Filing Number: 793886
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| Filing Accepted: 11/23/2024 |
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HERSTON DENTAL SERVICES
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First Name |
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ADAM |
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4191 TAMIAMI TRAIL |
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PORT CHARLOTTE,
FL
33952
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| Email Address
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BGM@WEKLAW.COM |
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Insured |
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| Last/Business Name* |
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HERSTON DENTAL SERVICES |
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First Name |
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| Policy # * |
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FSF15931899 003 |
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Claim #* |
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KY22K294040X |
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Attorney is Applicable
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| Last Name* |
MELENDEZ
First Name *
BRITTANY
Initial
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| Street Address* |
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708 E COLONIAL DR, SUITE 103, ORLANDO, FL, 32803 |
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ORLANDO
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FLORIDA
32803
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| Email Address * |
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BGM@WEKLAW.COM |
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| Insurer Type
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 Authorized Insurer
 Unauthorized Insurer
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| Insurer Name |
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WESTCHESTER SURPLUS LINES INSURANCE COMPANY
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| Street Address* |
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,
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NAIC Company Code 10172 |
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| Name of individual responsible for violation (if any):*
N/A
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| Type of Insurance
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Commercial Property & Casualty
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| Reason for Notice
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Claim Delay
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Unsatisfactory Settlement Offer
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Unfair Trade Practice
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Statutory provision(s) which the insurer allegedly violated.
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| 624.155(1)(b)(1) |
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Not attempting in good faith to settle claims when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insured and with due regard for her or his interests.
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| 624.155(1)(b)(3) |
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Except as to liability coverages, failing to promptly settle claims, when the obligation to settle a claim has become reasonably clear, under one portion of the insurance policy coverage in order to influence settlements under other portions of the insurance policy coverage.
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| 626.9541(1)(i)(3)(a) |
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Failing to adopt and implement standards for the proper investigation of claims.
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| 626.9541(1)(i)(3)(c) |
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Failing to acknowledge and act promptly upon communications with respect to claims.
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Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
A. Coverage
We will pay for direct physical loss of or damage to
Covered Property at the premises described in the
Declarations caused by or resulting from any
Covered Cause of Loss.
1. Covered Property
Covered Property, as used in this Coverage
Part, means the type of property described in
this section, A.1., and limited in A.2. Property
Not Covered, if a Limit Of Insurance is shown
in the Declarations for that type of property.
a. Building, meaning the building or structure
described in the Declarations, including:
(1) Completed additions;
(2) Fixtures, including outdoor fixtures;
(3) Permanently installed:
(a) Machinery; and
(b) Equipment;
(4) Personal property owned by you that is
used to maintain or service the building
or structure or its premises, including:
(a) Fire-extinguishing equipment;
(b) Outdoor furniture;
(c) Floor coverings; and
(d) Appliances used for refrigerating,
ventilating, cooking, dishwashing or
laundering;
(5) If not covered by other insurance:
(a) Additions under construction,
alterations and repairs to the building
or structure;
(b) Materials, equipment, supplies and
temporary structures, on or within
100 feet of the described premises,
used
for making
additions,
alterations or repairs to the building
or structure.
CP 00 10 10 12
b. Your Business Personal Property
consists of the following property located in
or on the building or structure described in
the Declarations or in the open (or in a
vehicle) within 100 feet of the building or
structure or within 100 feet of the premises
described in the Declarations, whichever
distance is greater:
(1) Furniture and fixtures;
(2) Machinery and equipment;
(3) "Stock";
(4) All other personal property owned by
you and used in your business;
(5) Labor, materials or services furnished or
arranged by you on personal property of
others;
(6) Your use interest as tenant in
improvements and
betterments.
Improvements and betterments are
fixtures, alterations, installations or
additions:
(a) Made a part of the building or
structure you occupy but do not own;
and
(b) You acquired or made at your
expense but cannot legally remove;
(7) Leased personal property for which you
have a contractual responsibility to
insure, unless otherwise provided for
under Personal Property Of Others.
c. Personal Property Of Others that is:
(1) In your care, custody or control; and
(2) Located in or on the building or structure
described in the Declarations or in the
open (or in a vehicle) within 100 feet of
the building or structure or within 100
feet of the premises described in the
Declarations, whichever distance is
greater.
© Insurance Services Office, Inc., 2011
Page 1 of 16
However, our payment for loss of or
damage to personal property of others will
only be for the account of the owner of the
property.
2. Property Not Covered
Covered Property does not include:
a. Accounts, bills, currency, food stamps or
other evidences of debt, money, notes or
securities. Lottery tickets held for sale are
not securities;
b. Animals, unless owned by others and
boarded by you, or if owned by you, only as
"stock" while inside of buildings;
c. Automobiles held for sale;
d. Bridges, roadways, walks, patios or other
paved surfaces;
e. Contraband, or property in the course of
illegal transportation or trade;
f.
The cost of excavations, grading, backfilling
or filling;
g. Foundations
of buildings,
structures,
machinery or boilers if their foundations are
below:
(1) The lowest basement floor; or
(2) The surface of the ground, if there is no
basement;
h. Land (including land on which the property
is located), water, growing crops or lawns
(other than lawns which are part of a
vegetated roof);
i.
j.
Personal property while airborne or
waterborne;
Bulkheads, pilings, piers, wharves or docks;
k. Property that is covered under another
coverage form of this or any other policy in
which it is more specifically described,
except for the excess of the amount due
(whether you can collect on it or not) from
that other insurance;
l.
Retaining walls that are not part of a
building;
m. Underground pipes, flues or drains;
n. Electronic data, except as provided under
the Additional Coverage, Electronic Data.
Electronic data means information, facts or
computer programs stored as or on,
created or used on, or transmitted to or
from computer software (including systems
and applications software), on hard or
floppy disks, CD-ROMs, tapes, drives, cells,
data processing devices or any other
repositories of computer software which are
used
with
electronically controlled
equipment. The term computer programs,
referred to in the foregoing description of
electronic data, means a set of related
electronic instructions which direct the
operations and functions of a computer or
device connected to it, which enable the
computer or device to receive, process,
store, retrieve or send data. This
paragraph, n., does not apply to your
"stock" of prepackaged software, or to
electronic data which is integrated in and
operates or controls the building's elevator,
lighting, heating, ventilation, air conditioning
or security system;
o. The cost to replace or restore the
information on valuable papers and
records, including those which exist as
electronic data. Valuable papers and
records include but are not limited to
proprietary information, books of account,
deeds, manuscripts, abstracts, drawings
and card index systems. Refer to the
Coverage Extension for Valuable Papers
And Records (Other Than Electronic Data)
for limited coverage for valuable papers and
records other than those which exist as
electronic data;
p. Vehicles
or
self-propelled
machines
(including aircraft or watercraft) that:
(1) Are licensed for use on public roads; or
(2) Are operated principally away from the
described premises.
This paragraph does not apply to:
(a) Vehicles or self-propelled machines
or autos you manufacture, process
or warehouse;
CP 00 10 10 12
Page 2 of 16
© Insurance Services Office, Inc., 2011
(b) Vehicles or self-propelled machines,
other than autos, you hold for sale;
(c) Rowboats or canoes out of water at
the described premises; or
(d) Trailers, but only to the extent
provided for in the Coverage
Extension for Non-owned Detached
Trailers; or
q. The following property while outside of
buildings:
(1) Grain, hay, straw or other crops;
(2) Fences, radio or television antennas
(including satellite dishes) and their
lead-in wiring, masts or towers, trees,
shrubs or plants (other than trees,
shrubs or plants which are "stock" or are
part of a vegetated roof), all except as
provided in the Coverage Extensions.
3. Covered Causes Of Loss
See applicable Causes Of Loss form as shown
in the Declarations.
4. Additional Coverages
a. Debris Removal
(1) Subject to Paragraphs (2), (3) and (4),
we will pay your expense to remove
debris of Covered Property and other
debris that is on the described premises,
when such debris is caused by or
results from a Covered Cause of Loss
that occurs during the policy period. The
expenses will be paid only if they are
reported to us in writing within 180 days
of the date of direct physical loss or
damage.
