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Building Permit #708-2016 - 91 MAIN STREET 12/9/2015
BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: '.?t'2j,. Date Issued: IMPORTANT: Applicant must Date Received all items on this LOCATION 91 Yd, M Azt+ (STREET Print I PROPERTY OWNER i�ov' R �c� e L, CQE,Dtr U n 104 Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential N Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 0.Septle 0 Well El Floodplain ❑ Wetlands ❑ Watershed. Distract ❑ Wates/Sewer DESCRIPTION OF WORK TO U O- B�E1 PERFORMED: `n n nM �Pn04 i t4 P z I Sou Nokelll' (,ell &J-665-07967 Identification - Please OWNER: Name: Address: or Print Clearly 11 . Contractor Name: AW s Cie'rne',L Phone: In- goy- Email:GJ�E`l� 1 2 0 e--'Q1k7Qhd'7r kel— Address:- /1/�i�l-.r J L -i AA 1110�.' ©!; Superviso Co stru 'InL'eraseG5 .-� �� Exp. Date: Home Improvemen icExp. Date: ARCH ITECT/ENGINEE Address: Phone: s • l -9q-475-& 133 7s FEE SCHEDULE. BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.0 PER S.F. Total Project Cost: -Ob FEE: $ 1� f Check No.: Receipt No.: NOTE: Persons contracting with ugjvgtXjfqqtray(gYs.do not have access to the guaranty fund Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL E Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m U FORM PLANNING & DEVELOPMENT Reviewed On _j/ Signature_' COMMENTS Per he k. 4t-'\X6r 1A -o, �*-CW CONSERVATION Reviewed on Sianature COMMENTS HEALTH COMMENTS Reviewed on Signature h r�? ( H, aj, Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Wafter & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street �. EPAR¢TMEIVT -,TG nY ite FIRED r ,_, rripDumpsfer o s � Locatedlaff1241MaintStr•eet_ ' -- ' "�" " "- ""� ` - - �"'- FireD`epartmen`t;�ignature%date ' - - COMMENTS. Dimension Number of Stories: I Total square feet of floor area, based on Exterior dimensions. 130D Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: lyes No MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine NOTES and DATA -- (For department use) Doc.Building Permit Revised 2014 A yz-e LA- ✓i�� o �vs wt�,G A I tyl U Pix -44 t ti►-pk LAVY1'-'j hl � 0"rjt, v �hvA tons — N v l9z D OCT- Ei�T LJ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 A Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits Building Permit Application Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses 4� Copy of Contract � Floor Plan Or Proposed Interior Work Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks Building Permit Application Certified Surveyed Plot Plan Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses Copy Of Contract Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations-(If•Applicable) . Mass check Energy Compliance Report (If'Applicable) Engip, eeringAffidavits-.for Engineered products TOTE: All.dumpster permifs require sign, off from Fire, Department prior to issuance of Bldg Permit New Construction (Single and Two Family) Building Permit Application + ' Certified Proposed Plot Plan Photo of H.I.C. And C.S.L. Licenses Workers Comp Affidavit Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Copy of Contract 2012 IECC Energy code, ; - t Engineering Affidavits for Engineered products IOTE: All dumpster permits require sign off from Fire Departmen't'pridr to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doe: Building Permit Revised 2014 W/ CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 708-2016 on 12/9/2015 Date: July 12, 2016 THIS CERTIFIES THAT THE BUILDING LOCATED at 91 1/2 Main Street MAY BE OCCUPIED AS a tenant fit up — Andover Federal Credit Union IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Andover Federal Credit Union 91 % Main Street North Andover, MA 01845 Fee: Fee Waived per Selectmen Receipt: Check : .r C O H 2 Z cfl Z COW _w CL W W M Mw E (I� O O Z N o = A� � C W Q t/1 •E m m a0CD� O — A ce .Q O 0 O CL � Q �CL O a Z CD O U cnCL CL U) B Q ,. t=_. W Q W p LU d ui d O i C LL Z Z �� �� LLA - a Z Z Z N ``. C 1 m(U a ui L''e m J J LU Y 0 O O_ :3 7 C _ m ��. .: i =3 z L O Oto LL c' U LL d' LL .CrN K LL CO N N C O H 2 Z cfl Z COW _w CL W W M Mw E (I� O O Z N o = A� � C W Q t/1 •E m m a0CD� O — A ce .Q O 0 O CL � Q �CL O a Z CD O U cnCL CL U) B -V a F— O m :ate Z W w CL w W CL MIA Z v v O 2 Z v v O E O Z O O CLN L O V cu a O cn O U ca cu r -m L 0 V N N C a O C D � m m ~ J O O V In LLI Z W 0 W CL W c c L N u N m O O •� ... v d Q1��7 LU yJj tom, LLI \ UJ Z Y O O. C: CLO � to 7 - N O, i f0 �`l O ` U- N LLO W U CG Li m N N F— O m :ate Z W w CL w W CL MIA Z v v O 2 Z v v O E O Z O O CLN L O V cu a O cn O U ca cu r -m L 0 V N N C a O C D � m m LL. v_1 C O � W 0 v O V L d 0 � ._ 0.0 O Cf) p' O > 2 tcC ma O C O O I— O_ 0 0 > F— O m :ate Z W w CL w W CL MIA Z v v O 2 Z v v O E O Z O O CLN L O V cu a O cn O U ca cu r -m L 0 V N N C a O C D � m m OF HoRTH 1ti O ti b t i . r 3�'rSAC11U5E"� CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 708-2016 on 12/9/2015 Date: July 12, 2016 THIS CERTIFIES THAT THE BUILDING LOCATED at 91 1/2 Main Street MAY BE OCCUPIED AS a tenant fit up — Andover Federal Credit Union IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Andover Federal Credit Union 91 % Main Street North Andover, MA 01845 Fee: Fee Waived per Selectmen Receipt: Check : Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 150,000.00 m $ - $ 1,800.00 Plumbing Fee $ 225.00 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 225.00 Total fees collected $ 2,350.00 91 1/2 Main Street 708-2016 on 12/9/2015 Andover Credit Union Q AR RM C W C rn 6 y S L �_43) .a o > c ' C d'a t C, p m 0 C 4)` Q 2 p a, o QtiC)Z abi _ m N �s�y RM Q A = VGA A N c > LLP U ii � i a fa `n s QLiVZ LiJ g� 7x� 0¢ k§ « tk �i t« � A kI / � c L ! Lu _ k k U/ UJ — kk j j E !2 uj Q > o § ƒ L U 2 § U §\� 2 k§ E� tk �i t« !« 7 kI / 74 IN n 'WD'w O Z Q ,� O D Q O Do L U O LL N to a)O N OO W W CL Z Z m C O '� LL O CC ? t U C LL W CL Z Z m J d O d' CO LL a z -jv�'i u u W _C d' U N N C LL oc O W Z Q (� -C O K C LL z LU OC Qa W W LL v 7 m O Z CU (% + a1 Y N O CL (1) m� I�j o EcL c V N CD 3 o. c J d CD W c -0 O to—_ cc 010 H Q -_ • V1 = o0 L Q cc 0Q V d•+ Q L L c H 06 a) V •� ujcom LU '0— O O LU .E U) CLd > N U) c c ._ .� CLov Em o W :a z Z 0 �m v C �a z F- 0cn Z F— ui CL v I XLLJ 'O1 V C W LLI -i CL Z Qq E o 0 z o c Q �E °' m W CL 0 a O CL Q CDr 0 v J Cc �C O W O CL Vy/ i CL 0 0 EEO O < LL In O m L Y \ O LL E +�+ ?O Ln U Q (ry Wa Z C7 Z C > m C i m 'a 7 LCL S d' T N C U LL O a Z Z m > Q. L cc LL O u a Z Q v W W w d U) LL a: W Z LA Q d' LL z D: W a W 25 LL m O Z (y N p O (n 7,M C C O Cc C Cc o � O tv �(D-a a o s o E `v. LST V Q_ r R 3 w° 1 • d i m d N �_D N . a) L O .a N � O O O O cc 4= CL N OO d C � .N 3 a) : L Q a .� a) m CJ «• c L `° 0 'U' a� v O Q L r- 124) cc ai•5 .O 2 m CN ~ y0, y O V m d LLJ C 'O --' O O 4) O -a CD FL+ 2 tyC o O. C O O LF E o o z oC � m � V/ •M W CL t 0 cc 0 CL a CL s =M Cc A.) J -0 •CL O O U) Z O V tU CLU B a Z Z 0 =m cn �- i— Q Z C) G Z H LU W Cl) iL XLLJ 0 W CL Z LF E o o z oC � m � V/ •M W CL t 0 cc 0 CL a CL s =M Cc A.) J -0 •CL O O U) Z O V tU CLU B Brown, Gerald From: Maylor, Andrew Sent: Thursday, December 10, 2015 9:01 AM To: Brown, Gerald Cc: Burzlaff, Laurie Subject: Permit Fee Waiver Gerry, At their meeting on November 30, 2015 the board of selectmen voted to waive the building permit fee for the Andover Federal Credit Union on Main Street. Andrew W. Maylor Town Manager Town of North Andover 120 Main Street North Andover, MA 01845 Phone 978.688.9510 Fax 978.688.9556 Email amaylor@northandoverma.gov Web www.northandoverma.gov 13 4CEl ❑0 1 General Contracting Agreement This General Contracting Agreement ("Agreement") is made this 18th day of November, 2015 between Christopher Clemente henceforth known as "Contractor," and Andover Federal Credit Union henceforth known as "Owner." Pursuant to the work described, the Contractor and Owner agree to the following: Section A Designee/Project Manager The Contractor has been approved by the Owner to utilize a Designee/Project Manager for the completion of said demolition and remodel of the property at 91 %2 Main Street, North Andover, MA 01845. The Contractor and Owner have appointed Lisa Morelli, CEO of Andover Federal Credit Union. The Contractor at any time may request the. Designee/Project.Manager to discuss/review all and any improvements to said building. Section 1 The Work The Contractor/ Designee/Project Manager and Owner agree that the following work will be done ori 91 'h Main Street, North Andover, MA 01845: • Four windows to be cinder blocked. The locations of windows are on the east and west side of the back of said building. • Vent fan to be removed and cinder blocked. Located in the back of said building. • Remove vent on the east side of building and cinder blocked. • Repair of east side wall • Interior cinderblock walls to be re -pointed and skim coated as needed. o Cost Estimate: $3,856.00 • Removal of all interior (ceiling, paneling, bathroom walls, wood flooring and all debris) with the exception of the HVAC unit and drain waste vents. o Cast Estimate: $5,200.00 • Temporary construction lighting and plugs to be installed by Andover Electric o Cost Estimate: $1,744.13 • Relocation of water pipe and meter above ground, with a temporary water source to be placed at the southeast interior wall of said building. o Cost Estimate: $1,450.00 • Design and Blueprints 11X17 stamped by Sam Kachmar Architect and Morelli Design. o Cost Estimate: $3,000.00 Continuation of Section 1 • Roof - replace rubber membrane o Cost Estimate: $11,995.00 • Framing, Insulation and Drywall o Cost Estimate: $17,250.00 • Finish plumbing (Two bathrooms and kitchen sink) o Cost Estimate: $8,950.00 • Finish electrical o Cost Estimate: $11,200.00 • Finish Carpentry, Teller Line, Kitchen Cabinets, Counters, Flooring and Painting o Cost Estimate: $23,800.00 • HVAC duct replacement and re -start o Cost Estimate: $6,875.00 • Glass vestibule and conference room o Cost Estimate: $12,155.19 • Exterior masonry siding o Cost Estimate: $6,755.00 • Exterior front windows and top fagade o Cost Estimate: $9,853.25 • Drop ceiling o Cost Estimate: $7,395.00 • Cameras, Vaults, Alarms and Security Systems o Cost Estimate: $18,490.00 Total Estimated Cost: $149,968.57 All items listed above are estimated costs and the proposed budget by the Owner for a total of $150,000.00, since bids are still being accepted for the remodel of 91 '/ Main Street, North Andover, MA 01845. Section 2 Timeline The Contractor and Owner agree that the work detailed above will be completed according to the following timeline: Work Start: November 19, 2015 Work Frequency: Five days per week with hours based on the necessity to keep the project in compliance with said timeline Work Completion: February 28, 2016 Any delays that arise during the course of the work must be discussed with Owner immediately. Section 3 Payment Owner agrees to pay the Contractor a total of $500.00, payable at project completion. All other payments to subcontractors will be paid as invoices are received and approved by the Designee/Project Manager. Section 4 Changes Any changes made to plans, materials used, time needed or any other portion of the work must be discussed with Owner prior to any decisions. Section 5 Permits Designee/Project Manager agrees to secure any permits necessary so that this work will be done within the parameters of the laws of Massachusetts Designee/Project Manager agrees that any fees for these permits are already included in the total amount charged to the Owner. Section 6 Workers Designee/Project Manager agrees that any laborer, subcontractor and/or employee that he/she hires for the purposes of this job is legally permitted to work in this function in this country. Section 7 Subcontractors Owner approved that the Contractor has hired a Designee/Project Manager (Lisa Morelli), who may hire subcontractors at his/her- discretion. Section 8 Insurance Owner agrees to maintain the appropriate Builders Risk Liability insurance on the 91 '/z Main Street, North Andover, MA 01845 property. The insurance is effective as of October 16, 2015 through April 16, 2016. Producer#ZU11335288, Doherty Insurance Agency, Inc., P.O. Box 1985, Andover, MA 01810-0034, with US Assure insurance, policy number BR08580716-001. Section 9 Cleanup Designee/Project Manager agrees that any debris, equipment, etc. will be removed from the property upon completion of the job. The location will be returned to the state in which it was found prior to the work, excepting, of course, the changes made as a result of the work. Invalidity or unenforceability of one or more provisions of this Agreement shall not affect any other provision of this Agreement. Contractor and Owner acknowledge that this Agreement is subject to the laws and regulations of the state of Massachusetts. AnJoVeAR 1 e'.L ,'-1�� r Un && Owner Name a,6 Owner .ign ure�� f . IA[k'DOW'rl F IaC RAL ONEDit UNION 19C LUPINE ROAD ANDOVER, NIA 01810 Ve Contractor Name Contractor Signature F<' i� The Commonwealth of Massachusetts Department of Industrial Accidents kip; I Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO 13E FILED WITH THE PER"ITI YG AUT HORTTY. --.._....