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State Farm®
Rental Dwelling
Policy
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FP-8103.3
 TABLE OF CONTENTS

DECLARATIONS
Your Name
Location of Your Residence
Policy Period
Coverages
Limits of Liability
Deductibles
Begins on Page
AGREEMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

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DEFINITIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
SECTION I - YOUR PROPERTY
COVERAGES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Coverage A - Dwelling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Coverage B - Personal Property . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Coverage C - Loss of Rents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Additional Coverages. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Inflation Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
LOSSES INSURED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
LOSSES NOT INSURED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
CONDITIONS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
SECTION II - YOUR LIABILITY
COVERAGES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
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Coverage L - Business Liability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Coverage M - Premises Medical Payments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
EXCLUSIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
ADDITIONAL COVERAGES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
CONDITIONS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
SECTION I AND SECTION II - CONDITIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
OPTIONAL POLICY PROVISIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
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Includes copyrighted material of State Farm Fire and Casualty Company.

Copyright, State Farm Fire and Casualty Company, 1983.
And also,
Includes copyrighted material of Insurance Services Office with its permission.
Copyright, Insurance Services Office, 1975, 1977.

FP-8103.3 Printed in U.S.A.

 RENTAL DWELLING POLICY - SPECIAL FORM 3

AGREEMENT

We agree to provide the insurance described in this policy. provisions of this policy.
You agree to pay premiums when due and comply with the

DEFINITIONS

“You” and “your” mean the “named insured” shown in the d. any employee of the named insured while acting
Declarations. Your spouse is included if a resident of your within the scope of that employment;

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household. “We”, “us” and “our” mean the Company shown e. any person or organization while acting as real
in the Declarations. estate manager for the named insured.
Certain words and phrases are defined as follows: The insurance afforded applies separately to each
1. “bodily injury” means bodily harm, sickness or dis- insured against whom claim is made, or suit is
ease. This includes required care, loss of services and brought, except with respect to the limit of our Com-
death resulting therefrom. Bodily injury does not pany’s liability.
include any of the following which are communicable: This insurance does not apply to bodily injury or per-
disease, bacteria, parasite, virus, or other organism, sonal injury or property damage arising out of the
any of which are transmitted by any insured to any conduct of any partnership or joint venture which is not
other person. It also does not include the exposure to designated in this policy as a named insured.
any such disease, bacteria, parasite, virus, or other 5. “insured premises” means:
organism by any insured to any other person.
a. the residence premises;
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2. “contract” means any written contract or agreement
wherein the named insured has expressly assumed b. one or two family premises of which you acquire
liability for damages to which this policy applies. ownership or control and for which you report your
intention to insure under this policy within 30 days
3. “Declarations” means the policy Declarations, any
after acquisition;
amended Declarations, the most recent renewal
notice or certificate, an Evidence of Insurance form, or c. the ways immediately adjoining on land; and
any endorsement changing any of these. d. one or two family dwelling premises alienated by
4. “insured” means: any insured if possession has been given to oth-
ers.
a. if the named insured is designated in the Declara-
tions as an individual and is a sole proprietor, the 6. “motor vehicle”, when used in Section II of this policy,
named insured and spouse; means:
b. if the named insured is designated in the Declara- a. a motorized land vehicle designed for travel on
tions as a partnership or joint venture, the partner- public roads or subject to motor vehicle registration.
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ship or joint venture so designated and any partner A motorized land vehicle in dead storage on an
or member thereof; insured premises is not a motor vehicle;
c. if the named insured is designated in the Declara- b. a trailer or semi-trailer designed for travel on public
tions as other than an individual, partnership or roads and subject to motor vehicle registration. A
joint venture, the organization trustees, directors or boat, camp, home or utility trailer not being towed
governors or stockholder thereof while acting within by or carried on a vehicle included in 6.a. is not a
the scope of their duties; motor vehicle;

FP-8103.3 1 Printed in U.S.A.

 c. a motorized golf cart, snowmobile, or other motor- c. personal injury;
ized land vehicle owned by any insured and
during the policy period. Repeated or continuous expo-
designed for recreational use off public roads, while
off an insured premises. A motorized golf cart sure to the same general conditions is considered to
be one occurrence.
while used for golfing purposes is not a motor
vehicle; 9. “personal injury” means injury arising out of one or
d. a motorized bicycle, tricycle or similar type of more of the following offenses:
equipment owned by any insured while off an a. false arrest, detention or imprisonment or malicious
insured premises; prosecution;
e. any vehicle while being towed by or carried on a b. libel, slander or defamation of character; or

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vehicle included in 6.a., 6.b., 6.c., or 6.d.
c. invasion of privacy, wrongful eviction or wrongful
7. “named insured” means the person or organization entry.
named in the Declarations of this policy.
10. “property damage” means physical damage to or
8. “occurrence”, when used in Section II of this policy, destruction of tangible property, including loss of use of
means an accident, including exposure to conditions, this property. Theft or conversion of property by any
which results in: insured is not considered to be property damage.
a. bodily injury; 11. “residence premises” means the one or two family
dwelling, other structures, and grounds which is shown
b. property damage; or
in the Declarations.

