or
their spray, all whether driven by wind or
not;

b.

Mudslide or mudflow;

c.

Water that backs up from a sewer or
drain except as provided under the
covered related expenses;

10. mechanical breakdown, including rupture or
bursting caused by centrifugal force; or
explosion or other damage to steam boilers,
steam pipe, steam engines or steam
turbines, hot water boilers or other water
heating equipment except sterilization
heating equipment heating equipment or
domestic water supply systems owned or
leased by you, or operated under your
control. If damage by fire or combustion
explosion results, we will pay for that
resulting damage. We will also pay for
damage caused by or resulting from the
explosion of gases or fuel within the furnace
of any fired vessel or within the flues or
passages through which the gases of
combustion pass;

d. Water under the ground surface
pressing on, or flowing or seeping
through:
(1) foundations, walls, floors or paved
surfaces;
(2) basements, whether paved or not;
or

(3) doors, windows or other openings.

11. continuous or repeated seepage or leakage
of water that happens over a period of 14
days or more;

But if damage by fire, explosion or
sprinkler leakage results, we will pay for
that resulting damage.

12. water, or other liquids, powder or molten
material that leaks or flows from plumbing,
heating, air conditioning or other equipment,
except fire protective systems, caused by or
resulting from freezing, unless:

B. We will not pay for damage caused by or
resulting from any of the following:

1. artificially generated
electric
current,
including electric arcing, that disturbs
electrical devices, appliances or wires;

a.

you do your best to maintain heat in the
building; or

b.

you drain the equipment and shut off the
water supply if the heat is not
maintained.

If damage by fire results, we will pay for that
resulting damage.
2. delay, loss of use or loss of market;

13. dishonest or criminal acts by you, any of
your partners,
employees,
directors,
trustees, authorized representatives or
anyone to whom you entrust the property for
any purpose:

3. smoke, vapor or gas from agricultural
smudging or industrial operations;
4.

wear and tear;

5.

rust, corrosion, fungus, decay, deterioration,
hidden or latent defect or any quality in

G-15159-E, ED. 02106

a.

Page 8 of 17

acting alone or with others; or

b. whether or not happening during the
hours of employment.

antennas, including their lead-in wiring,
masts or towers;

This exclusion shall not apply to acts of
destruction by your employees, but theft by
employees is not covered.

3.

any increase of damage caused by or
resulting from:
a. delay in rebuilding, repairing or replacing
the property or resuming your practice,
due to interference at the location of the
rebuilding, repair or replacement by
strikers or other persons; or

14. voluntary parting with any property by you or
anyone else to whom you have entrusted
the property if induced to do so by any
fraudulent scheme, trick, device or false
pretense;

b. suspension, lapse or cancellation of any
license, lease or contract.
If the
suspension, lapse or cancellation is
directly caused by the suspension of
your practice, we will cover such
damage that affects your practice
the
period
of
income
during
restoration, but not beyond the period
of restoration.

15. rain, snow, ice or sleet to personal property
in the open; or
16. collapse, except as provided under the
Definition of Covered Cause of Loss for
ALL RISKS OF DIRECT PHYSICAL LOSS
A., Collapse.
C. We will not pay for damage caused by or
resulting from any of the following. If damage by
a covered cause of loss results, we will pay for
the resulting damage:

4. any other consequential damage.
E.

1. weather conditions.
This exclusion only
applies if weather conditions contribute in
any way with a cause or event excluded in
Exclusions II. A.1. through 7. Above to
produce the damage;
2.

LIMITATIONS
1.

We will not pay for damage to:
a.

acts or decisions, including the failure to act
or decide, of any entity;

(1) the building first sustains damage
by a covered cause of loss to its
roof or walls through which the rain,
snow, sleet, ice, sand or dust enters;
or

3. faulty, inadequate or defective:
a.

planning,
zoning,
surveying, siting;

development,

(2) the damage is caused by or results
from thawing of snow, sleet or ice on
the building;

b. design, specifications, workmanship,
repair,
construction,
renovation,
remodeling, grading, compaction;
c.

b.

building materials and supplies not
attached as part of the building or
structure, unless held for sale by you,
caused by or resulting from theft;

c.

materials used in repair, construction,
renovation or remodeling; or

property that is missing, where the only
evidence of the loss or damage is a
shortage disclosed on taking inventory,
or other instances where there is no
physical evidence to show what
happened to the property;

d. maintenance;
of part or all of any property on or off the
described premises.
D. Special Exclusions
As respects practice Income coverage, we will
not pay for:
1. any damage caused by or resulting from:

d. gutters and downspouts caused by or
resulting from weight of snow, ice or
sleet;

a. damage or destruction of finished
stock or prosthesis; or
b.

e.

2. any damage caused by or resulting from
direct physical damage to radio or television

Page 9 of 17

property that has been transferred to any
entity or to a place outside the described
premises on the basis of unauthorized
instructions; or

f.

the time required to reproduce finished
stock or prosthesis;

G-15159-E, ED. 02106

the interior of any building caused by or
resulting from rain, snow, sleet, ice,
sand or dust, whether driven by wind or
not, unless:

outdoor radio or television antennas,
including their lead-in wiring, masts or

towers when damage is caused by
windstorm, hail, rain, sleet, snow, ice or
weight of ice.
2.

We will not pay for damage to your building or
your blanket dental practice personal
property in anyone event until the amount of
damage exceeds the deductible shown on the
Declarations. We will then pay the amount of
damage in excess of the deductible, up to the
applicable limit of insurance.

