HomeMy WebLinkAboutContract 55529Date Received: Apr 7, 2021
Time Received: 3:02 pm
Permit number: PN20-00141
City Contract No.: 55529
PUBLIC PROPERTY EASEMENT ENCROACHMENT LICENSE AGREEMENT
TIER 17
THIS AGREEMENT is made and entered into by and between THE CITY OF
FORT WORTH, a home rule municipal corporation of Tarrant County, Texas ("City"),
acting by and through its duly authorized City Manager, Assistant City Manager, or
Director of the Development Services Department, and Clearfork Tradition, LP., a(n)
Domestic Limited Partnership ("Licensee"), acting by and through its duly authorized
General Partner.
RECITALS
WHEREAS, Licensee is the owner of the real property located at 5755
Clearfork Main Street, Fort Worth, Texas 76107 ("Property"), being more particularly
described in the attached Exhibit "A" which is incorporated herein for all purposes; and
WHEREAS, the City owns or has an interest in an Emergency Access Easement
(the "Public Property") adjacent to the Property as shown in the attached Exhibit "B,"
which is incorporated herein for all purposes, [and as recorded in the deed records of
Tarrant County by instrument number D220182416]; and
WHEREAS, Licensee desires to construct, place, and maintain certain
improvements which will encroach in, on, above, or below the Public Property; and
WHEREAS, the City owns or has an interest in a Sanitary Sewer Easement (the
"Public Property") adjacent to the Property as shown in the attached E�ibit "B,"
which is incorporated herein for all purposes, [and as recorded in the deed recards of
Tarrant County by instrument number D220182416]; and
WHEREAS, Licensee desires to construct, place, and maintain certain
improvements which will encroach in, on, above, or below the Public Property; and
WHEREAS, to accommodate the needs of the Licensee, the City will allow the
encroachment under the terms and conditions as set forth in this Agreement.
NOW, THEREFORE, the City and Licensee agree as follows:
Tier II Easement Encroachment Agreement
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
AGREEMENT
1.
The City, in consideration of the payment by Licensee of the fee set out below
and covenants and agreements hereinafter contained to be kept and performed by
Licensee, hereby grants permission to Licensee to encroach in, on, above, or below and
occupy a portion of the City's Public Property as described in and at the location shown
on Exhibit "C," but only to the extent shown thereon, for the purpose of constructing,
installing, and maintaining a canopy encroaching into Emergency Access Easement
and construction of vehicular pavement, sidewalks, fences and two (2) security
camera poles for proposed multifamily (senior living) development in a Sanitary
Sewer Easement (the "Encroachment"). Upon completion of the Encroachment,
Licensee agrees to be responsible for maintaining the Encroachment within the Public
Property. Licensee shall not expand or otherwise cause the Encroachment to further
infringe in or on the Public Property beyond what is specifically described in E�ibit
«C.»
2.
All construction, installation, maintenance, and operation of the Encroachment
and the use or occupancy of the Public Property shall comply with and be performed in
strict compliance with this Agreement and with the charter, ordinances, codes, and
policies of the City. Prior to the construction or installation of the Encroachment,
Licensee shall submit all plans and specifications to the Director of the Development
Services Department or duly authorized representative. Licensee shall not commence
construction or installation of the Encroachment nor make any use of the Public Property
until after the execution of this Agreement.
3.
Licensee agrees that City may enter and utilize the Public Property at any time for
any public purpose, including installing, repairing, replacing, or maintaining
improvements to its public facilities or utilities necessary for the health, safety, and
welfare of the public. The City shall have no responsibility or liability for any damages
related to the Encroachment resulting from the City's use of the Public Property;
however, the City shall make reasonable efforts to minimize such damage.
4.
Upon termination of this Agreement, Licensee shall, at the option of and at no
expense to the City, upon written notice to Licensee given within ten (10) days following
such termination, remove the Encroachment and restore the Public Property to a
condition acceptable to the Director of Transportation and Public Works, the Director of
the Water Department, the Director of the Development Services Department or their
Tier II Easement Encroachment Agreement Page 2 of 13
Revised 11/2020
duly authorized representative. Any such removal of the Encroachment shall be in
accordance with then-existing City regulations and policies. It is understood and agreed
to by Licensee that if this Agreement terminates and Licensee fails to remove the
Encroachment and restore the Public Property, Licensee hereby gives City permission to
remove the Encroachment and any supporting structures from the Public Property, to
restore the Public Property, and to assess a lien on the Property for the costs expended by
the City in taking such actions.
5.
In order to defray all costs of inspection and supervision which the City has
incurred or will incur as a result of the construction, maintenance, inspection or
management of the Encroachment and use of Public Property as provided for by this
Agreement, Licensee agrees to pay to City at the time this Agreement is requested a one-
time application fee in the sum of Five Hundred Dollars ($500.00).
6.
The term of this Agreement shall be for thirty (30) years, commencing on the
date this Agreement is executed by the City (the "Initial Term"). Upon the expiration of
the Initial Term, the Agreement shall renew automatically under the same terms and
conditions for consecutive thirty (30) year terms unless terminated earlier in accordance
with this agreement. City and licensee agree that this Agreement may be terminated
upon Licensee's noncompliance with any of the terms of this Agreement. City shall
notify Licensee in writing of any such noncompliance and if Licensee does not cure the
noncompliance within thirty (30) days of notice from City, the City may terminate this
Agreement. However, the City may, at its sole option, allow the Agreement to remain in
effect so long as Licensee has taken reasonable measures to cure the noncompliance or is
continuing to diligently attempt to remedy the noncompliance.
7.
It is further understood and agreed between the parties hereto that the Public
Property to be used and encroached upon is held by City as trustee for the public; that
City exercises such powers over the Public Property as have been delegated to it by the
Constitution of the State of TeXas or by the Texas Legislature; and that City cannot
contract away its duty and its legislative power to control the Public Property for the use
and benefit of the public. It is accordingly agreed that if the governing body of City may
at any time during the term hereof determine in its sole discretion to use or cause or
permit the Public Property to be used for any other public purpose, including but not
being limited to underground, surface, or overhead communication, drainage, sanitary
sewerage, transmission of natural gas or electricity, or any other public purpose, whether
presently contemplated or not, that the parties agree to negotiate in good faith in order to
accommodate both the Encroachment and the public purpose.
8.
Tier II Easement Encroachment Agreement Page 3 of 13
Revised 11/2020
LICENSEE COVENANTS AND AGREES TO INDEMNIFY, AND DOES
HEREBY INDEMNIFY, HOLD HARMLESS, AND DEFEND CITY, ITS
OFFICERS, AGENTS, SERVANTS, EMPLOYEES, AND ELECTED OFFICIALS
FROM AND AGAINST ANY AND ALL CLAIMS OR SUITS FOR PROPERTY
DAMAGE OR LOSS AND/OR PERSONAL INJURY, INCLUDING DEATH, TO
ANY AND ALL PERSONS, OF WHATSOEVER HIND OR CHARACTER,
WHETHER REAL OR ASSERTED, ARISING OUT OF OR IN CONNECTION
WITH, DIRECTLY OR INDIRECTLY, THE CONSTRUCTION,
MAINTENANCE, OCCUPANCY, USE, EXISTENCE, OR LOCATION OF THE
ENCROACHMENT AND USES GRANTED HEREUNDER, WHETHER OR NOT
CAUSED, IN WHOLE OR IN PART, BY THE ALLEGED NEGLIGENCE OF
OFFICERS, AGENTS, SERVANTS, EMPLOYEES, CONTRACTORS,
SUBCONTRACTORS, LICENSEES, ELECTED OFFICIALS, OR INVITEES OF
THE CITY; AND LICENSEE HEREBY ASSUMES ALL LIABILITY AND
RESPONSIBILITY FOR SUCH CLAIMS OR SUITS. LICENSEE SHALL
LIKEWISE ASSUME ALL LIABILITY AND RESPONSIBILITY AND SHALL
INDEMNIFY CITY FOR ANY AND ALL INJURY OR DAMAGE TO CITY
PROPERTY ARISING OUT OF OR IN CONNECTION WITH THE
ENCROACHMENTS AND ANY AND ALL ACTS OR OMISSIONS OF
LICENSEE, ITS OFFICERS, AGENTS, SERVANTS, EMPLOYEES,
CONTRACTORS, SUBCONTRACTORS, LICENSEES, OR INVITEES.
9.
While this Agreement is in effect, Licensee agrees to furnish City with a
Certificate of Insurance naming City as certificate holder as proof that is has secured and
paid for a policy of public liability insurance covering all public risks related to the
proposed use and occupancy of public property as located and described in Exhibit "C."
The amounts of such insurance shall be not less than
$1,000,000
with the understanding and agreement by Licensee that such insurance amounts may be
revised upward at City's option and that Licensee shall so revise such amounts
immediately following notice to Licensee of such requirement. Such insurance policy
shall not be canceled or amended without at least thirty (30) days prior written notice to
the Building Official of the City. A copy of such Certificate of Insurance is attached as
Exhibit "D" and incorporated herein for all purposes. Licensee agrees, binds, and
obligates itself and its successors and assigns to maintain and keep in force such public
liability insurance at all times during the term of this Agreement and until the removal of
the Encroachment and restoration of the Public Property. All insurance coverage
required herein shall include coverage of all Licensee's contractors and subcontractors.
10.
Tier II Easement Encroachment Agreement Page 4 of 13
Revised 11/2020
Licensee agrees to deposit with the City when this Agreement is executed a
sufficient sum of money to be used to pay necessary fees to record this Agreement in the
real property records of the county in which the Encroachment is located. After being
recorded, the original shall be returned to the City Secretary of the City of Fort Worth.
11.
Licensee agrees to comply fully with all applicable federal, state, and local laws,
statutes, ordinances, codes, and regulations in connection with the construction,
operation, and maintenance of the Encroachment and use of the Public Property.
12.
Licensee agrees to pay promptly when due all fees, taxes, or rentals provided for
by this Agreement or by any federal, state, ar local statute, law, or regulation.
13.
Licensee covenants and agrees that it shall operate hereunder as an independent
contractor as to all rights and privileges granted hereunder and not as an officer, agent,
servant, or employee of City, and Licensee shall have exclusive control of and the
exclusive right to control the details of its operations, and all persons performing same,
and shall be solely responsible for the acts and omissions of its officers, agents, servants,
employees, contractors, subcontractors, licensees, and invitees. The doctrine of
respondeat superior shall not apply as between City and Licensee, its officers, agents,
servants, employees, contractors, and subcontractors, and nothing herein shall be
construed as creating a partnership or j oint enterprise between City and Licensee.
14.
Licensee agrees and acknowledges that this Agreement is solely for the purpose
of permitting Licensee to construct, maintain, and locate the Encroachment over or within
the Public Property and is not a conveyance of any right, title, or interest in or to the
Public Property, nor is it meant to convey any right to use or occupy property in which a
third-party may have an interest. Licensee agrees that it will obtain all necessary
permissions before occupying such property.
15.
In any action brought by the City for the enforcement of the obligations of the
Licensee, City shall be entitled to recover interest and reasonable attorneys' fees.
16.
Tier II Easement Encroachment Agreement Page 5 of 13
Revised 11/2020
The parties agree that the duties and obligations contained in Section 4 shall
survive the termination of this Agreement.
17.
Licensee covenants and agrees that it will not assign all or any of its rights,
privileges, or duties under this Agreement without the written approval of the City, and
any attempted assignment without such written approval shall be void. In the event
Licensee conveys the Property, Licensee may assign all of its rights and obligations under
this Agreement to the new owner of the Property, and Licensee shall be deemed released
from its duties and obligations hereunder upon City's approval in writing of such
assignment, which approval shall not be unreasonably conditioned or withheld.
Foreclosure by a secured lender of Licensee or assignment to a secured lender by
Licensee in the event of default or otherwise shall not require City approval provided that
said lender notifies City in writing within sixty (60) days of such foreclosure or
assignment and assumes all of Licensee's rights and obligations hereunder. However, no
change of ownership due to foreclosure or assignment to any secured lender of Licensee
shall be effective as to City unless and until written notice of such foreclosure or
assignment is provided to City.
18.
Any cause of action for breach of this Agreement shall be brought in Tarrant
County, TeXas. This Agreement shall be governed by the laws of the State of Texas.
19.
This Agreement shall be binding upon the parties hereto and their successors and
assigns.
20.
This Agreement may be executed in multiple counterparts, each of which shall be
considered an original, but all of which shall constitute one instrument
[SIGNATURES APPEAR ON FOLLOWING PAGE]
Tier II Easement Encroachment Agreement Page 6 of 13
Revised 11/2020
City:
CITY OF FORT WORTH
By. 4:F=lf; • DJ Harrell (Apr 6, 2021 10:02 CDT)
DJ Harrell, Director
Development Services
Date: Apr 6, 2021
ATTEST:
City Secretary
Licensee:
CLEARFORK TRADITION, LP
a Texas limited partnership
By: Clearfork Tradition GP, LLC,
a Texas limited liability company,
its General Part
By:
Name
Title: ger
Date: -------------
Approved As To Form and Legality
M:ifffe#tt:Murr� Matthew Murray (Apr 2, 202109:7 CDT)
Matthew A Murray
Assistant City Attorney
Ordinance No. 24161-04-2020
CONTRACT COMPLIANCE MANAGER:
By signing I acknowledge that I am the person
responsible for the monitoring and administration
of this contract, including ensuring all performance
and reporting requirements.
1.?a11ie c,Jtatiett 11PtaleJ Janie Scarlett Morales (Apr 2, 2021 09:36 CDT)
Janie Scarlett Morales, Planning Manager
Development Services
Tier II Easement Encroachment Agreement Page 7 of 13
Revised I I /2020
STATE OF TEXAS §
COUNTY OF TARRANT §
BEFORE ME, the undersigned authority, a Notary Public in and for the State of
Texas, on this day personally appeared D.J. Harrell, known to me to be the person
whose name is subscribed to the foregoing instrument, and acknowledged to me that he
executed the same for the purposes and consideration therein expressed, as the act and
deed of the City of Fort Worth, and in the capacity therein stated.
GIVEN UNDER MY HAND AND SEAL OF OFFICE this 6th day of
A�ril , 20 21 •
Jennifer L DigitallysignedbyJenniferL ,�p.RYPUe JENNIFER L. EZERNACK
Ezernack = /�� � Notary Public
Ezernack Date:2021.04.0610:1520-OS'oo' *�[f * STATE OF TEXAS
NT r��1 Q Notary I.D. 130561630
Notary Public in and for the State of Texas 9�FOF� My Comm. Exp. Mar. 1, 2024
After recording return to:
Development Services Department
Development Coordination — Contract Management Office
200 Texas Street
Fort Worth, Texas 76102
Tier II Easement Encroachment Agreement
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
STATE OF TEXAS §
COUNTY OF DALLAS §
BEFORE ME, the undersigned authority, a Notary Public in and for the State of
�,QS , on this day personally appeared Jonathan Perlman, Manager of Clearfork
Tradition GP, LLC, the General Partner of CLEARFORK TRADITION, LP, a Texas
limited partnership known to me to be the person whose name is subscribed to the
foregoing instrument, and acknowledged to me that he or she executed the same for the
purposes and consideration therein expressed, as the act and deed of Clearfork
Tradition, LP, a Domestic Limited Partnership, and in the capacity therein stated.
ST
GIVEN UNDER MY HAND AND SEAL OF OFFICE this ` day of
�, � I'.� , 20 Zi
��
�
2�.�
Notary Public in and for the
State of ���
���`P�P��� LISA C. GROS
�r°^P6
:�n= Notary Public, State of Texas
�.�l�+v� Comm. Expires 09-01-2023
�''��i°«i``�� Noiary ID 128726663
Tier II Easement Encroactunent Agreement
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
EXHIBIT A
Description of the Licensee's Property
Tier II Easement Encroachment Agreement Page 10 of 13
Revised 11/2020
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EXHIBIT B
Depiction of the Public Property
Tier II Easement Encroachment Agreement Page 11 of 13
Revised 11/2020
Exhibit B
DESCRIPTION OF A
VEHICULAR PAVEMENT ENCROACHMENT AREA
BEING a tract of land situated in the L.J. Edwards Survey, Abstract Number 464, City of Fort Worth,
Tarrant County, Texas, being a portion of that tract of land described by deed to Clearfork Tradition, L.P.,
recorded in Instrument Number D220015942, County Records, Tarrant County, Texas, and being more
particularly described by metes and bounds as follows:
COMMENCING at the southwest corner of said Clearfork Tradition tract and the southeast corner of
that tract of land described by deed to Tarrant Regional Water District, recorded in Instrument Number
D211018490, said County Records, from which the southwest corner of said Tarrant Regional Water
District tract, bears S 79°20'09"W, 15.58 feet, and being the southeast corner of Lot 1, Block 1, Edwards
Ranch Clearfork Addition, an addition to the City of Fort Worth, Texas, recorded in Cabinet B, Slide
3187, said County Records;
THENCE N 26°20'09"W, 37.10 feet, to the POINT OF BEGINIVING;
THENCE N 26°26'04"W, 14.84 feet;
THENCE N 79°20'09"E, 46.76 feet, to the beginning of a non-tangent curve to the left;
THENCE with said non-tangent curve to the left, an arc distance of 3 8.62 feet, through a central angle of
90°18'43", having a radius of 24.50 feet, the long chord which bears S 71°16'42"E, 34.74 feet;
THENCE N 63°33'S6"E, 0.78 feet, to the beginning of a curve to the left;
THENCE with said curve to the left, an arc distance of 2491 feet, through a central angle of 58°15' 18",
having a radius of 24.50 feet, the long chord which bears N 34°26' 17"E, 23.85 feet;
THENCE N 79°20'09"E, 27.50 feet, to the beginning of a non-tangent curve to the right;
THENCE with said non-tangent curve to the right, an arc distance of 59.96 feet, through a central angle
of 66°42'24", ha�ing a radius of 51.50 feet, the long chord which bears S 30°12'44"W, 56.63 feet;
THENCE S 63°33'S6"W, 0.78 feet, to the beginning of a curve to the right;
THENCE with said curve to the right, an arc distance of 75.74 feet, through a central angle of 84°15'39",
having a radius of 51.50 feet, the long chord which bears N 74°18' 15"W, 69.09 feet, to the beginning of a
reverse curve to the left;
THENCE with said reverse curve to the left, an arc distance of 515 feet, through a central angle of
84°15'39", having a radius of 3.50 feet, the long chord which bears N 74°18' 15"W, 4.70 feet;
THENCE S 63°33'S6"W, 14.78 feet to the Point of Beginning and containing 3,109 square feet or 0.071
acres of land more or less.
