Advanced_Monitoring_Methods_LLC_-_General-Auto-Umbrella-Professional_Liability__03.15.21__Workers_Comp__Exp_08.01.21_.pdf

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

ACCORDANCE WITH THE POLICY PROVISIONS.

INSURER(S) AFFORDING COVERAGE

INSURER F :

INSURER E :

INSURER D :

INSURER C :

INSURER B :

INSURER A :

NAIC #

NAME:

CONTACT

(A/C, No):

FAX

E-MAIL

ADDRESS:

PRODUCER

(A/C, No, Ext):

PHONE

INSURED

REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES

IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.

If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).

THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED

REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.

OTHER:

(Per accident)

(Ea accident)

N / A

SUBR

WVD

ADDL

INSD

THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.

$PROPERTY DAMAGE

BODILY INJURY (Per accident)

BODILY INJURY (Per person)

COMBINED SINGLE LIMIT

AUTOS ONLY

AUTOSAUTOS ONLY

NON-OWNED

SCHEDULEDOWNED

ANY AUTO

AUTOMOBILE LIABILITY

Y / N

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY

OFFICER/MEMBER EXCLUDED?

(Mandatory in NH)

DESCRIPTION OF OPERATIONS below If yes, describe under

ANY PROPRIETOR/PARTNER/EXECUTIVE

E.L. DISEASE - POLICY LIMIT

E.L. DISEASE - EA EMPLOYEE

E.L. EACH ACCIDENT

ER

OTH-

STATUTE

PER

LIMITS(MM/DD/YYYY)

POLICY EXP

(MM/DD/YYYY)

POLICY EFF

POLICY NUMBERTYPE OF INSURANCELTR

INSR

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

EXCESS LIAB

UMBRELLA LIAB $EACH OCCURRENCE

$AGGREGATE

OCCUR

CLAIMS-MADE

DED RETENTION $

$PRODUCTS - COMP/OP AGG

$GENERAL AGGREGATE

$PERSONAL & ADV INJURY

$MED EXP (Any one person)

$EACH OCCURRENCE

DAMAGE TO RENTED

$PREMISES (Ea occurrence)

COMMERCIAL GENERAL LIABILITY

CLAIMS-MADE OCCUR

GEN'L AGGREGATE LIMIT APPLIES PER:

POLICY

PRO-

JECT LOC

CERTIFICATE OF LIABILITY INSURANCE

DATE (MM/DD/YYYY)

CANCELLATION

AUTHORIZED REPRESENTATIVE

ACORD 25 (2016/03)

© 1988-2015 ACORD CORPORATION. All rights reserved.

CERTIFICATE HOLDER

The ACORD name and logo are registered marks of ACORD

HIRED

AUTOS ONLY

8/24/2020

Hall & Company 19660 10th Ave NE Poulsbo WA 98370

Julia Ardon 360-626-2956 360-626-2956 jardon@hallandcompany.com

Capitol Specialty Insurance Corporation 24097

Advanced Monitoring Methods LLC 710 Golf Club Drive Castle Rock CO 80108

1613245714

A X 4,000,000 X 50,000

X Separation Insds 5,000

4,000,000

4,000,000 X

EV20180271-03 3/15/2020 3/15/2021

4,000,000

A 1,000,000

X X

EV20180271-03 3/15/2020 3/15/2021

A X X $1,000,000EX20180311-03 3/15/2020 3/15/2021

$1,000,000 X 10,000

A Professional Liab; Claims Made EV20180271-03 3/15/2020 3/15/2021 Per Claim Aggregate

$1,000,000 $2,000,000

Certificate Holder(s) is/are an Additional Insured on the Commercial General Liability and Auto Liability when required by written contract or agreement regarding activities by or on behalf of the Named Insured. The Commercial General Liability insurance is primary insurance and any other insurance maintained by the Additional Insured shall be excess only and non-contributing with this insurance. A waiver of subrogation applies to the Commercial General Liability, Auto Liability and Excess Liability in favor of the Additional Insured

Arizona Department of Emergency and Military Affairs 5636 East McDowell Road Phoenix AZ 85008

USA

THIS CERTIFICATE SUPERSEDES PREVIOUSLY ISSUED CERTIFICATE

A X

Pinnacol Assurance 41190

Pinnacol Assurance 7501 E. Lowry Blvd.

Denver, CO 80230-7006

Advanced Monitoring Methods LLC 710 Golf CLub Dr Castle Rock, CO 80108

08/24/2020

4203917 08/01/2020 08/01/2021 1,000,000 1,000,000 1,000,000

2109504 Arizona Department of Emergency and Military Affairs 5636 E McDowell Rd Phoenix, AZ 85008-3455 lisa.ledbetter@azdema.gov

Pinnacol Assurance

Unless otherwise stated in the policy provisions, coverage in Colorado only.

IMPORTANT

If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).

If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).

DISCLAIMER

The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.

DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT (CONT)

CERTIFICATE HOLDER COPY

Arizona Department of Emergency and Military Affairs 5636 E McDowell Rd Phoenix, AZ 85008-3455

Capitol Specialty Insurance Corporation A Stock Company

PO Box 5900 Madison, WI 53705-0900

WHAT TO DO IF YOU HAVE A CLAIM OR POTENTIAL CLAIM OR INCIDENT

N-200 (09/16) © 2016 CapSpecialty, Inc. All rights reserved. Page 1 of 1

Send all notices of claims or potential claim notices, as well as other required material to:

Email (Preferred): claims@capspecialty.com

Or Mailing Address: Capitol Specialty Insurance Corporation Claims Department P. O. Box 5900 Madison, WI 53705

Or Overnight/Express: Capitol Specialty Insurance Corporation Claims Department 1600 Aspen Commons Suite 300 Middleton, WI 53562

Or Facsimile: (608) 829-7411

Or Toll Free: 800-475-4450 (Select #3 for Claims)

Please reference your policy for complete details relating to reporting requirements in connection with claims or potential claims, including what to include in your notices.

