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Dwellings, Private Structures Special Form California Department of Veterans Affairs
Form A
Dwellings, Private Structures
Special Form
California Department of Veterans Affairs
TO REPORT A LOSS: CALL SAMS & ASSOCIATES 1-800-626-1613
OR 916 368-7267
FOR GENERAL INFORMATION CALL CALIFORNIA DEPARTMENT
OF VETERANS AFFAIRS
TOLL FREE 1-800-952-LOAN (5626)
ISSUED UNDER MASTER EXCESS INSURANCE POLICY ISSUED
TO THE CALIFORNIA DEPARTMENT OF VETERANS AFFAIRS
(herein after called CDVA) for the period October 31, 2006 to
October 31, 2007
This Form A and the Annual CDVA Insurance Cer-
tificate (herein called Insurance Certificate) issued
to the Certificate Holder are issued subject to the
deductible(s), terms, conditions and provisions of
the Master Excess Insurance Policy issued to the
California Department of Veterans Affairs.
Insurance attaches only to those items specifi-
cally described in this Form A for which a specific
amount is shown on the Insurance Certificate. Un-
less otherwise provided, all conditions of this Form
A and the provisions of the Insurance Certificate
shall apply separately to each item covered.
Loss, if any, to be adjusted with and payable to the
California Department of Veterans Affairs, and the
Certificate Holder, as their interests may appear
under the terms and conditions as may be specified
by the California Department of Veterans Affairs.
Any loss hereunder shall not reduce the amount of
insurance under this Form A.
CERTIFICATE HOLDERS
DEDUCTIBLE CLAUSE
The Certificate Holder deductible is $250 each oc-
currence with respect to loss by any of the perils
insured against
The Certificate Holders Deductible Clause shall
apply separately for each occurrence covered
hereunder.
The Certificate Holders Deductible Clause shall
not apply to Additional Living Expense or Rental
Value coverage. 2
CDVA
Form A
Dwellings, Private StructuresSpecial Form
I. COVERAGE
This Form A insures the described Dwellings for Guar-
anteed Replacement Cost with limited building code
upgrades, all subject to the provisions and stipulations
of this Form A.
THIS COVERAGE DOES NOT APPLY TO PERSONAL
PROPERTY, HOUSEHOLD CONTENTS, PERSONAL
LIABILITY, WATER OR LAND, INCLUDING LAND
ON WHICH THE DWELLING IS LOCATED.
II. PERILS INSURED AGAINST
This Form A insures against risk of direct physical loss to
the property described in Section I. However, this Form
A does not insure against loss:
A. By wear and tear; deterioration; rust or mold; wet or
dry rot; contamination; smog; smoke, except sud-
den and accidental damage from smoke: smoke
from agricultural smudging or industrial operations;
mechanical breakdown; birds; bats, vermin; rodents;
insects or domestic animals; unless loss from a peril
not excluded in this Form A ensues, and then cover-
age under this Form A shall be provided only for such
ensuing loss.
B. By theft of any property: (1) which at the time of
loss is not an integral part of any Dwelling or Private
Structure or (2) from a Dwelling or Private Structure
in process of construction; unless loss from a peril
not excluded in this Form A ensues from theft or at-
tempted theft and then coverage under this Form A
shall be provided only for such ensuing loss.
C. By vandalism and malicious mischief, theft or at-
tempted theft, or glass breakage, if the described
Dwelling or Private Structure, had been vacant beyond
a period of 120 consecutive days immediately preced-
ing the loss; unless loss from a peril not excluded in
this Form A ensues, and then coverage under this Form
A shall be provided only for such ensuing loss.
D. To plumbing, heating or air conditioning systems or
domestic appliances or by leakage or overflow from
such systems or appliances, caused by or resulting
from freezing while the Dwelling or Private Structure
is vacant or while all occupants are absent therefrom
or while it is being constructed, unless the Certificate
Holder shall have exercised due diligence with respect
to maintaining heat in the Dwelling or Private Struc-
ture or unless such systems and appliances had been
drained and the water supply shut off.
E. To retaining walls not constituting part of a Dwelling
or Private Structure, piers, wharves or docks when
such loss is caused by pressure of weight of ice or
water, freezing, thawing or earth movement, unless
such loss is caused by collapse of any other structure,
as provided in SECTION VI - EXTENSIONS OF
COVERAGE, D. Collapse.
F. Loss or damage to foundations, walkways, cement
floors, sewer pipes, water pipes and gas pipes due
to tree roots causing cracking, lifting and bursting
from the pressure of tree roots unless such loss from
a peril not excluded in this Form A ensues, and then
coverage under this Form A shall be provided only
for such ensuing loss.
G. By settling, cracking, shrinking, gradual sinking,
bulging, or expansion of soil; damage resulting from
differential movement caused by seasonal volume
changes of the bearing soil underlying the structure.
H. Involving collapse, other than as provided in SEC-
TION VI - EXTENSION OF COVERAGE. D. Col-
lapse.
I. Excluded under SECTION III-ADDITIONAL EX-
CLUSIONS.
J. Intentional loss arising out of an act committed by
or at the direction of the Certificate Holder
III. ADDITIONAL EXCLUSIONS
A. This Form A does not insure against loss caused
directly or indirectly by any of the following. Such
loss is excluded regardless of any other cause or event
contributing concurrently or in any sequence to the
loss.
1. Earth movement, including but not limited to
earthquake, landslide, mudflow, earth sinking,
earth rising or shifting, unless fire or explosion as
insured against ensues, and then coverage under
this Form A shall be provided only for loss caused
by the fire or explosion.
2. Water damage, meaning any of the following:
a. Flood, surface water, waves, tidal water or
tidal wave, overflow of streams or other bod-
ies of water, or spray from any of the forego-
ing, all whether driven by wind or not;
b. Water which backs up through sewers or
drains; 
CDVA
Dwellings, Private StructuresSpecial Form Form A
c. Water below the surface of the ground includ-
ing that which exerts pressure on or other-
wise flows, seeps or leaks through sidewalks,
driveways, foundations, walls, basement or
other floors, or through doors, windows or
any other opening in such sidewalks, drive-
ways, foundations walls or floors;