"Integral Parts of this Document"
1. Description
2. Exhibit
Peloton Job No. TSL19001
Ft. Worth November 12, 2020
G:\JOB\TSL19001_Tradition Clearfork\MasterDev\_Survey\Exhibits\Legals\TSL19001_Ex4.docx Page 1 of2
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Lot l, Block l,
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Clearfork Addltlon
Cab. B, Sld. 3/87
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Tarrant
Reglonal Water Dlstrict
lnst,# D2/l0/8490
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CURVE TABLE
N0. DELTA RADIUS LENGTH BEARING DISTANCE
C1 90° 18'43" 24.50' 38.62' S 71° 16'42" E 34.74'
C2 58° 15'18" 24.50' 24.91' N 34° 26'17" E 23.85'
C3 66° 42'24" 51.50' 59.96' S 30° 12'44" W 56.63'
C4 84° 15'39" 51.50' 75.74' N 74° 18'15" W 69.09'
C5 84° 15'39" 3.50' S.15' N 74° 18'15" W 4.70'
LINE TABLE
d� �� ��
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N0. BEARING DISTANCE
L1 N 26° 26'04" W 14.84'
L2 N 63° 33'56" E 0.78'
L3 S 63° 33'56" W 0.78'
L4 S 63° 33'56" W 14.78'
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Clearfork Tradition, L.P.
Inst.# D220015942
C.R.T.C.T.
E
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Inst# T�T
C3 � C.R•
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Existing und wer � ne
So�itary Se
Trinity Rlver
Woter Control
Tarra�t CountY istrfct Number ��e
and ImproveVoln455
99 P9• I
�aRT,CT.
Exhibit of a
Vehicular Pavement
Encroachment Area
P E LOTO N Situated in the L.J. Edwards Survey, Abstract Number 464,
� I L A N D S O L U T I O N S City of Fort Worth, Tarrant County, Texas.
�nD9800�HTuLWOOD PARKWA�Y�BU�ITE�2�SOzz�� JOB # TSL19001 DRAWN BY: TBR CHECKED BY: DATE: 11-10-2020 PAGE # 2 of 2
DESCRIPTION OF A
SIDEWALK ENCROACHMENT AREA
BEING a tract of land situated in the L.J. Edwards Survey, Abstract Number 464, City of Fort Worth,
Tarrant County, Texas, being a portion of that tract of land described by deed to Clearfork Tradition, L.P.,
recorded in Instrument Number D220015942, County Records, Tarrant County, Texas, and being more
particularly described by metes and bounds as follows:
CONIIVIENCING at the southwest corner of said Clearfork Tradition tract and the southeast corner of
that tract of land described by deed to Tarrant Regional Water District, recorded in Instrument Number
D211018490, said County Records, from which the most westerly corner of said Clearfork Tradition tract
and the south right-of-way line of Acme Brick Plaza, a variable width right-of-way recorded in Cabinet
A, Slide 12513, said County Records, bears N 26°27'28"W, 256.61 feet, and the southeast corner of Lot
1, Block 1, Edwards Ranch Clearfork Addition, an addition to the City of Fort Worth, Texas, recorded in
Cabinet B, Slide 3187,said County Records, bears S 79°20'09"W, 15.58 feet;
THENCE N 79°20'09"E, 195.93 feet, with the south line of said Clearfork Tradition tract, to the POINT
OF BEGINNING;
THENCE over and across said Clearfork Tradition tract, the following courses and distances:
N 10°46' 13"W, 3.57 feet departing said south line, to the beginning of a curve to the left;
With said curve to the left, an arc distance of 40.41 feet, through a central angle of 77°10'42",
having a radius of 30.00 feet, the long chord which bears N 49°15' 17"W, 37.42 feet, to the
beginning of a reverse curve to the right;
With said reverse curve to the right, an arc distance of 29.20 feet, through a central angle of
49°00'S1", having a radius of 34.13 feet, the long chord which bears N 63°18'S6"W, 2832 feet;
N 79°20'09"E, 7.03 feet, to the beginning of a non-tangent curve to the left;
With said non-tangent curve to the left, an arc distance of 54.08 feet, through a central angle of
110° 10' S4", having a radius of 28.12 feet, the long chord which bears N 79°20' 09"E, 46.12 feet;
N 79°20'09"E, 7.15 feet, to the beginning of a non-tangent curve to the left;
With said non-tangent curve to the left, an arc distance of 43.59 feet, through a central angle of
22°29'S7", having a radius of 1 ll.00 feet, the long chord which bears S 00°35'02"W, 43.31 feet;
S 10°43'49"E, 7.53 feet, returning to the aforementioned south line of said Clearfork Tradition
tract;
THENCE S 79°20'09"W, 6.00 feet to the Point of Beginning and containing 855 square feet or 0.020
acres of land more or less.
"Integral Parts of this Document"
1. Description
2. E�ibit
Peloton Job No. TSL19001
Ft. Worth November 12, 2020
G:\JOB\TSL19001_Tradition Clearfork\MasterDev\_Survey\Exhibits\Legals\TSL19001_ExS.docx Page 1 of2
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N0. DELTA RADIUS LENGTH BEARING DISTANCE
C1 77° 10'42" 30.00' 40.41' N 49° 15'17" W 37.42'
C2 49° 00' 51" 34.13' 29.20' N 63° 18'S6" W 28.32'
C3 110° 10'S4" 28.12' S4.08' N 79° 20'09" E 46.12'
C4 22° 29'57" 111.00' 43.59' S 00° 35'02" W 43.31'
�,�1��
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Clearfork Addltlon
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GRAPHIC SCALE IN FEET
"Integral parts of this document"
1. Description
2. Exhibit
LINE TABLE
N0. BEARING DISTANCE
L1 N 10° 46'13" W 3.57'
L2 S 79° 20'09" W 6.00'
Clearfork Tradition, L.P.
Inst.* D220015942
C.R.T.C.T.
„E N7 9° � �5 9„E _ _ —
, _ _ _ —
0 2p'O9 — —
SeWer Esmt.
N79 7.03' _-- �, Sanitary �42g78 �
_— C3 8ss 5 Inst # D210
_ _---- C2 Fq. C�S C.RT.CTo
Point of � S ° '49��E
C1 � � 5�,
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BASIS OF BEARING IS THE TEXAS COORDINATE
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IRF = IRON ROD FOUND
�S = SANITARY SEWER MANHOLE
=FOR INFORMATIONAL PURPOSES ONLY
Point of
Beginning
-R,i�er
Trinity �ont #o�
County W°teistrfct �
Ta�d�mprovement D
�01.4559, P9• I
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Exhibit of a
Sidewalk Encroachment Area
P E LOTO N Situated in the L.J. Edwards Survey, Abstract Number 464,
� I L A N D S O L U T I O N S City of Fort Worth, Tarrant County, Texas.
�nD9800�HTuLWOOD PARKWA�Y�BU�ITE�2�SOzz�� JOB # TSL19001 DRAWN BY: TBR CHECKED BY: DATE: 11-10-2020 PAGE # 2 of 2
DESCRIPTION OF A
SIDEWALK ENCROACHMENT AREA
BEING a tract of land situated in the L.J. Edwards Survey, Abstract Number 464, City of Fort
Worth, Tarrant County, Texas, being a portion of that tract of land described by deed to Clearfork
Tradition, L.P., recorded in Instrument Number D220015942, County Records, Tarrant County,
Texas, and being more particularly described by metes and bounds as follows:
COMMENCING at the southwest corner of said Clearfork Tradition tract and the southeast corner
of that tract of land described by deed to Tarrant Regional Water District, recorded in Instrument
Number D211018490, said County Records, from which the most westerly corner of said Clearfork
Tradition tract and the south right-of-way line of Acme Brick Plaza, a variable width right-of-way
recorded in Cabinet A, Slide 12513, said County Records, bears N 26°27'28"W, 256.61 feet, and the
southeast corner of Lot 1, Block 1, Edwards Ranch Clearfork Addition, an addition to the City of
Fort Worth, Texas, recorded in Cabinet B, Slide 3187,said County Records, bears S 79°20'09"W,
15.58 feet;
THENCE N 79°20'09"E, 334.17 feet, with the south line of said Clearfork Tradition tract, to the
POINT OF BEGINNING;
THENCE N 10°39'S1"W, 8.60 feet, departing said south line, to the beginning of a curve to the left;
THENCE over and across said Clearfork Tradition tract, the following courses and distances:
With said curve to the left, an arc distance of 36.18 feet, through a central angle of
69°06'20", having a radius of 30.00 feet, the long chord which bears N 45° 13'02"W,
34.03 feet, to the beginning of a reverse curve to the right;
With said reverse curve to the right, an arc distance of 25.43 feet, through a central angle of
22°04'39", having a radius of 66.00 feet, the long chord which bears N 68°43'S2"W,
25.27 feet;
N 79°20'09"E, 9.38 feet, to the beginning of a non-tangent curve to the left;
With said non-tangent curve to the left, an arc distance of 15.21 feet, through a central angle
of 14°31'43", having a radius of 60.00 feet, the long chord which bears S 71°31'30"E,
15.17 feet, to the beginning of a compound curve to the left;
With said compound curve to the left, an arc distance of 36.07 feet, through a central angle of
68°53'49", having a radius of 30.00 feet, the long chord which bears N 66°45'44"E,
33.94 feet;
N 79°20'09"E, 7.86 feet;
S 18°33' 18"W, 18.92 feet, to the beginning of a curve to the left;
Peloton Job No. TSL19001
Ft. Worth November 12, 2020
G:\JOB\TSL19001_Tradition Clearfork\MasterDev\_Survey\Exhibits\Legals\TSL19001_EX6.docx Page 1 of3
With said curve to the left, an arc distance of 30.60 feet, through a central angle of
29°13'09", having a radius of 60.00 feet, the long chord which bears S 03°56'43"W, 30.27
feet;
S 10°39'S1"E, 4.20 feet, returning to the aforementioned south line of said Clearfork
Tradition tract;
THENCE S 79°20' 09"W, 6.00 feet, with said south line, to the Point of Beginning and containing
847 square feet or 0.019 acres of land more or less.
"Integral Parts of this Document"
1. Description (2 Pages)
2. Exhibit
Peloton Job No. TSL19001
Ft. Worth November 12, 2020
G:\JOB\TSL19001_Tradition Clearfork\Master Dev\_Survey\Exhibits\Legals\TSL19001_EX6.docx Page 2 of 3
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IRF = IRON ROD FOUND
�S = SANITARY SEWER MANHOLE
0 40 80
GRAPHIC SCALE IN FEET
"Integral parts of this document"
1. Description (2 Pages)
2. Exhibit
N0. DELTA RADIUS LENGTH BEARING DISTANCE
C1 69° 06'20" 30.00' 36.18' N 45° 13'02" W 34.03'
C2 22° 04'39" 66.00' 25.43' N 68° 43'S2" W 25.27'
C3 14° 31'43" 60.00' 15.21' S 71° 31'30" E 15.17'
C4 68° 53'49" 30.00' 36.07' N 66° 45'44" E 33.94'
C5 29° 13'09" 60.00' 30.60' S 03° 56'43" W 30.27'
,��'���
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Clearfork Tradition, L.P.
Inst.° D220015942
C.R.T.C.T.
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-
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Point of
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PELOTON
II L A N D S O L U T I O N S
9800 HILLWOOD PARKWAY. SUITE 250
�S18° 33'18"W
18.92'
-s�
;5 510° 39 5� E
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Sewer Eas ��g78
Inst# D2100
� RT.CT.
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Point of Trinity Water �ontro�
CountY istrict mber �ne
Beginning andT�mP °Veme��4D5g,Pg Nu
vo T
� R T.C•
Exhibit of a
Sidewalk Encroachment Area
Situated in the L.J. Edwards Survey, Abstract Number 464,
City of Fort Worth, Tarrant County, Texas.
JOB # TSL19001 DRAWN BY: TBR CHECKED BY: DATE: 11-11-2020 PAGE # 3 of 3
DESCRIPTION OF A
SIDEWALK ENCROACHMENT AREA
BEING a tract of land situated in the L.J. Edwards Survey, Abstract Number 464, City of Fort Worth,
Tarrant County, Texas, being a portion of that tract of land described by deed to Clearfork Tradition, L.P.,
recorded in Instrument Number D220015942, County Records, Tarrant County, Texas, and being more
particularly described by metes and bounds as follows:
COMMENCING at the southeast corner of said Clearfork Tradition tract and the southwest corner of
that tract of land described by deed to Clearfork Association, Inc., recorded in Instrument Number
D213004083, said County Records, and being in the north line of that tract of land described by deed to
the Tarrant County Water Control and Improvement District Number 1, recorded in Volume 4559, Page
1, said County Records, from which the southeast corner of said Clearfork Association tract and the
southwest corner of Lot 11R1, Block 1, Edwards Ranch Clearfork Addition, an addition to the City of
Fort Worth, Texas, recorded in Instrument Number D220007043, said County Records, bears
N 86°OS'40"E, 69.76 feet;
THENCE S 86°26'S2"W, 70.96, departing said north line, to the POINT OF BEGINNING;
THENCE over and across said Clearfork Traditions tract, the following courses and distances:
S 86°06'04"W, 59.83 feet;
N 03°53'S6"W, ll.92 feet, to the beginning of a non-tangent curve to the right;
With said non-tangent curve to the right, an arc distance of 41.62 feet, through a central angle of
66°19'21", having a radius of 35.96 feet, the long chord which bears N 59°35' 10"W, 3934 feet;
N 26°26'42"W, 12.60 feet;
N 79°20'09"E, 6.23 feet;
S 26°26'42"E, 10.91 feet, to the beginning of a curve to the left;
With said curve to the left, an arc distance of 34.56 feet, through a central angle of 66°OS'46",
having a radius of 29.96 feet, the long chord which bears S 59°28'08"E, 32.67 feet;
N 03°53'S6"W, ll.91 feet;
N 86°06'04"E, 6.00 feet;
S 03°53'S6"E, 23.83 feet;
N 86°06'04"E, 53.83 feet;
S 03 °53' S6"E, 6.00 feet to the Point of Beginning and containing 801 square feet or 0.018 acres
of land more or less.
"Integral Parts of this Document"
1. Description
2. Exhibit
Peloton Job No. TSL19001
Ft. Worth November 12, 2020
G:\JOB\TSL19001_Tradition Clearfork\MasterDev\_Survey\Exhibits\Legals\TSL19001_EX7.docx Page 1 of2
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BASIS OF BEARING IS THE TEXAS COORDINATE
SYSTEM NORTH CENTRAL ZONE 4202,NAD 83
IRF = IRON ROD FOUND
�S = SANITARY SEWER MANHOLE
=FOR INFORMATIONAL PURPOSES ONLY
CURVE TABLE
�
0 40 80
GRAPHIC SCALE IN FEET
"Integral parts of this document"
1. Description
2. Exhibit
N0. DELTA RADIUS LENGTH BEARING DISTANCE
C1 66° 19'21" 35.96' 41.62' N 59° 35'10" W 39.34'
C2 66° 05'46" 29.96' 34.56' S 59° 28'08" E 32.67'
����� �a�dQ�J
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Clearfork Tradition, L.P.
Inst.* D220015942
C.R.T.C.T.
50' Sanitary Sewer Esmt.
Inst # D210042878
C.R.T.C.Te
N79' 2�3�9 E --------------------------
6 2 ___ ---
_ — — — L2 N86° 06'04"E
__ ---- L1 6.00� Point of
C2 �`�1'- S - Commencing
� S `� L4 Ng6° 06'04"E
� S C1 53.83'
NO3°53'56"W� 80� Sq. Ft.
