Pioneer Development Liability Policy 1 2023 CopyCOMMERCIAL LINES POLICY - COMMON POLICY DECLARATIONS
NAUTILUS INSURANCE COMPANY
Scottsdale, Arizona
Transaction Type: Renewal
Renewal of Policy # NN1397188 Inspection Ordered:
Rewrite of Policy # [--]Yes 0 No
Cross Ref. Policy #
NIC Quote #
Named Insured and Mailing Address
(No., Street, Town or City, County, State, Zip Code)
Pioneer Development LLC
32 Perkins Ave
Northampton MA 01060
Agent and Mailing Address Agency No. 060000
(No., Street, Town or City, County, State, Zip Code)
RT SPECIALTY, A DIVISION OF RSG SPECIALT
1 Farm Glen Boulevard
Farmington
CT 06032
Policy No. NN1534053
This policy is insured by a company
which is not admitted to transact
insurance in the commonwealth, is not
supervised by the commissioner of
insurance and, in the event of an
insolvency of such company, a loss shall
not be paid by the Massachusetts Insurers
Insolvency Fund under chapter 175D.
Policy NO FLAT CANCELLATION
Period: From 04/27/2023 to 04/27/2024 at 12:01 A.M. Standard Time at your mailing address shown above.
Business Description: General Contractor Tax State MA
Form of Business: Limited Liability Company
IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY,
WE WILL PROVIDE YOU THE INSURANCE STATED IN THIS POLICY.
THIS POLICY CONSISTS OF THE FOLLOWING COVERAGE PARTS FOR WHICH A PREMIUM IS INDICATED.
THIS PREMIUM MAY BE SUBJECT TO ADJUSTMENT. PREMIUM
Commercial General Liability Coverage Part $ 9,226.00
$
Tax & Fee Schedule TOTAL ADVANCE PREMIUM $ 9,226.00
Surplus Lines Tax $ 369.04 Minimum & Deposit
Policy Fee 150.00
TOTAL TAXES & FEES $ 519.04
TOTAL $ 9,745.04
Form(s) and Endorsement(s) made a part of this policy at time of issue:
Refer to Schedule of Forms and Endorsements.
Countersigned: Farmington, CT By
04/12/1023
Countersignature or Authorized Representative, whichever is applicable
THESE DECLARATIONS TOGETHER WITH THE COMMON POLICY CONDITIONS, COVERAGE PART DECLARATIONS, COVERAGE PART COVERAGE
FORM(S) AND FORMS AND ENDORSEMENTS, IF ANY, ISSUED TO FORM A PART THEREOF, COMPLETE THE ABOVE NUMBERED POLICY.
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
E001 (02/14)
Hubbard
POLICY NUMBER: NN1534053
Named Insured: Pioneer Development LLC
SCHEDULE OF FORMS AND ENDORSEMENTS
COMMON POLICY
E001 (02/14)
E001J (07/20)
IL0017 (11/98)
E609 (09/21)
E915 (09/21)
E906
(02/21)
S013
(07/09)
E919
(01/20)
COMMERCIAL GENERAL LIABILITY
S150
(07/09)
S170
(07/09)
CG0001
(04/13)
CG2147
(12/07)
CG2173
(01/15)
CG2280
(04/13)
CG2196
IL0021
L201
L205
L216
L217
L223
L236
L238
L241
(03/05)
(09/08)
(07/10)
(11/10)
(04/16)
(06/17)
(09/22)
(06/07)
(06/07)
(07/09)
L251
(01/22)
L280
(06/07)
L288
(01/15)
L292
(06/07)
Nautilus Insurance Company Common Policy
Declarations
Nautilus Insurance Company Commercial Lines
Policy Jacket
Common Policy Conditions
Economic or Trade Sanctions Endorsement
U.S. Treasury Department's Office of Foreign
Assets Control (OFAC) Advisory Notice to
Policyholders
Service of Suit
Minimum Earned Premium Endorsement
Privacy Notice
Commercial General Liability Coverage Part
Declarations
Commercial General Liability Coverage Part
Declarations Extension
Commercial General Liability Coverage Form
(Occurrence Version)
Employment -Related Practices Exclusion
Exclusion of Certified Acts of Terrorism
Limited Exclusion - Contractors -
Professional Liability
Silica or Silica -Related Dust Exclusion
Nuclear Energy Liability Exclusion
Endorsement (Broad Form)
Exclusion - Exterior Insulation and Finish
Systems (EIFS)
Exclusion - Injury To Employees,
Contractors, Volunteers and Other Workers
Amendment of Definitions - Insured Contract
(Limited Form)
Exclusion - Punitive or Exemplary Damages
Total Exclusion - Pollution
Total Exclusion - Subsidence or Movement of
Soil, Land, Bedrock or Earth
Exclusion - Toxic Metals
Exclusion - Microorganisms, Biological
Organisms, Bioaerosols or Organic
Contaminants
Coverage Limitation and Exclusion -
Residential Construction Operations
Conditional Exclusion - Weather -Related
Property Damage (Roofing Operations)
Additional Conditions and Exclusions -
Contractors Subcontracted Work
Exclusion - Your Work Completed Prior to
The forms and endorsements shown on this Schedule constitute the entire policy at the time of issuance.
