SUPPLEMENTAL LIABILITY INSURANCE PROGRAM

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SUPPLEMENTAL

LIABILITY

INSURANCE

PROGRAM

Comprehensive Personal Liability Farm Comprehensive Personal Liability Premises and/or Farm Premises & Operations

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SUPPLEMENTAL LIABILITY INSURANCE MANUAL OHIO

INTRODUCTION

This manual provides for Comprehensive Personal Liability, Farm Comprehensive Personal Liability and Premises and/or Farm Premises & Operations Liability Insurance.

The rules, rates, forms and endorsements filed by or on behalf of the Company apply in all cases not provided for in this manual.

INDEX UNDERWRITING GUIDELINES RULES Program Description Policywriting Instructions Premium Determination CPL Classifications FCPL Classifications

Premises and/or Farm Premises & Operations Classifications POLLUTION LIABILITY EXPOSURE QUESTIONNAIRE

RECREATIONAL VEHICLE QUESTIONNAIRE OIL & GAS WELL EXPOSURE QUESTIONNAIRE

RATE PAGES

CPL Personal Liability Rates CPL Homeowner Combo Liability Rates FCPL Initial Farm and Farm Combo Liability Rates

Premises Liability Rates

Farm Premises & Operations Liability Rates FORMS & ENDORSEMENTS LISTINGS

Comprehensive Personal Liability Homeowner Combination Policy

Farmowner Combo Policy and Owner-Occupied Farm Premises and/or Farm Premises & Operations

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SUPPLEMENTAL LIABILITY INSURANCE MANUAL OHIO

INDEX Rule Page

Additional Insureds - CPL ... 3.2 Rules-4 Additional Insureds - FCPL ... 4.5 Rules-7 Additional Interests - CPL ... 3.1 Rules-4 Additional Interests - FCPL ... 4.1 Rules-6 Additional Interests – Premises ... 5.1 Rules-10 Additional Interests – Farm Premises & Operations ... 5.2 Rules-10 Business Activities - CPL ... 3.3 Rules-5 Business Activities - FCPL... 4.6 Rules-7 Calculation of Premium ... 2.3 Rules-3 Corporate Farms... 1.3 Rules-1 Classifications - CPL ... 3 Rules-4 Classifications - FCPL ... 4 Rules-6 Classifications - Premises and/or Farm Premises & Operations ... 5 Rules-10 Custom Farming... 4.2 Rules-7 Eligibility - Supplemental Liability Program ... UG-1

Exposure Basis... 2.1 Rules-3 Farm Employers Liability ... 4.9 Rules-8 Farm Pollution Limited Liability (Farm Premises & Operations)... 5.2 Rules-10 Farms - Personal Liability... 4.1 Rules-6 Farms - Premises & Operations ... 5.2 Rules-10 Fire Legal Liability ... 4.3 Rules-7 Fruit Picking - By Public ... 4.4 Rules-7 Horse & Buggy Medical Expense Coverage ... 4.11 Rules-9 Horse Boarding ... 4.8 Rules-8 Incidental Business Pursuits - CPL... 3.3 Rules-5 Incidental Business Pursuits – FCPL... 4.6 Rules-8 Incidental Farming – CPL... 3.3 Rules-5 Increased Exposure Adjustment ... UG-2

Limits – Basic – CPL and FCPL... 1.5 Rules-2 Limits – Basic – Premises and Farm Premises & Operations ... 1.6 Rules-2 Limits - Increased ... 1.7 Rules-2 Multiple Dwellings ... 1.4 Rules-1 Optional Pollution Liability - FCPL ... 4.10 Rules-9 Personal Injury - CPL ... 3.4 Rules-5 Personal Injury – FCPL ... 4.7 Rules-8 Personal Liability Coverage - Premises and/or Farm Premises & Operations ... 5.2 Rules-10 Policy Terms - Annual ... 1.9 Rules-2 Policywriting Instructions... 1.8 Rules-2 Premium Determination... 2 Rules-3 Program Description ... 1 Rules-1 Recreational Motor Vehicle Coverage Off Premises – CPL ... 6 Rules-14 Recreational Motor Vehicle Coverage Off Premises – FCPL ... 6 Rules-14 Required Coverages ... 2.2 Rules-3 Residences... 3.1 Rules-4 Vacancy... 5.2 Rules-10 Vegetable Picking - By Public... 4.4 Rules-7 Watercraft - CPL... 7 Rules-15 Watercraft – FCPL... 7 Rules-15

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1. This program is intended to provide liability coverage for those insureds who have a property insurance policy with one of our mutual protective association partners. This program may not be used to provide stand-alone liability coverage.

2. Risks must be neat, well maintained, free of debris or accumulations of property, unusual hazards, and show pride of ownership.

3. Porches and stairs must be in good repair and free of hazards or defects. Make certain any stairs or porches are clearly visible in the front and rear photos of the dwelling.

4. THE FOLLOWING MAY NOT BE BOUND WITHOUT PRIOR COMPANY APPROVAL: A. Applicants with any liability or medical payments loss in the last five years

B. Applicants that have been canceled or rejected by another company C. Risks with commercial or business activities

D. Risks with 6 or more horses for personal use or any animal boarding, instructional or show exposure E. Risks with tanning beds

F. Politicians (except town assemblymen, city council members, or selectmen for towns < 10,000) G. Radio and TV broadcasters and telecasters

H. Newspaper or magazine reporters, editors or publishers I. Labor leaders

J. Prominent figures: actors, actresses, professional athletes, or others in the public limelight K. Persons who represent a moral hazard or anyone who has been sued for libel or slander L. Law enforcement officials (except judges, bailiffs, correction officers, probation officers, fire

personnel, or state/town inspectors) M. Vacant properties

N. In-ground swimming pools with diving boards or slides O. In-ground swimming pools without fences

P. Stairs with no handrail and a rise of 24” or more

Q. Open outside primary stairways to second floor apartments R. Risks with more than 6 recreational motor vehicles

5. RISKS WITH THESE EXPOSURES ARE INELIGIBLE FOR COVERAGE:

A. Pit Bulls, Doberman Pinschers, Rottweilers, Malamutes, Akitas, Presa Canarios, Staffordshire Terriers, wolves, wolf hybrids or any animal considered “dangerous", "vicious" or having a biting history.

B. Vicious or aggressive animals including but not limited to bears, cougars, lions and large snakes C. Above-ground pools with diving boards or slides

D. Above-ground pools without a locked gate, steps that fold up or a railing around the pool deck. E. Tenant-occupied risks with a pool

F. Risks not having a stable record of financial responsibility G. Dwellings constructed for more than a four-family occupancy H. Mobile homes constructed for more than a two-family occupancy I. Commercial and public buildings

J. An oil or gas well that is not considered an exempt Mississippian well or an exempt domestic well according to Ohio Revised Code Sec. 1509.01

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6. Risks with Trampolines can be written if:

a. the Trampoline Liability has been excluded by using the WMIC SMP 62 Restriction to Policy form; or

b. the risk is owner occupied, the trampoline has a net, is tied down and a charge per trampoline is added to the policy premium

7. An Increased Exposure Adjustment may be applied to any policy that varies from the average risk. The company recognizes that standard rates may be inadequate depending on the individual risk conditions. The following areas will be considered when contemplating an adjustment:

a. Care, condition and use of premises, buildings or equipment

b. Condition of stairs, handrails, porches, decks, stair coverings and fences c. Risk location or unusual exposures

d. Insured’s cooperation with company/agent loss control recommendations e. Insured’s vocation or career

f. Storage practices and hazardous operation g. Loss history

This premium adjustment will be applied after all other rating procedures have been used. Refer to the rate pages for adjustment factor.

