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HomeMy WebLinkAboutInsurance Certificate: Butlers Glass Services, Inc. A"R" CERTIFICATE OF LIABILITY INSURANCE OATE(MMlDD/Y oz/zo/zo18 le 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 hoider is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or 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: Tom &a_ldunski Hart Insurance Agency PHONE FAX PO Box 1240 (A/C No ExO: (541) 779-4232 A/C No: (541) 772-3963 E-MAIL Grants Pass OR 97528 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC k INSURERA:Cincinnati Specialty underwrit 13037 INSURED (541) 773-5881 INSURER B: Cincinnati Insurance Company 10677 Butlers Glass Service Inc. INSURER C dba Bill's Glass INSURER D: 319 E McAndrews Road - - Medford OR 97501 INSURER E: _ INSURER F : COVERAGES CERTIFICATE NUMBER: Cert ID 6501 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR 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 - ADDL SUBR-- POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MMlDDlYYYY MMIDDIYYYY B X COMMERCIAL GENERAL LIABILrrY EACH OCCURRENCE $ 21000,000 CLAIMS-MADE IX I OCCUR Y III HPP 0374731 02/19/2018 02/19/2019 DAMAGE PREMISES TO Ea RENTED occurrence $ 500,000 i MED EXP (Any one person) $ 10 , 000 PERSONAL B ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 X POLICY JECO7 1:1 LOC PRODUCTS-COMP/OPAGG $ 4,000,000 P OTHER: Empl Benefits Liab $ 11000,000 AUTOMOBILE LIABILITY Ea aocideDISINGLE LIMIT $ 11000,000 B X•. ANYAUTO EBA 0374731 02/19/2018 02 /19/2 019 BODILY INJURY (Per person) $ I OWNED SCHEDULED AUTOS ONLY OS BODILY INJURY (Per accident) $ AUT HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) $ A UMBRELLA LIAB X OCCUR CS00086650 02/19/20181102/19/2019 EACH OCCURRENCE $ 11000,000 g EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED RETENTION$ A re ate $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY STATUTE ER ANYPROPRIETORIPARTNER/EXECUTIVE Ya li E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) E_._L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ i 5 $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) certificate holder is listed as additional insured per attached forms GA4720R and GA210 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. 90 N Mountain AUTHORIZED REPRESENTATIVE Ashland OR 97520 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OREGON AUTOMATIC ADDITIONAL INSURED - WHEN REQUIRED IN CONTRACT OR AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. For your work" performed in Oregon: 1. Automatic Additional Insured Pro- 1. SECTION II -WHO IS AN INSURED, 2. is vision amended to Include: The written or oral contract or agree- e. Any person or organization, hereinaf- ment must be currently in effect or become effective during the term of ter r refe referred to as ADDITIONAL IN- this Coverage Part The contract or agreement also must be executed (1) Who or which is not specificaiiy prior to the "bodily injury" "property named as an additional insured damage" or "personal and advertising under any other provision of, or injury" to which this endorsement per- endorsement added to, this tains. Coverage Part; and 2. Conformance to Specific Written (2) For whom you are required to Contract or Agreement add as an additional insured on If a written contract or agreement be- this Coverage Part tween you and the additional insured under: specifies that coverage for the addi- tional insured: (1) A written contract or agreement; or a. Be provided by the Insurance Services Office additional in- (2) An oral agreement or contract sured form number CG 32 61, where a certificate of insurance CG 32 62 or CG 32 63; or showing that person or organiza- tion as an additional insured has b. Indude coverage for completed been issued; operations; or but only to the extent that the liability c. Include coverage for your work"; is caused by your work" performed and where the limits or coverage pro- for that additional insured and only to vided to the additional insured is the extent that such liability is caused more restrictive than was specifically by your negligence or the negligence required in that written contract or of those acting on your behalf. A per- son or organization's status as an in- agreement, the terms of Paragraphs sured under this endorsement con- A3. and / or AA.b., or any combina- tinues for only the period of time re- tion thereof, of this endorsement shall be interpreted as providing the limits quired by the written contract or or coverage required by the terms of agreement, but in no event beyond the written contract or agreement, but the expiration date of this Coverage only to the extent that such limits or Part. If there is no written contract or coverage is