unless loss by fire or explosion as insured against
hereunder ensues, and then coverage under this
Form A shall be provided only for such ensuing
loss.
3. War Risk and Governmental Action, meaning:

Hostile or warlike action in time of peace or war,
including action in hindering, combating or de-
fending against an actual, impending or expected
attack (1) by any government or sovereign power
(de jure or de facto), or by any authority maintain-
ing or using military, naval or air forces; or (2)
by military, naval or air forces; or (3) by agent of
any such government, power, authority or forces,
it being understood that any discharge, explosion
or use of any weapon of war employing nuclear
fission or fusion shall be conclusively presumed
to be such a hostile or warlike action by such a
government, power, authority or forces; insur-
rection, rebellion, revolution, civil war, usurped
power, or action taken by governmental author-
ity in hindering, combating or defending against
such an occurrence, seizure or destruction under
quarantine or customs regulations, confiscation
by order of any government or public authority,
or risks of contraband or illegal transportation or
trade.
4. Nuclear Hazard, to the extent set forth in the
Nuclear Clause and Nuclear Exclusion below.
Nuclear Clause: The word fire in this Form A
is not intended to and does not embrace nuclear
reaction or nuclear radiation or radioactive con-
tamination, all whether controlled or uncon-
trolled, and loss by nuclear reaction or nuclear
radiation or radioactive contamination is not
intended to be and is not insured against by this
Form A, whether such loss be direct or indirect,
proximate or remote, or be in whole or in part
caused by, contributed to, or aggravated by fire
or any other perils insured against by this Form
A.

However, subject to the foregoing and all provi-
sions of this Form A, direct loss by fire result-
ing from nuclear reaction or nuclear radiation or
radioactive contamination is insured against by
this Form A.

Nuclear Exclusion: Loss by nuclear reaction or
nuclear radiation or radioactive contamination, all
whether controlled, uncontrolled, or due to any
act or condition incident to any of the foregoing is
not insured against by this Form A, whether such
loss be direct or indirect, proximate or remote,
or be in whole or in part caused by, contributed
to, or aggravated by any of the perils insured
against by this Form A; and nuclear reaction or
nuclear radiation or radioactive contamination,
all whether controlled or uncontrolled, is not
explosion or smoke. This clause applies to
all perils insured against hereunder except the
peril of fire, which is otherwise provided for in
the nuclear clause above.
5. Absolute Pollution Exclusion: This Form A does
not apply to any loss, demand, claim or suit
arising out of or in any way related to pollution