(2) Debris Removal does not apply to costs
to:
(a) Remove debris of property of yours
that is not insured under this policy,
or property in your possession that is
not Covered Property;
(b) Remove debris of property owned by
or leased to the landlord of the
building
where your described
premises are located, unless you
have a contractual responsibility to
insure such property and it is insured
under this policy;
(c) Remove any property that is
Property Not Covered, including
property addressed under the
Outdoor Property
Coverage
Extension;
(d) Remove property of others of a type
that would not be Covered Property
under this Coverage Form;
(e) Remove deposits of mud or earth
from the grounds of the described
premises;
(f)
Extract "pollutants" from land or
water; or
(g) Remove, restore or replace polluted
land or water.
(3) Subject to the exceptions in Paragraph
(4), the following provisions apply:
(a) The most we will pay for the total of
direct physical loss or damage plus
debris removal expense is the Limit
of Insurance applicable to the
Covered Property that has sustained
loss or damage.
(b) Subject to (a) above, the amount we
will pay for debris removal expense
is limited to 25% of the sum of the
deductible plus the amount that we
pay for direct physical loss or
damage to the Covered Property that
has sustained loss or damage.
However, if no Covered Property has
sustained direct physical loss or
damage, the most we will pay for
removal of debris of other property (if
such removal is covered under this
Additional Coverage) is $5,000 at
each location.
(4) We will pay up to an additional $25,000
for debris removal expense, for each
location, in any one occurrence of
physical loss or damage to Covered
Property, if one or both of the following
circumstances apply:
(a) The total of the actual debris removal
expense plus the amount we pay for
direct physical loss or damage
exceeds the Limit of Insurance on
the Covered Property that has
sustained loss or damage.
(b) The actual debris removal expense
exceeds 25% of the sum of the
deductible plus the amount that we
pay for direct physical loss or
damage to the Covered Property that
has sustained loss or damage.
Page 3 of 16
CP 00 10 10 12
© Insurance Services Office, Inc., 2011
Therefore, if (4)(a) and/or (4)(b) applies,
our total payment for direct physical loss
or damage and debris removal expense
may reach but will never exceed the
Limit of Insurance on the Covered
Property that has sustained loss or
damage, plus $25,000.
(5) Examples
The following examples assume that
there is no Coinsurance penalty.
Example 1
Limit of Insurance:
Amount of Deductible:
Amount of Loss:
Amount of Loss Payable:
Debris Removal Expense:
Debris Removal Expense Payable:
($10,000 is 20% of $50,000.)
$ 90,000
$
500
$ 50,000
$ 49,500
($50,000 – $500)
$ 10,000
$ 10,000
The debris removal expense is less than 25% of the
sum of the loss payable plus the deductible. The sum
of the loss payable and the debris removal expense
($49,500 + $10,000 = $59,500) is less than the Limit
of Insurance. Therefore, the full amount of debris
removal expense is payable in accordance with the
terms of Paragraph (3).
Example 2
Limit of Insurance:
Amount of Deductible:
Amount of Loss:
Amount of Loss Payable:
Debris Removal Expense:
Debris Removal Expense Payable
Basic Amount:
Additional Amount:
$ 90,000
$
500
$ 80,000
$ 79,500
($80,000 – $500)
$ 40,000
$ 10,500
$ 25,000
The basic amount payable for debris removal
expense under the terms of Paragraph (3) is
calculated as follows: $80,000 ($79,500 + $500) x .25
= $20,000, capped at $10,500. The cap applies
because the sum of the loss payable ($79,500) and
the basic amount payable for debris removal expense
($10,500) cannot exceed the Limit of Insurance
($90,000).
The additional amount payable for debris removal
expense is provided in accordance with the terms of
Paragraph (4), because the debris removal expense
($40,000) exceeds 25% of the loss payable plus the
deductible ($40,000 is 50% of $80,000), and because
the sum of the loss payable and debris removal
expense ($79,500 + $40,000 = $119,500) would
exceed the Limit of Insurance ($90,000). The
additional amount of covered debris removal expense
is $25,000, the maximum payable under Paragraph
(4). Thus, the total payable for debris removal
expense in this example is $35,500; $4,500 of the
debris removal expense is not covered.
b. Preservation Of Property
If it is necessary to move Covered Property
from the described premises to preserve it
from loss or damage by a Covered Cause
of Loss, we will pay for any direct physical
loss or damage to that property:
(1) While it is being moved or while
temporarily stored at another location;
and
(2) Only if the loss or damage occurs within
30 days after the property is first moved.
c. Fire Department Service Charge
When the fire department is called to save
or protect Covered Property from a
Covered Cause of Loss, we will pay up to
$1,000 for service at each premises
described in the Declarations, unless a
higher limit is shown in the Declarations.
Such limit is the most we will pay
regardless of the number of responding fire
departments or fire units, and regardless of
the number or type of services performed.
This Additional Coverage applies to your
liability for fire department service charges:
(1) Assumed by contract or agreement prior
to loss; or
(2) Required by local ordinance.
No Deductible applies to this Additional
Coverage.
CP 00 10 10 12
Page 4 of 16
© Insurance Services Office, Inc., 2011
d. Pollutant Clean-up And Removal
We will pay your expense to extract
"pollutants" from land or water at the
described premises if the discharge,
dispersal, seepage, migration, release or
escape of the "pollutants" is caused by or
results from a Covered Cause of Loss that
occurs during the policy period. The
expenses will be paid only if they are
reported to us in writing within 180 days of
the date on which the Covered Cause of
Loss occurs.
This Additional Coverage does not apply to
costs to test for, monitor or assess the
existence, concentration or effects of
"pollutants". But we will pay for testing
which is performed in the course of
extracting the "pollutants" from the land or
water.
The most we will pay under this Additional
Coverage for each described premises is
$10,000 for the sum of all covered
expenses arising out of Covered Causes of
Loss occurring during each separate 12
month period of this policy.
e. Increased Cost Of Construction
(1) This Additional Coverage applies only to
buildings to which the Replacement
Cost Optional Coverage applies.
(2) In the event of damage by a Covered
Cause of Loss to a building that is
Covered Property, we will pay the
increased costs incurred to comply with
the minimum standards of an ordinance
or law in the course of repair, rebuilding
or replacement of damaged parts of that
property, subject to the limitations stated
in e.(3) through e.(9) of this Additional
Coverage.
(3) The ordinance or law referred to in e.(2)
of this Additional Coverage is an
ordinance or law that regulates the
construction or repair of buildings or
establishes zoning or land use
requirements at the described premises
and is in force at the time of loss.
(4) Under this Additional Coverage, we will
not pay any costs due to an ordinance
or law that:
(a) You were required to comply with
before the loss, even when the
building was undamaged; and
(b) You failed to comply with.
(5) Under this Additional Coverage, we will
not pay for:
(a) The enforcement of or compliance
with any ordinance or law which
requires demolition, repair,
replacement,
reconstruction,
remodeling
or remediation of
property due to contamination by
"pollutants" or due to the presence,
growth, proliferation, spread or any
activity of "fungus", wet or dry rot or
bacteria; or
(b) Any costs associated with the
enforcement of or compliance with
an ordinance or law which requires
any insured or others to test for,
monitor, clean up, remove, contain,
treat, detoxify or neutralize, or in any
way respond to, or assess the
effects of "pollutants", "fungus", wet
or dry rot or bacteria.
(6) The most we will pay under this
Additional Coverage, for each described
building insured under this Coverage
Form, is $10,000 or 5% of the Limit of
Insurance applicable to that building,
whichever is less. If a damaged building
is covered under a blanket Limit of
Insurance which applies to more than
one building or item of property, then the
most we will pay under this Additional
Coverage, for that damaged building, is
the lesser of $10,000 or 5% times the
value of the damaged building as of the
time of loss times the applicable
Coinsurance percentage.