SECTION I - COVERAGES
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COVERAGE A - DWELLING space. Structures connected to the dwelling by only a
fence, utility line, or similar connection are considered to be
We cover:
other structures.
1. the dwelling on the residence premises shown in the
We do not cover other structures:
Declarations used principally as a private residence,
including structures attached to the dwelling; 1. not permanently attached to or otherwise forming a part
of the realty;
2. materials and supplies located on or adjacent to the
residence premises for use in the construction, alter- 2. used in whole or in part for commercial, manufacturing
ation or repair of the dwelling or other structures on the or farming purposes; or
residence premises;
3. rented or held for rental to any person not a tenant of
3. wall-to-wall carpeting attached to the dwelling on the the dwelling, unless used solely as a private garage.
residence premises; and
COVERAGE B - PERSONAL PROPERTY
4. outdoor antennas.
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We cover personal property owned or used by any insured

Except as specifically provided in the SECTION I, ADDI- which is rented or held for rental with the residence pre-
TIONAL COVERAGES, for Land, we do not cover land or mises or used for the maintenance of the residence pre-
any costs required to replace, rebuild, stabilize or other- mises. This coverage applies only while the personal
wise restore the land. property is on the residence premises or temporarily off
premises for repairs.
Dwelling Extension. We cover other structures on the
residence premises, separated from the dwelling by clear

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Property Not Covered. We do not cover: the limit of liability applying to the damaged property.
When the amount payable for the actual damage to the
1. articles separately described and specifically insured in
property plus the expense for debris removal exceeds
this or any other insurance; the limit of liability for the damaged property, an addi-
2. animals, birds or fish; tional 5% of that limit of liability will be available to cover
debris removal expense.
3. any engine or motor propelled vehicle or machine,
including the parts, designed for movement on land. 2. Reasonable Repairs. We will pay the reasonable cost
We do cover those used solely for the service of the incurred by you of repairing damage to covered prop-
residence premises and not licensed for use on pub- erty necessary to protect the property from further
lic highways; damage or loss, provided coverage is afforded for the
peril causing the loss. This coverage does not increase

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4. watercraft, including motors, equipment and accesso- the limit of liability applying to the property being
ries; repaired.
5. aircraft and parts; 3. Trees, Shrubs and Other Plants. We cover outdoor
6. outdoor signs. trees, shrubs, plants or lawns, on the residence pre-
mises, for loss caused by the following Losses
COVERAGE C - LOSS OF RENTS Insured: Fire or lightning, Explosion, Riot or civil com-
The limit of liability for Coverage C is the total limit for all motion, Aircraft, Vehicles not owned or operated by a
the following coverages. resident of the residence premises, Vandalism or
malicious mischief or Theft. The limit of liability for this
1. Fair Rental Value. If a Loss Insured causes that part of coverage shall not exceed 5% of the limit of liability
the residence premises rented to others or held for that applies to the dwelling for all trees, shrubs, plants
rental by you to become uninhabitable, we cover its fair and lawns nor more than $500 for any one tree, shrub
rental value. Payment shall be for the shortest time or plant. This coverage may increase the limit of liabil-
required to repair or replace the part of the premises
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rented or held for rental but not exceeding 12 consecu- grown for business purposes.
tive months from the date of loss. This period of time is
not limited by expiration of this policy. Fair rental value 4. Fire Department Service Charge. We will pay up to
shall not include any expense that does not continue $500 for your liability assumed by contract or agree-
while that part of the residence premises rented or ment for fire department charges incurred when the
held for rental is uninhabitable. fire department is called to save or protect covered
property from a Loss Insured. No deductible applies to
2. Prohibited Use. If a civil authority prohibits you from this coverage. This coverage may increase the limit
use of the residence premises as a result of direct otherwise applicable.
damage to neighboring premises by a Loss Insured in
this policy, we cover any resulting Fair Rental Value 5. Property Removed. Covered property, while being
loss for a period not exceeding two weeks during removed from a premises endangered by a Loss
which use is prohibited. Insured, is covered for direct loss from any cause. This
coverage also applies to the property for up to 30 days
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We do not cover loss or expense due to cancellation of while removed. We will also pay for reasonable
a lease or agreement. expenses incurred by you for the removal and return of
ADDITIONAL COVERAGES the covered property. This coverage does not increase
the limit applying to the property being removed.
1. Debris Removal. We will pay the reasonable expense
incurred by you in the removal of debris of covered 6. Personal Effects. We will pay up to $500 for loss at
property provided coverage is afforded for the peril the residence premises caused by a Loss Insured to
causing the loss. Debris removal expense is included in personal effects of others while such property is in your

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 care, custody or control. This coverage is subject to This coverage does not increase the limits applying to
the limitations and exclusions applicable to Coverage the damaged property.
B - Personal Property. This coverage is limited to $100 11. Collapse. We insure for direct physical loss to covered
per person and does not increase the limit of liability property involving collapse of a building or any part of
applying to Coverage B - Personal Property. a building caused only by one or more of the following:
7. Burglary. We will pay for loss of personal property a. fire, lightning, explosion, windstorm or hail, smoke,
owned or used by any insured which is rented or held aircraft or vehicles, riot or civil commotion, vandal-
for rental with the residence premises, when the loss ism, leakage from fire extinguishing equipment, vol-
is from a known location within a building on the resi- canic action, falling objects, weight of ice, snow or
dence premises when it is probable that the property sleet, water damage, breakage of building glass, all
has been stolen and there is visible evidence of forc- only as insured against in this policy;