For damage by theft, the following types of
property are covered only up to the limits
shown:
a. $2,500 for furs, fur garments,
garments trimmed with fur;
b.

c.

or

E. Inflation Guard
1. The Limit of Insurance for building and
blanket dental practice personal property
to which this coverage applies will
automatically increase by the quarterly
percentage shown on the Declarations.

$5,000 for jewelry, watches, watch
movements, jewels, pearls, precious
and semi-precious stones, bullion, gold,
silver, platinum and other precious alloys
or metals. This limit does not apply to
jewelry and watches worth $100 or less
per item;

2. The amount of increase will be:
a.

$250 for stamps, tickets and letters of
credit.

b. the percentage of quarterly increase
shown on the Declarations applied pro
rata during each year.

III. LIMITS OF INSURANCE

A. The most we will pay for damage in anyone
event is the applicable limits of insurance shown
on the Declarations.

the most recent limit of insurance
exclusive of this coverage; multiplied by

F. Valuation
We will determine the value of covered property
in the event of damage as follows:

B. The Limits of Insurance applicable to your
Practice Income, Extra Expense and Extended
Practice Income shall be subject to annual
aggregate limit of insurance of $1,000,000 for
any damage caused by a Covered Cause of
Loss.

1.

Building: Your Blanket Dental Practice
Personal Property:
a. On the basis of replacement cost,
without deduction for depreciation.

C. Unless otherwise indicated, the limits of
insurance applicable to the covered related
expenses are in addition to the limits of
insurance shown on the declarations. Payments
under the following Covered Related Expenses
will not increase the applicable limit of insurance:

b. This valuation does not apply to:
(1) property of others;
(2) contents of a residence;
(3) manuscripts;

1. preservation of property; or

(4) fine arts;

2. debris removal; but if:

(5) outdoor equipment
furniture; or

a.

the sum of direct physical damage and
debris removal expense exceeds the
limit of insurance; or

c.

we will pay up to an additional $25,000 for
each location in anyone event.
As respects practice income and rents the
following will not increase the limit of
insurance:
a.

Alterations and New buildings;

(1) until the damaged property is
actually repaired or replaced; and

Expense to Reduce Damage.

D. Deductible
G-15159-E, ED. 02/06

You may make a claim for damage
covered by this insurance on an actual
cash value basis instead of on a
replacement cost baSis. In the event
you elect to have damage settled on an
actual cash value basis, you may still
make a claim on a replacement cost
basis if you notify us of your intent to do
so within 180 days after the damage.

d. We will not pay on a replacement cost
basis for any damage:

b. Civil authority; and
c.

outdoor

(6) stock.

b. the debris removal expense exceeds the
amount payable under the 25% debris
removal for covered related expenses;

3.

or

Page100f17

(2) unless the repairs or replacement
are made as soon as reasonably
possible after the damage.

b. labor to transcribe or copy the records
when there is a duplicate.
6.

These requirements do not apply when
damages are $10,000 or less.

Practice Income
a.

Actual Loss Sustained - If your practice
is suspended due to physical damage at
the described premises or power failure
as described under paragraph I.B.8., we
will pay for the actual loss of Practice
Income you sustain in accordance with
paragraph I.A.3. unless a Valued Daily
Limit is shown on the declarations. If a
Valued Daily Limit is shown on the
declarations, Practice Income will be
valued in accordance with paragraph
III.F.6.b. below.

b.

Valued Daily Limit - If your practice is
suspended due to physical damage at
the described premises or power failure
as described under paragraph I.B.8., we
will pay up to the number of days shown
on the declarations:

e. We will not pay more for damage on a
replacement cost basis than the least of:
(1) the limit of insurance applicable to
the damaged property; or
(2) the cost to replace, on the same
premises, the damaged property
with other property:
(a) of comparable
quality; and

material

and

(b) used for the same purpose; or

f.

2.

The amount you actually spend that is
necessary to repair or replace the
damaged property.

Stock you have sold but not delivered at the
selling price less discounts and expenses
you otherwise would have had.

(1) the limit per day shown on the
Declarations if your practice is
totally suspended; or

3. Glass at the cost of replacement with safety
glazing material if required by law.
.
4.

(2) the proportion of the limit per day if
your practice is partially suspended.
This proportion shall be calculated
as the ratio of reduced practice
hours compared to normal practice
hours.

Tenant's improvements and betterments at:
a.

replacement cost of the damaged
property if you make repairs promptly;

b.

a proportion of your original cost if you
do not make repairs promptly. We will
determine the proportionate value as
follows:

A day means a period of 24 hours,
beginning at 12:01 A.M. and during
which your practice was or would be
conducted.

(1) Multiply the original cost by the
number of days from the damage to
the expiration of the lease; and

c.

(2) Divide the amount determined in (1)
above by the number of days from
the installation of improvements to
the expiration of the lease.

7.

5.

Nothing if others pay for repairs or
replacement.

Rents or
sustained.
experience
experience

8.

If your lease contains a renewal
option, the expiration of the renewal
option period will replace the
expiration of the lease in this
procedure.
c.

Even if a Valued Daily Limit applies, you
may alternatively make a claim for
practice income covered by this
insurance on an actual loss sustained
basis during the period of restoration
in accordance with Condition V.J.7.
other income at actual loss
Consideration will be given to the
before the loss and the probable
had no loss occurred.

At actual cash value as of the time of
damage, except as provided above.