__..._..._..._......- ----•...... _........... ..� ApphcanE info—r_m_- -- .._ ation -------•---. __._...._................. / _ Ple`ascPiiiit- I:eQt�ilY Name (Business/Organizatiou/Lndividual): T— City/State/Zip: Are you an tnapleyer? Cheese the appropriate box: Phone #: 97S- FS 0 � — �� t.❑ I am a cmploycr with cmptayacs (full and/or part-time)., 2�&1 am a sole pmpridor orpartncrAip and have no employc= working for me in any capacity. [No workers' co -V. insurance raptirvd.] 3.01 am a bon-Amwncr doing all worst myself- [No workcrs' comp. invi ancz rcquired-I t 4.[]] am a bowcowner and will be hiring contractors to coodua all work on my ptoperty. I will casurc that all eootradorx chber bave workers' compaasxion insuraocc or arc sok Proprietors with ao employees. S Q I am a gtncxal c000vcyor and I bavc hired the sub -contractors listed on &c arrachcd shed. 71ese sub-coauactors have cmployc s and have wor'kai comp. iasurzocr : 6.0 We arc a corporation and its officers have cxcrcL&cd their right of mterapiion per MGL 152. § 1(41 and we have no aaployces [No workers comp. insurance required.) Type of project (required): 7. E] New construction 8. Remodeling 9. Demolition 10 ❑ Building addition 11.0 Electrical repairs or additions 12.E] PIumbing repairs or additions 13.❑Roof repairs I4. []Other Any applicant that cheeks box #1 must also fill out the section below sbowing their workers' compensation policy iofarmatioo. 1 Iiomoowaers wbo submit this affidavit indicating tbcy arc doing aI I work nod thm biro outside aoatrnctors muse submit a Dcm affidavit indicating such. rCootractors that cb,cek this box mtm attacbcd an ndd"uional sbcct sbowiag the name of the sub-coomcwn and state wbctbcr or not thaw cotitics have cmploycm If the stsb contraclats bavc rsnrloyocs, they must provide tbcir workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees Bdow is the policy and job site information. Insurance Company Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address. City/Statogip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as rcquircd under MGL c. 152, §25A is a criminal violation punishable by a fine up to 51,500.00 and/or one-year imprisanmcn4 as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 a day against the violator_ A copy of this statement may be forwarded to the Off ice of Investigations of the DIA for insurance covaagc verification. I do hereby c4arIffit under the pacts and penalties of perjury that the informatwn provideda is true and correct 5ignaturc: _-T� Date. / / 7,�/.� t=1t WAJMAAVlW Official use only. Do not write in this area, to be completed by city or town offuial City or Town: Permit/License Issuing Authority (circle one): L Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Phone f/• AL Massachusetts - Department of Public Safety Board of Building Regulations and Standards construction Sifperl isor License: CS -064287 CHRISTOPHER A-`CLEMENTE 3 Michael Way f Andover MA 01830 i r` Expiration Commissioner 09/23/2016 1 .-. Coup w�ch Sofal'yIlse9 �m)of aBixu3a p00 cubic feet (99 Unrestricted cone less �' enclosed space W WW.Massa oh ,rent editkov01theof ths cen e' posseaause Ior reo`atlon\ lops Failuret.heoius MassG0 StateBulding visit. for DFS licensing oormatton .s Important Notice to Policyholders The address for the headquarters of Zurich North America will change after August 1, 2016 due to a relocation of our office in the same city. The new address is: Customer Inquiry Center Zurich North America 1299 Zurich Way Schaumburg, IL 60196 1-800-382-2150 For specific questions regarding your policy, please contact your agent or broker. For other questions, you may contact the Customer Inquiry Center of Zurich North America. Any references to post office boxes previously provided remain unchanged. U -GU -1194-A CW (08/15) Page 1 of 1 ZURICH NOTIFICATION OF IMPORTANT CHANGES RELATING TO TERRORISM RISK INSURANCE ACT To Our Valued Customers: The Terrorism Risk Insurance Program Reauthorization Act of 2007 ("TRIPRA 2007") had been scheduled to expire on December 31, 2014. Congress enacted a six year extension of TRIA entitled, Terrorism Risk Insurance Program Reauthorization Act of 2015("TRIPRA 2015"), which will expire on December 31, 2020. For purposes of simplicity we will simply reference the act as TRIA. There are several important changes to TRIA included within the extension of which you should be aware: A. Change in Definition of "Act of Terrorism" Prior to the enactment of the extension legislation, TRIA had required that an "act of terrorism" meant any act that is certified by the Secretary of the Treasury in concurrence with the Secretary of State. However, this has been changed in that certification by the Secretary of the Treasury shall be in consultation with the Secretary of Homeland Security and the United States Attorney General. B. Reduction in the Federal Share of Terrorism Losses by Increasing the Insurer Co -Pay from 15% to 20% Over Five Years The United States Government may pay a share of insured losses resulting from an act of terrorism. The federal share will decrease by 5% from 85% to 80% over a five year period while the insurer share increases by the same amount during the same period. The schedule below illustrates the decrease in the federal share: January1, 2015 — December 31, 2015 federal share: 85% January1, 2016 — December 31, 2016 federal share: 84% January1, 2017 — December 31, 2017 federal share: 83% January1, 2018 — December 31, 2018 federal share: 82% January1, 2019 — December 31, 2019 federal share: 81% January1, 2020— December 31, 2020 federal share: 80% C. The Current Program Trigger for Aggregate Industry Insured Losses Will Increase from $100 Million to $200 Million Over Five Years The extension of TRIA increases the Program trigger from $100 million to $200 million over a five year period. This means that the Program trigger will increase by $20 million with respect to any such insured losses occurring in calendar year 2016 and continue to increase by $20 million until calendar year 2020. At the end of this five year period the Program trigger will be $200 million. D. Increases in the Recoupment of the Federal Share of Insured Losses The extension of TRIA increases the amount used to calculate marketplace aggregate retention from $27.5 billion to $37.5 billion in $2 billion increments beginning in the calendar year 2015 and reaching $37.5 billion in calendar year 2019. Beginning in calendar year 2020 the TRIA extension revises the mandatory recoupment amount to be the amount equal to the annual average of the sum of insurer deductibles for all insurers participating in the Program for the prior three calendar years, with such amount to be determined annually by the Secretary of the Treasury. Under the TRIA extension, the recoupment of mandatory recoupment amounts has increased from 133% to 140%. U -GU -766-B CW (01/15) Copyright © 2015 Zurich American Insurance Company Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 0 Disclosure Statement ZURICH��� It is our pleasure to present the enclosed policy to you for presentation to your customer. INSTRUCTION TO AGENT OR BROKER: WE REQUIRE THAT YOU TRANSMIT THE ATTACHED/ENCLOSED DISCLOSURE STATEMENT TO THE CUSTOMER WITH THE POLICY. Once again, thank you for your interest, and we look forward to meeting your needs and those of your customers. U -GU -873-A CW (06/11) Page 1 of 1 Q Disclosure Statement ZURICH!. NOTICE OF DISCLOSURE FOR AGENT & BROKER COMPENSATION If you want to learn more about the compensation Zurich pays agents and brokers visit: http://www.zurichnaproducercompensation.com or call the following toll-free number: (866) 903-1192. This Notice is provided on behalf of Zurich American Insurance Company and its underwriting subsidiaries. U -GU -874-A CW (06/11) Page 1 of 1 CONSTRUCTION MATERIALS AND INSTALLATION COVERAGE DECLARATIONS The Declarations, Supplemental Declarations, Common American Zurich Insurance Company Policy Conditions, Commercial Inland Marine Conditions, A Stock Company Coverage Form(s) And Endorsement(s), if any, issued to Administrative Office: 1400 American Lane and forming a part thereof, complete the Commercial Schaumburg, IL 60196 Insurance Policy numbered as follows: Q New Policy THIS IS A COINSURANCE CONTRACT gR08580716 ❑ Renewal of Please read your policy. ❑ Rewrite of In return for the payment of the premium, and subject to all terms of this policy, we agree with you to provide the insurance as stated in this policy. 1. Named Insured and Mailing Address: 2. Producer Information: Andover Federal Credit Union A Name: DOHERTY INSURANCE AGENCY, INC 19C Lupine Rd PO BOX 1985 Andover, MA 01810 ANDOVER, MA 01810-0034 B Telephone # +1 978 475 0260 C Fax # +1 978 475 0303 3. Policy Period — From: 10/16/2015 To: 04/16/2016 D Zurich Producer # 11335288 E Field Office Name 12:01 a.m. at your mailing address above. F Field Office Code 4. Form of Business: ❑ Individual ❑ Partnership x❑ Corporation ❑ Joint Venture []Other 5. Limits of Insurance (either One -Shot or Reporting Form as indicated below) FX1 SUPPLEMENTAL DECLARATIONS (if this box is checked, Supplemental Declarations is attached to and forms a part of this policy) ❑ Reporting Form (continuous policy) ❑x One -Shot (non -reporting form/single structure policy) ❑ Annual Rate El Monthly Rate (HBIS —4) ❑ 1-4 Family Dwelling x❑ Commercial Structure Property Location A) Any one building or structure $ 91 .5 Main Street B) All covered property at all locations $ North Andover, MA 01845 C) Rate Per Report D) Premium Per Report New Construction E) Total Taxes and Surcharges Per Report A) Any one building or structure $ (per attached endorsement) B) All covered property at all locations $ F) Total Fully Earned Policy Premium Per Report (same as A unless otherwise noted) Remodeling D) Renovations and improvements $ 150,000 E) Existing buildings or structures $ 75,000 F) Rate $ 0.36 G) Premium $ 828.00 H) Total Taxes and Surcharges $ 0.00 (per attached endorsement) 1) Total Fully Earned Policy Premium $ 828.00 minimum premium applicable) 6. Deductible: 0$500 ❑$1,000 ©$2,500 ❑$5,000 ❑Other 7. Forms Applicable To This Coverage Part: SEE SCHEDULE OF FORMS AND ENDORSEMENTS Countersigned: Date M Authorized Representative FM -170001 MA (04-10) CONSTRUCTION MATERIALS AND INSTALLATION COVERAGE SUPPLEMENTAL DECLARATIONS Policy Number: BRO8580716 Policy Type: ❑ Reporting Forms (continuous policy) OR 0 One -Shot (non -reporting form/single structure policy) ADDITIONAL COVERAGES (COVERAGE FORM) LIMIT OF INSURANCE a. Collapse Included b. Scaffolding, Construction Forms And Temporary Structures $ 20,000 Re -erection Of Scaffolding $ 10,000 c. Debris Removal $ 20,000 d. Back -Up Or Overflow Of Sewers, Drains Or Sumps $ 5,000 e. Fire Department Service Charge $ 10,000 f. Valuable Papers And Records $ 20,000 g. Pollutant Clean -Up And Removal $ 15,000 h. Ordinance Or Law — Direct Damage Loss To The Undamaged Portion Of The Building Demolition Cost $ Increased Cost Of Construction $ Combined Aggregate For Demolition Cost And Increased Cost Of Construction $ i. Preservation Of Property Included j. Rewards $ 10,000 k. Property At A Temporary Storage Location $ 10,000 I. Property In Transit $ 25,000 OPTIONAL ADDITIONAL COVERAGES (ENDORSEMENTS) ❑ Business Income (HBIS-95) $ Anticipated Project Completion Date Monthly Limit Of Indemnity (fraction) Deductible Period days Civil Authority Included ❑ Business Income And Extra Expense (HBIS-82) $ Anticipated Project Completion Date Monthly Limit Of Indemnity (fraction) Deductible Period days Business Income Included Extra Expense Included Civil Authority Included ❑ Development Or Subdivision Fences, Walls And Signs (HBIS-58) $ ❑ Expediting Expense (HBIS-93) $ ❑ Extra Expense (HBIS-92) $ ❑ Marine Model Home Contents Coverage (❑ HBIS-52 —OR— ❑ HBIS-77) $ ❑ Soft Costs Coverage (HBIS-88) $ Anticipated Project Completion Date Deductible Period days Expense To Mitigate Loss Included Civil Authority (coverage extended for 3 additional consecutive weeks) Included OPTIONAL COVERAGE EXTENSION (ENDORSEMENT) ❑ Builders Risk Green Building Coverage Extension (HBIS-96) Aggregate Limit of Liability $ "LEED° Building Rating" HBIS-91 MA (04-09) Policy Number BR085807.16 SCHEDULE OF