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Case 2:04-cv-00662-DGC Document 192-7 Filed 06/O1/2007 Page 1 013

A CORD U`VIBR.ELL·SECTIO\` Q
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A [.’ROD-CER APPLICANT
, ANERCC, ETA.
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TRANSACTION TYPE LIMIT OF LIABLLITY RETAIVED LMIT
NEW PROPOSED RETROACTIVE DATE S 'LEQQQQQQ EAC·w OCCQRRENCE I
x QENEWA- 1
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PRIINIARY LOCATION 34 SLBSIDIARIES {ACCORD 125)
I NAMEANDLOCAT1O'< OF PRIMARY AND ALLSLBSIDIARY CO\IPANIB'C):x:r>¤:x;.c-.1· A.*<*<'LAL. PAYRDL1. A.’·<’¤.GROSSSAL.:'LS FOREIGN GROSS SALLS IEMP
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L"“ER··Y·”G POLICY . AAS Aw Paocyw wcax. Acczssr :2 ;0cAf*c~ aasx axcgnan ;~:~S:A23
“ ORSELF INSURED FROM ANY PREVZOLS COVERAGE V
2 ENDZCATE ENTRY DATE [NCC L.\INT`ERRL?7E'.l
CLAIMS MADE COVERAGE 5. V/AS `TAfI.' COVERAGE PLRCHASE3 FOR ANY FREVZCCS PRLVARY OR LXCES E3L..CY`
B ARE DEFENSE COSTS `·~"‘~I~ ACZJRECNE ;:~1’TS A xanax; _,w** >< ;~;.w`5:~

CEECX Al,- CDVERACES .N E.N3E?-"`NC PC., C ES A..SO C—·ECI< F ANY EXRCSLRES ARE ¤REjE*·" ECR EAZ:s CZVEQACE PROM 35 AN EX?LA‘~.·\` CIN E. D~EEERE?~·"'L.~1T’S EXTENSCNS CR EXC-..SICNS EXELAN AN'SPECl.A-CGVERAC:'iS 5EYO’~'.1.TAN'.)ARDECR~*S E>(PZ..A.’¤A-L E Ci{.E.CKlEAPF’¤O’R2A’E COVERAGE EX?’.)S$lE. C3‘»TiLx{.ZE EKHTSCREX
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COVERAGE EXPOSLJRE X CARAL'.E· V
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X A RCRA? EASSENCER ;,.A§ -"Y X L. QCOR L..AZi`Z.T"Y
X A3OI"ZC*· L.’~I)ER..Y`NC NSCQANCE COVERAGE N?ZR-x'C` ’~E..,ZE A,- R5`:} C` CNE E G `JASER EN3CRSE~ EN"S S SC? ~ *·A" LIN SE£·iLQCA"C’~· ·~-A ZR
EXCENE CNS CE CDVERACE A’“AC¥· SE;EAR.A`E S?·EE` 'F NEZE.55ARX`
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»VHE`··ER (NS,RE'j ZR NCTSPECFX 3»~`E ZZ~EiACE DESC? TON A~·C-N" EA 2 ,A~*C`.N" Q;."§`AN3.NC, I
iSEE A"AC%E2 -3SS DFA I
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Acmg 13; .5 ’;¤.sg~ ACTACH TO APPLICANT ?~‘?GRx;ATt©N‘ AND :;x;y@R;;A; ;;,I3i;,iTY ;;cT::>~:$ ACGRD Q R?<>ixT?©N Z