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ible entry to or forcible exit from that building. This cov-
erage does not increase the limit of liability applying to (1) falling objects does not include loss of or dam-
Coverage B - Personal Property. age to:
8. Arson Reward. We will pay $1,000 for information (a) personal property in the open; or
which leads to an arson conviction in connection with a (b) the interior of a building or structure, or prop-
fire loss to property covered by this policy. This cover-
erty inside a building or structure, unless the
age may increase the limit otherwise applicable. How-
roof or an outside wall of the building or
ever, the $1,000 limit shall not be increased regardless structure is first damaged by a falling object;
of the number of persons providing information.
(2) water damage means accidental discharge or
9. Land. We will pay up to $10,000 for the cost required
leakage of water or steam as the direct result of
to replace, rebuild, stabilize or otherwise restore the the breaking or cracking of any part of a system
land necessary to support the insured dwelling sustain-
or appliance containing water or steam;
ing a covered loss. This may increase the limit apply-
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ing to the property. b. hidden decay;
10. Volcanic Action. We cover direct physical loss to a c. hidden insect or vermin damage;
covered building or covered property contained in a
d. weight of contents, equipment, animals or people;
building resulting from the eruption of a volcano when
the loss is directly and immediately caused by: e. weight of ice, snow, sleet or rain which collects on a
a. volcanic blast or airborne shock waves; roof; or
b. ash, dust or particulate matter; or f. use of defective material or methods in construc-
c. lava flow. tion, remodeling or renovation if the collapse occurs
during the course of construction, remodeling or
We will also pay for the removal of that ash, dust or renovation.
particulate matter which has caused direct physical
loss to a covered building or covered property con- Loss to an awning, fence, patio, pavement, swimming
tained in a building. pool, underground pipe, flue, drain, cesspool, septic
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tank, foundation, retaining wall, bulkhead, pier, wharf

One or more volcanic eruptions that occur within a 72- or dock is not included under items b., c., d., e., and f.
hour period shall be considered one volcanic eruption. unless the loss is a direct result of the collapse of a
building.

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 Collapse does not include settling, cracking, shrinking, To find the limits on a given date:
bulging or expansion.
1. divide the Index on that date by the Index as of the
This coverage does not increase the limit applying to effective date of this Inflation Coverage provision; then
the damaged property.
2. multiply the resulting factor by the limits of liability for
INFLATION COVERAGE Coverage A and Coverage B separately.
The limits of liability shown in the Declarations for Cover- The limits of liability will not be reduced to less than the
ages A and B will be increased at the same rate as the amounts shown in the Declarations.
increase in the Inflation Coverage Index shown in the Dec-
If during the term of this policy, the Coverage A limit of lia-
larations.
bility is changed at your request, the effective date of this

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Inflation Coverage provision is changed to coincide with
the effective date of such change.

SECTION I - LOSSES INSURED

COVERAGE A - DWELLING AND COVERAGE B - described in Coverage A and Coverage B, except as pro-
PERSONAL PROPERTY vided in Section I - Losses Not Insured.
We insure for accidental direct physical loss to the property

SECTION I - LOSSES NOT INSURED

1. We do not insure for loss to the property described in d. theft in or to a dwelling under construction, or of
Coverage A and Coverage B either consisting of, or materials and supplies for use in the construction
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directly and immediately caused by, one or more of the until the dwelling is completed and occupied;
following:
e. theft of any property which is not actually part of
a. collapse, except as specifically provided in any building or structure;
SECTION I, ADDITIONAL COVERAGES for Col-
f. mysterious disappearance;
lapse;
g. vandalism and malicious mischief or breakage of
b. freezing of a plumbing, heating, air conditioning or
automatic fire protective sprinkler system, or of a glass and safety glazing materials if the dwelling
has been vacant for more than 30 consecutive
household appliance, or by discharge, leakage or
days immediately before the loss. A dwelling being
overflow from within the system or appliance
caused by freezing, while the dwelling is vacant, constructed is not considered vacant;
unoccupied or being constructed unless you have h. continuous or repeated seepage or leakage of
used reasonable care to: water or steam from a:
(1) maintain heat in the building; or
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(1) heating, air conditioning or automatic fire pro-

tective sprinkler system;
(2) shut off the water supply and drain the system
and appliances of water; (2) household appliance; or
c. freezing, thawing, pressure or weight of water or (3) plumbing system, including from, within or
ice, whether driven by wind or not, to a fence, pave- around any shower stall, shower bath, tub
ment, patio, swimming pool, foundation, retaining installation, or other plumbing fixture, including
wall, bulkhead, pier, wharf or dock; their walls, ceilings or floors;

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 which occurs over a period of time and results in Earth movement also includes volcanic explosion
deterioration, rust, mold, or wet or dry rot. If loss is or lava flow, except as specifically provided in SEC-
caused by water or steam not otherwise excluded, TION I, ADDITIONAL COVERAGES for Volcanic
we will cover the cost of tearing out and replacing Action.
any part of the building necessary to repair the sys-
tem or appliance. We do not cover loss to the sys- We do insure for any direct loss by fire, explosion
tem or appliance from which the water or steam other than explosion of a volcano, theft, or break-
escaped; age of glass or safety glazing materials resulting
from earth movement.
i. wear, tear, marring, scratching, deterioration, inher-
ent vice, latent defect and mechanical breakdown; c. Water Damage, meaning:
(1) flood, surface water, waves, tidal water, over-

