1/28/2015 5060277 CGDI GCN INSURED COPY 1/22/2017 ____ 000048880163 PH - GERMANIA INSURANCE COMPANY MATT GARCIA AND MAYRA GARCIA DBA AUSTIN HARDWOOD FLOORING INC 5120 DACY LN ____ BUDA TX 78610-5857 00042986810 1 500 5060277 1/22/2015 1/22/2016 0 389 PH 512 262-3388 HAYS INSURANCE GROUP LLC MATT GARCIA AND MAYRA GARCIA 316B MAIN ST DBA AUSTIN HARDWOOD FLOORING INC BUDA TX 78610 5120 DACY LN BUDA TX 78610-5857 1,000,000 1,000,000 500,000 500,000 100,000 5,000 XX FLOORING INSTALLATION 5120 DACY LN BUDA TX 78610 FLOOR COVERING INSTALLATION- 94569 31,900 0010.851 PREMISES $346.00 NOT CERAMIC TILE OR STONE FLOOR COVERING INSTALLATION- 94569 31,900 0003.683 PRODUCTS $117.00 NOT CERAMIC TILE OR STONE Additional classifications on back $484.00 $484.00 * PCO CGL180 CG0062 CG2170 CG2176 CG2639 CG2646 GL-ASBEX IL0985 CG0300 HAYS INSURANCE GROUP LLC 􀀀􀀀􀀀􀀀 􀀀 􀀀􀀀􀀀􀀀 􀀀 􀀀􀀀􀀀􀀀 􀀀 􀀀􀀀􀀀􀀀 􀀀 􀀀􀀀􀀀􀀀 􀀀=((( 􀀀􀀀􀀀􀀀 􀀀 =((( COMMERCIAL GENERAL LIABILITY EXTENSION OF DECLARATIONS Policy Number LOCATION OF PREMISES Location of All Premises You Own, Rent or Occupy: PREMIUM Classification Code No. Premium Basis Pr/Co All Other Pr/Co All Other Rate Advance Premium Extension of Declarations - Total Advance Premium CGDBCK 1/28/2015 1 500 005060277 PCO CLASS MINIMUM PREMIUM 00000 0 .000 $21.00 􀀀􀀀􀀀􀀀􀀀7( 􀀀􀀀􀀀􀀀 􀀀 7( FUNGUS OR SPORE EXCLUSION ENDORSEMENT THIS ENDORSEMENT CHANGES YOUR POLICY. PLEASE READ IT CAREFULLY This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE FORM This insurance does not apply to: (1) "Bodily injury", "property damage", or "personal and advertising in jury" caused directly or indirectly, in whole or in part, by: a. Any "fungus" or "spore", including "fungi" or "spores"; or b. Any substance, vapor or gas produced by or arising out of any "fungus" or "spore", including "fungi" or "spores"; or c. Any material, product, building component, building or structure that contains, harbors,, nurtures or acts as a medium for any "fungus" or "spore", including "fungi" or "spores"; or d. Actual, alleged or threatened discharge, dispersal, seepage, migration, release, or escape of any "fungus" or "spore", including "fungi" or "spores". Such damage or injury is excluded regardless of any other cause, event, material, product and/or building component that contributed concurrently or in any sequence to that injury or damage. (2) Any loss, cost or expense arising out of any: a. 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 any "fungus" or "spore", including "fungi" or "spores" or the effects of same (including, but not limited to, any form or type of mold, mildew, mushroom, toadstool, smut, or rust). b. Claim or "suit" 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 any "fungus" or "spore", including "fungi" or "spores" or the effects of same (including, but not limited to, any form or type of mold, mildew, mushroom, toadstool, smut, or rust). (3) With respect to this endorsement, Exclusion 2.b.- Contractual Liability is replaced by the following: a. "Bodily injury" or "property damage" for which the insured is obligated to pay damages by reason of the assumption of liability in a contract or agreement. CGL 180 Includes copyrighted material of Insurance Services Office, Inc. with its permission Copyright, Insurance Services Office, Inc. 1998 Ed 08/01/2002 Page 1 of 2 CG180A 1/28/2015 02 1 500 005060277 􀀀􀀀􀀀 􀀀+( 􀀀􀀀􀀀 􀀀 +( We shall have no duty to investigate, defend or indemnify any insured against any loss, claim, "suit", or other proceeding alleging injury or damages of any kind, to include, but not limited to, "bodily injury", "property damage", or "personal and advertising injury" to which this endorsement applies. Additional Definitions For the purpose of this endorsement, the following definitions are added: "Fungus" and/or "fungi" includes, but is not limited to, any form or type of mold, mildew, mushroom, toadstool, smut or rust. "Spore" and/or "spores" means any reproductive body produced by or arising out of any "fungus" or "fungi". ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. CGL 180 Includes copyrighted material of Insurance Services Office, Inc. with its permission Copyright, Insurance Services Office, Inc. 1998 Ed. 08/01/2002 Page 2 of 2 CG180B 1/28/2015 1 500 005060277 COMMERCIAL GENERAL LIABILITY CG 00 62 12 02 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAR LIABILITY EXCLUSION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Exclusion i. under Paragraph 2., Exclusions of Section I - Coverage A - Bodily Injury And Property Damage Liability is replaced by the following: The following exclusion is added to Paragraph 2., Exclusions of Section I - Coverage B - Personal And Advertising Injury Liability: A. B. 2. Exclusions 2. Exclusions - - - This insurance does not apply to: This insurance does not apply to: i. War War "Bodily injury" or "property damage", however caused, a r i s i n g , d i r e c t l y o r indirectly, out of: "Personal and advertising injury", however caused, a r i s i n g , d i r e c t l y o r indirectly, out of: (1) War, including undeclared or civil war; or a. War, including undeclared or civil war; or (2) W ar l ik e a c ti o n b y a military force, including action in hindering or defending against an a c t u a l o r e x p e c t e d a t t a c k , b y a n y government, sovereign or other authority using military personnel or other agents; or b. W ar l ik e a c ti o n b y a military force, including action in hindering or defending against an a c t u a l o r e x p e c t e d a t t a c k , b y a n y government, sovereign or other authority using military personnel or other agents; or (3) Insurrection, rebellion, r ev o lu t io n , u su r pe d power, or action taken by governmental authority in hindering or defending against any of these. c. Insurrection, rebellion, r ev o lu t io n , u su r pe d power, or action taken by governmental authority in hindering or defending against any of these. Exclusion h. under Paragraph 2., Exclusions of Section I - Coverage C - Medical Payments does not apply. Medical payments due to war are now subject to Exclusion g. of Paragraph 2., Exclusions of Section I - Coverage C - Medical Payments since "bodily injury" arising out of war is now excluded under Coverage A. C. CG 00 62 12 02 CG0062 1/28/2015 03 1 500 005060277 Insurance Act. The criteria of terrorism pursuant to the federal Terrorism Risk Attorney General of the United States, to be an act concurrence with the Secretary of State and the certified by the Secretary of the Treasury, in "Certified act of terrorism" means an act that is established by the Secretary of the Treasury. pro rata allocation in accordance with procedures case insured losses up to that amount are subject to such losses that exceeds $100 billion, and in such for the payment of any portion of the amount of Terrorism Risk Insurance Act, we shall not be liable have met our insurer deductible under the Year (January 1 through December 31) and we Insurance Act exceed $100 billion in a Program acts certified under the federal Terrorism Risk If aggregate insured losses attributable to terrorist TERRORISM CAP ON LOSSES FROM CERTIFIED ACTS OF UNDERGROUND STORAGE TANK POLICY RAILROAD PROTECTIVE LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART This endorsement modifies insurance provided under the following: CG217A CG 21 70 01 08 Page 1 of 1 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. United States Government by coercion. influence the policy or affect the conduct of the civilian population of the United States or to or individuals as part of an effort to coerce the infrastructure and is committed by an individual dangerous to human life, property or 2. The act is a violent act or an act that is CG 21 70 01 08 Insurance Act; and types of insurance subject to the Terrorism Risk $5 million in the aggregate, attributable to all 1. The act resulted in insured losses in excess of terrorism" include the following: Terrorism Risk Insurance Act for a "certified act of contained in the 1/28/2015 1 500 005060277 "Certified act of terrorism" B. The following definition is added: This insurance does not apply to: This endorsement modifies