Wartman v. International Specialty Insurance Court Documents

Case 4:17-cv-00871-MEM Document 1-1 Filed 05/17/17 Page 1 of 22
Exhibit A
Notice to Policyholder: This policy is written by a domestic surplus lines insurer, an

eligible unauthorized insurer pursuant to section 2 of P.L.2011 c. 39 (C.17:22-6.69b), and
is not subject to the rate or form filing or approval requirements of the New Jersey
Department of Banking and Insurance. This policy may contain conditions, limitations,
exclusions and different terms than a policy otherwise issued by a New Jersey
authorized or admitted insurer. This policy is not covered by the New Jersey Property
Liability Guarantee Association. This policy may be covered by the New Jersey Surplus
Lines Insurance Guaranty Fund, but only to the extent provided pursuant to section 2
of P.L.1984, c. 101 (C.17:22-6.71).
Lloyds
Certificate
This Insurance is effected with Certain Underwriters at
Lloyds, London.
This Certificate is issued in accordance with the

limited authorization granted to the Correspondent by certain
Underwriters at Lloyds, London whose syndicate numbers and
the proportions underwritten by them can be ascertained from the
office of said Correspondent (such Underwriters being hereinafter
called Underwriters) and in consideration of the premium
specified herein, Underwriters hereby bind themselves severally
and not jointly, each for his own part and not one for another, their
Executors and Administrators.
The Assured is requested to read this Certificate, and if

not correct, return it immediately to the Correspondent for
appropriate alteration.
All inquiries regarding this Certificate should be addressed to the

following Correspondent:
110 Oakwood Drive #420

Winston Salem, NC 27103
(800) 849-0474
SLC-3 (USA) NMA2868 (24/08/00)

CERTIFICATE PROVISIONS
1. Signature Required. This Certificate shall not be valid unless signed by the Correspondent on the attached Declaration
Page.
2. Correspondent Not Insurer. The Correspondent is not an Insurer hereunder and neither is nor shall be liable for any
loss or claim whatsoever. The Insurers hereunder are those Underwriters at Lloyd's, London whose syndicate numbers
can be ascertained from the office of said Correspondent. As used in this Certificate "Underwriters" shall be deemed to
include incorporated as well as unincorporated persons or entities that are Underwriters at Lloyd's, London.
3. Cancellation. If this Certificate provides for cancellation and this Certificate is cancelled after the inception date, earned
premium must be paid for the time the insurance has been in force.
4. Assignment. This Certificate shall not be assigned either in whole or in part without the written consent of the
Correspondent endorsed hereon.
5. Attached Conditions Incorporated. This Certificate is made and accepted subject to all the provisions, conditions and
warranties set forth herein, attached or endorsed, all of which are to be considered as incorporated herein.
6. Short Rate Cancellation. If this Certificate provides for short rate cancellation, the table below will be used to calculate
the short rate proportion of the premium when applicable under the terms of cancellation.
Short Rate Cancellation Table For Term of One Year
Days Insurance Percent of Days Insurance Percent of Days Insurance Percent of Days Insurance Percent of
In Force One Year In Force One Year In Force One Year In Force One Year
Premium Premium Premium Premium
1......5% 66-69......29% 154-156.....53% 256-260....77%
2.....................6 70-73......30 157-160.....54 261-264....78
3-4...7 74-76...31 161-164.....55 265-269....79
5-6.......8 77-80......32 165-167....56 270-273 (9 Mos.)....80
7-8...9 81-83......33 168-171.57 274-278....81
9-1010 84-87......34 172-175.58 279-282....82
11-12..11 88-91 (3 mos.)......35 176-178.59 283-287.83
13-14.........12 92-94......36 179-182 (6 mos.)..60 288-291........84
15-16......13 95-98......37 183-187..61 292-296....85
17-18..................................14 99-102....38 188-191..62 297-301....86
19-20..................................15 103-105.........39 192-196..63 302-305 (10 mos.)......87
21-22..................................16 106-109.........40 197-200..64 306-310........88
23-25..................................17 110-113......41 201-205..65 311-314.....89
26-29..................................18 114-116......42 206-209..66 315-319.....90
30-32 (1 mos.)....................19 117-120......43 210-214 (7 mos.)..67 320-323.....91
33-36..................................20 121-124 (4 mos.)......44 215-218..68 324-328.....92
37-40..................................21 125-127......45 219-223..69 329-332.....93
41-43..................................22 128-131...46 224-228..70 333-337 (11 mos.)...94
44-47..................................23 132-135..........47 229-232..71 338-342.....95
48-51..................................24 136-138..........48 233-237..72 343-346.....96
52-54..................................25 139-142......49 238-241..73 347-351.....97
55-58..................................26 143-146......50 242-246 (8mos.)...74 352-355.....98
59-62 (2 mos.)....................27 147-149......51 247-250..75 356-360.99
63-65..................................28 150-153 (5 mos.)......52 251-255..76 361-365 (12 mos.)..100
This Declaration Page is attached to and forms part of Certificate Provisions (Form SLC-3 USA NMA2868)
Previous No. N/A Authority Ref. No. HGBA16062 Certificate No. B1132HGBA16062100
1. Name and Address of the Assured:
Nyeem Wartman
c/o KPM Sports
1 Gateway Center #2600
Newark, NJ 07102
2. Effective from August 09, 2016 to August 01, 2017
both days at 12:01 a.m. standard time.
3. Insurance is effective with certain UNDERWRITERS AT LLOYDS, LONDON

