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HomeMy WebLinkAboutInsurance Certificate: Shea Carr & Jewell Inc Client#: 116497 SHEACARR ACORDm CERTIFICATE OF LIABILITY INSURANCE 6/17/2D DD/YWY) 6/17/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). _ - - - - - - _ PRODUCER.:' - CONTACT. NAME: Sandy-Kulseth PropeLlnsurancec--` (AIC,N E,n:3602522368 A/c NO,.360.7547537...... PHON, Olympia Commercial lnsurenceADDRESS: sjk@propelinsurance.com - P.O. Box 2007. _ INSURERS) AFFORDING COVERAGE . NAIC It Olympia, WA 98507, INSURER A: Transportation Insurance Comp. INSURED INSURER B: Continental Casualty Company 20443 Shea, Carr & Jewell Inc INSURER C: Continental Insurance Company 2102 Carriage Dr SW # H INSURER D: Beazley Insurance Company Olympia, WA 98502 INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT; TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE NADDLSUBR SR MD POLICY NUMBER MM/DICY EFF MM/DCD/(YYYYY LIMITS A GENERAL LIABILITY Y Y 2090667295 6/15/2013 06/151201 EACH MIS~COCCURRENCE $2 000 000 X COMMERCIAL GENERAL LIABILITY PREESOEaEoNaT.uEnence E300 OOO CLAIMS-MADE a OCCUR - - MED EXP (An one person) $10,000 - - - - - - PERSONAUS ADV INJURY s2,000,000 - GENERAL AGGREGATE - E4,000 000 - - "--"--PRODUCTS-COMP/OP AGG $4,000,000°---- GEN'L AGGREGATE LIMRAFPLIES PER ' POLICY X FE LOC Y AUTOMOBILE E LIABILITY_ ^ --y ;Y, 4012152794 6/15/2013 061151201 EdaacccidentSINGLELIMIT $11,000,000,- ANY ANY AUTO BODILY INJURY liner person) $ ALL OWNED SCHEDULED r BODILY INJURY (Per accident) $ AUTOS'. AUTOS . - HIRED AUTOS X NON-OWNED - - - - PROPERTY DAMAGE E AUTOS Per acdtlent $ B X UMBRELLA LIAR X OCCUR 4016629451 6115/2013 06/15/201 EACH OCCURRENCE S3 000 000 EXCESS DAB CLAIMS-MADE AGGREGATE s3,000,000 DED RETENTIONS $ WORKERSCOMPENSATION WA STATE FUND A NA WC STATU. FORTH- AND EMPLOYERS' LIABILITY A ANY PROPRIETOWPARTNERIEXECUTNE Y/ N 2090667295 611512013 06/15/2014 E.L. EACH ACCIDENT $1 000 000 OFFICER/MEMBER EXCLUDED? N N/A (Mandatory in NH) (WA STOP GAP) E.L. DISEASE - EA EMPLOYEE 31,000000 If yes, describe antler DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1,000,000 D Professional VlOBC2120301 611712013 061171201 $1,000,000 each claim Liability $2,000,000 Aggregate I [I Ded:$50 000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ANach ACORD 101, Additional Remarks Schedule, N morespace Is required) Additional Insureds: The City of Ashland, Oregon and its elected officials, officers and employees. CERTIFICATE HOLDER CANCELLATION City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 East Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) 1 Of 1 The ACORD name and logo are registered marks of ACORD #S1 I GM2/M1159924 KRG00 This page has been left blank intentionally. + snea, Carr a ie ell me r.yns..` 2090667296 SB-146968-A C/VA (Ed. 01/06) IMPORTANT: THIS ENDORSEMENT CONTAINS DUTIES THAT APPLY TO THE ADDITIONAL INSURED IN THE EVENT OF OCCURRENCE, OFFENSE, CLAIM OR SUIT. SEE PARAGRAPH C., OF THIS ENDORSEMENT FOR THESE DUTIES. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED ENDORSEMENT WITH PRODUCTS-COMPLETED OPERATIONS COVERAGE 8r BLANKET WAIVER OF SUBROGATION Architects, Engineers and Surveyors This endorsement modifies insurance provided under the following: BUSINESSOWNERS LIABILITY COVERAGE FORM BUSINESSOWNERS COMMON POLICY CONDITIONS A. WHO IS AN INSURED (Section C.) of the 4. The insurance provided to the additional insured Businessowners Liability Coverage Form is does not apply to "bodily injury," "property amended to include as an insured any person or damage," "personal and advertising injury" organization whom you are required to add as an arising out of an architect's, engineer's, or additional insured on this policy under a written surveyor's rendering of or failure to render any contract or written agreement; but the written professional services including: contract or written agreement must be: a. The preparing, approving, or failing to 1. Currently in effect or becoming effective during prepare or approve maps, shop drawings, the term of this policy; and opinions, reports, surveys, field orders, 2. Executed prior to the "bodily injury," "property change orders or drawings and damage," or "personal and advertising injury." specifications by any architect, engineer or surveyor performing services on a project of B. The insurance provided to the additional insured is which you serve as construction manager; limited as follows: or 1. That person or organization is an additional b. Inspection, supervision, quality control, insured solely for liability due to your negligence engineering or architectural services done specifically resulting from "your work" for the by you on a project of which you serve as additional insured which is the subject of the construction manager. written contract or written agreement. No 5. This insurance does not apply to "bodily injury," coverage applies to liability resulting from the "property damage," or "personal and advertising sole negligence of the additional insured. - injury" arising out of: 2. The Limits of Insurance applicable to the a. The construction or demolition work while additional insured are those specified in the you are acting