S902 (07/09) Page 1 of 2
Hubbard
POLICY NUMBER: NN1534053
Named Insured: Pioneer Development LLC
SCHEDULE OF FORMS AND ENDORSEMENTS
Specified Date
L305
(08/07)
Exclusion - All Operations Covered By a
Consolidated (Wrap -Up) Insurance Program
L320
(06/09)
Exclusion - Tainted Drywall Material
L335
(10/15)
Exclusion - Construction Operations in
Colorado or New York
L342
(09/16)
Exclusion - Continuous or Progressive Damage
L343
(06/20)
Exclusion - Unmanned Aircraft, Other Than
Unmanned Aircraft, Auto or Watercraft
(Limited)
L380
(03/22)
Exclusion - Cyber Incident
L354
(01/22)
Exclusion - Snow or Ice Operations
L379
(06/21)
Exclusion - Welding Hazards
L369
(09/21)
Exclusion - Communicable or Infectious
Disease
L408
(03/12)
Changes - Civil Union Or Domestic Partnership
L411
(07/22)
Privacy Breach Coverage
L416
(09/21)
Contractors Extension Endorsement
L601
(11/20)
Amendment of Conditions - Premium Audit
L850
(05/09)
Deductible Liability Insurance (Including
Allocated Loss Adjustment Expense)
S185
(02/22)
Lost Key Coverage
S038
(04/16)
Amendment of Liquor Liability Exclusion
S261
(07/09)
Exclusion - Asbestos
The forms and endorsements shown on this Schedule constitute the entire policy at the time of issuance.
S902 (07/09) Page 2 of 2
COMMON POLICY CONDITIONS
All Coverage Parts included in this policy are subject to the following conditions.
A. Cancellation
1. The first Named Insured shown in the Declara-
tions may cancel this policy by mailing or de-
livering to us advance written notice of cancel-
lation.
2. We may cancel this policy by mailing or deliv-
ering to the first Named Insured written notice
of cancellation at least:
a. 10 days before the effective date of cancel-
lation if we cancel for nonpayment of pre-
mium; or
b. 30 days before the effective date of cancel-
lation if we cancel for any other reason.
3. We will mail or deliver our notice to the first
Named Insured's last mailing address known to
us.
4. Notice of cancellation will state the effective
date of cancellation. The policy period will end
on that date.
5. If this policy is cancelled, we will send the first
Named Insured any premium refund due. If we
cancel, the refund will be pro rata. If the first
Named Insured cancels, the refund may be
less than pro rata. The cancellation will be ef-
fective even if we have not made or offered a
refund.
6. If notice is mailed, proof of mailing will be suf-
ficient proof of notice.
B. Changes
This policy contains all the agreements between
you and us concerning the insurance afforded.
The first Named Insured shown in the Declara-
tions is authorized to make changes in the terms
of this policy with our consent. This policy's terms
can be amended or waived only by endorsement
issued by us and made a part of this policy.
C. Examination Of Your Books And Records
We may examine and audit your books and rec-
ords as they relate to this policy at any time during
the policy period and up to three years afterward.
