Document:

exv10w16

 

Exhibit 10.16

EXCESS LIABILITY POLICY
DECLARATION

	 	 	 	 	 	 	 
	

	Policy	 	
COLUMBIA CASUALTY COMPANY
	 	Symbol
	 	Policy Number
	Issued by	 	CNA Insurance Companies	 	 	 	 
	 	 	CNA Plaza	 	 	 	 
	 	 	
Chicago, IL 60685
	 	GPE
	 	167040836
	

	Producer’s Name	 	
Stewart Smith East, Inc.
	 	Producer Code	 
	and Address	 	
Wall Street Plaza
	 	975-948607	 	 
	 	 	
88 Pine Street	 	 	 	 
	 	 	
New York, NY 10005	 	 	 	 
	

	Named Insured	 	
Current & Retired Executives of General Dynamics Corporation and
as per	 	 	 	 
	 	 	
Endorsement No. 1	 	 	 	 
	

	Sponsoring	 	General Dynamics Corporation	 	 	 	 
	Organization	 	3190 Fairview Park Drive	 	 	 	 
	and Address	 	Falls Church, VA 22042	 	 	 	 
	

	Policy Period	 	
From       June 5,
2001       through       June 6, 2002	 	 	 	 
	 	 	
12:01 a.m. Standard Time at the Address of the sponsoring organization
as stated herein	 	 
	

	Limit of Liability	 	
$5,000,000                   Each Occurrence	 	 	 	 
	

	
If exposure exists, the Named Insured agrees to maintain during the term of the policy at least the following underlying coverages and minimum
required underlying limits. Overseas residents must obtain the
maximum limits and coverages available within the country of
residency.
        
	

	 	 	 	 	 	 	 
	 	 	

	 	 	
Exposures
	 	Coverages
	 	Minimum Required Underlying Limit
	 	 	

	 	 	
Automobile

Liability
	 	Bodily Injury

Property Damage
	 	$250,000 Per Person, $500,000 Per
Occurrence,
 $50,000 Per Occurrence
	 	 	

	Schedule of
Required
Underlying
Insurance	 	

Personal

Liability
		-or-

Combined Single Limit

Combined Single Limit

(Required for all property owned or
rented)
		$300,000 Per Occurrence

($325,000 in Texas)

$100,000 Per Occurrence
	 	 	

	 	 	
Watercraft

Liability
	 	Bodily Injury/Property

Damage or Combined
 Single Limit
	 	$100,000 Per Occurrence
	 	 	

	 	 	
Employers Liability
	 	Combined Single Limit
	 	$100,000 Per Occurrence
	 	 	

	 	 	
UM/UIM (only when
coverage is

provided under
this policy)
	 	Bodily Injury

Property Damage
	 	$250,000 Per Person, $500,000 Per
Occurrence
 $50,000 Per Occurrence
	 	 	 	 	

	 	 	 	 	-or-

Combined Single Limit
	 	$300,000 Per Occurrence

($325,000 in Texas)
	

	Premium	 	
$22,425.00
	 	Advance Premium payable at inception
	

	Endorsements	 	
Forming a part of this policy inception. Endorsement No. 1-4	 	 
	

Issued this 30th day of May 2001

	 	 	 
		 	
	 	 	
Authorized Representative:

 

EXCESS LIABILITY POLICY

INTRODUCTION

Various provisions in this policy restrict coverage. Read the entire
policy carefully to determine rights, duties and what is and is not
covered.

Throughout this policy the words, “you” and “your” mean the individual who
is a member of the Defined Group shown as the Named Insured in the
Declaration. “We”, “us” and “our” refer to the Company providing this
insurance.

 INSURING AGREEMENT

 

We agree to provide insurance described in this policy in return for the
premium paid by the Sponsoring Organization and your compliance with the
terms and conditions of this policy.

We will pay all sums up to the amounts of our limits of liability shown on
the policy Declaration, more fully defined by the term Net Loss, that the
Insured becomes legally obligated to pay for Personal Liability in excess
of all required underlying insurance covering those damages, even if the
underlying limit is more than the Required Underlying Limit.

If you are a member of a residential property association, we will pay for
your share of any loss assessment for legal liability during the policy
period charged against you by that association. However, we do not cover
loss assessments resulting from a deductible in the policy of insurance
purchased by a residential property association. This coverage applies
only to that portion of an assessment which is in excess of $50,000. This
coverage does not increase our limit of liability.

We will pay the Sponsoring Organization up to a $1,000,000 aggregate limit
for all sums that the Sponsoring Organization becomes legally obligated to
pay as damages because of a Wrongful Act which occurs and is reported to us
during the policy period.

Schedule of Required Underlying Insurance includes all liability coverages
that apply to the covered damages. Failure
to comply with the required underlying Insurance as shown on the policy
Declaration will result in a gap in coverage.

This insurance applies to Personal Liability only if:

	1.	 	The Personal Liability is caused by an Occurrence that takes place in
the Policy Territory; and
	 
	2.	 	The Personal Liability occurs during the Policy Period.

WHAT WE DO NOT COVER

This insurance does not apply to:

	1.	 	Personal Liability caused intentionally by any person.
	 
	 	 	This does not apply to:

	 	(a)	 	any act by an Insured while trying to prevent or eliminate danger
in the use of Automobiles or watercraft; or
	 
	 	(b)	 	while trying to protect persons or property;

	2.	 	Personal Liability arising out of the ownership, maintenance or use of
any aircraft or hovercraft. This does not apply to:

	 	 	(a)	 	model airplanes of the hobby
type which do not carry people or cargo.
	 
	 	 	(b)	 	an aircraft chartered with crew by an Insured.

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	3.	 	Personal Liability arising out of any watercraft you own, rent or
use, or is, in your care custody or control if it is:

	 	 	(a)	 	powered by an inboard or inboard-outboard motor of more
than 50 horsepower;
	 
	 	 	(b)	 	a sailing vessel (with or without auxiliary power) 26 feet
or more in overall 1ength;
	 
	 	 	(c)	 	powered by any outboard motor(s), singly or in combination,
of more than 25 total horsepower.

	 	 	However, this exclusion does not apply if such liability is covered by
valid and collectible underlying Insurance as listed in the Schedule of
Required Underlying Insurance shown on the policy Declaration, for the
full limit shown therein, and then only for such liability for which
coverage is afforded under said underlying insurance.
	 
	4.	 	Personal Liability arising out of the use of any Automobile or
watercraft in any prearranged or organized race, speed contest, other
competition or practice. However, this exclusion does not apply to
sailboats.
	 
	5.	 	Personal Liability resulting from any act or failure to act by
any Insured as a director or officer of any organization. This does
not apply to positions in a non-profit organization for which the
Insured does not receive pay.
	 
	6.	 	We do not cover assessments charged against you or a residential
property association by any
governmental body.
	 
	7.	 	Personal Liability for
providing or failing to provide
professional services by:

	 	 	(a)	 	the Insured or;
	 
	 	 	(b)	 	any person for whom the Insured is legally responsible.

	8.	 	Personal Liability resulting from your Business Activity or
business property. This exclusion does not apply to:

	 	 	(a)	 	residential property you rent out or are holding out for
rental for use as a place to live. But such property must be
covered by Required Underlying Limit(s). By residential property,
we mean, condominium, apartment, co-operative, a 1,2,3, or 4
family house, and any smaller detached structures on the property
such as a garage or storage shed, the grounds, and private roads on
the property;
	 
	 	 	(b)	 	activities which are described in an endorsement attached
to this policy;
	 
	 	 	(c)	 	the use of any Automobile provided it is not used to carry
persons or property for a fee. This exclusion does not apply to a
share-the-expense ride;
	 
	 	 	(d)	 	volunteer work for charity;
	 
	 	 	(e)	 	incidental business activities which generate less than $10,000 in
gross annual revenues.

