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GOOODFS 23794495K6

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B. Subparagraph i.d. under SUPPLEMENTARY
PAYMENTS - COVERAGES A AND B is deleted
in its entirety and replaced with the following:

d. All reasonable expenses incurred by the
insured at our request to assist us in the
investigation or defense of the claim or
“suit”, including actual loss of earnings up to
$1,000 a day because of time off from work.

SECTION I - WHO IS AN INSURED - Amendments
Not-for-Profit Organization Members

The following paragraph is added to SECTION Ii -
WHO IS AN INSURED:

if you are an organization other than a partnership,
joint venture, or a limited fiability company, and you
are a not-for-profit organization, the following are
included as additional insureds:

4. Your officials:

Your trustees;

Your members:

Your board members;

Your commission members:

Your agency members;

Your insurance managers;

Your elective or appointed officers; and
9. Your “not-for-profit members”,

SN PnP eM

However only with respect fo their liability for your
activities or activities they perform on your behalf.

Employees As Insureds Modified

A. Subparagraph 2.a.(1Ka) under SECTION Il -
WHO IS AN INSURED does not apply to “bodily
injury” to a “temporary worker” caused by a co-
“employee” who is not a “temporary worker”.

B. Subparagraph 2.a.(2) under SECTION Ii - WHO
iS AN INSURED does not apply to “property
damage” fo the property of a “temporary
worker" or “volunteer worker" caused by a co-
“employee” who is not a “temporary worker" or
“volunteer worker”.

C. Subparagraph 2.a.(ifd} under SECTION I -
WHO IS AN INSURED does not apply to “bodily
injury” caused by cardio-pulmonary resuscita-
tion or first aid services administered by @ co-
“employee ”.

With respect to this provision only, Subparagraph

(1) of Exciusion 2. e. Employer's Liability under

SECTION I - COVERAGES, COVERAGE A BODILY

INJURY AND PROPERTY DAMAGE LIABILITY does

not apply.

Newly Formed Or Acquired Organizations

A. Subparagraph 3.a. under SECTION Il - WHO 1S
AN INSURED is deleted in its entirety and
replaced with the following:

Copyright, 2018 Selective Insurance Company of America. AH rights reserved.
includes copyrighted material of insurance Services Office, Inc., with its permission.

a. Coverage under this provision is afforded
only until the 180th day after you acquire or
form the organization or the end of the
policy period, whichever is earlier, However,
COVERAGE A does not apply to “bodily
injury” or “property damage” that occurred
before you acquired or formed the argani-

Zation.
B. The following paragraph is added to
SECTION Ho - WHO iS AN INSURED,

Paragraph 3:

if you are engaged in the business of can-
struction of dwellings three stories or less in
height, or other buildings three stories or
less in height and less than 25,000 square
feet in area, you will also be an insured with
respect io “your work” only, for the period of
time described above, for your liability
arising out of the conduct of any partnership
or joint venture of which you are or were a
member, even if ihat partnership or joint
veniure is not shown as a Named Insured.
However, this provision only applies if you
maintain or maintained an interest of at
leasi fifty percent in that partnership or joint
venture for the period of that partnership or
joint venture.

This provision does not apply to any partnership or
joint venture that has been dissolved or otherwise
ceased to function for more than thirty-six months.

With respeci to the insurance provided by this
provision, Newly Formed or Acquired Organizations,
the folfowing is added to SECTION IV - COMMER-
CIAL GENERAL LIABILITY, Paragraph 4. Other
Insurance, Subparagraph b. Excess insurance:

The insurance provided by this provision, Newly
Formed or Acquired Organizations, is excess aver
any other insurance available to the insured,
whether primary, excess, contingent or on any other
basis.