Examples where this adjustment would be applied include:

a. Risks with diving boards or slides for an in-ground swimming pool b. Risks with stairs that have no handrail and a rise of 24” or more c. Risks with open outside primary stairways to a second floor apartment

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OHIO RULE 1 - PROGRAM DESCRIPTION

1.1 Comprehensive Personal Liability (CPL)

A policy may be issued to a person maintaining a residence in a one to four family dwelling.

Use GL-1 – Personal Liability Coverage Policy or WMIC Broad Form HO-2, Special Form HO-3 or Tenant Form HO-4

1.2 Farm Comprehensive Personal Liability Coverage (FCPL)

A policy may be issued to a person maintaining a residence in a one to four family dwelling, set of buildings, or land used for farming. Farming means the growing of crops or the caring for livestock. Farming includes the operation of roadside stands and farm markets used mainly for the sale of the Insured's own farm products.

Use WMIC GL-2.0 - Farmer's Personal Liability Coverage Policy

The following must be referred to the Company for determination of eligibility:

 Roadside stands in excess of 250 sq. ft.

 Risks with oil or gas wells on the premises. When writing such risks, you must complete and submit the Oil & Gas Well Exposure Questionnaire.

1.3 Premises and/or Farm Premises & Operations

(Incorporated Farms, Commercial Farms and Rental Dwellings)

Incorporated farms or commercial farm exposures may need to use forms WMIC GL-600 or WMIC GL-610.

WMIC GL-600 Commercial Liability Coverage (Premises Only)

This form provides liability coverage arising out of the insured premises and operations necessary or incidental to the insured premises. Liability principal coverages include: bodily injury and property damage liability including the products and completed work hazard; medical payments; and fire legal liability. The WMIC GL-600 includes an insuring agreement, definitions, defense coverage,

exclusions and conditions.

WMIC GL-610 Commercial Liability Coverage (Farm Premises and Operations)

This form provides commercial liability coverage for farm premises and operations. It includes an insuring agreement, definitions, principal and supplemental coverages, defense coverages,

exclusions and conditions.

WMIC GL-9 Personal Liability Coverage

Farm premises and operations liability provided by Form WMIC GL-610 can be extended to include coverage for the personal liability exposures of individuals.

1.4 Owners Occupants of 2 – 4 Family Dwellings

Liability coverage in connection with the Insured's private residence may be provided by a CPL or FCPL policy. Theadditional rental units must be identifiedon the policy and an additional premium charge made.

Use GL-1 - Personal Liability Policy or WMIC GL-2.0 - Farm Personal Liability Policy or WMIC Broad Form HO-2, Special Form HO-3 or Tenant Form HO-4

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SUPPLEMENTAL LIABILITY INSURANCE RULES OHIO

1.5 Basic Limits - Comprehensive Personal Liability (CPL) and Farm Comprehensive Personal Liability (FCPL):

1.5.1 Coverage L (Liability) - $ 100,000 combined single limit

A Products Aggregate Limit applies separately to each year of the FCPL policy or any

applicable policy period less than one year (other than an extension of less than one year after the policy is issued). The Products Aggregate Limit will be two times the BI/PD Each

Occurrence Limit.

1.5.2 Coverage M (Med Pay to Others) - $ 1,000 per person $ 25,000 per accident

1.6 Basic Limits - Premises Liability and Farm Premises & Operations Liability: 1.6.1 Coverage L (Liability) - $ 100,000 combined single limit

A General Aggregate Limit applies separately to each year of the policy or any applicable policy period less than one year (other than an extension of less than one year after the policy is issued). The General Aggregate Limit applies separately to each location shown on the declarations and will be two times the BI/PD Each Occurrence Limit.

1.6.2 Coverage M (Med Pay to Others) - $ 1,000 per person

1.6.3 Coverage N (Products/Completed Work) - $100,000 combined single limit

A Products/Completed Work Hazard Aggregate Limit applies separately to each year of the policy or any applicable policy period less than one year (other than an extension of less than one year after the policy is issued). The Products/Completed Work Hazard Aggregate Limit applies separately to each location shown on the declarations and will be two times the BI/PD Each Occurrence Limit.

1.7 Increased Limits

Higher limits of liability for Coverages L, M and N are shown in the Rate Pages. The maximum limit for Med Pay to Others is $10,000.

1.8 Policywriting Instructions

All required and optional liability coverages must be written at the same limit except for optional coverages.

1.9 Annual Policy Term

Annual premiums and rates are shown in this manual. 2.0 Pollution Liability Exposure Questionnaire

When writing optional pollution liability coverage, you must complete and submit the pollution liability exposure questionnaire.

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RULE 2 - PREMIUM DETERMINATION 2.1 Exposure Basis

The exposure basis is indicated within each classification.

Receipts means $1,000 of receipts and refers to the gross amount of money charged by the Insured for the Insured’s operations.

2.2 Required Coverages

Coverage is required for the following exposures if they exist:

 All residence premises of the Named Insured.

 All farm premises of the Named Insured. 2.3 Calculation of Premium

The premium is computed as follows:

2.3.1 Determine the classifications for all required and optional coverages from Rules 3, 4 or 5 and calculate the number of exposure bases.

2.3.2 Obtain the rates at the appropriate limit for the classifications determined in 2.3.1 from the Rate Pages.

2.3.3 If applicable, add the charges for higher limits of Medical Payments to the rates determined in 2.3.2.

2.3.4 Multiply the rates determined in 2.3.3 by the respective number of exposure bases

determined in 2.3.1(subject to special minimum premiums shown in Rules 3, 4 or 5). The total of these products is the policy premium.

2.3.5 All coverage premiums and endorsements attached to the policy shall be adjusted to the nearest dollar. For this purpose an amount of fifty cents ($.50) or more shall be rounded to the next highest whole dollar. Premium adjustments apply separately to individual

coverages.

2.3.6 If insurance is cancelled or reduced at the request of the insured or Company, the earned premium shall be computed on a pro-rata basis. Unearned premium in an amount less than $5.00 will not be returned.

2.3.7 All changes requiring premium adjustments shall be computed on a pro-rata basis and adjusted to the nearest dollar. For this purpose an amount of fifty cents ($.50) or more shall be rounded to the next highest whole dollar.

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RULE 3 – COMPREHENSIVE PERSONAL LIABILITY (CPL) CLASSIFICATIONS 3.1 Residences

Code No. Rating Basis

70000 Initial Residence - one family...each 70100 Additional Charge for a two family dwelling...each

This charge is in addition to the premium for Code No. 70000.

70130 Additional Charge for a three family dwelling...each This charge is in addition to the premium for Code No. 70000.

70140 Additional Charge for a four family dwelling...each This charge is in addition to the premium for Code No. 70000.

70200 Additional Residence maintained by the Named Insured...each 70300 Additional Resident – Not Otherwise Covered...each

Attach Endorsement GL-72 - Additional Insureds and Additional Residences 70400 Additional Charge for Incidental Office, Professional, Private

School or Studio Occupancy by an Insured...each This applies to all of the above classifications. Attach Endorsement.

70500 Private Residence for rental or sale, not occupied by an Insured, with or without incidental office, professional, private school

or studio occupancy...each Attach Endorsement - Additional Residence

70600 Two Family Dwelling for rental or sale, not occupied by an Insured, with or without incidental office, professional, private school or studio occupancy...each Attach Endorsement - Additional Residence

70630 Three Family Dwelling for rental or sale, not occupied by an Insured, with or without incidental office, professional, private school or studio occupancy...each Attach Endorsement - Additional Residence

70640 Four Family Dwelling for rental or sale, not occupied by an Insured, with or without incidental office, professional, private school or studio occupancy...each Attach Endorsement - Additional Residence

If two or more persons co-own and occupy separate portions of a two to four family dwelling, a single policy may be issued to cover these persons as Named Insureds. Compute the premium for each portion using Code No. 70000.

