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CAUSE NO. C-2791-22-E
313 HACKBERRY LAND § IN THE DISTRICT COURT
Plaintiff, §
§
v. §
§ HIDALGO COUNTY, TEXAS
GREAT LAKES INSURANCE SE and §
UNDERWRITERS AT LLOYD’S, §
LONDON §
Defendant. § 275th JUDICIAL DISTRICT
DECLARATION OF LISA CARROLL
1. “My name is Lisa Carroll, my date of birth is , and my address
is . I declare under penalty of perjury that the facts stated in
this declaration are true and correct.
2. I am of sound mind and competent to make this declaration. I have personal
knowledge of all the facts stated within this declaration based on my personal knowledge of the
facts of this case and my personal review of the books and records of Great Lakes Insurance SE
(“Great Lakes”) and Underwriters at Lloyd’s (“Underwriters”) (collectively, “Defendants”)
pertaining to policy number GK20390630574 and the claim at issue in this case, including the
records attached to this declaration. I am authorized to make this declaration.
3. I am a Vice President – Claims for Amwins Access Insurance Services, LLC.
Amwins is a managing general agent for Great Lakes and Underwriters and serves as a custodian
of records for Great Lakes and Underwriters. Attached hereto are business records of Great Lakes
and Underwriters. The documents attached hereto as Exhibits A-1 and A-2 are true and correct
copies of documents kept by Great Lakes and Underwriters in their file for this claim in the regular
course of business, and it was the regular course of business of Great Lakes and Underwriters for
an employee or representative with knowledge of the act or event recorded to make or keep the
record, and these records were made or kept at or near the time of the act or event, or reasonably
soon thereafter.
4. Great Lakes’ and Underwriters’ records regarding the claim at issue in this lawsuit
reflect the following facts:
a. 313 Hackberry (“Plaintiff”) is the named insured under Defendants’ policy
number GK20390630574, which insured a residential building located at
313 West Hackberry, McAllen, Texas 78501 (the “Property”) from March
2, 2020 to March 3, 2021.
b. Plaintiff submitted an Acord Property Loss Notice to Defendants on July
29, 2020 alleging the Property sustained storm damage on July 29, 2020.
Upon receipt, Defendants promptly assigned an adjuster to investigate the
A Page 1 of 2
alleged loss. After thoroughly investigating the claim, Defendants, through
the assigned adjuster, communicated its claim decision to Plaintiff.
FURTHER DECLARANT SAYETH NOT.”
Executed in Bexar County, State of Texas, on _February 21_____, 2023.
Lisa Carroll
Vice President – Claims, Amwins Access Insurance
Services, LLC
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COMMERCIAL LINES POLICY
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COMMON POLICY DECLARATIONS co
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POLICY NUMBER: GK20390630574 RENEWAL OF: GK19390625945
Insured Name and Mailing Address Agent or Broker and Mailing Address
313 Hackberry Land 8403
The Klement Agency
PO Box 820
705 Brookside Dr PROSPER TX
Spring Branch TX 78070 75078
PARTICIPATION PARTICIPATION PARTICIPATION
OF INSURANCE OF INSURANCE OF INSURANCE CONTRACT
INSURER PROPERTY GENERAL LIAB. EQUIP. BRKDWN. NO.&YEAR
Great Lakes Insurance SE 90 100 100 RS03906A20
Underwriters at Lloyd's, London lO 0 0 B0759 AM07625A20
Hereon 100%
Policy Period: From 2020-03-02 To 2021-03-02 at 12:01 A.M. Standard Time at your mailing address shown above.
Form of Business: D Individual D Partnership D Joint Venture D Trust D Limited Liability Company
~ Organization, including a Corporation (but not including a Partnership, Joint Venture or Limited Liability Company)
Business Description: ~H=a~b=ita=ti=·o=nal~---------------------------
IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE
WITH YOU TO PROVIDE THE INSURANCE AND LIMITS AS 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 Property Coverage Part $ 1468.00
Commercial Inland Marine Coverage Part $ 0.00
Commercial Crime Coverage Part $ 0.00
Commercial General Liability Coverage Part $ 81.00
Terrorism Risk Insurance Act $
$
TOTAL ADVANCE PREMIUM $ 1549.00
Fees/Charges/Taxes
$ 225.00 PolicxFee $ $
$ 86.04 5llmllll.l. $ $
$ 2.66 Smmnine: Fee $ TOTAL CHARGES $ 1862.70
Forms and endorsement(s) made a part of this policy at time of issue: SEE SCHEDULE OF FORMS AND ENDORSEMENTS
----------l;overholder·---------
Correspondent Contact Surplus Lines Procuring Surplus Lines Tax/License No.
n__:_, 0
McClelland and Hine, a divilrion of Worldwide Facilities, LLC TX 14971
725 S Figueroa. 19th Floor
Los Angeles, CA 90017 ~
Countersigned: San Antonio TX Date: 03/17/2020._____ _ _ Q-"""''--------------------
Countersigned by Authorized Representative
SLA# Not Applicable Total # of Locations ••• Date Issued 03/17/2020 Initials jenellt
JCBC 1000 IL 0818
•••Refer to coverage declarations Page 1 of 1
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TEXAS COMPLAINTS NOTICE
IMPORTANT NOTICE A VISO IMPORTANTE
To obtain information or make a complaint: Para obtener informaci6n o para presentar una
queja:
You may contact the Texas Department of Usted puede comunicarse con el
Insurance to obtain information on companies, Departamento de Seguros de Texas para
coverages, rights or complaints at: obtener informaci6n sobre compafiias,
coberturas, derechos, o quejas al:
1-800-252-3439 1-800-252-3439
You may write the Texas Department of Usted puede escribir al Departamento de
Insurance: Seguros de Texas a:
P. 0. Box 149104 P. 0. Box 149104
Austin, TX 78714-9104 Austin, TX 78714-9104
Fax: (512) 490-1007 Fax: (512) 490-1007
Web: www.tdi.texas.gov Web: www.tdi.texas.gov
E-mail: ConsumerProtection@tdi.texas.gov E-mail: ConsumerProtection@tdi.texas.gov
PREMIUM OR CLAIM DISPUTES: DISPUTAS POR PRIMAS DE SEGUROS
0 RECLAMACIONES: Si tiene una disputa
Should you have a dispute concerning your relacionada con su prima de seguro o con una
premium or about a claim you should contact reclamaci6n, usted debe comunicarse con el
the agent first. If the dispute is not resolved, agente primero. Si la disputa no es resuelta,
you may contact the Texas Department of usted puede comunicarse con el
Insurance. Departamento de Seguros de Texas.