The amount payable under this
Additional
Coverage is additional
insurance.
(7) With respect to this Additional
Coverage:
(a) We will not pay for the Increased
Cost of Construction:
(i) Until the property is actually
repaired or replaced at the same
or another premises; and
(ii) Unless the repair or replacement
is made as soon as reasonably
possible after the loss or
damage, not to exceed two
years. We may extend this period
in writing during the two years.
Page 5 of 16
CP 00 10 10 12
© Insurance Services Office, Inc., 2011
(b) If the building is repaired or replaced
at the same premises, or if you elect
to rebuild at another premises, the
most we will pay for the Increased
Cost of Construction, subject to the
provisions of e.(6) of this Additional
Coverage, is the increased cost of
construction at the same premises.
(c) If the ordinance or law requires
relocation to another premises, the
most we will pay for the Increased
Cost of Construction, subject to the
provisions of e.(6) of this Additional
Coverage, is the increased cost of
construction at the new premises.
(8) This Additional Coverage is not subject
to the terms of the Ordinance Or Law
Exclusion to the extent that such
Exclusion would conflict with the
provisions of this Additional Coverage.
(9) The costs addressed in the Loss
Payment and Valuation Conditions and
the Replacement Cost Optional
Coverage, in this Coverage Form, do
not include the increased cost
attributable to enforcement of or
compliance with an ordinance or law.
The amount payable under this
Additional Coverage, as stated in e.(6)
of this Additional Coverage, is not
subject to such limitation.
f.
Electronic Data
(1) Under this Additional Coverage,
electronic data has the meaning
described under Property Not Covered,
Electronic
Data. This Additional
Coverage does not apply to your "stock"
of prepackaged software, or to
electronic data which is integrated in
and operates or controls the building's
elevator, lighting, heating, ventilation, air
conditioning or security system.
(2) Subject to the provisions of this
Additional Coverage, we will pay for the
cost to replace or restore electronic data
which has been destroyed or corrupted
by a Covered Cause of Loss. To the
extent that electronic data is not
replaced or restored, the loss will be
valued at the cost of replacement of the
media on which the electronic data was
stored, with blank media of substantially
identical type.
(3) The Covered Causes of Loss applicable
to Your Business Personal Property
apply to this Additional Coverage,
Electronic Data, subject to the following:
(a) If the Causes Of Loss – Special
Form applies, coverage under this
Additional Coverage, Electronic
Data, is limited to the "specified
causes of loss" as defined in that
form and Collapse as set forth in that
form.
(b) If the Causes Of Loss – Broad Form
applies, coverage
under this
Additional Coverage, Electronic
Data, includes Collapse as set forth
in that form.
(c) If the Causes Of Loss form is
endorsed to add a Covered Cause of
Loss, the additional Covered Cause
of Loss does not apply to the
coverage
provided
under this
Additional Coverage, Electronic
Data.
(d) The Covered Causes of Loss include
a virus, harmful code or similar
instruction introduced into or enacted
on a computer system (including
electronic data) or a network to
which it is connected, designed to
damage or destroy any part of the
system or disrupt its normal
operation. But there is no coverage
for loss or damage caused by or
resulting from manipulation of a
computer system
(including
electronic data) by any employee,
including a temporary or leased
employee, or by an entity retained by
you or for you to inspect, design,
install, modify, maintain, repair or
replace that system.
CP 00 10 10 12
Page 6 of 16
© Insurance Services Office, Inc., 2011
(4) The most we will pay under this
Additional Coverage, Electronic Data, is
$2,500 (unless a higher limit is shown in
the Declarations) for all loss or damage
sustained in any one policy year,
regardless of the number of occurrences
of loss or damage or the number of
premises, locations
or
computer
systems involved. If loss payment on the
first occurrence does not exhaust this
amount, then the balance is available for
subsequent loss or damage sustained in
but not after that policy year. With
respect to an occurrence which begins
in one policy year and continues or
results in additional loss or damage in a
subsequent policy year(s), all loss or
damage is deemed to be sustained in
the policy year in which the occurrence
began.
5. Coverage Extensions
Except as otherwise provided, the following
Extensions apply to property located in or on
the building described in the Declarations or in
the open (or in a vehicle) within 100 feet of the
described premises.
If a Coinsurance percentage of 80% or more,
or a Value Reporting period symbol, is shown
in the Declarations, you may extend the
insurance provided by this Coverage Part as
follows:
a. Newly Acquired Or Constructed
Property
(1) Buildings
If this policy covers Building, you may
extend that insurance to apply to:
(a) Your new buildings while being built
on the described premises; and
(b) Buildings you acquire at locations,
other than the described premises,
intended for:
(i) Similar use as the building
described in the Declarations; or
(ii) Use as a warehouse.
The most we will pay for loss or damage
under this Extension is $250,000 at
each building.
(2) Your Business Personal Property
(a) If this policy covers Your Business
Personal Property, you may extend
that insurance to apply to:
(i) Business personal property,
including such property that you
newly acquire, at any location
you acquire other than at fairs,
trade shows or exhibitions; or
(ii) Business personal property,
including such property that you
newly acquire, located at your
newly constructed or acquired
buildings
at the location
described in the Declarations.
The most we will pay for loss or
damage under this Extension is
$100,000 at each building.
(b) This Extension does not apply to:
(i) Personal property of others that
is temporarily in your possession
in the course of installing or
performing work on such
property; or
(ii) Personal property of others that
is temporarily in your possession
in the
course of your
manufacturing or wholesaling
activities.
(3) Period Of Coverage
With respect to insurance provided
under this Coverage Extension for
Newly Acquired Or Constructed
Property, coverage will end when any of
the following first occurs:
(a) This policy expires;
(b) 30 days expire after you acquire the
property or begin construction of that
part of the building that would qualify
as covered property; or
(c) You report values to us.
We will charge you additional premium
for values reported from the date you
acquire
the property or begin
construction of that part of the building
that would qualify as covered property.
Page 7 of 16
CP 00 10 10 12
© Insurance Services Office, Inc., 2011
b. Personal Effects And Property Of Others
d. Property Off-premises
You may extend the insurance that applies
to Your Business Personal Property to
apply to:
(1) Personal effects owned by you, your
officers, your partners or members, your
managers or your employees. This
Extension does not apply to loss or
damage by theft.
(2) Personal property of others in your care,
custody or control.
The most we will pay for loss or damage
under this Extension is $2,500 at each
described premises. Our payment for loss
of or damage to personal property of others
will only be for the account of the owner of
the property.
c. Valuable Papers And Records (Other
Than Electronic Data)
(1) You may extend the insurance that
applies to Your Business Personal
Property to apply to the cost to replace
or restore the lost information on
valuable papers and records for which
duplicates do not exist. But this
Extension does not apply to valuable
papers and records which exist as
electronic data. Electronic data has the
meaning described under Property Not
Covered, Electronic Data.
(2) If the Causes Of Loss – Special Form
applies, coverage under this Extension
is limited to the "specified causes of
loss" as defined in that form and
Collapse as set forth in that form.
(3) If the Causes Of Loss – Broad Form
applies, coverage under this Extension
includes Collapse as set forth in that
form.
(4) Under this Extension, the most we will
pay to replace or restore the lost
information is $2,500 at each described
premises, unless a higher limit is shown
in the Declarations. Such amount is
additional insurance. We will also pay
for the cost of blank material for
reproducing the records (whether or not
duplicates exist) and (when there is a
duplicate) for the cost of labor to
transcribe or copy the records. The
costs of blank material and labor are
subject to the applicable Limit of
Insurance on Your Business Personal
Property and, therefore, coverage of
such costs is not additional insurance.
(1) You may extend the insurance provided
by this Coverage Form to apply to your
Covered Property while it is away from
the described premises, if it is:
(a) Temporarily at a location you do not
own, lease or operate;
(b) In storage at a location you lease,
provided the lease was executed
after the beginning of the current
policy term; or
(c) At any fair, trade show or exhibition.
