Kindred_Spirits_COI_Redacted.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

6/13/2025

Independence Insurance Group, PLLC

10210 N 32nd St

#C-3

Phoenix AZ 85028

RACHEL PLOSKI

(480) 656-1036 rachel@indieinsurance.com

KINDRED SPIRITS GROUP HOME LLC

AMGUARD

A

Y Y C1GP607873 05/03/2025 05/03/2026

1,000,000

100,000

5,000

1,000,000

3,000,000

3,000,000

A

Y Y C2GP605375 05/09/2025 05/09/2026

1,000,000

A Professional Liability

C1GP607873 05/03/2025 05/03/2026

OCC 1,000,000

AGG 3,000,000

1 LOCATION:

THE STATE OF ARIZONA, DEPARTMENT OF CHILD SAFETY

PO BOX 6030

SITE CODE C010-20

PHOENIX AZ 85012

GL 108 02 01 19 Includes copyrighted material of Insurance Services Office, Inc. with permission. Page 1 of 10

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

SOCIAL SERVICES GENERAL LIABILITY ENHANCEMENT

ENDORSEMENT

It is understood and agreed that the following extensions only apply in the event that no other specific coverage for the indicated loss exposures are provided under this policy. If such specific coverage applies, the terms, conditions, and limits of that coverage are the sole and exclusive coverage applicable under this policy.

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE FORM

The following is a summary of the Limits of Insurance and Additional Coverage provided by this endorsement. For complete details on specific coverages, consult the policy contract wording.

A) Medical Payments Limit increased to $20,000 and Extended Reporting Period 3 Years

B) Supplementary Payments Bail bonds increased to $5,000 / Loss of Earnings increased to $1,000 each day

C) Legal Liability Extension For fire, lightning, explosion, smoke, and leaks from sprinklers limit increased to $1,000,000

D) Broadened definition of Who is an Insured

E) Knowledge or Notice of Occurrence

F) Broadened definition of Advertising Injury includes televised or videotaped publication

G) Amended definition of Bodily Injury to include mental anguish

H) Amended Unintentional Failure to Disclose Hazards

I) Amended Liberalization Clause

J) Property Damage force to protect persons or property

K) Premises Sold or Abandoned by You

L) Blanket Additional Insured - Funding sources

M) Blanket Additional Insured - Managers or lessors of premises

N) Blanket Additional Insured with Primary and Non-Contributory Wording By Contract, Agreement or Permit

O) General Aggregate Limit Per Location

P) Blanket Special Events Coverage

Q) Non-Owned Watercraft Coverage - Length is increased to 65 feet

R) Blanket Waiver of Subrogation

S) Waiver of Immunity

T)

U) Liquor Liability Exception to Exclusion

GL 108 02 01 19 Includes copyrighted material of Insurance Services Office, Inc. with permission. Page 3 of 10

2. Each of the following is also an insured, but only while working within the scope of their duties related to the conduct of your business;

a. , b.

c. Independent Contractors or independent contractors are insureds for:

(1)

(a) To you, to your partners or members (if you are a partnership or joint venture), to your members (if you are a limited liability company), to a co-while in the course of his or her employment or performing duties related to the conduct of your business, or to your other contractors while performing duties related to the conduct of your business;

(b) To the spouse, child, parent, brother or sister of that co-independent contractors as a consequence of Paragraph (1)(a) above;

(c) For which there is any obligation to share damages with or repay someone else who must pay damages because of the injury described in Paragraphs (1)(a) or

(b) above; or

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

(2) Property d

(a) Owned, occupied or used by,

(b) Rented to, in the care, custody or control of, or over which physical control is being exercised for any purpose by contractors, any partner or member (if you are a partnership or joint venture), or any member (if you are a limited liability company).

d. Medical directors and administrators, including professional persons;

e. If you are an organization other than a partnership or joint venture, your managers and supervisors are also insureds, but only with respect to their duties as your managers and supervisors;

f. If you are a limited liability company, your members are insureds, but only with respect to their duties related to the conduct of your business;

g. Any organization and subsidiary thereof which you control and actively manage on the effective date of this endorsement;

h. Any person or organization that has financial control of you or owns, maintains or controls premises occupied by you and requires you to name them as an additional insured but only with respect to their liability arising out of:

(1) Their financial control of you; or

(2) Premises they own maintain or control while you lease or occupy these premises.