Percentage: 100%
4. Amount Coverage Rate Premium

As Per the Attached Worldwide, Full Twenty-Four Not Applicable See Attached
5. Forms attached hereto and special conditions: As Per the Attached
6. Service of Suit may be made upon:
Mendes & Mount Foley & Lardner LLP (if California)

750 Seventh Avenue 555 California Street, Suite 1700
New York, NY 10019 San Francisco, CA 94104-1520
U.S.A. U.S.A.
Lloyds Kentucky, Inc. (if Kentucky) Locke Lord LLP (if Illinois)
200 West Main Street 111 S Wacker Dr
Frankfort, KY 40601-1806 Chicago, IL 60606
U.S.A. U.S.A.
7. In the event of a claim, please notify the following: International Specialty Insurance, Inc.
110 Oakwood Drive, Suite 420
Winston-Salem, NC 27103
800-849-0474
by
_______________________________________
Correspondent
Dated September 06, 2016

Attaching to and forming a part of
Policy No. B1132HGBA16062100
Re: NYEEM WARTMAN
Assured: NYEEM WARTMAN
Address of Assured: c/o KPM Sports

1 Gateway Center #2600
Newark, NJ 07102
Intended Occupation: Professional Football Player
Policy Term: From: 12:01 a.m. August 9, 2016

To: 12:01 a.m. August 1, 2017* or
Local Standard Time at the address of the Assured.
a) with respect to Interest Section A only, the date the Assured receives an
Offer from any Professional Football Team, whichever is sooner; and
b) with respect to Interest Section B only, the date the Assured signs a
contract with any Professional Football Team, whichever is sooner.
Limit of Indemnity: Interest Section A. $500,000.00

Interest Section B. $1,000,000.00
Interest Section C. NOT COVERED
Premium: $8,000.00 base premium

$50.00 ISI policy fee
$400.00 (5%) NJ surplus lines tax
$0.00 (0%) NJ stamping fee
Total Due: $8,450.00
Minimum Earned
Premium: $1,600.00
Interest: This Insurance is to indemnify the Assured:
A. for his Aggregate Ascertained Net Loss, up to, but not exceeding the
Limit of Indemnity, should the Assured not receive an Offer from a
Professional Football Team that totals $2,800,000 or more of
Compensation over four (4) years, or pro-rata per annum, solely and
directly as a result of Death or Injury or Illness occurring during the
period of this Insurance, subject always to the Terms, Warranties,
Conditions, and Exclusions contained herein or endorsed hereon;
or
B. the Limit of Indemnity if the Assured suffers a Permanent Total Disability

occurring during the period of this Insurance solely and directly as a
result of an Injury or Illness, subject always to the Elimination Period
being exhausted and the Terms, Warranties, Conditions, and Exclusions
contained herein or endorsed hereon;
or
C. the Limit of Indemnity if the Assured suffers Accidental Death
1
Re: NYEEM WARTMAN
UNDERWRITING REQUIREMENTS: Application Form Dated: TBA