PO Box 5900 Madison, WI 53705-0900

Declarat ions

ENV-XS 003 (09/17) © 2017 CapSpecialty, Inc. All rights reserved. Page 1 of 2

Environemental Excess Follow Form Policy Policy No.: EX20180311-01 Renewal of Policy No.: Not Applicable

Issuing Company: Capitol Specialty Insurance Corporation

THIS EXCESS POLICY MAY PROVIDE COVERAGE ON BOTH A CLAIMS-MADE AND OCCURRENCE BASIS, IN CONFORMANCE WITH THE UNDERLYING POLICIES. IF THE COVERAGE PROVIDED APPLIES ON AN OCURRENCE BASIS, THEN COVERAGE IS LIMITED TO LIABILITY FOR ONLY THOSE CLAIMS ARISING OUT OF COVERED EVENTS WHICH TAKE PLACE DURING THE POLICY PERIOD. IF THE COVERAGE PROVIDED APPLIES ON A CLAIMS-MADE BASIS, COVERAGE IS LIMITED TO LIABILITY FOR ONLY THOSE CLAIMS THAT ARE FIRST MADE AGAINST AN INSURED DURING THE POLICY PERIOD OR ANY APPLICABLE EXTENDED REPORTING PERIOD, AND REPORTED TO

US IN ACCORDANCE WITH THE TERMS SET FORTH IN THIS POLICY.

THE LIMITS OF INSURANCE MAY BE REDUCED AND EXHAUSTED BY THE PAYMENT OF CLAIM RELATED COSTS, INCLUDING COSTS

INCURRED IN THE DEFENSE, INVESTIGATION AND SETTLEMENT OF ANY CLAIM.

PLEASE READ THIS POLICY CAREFULLY TO DETERMINE COVERAGE HEREUNDER, AND DISCUSS WITH YOUR INSURANCE AGENT OR

BROKER.

Item 1. Named Insured and Mailing Address:

Advanced Monitoring Methods LLC 710 Golf Club Drive Castle Rock, CO 80108

Item 2. Policy Period: Effective Date Expiration Date 03/15/2018 03/15/2019

12:01 a.m. standard time at the mailing address of the First Named Insured as shown in Item 1. above.

A. Per Claim Limit Not Applicable each Claim

B. Per Occurrence Limit $1,000,000 each Covered Event

C. Aggregate Limits

i. $1,000,000 Policy Aggregate Limit

Item 3. Proposed Limits of Insurance:

ii. $1,000,000 Aggregate Limit for Products-Completed Operations Hazard

Item 4. Retroactive Date: Not Applicable Applies to all Claims-Made Coverages

Item 5. Policy Premium:

Coverage Premium: $ 2,000.00 TRIA Premium: $ Rejected Total Policy Premium: $ 2,000.00

* The Issuing Company is not responsible for and does not collect or file surplus lines taxes or any other applicable fees. It is the responsibility of the surplus lines producing agent to determine such amounts, and collect and file those taxes and fees in accordance with the applicable states surplus lines laws and/or regulations

Item 6. Minimum Earned Premium Percentage: 25%

60.00 N/A N/A N/A

The cost of the insurance coverage provided herein includes a fee to a wholesale intermediary in addition to the premium charges.

This policy is a claims-made policy which provides liability coverage only if a claim is made during the policy period or any applicable extended reporting period.

This contract is delivered as surplus line coverage under the Nonadmitted Insurance Act. The insurer issuing this contract is not licensed in Colorado but is an eligible nonadmitted insurer. There is no protection under the provisions of the Colorado Guaranty Association Act.

AssuredPartners of Washington LLC dba Hall & Company

STATE TAX $_________

STATE FEE $_________

BROKER FEE $_________

FILING FEE $_________

PO Box 5900 Madison, WI 53705-0900

Declarat ions Policy No.: EX20180311-01 Named Insured: Advanced Monitoring Methods LLC

ENV-XS 003 (09-17) © 2017 CapSpecialty, Inc. All rights reserved. Page 2 of 2

Item 7. Forms and Endorsements:

WHAT TO DO IF YOU HAVE A CLAIM OR POTENTIAL CLAIM OR INCIDENT N-200 (09/16)

Excess Declarations ENV-XS 003 (09-17) Schedule of Underlying ENV-XS 450 (11-17) Excess Follow Form Policy XS 004 09 17 Non-Concurrency of Policy Periods - Underlying Insurance XS 507 09 17 TRIA - Conditional Exclusion of Terrorism XS-9501 (09/17) TRIA - Exclusion of Certified Acts of Terrorism XS-9503 (09/17) Premium and Rate - Minimum Earned Premium XS 025 09 17 Service of Suit E-9000S (02/17)

THESE DECLARATIONS, THE POLICY FORM, ANY SCHEDULES OR ENDORSEMENTS THERETO, AND THE APPLICATION, CONSTITUTE THE ENTIRE AGREEMENT BETWEEN THE ISSUING COMPANY AND THE INSURED RELATING TO THIS INSURANCE.

In Witness Whereof, we have caused this Excess Policy to be executed and attested, and, if required ty state law, this Excess Policy shall not be valid unless countersigned by our authorized representative.