(2) This Extension does not apply to
property:
(a) In or on a vehicle; or
(b) In the care, custody or control of
your salespersons, unless the
property is in such care, custody or
control at a fair, trade show or
exhibition.
(3) The most we will pay for loss or damage
under this Extension is $10,000.
e. Outdoor Property
You may extend the insurance provided by
this Coverage Form to apply to your
outdoor fences, radio and television
antennas (including satellite dishes), trees,
shrubs and plants (other than trees, shrubs
or plants which are "stock" or are part of a
vegetated roof), including debris removal
expense, caused by or resulting from any of
the following causes of loss if they are
Covered Causes of Loss:
(1) Fire;
(2) Lightning;
(3) Explosion;
(4) Riot or Civil Commotion; or
(5) Aircraft.
The most we will pay for loss or damage
under this Extension is $1,000, but not
more than $250 for any one tree, shrub or
plant. These limits apply to any one
occurrence, regardless of the types or
number of items lost or damaged in that
occurrence.
CP 00 10 10 12
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© Insurance Services Office, Inc., 2011
Subject to all aforementioned terms and
limitations of coverage, this Coverage
Extension includes the expense of
removing from the described premises the
debris of trees, shrubs and plants which are
the property of others, except in the
situation in which you are a tenant and such
property is owned by the landlord of the
described premises.
f.
Non-owned Detached Trailers
(1) You may extend the insurance that
applies to Your Business Personal
Property to apply to loss or damage to
trailers that you do not own, provided
that:
(a) The trailer is used in your business;
(b) The trailer is in your care, custody or
control at the premises described in
the Declarations; and
(c) You have a contractual responsibility
to pay for loss or damage to the
trailer.
(2) We will not pay for any loss or damage
that occurs:
(a) While the trailer is attached to any
motor vehicle or
motorized
conveyance, whether or not the
motor vehicle or
motorized
conveyance is in motion;
(b) During hitching
or
unhitching
operations, or when a trailer
becomes accidentally unhitched from
a motor vehicle or motorized
conveyance.
(3) The most we will pay for loss or damage
under this Extension is $5,000, unless a
higher limit is shown in the Declarations.
(4) This insurance is excess over the
amount due (whether you can collect on
it or not) from any other insurance
covering such property.
g. Business Personal Property Temporarily
In Portable Storage Units
(1) You may extend the insurance that
applies to Your Business Personal
Property to apply to such property while
temporarily stored in a portable storage
unit (including a detached trailer)
located within 100 feet of the building or
structure described in the Declarations
or within 100 feet of the premises
described in the Declarations, whichever
distance is greater.
(2) If the applicable Covered Causes of
Loss form or endorsement contains a
limitation or exclusion concerning loss or
damage from sand, dust, sleet, snow,
ice or rain to property in a structure,
such limitation or exclusion also applies
to property in a portable storage unit.
(3) Coverage under this Extension:
(a) Will end 90 days after the business
personal property has been placed in
the storage unit;
(b) Does not apply if the storage unit
itself has been in use at the
described premises for more than 90
consecutive days, even if the
business personal property has been
stored there for 90 or fewer days as
of the time of loss or damage.
(4) Under this Extension, the most we will
pay for the total of all loss or damage to
business personal property is $10,000
(unless a higher limit is indicated in the
Declarations
for
such Extension)
regardless of the number of storage
units. Such limit is part of, not in addition
to, the applicable Limit of Insurance on
Your Business Personal Property.
Therefore,
payment
Extension
under this
will not increase the
applicable Limit of Insurance on Your
Business Personal Property.
(5) This Extension does not apply to loss or
damage otherwise covered under this
Coverage Form or any endorsement to
this Coverage Form or policy, and does
not apply to loss or damage to the
storage unit itself.
Each of these Extensions is additional
insurance unless otherwise indicated. The
Additional Condition, Coinsurance, does not
apply to these Extensions.
B. Exclusions And Limitations
See applicable Causes Of Loss form as shown in
the Declarations.
C. Limits Of Insurance
The most we will pay for loss or damage in any
one occurrence is the applicable Limit Of
Insurance shown in the Declarations.
The most we will pay for loss or damage to
outdoor signs, whether or not the sign is attached
to a building, is $2,500 per sign in any one
occurrence.
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CP 00 10 10 12
© Insurance Services Office, Inc., 2011
The amounts of insurance stated in the following
Additional Coverages apply in accordance with the
terms of such coverages and are separate from
the Limit(s) Of Insurance shown in the
Declarations for any other coverage:
1. Fire Department Service Charge;
2. Pollutant Clean-up And Removal;
3. Increased Cost Of Construction; and
4. Electronic Data.
Payments under the Preservation Of Property
Additional Coverage will not increase the
applicable Limit of Insurance.
D. Deductible
In any one occurrence of loss or damage
(hereinafter referred to as loss), we will first reduce
the amount of loss if required by the Coinsurance
Condition or the Agreed Value Optional Coverage.
If the adjusted amount of loss is less than or equal
to the Deductible, we will not pay for that loss. If
the adjusted amount of loss exceeds the
Deductible, we will then subtract the Deductible
from the adjusted amount of loss and will pay the
resulting amount or the Limit of Insurance,
whichever is less.
When the occurrence involves loss to more than
one item of Covered Property and separate Limits
of Insurance apply, the losses will not be
combined in determining application of the
Deductible. But the Deductible will be applied only
once per occurrence.
Example 1
(This example assumes there is no Coinsurance
penalty.)
Deductible: $ 250
Limit of Insurance – Building 1:
$ 60,000
Limit of Insurance – Building 2:
Loss to Building 1:
Loss to Building 2:
$ 80,000
$ 60,100
$ 90,000
The amount of loss to Building 1 ($60,100) is less
than the sum ($60,250) of the Limit of Insurance
applicable to Building 1 plus the Deductible.
The Deductible will be subtracted from the amount of
loss in calculating the loss payable for Building 1:
$
–
60,100
250
$
59,850 Loss Payable – Building 1
The Deductible applies once per occurrence and
therefore is not subtracted in determining the amount
of loss payable for Building 2. Loss payable for
Building 2 is the Limit of Insurance of $80,000.
Total amount of loss payable:
$59,850 + $80,000 = $139,850
Example 2
(This example, too, assumes there is no Coinsurance
penalty.)
The Deductible and Limits of Insurance are the same
as those in Example 1.
Loss to Building 1:
$ 70,000
(Exceeds Limit of Insurance plus Deductible)
Loss to Building 2:
$ 90,000
(Exceeds Limit of Insurance plus Deductible)
Loss Payable – Building 1:
$ 60,000
(Limit of Insurance)
Loss Payable – Building 2:
(Limit of Insurance)
Total amount of loss payable:
E. Loss Conditions
$ 80,000
$ 140,000
The following conditions apply in addition to the
Common Policy Conditions and the Commercial
Property Conditions:
1. Abandonment
There can be no abandonment of any property
to us.
2. Appraisal
If we and you disagree on the value of the
property or the amount of loss, either may
make written demand for an appraisal of the
loss. In this event, each party will select a
competent and impartial appraiser. The two
appraisers will select an umpire. If they cannot
agree, either may request that selection be
made by a judge of a court having jurisdiction.
The appraisers will state separately the value
of the property and amount of loss. If they fail
to agree, they will submit their differences to
the umpire. A decision agreed to by any two
will be binding. Each party will:
a. Pay its chosen appraiser; and
b. Bear the other expenses of the appraisal
and umpire equally.
If there is an appraisal, we will still retain our
right to deny the claim.
3. Duties In The Event Of Loss Or Damage
a. You must see that the following are done in
the event of loss or damage to Covered
Property:
(1) Notify the police if a law may have been
broken.
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© Insurance Services Office, Inc., 2011
4. Loss Payment
(2) Give us prompt notice of the loss or
damage. Include a description of the
property involved.