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j. rust, mold, or wet or dry rot;
flow of a body of water, or spray from any of
k. contamination; these, whether or not driven by wind;
l. smog, smoke from agricultural smudging or indus- (2) water which backs up through sewers or drains,
trial operations; or water which enters into and overflows from
within a sump pump, sump pump well or any
m. settling, cracking, shrinking, bulging, or expansion
other system designed to remove subsurface
of pavements, patios, foundation, walls, floors,
water which is drained from the foundation area;
roofs or ceilings; or
n. birds, vermin, rodents, insects or domestic animals. (3) natural water below the surface of the ground,
We do cover the breakage of glass or safety glaz-
including water which exerts pressure on, or
ing material which is a part of a building, when
seeps or leaks through a building, sidewalk,
caused by birds, vermin, rodents, insects or driveway, foundation, swimming pool or other
domestic animals.
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However, we do insure for any ensuing loss from items
However, we do insure for direct loss by fire, explo-
a. through n. unless the loss is itself a Loss Not
sion, or theft resulting from water damage.
Insured by this Section.
d. Neglect, meaning neglect of the insured to use all
2. We do not insure under any coverage for any loss reasonable means to save and preserve property
which would not have occurred in the absence of one
at and after the time of a loss, or when property is
or more of the following excluded events. We do not
endangered by a Loss Insured.
insure for such loss regardless of: (a) the cause of the
excluded event; or (b) other causes of the loss; or (c) e. War, including any undeclared war, civil war, insur-
whether other causes acted concurrently or in any rection, rebellion, revolution, warlike act by a mili-
sequence with the excluded event to produce the loss. tary force or military personnel, destruction or
seizure or use for a military purpose, and including
a. Ordinance or Law, meaning enforcement of any any consequence of any of these. Discharge of a
ordinance or law regulating the construction, repair,
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nuclear weapon shall be deemed a warlike act

or demolition of a building or other structure, unless
even if accidental.
specifically provided under this policy.
f. Nuclear Hazard, meaning any nuclear reaction,
b. Earth Movement, meaning the sinking, rising, radiation, or radioactive contamination, all whether
shifting, expanding, or contracting of earth, all
controlled or uncontrolled or however caused, or
whether combined with water or not. Earth move-
any consequence of any of these. Loss caused by
ment includes but is not limited to earthquake, land- the nuclear hazard shall not be considered loss
slide, mudflow, sinkhole, subsidence and erosion.

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 caused by fire, explosion, or smoke. However, we b. defect, weakness, inadequacy, fault or unsound-
do insure for direct loss by fire resulting from the ness in:
nuclear hazard.
(1) planning, zoning, development, surveying, sit-
3. We do not insure under any coverage for any loss con- ing;
sisting of one or more of the items below. Further, we
(2) design, specifications, workmanship, construc-
do not insure for loss described in paragraphs 1. and
2. immediately above regardless of whether one or tion, grading, compaction;
more of the following: (a) directly or indirectly cause, (3) materials used in construction or repair; or
contribute to or aggravate the loss; or (b) occur before,
at the same time, or after the loss or any other cause (4) maintenance;
of the loss: of any property (including land, structures, or

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a. conduct, act, failure to act, or decision of any per- improvements of any kind) whether on or off the
son, group, organization or governmental body residence premises.
whether intentional, wrongful, negligent, or without However, we do insure for any ensuing loss from items
fault; a. and b. unless the ensuing loss is itself a Loss Not
Insured by this Section.

SECTION I - CONDITIONS

1. Insurable Interest and Limit of Liability. Even if more d. as often as we reasonably require:
than one person has an insurable interest in the prop-
erty covered, we shall not be liable: (1) exhibit the damaged property;
(2) provide us with records and documents we
a. to the insured for an amount greater than the
request and permit us to make copies; and
MP insured’s interest; nor
b. for more than the applicable limit of liability. (3) submit to examinations under oath and sub-
scribe the same;
2. Your Duties After Loss. In case of a loss to which this
e. submit to us, within 60 days after the loss, your
insurance may apply, you shall see that the following
duties are performed: signed, sworn proof of loss which sets forth, to the
best of your knowledge and belief:
a. give immediate notice to us or our agent, and in
(1) the time and cause of loss;
case of theft, vandalism, or malicious mischief, also
to the police; (2) interest of the insured and all others in the
property involved and all encumbrances on the
b. protect the property from further damage or loss,
property;
make reasonable and necessary repairs required
to protect the property, and keep an accurate (3) other insurance which may cover the loss;
record of repair expenditures;
(4) changes in title or occupancy of the property
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c. prepare an inventory of damaged personal property during the term of this policy;
showing in detail, the quantity, description, actual
cash value and amount of loss. Attach to the inven- (5) specifications of any damaged building and
tory all bills, receipts and related documents that detailed estimates for repair of the damage;
substantiate the figures in the inventory; (6) an inventory of damaged personal property
described in 2.c.;
(7) records supporting the fair rental value loss.

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3. Loss Settlement. Covered property losses are settled 4. Loss to a Pair or Set. In case of loss to a pair or set,
as follows: we may elect to:
a. Personal property and structures that are not build- a. repair or replace any part to restore the pair or set
ings at actual cash value, up to the applicable limit to its value before the loss; or
of liability, at the time of loss. There may be deduc-
b. pay the difference between actual cash value of the
tion for depreciation. We will not pay an amount
exceeding that necessary to repair or replace; property before and after the loss.
5. Glass Replacement. Loss for damage to glass
b. Carpeting, domestic appliances, awnings and out-
caused by a Loss Insured shall be settled on the basis
door antennas, whether or not attached to build-
ings, at actual cash value, up to the applicable limit of replacement with safety glazing materials when
required by ordinance or law.

