Retail Liquor Store Product - Package

USLI.COM 888-523-5545

ASARETAIL LIQUOR STORE, DO YOU HAVE THE RIGHT COVERAGE? Businessowners coverage form Coverage for your Liquor liability exposure General Liability that includes coverage for mental anguish or emotional distress No liability deductible 25% Peak Season

Why you should place coverage with United States Liability Insurance Group’s Retail Liquor Store Product?

OUR COMPETITORS’ COVERAGE FEATURES GROUP POLICY

Liquor liability coverage available ? Businessowners coverage form ?

A.M. Best rated A++ carrier ?

General Liability that expands the definition of “Bodily Injury” to include mental anguish or emotional distress with no deductible ? No liability deductible ?

Business income on an actual loss sustained basis with a stated limit ? Business Personal Property including inventory ?

25% Peak season ?

Replacement cost coverage is available ?

Special cause of loss is available ? Value Plus Endorsement is available on accounts eligible for Special Form offering 13 valuable coverage enhancements including: Money & Securities, Employee Dishonesty, Signs, Water ? Back-up and more

WHY CHOOSE TO BE INSURED WITH UNITED STATES LIABILITY INSURANCE GROUP? One of only 20 A++ rated insurance groups in the United States by A.M. Best. A proud member of the Berkshire Hathaway Group, recently voted the #1 most admired Property & Casualty Company in the world (Fortune Magazine 2004).

Insure your financial well-being with a stable Company that will be there to pay your claim.

This document does not amend, extend or alter the coverage afforded by the Policy. For a complete understanding of any insurance you purchase, you must first read your Policy, Declaration Page and any Endorsements and discuss them with your Broker. A specimen policy is available from an Agent of the Company. Your actual Policy Conditions may be amended by Endorsement or affected by State Laws. RLSP-POS-6-06 USLI.COM 888-523-5545

Retail Liquor Store Product – Package

This product targets Retail Stores that sell or distribute alcohol for ADDITIONAL ADVANTAGES: off-premises consumption. u A.M. Best rated A++ carrier u Quick quote turnaround COVERAGE AND PRODUCT FEATURES: u Offered only through the professional wholesaler u On one policy we can offer: • Property coverage • Equipment Breakdown coverage • General Liability coverage • Crime coverage • Liquor Liability coverage u Written on a Businessowners coverage form u Covers Business Personal Property including inventory u 25% Peak season included in the Businessowners coverage form u Business Income on an actual loss sustained basis with a stated limit u Non owned and hired auto coverage available if no delivery u No liability deductible u New ventures are eligible u Value Plus endorsement is available on accounts eligible for Special Form. The endorsement offers 13 valuable coverage enhancements including: Money & Securities, Employee Dishonesty, Signs, Water Back-up and more

LIMITS OF INSURANCE: u Liquor Liability limits up to: • $1,000,000 each Occurrence • $2,000,000 Aggregate u General Liability limits up to: • $1,000,000 each Occurrence • $2,000,000 Aggregate u Property limits up to: • $3,000,000 maximum property value in protection class 1-8 • $1,000,000 maximum property value in protection class 9-10 • $500,000 maximum property value per location in coastal zones (wind exclusion may apply)

Retail Liquor Store Product Claim Examples

Property: A fire began at the insured’s premises when an employee of the liquor store carelessly tossed a cigarette in the break room trashcan. The fire caused both $41,000 in building damage and $17,000 in business personal property damage. In order to repair the damage, the liquor store had to shut down for 20 days, causing a $14,000 loss in income and $10,000 in extra expenses.

General Liability: A customer of the liquor store went to use the restroom. The tile floor area just outside of the restroom was still wet. The customer slipped and fell, breaking their arm. The customer filed a lawsuit against the liquor store for pain and suffering, medical bills, and rehabilitation expenses.

Liquor Liability: A liquor store denied service to a patron who appeared intoxicated. The patron was later involved in an automobile accident. Despite denying service, the liquor store was brought into the claim. Ultimately, the liquor store was not found liable, but had to pay $75,000 in defense costs.

Automatic Businessowners coverages: The liquor store installed a bright neon sign above the front door in order to attract new business. During a heavy windstorm, the sign cracked, and a portion of it fell to the ground smashing into pieces.

Value Plus: An employee of the liquor store was going through tough financial times. They ‘forgot’ to turn on the alarm system when closing up for the night. No signs of break-in were evident. The owner noticed inventory levels were repeatedly lower when this employee closed the store for the night. Cash in the register also was mysteriously low on these same nights. The insured notified the police, and also made an employee dishonesty claim, and a money and securities claim.

Equipment Breakdown: The piping within the hot water heater ruptured from over usage, causing the liquor store to have to shut down for 3 days. An equipment breakdown claim was made.

RLSP PKG-CLA (10/06) USLI.COM 888-523-5545

Liquor Liability Representation Application Retail Stores, Liquor Stores and Wholesale Operations – All States Excluding Texas YOU CAN OBTAIN A QUOTE BY PROVIDING THE INFORMATION IN SECTION I - INSTANT QUOTE BELOW, SUBJECT TO THE REMAINDER PROVIDED PRIOR TO BINDING. I. INSTANT QUOTE INFORMATION Instant Quote is only available for accounts with no losses or violations in the past 5 years.