D. Inspections And Surveys
1. We have the right to:
a. Make inspections and surveys at any time;
IL 00 17 11 98
b. Give you reports on the conditions we find;
and
c. Recommend changes.
2. We are not obligated to make any inspections,
surveys, reports or recommendations and any
such actions we do undertake relate only to in-
surability and the premiums to be charged. We
do not make safety inspections. We do not un-
dertake to perform the duty of any person or
organization to provide for the health or safety
of workers or the public. And we do not warrant
that conditions:
a. Are safe or healthful; or
b. Comply with laws, regulations, codes or
standards.
3. Paragraphs 1. and 2. of this condition apply
not only to us, but also to any rating, advisory,
rate service or similar organization which
makes insurance inspections, surveys, reports
or recommendations.
4. Paragraph 2. of this condition does not apply
to any inspections, surveys, reports or recom-
mendations we may make relative to certifica-
tion, under state or municipal statutes, ordi-
nances or regulations, of boilers, pressure ves-
sels or elevators.
E. Premiums
The first Named Insured shown in the Declara-
tions:
1. Is responsible for the payment of all premiums;
and
2. Will be the payee for any return premiums we
pay.
F. Transfer Of Your Rights And Duties Under
This Policy
Your rights and duties under this policy may not
be transferred without our written consent except
in the case of death of an individual named in-
sured.
If you die, your rights and duties will be trans-
ferred to your legal representative but only while
acting within the scope of duties as your legal rep-
resentative. Until your legal representative is ap-
pointed, anyone having proper temporary custody
of your property will have your rights and duties
but only with respect to that property.
IL 00 17 11 98 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 0
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ECONOMIC OR TRADE SANCTIONS ENDORSEMENT
No insurer shall be deemed to provide cover and no insurer shall be liable to defend any claim, pay any claim or
provide any benefit under this policy to the extent that the provision of such cover, defense, payment or benefit
would expose that insurer to any sanction, prohibition or restriction under any economic or trade sanctions laws or
regulations of the United States of America, Canada, United Kingdom or European Union. Affected policy
provisions also include, but are not limited to, those relating to cancellation, nonrenewal, premium or payments.
Economic or trade sanctions laws or regulations shall include, but not be limited to, those laws or regulations
administered and enforced by the United States Department of Treasury's Office of Foreign Assets Control
("OFAC").
All other terms and conditions remain unchanged.
E609 (09/21) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1
U.S. TREASURY DEPARTMENT'S
OFFICE OF FOREIGN ASSETS CONTROL (OFAC)
ADVISORY NOTICE TO POLICYHOLDERS
PLEASE READ THIS NOTICE CAREFULLY.
No coverage is provided by this Policyholder Notice nor can it be construed to replace any provisions of your
policy. You should read your policy and review your Declarations page for complete information on the coverages
you are provided.
This Notice provides information concerning possible impact on your insurance coverage due to economic or
trade sanctions laws or regulations of the United States of America that are administered and enforced by the
Office of Foreign Assets Control ("OFAC").
OFAC administers and enforces sanctions policy under federal law and/or Presidential declarations of national
emergency. Based on economic and trade sanctions laws and regulations of the United States, Canada, United
Kingdom, European Union, and other governments, OFAC maintains and publishes a list of foreign governments
and agents, front organizations, terrorists, terrorist organizations and narcotics traffickers as Specially Designated
Nationals. This list can be located on the United States Treasury's web site: http://www.treasury.gov/ofac.
In accordance with OFAC regulations, if it is determined that you or any other insured, or any person or entity
claiming the benefits of this insurance has violated U.S. sanctions law or is a Specially Designated National, as
identified by OFAC, this insurance will be considered a blocked or frozen contract and all provisions of this
insurance are immediately subject to OFAC. When an insurance policy is considered to be such a blocked or
frozen contract, no payments or premium refunds may be made without authorization from OFAC. Other
limitations on the premiums and payments also apply, including payments of policy benefits to third parties.
E915 (09/21) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1
SERVICE OF SUIT
Pursuant to any statute of any state, territory or district of the United States which makes provision therefore, the
Company hereby designates the Superintendent, Commissioner or Director of Insurance or other Officer specified
for that purpose in the Statute, or his/her 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 you or any
beneficiary hereunder arising out of this contract of insurance, and hereby designates the below named as the
person to whom the said Officer is authorized to mail such process or a true copy thereof.
