IS SUBJECT TO A GENERAL AGGREGATE LIMIT
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1 BUSINESSOWNERS COVERAGE PART DECLARATIONS CONDOMINIUM PAC POLICY NO.: ISSUE DATE: INSURING COMPANY: THE TRAVELERS INDEMNITY COMPANY OF AMERICA 680-1G /24/2016 POLICY PERIOD: From to :01 A.M. Standard Time at your mailing address FORM OF BUSINESS: CORPORATION COVERAGES AND LIMITS OF INSURANCE: Insurance applies only to an item for which a "limit" or the word "included" is shown. COMMERCIAL GENERAL LIABILITY COVERAGE OCCURRENCE FORM LIMITS OF INSURANCE General Aggregate (except Products-Completed Operations Limit) $ 4,000,000 Products-completed Operations Aggregate Limit $ 4,000,000 Personal and Advertising Injury Limit $ 2,000,000 Each Occurrence Limit $ 2,000,000 Damage to Premises Rented to You $ 300,000 Medical Payments Limit (any one person) $ 5,000 BUSINESSOWNERS PROPERTY COVERAGE DEDUCTIBLE AMOUNT: Businessowners Property Coverage: $ 10,000 per occurrence. Building Glass: $ 10,000 per occurrence. BUSINESS INCOME/EXTRA EXPENSE LIMIT: Actual loss for 12 consecutive months Period of Restoration-Time Period: Immediately ADDITIONAL COVERAGE: Fine Arts: $ 25,000 Other additional coverages apply and may be changed by an endorsement. Please read the policy. SPECIAL PROVISIONS: COMMERCIAL GENERAL LIABILITY COVERAGE IS SUBJECT TO A GENERAL AGGREGATE LIMIT MP T (Page 1 of 5)
2 BUSINESSOWNERS PROPERTY COVERAGE BUILDING $ 20,023,214 Blanket Limit RC* N/A 0.0% BUSINESS PERSONAL PROPERTY COVERAGE EXTENSIONS: Accounts Receivable Valuable Papers INCLUDED IN BLANKET LIMIT RC* N/A 0.0% $ 25,000 $ 25,000 MP T (Page 2 of 5)
3 BUSINESSOWNERS PROPERTY COVERAGE BUILDING INCLUDED IN BLANKET LIMIT RC* N/A 0.0% MP T (Page 3 of 5)
4 BUSINESSOWNERS PROPERTY COVERAGE MP T (Page 4 of 5)
5 BUSINESSOWNERS PROPERTY COVERAGE BUILDING INCLUDED IN BLANKET LIMIT RC* N/A 0.0% Other coverage extensions apply and may be changed by an endorsement. Please read the policy. MP T (Page 5 of 5)
6 POLICY NUMBER: EFFECTIVE DATE: ISSUE DATE: 680-1G /01/ /24/2016 LISTING OF FORMS, ENDORSEMENTS AND SCHEDULE NUMBERS THIS LISTING SHOWS THE NUMBER OF FORMS, SCHEDULES AND ENDORSEMENTS BY LINE OF BUSINESS PN T IL T MP T IL T IL T IL T IMPORTANT NOTICE TO NORTH CAROLINA POLICYHOLDERS - CAUSES OF LOSS NOT COVERED COMMON POLICY DECLARATIONS BUSINESSOWNERS COVERAGE PART DECLARATIONS FORMS ENDORSEMENTS AND SCHEDULE NUMBERS COMMON POLICY CONDITIONS ADDITIONAL LOCATIONS BUSINESSOWNERS MP T MP T MP T MP T MP T MP T MP T MP T MP T MP T MP T MP T MP T TABLE OF CONTENTS - BUSINESSOWNERS COVERAGE PART - DELUXE PLAN BUSINESSOWNERS PROPERTY COVERAGE SPECIAL FORM AMENDATORY PROVISIONS CONDOMINIUM ASSOCIATIONS POWER PAC PREMIER ENDORSEMENT FEDERAL TERRORISM RISK INSURANCE ACT DISCLOSURE NON-COMPENSATED OFFICERS INCLUDED FOR EMPLOYEE DISHONESTY VOLUNTEER WORKERS INCLUDED FOR EMPLOYEE DISHONESTY PROPERTY MANAGERS INCLUDED FOR EMPLOYEE DISHONESTY EQUIPMENT BREAKDOWN - SERVICE INTERRUPTION LIMITATION AMENDATORY PROVISIONS - GREEN BUILDING AND BUSINESS PERSONAL PROP COV ENHANCEMENTS EMPLOYEE DISHONESTY AND FORGERY OR ALTERATION INCREASED LIMIT FUNGUS, ROT, BACTERIA AND OTHER CAUSES OF LOSS CHANGES NORTH CAROLINA CHANGES COMMERCIAL GENERAL LIABILITY CG T CG CG D CG D CG D CG D CG D CG D CG D CG T TABLE OF CONTENTS - COMMERCIAL GENERAL LIABILITY COVERAGE FORM CG COMMERCIAL GENERAL LIABILITY COVERAGE FORM EXCLUSION - REAL ESTATE DEVELOPMENT ACTIVITIES - COMPLETED OPERATIONS AMENDMENT OF COVERAGE - POLLUTION AMENDATORY ENDR- PRODUCTS-COMPLETED OPERATIONS HAZARD AMENDMENT OF COVERAGE B - PERSONAL AND ADVERTISING INJURY LIABILITY OTHER INSURANCE - ADDITIONAL INSUREDS XTEND ENDORSEMENT AMEND - NON CUMULATION OF EACH OCC ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION IL T PAGE: 1 OF 2