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of liability, at the time of loss. We will not pay an
amount exceeding that necessary to repair or 6. Appraisal. If you and we fail to agree on the amount of
replace; loss, either one can demand that the amount of the
loss be set by appraisal. If either makes a written
c. Buildings under Coverage A at replacement cost
demand for appraisal, each shall select a competent,
without deduction for depreciation, subject to the
independent appraiser and notify the other of the
following:
appraiser’s identity within 20 days of receipt of the writ-
(1) We will not pay more than the $10,000 limit on ten demand. The two appraisers shall then select a
Land as provided in SECTION I, ADDITIONAL competent, impartial umpire. If the two appraisers are
COVERAGES. unable to agree upon an umpire within 15 days, you or
we can ask a judge of a court of record in the state
(2) We will pay the cost of repair or replacement,
where the residence premises is located to select an
without deduction for depreciation, but not
umpire. The appraisers shall then set the amount of
exceeding the smallest of the following the loss. If the appraisers submit a written report of an
amounts:
MP agreement to us, the amount agreed upon shall be the
(a) the limit of liability under this policy applying amount of the loss. If the appraisers fail to agree within
to the building; a reasonable time, they shall submit their differences
to the umpire. Written agreement signed by any two of
(b) the replacement cost of that part of the build- these three shall set the amount of the loss. Each
ing damaged for equivalent construction and appraiser shall be paid by the party selecting that
use on the same premises; or appraiser. Other expenses of the appraisal and the
(c) the amount actually and necessarily spent to compensation of the umpire shall be paid equally by
repair or replace the damaged building. you and us.
(3) We will pay the actual cash value of the damage 7. Other Insurance. If a loss covered by this policy is
to the buildings, up to the policy limit, until actual also covered by other insurance, we will pay only the
repair or replacement is completed. proportion of the loss that the limit of liability that
applies under this policy bears to the total amount of
(4) You may disregard the replacement cost loss insurance covering the loss.
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settlement provisions and make claim under

this policy for loss or damage to buildings on an 8. Suit Against Us. No action shall be brought unless
actual cash value basis and then make claim there has been compliance with the policy provisions
within 180 days after loss for any additional lia- and the action is started within one year after the date
bility on a replacement cost basis. of loss or damage.
9. Our Option. We may repair or replace any part of the
property damaged or stolen with equivalent property.

8 FORM 3
 Any property we pay for or replace becomes our prop- your failure to do so. Policy conditions relating
erty. to Appraisal, Suit Against Us and Loss Payment
apply to the mortgagee.
10. Loss Payment. We will adjust all losses with you. We
will pay you unless some other person is named in the c. If this policy is cancelled by us, the mortgagee shall
policy or is legally entitled to receive payment. Loss will be notified at least 10 days before the date cancel-
be payable 60 days after we receive your proof of loss lation takes effect.
and:
d. If we pay the mortgagee for any loss and deny pay-
a. reach agreement with you; ment to you:
b. there is an entry of a final judgment; or (1) we are subrogated to all the rights of the mort-
c. there is a filing of an appraisal award with us. gagee granted under the mortgage on the prop-

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erty; or
11. Abandonment of Property. We need not accept any
property abandoned by any insured. (2) at our option, we may pay to the mortgagee the
whole principal on the mortgage plus any
12. Mortgage Clause. The word “mortgagee” includes
accrued interest. In this event, we shall receive
trustee.
a full assignment and transfer of the mortgage
a. If a mortgagee is named in this policy, any loss pay- and all securities held as collateral to the mort-
able under Coverage A shall be paid to the mort- gage debt.
gagee and you, as interests appear. If more than
e. Subrogation shall not impair the right of the mort-
one mortgagee is named, the order of payment
gagee to recover the full amount of the mortgagee’s
shall be the same as the order of precedence of the claim.
mortgages.
13. No Benefit to Bailee. We will not recognize any
b. If we deny your claim, that denial shall not apply to
assignment or grant any coverage for the benefit of
a valid claim of the mortgagee, if the mortgagee:
MP any person or organization holding, storing or trans-
(1) notifies us of any change in ownership, occu- porting property for a fee regardless of any other provi-
pancy or substantial change in risk of which the sion of this policy.
mortgagee is aware; 14. Intentional Acts. If you or any person insured under
(2) pays any premium due under this policy on this policy causes or procures a loss to property cov-
demand if you have neglected to pay the pre- ered under this policy for the purpose of obtaining
mium; insurance benefits, then this policy is void and we will
not pay you or any other insured for this loss.
(3) submits a signed, sworn statement of loss
within 60 days after receiving notice from us of

SECTION II - LIABILITY COVERAGES

COVERAGE L - BUSINESS LIABILITY 2. provide a defense at our expense by counsel of our
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choice. We may make any investigation and settle any

If a claim is made or a suit is brought against any insured
claim or suit that we decide is appropriate. Our obliga-
for damages because of bodily injury, personal injury, or tion to defend any claim or suit ends when the amount
property damage to which this coverage applies, caused
we pay for damages, to effect settlement or satisfy a
by an occurrence, and which arises from the ownership,
judgment resulting from the occurrence, equals our
maintenance, or use of the insured premises, we will: limit of liability.
1. pay up to our limit of liability for the damages for which
the insured is legally liable; and

9 FORM 3
The total limit of the Company’s liability for all occurrences an accident causing bodily injury which arises out of a
in any one policy year shall not exceed the annual aggre- condition on the insured premises or for which the
gate limit shown in the Declarations for Coverage L - Busi- insured is provided bodily injury liability coverage under
ness Liability. this policy. Medical expenses means reasonable charges
for medical, surgical, x-ray, dental, ambulance, hospital,
COVERAGE M - PREMISES MEDICAL PAYMENTS
professional nursing, prosthetic devices and funeral ser-
We will pay the necessary medical expenses incurred or vices.
medically ascertained within three years from the date of

