Commercial Lines Policy - PTO Today

1 BJP-190-1 (12-98) Commercial Lines Policy THIS Policy CONSISTS OF: DECLARATIONS COMMON Policy CONDITIONS ONE OR MORE COVERAGE PARTS. A COVERAGE PART CONSISTS OF: ONE OR MORE COVERAGE FORMS APPLICABLE FORMS AND ENDORSEMENTS Philadelphia Indemnity Insurance CompanyBJP-190-1 (12-98) IN WITNESS WHEREOF, we have caused this Policy to be executed and attested, and, if required by state law, this Policy shall not be valid unless signed by our authorized representative.

2 President & CEO Secretary IMPORTANT NOTICE To obtain information or make a complaint: 1. You may call Philadelphia Indemnity Insurance Company s toll-free telephone number for information or to make a complaint at 1-877-438-7459 2. You may write to Philadelphia Indemnity Insurance Company at One Bala Plaza, Suite 100 Bala Cynwyd, PA 19004 FAX # (610) 617-7940 3. ATTACH THIS NOTICE TO YOUR Policy PI-Notice (4/00) PI-Notice-AR (11/09) NOTICE If we at Philadelphia Indemnity Insurance Company fail to provide you with reasonable and adequate service, you should feel free to contact: Arkansas Insurance Department 1200 West Third Street Little Rock, AR 72201 (501) 371-2640 or (800) 852-5494 PI-Notice TX (7-07) IMPORTANT NOTICE To obtain information or make a complaint.

3 1 You may call _____ toll-free telephone number for information or to make a complaint at: 1-877-438-7459 2 You may also write to _____ at: One Bala Plaza, Suite 100 Bala Cynwyd, PA 19004 FAX # (610) 617-7940 3 You may contact the Texas Department of Insurance to obtain information on companies, coverages, rights or complaints at: 1-800-252-3439 4 You may write the Texas Department of Insurance: Box 149104 Austin, TX 78714-9104 Fax: (512) 475-1771 Web: E-mail: 5 PREMIUM OR CLAIM DISPUTES: Should you have a dispute concerning your premium or about a claim you should contact _____ first.

4 If the dispute is not resolved, you may contact the Texas Department of Insurance. 6 ATTACH THIS NOTICE TO YOUR Policy : This notice is for information only and does not become a part or condition of the attached document. AVISO IMPORTANTE Para obtener informacion o para someter una queja: Usted puede llamar al numero de telefono gratis de _____ para informacion o para someter una queja al: 1-877-438-7459 Usted tambien puede escribir a _____: One Bala Plaza, Suite 100 Bala Cynwyd, PA 19004 FAX # (610) 617-7940 Puede comunicarse con el Departamento de Seguros de Texas para obtener informacion acerca de companias, coberturas, derechos o quejas al: 1-800-252-3439 Puede escribir al Departamento de Seguros de Texas.

5 Box 149104 Austin, TX 78714-9104 Fax: (512) 475-1771 Web: E-mail: DISPUTAS SOBRE PRIMAS O RECLAMOS: Si tiene una disputa concerniente a su prima o a un reclamo, debe comunicarse con el _____ primero. Si no se resuelve la disputa, puede entonces comunicarse con el departamento (TDI). UNA ESTE AVISO A SU POLIZA: Este aviso es solo para proposito de informacion y no se convierte en parte o condicion del documento adjunto. Philadelphia Indemnity Insurance CompanyPhiladelphia Indemnity Insurance CompanyPhiladelphia Indemnity Insurance CompanyPhiladelphia Indemnity Insurance CompanyPhiladelphia Indemnity Insurance CompanyPhiladelphia Indemnity Insurance Company IL N 175 11 11 IL N 175 11 11 Insurance Services Office, Inc.

6 , 2011 Page 1 of 1 ILLINOIS NOTICE TO POLICYHOLDERS REGARDING THE RELIGIOUS FREEDOM PROTECTION AND CIVIL UNION ACT Dear Policyholder: This is to provide notice that, pursuant to Illinois Department of Insurance Company Bulletin 2011-06 (CB 2011-06), this Policy is in compliance with the Illinois Religious Freedom Protection and Civil Union Act ("the Act", 750 ILL. COMP. STAT. 75/1). The Act, which became effective on June 1, 2011, creates a legal relationship between two persons of either the same or opposite sex who establish a civil union.

7 The Act provides that parties to a civil union are entitled to the same legal obligations, responsibilities, protections and benefits that are afforded or recognized by the law of Illinois to spouses, whether they are derived from statute, administrative rule, Policy , common law or any source of civil or criminal law. In addition, this law requires recognition of a same-sex civil union, marriage, or other substantially similar legal relationship, except for common law marriage, legally entered into in other jurisdictions.

8 The Act further provides that "party to a civil union" shall be included in any definition or use of the terms "spouse", "family", "immediate family", "dependent", "next of kin" and other terms descriptive of spousal relationships as those terms are used throughout the law. According to CB 2011-06, this includes the terms "marriage" or "married" or any variations thereof. CB 2011-06 also states that if policies of insurance provide coverage for children, the children of civil unions must also be provided coverage.

9 IL N 176 01 12 IL N 176 01 12 Insurance Services Office, Inc., 2011 Page 1 of 1 DELAWARE NOTICE TO POLICYHOLDERS REGARDING THE CIVIL UNION AND EQUALITY ACT Dear Policyholder: This is to provide notice that, pursuant to the Delaware Insurance Department Domestic/Foreign Insurers Bulletin No. 46, this Policy is in compliance with the Delaware Civil Union and Equality Act of 2011, 78 Del. Laws Ch. 22 (2011) (the "Act"). The Act, which becomes effective January 1, 2012, creates a form of legal union between two persons of the same sex who establish a civil union in accordance with the requirements of Delaware law.

10 The Act provides that parties to a civil union shall have all of the same rights, protections and benefits, and shall be subject to the same responsibilities, obligations and duties, under Delaware law as are granted to, enjoyed by, or imposed upon married spouses. The Act further provides that a party to a civil union shall be included in any definition or use of the terms "dependent", "family", "husband and wife", "immediate family", "next of kin", "spouse", "stepparent", "tenants by the entirety", and other terms, whether or not gender-specific, that denote a spousal relationship or a person in a spousal relationship, as those terms are used throughout Delaware law.