{All other provisions of this section remain
unchanged)

Blanket Additional Insureds - As Required By
Contract

Subject to the Primary and Non-Centributory provi-
sion set forth in this endorsement, SECTION II -
WHO iS AN INSURED is amended to include as an
additional insured:

A. Owners, Lessees or Contractars/Architects,
Engineers and Surveyors

1. Any person or organization for whom you
are performing operations when you and
such person or organization have agreed in
a written contract, written agreement or
written permit that such person or organi-
zation be added as an additional insured on
your commercial general liability policy; and

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2. Any other person or organization, including
any architects, engineers or surveyors not
engaged by you, whom you are required io
add as an additional insured under your
policy in the contract or agreement in
Paragraph 1. above:

Such person or organization is an additional
insured only with respect to liability for “bodily
injury", “property damage” or “personal and
advertising injury” caused, in whole or in part,
by:

a. Your acts or omissions; or

b. The acts of omissions of those acting on
your behalf;

in the performance of your ongoing operations
performed for the additional insured in Para-
graph 1., above.

However, this insurance does not appiy to:
"Bodily injury”, “property damage” or “personal
and advertising injury” arising out of the render-
ing of, or the failure fo render, any professional
architectural, engineering or surveying services
by or for you, including:

a, The preparing, approving, or failing to
prepare of approve, maps, shop
drawings, opinions, reports, surveys,
field orders, change orders or drawings
and specifications; and

b. Supervisory, inspection, architectural or
engineering activities.
Professional services do not include services
within construction means, methods, tech-
niques, sequences and precedures employed by
you in connection with your operations in your
capacity as a construction contracter.

A person or organization's status as an
additional insured under this endorsement ends
when your operations for the person or organi-
zation described in Paragraph 1. above are
completed.

Other Additional Insureds

Any of the following persons ar organizations
with whom you have agreed in a written
contract, written agreement or written permit
that such persons or organizations be added as
an additional insured on your commercial
general liability policy:

1. Lessors of Leased Equipment

Any person or organization from whom you
lease equipment, but only with respect to
liability for “bodily injury", “property dam-
age” or “personal and advertising injury"
caused, in whole or in part, by your
maintenance, operation or use of equipment
leased fo you by such person or organi-
zation.

Copyright, 2018 Selective Insurance Company of America. All rights reserved.
Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 6 of 9

TACMREATOS FAP

With respect to the insurance afforded to
these additional insureds, this insurance
does not apply to any “occurrence” which
takes place after the equipment iease
expires.

Managers or Lessars of Premises

Any person or organization from whom you
lease premises, but only with respect to
liability arising out of the ownership,
maintenance or use of that part of the
premises leased to you.

This insurance does not apply to any
“occurrence” which takes place after you
cease to be a tenant of that premises.

Mortgagees, Assignees or Receivers

Any person or organization with respect to
their liability as mortgagee, assignee or
receiver and arising out of the ownership,
maintenance or use of your premises.

This insurance does not apply to any
“occurrence” which takes place after the
mortgage is satisfied, or the assignment or
receivership ends.

Any Person or Organization Other Than A
Joint Venture

Any person or organization (other than a
joint venture of which you are a member),
but only with respect to liability for “bodily
injury”, “property damage” or “personal and
advertising injury" caused, in whole or in
part, by your acts or omissions or the acts of
omissions of those acting on your behalf in
the performance of your ongoing operations
or in connection with property owned by

you.

State or Governmentai Agency or Palitical
Subdivision - Permits or Authorizations

Any state or governmental agency or
subdivision or political subdivision, but only
with respect to:

a. Operations performed by you or on your
behalf for which the state or govern-
mental agency or subdivision or political
subdivision has issued a permit or
authorization; or

b, The following hazards for which the
state or governmental agency or sub-
division or political subdivision has
issued a permit or authorization in
connection with premises you own, rent
or control and to which this insurance
applies:

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DOOUGFS 2379449547

UPUREA

(4) The existence, maintenance, repair,
construction, erection or removal of
advertising signs, awnings, cano-
pies, cellar entrances, coai holes,
driveways, manholes, marquees,
hoist away openings, sidewalk
vaults, street banners or decora-
tions and similar exposures;

(2) The construction, erection or re-
moval of elevators; or

(3) The ownership, maintenance or use
of any elevators covered by this
insurance,

This insurance does not apply to:

{a} “Bodily injury" or “praperty
damage” arising out of opera-
tions performed for the federal
government, siate or munici-
pality; or

(b) “Bodily injury” or “property
damage" included within the
“products-completed operations
hazard”.

With respect to Paragraphs 2. through 4.,,
this insurance does not apply to structural
alterations, new construction or demolition
operations performed by or on behalf of
such person or organization.

