# Premises Medical Payments Insurance Co. Page Part

## Policy No.
EA 855-0600

## Effective Date
[Not specified]

## Agency No.
[Not specified]

### Schedule
#### Coverage
1. Premises and operations
2. Elevators
3. Sports activities

#### Advance Premium
1. Incl.

#### Total Advance Premium
$ 1,114.17

#### Composite Rate
See Ex. 3

## It is agreed that exclusion (c) (5) is void.

### I. Coverage - Premises Medical Payments
The company will pay to or for each person who sustains bodily injury caused by accident all reasonable medical expenses incurred within one year from the date of the accident on account of such bodily injury, provided such accident occurs while serving as a tenant on the leased premises or Bi operations wit, respect to which the named insured is afforded coverage for bodily injury liability under this policy.

#### Exclusions
This insurance does not apply:
(a) to bodily injury
(b) arising out of the ownership, maintenance, operation, use, loading or unloading of any automobile unless a premium charge is entered for elevators in the policy with respect to Premises Medical Payments Coverage;
(c) arising out of the ownership, maintenance, operation, use, loading or unloading of any automobile or aircraft owned or operated by or rented or loaned to the named insured, or
(d) any other automobile or aircraft operated by any person in the course of his employment by the named insured; but this exclusion does not apply to the parking of an automobile on the leased premises if such automobile is not owned by or rented or loaned to the named insured;
(e) arising out of the ownership, maintenance, operation, use, loading or unloading of any watercraft, if the bodily injury occurs away from the leased premises; or
(f) arising out of and in the course of the transportation of mobile equipment by an automobile owned or operated by or rented or loaned to the named insured;
(g) to bodily injury
(h) included within the completed operations hazard or the products hazard;
(i) arising out of operations performed for the named insured by independent contractors other than (i) maintenance and repair of the leased premises or (ii) structural alterations at such premises which do not involve changing the size or configuration of such structures;
(j) resulting from the selling, serving or giving of any alcoholic beverage (k) in violation of any statute, ordinance or regulation, (l) to a minor, (m) to a person under the influence of alcohol or intoxication which causes or contributes to the bodily injury, or (n) to a person who is intoxicated at the time of the accident if the named insured is a person or organization engaged in the business of manufacturing, distributing, selling or serving alcoholic beverages or is an owner or operator of premises used for such purposes;
(o) to bodily injury
(p) to bodily injury
(q) to bodily injury
(r) to bodily injury
(s) to bodily injury
(t) to the named insured, any partner therein, any tenant or other person regularly residing on the leased premises or any employee of any of the foregoing if the bodily injury arises out of and in the course of his employment therewith;
(u) to any other tenant if the bodily injury occurs on that part of the leased premises rented from the named insured or to any employee of such a tenant.

### II. Limits of Liability
The limit of liability for Premises Medical Payments Coverage stated in the declarations as applicable to "each person" is the limit of the company's liability for all medical expenses for bodily injury to any one person as the result of any one accident. Subject to the above provision respecting "each person", the total liability of the company for Premises Medical Payments Coverage for medical expenses for bodily injury to two or more persons as the result of any one accident shall not exceed the limit of liability stated in the declarations as applicable to "each accident".

When more than one medical payments coverage afforded by this policy applies to the loss, the company shall not be liable for more than the amount of the highest applicable limit of liability.

### III. Additional Definitions
When used in reference to this insurance (excluding endorsements forming a part of the policy):
- "Leased premises" means all premises owned by or rented to the named insured with respect to which the named insured is afforded coverage for bodily injury liability under this policy, and includes the ways and methods adjoining on said premises.
- "Medical expense" means expenses for necessary medical, surgical, x-ray and dental services, including prosthetic devices, and necessary ambulance, hospital, professional nursing and funeral services.

### IV. Policy Period, Territory
This insurance applies only to accidents which occur during the policy period within the United States of America, its territories or possessions, or Canada.

### V. Additional Condition
**Medical Reports; Proof and Payment of Claim**
As soon as practicable the injured person or someone on his behalf shall give to the company written notice of the accident and if requested, shall give to each request from the company, execute authorization to enable the company to obtain medical reports of record. The injured person shall submit himself to physical examination by physician selected by the company as soon as the company may reasonably require. The company may pay the injured person the amount payable hereunder for such examination. Payment shall not constitute an admission of liability of any person or, except heretofore, of the company.