1•92� S86° 06'04"W
59.83'
S74° 42'49"�N
n 2.25
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LINE TABLE
N0. BEARING DISTANCE
L1 N 26° 26'42" W 12.60'
L2 S 26° 26'42" E 10.91'
L3 N 03° 53'56" W 11.91'
L4 S 03° 53'56" E 23.83'
L5 S 03° 53'56" E 6.00'
PELOTON
II L A N D S O L U T I O N S
9800 HILLWOOD PARKWAY. SUITE 250
S86° 26'52"W
L5 70.9„ 6' _
Point of
Beginning
�
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Edwards Ranch
Clearfork Addltlon
lnst,# 220007043
c.R.r.c.r.
S s —
s�
N86° 05'40"E
69.76'
Trinity River
Tarrant County Water Control
and Improvement Distrlct #I
Vol, 45599 Pg� I
CeR.T .C.T .
Exhibit of a
Sidewalk Encroachment Area
Situated in the L.J. Edwards Survey, Abstract Number 464,
City of Fort Worth, Tarrant County, Texas.
JOB # TSL19001 DRAWN BY: TBR CHECKED BY: DATE: 11-11-2020 PAGE # 2 of 2
DESCRIPTION OF
3 — FENCE ENCROACHMENT ROUTES
ROUTE 1
BEING a proposed fence line route, situated in the L.J. Edwards Survey, Abstract Number 464,
City of Fort Worth, Tarrant County, Texas, being a portion of that tract of land described by deed
to Clearfork Tradition, LP, recorded in Instrument Number D220015942, County Records,
Tarrant County, Texas, and being more particularly described by metes and bounds as follows:
COMMENCING at southeast corner of said Cleafork Tradition tract and the southwest corner
of that tract of land described by deed to Clearfork Association, Inc., recorded in Instrument
Number D212290570, said County Records, and being in the north line of that tract of land
described by deed to Tarrant County Water Control and Improvement District Number One,
recorded in Volume 4559, Page 1, said County Records, from which the southeast corner of said
Clearfork Association tract and the southwest corner of Lot 11R1, Block 1, Edwards Ranch
Clearfork Addition, an addition to the City of Fort Worth, Tarrant County, Texas, recorded in
Instrument Number D220007043, said County Records, bears N 86°OS'40"E, 69.76 feet;
THENCE S 86°53'46"W, 17.86 feet, departing said north line, to the POINT OF
BEGINNING;
THENCE N 26°26'42"W, 53.86 feet, and there ending;
ROUTE 2
BEING a proposed fence line route, situated in the L.J. Edwards Survey, Abstract Number 464,
City of Fort Worth, Tarrant County, Texas, being a portion of that tract of land described by deed
to Clearfork Tradition, LP, recorded in Instrument Number D220015942, County Records,
Tarrant County, Texas, and being more particularly described by metes and bounds as follows:
COMMENCING at southeast corner of said Cleafork Tradition tract and the southwest corner
of that tract of land described by deed to Clearfork Association, Inc., recorded in Instrument
Number D212290570, said County Records, and being in the north line of that tract of land
described by deed to Tarrant County Water Control and Improvement District Number One,
recorded in Volume 4559, Page 1, said County Records, from which the southeast corner of said
Clearfork Association tract and the southwest corner of Lot 11R1, Block 1, Edwards Ranch
Clearfork Addition, an addition to the City of Fort Worth, Tarrant County, Texas, recorded in
Instrument Number D220007043, said County Records, bears N 86°OS'40"E, 69.76 feet;
THENCE S 86°53'46"W, 17.86 feet, departing said north line, to the POINT OF
BEGINNING;
THENCE over and across said Clearfork Tradition tract, the following bearings and distances:
Peloton Job No. HWA19011
Ft Worth November 12, 2020
G:\JOB\TSL19001_Tradition Clearfork\MasterDev\_Survey\Exhibits\Legals\TSL19001_EX8.docx Page 1 of3
S 86°11'18"W, 119.09 feet;
S 79°50'S7"W, 315.33 feet
N 26°30'35"W, 48.09 feet, and there ending;
ROUTE 3
BEING a proposed fence line route, situated in the L.J. Edwards Survey, Abstract Number 464,
City of Fort Worth, Tarrant County, Texas, being a portion of that tract of land described by deed
to Clearfork Tradition, LP, recorded in Instrument Number D220015942, County Records,
Tarrant County, Texas, and being more particularly described by metes and bounds as follows:
COMMENCING at southeast corner of said Cleafork Tradition tract and the southwest corner
of that tract of land described by deed to Clearfork Association, Inc., recorded in Instrument
Number D212290570, said County Records, and being in the north line of that tract of land
described by deed to Tarrant County Water Control and Improvement District Number One,
recorded in Volume 4559, Page 1, said County Records, from which the southeast corner of said
Clearfork Association tract and the southwest corner of Lot 11R1, Block 1, Edwards Ranch
Clearfork Addition, an addition to the City of Fort Worth, Tarrant County, Texas, recorded in
Instrument Number D220007043, said County Records, bears N 86°OS'40"E, 69.76 feet;
THENCE S 86°53'46"W, 17.86 feet, departing said north line;
THENCE S 86°11'18"W, 53.08 feet, to the POINT OF BEGINNING;
THENCE N 03°34'S6"W, 30.09 feet;
THENCE S 86°06'04"W, 60.17 feet;
THENCE S 03°53'S6"E, 30.00 feet, and there ending;
"Integral Parts of this Document"
1. Description — 2 Pages
2. E�ibit
Peloton Job No. HWA19011
Ft Worth November 12, 2020
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E�ibit B
Deseriptian af $n
Emerge�ey Access Easement Encrnachment
BEING a portion oF Lot ?, Black 1, Edwards Ranch Clearfaric Additian, an additian to the City
of Fort Worth, Tarrant County, Texas, according tc� the pla.t recorded iz� Instrument Nun�.ber
D22Q 18241 G, Cc�unty Records, Tarrant Ca�nty, Texas and heing more particularly describ�d hy
anet�s and b��nds as fa]]aws:
CDMMENCING at a 518 inch iron faund with plastic cap stainped `Peloton' found at a
reentrant carner of said Lot 2 and the i�orthwest carr-ser of that certain tract ❑f land described by
d�ed ta Clearfork Associatia�i, inc., recorded in Instruxnent N�mber D2134�4Q83, said Co�nty
Itecards;
THENCE 5 26°3Q'33"E, Si.28 feet, witl� an east line of said Lnt Z and the west line afsaid
Clearfork Association tract, fron� which a 5l8 inch iron found with plastic cap stamped `Pe]aton'
hear� S 26°3D'33"E, 2 i 3.84 feet;
THENCE S 63°33'S6"W, 7?.87 feet, lea�ing said �ast line, to the P�II�T QF BEG1NN11VG;
THENCE S 63°33'Sf�"W, 40.25 Feet;
THEN�E N 2G°2G'�4"W, 1 Z,fl4 feet;
THENCE N 53°33'S5"E. 4U.?5 f�et;
TH�NCE S�b°25'Q4"E, 12.aa fe�t to t�ie Point of Beg'rnning and cnntaining 483 square feet or
4.f}I l a�res of la��d more ar l�ss.
"lnteyra! parts nF this d�f�umcnt"
3. UL'5CfIF1Yl(7i1
?. Exhibit
Pcfnton Jcib No. TSLI �H10 i Tra�kinK Nn. lti� A
S.FiW Marcli f 5, 20� 1
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EXHIBIT C
Depiction and Description of the Encroachment
Tier II Easement Encroachment Agreement Page 12 of 13
Revised 11/2020
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EXHIBIT D
Certificate of Insurance
Tier II Easement Encroachment Agreement Page 13 of 13
Revised 11/2020
�' Issuing Company:
�� MedPro Group National Fire & Marine Insurance Company
� aRe,��t��,�eH�,f���:,y�on,rn,y Omaha, Nebraska
SENIOR CARE LIABILITY POLICY
GENERAL LIABILITY COVERAGE PART
NOTICE:
This Coverage Part may contain claims-made and reported coverage. Please read this Coverage
Part carefully.
I. INSURING CLAUSES
A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY
1. Claims-Made and Reported
If "Claims-Made and Reported" is shown on the Declarations with respect to this Coverage Part, the following
provisions apply:
a. The company will pay on behalf of any insured all loss and claims expense, subject to any applicable
Deductible or Self-Insured Retention, and up to the Limits of Liability shown on the Declarations with
respect to this Insuring Clause, arising from an event resulting in bodily injury or property damage
that took place on or after the applicable retroactive date shown on the Declarations. Moreover, to be
covered under this policy, the loss or claims expense must arise from:
(1) a claim that was first made against, and received by, an insured during the policy period, and
reported to the company, in writing, during the policy period or within any applicable e�ctended
reporting period; or
(2) a potential claim that was first known about or discovered by an insured during the policy period,
and reported to the company, in writing, during the policy period or within the automatic limited
extended reporting period.
b. All claims and potential claims for damages arising out of, or in connection with, bodily injury to the
same person, including damages claimed by any person or organization for care, loss of services, or death
resulting at any time from bodily injury, will be deemed to have been first made on the date that the first
of those claims is made against any insured, or the date the first of such potential claims is discovered
by an authorized insured, whichever date is earlier. Additionally, all claims and potential claims for
damages because of property damage causing loss to the same person or organization will be deemed
to have been first made on the date that the first of those claims is made against any insured, or the
date the first of the potential claims is discovered by an authorized insured, whichever date is earlier.
Only the policy in effect when the first such claim is made and reported to the company, or the first such
potential claim is discovered and reported to the company, whichever is earlier, will apply to all related
claims and potential claims, no matter when those related claims are made or reported, or potential
claims are discovered and reported. If, prior to the effective date of this policy, the first such claim is
made, or the first such potential claim is discovered, this policy will not apply to that claim or potential
claim, nor to any related claim or potential claim made during this policy period or any extended
reporting period.
2. Occurrence
If ��Occurrence" is shown on the Declarations with respect to this Coverage Part, the following provisions apply:
a. The company will pay on behalf of an insured all loss and claims expense, subject to any applicable
Deductible or Self-Insured Retention, and up to the Limits of Liability shown on the Declarations with
respect to this Insuring Clause, arising from an event resulting in bodily injury or property damage
that occurred during the policy period.
0012-PGS-00-1215 Page 1 of 11 O 2015 MedPro Group. All rights reserved.
b. An event will be deemed to have occurred on the earliest date of any related acts or omissions that gave
rise to or contributed to the event.
B. PERSONAL AND ADVERTISING INJURY LIABILITY
1. Claims-Made and Reported
If "Claims-Made and Reported" is shown on the Declarations with respect to this Coverage Part, the following
provisions apply:
a. The company will pay on behalf of any insured all loss and claims expense, subject to any applicable
Deductible or Self-Insured Retention, and up to the Limits of Liability shown on the Declarations with
respect to this Insuring Clause, arising from an offense resulting in personal and advertising injury that
took place on or after the applicable retroactive date shown on the Declarations. Moreover, to be covered
under this policy, the loss or claims expense must arise from:
(1) a claim that was first made against, and received by, an insured during the policy period, and
reported to the company, in writing, during the policy period or within any applicable e�ctended
reporting period; or
(2) a potential claim that was first known about or discovered by an insured during the policy period,
and reported to the company, in writing, during the policy period or within the automatic limited
e�ctended reporting period.
b. All claims and potential claims for damages arising out of, or in connection with the same personal
and advertising injury will be deemed to have been first made on the date that the first of those claims
is made against any insured, or the date the first of such potential claims is discovered by an
authorized insured, whichever date is earlier. Only the policy in effect when the first such claim is made
and reported to the company, or the first such potential claim is discovered and reported to the
company, whichever is earlier, will apply to all related claims and potential claims, no matter when
those related claims are made or reported, or potential claims are discovered and reported. If, prior to
the effective date of this policy, the first such claim is made, or the first such potential claim is
discovered, this policy will not apply to that claim or potential claim, nor to any related claim or
potential claim made during this policy period or any extended reporting period.
2. Occurrence
If ��Occurrence" is shown on the Declarations with respect to this Coverage Part, the following provisions apply:
a. The company will pay on behalf of an insured all loss and claims expense, subject to any applicable
Deductible or Self-Insured Retention, and up to the Limits of Liability shown on the Declarations with
respect to this Insuring Clause, arising from an offense resulting in personal and advertising injury that
occurred during the policy period.
b. An offense will be deemed to have occurred on the earliest date of any related acts or omissions that gave
rise to or contributed to the offense.
C. MEDICAL PAYMENTS
1. Claims-Made and Reported
If "Claims-Made and Reported" is shown on the Declarations with respect to this Coverage Part, the following
provisions apply:
a. The company will pay on behalf of any named insured, medical expenses for bodily injury caused
by an accident, regardless of fault, and up to the Limits of Liability shown on the Declarations with respect
to this Insuring Clause. However, the medical expenses must have been caused by an accident that took
place on or after the applicable Retroactive Date shown on the Declarations. Moreover, to be covered under
this policy, the medical expenses must:
(1) arise from a claim that was first made against, and received by, a named insured during the policy
period, and reported to the company, in writing, during the policy period;
(2) arise from an accident that occurred on a premises owned or occupied by, or on the ways next to
premises owned or occupied by, a named insured; and
(3) result from the operations of a named insured.
0012-PGS-00-1215 Page 2 of 11 O 2015 MedPro Group. All rights reserved.
b. for damages arising out of, or in connection with the same accident will be deemed to have been first made
on the date that the first of those claims is made against any insured, or the date the first of such
potential claims is discovered by an authorized insured, whichever date is earlier. Only the policy in
effect when the first such claim is made and reported to the company, or the first such potential claim
is discovered and reported to the company, whichever is earlier, will apply to all related claims and
potential claims, no matter when those related claims are made or reported, or potential claims are
discovered and reported. If, prior to the effective date of this policy, the first such claim is made, or the
first such potential claim is discovered, this policy will not apply to that claim or potential claim, nor
to any related claim or potential claim made during this policy period or any extended reporting
period.
2. Occurrence
If ��Occurrence" is shown on the Declarations with respect to this Coverage Part, the following provisions apply:
a. the company will pay on behalf of a named insured, medical expenses for bodily injury caused by
an accident, regardless of fault, and up to the Limits of Liability shown on the Declarations with respect to
this Insuring Clause. However, the medical expenses must be caused by an accident that occurred during
the policy period. Moreover, to be covered under this policy, the medical expenses must:
(1) be submitted to the company, in writing, within one year of the accident;
(2) arise from an accident that occurred on a premises owned or occupied by, or on the ways next to
premises owned or occupied by, a named insured; and
(3) result from the operations of a named insured.
b. An accident will be deemed to have occurred on the earliest date of any related acts or omissions that gave
rise to or contributed to the accident.
However, payments for medical expenses shall not be subject to any Deductible or Self-Insured Retention.
II.
A. EXCLUSIONS APPLICABLE TO THIS COVERAGE PART
The coverage provided under this Coverage Part does not apply to:
1. Contractual Liabilitv
Any claim or potential claim arising out of, or in connection with, an insured's obligation to pay damages
by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for
damages:
a. that the insured would have in the absence of the contract or agreement; or
b. assumed in a contract or agreement that is an insured contract, provided the bodily injury, property
damage, personal and advertising injury or medical expenses occurred subsequent to the execution
of the contract or agreement. Only for the purposes of liability assumed in an insured contract,
reasonable attorneys' fees and necessary litigation expenses incurred by or for a parly, other than an
insured, are deemed to be damages because of bodily injury, property damage, personal and
advertising injury or medical expenses, provided:
(1) liability to or for that party's defense has also been assumed in the same insured contract; and
(2) attorneys' fees and litigation expenses are for the defense against a civil or alternative dispute
resolution proceeding in which damages to which this insurance applies are alleged.
2. Contamination
Any claim or potential claim arising out of, or in connection with, a superbug contamination.
3. Electronic Data
Any claim or potential claim arising out of, or in connection with, the loss of, loss of use of, damage to,
corruption of, inability to access, or inability to manipulate electronic data. As used in this exclusion, "electronic
data" means information, facts, or programs stored as or on, created or used on, or transmitted to or from
0012-PGS-00-1215 Page 3 of 11 O 2015 MedPro Group. All rights reserved.
computer software, including systems and applications software, hard or floppy disks, CD-ROMS, tapes, drives,
cells, data processing devices, or any other media that are used with electronically controlled equipment or by
means of the internet.
4. Employees
Any claim or potential claim arising out of, or in connection with, the acts or omissions of an employee,
involving:
a. bodily injury, personal and advertising injury or medical expenses:
(1) to another employee or agent of a named insured;
(2) to the spouse, relative or dependent as a consequence of subparagraph a.(1), above; or
(3) for which there is any duty to share damages or loss with, or repay, another party liable for the loss as
a consequence of subparagraphs a.(1) and a.(2), above.
b. property damage to property:
(1) owned, occupied, or used by an insured;
(2) rented to an insured; or
(3) in the care, custody, or control of an insured.
5. Privacv
Any claim or potential claim arising out of, or in connection with, any disclosure of or access to any person's
or organization's confidential, proprietary or personal information, including personally identifiable information,
financial information, patents, trade secrets, processing methods, customer lists, credit card information, health
information, or any other type of nonpublic information. This exclusion applies even if the claim or potential
claim is for notification costs, credit monitoring expenses, forensic expenses, public relations expenses or any
other loss, claims expense, cost or expense incurred by an insured or others resulting from the excluded
claims or potential claims.