IV. DEFINITIONS
"Accounts Receivable Records" means:

Valuable papers and records, including
those which exist on electronic media and
records, other than prepackaged software
programs, at the cost of:

A. all sums due you from customers, provided you
are unable to effect collection;

a. blank materials for reproducing the
records; and

B. interest charges on any loan to offset impaired
collections pending repayment of such amounts
made uncollectible by damage;

G-15159-E, ED. 02106

Page 11 of 17

C. collection expenses in excess of normal
collection cost made necessary because of
damage; and

1. additions under construction, alterations and
repairs to the building;
2.

D. other reasonable expenses incurred by you in
re-establishing records of accounts receivable
following such damage.
"Blanket Dental Practice Personal Property"
means property other than buildings, consisting of
the following:

materials,
equipment,
supplies
and
temporary structures, on or within 1000 feet
of the described premises, used for making
additions, alterations or repairs to the
building.

B. machinery and equipment;

"Covered Causes of Loss" means ALL RISK OF
DIRECT PHYSICAL LOSS except as excluded or
limited in Section II. Of this Coverage Part. ALL
RISK OF DIRECT PHYSICAL LOSS shall also
include the following:

C. stock;

A. Collapse

A. furniture and fixtures;

1. We will pay for damage caused by or
resulting from collapse of a building or any
of its parts caused only by one or more of
the following:

D. all other personal property owned by you and
used in your practice;

E. labor, materials or services furnished or
arranged by you on personal property of others;
and

a.

the specified causes of loss or
breakage of building glass, all only as
insured against in this Coverage Part;

b.

hidden decay;

1. made a part of the building you occupy but
do not own; and

c.

hidden insect or vermin damage;

d.

weight of people or personal property;

2.

e.

weight of rain that collects on a roof; and

f.

use of defective material or methods in
construction, remodeling or renovation if
the collapse happens during the course
of the construction, remodeling or
renovation.

F. your use interest as tenant in improvements and
betterments. Improvements and betterments
are fixtures, alterations, installations or additions:

you acquired or made at your expense but
cannot legally remove.

"Building" means the building or structure described
on the Declarations, including:

A. completed additions;
B. permanently installed;

2.

2.

machinery; and

We will not pay for damage to the following
types of property unless the damage is a
direct result of the collapse of a building;

3.

equipment;

a.

4.

radio and television antennas and satellites
including lead-in wiring and masts.

outdoor radio or television antennas,
including their lead-in wiring, masts or
towers;

b.

awnings; gutters and downspouts;

c.

yard fixtures, outdoor swimming pools;

d.

fences; piers, wharves and docks;
beach
or
diving
platforms
or
appurtenances; or

e.

retaining walls; walks, roadways and
other paved surfaces.

1. fences, fixtures;

B. outdoor fixtures;
C. an appurtenant structure for up to 10 percent of
the building limit.
D. personal property owned by you that is used to
maintain or service the building or its premises,
including:
1. fire extinguishing equipment;
2.
3.

floor coverings; and

4.

appliances used for refrigerating, ventilating,
cooking, dishwashing or laundering; and

Collapse does not include settling, cracking,
shrinkage, bulging or expansion, nor shall
this coverage increase the Limits of
Insurance of this Coverage Part.

outdoor furniture;

B. Water Damage

If damage caused by or resulting from covered
water damage or other liquid, powder or molten
material damage happens, we will also pay the

E. If not covered by other insurance:

G-15159-E, ED. 02106

Page120f17

cost to tear out and replace any part of the
building to repair damage to the system or
appliance from which the water or other
substance escapes.
We will not pay the cost to repair any defect that
caused the damage; but we will pay the cost to
repair or replace damaged parts of fire
extinguishing equipment if the damage:
1. results in discharge of any sUbstance from
an automatic fire protection system; or
2.

is directly caused by freezing.

"Damage" means partial or total loss of or damage
to your covered property.
"Electronic Media and Records" means:
A. electronic data processing, recording or storage
media such as films, tapes, discs, drums or
cells.
B. data stored on such media; or
C. programming records used for electronically
controlled equipment.
"Elevator" means a hoisting or lowering device to
connect floor or landings. It mayor may not be in
service. It may consist of several parts, such as: a
car or platform; a shaft, hoistway, stairway, or
runway; power equipment and machinery. For the
purpose of this Coverage Part, elevator does not
include:
A. an auto servicing hoist;

C. any hod or material hoist used in construction
operations;
used

exclusively for

E. a dumbwaiter used exclusively for carrying
property and having a compartment height of 4
or less feet.
"Falling Objects" means damage to the interior of a
building or property inside provided that the roof or
an outside wall of the building is first damaged by a
falling object. Falling objects does not include
damage to:

A. personal property in the open; or
B. the interior of a building, or property inside a
building, unless the roof or an outside wall of
the building is first damaged by a falling
object.
"Fine Arts" means paintings, etchings, pictures,
tapestries, statuary, marbles, bronzes, porcelains
G-15159-E, ED. 02/06

"Finished Stock"
manufactured.

means

stock

you

have

"Period of Restoration" means the period of time
that:

A. begins 24 hours immediately following direct
physical damage or power failure as described
under paragraph I.B.8 caused by or resulting
from any Covered Cause of Loss at the
described premises or power failure as
described in paragraph I.B.8.; and
B. ends on the date when the property at the
described premises should be repaired, rebuilt or
replaced with reasonable speed and similar
quality.
Period of restoration does not include any
increased period required due to the enforcement of
any ordinance or law that:
•

regulates the construction, use or repair, or
requires the tearing down of any property; or

•

requires you or others to test for, monitor, clean
up, remove, contain, treat, detoxify or neutralize,
or in any way respond to, or assess the effects
of pollutants.