Attach Endorsement - Additional Insureds 3.2 Additional Insureds

71100 Other residents of the Named Insured household...each Attach Endorsement - Additional Insured

71110 Partners or Co-Owners...each Attach Endorsement - Additional Insureds

71111 Additional Insureds and Additional Residences ...each Attach Endorsement - Additional Insureds and Additional Residences

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RULE 3 – COMPREHENSIVE PERSONAL LIABILITY (CPL) CLASSIFICATIONS (Continued) 3.3 Business Activities

71600 Salespersons, Collectors or Messengers - installation,

demonstration or servicing...each 71700 Teachers - athletic, laboratory, manual training, physical

training and swimming instructors ...per teacher 71800 Teachers - corporal punishment of pupils ...per teacher 71900 Teachers - not otherwise classified...per teacher

Teachers does not include principals or administrative supervisors Attach Endorsement - Business Activities

72000 Incidental Business Pursuits...per policy Coverage may be extended for the loss arising out of the insured’s incidental

business activities. This coverage is available only when the insured’s annual gross receipts from these activities are 10% or less of the total farming and incidental business annual gross receipts. Following is a list of typical incidental business activities: application of liquid fertilizer (excluding anhydrous ammonia); bait shop; ceramic shop; Christmas tree raising and sales; crop dryers (no coverage for loss or damage to the grain being dried); drapery or dressmaking (excluding any

manufacture or use of cleaning equipment); flower shop; fruit grading and packing store; greenhouse and/or nursery, flowers, evergreen or shrub raising on premises; pick your own fruit; salesperson for jewelry or kitchenware – no inventory or sales on premises; salesperson for feed, fertilizer or seeds- no inventory or delivery of products; salesperson for cosmetics – no inventory or sales on premises; seed sales; shearing of sheep off premises.

Attach Endorsement WMIC-GL 90 10 – Incidental Business Pursuits

75600 Incidental Farming...per policy Coverage is available when farming on the residence premises or away from premises is only incidental, farming is not the business of the insured, there are no farm

structures and the acreage does not exceed one hundred (100) acres. Over 100 acres must be written in the Farm Personal Liability Program. Extends coverages L and M to apply to farming operations specified in the endorsement or in the declarations. Attach Endorsement – Incidental Farming

3.4 Personal Injury

73000 Personal Injury...per policy Attach Endorsement - Personal Injury Endorsement

3.5 Trampoline Charge

Unless the liability is excluded via endorsement, owner-occupied dwellings with trampolines that have side netting and are tied down will be charged an additional fee per trampoline.

80000 Trampoline Charge...per trampoline 3.6 Recreational Motor Vehicle Coverage (Off Premises) – Refer to Rule 6

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RULE 4 - FARM COMPREHENSIVE PERSONAL LIABILITY (FCPL) CLASSIFICATIONS 4.1 Farms

The initial farm premises means the principal farm premises and all additional farm land without buildings, maintained by the Insured in connection with the principal farm premises. An additional farm premises means other farm land with or without buildings, maintained by the Insured in connection with the initial farm premises.

75000 Initial Farm Premises - not more than 160 acres...each 75100 Initial Farm Premises - over 160, but less than 500 acres...each 75200 Initial Farm Premises - 500 acres to 1,000 acres ...each 75250 Initial Farm Premises – more than 1,000 acres...each 75300 Additional Owned Farm Premises w/Outbuildings or Pasture...each 75400 Farm Premises for Rental or Sale, Including Buildings,

Not Occupied by an Insured w/Outbuildings or Pasture...each Attach Endorsement GL-73 - Additional Residences or Farms Rented to Others

70100 Additional Charge for a two family dwelling...each This charge is in addition to the premium for Code No. 75000.

70130 Additional Charge for a three family dwelling...each This charge is in addition to the premium for Code No. 75000.

70140 Additional Charge for a four family dwelling...each This charge is in addition to the premium for Code No. 75000.

70200 Additional Residence maintained by the Named Insured...each 703002 Additional Resident – Not Otherwise Covered...each 70400 Incidental Office (not farm office), Professional, Private School

or Studio Occupancy by an Insured ...each Attach Endorsement GL-80 - Office, Professional, Private School or Studio

Occupancy

705002 Private Residence for rental or sale, not occupied by an Insured, with or without incidental office, professional, private school

or studio occupancy...each Attach Endorsement - Additional Residence

706002 Two Family Dwelling for rental or sale, not occupied by an Insured, with or without incidental office, professional, private school or studio

occupancy...each Attach Endorsement - Additional Residence

706302 Three Family Dwelling for rental or sale, not occupied by an Insured, with or without incidental office, professional, private school or studio

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RULE 4 - FARM COMPREHENSIVE PERSONAL LIABILITY (FCPL) CLASSIFICATIONS (continued)

706402 Four Family Dwelling for rental or sale, not occupied by an Insured, with or without incidental office, professional, private school or studio

If the Insured resides at a location separate from the farm premises, that residence is rated as Code No. 70200. If two or more persons co-own and operate a farm and maintain separate households on the farm premises, a single policy may be issued to cover these persons as Named Insureds.

Compute the FCPL premium for one household using the accumulated acreage and compute the CPL premium for the other household.

Attach Endorsement GL-71 - Additional Insureds 4.2 Custom Farming

The policy provides coverage for Custom Farm Work only if receipts from custom farm work for the 12 months just before the date of the occurrence do not exceed $5,000.

76200 Custom Farming...receipts Attach Endorsement GL-75 - Custom Farming

4.3 Fire Legal Liability – Farms

77000 Fire Legal Liability – farms...per location Attach Endorsement WMIC GL-77 - Fire Legal Liability - Farms

4.4 Fruit or Vegetable Picking - By Public

77500 Fruit or Vegetable Picking - by public - no off-ground picking...receipts 77600 Fruit or Vegetable Picking - by public – including off-ground picking...receipts

Attach Endorsement WMIC GL-78 - Fruit or Vegetable Picking - By Public 4.5 Additional Insureds

711002 Persons or Organizations...each Attach Endorsement - Additional Insured Persons or Organizations

711102 Partners or Co-Owners...each Attach Endorsement - Additional Insureds Partners or Co-Owners

711112 Additional Insureds ...each Attach Endorsement - Additional Insureds

4.6 Business Activities

demonstration or servicing...each 717002 Teachers - athletic, laboratory, manual training, physical

training and swimming instructors ...per teacher 718002 Teachers - corporal punishment of pupils ...per teacher 719002 Teachers - not otherwise classified...per teacher

Teachers does not include principals or administrative supervisors Attach Endorsement WMIC GL-74 - Business Activities

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72000 Incidental Business Pursuits...per policy Coverage may be extended for the loss arising out of the insured’s incidental business activities. This coverage is available only when the insured’s annual gross receipts from these activities are 10% or less of the total farming and incidental business annual gross receipts. Following is a list of typical incidental business activities: application of liquid fertilizer (excluding anhydrous ammonia); bait shop; ceramic shop; Christmas tree raising and sales; crop dryers (no coverage for loss or damage to the grain being dried); drapery or dressmaking (excluding any manufacture or use of cleaning equipment); flower shop; fruit grading and packing store; greenhouse and/or nursery, flowers, evergreen or shrub raising on premises; pick your own fruit; salesperson for jewelry or kitchenware – no inventory or sales on premises; salesperson for feed, fertilizer or seeds- no inventory or delivery of products; salesperson for cosmetics – no inventory or sales on premises; seed sales; shearing of sheep off premises.