Secretary President

March 28, 2018 Authorized Representative Date

Forms a part of Policy No.: EX20180311-01 Issuing Company: Capitol Specialty Insurance Corporation

SCHEDULE OF UNDERLYING POLICIES

Environmental Excess Follow Form Policy

ENV-XS 450 (11-17) © 2017 CapSpecialty, Inc. All rights reserved. Page 1 of 1

Item A. Schedule of Our Underlying Policies Insurer

Coverage Policy No.

Policy Period

Limit(s) Deductible/ Retention

Capitol Specialty Insurance Corporation General Liability

EV20180271-01

03/15/2018 - 03/15/2019

$4,000,000 Per Occurrence $4,000,000 Aggregate

$2,500

THE LIMITS SHOWN FOR ALL COVERAGES LISTED ABOVE ARE SUBJECT TO THE FOLLOWING POLICY AGGREGATE LIMIT:

$1,000,000

Item B. Schedule of Other Underlying Policies Insurer

Coverage Policy No.

Policy Period

Limit(s) Attachment Point

Deductible/ Retention

None

Excess Follow Form Policy

XS 004 (09-17) © 2017 CapSpecialty, Inc. All rights reserved. Page 1 of 6

Various provisions in this Policy restrict coverage, specify what is or is not covered and designate rights and obligations.

Payment of Claim Related Costs, including costs associated with the defense, investigation and settlement of a Claim, shall reduce and may exhaust the Limits of Insurance specified in Item 3. of the Declarations.

Throughout this Policy the words You and Your refer to the Named Insured specified in the Declarations. The words We, Us and Our refer to the Company providing this insurance.

In addition to any applicable definitions in Our Underlying Policies, which when used in this Policy have the same meaning as in Our Underlying Policies, other words and phrases that appear in this Policy in bold font have special meaning as provided above or in SECTION III. DEFINITIONS. If any term is defined both in this Policy and in an Underlying Policy, the definition of that term set forth herein shall apply to determine coverage under this Policy.

In consideration of the payment of premiums under this Policy, and in reliance upon the statements contained in any Applications or other materials and information submitted therewith, and subject to the terms and conditions of this Policy, the Insured and the Company providing this insurance agree as follows:

I. INSURING AGREEMENT – EXCESS FOLLOW FORM LIABILITY

A. We will pay on the Insured’s behalf, subject to the Limits of Insurance set forth in Item 3. of the Declarations, loss, damages, Claim Related Costs and other covered amounts, in excess of the Applicable Underlying Limits plus any applicable deductible or retention, or the Attachment Point. In no event will this Policy provide coverage broader than that provided by the most restrictive of the Underlying Policies.

B. Where this Policy provides coverage for a Claim excess of the Underlying Policies, this Policy is subject to the same terms and conditions set forth in the Underlying Policies, except with respect to any contrary provision in this Policy, in which case the provisions in this Policy shall apply.

C. In the event that the Applicable Underlying Limit of Our Underlying Policy is exhausted by the payment of loss, damages, Claim Related Costs or other covered amounts in a pending Claim, and the Insured has paid any applicable retentions(s) or deductibles), this Policy’s coverage will apply to a subsequent Claim on a primary basis, subject to the Insured’s payment of any applicable deductible or retention under Our Underlying Policy.

D. In the event that the Applicable Underlying Limit of an Other Underlying Policy is reduced or exhausted by payment of loss, damages, Claim Related Costs or other covered amounts in a Claim by the Underlying Insurer, and the Insured has paid any applicable retention(s) and deductible(s), this Policy’s coverage shall apply excess of either the remaining amount of the Applicable Underlying Limit or the Attachment Point, whichever amount is greater. In no event shall this Policy drop down and apply as primary insurance for any Claim with respect to the Other Underlying Policies.

II. DEFENSE AND SETTLEMENT OF CLAIMS

A. We will have the right and duty to defend any Claim which requires payment under this Policy. Our right and duty to defend any Claim or pay Claim Related Costs shall only apply when the Applicable Underlying Limit(s) have been fully exhausted by the payment of loss, damages, Claim Related Costs or other amounts payable pursuant to the Underlying Policies.

B. We will have no duty to defend or pay Claim Related Costs for any Claim that any other insurer has a duty to defend or to which this Policy does not apply. In the event that We elect, at our sole discretion, to join in the defense of any Claim that any other insurer has a duty to defend, any amounts incurred by Us in such defense shall reduce the applicable Limits of Insurance set forth at Item 3. of the Declarations.

We have the right to seek reimbursement for any Claim Related Costs or other amounts we pay or incur in connection with any Claim that We defend which is found, or agreed by the parties to this Policy, to not be covered under this Policy.

C. We shall have the right and be given the opportunity to associate with the Insured and any Underlying Insurer in the investigation, adjustment, control and defense of any Claim which is reasonably likely to require payment under this Policy due to the potential exhaustion of any Applicable Underlying Limit(s). The Insured and the Underlying Insurer shall cooperate with Us in all aspects of the investigation, adjustment, control and defense of any such Claim.

XS 004 (09-17) © 2017 CapSpecialty, Inc. All rights reserved. Page 2 of 6

D. Our right and duty to defend any Claim ends at such time when allegations potentially covered by this Policy are withdrawn or dismissed with prejudice, or when the applicable Limit of Insurance specified in Item 3. of the Declarations has been exhausted by the payment of loss, damages, Claim Related Costs or other amounts payable under this Policy.