The expiration date of this policy will not cut short the
period of restoration.
"Practice Income" means the:

B. a hoist without a platform outside a building,
which does not have mechanical power or is not
attached to a building wall;

D. an inclined conveyor
carrying property; or

and bric-a-brac, art glass windows and other bona
fide works of art or rarity, historical value or artistic
merit.

A. net income, meaning net profit or loss before
income taxes, that would have been earned or
incurred; and
B. continuing normal operating expenses, including
payroll.
"Rents" or other income means the sum of:

A. gross income from the described property;
B. the amount of all charges assumed by the
tenants which would otherwise be your
obligations; and
C. rental value of that portion occupied by you or
vacant portions that would have been rented had
no damage occurred.
"Sinkhole Collapse" means the sudden sinking or
collapse of land into underground empty spaces
created by the action of water on limestone or
dolomite. This cause of damage does not include:

A. the cost of filling sinkholes; or
B. sinking or collapse of land into man-made
underground cavities.
Page 130f17

4 Years in Wyoming;

"Specified Causes of Loss" means the following:
fire; lightning; explosion; windstorm or hail; smoke;
aircraft or vehicles; riot or civil commotion;
fire
extinguishing
vandalism;
leakage from
equipment; sinkhole collapse; volcanic action;
failing objects: weight of snow, ice or sleet; water
damage.
"Stock" means merchandise held in storage or for
sale, raw materials and in-process or finished goods,
including supplies used in their packing or shipping.
"Valuable Papers and Records" means written,
printed or otherwise inscribed documents and
records including books, maps, films, drawings,
abstracts, deeds, mortgages, manuscripts, x-ray
negatives and prints and patient's charts.
"Volcanic Action" means direct damage resulting
from the eruption of a volcano when the damage is
caused by:

3 Years in Maryland, Norlh Carolina, North
Dakota or Ulah; or
2 Years in all other States;
aller the date on which the direct physical
damage happened.
C. Liberalization

If we adopt any revision that would broaden the
coverage under this Coverage Part without
additional premium within 45 days prior to or
during the policy period, the broadened coverage
will immediately apply to this Coverage Part.
D. No Benefits to Bailee
No entity, other than you, having custody of
covered property will benefit from this insurance.
E. Other Insurance

A. airborne volcanic blast or airborne shock waves;

1.

You may have other insurance subject to
the same plan, terms, conditions and
provisions as the insurance under this
Coverage Part. If you do, we will pay our
share of the covered damage. Our share is
the proportion that the applicable limit of
insurance under this Coverage Part bears to
the limits of insurance of all insurance
covering on the same basis.

2.

If there is other insurance covering the same
damage, other than that described in 1.
Above, we will pay onty for the amount of
covered damage in excess of the amount
due from that other insurance, whether you
can collect on it or not. But we will not pay
more than the applicable limit of insurance.

B. ash, dust or particulate matter; or
C. lava flow.
All volcanic eruptions that happen within any 168hour period will constitute a single event.
Volcanic action does not include the cost to remove
ash, dust or particulate matter that does not cause
direct physical damage to the described property.
"Water Damage" means accidental discharge or
leakage of water or steam as the direct result of the
breaking or cracking of any part of a system or
appliance containing water or steam.
V. CONDITIONS
The following Conditions apply in addition to the
Common Policy Conditions.

F. Transfer of Rights of Recovery
The following is added to the Common Policy
Conditions:

A. Control of Property
Any act or neglect of any person other than you
beyond your direction or conlrol will not affect
this insurance.

You may waive your rights against another party
in writing:
1. prior to damage to your covered property or
covered income.

The breach of any condition of this Coverage
Part at anyone or more locations will not affect
coverage at any location where, at the time of
damage, the breach of condition does not exist.

2.

B. Legal Action Against Us

a.

No one may bring a legal action against us under
this Coverage Part unless the action is brought
within:

someone insured by this insurance;

b.

The following is added to the Common Policy
Conditions:

a business;
(1) owned or controlled by you; or
(2) that owns or controls you; or

6 Years in South Dakota;

(3) your tenant.

5 Years in Florida or Kansas;
G-15159-E, ED. 02106

aller damage to your covered property or
covered income only if, at the time of
damage, that party is one of the following:

This will not restrict your insurance.
Page 140f17

7.

If requested, permit us to question you
under oath at such times as may be
reasonably required about any matter
relating to this insurance or your claim,
including your books and records. In such
event, your answers must be signed.

8.

Send us a signed, sworn statement of
damage containing the information we
request to investigate the claim. You must
do this within 60 days after our request. We
will supply you with the necessary forms.

9.

G. Abandonment

Cooperate with us in the investigation or
settlement of the claim.

There can be no abandonment of any property to
us.
H. Appraisal

If we and you disagree on the value of the
property, the amount of net income and
operating expense, or the amount of damage,
either may make written demand for an appraisal
of the damage. In this event, each party will
select a competent and impartial appraiser. The
two appraisers will select an umpire. If they
cannot agree, either may request that selection
be made by a judge of a court having
jurisdiction. The appraisers will state separately
the value of the property and amount of
damage. If they fail to agree, they will submit
their differences to the umpire. A decision
agreed to by any two will be binding. Each party
will:

10. Resume all or part of your practice as
quickly as possible.

J.

Payment for Damage
1.

In the event of damage covered by this
Coverage Part, at our option we will either:

1. pay its chosen appraiser; and

b.

pay the cost of repairing or replacing the
damaged property;

If there is an appraisal, we will still retain our
right to deny the claim.

I.

a. pay the value of damaged property;

2. bear the other expenses of the appraisal and
umpire equally.

c.

take all or any part of the property at an
agreed or appraised value; or

Duties In the Event of Damage

d.

repair, rebuild or replace the property
with other property of like kind and
quality.