Attach Endorsement WMIC-GL 90 10 – Incidental Business Pursuits 4.7 Personal Injury

730002 Personal Injury

Attach Endorsement WMIC-GL-81 - Personal Injury 4.8 Horse-Related Liability

77700 Horse Liability ...per horse The policy automatically provides coverage for the insured’s legal liability for

ownership of horses. However, an additional premium charge is necessary for each horse in excess of two.

77800 Horse Boarding ...per stall The policy may be extended to provide coverage for liability arising out of the boarding of horses by the insured on the insured premises. Eligible operations are limited to insureds that are familiar with horses and involve no more than 10 stalls.

Attach Endorsement WMIC GL-478 – Horse Boarding Operations 4.9 Farm Employer’s Liability

78100 Farm Employer’s Liability ...per policy In Ohio, the Workers’ Compensation Insurance Fund is the exclusive remedy for injured employees. However, the possibility of suit still exists in areas not covered by the fund, such as Loss of Consortium or a suit brought by an injured employee against a negligent party who, in turn, subrogates against the employer for recovery. This endorsement provides coverage for farm employers’ liability and farm employees’ medical payments. Designated employees may be excluded. The limits of insurance (liability – each

occurrence; medical payments – each farm employee) must equal the limits of liability for all exposures covered under the policy. Workers’ Compensation is required.

Requests for coverage must include a workers’ compensation certificate number and the effective date of the most recent certificate.

Attach Endorsement WMIC GL-872 – Farm Employers Liability Coverage

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4.10 FCPL Increased Optional Pollution Liability for Farm Risks

Pollution Liability Coverage is provided under the policy up to a limit of $25,000 for certain pollution incidents involving discharge, dispersal, release or escape of pollutants usual to agricultural operations. Incidents are covered only if they are sudden and accidental. Increased limits are available and must appear on the declaration page. (See page Rates – 3) $500,000 is the maximum amount of coverage that can be purchased as an optional coverage.

78000 Optional Limited Pollution Liability...Per Policy The increased limit must be shown on the Declaration’s Page.

4.11 Horse & Buggy Medical Expense Coverage

The policy may be extended to provide coverage for medical expense liability arising out of the use and operation of a horse and buggy for transportation. The endorsement includes $5,000 in medical payments for the named insured, immediate family members or any person using or occupying the insured’s horse and buggy with the insured’s permission.

77900 Horse & Buggy Medical Expense Coverage...per policy Attach Endorsement WMIC GL-480

4.12 Trampoline Charge

Unless the liability is excluded via endorsement, owner-occupied dwellings with trampolines that have side netting and are tied down will be charged an additional fee per trampoline.

80000 Trampoline Charge...per trampoline 4.13 Recreational Motor Vehicle Coverage (Off Premises) - Refer to Rule 6

4.14 Watercraft – Refer to Rule 7

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RULE 5 - PREMISES AND/OR FARM PREMISES & OPERATIONS LIABILITY CLASSIFICATIONS

5.1 Premises

The WMIC GL-600 form provides liability coverage arising out of the insured premises and operations necessary or incidental to the insured premises. Liability principal coverages include: bodily injury and property damage liability including the products and completed work hazard; medical payments; and fire legal liability. The WMIC GL-600 includes an insuring agreement, definitions, defense coverage, exclusions and conditions.

01001 Dwelling – 1 Family...each 01005 Dwelling – 2 Family...each 01009 Dwelling – 3 Family...each 01013 Dwelling – 4 Family...each If two or more persons co-own the insured premises, a single policy may be issued to cover these persons as Additional Insureds. Attach Endorsement GL-108 - Additional Insured

01700 Vacancy - Additional Charge...each Apply charge if a dwelling becomes vacant for more than 30 days during the policy period. 5.2 Farm Premises & Operations

The WMIC GL-610 form provides commercial liability coverage for farm premises and operations. It includes an insuring agreement, definitions, principal and supplemental coverages, defense

coverages, exclusions and conditions.

02400 Farms (160 acres or less)...each 02500 Farms (more than 160/less than 500 acres)...each 02600 Farms (500 to 1,000 acres)...each 02650 Farms (more than 1,000 acres)...each 02660 Add’l Farm Premises w/ Buildings or Pasture...each 02001 Dwelling – 1 Family...each 02005 Dwelling – 2 Family...each 02009 Dwelling – 3 Family...each 02013 Dwelling – 4 Family...each If two or more persons co-own the insured premises, a single policy may be issued to cover these persons as Additional Insureds. Attach Endorsement GL-108 - Additional Insured

70000 Personal Liability Coverage...Per Policy Farm premises and operations liability provided by Form GL-610 can be extended to include coverage for the personal liability exposures of individuals. Attach Endorsement WMIC GL-9 – Personal Liability Coverage

02700 Vacancy - Additional Charge...each Apply charge if a dwelling becomes vacant for more than 30 days during the policy period. 78002 Limited Farm Pollution Liability...Per Policy

The policy provides Limited Pollution Liability Coverage up to a limit of $25,000 for certain pollution incidents involving discharge, dispersal, release or escape of pollutants

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RULE 5 - PREMISES AND/OR FARM PREMISES & OPERATIONS LIABILITY CLASSIFICATIONS (continued)

usual to agricultural operations. Incidents are covered only if they are sudden and accidental. Increased limits are available and must appear on the declaration page. (See page Rates – 8) $500,000 is the maximum amount of coverage that can be purchased as an optional coverage.

Attach Endorsement WMIC GL 09 38 – Limited Farm Pollution Liability Coverage 5.2 Farm Premises & Operations (continued)

If Endorsement WMIC GL-9 – Personal Liability Coverage is used to cover the personal liability exposures of individuals, the following optional coverages and forms may also be used:

754 00 Farm Premises for Rental or Sale, Including Buildings,

Not Occupied by an Insured w/Outbuildings or Pasture...each Attach Endorsement GL-73 - Additional Residences or Farms Rented to Others

76200 Custom Farming...receipts Attach Endorsement GL-75 - Custom Farming

70100 Additional Charge for a two family dwelling...each 70130 Additional Charge for a three family dwelling...each 70140 Additional Charge for a four family dwelling...each 70200 Additional Residence maintained by the Named Insured...each

Attach Endorsement GL-72 - Additional Insureds and Additional Residences

703002 Additional Resident – Not Otherwise Covered...each Attach Endorsement GL-72 - Additional Insureds

70400 Incidental Office (not farm office), Professional, Private School

or Studio Occupancy by an Insured ...each Attach Endorsement GL-80 - Office, Professional, Private School or Studio

Occupancy

705002 Private Residence for rental or sale, not occupied by an Insured, with or

without incidental office, professional, private school or studio occupancy...each Attach Endorsement GL-73 - Additional Residences or Farms

706002 Two Family Dwelling for rental or sale, not occupied by an Insured, with or without incidental office, professional, private school or studio occupancy...each Attach Endorsement GL-73 - Additional Residences or Farms

706302 Three Family Dwelling for rental or sale, not occupied by an Insured, with or without incidental office, professional, private school or studio occupancy...each Attach Endorsement GL-73 - Additional Residences or Farms

706402 Four Family Dwelling for rental or sale, not occupied by an Insured, with or without incidental office, professional, private school or studio occupancy...each Attach Endorsement GL-73 - Additional Residences or Farms