as a construction or written contract or written agreement or in the demolition contractor. This exclusion does Declarations of this policy, whichever is less. not apply to work done for or by you at your These Limits of Insurance are inclusive of, and premises. not in addition to, the Limits of Insurance shown in the Declarations. C. BUSINESSOWNERS GENERAL LIABILITY 3. The coverage provided to the additional insured CONDITIONS - Duties In The Event of within this endorsement and section titled Occurrence, Offense, Claim or Suit (Section E.2.) LIABILITY AND MEDICAL EXPENSE of the Businessowners Liability Coverage Form is DEFINITIONS - "Insured Contract" (Section amended to add the following: F.9.) within the Businessowners Liability An additional insured under this endorsement will as Coverage Form, does not apply to "bodily injury' soon as practicable: or "property damage" arising out of the 1. Give written notice of an occurrence or an products-completed operations hazard" unless offense to us which may result in a claim or required by the written contract or written "suit" under this insurance; agreement. SB-146968-A Page 1 of 2 (Ed. 01/06) snea, carr & deweu me 2090667295 SB-14 01/06) CMA (Ed. 01/06) 2. Tender the defense and indemnity of any claim insured against that "suit" If no other insurer or_"suit" to.us for loss we cover. under. this. , defends, we will undertake to do so, but we will Coverage Part;, • be entitled to the additional insured's rights 3. Tender thedefense and indemnity of any claim against all-those other insurers. or "suit" to any other insurer which also has._..._;:... . When this, insurance Js excess. over.other._, insurance for a loss we cover under this insurance, we will pay' only our'hare of the Coverage Part; and : amount.of the loss, if any, that exceeds the sum 4. Agree to make available any other insurance of: which the additional insured has for a loss we (a) The total amount that all such other cover under this Coverage Part. insurance would pay for the loss in the We have no duty to defend or indemnify an absence of this insurance; and additional insured under this endorsement until we (b) The total of all deductible and self-insured receive written notice of a claim or "suit" from the amounts under all that other insurance. additional insured. We will share the remaining loss, if any, with D. OTHER INSURANCE (Section H. 2. & 3.) of the any other insurance that is not de'§c~ibed-in this Businessowners Common Policy Conditions are Excess Insurance provision and was not bought deleted and replaced with the following: specifically to apply in excess of the Limits of 2. This insurance is excess over any other Insurance shown in the Declarations of this Coverage insurance naming the additional insured as an Part. insured whether primary, excess, contingent or E. TRANSFER OF RIGHTS OF RECOVERY on any other basis unless a written contract or AGAINST OTHERS TO US (Section K.2.) of the written agreement specifically requires that this Businessowners Common Policy Conditions is insurance be either, primary or primary and deleted and replaced with the following: noncontributing to the additional'insured's own -coverage. .This insurance is excess over any 2• , We h6hie"6ny right, of recovery.we.may have other insurance to which the additional insured against any.person or organization' against whom has been added as. an additional insured by you have agreed to waive such right of recovery in a -endorsement. . written contract or agreement' because of payments we make for injury or damage arising out of your 3. When this insurance is excess, we will have no ongoing operations or "your work" done under a duty under Coverages A or B to defend the contract with that person or organization and additional insured against any "suit" if any other included within the "products-completed operations insurer has a duty to defend the additional hazard." SB-146968-A Page 2 of 2 (Ed. 01/06) rv~vvv. rvv 4 1i~~~1 CNA SB-146932-E (Ed. 06/11) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ"IT CAREFULLY. BLANKET ADDITIONAL INSURED LIABILITY EXTENSION This endorsement=modifies insurance provided under the following: BUSINESSOWNERS LIABILITY COVERAGE FORM - " Coverage afforded, under this extension of coverage endorsement does not apply to any person or organization covered as an additional insured on any other endorsement now or hereafter attached to this Policy. 