	9.	 	Personal Liability covered by a nuclear energy liability policy
or that would have been covered by any such policy if its limit had
not been exceeded.
	 
	10.	 	Personal Injury arising out of the transmission of, or threat of
transmission of, a communicable sickness or disease by an Insured.
	 
	11.	 	Any obligation for which an Insured may be held liable under any
workers compensation, non-occupational disability, unemployment
compensation, or similar law.
	 
	12.	 	Discrimination due to age, race, color, sex, creed, national
origin, or any other discrimination. However, coverage is provided on
a Following Form basis if the coverage is provided under a required
primary underlying insurance policy.
	 
	13.	 	Molestation, misconduct or
abuse arising out of any actual
alleged or threatened sexual molestation, sexual misconduct or sexual
harassment, or abuse. However, coverage is provided on a Following
Form basis if the coverage is provided under a required primary
underlying insurance policy.
	 
	14.	 	Property Damage to:

	 	 	(a)	 	property owned by an Insured.
	 
	 	 	(b)	 	any other property, which is rented to, used by, occupied
by, or in the care, custody, or control of an Insured. However,
this only applies to the extent that the Insured has agreed in
writing to provide

Page 2 of 10

 

	 	 	 	insurance for this property.

	15.	 	The owner or lessee of an Automobile or watercraft loaned to or hired
by you.
	 
	16.	 	Sums which an Insured is entitled to recover from the owner or operator
of an “Uninsured Motor Vehicle.”

DEFENSE RELATED DUTIES

	1.	 	If a claim or suit alleges damages covered by underlying
policies, and the obligation of all underlying policies either to:

	 	 	a.	 	investigate and defend the Insured; or
	 
	 	 	b.	 	pay the cost of such investigation and defense

	 	 	ceases solely through exhaustion of all underlying limits of liability
through payment of a combination of
covered expenses, settlements or judgments for Occurrence taking place
during our Policy Period, then we
shall assume the investigation and defense of the Insured against claims
or suits seeking damages. If we are not permitted, by law or otherwise,
to assume the investigation and defense in 1.a. above, we will
reimburse the Insured for reasonable defense costs and expenses incurred
with our written consent. However, such reimbursements exclude:

	 	 	a.	 	office expenses of the Insured;
	 
	 	 	b.	 	salaries and expenses of an Employee(s); and
	 
	 	 	c.	 	general retainer fees of
counsel retained by the Insured.

	2.	 	We will investigate and defend claims or suits brought against an
Insured for a claim or suit that alleges damages from an Occurrence
not covered by:

	 	 	a.	 	required underlying insurance: and or
	 
	 	 	b.	 	unscheduled underlying insurance;

	 	 	but which seeks damages arising out of an Occurrence otherwise covered
under this policy.
	 
	3.	 	We will investigate and defend
an Insured or reimburse an
Insured for such costs of investigation and defense described in either
1. or 2 above, even if the allegations of a suit are:

	 	 	a.	 	groundless,
	 
	 	 	b.	 	false, or
	 
	 	 	c.	 	fraudulent,

	 	 	but only until we make payment
or offer to pay or deposit in court that
part of the judgment(s) not exceeding our limit of liability.
	 
	4.	 	With regard to claims or suits covered by unscheduled underlying
insurance or covered by this policy, only we shall, with your consent,
have the right to make settlement. However, if you refuse to consent
to any settlement mutually agreed upon by us and the plaintiff,
recommended in writing by us, and you elect to contest or continue any
legal proceedings, our liability shall not exceed the amount for which
the claim suit could have been settled plus the cost and expenses
incurred up to the date of refusal.
	 
	5.	 	When the limit of insurance has been used up in the payment of
judgments or settlements:

	 	 	a.	 	We will notify the Named Insured in writing, as
soon as practicable, that:
	 

	 	 	1.	 	such limit has been used up; and
	 

	 	 	2.	 	our duty to defend claims or suits
seeking damages subject to that limit has ended.
	 

	 	 	b.	 	We shall initiate, and cooperate in, the transfer of control
to any appropriate Insured, of all claims and suits seeking
damages, which are subject to that limit and which are reported to
us before that limit is used up. The Insured must cooperate in the
transfer of control of said claims and suits.

Page 3 of 10

 

 

SUPPLEMENTARY PAYMENTS

     In addition to our limit of liability, we will pay on behalf of an Insured:

	 	1.	 	The cost of bail bonds required because of an Occurrence. This
includes related traffic law violations, resulting in Personal Liability
covered under this policy.
	 
	 	2.	 	All costs taxed against an Insured.
	 
	 	3.	 	Premiums on appeal bonds and bonds to release attachments in any suit
we defend.
	 
	 	4.	 	Interest accruing after a judgment is entered in any suit we defend. Our duty to pay interest ends when we offer to pay that part of the judgment, which does not exceed our limit
of liability for this coverage.
	 
	 	5.	 	Other reasonable expenses incurred at our request. This includes
loss of earnings up to $100 per day or a maximum of $5,000.

		
	 	The amounts we pay for defense, and the other supplementary payments described
above, will not reduce the limits of insurance.

LIMITS OF LIABILITY

The limit of liability shown in the Declaration is the amount you have selected
and is the maximum amount that we will pay for all damages for Personal
Liability from any one Occurrence. This amount is the most we will pay and will
not be added to in any way, mulitpiled by any factor, or otherwise increased for
any reason, regardless of the number of:

	 	•	 	Insureds
	 
	 	•	 	suits brought
	 
	 	•	 	claims made
	 
	 	•	 	premiums charged or premiums shown, either separately or collectively
in the Declaration, or in any other document attached to or made part
of your policy.
	 
	 	•	 	Automobiles or watercrafts owned or involved in the Occurrence.

Subject to our limit of liability we will be liable only for the Net Loss
resulting from any one Occurrence:

	 	1.	 	in excess of Required Underlying Limit(s) or
	 
	 	2.	 	in excess of valid and collectible insurance, if the Occurrence arises
from the use of an Automobile which is hired by you or loaned to you
for a period of sixty (60) days or less. Any Automobile hired by you or
loaned to you for a period of more than sixty (60) days will be subject
to the Required Underlying Limit for Automobile Liability on the policy
Declaration.
	 
	 	3.	 	in excess of valid and collectible insurance, if the Occurrence
arises from the use of a watercraft which is hired by you or loaned to
you for a period of thirty (30) days or less. Any watercraft hired by
you or loaned to you for a period of more than thirty (30) days will be
subject to the Required Underlying Limit for watercraft liability on
the policy Declaration.

GENERAL CONDITIONS

DUTIES AFTER AN OCCURRENCE

		
	 	As soon after an injury or Occurrence takes place that is likely to
involve coverage under this policy, we must be notified or soon as reasonably
possible. You or the Sponsoring Organization should tell us how, when and

Page 4 of 10

 

 

		
	 	where the Occurrence happens. You or the Sponsoring Organization should also
include the names and address of any injured persons and of any witnesses.
Notice to a licensed agent of the Insurer shall be deemed notice to the
Insurer.
	 
	 	Any Insured seeking any coverage must:

	 	1.	 	cooperate with the underlying insurers, as required by their
policies, and with us in the investigation, settlement or defense on
any claim or suit.
	 