(3) As soon as possible, give us a
description of how, when and where the
loss or damage occurred.
(4) Take all reasonable steps to protect the
Covered Property from further damage,
and keep a record of your expenses
necessary to protect the Covered
Property, for consideration in the
settlement of the claim. This will not
increase the Limit of Insurance.
However, we will not pay for any
subsequent loss or damage resulting
from a cause of loss that is not a
Covered Cause of Loss. Also, if
feasible, set the damaged property
aside and in the best possible order for
examination.
(5) At our request, give us complete
inventories of the damaged and
undamaged property. Include quantities,
costs, values and amount of loss
claimed.
(6) As often as may be reasonably required,
permit us to inspect the property proving
the loss or damage and examine your
books and records.
Also, permit us to take samples of
damaged and undamaged property for
inspection, testing and analysis, and
permit us to make copies from your
books and records.
(7) Send us a signed, sworn proof of loss
containing the information we request to
investigate the claim. You must do this
within 60 days after our request. We will
supply you with the necessary forms.
(8) Cooperate with us in the investigation or
settlement of the claim.
b. We may examine any insured under oath,
while not in the presence of any other
insured and at such times as may be
reasonably required, about any matter
relating to this insurance or the claim,
including an insured's books and records. In
the event of an examination, an insured's
answers must be signed.
a. In the event of loss or damage covered by
this Coverage Form, at our option, we will
either:
(1) Pay the value of lost or damaged
property;
(2) Pay the cost of repairing or replacing the
lost or damaged property, subject to b.
below;
(3) Take all or any part of the property at an
agreed or appraised value; or
(4) Repair, rebuild or replace the property
with other property of like kind and
quality, subject to b. below.
We will determine the value of lost or
damaged property, or the cost of its repair
or replacement, in accordance with the
applicable terms of the Valuation Condition
in this Coverage Form or any applicable
provision which amends or supersedes the
Valuation Condition.
b. The cost to repair, rebuild or replace does
not include the increased cost attributable
to enforcement of or compliance with any
ordinance or
law regulating the
construction, use or repair of any property.
c. We will give notice of our intentions within
30 days after we receive the sworn proof of
loss.
d. We will not pay you more than your
financial interest in the Covered Property.
e. We may adjust losses with the owners of
lost or damaged property if other than you.
If we pay the owners, such payments will
satisfy your claims against us for the
owners' property. We will not pay the
owners more than their financial interest in
the Covered Property.
f.
We may elect to defend you against suits
arising from claims of owners of property.
We will do this at our expense.
g. We will pay for covered loss or damage
within 30 days after we receive the sworn
proof of loss, if you have complied with all
of the terms of this Coverage Part, and:
(1) We have reached agreement with you
on the amount of loss; or
(2) An appraisal award has been made.
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© Insurance Services Office, Inc., 2011
h. A party wall is a wall that separates and is
common to adjoining buildings that are
owned by different parties. In settling
covered losses involving a party wall, we
will pay a proportion of the loss to the party
wall based on your interest in the wall in
proportion to the interest of the owner of the
adjoining building. However, if you elect to
repair or replace your building and the
owner of the adjoining building elects not to
repair or replace that building, we will pay
you the full value of the loss to the party
wall, subject to all applicable policy
provisions including Limits of Insurance, the
Valuation and Coinsurance Conditions and
all other provisions of this Loss Payment
Condition. Our payment under the
provisions of this paragraph does not alter
any right of subrogation we may have
against any entity, including the owner or
insurer of the adjoining building, and does
not alter the terms of the Transfer Of Rights
Of Recovery Against Others To Us
Condition in this policy.
5. Recovered Property
If either you or we recover any property after
loss settlement, that party must give the other
prompt notice. At your option, the property will
be returned to you. You must then return to us
the amount we paid to you for the property. We
will pay recovery expenses and the expenses
to repair the recovered property, subject to the
Limit of Insurance.
6. Vacancy
a. Description Of Terms
(1) As used in this Vacancy Condition, the
term building and the term vacant have
the meanings set forth in (1)(a) and
(1)(b) below:
(a) When this policy is issued to a
tenant, and with respect to that
tenant's interest in Covered Property,
building means the unit or suite
rented or leased to the tenant. Such
building is vacant when it does not
contain enough business personal
property to conduct customary
operations.
(b) When this policy is issued to the
owner or general lessee of a
building, building means the entire
building. Such building is vacant
unless at least 31% of its total
square footage is:
(i) Rented to a lessee or sublessee
and used by the lessee or
sublessee
to conduct its
customary operations; and/or
(ii) Used by the building owner to
conduct customary operations.
(2) Buildings
under construction
renovation are not considered vacant.
b. Vacancy Provisions
or
If the building where loss or damage occurs
has been vacant for more than 60
consecutive days before that loss or
damage occurs:
(1) We will not pay for any loss or damage
caused by any of the following, even if
they are Covered Causes of Loss:
(a) Vandalism;
(b) Sprinkler leakage, unless you have
protected the system against
freezing;
(c) Building glass breakage;
(d) Water damage;
(e) Theft; or
(f)
Attempted theft.
(2) With respect to Covered Causes of Loss
other than those listed in b.(1)(a)
through b.(1)(f) above, we will reduce
the amount we would otherwise pay for
the loss or damage by 15%.
7. Valuation
We will determine the value of Covered
Property in the event of loss or damage as
follows:
a. At actual cash value as of the time of loss
or damage, except as provided in b., c., d.
and e. below.
b. If the Limit of Insurance for Building
satisfies the Additional Condition,
Coinsurance, and the cost to repair or
replace the damaged building property is
$2,500 or less, we will pay the cost of
building repairs or replacement.
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© Insurance Services Office, Inc., 2011
The cost of building repairs or replacement
does not include the increased cost
attributable
to enforcement
of or
compliance with any ordinance or law
regulating the construction, use or repair of
any property.
However, the following property will be
valued at the actual cash value, even when
attached to the building:
(1) Awnings or floor coverings;
(2) Appliances for refrigerating, ventilating,
cooking, dishwashing or laundering; or
(3) Outdoor equipment or furniture.
c. "Stock" you have sold but not delivered at
the selling price less discounts and
expenses you otherwise would have had.
d. Glass at the cost of replacement with
safety-glazing material if required by law.
e. Tenants' Improvements and Betterments at:
(1) Actual cash value of the lost or
damaged property if you make repairs
promptly.
(2) A proportion of your original cost if you
do not make repairs promptly. We will
determine the proportionate value as
follows:
(a) Multiply the original cost by the
number of days from the loss or
damage to the expiration of the
lease; and
(b) Divide the amount determined in (a)
above by the number of days from
the installation of improvements to
the expiration of the lease.
If your lease contains a renewal option,
the expiration of the renewal option
period will replace the expiration of the
lease in this procedure.
(3) Nothing if others pay for repairs or
replacement.
F. Additional Conditions
The following conditions apply in addition to the
Common Policy Conditions and the Commercial
Property Conditions:
1. Coinsurance
If a Coinsurance percentage is shown in the
Declarations, the following condition applies:
a. We will not pay the full amount of any loss if
the value of Covered Property at the time of
loss times the Coinsurance percentage
shown for it in the Declarations is greater
than the Limit of Insurance for the property.
Instead, we will determine the most we will
pay using the following steps:
(1) Multiply the value of Covered Property
at the time of loss by the Coinsurance
percentage;
(2) Divide the Limit of Insurance of the
property by the figure determined in
Step (1);
(3) Multiply the total amount of loss, before
the application of any deductible, by the
figure determined in Step (2); and
(4) Subtract the deductible from the figure
determined in Step (3).
We will pay the amount determined in Step
(4) or the Limit of Insurance, whichever is
less. For the remainder, you will either have
to rely on other insurance or absorb the
loss yourself.