Medical Form Dated: TBA
CONDITIONS: ISI wording as agreed by the Company

To follow the terms, conditions, limitations and
exclusions of the Policy form or as endorsed hereon.
FORMS ATTACHED HERETO

AND SPECIAL CONDITIONS: Privacy Policy Statement
Nuclear/Radioactive Exclusion Clause LSW 1210
Security List
Sanctions Clause
Endorsement(s)
SUBJECTIVITIES: The Insured Person shall provide Underwriters with a
completed Application and Medical Report within 30
days of inception. Between inception and deadline
cover is provided by Underwriters on the terms and
conditions specified within the Policy to which this
condition is attached.
Failure to provide the information within 30 days may
result in the Policy being cancelled back to inception and
time on risk premium may be charged.
Coverage will exclude any claims arising from Injury(ies)
and/or Sickness to any part of the body for which the
Insured Person has been recommended and/or given
any medical treatment by a qualified Physician during
the eighteen (18) month period prior to the Effective
Date of Coverage and which resulted in a period of Total
Disability of not less than five consecutive days. This
exclusion will apply during the underwriting/conditional
coverage period.
These conditions and exclusions may be waived upon
Underwriters receipt and consent of:
1. Completed Application form

2. Medical Report
3. Any such additional information that Underwriters may require
4. Justification of sum insured.
Underwriters reserve the right based on medical

information received to apply Exclusions where
appropriate.
In the event the information provided is deemed
unsatisfactory by Underwriters, coverage may be
cancelled and time on risk premium may be charged.
INFORMATION: Date of Birth: December 16, 1992

Team: Penn State University
2
Re: NYEEM WARTMAN
Definitions: Aggregate Ascertained Net Loss means $2,800,000 less the total
Compensation included in the largest Offer made by a Professional Football
Team. It is understood and agreed that there can be no claim under this
Insurance with respect to Interest Section A if the Aggregate Ascertained Net
Loss calculation results in zero or a negative number. It is further understood and
agreed that in the event of a valid and collectible claim under this Insurance if the
Aggregate Ascertained Net Loss calculation results in a positive number greater
than $500,000 the Assured will only be indemnified the maximum Limit of
Indemnity for Interest Section A.
Death means death of the Assured occurring during the period of this
Insurance caused by Injury or Illness.
"Injury" means:
A. with respect to Interest section A, bodily injury sustained by the Assured
during the period of this Insurance which i) requires the Assured to be
medically determined to render him unable to participate in his Intended
Occupation for a minimum of thirty (30) Regular Season, Post Season or
Off Season days, and ii) requires medical treatment by a Physician, and
iii) has negatively affected the Assured skills in a manner that causes
substantial and material deterioration in his ability to perform in his
Intended Occupation.
B. with respect to Interest section B, bodily injury sustained by the Assured

during the period of this Insurance which i) requires the Assured to
receive medical treatment by a Physician, and ii) prevents the Assured
from ever again participating in his Intended Occupation.
"Illness" means:
A. with respect to Interest section A, illness first manifested in the Assured

during the period of this Insurance which i) requires the Assured to be
Off Season days, and ii) requires medical treatment by a Physician, and
iii) has negatively affected the Assureds skills in a manner that causes
substantial and material deterioration in his ability to perform in his
Intended Occupation.
B. with respect to Interest section B, illness first manifested in the Assured

during the period of this Insurance which i) requires the Assured to
receive medical treatment by a Physician, and ii) prevents the Assured
from ever again participating in his Intended Occupation.
3
Re: NYEEM WARTMAN
Physician means a licensed healthcare practitioner, other than the Assured or

a member of the Assureds immediate family, providing services or treatment
within the scope of his or her license.
Compensation means money, property, investments, loans, options or

anything else of value, whether or not in cash, regardless of when paid,
including, but not limited to, Salary and Signing Bonus included in an Offer made
by a Professional Football Team, including Roster and Reporting Bonuses.
Salary means Compensation, regardless of when paid, for playing Football for
a Professional Football Team, excluding Signing, Reporting, Roster and
Performance Bonuses.
Signing Bonus means Compensation, regardless of when paid, for signing a

contract with a Professional Football Team or any other activity not contingent
upon the Assured attaining or surpassing a particular level of performance.
Reporting Bonus means Compensation, for reporting to training camp or any

other activity not contingent upon the Assured attaining or surpassing a particular
level of performance.
Roster Bonus means Compensation, for making the roster or any other activity
not contingent upon the Assured attaining or surpassing a particular level of
performance.
Performance Bonus means Compensation, contingent upon the Assured

attaining or surpassing a particular level of performance.
Offer means a proposal, oral or written, to play Football for a Professional