	 	2.	 	as soon as reasonably possible tell us if a claim is made or a
suit is brought. That person must also send to us or the underlying
insurer copies of any notices of legal papers received concerning the
Occurrence.
	 
	 	3.	 	attend hearings and trials.
	 
	 	4.	 	cooperate in securing and giving evidence.
	 
	 	5.	 	cooperate in having witnesses attend any deposition, hearing or
trial.
	 
	 	6.	 	at our request, enforce any right of contribution or indemnity
against any person or organization who may be liable to the Insured,
because of a loss covered under this policy.

APPEALS

		
	 	If the Insured or any underlying insurer elects not to appeal a judgment,
which exceeds the underlying limit, we may elect to do so. We shall be
responsible for all costs, taxes, expenses and interests on judgments
incidental to the appeal.

WHEN LOSS PAYABLE

		
	 	The Insured may make claim for payment after the Net Loss has been
determined in excess of the Required Underlying Limit(s) or underlying
insurance limit if greater.
	 	 
	 	
This will be determined after a trial or by written agreement of the Insured, the claimant and us.

LEGAL ACTION AGAINST US

		
	 	No legal action will be brought against us unless the Insured has fully
complied with all the terms of this policy; and the amount of the
Insured’s obligation to pay has been finally determined by:

	 	1.	 	Judgment against the Insured;
	 
	 	2.	 	Written agreement between us, the Insured and the claimant; or
	 
	 	3.	 	Judgment against the Insured remains unsatisfied at the
expiration of 30 days from the serving of notice of the entry of
judgment upon the Insured, its attorney or us.

OTHER INSURANCE

Our coverage is excess over any other valid and collectible insurance. This
means all insurance which covers you or any Insured, whether it is shown in the
schedule or not. Only when all such insurance has been exhausted will this
policy apply.

OUR RIGHT TO RECOVER PAYMENT

	1.	 	If we make a payment under this policy, we will share recovery rights
with the Insured and any underlying insurer. If the person to or for whom
payment was made has a right to recover damages from another we will be
subrogated to that right. That person will:

	 	 	 
	(a)	 	
do whatever is necessary to enable us to exercise our right and
	(b)	 	
do nothing after the loss to prejudice them.

	2.	 	If we make a payment under this policy and the person to or for whom
payment is made recovers damages from another, that person will hold in
trust for us the proceeds of the recovery. That person will reimburse us
to the extent of our payment.

Page 5 of 10

 

 

	3.	 	Recoveries will be applied:

	 	(a)	 	first to reimburse any party (including the Insured) that
may have been paid any amount in excess of our limit of liability;
	 	(b)	 	then to reimburse us up to the amount paid;
	 	(c)	 	last, to reimburse any interest (including the Insured) that
may have been paid any amount either under underlying policies or
otherwise.

A different sharing may be made by a written agreement signed by all interested
parties. Any expenses incurred in making recoveries will be shared by
interested parties in the ratio of their respective losses.

CHANGES

This policy contains all the agreements between you and us. Its terms may not
be changed or waived except by endorsement issued by us. If a change requires a
premium adjustment, we will adjust the premium as of the effective date change.

TRANSFER OF YOUR INTEREST IN THIS POLICY

	 	 	Your rights and duties under this policy except as provided for the Sponsoring
Organization in this policy may not be assigned without written consent.
However, if a Named Insured shown in the policy Declaration dies, coverage
will be provided until the annual anniversary date of the policy for:

	 	1.	 	the surviving spouse if resident in the same household at the time of
death; or
	 
	 	2.	 	any member of your household who is covered under this policy at the
time of your death, but only while a resident of the premises insured by
this policy;
	 
	 	3.	 	the liability of your property and premises, your legal
representatives; or until a legal representative is appointed and
qualified, the person who has proper temporary custody of your property
and premises.

IF YOU BECOME BANKRUPT OR INSOLVENT

		
	 	We will meet all our obligations under this policy regardless of whether
the Insured or the Insured’s estate becomes
bankrupt or insolvent.

LIBERALIZATION

		
	 	We may extend or broaden the insurance provided under this policy, without
premium charge, by amendment or substitution of form. If we do this during the
period that this policy is in the force or within 60 days prior to its
effective date, the extended or broadened insurance will apply to your policy.

CONFORMITY

		
	 	If any provision of this policy is in conflict with the laws of the state
or country in which you reside, this policy is amended to conform to the
requirements of those laws.

KEEPING REQUIRED UNDERLYING INSURANCE IN FORCE

If you fail to keep required underlying policies in force for the full amount
of the Required Underlying Limit(s), we will not provide coverage unless and
until the amount of all claims resulting from a single Occurrence exceed the
Required Underlying Limit(s). If any underlying policy has an
aggregate limit, which is not reinstated after a loss, you must try, within reason, to have
coverage reinstated promptly.

CONCEALMENT OR FALSE INFORMATION

		
	 	We may void this policy or deny coverage
if you, or any Insured, has
intentionally concealed, given false information or misrepresented any material
fact:

	 	1.	 	in the application;
	 
	 	2.	 	in any other notice regarding underlying insurance; or
	 
	 	3.	 	related to an Occurrence.

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PREMIUM

		
	 	The Sponsoring Organization is responsible for the payment of all premiums to
us. All return premiums, if any, will be sent to the Sponsoring
Organization.

SPECIAL CONDITIONS

	 	1.	 	We retain the right to review, modify, or amend writing
communications sent to employees or members of the Defined
Group regarding this excess liability coverage prior to distribution.
	 
	 	2.	 	An employee or member of a
Defined Group shall have the right to
refuse this excess liability coverage offered by the Sponsoring
Organization.

NOTICE OF NONRENEWAL AND CANCELLATION

     Cancellation:

	 	1.	 	The Sponsoring
Organization may cancel the coverage afforded by this
policy for any reason upon 30 days written notice to us and each
affected member of the Defined Group.
	 
	 	2.	 	We may cancel this policy at any time by giving the Sponsoring
Organization at the address shown on the policy Declaration written
notice:

	 	(a)	 	at least 20 days in advance of the date cancellation is to
take effect, if cancellation is for non-payment of premium, or
	 
	 	(b)	 	at least 60 days in advance of the date cancellation is to
take effect for any reason other than non-payment of premium.

	 	3.	 	The Sponsoring
Organization shall mail or deliver written notice of
such cancellation to each affected member of the Defined Group within 10
days of receiving a cancellation from the Insurer.
	 
	 	4.	 	We may deliver any notice of cancellation to the address shown on the
policy Declaration instead of mailing it. Proof of mailing or delivery
of any notice will be sufficient proof of notice.
	 
	 	5.	 	If the policy is cancelled, a return premium may be due. This refund
will be promptly forwarded to the Sponsoring Organization. No refunds
will be made by us to individual Named Insureds. Should the policy be
cancelled, at the request of the Sponsoring Organization, the amount to
be refunded will be computed at 90% of pro-rata. However, making or
offering to make the refund is not a condition of cancellation.

Nonrenewal:

If we decide not to renew this policy, notice will be sent as provided in
Cancellation Items 2, 3, and 4.

Conditional Renewal:

If we conditionally renew this policy subject to a:

	 	1.	 	Change of limits;
	 
	 	2.	 	Change in type of coverage;
	 
	 	3.	 	Reduction or elimination of coverage;
	 
	 	4.	 	Addition of exclusion; or
	 
	 	5.	 	Increase in premiums in excess of 10% exclusive of any premium
increase due to and commensurate with inside value added or increased
exposure units; or as a result of experience rating, loss rating,
retrospective rating or audit;

		
	 	If we decide to conditionally renew this policy, notice will be sent as
provided in Cancellation Items 2, 3, and 4.