ATTACH THIS NOTICE TO YOUR ADJUNTE ESTE AVISO A SU POLIZA:
POLICY: This notice is for information only Este aviso es solamente para prop6sitos
and does not become a part or condition of the informativos y no se convierte en parte o en
attached document. condici6n del documento adjunto.
19 October 2015
REF 9080B
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TEXAS SURPLUS LINES NOTICE
This insurance contract is with an insurer not licensed to transact insurance in this state
and is issued and delivered as surplus line coverage under the Texas insurance statutes.
The Texas Department of Insurance does not audit the finances or review the solvency of
the surplus lines insurer providing this coverage, and the insurer is not a member of the
property and casualty insurance guaranty association created under Chapter 462,
Insurance Code. Chapter 225, Insurance Code, requires payment of the appropriate rate
of tax on gross premium.
REF 9079 (amended)
01 September 2013
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COMMERCIAL PROPERTY COVERAGE PART DECLARATIONS -DETAIL
Policy No. GK20390630574 ~
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DESCRIPTION OF PREMISES ~
Prem# I Bld2# I LOCATION (Address Citv. County, State Zip)
l l 313 West Hackberry
McAllen Hidalgo TX 78501
UNDERWRITING INFORMATION AND MISCELLANEOUS RISK DATA
Public Protection Class 2
Building Construction Type Joisted Masoruy
Year Built 2003
Occupancy DWELLINGS - ONE FAMILY (LESSORS RISK ONLY)
Wind Coverage• Included
*If wind coverage shows "excluded", refer to the Forms Schedule fur the windstonn exclusion endorsement.
COVERAGES PROVIDED I tlfExtra Expense coverage,
Insurance at the Described Premises anulies only for those Covera2es for which a Limit of Insurance is shown. limits on the loss navment.
COVERAGE◊ I LIMIT OF
INSURANCE (US$)
I COVERED CAUSE
OFLOSS
I VALUATION*
I COINSURANCEt
I RATES I PREMIUM
(US$)
Bldg 185000 Special RCV 80% 0.7935 1468
◊ COVERAGE ABBREVIATIONS *VALUATION
BLDG = Building BPP = Business Personal Property ACV = Actual Cash Value
BI = Business Income HPP = Household Personal Property RC = Replacement Cost
BLKT = Blanket PPO = Personal Property of Others AGRV = Agreed Value
BTMIM = Betterments & Improvements
DEDUCTIBLES
$ 2% deductible applies to Windstorm/Hurricane/Hail, subject to a minimum deductible of$ 2500
$ 0 deductible applies to Named Storms, subject to a minimum deductible of$NJA
$ 0 deductible applies to Other NI A
$1% deductible applies to all losses except as noted above, subject to a minimum deductible of$ l 000
Windstorm/Hurricane/Hail and Named Storm Deductibles apply on a Per Item/ Per Occurrence basis. All other deductibles
apply on a per occurrence basis unless stated otherwise in this policy.
These Declarations are part of the Policy Declarations containing the name of the Insured and the policy period.
MHI-CFlS0 (08/17)
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COMMERCIAL GENERAL LIABILITY COVERAGE PART DECLARATIONS ~
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Policy Number: GK20390630574 Effective Date: 2020-03-02 ••
LIMITS OF INSURANCE
General Aggregate Limit (Other than Products/Completed Operations) $ 2,000,000
Products/Completed Operations Limit $ Included
Each Occurrence Limit $ 1,000,000
Personal and Advertising Injury Limit $ 1,000,000
Fire Damage Limit $ 100 000 Any One Fire
Medical Expense Limit $ 5'000 Any One Person
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BUSINESS DESCRIPTION AND LOCATION OF PREMISES
Form of Business•: Other
Business Description•:
Location of All Premises You Own, Rent, or Occupy:
1 313 West Hackberry McAllen Hidalgo TX 78501
PREMIUM:
Class Code# Premium Rate Advance Premium
Class Code Description Basis Pr/CO All Other Pr/CO All Other
63010 e I Im:luded 80.8500 0 81
Dwellings - oIW-family (lessors risk only)
Mimmum premium may apply. Total Advance Premium 81.00
Premium Basis: (a) Area per 1,000 square feet (s) Gross Sales per $1,000 (u) Units per I
(c) Total Cost per $1,000 (t) Other (e) Each
(m) Admissions per 1,000 (g) Gallons per 1,000 (p) Payroll per $1,000
POLICY MAY BE AUDITABLE.
FORMS AND ENDORSEMENTS (Other than applicable forms & endorsements shown elsewhere in the policy):
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
•Information omitted if shown elsewhere in the policy.
••Inclusion of date optional
•••see Each Occurrence Limit.
THESE DECLARATIONS ARE PART OF THE POLICY DECLARATIONS CONTAINING THE NAME OF THE
INSURED AND THE POLICY PERIOD.
