This is a legal contract between the policyholder and

Trisura Insurance Company

(A Stock Insurance Company)

PLEASE READ YOUR POLICY CAREFULLY

Contact Us:
CLAIMS: …………………………………………. (800) 319-1390
POLICY ADMINISTRATION: ……………...(800) 319-1390

Main Office:
Phone: (405) 594-4960 Fax: (405) 594-4969
210 Park Ave, Ste 1400, Oklahoma City, Oklahoma 73102

LA TC Jacket 07 20 Page 1 of 63
 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 countersigned by our

authorized representative.

President Secretary

LA TC Jacket 07 20 Page 2 of 63
 Rev.12/2021

WHAT DOES MILLENNIAL SPECIALTY INSURANCE,

FACTS LLC (MSI)

DO WITH YOUR PERSONAL INFORMATION?

Why? Financial companies choose how they share your personal information. Federal law gives
consumers the right to limit some but not all sharing. Federal law also requires us to tell you
how we collect, share, and protect your personal information. Please read this notice carefully to
understand what we do.

What? The types of personal information we collect and share depend on the product or service you
have with us. This information can include:
� Social Security number and income
� credit scores and credit-based insurance scores
� medical information and employment information

How? All financial companies need to share customers' personal information to run their everyday
business. In the section below, we list the reasons financial companies can share their
customers' personal information; the reasons MSI chooses to share; and whether you can limit
this sharing.

Reasons we can share your personal information Does MSI share? Can you limit this sharing?

For our everyday business purposes—

such as to process your transactions, maintain
your account(s), respond to court orders and legal Yes No
investigations, or report to credit bureaus

For our marketing purposes—

to offer our products and services to you Yes No

For joint marketing with other financial companies No We don't share

For our affiliates’ everyday business purposes—

information about your transactions and experiences Yes No

For our affiliates’ everyday business purposes—

information about your creditworthiness No We don't share

For our affiliates to market to you No We don't share

For nonaffiliates to market to you No We don't share

To limit
our sharing

Questions? Call (844) 788-0873 or email us at: [email protected]

MSI PN 02 22 Page 3 of 63
 Who are we
Millennial Specialty Insurance, LLC
Who is providing this notice?

What we do
How does MSI To protect your personal information from unauthorized access
protect my personal information? and use, we use security measures that comply with federal law.
These measures include computer safeguards and secured files
and buildings.

How does MSI We collect your personal information, for example, when you
collect my personal information?
 apply for insurance or pay insurance premiums
 file an insurance claim or give us your contact information
 provide employment information
We also collect your personal information from others, such as credit
bureaus, affiliates or other companies.

Why can’t I limit all sharing? Federal law gives you the right to limit only
 sharing for affiliates’ everyday business purposes—information
about your creditworthiness
 affiliates from using your information to market to you
 sharing for nonaffiliates to market to you
State laws and individual companies may give you additional rights to
limit sharing. See below for more on your rights under state law.

Definitions
Affiliates Companies related by common ownership or control. They can be
financial and nonfinancial companies.
 Our affiliates include Baldwin Risk Partners, LLC (BRP) and
companies that use the BRP or Baldwin Risk Partners name.

Nonaffiliates Companies not related by common ownership or control. They can be

financial and nonfinancial companies.
 MSI does not share with nonaffiliates so they can market to you.

Joint marketing A formal agreement between nonaffiliated financial companies that

together market financial products or services to you.
 MSI doesn't jointly market.

Other important information

MSI PN 02 22 Page 4 of 63
 California: Under California law, we will not share information we collect about you with companies outside of MSI
and its affiliates, unless the law allows. For example, we may share information with your consent, to service your
accounts, or to provide rewards or benefits you are entitled to. We will limit sharing among our companies to the extent
required by California law.

MSI PN 02 22 Page 5 of 63
 Other important information

For MA Insurance Customers only: You may ask, in writing, for the specific reasons for an adverse underwriting decision.
An adverse underwriting decision is where we decline your application for insurance, offer to insure you at a higher than
standard rate or terminate your coverage.

Vermont: Under Vermont law, we will not share information we collect about Vermont residents with companies outside of
our corporate family, unless the law allows. For example, we may share information with your consent or to service your
accounts. We will not share information about your creditworthiness within our corporate family, but we may share
information about our transactions or experiences with you within our corporate family without your consent.

For Insurance Customers in AZ, CA, CT, GA, IL, ME, MA, MN, MT, NV, NJ, NC, OH, OR and VA only: The term
“Information” in this part means customer information obtained in an insurance transaction. We may give your Information
to state insurance officials, law enforcement, group policy holders about claims experience or auditors as the law allows or
requires. We may give your Information to insurance support companies that may keep it or give it to others. We may
share medical information so we can learn if you qualify for coverage, process claims or prevent fraud, or if you say we
can. To see your Information, write MSI at PO Box 210788, Bedford, TX 76095. You must state your full name, address,
the insurance company, policy number (if relevant) and the Information you want. We will tell you what Information we
have. You may see and copy the Information (unless privileged) at our office or ask that we mail you a copy for a fee. If
you think any Information is wrong, you must write us. We will let you know what actions we take. If you do not agree with
our actions, you may send us a statement.

MSI PN 02 22 Page 6 of 63
 For Service Call Your Agency. Contents
For Claims call: (800) 319-1390 New Business
Page 7 of 63

TRISURA INSURANCE COMPANY RENTERS POLICY DECLARATION PAGE

Policy Number: Policy Period: 2/10/2024 12:01 A.M. Central to 2/10/2025 12:01 A.M. Central Time at
85618542 Time at the property location of the Primary the property location of the Primary
Named Insured. Named Insured.
This policy is continuous until cancelled or nonrenewed.
NAME AND MAILING ADDRESS OF INSURED: AGENCY NAME AND ADDRESS
Yeni Perez (800) 319-1390
2700 Ernest Street, 362 ePremium Insurance Agency, LLC
Lake Charles, LA, 70601 4770 Duke Drive, Suite 200
Mason, OH, 45040
Prop Loc: 2700 Ernest Street, 362, Lake Charles, LA, 70601
In return for the payment of premium, and subject to all the terms of the policy, we agree to provide you with insurance coverage as stated in this policy.
Insurance is to be provided only with respect to the location(s) and/or coverage(s) for which a limit of liability is specified, subject to all conditions of this policy.
SECTION I - PROPERTY COVERAGE LIMITS SECTION II - LIABILITY COVERAGE LIMITS
C D E F
PERSONAL PROPERTY LOSS OF USE PERSONAL LIABILITY MEDICAL PAYMENTS
$15,000 $3,000 TO OTHERS
$100,000 $1,000 $25,000
each occurrence each person each occurrence

Loss Deductible for Section I: $500 Wind/Hail Deductible: $1,000

Subject to the following form(s) and endorsement(s) attached and/or revision(s) included, made part of this policy at the time of issue.
COVERAGE FORMS FORM NUMBERS PREMIUMS

Coverage C, D, E, F SECTION I & II $262.00

Increased Deductible Credit SECTION I Included

Homeowner 4 - Contents Broad Form HO 00 04 05 11 Included

Limited Fungi, Wet or Dry Rot, or Bacteria Coverage - Louisiana TC HO 03 41 0121 Included
No Section II Liability Coverages for Home Day Care HO 0496 1000 Included
Water Exclusion Endorsement HO 1609 0109 Included
Animal Liability Limitation Endorsement TC HO4-PL (07/20) Included
Personal Property Replacement Cost Loss Settlement TC HO 04 90 07 20 Included
Rental Income Coverage TC HO4-RI (07/20) Included
Tenants Mandatory Endorsement - Louisiana TC HO 02 04 LA 01 21 Included
Special Provisions - Louisiana HO 01 17 03 23 Included
Identity Fraud Expense Coverage TC HO 04 55 07 20 $5,000 /$12.00
Forcible Entry Theft Endorsement TC HO4-FE (07/20) $-26.00
Pet Damage Endorsement TC HO4-PD (01/21) $500 /$18.00
Biohazard Clean-up Endorsement TC BIO EN 07 20 Included
Refrigerated Property Coverage Endorsement HO 0498 0511 $500 /$10.00
Total Endorsement $14.00
Premium
Policy Fee $15.00
Emergency Assessment $5.00

Total Amount $296.00

This Policy Does Not Cover Damage Caused By Flooding. Contact Your Agency To Learn More.
MESSAGES!

MESSAGES!

Coverage Includes Personal Property Replacement Cost.

Premium Automatically Deducted on a Monthly Basis.

LA Dec Page 07 20 210 Park Ave. Ste 1400, Oklahoma City, Oklahoma 73102
 Page 8 of 63
SUPPLEMENTAL DECLARATIONS PAGE
Policy Number: Policy Period: 2/10/202412:01 to 2/10/2025 12:01 A.M. Central Time at
85618542 A.M. Central Time at the property the property location of the Primary
location of the Primary Named Named Insured.
Insured.

Insured(s) Email Address: [email protected]

This policy is continuous until cancelled or nonrenewed

NOTICES FORM NUMBERS

MSI Privacy Notice MSI PN 02 22
Homeowners Insurance Policy Coverage Disclosure TC LA H4 Appendix B 05 20
Summary
Important Information Required by the LA DOI TC LA H4 Appendix C 05 20
Policyholders Advisory Notice OPT NT 0819
Consent to Electronic Form and Delivery of Insurance Consent Notice 07 20
Transaction Documents Notice
OFAC Notice ILP 0010104
Louisiana Fraud Statement IL N 048 09 03

Payment Plan: Monthly

Billing Schedule:

Date Amount
3/1/2024 $25.00
4/1/2024 $25.00
5/1/2024 $25.00
6/1/2024 $25.00
7/1/2024 $25.00
8/1/2024 $25.00
9/1/2024 $25.00
10/1/2024 $25.00
11/1/2024 $25.00
12/1/2024 $24.99

*Each installment includes a $2.00 installment fee. The initial payment does not include an installment fee. No
installment fees apply when on an annual payment plan

A $15.00 Policy Fee is included with your First Installment or Initial Down Payment. A $5.00 Emergency
Assessment charge is included with your First Installment or Initial Down Payment.

The premium includes a charge for local government premium taxes.

_______________________________
Authorized Representative Signature
 HOMEOWNERS
HO 00 04 05 11

HOMEOWNERS 4 – CONTENTS BROAD FORM

AGREEMENT 2. "Bodily injury" means bodily harm, sickness or
We will provide the insurance described in this policy disease, including required care, loss of
in return for the premium and compliance with all services and death that results.
applicable provisions of this policy. 3. "Business" means:
DEFINITIONS a. A trade, profession or occupation engaged
A. In this policy, "you" and "your" refer to the "named in on a full-time, part-time or occasional
insured" shown in the Declarations and the spouse basis; or
if a resident of the same household. "We", "us" and b. Any other activity engaged in for money or
"our" refer to the Company providing this insurance. other compensation, except the following:
B. In addition, certain words and phrases are defined (1) One or more activities, not described in
as follows: (2) through (4) below, for which no
1. "Aircraft Liability", "Hovercraft Liability", "Motor "insured" receives more than $2,000 in
Vehicle Liability" and "Watercraft Liability", total compensation for the 12 months
subject to the provisions in b. below, mean the before the beginning of the policy period;
following: (2) Volunteer activities for which no money is
a. Liability for "bodily injury" or "property received other than payment for
damage" arising out of the: expenses incurred to perform the activity;
(1) Ownership of such vehicle or craft by an (3) Providing home day care services for
"insured"; which no compensation is received, other
than the mutual exchange of such
(2) Maintenance, occupancy, operation, services; or
use, loading or unloading of such vehicle
or craft by any person; (4) The rendering of home day care services
to a relative of an "insured".
(3) Entrustment of such vehicle or craft by an
"insured" to any person; 4. "Employee" means an employee of an
"insured", or an employee leased to an "insured"
(4) Failure to supervise or negligent by a labor leasing firm under an agreement
supervision of any person involving such between an "insured" and the labor leasing firm,
vehicle or craft by an "insured"; or whose duties are other than those performed by
(5) Vicarious liability, whether or not a "residence employee".
imposed by law, for the actions of a child 5. "Insured" means:
or minor involving such vehicle or craft.
a. You and residents of your household who
b. For the purpose of this definition: are:
(1) Aircraft means any contrivance used or (1) Your relatives; or
designed for flight except model or hobby
aircraft not used or designed to carry (2) Other persons under the age of 21 and in
people or cargo; your care or the care of a resident of your
household who is your relative;
(2) Hovercraft means a self-propelled
motorized ground effect vehicle and b. A student enrolled in school full-time, as
includes, but is not limited to, flarecraft defined by the school, who was a resident of
and air cushion vehicles; your household before moving out to attend
school, provided the student is under the age
(3) Watercraft means a craft principally of:
designed to be propelled on or in water
by wind, engine power or electric motor; (1) 24 and your relative; or
and
(4) Motor vehicle means a "motor vehicle" as
defined in 7. below.

HO 00 04 05 11 © Insurance Services Office, Inc., 2010 Page 9 of 63

 (2) 21 and in your care or the care of a g. Individual or family cemetery plots or burial
resident of your household who is your vaults of an "insured"; or
relative; or h. Any part of a premises occasionally rented
c. Under Section II: to an "insured" for other than "business" use.
(1) With respect to animals or watercraft to 7. "Motor vehicle" means:
which this policy applies, any person or a. A self-propelled land or amphibious vehicle;
organization legally responsible for these or
animals or watercraft which are owned by
you or any person described in 5.a. or b. b. Any trailer or semitrailer which is being
"Insured" does not mean a person or carried on, towed by or hitched for towing by
organization using or having custody of a vehicle described in a. above.
these animals or watercraft in the course 8. "Occurrence" means an accident, including
of any "business" or without consent of continuous or repeated exposure to
the owner; or substantially the same general harmful
(2) With respect to a "motor vehicle" to which conditions, which results, during the policy
this policy applies: period, in:
(a) Persons while engaged in your a. "Bodily injury"; or
employ or that of any person b. "Property damage".
described in 5.a. or b.; or
9. "Property damage" means physical injury to,
(b) Other persons using the vehicle on an destruction of, or loss of use of tangible
"insured location" with your consent. property.
Under both Sections I and II, when the word an 10. "Residence employee" means:
immediately precedes the word "insured", the
a. An employee of an "insured", or an
words an "insured" together mean one or more employee leased to an "insured" by a labor
"insureds". leasing firm, under an agreement between
6. "Insured location" means: an "insured" and the labor leasing firm,
a. The "residence premises"; whose duties are related to the maintenance
or use of the "residence premises", including
b. The part of other premises, other structures household or domestic services; or
and grounds used by you as a residence;
and b. One who performs similar duties elsewhere
not related to the "business" of an "insured".
(1) Which is shown in the Declarations; or
A "residence employee" does not include a
(2) Which is acquired by you during the temporary employee who is furnished to an
policy period for your use as a residence; "insured" to substitute for a permanent
c. Any premises used by you in connection with "residence employee" on leave or to meet
a premises described in a. and b. above; seasonal or short-term workload conditions.
d. Any part of a premises: 11. "Residence premises" means:
(1) Not owned by an "insured"; and a. The one-family dwelling where you reside;
(2) Where an "insured" is temporarily b. The two-, three- or four-family dwelling
residing; where you reside in at least one of the family
e. Vacant land, other than farm land, owned by units; or
or rented to an "insured"; c. That part of any other building where you
f. Land owned by or rented to an "insured" on reside;
which a one-, two-, three- or four-family and which is shown as the "residence premises"
dwelling is being built as a residence for an in the Declarations.
"insured"; "Residence premises" also includes other
structures and grounds at that location.