This insurance does not apply to structural alterations, new construction and demolition operations performed by or for that person or organization.

i. Any State or Political Subdivision subject to the following provision:

This insurance applies only with respect to the following hazards for which the state or political subdivision has issued a permit in connection with premises you own, rent, or control and to which this insurance applies:

(1) The existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults, street banners, or decorations and similar exposures; or

(2) The construction, erection, or removal of elevators; or

GL 108 02 01 19 Includes copyrighted material of Insurance Services Office, Inc. with permission. Page 4 of 10

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

However, the insurance afforded for any organization and subsidiary thereof not named in the Declarations as a Named Insured, does not apply to injury or damage with respect to which an insured under this endorsement is also an insured under another policy, or would be an insured under such policy but for its termination or the exhaustion of its limits of insurance.

j.

his or her rendering or failure to render professional services to patients;

k. Your members but only with respect to their liability for your activities or activities they perform on your behalf;

l. Your trustees or members of the board of governors while acting within the scope of their duties as such on your behalf;

m. Any entity you are required in a written contract (hereinafter called Additional Insured) to name as an insured is an insured but only with respect to liability the Additional Insured, or acts or omissions of the Additional Insured in connection with to the extent set forth below:

rendering or failure to render any professional services by or for you, including:

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

(2) Supervisors, inspection, or engineering services.

Any coverage provided under this provision shall be excess over any other valid and collectible insurance available to the Additional Insured(s) whether primary, excess, contingent or on any other basis unless a contract specifically requires that this insurance be primary or you request that it apply on a primary basis.

Paragraph 3.a. of Section II Who Is An Insured is deleted and replaced by the following:

a. Coverage under this provision is, subject to

(1) and (2) below:

(1) Effective on the acquisition or formation date; and

(2) Afforded only until the end of the policy period of this Coverage Part or the next anniversary of its inception date, whichever is earlier.

E) KNOWLEDGE OR NOTICE OF OCCURRENCE

1) As it relates to any loss reporting requirements under this policy, it is understood and agreed that knowledge of an o by an agent, servant or not in itself constitute knowledge by you, unless a corporate officer of yours shall have received notice from said agent, servant, rson.

2) Your failure to give first report of a claim to us shall not invalidate coverage under this policy if the loss was inadvertently reported to another insurer. However, you shall report reasonable time once you become aware of such error.

F) ADVERTISING INJURY TELEVISED OR

VIDEOTAPED PUBLICATION

1)

14. d., e., f. and g. are changed following offenses:

d. Oral, written, televised, or videotaped publication of material that slanders or libels a person or organization or goods, products, or services;

e. Oral, written, televised, or videotaped publication of material that violates a

f. Misappropriation of advertising ideas or style of doing business; or

GL 108 02 01 19 Includes copyrighted material of Insurance Services Office, Inc. with permission. Page 5 of 10

g. Infringement of copyright, title, or slogan.

2) Exclusions b. and c. of Coverage B., Personal and Advertising Injury Liability, are changed to read:

b.

out of oral, written, televised, or videotaped publication of material, if done by or at the direction of the insured with knowledge of its falsity;

c.

out of oral, written, televised, or videotaped publication of material whose first publication took place before the beginning of the policy period.

G) BODILY INJURY MENTAL ANGUISH

a. Bodily injury, sickness, or disease sustained by a person, and includes mental anguish resulting from any of these; and

b. Except for mental anguish, includes death resulting from the foregoing (item above) at any time.

H) UNINTENTIONAL FAILURE TO DISCLOSE

HAZARDS

It is agreed that, based on our reliance on your representations as to existing hazards, if you should unintentionally fail to disclose all such hazards prior to the beginning of the policy period of this Coverage Part, we shall not deny coverage under this Coverage Part because of such failure.

I) LIBERALIZATION

If we adopt a change in our forms or rules which would broaden your coverage without an additional premium charge, your policy will automatically provide the additional coverages as of the date the revision is effective in your state.

J)

SECTION I Coverages, Coverage A, 2.

Exclusions, a. is deleted and replaced by the following:

a. Expected or Intended Injury intended from the standpoint of the insured. This reasonable force to protect persons or property.

K) PREMISES SOLD OR ABANDONED BY YOU

SECTION I Coverages, Coverage A., 2.

Exclusions, j. (2) is deleted and replaced by the following:

(2) Premises you sell, give away, or abandon, if those premises, and occurred from hazards that were known by you or should have reasonably been known by you, at the time the property was transferred or abandoned.