You must see that the following are done in the
event of damage to covered property:
2.

3.

4.

5.

6.

At our request, give us complete inventories
of the damaged and undamaged property.
Include quantities, costs, values and amount
of damage claimed.

We will pay for covered damage within 30
days after we receive the sworn statement of
damage if:
a.

Page 15 of 17

you have complied with all of the terms
of this Coverage Part; and

b.

Permit us to inspect the property and
records proving the damage. Also permit us
to take samples of damaged property for
inspection, testing and analysis.

G-15159-E, ED. 02106

We may elect to defend you against suits
arising from claims of owners of property.
We will do this at our expense.

6.

Take all reasonable steps to protect the
Covered Property from further damage by a
covered cause of loss. If feasible, set the
damaged property aside and in the best
possible order for examination. Also keep a
record of your expenses for emergency and
temporary repairs, for consideration in the
This will not
settlement of the claim.
increase the limit of insurance.

We may adjust damages with the owners of
damaged property if other than you. If we
pay the owners, such payments will satisfy
your claims against us for the owners'
property. We will not pay the owners more
than their financial interest in the covered
property.

5.

As soon as possible, give us a description of
how, when and where the damage
happened.

We will not pay you more than your
financial interest in the covered property.

4.

2. Give us prompt written notice of the
Include a description of the
damage.
property involved.

We will give notice of our intentions within 30
days after we receive the sworn statement of
damage.

3.

1. Notify the police if a law may have been
broken.

we have reached agreement with you
on the amount of damage, or an
appraisal award has been made.

We will pay recovery expenses and the
expenses to repair the recovered property,
subject to the limit of insurance.

7. The amount of practice income loss will be
determined based on:
a.

the net income of the practice before the
direct physical damage happened;

b.

Vacancy

If the building where damage happens has
been vacant for more than 60 consecutive days
before the damage, we will:

the likely net income of the practice if no
damage happened;

c.

l.

the operating expenses, including payroll
expenses, necessary to resume your
practice with the same quality of service
that existed just before the direct
physical damage; and

1. not pay for any damage caused by any of
the following even if they are covered
causes of loss:
a. vandalism;

d. other relevant sources of information,
including:
(1) your
financial
records
accounting procedures;

b.
c.

(3) deeds, liens or contracts.
We will reduce the amount of your practice
income recovery by any amounts paid to
you, or to the extent you can resume your
practice, in whole or in part, by using
damaged or undamaged property, including
merchandise or stock, at the described
premises or elsewhere.

2.

8.

K.

reduce the amount we would otherwise pay
for the damage by 15%.

M. Mortgage Holders
1. The term "mortgage holder" includes:
a.
b.

the owner of the building at the
described premises which is leased or
rented to you, but only during the time
you are a tenant in that building;

c.

the owner of any equipment, materials
or supplies which are leased to you, but
only while at the described premises;
and

d.

the period, beginning with the date of
direct, physical damage, necessary to
repair,
rebuild
or replace,
with
reasonable speed and similar quality,
other property at the described premises
due to damage caused by the same
event.

any trustees;

any creditor with whom you have
entered a contract for the sale of
covered property whose interest is
established by written contract.

90 consecutive days from the date of
direct physical damage; or

b.

actual or attempted theft;

A building is vacant when it does not contain
enough blanket dental practice personal
property to conduct customary practice, but
buildings under construction are not considered
vacant.

We will not pay for any loss of practice
income caused by direct physical damage
to electronic media and records after the
longer of:
a.

water damage; or

e.

(2) bills, invoices and other vouchers;
and

building glass breakage;

d.

and

sprinkler leakage, unless you have
protected the system against freezing;

If you sustain any rents or other income
reduction covered under this Coverage Part
which exceeds the amount of coverage, all
recoveries on account of the damage, less
the actual cost of recovery, shall be applied
to the reimbursement of you to the extent of
your uninsured amount less the deductible
amount.

2.

We will pay for covered damage to covered
property to each mortgage holder shown on
the Declarations in their order of
precedence, as interests may appear.

3.

The mortgage holder has the right to receive
damage payment even if the mortgage
holder has started foreclosure or similar
action on the covered property.

4.

If we deny your claim because of your acts
or because you have failed to comply with
the terms of this Coverage Part, the

Recovered Property
If either you or we recover any property after
damage settlement, that party must give the
other prompt notice. At your option, the property
will be returned to you. You must then return to
us the amount we paid to you for the property.

G-15159-E, ED. 02106

Page160f17

mortgage holder will still have the right to
receive damage payment if the mortgage
holder:
a. pays any premium due under this
Coverage Part at our request if you
have failed to do so;
b.

submits a signed, sworn statement of
damage within 60 days after receiving
notice from us of your failure to do so;
and

c.

has notified us of any change in
ownership, occupancy or substantial
change in risk known to the mortgage
holder.

All of the terms of this Coverage Part will
then apply directly to the mortgage holder.
5.

If we pay the mortgage holder for any
damage and deny payment to you because
of your acts or because you have failed to
comply with the terms of this Coverage Part:

a.

the mortgage holder's rights under the
mortgage will be transferred to us to the
extent of the amount we pay; and

b.

the mortgage holder's right to recover
the full amount of the mortgage holder's
claim will not be impaired.

At our option, we may pay to the mortgage
holder the whole principal on the mortgage
plus any accrued interest. In this event,
your mortgage and note will be transferred
to us and you will pay your remaining
mortgage debt to us.
6.