HO 00 04 05 11 © Insurance Services Office, Inc., 2010 Page 10 of 63

SECTION I – PROPERTY COVERAGES 3. Special Limits Of Liability
A. Coverage C – Personal Property The special limit for each category shown below
1. Covered Property is the total limit for each loss for all property in
that category. These special limits do not
We cover personal property owned or used by increase the Coverage C limit of liability.
an "insured" while it is anywhere in the world.
After a loss and at your request, we will cover a. $200 on money, bank notes, bullion, gold
personal property owned by: other than goldware, silver other than
silverware, platinum other than
a. Others while the property is on the part of the platinumware, coins, medals, scrip, stored
"residence premises" occupied by an value cards and smart cards.
"insured"; or
b. $1,500 on securities, accounts, deeds,
b. A guest or a "residence employee", while the evidences of debt, letters of credit, notes
property is in any residence occupied by an other than bank notes, manuscripts,
"insured". personal records, passports, tickets and
2. Limit For Property At Other Locations stamps. This dollar limit applies to these
a. Other Residences categories regardless of the medium (such
as paper or computer software) on which the
Our limit of liability for personal property material exists.
usually located at an "insured's" residence,
other than the "residence premises", is 10% This limit includes the cost to research,
replace or restore the information from the
of the limit of liability for Coverage C, or
lost or damaged material.
$1,000, whichever is greater. However, this
limitation does not apply to personal c. $1,500 on watercraft of all types, including
property: their trailers, furnishings, equipment and
outboard engines or motors.
(1) Moved from the "residence premises"
because it is: d. $1,500 on trailers or semitrailers not used
with watercraft of all types.
(a) Being repaired, renovated or rebuilt;
and e. $1,500 for loss by theft of jewelry, watches,
furs, precious and semiprecious stones.
(b) Not fit to live in or store property in; or
f. $2,500 for loss by theft of firearms and
(2) In a newly acquired principal residence
related equipment.
for 30 days from the time you begin to
move the property there. g. $2,500 for loss by theft of silverware, silver-
plated ware, goldware, gold-plated ware,
b. Self-storage Facilities
platinumware, platinum-plated ware and
Our limit of liability for personal property pewterware. This includes flatware,
owned or used by an "insured" and located hollowware, tea sets, trays and trophies
in a self-storage facility is 10% of the limit of made of or including silver, gold or pewter.
liability for Coverage C, or $1,000,
whichever is greater. However, this limitation h. $2,500 on property, on the "residence
premises", used primarily for "business"
does not apply to personal property:
purposes.
(1) Moved from the "residence premises"
because it is: i. $1,500 on property, away from the
"residence premises", used primarily for
(a) Being repaired, renovated or rebuilt; "business" purposes. However, this limit
and does not apply to antennas, tapes, wires,
(b) Not fit to live in or store property in; or records, disks or other media that are:
(2) Usually located in an "insured's" (1) Used with electronic equipment that
residence, other than the "residence reproduces, receives or transmits audio,
premises". visual or data signals; and
(2) In or upon a "motor vehicle".
j. $1,500 on portable electronic equipment
that:
(1) Reproduces, receives or transmits audio,
visual or data signals;

HO 00 04 05 11 © Insurance Services Office, Inc., 2010 Page 11 of 63

 (2) Is designed to be operated by more than h. Property rented or held for rental to others
one power source, one of which is a off the "residence premises";
"motor vehicle's" electrical system; and i. "Business" data, including such data stored
(3) Is in or upon a "motor vehicle". in:
k. $250 for antennas, tapes, wires, records, (1) Books of account, drawings or other
disks or other media that are: paper records; or
(1) Used with electronic equipment that (2) Computers and related equipment.
reproduces, receives or transmits audio, We do cover the cost of blank recording or
visual or data signals; and storage media and of prerecorded computer
(2) In or upon a "motor vehicle". programs available on the retail market;
4. Property Not Covered j. Credit cards, electronic fund transfer cards
We do not cover: or access devices used solely for deposit,
withdrawal or transfer of funds except as
a. Articles separately described and provided in C.6. Credit Card, Electronic Fund
specifically insured, regardless of the limit for Transfer Card Or Access Device, Forgery
which they are insured, in this or other And Counterfeit Money under Section I –
insurance; Property Coverages; or
b. Animals, birds or fish; k. Water or steam.
c. "Motor vehicles". B. Coverage D – Loss Of Use
This includes a "motor vehicle's" equipment The limit of liability for Coverage D is the total limit
and parts. for the coverages in 1. Additional Living Expense,
However, this Paragraph 4.c. does not apply 2. Fair Rental Value and 3. Civil Authority Prohibits
to: Use below.
(1) Portable electronic equipment that: 1. Additional Living Expense
(a) Reproduces, receives or transmits If a loss by a Peril Insured Against under this
audio, visual or data signals; and policy to covered property or the building
containing the property makes the "residence
(b) Is designed so that it may be operated
from a power source other than a premises" not fit to live in, we cover any
necessary increase in living expenses incurred
"motor vehicle's" electrical system.
by you so that your household can maintain its
(2) "Motor vehicles" not required to be normal standard of living.
registered for use on public roads or
property which are: Payment will be for the shortest time required to
repair or replace the damage or, if you
(a) Used solely to service a residence; or permanently relocate, the shortest time required
(b) Designed to assist the handicapped; for your household to settle elsewhere.
d. Aircraft, meaning any contrivance used or 2. Fair Rental Value
designed for flight, including any parts If a loss covered under Section I makes that part
whether or not attached to the aircraft. of the "residence premises" rented to others or
We do cover model or hobby aircraft not held for rental by you not fit to live in, we cover
used or designed to carry people or cargo; the fair rental value of such premises less any
expenses that do not continue while it is not fit
e. Hovercraft and parts. Hovercraft means a
to live in.
self-propelled motorized ground effect
vehicle and includes, but is not limited to, Payment will be for the shortest time required to
flarecraft and air cushion vehicles; repair or replace such premises.
f. Property of roomers, boarders and other
tenants, except property of roomers and
boarders related to an "insured";
g. Property in an apartment regularly rented or
held for rental to others by an "insured";

HO 00 04 05 11 © Insurance Services Office, Inc., 2010 Page 12 of 63

 3. Civil Authority Prohibits Use (b) Block a ramp or other fixture designed
If a civil authority prohibits you from use of the to assist a handicapped person to
"residence premises" as a result of direct enter or leave the dwelling building.
damage to neighboring premises by a Peril The $1,000 limit is the most we will pay in
Insured Against, we cover the loss as provided any one loss, regardless of the number of
in 1. Additional Living Expense and 2. Fair fallen trees. No more than $500 of this limit
Rental Value above for no more than two will be paid for the removal of any one tree.
weeks. This coverage is additional insurance.
4. Loss Or Expense Not Covered 2. Reasonable Repairs
We do not cover loss or expense due to a. We will pay the reasonable cost incurred by
cancellation of a lease or agreement. you for the necessary measures taken solely
The periods of time under 1. Additional Living to protect covered property that is damaged
Expense, 2. Fair Rental Value and 3. Civil Authority by a Peril Insured Against from further
Prohibits Use above are not limited by expiration of damage.
this policy. b. If the measures taken involve repair to other
C. Additional Coverages damaged property, we will only pay if that
1. Debris Removal property is covered under this policy and the
damage is caused by a Peril Insured
a. We will pay your reasonable expense for the Against. This coverage does not:
removal of:
(1) Increase the limit of liability that applies
(1) Debris of covered property if a Peril to the covered property; or
Insured Against that applies to the
damaged property causes the loss; or (2) Relieve you of your duties, in case of a
loss to covered property, described in
(2) Ash, dust or particles from a volcanic C.4. under Section I – Conditions.
eruption that has caused direct loss to a
building or property contained in a 3. Trees, Shrubs And Other Plants
building. We cover trees, shrubs, plants or lawns, on the
This expense is included in the limit of "residence premises", for loss caused by the
liability that applies to the damaged property. following Perils Insured Against:
If the amount to be paid for the actual a. Fire or Lightning;
damage to the property plus the debris b. Explosion;
removal expense is more than the limit of
liability for the damaged property, an c. Riot or Civil Commotion;
additional 5% of that limit is available for d. Aircraft;
such expense. e. Vehicles not owned or operated by a
b. We will also pay your reasonable expense, resident of the "residence premises";
up to $1,000, for the removal from the
f. Vandalism or Malicious Mischief; or
"residence premises" of:
g. Theft.
(1) Your trees felled by the peril of
Windstorm or Hail or Weight of Ice, Snow We will pay up to 10% of the limit of liability that
or Sleet; or applies to Coverage C for all trees, shrubs,
plants or lawns. No more than $500 of this limit
(2) A neighbor's trees felled by a Peril will be paid for any one tree, shrub or plant. We
Insured Against under Coverage C; do not cover property grown for "business"
provided the trees: purposes.
(3) Damage a covered structure; or This coverage is additional insurance.
(4) Do not damage a covered structure, but:
(a) Block a driveway on the "residence
premises" which prevents a "motor
vehicle", that is registered for use on
public roads or property, from
entering or leaving the "residence
premises"; or

HO 00 04 05 11 © Insurance Services Office, Inc., 2010 Page 13 of 63

 4. Fire Department Service Charge (c) If an "insured" has not complied with
We will pay up to $500 for your liability assumed all terms and conditions under which
by contract or agreement for fire department the cards are issued or the devices
charges incurred when the fire department is accessed; or
called to save or protect covered property from (2) Loss arising out of "business" use or
a Peril Insured Against. We do not cover fire dishonesty of an "insured".
department service charges if the property is c. If the coverage in a. above applies, the
located within the limits of the city, municipality following defense provisions also apply:
or protection district furnishing the fire
department response. (1) We may investigate and settle any claim
or suit that we decide is appropriate. Our
This coverage is additional insurance. No duty to defend a claim or suit ends when
deductible applies to this coverage. the amount we pay for the loss equals
5. Property Removed our limit of liability.
We insure covered property against direct loss (2) If a suit is brought against an "insured" for
from any cause while being removed from a liability under a.(1) or (2) above, we will
premises endangered by a Peril Insured Against provide a defense at our expense by
and for no more than 30 days while removed. counsel of our choice.
This coverage does not change the limit of (3) We have the option to defend at our
liability that applies to the property being expense an "insured" or an "insured's"
removed. bank against any suit for the enforcement
6. Credit Card, Electronic Fund Transfer Card of payment under a.(3) above.
Or Access Device, Forgery And Counterfeit 7. Loss Assessment
Money a. We will pay up to $1,000 for your share of
a. We will pay up to $500 for: loss assessment charged during the policy
(1) The legal obligation of an "insured" to pay period against you, as owner or tenant of the
because of the theft or unauthorized use "residence premises", by a corporation or
of credit cards issued to or registered in association of property owners. The
an "insured's" name; assessment must be made as a result of
direct loss to property, owned by all
(2) Loss resulting from theft or unauthorized members collectively, of the type that would
use of an electronic fund transfer card or be covered by this policy if owned by you,
access device used for deposit, caused by a Peril Insured Against under
withdrawal or transfer of funds, issued to Coverage C, other than:
or registered in an "insured's" name;
(1) Earthquake; or
(3) Loss to an "insured" caused by forgery or
alteration of any check or negotiable (2) Land shock waves or tremors before,
instrument; and during or after a volcanic eruption.
(4) Loss to an "insured" through acceptance The limit of $1,000 is the most we will pay
in good faith of counterfeit United States with respect to any one loss, regardless of
or Canadian paper currency. the number of assessments. We will only
apply one deductible, per unit, to the total
All loss resulting from a series of acts amount of any one loss to the property
committed by any one person or in which described above, regardless of the number
any one person is concerned or implicated is of assessments.
considered to be one loss.
b. We do not cover assessments charged
This coverage is additional insurance. No against you or a corporation or association
deductible applies to this coverage. of property owners by any governmental
b. We do not cover: body.
(1) Use of a credit card, electronic fund c. Paragraph P. Policy Period under Section I
transfer card or access device: – Conditions does not apply to this coverage.
(a) By a resident of your household; This coverage is additional insurance.
(b) By a person who has been entrusted
with either type of card or access
device; or

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 8. Collapse e. Loss to an awning, fence, patio, deck,
a. The coverage provided under this Additional pavement, swimming pool, underground
Coverage – Collapse applies only to an pipe, flue, drain, cesspool, septic tank,
abrupt collapse. foundation, retaining wall, bulkhead, pier,
wharf or dock is not included under d.(2)
b. For the purpose of this Additional Coverage through (6) above, unless the loss is a direct
– Collapse, abrupt collapse means an abrupt result of the collapse of a building or any part
falling down or caving in of a building or any of a building.
part of a building with the result that the
building or part of the building cannot be f. This coverage does not increase the limit of
occupied for its intended purpose. liability that applies to the damaged covered
property.
c. This Additional Coverage – Collapse does
not apply to: 9. Glass Or Safety Glazing Material
(1) A building or any part of a building that is a. We cover:
in danger of falling down or caving in; (1) The breakage of glass or safety glazing
(2) A part of a building that is standing, even material which is part of a building, storm
if it has separated from another part of door or storm window and covered as
the building; or Building Additions And Alterations;
(3) A building or any part of a building that is (2) The breakage of glass or safety glazing
standing, even if it shows evidence of material which is part of a building, storm
cracking, bulging, sagging, bending, door or storm window and covered as
leaning, settling, shrinkage or expansion. Building Additions And Alterations when
caused directly by earth movement; and
d. We insure for direct physical loss to covered
property involving abrupt collapse of a (3) The direct physical loss to covered
building or any part of a building if such property caused solely by the pieces,
collapse was caused by one or more of the fragments or splinters of broken glass or
following: safety glazing material which is part of a
building, storm door or storm window.
(1) The Perils Insured Against;
b. This coverage does not include loss:
(2) Decay, of a building or any part of a
building, that is hidden from view, unless (1) To covered property which results
the presence of such decay is known to because the glass or safety glazing
an "insured" prior to collapse; material has been broken, except as
provided in a.(3) above; or
(3) Insect or vermin damage, to a building or
any part of a building, that is hidden from (2) On the "residence premises" if the
view, unless the presence of such dwelling has been vacant for more than
damage is known to an "insured" prior to 60 consecutive days immediately before
collapse; the loss, except when the breakage
results directly from earth movement as
(4) Weight of contents, equipment, animals provided in a.(2) above. A dwelling being
or people; constructed is not considered vacant.
(5) Weight of rain which collects on a roof; or c. This coverage does not increase the limit of
(6) Use of defective material or methods in liability that applies to the damaged property.
construction, remodeling or renovation if 10. Building Additions And Alterations
the collapse occurs during the course of
the construction, remodeling or We cover under Coverage C the building
renovation. improvements or installations, made or acquired
at your expense, to that part of the "residence
premises" used exclusively by you. The limit of
liability for this coverage will not be more than
10% of the limit of liability that applies to
Coverage C.
This coverage is additional insurance.

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 11. Ordinance Or Law 12. Grave Markers
a. You may use up to 10% of the limit of liability We will pay up to $5,000 for grave markers,
that applies to Building Additions And including mausoleums, on or away from the
Alterations for the increased costs you incur "residence premises" for loss caused by a Peril
due to the enforcement of any ordinance or Insured Against.
law which requires or regulates: This coverage does not increase the limits of
(1) The construction, demolition, liability that apply to the damaged covered
remodeling, renovation or repair of that property.
part of a covered building or other SECTION I – PERILS INSURED AGAINST
structure damaged by a Peril Insured
Against; We insure for direct physical loss to the property
described in Coverage C caused by any of the
(2) The demolition and reconstruction of the following perils unless the loss is excluded in Section I
undamaged part of a covered building or – Exclusions.
other structure, when that building or
other structure must be totally 1. Fire Or Lightning
demolished because of damage by a 2. Windstorm Or Hail
Peril Insured Against to another part of This peril includes loss to watercraft of all types and
that covered building or other structure; their trailers, furnishings, equipment, and outboard
or engines or motors, only while inside a fully enclosed
(3) The remodeling, removal or replacement building.
of the portion of the undamaged part of a
This peril does not include loss to the property
covered building or other structure contained in a building caused by rain, snow, sleet,
necessary to complete the remodeling, sand or dust unless the direct force of wind or hail
repair or replacement of that part of the damages the building causing an opening in a roof
covered building or other structure or wall and the rain, snow, sleet, sand or dust enters
damaged by a Peril Insured Against. through this opening.
b. You may use all or part of this ordinance or 3. Explosion
law coverage to pay for the increased costs
you incur to remove debris resulting from the 4. Riot Or Civil Commotion
construction, demolition, remodeling, 5. Aircraft
renovation, repair or replacement of property
This peril includes self-propelled missiles and
as stated in a. above.
spacecraft.
c. We do not cover:
6. Vehicles
(1) The loss in value to any covered building
or other structure due to the 7. Smoke
requirements of any ordinance or law; or This peril means sudden and accidental damage
from smoke, including the emission or puffback of
(2) The costs to comply with any ordinance
smoke, soot, fumes or vapors from a boiler, furnace
or law which requires any "insured" or
or related equipment.
others to test for, monitor, clean up,
remove, contain, treat, detoxify or This peril does not include loss caused by smoke
neutralize, or in any way respond to, or from agricultural smudging or industrial operations.
assess the effects of, pollutants in or on 8. Vandalism Or Malicious Mischief
any covered building or other structure.
This peril does not include loss to property on the
Pollutants means any solid, liquid, "residence premises", and any ensuing loss caused
gaseous or thermal irritant or by any intentional and wrongful act committed in the
contaminant, including smoke, vapor, course of the vandalism or malicious mischief, if the
soot, fumes, acids, alkalis, chemicals and dwelling has been vacant for more than 60
waste. Waste includes materials to be consecutive days immediately before the loss. A
recycled, reconditioned or reclaimed. dwelling being constructed is not considered
This coverage is additional insurance. vacant.
9. Theft
a. This peril includes attempted theft and loss of
property from a known place when it is likely that
the property has been stolen.