Termination:

Should an individual for any reason no longer
qualify as a Named Insured
coverage will cease at the annual anniversary date or policy cancellation date,
whichever comes first. However, the Sponsoring Organization has the option of
canceling the Named Insured’s coverage upon termination of employment. No
refunds will be made by us to individual Named Insureds.

Page 7 of 10

 

 

DEFINITIONS

Automobile means a private passenger car and any other motorized land vehicle
designed for travel on public roads and subject to motor vehicle registration.
It also means a trailer, semi-trailer, farm tractor, or farm implements while
being towed by a covered vehicle.

Bodily injury means physical bodily harm, including sickness or disease. This
includes require care, loss of services and death resulting therefrom.

Business Activity means any full or part time gainful employment, trade,
profession, or occupation of the insured, other than Farming as defined in the
policy. Business Activity does not mean part time jobs of insured who are
students under the age of 25 or activities which are ordinarily incidental to
non-business pursuits.

Business Property means property on which a business is conducted and property,
or any part of it, rented to others or held for rental.

Certificate of insurance means any policy or other evidence of insurance issued
to a Defined Group member under this policy.

Defined Group means those individuals meeting the criteria for qualifications
as a Named Insured as defined by the Sponsoring Organization.

Employee means a person who receives, or has received, income, wages or
salaries from the Sponsoring Organization.

Employer means a person, partnership, corporation or other entity, which pays,
or has paid income, wages or salaries to a person or persons.

Farming means agricultural operations or the raising of animals, which produced
$10,000 or less in gross annual revenues.

Follow form means we cover damages to the extent they are both covered under
the required primary underlying insurance and not excluded under this policy.
When no primary underlying coverage exists, the extent of coverage provided on
a follow form basis will be determined as if the required underlying insurance has been
written on personal lines policy forms filed by the Insurance Services Office.

Group Policy means group personal excess insurance written for the Defined
Group of the Sponsoring Organization. A group policy shall have a common
inception and expiration date; however, a new employee within the Defined Group
may be added during the policy period.

Insured means:

     1.     you or any Relative.

     2.a.  any person:

               (1)  using your Automobile or watercraft, or

               (2)  having custody of any of your animals;

        b.
 such person must:

               (1)  have your permission for such use of custody, and

               (2)  limit the use of custody as you may require.

     3.     Named
Insured(s).

     4.     any other person organization, however coverage is only for the
legal responsibility for acts or
            
omissions of those persons for whom coverage is afforded above.

     5.     Sponsoring Organization as respects to a Wrongful Act.

Named Insured(s) means individuals who are members of the Defined Group.

Page 8 of 10

 

Net Loss means the sum actually ____ or payable due to a claim for which the
insured is liable either by a settlement we agreed to or a final judgment. Such
sums will include proper adjustment for recoveries and salvage.

Occurrence means an accident including continuous or repeated exposure to
substantially the same conditions neither expected nor intended by the insured
except to protect persons or property.

Occupying means in, upon, or getting in, out, on or off or loading or
unloading.

Personal Liability means Personal Injury, Bodily Injury, or Property Damage.

Personal Injury means:

	 	1.	 	bodily injury, shock, mental anguish, mental injury, sickness
or disease, including death resulting therefrom;
	 
	 	2.	 	injury because of false arrest, detention or imprisonment,
malicious prosecution, wrongful entry or eviction, humiliation,
libel, slander, defamation of
character or invasion of privacy.

Policy Period means one year, or longer if agreed to in writing by the company
prior to the inception date of the policy.

Policy Territory means anywhere in the world.

Property Damage means physical injury to or destruction of tangible property.
This include loss of use of such property.

Recreational Vehicle means any motorized land vehicle which is designed for
recreational use off public roads and not subject to any motor vehicle
registration act, or in dead storage on an insured location.

Relative means a person related to you by blood, marriage or adoption who is a
resident of your household. This includes a ward, foster child or child held in
joint custody. For the purposes of this definition, to be considered a resident
of your household when evaluating coverage for a loss, a person must have been
actually residing in your household on the date the loss occurred. However,
your son, daughter, ward, foster child, or child held in joint custody in the
United States military or away at school will be considered a resident of your
household unless he or she has demonstrated an intent to reside elsewhere
permanently.

Required Underlying Limit(s) mean the minimum limits you are required to
maintain in force for the types of insurance and exposures described in the
Schedule of Required Underlying Insurance in the policy Declaration.

Sponsoring Organization means a person, partnership, corporation, or other
entity, which sponsors and defines the criteria for qualification as a Named
Insured.

Uninsured Motor Vehicle means an Automobile:

	 	1.	 	for which no liability bond or policy applies at the time of
the Occurrence;
	 
	 	2.	 	that is an Underinsured Motor Vehicle. An Underinsured Motor
Vehicle is a registered motor vehicle for which a Bodily Injury
liability bond or policy applies at the time of an Occurrence but the
amount paid under that bond or policy to an Insured is not enough to
pay the full amount the Insured is legally entitled to recover as
damages caused by the Occurrence.
	 
	 	3.	 	for which an insuring or bonding company denies coverage or is
or becomes insolvent; or
	 
	 	4.	 	that is a hit-and-run vehicle and neither the driver nor owner
can be identified. The vehicle must:

	 	(a)	 	hit you or any Relative, your registered motor vehicle,
you or any Relative is occupying; or
	 
	 	(b)	 	cause an Occurrence resulting in Bodily Injury to you or
any relative without hitting you, any Relative, your Automobile or an Automobile you
or any Relative is occupying.

If there is no physical contact with the hit-and-run vehicle, the facts of the
Occurrence must be proved. We will accept only competent evidence other that
the testimony of a person making claims under this or any similar coverage.

However, Uninsured Motor Vehicle does not include any vehicle:

	 	1.	 	owned or operated by a self-insurer under any applicable motor
vehicle law except a self-insurer who is or becomes insolvent and
cannot provide the amounts required by that motor vehicle law;
	 
	 	2.	 	owned by a governmental unit or agency;

Page 9 of 10

 

	 	3.	 	designed for use mainly ???? public roads while not on public roads; or
	 
	 	4.	 	owned by or furnished or available for the regular use of you
or any Relative.

Wrongful Act means any breach of duty, neglect, error, misstatement, misleading
statement, omission or other act done relative to the administration of this
personal excess liability coverage provided to the Named Insured.

 

In Witness Whereof, we have caused this policy to be executed and attested,
and, if required by state law, this policy will not be valid unless
countersigned by our authorized representative.

