COMMERCIAL LINES MANUAL DIVISION THIRTEEN COMMERCIAL LIABILITY UMBRELLA MIDDLESEX MUTUAL ASSURANCE COMPANY EXCEPTION PAGE EXCEPTION PAGES

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Lester Welch
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1 2. REFERRALS TO COMPANY Refer also to Rule POLICY WRITING MINIMUM PREMIUM Delete 8.A. and 8.B. Refer to Rule 13. for minimum premiums. 9. ADDITIONAL PREMIUM CHANGES A. Calculation Of Premium Delete 9.A.2. and replace with the following: If changes are made to a ratable exposure during the policy period, apply the rates and rules in effect at the beginning of the policy period. This rule applies to existing exposure changes, and to any new exposures added after the beginning of the policy period, except for any rules specifically written to apply otherwise for reasons such as statutory or regulatory compliance. The additional premium developed is in addition to any applicable policy writing minimum premium. B. Waiver Of Premium Delete additional premium waiver. 10. RETURN PREMIUM CHANGES B. Waiver Of Premium Delete return premium waiver. 13. MINIMUM PREMIUMS The following is added: Minimum Premiums apply as follows: Limit of Liability Low Hazard BOP Standard BOP Non- Contractors Standard BOP Contractors General Liability 1 st million $225 $425 $475 $600 2 nd million $225 $400 $400 $500 3 rd million $225 $400 $400 $500 4 th million $225 $400 $400 $500 5 th million $225 $400 $400 $500 CU-E-1

and replace with the following: If changes are made to a ratable exposure during the policy period, apply the rates and rules in effect at the beginning of the policy period.

2 22. DESCRIPTION OF COMMERCIAL LIABILITY UMBRELLA COVERAGE In addition to the forms designated as mandatory by ISO, the following forms are also mandatory. Punitive Damages Exclusion AIL Mutual Conditions Middlesex Mutual Assurance Company AIL Asbestos Exclusion ACU Liquor Liability Exclusion ACU In our CAPsure program the following forms are also mandatory. Exclusion - Athletic or Sports Participants CU Directors and Officers Liability Exclusion ACU Terrorism Forms The following will be added to all policies for new business and renewal. IL Disclosure Pursuant To Terrorism Risk Insurance CU Cap On Losses From Certified Acts Of Terrorism When terrorism coverage is rejected on an underlying policy the following notice will be sent to the insured for signature. PNAWA 02 Terrorism Coverage Rejection Statement When the insured chooses to exclude coverage and returns the Rejection Statement the ISO exclusion endorsement will be attached. CU Exclusion Of Certified Acts Of Terrorism 25. DESCRIPTION OF ADDITIONAL OPTIONAL ENDORSEMENTS Aircraft Dusting or Spraying Exclusion - ACU In Vermont, due to possible pollution liability exposure, this endorsement could only be used on a riskby-risk basis after approval of an individual risk "consent to rate" filing. 28. SPECIAL RULE FOR INDIVIDUAL RISK SITUATIONS Delete 28.A.1. and 28.A.2. and replace with the following: A. Refer to company for any risk or exposure for which the coverage to be written is materially broader or more restrictive than the coverage upon which the manual rate is based. 39. PREMIUM DETERMINATION Delete Rule 39. and replace with the following: COMPANY RATES Premium is calculated as follows: 1 st Million Layer Premium (GL + BOP + Auto + Garage) x Judgment Factor + D&O + Professional Liability + Liquor Liability + Swimming Pools = 1 st Layer Premium Note: Any Judgment credit must not exceed credit on underlying. CU-E-2 Revised 08/15/2011

3 2 nd & Subsequent Layer Premium Layers Above $1 Million 2 nd million=1 st Layer Premium X.40 3 rd million=1 st Layer Premium X.16 4 th million=1 st Layer Premium X.08 5 th million=1 st Layer Premium X.04 6 th million=1 st Layer Premium X.03 Any layer above 5 million must be referred for pricing. Total Umbrella Premium (1 st Million + 2 nd Million + 3 rd Million + 4 th Million + etc.) = Total Umbrella Premium Rating Formulas and Rating Tables: Unmodified Premium in the following formulas will be comprised of the liability premium based on class code only. (Unmodified premium will not include any optional coverages.) General Liability GL Unmodified Layer GL Unmodified Layer Premises/Ops Premium X Factor + Products Premium X Factor Hired & Non-Owned + Auto Charge = General Liability l Premises/Operations Underlying Limit will always equal Products Completed Operations Underlying limit Underlying Limits Occurrence /Aggregate Premises Operations (Limit ID from GL Rate Pages) Products Completed Operations (Limit ID from GL Rate Pages) A B C 500/ /1, ,000/1, ,000/2, ,000/2, ,000/5, Businessowners (BOP) BOP Liability Layer Hired & Non-Owned Unmodified Premium X Factor + Auto Charge = BOP CU-E-3

Total Umbrella Premium (1 st Million + 2 nd Million + 3 rd Million + 4 th Million + etc.