FORMS AND ENDORSEMENTS Named Insured: Andover Federal Credit Union Effective Date: 10/16/20.15 12:01 A.M., Standard Time Agent Name: DOI-IERTY :INSURANCE AGENCY, INC Agent No.: 1.1335288 FM170001 MA(04/10), I1BIS-91 MA(04/09), U -GU -619-A CW(10/02), 4047:1(04/09), I -IBIS -37 MA(04/09), I -IBIS -1 MA(04/09), I-1BIS-2 MA(04/09), I -IBIS -79 MA(04/09),1-1BI.S-83 MA(04/09), IIBIS-84 MA(04/09), U -GU -630-D CW(01/15), U -GU -767-.B CW(01/15), 1L0003(09/08), CM0001(09/04), IL0017(1.1/98), U -GU -I 191-A CW(03/15), U -GU -319-F(01/09) U -GU -619-A CW (10/02) M Construction Materials And Installation ZURICH Coverage Form Various provisions in this policy restrict coverage. Read the entire policy carefully to determine rights, duties and what is and is not covered. Throughout this policy, the words "you" and "your" refer to the Named Insured shown in the Declarations. The words "we", "us" and "our' refer to the Company providing this insurance. Words and phrases that appear in quotation marks have special meaning. Refer to Section F. DEFINITIONS. Coverage provided by Coverage Form is also subject to all Conditions in the Common Policy Conditions and Commercial Inland Marine Conditions forms. A. COVERAGE We will pay for direct physical loss or damage to Covered Property from any Covered Cause of Loss described in this Coverage Form. 1. Covered Property, as used in the Coverage Form, means: Property which has been installed, or is to be installed in any "commercial structure" or any one to four family dwelling, private garage or other structure that will be used to service the "commercial structure" or one to four family dwelling at the location which you have reported to us. This includes: a. Your property; b. Property of others for which you are legally responsible; c. Paving, curbing, fences and outdoor fixtures; d. Trees, shrubs, plants and lawns installed by you or on your behalf; e. Completed single family dwelling which is being used as a Model Home when reported to us as such on monthly reports with an amount shown; and f. Foundations of buildings and foundations of structures in the course of construction. 2. Property Not Covered Covered Property does not include: a. Existing buildings or structures to which an addition, alteration, improvement, or repair is being made, unless specifically endorsed; b. Plans, blueprints, designs or specifications, except as provided in paragraph A.4. Additional Coverage of this Coverage Form; c. Land and water; d. "Existing inventory", unless specifically endorsed; e. Contractors tools and equipment. 3. Covered Cause Of Loss Covered Cause of Loss means risk of direct physical loss or damage to Covered Property, except those causes of loss listed in Section B. EXCLUSIONS. 40471 MA (04-09) Page 1 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission 4. Additional Coverages a. Collapse We will pay for direct physical loss or damage to Covered Property, caused by collapse of all or part of a building or structure insured under this Coverage Form, if the collapse is caused by one or more of the following: (1) Fire; lightning; windstorm; hail; explosion; smoke; aircraft; vehicles; riots; civil commotion; vandalism; breakage of glass, falling objects; weight of snow, ice or sleet; or "water damage"; but only if the causes of loss are otherwise covered in this Coverage Form; (2) Hidden decay; (3) Hidden insect or vermin damage; (4) Weight of people or personal property; (5) Weight of rain that collects on a roof; (6) Use of defective materials or methods in construction, remodeling or renovation if the collapse occurs during the course of the construction, remodeling or renovation. This Additional Coverage does not increase the Limits of Insurance provided in the Coverage Form. b. Scaffolding, Construction Forms And Temporary Structures (1) We will pay for direct physical loss or damage which is caused by or results from a Covered Cause of Loss, to scaffolding, construction forms and temporary structures, including fully enclosed office and fully enclosed tool trailers, but only while they are at a construction site you have reported to us. The most we will pay under this Additional Coverage is the amount shown in the Supplemental Declarations for Scaffolding, Construction Forms And Temporary Structures. (2) We will also pay for the cost of re -erection of the scaffold if the loss or damage of the scaffolding is caused by or results from a Covered Cause of Loss. The most we will pay under this Additional Coverage is the amount shown in the Supplemental Declarations for Re -erection Of Scaffolding. No deductible applies to this Additional Coverage. c. Debris Removal We will pay your expenses to remove debris of Covered Property. This debris must result from a Covered Cause of Loss under this Coverage Form. The expenses will be paid only if they are reported to us in writing within 180 days of the date of direct physical loss or damage. If the sum of the loss or damage and debris removal expenses exceeds the limit of insurance applicable to the property, we will pay an additional amount of debris removal expenses you incur in excess of the limit of insurance applicable to the property up to, but not exceeding the amount shown in the Supplemental Declarations for Debris Removal. This Additional Coverage does not apply to costs to: (1) Extract "pollutants" from land or water; or (2) Remove, restore or replace polluted land or water. No deductible applies to this Additional Coverage. d. Back -Up Or Overflow Of Sewers, Drains Or Sumps We will pay for loss or damage to Covered Property caused by water that backs up or overflows from a sewer, drain or sump from within the reported location. The most we will pay under this Additional Coverage is the amount shown in the Supplemental Declarations for Back -Up Or Overflow Of Sewers, Drains Or Sumps. No deductible applies to this Additional Coverage. 40471 MA (04-09) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 of 12 e. Fire Department Service Charge When the fire department is called to save or protect Covered Property from a Covered Cause of Loss, we will pay for your liability for the fire department service charges which are: (1) Assumed by contract or agreement prior to loss or damage; or (2) Required by local ordinance. The most we will pay under this Additional Coverage is the amount shown in the Supplemental Declarations for Fire Department Service Charge. No deductible applies to this Additional Coverage. f. Valuable Papers And Records We will pay for direct physical loss or damage to "valuable papers and records" caused by or resulting from a Covered Cause of Loss. The value will be based on the blank materials for reproducing the records and labor to transcribe or copy the records when there is a duplicate. When there is no duplicate, we will pay the costs to research, replace, restore or reproduce the lost information on lost or damaged "valuable papers and records". The most we will pay under this Additional Coverage is the amount shown in the Supplemental Declarations for Valuable Papers And Records. No deductible applies to this Additional Coverage. g. Pollutant Clean -Up And Removal We will pay your expense to extract "pollutants" from land or water at locations reported to us if the discharge, dispersal, seepage, migration, release or escape of the "pollutants" is caused by or results from a Covered Cause of Loss that occurs during the policy period. The expenses will be paid only if they are reported to us in writing within 180 days of the date on which the Covered Cause of Loss occurs. This Additional Coverage does not apply to costs to test for, monitor, or assess the existence, concentration or effects of "pollutants". But we will pay for testing which is performed in the course of extracting the "pollutants" from land or water. The most we will pay under this Additional Coverage is the amount shown on the Supplemental Declarations for Pollutant Clean -Up And Removal for the sum of all expenses which are incurred as a result of all Covered Causes of Loss during each separate 12 month period from the effective date of the policy. No deductible applies to this Additional Coverage. h. Ordinance Or Law — Direct Damage (1) Coverage For Loss To Undamaged Portion Of The Building Or Structure (a) If a Covered Cause of Loss occurs to Covered Property at the construction site reported to us, we will pay for loss or damage to the undamaged portion of the property as a consequence of enforcement of any ordinance or law that: (i) Requires the demolition of parts of the same property not damaged by a Covered Cause of Loss; (ii) Regulates the construction or repair of property, or establishes zoning or land use requirements at the construction site; and (iii) Is in force at the time of loss or damage. (b) Coverage for loss or damage to the undamaged portion of the structure is included within the applicable limit of insurance for that location at the construction site. This only applies when the ordinance or law went into effect after the start of the construction of the structure or dwelling. 40471 MA (04-09) Page 3 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. (2) Demolition Cost Coverage (a) If a Covered Cause of Loss occurs to Covered Property at the construction site reported to us, we will pay the cost to demolish and clear the construction site of undarnaged parts of the property, caused by enforcement of building, zoning or land use ordinance or law. (b) The most we will pay for Demolition Cost is the amount of loss or damage or the amount shown in the Supplemental Declarations for Demolition Cost Coverage, whichever is less. (3) Increased Cost Of Construction Coverage (a) If a Covered Cause of Loss occurs to Covered Property at the construction site reported to us, we will pay for the increased cost necessary to repair or reconstruct the damaged portions of that Covered Property when the increased cost is a consequence of enforcement of building, zoning or land use ordinance or law. If the Covered Property is repaired or rebuilt, it must be intended for the same occupancy as the property prior to the loss or damage, unless otherwise required by zoning land use ordinance or law. (b) If the ordinance or law requires relocation to another site, we will pay the increased cost of construction at the new site as set forth below in paragraph (c) below. (c) The most we will pay for Increased Cost of Construction Coverage is the amount of loss or damage or the amount shown in the Supplemental Declarations for Increased Cost Of Construction Coverage, whichever is less.. (4) The most we will pay in total for Demolition Cost Coverage and Increased Cost of Construction Coverage for loss or damage from any one occurrence is the limit shown in the Supplemental Declarations for Combined Aggregate For Demolition Cost And Increased Cost Of Construction. (5) We will not pay under: (a) Coverage For Loss To The Undamaged Portion Of The Building Or Structure; (b) Demolition Cost Coverage; or (c) Increased Cost Of Construction Coverage for costs associated with the enforcement of any ordinance or law which requires any insured or others to test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to or assess the effects of "pollutants". (6) In the event that this policy is endorsed to provide coverage for existing buildings or structures, or the policy covers renovation, remodeling or other work being done on such buildings or structures, this Additional Coverage shall not apply to such buildings or structures. i. Preservation Of Property If it is necessary to move Covered Property from the location reported to us or described on the Declarations, to preserve it from loss or damage by a Covered Cause of Loss, we will pay for any direct physical loss or damage to that property: (1) While it is being moved or while temporarily stored at another location; and (2) Only if the loss or damage occurs within 30 days after the property is first moved. This Additional Coverage is part of, and not in addition to, the Limit of Insurance applicable to the Covered Property. Rewards At our option, we may reimburse you for rewards you pay, other than to you, your partners or officers, for information which leads to the conviction of any one or more persons responsible for loss or damage covered under this Coverage Form. We will be the sole judge as to the payment and amount of reimbursement. The most we will pay for this Additional Coverage is the amount shown in the Supplemental Declarations for Rewards. 