The provisions of this coverage extension do not
apply unless the written contract or written agree-
ment has been signed by the Named insured or
written permit issued prior to the “bodily injury” or
“property damage” or “personal and advertising
injury”.

Broad Form Vendors Coverage

Subject to the Primary and Non-Contributory
provision set forth in this endorsement, SECTION Hl-
WHO IS AN INSURED is amended to include as an
additional insured any person or organization
(referred to below as vendor} for whom you have
agreed in a written contract or written agreement to
provide coverage as an additional insured under
your policy. Such person or arganization is an
additional insured only with respect to “bodily
injury" or “property damage” arising out of “your
products” which are distributed or sold in the
regular course of the vendor's business. However,
ihe insurance afforded the vendor does not apply to:

a. “Bodily injury" or “properly damage" for
which the vendor is obligated to pay
damages by reason of the assumption of
liability in a contract or agreement; however
this exclusion does not apply to liability for
damages that the vendor would have in the
absence of the contract or agreement;

b. Any express warranty unauthorized by you;

Copyright, 2018 Selective insurance Company of America. All rights reserved.
Includes copyrighted material of Insurance Services Office, Inc., with its permission.

ec. Any physical or chemical change in the
product made Intentionally by the vendor,

d, Repackaging, unless unpacked solely for
the purpose of inspection, demonstration,
testing, or the substitution of parts under
instructions from the manufacturer, and then
repackaged in the original container.

e. Any failure to make such inspections,
adjustments, tests or servicing as the
vendor has agreed fo make or normally
undertakes to make in the usual course of
business in connection with the sale of the
product; or

f. Products which, after distribution or sale by
you, have been labeled or re-labeled or
used as a container, part of ingredient of
any other thing or substance by or for the
vendor; however this insurance does nat
apply to any insured person or organization,
from who you have acquired such products,
or any ingredient, part or container, entering
into, accompanying or containing such
products.

The provisions of this coverage extension do not
apply unless the written contract or written agree-
ment has been signed by the Named Insured prior
to the “bodily injury” or “property damage”.
Incidental Malpractice

Subparagraph 2.a.(1}{d) under SECTION Il - WHO IS

AN INSURED is deleted in its entirety and replaced

with the following:

{d} Arising out of his or her providing or failing to
provide professional health care services.

This does not apply to nurses, emergency
medical technicians or paramedics if you are not
in the business or occupation of providing any
such professional services.

This also does not apply to “bodily injury”
caused by cardio-pulmonary resuscitation or
first aid services administered by a co-
“employee”.
This provision does not apply if you are a Social
Service or Senior Living risk.
SECTION IV - COMMERCIAL GENERAL LIABILITY
CONDITIONS - Amendments

Knowledge Of Occurrence, Claim, Suit Or Lass

The following is added to Paragraph 2. Duties in the
Event of Occurrence, Offense, Claim or Suit under
SECTION IV - COMMERCIAL GENERAL LIABILITY
CONDITIONS:

The requirements under this paragraph do not apply
until after the “occurrence” or offense is known to:

4. You, if you are an individual:
2. A partner, if you are a partnership:

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THORAC H IS ena

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3. An “executive officer” or insurance manager, if
you are a corporation;

4, Your members, managers or _ insurance
manager, if you are a limited ilability company;
or

5. Your elected or appointed officials, officers,
members, trustees, board members, commis~-
sion members, agency members, ar your
administrator or your insurance manager if you
are an organization other than a partnership,
joint venture, or limited liability company.

Primary and Non-Contributery Provision

The following is added to Paragraph 4. Other Insur-
ance, b. Excess Insurance under SECTION IV-
COMMERCIAL GENERAL LIABILITY CONDITIONS:

This insurance is primary to and we will not seek
contribution from any other insurance available to
an additional insured under this policy provided
that:

(1) The additional insured is a Named Insured
under such other insurance; and

(2) You have agreed in a written contract, written
agreement or written permit that this insurance
would be primary and would not seek contri-
bution from any other insurance available to the
additional insured.