MHI-CGL-100 (01/18)
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SCHEDULE OF FORMS AND ENDORSEMENTS
Fonn Number Edition Date Fonn/Endorsement Title Page
JCBC1000IL 08/16 Common Policy Dedarations Joint Certificate 1
REF-9080B 10/15 Texas Complaints Notice 2
REF-9079a 09/13 Texas Surplus Lines Notice 3
MHICF-150 08/17 Commercial Property Coverage Part Dedarations 4
MHI-CGL-100 01/18 Commercial General Liability Coverage Part Declaratio1ns 5
CG-0001 10/93 Commercial General Liability Coverage Fonn 7
CG-2144 07/98 Limitation of Coverage to Designated Premises or Projt1ct 19
CP-0010 06/07 Building Business Personal Property Coverage Fonn 20
CP-0090 07/88 Commercial Property Conditions 35
CP-0321 06/07 Windstonn or Hail Percentage Deductible 37
CP-1030 06/07 Causes of Loss-Special 41
CP-1032 08/08 Water Exdusion Endorsement 51
CP-1056 06/07 Sprinkler Leakage Exclusion 52
CP-1211 10/00 Burglary And Robbery Protective Safeguards 54
GLISE(i) 02'20 Great Lakes Insurance SE Privacy Policy Statement 55
GLK-4150-PR 12/14 Amendatory Appraisal Endorsement 56
IL-0017 11/98 Common Policy Conditions 58
IL-0021 05/04 Nudear Energy Liability Exdusion Endorsement 59
IL-0415 04/98 Protective Safeguards 61
IL-0935 07/02 Exdusion of Certain Computer-Related Losses 63
JCBC-4155IL 02'20 Combination Endorsement for Joint Certificate Policies 64
JC-5103 03/15 Policy Provisions Clause 71
JCBC-4121 08/16 Lloyds Syndicate Schedule-2018 73
MHl-18 11/07 Amendatory Endorsement - Minimum Earned Premium / Policy Fees 74
Fully Earned
MHl-26GK&LL 10/18 General Certificate Provisions [Participating] 75
MHl-40 06/05 Commercial General Liability - Additional Exclusions 76
MHl-47 06/13 Loss Conditions 78
MHl-48 08/09 Property Endorsement 79
MHl-63 06/99 Premium Audit Condition 80
MHl-176 10/19 ACV Limitation Roofs and Roof Surfacing 81
MHl-183 09/17 Exdusion-Prior Damage to Property 82
MHl-280 06/18 Amendatory Endorsement-Roof Exclusion Due to ~e 83
REF-5390 01'20 US Terrorism Risk Insurance Act of 2002 as Amended-Not Purchased 84
Clause
REF/NMA-1998 01'20 Sarvice of Suit Clause (USA) 85
REF-2920a Terrorism Exdusion 86
REF-3100 09/10 Sanction Limitation and Exdusion Clause 87
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COMMERCIAL GENERAL LIABILITY '-I
CG00011093 ~
COMMERCIAL GENERAL LIABILITY COVERAGE FORM
Vanous provisions in this policy restrict coverage. (2) The "bodily injury" or "property damage"
Read the entire policy carefully to determine rights, occurs during the policy period.
duties and what is and is not covered. c. Damages because of "bodily injury" include
Throughout this policy the words "you" and "your" damages claimed by any person or organiza-
refer to the Named Insured shown in the Declara- tion for care, loss of services or death resulting
tions, and any other person or organization qualifying at any time from the "bodily injury".
as a Named Insured under this policy. The words 2. Exclusions.
"we", "us" and "our" refer to the company providing
this insurance. This insurance does not apply to:
The word "insured" means any person or organization a. Expected or Intended Injury
qualifying as such under WHO IS AN INSURED "Bodily injury" or "property damage" expected
(SECTION II). or intended from the standpoint of the insured.
Other words and phrases that appear in quotation This exclusion does not apply 1o "bodily injury"
marks have special meaning. Refer to DEFINITIONS resulting from the use of reasonable force 1o
(SECTION V). protect persons or property.
SECTION I - COVERAGES b. Contractual Liability
COVERAGE A. BODILY INJURY AND PROP- "Bodily injury" or "property damage" for which
ERTY DAMAGE LIABILITY the insured is obligated to pay damages by
reason of the assumption of liability in a con-
1. Insuring Agreement. tract or agreement. This exclusion does not
a. We will pay those sums that the insured be- apply to liability for damages:
comes legally obligated to pay as damages (1) Assumed in a contract or agreement that is
because of "bodily injury" or "property damage" an "insured contract", provided the "bodily
to which this insurance applies. We will have injury" or "property damage" occurs subse-
the right and duty to defend any "suit" seeking quent to the execution of the contract or
those damages. We may at our discretion in- agreement; or
vestigate any "occurrence" and settle any claim
or "suit" that may result. But: (2) That the insured would have in the absence
of the contract or agreement.
(1) The amount we will pay for damages is
limited as described in LIMITS OF INSUR- c. Liquor Liability
ANCE (SECTION Ill); and "Bodily injury" or "property damage" for which
(2) Our right and duty to defend end when we any insured may be held liable by reason of:
have used up the applicable limit of insur- (1) Causing or contributing 1o the intoxication of
ance in the payment of judgments or set- any person;
tlements under Coverages A or B or medi- (2) The furnishing of alcoholic beverages to a
cal expenses under Coverage C. person under the legal drinking age or un-
No other obligation or liability 1o pay sums or der the influence of alcohol; or
perform acts or services is covered unless ex- (3) Any statute, ordinance or regulation relating
plicitly provided for under SUPPLEMENTARY to the sale, gift, distribution or use of alco-
PAYMENTS - COVERAGES A AND B. holic beverages.
b. This insurance applies to "bodily injury" and This exclusion applies only if you are in the
"property damage" only if:
business of manufacturing, distributing, selling,
(1) The "bodily injury" or "property damage" is serving or furnishing alcoholic beverages.
caused by an "occurrence" that takes place
in the "coverage territory"; and
CG 00011093 Copyright, ISO Commercial Risk Services, Inc., 1992 Page 1 of 1 □
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d. Workers Compensation and Slmllar Laws (d) At or from any premises, site or location
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Any obligation of the insured under a workers on which any insured or any contractors
compensation, disability benefits or unem- or subcontractors working directly or in-
ployment compensation law or any similar law. directly on any insured's behalf are per-
forming operations:
e. Employer's Liability
(I) If the pollutants are brought on or to
"Bodily injury" to: the premises, site or location in con-
(1) An "employee" of the insured arising out of nection with such operations by such
and in the course of: insured, contractor or subcontractor;
(a) Employment by the insured; or or
(II) If the operations are to test for, moni-
(b) Performing duties related to the conduct
tor, clean up, remove, contain, treat,
of the insured's business; or
detoxify or neutralize, or in any way
(2) The spouse, child, parent, brother or sister respond to, or assess the effects of
of that "employee" as a consequence of pollutants.
paragraph (1) above.