1. ADDITIONAL INSURED - BLANKET VENDORS h. "Bodily injury" or "property damage" arising WHO IS AN INSURED is amended to include as an out of the sole negligence of the vendor for additional insured any person or organization its own acts or omission or those of its (referred to below as vendor) with whom you employees anyone else acting its agreed, because of a written contract or agreement behalf. However, this, exclusion does s not to provide insurance, but only with respect to "bodily apply to: injury' or "property damage" arising out of "your (1) The exceptions contained in products" which are distributed or sold in the regular Subparagraphs d. or f.; or course of the vendor's business, subject to the following additional exclusions: (2) Such inspections, adjustments, tests or servicing as the vendor has agreed to 1. The insurance afforded the vendor does not make or normally undertakes to make apply to: in the usual course of business, in a. "Bodily injury" or. "property damage" for connection with the distribution or sale which the vendor is obligated to pay of the products. ' damages' by reason of the' assumption of .2. This insurance does not apply.to any insured liability', in_ a' 'contract 'or agreement. This person or. organization,' from whom you have exclusion` does not' apply' to liability for acquired such products, or any ingredient, part damages that the vendor would have in the or container, entering into, accompanying or absence of the contract or agreement; containing such products. b. Any express warranty unauthorized by you; 3. This provision 2. does not apply to any vendor c. Any physical or chemical change in the included as an insured by an endorsement product made intentionally by the vendor; issued by us and made a part of this Policy. d. Repackaging, except when unpacked solely 4. This provision 2. does not apply if "bodily injury" for the purpose of inspection, or "property damage" included within the "products demonstration, testing, or the substitution of -completed operations hazard" is under instructions from the excluded either by the provisions of the Policy or parts manufacturer, and then repackaged in the by endorsement. original container, 2. MISCELLANEOUS ADDITIONAL INSUREDS e. Any failure to make such inspections, WHO IS AN INSURED is amended to include as an adjustments, tests or servicing as the insured any person or organization (called additional vendor has agreed to make or normally insured) described in paragraphs 2.a, through 2.h. undertakes to make in the usual course of below whom you are required to add as an business, in connection with the distribution additional insured on this policy under a written or sale of the products; contract or agreement but the written contract or f. Demonstration, installation, servicing or agreement must be: repair operations, except such operations 1. Currently in effect or becoming effective during performed at the vendor's premises in the term of this policy; and connection with the sale of the product; 2. Executed prior to the "bodily injury," "property g. Products which, after distribution or sale by damage" or "personal and advertising injury," you, have been labeled or relabeled or used but as a container, part or ingredient of any Only the following persons or organizations are other thing or substance by or for the additional insureds under this endorsement and vendor; or coverage provided to such additional insureds is limited as provided herein: SB-146932-E Page 1 of 5 (Ed. 06/11) CNA SB-146932-E (Ed. 06/11) a: Additional insured' =Your Work (b) The: •constntction,~ Erection, or That person or organization for whom you removal of elevators; or do work is an additional. insured solely for (2) This insurance applies only with respect liabilitydue to your ,negligenc.e specifically to operations-performed,by you or on resultirlg4rom your work for-fhe additional .your.• behalf; ,for-; which.; the state or insured which is,the.subject of the written political subdivision.has issued a permit. contract or. written agreement. No coverage This insurance does not apply to "bodily applies to liability resulting from the sole injury," "property damage" or "personal and negligence of the additional insured. advertising injury" arising out of operations The insurance provided to the additional performed for the state or municipality, insured is limited as follows: c. Controlling Interest (1) The Limits of Insurance applicable to Any persons or organizations with a the additional insured are those controlling interest in you but only with specified in the written contract or written agreement or in the Declarations respect to their liability arising out of. of this policy, whichever is less. These (1) Their financial control of you; or Limits of Insurance are inclusive of, and not in addition to, the Limits of (2) Premises they own, maintain or control Insurance shown in the Declarations. while you lease or occupy these premises. (2) The coverage provided to the additional insured by this endorsement and This insurance does not apply to structural paragraph F.1: of , the• definition of alterations, new construction and demolition "insured contract" under Liability and operations performed, b'y ;or for such additional insured. ""Medical Expenses Definitions do not apply to "bodily injury" or "property _ d.' Managers or Lessors of.Premises damage'.' arising. out. of the "products- completed operations hazard" unless A manager or lessor, premises but only required 'by the -written contract or with respect to :liability arising out of the iNritteh agreemenf. ownership, maintenance, or use of that specific part of the premises leased to you (3) The insurance provided to the additional and subject to the following additional insured does not apply to "bodily injury," exclusions: "property damage," or "personal and advertising injury" arising out of the This insurance does not apply to: rendering or failure to render