BUMNESS WBWaY CMVERAGE FORM
<br />Z ApokoWe To MeTcW Expenses Cover3gee
<br />e A, "rust' an e arm Onsured your trus"ees
<br />VVe �,POH no� pay exj��enses for bo6h,,, in��vy":
<br />are bso irsureds, but mmy *11h respect to
<br />ther MAK as =Mns.
<br />a, Any tnsuired
<br />Tb any On xeck exago %cknker wKe 0
<br />1 Each c',f th(e foflc,�v,,6rig A apso �iri msurnd
<br />b, Bred Person
<br />a, Einployees And Volunteer Workers
<br />To a peamn Wd W do wok kg Or on W0
<br />Y" o u r 1',,/ o I u rs` wh0e
<br />Of 311y �nsmerj ar -.,) �enant io�f any 41sured
<br />'A�or����o
<br />pedowmg Wes WaNTe czdf
<br />our busOess o your ployees" other
<br />c, Oijury On NorrnaHy Occup�erl Prevn�ses
<br />than erther your 'exeCUtk/e officers" (�� ✓ you
<br />ro a persi:m, injiw'ed on that pe crf
<br />as an organz0on other than a
<br />fbe
<br />P" _arybj'GS YC)j) rt ff' jt rJ'je e S
<br />pailmeirshq), �okr� venture or firn�ted ��aWjily
<br />nUMWY Occupies,
<br />cornpany) or your rrranag !.,rs (it you are a
<br />d, Workers' Compensaticm And Sim0jr
<br />iiimited lbb0y carrqpany), bW only fcx acts
<br />Laws
<br />wNhm the scope of thek empaynnnu Q,
<br />To
<br />yic�u c�r mdWe pedr)�ming
<br />,� dut,es reIatcd Icm
<br />a perscn,, wheffier r)y ni!�A a i i
<br />Me Cory"! 0 YWY Wows
<br />AnTbyee 0 a, maned, q berrMhs for
<br />the 1) )d4y rrpuG ," afe If' "uyabu e or must be',
<br />Hov e ,,e none of these, 'tmipby es" or
<br />rs-crv�ded under a workers m: )mpensatGon
<br />"Windeer YwA kers" are insureds for
<br />or dasabk hty t,,enefits)aw a sin0air l'avv
<br />(1) "Bo&y kl,twry" cr. "personal and
<br />e AhMs AcUvWes
<br />Avuhsog "JI":
<br />ro a person injured vvh,he pracfiang)
<br />To you, kD YCK�r p�jrU)e�'�, 01.
<br />Snstrkjcl.�ng or p'wlicipa�ing ki any physica�
<br />nwnZers R you am a pwlershp
<br />exurkes or game, spots or WhWc
<br />co wenC ure), t your ernbers
<br />COW&
<br />(4 y(.'si are a 4rni�ed Piat)rNy
<br />f. Piroducts-Campleted Operato.)ris Hazard
<br />C�')Injpany�' C")r a
<br />vvNe �n flie c��)uirse of his or her
<br />lrrr'�ude(t w0h the "�,M),-JL[CtS
<br />ernphymeM or pertamby TdAs
<br />operaUons hazwd"'
<br />WWd to IN: cordxt of yair
<br />g. Bushess LAW: Oky ExcWsWns
<br />t.,usiness, cr tc, your rrther
<br />Exckjdr,,d un,,,Jer Business L)@Wfly Coveraqe,
<br />W ol ed S' whi!e
<br />per'1r',rrrwrg dutles related k; the
<br />C, WHO IS AN INSURED
<br />::mm", M YMU bmhess
<br />1—" ymj am deslnWed A Te CeQnActns as
<br />�b) F)) the sprl�)use, 4:hrd parent,
<br />a, An mdNmduah you and your spouse are
<br />bmther or �! s,te� of That c&
<br />insureds, but on; y Mth rn adrw crg to
<br />or that "voluntew
<br />condU(1 oll: a bus4 eos whk�h you are t h e
<br />vworker" as a C,,,f
<br />Ste oNner
<br />ParagraN,: h (1)(a) jno ,,e�
<br />b� A �,mflnemhirp csr jonnt venture, you an� an
<br />(c � Ffri which thefu, G ,viy obhgaVon
<br />insured You� rnemt,,ers ycnir rr,,Wnera, and
<br />�(�) share damages w1lh or `("'?Ipay
<br />are alsoxsuireds, but only` mth
<br />s,,.:)rn(wone eMse wd cw rriusl pa',✓
<br />respect t(,.) theo!)vokld Of yCAA LUSkless
<br />danaqe ' becau5,e : flre 49P�4,fiy
<br />c� A bmited NabiO,� corrip;iny yru an�,, an
<br />�es'cibed in Piragiard* (1)�a) of
<br />krsurei,i Your n"rembers are also �nsureds,
<br />(b) above; or
<br />but on10,V with respect k) 'he conduc� of y,,our
<br />(d) AhIng out of his or her pRmdng
<br />bkjsf�'ess Yroir managers, are msured5, but
<br />cr f alNflg to provkie
<br />Wy W mqmd to W Wes as ymr
<br />health are se"ces,
<br />nwagus
<br />A YW am MA al to banns cAf
<br />K oMmkWon Wer Wra) a pmVeNhp,
<br />p coodlnq protessr(;NnJ care
<br />�o nt 'Ger'[Ure or tirrited IaNiry CCMIPW) d€;,'yGa
<br />ser,,Vices Paiagraph (d tJoes appifly
<br />xeanVnsured
<br />%) any, nurse, ernergency mjedk:�,'iN
<br />, �,)jjt �7,fj�y yqf,�� r,�,o,
<br />an�', �
<br />techn�danl or l�)cvarneJc emt,floyed by
<br />to thev dutes a�s your cffi�;�ers oq dYrec(oi�s
<br />yc',u to suc�� services
<br />butoNy
<br />(2)
<br />nth Iespet,,,t to kheu as stuckhrAders,
<br />�ai) (),,,vned, oc,:;upk,,,,d or us,�,,d by,
<br />Page 10 of 24 ]Ej ID
<br />Fami SS 00 08 04 05
<br />APR C" 0 181
<br />3
<br />BY
<br />
|