40471 MA (04-09) Page 4 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Property At A Temporary Storage Location (1) We will pay for direct physical loss or darnage caused by a Covered Cause of Loss to Covered Property while temporarily in storage at a location other than a location which you have reported to us. (2) We will not pay under this Additional Coverage for property in storage if the property has not been specifically allocated to or otherwise identified with a covered building or structure. (3) The most we will pay for this Additional Coverage is the amount shown in the Supplemental Declarations for Property At A Temporary Storage Location. I. Property In Transit We will pay for direct physical loss or damage caused by a Covered Cause of Loss to Covered Property while in transit. The most we will pay for this Additional Coverage is the amount shown in the Supplemental Declarations for Property In Transit. B. EXCLUSIONS 1. We will not pay for a loss or damage caused directly or indirectly by any of the following. Such loss or damage is excluded regardless of any other cause or event that contributes concurrently or in any sequence to the loss or damage. a. Governmental Action Seizure or destruction of property by order of any governmental authority. But we will pay for acts of destruction ordered by governmental authority and taken at the time of a fire to prevent its spread, if that fire would be covered under this Coverage Form. b. Nuclear Hazard Nuclear reaction or radiation, or radioactive contamination, however caused. But if nuclear reaction or radiation contamination results in fire, we will pay for the loss or damage caused by that fire. c. War And Military Action (1) War, including undeclared or civil war; (2) Warlike action by a military force, including action hindering or defending against an actual or expected attack by any government sovereign or other authority using military personnel or other agents; or (3) Insurrection, rebellion, revolution, usurped power or action taken by government authority in hindering or defending against any of these. d. Earth Movement (1) Any earth movement (other than sinkhole collapse), such as an earthquake, landslide, mine subsidence or earth sinking, rising or shifting. But if earth movement results in fire or explosion, we will pay for the loss or damage caused by that.fire or explosion. (2) Volcanic Action Volcanic eruption, explosion or effusion. But if volcanic eruption, explosion or effusion results in fire, building glass breakage or volcanic action, we will pay for the loss or damage caused by that fire, building glass breakage or volcanic action. Volcanic action means direct loss or damage resulting from the eruption of a volcano when the loss or damage is caused by: (a) Airborne volcanic blast or airborne shock waves; (b) Ash, dust or particulate matter; or (c) Lava flow. All volcanic eruptions that occur within any 168 hour period will constitute a single occurrence 40471 MA (04-09) Page 5 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Volcanic action does not include the cost to remove ash, dust or particulate matter that does not cause direct physical loss or damage to the described property. This exclusion does not apply to Covered Property while in transit. e. Water (1) Flood, surface water, waves, tides, tidal waves, overflow of any body of water or their spray, all whether driven by wind or not,- (2) ot; (2) The interior of any building or structure caused by or resulting from rain, snow, sleet, ice, sand or dust, whether driven by wind or not, unless: (a) The building or structure first sustains damage by a Covered Cause of Loss to its roof or walls through which the rain, snow, sleet, ice, sand or dust enters; or (b) The loss or damage is caused by or results from thawing of snow, sleet or ice on the building or structure. (3) Mudslide or mudflow; (4) Water that backs up or overflows from a sewer, drain or sump, except as provided in the Back -Up Or Overflow Of Sewers, Drains Or Sumps Additional Coverage; (5) Water under the ground surface pressing on, or flowing or seeping through: (a) Foundations, walls, floors or paved surfaces; (b) Basements, whether paved or not; or (c) Doors, windows or other openings. But if water, as described in e.(1) through e.(5) above, results in fire, explosion or sprinkler leakage, we will pay for the loss or damage caused by that fire, explosion or sprinkler leakage. 2. We will not pay for a loss or damage caused by or resulting from any of the following: a. Delay, loss of use, or loss of market. This does not include "profit' if reported in compliance with the Reporting Provisions Additional Condition; b. Dishonest or criminal acts by you, any of your partners, employees or leased employees, directors, trustees, authorized representatives or anyone to whom you entrust the property for any purpose. This exclusion applies: (1) While acting alone or in collusion with others; or (2) Whether or not occurring during the hours of employment. This exclusion does not apply to acts of destruction by your employees or leased employees; but theft by employees or leased employees is not covered. This exclusion does not apply to Covered Property while it is entrusted to others who are carriers for hire. c. Unexplained or mysterious disappearance except for property in custody of a carrier for hire. d. Shortage of property found on taking inventory. e. Penalties for noncompliance with contract conditions. f. Collapse, except as provided in the Collapse Additional Coverage. g. (1) Wear and tear; (2) Any quality in the property itself that causes it to damage or destroy itself; or that causes gradual deterioration; (3) Insects, vermin, rodents,- (4) odents;(4) Corrosion, rust, fungus, mold, mildew, rot; 40471 MA (04-09) Page 6 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. (5) Dampness, changes in or extremes of temperatures, freezing; However, we will cover freezing loss or damage to property in the building reported to us, if you have shut off the water supply and drained the plumbing systems and appliances or made a reasonable effort to maintain heat in the building. (6) Settling, cracking, shrinking, or expansion of any Covered Property. h. Rain, snow, sleet, sand or dust if Covered Property is in the open. This does not apply to Covered Property in the custody of a carrier for hire. i. Artificially generated electrical current; mechanical breakdown; rupturing or bursting caused by centrifugal force. j. Testing, start-up, commissioning, examination or trial of Covered Property such as boilers, ovens, stoves, turbines, pumps, process equipment or equipment of a similar nature to prove their ability or function. This includes any form of testing making use of feedstock, including operational tests, performance tests, or other tests performed in conjunction with such testing. This exclusion does not apply to "electrical testing", "mechanical testing", "pneumatic testing" or "hydrostatic testing" used in the start-up and testing of building systems that are intended to service a building. 3. We will not pay for loss or damage caused by or resulting from any of the following. But if loss or damage by a Covered Cause of Loss results, we will pay for the resulting loss or damage caused by that Covered Cause of Loss. a. Weather conditions which contribute in any way to a cause or event excluded in paragraph 1. above to produce the loss or damage. b. Acts or decisions, including the failure to act or decide, of any person, group, or organization representing a governmental, regulatory or controlling body. c. Faulty, inadequate or defective: (1) Planning, zoning, development, surveying, siting; (2) Design, specifications, workmanship, repair, construction, renovation, remodeling, grading, compaction; (3) Materials used in repair, construction, renovation or remodeling; or (4) Maintenance of all or part of any Covered Property wherever located. d. The discharge, dispersal, seepage, migration, release or escape of "pollutants", except as provided under Pollutant Clean -Up And Removal Additional Coverage. C. LIMITS OF INSURANCE The most we will pay for loss or damage to any one building or structure is the lesser of the Limit of Insurance shown in the Declarations for that one building or structure or the "total estimated completed value" that was reported to us for that one building or structure. The most we will pay for loss or damage in any one occurrence is the limit shown in the Declarations for all Covered Property at all locations. D. DEDUCTIBLE We will not pay for loss or damage until the amount of covered loss or damage exceeds the Deductible shown in the Declarations. We will then pay the amount of the covered loss or damage which exceeds the Deductible, up to the applicable Limit of Insurance. E. ADDITIONAL CONDITIONS The following conditions apply in addition to the Common Policy Conditions and the Commercial Inland Marine Conditions: 1. Coverage Territory The coverage territory is United States of America (including its territories and possessions) and Canada. 40471 MA (04-09) Page 7 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 2. Where Coverage Applies This coverage applies to Covered Property while within the coverage territory while: a. At any construction site you have reported,- b. eported;b. Temporarily at other premises, if the property has been designated to be installed at a location you have reported to us; or c. In transit except imports or exports while ocean marine coverage applies. 3. When Coverage Begins And Ends We will cover risk of loss or damage from the time when you are legally responsible for the Covered Property on or after the effective date of this policy if all other conditions are met. Coverage will end at the earliest of the following: a. Once your interest in the Covered Property ceases; b. Ninety days after initial occupancy of the Covered Property unless: (1) That building is being used as a model home, (2) That building is being remodeled and is a single family dwelling; or (3) That building is being used as a "model home leaseback". c. When the Covered Property is leased to or rented to others: (1) For a single family dwelling, when the building is leased or rented to others,- (2) thers;(2) For a two, three or four family dwelling, when 50% or more of the units in the structure are leased to or rented to others; or (3) For a "commercial structure", when 75% or more of the square footage space is leased to or rented to others. This does not apply to pre -leases established prior to construction. d. When you abandon the reported location with no intention to complete it; e. At the end of 12 months from the month when you first reported the location to us unless you report the location again and pay an additional premium. If the location is reported again and the additional premium is paid, coverage will end at the end of 12 months from the month when you re-reported the location to us as described in the Reporting Provisions Additional Condition. You have the option to report the same location a third time at the end of the second 12 month period, provided the required additional premium is paid. Coverage for this third 12 month term will end at the end of 12 months from the month you re-reported the location for a third term; Coverage for existing buildings or structures that are being or have been remodeled: At the end of 12 months from the month when you first reported the location to us unless you report the location again and pay an additional premium. If the location is reported again and the additional premium is paid, coverage will end at the end of 12 months from the month when you re-reported the location to us as described in the reporting provision below. There is no option to report a third year. f. When permanent property insurance applies; or g. Once the Covered Property is accepted by the owner or buyer. 