711002 Additional Insured - Persons or Organizations...each Attach Endorsement GL-70 - Additional Insured Persons or Organizations

711112 Additional Insureds ...each Attach Endorsement GL-72 - Additional Insureds

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5.2 Farm Premises & Operations (continued)

demonstration or servicing...each Attach Endorsement WMIC GL-74 - Business Activities

717002 Teachers - athletic, laboratory, manual training, physical

training and swimming instructors ...per teacher Attach Endorsement WMIC GL-74 - Business Activities

718002 Teachers - corporal punishment of pupils ...per teacher Attach Endorsement WMIC GL-74 - Business Activities

719002 Teachers - not otherwise classified...per teacher Teachers does not include principals or administrative supervisors

Attach Endorsement WMIC GL-74 - Business Activities

72000 Incidental Business Pursuits...per policy Coverage may be extended for the loss arising out of the insured’s incidental business activities. This coverage is available only when the insured’s annual gross receipts from these activities are 10% or less of the total farming and incidental business annual gross receipts. Following is a list of typical incidental business activities: application of liquid fertilizer (excluding anhydrous ammonia); bait shop; ceramic shop; Christmas tree raising and sales; crop dryers (no coverage for loss or damage to the grain being dried); drapery or dressmaking (excluding any manufacture or use of cleaning equipment); flower shop; fruit grading and packing store; greenhouse and/or nursery, flowers, evergreen or shrub raising on premises; pick your own fruit;

salesperson for jewelry or kitchenware – no inventory or sales on premises; salesperson for feed, fertilizer or seeds- no inventory or delivery of products;

salesperson for cosmetics – no inventory or sales on premises; seed sales; shearing of sheep off premises.

Attach Endorsement WMIC-GL 90 10 – Incidental Business Pursuits 730002 Personal Injury

Attach Endorsement WMIC-GL-81 - Personal Injury

77000 Fire Legal Liability – farms...per location Attach Endorsement WMIC GL-77 - Fire Legal Liability - Farms

77500 Fruit or Vegetable Picking - by public - no off-ground picking...receipts Attach Endorsement WMIC GL-78 - Fruit or Vegetable Picking - By Public

77600 Fruit or Vegetable Picking - by public – including off-ground picking...receipts Attach Endorsement WMIC GL-78 - Fruit or Vegetable Picking - By Public

(19)

5.2 Farm Premises & Operations (continued)

77700 Horse Liability ...per horse The policy automatically provides coverage for the insured’s legal liability for ownership of horses. However, an additional premium charge is necessary for each horse in excess of two.

77800 Horse Boarding ...per stall The policy may be extended to provide coverage for liability arising out of the boarding of horses by the insured on the insured premises. Eligible operations are limited to insureds that are familiar with horses and involve no more than 10 stalls.

Attach Endorsement WMIC GL-478 – Horse Boarding Operations

77900 Horse & Buggy Medical Expense Coverage...per policy The policy may be extended to provide coverage for medical expense liability arising out of the use and operation of a horse and buggy for transportation. The endorsement includes $5,000 in medical payments for the named insured, immediate family members or any person using or occupying the insured’s horse and buggy with the insured’s permission.

Attach Endorsement WMIC GL-480

78100 Farm Employer’s Liability ...per policy In Ohio, the Workers’ Compensation Insurance Fund is the exclusive remedy for injured employees. However, the possibility of suit still exists in areas not covered by the fund, such as Loss of Consortium or a suit brought by an injured employee against a negligent party who, in turn, subrogates against the employer for recovery. This endorsement provides coverage for farm employers’ liability and farm

employees’ medical payments. Designated employees may be excluded. The limits of insurance (liability – each occurrence; medical payments – each farm employee) must equal the limits of liability for all exposures covered under the policy.

Workers’ Compensation is required. Requests for coverage must include a

workers’ compensation certificate number and the effective date of the most recent certificate.

Attach Endorsement WMIC GL-872 – Farm Employers Liability Coverage

95000 Recreational Motor Vehicle Coverage Endorsement...per Unit Refer to Rule 6

9600(2-7) Watercraft Liability...per Unit Refer to Rule 7

(20)

RULE 6 – RECREATIONAL MOTOR VEHICLE COVERAGE ENDORSEMENT

The Recreational Motor Vehicle Coverage Endorsement extends bodily injury liability coverage, property damage liability coverage and medical payments for off-premise use of recreational motor vehicles. Home office approval is required for risks with more than 6 recreational motor vehicles. When writing this

coverage, you must complete and submit the Recreational Vehicle Questionnaire. 6.1 Eligible Drivers

a) The household driving record must not exceed six violations or more than one at-fault accident in the past three years.

6.2 Eligible Vehicles

This endorsement applies only to motorized land vehicles designed for recreational use off public roads, including snowmobiles, all-terrain vehicles and similar motorized vehicles.

6.3 Ineligible Risks

The following are not eligible for coverage:

a) Risks in which the owner or any other operator has had a major violation in the last 5 years, whether in a boat or motor vehicle

b) Risks where any operator has demonstrated a poor driving record or has shown a lack of concern for traffic laws and the safety of others

c) Motorcycles, motorbikes, mopeds, minibikes, dirt bikes, or any ATV designed or able to be licensed for road use.

d) Vehicles used in races or speed contests e) Any three-wheeled ATV

f) Any ATV over 700cc’s

g) Any Racer/Competitor Class ATV’s including, but not limited to, the following: i. Honda - TRX

ii. Kawasaki - Lakota or Mojave

iii. Yamaha – Raptor, Banshee, Warrior, Wolverine or YFZ450 iv. Polaris - Scrambler

v. Suzuki - Quad Racer

h) Any snowmobile over 600cc’s or racer/competition class snowmobiles (ie. Phaser, V-Max) i) Any recreational vehicle used for business purposes

j) Any recreational vehicle leased or rented to others k) Golf carts being used on public streets or highways l) Go-carts (homemade or kit)

6.4 Recreational Motor Vehicle Liability Classification (CPL and FCPL)

95000 Recreational Motor Vehicle Coverage Endorsement...per Unit 6.5 Recreational Motor Vehicle Liability Classification (CPL Homeowner Combo)

95000 Recreational Motor Vehicle Coverage Endorsement...per Unit

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RULE 7 – WATERCRAFT LIABILITY

Watercraft liability can be added to Comprehensive Personal Liability (CPL) and Farm Comprehensive Personal Liability (FCPL) policies. The policy includes coverage for a watercraft owned by or rented to an insured which is powered by inboard, outboard or inboard/outboard motors which total 50 horsepower or less, and sailboats owned by or rented to an insured that are less than 26 feet in length.

7.1 Eligible Property

Watercraft liability may be used to cover boats that meet all the following requirements: a) Owned by individuals for personal pleasure use

b) 30 feet or less in overall length

c) Capable of maximum speeds not greater than 50 mph

d) 20 years or less in age for new business. Use the manufacture year to determine the age of each boat.

e) Valued at $50,000 or less

Use the combined values of the boat and motor(s) to determine the eligibility status for boats powered by outboard motors.

7.2 Eligible Drivers

a) The owner insured must be at least 21 years of age and have a valid Ohio drivers license with a good driving record (Home Office must approve owners under 21 years of age)

b) A current motor vehicle report (MVR) will be ordered by the company to determine eligibility of all operators or residents in the household.