 

	 	 	 
	[SIG]	 	
[SIG]
	Chairman of the Board	 	
Secretary

Page 10 of 10

 

[CNA LOGO]

	 	 	 
	Insured: Current & Retired Executives of General Dynamics Corporation and as
per
Endorsement No. 1	 	
Endorsement: 1
	 	 	 
	Producer: Stewart Smith East, Inc.	 	
Policy No: GPE 167040836
	

NAMED INSURED ENDORESEMENT

The following Current & Retired Executives of General Dynamics Corporation are
Named Insureds under this policy for a limit of liability of $5,000,000:

	 	 	 
	Anders, William	 	
Toner, Michael W.
	Baler, David D.	 	
Turner Jr., James E.
	Bankus, Kent G.	 	
Veitch, Arthur J.
	Boisture Jr., W.W.	 	
Vortmann, Richard H.
	Bruntrager, Edward C.	 	
Welch, John K.
	Cameron, Allan C.	 	
Wylie, W. Peter
	Chabraja, Nicholas D.	 	
Wynne, Michael W.
	Chandler, Michael E.	 	 
	Chase, Alan C.	 	 
	Dahlberg, Kenneth C.	 	 
	DeMuro, Gerard J.	 	 
	Fogg, David H.	 	 
	Hall, Asaph H.	 	 
	Hall, Charles M.	 	 
	Heebner, David K.	 	 
	Hesse, Paul A.	 	 
	Hill, Kenneth A.	 	 
	Hudson, Linda P.	 	 
	Kozen, Raymond E.	 	 
	Mancuso, Michael J.	 	 
	McQueary, Charles E.	 	 
	Mellor, James R.	 	 
	Oliver, Walter M.	 	 
	Pease, Kendell	 	 
	Rambeau, Arch H.	 	 
	Savner, David A.	 	 
	Schmieder, William O.	 	 
	Schmutte, Daniel P.	 	 
	Schwartz, John W.	 	 
	Scott, David E.	 	 
	Sechler, Henry J.	 	 
	Stewart, John F.	 	 

Nothing herein contained shall be held to vary, alter, waive, or extend any of
the terms, conditions, or limitations of the policy to which this endorsement
is attached other than as above stated.

	 	 	 	 	 
	 	 	 	 	COLUMBIA CASUALTY COMPANY
	Issued On:	 	
May 30, 2001	 	 
	Effective Date:	 	
June 5, 2001
	 	[SIG]
	 	 	 	 	

	CES12451 (3/99)	 	 	 	Authorized Representative

 

 

[CNA LOGO]

	 	 	 
	Insured: Current & Retired Executives of General Dynamics Corporation and as
per
Endorsement No. 1	 	
Endorsement: 2
	 	 	 
	Producer: Stewart Smith East, Inc.	 	
Policy No: GPE 167040836
	

Rate and Premium Schedule

	 	 	 	 	 	 	 	 	 	 	 	 	 
	Rate per Participant	Policy Limit	No. of Participants	Total Premium
	
	
	
	

	$575.00
	 	 	 	$	5,000,000	 	 	39	 	$	22,425.00	 
	 
	 	 	 	 	 	 	 	 	 	 	
	 
	 
	 	 	 	 	 	The total premium for this policy is:	 	$	22,425.00	 

The premium for this policy shall be adjusted upon renewal based on an updated
listing of participants to be furnished to us at that time.

Nothing herein contained shall be held to vary, alter, waive, or extend any of
the terms, conditions, or limitations of the policy to which this endorsement
is attached other than as above stated.

	 	 	 	 	 
	Issued On:	 	
May 30, 2001
	 	COLUMBIA CASUALTY COMPANY
	Effective Date:	 	
June 5, 2001
	 	[SIG]

Authorized Representative
	G136618A (Ed: 10/99)	 	 	 	 

 

 

	 	 	 
	[CNA LOGO]	 	 
	Insured: Current & Retired Executives of General Dynamics Corporation and as per

Endorsement No. 1	 	
Endorsement: 3
	 	 	 
	Producer: Stewart Smith East, Inc.	 	
Policy No: GPE 167040836
	

SERVICE OF SUIT CLAUSE

It is agreed that in the event of the failure of the Insurer to pay any amount
claimed to be due here under, the Insurer, at the request of the insured, will
submit to the jurisdiction of any court of competent jurisdiction within the
United States and will comply with all requirements necessary to give such
court jurisdiction and all matters arising here under shall be determined in
accordance with the law and practice of such court.

It is further agreed that service of process in such suit may be made upon the
General Counsel, Columbia Casualty, CNA Plaza, Chicago, IL and that in any suit
instituted against such person upon this policy, the Insurer will abide by the
final decision of such court or of any appellate court in the event of an appeal.

The above-named is authorized and directed to accept service of process on
behalf of the Insurer in any such suit and, upon the request of the Insured, to
give a written undertaking to the Insured that he will enter a general
appearance upon the Insurer’s behalf in the event such suit shall be
instituted.

Further, pursuant to any statute of any state, territory or district of the
United States which makes provision therefor, the Insurer hereby designates the
Superintendent, Commissioner or Director of Insurance or other officer
specified for that purpose in the statute, or his successor or successors in
office, as its true and lawful attorney upon whom may be served any lawful
process in any action, suit or proceeding instituted by or on behalf of the
insured or any beneficiary here under arising out of this contract of
insurance, and hereby designates the above-named as the person to whom the said
officer is authorized to mail such process or true copy thereof.

All other provisions of the policy remain unchanged.

Nothing herein contained shall be held to vary, alter, waive, or extend any of
the terms, conditions, or limitation of the policy to which this endorsement is
attached other than as above stated.

	 	 	 
	Issued On:	May 30, 2001	
COLUMBIA CASUALTY COMPANY
	Effective Date:	June 6, 2001	
[SIG]

Authorized Representative
	CES SUIT (3/99)	 	 

 

 

	 	 	 
	[CNA LOGO]	 	 
	Insured: Current & Retired Executives of General Dynamics Corporation and as per

Endorsement No. 1	 	
Endorsement: 4
	Producer: Stewart Smith East, Inc.	 	
Policy No: GPE 167040836
	

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

Supplementary Uninsured/Underinsured Motorists Coverage Extension

WHAT WE DO NOT COVER, Item No. 16, is deleted and replaced with the following:

     This Insurance does not apply to:

	16.	 	Sums which an insured is entitled to recover from the owner or operator
of an “Uninsured Motor Vehicle”.

However, this exclusion does not apply if such liability is covered by valid
and collectible underlying insurance as listed in the Schedule of Required
Underlying Insurance shown on the policy Declaration, for the full limit shown
therein, and then only for such liability for which coverage is afforded under
said underlying insurance.

Nothing herein contained shall be held to vary, alter, waive, or extend any of
the terms, conditions, or limitations of the policy to which this endorsement
is attached other than as above stated.

	 	 	 	 	 
	Issued On:	 	
May 30, 2001
	 	COLUMBIA CASUALTY COMPANY
	Effective Date:	 	
June 5, 2001
	 	[SIG]

Authorized Representative
	G-129402A (Ed. 3/99)exv10w17

 

Exhibit 10.17

	 	 	 	 
		 	Lloyd’s, London	 

This Insurance is effected with certain Underwriters at Lloyd’s, London (not
incorporated).

This Certificate is issued in accordance with the
limited authorization granted
to the Correspondent by certain Underwriters at Lloyd’s, London whose names and
the proportions underwritten by them can be ascertained from the office of said
Correspondent (such Underwriters being hereinafter called “Underwriters”) and
in consideration of premium specified herein, Underwriters do hereby bind
themselves each for his own part, and not one for another, their heirs,
executors and administrators.

The Assured/Owner is requested to read this certificate, and if not correct,
return it immediately to the Correspondent for appropriate alteration.

	 	 	 
	In the event of a claim under
this certificate, please notify the following Correspondent:	 	
ASU International LLC
	 	 	
500 Unicorn Park Drive
	 	 	
Woburn, MA 01801
	 	 	
(781) 994-6000

	 	 	 
	The Broker:	 	
Aon Consulting
	 	 	
8182 Maryland Ave., #550
	 	 	
St. Louis, Missouri 63105
	 	 	 
	The Agent:	 	
Michael Coulter-Smith, CLU
	 	 	
Coulter & Company Financial Services, LP
	 	 	
987 Gardenview Office Parkway
	 	 	
St. Louis, Missouri 63141
	 	 	
314.432.1600; 314.432.1639 [fax]
	 	 	
cacfs@il.net [e-mail]

 

 

CERTIFICATE PROVISIONS

1.     Signature Required. This certificate shall not be valid unless
signed by the Correspondent on the attached Declaration Page.