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 b. This peril does not include loss caused by theft: (4) Caused by mold, fungus or wet rot unless
(1) Committed by an "insured"; hidden within the walls or ceilings or beneath
the floors or above the ceilings of a structure.
(2) In or to a dwelling under construction, or of
materials and supplies for use in the c. In this peril, a plumbing system or household
construction until the dwelling is finished and appliance does not include a sump, sump pump
occupied; or related equipment or a roof drain, gutter,
downspout or similar fixtures or equipment.
(3) From that part of a "residence premises"
rented by an "insured" to someone other d. Section I – Exclusion 3. Water, Paragraphs a.
than another "insured"; or and c. that apply to surface water and water
below the surface of the ground do not apply to
(4) That occurs off the "residence premises" of: loss by water covered under this peril.
(a) Trailers, semitrailers and campers; 13. Sudden And Accidental Tearing Apart,
(b) Watercraft of all types, and their Cracking, Burning Or Bulging
furnishings, equipment and outboard This peril means sudden and accidental tearing
engines or motors; or apart, cracking, burning or bulging of a steam or hot
(c) Property while at any other residence water heating system, an air conditioning or
owned by, rented to, or occupied by an automatic fire protective sprinkler system, or an
"insured", except while an "insured" is appliance for heating water.
temporarily living there. Property of an This peril does not include loss caused by or
"insured" who is a student is covered resulting from freezing except as provided in Peril
while at the residence the student Insured Against 14. Freezing below.
occupies to attend school as long as the
student has been there at any time during 14. Freezing
the 90 days immediately before the loss. a. This peril means freezing of a plumbing,
10. Falling Objects heating, air conditioning or automatic fire
protective sprinkler system or of a household
This peril does not include loss to the property appliance, but only if you have used reasonable
contained in the building unless the roof or an care to:
outside wall of the building is first damaged by a
falling object. Damage to the falling object itself is (1) Maintain heat in the building; or
not included. (2) Shut off the water supply and drain all
11. Weight Of Ice, Snow Or Sleet systems and appliances of water.
This peril means weight of ice, snow or sleet which However, if the building is protected by an
causes damage to the property contained in the automatic fire protective sprinkler system, you
building. must use reasonable care to continue the water
supply and maintain heat in the building for
12. Accidental Discharge Or Overflow Of Water Or coverage to apply.
Steam
b. In this peril, a plumbing system or household
a. This peril means accidental discharge or appliance does not include a sump, sump pump
overflow of water or steam from within a or related equipment or a roof drain, gutter,
plumbing, heating, air conditioning or automatic downspout or similar fixtures or equipment.
fire protective sprinkler system or from within a
household appliance. 15. Sudden And Accidental Damage From
Artificially Generated Electrical Current
b. This peril does not include loss:
This peril does not include loss to tubes, transistors,
(1) To the system or appliance from which the electronic components or circuitry that is a part of
water or steam escaped; appliances, fixtures, computers, home
(2) Caused by or resulting from freezing except entertainment units or other types of electronic
as provided in Peril Insured Against 14. apparatus.
Freezing; 16. Volcanic Eruption
(3) On the "residence premises" caused by This peril does not include loss caused by
accidental discharge or overflow which earthquake, land shock waves or tremors.
occurs away from the building where the
"residence premises" is located; or

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SECTION I – EXCLUSIONS b. Water which:
We do not insure for loss caused directly or indirectly (1) Backs up through sewers or drains; or
by any of the following. Such loss is excluded (2) Overflows or is otherwise discharged from a
regardless of any other cause or event contributing sump, sump pump or related equipment;
concurrently or in any sequence to the loss. These
exclusions apply whether or not the loss event results c. Water below the surface of the ground, including
in widespread damage or affects a substantial area. water which exerts pressure on, or seeps, leaks
or flows through a building, sidewalk, driveway,
1. Ordinance Or Law patio, foundation, swimming pool or other
Ordinance Or Law means any ordinance or law: structure; or
a. Requiring or regulating the construction, d. Waterborne material carried or otherwise
demolition, remodeling, renovation or repair of moved by any of the water referred to in 3.a.
property, including removal of any resulting through 3.c. of this exclusion.
debris. This Exclusion 1.a. does not apply to the This Exclusion 3. applies regardless of whether any
amount of coverage that may be provided for in of the above, in 3.a. through 3.d., is caused by an
C.11. Ordinance Or Law under Section I – act of nature or is otherwise caused.
Property Coverages;
This Exclusion 3. applies to, but is not limited to,
b. The requirements of which result in a loss in escape, overflow or discharge, for any reason, of
value to property; or water or waterborne material from a dam, levee,
c. Requiring any "insured" or others to test for, seawall or any other boundary or containment
monitor, clean up, remove, contain, treat, system.
detoxify or neutralize, or in any way respond to, However, direct loss by fire, explosion or theft
or assess the effects of, pollutants. resulting from any of the above, in 3.a. through 3.d.,
Pollutants means any solid, liquid, gaseous or is covered.
thermal irritant or contaminant, including smoke, 4. Power Failure
vapor, soot, fumes, acids, alkalis, chemicals and
waste. Waste includes materials to be recycled, Power Failure means the failure of power or other
reconditioned or reclaimed. utility service if the failure takes place off the
"residence premises". But if the failure results in a
This Exclusion 1. applies whether or not the loss, from a Peril Insured Against on the "residence
property has been physically damaged. premises", we will pay for the loss caused by that
2. Earth Movement peril.
Earth Movement means: 5. Neglect
a. Earthquake, including land shock waves or Neglect means neglect of an "insured" to use all
tremors before, during or after a volcanic reasonable means to save and preserve property
eruption; at and after the time of a loss.
b. Landslide, mudslide or mudflow; 6. War
c. Subsidence or sinkhole; or War includes the following and any consequence of
d. Any other earth movement including earth any of the following:
sinking, rising or shifting. a. Undeclared war, civil war, insurrection, rebellion
This Exclusion 2. applies regardless of whether any or revolution;
of the above, in 2.a. through 2.d., is caused by an b. Warlike act by a military force or military
act of nature or is otherwise caused. personnel; or
However, direct loss by fire, explosion or theft c. Destruction, seizure or use for a military
resulting from any of the above, in 2.a. through 2.d., purpose.
is covered. Discharge of a nuclear weapon will be deemed a
3. Water warlike act even if accidental.
This means: 7. Nuclear Hazard
a. Flood, surface water, waves, including tidal This Exclusion 7. pertains to Nuclear Hazard to the
wave and tsunami, tides, tidal water, overflow of extent set forth in M. Nuclear Hazard Clause under
any body of water, or spray from any of these, Section I – Conditions.
all whether or not driven by wind, including
storm surge;

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8. Intentional Loss 4. Protect the property from further damage. If
Intentional Loss means any loss arising out of any repairs to the property are required, you must:
act an "insured" commits or conspires to commit a. Make reasonable and necessary repairs to
with the intent to cause a loss. protect the property; and
In the event of such loss, no "insured" is entitled to b. Keep an accurate record of repair expenses;
coverage, even "insureds" who did not commit or 5. Cooperate with us in the investigation of a claim;
conspire to commit the act causing the loss.
6. Prepare an inventory of damaged personal
9. Governmental Action property showing the quantity, description,
Governmental Action means the destruction, actual cash value and amount of loss. Attach all
confiscation or seizure of property described in bills, receipts and related documents that justify
Coverage C by order of any governmental or public the figures in the inventory;
authority. 7. As often as we reasonably require:
This exclusion does not apply to such acts ordered a. Show the damaged property;
by any governmental or public authority that are
taken at the time of a fire to prevent its spread, if the b. Provide us with records and documents we
loss caused by fire would be covered under this request and permit us to make copies; and
policy. c. Submit to examination under oath, while not
SECTION I – CONDITIONS in the presence of another "insured", and
sign the same;
A. Insurable Interest And Limit Of Liability
8. Send to us, within 60 days after our request,
Even if more than one person has an insurable your signed, sworn proof of loss which sets
interest in the property covered, we will not be liable forth, to the best of your knowledge and belief:
in any one loss:
a. The time and cause of loss;
1. To an "insured" for more than the amount of
such "insured's" interest at the time of loss; or b. The interests of all "insureds" and all others
in the property involved and all liens on the
2. For more than the applicable limit of liability. property;
B. Deductible c. Other insurance which may cover the loss;
Unless otherwise noted in this policy, the following d. Changes in title or occupancy of the property
deductible provision applies: during the term of the policy;
With respect to any one loss: e. Specifications of damaged buildings and
1. Subject to the applicable limit of liability, we will detailed repair estimates;
pay only that part of the total of all loss payable f. The inventory of damaged personal property
that exceeds the deductible amount shown in described in 6. above;
the Declarations.
g. Receipts for additional living expenses
2. If two or more deductibles under this policy incurred and records that support the fair
apply to the loss, only the highest deductible rental value loss; and
amount will apply.
h. Evidence or affidavit that supports a claim
C. Duties After Loss under C.6. Credit Card, Electronic Fund
In case of a loss to covered property, we have no Transfer Card Or Access Device, Forgery
duty to provide coverage under this policy if the And Counterfeit Money under Section I –
failure to comply with the following duties is Property Coverages, stating the amount and
prejudicial to us. These duties must be performed cause of loss.
either by you, an "insured" seeking coverage, or a D. Loss Settlement
representative of either:
Covered property losses are settled at actual cash
1. Give prompt notice to us or our agent; value at the time of loss but not more than the
2. Notify the police in case of loss by theft; amount required to repair or replace.
3. Notify the credit card or electronic fund transfer E. Loss To A Pair Or Set
card or access device company in case of loss In case of loss to a pair or set we may elect to:
as provided for in C.6. Credit Card, Electronic
Fund Transfer Card Or Access Device, Forgery 1. Repair or replace any part to restore the pair or
And Counterfeit Money under Section I – set to its value before the loss; or
Property Coverages;

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 2. Pay the difference between actual cash value of J. Loss Payment
the property before and after the loss. We will adjust all losses with you. We will pay you
F. Appraisal unless some other person is named in the policy or
If you and we fail to agree on the amount of loss, is legally entitled to receive payment. Loss will be
either may demand an appraisal of the loss. In this payable 60 days after we receive your proof of loss
event, each party will choose a competent and and:
impartial appraiser within 20 days after receiving a 1. Reach an agreement with you;
written request from the other. The two appraisers 2. There is an entry of a final judgment; or
will choose an umpire. If they cannot agree upon an
umpire within 15 days, you or we may request that 3. There is a filing of an appraisal award with us.
the choice be made by a judge of a court of record K. Abandonment Of Property
in the state where the "residence premises" is We need not accept any property abandoned by an
located. The appraisers will separately set the "insured".
amount of loss. If the appraisers submit a written
report of an agreement to us, the amount agreed L. No Benefit To Bailee
upon will be the amount of loss. If they fail to agree, We will not recognize any assignment or grant any
they will submit their differences to the umpire. A coverage that benefits a person or organization
decision agreed to by any two will set the amount holding, storing or moving property for a fee
of loss. regardless of any other provision of this policy.
Each party will: M. Nuclear Hazard Clause
1. Pay its own appraiser; and 1. "Nuclear Hazard" means any nuclear reaction,
2. Bear the other expenses of the appraisal and radiation, or radioactive contamination, all
umpire equally. whether controlled or uncontrolled or however
caused, or any consequence of any of these.
G. Other Insurance And Service Agreement
2. Loss caused by the nuclear hazard will not be
If a loss covered by this policy is also covered by: considered loss caused by fire, explosion, or
1. Other insurance, we will pay only the proportion smoke, whether these perils are specifically
of the loss that the limit of liability that applies named in or otherwise included within the Perils
under this policy bears to the total amount of Insured Against.
insurance covering the loss; or
3. This policy does not apply under Section I to
2. A service agreement, this insurance is excess loss caused directly or indirectly by nuclear
over any amounts payable under any such hazard, except that direct loss by fire resulting
agreement. Service agreement means a service from the nuclear hazard is covered.
plan, property restoration plan, home warranty
N. Recovered Property
or other similar service warranty agreement,
even if it is characterized as insurance. If you or we recover any property for which we have
made payment under this policy, you or we will
H. Suit Against Us notify the other of the recovery. At your option, the
No action can be brought against us unless there property will be returned to or retained by you or it
has been full compliance with all of the terms under will become our property. If the recovered property
Section I of this policy and the action is started is returned to or retained by you, the loss payment
within two years after the date of loss. will be adjusted based on the amount you received
I. Our Option for the recovered property.
If we give you written notice within 30 days after we O. Volcanic Eruption Period
receive your signed, sworn proof of loss, we may One or more volcanic eruptions that occur within a
repair or replace any part of the damaged property 72-hour period will be considered as one volcanic
with material or property of like kind and quality. eruption.
P. Policy Period
This policy applies only to loss which occurs during
the policy period.

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Q. Concealment Or Fraud b. Is caused by the activities of an "insured";
We provide coverage to no "insureds" under this c. Is caused by a "residence employee" in the
policy if, whether before or after a loss, an "insured" course of the "residence employee's"
has: employment by an "insured"; or
1. Intentionally concealed or misrepresented any d. Is caused by an animal owned by or in the
material fact or circumstance; care of an "insured".
2. Engaged in fraudulent conduct; or SECTION II – EXCLUSIONS
3. Made false statements; A. "Motor Vehicle Liability"
relating to this insurance. 1. Coverages E and F do not apply to any "motor
R. Loss Payable Clause vehicle liability" if, at the time and place of an
"occurrence", the involved "motor vehicle":
If the Declarations shows a loss payee for certain
listed insured personal property, the definition of a. Is registered for use on public roads or
"insured" is changed to include that loss payee with property;
respect to that property. b. Is not registered for use on public roads or
If we decide to cancel or not renew this policy, that property, but such registration is required by
loss payee will be notified in writing. a law, or regulation issued by a government
agency, for it to be used at the place of the
SECTION II – LIABILITY COVERAGES "occurrence"; or
A. Coverage E – Personal Liability c. Is being:
If a claim is made or a suit is brought against an (1) Operated in, or practicing for, any
"insured" for damages because of "bodily injury" or prearranged or organized race, speed
"property damage" caused by an "occurrence" to contest or other competition;
which this coverage applies, we will:
(2) Rented to others;
1. Pay up to our limit of liability for the damages for
which an "insured" is legally liable. Damages (3) Used to carry persons or cargo for a
include prejudgment interest awarded against charge; or
an "insured"; and (4) Used for any "business" purpose except
2. Provide a defense at our expense by counsel of for a motorized golf cart while on a golfing
our choice, even if the suit is groundless, false facility.
or fraudulent. We may investigate and settle any 2. If Exclusion A.1. does not apply, there is still no
claim or suit that we decide is appropriate. Our coverage for "motor vehicle liability", unless the
duty to settle or defend ends when our limit of "motor vehicle" is:
liability for the "occurrence" has been exhausted a. In dead storage on an "insured location";
by payment of a judgment or settlement.
b. Used solely to service a residence;
B. Coverage F – Medical Payments To Others
c. Designed to assist the handicapped and, at
We will pay the necessary medical expenses that the time of an "occurrence", it is:
are incurred or medically ascertained within three
years from the date of an accident causing "bodily (1) Being used to assist a handicapped
injury". Medical expenses means reasonable person; or
charges for medical, surgical, x-ray, dental, (2) Parked on an "insured location";
ambulance, hospital, professional nursing, d. Designed for recreational use off public
prosthetic devices and funeral services. This roads and:
coverage does not apply to you or regular residents
of your household except "residence employees". (1) Not owned by an "insured"; or
As to others, this coverage applies only: (2) Owned by an "insured" provided the
1. To a person on the "insured location" with the "occurrence" takes place:
permission of an "insured"; or (a) On an "insured location" as defined in
2. To a person off the "insured location", if the Definition B.6.a., b., d., e. or h.; or
"bodily injury": (b) Off an "insured location" and the
a. Arises out of a condition on the "insured "motor vehicle" is:
location" or the ways immediately adjoining; (i) Designed as a toy vehicle for use
by children under seven years of
age;