4 Underlying Limits Low Hazard * Standard All Contractors Occurrence /Aggregate Non-Contractors Non-Contractors 500/1, ,000/2, ,000/4, * Hazard assigned as follows. Worlds Apart/CAPsure Programs Low Hazard: Small Risk Dwellings ( 1-4 Family): Up to 24 total units. Apartment Buildings: Up to 2 Buildings with 12 or less units in each building. Condominiums: Up to 2 buildings up to 20 units. Standard Hazard: Large Risk All other. All Other Businessowner Policies Low Hazard: All non-contractor classifications except those listed as Standard Non-Contractors below. Standard Non-Contractors Convenience Food Stores With Gas Sales No Restaurant With Limited Cooking Restaurant No Gas Sales With Fast Food Restaurant No Gas Sales With Limited Cooking Restaurant - With Gas Sales With Fast Food Restaurant With Gas Sales Meat, Fish, Poultry or Seafood Distributors Fish or Seafood Meat Poultry Fish or Seafood Meat or Poultry Motels No Restaurants With Limited Cooking Restaurants With Fast Food Restaurants CU-E-4

Condominiums: Up to 2 buildings up to 20 units. Standard Hazard: Large Risk All other.

5 Fast Food Restaurants Cafes Cafeteria Style - Buffet Chicken Delicatessens and Sandwich Shops Drive-ins/Service in Car (When Drive-ins/Service in Car and any other eligible classification applies, rate and code the restaurant as Drive-ins/Service in Car.) Drug Stores Hamburger/Malt Shops Hotdog Shops Oriental Style Other Ethnic Style Pizza Shops Roast Beef Seafood Take Out Only Restaurants no on-premises consumption of food (When Take Out Only Restaurants no on-premises consumption of food and any other eligible restaurant classification applies, rate and code the restaurant as Take Out Only Restaurants no on-premises consumption of food. Limited Cooking Restaurants Cafes Delicatessens and Sandwich Shops Drive-ins/Service in Car (When Drive-ins/Service in Car and any other eligible Restaurant classification applies, rate and code the restaurant as Drive-ins/Service In Car.) Drug Stores Pizza Shops Salad Bars Take Out Only Restaurants no on-premises consumption of food (When Take Out Only Restaurants no on-premises consumption of food and any other eligible restaurant classification applies, rate and code the restaurant as Take Out Only Restaurants no on-premises consumption of food. CU-E-5

) 09131 Drug Stores 09151 Hamburger/Malt Shops 09161 Hotdog Shops 09181 Oriental Style 09191 Other Ethnic Style 09201 Pizza Shops 09221 Roast Beef 09241 Seafood 09251 Take Out Only Restaurants no

6 Auto Auto Liability Layer Unmodified Premium X Factor = Auto Underlying Limits CSL or Split Category Check Vehicle Type 1 st = PPA, Trucks & Tractors, Buses, All Other If Truck, then determine Light, Medium, Heavy, Extra Heavy Private Light Medium Heavy Extra Heavy Buses All Other Pass 500 CSL ,000 CSL ,500 CSL ,000 CSL Garage Garage Unmodified Premium X Layer Factor = Garage Use Per Person 500/ ,000/1, ,000/2, Directors and Officers Liability Directors and Officers Premium X Layer Factor = Directors and Officers Liability Person/Aggregate. 300,000 N/A 500, ,000, ,000, Liquor Liability Liquor Liability Premium X Layer Factor = Liquor Liability Person/Aggregate. Each Common Cause / Aggregate Limits 300, /300 or 300/600 N/A 500, /500 or 500/1, ,000,000 1,000/1,000 or 1,000/2, ,000,000 2,000/2,000 or 2,000/4, CU-E-6

14 Garage Garage Unmodified Premium X Layer Factor = Garage Use Per Person 500/500.28 1,000/1,000.20 2,000/2,000.

7 Employee Benefits Liability Employee Benefits Premium X Layer Factor = Employee Benefits Liability Occurrence /Aggregate 300/300 N/A 300/600 N/A 300/900 N/A 500/ / / / / / / / / Other Liability Other Liability Description Professional Liability (Prof Liab) Personal Liability Swimming Pool Charge Hired and Non-owned Auto Hired and Non-Owned Auto GL no associated Auto Policy BOP no associated Auto Policy Hired and Non-Owned Auto Only Policy Rate $50 flat Not Applicable $50 /pool w/out diving board $500 /pool with diving board Rate $25 flat $25 flat Premium of Class code included within Auto Refer to company for limits above $5,000, TERRORISM PREMIUM DETERMINATION Delete 41. and replace with the following: Terrorism coverage will be provided at no additional charge. When coverage is rejected on the underlying the insured will be asked to provide a rejection form to exclude coverage on the umbrella. CU-E-7

26 Other Liability Other Liability Description Professional Liability (Prof Liab) Personal Liability Swimming Pool Charge Hired and Non-owned Auto Hired and Non-Owned Auto GL no associated Auto

COMMERCIAL LINES MANUAL DIVISION THIRTEEN COMMERCIAL LIABILITY UMBRELLA MIDDLESEX MUTUAL ASSURANCE COMPANY EXCEPTION PAGES

COMMERCIAL LINES MANUAL DIVISION THIRTEEN COMMERCIAL LIABILITY UMBRELLA MIDDLESEX MUTUAL ASSURANCE COMPANY EXCEPTION PAGES 2. REFERRALS TO COMPANY Refer also to Rule 39. 8. POLICY WRITING MINIMUM PREMIUM Delete 8.A. and 8.B. Refer to Rule 13. for minimum premiums. 9. ADDITIONAL PREMIUM CHANGES A. Calculation Of Premium Delete