E. When We have a duty to defend a Claim, in the event that the Insured is entitled by law to select counsel to defend the Claim, the attorney fees and all other litigation expenses We must pay to that counsel are limited to the rates We pay to counsel that We retain in the ordinary course of business in the defense of similar Claims or Suits where the Claim arose or is defended. The Insured agrees that any such counsel will timely respond to Our requests for information regarding the Claim. We may additionally require that any such counsel have certain minimum qualifications with respect to their competency as well as sufficient professional liability and errors and omissions insurance coverage.

F. The Insured shall not admit liability or settle any Claim which requires payment under this Policy without our prior written consent.

III. DEFINITIONS

The defined terms and phrases in this Policy may be used throughout this Policy in their plural or singular form.

A. Applicable Underlying Limit(s) means the applicable limits of insurance set forth in the Schedule of Underlying Policies.

B. Application means any documents and information submitted to or obtained by Us in connection with the application process for this Policy, including without limitation any Underlying Policies submitted to Us and all publicly available material published or disseminated by an Insured about an Insured that We obtain as part of the application process.

If this Policy is a renewal of a Policy We issued, Application also means all previous documents and information previously submitted to or obtained by Us in connection with the application process for all such preceding Policies We issued.

C. Attachment Point means the amount shown in the Attachment Point column in Item B. of the Schedule of Underlying Policies.

D. Claim means any written demand for loss or damages for which coverage is provided by the Underlying Policies. A Claim shall include any Suit.

E. Claim Related Costs means all costs and expenses incurred by Us or at Our request associated with the investigation, handling, defense, settlement or appeal of any Claim against the Insured. If used in relation to Other Underlying Policies, Claim Related Costs shall mean all such costs incurred by or at the request of the Underlying Insurer.

F. Covered Event means any incident, event or Occurrence for which coverage is provided by the Underlying Policies.

G. Insured means any person or organization qualifying as such under the Underlying Policies.

H. Named Insured means the Insured specified in Item 1. of the Declarations.

I. Occurrence means an accident, including continuous or repeated exposure to substantially the same general harmful conditions.

J. Other Underlying Policies means any Underlying Policy set forth in Item B. of the Schedule of Underlying Policies which is attached to this Policy.

K. Our Underlying Policies means any Underlying Policy set forth in Item A. of the Schedule of Underlying Policies which is attached to this Policy.

L. Policy Period means the period from the Effective Date to the Expiration Date of this Policy, as specified in Item 2. of the Declarations. However, if this Policy is cancelled by either You or Us, the Policy Period ends at the effective date of the cancellation.

M. Suit means a civil proceeding seeking loss or damages for which coverage is provided by the Underlying Policies. Suit includes an arbitration proceeding or any other alternative dispute resolution proceeding to which You must submit or do submit with Our consent.

N. Underlying Insurer(s) means the company or companies that issued the Underlying Policies.

O. Underlying Policies means both Our Underlying Policies and the Other Underlying Policies.

IV. LIMITS OF INSURANCE

A. LIMITS OF INSURANCE

1. The Policy Aggregate Limit of Insurance specified at Item 3.C.i. in the Declarations is the most We shall pay for all loss, damages, Claim Related Costs and other amounts payable under this Policy.

XS 004 (09-17) © 2017 CapSpecialty, Inc. All rights reserved. Page 3 of 6

2. Subject to the Policy Aggregate Limit of Insurance, the Aggregate Limit for Products-Completed Operations Hazard specified at Item 3.C.ii. in the Declarations is the most We shall pay for all amounts payable under this Policy relating to Products-Completed Operations Hazard, as described in Our Underlying Policy providing this coverage.

3. Subject to the Policy Aggregate Limit of Insurance, the Per Claim Limit specified at Item 3.A. in the Declarations is the most We shall pay for all amounts payable under this Policy relating to each Claim.

4. Subject to the Policy Aggregate Limit of Insurance, the Per Occurrence Limit specified at Item 3.B. in the Declarations is the most We shall pay for all amounts payable under this Policy relating to each Covered Event.

5. If the Policy Aggregate Limit of Insurance is exhausted, We shall have no further obligation to make any further payments to or on behalf of the Insured under this Policy, or to defend or continue to defend any Claim.

6. If the Policy Period is extended after issuance for an additional period, the additional period will be deemed part of the Policy Period and shall not increase the Limits of Insurance specified at Item 3. of the Declarations.

7. The purchase of an Extended Reporting Period shall neither increase nor reinstate any Limit of Insurance.

V. CONDITIONS

A. MAINTENANCE OF UNDERLYING INSURANCE

1. The Insured will maintain all Underlying Policies in full effect while this Policy is in effect, except for any reduction or exhaustion of Applicable Underlying Limit(s) by reason of actual payments thereunder by the Underlying Insurer(s). If any of the Underlying Policies expires, the Insured agrees to renew that Underlying Policy at limits at least equal to the expiring limits. If the Insured fails to do so, We shall only be liable to the extent We would have been liable had the Insured so maintained the Underlying Policies and the Insured shall be deemed to be self-insured for the amount of Applicable Underlying Limit(s) that were not maintained.

2. Our obligations under this Policy shall not be increased, expanded or otherwise changed as a result of:

a. Any positions taken by the Underlying Insurers with respect to coverage;

b. The Insured’s failure to comply with any condition of any Underlying Policies; or

c. Insolvency, bankruptcy, liquidation or the inability or refusal to pay by any of the Underlying Insurers, or the cancellation of any of the Underlying Policies.