HO 00 04 05 11 © Insurance Services Office, Inc., 2010 Page 21 of 63

 (ii) Powered by one or more batteries; c. Is not a sailing vessel and is powered by:
and (1) An inboard or inboard-outdrive engine or
(iii) Not built or modified after motor, including those that power a water
manufacture to exceed a speed of jet pump, of:
five miles per hour on level (a) 50 horsepower or less and not owned
ground; by an "insured"; or
e. A motorized golf cart that is owned by an (b) More than 50 horsepower and not
"insured", designed to carry up to four owned by or rented to an "insured"; or
persons, not built or modified after
manufacture to exceed a speed of 25 miles (2) One or more outboard engines or motors
per hour on level ground and, at the time of with:
an "occurrence", is within the legal (a) 25 total horsepower or less;
boundaries of: (b) More than 25 horsepower if the
(1) A golfing facility and is parked or stored outboard engine or motor is not
there, or being used by an "insured" to: owned by an "insured";
(a) Play the game of golf or for other (c) More than 25 horsepower if the
recreational or leisure activity allowed outboard engine or motor is owned by
by the facility; an "insured" who acquired it during
(b) Travel to or from an area where the policy period; or
"motor vehicles" or golf carts are (d) More than 25 horsepower if the
parked or stored; or outboard engine or motor is owned by
(c) Cross public roads at designated an "insured" who acquired it before
points to access other parts of the the policy period, but only if:
golfing facility; or (i) You declare them at policy
(2) A private residential community, inception; or
including its public roads upon which a (ii) Your intent to insure them is
motorized golf cart can legally travel, reported to us in writing within 45
which is subject to the authority of a days after you acquire them.
property owners association and
The coverages in (c) and (d) above apply
contains an "insured's" residence. for the policy period.
B. "Watercraft Liability" Horsepower means the maximum power
1. Coverages E and F do not apply to any rating assigned to the engine or motor by the
"watercraft liability" if, at the time of an manufacturer.
"occurrence", the involved watercraft is being:
C. "Aircraft Liability"
a. Operated in, or practicing for, any This policy does not cover "aircraft liability".
prearranged or organized race, speed
contest or other competition. This exclusion D. "Hovercraft Liability"
does not apply to a sailing vessel or a This policy does not cover "hovercraft liability".
predicted log cruise;
E. Coverage E – Personal Liability And Coverage
b. Rented to others; F – Medical Payments To Others
c. Used to carry persons or cargo for a charge; Coverages E and F do not apply to the following:
or
1. Expected Or Intended Injury
d. Used for any "business" purpose.
"Bodily injury" or "property damage" which is
2. If Exclusion B.1. does not apply, there is still no expected or intended by an "insured", even if the
coverage for "watercraft liability" unless, at the resulting "bodily injury" or "property damage":
time of the "occurrence", the watercraft:
a. Is of a different kind, quality or degree than
a. Is stored; initially expected or intended; or
b. Is a sailing vessel, with or without auxiliary b. Is sustained by a different person, entity or
power, that is: property than initially expected or intended.
(1) Less than 26 feet in overall length; or
(2) 26 feet or more in overall length and not
owned by or rented to an "insured"; or

HO 00 04 05 11 © Insurance Services Office, Inc., 2010 Page 22 of 63

 However, this Exclusion E.1. does not apply to b. Warlike act by a military force or military
"bodily injury" or "property damage" resulting personnel; or
from the use of reasonable force by an "insured" c. Destruction, seizure or use for a military
to protect persons or property; purpose.
2. "Business" Discharge of a nuclear weapon will be deemed
a. "Bodily injury" or "property damage" arising a warlike act even if accidental;
out of or in connection with a "business" 6. Communicable Disease
conducted from an "insured location" or
engaged in by an "insured", whether or not "Bodily injury" or "property damage" which
the "business" is owned or operated by an arises out of the transmission of a
"insured" or employs an "insured". communicable disease by an "insured";
This Exclusion E.2. applies but is not limited 7. Sexual Molestation, Corporal Punishment
to an act or omission, regardless of its nature Or Physical Or Mental Abuse
or circumstance, involving a service or duty "Bodily injury" or "property damage" arising out
rendered, promised, owed, or implied to be of sexual molestation, corporal punishment or
provided because of the nature of the physical or mental abuse; or
"business". 8. Controlled Substance
b. This Exclusion E.2. does not apply to: "Bodily injury" or "property damage" arising out
(1) The rental or holding for rental of an of the use, sale, manufacture, delivery, transfer
"insured location"; or possession by any person of a Controlled
(a) On an occasional basis if used only Substance as defined by the Federal Food and
as a residence; Drug Law at 21 U.S.C.A. Sections 811 and 812.
Controlled Substances include but are not
(b) In part for use only as a residence, limited to cocaine, LSD, marijuana and all
unless a single-family unit is intended narcotic drugs. However, this exclusion does
for use by the occupying family to not apply to the legitimate use of prescription
lodge more than two roomers or drugs by a person following the lawful orders of
boarders; or a licensed health care professional.
(c) In part, as an office, school, studio or Exclusions A. "Motor Vehicle Liability", B.
private garage; and "Watercraft Liability", C. "Aircraft Liability", D.
(2) An "insured" under the age of 21 years "Hovercraft Liability" and E.4. "Insured's" Premises
involved in a part-time or occasional, self- Not An "Insured Location" do not apply to "bodily
employed "business" with no employees; injury" to a "residence employee" arising out of and
3. Professional Services in the course of the "residence employee's"
employment by an "insured".
"Bodily injury" or "property damage" arising out
of the rendering of or failure to render F. Coverage E – Personal Liability
professional services; Coverage E does not apply to:
4. "Insured's" Premises Not An "Insured 1. Liability:
Location" a. For any loss assessment charged against
"Bodily injury" or "property damage" arising out you as a member of an association,
of a premises: corporation or community of property
a. Owned by an "insured"; owners, except as provided in D. Loss
Assessment under Section II – Additional
b. Rented to an "insured"; or Coverages;
c. Rented to others by an "insured"; b. Under any contract or agreement entered
that is not an "insured location"; into by an "insured". However, this exclusion
does not apply to written contracts:
5. War
(1) That directly relate to the ownership,
"Bodily injury" or "property damage" caused
maintenance or use of an "insured
directly or indirectly by war, including the
location"; or
following and any consequence of any of the
following: (2) Where the liability of others is assumed
by you prior to an "occurrence";
a. Undeclared war, civil war, insurrection,
rebellion or revolution;

HO 00 04 05 11 © Insurance Services Office, Inc., 2010 Page 23 of 63

 unless excluded in a. above or elsewhere in 2. To any person eligible to receive benefits
this policy; voluntarily provided or required to be provided
2. "Property damage" to property owned by an under any:
"insured". This includes costs or expenses a. Workers' compensation law;
incurred by an "insured" or others to repair, b. Non-occupational disability law; or
replace, enhance, restore or maintain such
property to prevent injury to a person or damage c. Occupational disease law;
to property of others, whether on or away from 3. From any:
an "insured location"; a. Nuclear reaction;
3. "Property damage" to property rented to, b. Nuclear radiation; or
occupied or used by or in the care of an
"insured". This exclusion does not apply to c. Radioactive contamination;
"property damage" caused by fire, smoke or all whether controlled or uncontrolled or
explosion; however caused; or
4. "Bodily injury" to any person eligible to receive d. Any consequence of any of these; or
any benefits voluntarily provided or required to
be provided by an "insured" under any: 4. To any person, other than a "residence
employee" of an "insured", regularly residing on
a. Workers' compensation law; any part of the "insured location".
b. Non-occupational disability law; or SECTION II – ADDITIONAL COVERAGES
c. Occupational disease law; We cover the following in addition to the limits of
5. "Bodily injury" or "property damage" for which an liability:
"insured" under this policy: A. Claim Expenses
a. Is also an insured under a nuclear energy We pay:
liability policy issued by the:
1. Expenses we incur and costs taxed against an
(1) Nuclear Energy Liability Insurance "insured" in any suit we defend;
Association;
2. Premiums on bonds required in a suit we
(2) Mutual Atomic Energy Liability defend, but not for bond amounts more than the
Underwriters; Coverage E limit of liability. We need not apply
(3) Nuclear Insurance Association of for or furnish any bond;
Canada; 3. Reasonable expenses incurred by an "insured"
or any of their successors; or at our request, including actual loss of earnings
(but not loss of other income) up to $250 per
b. Would be an insured under such a policy but day, for assisting us in the investigation or
for the exhaustion of its limit of liability; or
defense of a claim or suit; and
6. "Bodily injury" to you or an "insured" as defined 4. Interest on the entire judgment which accrues
under Definition 5.a. or b. after entry of the judgment and before we pay or
This exclusion also applies to any claim made tender, or deposit in court that part of the
or suit brought against you or an "insured" to: judgment which does not exceed the limit of
a. Repay; or liability that applies.
b. Share damages with; B. First Aid Expenses
another person who may be obligated to pay We will pay expenses for first aid to others incurred
damages because of "bodily injury" to an by an "insured" for "bodily injury" covered under this
"insured". policy. We will not pay for first aid to an "insured".
G. Coverage F – Medical Payments To Others C. Damage To Property Of Others
Coverage F does not apply to "bodily injury": 1. We will pay, at replacement cost, up to $1,000
per "occurrence" for "property damage" to
1. To a "residence employee" if the "bodily injury": property of others caused by an "insured".
a. Occurs off the "insured location"; and 2. We will not pay for "property damage":
b. Does not arise out of or in the course of the a. To the extent of any amount recoverable
"residence employee's" employment by an under Section I;
"insured";

HO 00 04 05 11 © Insurance Services Office, Inc., 2010 Page 24 of 63

 b. Caused intentionally by an "insured" who is 3. Regardless of the number of assessments, the
13 years of age or older; limit of $1,000 is the most we will pay for loss
c. To property owned by an "insured"; arising out of:
d. To property owned by or rented to a tenant a. One accident, including continuous or
of an "insured" or a resident in your repeated exposure to substantially the same
household; or general harmful condition; or
e. Arising out of: b. A covered act of a director, officer or trustee.
An act involving more than one director,
(1) A "business" engaged in by an "insured"; officer or trustee is considered to be a single
(2) Any act or omission in connection with a act.
premises owned, rented or controlled by 4. We do not cover assessments charged against
an "insured", other than the "insured you or a corporation or association of property
location"; or owners by any governmental body.
(3) The ownership, maintenance, SECTION II – CONDITIONS
occupancy, operation, use, loading or
unloading of aircraft, hovercraft, A. Limit Of Liability
watercraft or "motor vehicles". Our total liability under Coverage E for all damages
This Exclusion e.(3) does not apply to a resulting from any one "occurrence" will not be
"motor vehicle" that: more than the Coverage E Limit Of Liability shown
in the Declarations. This limit is the same
(a) Is designed for recreational use off regardless of the number of "insureds", claims
public roads; made or persons injured. All "bodily injury" and
(b) Is not owned by an "insured"; and "property damage" resulting from any one accident
(c) At the time of the "occurrence", is not or from continuous or repeated exposure to
required by law, or regulation issued substantially the same general harmful conditions
by a government agency, to have shall be considered to be the result of one
been registered for it to be used on "occurrence".
public roads or property. Our total liability under Coverage F for all medical
expense payable for "bodily injury" to one person
D. Loss Assessment
as the result of one accident will not be more than
1. We will pay up to $1,000 for your share of loss the Coverage F Limit Of Liability shown in the
assessment charged against you, as owner or Declarations.
tenant of the "residence premises", during the
policy period by a corporation or association of B. Severability Of Insurance
property owners, when the assessment is made This insurance applies separately to each
as a result of: "insured". This condition will not increase our limit
of liability for any one "occurrence".
a. "Bodily injury" or "property damage" not
excluded from coverage under Section II – C. Duties After "Occurrence"
Exclusions; or In case of an "occurrence", you or another "insured"
b. Liability for an act of a director, officer or will perform the following duties that apply. We have
trustee in the capacity as a director, officer no duty to provide coverage under this policy if your
or trustee, provided such person: failure to comply with the following duties is
prejudicial to us. You will help us by seeing that
(1) Is elected by the members of a
corporation or association of property these duties are performed:
owners; and 1. Give written notice to us or our agent as soon as
is practical, which sets forth:
(2) Serves without deriving any income from
the exercise of duties which are solely on a. The identity of the policy and the "named
behalf of a corporation or association of insured" shown in the Declarations;
property owners. b. Reasonably available information on the
2. Paragraph I. Policy Period under Section II – time, place and circumstances of the
Conditions does not apply to this Loss "occurrence"; and
Assessment Coverage. c. Names and addresses of any claimants and
witnesses;

HO 00 04 05 11 © Insurance Services Office, Inc., 2010 Page 25 of 63

 2. Cooperate with us in the investigation, G. Bankruptcy Of An "Insured"
settlement or defense of any claim or suit; Bankruptcy or insolvency of an "insured" will not
3. Promptly forward to us every notice, demand, relieve us of our obligations under this policy.
summons or other process relating to the H. Other Insurance
"occurrence";
This insurance is excess over other valid and
4. At our request, help us: collectible insurance except insurance written
a. To make settlement; specifically to cover as excess over the limits of
b. To enforce any right of contribution or liability that apply in this policy.
indemnity against any person or I. Policy Period
organization who may be liable to an This policy applies only to "bodily injury" or
"insured"; "property damage" which occurs during the policy
c. With the conduct of suits and attend period.
hearings and trials; and J. Concealment Or Fraud
d. To secure and give evidence and obtain the We do not provide coverage to an "insured" who,
attendance of witnesses; whether before or after a loss, has:
5. With respect to C. Damage To Property Of 1. Intentionally concealed or misrepresented any
Others under Section II – Additional Coverages, material fact or circumstance;
submit to us within 60 days after the loss a
sworn statement of loss and show the damaged 2. Engaged in fraudulent conduct; or
property, if in an "insured's" control; 3. Made false statements;
6. No "insured" shall, except at such "insured's" relating to this insurance.
own cost, voluntarily make payment, assume
SECTIONS I AND II – CONDITIONS
obligation or incur expense other than for first
aid to others at the time of the "bodily injury". A. Liberalization Clause
D. Duties Of An Injured Person – Coverage F – If we make a change which broadens coverage
Medical Payments To Others under this edition of our policy without additional
premium charge, that change will automatically
1. The injured person or someone acting for the apply to your insurance as of the date we
injured person will:
implement the change in your state, provided that
a. Give us written proof of claim, under oath if this implementation date falls within 60 days prior
required, as soon as is practical; and to or during the policy period stated in the
b. Authorize us to obtain copies of medical Declarations.
reports and records. This Liberalization Clause does not apply to
2. The injured person will submit to a physical changes implemented with a general program
exam by a doctor of our choice when and as revision that includes both broadenings and
often as we reasonably require. restrictions in coverage, whether that general
program revision is implemented through
E. Payment Of Claim – Coverage F – Medical introduction of:
Payments To Others
1. A subsequent edition of this policy; or
Payment under this coverage is not an admission
of liability by an "insured" or us. 2. An amendatory endorsement.
F. Suit Against Us B. Waiver Or Change Of Policy Provisions
1. No action can be brought against us unless A waiver or change of a provision of this policy must
there has been full compliance with all of the be in writing by us to be valid. Our request for an
terms under this Section II. appraisal or examination will not waive any of our
rights.
2. No one will have the right to join us as a party to
any action against an "insured". C. Cancellation
3. Also, no action with respect to Coverage E can 1. You may cancel this policy at any time by
be brought against us until the obligation of such returning it to us or by letting us know in writing
"insured" has been determined by final of the date cancellation is to take effect.
judgment or agreement signed by us.

HO 00 04 05 11 © Insurance Services Office, Inc., 2010 Page 26 of 63

 2. We may cancel this policy only for the reasons D. Nonrenewal
stated below by letting you know in writing of the We may elect not to renew this policy. We may do
date cancellation takes effect. This cancellation so by delivering to you, or mailing to you at your
notice may be delivered to you, or mailed to you mailing address shown in the Declarations, written
at your mailing address shown in the notice at least 30 days before the expiration date of
Declarations. Proof of mailing will be sufficient this policy. Proof of mailing will be sufficient proof of
proof of notice. notice.
a. When you have not paid the premium, we E. Assignment
may cancel at any time by letting you know
at least 10 days before the date cancellation Assignment of this policy will not be valid unless we
takes effect. give our written consent.
b. When this policy has been in effect for less F. Subrogation
than 60 days and is not a renewal with us, An "insured" may waive in writing before a loss all
we may cancel for any reason by letting you rights of recovery against any person. If not waived,
know at least 10 days before the date we may require an assignment of rights of recovery
cancellation takes effect. for a loss to the extent that payment is made by us.
c. When this policy has been in effect for 60 If an assignment is sought, an "insured" must sign
days or more, or at any time if it is a renewal and deliver all related papers and cooperate with
with us, we may cancel: us.
(1) If there has been a material Subrogation does not apply to Coverage F or
misrepresentation of fact which if known Paragraph C. Damage To Property Of Others under
to us would have caused us not to issue Section II – Additional Coverages.
the policy; or
G. Death
(2) If the risk has changed substantially If any person named in the Declarations or the
since the policy was issued. spouse, if a resident of the same household, dies,
This can be done by letting you know at least the following apply:
30 days before the date cancellation takes
1. We insure the legal representative of the
effect. deceased but only with respect to the premises
d. When this policy is written for a period of and property of the deceased covered under the
more than one year, we may cancel for any policy at the time of death; and
reason at anniversary by letting you know at
2. "Insured" includes:
least 30 days before the date cancellation
takes effect. a. An "insured" who is a member of your
household at the time of your death, but only
3. When this policy is canceled, the premium for while a resident of the "residence premises";
the period from the date of cancellation to the
and
expiration date will be refunded pro rata.
b. With respect to your property, the person
4. If the return premium is not refunded with the having proper temporary custody of the
notice of cancellation or when this policy is property until appointment and qualification
returned to us, we will refund it within a of a legal representative.
reasonable time after the date cancellation
takes effect.

HO 00 04 05 11 © Insurance Services Office, Inc., 2010 Page 27 of 63

 Trisura Insurance Company
Limited Fungi, Wet Or Dry Rot, Or Bacteria Coverage – Louisiana

Name of Insured: Yeni Perez Endorsement Effective Date:

Policy Number: 85618542 Policy Period: 2/10/2024 To 2/10/2025 Endorsement Number: N/A

The above information only needs to be completed when issued subsequent to initial preparation of policy.