Unintentional Failure To Disclose Hazards

The following is added to Paragraph 6.
Representations under SECTION IV - COMMERCIAL
GENERAL LIABILITY CONDITIONS:

However, if you should unintentionally fail to
disclose any existing hazards in your representa-
tions to us at the inception date of the policy, ar
during the policy period in connection with any
additional hazards, we shall not deny coverage
under this Coverage Part based upon such failure ta
disclose hazards.

Waiver Of Transfer Of Rights Of Recovery

The following is added to Paragraph 8. Transfer of
Rights Of Recovery Against Others To Us under
SECTION IV - COMMERCIAL GENERAL LIABILITY
CONDITIONS:

We will waive any right of recovery we may have
against a person or organization because of pay-
ments we make for “bodily injury” or “property
damage” arising aut of your ongoing operations or
“your work" done under a written contract or written
agreement and included in the “products-completed
operations hazard”, if:

1. You have agreed to waive any right of recovery
against that person or organization in a written
contract or writlen agreement;

2, Such person or organization is an additional
insured on your policy; or

Copyright, 2018 Selective insurance Company of America. All rights reserved,
Includes copyrighted material of Insurance Services Office, Inc., with its permission.

3. You have assumed the liability of that person or
organization in that same contract, and it is an
“insured contract”,

The section above only applies to that person or
organization identified above, and only if the “bodily
injury” or “property damage” occurs subsequent to
the execution of the written contract or written
agreement.

Liberalization

The following condition is added to SECTION IV-
COMMERCIAL GENERAL LIABILITY CONDITIONS:

lf we revise this Coverage Part to provide more
coverage without additional premium charge, sub-
ject to our filed company rules, your policy will
automatically provide the additional coverage as of
the day the revision is effective in your state.

Two or More Coverage Parts or Policies Issued By
Us

(This provision is not Applicable in the state of New
York or Wisconsin).

The following condition is added io SECTION IV -
COMMERCIAL GENERAL LIABILITY CONDITIONS:

[t is our intention that the various coverage parts or
policies issued to you by us, or any company
affttiated with us, do not provide any duplication or
overlap of coverage. We have exercised diligence to
draft our coverage parts and policies to reflect this
intention. However, if the facts and circumstances
that will respond to any claim or “suit” give rise to
actual or claimed duplication or overlap of coverage
between the various coverage parts or policies
issued to you by us or any company affiliated with
us, the limit of insurance under all such coverage
parts ar policies combined shall not exceed the
highest applicabie limit under this coverage, or any
one of the other coverage forms or policies,

This condition does not apply to any Excess or
Umbrella policy issued by us specifically to apply as
excess insurance aver this coverage part or policy
to which this coverage part is attached.

SECTION V - DEFINITIONS
Discrimination
(This provision does not apply in New York).

A. The following is added to Definition 14. “Per-
sonal and advertising injury”:

“Personal and advertising injury” also means
“discrimination” that results in injury to the
feelings or reputation of a natural person, how-
ever only if such “discrimination” or humiliation
is:

4. Not done by or at the direction of:
a. The insured: or

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DOMGGFS 2379445588

EAC TVA TET AE ELA

b. Anyone considered an insured under
SECTION li - WHO IS AN INSURED;

2. Not done intentionally to cause harm to
another person.

3. Not directly or indirectly related to the em-
ployment, prospective employment or termi-
nation of employment of any person or
persons by any insured.

4. Not arising cut of any “advertisement” by
the insured.

B. The following definition is added to SECTION V -
DEFINITIONS:

“Discrimination” means:

a. Any act or conduct that would be considered
discrimination under any applicable federal,
state, or local statute, ordinance or law;

b. Any act or conduct that results in disparate
treaiment of, or has disparate impact on, a
person, because of that person’s race,
religion, gender, sexual orientation, age,
disability or physical impairment; or

c Any act or conduct characterized or inter-
preted as discrimination by a person based
on that person’s race, religion, gender,
sexual orientation, age, disability or physi-
cal impairment.

lt dees not include acts or conduct character-
ized or interpreted as sexual intimidation or
sexual harassment, or intimidation or harass-
ment based on a person's gender.