Football Team.
Professional Football Team means a recognized Professional Football Team

(i.e. a team in the NFL, AFL or CFL).
Elimination Period means twelve (12) consecutive months of the Assured

being unable to engage in his Intended Occupation solely and directly as a result
of an Injury or Illness (as defined under sections B of the definitions of Injury and
Illness) occurring during the period of this Insurance.
Permanent Total Disability means that solely and directly as a result of an

Injury or Illness (as defined under sections B of the definitions of Injury and
Illness) occurring during the period of this Insurance, the Assured is permanently
and continuously prevented from ever again engaging in his Intended
Occupation.
Conditions
Precedent: It is a condition precedent to the liability of the Underwriters that the Assured has
declared that all information supplied to Underwriters is in all respects true and
complete and unchanged at the inception of this Insurance. Further, the Assured
agrees that all such information is material and such items form the basis of this
Insurance and are incorporated herein.
4
Re: NYEEM WARTMAN
Warranties: The Assured warrants that at inception of this Insurance he:
1. knows of no matter, fact or circumstance likely to give rise to a claim

under this Insurance;
2. has never tested positive for the HIV virus;
3. has never tested positive for steroid use;
4. has never been charged and convicted of a felony or any drug related
crime;
5. is in good health and has not concealed any material fact from
Underwriters.
Conditions: 1. If a claim is filed under this Insurance Underwriters reserve the right to
require the Assured to be examined by Underwriters' Physicians. The
Assured agrees to cooperate and to submit to all reasonable medical
tests Underwriters physicians may require.
2. It is understood and agreed that this Insurance is subject to receipt and

approval by Underwriters of a copy of the Assureds most recent team
physical, a satisfactory ISI Athletes Disability Insurance Application
completed by the Assured, and premium payment within (30) days of the
inception date of coverage. These documents will attach to and form part
of this Insurance.
3. Any word or expression to which a specific meaning has been attached

in any part of this Insurance shall bear such meaning wherever it may
appear.
4. Any fraud, misstatement or concealment in the information provided to

Underwriters or in the making of a claim or otherwise howsoever, shall
render all claims hereunder forfeit.
5. The Assured shall at all times do and concur in doing all things
necessary to avoid or diminish a loss under this Insurance.
6. The Assured shall observe and fulfill the terms and conditions contained
herein or endorsed hereon.
7. It is understood and agreed that no other insurance shall be effected by

the Assured to protect the interest insured hereunder without prior advice
to Underwriters hereon. In the event that such other insurance is effected
Underwriters reserve the right to amend the terms and conditions of this
Insurance.
8. The premium and any expense incurred in the formulation of a claim

hereunder shall not be a recoverable item.
9. This Insurance may be cancelled at any time by the Assured by writing to

their insurance agent who effected this Insurance. The Assured will then
be entitled to the pro rata return of the paid premium based on season
5
Re: NYEEM WARTMAN
and off-season, subject to the Minimum Earned Premium, provided no

claim has been made during the period of this Insurance.
10. Underwriters reserve the right to pursue an action for recovery from any
party, whether before or after payment of a loss, at their sole discretion
and in the name of the Assured or otherwise. In the event of any
payment under this Insurance, Underwriters shall be subrogated to the
extent of such payment to all the Assureds rights of recovery and the
Assured shall execute all papers required and shall do everything that
may be necessary to secure such rights.
11. This Insurance may not be assigned in whole or in part without the
written consent of Underwriters.
12. It is understood and agreed that a) with respect to Interest Section A

there can be no claim under this Insurance if the Assured receives an
Offer from a Professional Football Team that totals $2,800,000 or more
of Compensation and b) with respect to Interest Section B there can be
no claim under this Insurance if the Assured signs a new contract with a
Professional Football Team.
13. It is understood and agreed that once a Professional Football Team