6. Professional Liabilitv
Any claim or potential claim arising out of, or in connection with, a health care event.
7. Recording And Distribution Of Material Or Information In Violation Of Law
Any claim or potential claim arising out of, or in connection with, any act or omission that violates or is
alleged to violate:
a. the Telephone Consumer Protection Act (TCPA), including any amendment of or addition to such law;
b. the CAN-SPAM Act of 2003, including any amendment of or addition to such law;
c. the Fair Credit Reporting Act (FCRA), and any amendment of or addition to such law, including the Fair and
Accurate Credit Transaction Act; or
d. any federal, state or local statute, ordinance or regulation, other than the TCPA or CAN-SPAM Act of 2003,
or FCRA and their amendments and additions, that addresses, prohibits, or limits the printing,
dissemination, disposal, collecting, recording, sending, transmitting, communicating or distribution of
material or information.
8. Residents Rights
Any claim or potential claim arising out of, or in connection with, a violation of any law relating to residents'
rights.
9. Sexual Acts
Any claim or potential claim arising out of, or in connection with, any actual or threatened sexual conduct
by any person of another person while in the care, custody, or control of any insured.
Under this exclusion, the company's duty to defend the insured for such claim or potential claim will cease
when it is established by trial or arbitration verdict, court ruling, regulatory ruling or legal admission that the
insured engaged in any act excluded in this exclusion.
0012-PGS-00-1215 Page 4 of 11 O 2015 MedPro Group. All rights reserved.
This exclusion does not apply to any claim or potential claim brought against any insured who did not
direct or act in concert to commit, directly participate in or direct another in connection with any of the acts
excluded from coverage under this exclusion.
B. EXCLUSIONS APPLICABLE TO THE BODILY INJURY AND PROPERTY DAMAGE LIABILITY INSURING CLAUSE AND
THE MEDICAL PAYMENTS INSURING CLAUSE
The coverage provided under the Bodily Injury and Property Damage Liabiliry Insuring Clause and the Medical
Payments Insuring Clause does not apply to:
1. Aircraft, Auto Or Watercraft
Bodily injury, property damage or medical expenses arising out of, or in connection with, the ownership,
maintenance, use, or entrustment to others of any aircraft, auto, or watercraft owned or operated by or rented
to or loaned to any insured. Use includes operation and loading or unloading.
a. This exclusion applies even if the claims or potential claims against any insured allege negligence or
other wrongdoing in the supervision, hiring, employment, training, or monitoring of others by that insured
if the event or accident which caused the bodily injury, property damage or medical expenses
involved the ownership, maintenance, use, or entrustment to others of any aircraft, auto, or watercraft
that is owned or operated by or rented or loaned to any insured.
b. This exclusion does not apply to:
(1) the loading or unloading of a patient;
(2) a watercraft while on shore on premises owned or rented by the insured;
(3) a watercraft that is:
a) not owned by an insured;
b) less than 26 feet long; and
c) not being used to carry persons or property for a charge.
(4) parking an auto on or next to a site owned or occupied by an insured, but only if the auto is not
owned, rented, or being used by an insured;
(5) liability assumed under an insured contract for the ownership, maintenance, or use of an aircraft or
watercraft; or
(6) bodily injury, property damage or medical expenses arising out of, or in connection with:
a) the operation of machinery or equipment that is attached to, or part of, a land vehicle that would
qualify under the definition of mobile equipment if it were not subject to a compulsory or financial
responsibility law or other motor vehicle insurance law in the state where it is licensed or principally
garaged; or
b) the operation of any of the machinery or equipment listed in subparagraph 2.a or 2.b of the
definition of mobile equipment.
2. Asbestos
Any claim or potential claim arising out of, or in connection with, asbestos, or any materials containing
asbestos in whatever form or quantity.
3. Damage To Impaired Property Or Property Not Physically Injured
Property damage to impaired property or property that has not been physically injured arising out of, or
in connection with:
a. a defect, deficiency, inadequacy, or dangerous condition in the insured's product or insured's work;
or
b. a delay or failure by an insured to perform under the terms of a contract or agreement.
This exclusion does not apply to the loss of use of other property arising out of, or in connection with, sudden
and accidental physical injury to the insured's product or the insured's work after it has been put to its
intended use.
0012-PGS-00-1215 Page 5 of 11 O 2015 MedPro Group. All rights reserved.
4. Damaae To The Insured's Product
Property damage to the insured's product arising out of, or in connection with, it or any part of it.
5. Damage To The Insured's Work
Property damage to the insured's work arising out of, or in connection with, the insured's work or any
part of it, and included in the products completed operations hazard. This exclusion does not apply if the
damaged work, or the work out of which the damage arises, was performed by a subcontractor on behalf of
the insured.
6. Damage To Propertv
Property damage to:
a. property an insured owns, rents, or occupies, including any costs or expenses incurred by an insured, or
any other person or organization for repair, replacement, enhancement, restoration, or maintenance of
such property for any reason, including prevention of injury to a person or damage to another's properly;
b. premises an insured sells, gives away, or abandons if the property damage arises out of, or in
connection with, any part of those premises;
c. property loaned to an insured;
d. personal property in the care, custody, or control of an insured;
e. that particular part of real property on which an insured or any contractors or subcontractors, working
directly or indirectly on behalf of an insured, are performing operations if the property damage arises
out of those operations; or
f. that particular part of any property that must be restored, repaired, or replaced because the insured's
work was incorrectly performed on it.
Subparagraphs a, c, and d of this exclusion do not apply to property damage (other than damage by fire) to
a premises, including the contents of such premises, rented to an insured for a period of 7 or fewer consecutive
days. A separate limit of liability applies to the Damage to Premises Rented to an Insured as described in the
Limits of Liability provision.
Subparagraph b of this exclusion does not apply if the premises are the insured's work and were never
occupied, rented, or held for rental by an insured.
Subparagraph f of this exclusion does not apply to property damage included in the products completed
operations hazard.
7. Expected Or Intended Injurx
Bodily injury, property damage or medical expenses arising out of, or in connection with, any act
expected or intended by an insured to cause bodily injury, property damage or medical expenses. This
exclusion applies even if an insured's act causes bodily injury, property damage or medical expenses:
a. of a different rype or degree than expected or intended; or
b. to a different person or organization than expected or intended.
However, this exclusion does not apply to bodily injury or medical expenses arising out of, or in connection
with, an insured's use of reasonable force to protect persons or property.
8. Fungi And Bacteria
a. Bodily injury, property damage or medical expenses arising out of, or in connection with, the actual,
alleged or threatened inhalation of, injection of, contact with, exposure to, existence of, or presence of any
fungi or bacteria on or within a building or structure, including its contents, regardless of whether any other
cause, event, material or product contributed concurrently or in any sequence to such injury or damage.
b. Any loss, cost or expense arising out of, or in connection with, the abating, testing, monitoring, cleaning,
removing, containing, treating, detoxifying, neutralizing, remediating, or disposing of, or in any way
responding to, or assessing the effects of, fungi or bacteria, by any insured or by any other person or
organization.
This exclusion shall not apply to any fungi or bacteria contained in a good or product intended for bodily
0012-PGS-00-1215 Page 6 of 11 O 2015 MedPro Group. All rights reserved.
consumption. For the purposes of this exclusion, the term fungi includes any type or form of fungus, including
mold or mildew and any mycotoxins, spores, scents, or byproducts produced or released by fungi.
9. Liquor Liabilitv
Bodily injury, property damage or medical expenses arising out of, or in connection with, any insured's
liability by reason of:
a. causing or contributing to the intoxication of any person;
b. the furnishing of alcoholic beverages to a person under the legal drinking age or under the influence of
alcohol; or
c. any statute, ordinance or regulation relating to the sale, gift, distribution or use of alcoholic beverages.
This exclusion applies only if the insured is in the business of manufacturing, distributing or selling alcoholic
beverages.
10. Mobile Equipment
Bodily injury, property damage or medical expenses arising out of, or in connection with:
a. the transportation of mobile equipment by an auto owned or operated by or rented or loaned to an
insured; or
b. the use of mobile equipment in, while in practice for, or while being prepared for any prearranged racing,
speed, demolition, or stunting activity.
11. Personal And Advertising Injurx
Bodily injury arising out of, or in connection with, personal and advertising injury.
1z. Pollution
a. Any bodily injury, property damage or medical expenses arising out of, or in connection with, the
actual, alleged, or threatened discharge, dispersal, seepage, migration, release, or escape of pollutants:
(1) at or from any premises, site, or location that is or was at any time owned or occupied by or rented or
loaned to any insured. However, this does not apply to:
a) bodily injury if sustained within a building and caused by smoke, fumes, vapor, or soot produced
by or originated from equipment that is used to heat, cool, or dehumidify the building or equipment
that is used to heat water for personal use by the building's occupants or guests;
b) bodily injury, property damage or medical expenses for which an insured may be held
liable, if it is a contractor, and the owner or lessee of such premises, site, or location has been
added to the policy as an additional insured with respect to an insured's ongoing operations
performed for that additional insured at that premises, site, or location, and such premises, site,
or location is not or never was owned or occupied by or rented or loaned to any insured, other
than that additional insured; or
c) bodily injury, property damage or medical expenses arising out of, or in connection with,
heat, smoke, or fumes from a fire that becomes uncontrollable or breaks out from where it was
intended to be.
(2) at or from any premises, site, or location that is or was at any time used by or for any insured or
others for the handling, storage, disposal, processing, or treatment of waste.
(3) which are or were at any time transported, handled, stored, treated, disposed of or processed as waste
by or for any insured or any other person or organization for whom an insured may be legally
responsible.
(4) at or from any premises, site, or location on which any insured or any contractors or subcontractors,
working directly or indirectly on any insured's behalf, are performing operations if the pollutants
were brought on or to the premises, site, or location in connection with such operations by such
insured, contractor, or subcontractor. However, this subparagraph does not apply to:
a) bodily injury, property damage or medical expenses arising out of, or in connection with,
the escape of fuels, lubricants, or other operating fluids, which are needed to perform the normal
0012-PGS-00-1215 Page 7 of 11 O 2015 MedPro Group. All rights reserved.
electrical, hydraulic, or mechanical functions necessary for the operation of mobile equipment
or its parts, if such fuels, lubricants, or other operating fluids escape from a vehicle part designed
to hold, store, or receive them. This exception does not apply if the bodily injury, property
damage or medical expenses arises out of the intentional discharge, dispersal, or release of
fuels, lubricants, or other operating fluids or if such fuels, lubricants, or other operating fluids are
brought on or to the premises, site, or location with the intent that they be discharged, dispersed,
or released as part of the operations being performed by such insured, contractor, or
subcontractor;
b) bodily injury, property damage and medical expenses sustained within a building and caused
by the release of gases, fumes, or vapors from materials brought into the building in connection
with operations being performed by an insured, or on its behalf by a contractor or subcontractor;
or
c) bodily injury, property damage or medical expenses arising out of, or in connection with,
heat, smoke, or fumes from a fire that becomes uncontrollable or breaks out from where it was
intended to be.
(5) arising out of, or in connection with, any premises, site, or location on which any insured or any
contractors or subcontractors, working directly or indirectly on any insured's behalf, are performing
operations if such operations are to test for, monitor, clean up, remove, contain, treat, detoxify, or
neutralize, or in any other way respond to or assess the effects of, pollutants.
Subparagraphs (a)(1) and (a)(4) do not apply with respect to the application or storage of fertilizers,
fungicides, herbicides, or pesticides in the normal maintenance of an insured's location, but only if:
i. the storage and application of such fertilizers, fungicides, herbicides, or pesticides complies with all
applicable federal, state or local government laws;
ii. the insured meets all license or certification requirements under any federal, state or local laws in
order to perform the application of any such fertilizers, fungicides, herbicides, or pesticides;
iii. the fertilizers, fungicides, herbicides, or pesticides does not include mercury or any mercury
compounds; and
iv. the pollutants related to such fertilizers, fungicides, herbicides, or pesticides emanate from the
insured's location.
b. Any damages, loss, cost, or expense arising out of, or in connection with, any:
(1) request, demand, order, or statutory or regulatory requirement that any insured or others test for,
monitor, clean up, remove, contain, treat, detoxify, or neutralize , or in any way respond to or assess
the effects of, pollutants; or
(2) claim or potential claim by or on behalf of a governmental authority for damages because of testing
for, monitoring, cleaning up, removing, containing, treating, detoxifying, or neutralizing, or in any way
responding to or assessing the effects of pollutants.
However, this subparagraph does not apply to liability for damages because of property damage that an
insured would have in the absence of such request, demand, order, or statutory or regulatory requirement,
or such claim or potential claim by or on behalf of a governmental authority.
13. Recall Of Products, Work, Or Impaired Propertv
Any claim or potential claim arising out of, or in connection with, any loss, cost, or expense incurred by an
insured or others for the loss of use, withdrawal, recall, inspection, repair, replacement, adjustment, removal,
or disposal of:
a. the insured's product;
b. the insured's work; or
c. impaired property
if such product, work, or property is withdrawn or recalled from the market or from use due to a known or
suspected defect, deficiency, inadequacy, or dangerous condition to it.
0012-PGS-00-1215 Page 8 of 11 O 2015 MedPro Group. All rights reserved.
14. Silica
Any claim or potential claim arising out of, or in connection with, silica, including, but not limited to:
a. inhaling, ingesting or physical exposure to silica directly or through any goods, products, structures, real
estate or land containing silica;
b. the use or presence of silica in any process or operation of any type, including but not limited to
construction, manufacturing, sandblasting, cleaning, drilling, farming or mining;
c. the use or presence of silica in any good, product, structure, real estate or land, or any component part of
any good, product, structure, real estate or land; or
d. the manufacture, sale, transportation, handling, storage or disposal of silica or any goods, products,
structures, real estate or land containing silica;
e. any disease actually or allegedly caused by, contributed to or aggravated by silica, including but not limited
to silicosis, chronic silicosis, accelerated silicosis, acute silicosis, conglomerate silicosis, any auto-immune
disorder, tuberculosis, silicoproteinosis, cancer, scleroderma, emphysema, pneumoconiosis, pulmonary
fibrosis, progressive massive fibrosis, any lung disease or any other ailment actually or allegedly caused
by, contributed to or aggravated by silica;
f. any costs of inedical or other testing, monitoring or diagnosis arising out of, or in connection with, any
actual, alleged, threatened or feared bodily injury arising in whole or in part, directly or indirectly, out of
silica; or
g. any costs of investigations, feasibility studies, cleaning, removal or remediation of the actual or alleged
presence of silica in or on any goods, products structures, real estate or land.
As used in this exclusion, ��silica" means silica in any form and any of its derivatives, including but not limited
to silica dust, silicon dioxide (SiOz), crystalline silica, quartz, or non-crystalline (amorphous) silica.
The exclusions for "AIRCRAFT, AUTO OR WATERCRAFT," ��DAMAGE TO IMPAIRED PROPERTY OR PROPERTY NOT
PHYSICALLY INJURED," ��DAMAGE TO THE INSURED'S PRODUCT," ��DAMAGE TO THE INSURED'S WORK,"
��DAMAGE TO PROPERTY," ��LIQUOR LIABILIIY," "MOBILE EQUIPMENT," "POLLUTION," and ��RECALL OF
PRODUCTS, WORK, OR IMPAIRED PROPERTY" do not apply to damage by fire to premises while rented to an
insured or temporarily occupied by an insured with the permission of its owner. A separate limit of liability applies
to Damage to Premises Rented to an Insured as described in the Limits of Liability.
C. EXCLUSIONS APPLICABLE TO PERSONAL AND ADVERTISING INJURY LIABILITY INSURING CLAUSE
The coverage provided under the Personal and Advertising Injury Liability Insuring Clause does not apply to:
1. Breach Of Contract
Personal and advertising injury arising out of, or in connection with, a breach of contract, except an implied
contract to use another's advertising idea in an insured's advertisement.
2. Electronic Chatrooms Or Bulletin Boards
Personal and advertising injury arising out of, or in connection with, an electronic chatroom or bulletin
board an insured hosts, owns, or over which an insured exercises control.
3. Infringement Of Copyriaht, Patent, Trademark, Or Trade Secret
Personal and advertising injury arising out of, or in connection with, the infringement of copyright, patent,
trademark, trade secret, or other intellectual property rights. However, this exclusion shall not apply to the
infringement of copyright, trade, dress, or slogan in an insured's advertisement.
4. Insureds In Media And Internet Type Businesses
Personal and advertising injury committed by an insured whose business is:
a. advertising, broadcasting, publishing, or telecasting;
b. designing or determining content for the websites of others; or
c. an internet search, access, content, or service provider.
However, this exclusion does not apply to claims arising from false arrest, detention or imprisonment, malicious
0012-PGS-00-1215 Page 9 of 11 O 2015 MedPro Group. All rights reserved.
prosecution, or the wrongful eviction from, or wrongful entry into, or invasion of the private occupancy of a
room dwelling or premises occupied by, or on behalf of, its owner, landlord, or lessor.
For the purposes of this exclusion, the placing of frames, borders, or links, or advertising for an insured or
others is not considered, by itself, to be the business of advertising, broadcasting, publishing, or telecasting.