SECTION II - EXCLUSIONS

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1. Coverage L - Business Liability and Coverage M - with regard to the ownership, maintenance or use
Premises Medical Payments do not apply to: of any aircraft, watercraft, or motor vehicle (or any
other motorized land conveyance) which is not cov-
a. bodily injury, personal injury, or property dam-
ered under Section II of this policy;
age:
e. bodily injury, personal injury, or property dam-
(1) which is either expected or intended by an
age caused directly or indirectly by war, civil war,
insured; or insurrection, rebellion, revolution, warlike act by a
(2) to any person or property which is the result of military force or military personnel, destruction or
willful and malicious acts of an insured; seizure or use for a military purpose, and including
any consequence of any of these. Discharge of a
b. bodily injury, personal injury, or property dam- nuclear weapon shall be deemed a warlike act
age arising out of the rendering or failing to render even if accidental;
professional services;
f. bodily injury, personal injury, or property dam-
MPc. bodily injury, personal injury, or property dam- age arising out of premises, other than the insured
age arising out of the ownership, maintenance, premises, or to liability assumed by the insured
use, loading or unloading of: under any contract or agreement relating to such
(1) aircraft; premises;
(2) any motor vehicle owned or operated by, or g. to bodily injury or property damage for which the
rented or loaned to any insured; or insured may be held liable:
(3) any watercraft owned by or operated by, or (1) as a person or organization engaged in the
rented or loaned to any insured; business of manufacturing, distributing, selling
or serving alcoholic beverages; or
d. bodily injury, personal injury, or property dam-
age arising out of: (2) if not so engaged, as an owner or lessor of pre-
mises used for such purposes, if such liability is
(1) the entrustment by any insured to any person; imposed:
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(2) the negligent supervision by any insured of any (a) by, or because of the violation of any statute,
person; ordinance or regulation pertaining to the
(3) any liability statutorily imposed on any insured; sale, gift, distribution or use of any alcoholic
or beverages; or

(4) any liability assumed through an unwritten or (b) by reason of the selling, serving or giving of
written agreement by any insured; any alcoholic beverage to a minor or to a
person under the influence of alcohol or

10 FORM 3
 which causes or contributes to the intoxica- (4) at or from any site or location on which the
tion of any person; named insured, employee or any contractor or
subcontractor working directly or indirectly on
but part (b) of this exclusion does not apply with behalf of the named insured is performing
respect to liability of the insured or his indemni-
operations:
tee as an owner or lessor described in (2)
above; (a) if the pollutants are brought on or to the site
or location in connection with such opera-
h. the legal liability of any insured to:
tions; or
(1) any person who is in the care of any insured
(b) if the operations are to test for, monitor,
because of child care services provided by or at clean up, remove, contain, treat, detoxify or
the direction of:

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neutralize pollutants.
(a) any insured;
Subparagraphs (1) and (4)(a) of this exclusion do
(b) any employee of any insured; or not apply to bodily injury or property damage
caused by heat, smoke or fumes which result from
(c) any other person actually or apparently act- a hostile fire or poisoning or asphyxiation due to
ing on behalf of any insured; escape of fumes from a furnace or flue because of
(2) any person who makes a claim because of a malfunction of the furnace or flue.
bodily injury or property damage to any per- In addition, Coverage L and Coverage M do not
son who is in the care of any insured because apply to loss, cost or expense arising out of any
of child care services provided by or at the governmental direction or request that the named
direction of: insured test for, monitor, clean up, remove, con-
(a) any insured; tain, treat, detoxify or neutralize pollutants;
(b) any employee of any insured; or As used in this exclusion:
MP
(c) any other person actually or apparently act- “hostile fire” means one which becomes uncontrol-
ing on behalf of any insured; lable or breaks out from where it was intended to
be.
i. bodily injury or property damage arising out of
the actual, alleged or threatened discharge, dis- “pollutants” means any solid, liquid, gaseous or
persal, spill, release or escape of pollutants: thermal irritant or contaminant, including smoke,
vapor, soot, fumes, acids, alkalis, chemicals and
(1) at or from premises owned, rented or occupied waste.
by the named insured;
“waste” includes materials to be recycled, recondi-
(2) at or from any site or location used by or for the tioned or reclaimed.
named insured or others for the handling, stor-
age, disposal, processing or treatment of waste; j. bodily injury to an employee of the insured aris-
ing out of and in the course of employment by the
(3) which are at any time transported, handled, insured or the spouse, child, parent, brother or sis-
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stored, treated, disposed of, or processed as ter of that employee as a consequence of employ-
waste by or for the named insured or any per- ment of that employee by the insured.
son or organization for whom the named
insured may be legally responsible; or This exclusion applies:
(1) whether the insured may be liable as an
employer or in any other capacity; and

11 FORM 3
 (2) to any obligation to share damages with or f. personal injury caused by a violation of a penal
repay someone else who must pay damages law or ordinance committed by or with the knowl-
because of the injury; edge or consent of any insured;
k. bodily injury to you or any insured and if resi- g. personal injury sustained by any person as a
dents of your household: result of an offense directly or indirectly related to
the employment of the person by the insured;
(1) your relatives;
h. personal injury arising out of any publication or
(2) any other person under the age of 21 who is in
utterance in item b. of the definition of personal
the care of an insured.
injury:
2. Coverage L - Business Liability, does not apply to: (1) if the first injurious publication or utterance of