makes an Offer, it will be considered a valid Offer under this Insurance,
even if the Offer is subsequently rejected or withdrawn or the Offer
expires.
14. It is understood and agreed that in the event of a valid and collectible
claim, no benefits will be paid under this Insurance after the Assured has
received $2,800,000 in Compensation from a Professional Football
Team.
15. The subscribing insurers' obligations under contracts of insurance to

which they subscribe are several and not joint and are limited solely to
the extent of their individual subscriptions. The subscribing insurers are
not responsible for the subscription of any co-subscribing Underwriter
who for any reason does not satisfy all or part of its obligations.
Whenever or wherever reference is made to "insurers" in this condition,

the same shall be deemed to read "Underwriters."
16. It is understood and agreed that there can be no claim with respect to
Interest Section A under this Insurance if the Assured has not been
Off Season days.
6
Re: NYEEM WARTMAN
Exclusions: This Insurance does not cover any loss directly or indirectly arising out of,
contributed to by, or resulting from:-
1. any fraud, misrepresentation or concealment by the Assured.
2. the Assured being under the influence of any drugs or narcotics not
legally available unless used as prescribed by a licensed Physician for a
medical condition other than drug addiction.
3. Death or Injury sustained by the Assured while intoxicated, provided that

the level of alcohol in the Assureds blood at the time of Death or Injury is
found to exceed the level at which a person would be deemed
intoxicated under the applicable laws of the situs in which the Death or
Injury was sustained.
4. the Assured committing or attempting to commit a felonious act, as

defined by the laws of the jurisdiction where the crime takes place, which
results in a conviction of the Assured.
5. the Assured not receiving an Offer from a Professional Football Team

that totals $2,800,000 or more of Compensation for any reason, other
than due to Death, Injury or Illness as defined herein.
6. the Assured not signing a contract with a Professional Football Team for
any reason, other than due to Death or Permanent Total Disability as
defined herein.
7. the Assureds mental, nervous or psychological disease or disorder.
8. the Assured committing or attempting to commit suicide or intentional

self-injury.
9. the Assured spending time in a drug or alcohol rehabilitation clinic and/or

program, whether as an inpatient or outpatient.
10. the Assured in, boarding or alighting from any aircraft:
a) in the capacity of pilot or crew member;
b) being used for fire fighting, pipe or power line inspection, aerial
photography or exploration.
This exclusion does not apply to passengers who temporarily perform

pilot or crew functions in a life-threatening emergency.
11. the Assureds participation in or practicing any other sport for pay other
than the Assureds Intended Occupation.
12. any act of declared or undeclared War or Assureds participation in a riot.

Declared or undeclared War does not include acts of terrorism.
War is used to mean:
a) hostilities following a declaration of War by a governmental

authority;
7
Re: NYEEM WARTMAN
b) if there is no declaration of War, then armed, open and

continuous hostilities between two countries.
13. This Insurance does not cover any loss directly or indirectly arising out
of, contributed to by, or resulting from the accidental release or actual,
threatened, feared or perceived use of any biological, chemical,
radioactive or nuclear agent, material, device or weapon.
14. a) ionizing radiations or contamination by radioactivity from any nuclear

waste from the combustion of nuclear fuel, however caused
b) the radioactive, toxic, explosive or other hazardous properties of any

nuclear assembly or nuclear component thereof, however caused.
15. Coverage does not apply to any loss arising from Osteoarthritis,
cumulative injury or any other degenerative process of the joints, bones,
tendons or ligaments.
16. It is understood and agreed that there can be no claim with respect to
Interest Section A under this Insurance if the Assured has not been
Off Season days.
Claims Procedure: It is a condition precedent to the liability of Underwriters that in the event
of any happening or circumstance which could give rise to a claim under
this Insurance, the Assured shall:
1. a) as a matter of urgency give notice by the most expeditious means of the

happening of any circumstance to:
International Specialty Insurance, Inc.

110 Oakwood Drive, Suite 420
Winston-Salem, NC 27103
Telephone: 336-835-2230
Facsimile: 336-835-1729
b) confirm the facts in writing as soon as possible, with as

much information as available.
c) take all steps to minimize or avoid any loss hereunder.
d) make no admission of liability without the prior written

consent of Underwriters.
e) provide Underwriters or their appointed representatives with:
i) all necessary assistance in a timely manner,

ii) all information required
iii) all documentation and records necessary to establish and
assess indemnity hereunder,
iv) copies or extracts as may be required.
f) prove the loss to the satisfaction of Underwriters.