3. If during the Policy Period the terms or conditions of any of the Underlying Policies change in any manner, or if any Underlying Policy is cancelled or expires or is no longer being maintained, or if any Applicable Underlying Limit(s) are reduced or exhausted, or if any additional premiums are charged on an Underlying Policy, the Named Insured will give Us written notice with full particulars as soon as practicable, but no later than thirty (30) days after the effective date of such change. Any changes to any Underlying Policy will not be binding on Us unless specifically agreed to by Us in writing, and unless the Insured has paid any additional Premium We assess as a result of the change.

4. This Policy will not provide excess coverage for any coverage provided by an Underlying Policy to which a reduced limit or sublimit of insurance applies. However, this Policy shall recognize the reduction or exhaustion of the Applicable Underlying Limit(s) due to payment of loss, damages, Claim Related Costs or other covered amounts under such sublimited coverage.

B. CLAIMS-MADE OR OCCURRENCE COVERAGE FOLLOWS UNDERLYING

This excess Policy may provide coverage on both a claims-made and occurrence basis, in conformance with the Underlying Policies, and subject to all terms and conditions of this Policy. If the coverage provided by this Policy applies on an occurrence basis, then this Policy’s coverage is limited to liability for only those Claims arising out of Covered Events which take place during the Policy Period. If the coverage provided by this Policy applies on a claims-made basis, then this Policy’s coverage is limited to liability for only those Claims that are first made against an Insured during the Policy Period or any applicable extended reporting period, and reported to Us in accordance with the terms of this Policy.

C. NOTICE OF CLAIM

1. It is a condition precedent to coverage under this Policy that the Insured notify Us in writing as soon as practicable after a Claim is made for which coverage is provided by an Underlying Policy.

2. Notice of a Claim under Our Underlying Policy shall be accepted as notice of such Claim under this Policy.

3. Notice of a Claim under an Other Underlying Policy shall not be considered notice to Us. You must provide written notice directly to Us.

XS 004 (09-17) © 2017 CapSpecialty, Inc. All rights reserved. Page 4 of 6

4. You shall also provide Us with written notice, as soon as practicable, of:

a. Any offer of settlement for a Claim if such offer would require payment under this Policy; or

b. A Claim under any Underlying Policy is paid.

5. Notice shall be sent to Us at Our address shown in the notice entitled “WHAT TO DO IF YOU HAVE A CLAIM OR POTENTIAL CLAIM OR INCIDENT” which is attached to the front of this Policy.

6. Notice to an insurance broker or agent shall not be considered notice to Us.

D. ASSIGNMENT

This Policy may be assigned with Our prior written consent, which consent shall not be unreasonably withheld or delayed. Assignment of interest under this Policy shall not bind Us until its consent is endorsed thereon.

E. BANKRUPTCY

Bankruptcy or insolvency of the Insured or of the Insured’s estate shall not relieve Us of Our obligations under this Policy nor deprive Us of Our rights or defenses under this Policy. Our liability under this Policy shall be in no way increased or expanded as a result of the Insured’s bankruptcy, insolvency, or inability or refusal to pay any of your Underlying Insurers.

F. CANCELLATION AND NONRENEWAL

1. Cancellation

a. The Named Insured may cancel this Policy by mailing or delivering to Us advance written notice of cancellation. If the Named Insured cancels, We will send the Named Insured any premium refund due, which will be calculated as 90% of the prorated return Premium. Cancellation shall be effective even if We have not made or offered a refund.

b. We may cancel this Policy by mailing or delivering to the Named Insured written notice of cancellation within the time mandated by applicable state law, or if no applicable state law exists, at least:

i. Ten (10) days before the effective date of cancellation if We cancel for non-payment of premium; or

ii. Thirty (30) days before the effective date of cancellation if We cancel for any other reason.

If We cancel this Policy, We will send the Named Insured any premium refund due, which will be calculated pro rata, but cancellation shall be effective even if We have not made or offered a refund.

2. Nonrenewal

We may elect to non-renew this Policy for any reason. In the event that We do so, We shall inform the Named Insured of that decision in writing within the time mandated by applicable state law, or if no applicable state law exists, at least sixty (60) days prior to the effective date of non-renewal.

3. Notice

We shall mail or deliver Our notice of cancellation or non-renewal to the Named Insured’s last mailing address known to Us and, if mailed, proof of mailing shall be sufficient proof of notice.

Notice of cancellation shall state the effective date of cancellation, which is when the Policy Period shall end.

G. CHANGES

This Policy contains all the agreements between You and Us concerning the insurance afforded. The Named Insured is authorized to act behalf of all Insureds with respect to any changes under this Policy. This Policy’s terms can be amended or waived only by endorsement issued by Us and made a part of this Policy.

H. COMPLIANCE WITH ECONOMIC OR TRADE SANCTIONS

This insurance does not apply, and no payment shall be made hereunder, to the extent that trade sanctions or economic sanctions, embargos or other similar programs, laws or regulations, in the United States, the European Union, or any other country, prohibit Us from providing insurance or making payment.

I. CONFORMITY WITH STATUTE

Any terms of this Policy which are in conflict with the terms of any applicable laws construing this Policy, including any endorsement to this Policy, are hereby amended to conform to such laws. In the event any portion of this Policy shall be declared or deemed invalid or unenforceable under applicable law, such invalidity or unenforceability shall not affect the validity or enforceability of any other portion of this Policy.

XS 004 (09-17) © 2017 CapSpecialty, Inc. All rights reserved. Page 5 of 6

J. EXTENDED REPORTING PERIOD

An Optional Extended Reporting Period is not available under this Policy unless the Insured elects and purchases an Optional Extended Reporting Period for the applicable coverage on an Underlying Policy.