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a. liability: the same or similar material by or on behalf of
the insured was made prior to the effective date
(1) for your share of any loss assessment charged of this insurance; or
against all members of an association of prop-
erty owners; or (2) concerning any business or services made by
or at the direction of any insured with knowl-
(2) assumed under any unwritten contract or edge of the falsity;
agreement, or by contract or agreement in con-
nection with any business of the insured other i. property damage or personal injury to premises
than the rental of the insured premises; you sell, give away or abandon, if the property
damage, or personal injury arises out of those
b. property damage to property owned by any premises.
insured;
3. Coverage M - Premises Medical Payments does not
c. property damage to property rented to, occupied apply to bodily injury:
or used by or in the care of the insured;
MP
a. to any person, eligible to receive any benefits
d. bodily injury or personal injury to any person eli- required to be provided or voluntarily provided
gible to receive any benefits required to be pro- under any workers’ or workmen’s compensation,
vided or voluntarily provided by the insured under non-occupational disability or occupational disease
any workers’ or workmen’s compensation, non- law;
occupational disability or occupational disease law;
b. from any nuclear reaction, radiation or radioactive
e. bodily injury, personal injury, or property dam- contamination, all whether controlled or uncon-
age for which any insured under this policy is also trolled or however caused, or any consequence of
an insured under a nuclear energy liability policy or any of these;
would be an insured but for its termination upon
exhaustion of its limit of liability. A nuclear energy c. to any insured, any tenant or other person regu-
liability policy is a policy issued by Nuclear Energy larly residing on the insured premises or to any
Liability Insurance Association, Mutual Atomic employees of any of the foregoing if the bodily
injury arises out of or in the course of their employ-
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Energy Liability Underwriters, Nuclear Insurance

Association of Canada, or any of their successors; ment;
d. to any person engaged in maintenance and repair
of the insured premises or alteration, demolition
or new construction at such premises.

12 FORM 3
 SECTION II - ADDITIONAL COVERAGES

We cover the following in addition to the limits of liability: assisting us in the investigation or defense of any
claim or suit;
1. Claim Expenses. We pay:
d. prejudgment interest awarded against the insured
a. expenses incurred by us and costs taxed against on that part of the judgment we pay; and
any insured in any suit we defend;
e. interest on the entire judgment which accrues after
b. premiums on bonds required in a suit defended by
entry of the judgment and before we pay or tender,
us, but not for bond amounts greater than the limit or deposit in court that part of the judgment which
of liability for Coverage L. We are not obligated to
does not exceed the limit of liability that applies.
apply for or furnish any bond;

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2. First Aid Expenses. We will pay expenses for first aid
c. reasonable expenses incurred by any insured at to others incurred by any insured for bodily injury
our request, including actual loss of earnings (but
covered under this policy. We will not pay for first aid to
not loss of other income) up to $50 per day for
you or any other insured.

SECTION II - CONDITIONS

1. Limit of Liability. The Coverage L limit is shown in the b. immediately forward to us every notice, demand,
Declarations. This is our limit for all damages from summons or other process relating to the accident
each occurrence regardless of the number of or occurrence;
insureds, claims made or persons injured.
c. at our request, assist in:
The Coverage M limit is shown in the Declarations.
(1) making settlement;
This is our limit for all medical expense payable for
MP
bodily injury to one person as the result of one acci- (2) the enforcement of any right of contribution or
dent. indemnity against any person or organization
who may be liable to any insured;
2. Severability of Insurance. This insurance applies
separately to each insured. This condition shall not (3) the conduct of suits and attend hearings and tri-
increase our limit of liability for any one occurrence. als;
(4) securing and giving evidence and obtaining the
3. Duties After Loss. In case of an accident or occur-
attendance of witnesses;
rence, the insured shall perform the following duties
that apply. You shall cooperate with us in seeing that d. the insured shall not, except at the insured’s own
these duties are performed: cost, voluntarily make any payment, assume any
obligation or incur any expense other than for first
a. give written notice to us or our agent as soon as aid to others at the time of the bodily injury.
practicable, which sets forth:
4. Duties of an Injured Person - Coverage M - Pre-
(1) the identity of this policy and insured;
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mises Medical Payments. The injured person, or,

(2) reasonably available information on the time, when appropriate, someone acting on behalf of that
place and circumstances of the accident or person, shall:
occurrence; and a. give us written proof of claim, under oath if
(3) names and addresses of any claimants and required, as soon as practicable;
available witnesses; b. execute authorization to allow us to obtain copies
of medical reports and records; and

13 FORM 3
 c. submit to physical examination by a physician respect to Coverage L shall be brought against us until
selected by us when and as often as we reasonably the obligation of the insured has been determined by
require. final judgment or agreement signed by us.
5. Payment of Claim - Coverage M - Premises Medical 7. Bankruptcy of any Insured. Bankruptcy or insolvency
Payments. Payment under this coverage is not an of any insured shall not relieve us of any of our obliga-
admission of liability by any insured or us. tions under this policy.
6. Suit Against Us. No action shall be brought against us 8. Other Insurance - Coverage L - Business Liability.
unless there has been compliance with the policy pro- This insurance is excess over any other valid and col-
visions. lectible insurance except insurance written specifically
to cover as excess over the limits of liability that apply
No one shall have any right to join us as a party to any

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in this policy.
action against any insured. Further, no action with

SECTION I AND SECTION II - CONDITIONS

1. Policy Period. This policy applies only to loss under your mailing address shown in the Declarations.
Section I or bodily injury, personal injury, or property Proof of mailing shall be sufficient proof of notice:
damage under Section II which occurs during the
(1) When you have not paid the premium, whether
period this policy is in effect.
payable to us or to our agent or under any
2. Concealment or Fraud. This policy is void as to you finance or credit plan, we may cancel at any
and any other insured, if you or any other insured time by notifying you at least 10 days before the
under this policy has intentionally concealed or misrep- date cancellation takes effect.
resented any material fact or circumstance relating to
this insurance, whether before or after a loss. (2) When this policy has been in effect for less than
MP 60 days and is not a renewal with us, we may
3. Liberalization Clause. If we adopt any revision which cancel for any reason by notifying you at least
would broaden coverage under this policy without 10 days before the date cancellation takes
additional premium, within 60 days prior to or during effect.
the period this policy is in effect, the broadened cover-
(3) When this policy has been in effect for 60 days
age will immediately apply to this policy.
or more, or at any time if it is a renewal with us,
4. Waiver or Change of Policy Provisions. A waiver or we may cancel if there has been a material mis-
change of any provision of this policy must be in writing representation of fact which, if known to us,
by us to be valid. Our request for an appraisal or exam- would have caused us not to issue this policy or
ination shall not waive any of our rights. if the risk has changed substantially since the
policy was issued. We may cancel this policy by
5. Cancellation.
notifying you at least 30 days before the date
a. You may cancel this policy at any time by notifying cancellation takes effect.
us in writing of the date cancellation is to take
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(4) When this policy is written for a period longer