5. Knowing Violation Of Rights Of Others
Personal and advertising injury caused by, or at the direction of, an insured with the knowledge that the
act would violate the rights of another and would inflict personal and advertising injury.
6. Material Published Prior To Policy — Claims-Made and Reported Only
Only with respect to any Coverage Part shown on the Declarations as "Claims-Made and Reported," personal
and advertising injury arising out of, or in connection with, oral or written publication of material whose first
publication took place before the applicable retroactive date shown on the Declarations.
7. Material Published Prior To Policy — Occurrence Onlx
Only with respect to any Coverage Part shown on the Declarations as "Occurrence," personal and advertising
injury arising out of, or in connection with, oral or written publication of material whose first publication took
prior to the policy period.
8. Material Published With Knowledge Of Falsitv
Personal and advertising injury arising out of, or in connection with, oral or written publication of material
if done by, or at the direction of, an insured with knowledge of its falsity.
9. Quality Or Performance Of Goods — Failure To Conform To Statements
Personal and advertising injury arising out of, or in connection with, the failure of goods, products, or
services to conform to any statement of quality or performance in an insured's advertisement.
10. Unauthorized Use Of Another's Name Or Product
Personal and advertising injury arising out of, or in connection with, the unauthorized use of another's
name or product in an insured's email address, domain name, or metatag, or other similar tactics to mislead
another's potential customers.
11. Wrong Description Of Prices
Personal and advertising injury arising out of, or in connection with, the wrong description of the price of
the goods, products, or services in an insured's advertisement.
D. EXCLUSIONS APPLICABLE TO MEDICAL PAYMENTS INSURING CLAUSE
1. Medical Expenses
The coverage provided under Medical Payments Insuring Clause does not apply to medical expenses arising
out of, or in connection with, bodily injury:
a. to an insured, except volunteers;
b. to a person hired to do work for, or on behalf of, an insured or tenant of an insured;
c. to a person injured on that part of a premises owned or rented by an insured that the injured person
normally occupies;
d. to any person, whether or not an employee, who is eligible for benefits under a workers' compensation,
occupational disease, disabiliry benefits, or similar law;
e. to a person injured while practicing, instructing or participating in any physical exercises or games, sports,
or athletic contests;
f. covered as a products completed operations hazard; or
g. to any inmate, patient, or prisoner, who is being treated, cared for, detained, or imprisoned by any insured
or in any premises of any insured.
0012-PGS-00-1215 Page 10 of 11 O 2015 MedPro Group. All rights reserved.
III.LIMITS OF LIABILITY
A. GENERAL RESTRICTIONS
The Limits of Liability shown on the Declarations is the most the company will pay regardless of the number of:
1. insureds;
2. claims made or potential claims first discovered; or
3. persons or organizations making claims or potential claims.
B. GENERAL AGGREGATE LIMIT
The General Aggregate Limit shown on the Declarations is the most the company will pay for loss, claims
expense, if shown on the Declarations as "Defense Within Limits," and medical expenses under this Coverage
Part except for loss and claims expense included in the products completed operations hazard.
C. PRODUCTS COMPLETED OPERATIONS HAZARD AGGREGATE LIMIT
The Products Completed Operations Hazard Aggregate Limit shown on the Declarations is the most the company
will pay under the Bodily Injury and Property Damage Liability Insuring Clause for loss and claims expense, if
shown on the Declarations as "Defense Within Limits," because of bodily injury and property damage included
in the products completed operations hazard.
D. PERSONAL AND ADVERTISING INJURY LIABILITY LIMIT
Subject to subparagraph B. above, the Personal and Advertising Injury Liability Limit shown on the Declarations is
the most the company will pay for loss and claims expense, if shown on the Declarations as "Defense Within
Limits," under the Personal and Advertising Injury Liability Insuring Clause because of personal and advertising
injury sustained by any one person or organization.
E. PER EVENT LIMIT
Subject to subparagraphs B. or C. above, whichever applies, the Per Event Limit shown on the Declarations is the
most the company will pay for:
1. loss and claims expense, if shown on the Declarations as ��Defense Within Limits," under the Bodily Injury
and Property Damage Liability Insuring Clause; and
2. medical expenses under the Medical Payments Insuring Clause;
because of all bodily injury and property damage arising out of any one event.
F. DAMAGE TO PREMISES RENTED TO AN INSURED LIMIT
Subject to subparagraph E. above, the Damage to Premises Rented to an Insured Limit shown on the Declarations
is the most the company will pay under the Bodily Injury and Property Damage Liability Insuring Clause for loss
or claims expense, if shown on the Declarations as ��Defense Within Limits," because of property damage to
any one premises, while rented to a named insured or temporarily occupied by a named insured with permission
of the owner.
G. MEDICAL EXPENSE LIMIT
Subject to subparagraph E. above, the Medical Expense Limit shown on the Declarations is the most the company
will pay under the Medical Payments Insuring Clause for medical expenses because of bodily injury sustained
by any one person.
0012-PGS-00-1215 Page 11 of 11 O 2015 MedPro Group. All rights reserved.
This page has been left blank intentionally.
�� MedProGroup
' _ a l:rik,hirr }I�elhru.ru �uurprun�
Issuing Company:
National Fire & Marine Insurance Company
Omaha, Nebraska
THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY,
Endorsement No.:
Forming Part of Policy No.: NSC100918
ISSU@d t0: Clearfork Tradition, LP
Effective Date of Endorsement: at 12:01 a.m. at the address of the First Named Insured stated herein.
BLANKET ADDITIONAL INSURED — MORTGAGEES, PREMISES LESSORS AND EQUIPMENT
LESSORS ENDORSEMENT (GENERAL LIABILITY)
Only with respect to coverage provided under this endorsement and under the General Liability Coverage Part, and in
consideration of the payment of the additional premium due, if any, and in reliance upon the representations of all insureds,
the company and the insureds agree to amend the policy as follows:
The definition of additional insured in the Definitions section of the Common Policy Provisions and Conditions is deleted
and replaced with the following:
Additional insured means a mortgagee, premises lessor or equipment lessor named in a claim or potential
claim that arises from an event, offense or accident that results from the acts or omissions of an insured with respect
to the ownership, maintenance, operation or use of premises or equipment mortgaged or leased to a named insured
that took place during the term of the mortgage or lease for those premises or equipment. However, such mortgagee,
premises lessor or equipment lessor is not an additional insured with respect to losses arising from, or in
connection with, any acts or omissions alleged to have been committed by that mortgagee, premises lessor or
equipment lessor.
The following definition is added to the Definitions section of the Common Policy Provisions and Conditions:
Mortgagee, premises lessor or equipment lessor means any person or organization who provides premises and/or
equipment to an organization that is a named insured pursuant to a written mortgage or lease agreement during the
policy period.
The following subparagraph is added to all Insuring Clauses of the General Liability Coverage Part:
The company's duty to defend and pay losses or claims expense on behalf of any insured shall extend to any
additional insured meeting the terms and conditions of this policy, but only with respect to any loss or claims
expense payable as the result of the additional insured's vicarious liability for the acts or omissions of an insured
otherwise covered under this Coverage Part.
However, the coverage provided to an additional insured shall not be broader than that which an insured is required
by written contract or agreement to provide to that additional insured. Additionally, coverage shall not apply to
structural alterations, new construction or demolition operations performed by or on behalf of an additional insured.
The following provision is added to the Limits of Liability section of the General Liability Coverage Part:
1508-PGX-00-1215 Page 1 of 2 O 2015 MedPro Group. All rights reserved.
ADDITIONAL INSUREDS
All additional insureds share the Limits of Liability applicable to any claim with any insured for which the additional
insured is alleged to be vicariously liable with respect to that same claim.
All other terms and conditions of the policy remain unchanged.
1508-PGX-00-1215 Page 2 of 2 O 2015 MedPro Group. All rights reserved.
�' Issuing Company:
�� MedPro Group National Fire & Marine Insurance Company
� u��k,%�r�f!«�,�u�ay�o„=n��y Omaha, Nebraska
SENIOR CARE LIABILITY POLICY
COMMON POLICY PROVISIONS AND CONDITIONS
NOTICE:
This policy may contain claims-made and reported coverage. Please read this policy carefully.
In consideration of the payment of the premium due, and in reliance upon the representations of all insureds, the company
and all insureds agree as follows, subject to the terms and conditions of this policy, including the applicable Limits of Liabiliry:
I.
These definitions apply to all Coverage Parts:
A. Additional insured means any person or organization listed on a Schedule of Additional Insureds.
B. Advertisement means a notice that is broadcast or published to the general public or specific market segments
about any named insured's goods, products, or services for the purpose of attracting customers or supporters. For
the purposes of this definition:
1. notices that are published include material placed on the internet or on similar electronic means of
communication; and
2. regarding websites, only that part of a website that is about any named insured's goods, products, or services
for the purposes of attracting customers or supporters is considered an advertisement.
C. Authorized insured means any insured authorized by the first named insured to give notice of a claim or
potential claim to the company.
D. Automobile or auto means:
1. any land motor vehicle, trailer or semi-trailer, including any attached machinery and equipment, designed for use
on public roads; or
2. any other land vehicle that is subject to a compulsory or financial responsibility law or other motor vehicle
insurance law in the state where it is licensed or principally garaged.
However, automobile or auto does not include mobile equipment.
E. Bodily injury means any damage to the human body, including sickness or disease and any mental injury, shock,
emotional distress, or death arising therefrom. In addition, it includes damages claimed for the cost of any care, loss
of services, or loss of consortium arising therefrom.
F. Case management means identifying patients with specific health care needs and developing a plan to ensure an
efficient use of resources to achieve the best outcome.
G. Claim means an express, written demand upon an insured for money or services as compensation for damages,
including a suit. As used in this definition, ��suit" means a civil proceeding in which damages to which this insurance
applies are alleged. Suit also includes an arbitration or other alternative dispute resolution proceeding in which such
damages are claimed and to which an insured must submit or does submit with the company's consent. However,
this definition does not apply to coverage provided under the Cyber Liability and Breach Response Coverage Part.
H. Claims expense means all costs and expenses incurred in connection with the investigation, adjustment, and
defense of any claim or potential claim. Such costs and expenses:
1. shall only include:
a. attorneys' fees paid to the law firm selected to defend an insured;
0010-PXS-00-1215 Page 1 of 19 O 2015 MedPro Group. All rights reserved.
b. court costs;
c. expert fees;
d. reporter fees;
e. the cost of any alternative dispute resolution ordered by a court, otherwise required by law, or pre-approved
by the company;
f. post-judgment interest on that portion of the judgment that does not exceed the Limit of Liability available
under the particular coverage provided; and
g. such other costs and expenses that the company determines to be reasonably related to the defense of a
claim or potential claim.
2. shall not include:
a. loss;
b. attorneys' fees awarded to a claimant;
c. the salary of any employee of an insured; or
d. the forgiveness of any amounts owed for the cost of care or services rendered by an insured.
However, this definition does not apply to coverage provided under the Cyber Liability and Breach Response Coverage
Part.
I. Company means the Issuing Company shown on the Declarations.
J. Employee means any person who receives a W-2 or 1099 IRS tax form from any named insured that is an
organization, and who was acting within the scope of his or her duties on behalf of that named insured at the time
of the event, offense, health care event or any other act or omission that results in a claim or potential claim
that is otherwise covered under this policy. Employee also includes any leased worker, temporary worker or
volunteer so long as such person is or was acting within the scope of his or her duties on behalf of a named insured
that is an organization.
As used in this definition:
1. "leased worker" means a person leased to, or used by, a named insured that is an organization through a labor
leasing firm or a locum tenens or staffing organization under an agreement between a named insured and the
labor leasing firm, or locum tenens or staffing organization, to perform duties related to the conduct of that
named insured's business. Leased worker does not include a temporary worker;
2. ��temporary worker" means a person who is furnished to a named insured that is an organization to substitute
for a permanent employee on leave or to meet seasonal or short-term workload conditions. A temporary worker
does not include a leased worker; and
3. ��volunteer" means a person who provides his or her services or labor to a named insured that is an
organization, without being paid by that named insured, under the supervision or direction of the named
insured. Volunteer does not include any independent contractor or staff physician.
However, only with respect to the coverage provided under the Professional Liability Coverage Part, employee does
not mean any physician, surgeon, podiatrist, chiropractor, dentist, certified registered nurse anesthetist, midwife,
resident or intern.
Additionally, this definition does not apply to coverage provided under the Cyber Liability and Breach Response
Coverage Part.
K. Event means an accident. All injuries arising out of, or in connection with:
1. the same or related acts or omissions; or
2. the continuous or repeated exposure to substantially the same harmful conditions;
will be considered one event. For the purposes of this definition, all injuries to a mother and fetus (or fetuses) from
conception through delivery shall constitute one event.
L. E�ctended reporting period means the period of time after the cancellation or nonrenewal of any Coverage Part
shown on the Declarations or any endorsement as ��Claims-Made and Reported" during which an insured may report
0010-PXS-00-1215 Page 2 of 19 O 2015 MedPro Group. All rights reserved.
a claim or potential claim.
M. First named insured means the person or organization shown as the First Named Insured on the Declarations.
N. Health care event means any event in the rendering of, or failure to render, professional services that results in
injury. All injuries arising out of, or in connection with, the same or related acts or omissions in furnishing
professional services shall be considered one health care event.
O. Impaired property means tangible property, other than the insured's product or the insured's work, which
cannot be used or becomes less useful because:
1. it incorporates the insured's product or insured's work that is known or thought to be defective, deficient,
inadequate, or dangerous; or
2. an insured has failed to fulfill the terms of a contract or agreement if such property can be restored to use by:
a. the repair, replacement, adjustment, or removal of the insured's product or insured's work; or
b. an insured's fulfillment of the terms of the contract.
P. Insured means:
1. the first named insured;
2. any named insured;
3. any employee;
4. any administrator, partner, superintendent, director, officer, member, trustee, stockholder, medical director,
department head or head of the medical staff, student, board or committee member or staff member, but only to
the extent that he or she is acting within the scope of his or her duties on behalf of any named insured. As used
to define insured, student means an unlicensed person, other than a resident, enrolled in a licensed or accredited
training program operated by any named insured that is an organization relative to the delivery of professional
services;
5. any spouse or domestic partner of any individual insured, but only with respect to the conduct of the business of
a named insured that is an organization. As used in this definition, "domestic partner" means any person
qualifying as such under any federal, state or local laws or under a named insured's employee benefit plans or
employee benefits program;
6. any organization formed or acquired by a named insured that is an organization during the policy period, over
which that named insured maintains at least majority ownership; however, coverage under this subparagraph is
afforded only:
a. after the company has received an application, and has agreed in writing to add the newly formed or
acquired organization to the policy as an insured;
b. for a loss, event, offense, health care event, bodily injury, property damage or personal and
advertising injury or other claim or potential claim otherwise covered by this policy that occurred after
the organization was formed or acquired by the named insured; and
c. unless otherwise stated on a Schedule of Named Insureds, the newly formed or acquired organization will
share Limits of Liability with the named insured that formed or acquired that newly formed or acquired
organization;
7. the estate, heirs, executors, administrators, assigns and legal representatives of an insured in the event of such
insured's death, incapacity, insolvency or bankruptcy, but only to the extent that such insured would have been
provided coverage under this policy; or
8. any organization, or any person other than an employee, while acting as a named insured's real estate
manager.
Q. Insured contract means:
1. a contract for a lease of premises, except for that portion of the contract for a lease of premises that indemnifies
any person or organization for damage by fire to premises while rented to an insured or temporarily occupied by
an insured with permission of the owner;
2. an agreement between a railroad and an insured under which the insured will hold the railroad harmless for
0010-PXS-00-1215 Page 3 of 19 O 2015 MedPro Group. All rights reserved.
certain liability arising out of the use of a sidetrack;
3. any easement or license agreement, except in connection with construction or demolition operations on, or within
50 feet of, a railroad;
4. an obligation, as required by ordinance, law or regulation, to indemnify a municipality, except in connection with
work for a municipality; or
5. any agreement to maintain an elevator;
6. any provision in any other contract or agreement pertaining to an insured's business (including an
indemnification of a municipality in connection with work performed for a municipality) under which an insured
assumes the tort liability of another party to pay for bodily injury or property damage to a third person or
organization. As used in this definition, "tort liability" means a liability that would be imposed by law in the
absence of any contract or agreement. This does not include any provision:
a. that indemnifies a railroad for bodily injury or property damage arising out of construction or demolition
operations within 50 feet of any railroad property and affecting any railroad bridge or trestle, tracks,
roadbeds, tunnel, underpass or crossing;
b. that indemnifies an architect, engineer or surveyor for injury or damage arising out of:
(1) preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys,
field orders, change orders or drawings and specifications; or
(2) giving directions or instructions, or failing to give them, if that is the primary cause of the injury or
damage; or
c. under which the insured, if an architect, engineer or surveyor, assumes liability for an injury or damage
arising out of the insured's rendering or failure to render professional services, including those listed in b.
above and supervisory, inspection, architectural or engineering activities.
R. Insured's product
1. means:
a. any goods or products, other than real property, manufactured, sold, handled, distributed, or disposed of by:
(1) a named insured;
(2) others trading under a named insured's name; or
(3) a person or organization whose business or assets a named insured has acquired.
b. containers (other than vehicles), materials, parts, or equipment furnished in connection with such goods or
products.