If we cancel this policy, we will give written
notice to the mortgage holder at least:

a.

b.

7.

10 days before the effective date of
cancellation if we cancel for your
nonpayment of premium; or
30 days before the effective date of
cancellation if we cancel for any other
reason.

If we elect not to renew this policy, we will
give written notice to the mortgage holder at
least 10 days before the expiration date of
this policy.

G-15159-E, ED. 02106

Page 17 of 17

WASHINGTON AMENDATORY ENDORSEMENT
BUILDING, BLANKET DENTAL PRACTICE PERSONAL PROPERTY AND INCOME COVERAGE PART
1. directly and solely results in
damage; or

We agree with you that the Building, Blanket
Dental Practice Personal Property and Income
Coverage Part is amended as follows:
A.

2. initiates a sequence of events that
results in damage, regardless of the
nature of any intermediate or final
event in that sequence.

Under Section I., COVERAGE
AGREEMENTS, A, Property Covered,
2.,Your Blanket Dental Practice
Personal Property, the following is
added:

D.

Section II. EXCLUSIONS, B.5. and B.9.
are modified to include the following:

Your Blanket Dental Practice
Personal Property includes personal
effects and property of others that you
lease or rent under written contract to the
extent of your liability for the damage.

But this exclusion shall not apply as
specifically described in Section IV.,
DEFINITIONS, "Covered Causes of
Loss," A Collapse.

B. Section I. COVERAGE AGREEMENTS,
B., Covered Related Expenses, 12.,
Personal Effects and Property of Others,
b., is deleted and replaced by the
following:
b.

Under Section II. EXCLUSIONS, B.13.,
the following is added:

E.

This exclusion or the Concealment,
Misrepresentation, Fraud Condition will
not apply to deny an insured's claim for
an otherwise covered property loss if
caused by an act of domestic abuse by
another insured under the policy, and the
insured making the claim files a police
report and cooperates with any law
enforcement investigation, and did not
cooperate in or contribute to the creation
of the damage.

Personal property of others:
(1) in your care, custody or control,
except as provided in Your
Blanket Dental Practice
Personal Property above; and
(2) located in or on the building
described on the Declarations or
in the open, or in a vehicle, within
100 feet of the described
premises. The most we will pay
for damage is $10,000 at each
described premises. Our
payment, for damage to
personal property of others will
only be for the account of the
owner of the property.

Domestic abuse means physical harm,
bodily injury, assault, or the infliction of
fear of imminent physical harm, bodily
injury or assault between family or
household members. It includes sexual
assault of one family or household
member against another, stalking as
defined by RCW 9A46.11 a of one family
or household member by another family
or household member, or intentionally,
knowingly or recklessly causing damage
to property so as to intimidate or attempt
to control the behavior of another family
or household member.

C. Under Section II. EXCLUSIONS A.,
the first paragraph is deleted and
replaced as follows:
A We will not pay for damage caused
by any of the excluded events described
below. Damage will be considered to
have been caused by an excluded event if
the occurrence of that event:

G·15175·G46
(Ed. 01/01)

F.

Page

1 of 3

Section III. LIMITS OF INSURANCE, F.,
Valuation, 1., Building; Your Blanket
Dental Practice Personal Property:, e.
(2) is replaced by the following:

(2) the cost to replace, on the same
premises, the damaged
property with other new property:
G.

matter following a volcanic eruption.
Subsequent deposits arising from the
movement of volcanic dust or ash by wind
or other means are not covered.

Section IV. DEFINITIONS, 'Volcanic
Action" is deleted and replaced by the
following:

The following provision applies only to I.,
COVERAGE AGREEMENTS, A,
Property Covered, 5., Extended Practice
Income and 6., Rents.

UVolcanic Action" means direct
damage
resulting from the eruption of a volcano
when the damage is caused by:

The period of restoration arising from
the need to remove is the time necessary
to remove the matter described with
reasonable speed from the Covered
Property.

A Volcanic blast or airborne shock
waves; or
B. Ash, dust or particulate matter.

Votcanic Action does not include
damage caused by, resulting from,
contributed to or aggravated by:

Volcanic Action does not mean
damage to:

A Land;

A. Fire,
B. Explosion,
C. Flood, surface water, waves, tides,
tidal waves, overfiow of any body of
water, or their spray, all whether
driven by wind or not; or
D. Earth movement, including but not
limited to earthquake, volcanic
eruption, landslide, lava now, mud
ftow, earth sinking, earth rising or
shifting.

B.

Property in the open or in open
sheds; or
C. Portions of buildings not completely
enciosed, or personal property
contained within those buildings.
All volcanic eruptions that occur within
any 72-hour period will constitute a single
event.
Covered Related Expenses inciudes the
cost to:
a.

b.

remove the ash, dust or particulate
matter from the interior and exterior
surfaces of the covered building;
and
ciean equipment and stock. If stock
cannot be returned to its state before
the volcanic eruption, the measure of
damage will be the reduction in
actual cash value.

H. Under section V. CONDITIONS, H.,
Appraisal, the last paragraph does not
apply.

I.

Insurance Commissioner's
Regulation No. 335/wAC-284-21-010
requires that Form 372 (Ed. 11-50) or
Form 438 BFU (Ed. 5-42) be
endorsed on this policy to replace
this Condition.

