RLI Insurance Company Peoria, Illinois A Stock Insurance Company. Personal Umbrella Liability Policy SPECIMEN

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1 Policy Number: RLI Insurance Company Peoria, Illinois A Stock Insurance Company Personal Umbrella Liability Policy STATE OF NEW YORK AMENDATORY ENDORSEMENT In accordance with the laws and regulations of the state of New York, the policy is amended, as of its effective date, as follows: 1) PART I - DEFINITIONS is amended by replacing Definition C. as follows: "C. Bodily Injury means bodily injury, sickness or disease sustained by a person, including death from any of these any time. Bodily Injury also includes disability, mental anguish, mental injury, shock or fright resulting in or from otherwise covered bodily injury." 2) Section A.1.b. of PART III - WHAT WE WILL DO is replaced as follows: "b. If such Injury is not covered under the applicable Basic Policies and coverage is afforded under this policy, to the extent such amount exceeds the Self Insured Retention amount stated in the Declarations. Insured's consent is required to settle claims within the insured's retention, unless such consent is unreasonably withheld." 3) Section B.1. of PART III - WHAT WE WILL DO is replaced as follows: "1. We have the right and duty to defend you or such person against legal actions seeking payment from you or such person because of Injury. We will do this even if the allegations are groundless, false or fraudulent. We will pay the cost of this defense in addition to the Limit of Coverage." 4) Section B.3. of PART III - WHAT WE WILL DO is replaced as follows: "Our duty to defend, and any obligation we have to pay other defense costs or expenses under Section B. of the policy, ends when the amount we pay for any or all Injury, as determined by judgments or settlements, equals our Limit of Coverage. For claims or suits that we are defending: a. If we conclude that, based on claims or suits which have been reported to us and to which this insurance may apply, our Limit of Coverage is likely to be used up in the payment of judgments or settlements, we will notify you, in writing, to that effect. PUA 431 (04/10) Page 1 of 5

2 b. When the Limit of Coverage has actually been used up in the payment of judgments or settlements, we will notify you, in writing, that the limit has been used up and our duty to defend any suit seeking damages subject to that limit has also ended. c. We will initiate, and cooperate in, the transfer of control, of all claims and suits seeking damages which are subject to our Limit of Coverage and which are reported to us before that limit is used up. You and any other insured involved in a suit must cooperate in the transfer of control of said claims and suits. We agree to take such steps, as we deem appropriate, to avoid a default in, or continue the defense of, such suits until such transfer is completed, provided you and any other insured involved in the suit are cooperating in completing such transfer. We will take no action whatsoever with respect to any claim or suit seeking damages that would have been subject to that limit, had it not been used up, if the claim or suit is reported to us after our Limit of Coverage has been used up. You, and any other insured involved in a suit seeking damages subject to our Limit of Coverage, must arrange for the defense of such suit within such time period as agreed to between the appropriate insured and us. Absent any such agreement, arrangements for the defense of such suit must be made as soon as practicable. d. You will reimburse us for expenses we incur in taking those steps we deem appropriate in accordance with paragraph c. above. Your duty to reimburse us will begin on: (1) The date on which our Limit of Coverage is used up, if we sent notice in accordance with paragraph a. above; or (2) The date on which we sent notice in accordance with paragraphs b. above, if we did not send notice in accordance with paragraph a. above. e. The exhaustion of our Limit of Coverage by the payments of judgments or settlements, and the resulting end of our duty to defend, will not be affected by our failure to comply with any of the provisions of this Condition." 5) Section C.8. of PART III - WHAT WE WILL DO is replaced as follows: "8. In regard to C.1. through C.7. above, we will not be responsible, nor will we pay for, any defense, investigation, negotiation, legal fees, court costs, interest, or any similar fees or costs, when we have no duty to defend. We do, however, have the right to enter any such matter if we wish." 6) Section C.9. of PART III - WHAT WE WILL DO is replaced as follows: "9. If the Basic Policies do not provide coverage due to failure to comply with notice conditions in those Basic Policies, this policy also will not provide coverage for that claim. However, the claim may not be denied because of failure to provide timely notice if: a. It was not reasonably possible to give notice within the prescribed time, and notice was given as soon as reasonably possible thereafter, even if we were prejudiced, or b. The insurer has not been prejudiced, even if the claim was not made as soon as reasonably possible." PUA 431 (04/10) Page 2 of 5