Electronic Data

The following definition is added to SECTION V-
DEFINITIONS:

“Electronic data" means information, facts or
programs stored as or on, created or used on, or
transmitted to or from computer software, including
systems and applications software, hard or floppy
disks, CD-ROMS, tapes, drives, cell, data pro-
cessing devices or any other media which are used
with electronically controlled equipment. For the
purpose af the Electronic Data Liability coverage
provided by this endorsement, Definition 17. “Prop-
erty damage” is deleted in tts entirety and replaced
by the following:
17. “Property damage” means:
a. Physical injury to tangible property, includ-
ing all resuiting loss of use of that property.
AH such loss of use shall be deemed to
occur at the time of the physical injury that
caused it; or

Copyright, 2018 Selective Insurance Company of America. All rights reserved.
Includes copyrighted material of Insurance Services Office, Inc., with its permission.

b. Loss of, loss of use of, damage to,
corruption of, inability to access, or inability
to properly manipulate “electronic data", re-
suiting from physical injury io tangible
property. All such loss of “electronic data”
shail be deemed to occur at the time of the
“occurrence” that caused it.

For the purpose of the Electronic Data Liability
coverage provided by this endorsement, “electronic
data” is not tangible property.

Employee Amendment

Definition 5. “Employee” under SECTION V- DEFINI-
TIONS fs deleted in its entirety and replaced by the
following:

5. “Employee” includes a “leased worker", or a
“temporary worker”. If you are a School,
“Employee” also includes a student teacher.

Golfing Facility

The following definition is added to SECTION V -
DEFINITIONS:

“Golfing facility” means a golf course, golf club,
driving range, or miniature golf course.

Mental Anguish Amendment
(This provision does not apply in New York).

Definition 3. “Bodily injury" under SECTION V-
DEFINITIONS is deleted in its entirety and replaced
with the following:

3. “Bodily injury" means bodily injury, sickness or
disease sustained by a person, including death
resulting from any of these at any time. This
includes mental anguish resulting fram any
bodily injury, sickness or disease sustained by a
person. (In New York, mental anguish has been
determined to be “bodily injury”).

Not-for-profit Member

The following definition is added to SECTION V-
DEFINITIONS:

“Not-for-profit member” means a person who is a
member of a not-for-profit organization, including
clubs and churches, who receives no financial ar
other compensation.

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Page 9 of $

FRIAR Ee

AAR Pe torino ay

QBE QBE INSURANCE CORPORATION

STATE OF DOMICILE: PENNSYLVANIA

APPLICATION FOR EXCESS LOSS INSURANCE POLICY

Policy Number: LGS02732-22

1.

10.

11.

Full legal name of Policyhoider: Tax ID Number:
City of Nashua 02-6000581
(as it will appear in the Policy)

Principal Office Address:
229 Main Street Nashua, NH 03060

(street) (city) (state) (zip)
Contact Person: Kim Kleiner Email: kleinerk@nashuanh.gov

Nature of Business:9111 Executive Offices

if Employee Benefit Plans of subsidiary or affiliated companies (companies under common contro! through
stock ownership, contract, or otherwise) are to be included, list legal names and addresses of such
companies and the nature of their business:

Full name of Your Employee Benefit Plan:

A copy of Your Employee Benefit Plan Document, and those of any subsidiary or affiliated companies
that are to be included, must be attached to, and shall form a part of, this Application.

Effective Date: July 01, 2022

Endorsements:
Advance Reimbursement Endorsement AH-MSL-5013
Expedited Reimbursement Endorsement AH-MSL-5011-NH
New Hampshire Endorsement AH-MSL-5010-NH
Rate Stabilization Endorsement AH-MSL-5005

N/A

Your Designated Third Party Administrator (for purpose of claims administration under Your Employee
Benefit Plan):

Name: Anthem
Address: 1155 Elm Street
City, State, Zip: Manchester, NH 03101

Your broker/agent of record:

Name: HUB International Limited
Address: 1667 Elm Street, Suite 3
City, State, Zip: Manchester, NH 03101

AH-MSL-1001-NH (11-21) © QBE, 2021 Page 1 of 4

FlitePac®

Commercial Automobile Extension

COMMERCIAL AUTO
CA 78 OSNH 11 17

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

This endorsement modifies insurance provided under the following:

BUSINESS AUTO COVERAGE FORM

With respect to coverage provided by this endorsement, the provisions of the Business Auto Coverage Form apply unless
modified by the endorsement.