included within the terms agreement, or if no period of time is of the Coverage Part to which this required by the written contract or endorsement is attached. agreement, a person or organiza- tion's status as an insured under this 3. SECTION III - LIMITS OF INSURANCE is endorsement ends when your opera- amended to Include: bons for that insured are completed. The limits applicable to the additional in- t. SECTION IV - COMMERCIAL GENERAL sured are those specified in the written LIABILITY CONDITIONS is amended to contract or agreement or in the Deciara- indude: tions of this Coverage Part, whichever are less. If no limits are specified in the written contract or agreement, or If there is no Includes copyrighted material of Insurance GA 472 OR 0910 Services Office, Inc., with its permission. Page 1 of 4 I written contract or agreement, the limits the "products-completed operations applicable to the additional insured are hazard". those specified in the Declarations of this c. "Bodily injury" or "property damage" Coverage Part. The limits of insurance arising out of "your work" for which a are inclusive of and not in addition to the g limits of insurance shown in the Dedara- consolidated (wrap-up) insurance bons program has been provided by the prime contractor / project manager or 4. The following are added to SECTION 1 - owner of the construction project In COVERAGES, COVERAGE A. BODILY which you are involved. INJURY AND PROPERTY DAMAGE U- 5. SECTION N -COMMERCIAL GENERAI. ABILITY, 2 Exclusions and SECTION I - LIABILITY CONDITIONS, 5. Other In- SONAL COVERAGES AND , COVERAGE ADVERTISING B. PER INJURY - surance is amended to include: LIABILITY, 2. Exclusions: a. Where ,required by a -'vwritten.cont,. is pn The insurance provided to the addiional qr agreement,=this insurance = insured does not apply to: maryand / or rionoontnbutoryas re- spells any other msurance'poluy is= a. "Bodily injury", "property damage" or sued to the additional insured and "personal and advertising Injury" arcs- 'such other rnsurance'`policy shall be ing out of the: exr_-ss and 1 or hpncontributing; :whicheyer applies, with this:. insuc- (1) Rendering of, or failure to ren- ;ahce; der, any professional services by you or on your behalf, but only b. Any insurance provided by this en- with respect to either or both of dorsement shall be primary to other the following operations: insurance available to the additional insured except: (a) Providing engineering, ar- chitectural or surveying ser- (1) As otherwise provided in SEC- vices to others; and TION N - COMMERCIAL GEN- ERAL LIABILITY CONDITIONS, (b) Providing or hiring inde- 5. Other Insurance, b. Excess pendent professionals to Insurance; or provide, engineering, archi- tectural or surveying ser- (2) For any other valid and collecti- vices in connection with ble insurance available to the construction work you per- additional Insured as an addi- form tional insured by attachment of an endorsement to another in- (2) Subject to Paragraph (3) below, surance policy that is written on professional services include: an excess basis. In such case, (a) Preparing, approving, or fail- the coverage provided under this ing to prepare or approve, endorsement shall also be ex- maps, shop drawings, opin- case ions, reports, surveys, field B. For "your work" performed in the "coverage orders, change orders, or territory" but not In Oregon: drawings and specifications; and 1. SECTION II -WHO IS AN INSURED, 2. is amended to include: (b) Supervisory or inspection activities performed as part e. Any person or organization, hereinaf- of any related architectural ter referred to as ADDITIONAL IN- or engineering activities. SURED: (3) Professional services do not in- (1) Who or which is not specifically clude services within construc- named as an additional insured tion means, methods, tech- under any other provision of, or niques, sequences and proce- endorsement added to, this dures employed by you in con- Coverage Part; and nection with construction work (2) For whom you are required to perform. you add as an additional insured on b. 