The Insured will be entitled to purchase an Optional Extended Reporting Period pursuant to the terms and conditions of the Underlying Policies except as specified herein. The additional Premium for the Optional Extended Reporting Period for this Policy is fully earned at the inception of the Optional Extended Reporting Period. The Optional Extended Reporting Period is not cancelable. The additional Premium for the Optional Extended Reporting Period for this Policy will be a percentage of the annual Premium to be determined at the time We receive Your written election, not to exceed 200% of the annual premium in effect at the time of election and cannot be less than the highest amount charged by the applicable Underlying Insurer for an Extended Reporting Period on their Underlying Policy.

If an Underlying Policy provides an Automatic Extended Reporting Period, this Policy will provide an Automatic Extended Reporting Period subject to the same terms and conditions of the Underlying Policy.

K. LEGAL ACTION AGAINST US

No person or organization has a right under this Policy to join Us as a party or otherwise bring Us into a Suit asking for damages from any of You or to sue Us on this Policy unless all of its terms have been fully complied with.

L. OTHER INSURANCE

If other valid and collectible umbrella or excess insurance is available to the Insureds covering loss or damages that are also covered under this Policy, this Policy shall apply excess of, and shall not contribute with, such other insurance.

Other excess insurance purchased to specifically apply over the limits of insurance of this Policy is permitted without prejudice to this insurance and shall not reduce or change Our obligations under this Policy.

M. REPRESENTATIONS

By accepting this Policy, You agree that: the statements in the Declarations, Application, any other underwriting, loss control or claims related information or documentation, and any other information or documentation submitted to Us, was accurate and complete at the time You reported that information or provided that documentation; and We have issued this Policy in reliance upon Your representations.

N. SOLE AGENT

The Named Insured shall act on behalf of all Insureds for the payment or return of premium, payment of retention amounts, receipt and acceptance of any endorsement issued to form a part of this Policy, giving and receiving notice of cancellation or non-renewal, and the exercise of all rights provided under this Policy.

O. TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US

If the Insured has rights to recover all or part of any payment We have made under this Policy, those rights are transferred to Us. The Insured must do nothing to impair them. At Our request, the Insured shall bring a claim or transfer those rights to Us and help Us enforce them. Reimbursement shall be made in the following order:

1. First, to Us;

2. Next, to any interest (including the Insured) who has paid any amount in excess of the Limits of Insurance.

3. Then to any interest (including the Insured) as are entitled to claim the remainder, if any.

A different order may apply if agreed upon by all interests. Expenses incurred in the process of recovery shall be divided among all interests according to the ratio of their respective recoveries.

P. UNIMPAIRED AGGREGATE

In the event that any limit of insurance of any Underlying Policy has been reduced and is not in full effect as of the Inception Date of this Policy, the amount by which the Underlying Policy’s limit of insurance has been reduced shall be borne by the Insured and shall be uninsured.

VI. EXCLUSIONS

1. No coverage shall be provided under this Policy for any Claim:

a. Cross Suits

Brought by any of the following:

XS 004 (09-17) © 2017 CapSpecialty, Inc. All rights reserved. Page 6 of 6

i. any related business enterprise which is operated, managed or owned, in whole or in part, by the Insured;

ii. a parent company of the Insured;

iii. any affiliated or subsidiary company of the Insured; or

iv. any Named Insured against another Named Insured.

b. Related Parties

Brought by any related business enterprise which is operated, managed or owned, in whole or in part, by the Insured; a parent company of the Insured; or any affiliated or subsidiary company of the Insured.

2. No coverage shall be provided under this Policy for any Claim based upon, arising out of, relating to or resulting from, in whole or in part:

a. Employment Related Practices

Any employment related practices, policies, procedures, acts or omissions; any employment or labor law;

any labor contract or agreement; or any employee benefit, benefit plan or program.

b. Hostile Acts; Force Majeure

Any consequence, whether direct or indirect, of war, invasion, act of foreign enemy, hostilities (whether war be declared or not), civil war, rebellion, revolution, insurrection for military or usurped power, strike, riot, civil commotion, flood, earthquake, windstorm or other Acts of God.

c. Workers’ Compensation and Similar Laws

Any obligation of any Insured under a workers’ compensation, occupational disease, disability benefits or unemployment compensation law or any similar law.

d. Fraud and Dishonesty

Any fraudulent, criminal or dishonest acts of any Insured.

3. No coverage shall be provided under this Policy for:

a. Punitive or Exemplary Damages

Punitive damages or exemplary damages.

b. Fines, Penalties or Assessments

Any civil, administrative or criminal fines, penalties, taxes, assessments, multiplied damages, liquidated damages or damages for delay.

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

Non-Concurrency of Policy Periods – Underlying Insurance This endorsement modifies insurance provided under the Follow-Form Excess Policy:

If this endorsement is issued after the Policy has been issued, it is deemed to have been added to the list of forms and endorsements on the Declarations.

All other terms and conditions of this Policy remain unchanged.

XS 507 (09-17) © 2017 CapSpecialty, Inc. All rights reserved. Page 1 of 1

It is hereby understood and agreed that:

If there is any Underlying Insurance listed in the Schedule of Underlying which is attached to this Policy, with a Policy Period that is non-concurrent with the Policy Period of this Policy, then We will only recognize the reduction of exhaustion of the limits of insurance of such Underlying Insurance, for the purpose of triggering Our obligation to make any payments under this Policy, by payments of loss, damages or defense expenses from either: (1) Claims first made during the Policy Period of this Policy (if the Underlying Insurance provides claims-made coverage), or from (2) any Covered Event that takes place during the Policy Period of this Policy (if the Underlying Insurance provides occurrence-based coverage).