Subparagraphs (a) and (d)(i) do not apply
This exclusion applies: to "bodily injury" or "property damage" aris-
(1) Whether the insured may be liable as an ing out of heat, smoke or fumes from a hos-
employer or in any other capacity; and tile fire.
(2) To any obligation to share damages with or As used in this exclusion, a hostile fire
repay someone else who must pay dam- means one which becomes uncontrollable
ages because of the injury. or breaks out from where it was intended to
be.
This exclusion does not apply to liability as-
sumed by the insured under an "insured con- (2) Any loss, cost or expense arising out of
tract". any:
f. Pollution (a) Request, demand or order that any
insured or others test for, monitor, clean
(1) "Bodily injury" or "property damage" arising
up, remove, contain, treat, detoxify or
out of the actual, alleged or threatened dis-
neutralize, or in any way respond to, or
charge, dispersal, seepage, migration, re- assess the effects of pollutants; or
lease or escape of pollutants:
(b) Claim or suit by or on behalf of a gov-
(a) At or from any premises, site or location
ernmental authority for damages be-
which is or was at any time owned or
cause of testing for, monitoring, cleaning
occupied by, or rented or loaned to, any up, removing, containing, treating, de-
insured; toxifying or neutralizing, or in any way
(b) At or from any premises, site or location responding to, or assessing the effects
which is or was at any time used by or of pollutants.
for any insured or others for the han- Pollutants means any solid, liquid, gaseous or
dling, storage, disposal, processing or thermal irritant or contaminant, including
treatment of waste; smoke, vapor, soot, fumes, acids, alkalis,
(c) Which are or were at any time trans- chemicals and waste. Waste includes materi-
ported, handled, stored, treated, dis- als to be recycled, reconditioned or reclaimed.
posed of, or processed as waste by or g. Aircraft, Auto or Watercraft
for any insured or any person or organi-
zation for whom you may be legally re- "Bodily injury" or "property damage" arising out
sponsible; or of the ownership, maintenance, use or en-
trustment to others of any aircraft, "auto" or wa-
tercraft owned or operated by or rented or
loaned to any insured. Use indudes operation
and "loading or unloading".
Page2 of 12 Copyright, ISO Commercial Risk Services, Inc., 1992 CG 00 011093 □
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This exclusion does not apply to: (5) That particular part of real property on ~
(1) A watercraft while ashore on premises you which you or any contractors or subcontrac-
own or rent; tors working directly or indirectly on your
behalf are performing operations, if the
(2) A wateraaft you do not own that is: "property damage" arises out of those op-
(a) Less than 26 feet long; and erations; or
(b) Not being used to carry persons or (6) That particular part of any property that
property for a charge; must be restored, repaired or replaced be-
(3) Parking an "auto" on, or on the ways next cause "your work" was incorrectly per-
formed on it.
to, premises you own or rent, provided the
"auto" is not owned by or rented or loaned Paragraph (2) of this exclusion does not apply
to you or the insured; if the premises are "your work" and were never
(4) Liability assumed under any "insured con- occupied, rented or held for rental by you.
tract" for the ownership, maintenance or Paragraphs (3), (4), (5) and (6) of this exclu-
use of aircraft or watercraft; or sion do not apply to liability assumed under a
sidetrack agreement.
(5) "Bodily injury" or "property damage" arising
out of the operation of any of the equipment Paragraph (6) of this exclusion does not apply
listed in paragraph f.(2) or f.(3) of the defini- to "property damage" included in the "products-
tion of "mobile equipment". completed operations hazard".
h. Mobile Equipment k. Damage to Your Product
"Bodily injury" or "property damage" arising out "Property damage" to "your product" arising out
of: of it or any part of it.
(1) The transportation of "mobile equipment" by I. Damage to Your Work
an "auto" owned or operated by or rented or "Property damage" to "your work" arising out of
loaned to any insured; or it or any part of it and included in the "products-
(2) The use of "mobile equipment" in, or while completed operations hazard".
in practice for, or while being prepared for, This exclusion does not apply if the damaged
any prearranged racing, speed, demolition, work or the work out of which the damage
or stunting activity. arises was performed on your behalf by a sub-
I. War contractor.
"Bodily injury" or "property damage" due to m. Damage to Impaired Property or Property
war, whether or not dedared, or any act or Not Physically Injured
condition incident to war. War includes civil "Property damage" to "impaired property" or
war, insurrection, rebellion or revolution. This property that has not been physically injured,
exclusion applies only to liability assumed un- arising out of:
der a contract or agreement.
(1) A defect, deficiency, inadequacy or danger-
J. Damage to Property ous condition in "your product" or "your
"Property damage" to: work"; or
(1) Property you own, rent, or occupy; (2) A delay or failure by you or anyone acting
(2) Premises you sell, give away or abandon, if on your behalf to perform a contract or
the "property damage" arises out of any agreement in accordance with its terms.
part of those premises; This exdusion does not apply to the loss of use
(3) Property loaned to you; of other property arising out of sudden and ac-
cidental physical injury to "your product" or
(4) Personal property in the care, custody or "your work" after it has been put to its intended
control of the insured; use.