3 7) PART IV - WHAT IS NOT COVERED - EXCLUSIONS is amended by replacing Exclusion E. as follows: "E. Any obligation you or anyone else has to provide benefits to employees under a worker's compensation, occupational disease, unemployment compensation, disability benefits law, or any similar law. However, this exclusion does not apply to liability that the policyholder may incur, under the provisions of the New York worker's compensation law, to an employee arising out of the course of employment of less than forty (40) hours per week in and about the residence of the policyholder in New York State and which is required, under the provisions of such law, to be covered by this comprehensive personal liability insurance." 8) PART IV - WHAT IS NOT COVERED - EXCLUSIONS is amended by replacing Exclusion N. as follows: "N. Injury arising out of any physical abuse, sexual abuse, or licentious, immoral or sexual behavior, or embarrassment, harassment or humiliation." 9) PART IV - WHAT IS NOT COVERED - EXCLUSIONS is amended by deleting Exclusion R. in its entirety. 10) PART IV - WHAT IS NOT COVERED - EXCLUSIONS is amended by deleting Exclusion W. in its entirety. 11) PART IV - WHAT IS NOT COVERED - EXCLUSIONS is amended by replacing exclusion BB. as follows: "BB. Injury which arises, directly or indirectly, out of the discharge, dispersal, release or escape of smoke, vapors, soot, fumes, acids, alkalis, toxic chemicals, liquids or gases, waste materials or other irritants, contaminants or pollutants into or upon land, the atmosphere or any water course or body of water, unless such discharge, dispersal, release or escape is sudden or accidental." 12) Section B.1. of PART VI CONDITIONS is replaced as follows: "1. Notify us or our agent as soon as possible. However, coverage may not be denied because of failure to provide timely notice if: a. It was not reasonably possible to give notice within the prescribed time, and notice was given as soon as reasonably possible thereafter, even if we were prejudiced, or b. The insurer has not been prejudiced, even if the claim was not made as soon as reasonably possible;" 13) PART VI CONDITIONS is amended by replacing Condition D. Legal Actions Against Us as follows: "D. Legal Actions Against Us 1. Except as provided in Paragraph 2., no one can bring us into any legal action against you or anyone else covered by this policy. No legal action shall be brought against us unless you have complied with the policy provisions, nor until your obligation has been set by final judgment or agreement with us. 2. With respect to personal injury (as defined under New York Law) or wrongful death claims, if we disclaim liability or deny coverage based on a failure to provide timely notice, then the injured person or other claimant may maintain an action directly against the insurer, on the sole question of late notice, unless the insured or we, within sixty (60) days of the disclaimer or denial, initiates an action to declare the rights of the parties under the policy, and names the injured person or other claimant as a party to the action." PUA 431 (04/10) Page 3 of 5