4. Reporting Provisions a. Each month you must report to us the "total estimated completed values" of all Covered Property for each location started during the previous month. This report must be made on the form we provide. For the purpose of these reports, a location is started when you first put any building materials (including the foundation) on the construction site. 40471 MA (04-09) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 8 of 12 If your policy is endorsed to provide coverage for existing structures that you are renovating or adding onto and for which you seek coverage, a location is started on the earlier of the following: (1) When you first put any building materials, which includes any new, altered or expanded foundation, on the site; or (2) When you acquire title to the existing structure. b. You must pay premiums based on the "total estimated completed value" of the Covered Property using the rate we furnish. You must send your premium payment with the report for the reported locations to be covered. We must receive your report and the accompanying premium payments at the address designated in our form by the last business day of the month in which the report is due, or the report is late. c. If a report is received late, coverage begins on the day the report is received, and there is no coverage for any loss or damage that occurred before that report was received. Our acceptance of a report of values and premium payment does not waive or change any part of this policy nor stop us from asserting any right we have under the terms of this policy. d. The premium charged is fully earned and no refund is due you when coverage ends. e. A dwelling being used as a Model Home must be reported and should be identified as a Model Home. f. You will keep accurate construction records regarding property we cover under this policy. This includes the "total estimated completed value" of the Covered Property and a record of all contracts of sale dealing with the Covered Property. g. If at the end of 12 months from the time you first reported a start to us, you still have that location in your inventory, you may report that location to us a second time. If at the end of the second 12 months from the time you first reported a start to us and you still have that location in your inventory, you may report that location to us a third time. Coverage for existing buildings or structures that are being or have been remodeled: If at the end of 12 months from the time you first reported a start to us, you still have that location in your inventory, you may report that location to us a second time. There is no option to report a third time (year). h. Cancellation of this policy will not affect the insurance in force on any location which you have reported to us or on any location which started before the effective date of the cancellation notice if that location is reported on the report due and premium payment is made. However, you cannot report any location currently in your inventory a second time after the effective date of cancellation. However, coverage may be canceled on any location if notice is given in writing in accordance with the cancellation provision in the Common Policy Conditions, or state amendatory endorsements. 5. Mortgage Holders Clause a. The term mortgage holder includes trustees. b. We will pay for covered loss or damage to Covered Property to each mortgage holder shown on a Certificate of Insurance issued by the current Agent of Record. c. The mortgage holder has the right to receive payment for loss or damage even if the mortgage holder has started foreclosure or similar action on the Covered Property. d. If we deny your claim because of your acts or because you have failed to comply with the terms of this Coverage Part, the mortgage holder will still have the right to receive payment for loss or damage to Covered Property if the mortgage holder: (1) Pays any premium due under this Coverage Part at our request if you have failed to do so; (2) Submits a signed, sworn proof of loss within 60 days after receiving notice from us of your failure to do so; (3) Has notified us of any change in ownership, occupancy or substantial change in risk known to the mortgage holder. All of the terms of this Coverage Part will then apply directly to the mortgage holder. 40471 MA (04-09) Page 9 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. e. If we pay the mortgage holder for any loss or damage and deny payment to you because of your acts or because you have failed to comply with the terms of this Coverage Part: (1) The mortgage holder's rights under the mortgage will be transferred to us to the extent of the amount we pay; and (2) The mortgage holder's rights to recover the full amount of the mortgage holder's claim will not be impaired. At our option, we may pay to the mortgage holder the whole principal on the mortgage plus any accrued interest. In this event, your mortgage and note will be transferred to us and you will pay your remaining mortgage debt to us. f. If we cancel this policy, we will give written notice to the mortgage holder at least: (1) 10 days before the effective date of cancellation if we cancel for non-payment of premium; or (2) 30 days before the effective date of cancellation if we cancel for any other reason. g. We will not notify the mortgage holder if: (1) You cancel this policy, or (2) Coverage ends for any reason other than if we cancel the policy. 6. Waiver Of Coinsurance If there is loss or damage to Covered Property and the cost to repair or replace such property is less than or equal to $25,000, we will adjust the loss or damage without regard to the Coinsurance Additional Condition. 7. Coinsurance If the reported value is less than the "total estimated completed value", you will bear a portion of any loss or damage. The amount we will pay is determined by the following steps: a. Divide the reported value by the "total estimated completed value" of the Covered Property; b. Multiply the total amount of the covered loss or damage before the application of any deductible by the percentage determined in paragraph a.; c. Subtract the deductible from the figure determined in paragraph b. Example No. 1 (This example assumes there is no penalty for underinsurance.) Deductible $1,000 Reported Value $100,000 "Total Completed Estimated Value" $100,000 Amount of loss or damage $60,000 a. Reported value divided by "total estimated completed value" $100,000/$1100,000 = 1.00 b. Amount of loss or damage multiplied by percentage in paragraph a. $60,000 x 1.00 = $60,000 c. Deductible amount subtracted from result of paragraph b. $60,000 - $1,000 = $59,000 40471 MA (04-09) Page 10 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Example No. 2 (This example assumes there is a penalty for underinsurance) Deductible $1,000 Reported Value $100,000 "Total estimated completed value" $120,000 Amount of loss or damage $60,000 a. Reported value divided by "total estimated completed value" $100,000/$120,000 = .833 b. Amount of loss or damage multiplied by percentage in paragraph a. $60,000 x .833 = $49,980 c. Deductible amount Subtracted from result of paragraph b. $49,980 - $1,000 = $48,980 8. Liberalization Clause If we adopt any revision which would broaden the coverage under this Coverage Form without additional premium within 60 days prior to or during the policy period, the broadened coverage will immediately apply to this policy. 9. Interest Of Subcontractors, Sub -Subcontractors, Suppliers We cover the interest which your subcontractors, your sub -subcontractors and your suppliers have in the Covered Property, but only while such property is situated at a construction site you have reported to us. This condition does not impair any right of subrogation we would otherwise have. 10. Unintentional Failure To Disclose Hazards Your failure to disclose all hazards existing as of the inception date of the policy shall not affect the coverage afforded by this policy, provided such failure to disclose all hazards is not intentional and the hazard is reported to us as soon as practicable after you learn about it. F. DEFINITIONS 1. "Commercial structure" means any structure other than a one to four family dwelling. 2. "Electrical testing" means the testing of systerns that are operated by electricity, excluding service equipment and service conductors, electrical systems greater than 600 volts nominal and electrical systems that are greater than single phase. 3. "Existing inventory" means buildings or structures in the course of construction that are more than 30% complete prior to the inception date of this policy. 4. "Hydrostatic testing" means testing through the use of water or other fluids, which are processed through the machinery or system being tested. 5. "Mechanical testing" means testing of moving parts of equipment and components, which are part of the buildings or structures insured, by operation of such equipment or components. 6. "Model home leaseback" means a dwelling purchased from the Insured and is then leased back to the Insured, by the purchaser, to be used by the Insured as a model home until the purchaser occupies the dwelling as a residence. 7. "Overhead" means those business expenses, other than materials and labor, incurred either directly or indirectly due to the construction of a dwelling or structure. 8. "Pollutants" mean any solid, liquid, gaseous or thermal irritant or contaminant, including smoke, vapor, soot Ir acids, alkalis, chemicals and waste. Waste includes materials to be recycled, reconditioned or reclaimed. 9. "Pneumatic testing" means testing through the use of compressed air or other gas to fill test cavities which is processed through the machinery or system being tested. 40471 MA (04-09) Page 11 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 10. "Profit" means the difference between the selling price of the land and completed structure and your cost of the land and the completed structure. If you do not have a signed contract for the sale of the completed structure and land, the allowance for "profit' will not exceed 20%. 11. "Total estimated completed value" means all costs associated with the building and designing of the Covered Property including labor, "overhead" and materials and if included, "profit". 12. "Valuable papers and records" means inscribed, printed or written documents, manuscripts or records, including abstracts, books, deeds, drawings, films, maps or mortgages. However, "valuable papers and records" does not mean: a. Money or securities; b. Converted data; c. Programs or instructions used in your data processing operation, including the materials on which the data is recorded. 13. "Water damage" means accidental discharge or leakage of water or steam as the direct result of the breaking apart or cracking of any part of a system or appliance (other than a sump system including its related equipment and parts) containing water or steam. 40471 MA (04-09) Page 12 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Remodeler Coverage - Massachusetts ZURICH� THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: CONSTRUCTION MATERIALS AND INSTALLATION COVERAGE FORM The following is added to Section A. COVERAGE, Paragraph 4. Additional Coverages Remodeler Coverage (1) We will pay for loss or damage due to a Covered Cause of Loss to "existing buildings or structures" described in the Declarations to which "renovations and improvements" are being made. (2) Paragraph a. in Property Not Covered does not apply to this Additional Coverage. (3) The most we will pay under this Additional Coverage for loss or damage to "existing buildings or structures" is the amount shown in the Declarations for Existing Buildings Or Structures. The most we will pay under this Additional Coverage for loss or damage to "renovations and improvements" is the amount shown in the Declarations for Renovations And Improvements. (4) The Valuation Condition, found anywhere in the policy, is replaced by the following with respect to this Additional Coverage: Valuation In the event of loss or damage, the value of the property will be determined as of the time of loss or damage. (a) The value of "existing buildings or structures" will be "actual cash value". (b) The value of the "renovations and improvements" will be the lesser of the cost to repair or the cost to replace with like kind and quality to the same point of completion that had been achieved immediately before the loss or damage. (5) Additional Condition The following Additional Condition applies to this Additional Coverage: Ongoing Construction Activity During the policy period when no "construction activity" has been performed within 60 consecutive days before the loss or damage occurs: (a) We will not pay for any loss or damage caused by any of the following even if they are Covered Causes of Loss: (i) Vandalism; (ii) Sprinkler leakage, unless you have protected the system against freezing; (iii) Building glass damage; (iv) "Water damage"; (v) Theft; or (vi) Attempted theft. HBIS-37 MA (04-09) Page 1 of 2 Includes copyrighted material of Insurance Services Office, Inc., with its permission. (b) With respect to Covered Causes of Loss other than those listed in (1) through (6) above, we will reduce the amount we would otherwise pay for the loss or damage by 15%. (6) Additional Definitions The following Additional Definitions apply to this Additional Coverage (a) "Actual cash value" means the cost to repair or replace the lost or damaged Covered Property reduced by each of the following: (i) Physical