effect. We may waive the requirement that the
than one year, we may cancel for any reason at
notice be in writing by confirming the date and time anniversary by notifying you at least 30 days
of cancellation to you in writing.
before the date cancellation takes effect.
b. We may cancel this policy only for the reasons
c. When this policy is cancelled, the premium for the
stated in this condition by notifying you in writing of period from the date of cancellation to the expira-
the date cancellation takes effect. This cancellation
tion date will be refunded. When you request can-
notice may be delivered to you, or mailed to you at

14 FORM 3
 cellation, the return premium will be based on our 9. Death. If any person named in the Declarations or the
rules for such cancellation. The return premium spouse, if a resident of the same household, dies:
may be less than a full pro rata refund. When we
cancel, the return premium will be pro rata. a. we insure the legal representative of the deceased
but only with respect to the premises and property
d. If the return premium is not refunded with the notice of the deceased covered under this policy at the
of cancellation or when this policy is returned to us, time of death;
we will refund it within a reasonable time after the
b. insured includes with respect to your property, the
date cancellation takes effect.
person having proper temporary custody of the
6. Non-Renewal. We may elect not to renew this policy. property until appointment and qualification of a
If we elect not to renew, a written notice will be deliv- legal representative.

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ered to you, or mailed to you at your mailing address
10. Conformity to State Law. When a policy provision is
shown in the Declarations. The notice will be mailed
or delivered at least 30 days before the expiration date in conflict with the applicable law of the State in which
this policy is issued, the law of the State will apply.
of this policy. Proof of mailing shall be sufficient proof
of notice. 11. Inspection and Audit. We shall be permitted but not
obligated to inspect your property and operations at
7. Assignment. Assignment of this policy shall not be
valid unless we give our written consent. any time. However, our right to inspect or our actual
inspection and report shall not constitute an undertak-
8. Subrogation. Any insured may waive in writing ing on your behalf or for your benefit or the benefit of
before a loss all rights of recovery against any person. others to determine or warrant that the property or
If not waived, we may require an assignment of rights operations are safe or healthful, or are in compliance
of recovery for a loss to the extent that payment is with any law, rule or regulation.
made by us.
We may examine and audit your books and records at
If an assignment is sought, any insured shall sign and any time during the policy period and within three
MP
deliver all related papers and cooperate with us in any years after the final termination of this policy, as far as
reasonable manner. they relate to the subject matter of this insurance.
Subrogation does not apply under Section II to Pre-
mises Medical Payments.

OPTIONAL POLICY PROVISIONS

Each Optional Provision applies only as indicated in the This option applies only with respect to the location shown
Declarations or Extension Certificate. in the Declarations.
Option AI - Named Additional Insured. The definition of Option RC - Replacement Cost - Contents. Under SEC-
insured in this policy includes the person or organization TION I - CONDITIONS, items a. and b. of the Loss Settle-
named in the Declarations as an additional insured or ment Condition are replaced with the following:
whose name is on file with us with respect to:
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a. (1) Fences and the following personal property at

1. Section I: Coverage A - Dwelling; actual cash value at the time of loss:
2. Section II: Coverage L - Business Liability and Cov-
(a) antiques, fine arts, paintings, statuary and
erage M - Premises Medical Payments but only with
similar articles which by their inherent nature
respect to the residence premises. This coverage
does not apply to bodily injury to any employee aris- cannot be replaced with new articles;
ing out of or in the course of the employee’s employ- (b) articles whose age or history contribute sub-
ment by the person or organization. stantially to their value including, but not lim-

15 FORM 3
 ited to, memorabilia, souvenirs and at the time of loss without deduction for deprecia-
collectors items; tion, subject to the following:
(c) property not useful for its intended purpose. (1) We will pay the cost of repair or replacement but
not exceeding the smallest of the following
(2) We will not pay:
amounts:
(a) an amount exceeding that necessary to
(a) replacement cost at time of loss;
repair or replace the property; or
(b) the full cost of repair;
(b) an amount in excess of the limit of liability
applying to the property. (c) any special limit of liability described in the
policy; or
b. Other personal property, carpeting, domestic appli-

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ances, awnings and outdoor antennas, whether or (d) any applicable Coverage A or Coverage B
not attached to buildings, and other structures limit of liability.
(except fences) that are not buildings under Dwell-
ing Extension, at the cost of repair or replacement (2) Loss to property not repaired or replaced within
one year after the loss will be settled on an
actual cash value basis.

IN WITNESS WHEREOF, this Company has executed and attested these presents; but this policy shall not be valid unless
countersigned by the duly authorized Agent of this Company at the agency hereinbefore mentioned.
MP
Secretary President

The Board of Directors, in accordance with Article VI(c) of this Company's Articles of Incorporation, may from time to time dis-
tribute equitably to the holders of the participating policies issued by said Company such sums out of its earnings as in its
judgment are proper.
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