8
Re: NYEEM WARTMAN
g) forward immediately to Underwriters or its representatives any letter,

writ, or other document received in connection with any claim made
under this Insurance.
2. The Assured as often as may be reasonably required shall submit to

examination under oath on all matters connected with a claim, by any
person named by Underwriters at such reasonable time and place as
may be designated by Underwriters or its representatives.
So far as is in his power the Assured shall cause all persons interested in
him to comply with the foregoing.
No such examination under oath or examination of books or documents,

nor any other act of Underwriters or their representatives in connection
with any investigation hereunder, shall be deemed a waiver of any
defense, which Underwriters might otherwise have. All such
examinations and acts shall be deemed to have been made or done
without prejudice to the Underwriters liability.
3. As soon as is practicable, the Assured will render a signed and sworn

Proof of Loss to Underwriters or their representative to substantiate the
occurrence, nature, cause and amount of loss claimed under this
Insurance.
4. Underwriters reserve the right, if they so wish, to:
a. take such steps as they deem necessary to prevent, mitigate or

minimize a loss.
b. take over and conduct the defense or settlement of claims made

against the Assured that are covered by this Insurance.
c. pursue all rights or remedies available to the Assured whether or

not payment has been made hereunder.
d. require independent medical examination of the Assured who

gives rise to a claim hereunder.
5. It is understood and agreed that with respect to Interest section A, in the

event of a valid and collectible claim, no loss will be paid under this
Insurance until the Assured has signed a release and submitted it to
Underwriters, agreeing in the event the Assured signs a contract(s) with
a Professional Football Team(s) for any or all seasons covering the 2017
through 2020 seasons, and the aggregate total of a, b and c described
below exceed $2,800,000, that he will refund to Underwriters the amount
in excess of $2,800,000:
a) the amount of Compensation set forth in the largest Offer made prior
to payment of the benefit, whether or not the Offer was accepted,
b) the amount of the benefit paid and
c) the amount of Compensation and other payments of whatever name

or nature after the benefit was paid from contract(s) signed with
Professional Football Teams for the 2017 through 2020 seasons.
9
Re: NYEEM WARTMAN
6. It is understood and agreed that with respect to Interest section B, in the

event of a valid and collectible claim, no loss will be paid under this
Insurance until the Assured has signed a release and submitted it to
Underwriters agreeing in the event the Assured shall ever return to his
Intended Occupation, he will refund the total amount of benefit received
under this Insurance in full to Underwriters.
10
Re: NYEEM WARTMAN
LLOYD'S PRIVACY POLICY STATEMENT
UNDERWRITERS AT LLOYDS, LONDON
The Certain Underwriters at Lloyds, London want you to know how we protect the confidentiality of your
non-public personal information. We want you to know how and why we use and disclose the information
that we have about you. The following describes our policies and practices for securing the privacy of our
current and former customers.
INFORMATION WE COLLECT
The non-public personal information that we collect about you includes, but is not limited to:
Information contained in applications or other forms that you submit to us; such as, name,
address, and payment history.
Information about your transactions with our affiliates or other third-parties; such as, balances
and payment history.
Information we receive from a consumer-reporting agency; such as, credit-worthiness or
credit history.
INFORMATION WE DISCLOSE
We disclose the information that we have when it is necessary to provide our products and services. We
may also disclose information when the law requires or permits us to do so.
CONFIDENTIALITY AND SECURITY
Only our employees and others who need the information to service your account have access to your
personal information. We have measures in place to secure our paper files and computer systems.
RIGHT TO ACCESS OR CORRECT YOUR PERSONAL INFORMATION
You have a right to request access to or correction of your personal information that is in our possession.
CONTACTING US
If you have any questions about this privacy notice or would like to learn more about how we protect your
privacy, please contact the agent or broker who handled this insurance. We can provide a more detailed
statement of our privacy practices upon request.
LSW1135B
11
Re: NYEEM WARTMAN
SERVICE OF SUIT CLAUSE (U.S.A.)
It is agreed that in the event of the failure of the Underwriters hereon to pay any amount claimed to be due
hereunder, the Underwriters hereon, at the request of the Assured (or Reinsured), will submit to the
jurisdiction of a Court of competent jurisdiction within the United States. Nothing in this Clause constitutes or
should be understood to constitute a waiver of Underwriters' rights to commence an action in any Court of
competent jurisdiction in the United States, to remove an action to a United States District Court, or to seek
a transfer of a case to another Court as permitted by the laws of the United States or of any State in the
United States. It is further agreed that service of process in such suit may be made upon
Mendes & Mount