any (1) Any "occurrence" which takes place professional services. after you cease to be a tenant in that b. State or Political Subdivisions premises; or A state or political subdivision subject to the (2) Structural alterations, new construction following provisions: or demolition operations performed by or on behalf of such additional insured. (1) This insurance applies only with respect to the following hazards for which the e. Mortgagee, Assignee or Receiver state or political subdivision has issued A mortgagee, assignee or receiver but only a permit in connection with premises with respect to their liability as mortgagee, you own, rent, or control and to which assignee, or receiver and arising out of the t his insurance applies: ownership, maintenance, or use of a (a) The existence maintenance, repair, premises by you: - construction, erection, or removal of This insurance does not apply to structural r " advertlsin si ns;' awnings, . . alterations Cnew coristructwn_oi .demolition canopies,-cellar "entrances, coal operations performed by or for- such holes; c , driveways, manholes, additional insured.. . marquees, hoistaway openings, sidewalk vaults, street banners, or f. Owners/Other Interests - Land is Leased decorations and similar exposures; An owner or other interest from whom land or has been leased by you but only with respect to liability arising out of the ownership, maintenance or use of that SB-146932-E Page 2 of 5 1Ed.06/111 CNA S (Ed. 032-) (Ed. 06/11) specific part of.the land leased to you and a written contract-or written agreement subject to the* following additional specifically requires'ttiat this-insurance exclusions: be either primary' or primary and . noncontr ibuting. This insurance does not apply to: , (1) Any' occurrence" which takes place A LEGAL LIABILITY .DAMAGE TO PREMISES = after:you'cease to lease that land; A. 'Under B. Exclusions; "1.~'Applicable to or Business'Liability-Coverage; Exclusion k. (2) Structural alterations, new Damage To Property, is replaced by the construction or demolition following: operations performed by or on k. Damage To Property behalf of such additional insured. "Property damage" to: g. Co-owner of Insured Premises 1. Property you own, rent or occupy, A co-owner of a premises co-owned by you including any costs, or expenses and covered under this insurance but only incurred by you, or any other with respect to the co-owners liability as co- person, organization or entity, for owner of such premises. repair, replacement, enhancement, h. Lessor of Equipment restoration or maintenance of such property for any reason, including Any person or organization from whom you prevention of injury to a person or lease equipment. Such person or damage to another's property; organization are insureds only with respect 2. Premises you sell, give away or to their liability arising out of the maintenance, operation 'or use, by you of abandon, if the "property damage" equipment leased'to you by such person or ,.arises but of any part of those ;organization. A.person's or organization's premises; status ,as an insured under this ° I` Property loaned'to you; endorsement ' ends . when their written contract or agreement with you for such Personal property in the care, leased equipment ends. - custody or control of the insured; With respect to the insurance afforded 6. That particular part of any real these additional insureds, the following property on which you or any additional exclusions apply: contractors or subcontractors working directly or indirectly in your This insurance does not apply: behalf are performing operations, if (1) To any "occurrence" which takes place the "property damage" arises out of after the equipment lease expires; or those operations; or (2) To "bodily injury," "property damage" or 6. That particular part of any property "personal and advertising injury" arising that must be restored, repaired or out of the sole negligence of such replaced because 'your work" was additional insured. incorrectly performed on it. Any insurance provided to an additional insured Paragraph 2 of this exclusion does not designated under paragraphs b. through h. apply if the premises are "your work" above does not apply to "bodily injury" or and were never occupied, rented or "property damage" included within the held for rental by you. "products-completed operations hazard." Paragraphs 1, 3, and 4, of this I The following is added to.Paragraph- H. of the exclusion do, not apply to "property BUSINESSOWNERS ; COMMON POLICY damage" (other than damage by fire or explosion) , to premises: CONDITIONS: ; . H. Other Insurance (1) •rented to your- - 4. This insurance is excess over any other (2) temporarily occupied by you with insurance naming the additional insured the permission of the owner, or as an insured whether primary, excess, (3) to the contents of premises rented contingent or on any other basis unless to you for a period of 7 or fewer consecutive days. SB-146932-E Page 3 of 5 (Ed. 06/11) CNA SB-146932-E (Ed. 06111) _ ;A separate limit of insurance applies to "occurrence," offense, 'claim- or "suit' is Damage To Premises Rented To You known to: as described in Section D - Liability and (1) You or any additionaLinsured that is an Medical'Expenses Limits of Insurance. individual; Paragraphs .3, 4,. 