Example 1 (Underinsurance)
When: The value of the property is:
The Coinsurance percentage
for it is:
The Limit of Insurance for it is:
The Deductible is:
The amount of loss is:
$250,000
80%
$100,000
$
250
$ 40,000
Step (1): $250,000 x 80% = $200,000
(the minimum amount of insurance to
meet your Coinsurance requirements)
Step (2): $100,000 ÷ $200,000 = .50
Step (3): $40,000 x .50 = $20,000
Step (4): $20,000 – $250 = $19,750
We will pay no more than $19,750. The remaining
$20,250 is not covered.
Example 2 (Adequate Insurance)
When: The value of the property is:
The Coinsurance percentage
for it is:
The Limit of Insurance for it is:
$250,000
80%
$200,000
The Deductible is:
The amount of loss is:
$
250
$ 40,000
The minimum amount of insurance to meet your
Coinsurance requirement is $200,000 ($250,000 x
80%). Therefore, the Limit of Insurance in this
example is adequate, and no penalty applies. We will
pay no more than $39,750 ($40,000 amount of loss
minus the deductible of $250).
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b. If one Limit of Insurance applies to two or
more separate items, this condition will
apply to the total of all property to which the
limit applies.
Example 3
When:
The value of the property is:
Building at Location 1:
Building at Location 2:
Personal Property
at Location 2:
The Coinsurance percentage
for it is:
The Limit of Insurance for
Buildings and Personal Property
at Locations 1 and 2 is:
The Deductible is:
The amount of loss is:
Building at Location 2:
Personal Property
at Location 2:
$ 75,000
$100,000
$ 75,000
$250,000
90%
$180,000
$ 1,000
$ 30,000
$ 20,000
$ 50,000
Step (1): $250,000 x 90% = $225,000
(the minimum amount of insurance to
meet your Coinsurance requirements
and to avoid the penalty shown below)
Step (2): $180,000 ÷ $225,000 = .80
Step (3): $50,000 x .80 = $40,000
Step (4): $40,000 – $1,000 = $39,000
We will pay no more than $39,000. The remaining
$11,000 is not covered.
2. Mortgageholders
a. The term mortgageholder includes trustee.
b. We will pay for covered loss of or damage
to buildings or structures to each
mortgageholder shown in the Declarations
in their order of precedence, as interests
may appear.
c. The mortgageholder has the right to receive
loss payment even if the mortgageholder
has started foreclosure or similar action on
the building or structure.
d. If we deny your claim because of your acts
or because you have failed to comply with
the terms of this Coverage Part, the
mortgageholder will still have the right to
receive loss payment if the mortgageholder:
(1) Pays any premium due under this
Coverage Part at our request if you
have failed to do so;
(2) Submits a signed, sworn proof of loss
within 60 days after receiving notice
from us of your failure to do so; and
(3) Has notified us of any change in
ownership, occupancy or substantial
change in risk known to the
mortgageholder.
All of the terms of this Coverage Part will
then apply directly to the mortgageholder.
e. If we pay the mortgageholder for any loss
or damage and deny payment to you
because of your acts or because you have
failed to comply with the terms of this
Coverage Part:
(1) The mortgageholder's rights under the
mortgage will be transferred to us to the
extent of the amount we pay; and (2) The mortgageholder's right to recover
the full amount of the mortgageholder's
claim will not be impaired.
At our option, we may pay to the
mortgageholder the whole principal on the
mortgage plus any accrued interest. In this
event, your mortgage and note will be
transferred to us and you will pay your
remaining mortgage debt to us.
f.
If we cancel this policy, we will give written
notice to the mortgageholder at least:
(1) 10 days before the effective date of
cancellation if we cancel for your
nonpayment of premium; or
(2) 30 days before the effective date of
cancellation if we cancel for any other
reason.
g. If we elect not to renew this policy, we will
give written notice to the mortgageholder at
least 10 days before the expiration date of
this policy.
G. Optional Coverages
If shown as applicable in the Declarations, the
following Optional Coverages apply separately to
each item:
1. Agreed Value
a. The Additional Condition, Coinsurance,
does not apply to Covered Property to
which this Optional Coverage applies. We
will pay no more for loss of or damage to
that property than the proportion that the
Limit of Insurance under this Coverage Part
for the property bears to the Agreed Value
shown for it in the Declarations.
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b. If the expiration date for this Optional
Coverage shown in the Declarations is not
extended,
the Additional Condition,
Coinsurance, is reinstated and this Optional
Coverage expires.
c. The terms of this Optional Coverage apply
only to loss or damage that occurs:
(1) On or after the effective date of this
Optional Coverage; and
(2) Before the Agreed Value expiration date
shown in the Declarations or the policy
expiration date, whichever occurs first.
2. Inflation Guard
a. The Limit of Insurance for property to which
this Optional Coverage applies will
automatically increase by the annual
percentage shown in the Declarations.
b. The amount of increase will be:
(1) The Limit of Insurance that applied on
the most recent of the policy inception
date, the policy anniversary date, or any
other policy change amending the Limit
of Insurance, times
(2) The percentage of annual increase
shown in the Declarations, expressed as
a decimal (example: 8% is .08), times
(3) The number of days since the beginning
of the current policy year or the effective
date of the most recent policy change
amending the Limit of Insurance, divided
by 365.
Example
If:
The applicable Limit of Insurance is: $ 100,000
The annual percentage increase is:
The number of days since the
beginning of the policy year
(or last policy change) is:
The amount of increase is:
$100,000 x .08 x 146 ÷ 365 =
3. Replacement Cost
8%
146
$ 3,200
a. Replacement Cost (without deduction for
depreciation) replaces Actual Cash Value in
the Valuation Loss Condition of this
Coverage Form.
b. This Optional Coverage does not apply to:
(1) Personal property of others;
(2) Contents of a residence;
(3) Works of art, antiques or rare articles,
including etchings, pictures, statuary,
marbles, bronzes, porcelains and bric-a
brac; or
(4) "Stock", unless the Including "Stock"
option is shown in the Declarations.
Under the terms of this Replacement Cost
Optional Coverage, tenants' improvements
and betterments are not considered to be
the personal property of others.
c. You may make a claim for loss or damage
covered by this insurance on an actual cash
value basis instead of on a replacement
cost basis. In the event you elect to have
loss or damage settled on an actual cash
value basis, you may still make a claim for
the additional coverage this Optional
Coverage provides if you notify us of your
intent to do so within 180 days after the loss
or damage.
d. We will not pay on a replacement cost basis
for any loss or damage:
(1) Until the lost or damaged property is
actually repaired or replaced; and
(2) Unless the repair or replacement is
made as soon as reasonably possible
after the loss or damage.
With respect to tenants' improvements and
betterments, the following also apply:
(3) If the conditions in d.(1) and d.(2) above
are not met, the value of tenants'
improvements and betterments will be
determined as a proportion of your
original cost, as set forth in the
Valuation Loss Condition of this
Coverage Form; and
(4) We will not pay for loss or damage to
tenants' improvements and betterments
if others pay for repairs or replacement.
e. We will not pay more for loss or damage on
a replacement cost basis than the least of
(1), (2) or (3), subject to f. below:
(1) The Limit of Insurance applicable to the
lost or damaged property;
(2) The cost to replace the lost or damaged
property with other property:
(a) Of comparable material and quality;
and
(b) Used for the same purpose; or
(3) The amount actually spent that is
necessary to repair or replace the lost or
damaged property.
If a building is rebuilt at a new premises, the
cost described in e.(2) above is limited to
the cost which would have been incurred if
the building had been rebuilt at the original
premises.
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f.
H. Definitions
The cost of repair or replacement does not
include the increased cost attributable to
enforcement of or compliance with any
ordinance or
law regulating the
construction, use or repair of any property.