750 Seventh Avenue
New York, NY 10019
U.S.A.
Foley & Lardner LLP (if California)

555 California Street, Suite 1700
San Francisco, CA 94104-1520
U.S.A.
Locke Lord LLP (if Illinois)

111 South Wacker Drive
Chicago, Illinois 60606
U.S.A.
and that in any suit instituted against any one of them upon this contract, Underwriters will abide by the final
decision of such Court or of any Appellate Court in the event of an appeal.
The above-named are authorized and directed to accept service of process on behalf of Underwriters in any
such suit and/or upon the request of the Insured (or Reinsured) to give a written undertaking to the Assured
(or Reinsured) that they will enter a general appearance upon Underwriters' behalf in the event such a suit
shall be instituted.
Further, pursuant to any statute of any state, territory or district of the United States which makes provision
therefore, Underwriters hereon hereby designate the Superintendent, Commissioner or Director of
Insurance or other officer specified for that purpose in the statute, or his successor or successors in office,
as their true and lawful attorney upon whom may be served any lawful process in any action, suit or
proceeding instituted by or on behalf of the Assured (or Reinsured) or any beneficiary hereunder arising out
of this contract of insurance (or reinsurance), and hereby designate the above-named as the person to
whom the said officer is authorized to mail such process or a true copy thereof.
NMA 1998
12
Re: NYEEM WARTMAN
NUCLEAR/RADIOACTIVE EXCLUSION CLAUSE
This insurance does not cover claims in any way caused or contributed to by:
Nuclear reaction, nuclear radiation or radioactive contamination
LSW1210
13
Re: NYEEM WARTMAN
SEVERAL LIABILITY NOTICE
The subscribing insurers obligations under contracts of insurance to which they subscribe are several
and not joint and are limited solely to the extent of their individual subscriptions. The subscribing
insurers are not responsible for the subscription of any co-subscribing insurer who for any reason does
not satisfy all or part of its obligations.
08/94
LSW1001 (Insurance)
14
Re: NYEEM WARTMAN
SANCTION LIMITATION AND EXCLUSION CLAUSE
No (re)insurer shall be deemed to provide cover and no (re)insurer shall be liable to pay any claim or
provide any benefit hereunder to the extent that the provision of such cover, payment of such claim or
provision of such benefit would expose that (re)insurer to any sanction, prohibition or restriction under
United Nations resolutions or the trade or economic sanctions, laws or regulations of the European Union,
United Kingdom or United States of America.
LMA3100
15 September 2010
15
Re: NYEEM WARTMAN
POLICY MODIFICATIONS
ENDORSEMENT NO. 01
Name of Insured Person: NYEEM WARTMAN
Policy Modifications: The Policy is amended by the addition of the following:

Recurrent Disability Period and Rehabilitation Period shall be:
If, following Total Disability, the Insured Person Participates in his or her Intended Occupation for four (4)
or more games during the Regular Season or Postseason and/or play-off or championship games, any
Total Disability beginning thereafter will constitute a separate and distinct Total Disability, subject to all
the provisions of this Policy
If the Insured Person Participates in his or her Intended Occupation for less than four (4) games during
the Regular Season or Postseason and/or play-off or championship games, any subsequent Total
Disability arising out of the same Injury, Sickness or Disease will be deemed a part of the prior Total
Disability solely for purposes of determining the Elimination Period.
A separate Elimination Period shall be required if the subsequent disability results from an Injury,
Sickness or Disease that is unrelated to the Injury, Sickness or Disease resulting in the prior Total
Disability.
Additional Premium: N/A

Return Premium: N/A
Date of Issue: September 6, 2016
ENDORSEMENT: This endorsement forms a part of Policy No. B1132HGBA16062100 and is effective
August 9, 2016. This endorsement does not vary, waive, alter or extend any of the terms, conditions, or
provisions of the Policy, except as stated herein.
Signed for International Specialty Insurance, Inc.
Authorized Representative
16
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
One$Lime$Street$London$EC3M$7HA$

Wartman v. International Specialty Insurance Court Documents

Загружено:

Сведения о документе

Авторское право

Доступные форматы

Поделиться этим документом

Поделиться или встроить документ

Параметры публикации

Этот документ был вам полезен?