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

FOR USE WITH ALL FORMS EXCEPT HO 00 03 AND HO 00 05

SCHEDULE*

These limits of liability apply to the total of all loss or costs payable under this endorsement, regardless of the number of
"occurrences", the number of claims-made, or the number of locations insured under this endorsement and listed in this
Schedule.
1. Section I - Property Coverage Limit Of Liability for the Additional Coverage "Fungi", Wet Or Dry Rot, Or Bacteria. $5,000

2. Section II - Coverage E Aggregate Sublimit Of Liability for "Fungi", Wet Or Dry Rot, Or Bacteria. $10,000

*Entries may be left blank if shown elsewhere in this policy for this coverage.

DEFINITIONS the building or other covered property as

needed to gain access to the "fungi", wet or
The following definitions are added: dry rot, or "bacteria"; and
"Fungi" (4) The cost of testing of air or property to
confirm the absence, presence or level of
a. "Fungi" means any type or form of fungus, including "fungi", wet or dry rot, or "bacteria", whether
mold or mildew, and any mycotoxins, spores, scents performed prior to, during or after removal,
or by-products produced or released by fungi. repair, restoration or replacement. The cost
b. Under Section II, this does not include any fungi that of such testing will be provided only to the
are, are on, or are contained in, a good or product extent that there is a reason to believe that
intended for consumption. there is the presence of fungi, wet or dry rot,
or "bacteria".
"Bacteria"
b. The coverage described in 13.a. only applies
"Bacteria" means any type, kind or form of bacterium. when such loss or costs are a result of a Peril
Insured Against that occurs during the policy
SECTION I – PROPERTY COVERAGES period and only if all reasonable means were used
to save and preserve the property from further
E. Additional Coverages damage at and after the time the Peril Insured
Against occurred.
The following Additional Coverage is added:
c. The amount shown in the Schedule for this
13. "Fungi", Wet Or Dry Rot, Or "Bacteria" coverage is the most we will pay for the total of
all loss or costs payable under this Additional
a. The amount shown in the Schedule above is the Coverage regardless of the:
most we will pay for:
(1) Number of locations insured under this
(1) The total of all loss payable under Section I endorsement; or
– Property Coverages caused by "fungi", wet
or dry rot, or "bacteria"; (2) Number of claims made.
(2) The cost to remove "fungi", wet or dry rot, or This coverage does not increase the limit of liability
"bacteria" from property covered under applying to the damaged covered property.
Section I;
(This is Additional Coverage C.13. in Form HO 00 04; D.12. in
(3) The cost to tear out and replace any part of Form HO 00 06 and E.9. in Form HO 00 08.)

Includes copyrighted material of Insurance Services Office, Inc., with its permission.
Copyright, Insurance Services Office, Inc., 2004 Page 28 of 63
TC HO 03 41 01 21
 LIMITED FUNGI, WET OR DRY ROT, OR BACTERIA COVERAGE - LOUISIANA

SECTION I – PERILS INSURED AGAINST SECTION I – CONDITIONS

12. Accidental Discharge Or Overflow Of Water Or Steam Condition P. Policy Period is replaced by the following:
Paragraph b.(5) is replaced by the following: P. Policy Period
(5) Caused by constant or repeated seepage or This policy applies to loss or costs which occur during
leakage of water or the presence or condens- the policy period.
ation of humidity, moisture or vapor, over a
period of weeks, months or years unless such (This is Condition O. in Form HO 00 04.)
seepage or leakage of water or the presence or
condensation of humidity, moisture or vapor and SECTION II – CONDITIONS
the resulting damage is unknown to all
"insureds" and is hidden within the walls or Condition A. Limit Of Liability is replaced by the following:
ceilings or beneath the floors or above the
ceilings of a structure. A. Limit Of Liability
(This is Paragraph b.(4) in Form HO 00 04.) Our total liability under Coverage E for all damages
resulting from any one "occurrence" will not be more
SECTION I – EXCLUSIONS than the Coverage E limit of liability shown in the
Declarations. This limit is the same regardless of the
The following exclusion is added: number of "insureds", claims made or persons injured.
All "bodily injury" and "property damage" resulting from
10. "Fungi", Wet Or Dry Rot, Or "Bacteria" any one accident or from continuous or repeated
exposure to substantially the same general harmful
"Fungi", Wet Or Dry Rot, Or "Bacteria" meaning the conditions will be considered to be the result of one
presence, growth, proliferation, spread or any activity of "occurrence".
"fungi", wet or dry rot, or "bacteria".
Our total liability under Coverage F for all medical
This exclusion does not apply: expense payable for "bodily injury" to one person as the
result of one accident will not be more than the
a. When "fungi", wet or dry rot, or "bacteria" results from Coverage F limit of liability shown in the Declarations.
fire or lightning;
However, our total liability under Coverage E for the total
b. To the extent coverage is provided for in the "Fungi", of all damages arising directly or indirectly, in whole or in
Wet Or Dry Rot, Or "Bacteria" Additional Coverage part, out of the actual, alleged or threatened inhalation
under Section I – Property Coverages with respect to of, ingestion of, contact with, exposure to, existence of,
loss caused by a Peril Insured Against other than fire or presence of any "fungi", wet or dry rot, or "bacteria"
or lightning; or will not be more than the Section II – Coverage E
Aggregate Sublimit Of Liability for "Fungi", Wet Or Dry
c. With respect to "fungi", wet or dry rot, or "bacteria" Rot, Or "Bacteria". That sublimit is the amount shown in
that is located on the portion of the covered property the Schedule. This is the most we will pay regardless of
that must be repaired or replaced because of direct the:
physical damage caused by a Peril Insured Against.
1. Number of locations insured under the policy to which
However, the exclusion shall continue to apply to: this endorsement is attached;
(1) The cost to treat, contain, remove or dispose of 2. Number of persons injured;
"Fungi", Wet Or Dry Rot, or "Bacteria" beyond
that which is required to repair or replace the 3. Number of persons whose property is damaged;
covered property physically damaged by a Peril
Insured Against; 4. Number of "insureds"; or
(2) The cost of any testing of air or property to 5. Number of "occurrences" or claims made.
confirm the absence, presence or level of "Fungi",
Wet Or Dry Rot or "Bacteria" whether performed This sublimit is within, but does not increase, the
prior to, during or after removal, repair, Coverage E limit of liability. It applies separately to each
restoration or replacement; and consecutive annual period and to any remaining period
of less than 12 months, starting with the beginning of the
(3) Any increase in loss under Coverage D – Loss policy period shown in the Declarations.
Of Use and Additional Coverage 1. Debris
Removal resulting from c.(1) and (2). All other provisions of the policy apply.
Direct loss by a Peril Insured Against resulting from
"fungi", wet or dry rot, or "bacteria" is covered.

Includes copyrighted material of Insurance Services Office, Inc., with its permission.
Copyright, Insurance Services Office, Inc., 2004 Page 29 of 63
TC HO 03 41 01 21
 HOMEOWNERS
HO 04 96 10 00

THIS ENDORSEMENT DOES NOT CONSTITUTE A REDUCTION OF COVERAGE.

NO SECTION II – LIABILITY COVERAGES FOR

HOME DAY CARE BUSINESS
LIMITED SECTION I – PROPERTY COVERAGES FOR
HOME DAY CARE BUSINESS

A. "Business", as defined in the policy, means: D. With respect to C. above, home day care service is
1. A trade, profession or occupation engaged in on only an example of an activity engaged in for money
a full-time, part-time, or occasional basis; or that may be a "business". Any single activity or
combination of activities:
2. Any other activity engaged in for money or other
compensation, except the following: 1. Described in A.2. above, and
a. One or more activities: 2. Engaged in for money by a single "insured";
(1) Not described in b. through d. below; may be considered a "business" if the $2000
and threshold is exceeded.
(2) For which no "insured" receives more E. With respect to A. through D. above, coverage does
than $2000 in total compensation for the not apply to or is limited with respect to home day
12 months before the beginning of the care service which is a "business". For example,
policy period; this policy:
b. Volunteer activities for which no money is 1. Does not provide:
received other than payment for expenses a. Section II coverages. This is because a
incurred to perform the activity; "business" of an "insured" is excluded under
c. Providing home day care services for which E.2. of Section II – Exclusions;
no compensation is received, other than the b. Coverage, under Section I, for other
mutual exchange of such services; or structures from which any "business" is
d. The rendering of home day care services to conducted; and
a relative of an "insured". 2. Limits Section I coverage, under Coverage C –
B. If an "insured" regularly provides home day Special Limits of Liability, for "business"
care services to a person or persons other than property:
"insureds" as their trade, profession or occupation, a. On the "residence premises" for the home
that service is a "business". day care "business" to $2,500. This is
C. If home day care service is not a given "insured's" because Category h. (e. in Form HO 00 08)
trade, profession or occupation but is an activity: imposes that limit on "business" property on
the "residence premises";
1. That an "insured" engages in for money or other
compensation; and b. Away from the "residence premises" for the
home day care "business" to $500. This is
2. From which an "insured" receives more than because Category i. (f. in Form HO 00 08)
$2,000 in total/combined compensation from it imposes that limit on "business" property
and any other activity for the 12 months before away from the "residence premises".
the beginning of the policy period; Category i. does not apply to property
the home day care service and other activity will be described in Categories j. and k. (g. and h.
considered a "business". respectively in Form HO 00 08).

HO 04 96 10 00 Copyright, Insurance Services Office, Inc., 1999 Page 30 of 63

 HOMEOWNERS
HO 16 09 01 09

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

WATER EXCLUSION ENDORSEMENT

SECTION I – EXCLUSIONS d. Waterborne material carried or otherwise
3. Water Damage is replaced by the following: moved by any of the water referred to in 3.a.
through 3.c. of this Exclusion.
3. Water
This Exclusion (3.) applies regardless of
This means: whether any of the above, in 3.a. through 3.d.,
a. Flood, surface water, waves, including tidal is caused by an act of nature or is otherwise
wave and tsunami, tides, tidal water, caused.
overflow of any body of water, or spray from This Exclusion (3.) applies to, but is not limited
any of these, all whether or not driven by to, escape, overflow or discharge, for any
wind, including storm surge; reason, of water or waterborne material from a
b. Water which: dam, levee, seawall or any other boundary or
containment system.
(1) Backs up through sewers or drains; or
However, direct loss by fire, explosion or theft
(2) Overflows or is otherwise discharged
resulting from any of the above, in 3.a. through
from a sump, sump pump or related
3.d., is covered.
equipment;
All other provisions of this policy apply.
c. Water below the surface of the ground,
including water which exerts pressure on, or
seeps, leaks or flows through a building,
sidewalk, driveway, patio, foundation,
swimming pool or other structure; or

HO 16 09 01 09 © Insurance Services Office, Inc., 2008 Page 31 of 63

 Trisura Insurance Company
Animal Liability Limitation Endorsement
Name of Insured: Yeni Perez Endorsement Effective Date:

Policy Number: 85618542 Policy Period: 2/10/2024 To 2/10/2025 Endorsement Number: N/A

The above information only needs to be completed when issued subsequent to initial preparation of policy.

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

Section II – Liability Coverages, A. Coverage E – Personal 2. Provide a defense at our expense by counsel of our
Liability is deleted and replaced by: choice, even if the suit is groundless, false or
fraudulent. We may investigate and settle any claim or
suit that we decide is appropriate. Our duty to defend
A. Coverage E – Personal Liability ends when the amount we pay for damages
resulting from the "occurrence" equals our limit of
If a claim is made or a suit is brought against an "insured" liability.
for damages because of "bodily injury" or "property
damage" caused by an "occurrence" to which this cover- All other provisions of this policy apply.
age applies, we will:
1. Pay up to our limit of liability for the damages for
which an "insured" is legally liable, except that $10,000
per "occurrence" is the most we will pay for "bodily
injury" or "property damage" caused by an animal
which, at the time of loss, was owned by an "insured"
or intended to be in the custody, care or control of
an "insured".

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Copyright, Insurance Services Office, Inc., 1999
Page 32 of 63
TC HO4-PL (07/20)
 Trisura Insurance Company
Personal Property Replacement Cost
Loss Settlement
Name of Insured: Yeni Perez Endorsement Effective Date:

Policy Number: 85618542 Policy Period: 2/10/2024 To 2/10/2025 Endorsement Number: N/A

The above information only needs to be completed when issued subsequent to initial preparation of policy.

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

A. Eligible Property B. Ineligible Property

1. Covered losses to the following property are settled Property listed below is not eligible for replacement cost
at replacement cost at the time of the loss: loss settlement. Any loss will be settled at actual cash
value at the time of loss but not more than the amount
a. Coverage C; and required to repair or replace.

b. If covered in this policy: 1. Antiques, fine arts, paintings and similar articles of
rarity or antiquity which cannot be replaced.
(1) Awnings, outdoor antennas and outdoor
equipment; and 2. Memorabilia, souvenirs, collectors items and similar
articles whose age or history contribute to their value.
(2) Carpeting and household appliances;
whether or not attached to buildings. 3. Articles not maintained in good or workable
condition.
2. This method of loss settlement will also apply to the
following articles or classes of property if they are 4. Articles that are outdated or obsolete and are stored
separately described and specifically insured in this or not being used.
policy and not subject to agreed value loss settle-
ment: C. Replacement Cost Loss Settlement Condition

a. Jewelry; The following loss settlement condition applies to all

property described in A. above:
b. Furs and garments:
1. We will pay no more than the least of the following
(1) Trimmed with fur; or amounts:

(2) Consisting principally of fur; a. Replacement cost at the time of loss without
deduction for depreciation;
c. Cameras, projection machines, films and related
articles of equipment; b. The full cost of repair at the time of loss;

d. Musical equipment and related articles of equip- c. The limit of liability that applies to Coverage C, if
ment; applicable;

e. Silverware, silver-plated ware, goldware, gold- d. Any applicable special limits of liability stated in
plated ware and pewterware, but excluding: this policy; or

(1) Pens or pencils; e. For loss to any item described in A.2.a. - f. above,
the limit of liability that applies to the item.
(2) Flasks;
2. If the cost to repair or replace the property described
(3) Smoking implements; or in A. above is more than $500, we will pay no more
than the actual cash value for the loss until the actual
(4) Jewelry; and repair or replacement is complete.

f. Golfer's equipment meaning golf clubs, golf 3. You may make a claim for loss on an actual cash
clothing and golf equipment. value basis and then make claim for any additional
liability in accordance with this endorsement provided
Personal Property Replacement Cost loss settlement will not you notify us of your intent to do so within 180 days
apply to other classes of property separately described and after the date of loss.
specifically insured.

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Copyright, Insurance Services Office, Inc., 1999
Page 33 of 63
TC HO 04 90 07 20
 PERSONAL PROPERTY REPLACEMENT COST LOSS SETTLEMENT

1. In the event that covered property is damaged or

destroyed by a covered loss, we will pay your addi-
tional cost to repair or replace with property that meets
the following standards regarding energy effic- iency:

a. ENERGY STAR qualified appliances, including

but not limited to, clothes washers and dryers,
dishwasher, refrigerators and freezers;

b. ENERGY STAR qualified lighting fixtures, light

bulbs, and ceiling fans; and

c. ENERGY STAR qualified computers, electronics

and televisions.

All other provisions of this policy apply.

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Copyright, Insurance Services Office, Inc., 1999
Page 34 of 63
TC HO 04 90 07 20
 Trisura Insurance Company
Rental Income Coverage Endorsement
Name of Insured: Yeni Perez Endorsement Effective Date:

Policy Number: 85618542 Policy Period: 2/10/2024 To 2/10/2025 Endorsement Number: N/A

The above information only needs to be completed when issued subsequent to initial preparation of policy.

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

SECTION I - ADDITIONAL COVERAGE

The following has been added:

RENTAL INCOME COVERAGE

If the "residence premises" or another rental unit at the "insured location" is uninhabitable due to a loss caused by an
"insured" from one of the following perils: fire, smoke, explosion, or water damage, "we" will pay the property owner and/or
property manager Loss of Rental Income. "Our" limit of liability for Rental Income Coverage is $3,000.

a. The amount paid on a daily basis will be calculated based on the occupants' monthly rent payment divided by 30.

b. Under no circumstances will "we" pay more than $1,000 per month, per unit.

Payment will be for the shortest time required to repair or replace the damage.

Cause of loss must have originated from the "residence premises".

We do not cover rent payments for more than 12 months after the date of loss.

All other provisions of the policy apply.

Page 35 of 63
TC HO4-RI (07/20)
 Trisura Insurance Company
Tenants Mandatory Endorsement – Louisiana
Name of Insured: Yeni Perez Endorsement Effective Date:

Policy Number: 85618542 Policy Period: 2/10/2024 To 2/10/2025 Endorsement Number: N/A

The above information only needs to be completed when issued subsequent to initial preparation of policy.

