Insurance Businessowners Policy

INSURANCE BUSINESSOWNERS POLICY

Declarations

Insurer:   Policy Number:

Producer:   Producer Code:

Named Insured and Contact Information

Policy Period and Limits

Policy Period From:   To:

Coverage Summary (select applicable coverages and state limits)

Building Coverage   Limit:

Business Personal Property   Limit:

Business Income and Extra Expense   Limit:   Waiting Period (hrs):

Business Liability (General Liability)   Each Occurrence:   General Aggregate:

Deductible and Premium

Deductible per occurrence:   Annual Premium:

Additional Coverages and Options

Scheduled Property Endorsement

Ordinance or Law Coverage

Exclusions (Representative)

The following are examples of standard exclusions under this policy: intentional loss or dishonest acts by insured or agents; wear and tear, deterioration or mechanical breakdown; loss due to pollution except as specifically provided by endorsement; damages assessed as punitive, exemplary or multiplied damages unless required by law. Specific exclusions applicable to this policy are set forth in the Forms and Endorsements section below.

Conditions — Duties in the Event of Loss

It is a condition precedent to coverage that the insured shall: give prompt notice to the insurer of any loss; protect property from further damage and take reasonable steps to preserve evidence; submit to examination under oath and produce records as requested; provide a signed, sworn proof of loss within 60 days of insurer's request. Failure to comply with these conditions may result in denial of coverage to the extent the insurer is prejudiced.

Cancellation and Nonrenewal

The insurer may cancel this policy by giving written notice to the first named insured at the address shown in this policy. For reasons other than nonpayment of premium, notice shall be provided at least 30 days prior to the effective date of cancellation. For nonpayment of premium, notice shall be provided at least 10 days prior to the effective date of cancellation. The insured has the right to request reasons for cancellation and to submit documentation prior to the effective date of cancellation.

Subrogation and Recovery

To the extent the insurer pays for a loss, the insurer shall be subrogated to the insured's rights of recovery against any person or organization. The insured shall cooperate in securing and enforcing the insurer's subrogation rights, including executing documents and providing records and testimony as reasonably requested.

Premium Payment and Audit

The premium shown is an estimate. Final premium may be adjusted upon audit of insured records during or within 12 months after the policy period. Payment of deposit premium does not waive the insurer's right to examine records and adjust premium accordingly.

Beneficiary / Loss Payable / Mortgagee

Name:

Relationship to Insured:   Share Percentage:

Claims Reporting and Documentation Checklist

Date of Loss:   Location of Loss:

Photographs of Damage    Receipts/Invoicing    Police/Incident Report

Forms and Endorsements Attached

List of attached forms and endorsements incorporated into this policy:

Insured Declaration and Certification

By signing below, the undersigned insured certifies that the information provided in this document and any attachments is true and correct to the best of the insured's knowledge. The insured acknowledges receipt of the policy declarations and understands that coverage is subject to the terms, conditions, exclusions and endorsements of the policy. The insured authorizes the insurer to obtain and verify such information as may be necessary to underwrite, issue, renew, or audit the policy.

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