7.3 Ineligible Property

The following are not eligible for coverage:

a) 1-2 passenger personal watercraft exceeding 100 horsepower/ 900 cc b) 3-4 passenger personal watercraft exceeding 120 horsepower/ or 1000 cc c) Air propelled or air powered boats

d) Amphibious vehicles

e) Boats powered by converted automobile engines f) Boats used or developed for experimental purposes g) Converted military surplus vessels

h) Home-built or kit-built boats

i) House boats used as year-round or seasonal residences j) Hovercraft

k) Hydrofoils or Hydroplanes l) Ice Boats

m) Power boats owned for racing purposes

n) Property used for business, charter or other commercial purposes o) Sailboards or windsurfers

p) Submersible watercraft

(22)

RULE 7 – WATERCRAFT LIABILITY (continued)

7.4 Ineligible Risks or Non-Bound Risks

The following risks cannot be bound, but may be worthy of consideration. A completed application may be submitted to the company as a trial application on the following:

a) Risks in which the owner or any other operator has had a major violation in the last 5 years, whether in a boat or motor vehicle;

b) Risks where any operator has demonstrated a poor driving record or has shown a lack of concern for traffic laws and the safety of others;

c) Risks previously cancelled or rejected by another company;

d) Risks where the household driving record exceeds six violations or more than one at-fault accident in the past three years.

e) Risks that have had more than one boat physical damage or theft loss in the last 3 years f) Individuals with an unfavorable personal, business or financial reputation;

g) Individuals with an uncorrectable physical or mental impairment that could adversely affect their driving ability

6.5 Watercraft Liability Classifications

96002 Watercraft Endorsement (51-100 HP O/B)...per Unit 96003 Watercraft Endorsement (101 to 151 HP O/B)...per Unit 96004 Watercraft Endorsement (151+ HP O/B)...per Unit 96005 Watercraft Endorsement (1-175 HP I/B or Inboard/Outboard)...per Unit 96006 Watercraft Endorsement (176+ HP I/B or Inboard/Outboard)...per Unit 96007 Watercraft Endorsement (Sailboats with or without aux power)...per Unit

The Watercraft Endorsement provides coverage for bodily injury or property damage that results from the ownership, maintenance, use, loading or unloading of the watercraft listed on the endorsement, with certain exceptions. Attach Endorsement ML-75

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Complete this form when requesting optional limits or increased limits of pollution liability coverage.

Policy Number: _____________________________________ Inception Date:__________________________________ Agent Name / Number: _________________________________________________________________________________ Insured Name & Address: _______________________________________________________________________________ ____________________________________________________________________________________________________ Property Location:_____________________________________________________________________________________ How Long Have You Owned This Property? _______________________________________________________________ Select any items present on this property:

 Underground storage tanks. Size of each and details of use: _______________________________________________  Above ground storage tanks. Size of each and details of use: ______________________________________________  Livestock. How is manure stored and disposed of? _______________________________________________________  Wells, streams, bodies of water, or wetlands on the premises or on adjoining properties within 500 ft. of a manure

storage facility. Distance: __________________________________________________________________________  Degreasing units or solvents. Type and distance between the units and streams, bodies of water, or wetlands. Advise

how the waste solvents are disposed of._________________________________________________________________ ________________________________________________________________________________________________  Oil or gas wells (Complete the Oil and Gas Well Questionnaire)

 Painting or sandblasting. Details:____________________________________________________________________  Commercial pesticides or chemical applicators for loading or rinsing application equipment or holding tanks.

Details: __________________________________________________________________________________________  Agricultural chemicals or fertilizers or their containers (drums, cans, jugs or bags). Provide location, volume,

container conditions and approximate distances (in feet) to the nearest well or body of water: ______________________ ________________________________________________________________________________________________  Buried pits, dumps, cisterns, landfills, or other disposal sites. Provide location, volume, container types, storage

conditions and approximate distance (in feet) to the nearest well or body of water: _______________________________ ________________________________________________________________________________________________  PCBs. Details:____________________________________________________________________________________  Fuel oil tank in the basement. Is there an open sump nearby? ______________________________________________  Asbestos around pipes or ceiling tiles. Details and locations: ______________________________________________  Other pollution hazards that could contribute to contamination in any form at this or other locations owned by you.

Details: __________________________________________________________________________________________

1. Have there been any professionally conducted inspections for environmental hazards? Y ( ) N ( ) If yes, attach a copy of the inspection or report.

2. Has the Ohio or Federal EPA ever notified you of any potential contamination or violations? Y ( ) N ( ) If yes, provide details: _____________________________________________________________________

3. Have any previous pollution liability claims ever been filed by anyone for this location or any location Y ( ) N ( ) owned by you? If yes, provide details: ________________________________________________________

No coverage is provided by this form nor does it replace or add to any provisions of your policy.

I declare that I have examined this questionnaire and to the best of my knowledge and belief it is true, correct and complete. "Any person who, with intent to defraud or knowing that he is facilitating a fraud against an insurer or submits a false or deceptive statement could be guilty of insurance fraud.”

(24)

RECREATIONAL VEHICLE QUESTIONNAIRE

Complete this form when requesting optional limits or increased limits for recreational vehicle coverage.

Policy Number: _____________________________________ Inception Date:__________________________________ Agent Name / Number: _________________________________________________________________________________ Insured Name & Address: _______________________________________________________________________________ ____________________________________________________________________________________________________

Recreational Vehicle Information:* VEHICLE TYPE YEAR TRADE

NAME MODEL NAME & NO. SERIAL NUMBER CC’s MAX

MPH COV. AMOUNT DEDUCTIBLE $ $ $ $ $ $ * Contact the home office for risks with more than 6 recreational vehicles.

Family Information: Include all children.

* S = Single M=Married D - Divorced W = Widowed P = Separated These questions apply to all operators. Please read and complete them carefully:

1. In the last 3 years, have you or any operator(s) had insurance canceled, declined or renewal refused due to:

a. misrepresentation by the insured to the insurer? Y ( ) N ( ) b. loss of driving privileges through suspension, revocation, or expiration of the operator's license? Y ( ) N ( )

c. non-payment of premium? Y ( ) N ( )

If yes, explain: ____________________________________________________________________________________ 2. Do you or any operator(s) have any mental or physical impairments, including but not limited to

hypertension, heart problems, emotional problems, diabetes, epilepsy, etc.? Y ( ) N ( ) If yes, explain: ____________________________________________________________________________________ 3. Have you or any operator(s) been convicted of any moving violations in the past three years? Y ( ) N ( )

If yes, list below.

NAME CONVICTION

DATE OFFENSE

RVQ - 1 Wayne Mutual Insurance Company 1/2014

NAME (As shown on Drivers License)

DATE OF

BIRTH SEX

MARITAL STATUS*

RELATION TO

NAMED INSURED DRIVERS LICENSE # SSN

(25)

5. Have you or any operator(s) been cited or convicted of any of the following violations in the last 5 years?

 Driving while intoxicated? If yes, date of conviction: _________________________________________________  Driving under the influence of drugs? If yes, date of conviction: _________________________________________  Drag racing? If yes, date of conviction: _____________________________________________________________  Fleeing a police officer? If yes, date of conviction: ____________________________________________________  Leaving the scene of an accident? If yes, date of conviction: ____________________________________________  Felonies? If yes, describe felony and date of conviction:________________________________________________ 6. List all accidents/losses that have occurred in the last 3 years. If no accidents/losses, indicate “None”

RESULT OF ACCIDENT NAME ACC. DATE DESCRIBE ACCIDENT & WHO WAS CITED Bodily Injury/ _Death?