Payment for removal applies only to the
initial deposit of ash, dust or particulate

G-15175-G46
(Ed. 01101)

Section V. CONDITIONS, M., Mortgage
Holders is replaced by the following:

Page 20f3

All other provisions of the policy remain unchanged.
This endorsement is a part of your policy and takes effect on the policy effective date, unless a different
date is specified below:

Named Insured

Policy Number

Effective date of this endorsement

Countersigned By: _ _ _ _ _ _ _ _ _ _ __
Authorized Agent

G-15175-G46
(Ed. 01101)

Page 30f3

CNA

For All the Commitmcntsyou Make"

STATE PROVISIONS - WASHINGTON
Any cancellation or non-renewal provisions contained in
the policy to which this endorsement is attached are
deleted and replaced by the following:
I.

hour the cancellation is effective. The policy will
end on that date. The grounds for such
cancellation shall also be stated.

Cancellation

E. If notice is mailed, proof of mailing will be
sufficient proof of notice.

A. This policy can be canceled by either the first of
you named or us.
1.

You can cancel this policy at any time. To do
so, you must:
a. return the policy to us or any of our
authorized representatives; or
b. mail a written notice to us;
stating when the cancellation is to be
effective. We must receive the policy or
written notice before the cancellation date.

2.

We can cancel this policy by giving written
notice to you at least:
a.

10 days, if cancellation is for nonpayment of premium. However, you may
continue the coverage by payment in full
at any time prior to the date the
cancellation is effective; or

b.

45 days if cancellation is for any other
reason;

before the date the cancellation is effective.
B. We will mail or deliver notice to you at the last
mailing address known to us. A copy shall also
be mailed or delivered to your agent.
C. We will also mail or deliver notice to any
Mortgage Holder, pledgee or other person shown
by the policy to have an interest in any loss which
may happen under this policy, at their last mailing
address known to us. The notice will be the same
as that mailed or delivered to the first of you
named.
D. Notice of cancellation will state the date and

G-11715-E46
(ED. 04189)

F.

If this policy is canceled, we will send the first of
you named any premium refund due. If we
cancel, the refund will be pro-rata. If you cancel,
the refund will be at least 90% of the pro-rata
refund.
The cancellation will be effective even if we have
not made or offered a refund.

II.

Non-Renewal
If we decide not to renew this policy, 45 days advance
written notice shall be mailed or delivered to you at
the address shown in this policy. Like notice shall
also be mailed to each mortgagee, pledgee, or other
person shown by the policy to have an interest in any
loss which may happen. A copy shall also be mailed
or delivered to your agent. The notice shall include
the reason for such non-renewal.
In the event we are willing to renew this policy, a
premium billing notice shall be mailed or delivered to
you at the address shown in this policy not less than
20 days in advance of the renewal or anniversary date
of this policy. The premium billing notice shall be
based upon the rates and rules applicable to the
ensuing policy period. If we or our authorized
representatives fail to provide the required notice, you
shall be entitled to renewal of this policy at the same
premium rate and policy conditions as the expiring
policy.
Such renewal shall not prevent us from
making changes in the rates andlor contract
provisions of the policy once during the term of its
renewal after at least 20 days advance notice of such
change has been given to you.

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
FUNGI/MOLD / MILDEW / YEAST / MICROBE EXCLUSION
AND WATER DAMAGE LIMITATION
WASHINGTON
This endorsement modifies insurance provided under the following:
COMMON POLICY CONDITIONS
GENERAL LIABILITY COVERAGE PART

I.

THE GENERAL LIABILITY COVERAGE PART IS MODIFIED AS FOLLOWS:
The following is added to Section II, EXCLUSIONS:
We will not defend, or pay under this Coverage Part for:
loss due to fungi or microbes, meaning:

1. Injury or damage arising out of or relating to, in whole or in part, the actual, alleged or threatened
inhalation of, ingestion of, contact with, exposure to, existence of, or growth or presence of any
fungi or microbes.

2.

Any loss cost or expense arising out of or relating to Ihe 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 microbes by any insured or anyone else.

3.

Damage caused by water where there also exists any damage arising out of or relating to, in
whole or in pari, the actual, alleged or threatened inhalation of, ingestion of, contact with,
exposure to, existence of, or growth or presence of any fungi or microbes.

This exclusion does not apply where your business is food processing, sales, or serving, and the
Injury is caused solely by food poisoning in connection with such processing, sales or serving.

II.

THE COMMON POLICY CONDITIONS ARE MODIFIED AS FOLLOWS:
The following is added to Section XVIII,. Definitions:
"Fungi" means any form of fungus, including but not limited to, yeast, mold, mildew, rust, smut or
mushroom, and including any spores, mycotoxins, odors, or any other substances, products, or
byproducts produced by, released by, or arising out of the current or past presence of fungi. But
fungi does not include any fungi intended by the insured for consumption.

"Microbe" means any non-fungal microorganism or non-fungal, colony-form organism that causes
infection or disease. Microbe includes any spores, mycotoxins, odors, or other substances, products, or
byproducts produced by, released by, or arising out of the current or past presence of microbes. But
microbe does not mean microbes that were transmitted directly from person to person.

Page 1 of 1

G-142815·A46
(ED. 08/03)
Incorporates materials copyrighted by Insurance Services Offices, reprinted with their permission

CNA

fbr All tho Commitments You Maims

WASHINGTON AMENDATORY ENDORSEMENT
GENERAL LIABILITY COVERAGE PART
B.
We agree with you that the General Liability
Coverage Part is amended as follows:

Section II., EXCLUSIONS, H., is
deleted and replaced by the following:
H.

A.

Section II., EXCLUSIONS, A. applies
only to injury to any of your
employees whose employment is not
subject to the Industrial Insurance Act
of Washington (Washington Revised
Code Title 51).

injury or damage for which you
may be held liable as a result of:

A.

