Page 37 - Applied Plastics - Post Enrollment Binder

Accidental Death & Dismemberment

Insurance – Description of Coverage

Policyholder: Bank Newport, as Trustee of G.A.R.D Trust
Coverage

This plan coverage is offered to your employer, who as a member of the Trust is the policyholder, and all employees within
designated groups will be eligible for coverage as Insured Persons under the master group policy. Insured Persons are
covered for Accidental Death and Dismemberment (AD&D) which pays a benefit if a covered accident results in loss of life,
limb, sight, speech or hearing. Insured Persons are also covered if an accident results in quadriplegia (complete and
irreversible loss of all motion and all practical use of both arms and both legs), paraplegia (complete and irreversible loss of
all motion and all practical use of both legs), hemiplegia (complete and irreversible loss of all motion and all practical use
of one arm and one leg on the same side of the body) or uniplegia (complete and irreversible loss of all motion and all
practical use of one arm or one leg) which lasts longer than 365 days. Insured Persons are covered 24 hours a day, 365 days a
year, anywhere in the world.

The Maximum AD&D Principal Sum amount is equal to: $10,000
• 100% is payable for accidental loss of life, two or more members, sight of both eyes, speech and hearing or any
combination thereof, or loss of use of both arms and both legs.
• 50% is payable for accidental loss of one member, sight of one eye, speech or hearing, or loss of use of one arm or one
leg or both hands or both feet or a combination of a hand and a foot.
• Member means hand or foot.
• 25% is payable for the accidental loss of the thumb and index finger of the same hand, or loss of use of one hand or
one foot.

Loss means as respects the hand, complete severance through or above the knuckle joints of at least 4 fingers on the same
hand; with respect to the foot, complete severance through or above the ankle joint.

Beneficiary

Benefit for loss of life is payable to the beneficiary designated by the Insured, or if no such designation, then to the first
surviving class in the following order: a) the Insured’s spouse, b) in equal shares to the Insured’s surviving children, c) in
equal shares to the Insured’s surviving parents, d) in equal shares to the Insured’s surviving brothers and sisters, e) the
estate of the Insured. All other benefits payable under the policy are payable to the Insured.

Exclusions

Insurance does not apply to any Accident, Accidental Bodily Injury or Loss when the United States of America has imposed
any trades sanctions prohibiting the insurance, or there is any other legal prohibition against providing the insurance. In
addition no benefits will be paid for any Accident, Accidental Bodily Injury or Loss caused by or resulting from any of the
following: loss occurring while an Insured is in, entering, or exiting any aircraft owned, leased or operated by the
Policyholder or any aircraft owned, leased or operated by an employee of the Policyholder on the Policyholder’s behalf;
loss occurring while an Insured is in, entering, or exiting any aircraft while acting or training as a pilot or crew member;
loss caused by or resulting from an Insured's emotional trauma, mental or physical illness, disease, pregnancy, childbirth
or miscarriage, bacterial or viral infection or bodily malfunctions; suicide, attempted suicide or loss that is intentionally
self-inflicted; loss caused by or resulting from a declared or undeclared war.
Effective Date

Coverage is valid for 12 Months from the enrollment date and will cease on the date the master policy is terminated.

As a handy reference guide, please read this and keep it in a safe place with your other documents. This Description of
Coverage is not a contract of insurance but is simply an informative statement of the principal provisions of the insurance
while in effect. Complete provisions pertaining to this plan of insurance are contained in the master policy on file with the
Policyholder. Bank Newport, as Trustee of G.A.R.D Trust. If, a statement in this Description of Coverage and any provision
of the Policy differ, the policy will govern.
Accidental Death & Dismemberment Insurance ID Card
Agent: Resolution Reinsurance Intermediaries LLC 4408
Forest Drive, Suite 202, Columbia, SC 29206
Underwritten by: Federal Insurance Company, a member Name of Insured:
insurer of the Chubb Group of Insurance Companies 15 Policyholder: Bank Newport, As Trustee of G.A.R.D Trust
Mountain View Road, Warren, NJ 07059 Policy Number: 9907-24-66
This coverage is sponsored by Colonial Life and Underwritten Coverage valid for 12 months from enrollment date
by Chubb. For any inquiries regarding Colonial Life products, Effective Date: First effective date after defined enrollment period
please call 800-325-4368. Contact claims/policy information: 800.656.6267

The above person has been insured under a policy issued by Federal
Form: 44-01-0224 (Ed. 2/15) Insurance Company, subject to the terms and provisions of the policy.