L) ADDITIONAL INSURED FUNDING SOURCE

Under SECTION II Who is an Insured, the following is added:

Any person or organization with respect to their liability arising out of:

a. Their financial control of you; or

b. Premises they own, maintain, or control while you lease or occupy these premises.

This insurance does not apply to structural alterations, new construction, and demolition operations performed by or for that person or organization.

M) ADDITIONAL INSURED MANAGERS OR

LESSORS OF PREMISES Under SECTION II

Who is an Insured, the following is added:

Any person or organization with respect to their liability arising out of the ownership, maintenance, or use of that part of the premises leased to you, subject to the following additional exclusions:

This insurance does not apply to:

a.

cease to be a tenant in that premises.

b. Structural alteration, new construction, or demolition operations performed by or on behalf of that person or organization.

GL 108 02 01 19 Includes copyrighted material of Insurance Services Office, Inc. with permission. Page 6 of 10

N) BLANKET ADDITIONAL INSURED WITH

PRIMARY AND NON-CONTRIBUTORY

WORDING - BY CONTRACT, AGREEMENT OR

PERMIT

1) Any person or organization is an insured with whom you are required to add as an additional insured to this policy by a written contract or written agreement, or permit that is:

a) currently in effect or becoming effective during the term of this policy; and b) advertising injury.

2) This insurance provided to the additional insured by this endorsement applies as follows:

a) That person or organization is only an additional insured with respect to liability caused by your negligent acts or omissions at or from:

(1) Premises you own, rent, lease, or occupy, or

(2) Your ongoing operations performed for the additional insured at the job indicated by written contract or written agreement.

b) The limits of insurance applicable to the additional insured are those specified in the written contract or written agreement or in the Declarations of this policy, whichever is less. These limits of insurance are inclusive of and not in addition to the limits of insurance shown in the Declarations.

3) With respect to the insurance afforded these additional insureds, the following additional exclusions apply:

a) after:

(1) all work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the site of the covered operations has been completed; or

(2) which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations on or at the same project.

b) advertising of or failure to render any professional services.

4) Regardless of whether other insurance is available to an additional insured on a primary basis, this insurance will be primary and noncontributory if a written contract between you and the additional insured specifically requires that this insurance be primary.

O) GENERAL AGGREGATE LIMIT PER LOCATION

SECTION III Limits of Insurance, paragraph 2. is deleted and replaced by the following:

2. The most we will pay for all damages and medical expenses combined attributable to ongoing operations at any and all locations, regardless of the number of locations, insureds, is a Maximum General Policy Aggregate Limit equal to $10,000,000.

P) BLANKET SPECIAL EVENTS

This events hosted or operated by the named insured. However, this insurance does not apply to the following EXCLUDED EVENTS:

a) Parades

b) Aircraft

c) Motorcycle runs and automobile rallies

d) Fireworks

e) Firearms

f) Animals other than domesticated household pets

g) Carnivals and fairs with mechanical rides

h) Concerts

i) Events including contact sports

j) Rodeos

GL 108 02 01 19 Includes copyrighted material of Insurance Services Office, Inc. with permission. Page 7 of 10

k) Political rallies

l) Any event lasting more than three (3) days (including otherwise acceptable events)

m) Any event with greater than 1,000 people in attendance (including otherwise acceptable events)

Separate coverage may be available at the above. Possible additional charges may apply if coverage is provided.

Q) NON-OWNED WATERCRAFT

SECTION I Coverages. 2. Exclusions, paragraph g.(2) is deleted and replaced by the following:

(2) A watercraft you do not own that is:

(a) Less than 65 feet long, and

(b) Not being used to carry persons or property for a charge;

This provision applies to any person, who with your consent, either uses or is responsible for the use of a watercraft.

This insurance is excess over any other valid and collectible insurance available to the insured whether primary, excess, or contingent.

R) BLANKET WAIVER OF SUBROGATION

We will waive our rights of recovery to any person or organization with whom you are required by a written contract, written agreement, or permit that is:

a) currently in effect or becoming effective during the term of this policy; and b) advertising injury.

S) WAIVER OF IMMUNITY

We will waive, both in the adjustment of claims the insured, any charitable or governmental immunity of the insured, unless the insured requests, in writing, that we not do so.

Waiver of immunity, as a defense, will not subject us to liability for any portion of a claim or judgment, in excess, of the applicable limit of insurance.