insurance provided under the following: A. The following exclusion is added: CG 21 76 01 08 coercion. conduct of the United States Government by States or to influence the policy or affect the coerce the civilian population of the United individual or individuals as part of an effort to infrastructure and is committed by an dangerous to human life, property or 2. The act is a violent act or an act that is Insurance Act; and types of insurance subject to the Terrorism Risk $5 million in the aggregate, attributable to all 1. The act resulted in insured losses in excess of punitive damages. "certified act of terrorism" that are awarded as Damages arising, directly or indirectly, out of a TERRORISM PUNITIVE DAMAGES RELATED TO A CERTIFIED ACT OF TERRORISM EXCLUSION OF PUNITIVE DAMAGES UNDERGROUND STORAGE TANK POLICY RAILROAD PROTECTIVE LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART GL2176 CG 21 76 01 08 Page 1 of 1 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. terrorism" include the following: Terrorism Risk Insurance Act for a "certified act of Insurance Act. The criteria contained in the of terrorism pursuant to the federal Terrorism Risk Attorney General of the United States, to be an act concurrence with the Secretary of State and the certified by the Secretary of the Treasury, in means an act that is 1/28/2015 04 1 500 005060277 COMMERCIAL GENERAL LIABILITY CG 26 39 04 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. TEXAS CHANGES - EMPLOYMENT - RELATED PRACTICES EXCLUSION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART (2) To any obligation to share damages with or to repay someone else who must pay damages because of the injury. A. The following exclusion is added to Paragraph 2., Exclusions of Section I - Coverage A - Bodily Injury And Property Damage Liability: B. The following exclusion is added to Paragraph 2., Exclusions of Section I - Coverage B - Personal And Advertising Injury Liability: This insurance does not apply to: "Bodily injury" to: (1) A person arising out of any: (a) Refusal to employ that person; This insurance does not apply to: "Personal and advertising injury" to: (b) Termination of that person's employment; or (1) A person arising out of any: (c) Employment-related practices, policies, acts or omissions, such as coercion, demotion, evaluation, reassignment, discipline, defamation, harassment, humiliation or discrimination directed at that person; or (a) Refusal to employ that person; (b) Termination of that person's employment; or (c) Employment-related practices, policies, acts or omissions, such as coercion, demotion, evaluation, reassignment, discipline, defamation, harassment, humiliation or discrimination directed at that person; or (2) The spouse, child, parent, brother or sister of that person as a consequence of "bodily injury" to that person at whom any of the employment-related practices described in Paragraph (a), (b) or (c) above is directed. (2) The spouse, child, parent, brother or sister of that person as a consequence of "personal and advertising injury" to that person at whom any of the employment-related practices described in Paragraph (a), (b) or (c) above is directed. This exclusion applies: (1) Whether the insured may be liable as an employer or in any other capacity; and CG 26 39 04 99 CG2639 1/28/2015 1 500 005060277 COMMERCIAL GENERAL LIABILITY CG 26 46 04 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. TEXAS ABUSE OR MOLESTATION EXCLUSION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following exclusion is added to 2. Paragraph 2., Exclusions of Section I - Coverage A - Bodily Injury And Property Damage Liability and Paragraph 2., Exclusions of Section I - Coverage B - Personal And Advertising Injury Liability: The negligent: a. Employment; b. Investigation; c. Supervision; d. Reporting to the proper authorities, or failure to so This insurance does not apply to "bodily report; or injury", "property damage" or "personal and advertising injury" arising out of: e. Retention; of a person for whom any insured is or ever