deterioration; (ii) Depreciation; (iii) Obsolescence,- (iv) bsolescence;(iv) Depletion; (v) Non -conformity to codes, regulations, or statutes; and (vi) The cost to reconstruct or remodel undamaged portions of property. But in no event will "actual cash value" be more than the market value of the property excluding land as determined by the price which the property excluding land might be expected to realize prior to loss or damage if offered for sale in a fair market on the date of the loss or damage. (b) "Construction activity" means repair, replacement, or installation, including painting. (c) "Existing buildings or structures" means a building or structure that was constructed and standing prior to the inception of this policy and that will undergo renovation or rehabilitation. "Existing buildings or structures" only includes those parts of standing buildings or structures that are intended to become a permanent part of buildings or structures during renovation or rehabilitation. This does not include "renovations and improvements". (d) "Renovations and improvements" means your additions, alterations, improvements or repairs to the property location specified in the Declarations including materials and supplies, attachments, and fixtures which have been installed, or will be installed in the "existing buildings or structures". This does not include "existing buildings or structures". (e) "Rernodelers total estimated completed value" means the "actual cash value" of the "existing buildings or structures", plus the estimated cost of your "renovations and improvements" at the conclusion of the project. This does not include "overhead" or "profit'. All other terms, conditions, provisions and exclusions of this policy remain the same. HBIS-37 MA (04-09) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 of 2 Non -Reporting Endorsement - Massachusetts ZURICH' THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: CONSTRUCTION MATERIALS AND INSTALLATION COVERAGE FORM Section E.ADDITIONAI_ CONDITIONS is amended as follows: 1. Paragraph e. of Additional Condition 3. When Coverage Begins And Ends is replaced by the following: e. Upon expiration of the policy. 2. Additional Condition 4. Reporting Provisions is replaced by the following: 4. Reporting Provisions a. The premium charged is fully earned and no refund is due to you when coverage ends. b. You will keep accurate construction records regarding property we cover under this policy. This includes the "total estimated completed value" of the property and a record of all contracts of sale dealing with the property. 3. Additional Condition 7. Coinsurance is replaced by the following: 7. Coinsurance If the limit of insurance is less than the "total estimated completed value" of the property insured, you will bear a portion of any loss. The amount we will pay is determined by the following steps: a. Divide the limit of insurance by the "total estimated completed value" of the Covered Property; b. Multiply the total amount of the covered loss, before the application of any deductible, by the percentage determined in paragraph a.; c. Subtract the deductible from the figure determined in paragraph b. Example No 1. (This example assumes there is no penalty for underinsurance.) Deductible $1,000 Reported value $100,000 "Total Completed Estimated Value" $100,000 Amount of loss or damage $60,000 a. Limit of Insurance/Total Estimated Completed Value $100,000/$100,000 = 1.00 b. Amount of loss x percentage in A $60,000 x 1.00 = $60,000 c. Deductible amount subtracted from results in B $60,000 - $1,000 = $59,000 HBIS-1 MA (04-09) Page 1 of 2 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Total amount of loss payable = $59,000 Example No. 2 (This example assumes there is a penalty for underinsurance.) Deductible $1,000 Limit of Insurance $100,000 "Total Completed Estimated Value" $120,000 Amount of loss $60,000 a. Limit of Insurance/Total Estimated Completed Value $100,000/$120,000 = .833 b. Amount of loss x percentage in A $60,000 x .833 = $49,980 c. Deductible amount subtracted from results in B $49,980 - $1,000 = $48,980 Total amount of loss payable = $48,980 All other terms, conditions, provisions and exclusions of the policy remain the same. HEIS -1 MA (04-09) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 of 2 Earthquake Cause Of Loss Form - Massachusetts ZUR.ICW THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: CONSTRUCTION MATERIALS AND INSTALLATION COVERAGE FORM SCHEDULE 1 91 .5 Main Street, North Andover, MA 01845 Loc. # Address ❑x If this box is checked, Additional Condition 7. Coinsurance does not apply to the Earthquake Cause of Loss. Earthquake Limit of Insurance: $ 225,000 Any One Occurrence $ 225,000 Annual Aggregate Earthquake Deductible: $ OR 5 % of the total value at risk at the time of loss or damage, but not less than $ 10,000 A. Paragraph 1.d.(1) in Section B. EXCLUSIONS is replaced by the following: (1) Any earth movernent (other than sinkhole collapse or earthquake), such as a landslide, mine subsidence or earth sinking, rising or shifting. But if earth movement results in fire or explosion, we will pay for the loss or damage caused by that fire or explosion. B. For loss or damage caused by earthquake, Section C. LIMITS OF INSURANCE is replaced by the following: 1, The most we will pay for loss or damage caused by earthquake in any one occurrence is the Earthquake Limit of Insurance —Any One Occurrence amount shown in the Schedule. 2. The most we will pay for loss or damage caused by earthquake at all locations in any 12 -month policy period will be the Earthquake Limit of Insurance — Annual Aggregate shown in the Schedule. This is the most we will pay for the total of all loss or damage caused by earthquake sustained during that period of time even If there is more than one earthquake in a 12 -month period (starting with the beginning of the present annual policy period). The Earthquake Limit of Insurance shown in the Schedule does not increase the Limit of Insurance for any one building or structure as shown in the Declarations. C. For loss or damage caused by earthquake, Section D. DEDUCTIBLE is replaced by the following: 1. When the Earthquake Deductible is shown as a dollar amount in the Schedule, we will not pay for loss to Covered Property until the amount of the loss exceeds this Deductible. We will then pay the amount of loss in excess of this Deductible up to the Earthquake Limit of Insurance shown in the Schedule. 2. When the Earthquake Deductible is shown as a percentage in the Schedule, the Deductible amount will be determined by multiplying the total value of the project at risk at the time of loss or damage at the location you have reported to us by the percentage shown in the Schedule. This Deductible is calculated separately for, and applies separately to, each building or structure reported to us, if two or more buildings or structures sustain loss or damage. We will not pay for loss or damage to Covered Property at the location reported to us caused directly or indirectly by earthquake until the amount of the loss or damage exceeds the Earthquake Deductible shown in the Schedule. We will then pay the amount of loss or damage in excess of the Earthquake Deductible, up to the Earthquake Limit of Insurance shown in the Schedule. HBIS-2 MA (04-09) Page 1 of 2 Includes copyrighted material of Insurance Services Office, Inc. with its permission. D. For loss or damage caused by earthquake, Section E. ADDITIONAL CONDITIONS is amended to add the following: Special Earthquake Conditions a. All earthquake shocks that occur within any 168 -hour period will constitute a single earthquake. The expiration of this policy will not reduce the 168 -hour period. b. If a single earthquake begins during one annual policy period and ends during the following annual policy period, any Limit of Insurance applicable to the following annual policy period will not apply. c. If any earthquake results in fire or explosion, we will also pay for the loss or damage caused by fire or explosion. But the most we will pay for the total of all loss or damage caused by earthquake and fire or explosion is the Limit of Insurance applicable to fire or explosion. We will not pay the sum of the two Limits. d. We will not pay for loss or damage caused by or resulting from earthquake to exterior masonry veneer on wood frame walls for buildings with more than 10% of the total exterior wall area faced with masonry veneer (except stucco). This limitation does not apply if the Declarations specifically states 'Including Masonry Veneer'. e. If we do not pay for loss or damage caused by or resulting from earthquake to exterior masonry veneer on wood frame walls, the value of the veneer will not be included in the value of the Covered Property or the amount of the covered loss or damage when applying: (1) The Earthquake Deductible; and (2) Coinsurance Condition All other terms, conditions, provisions and exclusions of this policy remain the same. HBIS-2 MA (04-09) Page 2 of 2 Includes copyrighted material of Insurance Services Office, Inc. with its permission. Remodelers Non -Reporting Endorsement - Massachusetts ZURICH THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: CONSTRUCTION MATERIALS AND INSTALLATION COVERAGE FORM A. Section E. ADDITIONAL CONDITIONS is amended as follows: 1. Paragraph e. in Additional Condition 3. When Coverage Begins And Ends is replaced by the following: e. Upon expiration of the policy period. 2. Additional Condition 4. Reporting Provisions is deleted. 3. Additional Condition 6. Waiver Of Coinsurance is deleted. 4. Additional Condition 7. Coinsurance is replaced by the following: Coinsurance If the sum of the Renovations and Improvements limit of insurance plus the Existing Buildings or Structures limit of insurance is less than the "remodelers total estimated completed value" of the property insured, you will bear a portion of any loss or damage. The amount we will pay is determined by the following steps: a. Add the Renovations and Improvements limit of insurance to the Existing Buildings or Structures limit of insurance; b. Divide the sum of paragraph a. by the "rernodelers total estimated completed value" of the Covered Property; c. Multiply the amount of the covered loss or damage, before the application of any deductible, by the percentage determined in paragraph b.; d. Subtract the deductible from the figure determined in paragraph c. Example No. 1 (This example assumes there is no penalty for underinsurance) Renovations and Improvements Limit $200,000 Existing Buildings or Structures Limit $100,000 "Remodelers total estimated completed value" $300,000 Deductible $1,000 Amount of "renovations and improvements" covered loss or damage $50,000 Amount of "existing buildings or structures" covered loss or damage $40,000 HBIS-79 MA (04-09) Page 1 of 3 Includes copyrighted material of Insurance Services Office, Inc. with its permission. a. Renovations and Improvements Limit plus Existing Buildings or Structures Limit $200,000 + $100,000 = $300,000 b. Sum from paragraph a. divided by "remodelers total estimated completed value $300,000/$300,000 = 100% c. Amount of covered loss or damage multiplied by the percentage determined in paragraph b. $50,000 + $40,000 = $90,000 x 100% = $90,000 d. Subtract the deductible from the amount of covered loss $90,000 - $1,000 = $89,000 Total amount of loss or damage payable = $89,000. Example No. 2 (This example assumes there is a penalty for underinsurance) Renovations and Improvements Limit $200,000 Existing Buildings or Structures Limit $50,000 "Remodelers total estimated completed value" $300,000 Deductible $1,000 Amount of "renovations and improvements" covered loss or damage $50,000 Amount of "existing buildings or structures" covered loss or damage $40,000 a. Renovations and Improvements Limit plus the Existing Buildings or Structures Limit $200,000 + $50,000 = $250,000 b. Sum from paragraph 1. divided by the "remodelers total estimated completed value" $250,000/$300,000 = 83% c. Arnount of covered loss or damage multiplied by the percentage determined in paragraph 2. $50,000 + $40,000 = $90,000 x 83% = $74,700 d. Subtract the deductible from the amount of covered loss $74,700 - $1,000 = $73,700 Total amount of loss or damage payable = $73,700. B. The following are added to Section F. DEFINITIONS: "Actual cash value" means the cost to repair or replace the lost or damaged Covered Property reduced by each of the following: a. Physical deterioration; b. Depreciation; c. Obsolescence; d. Depletion; e. Non -conformity to codes, regulations, or statutes; and f. The cost to reconstruct or remodel