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

DEFINITIONS m. $1,000 or 10% of Coverage C, whichever is

greater, for loss from items in a "motor vehicle",
Paragraph 5. a. of the definition of "insured" is deleted and excluding those items that would be covered in
replaced with the following: subparagraph j. and k. above.
5. "Insured” means: n. $1,000 on fashion accessories. Fashion access-
ories are decorative items that supplement one’s
a. "You" and residents of "your" household who are: garment and include, but are not limited to, belts,
bowties, gloves, handbags, hats, leg warmers,
(1) "Your" relatives; or leggings, neckties, pins, purses, scarves, shoes,
stockings, sunglasses, suspenders, tights and
(2) Other persons under the age of 21 and in wigs. Fashion access- ories do not include
the care of any person named above; or jewelry, watches, furs, precious and
(3) Any person residing at the "insured location", semiprecious stones.
but only if that person is listed on the lease 4. Property Not Covered
or rental agreement that applies to the
"insured location". Paragraph f. is deleted and replaced with the
SECTION I – PROPERTY COVERAGES following:

A. Coverage C – Personal Property f. Property of roomers, boarders and other

tenants, except property of roomers and boarders
1. Covered Property is deleted and replaced by the who are related to or are an "insured".
following: B. Coverage D – Loss Of Use is deleted and replaced with
1. Covered Property the following:

"We" cover personal property owned or used by an B. Coverage D – Loss Of Use

"insured" while it is anywhere in the world. "Our" limit The limit of liability for Coverage D is the total limit for the
of liability for personal property away from the coverages in 1. Additional Living Expense, 2. Fair Rental
"residence premises" is 10% of the limit of liability for Value and 3. Civil Authority Prohibits Use below. In total
Coverage C, or $2,000, whichever is greater. the limit of liability under Coverage D is limited to 20% of
Personal property in a newly acquired principal Coverage C or $2,000, whichever is greater.
residence is not subject to this limitation for the 30
days immediately after "you" begin to move the 1. Additional Living Expense
property there.
2. Limit For Property At Other Residences is deleted If a loss by a Peril Insured Against under this policy
and replaced by the following: to covered property or the building containing the
property makes the "residence premises" uninhabit-
2. Limit For Property At Other Residences able, "we" cover any necessary increase in living
expenses incurred by "you" so that "your" household
"Our" limit of liability for personal property usually can maintain its normal standard of living.
located at an "insured's" residence, other than the
"residence premises", is 10% of the limit of liability for Payment will be for the shortest time required to repair
Coverage C, or $2,000, whichever is greater. or replace the damage or, if "you" permanently
relocate, the shortest time required for "your" house-
3. Special Limits Of Liability hold to settle elsewhere.
Subparagraph e. is deleted and replaced with the 2. Fair Rental Value
following:
If a loss covered under Section I makes that part of
e. $1,000 for loss by theft of jewelry, watches, furs, the "residence premises" rented to others or held for
precious and semiprecious stones. rental by "you" uninhabitable, "we" cover the fair
rental value of such premises less any expenses that
Subparagraph l., m. and n. are added: do not continue while it is not uninhabitable.
l. $1,000 on antiques, fine arts, paintings, Payment will be for the shortest time required to repair
sculptures, tapestries, rugs, statuary, memor- or replace such premises.
abilia, collectibles and similar articles.

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TC HO 02 04 LA (01/21)
 TENANTS MANDATORY ENDORSEMENT – LOUISIANA

1. Civil Authority Prohibits Use B. Duties After Loss

If a civil authority prohibits "you" from use of the 9. An "insured" who has made claim under this policy
"residence premises" as a result of direct damage to must notify "us" if they wish to obtain copies of any
neighboring premises by a Peril Insured Against, "we" claim-related documents that relate to their claim.
cover the loss as provided in 1. Additional Living "Claim-related documents" means all documents
Expense and 2. Fair Rental Value above for no more that relate to the evaluation of damages, including,
than two weeks. but not limited to, repair and replacement estimates
and bids, appraisals, scopes of loss, drawings,
2. Loss Or Expense Not Covered plans, reports, third-party findings on the amount of
loss, covered damages, and cost of repairs, and all
"We" do not cover loss or expense due to cancell- other valuation, measurement, and loss adjustment
ation of a lease or agreement. calculations of the amount of loss, covered damage,
and cost of repairs. However, work product and
"We" do not cover loss or expense for more than 12 attorney-client privileged documents, and docu-
months after the date of loss. However, if the loss or ments that indicate fraud by an "insured" or that
damage is in California only, and relates to a contain medically privileged information, are
government-declared state of emergency under the excluded from the documents "we" are required to
California Government Code, "we" will cover loss or provide.
expense up to 24 months.
Any claim-related documents will be provided within 15
The periods of time under 1. Additional Living days after receipt of the request for such documents.
Expense, 2. Fair Rental Value and 3. Civil Authority
Prohibits Use above are not limited by expiration of R. Adjusters
this policy; however, the events causing the
"residence premises" to be uninhabitable or the civil If, within a six-month period, "we" assign a third or
authority order prohibiting use of the "residence subsequent adjuster to be primarily responsible for a
premises" must have taken place during the policy claim, "we" shall, in a timely manner, provide "you" with
period. a written status report. For purposes of this condition, a
written status report will include a summary of any
SECTION I – PERILS INSURED AGAINST decisions or actions that are substantially related to the
disposition of a claim, including but not limited to, the
9. Theft is deleted and replaced with the following: amount of loss to structures or personal property, the
retention or consultation of design or construction
9. Theft professionals, the amount of coverage for loss to
structures or personal property and all items of dispute.
a. This peril includes attempted theft and loss of
property from a known place when it is likely that S. "Your" Duty to Select and Maintain Policy Limits
the property has been stolen, provided a police
report has been filed by the "insured". The limit of liability for Coverage C may be adjusted
annually to reflect changes in the cost of items of
b. This peril does not include loss caused by theft: personal property, inflation and other factors. If the
Coverage C limit of liability is adjusted, "we" will also
(1) Committed by an "insured"; increase the limits of liability for Coverage D by the same
percentage applied to Coverage C. Any such change will
(2) In or to a dwelling under construction, or of be made on the renewal or annual anniversary date of
materials and supplies for use in the this policy. However, it remains "your" responsibility to
construction until the dwelling is finished and select and maintain adequate amounts of insurance on
occupied; "your" personal property and loss of use.
(3) From that part of a "residence premises" SECTION II – EXCLUSIONS
rented by an "insured" to someone other than
another "insured"; or Paragraph F., Coverage E – Personal Liability paragraph
3. is deleted and replaced with the following:
(4) That occurs off the "residence premises" of:
3. "Property damage" to property rented to, occupied
(a) Trailers, semitrailers and campers; or used by or in the care of the "insured". This
exclusion does not apply to “property damage”
(b) Watercraft of all types, and their furnish- caused by fire, smoke, explosion or water damage.
ings, equipment and outboard engines
or motors; or SECTION II – ADDITIONAL COVERAGES
(c) Property while at any other residence Paragraph A. Claim Expenses, paragraph 1. is deleted and
owned by, rented to, or occupied by an replaced with the following:
"insured", except while an "insured" is
temporarily living there. Property of an A. Claim Expenses
"insured" who is a student is covered
while at the residence the student "We" pay:
occupies to attend school as long as the
student has been there at any time 1. Expenses "we" incur and costs taxed against an
during the 60 days immediately before "insured" in any suit "we" defend; however, "we" will
the loss. not pay any attorney’s fees awarded to any person
or party, whether such award arises out of contract,
(5) By unexplained or mysterious disappear- statute, rule of court or otherwise;
ance.
SECTION I – CONDITIONS
The following have been added:
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Page 37 of 63
TC HO 02 04 LA (01/21)
 TENANTS MANDATORY ENDORSEMENT – LOUISIANA

SECTION II – CONDITIONS
Section B. Severability Of Insurance is deleted.
SECTIONS I AND II – CONDITIONS
The following has been added.
H. Policy Amendments/Changes
Only the first named "insured" as shown in the
Declarations is allowed to request changes or amend-
ments to this policy. If such named “insured” moves or is
in any way unable to make such requests, then "we"
reserve the right to rewrite the policy applicable to the
"residence premises" with a new first named "insured".
All other provisions of this policy apply.

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Page 38 of 63
TC HO 02 04 LA (01/21)
 HOMEOWNERS
HO 01 17 03 23

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

SPECIAL PROVISIONS – LOUISIANA

SECTION I – PROPERTY COVERAGES (This is Paragraph C.6.c.(1) in Form HO 00 04 and
D. Coverage D – Loss Of Use D.6.c.(1) in Form HO 00 06.)
The following is added to Paragraph 1. Additional SECTION I – EXCLUSIONS
Living Expense: Paragraph 8. Intentional Loss is replaced by the
In the event of a total loss to the dwelling caused following:
by a Peril Insured Against, we will, upon your 8. Intentional Loss
request, render an advance payment equal to Intentional loss means any loss arising out of any
the estimated value of three months of act committed:
increased living expenses necessary for your
household to maintain its normal standard of a. With respect to loss caused by fire:
living. After three months, if it is determined that (1) By or at the direction of the "insured"; and
the actual cost of incurred additional living (2) With the intent to cause a loss.
expenses exceeds the amount previously
advanced, further payments will be made upon b. With respect to loss caused by a peril other than
submission of satisfactory proof of loss. fire and with respect to all "insureds" covered
under this Policy:
(This is Paragraph B.1. in HO 00 04 and C.1. in HO
00 06.) (1) By you or at your direction; and
E. Additional Coverages (2) With the intent to cause a loss.
Paragraph 2. Reasonable Repairs is replaced by (This is Exclusion A.8. in Forms HO 00 03 and
the following: HO 00 05.)
2. Reasonable Repairs SECTION I – CONDITIONS
We will pay the reasonable cost incurred by you Paragraph 8. of C. Duties After Loss is replaced by
for necessary repairs made solely to protect the following:
covered property from further damage if a Peril 8. Send to us your signed, sworn proof of loss
Insured Against causes the loss. This coverage which sets forth, to the best of your knowledge
does not increase the limit of liability that applies and belief:
to the property being repaired.
a. The time and cause of loss;
(This is Paragraph C.2. in Form HO 00 04 and D.2.
in Form HO 00 06.) b. The interests of all "insureds" and all others
in the property involved and all liens on the
Paragraph 6.c.(1) is replaced by the following: property;
6. Credit Card, Electronic Fund Transfer Card c. Other insurance which may cover the loss;
Or Access Device, Forgery And Counterfeit
Money d. Changes in title or occupancy of the property
during the term of the Policy;
c. If the coverage in a. applies, the following
defense provisions also apply: e. Specifications of damaged buildings and
detailed repair estimates;
(1) We may investigate and settle any claim
or suit that we decide is appropriate. Our f. The inventory of damaged personal property
described in 6. above;
duty to defend a claim or suit ends when
our limit of liability for the loss has been
exhausted by payment of a judgment or
settlement.

HO 01 17 03 23 © Insurance Services Office, Inc., 2022 Page 39 of 63

 g. Receipts for additional living expenses Paragraph F. Appraisal is replaced by the following:
incurred and records that support the fair F. Appraisal
rental value loss; and
If you and we fail to agree as to the amount of loss,
h. Evidence or affidavit that supports a claim either party may demand that the amount of the
under E.6. Credit Card, Electronic Fund loss be set by appraisal. If either party makes a
Transfer Card Or Access Device, Forgery written demand for appraisal, each party shall
And Counterfeit Money under Section I – select a competent appraiser and notify the other
Property Coverages, stating the amount and party of their appraiser's identity within twenty days
cause of loss. of receipt of the written demand for appraisal. The
This proof of loss must be sent to us within: appraisers shall select a competent and impartial
(1) 180 days after our request, if the loss umpire. If after fifteen days the appraisers have not
results from a catastrophic event for agreed upon who will serve as umpire, the umpire
which a state of disaster or emergency shall be appointed by a judge of the court of record
was declared pursuant to law by civil in which the property is located. The appraisers
officials; however, this 180-day period shall appraise the loss. If the appraisers submit
does not commence until the state of written notice of an agreement as to the amount of
emergency or disaster has ended and the loss to us, the amount agreed upon shall set the
you have access to your property; or amount of the loss. If the appraisers fail to agree
within thirty days, the appraisers shall submit their
(2) 60 days after our request in all other differences along with any supporting
cases. documentation to the umpire, who shall appraise
D. Loss Settlement the loss. The appraisers may extend the time to
Under Forms HO 00 02, HO 00 03 and HO 00 05, sixty days for which they must agree upon the
Paragraph 2.a.(2) is replaced by the following: amount of loss or submit their differences and
supporting documents to the umpire, if the
(2) The replacement cost of that part of the extension is agreed to by the appraisers from both
building damaged with material of like parties. A written agreement signed by the umpire
kind and quality; or and either party's appraiser shall set the amount of
Under Forms HO 00 02, HO 00 03 and HO 00 05, the loss, pursuant to the appraisal process, but
Paragraph 2.e. is replaced by the following: shall not preclude either party from exercising its
rights under the Policy or the law. Each appraiser
e. You may disregard the replacement cost shall be paid by the party selecting that appraiser.
loss settlement provisions and make claim
under this Policy for loss to buildings on an Other expenses of the appraisal and the expenses
actual cash value basis. You may then make of the umpire shall be divided and paid in equal
claim for any additional liability according to shares by you and us.
the provisions of this Condition D. Loss If there is an appraisal award, all applicable policy
Settlement, provided you notify us, within terms, limits, deductibles, and conditions shall
180 days after the date of loss, of your intent apply. If you file a lawsuit relative to this Policy
to repair or replace the damaged building. against us prior to a demand for appraisal, the
However, if the loss results from a lawsuit will be held in abatement during the period
catastrophic event for which a state of between a timely demand for appraisal and the
disaster or emergency was declared deadline for execution of an appraisal award,
pursuant to law by civil officials, this 180-day pursuant to this clause. The court of record in which
period does not commence until the state of the property is located may enforce the deadlines
emergency or disaster has ended and you of this clause, set a reasonable deadline for timely
have access to your property. demanding appraisal after all parties have filed
pleadings in a lawsuit, and require compliance with
discovery and disclosure obligations relative to
aspects of the lawsuit unrelated to the appraisal.

HO 01 17 03 23 © Insurance Services Office, Inc., 2022 Page 40 of 63

Paragraph J. Loss Payment is replaced by the (This is Condition Q. in Form HO 00 04.)
following: SECTION II – LIABILITY COVERAGES
J. Loss Payment A. Coverage E – Personal Liability
We will adjust all losses with you. We will pay you Paragraph 1. is replaced in all forms and
unless some other person is named in the Policy or Endorsement HO 24 73 by the following:
is legally entitled to receive payment. The
undisputed portion of the loss will be payable within 1. Pay up to our limit of liability for the damages for
30 days after we receive your proof of loss. which an "insured" is legally liable; and
Paragraph 3. of L. Mortgage Clause is replaced by the SECTION II – EXCLUSIONS
following: E. Coverage E – Personal Liability And Coverage
3. If this Policy is cancelled by us, the mortgagee F – Medical Payments To Others
will be notified: Paragraph 1. is replaced by the following in all
a. At least 10 days before the date cancellation forms and Endorsement HO 24 73:
takes effect if we cancel for nonpayment of 1. Expected Or Intended Injury
premium; or
"Bodily injury" or "property damage" with
b. At least 30 days before the date cancellation respect to loss:
takes effect if we cancel for any other
a. Caused by fire, which is expected or
reason. intended by the "insured", even if the "bodily
If the Policy is not renewed by us, the mortgagee injury" or "property damage":
will be notified at least 30 days before the date
(1) Is of a different kind, quality or degree
nonrenewal takes effect. than initially expected or intended; or
(This Condition does not apply to Form HO 00 04.) (2) Is sustained by a different person, entity
Paragraph R. Concealment Or Fraud is replaced by or property than initially expected or
the following: intended.
R. Concealment Or Fraud However, this Exclusion E.1.a. does not
1. With respect to loss caused by fire, we do not apply to "bodily injury" or "property damage"
provide coverage to the "insured" who, whether resulting from the use of reasonable force by
before or after a loss, has: the "insured" to protect persons or property.
a. Intentionally concealed or misrepresented b. Caused by a peril other than fire and with
any material fact or circumstance; respect to all "insureds" covered under this
Policy, which is expected or intended by one
b. Engaged in fraudulent conduct; or or more "insureds", even if the "bodily injury"
c. Made false statements; or "property damage":
relating to this insurance. (1) Is of a different kind, quality or degree
2. With respect to loss caused by a peril other than than initially expected or intended; or
fire and with respect to all "insureds" covered (2) Is sustained by a different person, entity
under this Policy, we provide no coverage for or property than initially expected or
loss if, whether before or after a loss, one or intended.
more "insureds" have: However, this Exclusion E.1.b. does not
a. Intentionally concealed or misrepresented apply to "bodily injury" or "property damage"
any material fact or circumstance; resulting from the use of reasonable force by
b. Engaged in fraudulent conduct; or one or more "insureds" to protect persons or
property.
c. Made false statements;
F. Coverage E – Personal Liability
relating to this insurance.
Paragraph 6. is deleted in all forms and
3. However, if the conduct specified above is in Endorsements HO 06 12 and HO 24 73.
relation to the procurement of the contract or
occurs subsequent to the issuance of the
contract, but if known to us would have caused
us not to issue the Policy, coverage will only be
denied if the conduct was committed with the
intent to deceive.