5,, and 6_of this exclusion do not apply" to liability (2) Any partner, -if you `'or an 'additional assumed under a'sidetrack agreement. insured is a partnership; Paragraph 6 of this exclusion does not (3) Any manager, if you or an additional apply to "property damage" included in insured is a limited liability company; the "products-completed operations (4) Any "executive officer" or insurance hazard" manager, if you or an additional insured B. Under B. Exclusions, 1. Applicable to is a corporation; Business Liability Coverage, the last (5) Any trustee, if you or an additional paragraph of 2. Exclusions. is deleted and insured is a trust; or.. replaced by the following: (6) Any elected or appointed official, if you Exclusions c, d, e, f, g, h, I, k, I, m, n, and or an additional insured is a political o, do not apply to damage by fire to subdivision or public entity. premises while rented to you or temporarily occupied by you with permission of the This paragraph e. applies separately to you owner or to the contents of premises rented and any additional insured. to you for a period of 7 or fewer consecutive 7, Bodily Injury days. A separate limit of insurance applies to this coverage as described in Section D. Section F. Liability and Medical Expenses Liability And Medical Expenses Limits Of Definitions, item 3. "Bodily Injury" is deleted insurance. and replaced with the following: C. The first Paragraph under item 5. Damage "Bodily injury" means bodily injury, sickness or To Premises Rented To You Limit of disease sustained by a person, including death, Section D. Liability And Medical humiliation, shock, mental anguish or mental Expenses Limits Of Insurance is replaced injury by that person at any time which results by the following: as a consequence of the bodily injury, sickness or disease. The most we will pay under Business Liability for damages because of "property 6. Expanded Personal and Advertising Injury damage" to any one premises, while Definition rented to you, or temporarily occupied by a. The following is added to Section F. you, with the permission of the owner, Liability and Medical Expenses including contents of such premises rented Definitions, item. 14. Personal and to you for a period of 7 or fewer consecutive Advertising Injury, in the days, is the Damage to Premises Rented to Businessowners General Liability You limit shown in the Declaration. Coverage Form: 5. Blanket Waiver of Subrogation h. Discrimination or humiliation that results in We waive any right of recovery we may have injury to the feelings or reputation of a against: natural person, but only if such discrimination or humiliation is: a. Any person or organization with whom you have a written contract that requires such a 1. Not done intentionally by or at the waiver. direction of: 6. Broad Knowledge of Occurrence a. The insured; or The following items are added to E. b. Any "executive officer," director, Businessowners General Liability stockholder, partner, member or Conditions in the Businessowners Liability manager (if you are a limited liability Coverage Form: company) of the insured; and e. Paragraphs a. and b. apply to you or to any 2. Not directly or indirectly related to the additional insured only when such employment, prospective employment, past employment or termination of SS-146932-E Page 4 of 5 1Ed. 061111 CNA SB-146932-E (Ed. 06/11) employment of,any,person or person by c. This provision (Expanded Personal and any insured. Advertising " Injury)' does, not apply if b. The following. is,. added .to, Exclusions, Personal and Advertising Injury Liability Section B.: is. excluded either by the provisions of the Policy or by endorsement: (15)Discrimination . Relating to Room, 9, personal and Advertisin Inju Re-defined Dwelling or Premises g ry . Caused by discrimination directly or Section F. Liability and. Medical Expenses indirectly related to the sale, rental, Definitions, item 14, Personal Advertising Injury, lease or sub-lease or prospective sale, Paragraph c. is replaced by the following: rental, lease or sublease of any room, c. The wrongful eviction from, wrongful entry dwelling or premises by or at the into, or invasion of the right of private direction of any insured. occupancy of a room dwelling or premises (16)Fines or Penalties that a person or organization occupies committed by or on behalf of its owner, Fines or penaft es'lev'ied or imposed by "landlord or lessor. a governmental entity because of discrimination. SB-146932-E Page 5 of 5 (Ed. 06/11) _T G O C v C X _L G d N L N A s on m n y s F POLICY NUMBER: 4012152794 COMMERCIAL AUTO CA 04 44 03 10 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: Shea, Carr & Jewell Inc Endorsement Effective Date: 06/15/2013 SCHEDULE Name(s) Of Person(s) Or Organization(s): Any person or organization as required by written contract Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us Condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization. CA 04 44 03 10 Copyright, Insurance Services Office, Inc., 2009 Page 1 of 1 This page has been left blank intentionally.