2. includes:
a. warranties or representations made at any time with regard to the fitness, quality, durability, performance, or
use of the goods or the insured's products; or
b. the providing of, or the failure to provide, warnings or instructions.
3. does not include:
a. vending machines; or
b. other property rented to, or located for, the use of others, but not sold to others by a named insured.
S. Insured's work
1. means:
a. work or operations performed by, or on behalf of, a named insured; or
b. materials, parts, or equipment furnished in connection with such work or operations.
2. includes:
a. warranties or representations made at any time with regard to the fitness, quality, durability, performance, or
use of the work or operations; or
0010-PXS-00-1215 Page 4 of 19 O 2015 MedPro Group. All rights reserved.
b. the providing of, or the failure to provide, warnings or instructions.
T. Loading or unloading means the handling of property:
1. after it is moved from the place where it is accepted for movement into or onto an aircraft, watercraft, or auto;
2. while it is in or on an aircraft, watercraft, or auto; or
3. while it is being moved from an aircraft, watercraft, or auto to the place where it is finally delivered.
It does not include the movement of property by means of a mechanical device, other than a hand truck, which is not
attached to the aircraft, watercraft, or auto.
U. Location means premises involving the same or connecting lots, or premises whose connection is interrupted only by
a street, roadway, waterway or right-of-way of a railroad.
V. Loss
1. Means civil damages, including prejudgment interest, which an insured becomes legally obligated to pay through
adjudication or settlement.
2. Does not include:
a. any damages that are greater than any applicable Limit of Liability;
b. any injunctive or other equitable relief;
c. claims expense;
d. attorneys' fees awarded to a claimant as a fine, penalry, or sanction based upon any insured's misconduct;
however, attorneys' fees awarded as a part of the claimant's damages in a covered claim for any other
purpose will be included as loss;
e. the salary of any employee; or
f. the forgiveness of any amounts owed for the cost of care or services rendered by an insured.
W. Managed care services means services provided to manage and/or administer a health care plan. As used in this
definition ��health care plan" means a medical benefits plan administered by a health maintenance organization,
preferred provider organization, or other similar organization which provides, or arranges to provide, healthcare
services to members under a written contract or agreement. These services can include any of the following acts
provided on behalf of the health care plan:
1. the creation, sale, and marketing of a health care plan;
2. the selection, credentialing, and contracting of health care providers;
3. the evaluation of the cost, quality and proper utilization of treatment options available or being provided to
participants;
4. the adjustment, investigation, and processing of claims for benefits; or
5. case management.
However, managed care services do not include treatment rendered, or which should have been rendered, to a
patient.
X. Medical expenses means the reasonable cost of necessary:
1. first aid administered at the time of the accident;
2. medical, surgical, diagnostic, and dental services;
3. prosthetic devices; and
4. ambulance, hospital, professional nursing, and funeral services.
Y. Mobile equipment
1. Means any of the following types of land vehicles, including any attached machinery or equipment:
a. bulldozers, farm machinery, forklifts, and other vehicles designed for use principally off public roads;
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b. vehicles maintained for use only on, or next to, premises owned or rented by a named insured;
c. vehicles that travel on crawler treads;
d. vehicles, whether self-propelled or not, maintained primarily to provide mobility to permanently mounted:
(1) power cranes, shovels, loaders, diggers, or drills; or
(2) road construction or resurfacing equipment, such as graders, scrapers, or rollers;
e. vehicles not described in subparagraphs 1.a, b, c, or d above, that are not self-propelled and are maintained
primarily to provide mobility to permanently attached equipment of the following types:
(1) air compressors, pumps, and generators, including spraying welding, building cleaning, geophysical
exploration, lighting, and well-servicing equipment; or
(2) cherry pickers and similar devices used to raise or lower workers; or
f. vehicles not described in subparagraphs i.a, b, c, or d above, maintained primarily for purposes other than
the transportation of persons or cargo.
2. Does not include self-propelled vehicles with the following types of permanently attached equipment, but will be
considered autos:
a. equipment designed primarily for:
(1) snow removal,
(2) road maintenance (but not construction or resurfacing); or
(3) street cleaning;
b. cherry pickers and similar devices mounted on car or truck chassis and used to raise or lower workers; and
c. air compressors, pumps, and generators, including spraying, welding, building cleaning, geophysical
exploration, lighting, and well-servicing equipment.
3. Does not include land vehicles that are subject to a compulsory or financial responsibility law or other motor
vehicle insurance law in the state where it is licensed or principally garaged. Land vehicles subject to a compulsory
or financial responsibiliry law or other motor vehicle insurance law are considered autos.
Z. Named insured means any of the following, but only if listed by name on a Schedule of Named Insureds:
1. any organization, including any corporations, partnerships or joint ventures;
2. any individual person, but only to the extent that such person was acting in the course and scope of his or her
duties of employment with the first named insured or another named insured; or
3. a location.
AA. Personal and advertising injury means injury, including consequential bodily injury, arising from one or more of
the following offenses:
1. false arrest, detention, or imprisonment;
2. malicious prosecution;
3. the wrongful eviction from, wrongful entry into, or invasion of the right of private occupancy of a room, dwelling,
or premises that a person occupies, committed by or on behalf of its owner, landlord, or lessor;
4. oral or written publication, in any manner, of material that slanders or libels a person or organization or
disparages a person's or organization's goods, products, or services;
5. oral or written publication, in any manner, of material that violates a person's right of privacy; or the use of
another's advertising idea in the insured's advertisement.
BB. Pollutants means any solid, liquid, gaseous, fuel, lubricant, thermal, acoustic, electrical, or magnetic irritant or
contaminant, including but not limited to smoke, vapor, soot, fumes, fibers, radiation, acid, alkalis, petroleum,
chemicals or waste. As used in this definition, "waste" means medical waste, biological infectants, and all other
materials to be disposed of, recycled, stored, reconditioned or reclaimed.
CC. Policy period means the period of time shown on the Declarations as the Policy Period. However, if the policy is
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terminated before the later of the dates shown on the Declarations, policy period means the period between the first
date shown on the Declarations and the date the policy was terminated.
DD. Potential claim means an event, including an incident arising from, or in connection with, that event, which an
insured knows or reasonably should know is likely to result in a claim.
EE. Products completed operations hazard
1. Means all bodily injury and property damage occurring away from any premises an insured owns or rents,
and arising out of the insured's product or insured's work except:
a. products that are still in the physical possession of an insured; or
b. work that has not yet been completed or has been abandoned. However, the insured's work will be
deemed completed at the earliest of the following times:
(1) when all of the work called for in the insured's contract has been completed;
(2) when all of the work to be done at the job site has been completed if the contract calls for work at more
than one job site; or
(3) when that part of the work at a job site has been put to its intended use by any person or organization
other than another contractor or subcontractor working on the same project.
Work that may need service, maintenance, correction, repair, or replacement, but which is otherwise
complete, will be deemed completed.
2. Does not include bodily injury or property damage arising out of, or in connection with:
a. the transportation of property, unless the injury or damage arises out of a condition in or on a vehicle not
owned or operated by an insured and that condition was created by the loading or unloading of the
vehicle by an insured;
b. the existence of tools, uninstalled equipment, or abandoned or unused materials; or
c. products or operations for which the classification, shown on the Declarations or in a policy schedule, states
that products completed operations hazard is subject to the General Aggregate Limit.
FF. Professional services means treatment, administrative services, beautician's and barber's services, pastoral
counseling services, peer review and utilization management not involving managed care services. As used in this
definition:
1. ��administrative services" means the planning, organizing, controlling or directing of the operations of an insured;
2. "beautician's and barber's services" means the provision of grooming services to a resident by a licensed
beautician or barber in his or her capacity as such, who is not employed by the insured, but who is invited to
perform such services by the insured at a location operated by an insured;
3. ��pastoral counseling services" means the provision of advice, guidance or other counseling sessions, without
compensation, by an ordained member of the clergy;
4. ��peer review" means the evaluation of a health care provider's fitness and qualification to provide treatment by a
professional review board or committee through formally adopted, written procedures for the purposes of
granting, determining or revoking clinical staff privileges at a hospital, clinic or other medical facility that is a
named insured, and which results in a patient alleging damages arising from a health care event; and
5. ��utilization management" means the process of evaluating treatment to a patient for its appropriateness or
necessity which results in a patient alleging damages arising from a health care event. In clarification and not in
limitation of the foregoing, utilization management will include prospective review of proposed treatment,
concurrent review of treatment, retrospective review of already rendered treatment, disease management,
case management, and the use of predictive modeling to identify individuals or populations for disease
management or case management.
GG. Property damage means:
1. physical injury to tangible property, including any resulting loss of use of that property. All such loss of use shall
be deemed to occur at the time of the physical injury that caused it; or
2. loss of use of tangible property that is not physically injured. All such loss of use shall be deemed to occur at the
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time of the event that caused it.
However, this definition does not apply to coverage provided under the Cyber Liability and Breach Response Coverage
Part.
HH. Resident means a person who lives or resides at a long-term care facility or other residential healthcare faciliry listed
by name on a Schedule of Named Insureds.
II. Residents' rights means any right granted to a resident under the Nursing Home Quality Reform Act of 1987, any
federal regulations promulgated pursuant to such law, including 42 C.F.R. 483.10, or any similar state law or
regulation regulating long-term care facilities or residential healthcare facilities.
JJ. Superbug contamination means the actual contamination of an insured's location with methicillin-resistant
staphylococcus aureus, vancomycin intermediate sensitive staphylococcus aureus or vancomycin-resistant
enterococcus. Superbug contamination does not include any contamination as a result of pollutants, war, an act
of terrorism or a certified act of terrorism.
KK. Treatment means:
1. medical, surgical, dental, mental health, or nursing services, including those rendered in connection with a clinical
trial. This shall also include first aid rendered at the scene of an accident without expectation of monetary
compensation, unless such accident occurred on the premises;
2. the provision of inedical examinations, opinions, or consultations regarding a person's medical condition within an
insured's practice as a licensed health care provider;
3. the provision of home health, hospice, rehabilitation or social services and adult day care and home-based
community operations, including a Program of All-inclusive Care for the Elderly (PACE), or any services related to
the provision, or protection of residents' rights, provided such insured is licensed, trained and qualified to
perform such services in the jurisdiction in which such professional services were rendered.
4. postmortem handling of bodies, including autopsies, organ donation or harvesting or other procedures; or
5. the furnishing of any of the following, but only as it relates to the rendering of inedical, surgical, dental, or nursing
services:
a. food and beverages;
b. blood, blood products, medications, supplies, equipment, or appliances; or
c. counseling or other social services.
As used in this definition, ��clinical trial" means a structured study with predetermined protocols approved by an
institutional review board, an independent ethics committee, an ethical review board or a research ethics board which
has been formally designated to approve, monitor, and review research involving humans in order to develop
effectiveness or safety data or treatment plans, pharmaceutical products or medical devices.
II. DEFENSE AND SUPPLEMENTAL PAYMENTS
These provisions apply to all Coverage Parts:
A. DEFENSE
The company will have the exclusive right and duty to defend any claim or potential claim against an insured to
which this policy applies, subject to the timely payment of any applicable Deductible or Self-Insured Retention.
However, the company has no duty to:
1. defend an insured until any applicable Self-Insured Retention has been exhausted by the payment of loss or
claims expense;
2. defend an insured after the applicable Limits of Liabiliry have been exhausted by the payment of loss or claims
expense;
3. appeal any judgment; however, the company may appeal any judgment as it deems expedient; or
4. pay any claims expense incurred by an attorney not retained or approved by the company, in writing, to
represent the insured.
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Upon the exhaustion of the applicable Limit of Liability provided under this policy, the insured shall become
responsible for all further claims expense arising from any claim or potential claim and the company has the
right to withdraw from the further defense of such claim or potential claim by tendering such defense to the
insured. If the insured cannot come to an agreement with the attorney assigned by the company regarding the
payment of future fees and costs, the insured shall take all steps necessary to allow the attorney to withdraw from
the matter.
B. SUPPLEMENTAL PAYMENTS
The company shall also pay, in addition to the Limits of Liability:
1. the premium on any bond required to proceed with an appeal approved by the company or to release
attachments to an insured's property; however, the face value of the bond may not exceed the applicable Limit
of Liabiliry or the total loss payable under the policy, whichever is less; in addition, the company has no duty to
apply for or furnish any such bond; and
2. reimbursement of reasonable expenses incurred by an insured at the company's request to assist in the
investigation and defense of a claim or potential claim; payment for actual loss of earnings shall not exceed
$500 for each day an individual insured is required to attend hearings, trials, or an insured's own deposition.
C. DEFENSE OUTSIDE THE LIMITS/WITHIN THE LIMITS SHOWN ON DECLARATIONS
The company's dury to defend shall also include a dury to pay claims expenses either:
1. in addition to the applicable Limits of Liability such that payment of claims expenses and other supplemental
payments will not reduce or exhaust the applicable Limits of Liability, if shown on the Declarations as "Defense
Outside Limits;" or
2. as part of the applicable Limits of Liability such that payment of claims expenses and other supplemental
payments reduce and can exhaust the applicable Limits of Liability, if shown on the Declarations as ��Defense
Within Limits."
III. EXCLUSIONS
The coverage provided under any Coverage Part of this policy does not apply to:
A. ADA
Any claim or potential claim arising out of, or in connection with, an insured's duty to comply with the Americans
with Disabilities Act of 1990 (ADA). This also includes any amendment or regulation that applies thereto or any
comparable federal, state, or local law. This exclusion does not apply to any such claim or potential claim that is
based on an insured's alleged negligence in the rendering of or failure to render professional services.
B. ANTITRUST
Any claim or potential claim arising out of, or in connection with, an insured's antitrust activity, except to the
extent such claim or potential claim arises out of any insured's alleged rendering of, or failure to render,
professional services. As used in this exclusion, "antitrust activity" means any actual or alleged price fixing, restraint
of trade, price discrimination, predatory pricing, monopolization, unfair business practices, or violation of common law
or the Federal Trade Commission Act of 1914, the Sherman Antitrust Act of 1890, the Clayton Act of 1914, any similar
federal, state, or local antitrust statute or law, or any rule or regulation promulgated under the Act, statute, or law.
C. BUSINESS PRACTICES
Any claim or potential claim arising out of, or in connection with, an insured's billing practices or advertising
activities. However, this exclusion does not apply to the coverage provided under the Personal and Advertising Injury
Liability Insuring Clause.
D. CLAIM OR POTENTIAL CLAIM REPORTED OR DISCOVERED PRIOR TO THE POLICY PERIOD
Only with respect to any Coverage Part shown on the Declarations as "Claims-Made and Reported":
1, any claim or potential claim which has or which should have been reported to any insurer, including through
any self-insured or captive program, prior to the policy period; and
2, any potential claim that was first known about or discovered, or should reasonably have been known about or
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discovered by, an authorized insured prior to the policy period.
E. CRIMINAL ACTS
Any claim or potential claim arising out of, or in connection with, any criminal act committed by, or at the direction
of, the insured.
F. DEFAULT JUDGMENT AND FAILURE TO COOPERATE
Any claim or potential claim that the company was unable to timely investigate or defend due to the acts or
omissions of any insured, including any resulting damages from a default judgment.
G. DISCRIMINATION
Any claim or potential claim arising out of, or in connection with, the violation of any statute, law, ordinance or
regulation prohibiting discrimination or humiliation because of race, creed, color, national origin, religion, age, gender
or any other protected class as defined by statute, law, ordinance or regulation.
H. ECONOMIC SANCTIONS EXCLUSION
Whenever coverage provided by this policy would be in violation of any U.S. economic trade sanctions such as, but not
limited to, those sanctions administered and enforced by the U.S. Treasury Department's Office of Foreign Assets
Control, such coverage shall be null and void. Similarly, any coverage relating to or referred to in any certificates or
other evidences of insurance or any claim or potential claim that would be in violation of U.S. economic or trade
sanctions as described above shall also be null and void.
I. EMPLOYEE BENEFITS LIABILITY
Any claim or potential claim arising out of, or in connection with, any group benefits administered on behalf of a
named insured's employees, including:
1. group insurance plans or programs, such as life, health, accident, dental, or legal advice;
2. individual retirement accounts, salary reduction plans under I.R.S. Code 401(k), or any amendment thereto,
savings plans, or employee stock subscription plans;
3. travel or vacation plans; or
4, workers' compensation, occupational disease, unemployment, Social Security, or disability benefits insurance.
J. EMPLOYER'S LIABILITY
Any claim or potential claim arising out of, or in connection with, bodily injury to:
1. an employee of a named insured arising out of, or in connection with, and in the course of:
a. employment by that named insured; or
b. performing duties related to the conduct of that named insured's business; or
2. the spouse, child, parent, brother, or sister of that employee as a consequence of subparagraph 1 above.
This exclusion shall apply whether a named insured may be held liable as an employer, or in any other capaciry, and
to any obligation to share damages with, or repay someone else who must pay damages, because of the injury. This
exclusion does not apply to liability assumed by an insured under an insured contract.