CG 00 011093 Copyright, ISO Commercial Risk Services, Inc., 1992 Page 3 of 1 □
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CAUSE NO. C-2791-22-E 313 HACKBERRY LAND § IN THE DISTRICT COURT Plaintiff, § § v. § § HIDALGO COUNTY, TEXAS GREAT LAKES INSURANCE SE and § UNDERWRITERS AT LLOYD’S, § LONDON § Defendant. § 275th JUDICIAL DISTRICT DECLARATION OF LISA CARROLL 1. “My name is Lisa Carroll, my date of birth is , and my address is . I declare under penalty of perjury that the facts stated in this declaration are true and correct. 2. I am of sound mind and competent to make this declaration. I have personal knowledge of all the facts stated within this declaration based on my personal knowledge of the facts of this case and my personal review of the books and records of Great Lakes Insurance SE (“Great Lakes”) and Underwriters at Lloyd’s (“Underwriters”) (collectively, “Defendants”) pertaining to policy number GK20390630574 and the claim at issue in this case, including the records attached to this declaration. I am authorized to make this declaration. 3. I am a Vice President – Claims for Amwins Access Insurance Services, LLC. Amwins is a managing general agent for Great Lakes and Underwriters and serves as a custodian of records for Great Lakes and Underwriters. Attached hereto are business records of Great Lakes and Underwriters. The documents attached hereto as Exhibits A-1 and A-2 are true and correct copies of documents kept by Great Lakes and Underwriters in their file for this claim in the regular course of business, and it was the regular course of business of Great Lakes and Underwriters for an employee or representative with knowledge of the act or event recorded to make or keep the record, and these records were made or kept at or near the time of the act or event, or reasonably soon thereafter. 4. Great Lakes’ and Underwriters’ records regarding the claim at issue in this lawsuit reflect the following facts: a. 313 Hackberry (“Plaintiff”) is the named insured under Defendants’ policy number GK20390630574, which insured a residential building located at 313 West Hackberry, McAllen, Texas 78501 (the “Property”) from March 2, 2020 to March 3, 2021. b. Plaintiff submitted an Acord Property Loss Notice to Defendants on July 29, 2020 alleging the Property sustained storm damage on July 29, 2020. Upon receipt, Defendants promptly assigned an adjuster to investigate the A Page 1 of 2 alleged loss. After thoroughly investigating the claim, Defendants, through the assigned adjuster, communicated its claim decision to Plaintiff. FURTHER DECLARANT SAYETH NOT.” Executed in Bexar County, State of Texas, on _February 21_____, 2023. Lisa Carroll Vice President – Claims, Amwins Access Insurance Services, LLC Page 2 of 2 Electronically Served 9/14/2022 2:05 PM <... 0 CT COMMERCIAL LINES POLICY ~ COMMON POLICY DECLARATIONS co "-I "-I ~ POLICY NUMBER: GK20390630574 RENEWAL OF: GK19390625945 Insured Name and Mailing Address Agent or Broker and Mailing Address 313 Hackberry Land 8403 The Klement Agency PO Box 820 705 Brookside Dr PROSPER TX Spring Branch TX 78070 75078 PARTICIPATION PARTICIPATION PARTICIPATION OF INSURANCE OF INSURANCE OF INSURANCE CONTRACT INSURER PROPERTY GENERAL LIAB. EQUIP. BRKDWN. NO.&YEAR Great Lakes Insurance SE 90 100 100 RS03906A20 Underwriters at Lloyd's, London lO 0 0 B0759 AM07625A20 Hereon 100% Policy Period: From 2020-03-02 To 2021-03-02 at 12:01 A.M. Standard Time at your mailing address shown above. Form of Business: D Individual D Partnership D Joint Venture D Trust D Limited Liability Company ~ Organization, including a Corporation (but not including a Partnership, Joint Venture or Limited Liability Company) Business Description: ~H=a~b=ita=ti=·o=nal~--------------------------- IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE INSURANCE AND LIMITS AS 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 Property Coverage Part $ 1468.00 Commercial Inland Marine Coverage Part $ 0.00 Commercial Crime Coverage Part $ 0.00 Commercial General Liability Coverage Part $ 81.00 Terrorism Risk Insurance Act $ $ TOTAL ADVANCE PREMIUM $ 1549.00 Fees/Charges/Taxes $ 225.00 PolicxFee $ $ $ 86.04 5llmllll.l. $ $ $ 2.66 Smmnine: Fee $ TOTAL CHARGES $ 1862.70 Forms and endorsement(s) made a part of this policy at time of issue: SEE SCHEDULE OF FORMS AND ENDORSEMENTS ----------l;overholder·--------- Correspondent Contact Surplus Lines Procuring Surplus Lines Tax/License No. n__:_, 0 McClelland and Hine, a divilrion of Worldwide Facilities, LLC TX 14971 725 S Figueroa. 19th Floor Los Angeles, CA 90017 ~ Countersigned: San Antonio TX Date: 03/17/2020._____ _ _ Q-"""''-------------------- Countersigned by Authorized Representative SLA# Not Applicable Total # of Locations ••• Date Issued 03/17/2020 Initials jenellt JCBC 1000 IL 0818 •••Refer to coverage declarations Page 1 of 1 A-1 GL 000093 Electronically Served 9/14/2022 2:05 PM c.... 0 O' ~ CD "-.j "-.j ~ TEXAS COMPLAINTS NOTICE IMPORTANT NOTICE A VISO IMPORTANTE To obtain information or make a complaint: Para obtener informaci6n o para presentar una queja: You may contact the Texas Department of Usted puede comunicarse con el Insurance to obtain information on companies, Departamento de Seguros de Texas para coverages, rights or complaints at: obtener informaci6n sobre compafiias, coberturas, derechos, o quejas al: 1-800-252-3439 1-800-252-3439 You may write the Texas Department of Usted puede escribir al Departamento de Insurance: Seguros de Texas a: P. 0. Box 149104 P. 0. Box 149104 Austin, TX 78714-9104 Austin, TX 78714-9104 Fax: (512) 490-1007 Fax: (512) 490-1007 Web: www.tdi.texas.gov Web: www.tdi.texas.gov E-mail: ConsumerProtection@tdi.texas.gov E-mail: ConsumerProtection@tdi.texas.gov PREMIUM OR CLAIM DISPUTES: DISPUTAS POR PRIMAS DE SEGUROS 0 RECLAMACIONES: Si tiene una disputa Should you have a dispute concerning your relacionada con su prima de seguro o con una premium or about a claim you should contact reclamaci6n, usted debe comunicarse con el the agent first. If the dispute is not resolved, agente primero. Si la disputa no es resuelta, you may contact the Texas Department of usted puede comunicarse con el Insurance. Departamento de Seguros de Texas. ATTACH THIS NOTICE TO YOUR ADJUNTE ESTE AVISO A SU POLIZA: POLICY: This notice is for information only Este aviso es solamente para prop6sitos and does not become a part or condition of the informativos y no se convierte en parte o en attached document. condici6n del documento adjunto. 