4 14) PART VI CONDITIONS is amended by replacing Condition H. Conform to Law as follows: "H. Conform to Law. It is hereby understood and agreed that, notwithstanding anything in this policy to the contrary, with respect to such insurance as is afforded by this policy, the terms of this policy, as respects coverage for operations in the State of New York, shall conform to the coverage requirements of the applicable insurance laws of the State of New York, or the applicable regulations of the New York Insurance Department; provided, however, that the company s limit of liability, as stated in this policy, shall be excess of the limits of liability of any underlying insurance, or self-insurance, as stated in the Declarations, or in any endorsement attached hereto." 15) PART VI CONDITIONS is amended by replacing Condition J. Other Insurance as follows: "J. Other Insurance. There may be other valid and collectible insurance, in addition to the Basic Policies, covering a claim which is also covered by this policy. If this occurs, the other insurance will pay first and this policy will respond in excess of, and not contribute with, the other insurance. This insurance does not apply until after exhaustion of all other valid and collectible insurance and/or other protection available to the insured (the Basic Policies, personal or commercial automobile insurance, employer s insurance and/or any other protection or indemnification whether primary, excess or contingent)." 16) PART VI - CONDITIONS is amended by replacing Condition L. Cancellation as follows: "L. Cancellation. 1. You may cancel this policy by mailing or delivering to our agent, or to us, advance notice of the date you wish it to be cancelled, enclosing therewith your copy of this policy. Your premium refund, if any, will be based on the short rate table. 2. If this policy has been in effect for sixty (60) days or less, and isn't a renewal, we may cancel it for any reason by mailing a written notice to you, at your address as stated in the Declarations, within this period. The notice will be mailed at least fifteen (15) days before the effective date of cancellation and will state the specific reason for cancellation. 3. If this policy has been in effect for more than sixty (60) days or is a renewal, we can cancel it during the Policy Period, in the manner described in 2. above, only for any of the following reasons: a. if you fail to pay any premium when due, provided, however, that the notice shall inform the insured of the amount due; b. if you are convicted of a crime that results from acts that increase the chance of loss; c. if you obtained the policy through fraud or misrepresented any material fact while obtaining the policy or presenting a claim; d. if we discover you have committed willful or reckless acts or omissions which increase the hazard insured against; e. if required pursuant to a program approved by the Superintendent of Insurance as necessary because a continuation of the present premium volume would be hazardous to the interests of our policyholders, our creditors or the public. PUA 431 (04/10) Page 4 of 5

5 4. Proof of mailing shall constitute proof of notice. 5. In lieu of cancellation, we may condition continuation of the policy upon change of limits or elimination of any coverage not required by law, upon mailing or delivering written notice to you at your address shown in the Declarations at least twenty (20) days prior to the effective date of such action. 6. No notice of cancellation, reduction of limits, substitution of policy form, elimination of coverages, conditioned renewal or of intention not to renew, or notice of the reasons therefor, that fails to include a provision required by law shall be an effective notice. A copy of such notice, or a summary of such notice, shall be mailed, delivered or transmitted to the insured's authorized agent or broker within seven days of the time such notice is mailed to the named insured." 17) PART VI - CONDITIONS is amended by replacing Condition M. Nonrenewal as follows: "M. Nonrenewal. 1. If we decide not to renew this policy or to condition its renewal upon change of limits or elimination of coverages, we will mail or deliver a written notice of such action to your mailing address as shown in the Declarations. We will mail or deliver this notice at least forty-five (45) days, but not more than sixty (60) days, before the expiration date of the policy. The notice will state the specific reason for nonrenewal or conditional renewal. However, the policy may not be nonrenewed or conditionally renewed during the period of three (3) years from the date it was first issued except for one or more of the reasons listed in the section entitled Cancellation of this policy. 2. Proof of mailing this notice to you at your address shown in the Declarations will be proof that you were notified. But we will not send this notice if you, your agent or your insurer, has mailed or delivered written notice to us that the policy has been replaced or is no longer desired." 18) PART VI - CONDITIONS is amended by replacing Condition N. Concealment - Misrepresentation as follows: "N. Concealment - Misrepresentation. This insurance does not provide coverage for you if you, whether before or after a loss or Occurrence, have: 1. intentionally concealed or misrepresented any material fact or circumstance; or 2. engaged in fraudulent conduct; relating to this insurance." 19) PART VI - CONDITIONS is amended by adding a new provision as follows: "P. In case judgment against the insured or his personal representative in an action brought to recover damages for injury sustained or loss or damage occasioned during the life of the policy or contract shall remain unsatisfied at the expiration of thirty days from the serving of notice of entry of judgment upon the attorney for the insured, or upon the insured, and upon the insurer, then an action may, except during a stay or limited stay of execution against the insured on such judgment, be maintained against the insurer under the terms of the policy or contract for the amount of such judgment not exceeding the amount of the applicable limit of coverage under such policy or contract." Attached to and forming part of the policy of the RLI Insurance Company. All other terms and conditions of the policy remain unchanged. PUA 431 (04/10) Page 5 of 5

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