Applicant’s Name:______Location Address: ______q Same as mailing address. City:______State: ______Zip: ______Number of locations to be insured: ______(complete one application per location) Description of Operations:

What year did the applicant start business at this location? ______Liquor Liability Section Each Common Cause Limit: $ ______Aggregate Limit: $ ______Exposure Basis: Retail alcohol receipts: $ ______Wholesale alcohol receipts: $______Does applicant offer on-premises tasting or sampling of alcoholic beverages? q Yes q No If yes, complete the following: a. Are more than eight ounces of samples permitted for any one patron per day? q Yes q No b. If persons other than the applicant’s employees are serving the samples, are they required to carry their own Liquor Liability insurance at limits equal to or greater than the applicant’s? q Yes q No Does applicant deliver alcoholic beverages to their customers? q Yes q No If yes, complete the following: a. Is alcohol only delivered to individuals age 21 or over with proper identification and signature required? q Yes q No b. Does applicant deliver to any of the following states: AK, AL, IA, IL, LA, MS, OR, RI and WV? q Yes q No Does the establishment attract a predominantly youthful crowd ranging from 21-25 years of age? q Yes q No What time does the sale of alcohol cease? ______q AM q PM q 24 hours Are all alcohol-serving employees certified in a Formal Alcohol Awareness Training Course not mandated by the state? q Yes q No If yes, provide the name of the course: ______To be eligible for a credit on your quote, Company requires copies of the certificates within 21 days of binding Does the establishment have and utilize an identification scanner device to verify age of patrons? q Yes q No Additional Interests Name Relationship/Interest Address City, State, Zip

II. ELIGIBILITY CRITERIA 1. Applicant has no knowledge of any liquor liability and/or assault and battery claims or the notification of potential liquor liability and/or assault and battery claims at this location within the past five years. q True q False If False, provide the following information on each claim: Date(s): ______Description(s): ______Total incurred losses (reserves and payments):______Status(open or closed): ______Measures in place to prevent future violations: ______2. Applicant has no knowledge of any fines or citations for violation of law or ordinance related to illegal activities or the sale of alcohol at this location within the past five years. q True q False If False, provide the following information on each fine or citation: Date(s): ______Description(s): ______Measures in place to prevent future violations: ______

LLA RET Rep 10/10 page 1 of 2 3. Applicant or any principal with a controlling interest in the applicant has not filed for bankruptcy in the last 12 months. q True q False 4. Applicant is not requesting Liquor Liability limits greater than the General Liability limits carried. q True q False * As a condition of coverage, General Liability limits must be maintained at limits equal to or greater than Liquor Liability limits. 5. Applicant has and will maintain a valid liquor license, if required by ordinance or law, prior to the applicant selling serving or distributing alcohol. q True q False q Not Required 6. Employees or other persons selling or serving alcohol are not permitted to consume alcohol during their hours of employment or service. q True q False 7. Applicant does not sell or serve alcohol away from the premises. q True q False If Off-Premises coverage is desired, attach a completed Catering Plus Supplemental Liquor Liability Application, form CP-APP, to this submission. 8. Within the past five years, applicant’s Liquor Liability coverage has not been cancelled or non-renewed. q True q False If False, explain: ______

III. ADDITIONAL APPLICANT INFORMATION Form of Business: q Individual q Corporation q Partnership q LLC q Other ______

Applicant’s Mailing Address:______(if different than the location address above) City:______State: ______Zip: ______Email Address of primary contact: ______Phone: ______Inspection Contact Name: ______Telephone/Email Address:______Audit Contact Name: ______Telephone/Email Address:______

Applicant’s Representation Statement: The undersigned represents to the best of his/her knowledge and belief that particulars and statements set forth are true and agree that those particulars and statements are material to the acceptance of the risk assumed by the Company. The undersigned further declares that any claim, incident or event taking place prior to the effective date of the insurance applied for which may render inaccurate, untrue, or incomplete any statement made will immediately be reported in writing to the applied for which may render inaccurate, untrue, or incomplete any statement made will immediately be reported in writing to the Company and the Company may withdraw or modify any outstanding quotations and/or authorization or agreement to bind the insurance. The signing of the Application does not bind the undersigned to purchase the insurance, nor does the review of the Application bind the Company to issue a policy. It is understood the Company is relying on the information supplied by the applicant prior to issuing a quote. It is agreed that this Application, including any material submitted therewith, shall be the basis of the contract should a policy be issued. Kentucky Fraud Statement: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance containing any materially false information or conceals, for the purpose of misleading, information concerning any fact material there to commits a fraudulent insurance act, which is a crime. Fraud Statement (other states): Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance may be guilty of a crime and may be subject to fines and confinement in prison’

Applicant’s Signature: ______Title: ______Date: ______(Owner, Officer or Partner) (Required) (Required)

If your state requires that we have information regarding your Authorized Retail Agent or Broker, please provide below.

Retail Agency Name: ______License #: ______Main Agency Phone Number: ______Agency Mailing Address: ______City: ______State: ______Zip Code: ______

LLA RET Rep 10/10 - United States Liability Insurance Group page 2 of 2