'Bodily injury" or "property damage" this Coverage Part arising out of "your work" included in under: Includes copyrighted material of Insurance GA 472 OR 0910 Services Office, Inc., with its permission. Page 2 of 4 i i (1) A written contract or agreement; B.3., BA.b. and / or B.4.c., or any or combination thereof, of this en- (2) An oral agreement or contract dorsement shall be interpreted as where a certificate of insurance providing the limits or coverage re- showing that person or organize- quired by the terms of the written tion as an additional insured has contract or agreement, but only to the been issued; extent that such limits or coverage is included within the terms of the Cov- but only with respect to liability arising erage Part to which this endorsement out of "your work" performed for that is attached. If, however, the written additional insured by you or on your contract or agreement specifies the behalf. A person or organization's Insurance Services Office additional status as an insured under this en- Insured form number CG 20 10 but dorsement continues for only the pe- does not specify which edition, or riod of time required by the written specifies an edition that does not ex- contract or agreement, but in no ist, Paragraphs B.3. and B.4.b. of event beyond the expiration date of this endorsement shall not apply and this Coverage Part. If there Is no writ- Paragraph B.4.c. of this endorsement ten contract or agreement, or if no shall apply. period of time is required by the writ- 3. SECTION III - LIMITS OF INSURANCE is ten contract or agreement, a person amended to include: or organization's status as an insured under this endorsement ends when The limits applicable to the additional in- your operations for that insured are sured are those specified in the written completed. contract or agreement or in the Declara- tions of this Coverage Part, whichever are LIABILITY CONDITIONS is amended to less. If to limits are specified in the written include: contract or agreement, or if there is no written contract or agreement, the limits 1. Automatic Additional Insured Pro- applicable to the additional insurers are vision those specified in the Declarations of this Coverage Part. The limits of insurance The written or oral contract or agree- are inclusive of and not in addition to the ment must be currently in effect or limits of insurance shown in the Dedara- become effective during the term of tions. this Coverage Part. The contract or agreement also must be executed 4. The following are added to SECTION I - prior to the "bodily injury", "property COVERAGES, COVERAGE A. BODILY damage" or "personal and advertising INJURY AND PROPERTY DAMAGE LI- injury" to which this endorsement per- ABILITY, 2 Exclusions and SECTION I - tains. COVERAGES, COVERAGE B. PER- SONAL AND ADVERTISING INJURY 2. Conformance to Specific Written LIABILITY, 2 Exclusions: Contract or Agreement The Insurance provided to the additional If a written contract or agreement be- insured does not apply to. tween you and the additional insured specifies that coverage for the addi- a. "Bodily injury", "property damage" or tional insured: "personal and advertising injury" aris- ing out of the: a. Be provided by the Insurance Services Office additional in- (1) Rendering of, or failure to ren- sured form number CG 20 10 or der, any professional services by CG 20 37 (where edition spec- you or on your behalf, but only fied); or with respect to either or both of the following operations: b. Include coverage for completed operations; or (a) Providing engineering, ar- chitectural or surveying ser- c. Include coverage for "your worK; vices to others; and and where the limits or coverage pro- (b) Providing or hiring inde- vided to the additional insured is pendent professionals to more restrictive than was specifically provide, engineering, archi- required in that written contract or tectural or surveying ser- agreement, the terms of Paragraphs vices in connection with Includes copyrighted material of Insurance GA 472 OR 09 10 Services Office, Inc., with its permission. Page 3 of 4 construction work you per- program has been provided by the form. prime contractor / project manager or owner of the construction project in (2) Subject to Paragraph (3) below, which you are involved. professional services include: 5. SECTION N -COMMERCIAL GENERAL (a) Preparing, approving, or fail- LIABILITY CONDITIONS, 5. Other In- Ing to prepare or approve, surance is amended to include: maps, shop drawings, opin- ions, reports, surveys, field a. Where required by a written contract orders, change orders, or or agreement, this insurance is pri- drawings and specifications; mary and / or nonoontributory as re- and spells any other insurance policy is- sued to the additional insured, and (b) Supervisory or inspection such other insurance policy shall be activities performed as part excess and / or noncontributing, of any related architectural whichever applies, with this insur- or engineering activities. ance. (3) Professional services do not in- b. Any insurance provided by this en- clude services within construc- dorsement shall be primary to other tion means, methods, tech- insurance available to the additional niques, sequences and proce- insured except: dures employed by you in con- nection with construction work (1) As otherwise provided in SEC- you perform. TION N - COMMERCIAL GEN- b. "Bodily injury", "property damage" or ERAL LIABILITY CONDITIONS, 5. Other Insurance, b. Excess "personal and advertising injury" aria- Insurance; or ing out of the sole negligence or wili- ful misconduct of, or for defects in (2) For any other valid and coilecti- design furnished by, the additional in- ble insurance available to the sured or its "employees". additional Insured as an addi- tional insured by attachment of c. 