19 October 2015 REF 9080B GL 000094 Electronically Served 9/14/2022 2:05 PM c.... 0 CT ~ CD ..... ..... ~ TEXAS SURPLUS LINES NOTICE This insurance contract is with an insurer not licensed to transact insurance in this state and is issued and delivered as surplus line coverage under the Texas insurance statutes. The Texas Department of Insurance does not audit the finances or review the solvency of the surplus lines insurer providing this coverage, and the insurer is not a member of the property and casualty insurance guaranty association created under Chapter 462, Insurance Code. Chapter 225, Insurance Code, requires payment of the appropriate rate of tax on gross premium. REF 9079 (amended) 01 September 2013 GL 000095 Electronically Served 9/14/2022 2:05 PM <... 0 CT COMMERCIAL PROPERTY COVERAGE PART DECLARATIONS -DETAIL Policy No. GK20390630574 ~ co "-I "-I DESCRIPTION OF PREMISES ~ Prem# I Bld2# I LOCATION (Address Citv. County, State Zip) l l 313 West Hackberry McAllen Hidalgo TX 78501 UNDERWRITING INFORMATION AND MISCELLANEOUS RISK DATA Public Protection Class 2 Building Construction Type Joisted Masoruy Year Built 2003 Occupancy DWELLINGS - ONE FAMILY (LESSORS RISK ONLY) Wind Coverage• Included *If wind coverage shows "excluded", refer to the Forms Schedule fur the windstonn exclusion endorsement. COVERAGES PROVIDED I tlfExtra Expense coverage, Insurance at the Described Premises anulies only for those Covera2es for which a Limit of Insurance is shown. limits on the loss navment. COVERAGE◊ I LIMIT OF INSURANCE (US$) I COVERED CAUSE OFLOSS I VALUATION* I COINSURANCEt I RATES I PREMIUM (US$) Bldg 185000 Special RCV 80% 0.7935 1468 ◊ COVERAGE ABBREVIATIONS *VALUATION BLDG = Building BPP = Business Personal Property ACV = Actual Cash Value BI = Business Income HPP = Household Personal Property RC = Replacement Cost BLKT = Blanket PPO = Personal Property of Others AGRV = Agreed Value BTMIM = Betterments & Improvements DEDUCTIBLES $ 2% deductible applies to Windstorm/Hurricane/Hail, subject to a minimum deductible of$ 2500 $ 0 deductible applies to Named Storms, subject to a minimum deductible of$NJA $ 0 deductible applies to Other NI A $1% deductible applies to all losses except as noted above, subject to a minimum deductible of$ l 000 Windstorm/Hurricane/Hail and Named Storm Deductibles apply on a Per Item/ Per Occurrence basis. All other deductibles apply on a per occurrence basis unless stated otherwise in this policy. These Declarations are part of the Policy Declarations containing the name of the Insured and the policy period. MHI-CFlS0 (08/17) GL 000096 Electronically Served 9/14/2022 2:05 PM <... 0 CT COMMERCIAL GENERAL LIABILITY COVERAGE PART DECLARATIONS ~ co "-I "-I ~ Policy Number: GK20390630574 Effective Date: 2020-03-02 •• LIMITS OF INSURANCE General Aggregate Limit (Other than Products/Completed Operations) $ 2,000,000 Products/Completed Operations Limit $ Included Each Occurrence Limit $ 1,000,000 Personal and Advertising Injury Limit $ 1,000,000 Fire Damage Limit $ 100 000 Any One Fire Medical Expense Limit $ 5'000 Any One Person ' BUSINESS DESCRIPTION AND LOCATION OF PREMISES Form of Business•: Other Business Description•: Location of All Premises You Own, Rent, or Occupy: 1 313 West Hackberry McAllen Hidalgo TX 78501 PREMIUM: Class Code# Premium Rate Advance Premium Class Code Description Basis Pr/CO All Other Pr/CO All Other 63010 e I Im:luded 80.8500 0 81 Dwellings - oIW-family (lessors risk only) Mimmum premium may apply. Total Advance Premium 81.00 Premium Basis: (a) Area per 1,000 square feet (s) Gross Sales per $1,000 (u) Units per I (c) Total Cost per $1,000 (t) Other (e) Each (m) Admissions per 1,000 (g) Gallons per 1,000 (p) Payroll per $1,000 POLICY MAY BE AUDITABLE. FORMS AND ENDORSEMENTS (Other than applicable forms & endorsements shown elsewhere in the policy): 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 •Information omitted if shown elsewhere in the policy. ••Inclusion of date optional •••see Each Occurrence Limit. THESE DECLARATIONS ARE PART OF THE POLICY DECLARATIONS CONTAINING THE NAME OF THE INSURED AND THE POLICY PERIOD. MHI-CGL-100 (01/18) GL 000097 Electronically Served 9/14/2022 2:05 PM SCHEDULE OF FORMS AND ENDORSEMENTS Fonn Number Edition Date Fonn/Endorsement Title Page JCBC1000IL 08/16 Common Policy Dedarations Joint Certificate 1 REF-9080B 10/15 Texas Complaints Notice 2 REF-9079a 09/13 Texas Surplus Lines Notice 3 MHICF-150 08/17 Commercial Property Coverage Part Dedarations 4 MHI-CGL-100 01/18 Commercial General Liability Coverage Part Declaratio1ns 5 CG-0001 10/93 Commercial General Liability Coverage Fonn 7 CG-2144 07/98 Limitation of Coverage to Designated Premises or Projt1ct 19 CP-0010 06/07 Building Business Personal Property Coverage Fonn 20 CP-0090 07/88 Commercial Property Conditions 35 CP-0321 06/07 Windstonn or Hail Percentage Deductible 37 CP-1030 06/07 Causes of Loss-Special 41 CP-1032 08/08 Water Exdusion Endorsement 51 CP-1056 06/07 Sprinkler Leakage Exclusion 52 CP-1211 10/00 Burglary And Robbery Protective Safeguards 54 GLISE(i) 02'20 Great Lakes Insurance SE Privacy Policy Statement 55 GLK-4150-PR 12/14 Amendatory Appraisal Endorsement 56 IL-0017 11/98 