HO 01 17 03 23 © Insurance Services Office, Inc., 2022 Page 41 of 63

SECTION II – CONDITIONS 3. The following applies if 2. above does not apply:
F. Suit Against Us does not apply. We may cancel this Policy only for the reasons
Paragraph J. Concealment Or Fraud is replaced by stated below by letting you know in writing of the
the following: date cancellation takes effect. This cancellation
notice may be delivered to you, or mailed to you
J. Concealment Or Fraud at your mailing address shown in the
1. We do not provide coverage to one or more Declarations.
"insureds" who, whether before or after a loss, Proof of mailing will be sufficient proof of notice.
have:
a. When you have not paid the premium,
a. Intentionally concealed or misrepresented regardless of the period of time this Policy
any material fact or circumstance; has been in effect, we may cancel at any
b. Engaged in fraudulent conduct; or time by letting you know at least 10 days
before the date cancellation takes effect.
c. Made false statements;
b. When this Policy has been in effect for less
relating to this insurance.
than 60 days and is not a renewal with us,
2. However, if the conduct specified above is in we may cancel for any reason by letting you
relation to the procurement of the contract or and any other known person shown by the
occurs subsequent to the issuance of the Policy to have an interest in any loss which
contract, but if known to us would have caused may occur thereunder know at least 30 days
us not to issue the Policy, coverage will only be before the date cancellation takes effect.
denied if the conduct was committed with the
c. When this Policy has been in effect for 60
intent to deceive.
days or more, or at any time if it is a renewal
SECTIONS I AND II – CONDITIONS with us except as provided in Item 3.e.
Paragraphs 1., 2., 3. and 4. of C. Cancellation are below, we may cancel:
replaced by the following: (1) If there has been a material
1. You may cancel this Policy at any time by letting misrepresentation of fact with the intent
us know in writing of the date cancellation is to to deceive:
take effect. (a) In the procurement of the contract; or
2. The following applies with respect to premium (b) At any other time since the Policy was
payments due on new and renewal policies, issued;
including installment payments:
which if known to us would have caused
a. If your premium payment check or other us not to issue the Policy; or
negotiable instrument is returned to us or our
agent or a premium finance company (2) If the risk has changed substantially
since the Policy was issued.
because it is uncollectible for any reason, we
may cancel the Policy subject to Paragraphs This can be done by letting you and any
b. and c. below. other known person shown by the Policy to
have an interest in any loss which may occur
b. We may cancel the Policy effective from the
thereunder know at least 30 days before the
date the premium payment was due, by
date cancellation takes effect.
sending you written notice by certified mail,
or by delivering such notice to you within 10 d. When this Policy is written for a period of:
days of the date that we receive notice of the (1) More than one year; or
returned check or negotiable instrument.
(2) Three years or less;
c. The cancellation notice will also advise you
that the Policy will be reinstated effective we may cancel for any reason at anniversary
from the date the premium payment was due by letting you and any other known person
if you present to us a cashier's check or shown by the Policy to have an interest in
money order for the full amount of the any loss which may occur thereunder know
returned check or other negotiable at least 30 days before the date cancellation
instrument within 10 days of the date that the takes effect.
cancellation notice was mailed.

HO 01 17 03 23 © Insurance Services Office, Inc., 2022 Page 42 of 63

 e. When this Policy has been in effect and c. If we cancel based on Paragraph 2. above,
renewed for more than three years, we may we will return the premium due, if any, within
cancel for any one of the following reasons: 10 days after the expiration of the 10-day
(1) If you have committed fraud with the period referred to in 2.c. If the Policy was
intent to deceive: financed by a premium finance company, or
if payment was advanced by the insurance
(a) In the procurement of the contract; or agent, we will send the return premium
(b) At any other time since the Policy was directly to such payor.
issued; Paragraph D. Nonrenewal is replaced by the following:
(2) If the insured risk has undergone a D. Nonrenewal
material change;
1. We may elect not to renew this Policy, subject
(3) If you have filed two or more claims that to the provisions of Paragraphs 2. and 3. below.
are not the result of an incident which is: We may do so by delivering to you and any other
(a) Due directly to forces of nature; and known person shown by the Policy to have an
interest in any loss which may occur thereunder,
(b) Exclusively without human
intervention; or mailing to you at your mailing address shown
in the Declarations and to any other known
within a continuous three-year period person shown by the Policy to have an interest
within the five years preceding the in any loss which may occur thereunder, written
current policy renewal date; or notice at least 30 days before the expiration
(4) If the continuation of this Policy date of this Policy. Proof of mailing will be
endangers our solvency. sufficient proof of notice.
This can be done by letting you and any 2. If this Policy has been in effect and renewed with
other known person shown by the Policy to us for more than three years, we will not
have an interest in any loss which may occur exercise our right of nonrenewal except:
thereunder know at least 30 days before the a. When you have not paid the premium;
date cancellation takes effect.
b. If you have committed fraud;
We will not, however, cancel this Policy,
regardless of the period of time this Policy has c. If the insured risk has undergone a
substantial change;
been in effect, based solely upon a loss caused
by an Act of God. An Act of God means an d. If you have filed two or more claims that are
incident due directly to natural causes and not the result of an incident which is:
exclusively without human intervention. (1) Due directly to forces of nature; and
4. If this Policy is cancelled, we will return any (2) Exclusively without human intervention;
premium refund due, subject to Paragraphs a.,
b. and c. below. The cancellation will be within a continuous three-year period of time
effective even if we have not made or offered a within the five years preceding the current
refund. policy renewal date; or
a. If you cancel this Policy, we will refund the e. If the continuation of this Policy endangers
return premium, if any, within 30 days after our solvency.
the date cancellation takes effect. The return 3. We will not, however, exercise our right of
premium shall be computed on a pro rata nonrenewal, regardless of the period of time this
basis, subject to the minimum premium Policy has been in effect with us, based solely
requirements. upon a loss caused by an Act of God. An Act of
b. If we cancel this Policy, and the return God means an incident due directly to natural
premium is not refunded with the notice of causes and exclusively without human
cancellation, we will refund it within a intervention.
reasonable time after the date cancellation
takes effect. We will send the refund to you,
or your agent, unless c. below applies. If the
premium is refunded to your agent, we will
notify you, at the time of cancellation, that a
return of unearned premium may be
generated by the cancellation.

HO 01 17 03 23 © Insurance Services Office, Inc., 2022 Page 43 of 63

F. Subrogation The following provision applies when Endorsement HO
The following paragraph is added: 06 12 is attached to the Policy:
If we pay an "insured" for a loss caused by another The Personal Injury Coverage provision in
"insured" who intentionally commits, or directs Endorsement HO 06 12, which replaces Paragraph 1.i.
another to commit, any act that results in loss by when the Personal Injury endorsement is attached to
fire, the rights of the "insured" to recover damages this Policy, is deleted.
from the "insured" who intentionally committed, or All other provisions of this Policy apply.
directed another to commit, such an act are
transferred to us to the extent of our payment. The
"insured" may not waive such rights.

HO 01 17 03 23 © Insurance Services Office, Inc., 2022 Page 44 of 63

 Trisura Insurance Company
Identity Fraud Expense Coverage
Name of Insured: Yeni Perez Endorsement Effective Date:

Policy Number: 85618542 Policy Period: 2/10/2024 To 2/10/2025 Endorsement Number: N/A

The above information only needs to be completed when issued subsequent to initial preparation of policy.

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

DEFINITIONS IDENTITY FRAUD EXPENSE

The following definitions are added with respect to this "We" will pay up to $5,000 for "expenses" incurred by an
endorsement only: "insured" as the direct result of any one "identity fraud" first
discovered or learned of during the policy period.
1. "Identity fraud" means the fraudulent use of a means of Any act or series of acts committed by one or more persons,
identification of an "insured" with the intent: or in which such person or persons are aiding or abetting
others against an "insured", is considered to be one "identity
a. to commit, or fraud". This period of “identity fraud” applies even if a series of
b. to aid or abet another to commit acts continues into a subsequent policy period.
any unlawful activity that is a violation of federal law or a This coverage is additional insurance.
felony under any applicable state or local law.
EXCLUSIONS
2. "Expenses" means:
The following additional exclusions apply to this coverage:
a. Costs for notarizing affidavits or documents attesting
to fraud required by financial institutions or similar "We" do not cover:
credit grantors or credit agencies.
1. Loss arising out of or in connection with a "business".
b. Cost for certified mail to law enforcement agencies,
credit agencies, financial institutions, or similar credit 2. "Expenses" incurred due to any fraudulent, dishonest or
grantors. criminal act by a/an:
c. Lost income resulting from time taken off work to: a. "Insured" or any person aiding or abetting an
"insured"; or
(1) Complete fraud affidavits; or b. By any authorized representative of an "insured";
(2) Meet with or talk to law enforcement agencies,
credit agencies and/or legal counsel; whether acting alone or in collusion with others.

up to a maximum payment of $500 per week. Total 3. Loss other than "expenses". Account balances which arise
payment for lost income is not to exceed four weeks. out of fraudulent or unauthorized charges would be one
example of loss other than "expenses".
d. Costs for re-filing for a loan or loans when the original SPECIAL DEDUCTIBLE
application is rejected solely as a result of “identity
fraud”. "We" will pay only that part of the loss that exceeds $250. No
other deductible applies to "identity fraud" expense coverage.
e. Reasonable attorney fees as a result of "identity
fraud" to: SECTION I – CONDITIONS
(1) Defend lawsuits brought against an "insured" by B. Duties After Loss
merchants, financial institutions or their collect-
ion agencies; The following is added:
(2) Remove any civil judgments wrongly entered Send to "us," within 60 days after "our" request:
against an "insured"; and
a. Receipts;
(3) Challenge the accuracy of any information in a b. Bills; or
consumer credit report. c. Other records;
f. Charges incurred for long distance telephone calls to that support "your" claim for "expenses" under "identity fraud"
report or discuss an actual "identity fraud" to: coverage.
(1) Merchants; All other provisions of this policy apply.
(2) Law enforcement agencies;
(3) Financial institutions; or
(4) Similar credit grantors, or credit agencies.
The following Additional Coverage is added under Section I:

Includes copyrighted material of Insurance Services Office, Inc., with its permission
Copyright, Insurance Services Office, Inc., 1999
Page 45 of 63
TC HO 04 55 07 20
 Trisura Insurance Company
Forcible Entry Theft Endorsement
Name of Insured: Yeni Perez Endorsement Effective Date:

Policy Number: 85618542 Policy Period: 2/10/2024 To 2/10/2025 Endorsement Number: N/A

The above information only needs to be completed when issued subsequent to initial preparation of policy.

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

TO THE EXTENT ANY PROVISION OF THIS ENDORSEMENT CONFLICTS WITH ANY PROVISION OF THE POLICY
OR ANY OF ITS OTHER ENDORSEMENTS, THE PROVISIONS OF THIS ENDORSEMENT WILL SUPERSEDE.

SECTION I – PERILS INSURED AGAINST

9. Theft is deleted and replaced with the following:

9. Theft

a. This peril includes attempted theft and loss of property, provided the loss is a result of forcible entry. There must
be visible evidence of physical damage at the point of entry which results in the forced entry, and loss of property
from a known place when it is likely that the property has been stolen. A police report must be filed by the
“insured”.

b. This peril does not include loss caused by theft:

(1) Committed by an "insured";

(2) In or to a dwelling under construction, or of materials and supplies for use in the construction until the dwelling
is finished and occupied;

(3) From that part of a "residence premises" rented by an "insured" to someone other than another "insured"; or

(4) That occurs off the "residence premises" of:

(a) Trailers, semitrailers and campers;

(b) Watercraft of all types, and their furnishings, equipment and outboard engines or motors; or

(c) Property while at any other residence owned by, rented to, or occupied by an "insured" except while an
"insured" is temporarily living there. Property of an "insured" who is a student is covered while at the
residence the student occupies to attend school as long as the student has been there at any time during
the 60 days immediately before the loss.

(5) By unexplained or mysterious disappearance.

All other provisions of this policy apply.

Page 46 of 63
TC HO4-FE (07/20)
 Trisura Insurance Company
Pet Damage Endorsement
Name of Insured: Yeni Perez Endorsement Effective Date:

Policy Number: 85618542 Policy Period: 2/10/2024 To 2/10/2025 Endorsement Number: N/A

The above information only needs to be completed when issued subsequent to initial preparation of policy.

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

In consideration of additional premium charged and paid, the

following is added under SECTION II – ADDITIONAL
COVERAGES C. Damage To Property Of Others:
3. Landlord’s Property
We will pay up to $500 per year for damage to real
and personal property of the landlord in the "residence
premises" if such damage is caused by an "insured"
and results from:
a. Fire;
b. Smoke;
c. Explosion;
d. Water damage; or
e. Pet damage (limited to $500 in coverage in
excess of any applicable security deposit or
special pet deposit that is a part of the
lease/rental agreement).
All other provisions of this policy apply.

Includes copyrighted material of Insurance Services Office, Inc., with its permission.
Copyright, Insurance Services Office, Inc., 1999
Page 47 of 63
TC HO4-PD (01/21)
 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

Trisura Insurance Company

BIOHAZARD CLEAN-UP
Under the LIABILITY SECTION, the following item E. is added under SECTION II - ADDITIONAL
COVERAGES:
E. In the unfortunate circumstance of the death of an insured, that occurs in the residence
premises, this policy will provide up to $2,000 for Biohazard Clean-up, in excess of any
applicable security deposit that is a part of the lease/rental agreement. Biohazard Clean-up
includes biohazard recovery, decontamination, and blood cleanup performed by a company
specifically licensed and/or certified to perform such services.
This coverage does not apply to any resulting damage to personal property. This coverage is limited
to the residence premises. The insured means you and any person residing at the residence premises,
but only if that person is listed on the lease, rental agreement or mortgage agreement that applies
to the residence premises for this coverage to apply.

TC BIO EN 07 20 Page 48 of 63
 HOMEOWNERS
HO 04 98 05 11

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

REFRIGERATED PROPERTY COVERAGE

A. Definitions 2. Coverage will apply only if you have maintained
With respect to the provisions of this endorsement the refrigeration unit in proper working condition
only, the following definition is added: immediately prior to the loss.
"Loss of power" means the complete or partial 3. This endorsement does not increase the limit of
interruption of electric power due to conditions liability for Coverage C.
beyond an "insured's" control. C. Section I – Exclusions
B. Section I – Property Coverages The Power Failure exclusion does not apply to this
The following coverage is added: coverage.
1. We insure, for up to $500, covered property D. Section I – Conditions
stored in freezers or refrigerators on the The following replaces any other deductible
"residence premises" for direct loss caused by: provision in this policy with respect to any one loss
a. "Loss of power" to the refrigeration unit. covered under this endorsement:
"Loss of power" must be caused by damage We will pay only that part of the total of all loss
to: payable that exceeds $100.
(1) Generating equipment; or All other provisions of this policy apply.
(2) Transmitting equipment; or
b. Mechanical failure of the unit which stores
the property.

HO 04 98 05 11 © Insurance Services Office, Inc., 2010 Page 49 of 63

 Important Information Required by the Louisiana
Department of Insurance

Homeowners Insurance Policy Coverage Disclosure

Summary
This form is promulgated pursuant to LSA‐R.S. 22:1332
(B)(1‐6) and (8)

THIS IS ONLY A SUMMARY OF YOUR COVERAGE AND DOES NOT

AMEND, EXTEND, OR ALTER THE COVERAGES OR ANY OTHER
PROVISIONS CONTAINED IN YOUR POLICY. INSURANCE IS A
CONTRACT. THE LANGUAGE IN YOUR POLICY CONTROLS YOUR
LEGAL RIGHTS AND OBLIGATIONS.

**READ YOUR INSURANCE POLICY FOR COMPLETE POLICY TERMS

AND CONDITIONS**

COVERAGE(S) FOR WHICH PREMIUM WAS PAID

Coverage A – Dwelling N/A

Coverage B – Other Structures N/A
Coverage C – Personal Property $15,000
Coverage D – Loss of Use $3,000
Coverage E – Personal Liability $100,000
Coverage F – Medical Payments To
$1,000
Others
Other(s):

Deductibles

This policy sets forth certain deductibles that will be applied to

claims for damages. When applicable, a deductible will be subtracted
from your total claim and you will be paid the balance subject to
applicable coverage limits.

• You may be able to reduce your premium by increasing your

deductible. Contact your producer (agent) or insurer for
details.

NOTICE: This policy does set forth a separate deductible for

covered losses caused by wind as defined in the policy.

TC LA H4 Appendix B 05 20 Page 50 of 63
 Separate Deductible Example—Hurricane, Wind or Named Storm
Damage.