undamaged portions of property. HBIS-79 MA (04-09) Page 2 of 3 Includes copyrighted material of Insurance Services Office, Inc. with its permission. But in no event will "actual cash value" be more than the market value of the property excluding land as determined by the price which the property excluding land might be expected to realize prior to loss or damage if offered for sale in a fair market on the date of the loss or damage. "Existing buildings or structures" means a building or structure that was constructed and standing prior to the inception of this policy and that will undergo renovation or rehabilitation. "Existing buildings or structures" only includes those parts of standing buildings or structures that are intended to become a permanent part of buildings or structures during renovation or rehabilitation. This does not include "renovations and improvements". "Renovations and improvements" means your additions, alterations, improvements or repairs to the Property Location specified in the Declarations including materials and supplies, attachments, and fixtures which have been installed, or will be installed in the "existing buildings or structures". This does not include "existing buildings or structures". "Remodelers total estimated completed value" means the "actual cash value" of the "existing buildings or structures", plus the estimated cost of your "renovations and improvements" at the conclusion of the project. This does not include overhead or profit. All other terms, conditions, provisions and exclusions of this policy remain the same. HBIS-79 MA (04-09) Page 3 of 3 Includes copyrighted material of Insurance Services Office, Inc. with its permission. Changes In Cancellation Condition - Massachusetts ZURICH' THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: CONSTRUCTION MATERIALS AND INSTALLATION COVERAGE FORM Paragraph 5. in the Cancellation Common Policy Condition is replaced by the following: 5. The premium for this coverage is fully earned and no refund is due when the policy is cancelled. All other terms, conditions, provisions and exclusions of the policy remain the same. 1 -IBIS -83 MA (04-09) Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc. with its permission. Chanties In Valuation Condition - MassachusettsZURICH"Y THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: CONSTRUCTION MATERIALS AND INSTALLATION COVERAGE FORM The Valuation General Condition in Commercial Inland Marine Conditions is replaced by the following: Valuation In the event of loss or damage, the value of the property will be determined as of the time of the loss or damage. 1. The value of the property will not be more than the amount necessary to replace the structure or repair the structure, whichever is less, to the same point of completion that had been achieved immediately before the loss or damage. 2. If the loss or damage involves building materials which have not been installed, the value of the property will not be more than the amount necessary to replace the materials with like kind and quality. All other terms, conditions, provisions and exclusions of the policy remain the same. HBIS-84 MA (04-09) Page 1 of 1 ZURICH THIS DISCLOSURE IS ATTACHED TO AND MADE PART OF YOUR POLICY. DISCLOSURE OF IMPORTANT INFORMATION RELATING TO TERRORISM RISK INSURANCE ACT SCHEDULE* Premium attributable to risk of loss from certified acts of terrorism for lines of insurance subject to TRIA: INCLUDED *Any information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Disclosure of Premium In accordance with the federal Terrorism Risk Insurance Act ("TRIA"), as amended, we are required to provide you with a notice disclosing the portion of your premium, if any, attributable to the risk of loss from terrorist acts certified under that Act for lines subject to TRIA. That portion of premium attributable is shown in the Schedule above. The premium shown in the Schedule above is subject to adjustment upon premium audit, if applicable. B. Disclosure of Federal Participation in Payment of Terrorism Losses The United States Government may pay a share of insured losses resulting from an act of terrorism. The federal share will decrease by 5% from 85% to 80% over a five year period while the insurer share increases by the same amount during the same period. The schedule below illustrates the decrease in the federal share: Januaryl, 2015 — December 31, 2015 federal share: 85% Januaryl, 2016 — December 31, 2016 federal share: 84% Januaryl, 2017 — December 31, 2017 federal share: 83% Januaryl, 2018 — December 31, 2018 federal share: 82% Januaryl, 2019 — December 31, 2019 federal share: 81% Januaryl, 2020 — December 31, 2020 federal share: 80% C. Disclosure of $100 Billion Cap on All Insurer and Federal Obligations If aggregate insured losses attributable to terrorist acts certified under TRIA exceed $100 billion in a calendar year (January 1 through December 31) and an insurer has met its deductible under the program, that insurer shall not be liable for the payment of any portion of the amount of such losses that exceeds $100 billion, and in such case insured losses up to that amount are subject to pro rata allocation in accordance with procedures established by the Secretary of Treasury. D. Availability As required by TRIA, we have made available to you for lines subject to TRIA coverage for losses resulting from acts of terrorism certified under TRIA with terms, amounts and limitations that do not differ materially from those for losses arising from events other than acts of terrorism. E. Definition of Act of Terrorism under TRIA TRIA defines "act of terrorism" as any act that is certified by the Secretary of the Treasury, in accordance with the provisions of the federal Terrorism Risk Insurance Act ("TRIA"), to be an act of terrorism. The Terrorism Risk Insurance Act provides that the Secretary of Treasury shall certify an act of terrorism: 1. To be an act of terrorism; 2. To be a violent act or an act that is dangerous to human life, property or infrastructure; U -GU -630-D CW (01/15) Copyright © 2015 Zurich American Insurance Company Page 1 of 2 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 3. To have resulted in damage within the United States, or outside of the United States in the case of an air carrier (as defined in section 40102 of Title 49, United States Code) or a United States flag vessel (or a vessel based principally in the United States, on which United States income tax is paid and whose insurance coverage is subject to regulation in the United States), or the premises of a United States mission; and 4. To have been committed by an individual or individuals as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion. No act may be certified as an act of terrorism if the act is committed as part of the course of a war declared by Congress (except for workers' compensation) or if losses resulting from the act, in the aggregate for insurance subject to TRIA, do not exceed $5,000,000. U -GU -630-D CW (01/15) Copyright © 2015 Zurich American Insurance Company Page 2 of 2 Includes copyrighted material of Insurance Services Office, Inc., with its permission. ZURICH CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM Insureds Name Policy Number Effective Endorsement Date Number THIS ENDORSEMENT CHANGES YOUR POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies your insurance: COMMERCIAL INLAND MARINE COVERAGE PART A. Cap on Losses From Certified Terrorism Losses "Certified act of terrorism" means an act that is certified by the Secretary of the Treasury, in accordance with provisions of the federal Terrorism Risk Insurance Act ("TRIA"), to be an act of terrorism. The Terrorism Risk Insurance Act provides that the Secretary of Treasury shall certify an act of terrorism: 1. To be an act of terrorism; 2. To be a violent act or an act that is dangerous to human life, property or infrastructure; 3. To have resulted in darnage within the United States, or outside of the United States in the case of an air carrier (as defined in section 40102 of Title 49, United States Code) or a United States flag vessel (or a vessel based principally in the United States, on which United States income tax is paid and whose insurance coverage is subject to regulation in the United States), or the premises of a United States mission; and 4. To have been committed by an individual or individuals as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion. No act may be certified as an act of terrorism if the act is committed as part of the course of a war declared by Congress (except for workers' compensation) or if losses resulting from the act, in the aggregate for insurance subject to TRIA, do not exceed $5,000,000. If aggregate insured losses attributable to one or more "certified acts of terrorism" exceed $100 billion in a calendar year (January 1 through December 31) and we have met our insurer deductible under the Terrorism Risk Insurance Act, we shall not be liable for the payment of any portion of the amount of such losses that exceeds $100 billion, and in such case insured losses up to that amount are subject to pro rata allocation in accordance with procedures established by the Secretary of Treasury. B. Application of Other Exclusions The terms and limitations of a terrorism exclusion or any other exclusion, or the inapplicability or omission of a terrorism exclusion or any other exclusion, do not serve to create coverage which would otherwise be excluded, limited or restricted under this policy. Copyright n 2015 Zurich American Insurance Company U -GU -767-B CW (01/15) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 IL 00 03 09 08 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALCULATION OF PREMIUM This endorsement modifies insurance provided under the following: CAPITAL ASSETS PROGRAM (OUTPUT POLICY) COVERAGE PART COMMERCIAL AUTOMOBILE COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL PROPERTY COVERAGE PART CRIME AND FIDELITY COVERAGE PART EMPLOYMENT-RELATED PRACTICES LIABILITY COVERAGE PART EQUIPMENT BREAKDOWN COVERAGE PART FARM COVERAGE PART LIQUOR LIABILITY COVERAGE PART MEDICAL PROFESSIONAL LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART The following is added: The premium shown in the Declarations was com- puted based on rates in effect at the time the policy was issued. On each renewal, continuation, or anni- versary of the effective date of this policy, we will compute the premium in accordance with our rates and rules then in effect. IL 00 03 09 08 © ISO Properties, Inc., 2007 Page 1 of 1 Wolters Kluwer Financial Services I Uniform Form STM COMMERCIAL INLAND MARINE CM 00 01 09 04 COMMERCIAL INLAND MARINE CONDITIONS The following conditions apply in addition to the Common Policy Conditions and applicable Additional Conditions in Commercial Inland Marine Coverage Forms: LOSS CONDITIONS A. Abandonment There can be no abandonment of any property to us. B. Appraisal If we and you disagree on the value of the prop- erty or the amount of loss, either may make writ- ten demand for an appraisal of the loss. In this event, each party will select a competent and im- partial appraiser. The two appraisers will select an umpire. If they cannot agree, either may re- quest that selection be made by a judge of a court having jurisdiction. The appraisers will state sepa- rately the value of the property and amount of loss. If they fail to agree, they will submit their differences to the umpire. A decision agreed to by any two will be binding. Each party will: Pay its chosen appraiser; and 2. Bear the other expenses of the appraisal and umpire equally. If there is an appraisal, we will still retain our right D to deny the claim. C. Duties In The Event Of Loss You must see that the following are done in the event of loss or damage to Covered Property: 1. Notify the police if a law may have been bro- ken. 2. Give us prompt notice of the loss or damage. Include a description of the property involved. 3. As soon as possible, give us a description of how, when and where the loss or damage oc- curred. 4. Take all reasonable steps to protect the Cov- ered Property from further damage, and keep a record of your expenses necessary to pro- tect the Covered Property, for consideration in the settlement of the claim. This will not in- crease the Limit of Insurance. However, we will not pay for any subsequent loss or dam- age resulting from a cause of loss that is not a Covered Cause of Loss. Also, if feasible, set the damaged property aside and in the best possible order for examination. 