Common Policy Conditions 58 IL-0021 05/04 Nudear Energy Liability Exdusion Endorsement 59 IL-0415 04/98 Protective Safeguards 61 IL-0935 07/02 Exdusion of Certain Computer-Related Losses 63 JCBC-4155IL 02'20 Combination Endorsement for Joint Certificate Policies 64 JC-5103 03/15 Policy Provisions Clause 71 JCBC-4121 08/16 Lloyds Syndicate Schedule-2018 73 MHl-18 11/07 Amendatory Endorsement - Minimum Earned Premium / Policy Fees 74 Fully Earned MHl-26GK&LL 10/18 General Certificate Provisions [Participating] 75 MHl-40 06/05 Commercial General Liability - Additional Exclusions 76 MHl-47 06/13 Loss Conditions 78 MHl-48 08/09 Property Endorsement 79 MHl-63 06/99 Premium Audit Condition 80 MHl-176 10/19 ACV Limitation Roofs and Roof Surfacing 81 MHl-183 09/17 Exdusion-Prior Damage to Property 82 MHl-280 06/18 Amendatory Endorsement-Roof Exclusion Due to ~e 83 REF-5390 01'20 US Terrorism Risk Insurance Act of 2002 as Amended-Not Purchased 84 Clause REF/NMA-1998 01'20 Sarvice of Suit Clause (USA) 85 REF-2920a Terrorism Exdusion 86 REF-3100 09/10 Sanction Limitation and Exdusion Clause 87 GL 000098 Electronically Served 9/14/2022 2:05 PM <... 0 CT ~ co '-I COMMERCIAL GENERAL LIABILITY '-I CG00011093 ~ COMMERCIAL GENERAL LIABILITY COVERAGE FORM Vanous provisions in this policy restrict coverage. (2) The "bodily injury" or "property damage" Read the entire policy carefully to determine rights, occurs during the policy period. duties and what is and is not covered. c. Damages because of "bodily injury" include Throughout this policy the words "you" and "your" damages claimed by any person or organiza- refer to the Named Insured shown in the Declara- tion for care, loss of services or death resulting tions, and any other person or organization qualifying at any time from the "bodily injury". as a Named Insured under this policy. The words 2. Exclusions. "we", "us" and "our" refer to the company providing this insurance. This insurance does not apply to: The word "insured" means any person or organization a. Expected or Intended Injury qualifying as such under WHO IS AN INSURED "Bodily injury" or "property damage" expected (SECTION II). or intended from the standpoint of the insured. Other words and phrases that appear in quotation This exclusion does not apply 1o "bodily injury" marks have special meaning. Refer to DEFINITIONS resulting from the use of reasonable force 1o (SECTION V). protect persons or property. SECTION I - COVERAGES b. Contractual Liability COVERAGE A. BODILY INJURY AND PROP- "Bodily injury" or "property damage" for which ERTY DAMAGE LIABILITY the insured is obligated to pay damages by reason of the assumption of liability in a con- 1. Insuring Agreement. tract or agreement. This exclusion does not a. We will pay those sums that the insured be- apply to liability for damages: comes legally obligated to pay as damages (1) Assumed in a contract or agreement that is because of "bodily injury" or "property damage" an "insured contract", provided the "bodily to which this insurance applies. We will have injury" or "property damage" occurs subse- the right and duty to defend any "suit" seeking quent to the execution of the contract or those damages. We may at our discretion in- agreement; or vestigate any "occurrence" and settle any claim or "suit" that may result. But: (2) That the insured would have in the absence of the contract or agreement. (1) The amount we will pay for damages is limited as described in LIMITS OF INSUR- c. Liquor Liability ANCE (SECTION Ill); and "Bodily injury" or "property damage" for which (2) Our right and duty to defend end when we any insured may be held liable by reason of: have used up the applicable limit of insur- (1) Causing or contributing 1o the intoxication of ance in the payment of judgments or set- any person; tlements under Coverages A or B or medi- (2) The furnishing of alcoholic beverages to a cal expenses under Coverage C. person under the legal drinking age or un- No other obligation or liability 1o pay sums or der the influence of alcohol; or perform acts or services is covered unless ex- (3) Any statute, ordinance or regulation relating plicitly provided for under SUPPLEMENTARY to the sale, gift, distribution or use of alco- PAYMENTS - COVERAGES A AND B. holic beverages. b. This insurance applies to "bodily injury" and This exclusion applies only if you are in the "property damage" only if: business of manufacturing, distributing, selling, (1) The "bodily injury" or "property damage" is serving or furnishing alcoholic beverages. caused by an "occurrence" that takes place in the "coverage territory"; and CG 00011093 Copyright, ISO Commercial Risk Services, Inc., 1992 Page 1 of 1 □ GL 000099 Electronically Served 9/14/2022 2:05 PM <- 8- ; ...., (D ...., d. Workers Compensation and Slmllar Laws (d) At or from any premises, site or location ~ Any obligation of the insured under a workers on which any insured or any contractors compensation, disability benefits or unem- or subcontractors working directly or in- ployment compensation law or any similar law. directly on any insured's behalf are per- forming operations: e. Employer's Liability (I) If the pollutants are brought on or to "Bodily injury" to: the premises, site or location in con- (1) An "employee" of the insured arising out of nection with such operations by such and in the course of: insured, contractor or subcontractor; (a) Employment by the insured; or or (II) If the operations are to test for, moni- (b) Performing duties related to the conduct tor, clean up, remove, contain, treat, of the insured's business; or detoxify or neutralize, or in any way (2) The spouse, child, parent, brother or sister respond to, or assess the effects of of that "employee" as a consequence of pollutants. paragraph (1) above. Subparagraphs (a) and (d)(i) do not apply This exclusion applies: to "bodily injury" or "property damage" aris- (1) Whether the insured may be liable as an ing out of heat, smoke or fumes from a hos- employer or in any other capacity; and tile fire. (2) To any obligation to share damages with or As used in this exclusion, a hostile fire repay someone else who must pay dam- means one which becomes uncontrollable ages because of the injury. or breaks out from where it was intended to be. This exclusion does not apply to liability as- sumed by the insured under an "insured con- (2) Any loss, cost or expense arising out of tract". any: f. Pollution (a) Request, demand or order that any insured or others test for, monitor, clean (1) "Bodily injury" or "property damage" arising up, remove, contain, treat, detoxify or out of the actual, alleged or threatened dis- neutralize, or in any way respond to, or charge, dispersal, seepage, migration, re- assess the effects of pollutants; or lease or escape of pollutants: (b) Claim or suit by or on behalf of a gov- (a) At or from any premises, site or location ernmental authority for damages be- which is or was at any time owned or cause of testing for, monitoring, cleaning occupied by, or rented or loaned to, any up, removing, containing, treating, de- insured; toxifying or neutralizing, or in any way (b) At or from any premises, site or location responding to, or assessing the effects which is or was at any time used by or of pollutants. for any insured or others for the han- Pollutants means any solid, liquid, gaseous or dling, storage, disposal, processing or thermal irritant or contaminant, including treatment of waste; smoke, vapor, soot, fumes, acids, alkalis, (c) Which are or were at any time trans- chemicals and waste. Waste includes materi- ported, handled, stored, treated, dis- als to be recycled, reconditioned or reclaimed. posed of, or processed as waste by or g. Aircraft, Auto or Watercraft for any insured or any person or organi- zation for whom you may be legally re- "Bodily injury" or "property damage" arising out sponsible; or of the ownership, maintenance, use or en- trustment to others of any aircraft, "auto" or wa- tercraft owned or operated by or rented or loaned to any insured. Use indudes operation and "loading or unloading". Page2 of 12 Copyright, ISO Commercial Risk Services, Inc., 1992 CG 00 011093 □ GL 000100 Electronically Served 9/14/2022 2:05 PM (.. 8- i CD ..... ..... This exclusion does not apply to: (5) That particular part of real property on ~ (1) A watercraft while ashore on premises you which you or any contractors or subcontrac- own or rent; tors working directly or indirectly on your behalf are performing operations, if the (2) A wateraaft you do not own that is: "property damage" arises out of those op- (a) Less than 26 feet long; and erations; or (b) Not being used to carry persons or (6) That particular part of any property that property for a charge; must be restored, repaired or replaced be- (3) Parking an "auto" on, or on the ways next cause "your work" was incorrectly per- formed on it. to, premises you own or rent, provided the "auto" is not owned by or rented or loaned Paragraph (2) of this exclusion does not apply to you or the insured; if the premises are "your work" and were never (4) Liability assumed under any "insured con- occupied, rented or held for rental by you. tract" for the ownership, maintenance or Paragraphs (3), (4), (5) and (6) of this exclu- use of aircraft or watercraft; or sion do not apply to liability assumed under a sidetrack agreement. (5) "Bodily injury" or "property damage" arising out of the operation of any of the equipment Paragraph (6) of this exclusion does not apply listed in paragraph f.(2) or f.(3) of the defini- to "property damage" included in the "products- tion of "mobile equipment". completed operations hazard". h. Mobile Equipment k. Damage to Your Product "Bodily injury" or "property damage" arising out "Property damage" to "your product" arising out of: of it or any part of it. (1) The transportation of "mobile equipment" by I. Damage to Your Work an "auto" owned or operated by or rented or "Property damage" to "your work" arising out of loaned to any insured; or it or any part of it and included in the "products- (2) The use of "mobile equipment" in, or while completed operations hazard". in practice for, or while being prepared for, This exclusion does not apply if the damaged any prearranged racing, speed, demolition, work or the work out of which the damage or stunting activity. arises was performed on your behalf by a sub- I. War contractor. "Bodily injury" or "property damage" due to m. Damage to Impaired Property or Property war, whether or not dedared, or any act or Not Physically Injured condition incident to war. War includes civil "Property damage" to "impaired property" or war, insurrection, rebellion or revolution. This property that has not been physically injured, exclusion applies only to liability assumed un- arising out of: der a contract or agreement. (1) A defect, deficiency, inadequacy or danger- J. Damage to Property ous condition in "your product" or "your "Property damage" to: work"; or (1) Property you own, rent, or occupy; (2) A delay or failure by you or anyone acting (2) Premises you sell, give away or abandon, if on your behalf to perform a contract or the "property damage" arises out of any agreement in accordance with its terms. part of those premises; This exdusion does not apply to the loss of use (3) Property loaned to you; of other property arising out of sudden and ac- cidental physical injury to "your product" or (4) Personal property in the care, custody or "your work" after it has been put to its intended control of the insured; use. CG 00 011093 Copyright, ISO Commercial Risk Services, Inc., 1992 Page 3 of 1 □ GL 000101 Electronically Served 9/14/2022 2:05 PM <- 0 CT ~ co "-I