K. EMPLOYMENT PRACTICES
Any claim or potential claim brought by an employee, or applicant for employment, which alleges an insured:
1. breached an actual or implied contract of employment;
2. violated an anti-discrimination statute;
3. engaged in any form of harassment;
4. engaged in libel or slander related to an employment relationship;
5. retaliated for the exercise of a public right or duty;
6. engaged in intentional or negligent infliction of emotional distress arising out of, or in connection with, an
employment relationship;
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7. wrongfully failed to hire, promote, or grant tenure;
8. wrongfully demoted; or
9. wrongfully terminated employment.
L. ERISA
Any claim or potential claim seeking to impose liability under the Employee Retirement Income Security Act of 1974
(ERISA), or any amendment or regulation that applies thereto.
M. FRAUDULENT CLAIMS
Any claim or potential claim made by an insured who knows that the claim or potential claim is false or
fraudulent, as regards to amount or otherwise; additionally, this policy shall become void and all claims and
potential claims hereunder shall be forfeited.
N. GOVERNMENTAL IMMUNITY AND OTHER PROTECTIONS
Any claim or potential claim for which an insured has:
1. immunity as a volunteer or as an employee or contractor of a federal, state, or local government; or
2. immunity, insurance, indemnity, or any other protection pursuant to any federal, state, or local laws, including but
not limited to the Federal Tort Claims Act.
O. INJUNCTIVE RELIEF, TAXES, FINES AND PENALTIES
Any claim or potential claim or other matter seeking:
1. injunctive relief;
2. any relief other than loss; or
3. the award of taxes, fines, penalties, or sanctions.
P. INSURED VERSUS INSURED
Any claim or potential claim initiated, alleged, or caused to be brought about, by any insured covered by this
policy against any other insured covered by this policy. This exclusion does not apply if the claim or potential
claim arises out of an insured providing professional services to another insured.
Q. MANAGED CARE SERVICES
Any claim or potential claim arising out of, or in connection with, any managed care services.
R. MEDICARE OR MEDICAID
Any claim or potential claim arising out of, or in connection with, any Medicare/Medicaid Claim. As used in this
exclusion, a��Medicare/Medicaid Claim" means a claim based on or arising out of, or in connection with, any actual or
alleged violation of law, regulation or rule with respect to Medicare, Medicaid, Tricare or any similar federal, state or
local governmental program.
S. MULTI-POLICY AND ANTI-STACKING
If more than one policy, Coverage Part or Insuring Clause applies, the following multi-policy and anti-stacking
exclusions apply:
1. if more than one policy issued by the company or by a past, present or future parent, subsidiary or affiliate
applies to the liability of an insured, the company's duty to pay for a loss will be confined to the policy
containing the largest applicable Limit of Liability; or
2. if more than one Coverage Part or Insuring Clause under this policy applies to the liability of an insured, the
company's duty to pay loss will be confined to the Coverage Part or Insuring Clause containing the largest
applicable Limit of Liability.
T. NUCLEAR ENERGY LIABILITY
Any claim or potential claim:
1. for which an insured has coverage under a nuclear energy liability policy issued by the:
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a. Nuclear Energy Liability Insurance Association;
b. Mutual Atomic Energy Liability Underwriters;
c. Nuclear Insurance Association of Canada; or
d. any successor or assign of the entities set forth in the subparagraphs above.
This policy also does not apply if such coverage did exist, but was terminated by the exhaustion of the insured's
limit of liability.
2. resulting from the hazardous properties of nuclear material for which an insured:
a. was required to maintain financial protection under the Atomic Energy Act of 1954 or any amendment or
regulation that applies thereto; or
b. was entitled to indemnity by the United States government or any agency thereof or would have been entitled
to had this policy not been issued.
U. OWNERSHIP OR MANAGEMENT OF NON-INSURED ENTITIES
Any claim or potential claim arising out of, or in connection with, the acts or omissions of any organization,
partnership, joint venture, or other business enterprise that is not a named insured, but which is owned, managed
or supervised by an insured. However, this exclusion does not apply to an organization defined as an insured.
V. RICO
Any claim or potential claim arising out of, or in connection with, an insured's violation of the Racketeer
Influenced Corrupt Organizations Act (RICO), or any comparable federal, state or local laws or any amendment or
regulation that applies thereto.
W. WAR
Any claim or potential claim arising out of, or in connection with:
1. war, including undeclared or civil war;
2. warlike action by a military force, including action in hindering or defending against an actual or expected attack
by any governmental, sovereign, or other authority using military personnel or other agents; or
3. insurrection, rebellion, revolution, usurped power, or action taken by governmental authority in hindering or
defending against any of these.
X. WORKERS' COMPENSATION AND OTHER SIMILAR LAWS
Any claim or potential claim arising out of, or in connection with, any obligation or damages arising under any law
related to:
1. workers' compensation;
2. occupational disease;
3. unemployment compensation;
4. disabiliry benefits; or
5. other similar law that provides for scheduled benefits as a result of an injury or disease.
The exclusions for "EMPLOYMENT PRACTICES," "EMPLOYER'S LIABILITY,"��WAR" and "WORKER'S COMPENSATION AND
OTHER SIMILAR LAWS" do not apply to damage by fire to premises while rented to an insured or temporarily occupied
by an insured with the permission of its owner. Only with respect to the coverage provided under the General Liability
Coverage Part, a separate limit of liabiliry applies to Damage to Premises Rented to an Insured as described in the Limits
of Liability.
IV. DEDUCTIBLES AND RETENTIONS
These provisions apply to all Coverage Parts:
A. LOSS AND CLAIMS EXPENSE
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If a Deductible or Self-Insured Retention is shown on the Declarations, and is designated as "Loss and Claims
Expense," it is agreed and understood that the company's duty to pay loss and claims expense for any claim or
potential claim thereunder will be limited in the following manner:
1. the company shall have a dury to pay loss and claims expense only in excess of the Deductible or Self-Insured
Retention. The Deductible or Self-Insured Retention shall be applied to claims expense first, then to loss;
2. the first named insured shall have a duty to pay all loss and claims expense up to the amount of the
Deductible or Self-Insured Retention, payment of which shall not be unreasonably withheld;
3. unless prohibited by law, the company has complete discretion to pay the entire loss and claims expense and
seek reimbursement from the first named insured for the Deductible or Self-Insured Retention. If this occurs,
the first named insured shall reimburse the company within 30 days of the company's payment of the
Deductible or Self-Insured Retention amount;
4. the applicable Limits of Liability shall be reduced by the amount of the Deductible payable as loss and claims
expense for such claims or potential claims. The applicable Limits of Liability shall not be reduced by the
amount of the Self-Insured Retention;
5. if a Deductible or Self-Insured Retention is shown on the Declarations, the Deductible or Self-Insured Retention
shall apply to all loss and claims expense arising from a single event, health care event, offense or other
covered incident, regardless of the number of insureds found liable for the loss and/or claims expense; and
6. if a Retention Aggregate is shown on the Declarations, the first named insured's duty to pay loss, regardless of
the number of claims or potential claims made, shall not exceed the Retention Aggregate.
B. LOSS ONLY
If a Deductible is shown on the Declarations, and is designated as ��Loss Only," it is agreed and understood that the
company's duty to pay loss for any claim or potential claim thereunder will be limited in the following manner:
1. the company shall have a duty to pay only loss in excess of the Deductible;
2. the first named insured shall have a duty to pay all loss up to the amount of the applicable Deductible,
payment of which shall not be unreasonably withheld;
3. unless prohibited by law, the company has complete discretion to pay the entire loss and seek reimbursement
from the first named insured for the Deductible. If this occurs, the first named insured shall reimburse the
company within 30 days of the company's payment of the Deductible amount;
4, the applicable Limits of Liability shall be reduced by the amount of the Deductible payable as loss for such claims
or potential claims;
5. if a Deductible is shown on the Declarations, the Deductible shall apply to all loss arising from a single event,
health care event, offense or other covered incident, regardless of the number of insureds found liable for the
loss; and
6. if a Retention Aggregate is shown on the Declarations, the first named insured's duty to pay loss, regardless of
the number of claims or potential claims made, shall not exceed the Retention Aggregate.
If more than one Deductible or Self-Insured Retention applies to a claim or potential claim, the first named insured's
dury to pay all applicable loss and/or claims expense will be limited to the largest such Deductible or Self-Insured
Retention.
V. CONDITIONS
These conditions apply to all Coverage Parts:
A. ACTION AGAINST THE COMPANY
1. No action shall lie against the company unless each insured is in full compliance with all of the terms of this
policy.
2. No person shall have the right to join the company as a party to a claim to determine an insured's liability
under this policy. Further, an insured shall not interplead the company into a claim.
3. No action shall lie against the company until the amount of loss has been finally determined by entry of
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judgment or written agreement between the insured, the claimant, and the company. Once the amount of loss
has been finally determined, the claimant shall be entitled to recover under the terms of this policy.
B. ARBITRATION
1. The company and the insureds agree that in any dispute, claim, potential claim or controversy arising out of,
relating to, or in connection with this policy, whether brought by or on behalf of an insured, the company, or
any other party, the company may elect to submit any such dispute, claim, potential claim or controversy to
binding arbitration, in accordance with Title 9 USC Sec. 1 et seq. (the Federal Arbitration Act) and shall be
governed by the Commercial Arbitration Rules of the American Arbitration Association.
2. The arbitration shall be presided over by three arbitrators chosen from the Commercial Insurance Panel of the
American Arbitration Association. The arbitrators shall be governed by the law of the state of the address of the
first named insured, as shown on the Declarations. The arbitration shall take place in the county that the
capital of that state is located.
3. The arbitrators shall have the discretion to order pre-arbitration discovery, including an exchange of documents
and deposition of potential witnesses. Each party shall bear its own arbitration costs and expenses including
attorneys' fees, unless otherwise provided by law.
4. Any arbitration award shall be in writing and shall specify the factual and legal bases of the award. Judgment on
the award rendered by the arbitrator shall be final and may be entered in any court having jurisdiction thereof.
Furthermore, this arbitration provision shall be a complete defense to any suit, action or proceeding in any
federal, state or local court or before any administrative tribunal with respect to any dispute, claim, potential
claim or controversy arising out of, relating to or in connection with this policy.
C. ASSISTANCE AND COOPERATION
1. After any claim is made, or any potential claim is first discovered, the insured shall not contract any expense,
voluntarily assume any liability in any situation, nor make or contract any settlement of the claim or potential
claim, except at the insured's own cost and responsibility, without the written authorization of the company.
2. The company's duty to defend and pay loss for any claim or potential claim otherwise covered under this
policy is strictly conditioned upon all insureds' cooperation with the company in the investigation, defense,
and/or settlement of any matter to which this policy applies. Such cooperation shall include, but is not limited to:
a. attendance at any deposition, hearing, or trial, as requested by the company;
b. assistance in securing and giving evidence;
c. obtaining the attendance of witnesses;
d. doing nothing to prejudice the company's ability to investigate, defend, and/or manage any matter to which
this policy applies;
e. submitting to recorded and/or sworn statements and to examinations under oath as requested by the
company; and
f. promptly producing, at the company's request, any records, documents and other information in an
insured's possession, custody or control.
3. If a claim or potential claim is, or might be, covered under any other policy of insurance, the insured shall
promptly give notice to such other insurers. The insured shall also provide the company with copies of the
applicable policies. The insured shall further act in good faith to enforce any rights held under such policies,
including the right to a defense.
D. BANKRUPTCY OR INSOLVENCY
The bankruptcy or insolvency of an insured or an insured's estate, or the non-payment by an insured or by any
other organization responsible for a Deductible or Self-Insured Retention, shall not act to modify any duty owed by an
insured or the company under the policy. Under no circumstances will such bankruptcy, insolvency or non-payment
require the company to assume or in any way be responsible for any Deductible or Self-Insured Retention, or
otherwise assume any obligation owed by any insured under this policy. The company will have no dury to pay loss
or claims expense for any claim or potential claim unless the insured or any other organization responsible for
the Self-Insured Retention timely pays the Self-Insured Retention in full.
E. CANCELLATION, NONRENEWAL AND/OR TERMINATION OF COVERAGE
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1. This policy may be canceled by the first named insured. The first named insured shall provide written notice
to the company requesting cancellation. The cancellation shall be effective on the date requested by the first
named insured or the date the notice is received by the company, whichever is later.
2. Any coverage contained within this policy may be terminated by the first named insured. The first named
insured shall provide written notice to the company requesting the coverage termination. The termination shall
be effective on the date requested by the first named insured or the date the notice is received by the
company, whichever is later.
3. This policy, or any coverage contained therein, may also be canceled, terminated or nonrenewed by the
company. The company will send notice to the first named insured at the last address on record with the
company.
4. If the first named insured cancels this policy, or terminates any coverage contained therein, earned premium
shall be computed in accordance with the standard short rate tables and procedure. If the company cancels this
policy, or terminates any coverage contained therein, earned premium shall be computed pro rata. Premium
adjustments shall be made within a reasonable period of time after cancellation. However, payment or tender of
unearned premium shall not be a condition of cancellation.
5. If the company cancels or nonrenews this policy for any reason other than non-payment of premium, the
company shall provide written notice to the first named insured not less than 30 days prior to the effective
date of such cancellation or nonrenewal. If the company cancels this policy for nonpayment of premium, the
company shall provide written notice to the first named insured not less than 10 days prior to the effective
date of such cancellation or nonrenewal.
6. If the company cancels or nonrenews this policy, coverage under the policy shall terminate on the earlier of:
a. the date stated on the cancellation or nonrenewal notice; or
b. the date an insured procures replacement coverage.
F. COVERAGE TERRITORY
This policy applies to claims or potential claims arising from acts, omissions, occurrences or offenses (including
offenses that take place through the Internet or similar electronic means of communication) occurring anywhere in the
world, with the exception of any country or jurisdiction which is subject to trade or other economic sanction or
embargo by the United States of America, provided that the claim or potential claim is made and any legal
proceedings are pursued within the United States, its territories and possessions, including Puerto Rico.
G. EXTENDED REPORTING PERIOD
Only with respect to any Coverage Part shown on the Declarations as ��Claims-Made and Reported," the following
provisions apply:
1. Automatic Limited Extended Reporting Period
a. In the event that coverage under this policy is terminated for any reason, the company will provide an
automatic limited extended reporting period of 30 days, starting with the end of the policy period,
during which claims and potential claims arising out of any specific coverage(s) may be reported to the
company in writing. However, the claim must have been first made against an insured during the policy
period, or the potential claim must have been first discovered by an insured during the policy period.
b. This automatic limited extended reporting period shall not extend the policy period or change the scope
of the coverage provided. Any claim or potential claim first reported to the company during the automatic
limited extended reporting period will be deemed to have been made on the last date on which this policy
is in effect. The Limits of Liability that apply at the end of the policy period are not renewed or increased for
claims or potential claims first reported during the automatic limited extended reporting period.
2. Ontional Extended Reporting Period
a. The company shall, upon written request by or on behalf of the first named insured, make an offer for an
e�ctended reporting period to the first named insured if coverage is or will be canceled or nonrenewed,
subject to the following:
(1) any such written request by or on behalf of the first named insured must be received by the company
no later than 30 days after the cancellation or nonrenewal of the coverage;
0010-PXS-00-1215 Page 15 of 19 O 2015 MedPro Group. All rights reserved.
(2) the company shall be required to send the offer for an extended reporting period only to the first
named insured or its authorized representative; and
(3) the coverage has been or will be canceled or nonrenewed with respect to:
a) the entire policy;
b) a Coverage Part; or
c) a named insured who:
i) has Limits of Liability listed in the Limits of Liability column of a Schedule of Named Insureds —
Professional Liability;
ii) does not share Limits of Liability with another named insured with respect to the General
Liabiliry Coverage Part or the Cyber Liabiliry and Breach Response Coverage Part; or
iii) shares Limits of Liability with another named insured, but only when all coverage available
under that shared limit is terminated.
b. The first named insured may accept the company's offer of an e�ctended reporting period by paying
the premium due within 30 days from either the date on which the policy expires or the date on which the
company receives the request for an e�ctended reporting period, whichever is later. Failure to pay the full
premium within this 30-day period will be deemed a rejection of the offer.
c. In the event of the purchase of an e�ctended reporting period, the entire premium for such e�ctended
reporting period shall be deemed earned at its commencement.
d. If an extended reporting period is purchased, a claim or potential claim otherwise covered by this
policy may be reported for the period of time set forth in the applicable extended reporting period
endorsement issued after termination of the policy period. The extended reporting period will begin at
the end of the policy period. However, the extended reporting period shall not:
(1) extend the policy period;
(2) apply to any claim or potential claim arising from a health care event, event, offense, bodily
injury, property damage, or personal and advertising injury that took place after the policy
period; or
(3) otherwise expand the coverage provided under this policy.
H. FIRST NAMED INSURED
1. The first named insured shall be authorized to act on behalf of all insureds with respect to this policy, with full
authority to bind all insureds. The first named insured's authority shall include, but is not limited to, the
following actions:
a. receipt of notices of cancellation or nonrenewal;
b. requesting or receiving endorsements issued to form a part of this policy;
c. payment of premiums due;
d. receiving return premium; and
e. receiving and/or responding to an offer for an e�ctended reporting period for any insured.
2. The first named insured shall notify the company in writing of any changes that might affect the insurance
provided under this policy, including cancellation and nonrenewal.