4. Extension Of Replacement Cost To
Personal Property Of Others
a. If the Replacement Cost Optional Coverage
is shown as applicable in the Declarations,
then this Extension may also be shown as
applicable. If the Declarations show this
Extension as applicable, then Paragraph
3.b.(1) of the Replacement Cost Optional
Coverage is deleted and all other provisions
of the Replacement Cost Optional
Coverage apply to replacement cost on
personal property of others.
b. With respect to replacement cost on the
personal property of others, the following
limitation applies:
If an item(s) of personal property of others
is subject to a written contract which
governs your liability for loss or damage to
that item(s), then valuation of that item(s)
will be based on the amount for which you
are liable under such contract, but not to
exceed the lesser of the replacement cost
of the property or the applicable Limit of
Insurance.
1. "Fungus" means any type or form of fungus,
including mold or mildew, and any mycotoxins,
spores, scents or by-products produced or
released by fungi.
2. "Pollutants" means any solid, liquid, gaseous or
thermal irritant or contaminant, including
smoke, vapor, soot, fumes, acids, alkalis,
chemicals and waste. Waste includes materials
to be recycled, reconditioned or reclaimed.
3. "Stock" means merchandise held in storage or
for sale, raw materials and in-process or
finished goods, including supplies used in their
packing or shipping.
A. Coverage
1. Business Income
Business Income means the:
a. Net Income (Net Profit or Loss before
income taxes) that would have been earned
or incurred; and
b. Continuing normal operating expenses
incurred, including payroll.
For manufacturing risks, Net Income includes
the net sales value of production.
Coverage is provided as described and limited
below for one or more of the following options
for which a Limit Of Insurance is shown in the
Declarations:
(1) Business Income Including "Rental
Value".
(2) Business Income Other Than "Rental
Value".
(3) "Rental Value".
If option (1) above is selected, the term
Business Income will include "Rental Value". If
option (3) above is selected, the term Business
Income will mean "Rental Value" only.
If Limits of Insurance are shown under more
than one of the above options, the provisions
of this Coverage Part apply separately to each.
We will pay for the actual loss of Business
Income you sustain due to the necessary
"suspension" of your "operations" during the
"period of restoration". The "suspension" must
be caused by direct physical loss of or damage
to property at premises which are described in
the Declarations and for which a Business
Income Limit Of Insurance is shown in the
Declarations. The loss or damage must be
caused by or result from a Covered Cause of
Loss. With respect to loss of or damage to
personal property in the open or personal
property in a vehicle, the described premises
include the area within 100 feet of such
premises.
With respect to the requirements set forth in
the preceding paragraph, if you occupy only
part of a building, your premises means:
(a) The portion of the building which you
rent, lease or occupy;
(b) The area within 100 feet of the
building or within 100 feet of the
premises
described
in the
Declarations, whichever distance is
greater (with respect to loss of or
damage to personal property in the
open or personal property in a
vehicle); and
(c) Any area within the building or at the
described premises, if that area
services, or is used to gain access
to, the portion of the building which
you rent, lease or occupy.
2. Extra Expense
a. Extra Expense Coverage is provided at the
premises described in the Declarations only
if the Declarations show that Business
Income Coverage applies at that premises.
b. Extra Expense means necessary expenses
you incur during the "period of restoration"
that you would not have incurred if there
had been no direct physical loss or damage
to property caused by or resulting from a
Covered Cause of Loss.
We will pay Extra Expense (other than the
expense to repair or replace property) to:
(1) Avoid or minimize the "suspension" of
business and to continue operations at
the described
premises
or
at
replacement premises or temporary
locations, including relocation expenses
and costs to equip and operate the
replacement location or temporary
location.
CP 00 30 10 12
© Insurance Services Office, Inc., 2011
Page 1 of 9
(2) Minimize the "suspension" of business if
you cannot continue "operations".
We will also pay Extra Expense to repair or
replace property, but only to the extent it
reduces the amount of loss that otherwise
would have been payable under this
Coverage Form.
3. Covered Causes Of Loss, Exclusions And
Limitations
See applicable Causes Of Loss form as shown
in the Declarations.
4. Additional Limitation – Interruption Of
Computer Operations
a. Coverage for Business Income does not
apply when a "suspension" of "operations"
is caused by destruction or corruption of
electronic data, or any loss or damage to
electronic data, except as provided under
the Additional Coverage, Interruption Of
Computer Operations.
b. Coverage for Extra Expense does not apply
when action is taken to avoid or minimize a
"suspension" of "operations" caused by
destruction or corruption of electronic data,
or any loss or damage to electronic data,
except as provided under the Additional
Coverage,
Interruption
Operations.
Of Computer
c. Electronic data means information, facts or
computer programs stored as or on,
created or used on, or transmitted to or
from computer software (including systems
and applications software), on hard or
floppy disks, CD-ROMs, tapes, drives, cells,
data processing devices or any other
repositories of computer software which are
used
with
electronically controlled
equipment. The term computer programs,
referred to in the foregoing description of
electronic data, means a set of related
electronic instructions which direct the
operations and functions of a computer or
device connected to it, which enable the
computer or device to receive, process,
store, retrieve or send data.
d. This Additional Limitation does not apply
when loss or damage to electronic data
involves only electronic data which is
integrated in and operates or controls a
building's
elevator, lighting, heating,
ventilation, air conditioning or security
system.
5. Additional Coverages
a. Civil Authority
In this Additional Coverage, Civil Authority,
the described premises are premises to
which this Coverage Form applies, as
shown in the Declarations.
When a Covered Cause of Loss causes
damage to property other than property at
the described premises, we will pay for the
actual loss of Business Income you sustain
and necessary Extra Expense caused by
action of civil authority that prohibits access
to the described premises, provided that
both of the following apply:
(1) Access to the area immediately
surrounding the damaged property is
prohibited by civil authority as a result of
the damage, and the described
premises are within that area but are not
more than one mile from the damaged
property; and
(2) The action of civil authority is taken in
response
to dangerous physical
conditions resulting from the damage or
continuation of the Covered Cause of
Loss that caused the damage, or the
action is taken to enable a civil authority
to have unimpeded access to the
damaged property.
Civil Authority Coverage for Business
Income will begin 72 hours after the time of
the first action of civil authority that prohibits
access to the described premises and will
apply for a period of up to four consecutive
weeks from the date on which such
coverage began.
Civil Authority Coverage for Extra Expense
will begin immediately after the time of the
first action of civil authority that prohibits
access to the described premises and will
end:
(1) Four consecutive weeks after the date
of that action; or
(2) When your Civil Authority Coverage for
Business Income ends;
whichever is later.
CP 00 30 10 12
Page 2 of 9
© Insurance Services Office, Inc., 2011
b. Alterations And New Buildings
We will pay for the actual loss of Business
Income you sustain and necessary Extra
Expense you incur due to direct physical
loss or damage at the described premises
caused by or resulting from any Covered
Cause of Loss to:
(1) New buildings or structures, whether
complete or under construction;
(2) Alterations or additions to existing
buildings or structures; and
(3) Machinery, equipment, supplies or
building materials located on or within
100 feet of the described premises and:
(a) Used in the construction, alterations
or additions; or
(b) Incidental to the occupancy of new
buildings.
If such direct physical loss or damage
delays the start of "operations", the "period
of restoration" for Business Income
Coverage will begin on the date
"operations" would have begun if the direct
physical loss or damage had not occurred.
c. Extended Business Income
(1) Business Income Other Than "Rental
Value"
If the necessary "suspension" of your
"operations" produces a Business
Income loss payable under this policy,
we will pay for the actual loss of
Business Income you incur during the
period that:
(a) Begins on the date property (except
"finished stock") is actually repaired,
rebuilt or replaced and "operations"
are resumed; and
(b) Ends on the earlier of:
(i) The date you could restore your
"operations", with reasonable
speed, to the level which would
generate the business income
amount that would have existed if
no direct physical loss or damage
had occurred; or
(ii) 60 consecutive days after the
date determined in (1)(a) above.
However, Extended Business Income
does not apply to loss of Business
Income incurred as a result of
unfavorable business conditions caused
by the impact of the Covered Cause of
Loss in the area where the described
premises are located.
Loss of Business Income must be
caused by direct physical loss or
damage at the described premises
caused by or resulting from any Covered
Cause of Loss.