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

Conditional Exclusion of Terrorism (Relating to Disposition of Federal Terrorism Risk Insurance Act)

This endorsement modifies insurance provided under the Excess Follow Form Policy:

XS-9501 (09/17) © 2017 CapSpecialty, Inc. All rights reserved. Page 1 of 3 Includes material copyrighted by Insurance Services Office, Inc., used with permission.

It is hereby understood and agreed that:

A. Applicability of the Provisions of this Endorsement

1. The provisions of this endorsement become applicable commencing on the date when any one or more of the following first occurs. However, if this Policy (meaning the Policy Period in which this endorsement applies) begins after such date, then the provisions of this endorsement become applicable on the date this Policy begins.

a. The federal Terrorism Risk Insurance Program (hereafter referred to as Program) established by the Terrorism Risk Insurance Act, has terminated with respect to the type of insurance provided under the Coverage Section; or

b. A renewal, extension or replacement of the Program has become effective without a requirement to make terrorism coverage available to the Insured or with revisions that:

1) Increase Our statutory percentage deductible under the Program for terrorism losses. (That deductible determines the amount of all certified terrorism losses We must pay in a calendar year before the federal government shares in subsequent payment of certified terrorism losses.); or

2) Decrease the federal government’s statutory percentage share in potential terrorism losses above such deductible;

or

3) Redefine terrorism or make insurance coverage for terrorism subject to the provisions or requirements that differ from those that apply to other types of events or occurrences under this Coverage Section.

2. If the provisions of this endorsement become applicable, such provisions:

a. Supersede any terrorism endorsement already endorsed to this Coverage Section that addresses Certified Acts of Terrorism and/or other acts of Terrorism, but only with respect to an incident(s) of terrorism however defined which results in a Claim first being made against an Insured or after the date when the provisions of this endorsement become applicable; and

b. Remain applicable unless We notify the Named Insured of changes in these provisions, in response to federal law.

3. If the provisions of this endorsement do not become applicable, any terrorism endorsement already endorsed to this Coverage Section that addresses Certified Acts of Terrorism and/or other acts of Terrorism will continue in effect unless We notify the Named Insured of changes to that endorsement in response to federal law.

B. Section III. DEFINITIONS of the Policy is amended to add the following additional definition:

Conditional Exclusion of Terrorism (Relating to Disposition of Federal Terrorism Risk Insurance Act)

Continued

XS-9501 (09/17) © 2017 CapSpecialty, Inc. All rights reserved. Page 2 of 3 Includes material copyrighted by Insurance Services Office, Inc., used with permission.

Terrorism means activities against persons, organizations or property of any nature:

1. That involve the following or preparation for the following:

a. Use or threat of force or violence; or

b. Commission or threat of a dangerous act; or

c. Commission or threat of an act that interferes with or disrupts an electronic, communication, information or mechanical system; and

2. When one or both of the following applies:

a. The effect is to intimidate or coerce a government or the civilian population or any segment thereof, or to disrupt any segment of the economy; or

b. It appears that the intent is to intimidate or coerce a government, or to further political, ideological, religious, social or economic objectives or to express (or express oppositions to) a philosophy or ideology.

C. Section VI. EXCLUSIONS of the Policy is amended to add the following additional exclusion:

No coverage shall be provided under this Policy for any Claim based upon, arising out of, relating to or resulting from, in whole or in part, Terrorism, including action in hindering or defending against an actual or expected incident of Terrorism. Any loss or damage is excluded regardless of any other cause or event that contributes concurrently or in any sequence to such loss or damage. But this exclusion applies only when one or more of the following are attributed to an incident of Terrorism:

1. The Terrorism is carried out by means of the dispersal or application of radioactive material, or through the use of nuclear weapon or device that involves or produces a nuclear reaction, nuclear radiation or radioactive contamination; or

2. Radioactive material is released, and it appears that one purpose of the Terrorism was to release such material; or

3. The Terrorism is carried out by means of the dispersal or application of pathogenic or poisonous biological or chemical materials; or

4. Pathogenic or poisonous biological or chemical materials are released, and it appears that one purpose of the Terrorism was to release such materials; or

5. The total insured damage to all types of property exceeds $25,000,000. In determining whether the $25,000,000 threshold is exceeded, We will include all insured damage sustained by property of all persons and entities affected by the Terrorism and business interruption losses sustained by owners or occupants of the damaged property. For the purpose of this provision, insured damage means damage that is covered by any plus damage that would be covered by any insurance but for the application of any terrorism exclusions; or

6. Fifty or more persons sustain death or serious physical injury. For the purpose of this provision, serious physical injury means:

a. Physical injury that involves a substantial risk of death; or

b. Protracted and obvious physical disfigurement; or

c. Protracted loss of or impairment of the function of a bodily member or organ.

Multiple incidents of Terrorism which occur within a seventy-two (72) hour period and appear to be carried out in concert or to have a related purpose or common leadership will be deemed to be one incident of Terrorism, for the purpose of determining whether the thresholds in Paragraphs 5. or 6. immediately above are exceeded.

With respect to this exclusion, Paragraphs 5. and 6. immediately above describe the threshold used to measure the magnitude of an incident of Terrorism and the circumstances in which the threshold will apply, for the purpose of determining whether this exclusion will apply to that incident. When the exclusion applies to that incident of Terrorism, there is not coverage under this Policy.

Conditional Exclusion of Terrorism (Relating to Disposition of Federal Terrorism Risk Insurance Act)

Continued

If this endorsement is issued after the Policy has been issued, it is deemed to have been added to the list of forms and endorsements on the Declarations.