T) VIOLATION OF RIGHTS OF RESIDENTS

1) The following is added to Section I

Coverages Coverage A, paragraph 1.

damages arising out of the violation of

2) As it relates to coverage provided in paragraph A.1. of this endorsement, the following exclusions are added to Section I

Coverages Coverage A-2. Exclusions:

This insurance does not apply to:

a) Liability arising out of the willful or

b) Fines or penalties assessed by a court or regulatory authority.

c) Liability arising out of any act or omission in the furnishing, or failure to furnish, professional services in the

3) As it relates to definition is added to Section V

Definitions:

a. Any right granted to a resident under any state law regulating your business as a health care facility.

b.

the United States Department of Health and Welfare regulations governing participation of Intermediate Care Facilities and Skilled Nursing Facilities, regardless of whether your facility is subject to those regulations.

U. LIQUOR LIABILITY EXCLUSION EXCEPTION

FOR SPECIAL EVENTS

SECTION I Coverages, Coverage A., 2.

Exclusions, c. is amended by adding the following subparagraph:

the selling, serving or furnishing of alcoholic beverages at any special

GL 108 02 01 19 Includes copyrighted material of Insurance Services Office, Inc. with permission. Page 8 of 10 events that are hosted or operated by the named insured.

V. NOTICE OF CANCELLATION PROVIDED BY US

TO THIRD PARTY

If this policy is cancelled by us we will send notice to the Named Insured and any party listed on file.

otice.

on file for any statutorily permitted reason other than non-payment of premium.

W. LIMITED RENTAL LEASE AGREEMENT

CONTRACTUAL LIABILITY SECTION I

COVERAGES, COVERAGE A. BODILY

INJURY AND PROPERTY DAMAGE

LIABILITY, Subsection 2. Exclusions, Paragraph b. Contractual Liability is amended to include the following:

(3) Based on the time of claim, we agree to indemnify the named insured for their liability assumed in a contract or agreement regarding the rental or lease of a premises on behalf of their client, up to $50,000. This coverage extension only applies to rental lease agreements. This liability insurance of the client.

X. HIPPA

SECTION I COVERAGES, COVERAGE B

PERSONAL AND ADVERTISING INJURY

LIABILITY, is amended as follows:

1. Paragraph 1. Insuring Agreement is amended to include the following:

We will pay those sums that the insured becomes legally obligated to pay as damages because Insurance Portability and Accountability Act (HIPAA). We have the right and the duty to seeking these damages. However, we will have no duty apply.

2. Paragraph 2. Exclusions is amended to include the following additional exclusions:

This insurance does not apply to:

a. Intentional, Willful, or Deliberate Violations

Any willful, intentional, or deliberate

b. Criminal Acts penalties under the HIPAA.

c. Other Remedies

Any remedy other than monetary damages for penalties assessed.

d. Compliance Reviews or Audits Any compliance reviews by the Department of Health and Human Services.

3. The following, when used on this coverage, are defined as follows:

a.

Department of Health and Human Services

(HHS)

b.

However, Compliance Review.

c.

to comply with the regulations included in the

HIPAA.

Y. Key and Lock Replacement Janitorial Services Client Coverage SECTION I COVERAGES, SUPPLEMENTARY PAYMENTS COVERAGES

A AND B is amended to include the following:

We will pay for the cost to replace keys and locks at loss to

$10,000 limit per occurrence and $10,000 policy aggregate.

We will not pay for loss or damage resulting from theft or any other dishonest or criminal act that you or any of your partners, members, officers, authorized representatives or any one to whom you entrust the key purpose commit, whether acting alone or in collusion with other persons.

The following, when used on this coverage, are defined as follows:

a. "Client" means an individual, company or organization with whom you have a written contract or work order for your services for a described premises and have billed for your services.

b. "Employee" means:

(1) Any natural person:

GL 108 02 01 19 Includes copyrighted material of Insurance Services Office, Inc. with permission. Page 9 of 10

(a) While in your service or for 30 days after termination of service;

(b) Who you compensate directly by salary, wages or commissions; and

(c) Who you have the right to direct and control while performing services for you;

or

(2) Any natural person who is furnished temporarily to you:

(a) To substitute for a permanent "employee" as defined in Paragraph (1) above, who is on leave; or

(b) To meet seasonal or short-term workload conditions;

while that person is subject to your direction and control and performing services for you.

(3) "Employee" does not mean:

(a) Any agent, broker, person leased to you by a labor leasing firm, factor, commission merchant, consignee, independent contractor or representative of the same general character; or

(b) Any "manager," director or trustee except while performing acts coming within the scope of the usual duties of an "employee."