Total Property Damage (including own)? Yes No $ Yes No $ Yes No $

7. Do you have a Personal Auto Policy with Wayne Mutual Insurance Company? Y ( ) N ( ) If yes, list policy #:_________________________________________________________________________________

8. Are any of the recreational vehicles listed above used away from the primary residence premises? Y ( ) N ( ) If yes, explain: ____________________________________________________________________________________

9. Are any of the recreational vehicles listed above used in racing or speed contests, for business purposes Y ( ) N ( ) (other than farming), or on public streets or highways?

If yes, explain: ____________________________________________________________________________________ Remarks: ____________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________

No coverage is provided by this form nor does it replace or add to any provisions of your policy.

I declare that I have examined this questionnaire and to the best of my knowledge and belief it is true, correct and complete. "Any person who, with intent to defraud or knowing that he is facilitating a fraud against an insurer or submits a false or deceptive statement could be guilty of insurance fraud.”

INSURED SIGNATURE: ___________________________________________ DATE: __________________________

(26)

OIL & GAS WELL EXPOSURE QUESTIONNAIRE

This form is necessary when requesting coverage for risks with an oil or gas well. Please complete this form and have the insured sign below.

Policy Number: ______________________________________________________________________________ Agency Name and #:___________________________________________________________________________ Insured Name & Address: ______________________________________________________________________

___________________________________________________________________________________________ Property Location: ____________________________________________________________________________ ___________________________________________________________________________________________

1. How many oil or gas wells are on the insured property? ___________________________________________

2. For how many of these wells does the insured own 100% of the oil & gas rights? _______________________

3. Is the gas or oil produced used primarily by the insured? Yes ( ) No ( )

4. If the gas is used primarily by the insured, does the insured have to pump the

oil from the well to maintain natural gas production? Yes ( ) No ( )

If yes, how many barrels of oil are sold per year to commercial oil refiners? ___________________________ If yes, how does the insured dispose of the salt brine? _____________________________________________ ________________________________________________________________________________________

5. Does the insured sell gas to others (ie. other property owners or gas companies)? Yes ( ) No ( )

6. If any of the oil is sold commercially, does the insured haul the oil to the refiners? Yes ( ) No ( )

7. Is a certificate of insurance required by the Ohio Dept. of Natural Resources? Yes ( ) No ( )

If yes, for how much? ______________________________________________________________________ No coverage is provided by this form nor does it replace or add to any provisions of your policy.

I declare that I have examined this questionnaire and to the best of my knowledge and belief it is true, correct and complete. "Any person who, with intent to defraud or knowing that he is facilitating a fraud against an insurer or submits a false or deceptive statement could be guilty of insurance fraud.”

INSURED SIGNATURE ___________________________________________ DATE __________________

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FORMS & ENDORSEMENTS

Form Edition Required Form

GL-1 1.0 Personal Liability Coverage X

GL-5 1.0 Additional Policy Conditions X

GL-70 1.0 Additional Insured - Persons or Organizations

GL-71 1.0 Additional Insureds - Partners or Co-owners

GL-72 1.0 Additional Insureds and Additional Residences

GL-73 1.0 Additional Residences or Farms Rented to Others

GL-74 1.0 Business Activities

GL-80 1.0 Office, Professional, Private School or

Studio Occupancy

GL-81 1.0 Personal Injury Endorsement

ML-75 1.0 Watercraft

WIG RTC 03 14 Restriction to Coverages (Wayne Insurance Group)

WMIC ML-320 09 08 Incidental Farming

WMIC ML-428 1.0 Motorized Vehicle Liability X

WMIC-GL 03 59 08 13 Personal Liability Coverage Amendatory Endorsement X

WMIC-GL 90 10 09 08 Incidental Business Pursuits

WMIC GL-RV 10 10 Recreational Motor Vehicle Liability

(28)

COMPREHENSIVE PERSONAL LIABILITY (CPL) HOMEOWNER COMBINATION POLICY

WMIC HO-2 2.0 Broad Form HO-2 X

or WMIC HO-3 2.0 Special Form HO-3 X

or WMIC HO-4 3.0 Tenant Form HO-4 X

ML-41 1.0 Additional Insured

ML-42 1.0 Office, Professional, Private School, or

Studio Occupancy

ML-46 1.0 Personal Injury

ML-70 2.0 Additional Residential Premises Rented to

Others – Liability Coverage Only

ML-320 1.0 Incidental Farming

ML-433 1.0 Additional Insureds – Residents of Household

WMIC-ML-71 2.0 Business Activities

WMIC-GL 03 58 08 13 Personal Liability Coverage Amendatory Endorsement X

WMIC SMP 62 02 07 Restriction to Policy

(29)

WMIC GL-2.0 Personal Liability Coverage (Farm) X

GL-5 2.0 Additional Policy Conditions - Ohio X

GL-70 2.0 Additional Insured – Persons or Organizations

GL-71 2.0 Additional Insured – Partners or Co-owners

GL-72 2.0 Additional Insureds

GL-73 2.0 Additional Residences or Farms

Rented to Others

GL-75 2.0 Custom Farm Work

GL-80 2.0 Office, Professional, Private School, or

Studio Occupancy

WMIC-GL-74 2.0 Business Activities

WMIC-GL-77 2.0 Fire Legal Liability – Farms

WMIC-GL-78 2.0 Fruit or Vegetable Picking – By Public

WMIC-GL-81 2.0 Personal Injury

WMIC-GL 03 61 08 13 Personal Liability Coverage (Farm) Amendatory Endorsement X

WMIC-GL 02 50 05 15 Certified Terrorism Loss X

WMIC-GL 95 08 13 Products Aggregate Limit X

WMIC GL-478 10 10 Horse Boarding Operations

WMIC GL-480 10 10 Horse & Buggy Medical Expense Coverage

WMIC GL-872 10 10 Farm Employer’s Liability Coverage

(30)

PREMISES AND/OR FARM PREMISES & OPERATIONS FORMS & ENDORSEMENTS

WMIC GL-600 1.0 Commercial Liability Coverage (Premises Only) X

or WMIC GL-610 2.1 Commercial Liability Coverage (Farm Premises & Operations) X

WMIC GL-9 1.0 Personal Liability Coverage (use with WMIC GL-610)

CL-100 1.0 Common Policy Conditions X

CL-0126 01-01 Amendatory Endorsement - Ohio X

GL-904 1.0 Personal & Advertising Injury (use with WMIC GL-600) X

GL-904 2.0 Personal & Advertising Injury (use with WMIC GL-610) X

GL-902 1.0 Contractual Liability Coverage X

WMIC-GL 02 70 08 13 Amendatory Endorsement X

WMIC-GL 02 50 05 15 Certified Terrorism Loss X

WMIC GL 09 38 05 15 Limited Farm Pollution Liability Cov (use with WMIC GL-610)

WMIC-GL 96 05 15 Products/Completed Work (use with WMIC GL-600) X

WMIC-GL 97 05 15 Products/Completed Work (use with WMIC GL-610) X

WMIC SMP 62 02 07 Restriction to Policy

The following forms may be used only if the WMIC GL-9 Personal Liability Coverage is included:

GL-70 2.0 Additional Insured – Persons or Organizations

GL-73 2.0 Additional Residences or Farms Rented to Others

GL-75 2.0 Custom Farm Work

GL-80 2.0 Office, Professional, Private School, or Studio Occupancy

WMIC-GL-74 2.0 Business Activities

WMIC-GL-77 2.0 Fire Legal Liability – Farms

WMIC-GL-78 2.0 Fruit or Vegetable Picking – By Public

WMIC-GL-81 2.0 Personal Injury

WMIC GL-478 10 10 Horse Boarding Operations

WMIC GL-480 10 10 Horse & Buggy Medical Expense Coverage

WMIC GL-872 10 10 Farm Employer’s Liability Coverage

(31)