'Bodily injury" or "property damage" an endorsement to another in- arising out of your work" included in suranoe policy that is written on the "products-completed operations an excess basis. In such case, hazard". the coverage provided under this d. Bodily injury" or "property damage" endorsement shall also be ex- arising out of "your work" for which a cess. consolidated (wrap-up) insurance I Includes copyrighted material of Insurance GA 472 OR 0910 Services Office, Inc., with Its permission. Page 4 of 4 I THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL GENERAL LIABILITY BROADENED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Endorsement - Table of Contents: Coverage: Begins on Page: 1. Employee Benefit Liability Co%erage ..................................................................................................2 2. Unintentional Failure to Disclose Hazards .........................................................................................7 3. Damage to Premises Rented to You 7 4. Supplementary Payments ........................................................................................_........................9 5. Medical Payments ..............................................................................................................................9 6. 180 Day Coverage for Newly Formed or Acquired Organizations 9 7. Waiver of Subrogation .......................................................................................................................9 8. Automatic Additional Insured - Specified Relationships: ..................................................................9 • Managers or Lessors of Premises; • Lessor of Leased Equipment; • Vendors; and • State or Political Subdivisions - Permits Relating to Premises 9. Property Damage to Bonx wed Equipment ......................................................................................12 10. Employees as Insureds - Specified Health Care Services: ............................................................12 • Nurses; • Emergency Medical Technicians; and • Paramedics 11. Broadened Notice of Occurrence .....................................................................................................12 B. Limits of Insurance: The Commercial General Liability Limits of Insurance apply to the insurance provided by this endorsement, except as provided below: 1. Employee Benefit Liability Coverage Each Employee Limit: $ 1,000,000 Aggregate Limit: $ 3,000,000 Deductible: $ 1,000 3. Damage to Premises Rented to You The lesser of: a. The Each Occurrence Limit shown in the Declarations; or b. $500,000 unless otherwise stated $ 4. Supplementary Payments a. Bail bonds: $ 1,000 b. Loss of earnings: $ 350 5. Medical Payments Medical Expense Limit: $ 10,000 9. Property Damage to Borrowed Equipment Each Occurrence Limit: $ 10,000 Deductible: $ 250 GA 210 02 07 Page 1 of 12 a) You did not have C. Coverages knowledge of a 1. Employee Benefit Liability Coverage claim or "suit' on or before the effective a. The following is added to SECTION I date of this en- - COVERAGES: Employee Benefit dorsement. Liability Coverage. You will be (1) Insuring Agreement deemed to have knowledge of a (a) We will pay those sums that claim or "suit" the insured becomes legally when any "author- obligated to pay as damages ized representa- caused by any act, error or tive"; omission of the insured, or of any other person for 1) Reports all, or whose ads the insured is le- any part, of the gally liable, to which this in- act, error or surance applies. We will omission to us have the right and duty to or any other defend the insured against insurer; any "suit seeking those damages. However, we will ii) Receives a have no duty to defend written or ver- against any "suit" seeking bal demand or damages to which this in- claim for dam- surance does not apply. We ages because may, at our discretion, inves- of the act, er- tigate any report of an act, ror or omis- error or omission and settle sion; and any claim or "suit" that may result. But: b) There is no other applicable insur- 1) The amount we will pay ance. for damages is limited as described in SEC- (2) Exclusions TION III - LIMITS OF This insurance does not apply to. INSURANCE; and 2) Our right and duty to