All other terms and conditions of this Policy remain unchanged.

XS-9501 (09/17) © 2017 CapSpecialty, Inc. All rights reserved. Page 3 of 3 Includes material copyrighted by Insurance Services Office, Inc., used with permission.

D. The terms and limitations of any terrorism exclusion, or the inapplicability or omission of a terrorism exclusion, do not serve to create coverage for any loss or damage that is otherwise excluded under this Policy.

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

Exclusion of Certified Acts of Terrorism This endorsement modifies insurance provided under the Excess Follow Form Policy:

If this endorsement is issued after the Policy has been issued, it is deemed to have been added to the list of forms and endorsements on the Declarations.

All other terms and conditions of this Policy remain unchanged.

XS 9503 (09-17) © 2017 CapSpecialty, Inc. All rights reserved. Page 1 of 1

It is hereby understood and agreed that:

A. Section III. DEFINITIONS of the Policy is amended to add the following additional definition:

Certified Act of Terrorism means an act that is certified by the Secretary of the Treasury, in accordance with the provisions of the federal Terrorism Risk Insurance Act, to be an act of terrorism pursuant to such Act. The criteria contained in the Terrorism Risk Insurance Act for a Certified Act of Terrorism include the following:

1. The act resulted in insured losses in excess of $5 million in the aggregate, attributable to all types of insurance subject to the Terrorism Risk Insurance Act; and

2. 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 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.

B. Section VI. EXCLUSIONS of the Policy is amended to add the following additional exclusion:

No coverage shall be provided under this Policy for any Claim based upon, arising out of, relating to or resulting from, in whole or in part, a Certified Act of Terrorism.

C. The terms and limitations of any terrorism exclusion, or the inapplicability or omission of a terrorism exclusion, do not serve to create coverage for any loss or damages that is otherwise excluded under this Policy.

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

Premium and Rate – Minimum Earned Premium This endorsement modifies insurance provided under the Excess Follow Form Policy:

If this endorsement is issued after the Policy has been issued, it is deemed to have been added to the list of forms and endorsements on the Declarations.

All other terms and conditions of this Policy remain unchanged.

XS 025 (09-17) © 2017 CapSpecialty, Inc. All rights reserved. Page 1 of 1

It is hereby understood and agreed that:

The following terms shall apply to the above-referenced policy.

Minimum Earned Premium Percentage: 25% Exposure Basis: N/A Exposure at Policy Effective Date: N/A Composite Rate: * N/A Policy Premium: $2,000.00

* This rate is subject to change as per Endorsement activity effective during the Policy Period.

A. Premium(s) due for this Policy shall be calculated as follows, in the event of the following:

1. This Policy remains in effect for ninety (90) days or less, the Minimum Earned Premium shall be the Total Policy Premium as specified in the Declarations, multiplied by the applicable Minimum Earned Premium percentage specified in the table above.

2. If this Policy is cancelled by You after this Policy has been in effect for more than ninety (90) days, the refund shall reflect the balance, if any, after applying the greater of the following:

a. The Minimum Earned Premium as calculated using the applicable percentage specified in the table above; or

b. Short Rate charge equal to ninety percent (90%) of the pro rata unearned premium;

The cancellation shall be effective even if we have not made or offered a refund.

3. If this policy is cancelled by Us after this Policy has been in effect for more than ninety (90) days for reasons other than the nonpayment of premium, the earned premium for this Policy shall be computed on a pro rata basis. The return premium shall be subject to the earned premium as determined by audit, if applicable.

Service of Suit

E-9000S (02/17) © 2017 CapSpecialty, Inc. All rights reserved. Page 1 of 1 Includes material copyrighted by Insurance Services Office, Inc., used with permission.

This endorsement modifies insurance provided under the following:

Environmental Excess Policy

It is hereby understood and agreed that:

Capitol Specialty Insurance Corporation (“CSIC”) may be sued upon any cause of action arising under any insurance contract made by CSIC or evidence of insurance issued or delivered by the producer, in the courts for the county(s) where the insurance provides coverage or in the courts of Dane County, Wisconsin, where the insurer maintains its home office.

It is further agreed that service of process in such suit may be made upon the appropriate person at the state Department of Insurance, Secretary of State or other designee as provided for in specific state laws and/or regulations.

When service of process is made upon a statutory designee according to state law, such process should be provided via mail to:

Vice President – Claims Capitol Specialty Insurance Corporation 1600 Aspen Commons Middleton, Wisconsin 53562-4718

The above-named is authorized and directed to accept service of process on our behalf in any suit. It is further agreed that in any suit instituted against any insured under this policy or otherwise upon this policy, we will abide by the final decision of such court or of any appellate court in the event of an appeal.

If this endorsement is issued after the Policy has been issued, it is deemed to have been added to the list of forms and endorsements on the Declarations.

All other terms and conditions of this Policy remain unchanged.

Authorized Representative

Forms a part of Policy No.: EV20180271-01

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

Additional Insureds – Primary and Non-Contributory Coverage – Owners or Contractors – At Written Request

This endorsement modifies insurance provided under the Environmental Policy for the following:

Commercial General Liability Coverage Form

ENV 6048 (12-17) © 2017 CapSpecialty, Inc. All rights reserved. Page 1 of 2

It is hereby understood and agreed that the following changes are incorporated into the Coverage Form(s) / Coverage Section(s) listed above.

If the Commercial General Liability Coverage Form is listed above, defined terms shown in bold may appear in quotations in such coverage form.

A. With respect to the Coverage Forms listed above, the Section…