was legally responsible and whose conduct would be excluded by Paragraph 1. above. The actual or threatened abuse or molestation by anyone of any person while in the care, custody or control of any insured, or 1. For the purpose of this endorsement, abuse means an act which is committed with the intent to cause harm. CG 26 46 04 99 CG2646 1/28/2015 05 1 500 005060277 monitor, clean up, remove, mitigate, abate, study, contain, regulatory requirement, direction or determination that any insured or others test for, investigate, ii. Claim or suit for damages arising out of or relating to any request, demand, order, statutory or p. Asbestos Exclusions DAMAGE LIABILITY, 2. Exclusions The following exclusion is added to SECTION I - COVERAGES, COVERAGE A - BODILY INJURY AND PROPERTY treat, encapsulate, control or take any other action regarding asbestos; or insured or others test for, investigate, monitor, clean up, remove, mitigate, abate, study, contain, i. Request, demand, order, statutory or regulatory requirement, direction or determination that any (2) Any sums that any insured or other entity must pay, repay or reimburse because of any: (1) GL-ASBEX-08-05 Ed 08/01/2005 Page 1 of 1 injury or damage; or whether any other cause, event, material or product contributed concurrently or in any sequence to the dispersal, release, leakage, leaching, friability, flaking, escape or presence of asbestos, regardless of asbestos or any products containing asbestos including the actual, alleged, or threatened discharge, "Bodily injury" or "Property Damage" caused by, resulting from or arising out of asbestos, exposure to GL805 2. Commercial General Liability Policy This endorsement modifies insurance provided under the following: ABSOLUTE ASBESTOS EXCLUSION THIS ENDORSEMENT CHANGES THE POLICY READ IT CAREFULLY This insurance does not apply to: (5) Any other loss, cost or expense arising out of or relating in any way to asbestos. (4) with items (1), (2) and (3) above; or Any obligation to share damages with or repay someone else who must pay damages in connection (3) given in connection with items (1) and (2) above; or Any supervision, instructions, recommendations, warnings or advice given or which should have been other action regarding asbestos; or treat, encapsulate, control or take any 1/28/2015 1 500 005060277 share equals 85% of that portion of the insured under the federal program. The federal Treasury, will pay a share of terrorism losses The United States Government, Department of the Additional information, if any, concerning the terrorism premium: Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Form(s) and/or Policy(s): This premium is the total Certified Acts premium attributable to the following Coverage Part(s), Coverage INSURANCE ACT DISCLOSURE PURSUANT TO TERRORISM RISK Terrorism Premium (Certified Acts) $ SCHEDULE IL985A IL 09 85 01 08 Page 1 of 1 IL 09 85 01 08 CHANGE THE TERMS AND CONDITIONS OF ANY COVERAGE UNDER THE POLICY. INSURANCE ACT. THIS ENDORSEMENT DOES NOT GRANT ANY COVERAGE OR RESPONSE TO THE DISCLOSURE REQUIREMENTS OF THE TERRORISM RISK THIS ENDORSEMENT IS ATTACHED TO AND MADE PART OF YOUR POLICY IN Terrorism Losses C. Cap On Insurer Participation In Payment Of =(( 􀀀􀀀􀀀􀀀􀀀 =(( 􀀀􀀀􀀀􀀀 􀀀 􀀀􀀀􀀀􀀀 􀀀 insured losses that exceeds $100 billion, and in such case payment of any portion of the amount of such Risk Insurance Act, we shall not be liable for the met our insurer deductible under the Terrorism (January 1 through December 31) and we have Act exceed $100 billion in a Program Year acts certified under the Terrorism Risk Insurance If aggregate insured losses attributable to terrorist Of Terrorism Losses B. Disclosure Of Federal Participation In Payment endorsement or in the policy Declarations. coverage is shown in the Schedule of this The portion of your premium attributable to such certified under the Terrorism Risk Insurance Act. any, attributable to coverage for terrorist acts a notice disclosing the portion of your premium, if Insurance Act, we are required to provide you with In accordance with the