2.     Correspondent Not Insurer. The Correspondent is not an Insurer
hereunder and neither is nor shall be liable for any loss or claim
whatsoever. The Insurers hereunder are those individual Underwriters at
Lloyd’s, London whose names can be ascertained as hereinbefore set
forth.

3.     Cancellation. If this certificate provides for cancellation and
this certificate is cancelled after the inception date, earned premium
must be paid for the time the insurance has been in force.

4.     Service of Suit. It is agreed that in the event of the failure of
the Underwriter heron to pay any amount claimed to be due hereunder,
the Underwriters hereon, at the request of the Insured, will submit to
the jurisdiction of a Court competent jurisdiction within the United
States. Nothing in this Clause constitutes or should be understood to
constitute a waiver of Underwriters’ rights to commence an action in
any Court of competent jurisdiction in the United States, to remove an
action to a United States District Court, or to seek a transfer of a
case to another Court as permitted by the laws of the United States or
of any State in the United States. It is further agreed that service of
process in such suit may be made upon the firm or person named in Item
6 of the attached Declaration Page, and that in any suit instituted
against any one of them upon this contract. Underwriters will abide by
the final decision of such Court or of any Appellate Court in the event
of an appeal.

     The above-named are authorized and directed to accept service of
process on behalf of Underwriters in any such suit and/or upon the
request of the Insured to give a written undertaking to the Insured that
they will enter a general appearance upon Underwriters’ behalf in the
event such a suit shall be instituted.

     Further, pursuant to any statute of any state, territory, or
district of the United States which makes provisions therefore,
Underwriters hereon hereby designate the Superintendent,
Commissioner or Director of Insurance or other officer specified
for that purpose in the statute, or his successor or successors in
office, as their true and lawful attorney upon whom may be served
any lawful process in any action, suit or proceeding instituted by
or on behalf of the Insured or any beneficiary hereunder arising
out of this contract of insurance, and hereby designate the
above-named as the person to whom the said officer is authorized
to mail such process or a true copy thereof.

5.     Assignment. This certificate shall not be assigned either in whole
or in part without the written consent of the Correspondent endorsed
hereon.

6.     Attached Conditions Incorporated. This certificate is made and
accepted subject to all the provisions, conditions and warranties set
forth herein, attached, or endorsed, all of which are to be considered
as incorporated herein.

7.     Short Rate Cancellation. If the attached provisions provide for
cancellation, the table below will be used to calculate the short rate
proportion of premium when applicable under the terms of cancellation.

Short Rate Cancellation Table For Term of One Year

 

 

This Declaration Page is attached to and forms part of certificate provisions
(Form SLC-3 USA).

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	Previous No.	 	NONE	 	 	 	Authority Ref. No.	 	001784	 	Certificate No. L
	

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	1	 	
Name and address

of the assured/Owner:
	 
	 	 	
In Respect of Insured:
	 
	

	 	 	 	 	 	 	 
	2	 	
Effective from July 1st 2000
	 	to
	 	July 1st 2003
	 	 	
both days at 12:01 a.m. standard time	 	 	 	 
	

	3	 	
Insurance is effective with certain

UNDERWRITERS AT LLOYD’S, LONDON.
	 	 	 	Percentage    100%
	

	 	 	 	 	 	 	 	 	 	 	 
	4	 	
Amount
	 	Coverage
	 	Rate
	 	Premium	 	 
	 	 	 	 	 	 	 	 	 	 	 
	 	 	
As per Schedule

attached.
	 	Individual Accidental
Death and Dismemberment -
as per wording attached.
	 	Not Applicable
	 	$

Payable

$
	 	

Annually
	 
	 
	 

	

	5	 	
Special Conditions	 	 
	 	 	
Full Twenty-Four (24) Hour Coverage, Worldwide

Application dated:	 	 
	 	 	
Insured’s Date of Birth:	 	 
	 	 	
Beneficiary:	 	 
	

	6	 	
Service of Suit may be made upon: Mendes and Mount, 750 Seventh Avenue, New York, NY 10019-6829
	 	 
	

	 	 	 	 	 
	 	Dated	ASU INERNATIONAL, LLC
	 	 	by	 	

Correspondent

 

 

LLOYD’S, LONDON

CERTIFICATE OF INSURANCE

WE THE UNDERWRITERS hereby agree with the Assured/Owner, to the extent and in
the manner hereinafter provided, that if anywhere in the World at any time
during the period of this Certificate the Insured shall sustain any bodily
Injury cause by an Accident, which shall solely and independently of any other
cause within twelve (12) calendar months from the date of Accident causing such
Injury to the Insured, We will pay to the Beneficiary, or after the total claim
shall be substantiated under this Certificate.

SCHEDULE

	 	 	 
	ASSURED/OWNER:	 	 
	 
	INSURED:	 	 
	(also referred to as “You” or “Your”)	 	 
	 
	EFFECTIVE DATE OF COVERAGE:	 	 
	 
	EXPIRATION DATE OF COVERAGE:	 	 
	 
	BENEFICIARY:	 	 
	 
	OCCUPATION:	 	 
	 
	PREMIUM:	 	
$
	 
	 	 	
Payment Mode: Annual Installment
	 
	        COVERAGE:	 	
Full Twenty-Four (24) Hour, Worldwide
	 
	        Benefit:	 	
Accidental Death and Dismemberment
	 
	        Amount of Benefit:	 	
$2,000,000 The Principal Sum
	 
	        Benefit:	 	
Accident Medical
	 
	        Amount of Benefit:	 	
$5,000
	 
	        Aggregate Maximum	 	 
	        Limit of Insurance:	 	$2,005,000

1

 

TALBE OF CONTENTS

	 	 	 	 	 	 
	SCHEDULE
	 	 	1	 
	DEFINITIONS
	 	 	3	 
	INSURING AGREEMENT
	 	 	4	 
	BENEFIT PROVISIONS
	 	 	5	 
	 	ACCIDENTAL DEATH AND DISMEMBERMENT
	 	 	5	 
	 	ACCIDENT MEDICAL
	 	 	6	 
	LIMITATIONS AND EXCLUSIONS
	 	 	9	 
	GENERAL PROVISIONS
	 	 	10	 
	ENDORSEMENTS:
	 	 	 	 
	 	EXPOSURE AND DISAPPEARANCE
	 	 	1	 

2

 

DEFINITIONS

Terms used as defined here or elsewhere in this Certificate will begin with a
capital letter.

Accident or Accidental means:

	 	1.	 	is a sudden and unexpected event which happens by chance;
	 
	 	2.	 	which arises from a source external to the Insured;
	 
	 	3.	 	which is independent of Sickness or disease; and
	 
	 	4.	 	which is the direct cause of a Loss.

Aggregate Maximum Limit of Insurance means the total Amount of Benefit payable
under this Certificate regardless of the number of claims paid.

Beneficiary means the person(s) named as
Beneficiary in the SCHEDULE.

Underwriters means certain Underwriters at Lloyd’s London whose names and the
proportions underwritten by them can be ascertained from the office of said
Correspondent (such Underwriters being hereinafter called
“Underwriters”)
Underwriters may also be referred to as We, Us or Our.

Coverage Period means the period of time between the Effective Date of Coverage
and Expiration Date of Coverage as shown in the SCHEDULE.

Injury means bodily injury which:

	 	1.	 	is Accidental;
	 
	 	2.	 	is independent of disease, Sickness or other cause; and
	 
	 	3.	 	occurs during the Coverage Period.