AMENDMENTS TO SECTION Il — LIABILITY COVER-
AGE

A.

Copyright, 2017 Selective insurance Company of America. All rights reserved.
Includes copyrighted material of Insurance Services Office, Inc., with its permission.

INSURED'S COPY

lf this policy provides Auto Liability coverage for
Owned Autos, the following extensions are applica-
ble accordingly:

NEWLY ACQUIRED OR FORMED ORGANIZA-
TIONS

The following is added to SECTION Ii, A.1. — Who
is An Insured:

Any organization you newly acquire or form, other
than a partnership, joint venture or limited liability
company over which you mainiain ownership or
majority interest, will qualify as a Named Insured if
there is no similar insurance available to that
organization. However:

1. Coverage under this provision is afforded only
until the 180th day after you acquire or form the
organization or the end of the policy period,
whichever is earlier;

2. Coverage does not appiy to “bodily injury” or
“property damage” resulting from an “accident”
that occurred before you acquired or formed the
organization.

No person cr organization is an “insured” with re-
spect to the conduct of any current or past partner-
ship, joint venture or limited lability company that is
not shown as a Named Insured in the Declarations.

EXPENSES FOR BAIL BONDS AND LOSS OF
EARNINGS

Paragraphs (2) and (4) of SECTION Ili, A.2.a. —
Supplementary Payments are deleted in their
entirety and replaced with the following:

(2) Up te the Limit of Insurance shown on the
FlitePac Schedule for the cost of bail bonds
(including bonds for related traffic law violations)
required because of an “accident” covered under
this policy. We do not have to furnish these
bonds.

(4) All reasonable expenses incurred by the “in-
sured” at our request. This includes actual loss
of earnings because of time off from work, which
we will pay up to the Limit of Insurance shown
on the ElitePac Schedule.

EMPLOYEE INDEMNIFICATION AND EMPLOY-
ER’S LIABILITY AMENDMENT

The following is added fo SECTION I, B.4. —
Exclusions:

This exclusion does not apply to a “volunteer
worker” who is not entitled to workers compensation,
disability or unemployment compensation benefits.

FELLOW EMPLOYEE COVERAGE

The Fellow Employee Exclusion, SECTION Il,
B.5. — is deleted in its entirety.

CARE, CUSTODY OR CONTROL AMENDMENT

The following is added to SECTION Hl, B.6. —
Exclusions:

This exclusion does not apply to property owned by
anyone other than an “insured”, subject to the
following:

1. The most we will pay under this exception for

any one “accident” is ihe Limit of Insurance
stated in the ElitePac Schedule; and

2. A per “accident” deductible as stated in the
ElitePac Schedule applies to this exception.

lf this policy provides Auto Liability coverage for

Owned Autos or Non-Owned Autos, the following

extension is applicable accordingly:
LIMITED LIABILITY COMPANIES

The following is added to SECTION Il, A.1. — Who
is An Insured:

lf you are a limited liability company, your members
and managers are “insureds” while using a covered
“auto” you don't own, hire or borrow during the
course of their duties for you.

CA 78 O9NH 07 17
Page 7 of 5

BLANKET ADDITIONAL INSUREDS — As Re-
quired By Contract

The following is added to SECTION #, A.4. — Who
Is An Insured:

Any person or organization whom you have agreed
in a written contract, written agreement or written
permit that such person or organization be added as
an additional “insured” on your policy. Such person
or organization is an additional “insured” only with
respect to liability for “bodily injury” or “property dam-
age” caused, in whole or in part, by your ownership,
maintenance or use of a covered “auto”. This cover-
age shall be primary and non-contributory with re-
spect to the additional “insured”. This provision only
applies if:
1. It is required in the written contract, written
agreement or written permit identified in this
section;

2. Itis permitted by law; and

3. The written contract or written agreement has
been executed (executed means signed by a
named insured) or written permit issued prior to
the “bodily injury” or “property damage”.