Это неприемлемый материал?

Авторское право:

Доступные форматы

Wartman v. International Specialty Insurance Court Documents

Загружено:

Авторское право:

Доступные форматы

Case 4:17-cv-00871-MEM Document 1-1 Filed 05/17/17 Page 1 of 22

Notice to Policyholder: This policy is written by a domestic surplus lines insurer, an

This Certificate is issued in accordance with the

The Assured is requested to read this Certificate, and if

All inquiries regarding this Certificate should be addressed to the

110 Oakwood Drive #420

SLC-3 (USA) NMA2868 (24/08/00)

Short Rate Cancellation Table For Term of One Year

1. Name and Address of the Assured:

2. Effective from August 09, 2016 to August 01, 2017

both days at 12:01 a.m. standard time.

3. Insurance is effective with certain UNDERWRITERS AT LLOYDS, LONDON

4. Amount Coverage Rate Premium

5. Forms attached hereto and special conditions: As Per the Attached

6. Service of Suit may be made upon:

Mendes & Mount Foley & Lardner LLP (if California)

Dated September 06, 2016

Assured: NYEEM WARTMAN

Address of Assured: c/o KPM Sports

Intended Occupation: Professional Football Player

Policy Term: From: 12:01 a.m. August 9, 2016

Limit of Indemnity: Interest Section A. $500,000.00

Premium: $8,000.00 base premium

Interest: This Insurance is to indemnify the Assured:

B. the Limit of Indemnity if the Assured suffers a Permanent Total Disability

C. the Limit of Indemnity if the Assured suffers Accidental Death

UNDERWRITING REQUIREMENTS: Application Form Dated: TBA

CONDITIONS: ISI wording as agreed by the Company

FORMS ATTACHED HERETO

1. Completed Application form

Underwriters reserve the right based on medical

INFORMATION: Date of Birth: December 16, 1992

B. with respect to Interest section B, bodily injury sustained by the Assured

A. with respect to Interest section A, illness first manifested in the Assured

B. with respect to Interest section B, illness first manifested in the Assured

Physician means a licensed healthcare practitioner, other than the Assured or

Compensation means money, property, investments, loans, options or

Signing Bonus means Compensation, regardless of when paid, for signing a

Reporting Bonus means Compensation, for reporting to training camp or any

Performance Bonus means Compensation, contingent upon the Assured

Offer means a proposal, oral or written, to play Football for a Professional

Professional Football Team means a recognized Professional Football Team

Elimination Period means twelve (12) consecutive months of the Assured

Permanent Total Disability means that solely and directly as a result of an

Warranties: The Assured warrants that at inception of this Insurance he:

1. knows of no matter, fact or circumstance likely to give rise to a claim

2. has never tested positive for the HIV virus;

3. has never tested positive for steroid use;

2. It is understood and agreed that this Insurance is subject to receipt and

3. Any word or expression to which a specific meaning has been attached

4. Any fraud, misstatement or concealment in the information provided to

7. It is understood and agreed that no other insurance shall be effected by

8. The premium and any expense incurred in the formulation of a claim

9. This Insurance may be cancelled at any time by the Assured by writing to

and off-season, subject to the Minimum Earned Premium, provided no

12. It is understood and agreed that a) with respect to Interest Section A

13. It is understood and agreed that once a Professional Football Team

15. The subscribing insurers' obligations under contracts of insurance to

Whenever or wherever reference is made to "insurers" in this condition,

1. any fraud, misrepresentation or concealment by the Assured.

3. Death or Injury sustained by the Assured while intoxicated, provided that

4. the Assured committing or attempting to commit a felonious act, as

5. the Assured not receiving an Offer from a Professional Football Team

7. the Assureds mental, nervous or psychological disease or disorder.