Loss means an injury of the Insured for which Benefits are payable according to
the SCHEDULE, Benefit Provisions, Limitations and Exclusions, and other terms
and provisions of this Certificate.

Occupation means the occupation shown in the SCHEDULE.

Physician means a licensed healthcare practitioner, other than the Insured or a
member of the Insured’s immediate family, providing services or treatment within the
scope of his or her license.

3

 

INSURING AGREEMENT

	1.	 	Scope of the Insurance;
	 
	 	 	In consideration of the payment of premium as required, Underwriters
agree to provide insurance against Loss with respect to each Coverage
as specified in the SCHEDULE. This insurance is for the Amount of
Benefit stated in the SCHEDULE.
	 
	2.	 	Certificate Term:
	 
	 	 	The Certificate begins and ends at 12:01 a.m. Standard Time at the
Insured’s address.
	 
	3.	 	The Time of Coverage of Insurance:
	 
	 	 	Coverage Begins:
	 
	 	 	The insurance of the Insured begins automatically at the latest of
the following:

	 	a.	 	on the date this Certificate is effective; or
	 
	 	b.	 	at the beginning of the Certificate term for which
premium has been paid.

	 	 	Coverage Ends:
	 
	 	 	The insurance of the Insured ends automatically at the earliest of
any of the following:

	 	a.	 	the day for which premiums was last paid; if premium
remains in default at the end of the Grace Period;
	 
	 	b.	 	the Expiration Date of Coverage, as shown in the
SCHEDULE; or
	 
	 	c.	 	the Occupation stated in the SCHEDULE changes during
the Coverage Period.
In such event Underwriters will refund any unearned premium on a
pro-rata basis. But, in no event will a refund be paid for more
than one (1) year prior to the date Underwriters receive notice of a
change in Occupation.

4

 

BENEFIT PROVISIONS

ACCIDENTAL DEATH AND DISMEMBERMENT

Underwriters will pay the amount shown in the Table
of Losses below for a listed Loss
which:

	 	a.	 	results solely from an Injury to the Insured which is
sustained while the insurance under this Certificate is in force;
and
	 
	 	b.	 	is sustained within three hundred and sixty five (365) days
after the date of such Injury.

TABLE OF LOSSES

	 	 	 
	FOR LOSS OF	 	AMOUNT PAYABLE
	 
	Life	 	
The Principal Sum
	Both Hands or Both Feet	 	
The Principal Sum
	Sight of Both Eyes	 	
The Principal Sum
	One Hand and One Foot	 	
The Principal Sum
	One Hand and Sight of One Eye	 	
The Principal Sum
	One Foot and Sight of One Eye	 	
The Principal Sum
	One Hand or One Foot	 	
One-Half (1/2) the Principal Sum
	Sight of One Eye	 	
One-Half (1/2) the Principal Sum

Loss with respect to hands or feet, means Loss by severance at or above the
wrist or ankle joint.

Loss of Sight means the total and irrecoverable Loss of vision, as determined
by a Physician.

In the event of multiple Losses resulting from a
single covered Accident, only
one Benefit, the Largest amount payable, will be paid.

Underwriters shall not be liable for any amount in excess of the Aggregate
Maximum Limit of Insurance per Accident stated in the SCHEDULE. If the
aggregate amount of all Benefits otherwise payable by reason of Loss under this
Coverage exceeds such Aggregate Maximum Limit of Insurance, Underwriters shall
not be liable as respects each Insured for a greater proportion of the Benefit
otherwise payable than the Aggregate Maximum Limit of Insurance per Accident
bears to the aggregate amount of all such Benefits.

5

 

BENEFIT PROVISIONS

ACCIDENT MEDICAL BENEFITS

(Continued)

BENEFIT PERIOD

A separate Benefit Period begins on the date of each Injury and continues for
the period of time specified in the SCHEDULE. The termination of this
Certificate has no effect on Benefits otherwise payable.

AMOUNT OF BENEFIT

The Amount of Benefit shown in the SCHEDULE is the total Benefit payable for
eligible Covered Expenses incurred.

EXCLUSIONS

The following are Exclusions which are in addition to the Exclusions in the
section entitled “LIMITATIONS AND EXCLUSIONS”. Covered Expenses will never
include, and no Benefits will ever be payable for, any charges:

	 	a.	 	which exceed the Reasonable and Customary charges;
	 
	 	 	 	“Reasonable and Customary” charges are those charges not in excess of the most
common charge for similar professional services in the locality where the
services are received. If a charge is in excess of the most common charge, no
payment will be made with respect to the excess, and the excess will not qualify
as a Covered Expense under the policy. The “most common charge” for any given
service and locality will be determined in good faith by Underwriters.
	 
	 	 	 	As to other services and supplies, “Reasonable and Customary” charges will be
determined in good faith by Underwriters, using a comparison of charges made by
other providers of similar services or supplies in the locality where the
services or supplies are received. No payment will be made with respect to any
amount in excess of the “Reasonable and Customary” charge; or
	 
	 	b.	 	for any and all dental work; or
	 
	 	c.	 	for services or supplies not specifically provided for in this
Certificate; or
	 
	 	d.	 	which would not have been made in the absence of insurance or which the
Insured is not legally obligated to pay; or
	 
	 	e.	 	for cosmetic procedures unless made necessary by the covered Injury to
restore body function; or
	 
	 	f.	 	for eyeglasses, contact lenses or hearing aids or for any examination or
fitting related to these devices unless made necessary by the covered
Injury; or

7

 

BENEFIT PROVISIONS

ACCIDENT MEDICAL BENEFITS

(Continued)

	 	g.	 	for the professional services performed by a member of the Insured’s
immediate family; or
	 
	 	h.	 	for care which is custodial in nature; or
	 
	 	i.	 	for Experimental Procedures;
	 
	 	 	 	“Experimental” means any medical procedure, equipment, treatment or course of
treatment, or drugs or medicines that is:

	 	 	 	 
	 	(1)	 	meant to investigate and is limited to research; or
	 
	 	(2)	 	not proven in an objective manner to have therapeutic value or benefit; or
	 
	 	(3)	 	restricted to use at those centers capable of carrying out disciplined clinical efforts and scientific studies; or
	 
	 	(4)	 	medically questionable as to effectiveness.

	 	 	 	Underwriters determine “Experimental” through studies, opinions and references
to or by the American Medical Association, the Federal Drug Administration, the
Department of Health and Human Services, the National Institutes of Health, the
Council of Medical Specialty Societies and any other association or Federal
program or agency that has the authority to approve medical testing or
treatment; or
	 
	 	j.	 	for services or supplies that
are not Medically Necessary;

“Medically Necessary” services and/or supplies mean those services or supplies as
provided by a Hospital, Physician, or other provider which are required to
identify or treat an Insured’s Injury and which, as determined by
Underwriters, are:

	 	 	 	 
	 	(1)	 	Consistent with the symptoms or diagnosis and treatment of the Insured’s
condition, disease, ailment, or injury; and
	 
	 	(2)	 	Appropriate with regard to standards of good medical practice; and
	 
	 	(3)	 	Not solely for the convenience of the Insured, his or her Physician,
Hospital, or other provider; and
	 
	 	(4)	 	The most appropriate supply or level of service which can be safely
provided to the Insured; and
	 
	 	(5)	 	When specifically applied to an inpatient, it further means that the
Insured’s medical symptoms or conditions require that the diagnosis or
treatment cannot be safely provided to the Insured as an outpatient.

	 	k.	 	for analysis and adjustments of spinal sublaxation, or diagnosis and
treatment by manipulation of the skeletal structure, or muscle stimulation
by any means (except treatment of fractures and dislocations of the
extremities); or

	 	l.	 	made, billed or incurred twelve (12) or more months from the date the
Benefit Period began. “Incurred” means the date the service treatment or
supply was delivered or provided.