[CARE, CLJSTODY, CONTROL
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· APPLECANT [A]ZS?1ECD *€ARN1I.5S N `HE LEASE. [9 i·\$ A ‘**A'\/ER SCSLBROCATTCN QC` IS A NAMES 'NSOREO 'N TEE EIRE RCCCY Q',) OT`~1ER{;_·;:;4-R,
ADDLTIONAL EXPOSLRES
;xp;_,`m ALL, ·YEs‘ RESPONSES PROVQDE OTHER WFORMATION REQLIRED YES NO EXPLAJN ALL. ‘YES‘ RzEPC~SE·;S PRGWDE OTHER .*~FCPL~[AT:¤>· R£Q_gIR§§ y;_; NO
ADVERTSERS i.iABlL1TY ?0L;.LT10~ L1Aa¤L;Tv any
l MEDIA LJSED· YELLOW PACE ANNLAL. COST. SZECCCCCZ ID DO CURRENT OR PAST PRODUCTS OR TEEIR COMPONENTS
2 SERVICES O; AN ACVERTTSRCC Asgycy CSEDA V CONTAIN HAZAROOLS MATERZ-\..S T`·1.A" WAV REQQJIRE
1 Aw COVERAGE ?Rcv:¤E¤ LNDER Acawcvs ¤0L::Y# »4 SPECIAL 3’S?°S`L"*ETR°E‘S7
AIRCRAFT LIABXLITY Zl INDECATE TEE COVERAGE CARRIED
4 OCS APPLICANT OWN / LEASE OPERATE AlRCRAF·T" Y X GL WITH STANZARG ISC POL...C`TZON' EXCI.L,S10?~ {
AUTO UABILITY I GI. WITH STANOARZISLOOEN 3: ACCIOENTA- ONLY
5 ARE EXPLCSEVE. CALSTGCS. F'..ANlMAB..5 OR STEER G; ~·/'T?1 ?CL..-;.vT_.cN COVERAGE ENOCRSEMEN"
GKNGEROLS CARGO HAGLEOR *4 ‘ SEPARATE POL.l.L,'TTC*~ COVERAGE
6 ARE PASSENGERS CARRiE.‘> PCR A FE? ~ iPRcc>LC: L;As:L;TY
7 AVY UNITS NOT INSQIRE3 EY LINOERLYINC POLICIET A IZ] ARE MYSSLES, ENGINE, :;.r:3.\NCE SYSTEMS ERAVXES OR ANY
a ARE ANY vER;:LEs CEASE3 ca RE>·`E2 TO OT`·€ERS” V , CTRERPROULYTLSEC ’i>¥TA;-E3 ~ A RCRA? A
9 TS HIREO AND NON/OWNED CON ERACE RRO\/OED" V Il} ARE FOREIGN PROD? .'JISTRIEL,"EO `N Q S ” R
cmwumou LIABILITY 24 ARE :.5. PRi>.’:LCT`S SSLS: GR 3.S?R:BL‘TE3 N EOREIGN ECLS'RiEE` A
` ERHDGE. OAM_ OR MARINE \·~'GRé< PERF·OR?~*EO” N I PROOLCT CIAESLITY LOSS .N PASTS VEAER fSPECIEYT
_}CRI3E T`{P1CA.. OES PERECRMEG ZATTACP SEPARATE SHEETS1 25 CROSS SALE FROM EACH OF JST} YEAPS
N/A ` S 'ZEZGOCZGI S `L7`?$GOOC s `TELICCOC
PRTELTTIVE LIABILITY
.2 CESCRZBE A;REE.`4;:.}T:x\v_Er\C?‘ SEPARA`ESr1EETS 27 OESCRIEEINOEPENOENT CCNTKATSRS
N/A SCES CSEO ZN 3..335, RENCVATNG
STORAGE FACZ-I'IES, **OVINC
I2 DOES APPLICKVE O‘·~"~4 REN`. OR OT~·ER»~' SE CSE CRANES` N
.4 OC SLJECONTRACTORS CARRY CON/ERACE3
OR LIMITS LESS THAN APP;1CA?~T’ M wATEszcnAF`r L:AsaL;Tv
E»u>L:>vE¤.s L:As:L1TY Z3 DOES APEQJCANT GWR OR LEASE ‘»/A`ERCRAP" V l
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!NCZOE.'VTAL.Â¥(ALPRA?ICE LABILITY {APARTWELNTS CO*<2N:1N\L"~1S ?{O'TE;S '~lC'TEL.S A
17 HCSPITALORFYELST AD FACZLITV ‘~‘¤\'NvA NET R ‘ [yea; »..¤#; :5»4~¤A; >;C_; ::,v-: 2;Aa:s
LX COVERACE PROVIOEZZ FOR 'JOC'ORSy*·L.RSES" N QV/A
19 ENDICATE I OE DOCTORS NQRSES BEDS
RENL&& VEHICLES
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.>1POR`A>·‘ ’APE’L.CA~TS$1O‘·AT;RE DATE ¤
`HESTATEMENTS \A‘~S`»~ EB CIV EN AEONE ARE TREE ANG KCCLQATE, `:1E APP;/QANT EAS NOT { i
I COINCEALUEOR OR—WIvSREiRESENiEG‘Ai`;MATER_5Ai.‘E.·\CT OR CIRCQMSTANCE CONCERNING I ;
··.S APrC.CA..OT~. ri.; APPLCA .C'~ OC:.> NL`. CONSTKC.: A BTNOER. E y
'ACORD LE! - S .f3y88> ATTACK TO APPLICKNT LNFORALATION SECTION AND QQNCMERCLL GENERAL ;;A3ii.;iv .@irf¤~: ?
E · Pa e 3 of 3
Case 2:04-cv-00662-DGC Document 192-7 Fnled 06/O1/2007 Q /M/Q

Case 2:04-cv-00662-DGC

Document 192-7

Filed 06/01/2007

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Case 2:04-cv-00662-DGC

Document 192-7

Filed 06/01/2007

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Case 2:04-cv-00662-DGC

Document 192-7

Filed 06/01/2007

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