7 POLICY NUMBER: EFFECTIVE DATE: ISSUE DATE: 680-1G /01/ /24/2016 COMMERCIAL GENERAL LIABILITY (CONTINUED) CG D CG D MP T CG D CG D CG D CG D CG D CG D CG D CG D CG D CG D CG D CG T CG F DIRECTORS AND OFFICERS LIABILITY ENDORSEMENT COMMUNITY ASSOCIATIONS AMEND COVG - POLLUTION-EQUIP EXCEPTION HIRED AUTO AND NON-OWNED AUTO LIABILITY FUNGI OR BACTERIA EXCLUSION AMENDMENT OF COVERAGE - PROPERTY DAMAGE EMPLOYMENT-RELATED PRACTICES EXCLUSION EXCLUSION - UNSOLICITED COMMUNICATION MOBILE EQUIPMENT REDEFINED - EXCLUSION OF VEHICLES SUBJECT TO MOTOR VEHICLE LAWS AMEND CONTRAL LIAB EXCL - EXC TO NAMED INS EXCLUSION - VIOLATION OF CONSUMER FINANCIAL PROTECTION LAWS EXCLUSION - ACCESS OR DISCLOSURE OF CONFIDENTIAL OR PERSONAL INFORMATION EXCLUSION - LEAD EXCLUSION - DISCRIMINATION EXCLUSION - WAR EXCLUSION - ASBESTOS DIR AND OFF LIAB ENDR - COMMUNITY ASSOCIATIONS - EXTENDED REPORTING PERIOD - NC MULTIPLE SUBLINE ENDORSEMENTS CG T LIMITATION WHEN TWO OR MORE POLICIES APPLY INTERLINE ENDORSEMENTS IL T IL T IL T IL IL IL T AMNDT COMMON POLICY COND-PROHIBITED COVG CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM EXCLUSION OF LOSS DUE TO VIRUS OR BACTERIA NUCLEAR ENERGY LIABILITY EXCLUSION ENDORSEMENT (BROAD FORM) NORTH CAROLINA CHANGES - CANCELLATION AND NONRENEWAL NORTH CAROLINA EFFECTIVE TIME CHANGES POLICY HOLDER NOTICES PN T EARTHQUAKE POLICYHOLDER NOTICE IL T PAGE: 2 OF 2
8 ADDITIONAL LOCATIONS POLICY NO.: 680-1G CONDOMINIUM PAC ISSUE DATE: 08/24/2016 THIS SCHEDULE OF LOCATIONS AND BUILDINGS APPLIES TO THE COMMON DECLARATIONS FOR THE PERIOD 09/01/2016to 09/01/2017 PREMISES LOCATION NUMBER BUILDING NUMBER OCCUPANCY ADDRESS CONDO ORCHARD VILLAS AVE CLUBHOUSE AND POOL CONDO CONDO CONDO CONDO CONDO CONDO CONDO CONDO CONDO CONDO ORCHARD VILLAS AVE 1521 ORCHARD VILLAS AVE 1511 ORCHARD VILLAS AVE 900 CAROLINA BELL RD 910 CAROLINA BELL RD 1500 ORCHARD VILLAS AVE 920 CAROLINA BELL RD 930 CAROLINA BELL RD 941 CAROLINA BELL RD 1490 ORCHARD VILLAS AVE 1501 ORCHARD VILLAS AVE IL T Page 1 of 1
9 ADDITIONAL LOCATIONS POLICY NO.: 680-1G CONDOMINIUM PAC ISSUE DATE: 08/24/2016 THIS SCHEDULE OF LOCATIONS AND BUILDINGS APPLIES TO THE COMMON DECLARATIONS FOR THE PERIOD 09/01/2016to 09/01/2017 PREMISES LOCATION NUMBER BUILDING NUMBER OCCUPANCY ADDRESS CONDO CAROLINA BELL RD CONDO CONDO ORCHARD, AND 961 & 965 CAROLINA BE CONDO'S CONDO CONDO CONDO ORCHARD VILLAS AVE 1445 ORCHARD VILLAS AVE 1451 ORCHARD VILLAS AVE 1481 ORCHARD VILLAS AVE 950 CAROLINA BELL RD 960 CAROLINA BELL RD CONDO 1471 ORCHARD VILLAS AVE CONDO CONDO CONDO 1444, 1450, ORCHARD VILLAS AVE 1461 ORCHARD VILLAS AVE 1444 ORCHARD VILLAS AVE IL T Page 1 of 1
10 BUSINESSOWNERS POLICY NUMBER: 680-1G ISSUE DATE: 08/24/2016 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EMPLOYEE DISHONESTY AND FORGERY OR ALTERATION INCREASED LIMIT This endorsement modifies insurance provided under the following: BUSINESSOWNERS PROPERTY COVERAGE SPECIAL FORM A. The BUSINESSOWNERS PROPERTY COVERAGE SPECIAL FORM is changed as follows: 1. The limit applicable to the Additional Coverage Employee Dishonesty is increased from $25,000 to $ 500, The limit applicable to the Additional Coverage Forgery or Alteration is increased from $25,000 to $ 500,000. MP T Copyright, The Travelers Indemnity Company, 2004 Page 1 of 1
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