8

 

LIMITATIONS AND EXCLUSIONS

Exclusions

This Certificate does not cover Loss caused by or resulting from any of the
following:

	1.	 	intentionally self-inflicted injuries; or
	 
	2.	 	suicide: attempted suicide; or
	 
	3.	 	any act of declared or undeclared War or Insured’s participation in a
riot. Declared or undeclared War does not include acts of terrorism. “War”
is used to mean:

	a)	 	
hostilities following a declaration of War by a governmental authority;
	b)	 	
if there is no declaration of War, then armed, open and continuous
hostilities between two countries; or

	4.	 	Accident occurring while the Insured is in or boarding or alighting from
any aircraft;

	a)	 	
in the capacity of pilot or crew member;
	b)	 	
being used for fire fighting, pipe or power line inspection, aerial
photography or exploration;

	 	 	This exclusion does not apply to passengers who temporarily perform pilot or
crew functions in a life threatening emergency; or
	 
	5.	 	any activity or condition specifically excluded by name on a Special
Exceptions Endorsement or Specific Activity Endorsement forming part of
this Certificate; or
	 
	6.	 	commission of or attempt to commit a felonious act as defined by the laws
of the jurisdiction where the crime takes place, which results in a
conviction of the Insured; or
	 
	7.	 	Insured’s emotional trauma, mental or nervous disease or mental sickness;
or
	 
	8.	 	Illness, disease, and bacterial infection; except bacterial infection of
an Accidental bodily injury or Accidental ingestion of a substance
contaminated by bacteria, unless specifically stated to be included for a
Coverage listed in the SCHEDULE.

9

 

GENERAL PROVISIONS

	1.	 	Premium; Premium is payable in advance. The amount of the premium is
stated in the SCHEDULE. The amount of the premium shall be as determined
by Underwriters or by its designated Administrator. Any premium paid, for
a Coverage other than Accidental Death and Dismemberment, for a period
beyond the date of the Insured’s death will be refunded.
	 
	2.	 	Grace Period: Each premium is payable when due. Premium is due as stated
in the SCHEDULE. Premium may be paid to Underwriters or to ASU
International LLC. Failure to pay a premium by the premium due date or
within the Grace Period is a default in payment of premium. A default of
premium will terminate this Certificate and all Coverage of this
Certificate.
	 
	 	 	A Grace Period of thirty-one (31) days will be granted for the payment of each
premium falling due after the first premium. During this Grace Period this
Certificate shall continue in force. If Underwriters have advised the
Assured/Owner that this Certificate will not be renewed at least thirty-one
(31) days before the renewal date, this Grace Period will not apply.
	 
	 	 	We will have the option to deduct any unpaid premium from any Amount of Benefit
payable under this Certificate.
	 
	3.	 	Notice of Claim: Written notice of claim must be given to Underwriters as
soon as reasonably possible. If possible, written notice of claim should
be given to Underwriters within twenty (20) days after the occurrence of
any surgery, arthroscopy, admission to a hospital, or Injury or Sickness
which causes the Insured to be unable to engage in the Occupation stated
in the SCHEDULE.
	 
	4.	 	Claim Forms: When Underwriters are advised of a claim, it will give the
claimant forms for filing Proof of Loss. If these forms are not given to
the claimant within fifteen (15) days, the claimant will meet the Proof
of Loss requirements by giving Underwriters a written statement of the
nature and extent of the Loss within the time stated in the Proof of Loss
provision.
	 
	5.	 	Proof of Loss: Written Proof of Loss must be given to Underwriters
withing twenty (20) days after any covered Loss occurs or as soon as is
reasonably possible. Proof of Loss will include all documents requested by
Underwriters to evaluate the claim.
	 
	6.	 	Time of Payment of Claims: Benefits payable under this Certificate for
any Loss will be paid within thirty (30) days of receipt of due Proof of
Loss.
	 
	7.	 	Payment of Claims: All benefits payable under this Certificate will be
payable to the Beneficiary.
	 
	8.	 	Physical Examinations and Autopsy: Underwriters, at their expense, have
the right to have the Insured examined as often as reasonably necessary
while a claim is pending. We may also have an autopsy made unless
prohibited by law.
	 
	9.	 	Representations and Severability: In granting Coverage to the Assured, We
have relied upon declarations and statements in the written application(s)
for Coverage signed by the Insured or the Beneficiary. All such
declarations and statements are the basis of Coverage and shall be
considered incorporated in and constituting part of this Certificate. A
copy of the written application(s) shall be attached to this Certificate.
	 
	10.	 	Examination under Oath: We have the right examine under oath, as often as
We may reasonably require, the Insured or the Beneficiary. We may also
require the Insured or the Beneficiary to provide a signed description of
the circumstances surrounding the Sickness or Injury and their interest in
the Loss. The Insured and the Beneficiary will also produce all records
and documents required by Us, and must permit Us to make copies of such
records or documents.

10

 

GENERAL PROVISIONS

(continued)

	11.	 	Legal Actions: No legal action may be brought to recover on this
Certificate until sixty (60) days after Underwriters have been given
written Proof of Loss. No such action may be brought after three (3) years
from the time written Proof of Loss is required to be given.
	 
	12.	 	Arbitration: In the event of a dispute under this Certificate, either We,
the Assured/Owner or the Beneficiary may make a written demand for
arbitration. In that case, We and the Assured/Owner or the Beneficiary
will each select an arbitrator. The two arbitrators will select a third.
If they cannot agree within fifteen (15) days, either We, the
Assured/Owner or the Beneficiary may request that the choice of arbitrator
be submitted to the American Arbitration Association. The arbitration will
be held in the state of the Assured/Owner’s or the Beneficiary’s principal
residence.
	 
	13.	 	Incontestability: No statement made by the Insured under this Certificate
relating to his insurability shall be used in contesting the validity of
this insurance after such insurance has been in force, prior to contest,
for a period of two (2) years (excluding any period of Total Disability)
nor unless it is contained in a written application signed by him.
	 
	14.	 	Not in Lieu of Workers’ Compensation: This Certificate is not in lieu of
and does not affect any requirement for coverage by Workers’ Compensation
insurance.
	 
	15.	 	Conformity with State Statutes: Any provision of this Certificate which,
on its effective date, is in conflict with the statutes of the state in
which this Certificate is delivered is hereby amended to conform to the
the minimum requirement of such statutes.

11

 

LLOYD’S, LONDON

ENDORSEMENT

Effective date of this
Endorsement:            July 1st 2000

	 	 	 
	Issued to:	 	
Endorsement No. 1

	 	 	 
	ASSURED/OWNER	 	
To be attahced to and form part of
	INSURED CERTIFICATE HOLDER:	 	
Certificate No.

EXPOSURE AND DISAPPEARANCE

Loss resulting from unavoidable exposure to the elements shall be covered to
the extent of the Benefits afforded the Insured.

If the body of the Insured has not been found within one year of the
disappearance, stranding, sinking or wrecking of any aircraft in which the
Insured was an occupant, then it shall be presumed, subject to all other terms
of this Certificate, that the Insured has suffered Loss of life covered under
this Certificate. But if the Insured is subsequently found to be living, any
Amount of Benefit paid must be refunded to Underwriters immediately by the
person or persons to whom paid.

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