It is further agreed that service of process in such suit may be made upon John Briggs, or his nominee of the
Company at 7233 East Butherus Drive, Scottsdale, Arizona 85260, and that in any suit instituted against the
Company upon this policy, it will abide by the final decision of such Court or of any Appellate Court in the event of
an appeal. Nothing herein shall constitute a selection or designation of forum, or a waiver of any of the Company's
rights to select a forum or court, including any of the federal courts of the United States. This includes any right to
commence an action in or remove or transfer an action to the United States District Court or any other court of
competent jurisdiction, as permitted by law.
E906 (02/21)
POLICY NUMBER: NN1534053
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
MINIMUM EARNED PREMIUM ENDORSEMENT
If this policy is cancelled at your request, there will be a minimum earned premium retained by us of
or 25 % of the premium for this insurance, whichever is greater.
Non-payment of premium is considered a request by the first Named Insured for cancellation of this policy.
If a policy fee, inspection fee or expense constant is applicable to this policy, they will be fully earned and no
refund will be made.
All other terms and conditions of this policy remain unchanged.
S013 (07/09) Includes copyrighted material of Insurance Services Office, Inc., with its permission.
PRIVACY NOTICE
W. R. Berkley Corporation
Notice of Privacy Policies
For additional information about our Privacy Policies and how we collect, use, and share personal
information, and to make a consumer request, please see our online Privacy Policy at:
https://www.berkley.com/privacy.
If you would like to receive a paper copy of this Notice and/or our Privacy Policies, please contact us at
either nic_regulatory@nautilus-ins.com or 480-509-6627.
Notice of Personal Information Collected
(Pursuant to the California Consumer Privacy Act (CCPA))
This notice applies only to information received and collected by W. R. Berkley Corporation ("Berkley"),
its affiliates and subsidiaries from residents of the state of California.
In this notice, when we refer to "we", "us" or "our", it means Nautilus Insurance Group or one or more
other operating units of W. R. Berkley Corporation ("Berkley operating units").
When we refer to "you" and "your" in this notice, we mean a resident of the state of California whose
personal information we may collect. More information about W. R. Berkley Corporation and Berkley
operating units can be found on https://www.berkley.com/our-business/operating-units.
Below is a table showing the categories of personal information that one or more of the Berkley operating
units collect in the course of performing insurance services and how it is used, Not every Berkley
operating unit collects every category of personal information or uses it in all the ways listed below.
[continued on next page]
E919 (01/20) Page 1 of
Personal Information Category
How it is Used
Identifiers
(such as name, address, social security #, drivers
license #, etc.)
Other Sensitive Information under California
Law
(Examples: physical description, financial
information, medical information, etc.)
Characteristics of protected classifications
under California or federal law
(Examples: race, sex, color, religion, national
origin, marital status, etc.)
To perform insurance services for policyholders/
Biometric information
beneficiaries/claimants; maintain and improve
(Examples: fingerprints, keystroke patterns, gait
quality of services; security; prevent fraud and
patterns, sleep/health data, etc.)
improper use; internal research; identify and
Geolocation Data
repair errors; comply with laws and regulations.
(Information to identify physical location)
Audio, electronic, visual, thermal, olfactory, or
similar information.
(Examples: audio and video recordings)
Professional oremployment-related
information.
(Example: job history)
Education information
(information not publicly available as defined
under federal law)
Commercial information
To perform insurance services for policyholders/
(Examples: records of personal property,
beneficiaries/claimants; security; prevent fraud
products, and services purchased or obtained,
and improper use; internal research; collections;
etc.)
comply with laws and regulations.
Internet or other electronic network activity
To perform insurance services for policyholders/
information
beneficiaries/claimants; maintain and improve
(Examples: browsing/search history, visitor's
quality of services; security; prevent fraud and
interaction with a website, etc.)
improper use; internal research; identify and
repair errors; comply with laws and regulations.
Infe rences drawn from any of the other
To perform insurance services for policyholders/
categories of information.
beneficiaries/claimants; maintain and improve
(use of any of the above categories to create a
quality of services; security; prevent fraud and
profile about a consumer)
improper use; internal research; identify and
repair errors; comply with laws and regulations.