2.

an employee of yours arising
out of and in the course of
employment by you; or
any obligation to share a loss
with or repay someone else
who must indemnify because
of the injury.

This exclusion does not apply to
liability you assume under an insured
contract.

Named Insured

Effective Date of Endorsement

(Ed. 01101)

furnishing of alcoholic
beverages to a person under
the legal drinking age or under
the influence of alcohol; or

3,

injury to:

1.

G-58004-G46

causing or contributing to the
alcoholic beverage
intoxication of any person;

2.
With respect to injury to your
employees whose employment is
subject to the Insurance Act of
Washington, Section II., EXCLUSIONS,
A. is deleted and replaced with the
following:

1.

any statute, ordinance or
regulation relating to the sale,
gift, distribution or use of
alcoholic beverages.

This exclusion only applies if you:

1.

manufacture, sell or distribute
alcoholic beverages; or

2.

serve or furnish alcoholic
beverages whether or not
such activity is for the
purposes of financial gain or
livelihood.

All other provisions of this policy remain
unchanged,

Policy Number
Countersigned By:: _ _ _ _ _ _ _ _-,---_
Authorized Agent

CNA

For Alltho Commitments. You :'tlalw*

POLICYHOLDER NOTICE
Economic and Trade Sanctions Conditions
Ethics and proper business conduct has been the cornerstone of CNA since 1897. While much has
changed during the last century, our commitment to these core values has not wavered. We strongly
believe that proper business conduct is more than the practice of avoiding wrong; it is also a matter of
choosing to do right. Nowhere is this more essential than helping in the fight against terrorism. As such,
we are committed to complying with U.S. Department of Treasury Office of Foreign Asset Control (OFAC)
requirements.
Through a variety of laws, OFAC administers and enforces economic sanctions against countries and
groups of individuals, such as terrorists and narcotics traffickers. These laws prohibit all United States
citizens (including corporations and other entities) and permanent residents from engaging in transactions
with sanctioned countries and with individuals and entities on the Specially Designated Nationals (SDN)
list. Because all U.S. citizens and companies are subject to this law, we wanted to be sure you were
aware of its scope and restrictions. If you haven't already done so, you may want to consider discussing
this issue with your legal counsel to ensure you are in compliance.
For insurance companies, accepting premium from, issuing a policy to, insuring property of, or making a
claim payment to an individual or entity that is the subject of U.S.-imposed economic sanctions or trade
embargoes usually are violations of these laws and regulations. Fines for violating OFAC requirements
can be substantial. CNA has established an OFAC compliance program part which includes the use of
exclusionary policy language. We believe this makes good business sense for CNA and you.
The purpose of this letter is to advise you that your policy includes OFAC exclusionary policy language,
which may reduce or eliminate certain coverage. Specifically, if it is determined that your policy violates
certain Federal or State laws or regulations, such as the U.S. list of Specially Designated Nationals or
Blocked Persons (organizations or individuals associated with terrorist groups), any term or condition of
your policy will be null and void to the extent it violates the applicable laws or regulations of the United
States.
We're sure you share our commitment to compliance and thank you for your cooperation.
Your policy language reads as follows:

ECONOMIC AND TRADE SANCTIONS CONDITION
The following condition is added to the Policy:
ECONOMIC AND TRADE SANCTIONS CONDITION
In accordance with laws and regulations of the United States concerning economic and trade embargoes,
this policy is void from its inception with respect to any term or condition of this policy that violates any
laws or regulations of the United States concerning economic and trade embargoes including, but not
limited to the following:
1. Any insured, or any person or entity claiming the benefits of an insured, who is or becomes a
Specially Designated National or Blocked Person or who is otherwise subject to U.S. economic or
trade sanctions;
2.

Any claim or "suit" that is brought in a Sanctioned Country or by a Sanctioned Country Government,
where any action in connection with such claim or suit is prohibited by U.S. economic or trade
sanctions;

OFACNB

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CNA

For All the Commitments You Make3>

3. Any claim or "suit" that is brought by any Specially Designated National or Blocked Person or any
person or entity who is otherwise subject to U.S. economic or trade sanctions;
4.

Property that is located in a Sanctioned Country or that is owned by, rented to or in the care, custody
or control of a Sanctioned Country Government, where any activities related to such property are
prohibited by U.S. economic or trade sanctions; or

5.

Property that is owned by, rented to or in the care, custody or control of a Specially Designated
National or Blocked Person, or any person or entity who is otherwise subject to U.S. economic or
trade sanctions.

As used in this endorsement a Specially Designated National or Blocked Person is any person or entity
that is on the list of Specially Designated Nationals and Blocked Persons issued by the U.S. Treasury
Department's Office of Foreign Asset Control (OFAC) as it may be from time to time amended.
As used in this endorsement a Sanctioned Country is any country that is the subject of trade or economic
embargoes imposed by the laws or regulations of the United States of America.

THIS DISCLOSURE NOTICE DOES NOT PROVIDE COVERAGE NOR DOES THIS NOTICE REPLACE
ANY PROVISIONS OF YOUR POLICY. YOU SHOULD READ YOUR POLICY AND REVIEW YOUR
DECLARATIONS PAGE FOR COMPLETE INFORMATION ON THE COVERAGE AND PRICE OF
YOUR POLICY. IF THERE IS ANY CONFLICT BETWEEN THE POLICY AND THIS NOTICE, THE
PROVISIONS OF THE POLICY SHALL PREVAIL. YOUR INDEPENDENT INSURANCE AGENT WILL
BE ABLE TO EXPLAIN THE TERMS OF THE CONTRACT IN DETAIL.

OFACNB

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