I. FRAUD WARNING
Any person, who knowingly and with intent to defraud any insurance company or other person, files an application for
insurance or statement of claim containing any materially false information or conceals, for the purpose of misleading,
information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects
such person to criminal and civil penalties, which may include voiding of the policy if allowed by law.
J. GOVERNMENTAL ACCESS TO RECORDS
If required by section 952 of the Omnibus Reconciliation Act of 1980, and after receipt of written request from the
0010-PXS-00-1215 Page 16 of 19 O 2015 MedPro Group. All rights reserved.
first named insured, the company will allow the U.S. Secretary of Health and Human Services or the U.S.
Comptroller General access to this policy as well as all books, documents and records necessary to verify the cost of
this policy. The company will also allow access to subcontracts between the company and any of its related
organizations, and to such organization's books, documents and other records to the extent required by law, and to
the extent that the company has possession, custody or control of such books, documents and records. Access will
be provided for up to 4 years after the services provided pursuant to this policy cease.
K. INSPECTION AND AUDIT
The company shall be permitted, at its own discretion and for its own benefit, to audit an insured's property,
operations, and any business records. The company shall also have the right to obtain a copy of any current or prior
insurance records. Any findings or recommendations made by the company as a result of an audit shall inure only to
the company's benefit. As a result, they may not be used as evidence of the insured's compliance with any safety
regulations or other industry standards.
L. MODIFICATIONS
Except as provided herein, this policy may not be modified except by written endorsement attached to and made a
part of this policy by the company. The company's decision not to insist on an insured's compliance with any
provision of this policy shall not operate to waive, modify, or void that provision, or any other provision, condition or
term of this policy.
M. NON-ASSIGNABILITY
No interest of an insured under this policy shall be assignable without the prior written consent of the company.
However, if the insured is a person and dies, the coverage afforded by this policy shall inure to the benefit of that
insured's estate.
N. OTHER INSURANCE
Unless otherwise noted in a Coverage Part:
1. if any other valid and collectible insurance is available to any insured with respect to a liabiliry covered by this
policy, and such insurance is afforded under a policy issued by a past, present or future parent, subsidiary or
affiliate of the company, then the maximum limits of liability under all policies shall not exceed the highest
remaining applicable limit of liability under any one policy;
2. if any other valid and collectible insurance is available to any insured for a claim or potential claim under a
policy not issued by a past, present or future parent, subsidiary or affiliate of the company, then this insurance
will be excess over such other insurance even if such other insurance is stated to be primary, excess, contingent
or otherwise. The company will pay only the company's share of the loss, if any, that exceeds the sum of:
a. the total amount that all such other insurance would pay for the loss in the absence of this insurance; and
b. the total of all deductible and self-insured amounts under all such other insurance; and
3. this condition shall not apply if such other valid insurance is written to be specifically excess of this policy.
O. PREMIUMS
1. The company's obligation to perform any duty under the policy is strictly conditioned upon the payment of the
premium when due. Therefore, this policy shall not be deemed to have been issued, delivered, or renewed and
shall not be applicable to any matter which would otherwise be covered herein, until:
a. the premium has been paid in full; or
b. if the company has agreed to finance the policy, the first installment has been paid in full.
If payment is made by check, electronic transfer or money order, it shall not be considered ��paid in full" until
honored by the payor's bank.
2. Premiums for this policy shall be computed in accordance with the company's rules, rates, and rating plans.
3. Any premium designated as deposit premium is merely a deposit on the actual amount owed. At the close of the
policy period, the company will compute the earned premium for that period. The deposit premium will then be
credited to that amount. If the deposit premium exceeds the earned premium, the company will refund the
difference to the first named insured. If the earned premium exceeds the deposit premium, the company will
bill the first named insured for the difference.
0010-PXS-00-1215 Page 17 of 19 O 2015 MedPro Group. All rights reserved.
4. The first named insured shall maintain records of the information necessary for premium computation. The
first named insured shall send copies of these records to the company at the end of the policy period as
directed by the company. Such information shall be subject to audit and verification by the company.
P. REPORTING REQUIREMENTS
1. The company's dury to defend and pay loss for any claim or potential claim otherwise covered under this
policy is strictly conditioned upon an authorized insured's forwarding, as soon as practicable and expressly
subject to the reporting requirements of the applicable Insuring Clause, notice of every claim, potential claim,
demand, suit, summons, or legal paper the insured receives.
2. If the Retention shown on the Declarations is a:
a. Deductible, an authorized insured shall, as soon as practicable, report any claim or potential claim;
b. Self-Insured Retention, an authorized insured shall, as soon as practicable, report any claim or potential
claim that:
(1) an authorized insured believes will results in damages that exceed the applicable Self-Insured
Retention;
(2) has a loss reserve exceeding 50% of the applicable Self-Insured Retention;
(3) involves a claimant's demand which exceeds the applicable Self-Insured Retention;
(4) contains allegations of unfair claim practices or bad faith;
(5) involves a suit naming the company or its affiliates as defendants; or
(6) thatcaused:
a) neurological injury, such as brain injury, spinal cord injury or nerve injury resulting in paralysis;
b) injury during pregnancy or delivery;
c) significant limitation of daily activities, such as feeding, continence or sexual function;
d) loss of sight or hearing;
e) elopement;
f) decubitus ulcers;
g) severe disfigurement, such as burns, amputation or scarring;
h) loss of any organ; or
i) death.
3. All such reports and documents shall be:
a. directed to the company using the contact information listed on the contact sheet attached to this policy;
b. in writing; and
c. include the following information:
(1) the identiry of all insureds implicated;
(2) all reasonably obtainable information with respect to the time, place and circumstances of the health
care event, event, offense or other matter for which coverage is sought under this policy;
(3) the nature and extent of the injury;
(4) the names and addresses of any injured persons;
(5) the names and addresses of available witnesses; and
(6) the basis for the insured's belief that a claim is reasonably likely to be made, as well as the date the
insured first came to this belief.
4. A health care event, event, offense, accident or other matter reported to the company as part of risk
management or loss control services shall not constitute the report of a claim or potential claim for purposes of
0010-PXS-00-1215 Page 18 of 19 O 2015 MedPro Group. All rights reserved.
coverage under this policy.
Q. REPRESENTATIONS
1. By acceptance of this policy, each insured agrees, represents, and warrants that the statements and particulars
made in all applications, including any statements and particulars made in any and all documents, supplemental
pages or other attachments for the purposes of any application, are true and correct. It is further understood and
agreed that any application and attachments are incorporated into, and shall form a part of, this policy. Therefore,
this policy and any endorsements hereto, and all applications and attachments, embody all agreements between
the company and any of its authorized representatives, and all insureds relating to this insurance.
2. In the event any application was executed or endorsed by an insured's insurance producer, the insured
acknowledges that the insurance producer has acted under the insured's express authority and that the insured
has thoroughly reviewed the information contained on any application.
3. The representations made by an insured in the applications and attachments are the basis for the coverage
provided, as well as the company's calculation of the applicable premium. Therefore, it is understood and agreed
that, to the extent permitted by law, the company reserves all rights, including the right to rescind this policy, or
deny any coverage provided for a claim or potential claim, based upon any material misrepresentation made
by any insured. As used in this condition, "material misrepresentation" means concealment, misrepresentation,
omission or fraud which, if known by the company, would have led to refusal by the company to make this
contract or provide coverage, or to make this contract or provide coverage on different terms or conditions.
4. No knowledge or information possessed by any insured shall be imputed to any other insured, except for
material facts or information known to the person or persons who signed the application. In the event of any
material misrepresentation in connection with any of the particulars or statements in the application, this policy
shall be void with respect to any insured who knew of such material misrepresentation or to whom such
knowledge is imputed.
R. SEPARATION OF INSUREDS
Except for any duties specifically assigned to the first named insured and Limits of Liability applicable to any
insured, this policy applies:
1. separately to each insured against whom a claim or potential claim is made; and
2. as if each insured were the only insured under this policy.
S. SETTLEMENT
The company may only settle a claim, potential claim or other matter brought against an insured with the
consent of the first named insured.
T. SUBROGATION
The company shall be subrogated to the rights of any insured to the extent of any payments made, or as allowed
by law. Insureds shall do nothing to prejudice those rights. At the company's request, an insured shall bring suit
or transfer those rights to the company. Insureds shall also help the company enforce its rights.
U. TERMS CONFORM TO STATUTE OR REGULATION
If any term of this policy, or any duty arising therefrom, would cause the company to violate any federal, state or
local law or regulation, the policy is amended to bring the company into compliance with such statute or regulation.
0010-PXS-00-1215 Page 19 of 19 O 2015 MedPro Group. All rights reserved.
This page has been left blank intentionally.
�' Issuing Company:
1 � MedPro Group National Fire & Marine Insurance Company
� a�e,�.s��a,��trzE,:�z,�ay�o,,,nrz,y Omaha, Nebraska
SENIOR CARE LIABILITY POLICY
PROFESSIONAL LIABILITY COVERAGE PART
NOTICE:
This Coverage Part may contain claims-made and reported coverage. Please read this Coverage
Part carefully.
I. INSURING CLAUSES
A. PROFESSIONAL LIABILITY
1. Claims-Made and Reported:
If "Claims-Made and Reported" is shown on the Declarations with respect to this Coverage Part, the following
provisions apply:
a. The company will pay on behalf of any insured all loss and claims expense, subject to any applicable
Deductible or Self-Insured Retention, and up to the Limits of Liability shown on the Declarations with
respect to this Coverage Part, arising from a health care event that took place on or after the applicable
Retroactive Date shown on the Declarations. Moreover, to be covered under this policy, the loss or claims
expense must arise from:
(1) a claim that was first made against, and received by, an insured during the policy period, and
reported to the company, in writing, during the policy period or within any applicable e�ctended
reporting period; or
(2) a potential claim that was first known about or discovered by an insured during the policy period,
and reported to the company, in writing, during the policy period or within the automatic limited
extended reporting period.
b. All claims and potential claims for damages arising out of, or in connection with the same health care
event will be deemed to have been first made on the date that the first of those claims is made against
any insured, or the date the first of such potential claims is discovered by an authorized insured,
whichever date is earlier. Only the policy in effect when the first such claim is made and reported to the
company, or the first such potential claim is discovered and reported to the company, whichever is
earlier, will apply to all related claims and potential claims, no matter when those related claims are
made or reported, or potential claims are discovered and reported. If, prior to the effective date of this
policy, the first such claim is made, or the first such potential claim is discovered, this policy will not
apply to that claim or potential claim, nor to any related claim or potential claim made during this
policy period or any extended reporting period.
2. Occurrence:
If ��Occurrence" is shown on the Declarations with respect to this Coverage Part, the following provisions apply:
a. The company will pay on behalf of an insured all loss and claims expense, subject to any applicable
Deductible or Self-Insured Retention, and up to the Limits of Liability shown on the Declarations with
respect to this Coverage Part, arising from a health care event that occurred during the policy period.
b. A health care event will be deemed to have occurred on the earliest date of any related acts or omissions
that gave rise to or contributed to the health care event.
0011-PPS-00-1215 Page 1 of 4 O 2015 MedPro Group. All rights reserved.
II. EXCLUSIONS
The coverage provided under this Coverage Part does not apply to:
A. CONTRACTUAL LIABILITY
Liability for the acts of another assumed by an insured under any contract or agreement, whether written, oral or
implied. This exclusion does not apply to liability for damages that the insured would have in the absence of the
contract or agreement.
B. ELECTRONIC DATA
Any claim or potential claim arising out of, or in connection with, the loss of, loss of use of, damage to, corruption
of, inability to access, or inability to manipulate electronic data. As used in this exclusion, ��electronic data" means
information, facts, or programs stored as or on, created or used on, or transmitted to or from computer software,
including systems and applications software, hard or floppy disks, CD-ROMS, tapes, drives, cells, data processing
devices, or any other media that are used with electronically controlled equipment or by means of the internet.
C. INTENTIONAL ACTS
Any loss for any claim or potential claim arising out of, or in connection with, any act listed below:
1. any criminal, intentional, dishonest or fraudulent act;
2. any romantic relationship, or any actual or threatened sexual conduct, with a current, former or prospective
patient; or
3. any willful violation of any law, statute, or regulation.
However, the company will pay claims expense to defend any insured against any claim or potential claim
involving any excluded act listed above when intertwined with any other act triggering any insuring agreement.
This exclusion does not apply to any claim or potential claim brought against any insured who did not direct
or act in concert to commit, directly participate in or direct another in connection with any of the acts excluded
from coverage under this exclusion.
D. PRIVACY
Any claim or potential claim arising out of, or in connection with, any disclosure of or access to any person's or
organization's confidential, proprietary or personal information, including personally identifiable information,
financial information, patents, trade secrets, processing methods, customer lists, credit card information, health
information, or any other type of nonpublic information. This exclusion applies even if the claim or potential
claim is for notification costs, credit monitoring expenses, forensic expenses, public relations expenses or any other
loss, claims expense, cost or expense incurred by an insured or others resulting from the excluded claims or
potential claims.
RESIDENTS' RIGHTS BROUGHT BY ANOTHER PERSON
Any claim or potential claim arising out of, or in connection with, any violation of any law relating to residents'
rights brought by any person other than a resident or a resident's legal representative.
F. RESIDENTS' RIGHTS BROUGHT BY MULTIPLE RESIDENTS
Any claim or potential claim arising out of, or in connection with, any violation of any law relating to residents'
rights laws brought by multiple claimants, groups of claimants, multi-party actions, potential class actions or
certified classes that allege the same or similar violations.
G. TREATMENT BY AN ADMINISTRATOR OR COMMITTEE MEMBER
Any claim or potential claim arising out of, or in connection with, the rendering of, or failure to render,
treatment by an administrator or committee member, unless it was provided in an emergency without an
expectation of compensation. As used in this exclusion:
1. ��administrator" means an owner, partner, stockholder, director, trustee, executive officer, medical director,
department head, or faculty member of a named insured; and
2. "committee member" means a person serving as a member of a committee or board formed or controlled by a
named insured. It also includes any person executing the directives of such a committee or board.
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III.ADDITIONAL CONDITIONS
In addition to the conditions in the Common Policy Provisions and Conditions, the following conditions apply to this
Coverage Part:
A. RETROACfIVE DATES
1. A named insured that has a date listed under the Retroactive Date column in a Schedule of Named Insureds
will be considered as having "Claims-Made and Reported" coverage as shown on the Declarations with respect
to the applicable Coverage Part.
2. A named insured that has "n/a" listed under the Retroactive Date column in a Schedule of Named Insureds
will be considered as having ��Occurrence" coverage as shown on the Declarations with respect to the applicable
Coverage Part.
B. TERMINATION DATES
If a named insured has a date listed under the Termination Date column in a Schedule of Named Insureds, any
health care event must have taken place before that date, and after any applicable Retroactive Date, to be
covered under the applicable Coverage Part. However, coverage for such named insured shall automatically
terminate in the event that the policy is canceled or nonrenewed, unless an extended reporting period is
purchased for that named insured under the applicable Coverage Part.
C. LIMITS OF LIABILITY
1. A named insured that has "FNI" or the name of any other named insured listed under the Limits of Liability
column in a Schedule of Named Insureds will share the Limits of Liability provided to that first named insured
or named insured.
2. If any named insured has an amount listed under the Limits of Liability column in a Schedule of Named
Insureds, and any other named insured lists that same named insured in its Limits of Liability column, all
such named insureds will share Limits of Liability.
3. A named insured that has an amount listed under the Limits of Liability column in a Schedule of Named
Insureds does not share the first named insured's or any other named insured's Limits of Liability as long
as no other named insured lists that same named insured in its Limits of Liability column.
D. RETENTIONS
1. A named insured that has ��FNI" or the name of any other named insured listed under the Retention column
in a Schedule of Named Insureds is subject to any Deductible or Self-Insured Retention applicable to that first
named insured or named insured.
2. If any named insured has an amount listed under the Retention column in a Schedule of Named Insureds,
and any other named insured lists that same named insured in its Retention column, all such named
insureds will share the Deductible or Self-Insured Retention.
3. A named insured that has an amount listed under the Retention column in a Schedule of Named Insureds
does not share the first named insured's or any other named insured's Deductible or Self-Insured
Retention as long as no other named insured lists that same named insured in its Retention column.
IV. LIMITS OF LIABILITY
A. PER EVENT LIMIT
The Per Event Limit shown on the Declarations is the most the company will pay under this Coverage Part for loss
and claims expense, if shown on the Declarations as ��Defense Within Limits," for any health care event
regardless of the number of:
1. insureds who share a Per Event Limit;
2. claims made or potential claims first discovered; or
3. persons or organizations making claims or potential claims.
B. AGGREGATE LIMIT
The Aggregate Limit shown on the Declarations is the most the company will pay under this Coverage Part for
loss and claims expense, if shown on the Declarations as ��Defense Within Limits," for all health care events
0011-PPS-00-1215 Page 3 of 4 O 2015 MedPro Group. All rights reserved.
regardless of the number of:
1. health care events;
2. insureds who share an Aggregate Limit;
3. claims made or potential claims first discovered; or
4. persons or organizations making claims or potential claims.
0011-PPS-00-1215 Page 4 of 4 O 2015 MedPro Group. All rights reserved.