This notice was updated on January 8, 2020
E919 (01/20) Page 2 of 2
COMMERCIAL GENERAL LIABILITY COVERAGE PART DECLARATIONS
POLICY NUMBER: NN1534053
❑x Extension of Declarations is attached. Effective Date: 04/27/2023 12:01 A.M. Standard Time
LIMITS OF INSURANCE ❑ If box is checked refer to form S132 Amendment of Limits of Insurance.
General Aggregate Limit (Other Than Products/Completed Operations) $ 2,000,000
Products/Completed Operations Aggregate Limit $ 2,000,000
Personal and Advertising Injury Limit $ 11000,000 Any One Person Or Organization
Each Occurrence Limit $ 1, 000,000
Damage To Premises Rented To You Limit $ loo, oo0 Any One Premises
Medical Expense Limit $ 5, 000 Any One Person
RETROACTIVE DATE CG 00 02 ONLY
This insurance does not apply to "bodily injury", "property damage" or "personal and advertising injury" which occurs
before the Retroactive Date, if any, shown here: (Enter Date or "NONE" if no Retroactive Date applies)
BUSINESS DESCRIPTION AND LOCATION OF PREMISES
BUSINESS DESCRIPTION: General Contractor
LOCATION OF ALL PREMISES YOU OWN, RENT, OR OCCUPY: X❑ Location address is same as mailing address.
1 32 Perkins Ave, Northampton, MA 01060
Additional locations (if any) will be shown on form S170, Commercial General Liability Coverage Part Declarations
Extension.
LOCATION OF JOB SITE (If Designated Projects are to be Scheduled):
PREMIUM
RATE
ADVANCE
Prem/Ops
Prod/Comp
CODE # - CLASSIFICATION
*
BASIS
PREMIUM
O s
91580 - Contractors -executive supervisor or
-o+
22,000
53.299
1,173
executive superintend
Included
Included
91583 . Contractors - subcontracted work in
c
950,000
0.752
714
connection with building
7.094
6,739
construction, reconstruction,
repair or erection - 1 or 2 family
dwellings
90795 - First Party Privacy Breach Cov-Med
If Any
Flat
250
Hazard-Med Exposure
90747 - Lost Key Coverage
If Any
Included
" PREMIUM BASIS SYMBOLS + = Products/Completed Operations are subject to the General Aggregate Limit
a = Area (per 1,000 sq. ft. of area) o = Total Operating Expenditures s = Gross Sales (per $1,000 of Gross Sales)
c = Total Cost (per $1,000 of Total Cost) (per $1,000 Total Operating Expenditures) t = See Classification
m = Admissions (per 1,000 Admissions) p = Payroll (per $1,000 of Payroll) u = Units (per unit)
PREMIUM FOR THIS PAGE $ 8,876
FORMS AND ENDORSEMENTS (other than applicable Forms and Endorsements shown elsewhere in thepolicy)
Forms and Endorsements applying to this Coverage Part and made part of this policy at time of issue:
Refer to Schedule of Forms and Endorsements
THESE DECLARATIONS ARE PART OF THE POLICY DECLARATIONS CONTAINING THE NAME OF THE INSURED AND THE POLICY PERIOD.
S150 (07/09) Includes copyrighted material of Insurance Services Office, Inc. with its permission.
COMMERCIAL GENERAL LIABILITY
COVERAGE PART DECLARATIONS EXTENSION
POLICY NUMBER: NN1534033 Effective Date: 0 4 / 2 7 / 2 0 2 3 12:01 A.M. Standard Time
LOCATION OF PREMISES
Location of All Premises You Own, Rent or Occupy:
PREMIUM
CODE # - CLASSIFICATION
*
PREMIUM
BASIS
RATE
ADVANCE
PREMIUM
Prem/Ops
Prod/Comp
90813 - L416 Contractors Extension
Endorsement — Premium is fully
earned
t
1
350.000
350
PREMIUM FOR
THIS COVERAGE PART $ 9,226
THESE DECLARATIONS ARE PART OF THE POLICY DECLARATIONS CONTAINING THE NAME OF THE INSURED AND THE POLICY PERIOD.
S170 (07/09) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1