(c) "Manager" means a person serving in a directorial capacity for a limited liability company.

Z. Damage to Property You Own, Rent or Occupy LIABILITY, Subsection 2. Exclusions, Paragraph

j. Damage to Property, Item (1) is deleted in its entirety and replaced with the following:

(1) Property you own, rent, or occupy, including any costs or expenses incurred by you, or any other person, organization or entity, for repair, replacement, enhancement, restoration or maintenance of such property for any reason, including prevention of injury to a person or damage to property is caused by your client, up to a $30,000 limit. A client is defined as a person under your direct care and supervision.

AA. Personal and Advertising Injury Abuse of Process, Discrimination

If COVERAGE B PERSONAL AND

ADVERTISING INJURY LIABILITY COVERAGE

is not otherwise excluded from this Coverage amended as follows:

1. SECTION V DEFINITIONS, Paragraph 14.b. is deleted in its entirety and replaced by the following:

b. Malicious prosecution or abuse of process;

2. SECTION V DEFINITIONS, Paragraph 14.

is amended by adding the following:

Discrimination based on race, color, religion, sex, age or national origin, except when:

a. Done intentionally by or at the direction of, or with the knowledge or consent of:

(1) Any insured; or

(2) Any executive officer, director, stockholder, partner or member of the insured;

b. Directly or indirectly related to the employment, former or prospective employment, termination of employment, or application for employment of any person or persons by an insured;

c. Directly or indirectly related to the sale, rental, lease or sublease or prospective sales, rental, lease or sub-lease of any room, dwelling or premises by or at the direction of any insured; or

d. Insurance for such discrimination is prohibited by or held in violation of law, public policy, legislation, court decision or administrative ruling.

The above does not apply to fines or penalties imposed because of discrimination.

BB. Duties in the Event of Occurrence, Claim or Suit

SECTION IV COMMERCIAL GENERAL

LIABILITY CONDITIONS, Paragraph 2. is amended as follows:

a. is amended to include:

This condition applies only when the

(1) You, if you are an individual;

(2) A partner, if you are a partnership; or

(3) An executive officer or insurance manager, if you are a corporation.

b. is amended to include:

This condition will not be considered breached unless the breach occurs after is known to:

(1) You, if you are an individual;

(2) A partner, if you are a partnership; or

(3) An executive officer or insurance manager, if you are a corporation.

GL 108 02 01 19 Includes copyrighted material of Insurance Services Office, Inc. with permission. Page 10 of 10

CC. EMPLOYEE CRIMINAL DEFENSE COSTS

ONLY COVERAGE

1. The following provision is added to the Policy:

Employee Criminal Defense Costs

Only Coverage

We will pay, on your right, but not the duty to defend your

2.

less of the

Criminal Defense Costs Only Coverage is in addition to and does not reduce the Limits of Insurance shown on the Declarations. However, the payment of

Criminal Defense Costs Only Coverage is included within and shall reduce the shown in Item V) of the Schedule above

$25,000 limit has been exhausted.

3. The following additional Exclusions apply to this Employee Criminal Defense Costs Only Coverage:

This insurance does not apply to:

a. Coverage Provided Under

Coverages A or B

Any coverage is provided under

COVERAGE A BODILY INJURY AND

PROPERTY DAMAGE LIABILITY

AND COVERAGE B PERSONAL

AND ADVERTISING INJURY

LIABILITY of this policy.

b. Damages, Fines or Penalties

Any damages or penalties.

4. The following additional Definitions apply to this Employee Criminal Defense Costs Only

Coverage:

a.

The prosecution of any of your with a court, or other regulatory enforcement agency, of an information, a complaint, or an indictment, and any amendments thereto, alleging that your committed one or more crimes involving one or more incidents, acts, or events.

Such incidents, acts or events must arise within the scop employment by you or occur while your the conduct of your business.

notwithstanding the fact that the prosecution or investigation may involve multiple incidents, multiple counts or charges, and/or multiple trial and/or appellate proceedings. A subsequent or different prosecution or investigation based on the same incidents, acts, or events that provided the basis for the original prosecution or investigation shall b.

(1) Reasonable attorney fees (including fees for the services of paralegals, law clerks and/or investigators working under the direction of said attorney); and

(2) Reasonable and necessary costs, excluding loss of income.

5.

payable under this Employee Criminal Defense Costs Only Coverage be payable as Supplementary Payments under Coverages A or B.

All other terms and conditions of the policy remain the same.