4. [f covered “auto” is not a non-owned “auto”.

c. lf this policy provides Auto Liability coverage for
Non-Owned Autos, the following extension is
applicable accordingly:

EMPLOYEES AS INSUREDS

if this policy provides Auto Liability coverage for
Non-Owned Autos, the following is added to
SECTION Hl, A.1. — Who Is An Insured:

Any “employee” of yours is an “insured” while using
a covered “auto” you don’t own, hire or borrow in
your business or your personal affairs.

An “employee” of yours is an “insured” while operat-
ing an “auto” hired or rented under a contract or
agreement in that “employee’s” name with your
permission, while performing duties related to ithe
conduct of your business.

AMENDMENTS TO SECTION Il — PHYSICAL
DAMAGE COVERAGE

if this policy provides Comprehensive, Specified Causes
of Loss or Collision coverage, the following extensions
are applicable for those “autos” for which Comprehen-
sive, Specified Causes of Loss or Collision coverage is
purchased:

TOWING AND LABOR

SECTION Ill, A.2. — Towing is deleted in its entirety
and replaced with the following:

We will pay all reasonable towing and labor cosis up to
the maximum Limit of Insurance shown on the ElitePac
Schedule per tow each time a covered “Private Passen-
ger Auto”, “Social Service Van or Bus” or “Light Truck” is
disabled and up to the maximum Limit of Insurance per
tow each time a covered “Medium Truck”, “Heavy Truck”
or “Extra Heavy Truck” is disabled.

Copyright, 2017 Selective Insurance Company of America. All rights reserved,
Includes copyrighted material of Insurance Services Office, Inc., with its permission.

INSURED'S COPY

For labor charges to be eligible for reimbursement the
labor must be performed at the place of disablement.

This coverage extension does not apply to Emergency
Services Organizations and Governmental Entities.

GLASS BREAKAGE DEDUCTIBLE

The following is added to SECTION III, A.3. — Glass
Breakage — Hitting A Bird Or Animal — Falling
Objects or Missifes:

if damaged glass is repaired rather than replaced, no
deductible will apply for such repair. This extension does
not apply to Emergency Services Organizations and
Governmental Entities.

ADDITIONAL TRANSPORTATION EXPENSES

SECTION Ill, A.4.a. — Transportation Expenses is
deleted in its entirety and replaced with the following:

We will pay up to the maximum Limit of insurance shown
on the ElitePac Schedule for temporary transportation
expenses that you incur because of any “loss” to a
covered “auto”, but only if the covered “auto" carries the
coverages and meets the requirements described in 1.
or 2, below:

4. We will pay temporary transportation expenses for
total theft of a covered “auto”. We will only pay for
such expenses incurred during the period beginning
24 hours after the theft and ending, regardless of the
policy's expiration, when the covered “auto” is
returned to use or we pay for its “loss”.

2. For “loss” other than total theft of a covered “auto”
under Comprehensive or Specified Causes of Loss
Coverage, or for any “loss” under Collision Coverage
to a covered “auto”, we will only pay for those iem-
porary transportation expenses incurred during the
policy period beginning 24 hours after the “loss” and
ending, regardless of the policy's expiration, with the
lesser of the number of days reasonably required te
repair or replace the covered “auto” or 30 days.

Paragraph 2. of this extension does not apply while
there are spare or reserve “autos” available to you
for your operations.

This coverage extension does not apply to Emergency
Services Organizations and Governmental Entities.

HIRED AUTO PHYSICAL DAMAGE COVERAGE

The following is added to SECTION II, Ad. —
Coverage Extensions:

Physical Damage coverage is hereby extended te apply
to Physical Damage “loss” to “autos” leased, hired,
rented or borrowed without a driver. We will provide
coverage equal to the broadest coverage available to
any covered “auto” shown in the Declarations. But, the
most we will pay for “loss” fo each “auto” under this
coverage extension is the lesser of:

4. The Limit of Insurance stated in the ElitePac Sched-
ule; or

2. The actual cash vaiue of the damaged or stolen
property as of the time of the “loss”; or

CA 78 OSNH 07 17
Page 2 of 5

3. The actual cost of repairing or replacing the dam-
aged or stolen property with other property of like
kind and quality. A part is of like kind and quality
when it is of equal or better condition than the pre-
accident part. We will use the original equipment
from the manufacturer when:

(a) The operational safety of the vehicle might
otherwise be impaired;

(b) Reasonable and diligent efforts to locate the
appropriate rebuilt, aftermarket or used part
have been unsuccessfui; or

(c} A new original equipment part of like kind
and quality is available and will result in the
lowest overall repair cost.