If applicable, the following illustrates how a separate deductible

applying to hurricane, wind or named storm damage is applied under
your policy:
The insurer shall comply with LSA‐R.S. 22:1332 B(6) by selecting and
inserting either option A or B below:

A. Developing its own standardized example to reflect how a

hurricane, wind, or named storm damage loss will be adjusted
under the policy. The standardized example shall set forth a
separate loss under each of Coverage A, B, C and D and the
total of all losses combined shall exceed by at least ten
percent (10%) the applicable deductible so that there shall be
a net payment to the insured.

B. Utilizing the standardized example prepared by the LDOI if

this standardized example properly reflects how a separate
deductible is applied to a hurricane, wind, or named storm
damage loss under the policy:

If the total insured value of the dwelling or Coverage A is $200,000

and you have a 2% hurricane, wind, or named storm deductible,
then your hurricane, wind or named storm deductible would be
$200,000.00 X .02 = $4,000.00.

Losses:

Coverage A – Dwelling ................................................. $15,000

Coverage B – Other Structures ...................................... $ 2,500
Coverage C – Personal Property.................................... $ 3,000
Coverage D – Loss of Use ............................................. $ 2,000
Total amount of all losses .............................................. $22,500
Less 2% hurricane, wind or named storm deductible ...... $ 4,000
Net payment to insured .................................................. $18,500

TO SEE EXACTLY HOW YOUR SEPARATE HURRICANE, WIND OR

NAMED STORM DEDUCTIBLE WILL APPLY, PLEASE REFER TO
YOUR POLICY.

TC LA H4 Appendix B 05 20 Page 51 of 63
 Limitations or Exclusions under this Policy

FLOOD - Flood damage is not covered, regardless of how caused,

when flood is the peril that causes the loss. Flood water includes but
is not limited to storm surge, waves, tidal water, overflow of a body
of water, whether driven by wind or not.

Flood Insurance may be available through the National Flood

Insurance Program (NFIP). NFIP flood insurance may provide
coverage for damage to your dwelling and/or contents subject to the
coverage limits and terms of the policy.
Excess Flood Insurance may be available under a separate policy
from this or another insurer if the amount of the primary flood
insurance is not enough to cover the value of your property.

• You may contact your producer (agent) or insurer for more

information on the NFIP and excess flood insurance.

MOLD - Damage caused solely by mold is covered under this policy.

**FOR ALL OTHER LIMITATIONS OR EXCLUSIONS REFER TO

YOUR POLICY FOR COMPLETE DETAILS ON TERMS AND
PROVISIONS**

Claim Filing Process

There may be time limitations for filing a claim and filing of a
satisfactory proof of loss. There may also be time limitations for
repairing and replacing damaged property that could cause you to not
recover the replacement cost for the insured loss of your property, if
applicable.

Payment of Claims

Depending on the terms of the insurance policy, some losses may be

based on actual cash value (ACV) and other losses based on
replacement cost (RC).

• ACV is the amount needed to repair or replace the damaged

or destroyed property, minus the depreciation.

• RC involves the initial payment of actual cash value (ACV) of

a loss, and the subsequent payment of the additional amount
that is actually and necessarily expended to repair or replace
the damaged or destroyed property.

TC LA H4 Appendix B 05 20 Page 52 of 63
 **Refer to your policy for the terms and conditions describing
how a particular loss is to be paid.

Payment and Adjustment of Claims

Pursuant to LSA‐R.S. 22:1892 and 22:1973, except in the case of

catastrophic loss, the insurer shall initiate loss adjustment of a
property damage claim and/or a claim for reasonable medical
expenses within fourteen (14) days after notification of loss by the
claimant.

In the case of catastrophic loss, the insurer shall initiate loss

adjustment of a property damage claim within thirty (30) days after
notification of loss by the claimant unless the Commissioner of
Insurance promulgates a rule to extend the time period for initiating
a loss adjustment for damages arising from a presidentially declared
emergency or disaster or a gubernatorially declared emergency or
disaster for up to an additional thirty (30) days. Thereafter, one
additional extension of the period of time for initiating a loss
adjustment may be allowed by the Commissioner of Insurance if
approved by the Senate Committee on Insurance and the House
Committee on Insurance.

All insurers shall make a written offer to settle any property damage
claim, including a third‐party claim, within thirty (30) days after the
receipt of satisfactory proof of loss of that claim.

Failure to make such payment within thirty (30) days after receipt of
such satisfactory written proofs and demand thereof or failure to
make a written offer to settle any property damage claim, including a
third‐party claim, within thirty (30) days after receipt of a satisfactory
proof of loss of that claim may result in a late penalty against the
insurer in addition to the payment of the claim.

If the insurer is found to be arbitrary, capricious, or without probable

cause in settling any property damage claim, the insurer must pay the
insured, in addition to the amount of the loss, fifty percent (50%)
damages on the amount found to be due from the insurer to the
insured, or one thousand dollars ($1,000.00), whichever is greater, as
well as attorney fees and costs, if applicable.

Reduction in Premium for Improvements or Modifications to Property

(La. R.S. 22:1332(B)(8))

TC LA H4 Appendix B 05 20 Page 53 of 63
 Certain improvements or modifications to your property, such as
adding storm shutters, modifying the roof design, and improving the
roof covering, may reduce your premium. Contact your insurance
producer or insurer for complete details on qualifying improvements
or modifications. For further guidance and assistance, see Regulation
94—Premium Adjustments for Compliance with Building Codes and
Damage Mitigation, found at LAC 37:XIII.Chapter 127.

Effective May 30, 2020

TC LA H4 Appendix B 05 20 Page 54 of 63
 Important Information Required by the Louisiana
Department of Insurance

Homeowners Insurance Policy Coverage Disclosure Summary

This form is promulgated pursuant to LSA‐R.S. 22:1332 (B)(1)‐(8)

THIS IS ONLY A SUMMARY OF YOUR COVERAGE AND DOES NOT AMEND, EXTEND,
OR ALTER THE COVERAGES OR ANY OTHER PROVISIONS CONTAINED IN YOUR
POLICY. INSURANCE IS A CONTRACT. THE LANGUAGE IN YOUR POLICY CONTROLS
YOUR LEGAL RIGHTS AND OBLIGATIONS.
**READ YOUR INSURANCE POLICY FOR COMPLETE POLICY
TERMS AND CONDITIONS**

COVERAGE(S) FOR WHICH PREMIUM WAS PAID:

Coverage & Description

C - Personal Property Unscheduled
D - Loss Of Use
E - Personal Liability
F - Medical Payments

Deductibles

This policy sets forth certain deductibles that will be applied to claims for
damages. When applicable, a deductible will be subtracted from your total claim
and you will be paid the balance subject to applicable coverage limits.

• You may be able to reduce your premium by increasing your deductible.

Contact your producer (agent) or insurer for details.

• If you file a claim that does not exceed the policy deductible and that
does not result in a payment either to you or on your behalf, that claim
will be used to increase the cost of your policy’s premium in the future
or as part of the basis for cancellation of your policy.

NOTICE: This policy does set forth a separate deductible for covered
LA H4 Appendix C 05 20 Page 55 of 63
 losses caused by wind as defined in the policy.
Separate Deductible Example—Hurricane, Wind or Named Storm Damage.

If applicable, the following illustrates how a separate deductible applying to

hurricane, wind or named storm damage is applied under your policy:

If the total insured value of the dwelling or Coverage A is $200,000.00 and you
have a 2% hurricane, wind, or named storm deductible, then your hurricane,
wind or named storm deductible would be $200,000.00 X .02 =
$4,000.00.

Losses:
Coverage A – Dwelling ................................................. $15,000
Coverage B – Other Structures ...................................... $ 2,500
Coverage C – Personal Property.................................... $ 3,000
Coverage D – Loss of Use ............................................. $ 2,000
Total amount of all losses .............................................. $22,500
Less 2% hurricane, wind or named storm deductible ..... $ 4,000
Net payment to insured .................................................. $18,500

TO SEE EXACTLY HOW YOUR SEPARATE HURRICANE, WIND OR NAMED STORM

DEDUCTIBLE WILL APPLY, PLEASE REFER TO YOUR POLICY.

Limitations or Exclusions under this Policy

FLOOD - Flood damage is not covered, regardless of how caused, when flood is
the peril that causes the loss. Flood water includes but is not limited to storm
surge, waves, tidal water, overflow of a body of water, whether driven by wind
or not.
Flood Insurance may be available through the National Flood Insurance Program
(NFIP). NFIP flood insurance may provide coverage for damage to your dwelling
and/or contents subject to the coverage limits and terms of the policy.

Excess Flood Insurance may be available under a separate policy from this or
another insurer if the amount of the primary flood insurance is not enough to
cover the value of your property.

• You may contact your producer (agent) or insurer for more information
on the NFIP and excess flood insurance.

MOLD - Damage caused solely by mold is covered under this policy.

LA H4 Appendix C 05 20 Page 56 of 63
 **FOR ALL OTHER LIMITATIONS OR EXCLUSIONS REFER TO YOUR POLICY
FOR COMPLETE DETAILS ON TERMS AND PROVISIONS**

Claim Filing Process

There may be time limitations for filing a claim and filing of a satisfactory proof
of loss. There may also be time limitations for repairing and replacing damaged
property that could cause you to not recover the replacement cost for the insured
loss of your property, if applicable.

Payment of Claims

Depending on the terms of the insurance policy, some losses may be based on
actual cash value (ACV) and other losses based on replacement cost (RC).

• ACV is the amount needed to repair or replace the damaged or

destroyed property, minus the depreciation.
• RC involves the initial payment of actual cash value (ACV) of a loss, and
the subsequent payment of the additional amount that is actually and
necessarily expended to repair or replace the damaged or destroyed
property.

** Refer to your policy for the terms and conditions describing how a
particular loss is to be paid.

Payment and Adjustment of Claims

Pursuant to LSA‐R.S. 22:1892 and 22:1973, except in the case of catastrophic loss,
the insurer shall initiate loss adjustment of a property damage claim and/or a
claim for reasonable medical expenses within fourteen (14) days after
notification of loss by the claimant.

In the case of catastrophic loss, the insurer shall initiate loss adjustment of a
property damage claim within thirty (30) days after notification of loss by the
claimant unless the Commissioner of Insurance promulgates a rule to extend the
time period for initiating a loss adjustment for damages arising from a
presidentially declared emergency or disaster or a gubernatorially declared
emergency or disaster for up to an additional thirty (30) days. Thereafter, one
additional extension of the period of time for initiating a loss adjustment may be
allowed by the Commissioner of Insurance if approved by the Senate Committee
LA H4 Appendix C 05 20 Page 57 of 63
on Insurance and the House Committee on Insurance.

All insurers shall make a written offer to settle any property damage claim,
including a third‐party claim, within thirty (30) days after the receipt of
satisfactory proof of loss of that claim.

Failure to make such payment within thirty (30) days after receipt of such
satisfactory written proofs and demand thereof or failure to make a written offer
to settle any property damage claim, including a third‐party claim, within thirty
(30) days after receipt of a satisfactory proof of loss of that claim may result in a
late penalty against the insurer in addition to the payment of the claim.

If the insurer is found to be arbitrary, capricious, or without probable cause in

settling any property damage claim, the insurer must pay the insured, in addition
to the amount of the loss, fifty percent (50%) damages on the amount found to
be due from the insurer to the insured, or one thousand dollars ($1,000.00),
whichever is greater, as well as attorney fees and costs, if applicable.

Reduction in Premium for Improvements or Modifications to Property (La. R.S.

22:1332(B)(8))

Certain improvements or modifications to your property, such as adding storm

shutters, modifying the roof design, and improving the roof covering, may
reduce your premium. Contact your insurance producer or insurer for complete
details on qualifying improvements or modifications. For further guidance and
assistance, see Regulation 94—Premium Adjustments for Compliance with
Building Codes and Damage Mitigation, found at LAC 37:XIII.Chapter 127.

Effective May 30, 2020

LA H4 Appendix C 05 20 Page 58 of 63
 Policyholders Advisory Notice
OPTIONAL ENDORSEMENTS / COVERAGES

At any time, you may opt out of any optional coverage and/or endorsements added to
your policy as shown on your Declarations Page. You may do this by contacting your
agent at (800) 319-1390.

OPT NT 08 19 Page 59 of 63
 Policyholders Advisory Notice
TENANTS OR LIABILITY
CONSENT TO ELECTRONIC FORM AND
DELIVERY OF INSURANCE TRANSACTION
DOCUMENTS NOTICE
This consent to electronic form and delivery of insurance transaction documents is made by the and
between Millennial Specialty Insurance, on behalf of Trisura Insurance Company and Yeni Perez.

Scope of Consent
You hereby agree to accept from Millennial Specialty Insurance electronic form and delivery of insurance
transaction documents (hereinafter “Documents”) as permitted under applicable laws. However, this
consent shall not preclude Millennial from sending certain Documents by U.S. Mail or other means. You
retain the right to receive paper copies of any Document received electronically under this agreement.
You may also request paper copies in addition to the electronic copies.

Electronic Delivery of Documents

You acknowledge that electronic delivery of Documents will occur when the Documents are made
available on the Millennial Specialty Insurance Self-Servicing website accessible through
(www.msimga.com). You are responsible at all times to notify us immediately in the event of any changes
to your e-mail address by either accessing the Self-Servicing website (www.msimga.com) to update your
email address or by contacting us at (800) 319-1390. If you are unable to retrieve an electronic
Document, you can telephone us at (800) 319-1390. If electronic delivery fails, we will take other
measures to provide you with delivery of the Documents.

System Requirements
You agree that the system intended for receipt and viewing of Documents conforms to the following
technical requirements:
• Browsers: Internet Explorer, Safari, Chrome, Firefox, Edge
• Needed Software/Electronic Document Formats: Use of Adobe Acrobat Reader or equivalent
for PDF files; Word program for Word files. The Adobe Reader software is available free of
charge from Adobe’s website www.adobe.com
• Access to an account with an Internet service provider and ability to send and receive e-mail
that contains hyperlinks to websites.
• Sufficient electronic storage capacity on your hard drive or other data storage unit in order to
download and save electronic Documents.
• A printer that is capable of printing from your browser, e-mail software or hard drive or other
data storage unit, in order to print paper copies of electronic Documents.

You consent to electronic form and delivery by choosing that option in the registration process; this step
acknowledges access to electronic Documents in your system. Millennial agrees to notify you of any
changes or updates regarding these system requirements should they arise in the future.

Security
To insure your privacy, you will be required to log in to the designated website each time to access
Documents or other communications, using a personal ID and Password. Your login and Documents are
encrypted and protected by secure socket layer technology.

CONSENT NOTICE 07 20 Page 60 of 63

 Policyholders Advisory Notice
Withdrawal of Consent
You retain the right to withdraw consent for electronic form and delivery of Documents at any time by
notifying ePremium Insurance Agency, LLC of such revoked consent by telephone (800) 319-1390 or by
writing to Millennial Specialty Insurance, 8821 Davis Blvd, Suite 500, Keller, TX, 76248. Upon revocation
of this consent, we will communicate all Documents via regular U.S. Mail delivery to the last known
designated insured’s mailing address. You agree to allow us a reasonable time to resume providing
Document information covered by this consent in paper form. Withdrawal of your consent will not affect
the legal validity and enforceability of any Documents received electronically. If you later decides to re-
enroll in the electronic form and delivery of Documents, you must repeat the consent process.

Notification of Change of Designated Electronic Transmittal Address(es)

In the event your address changes, you agree to notify us by telephone (800) 319-1390 and supply us
with the new address.

CONSENT NOTICE 07 20 Page 61 of 63

 IL P 001 01 04

U.S. TREASURY DEPARTMENT'S OFFICE OF FOREIGN

ASSETS CONTROL ("OFAC")
ADVISORY NOTICE TO POLICYHOLDERS
No coverage is provided by this Policyholder Notice nor can it be construed to replace any provisions of your policy.
You should read your policy and review your Declarations page for complete information on the coverages you are
provided.
This Notice provides information concerning possible impact on your insurance coverage due to directives issued
by OFAC. Please read this Notice carefully.
The Office of Foreign Assets Control (OFAC) administers and enforces sanctions policy, based on Presidential
declarations of "national emergency". OFAC has identified and listed numerous:
 Foreign agents;
 Front organizations;
 Terrorists;
 Terrorist organizations; and
 Narcotics traffickers;
as "Specially Designated Nationals and Blocked Persons". This list can be located on the United States Treasury's
web site – http//www.treas.gov/ofac.
In accordance with OFAC regulations, if it is determined that you or any other insured, or any person or entity
claiming the benefits of this insurance has violated U.S. sanctions law or is a Specially Designated National and
Blocked Person, as identified by OFAC, this insurance will be considered a blocked or frozen contract and all
provisions of this insurance are immediately subject to OFAC. When an insurance policy is considered to be such
a blocked or frozen contract, no payments nor premium refunds may be made without authorization from OFAC.
Other limitations on the premiums and payments also apply.

IL P 001 01 04 © ISO Properties, Inc., 2004 Page 62 of 63

 IL N 048 09 03

LOUISIANA FRAUD STATEMENT

Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly
presents false information in an application for insurance is guilty of a crime and may be subject to fines and
confinement in prison.

IL N 048 09 03 © ISO Properties, Inc., 2003 Page 63 of 63