5. You will not, except at your own cost, volun- tarily make a payment, assume any obliga- tion, or incur any expense without our con- sent. I? 6. As often as may be reasonably required, permit us to inspect the property proving the loss or damage and examine your books and records. Also permit us to take samples of damaged and undamaged property for inspection, test- ing and analysis, and permit us to make cop- ies frorn your books and records. 7. We may examine any insured under oath, while not in the presence of any other insured and at such times as may be reasonably re- quired, about any matter relating to this insur- ance or the claim, including an insured's books and records. In the event of an exami- nation, an insured's answers must be signed. 8. Send us a signed, sworn proof of loss con- taining the information we request to settle the claire. You must do this within 60 days after our request. We will supply you with the necessary forms. 9. Immediately send us copies of any demands, notices, summonses or legal papers received in connection with the claim or suit. 10. Cooperate with us in the investigation or set- tlement of the claim. Insurance Under Two Or More Coverages If two or more of this policy's coverages apply to the same loss or damage, we will not pay more than the actual amount of the loss or damage. Loss Payment 1. We will give notice of our intentions within 30 days after we receive the sworn proof of loss. 2. We will not pay you more than your financial interest in the Covered Property. 3. We may adjust losses with the owners of lost or damaged property if other than you. If we pay the owners, such payments will satisfy your claim against us for the owners' prop- erty. We will not pay the owners more than their financial interest in the Covered Prop- erty. 4. We may elect to defend you against suits arising from claims of owners of property. We will do this at our expense. 5. We will pay for covered loss or damage within 30 days after we receive the sworn proof of loss if you have complied with all the terms of this Coverage Part and: a. We have reached agreement with you on the amount of the loss; or b. An appraisal award has been made. CM 00 01 09 04 Copyright, ISO Properties, Inc., 2003 Page 1 of 3 UNIFORM 6. We will not be liable for any part of a loss that has been paid or made good by others. F. Other Insurance 1. You may have other insurance subject to the same plan, terms, conditions and provisions as the insurance under this Coverage Part. If you do, we will pay our share of the covered loss or damage. Our share is the proportion that the applicable Limit of Insurance under this Coverage Part bears to the Limits of in- surance of all insurance covering on the same basis. 2. If there is other insurance covering the same loss or damage, other than that described in 1. above, we will pay only for the amount of covered loss or damage in excess of the amount due from that other insurance, whether you can collect on it or not. But we will not pay more than the applicable Limit of Insurance. G. Pair, Sets Or Parts I. Pair Or Set must do nothing after loss to impair them. But you may waive your rights against another party in writing: 1. Prior to a loss to your Covered Property. 2. After a loss to your Covered Property only if, at time of loss, that party is one of the follow- ing: a. Someone insured by this insurance; or b. A business firm: (1) Owned or controlled by you; or (2) That owns or controls you. This will not restrict your insurance. GENERAL CONDITIONS G In case of loss or damage to any part of a pair or set we may: a. Repair or replace any part to restore the pair or set to its value before the loss or B damage; or b. Pay the difference between the value of the pair or set before and after the loss or damage. 2. Parts In case of loss or damage to any part of Cov- ered Property consisting of several parts when complete, we will only pay for the value C of the lost or damaged part. H. Recovered Property If either you or we recover any property after loss settlement, that party must give the other prompt notice. At your option, the property will be re- turned to you. You must then return to us the amount we paid to you for the property. We will pay recovery expenses and the expenses to re- pair the recovered property, subject to the Limit of Insurance. I. Reinstatement Of Limit After Loss The Limit of Insurance will not be reduced by the payment of any claim, except for total loss or damage of a scheduled item, in which event we will refund the unearned premium on that item. J. Transfer Of Rights Of Recovery Against Oth- ers To Us If any person or organization to or for whom we make payment under this Coverage Part has rights to recover damages from another, those rights are transferred to us to the extent of our payment. That person or organization must do everything necessary to secure our rights and Page 2 of 3 L" Concealment, Misrepresentation Or Fraud This Coverage Part is void in any case of fraud, intentional concealment or misrepresentation of a material fact, by you or any other insured, at any time, concerning: 1. This Coverage Part; 2. The Covered Property; 3. Your interest in the Covered Property; or 4. A claim under this Coverage Part. Control Of Property Any act or neglect of any person other than you beyond your direction or control will not affect this insurance. The breach of any condition of this Coverage Part at any one or more locations will not affect cover- age at any location where, at the time of loss or damage, the breach of condition does not exist. Legal Action Against Us No one may bring a legal action against us under this Coverage Part unless: 1. There has been full compliance with all the terms of this Coverage Part; and 2. The action is brought within 2 years after you first have knowledge of the direct loss or damage. No Benefit To Bailee No person or organization, other than you, having custody of Covered Property will benefit from this insurance. E. Policy Period, Coverage Territory We cover loss or damage commencing.- 1. ommencing: 1. During the policy period shown in the Decla- rations; and 2. Within the coverage territory. F. Valuation The value of property will be the least of the fol- lowing amounts: 1. The actual cash value of that property; Copyright, ISO Properties, Inc., 2003 CM 00 01 09 04 ,1 2. The cost of reasonably restoring that property In the event of loss or damage, the value of prop - to its condition immediately before loss or erty will be determined as of the time of loss or damage; or damage. 3. The cost of replacing that property with sub- stantially identical property. CM 00 01 09 04 Copyright, ISO Properties, Inc., 2003 Page 3 of 3 COMMON POLICY CONDITIONS All Coverage Parts included in this policy are subject to the following conditions. A. Cancellation 1. The first Named Insured shown in the Declara- tions may cancel this policy by mailing or deliv- ering to us advance written notice of cancella- tion. 2. We may cancel this policy by mailing or deliv- ering to the first Named Insured written notice of cancellation at least: a. 10 days before the effective date ofcancel- lation if we cancel for nonpayment of pre- mium; or b. 30 days before the effective date ofcancel- lation if we cancel for any other reason. 3. We will mail or deliver our notice to the first Named Insured's last mailing address known to us. D. Inspections And Surveys 1. We have the right to: a. Make inspections and surveys at anytime; b. Give you reports on the conditions we find; and c. Recommend changes. 2. We are notobligated to make any inspections, surveys, reports or recommendations and any such actions we do undertake relate only to insurability and the premiums to be charged. We do not make safety inspections. We do not undertake to perform the duty of any person or organization to provide for the health or safety of workers orthe public. And we do notwarrant that conditions: 4. Notice of cancellation will state the effective a. Are safe or healthful; or date of cancellation. The policy period will end b. Comply with laws, regulations, codes or on that date. standards. 5. If this policy is cancelled, we will send the first 3. Paragraphs 1. and 2. of this condition apply not Named Insured any premium refund due. If we only to us, but also to any rating, advisory, rate cancel, the refund will be pro rata. If the first service or similar organization which makesin- Named Insured cancels, the refund may be less surance inspections, surveys, reports or rec- than pro rata. The cancellation will be effective ommendations. even if we have not made or offered a refund. 6. If notice is mailed, proof of mailing will be suffi- cient proof of notice. B. Changes This policy contains all the agreements between you and us concerning the insurance afforded. The first Named Insured shown in the Declarations is authorized to make changes in the terms of this policy with our consent. This policy's terms can be amended orwaived only by endorsement issued by us and made a part of this policy. C. Examination Of Your Books And Records We may examine and audit your books and records as they relate to this policy atany tirne dur- ing the policy period and up to three years afterward. 4. Paragraph 2. of this condition does notapply to any inspections, surveys, reports or recommen- dations we may make relative to certification, under state or municipal statutes, ordinances or regulations, of boilers, pressure vessels or elevators. E. Premiums The first Named Insured shown in the Declarations: 1. Is responsible for the payment of all premiums; and 2. Will be the payee for any return premiums we pay. Page 1 of 2 IL 00 17 11 98 Copyright, Insurance Services Office, Inc., 1998 F. Transfer Of Your Rights And Duties Under This Policy Your rights and duties under this policy may not be transferred without our written consent except in the case of death of an individual named insured. If you die, your rights and duties will be transferred to your legal representative but only while acting within the scope of duties as your legal represen- tative. Until your legal representative is appointed, anyone having proper temporary custody of your property will have your rights and duties but only with respect to that property. Page 2 of 2 IL 00 17 11 98 Copyright, Insurance Services office, Inc., 1998 SANCTIONS EXCLUSION ZURICHf ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY The following exclusion is added to the policy to which it is attached and supersedes any existing sanctions language in the policy, whether included in an Exclusion Section or otherwise: SANCTIONS EXCLUSION Notwithstanding any other terms under this policy, we shall not provide coverage nor will we make any payments or provide any service or benefit to any insured, beneficiary, or third party who may have any rights under this policy to the extent that such cover, payment, service, benefit, or any business or activity of the insured would violate any applicable trade or economic sanctions law or regulation. The term policy may be comprised of common policy terms and conditions, the declarations, notices, schedule, coverage parts, insuring agreement, application, enrollment form, and endorsements or riders, if any, for each coverage provided. Policy may also be referred to as contract or agreement. We may be referred to as insurer, underwriter, we, us, and our, or as otherwise defined in the policy, and shall mean the company providing the coverage. Insured may be referred to as policyholder, named insured, covered person, additional insured or claimant, or as otherwise defined in the policy, and shall mean the party, person or entity having defined rights under the policy. These definitions may be found in various parts of the policy and any applicable riders or endorsements ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED U -GU -1191-A CW (03/I5) Page I of I S Important Notice — In Witness Clause ZURICH I A: In return for the payment of premium, and subject to the terms of this policy, coverage is provided as stated in this policy. IN WITNESS WHEREOF, this Company has executed and attested these presents and, where required by law, has caused this policy to be countersigned by its duly Authorized Representative(s). President Corporate Secretary QUESTIONS ABOUT YOUR INSURANCE? Your agent or broker is best equipped to provide information about your insurance. Should you require additional information or assistance in resolving a complaint, call or write to the following (please have your policy or claim number ready): Zurich in North America Customer Inquiry Center 1400 American Lane Schaumburg, Illinois 60196-1056 1-800-382-2150 (Business Hours: 8am - 4pm [CT)) Email: info.source@zurichna.com U -GU -319-17 (01/09) Page I of I