For each leased, hired, rented or borrowed “auto” our
Obligation to pay “losses” will be reduced by a deductible
equal to the highest deductible applicable to any owned
“auto” for that coverage. No deductible will be applied to
“losses” caused by fire or lightning.

SECTION IV, 8.5. Other Insurance Condition, Para-
graph 5.b. is deleted in its entirety and replaced by the
following:

For Hired Auto Physical Damage Coverage, the follow-
ing are deemed to be covered “autos” you own:

1. Any covered “auto” you lease, hire, rent, or borrow;
and

2. Any covered “auto” hired or rented by your “em-
ployee” under a contract or agreement in that “em-
ployee’s” name, with your permission, while perform-
ing duties related to the conduct of your business.

However, any “auto” that is leased, hired, rented or bor-
rowed with a driver is not a covered “auto”.

This coverage extension does not apply to Emergency
Services Organizations and Governmental Entities.

HIRED AUTO LOSS OF USE COVERAGE

The following is added to SECTION 1], A.4, — Cover-
age Extensions:

We will pay expenses for which you are legally responsi-
ble fo pay up to the Limit of Insurance shown on the
ElitePac Schedule per “accident” for loss of use of a
leased, hired, rented or borrowed “auto” if it results from
an “accident”.

This coverage extension does not apply to Emergency

Services Organizations, Governmental Entities, and
Schools.

AUTO LOAN/LEASE GAP COVERAGE (Not Appiica-
ble in New York)

The following is added to SECTION If], A.4. —- Cover-
age Extensions:

In the event of a total “loss” to a covered “auto” we will
pay any unpaid amouni due on the lease or loan for a
covered “auto”, less:

1. The amount paid under the Physical Damage Cover-
age Section of the policy; and

Copyright, 2017 Selective Insurance Company of America. All rights reserved.
Includes copyrighted material of Insurance Services Office, Inc., with its permission.

2. Any:

a. Overdue lease/loan payments at the time of
“loss”;

b. Financial penalties imposed under a lease for
excessive use, abnormal wear and tear, high
mileage or similar charges;

c. Security deposits not refunded by the lessor or
financial institution;

d. Costs for extended warranties, credit life, health,
accident, or disability insurance purchased with
the loan or lease; and

e. Carry-over balances from previous leases or
loans.

You are responsible for the deductible applicable to the
“loss” for the covered “auto”.

This extension only applies if the lessor or financial
institution is an additional “insured” under this Coverage
Form.

PERSONAL EFFECTS

The following is added to SECTION ill, Ad. —
Coverage Extensions:

If this policy provides Comprehensive Coverage for a
covered “auto” you own and that covered “auto” is
stolen, we will pay up to the Limit of Insurance shown on
the ElitePac Schedule, without application of a deducti-
ble, for lost personal effects that were in the covered
“auto” af the time of theft. Personal effects do not include
jewelry, tools, money, or securities. This coverage is
excess over any other collectible insurance.

AIRBAG COVERAGE

The following is added to SECTION ill, B.3.a. — Exclu-
sions:

Mechanical breakdown does net include the accidental
discharge of an airbag.

This coverage extension does not apply to Emergency
services Organizations and Governmentai Entities.

EXPANDED AUDIO, VISUAL, AND DATA ELEC-
TRONIC EQUIPMENT COVERAGE

SECTION Ill, B.4, —- Exclusions

This exciusion does not apply fo the following:
1. Global positioning systems;

2. “Telematic devices”; or

3. Electronic equipment that reproduces, receives or
transmits visual or data signals and accessories
used with such equipment, provided such equipment
is:

a. Permanently installed in or upon the covered
“auto” at the time of the “loss”;

b. Removable from a housing unit that is perma-
nenily installed in the covered “auto” at the time
of the “loss”;

c. Designed to be solely operated by use of power
from the “auto's” electrical system; or

CA 78 OSNH 07 17
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INSURED'S COPY