ADD’L $1,000 $100K $300K $500K $1,000K* MED PAY 70000 37 47 53 68 6 70100 13 18 20 26 2 70130 26 36 40 52 2 70140 39 54 60 78 2 70200 72 1.0 9 11 12 15 2 70300 72 1.0 9 11 12 15 2 70400 80 1.0 8 10 11 14 2 70500 73 1.0 17 22 24 30 2 70600 73 1.0 25 31 35 43 2 70630 73 1.0 50 62 70 86 2 70640 73 1.0 75 93 105 129 2 71100 70 1.0 5 6 7 9 2 711008 70 1.0 71110 71 1.0 5 6 7 9 2 71111 72 1.0 5 6 7 9 2 71600 74 1.0 6 7 8 9 2 71700 74 1.0 10 12 13 15 2 71800 74 1.0 8 10 13 18 71900 74 1.0 8 10 13 18 2 72000 WMIC GL-90 01 08 35 40 50 75 73000 81 1.0 10 13 15 20 75600 WMIC ML-320 1.0 26 35 39 50 (Continued)

TEACHER W/CORP PUNISHMENT TEACHERS – NOC

INCIDENTAL BUS PURSUITS PERSONAL INJURY

*Contact home office for approval CLASSIFICATIONS

INITIAL RESIDENCE – 1 FAMILY 2 FAMILY- ADD’L CHARGE 3 FAMILY- ADD’L CHARGE

INCIDENTAL FARMING ADD’L INSUREDS – PARTNERS/CO-OWNERS ADD’L INSUREDS & ADD’L

RESIDENCES

SALESPERSON, COLLECTOR TEACHER

All rates are for 12 months and subject to rounding to the closest $1

CODE ED

COMBINED SINGLE LIMIT GL

END

4 FAMILY- ADD’L CHARGE ADD’L RES. OCC BY INSURED

ADD’L RESIDENT - NOC

TERRITORY: OHIO

ADD’L INSURED – PERSON/ORG No Charge

Refer to Company for limits in excess of those shown. $1 million liability rates are shown for quote purposes

only and must have prior home office approval. MED PAY: Rates include $1,000 limit

INCIDENTAL OFFICE 1 FAMILY RENTAL DWELLING 2 FAMILY RENTAL DWELLING 3 FAMILY RENTAL DWELLING 4 FAMILY RENTAL DWELLING ADD’L INSURED – PERSON/ORG

(32)

ADD’L $1,000 $100K $300K $500K $1,000K* MED PAY 80000 75 98 107 145 95000 WMIC GL-RV 10 10 30 39 43 58 6 95001 WMIC GL-RV 10 10 20 29 33 48 2 96002 ML-75 1.0 41 57 72 104 6 96003 ML-75 1.0 46 65 83 119 6 96004 ML-75 1.0 62 88 114 166 6 96005 ML-75 1.0 49 69 88 127 6 96006 ML-75 1.0 57 80 104 150 6 96007 ML-75 1.0 43 59 75 108 6 1.75

*Contact home office for approval

8/2013

COMPREHENSIVE PERSONAL LIABILITY (CPL) RATES (AFFILIATED) - CONTINUED

CLASSIFICATIONS

MED PAY: Rates include $1,000 limit

TERRITORY: OHIO

only and must have prior home office approval.

CODE

WATERCRAFT LIABILITY (101 to 151 HP Outboard) WATERCRAFT LIABILITY

(151+ HP Outboard)

END TRAMPOLINE CHARGE

REC. VEHICLE LIABILITY (first unit)

ED

REC. VEHICLE LIABILITY (each additional unit) WATERCRAFT LIABILITY

(51 to 100 HP Outboard)

Rates - 2 Wayne Mutual Insurance Company

Increased Exposure Adjustment

WATERCRAFT LIABILITY (1 to 175 HP I/B or Inboard/Outboard)

WATERCRAFT LIABILITY (176+ HP I/B or Inboard/Outboard)

WATERCRAFT LIABILITY (Sailboats with or without aux power)

(33)

ADD’L $1,000 $100K $300K $500K $1,000K* MED PAY 70000 37 47 53 68 6 70100 13 18 20 26 2 70130 26 36 40 52 2 70140 39 54 60 78 2 70200 9 11 12 15 2 70300 9 11 12 15 2 70400 42 1.0 8 10 11 14 2 70500 70 2.0 17 22 24 30 2 70600 70 2.0 25 31 35 43 2 70630 70 2.0 50 62 70 86 2 70640 70 2.0 75 93 105 129 2 71100 41 1.0 5 6 7 9 2 71111 433 1.0 5 6 7 9 2 71600 71 2.0 6 7 8 9 2 71700 71 2.0 10 12 13 15 2 71800 71 2.0 8 10 13 18 71900 71 2.0 8 10 13 18 2 72000 WMIC GL-90 01 08 35 40 50 75 73000 46 1.0 10 13 15 20 75600 ML-320 1.0 26 35 39 50 CODE ED

COMBINED SINGLE LIMIT ML

END

*Contact home office for approval CLASSIFICATIONS

INITIAL RESIDENCE – 1 FAMILY 2 FAMILY- ADD’L CHARGE 3 FAMILY- ADD’L CHARGE 4 FAMILY- ADD’L CHARGE ADD’L RES. OCC BY INSURED

ADD’L RESIDENT - NOC

TERRITORY: OHIO

4 FAMILY RENTAL DWELLING ADD’L INSURED – PERSON/ORG

ADD’L INSUREDS - RESIDENTS OF HOUSEHOLD SALESPERSON, COLLECTOR

INCIDENTAL OFFICE 1 FAMILY RENTAL DWELLING 2 FAMILY RENTAL DWELLING 3 FAMILY RENTAL DWELLING

(Continued)

TEACHER

TEACHER W/CORP PUNISHMENT

PERSONAL INJURY INCIDENTAL FARMING

TEACHERS – NOC INCIDENTAL BUS PURSUITS

(34)

ADD’L $1,000 $100K $300K $500K $1,000K* MED PAY 80000 75 98 107 145 95000 WMIC GL-RV 10 10 30 39 43 58 6 95001 WMIC GL-RV 10 10 20 29 33 48 2 96002 ML-75 1.0 41 57 72 104 6 96003 ML-75 1.0 46 65 83 119 6 96004 ML-75 1.0 62 88 114 166 6 96005 ML-75 1.0 49 69 88 127 6 96006 ML-75 1.0 57 80 104 150 6 96007 ML-75 1.0 43 59 75 108 6 1.75

*Contact home office for approval

8/2013

Rates - 4 Wayne Mutual Insurance Company

Increased Exposure Adjustment

END

WATERCRAFT LIABILITY (101 to 151 HP Outboard)

COMPREHENSIVE PERSONAL LIABILITY (CPL) RATES (AFFILIATED) - CONTINUED

CLASSIFICATIONS

TRAMPOLINE CHARGE REC. VEHICLE LIABILITY

(first unit)

TERRITORY: OHIO

WATERCRAFT LIABILITY (151+ HP Outboard) WATERCRAFT LIABILITY (1 to 175 HP I/B or Inboard/Outboard)

Factor to apply to the liability policy premium REC. VEHICLE LIABILITY

(each additional unit) WATERCRAFT LIABILITY

(51 to 100 HP Outboard)

WATERCRAFT LIABILITY (176+ HP I/B or Inboard/Outboard)

WATERCRAFT LIABILITY (Sailboats with or without aux power)

ED

HOMEOWNER COMBINATION LIABILITY