federal Terrorism Risk A. Disclosure Of Premium losses that exceeds $100 billion. payment for any portion of the amount of such December 31), the Treasury shall not make any billion in a Program Year (January 1 through the Terrorism Risk Insurance Act exceed $100 losses attributable to terrorist acts certified under insurer retention. However, if aggregate insured such insured losses that exceeds the applicable amount of established by the Secretary of the Treasury. rata allocation in accordance with procedures losses up to that amount are subject to pro 1/28/2015 06 1 500 005060277 Policy Number: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DEDUCTIBLE LIABILITY INSURANCE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Coverage Amount and Basis of Deductible PER CLAIM OR PER OCCURRENCE Bodily Injury Liability $ $ OR Property Damage Liability $ $ OR Bodily Injury Liability and/or $ $ Property Damage Liability Combined (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) APPLICATION OF ENDORSEMENT (Enter below any limitations on the application of this endorsement. If no limitation is entered, the deductibles apply to damages for all "bodily injury" and "property damage", however caused): b. Under Property Damage Liability Coverage, to all damages sustained by any one person because of "property damage"; or Our obligation under the Bodily Injury Liability and Property Damage Liability Coverages to pay damages on your behalf applies only to the amount of damages in excess of any deductible amount stated in the Schedule above as applicable to such coverages. A. c. Under Bodily Injury Liability and/or Property Damage Liability coverage Combined, to all damages sustained by You may select a deductible amount on any one person because of: either a per claim or a per "occurrence" basis. Your selected deductible applies to the coverage option and to the basis of the deductible indicated by the placement of the deductible amount in the Schedule above. The deductible amount stated in the Schedule above applies as follows: B. (1) "Bodily injury" (2) "Property damage", or (3) "Bodily injury" and "property damage" combined as the result of any one "occurrence". If damages are claimed for care, loss of services or death resulting at any time from "bodily injury", a separate deductible amount will be applied to each person making a claim for such damages. With respect to "Property damage", person includes an organization. 1. PER CLAIM BASIS if the deductible amount indicated in the Schedule above is on a per claim basis, that deductible applies as follows: a. Under Bodily Injury Liability Coverage, to all damages sustained by any one person because of "bodily injury", CG 03 00 01 96 CR0300 07/17/01 1/28/2015 1 500 005060277 500.00 C. The terms of this insurance, including those with respect to: PER OCCURRENCE BASIS. If the deductible amount indicated in the Schedule above is on a "per occurrence" basis, that deductible amount applies as follows: 2. 1. Our right and duty to defend the insured against any "suits" seeking those a. Under Bodily Injury Liability damages; and Coverage, to all damages because of "bodily injury"; 2. b. Your duties in the event of an "occurrence", claim, or "suit" Under Property Damage Liability Coverage, to all damages because of "property damage"; or apply irrespective of the application of the deductible amount. c. Under Bodily Injury Liability and/or Property Damage Liability Coverage Combined, to all damages because of: D. We may pay any part or all of the deductible amount to effect settlement of any claim or "suit" and, upon notification of the action taken, you shall promptly reimburse us for such part of the deductible amount as has been paid by us. (1) "Bodily injury" (2) "Property damage", or (3) "Bodily injury" and "property damage" combined as the result of any one "occurrence", regardless of the number of persons or organizations who sustain damages because of that "occurrence". CG 03 00 01 96 Page 2 of 2 CR300B 07/31/01 1/28/2015 *07 1 500 005060277 1/28/2015 * 1 500 005060277