(2) "Rental Value"
If the necessary "suspension" of your
"operations" produces a "Rental Value"
loss payable under this policy, we will
pay for the actual loss of "Rental Value"
you incur during the period that:
(a) Begins on the date property is
actually repaired, rebuilt or replaced
and tenantability is restored; and
(b) Ends on the earlier of:
(i) The date you could restore tenant
occupancy, with reasonable
speed, to the level which would
generate the "Rental Value" that
would have existed if no direct
physical loss or damage had
occurred; or
(ii) 60 consecutive days after the
date determined in (2)(a) above.
However, Extended Business Income
does not apply to loss of "Rental Value"
incurred as a result of unfavorable
business conditions caused by the
impact of the Covered Cause of Loss in
the area where the described premises
are located.
Loss of "Rental Value" must be caused
by direct physical loss or damage at the
described premises caused by or
resulting from any Covered Cause of
Loss.
d. Interruption Of Computer Operations
(1) Under this Additional Coverage,
electronic data has the meaning
described under Additional Limitation –
Interruption Of Computer Operations.
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Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
Herston Dental Services ("Insured") purchased an insurance policy ("Policy") from Westchester Surplus Lines Insurance Company ("Westchester”) with effective coverage on the date of loss, on or about September 28, 2022, and Policy number FSF15931899 003to insure their property located 4191 Tamiami Trail, Port Charlotte, FL 33952 (the "Property").??
On or about September 28, 2022, the Property suffered severe damage as a result of Category 4 Hurricane Ian. Hurricane Ian made landfall less than 5 miles from the Property with sustained windspeeds of 145- 150 mph. As a result of this catastrophic hurricane, the Property sustained immediate direct wind damage to the roofing system, HVAC, deck, exterior walkway, exterior, necessitating replacement. Ensuing water damage was sustained to the interior of the property in multiple locations throughout the entirety of the property. (“Loss”). Westchester was notified of the Loss on or about October 7, 20222 and was granted access to the property in order to complete their inspection. Westchester acknowledged the claim and assigned claim number? KY22K294040X ("Claim") to the Loss. However, Westchester didn’t assign Crawford Global Technical Services to evaluate and assess the damage at the property until November 3, 2022, almost a month after the Loss. Further, Westchester failed to inspect the property until November 22, 2022, 45 days after the Loss was reported.
Westchester sent independent adjuster Anthony Lester to inspect the subject property. Mr. Lester confirmed that the observed damages to the property were due to Hurricane Ian, including the shingle roof, HVAC units, exterior components, windows, walls, ceiling, ceramic tile flooring as claimed. Based upon this inspection, Westchester issued payment of $33,168.38 for interior water damages to the property and roof damage, however, failed to account for the money needed to replace all flooring, walls and ceilings that were damaged from the water intrusion, in addition failed include payment for the HVAC units as recommended by Mr. Lester. The shingle roof was under scoped and had inaccurate measurements. Westchester failed to appropriately evaluate and assess the damage severely undervaluing the Loss and scope. Further, Westchester failed to fully and adequately indemnify the Insured for benefits owed.
On December 13, 2022, JS Held inspected the property and again found extension damage caused by Hurricane Ian. It was recommended by Mr. Lester that an additional supplemental payment of $15,486.14 was to be paid to the Insured for damages caused by Hurricane. Westchester has not made the supplemental payment. Further, the Westchester’s representatives who inspected agreed to the substantial damage including the interior ceiling caving in. However, Westchster determined that the tenant of the property could “board up the ceiling and remove the debris” in 1 -2 days and continue operating a business. Westchester failed to provide any business interruption coverage after it opined that the entirety of the continuous flooring would need to be replace, the ceilings and walls would need repair as there were hole from the drywall and insulation caving in, in addition to other significant damages. Notwithstanding the supplemental payment Westchester still fails to appropriately assess the scope and cost of the damages. The Insured mitigated his damages as is required under the Policy and Westchester again failed to provide any coverage for the completed mitigation services costing $82,692.28 by Santi Clean. This amount along with the contractor estimates that average a rebuild cost of $180,000.00 have yet to be suitably assessed and indemnified.
The Insured cooperated entirely throughout the investigation, promptly reported his loss and compiled with the post-loss conditions. Yet, Westchester failed and acted in a manner not consistent with proper post loss claim handling. The rationale and coverage amounts are not only conflicting but appear only to be rendered in order for WESTCHESTER to avoid paying what is rightfully owed to the Insured pursuant to the insurance policy for which they paid premiums. The investigation supports significant damage, yet the adjustment of the claim fails to get the property back to its pre-loss condition.
After being provided plenty of evidence (including photos, contractor estimates, and access to the property upon discovery of the leak) showing the extensive Hurricane Ian damage WESTCHESTER continues to refuse to provide additional money.
The Insured has fully complied with all applicable Policy provisions requiring cooperation with the?investigation;?however, WESTCHESTER has unequivocally failed to properly adjust this Claim, as further elaborated above. Rather than paying the actual damages and/or trying to appropriately settle with the Insured, WESTCHESTER has continued its pre-suit failures to act in good faith into litigation by delaying the prompt resolution of the claim. WESTCHESTER has not attempted, in good faith, to fully indemnify the Insured, under the circumstances, it could and should have done so had it acted fairly and honestly toward the policyholder and with due regard to the policyholder's interests.? Rather, WESTCHESTER has acted with only its own profit and shareholders in mind.
As a direct consequence of Westchester’s failure to adjust this Loss in good faith and make supplemental payments, the Insured continues to be without adequate compensation for the damages sustained at the Insured's Property more than two years.??
To date, WESTCHESTER has in bad faith failed to provide sufficient coverage under the Policy to the Insured. The Insured’ property continues to be in disarray. As a direct result of WESTCHESTER’s underpayment of the Claim and breach of the Florida Statutes, the Insured was?forced to seek the?help of licensed professionals to assist her, including a public adjuster, general contractor, and legal counsel.?Due to the amount of time that has passed since the date of loss and the information discussed above, there is irrefutable evidence that WESTCHESTER knowingly and intentionally, and in bad faith delayed the settlement process in order to further disadvantage the Insured. The financial detriment caused to the Insured is a direct result of WESTCHESTER reckless treatment of the claims process. The Insured submitted all documents requested in a timely fashion, made their property available for inspection immediately after the discovery of the loss, submitted an estimate, and satisfied all requests. However, WESTCHESTER failed at every step of the process to adequately establish or identify the basis of its gross mismanagement of the claim.?
To deny the Insured the benefit clearly due and owing under the Policy, for which they have time and time again been making premium payments for and after they has satisfied all of their obligations is morally and ethically reprehensible and reeks of Unfair Claims Practice and Bad Faith.
This notice is given in order to perfect the right to pursue the civil remedy authorized by Section 624.155, Florida Statutes, should WESTCHESTER fail to cure the violations set forth in this Civil Remedy Notice within the given cure period. Therefore, to cure the defects outlined in this Civil Remedy Notice, Westchester must: (1) Immediately tender all proceeds due and owing to the Insured that are fairly owed to the Insured under the insurance policy that would reasonably compensate the Insured in order to put the loss property back to its pre-loss condition; the Insured’s representative has provided their estimate for the repairs in the total amount of $189,631.47 for damage and $82,169.28 for mitigation (less previous payment) (2) Agree to reimburse the Insured's reasonable attorneys’ fees and costs for having to become involved to resolve the claim; and (3) Agree to reimburse the Insured for interest on the amount of benefits that was found to be?due and owing to the Insured, relating back to the date of loss.
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The submitter hereby states that this notice is given in order to perfect the rights of the
person(s) damaged to pursue civil remedies authorized by Section 624.155, Florida Statutes.
Before submitting a Notice using this system, please verify that all text has been entered
correctly and completely. Once the Notice has been submitted, the text cannot be changed
or deleted.
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DFS-10-363
Rev. 10/14/2008
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