de- (a) Bodily Injury, Property fend ends when we Damage or Personal and have used up the appli- Advertising Injury cable limit of insurance "Bodily injury", "property in the payment of judg- darnage" or "personal and ments or settlements. advertising injury'. No other obligation or liability (b) Dishonest, Fraudulent, to pay sums or perform acts Criminal or Malicious Act or services is covered unless explicitly provided for Damages arising out of any under Supplementary Pay- intentional, dishonest, ments. fraudulent, criminal or mali- cious act, error or omission, (b) This insurance applies to committed by any insured, damages only if the act, er- including the willful or reck- ror or omission, is neglii- less violation of any statute. gently committed in the "administration" of your "em- (c) Faail`~ure to Perform a Con- pioyee benefit program"; and 1) Occurs during the policy Damages arising out of fail- period; or ure of performance of con- tract by any insurer. 2) Occurred prior to the ef- fective date of this en- (d) Insufficiency of Funds dorsement provided: Damages arising out of an insufficiency of funds to GA 210 02 07 Page 2 of 12 meet any obligations under (j) Employment-Related Prac- any plan included in the tices "employee benefit program". Any liability arising out of (e) Inadequacy of Perform- any: ance of Investment / Ad- vice Given With Respect (1) Refusal to employ; to Participation (2) Termination of employ- Any claim based upon: ment; 1) Failure of any invest- (3) Coercion, demotion, ment to perform; evaluation, reassign- ment, discipline, defa- 2) Errors in providing in- mation, harassment, formation on past per- humiliation, discrimina- formance of investment tion or other employ- vehicles; or ment-related practices, 3) Advice given to any ads or omissions; or person with respect to (4) Consequential liability that person's decision to as a result of (1), (2) or participate or not to par- (3) above. ticipate in any plan in- cluded in the "employee This exclusion applies benefit program". whether the insured may be held liable as an employer or (f) Workers' Compensation in any other capacity and to and Similar taws any obligation to share dam- ages with Any claim arising out of your or repay someone else who must pay damages failure to comply with the because of the injury. mandatory provisions of any workers' compensation, un- (3) Supplementary Payments employment compensation insurance, social security or SECTION I - COVERAGES, disability benefits law or any SUPPLEMENTARY PAYMENTS similar law. - COVERAGES A AND B also apply to this Coverage. (g) ERISA b. Who is an Insured Damages for which any in- sured is liable because of Ii- As respects Employee Benefit Liability ability imposed on a fiduciary Coverage, SECTION II - WHO IS AN by the Employee Retirement INSURED is deleted in its entirety and Income Security Act of 1974, replaced by the following: as now or hereafter (1) If you are designated in the Dec- amended, or by any similar larations as: federal, state or local laws. Benefits (a) An individual, you and your (h) Available Bene spouse are insureds, but Any claim for benefits to the only with respect to the con- extent that such benefits are dud of a business of which available, with reasonable you are the sole owner. effort and cooperation of the (b) A partnership or joint ven- insured, from the applicable ture, you are an insured. funds accrued or other col- Your members, your part- lectible insurance. ners, and their spouses are (1) Taxes, Fines or Penalties also insureds but only with respect to the conduct of Taxes, fines or penalties, in- your business. cluding those imposed under the Internal Revenue Code (c) A limited liability company, or any similar state or local you are an insured. Your law. members are also insureds, but only with respect to the conduct of your business. Your managers are insur- GA 210 02 07 Page 3 of 12 eds, but only with respect to c. Limits of Insurance their duties as your manag- e As respects Employee Benefit Liability Coverage, SECTION III - LIMITS OF (d) An organization other than a INSURANCE is deleted in its entirety partnership, joint venture or and replaced by the following: limited liability company, you are an insured. Your "ex- (1) The Limits of Insurance shown in ecutive officers" and direc- Section B. Limits of Insurance, tors are insureds, but only 1. Employee Benefit Liability with respect to their duties Coverage and the rules below fix as your officers or directors, the most we will pay regardless Your stockholders are also of the number of: insureds, but only with re- (a) Insureds, sped to their liability as stockholders. (b) Claims made or "suits" (e) A trust, you are an insured. brought; Your trustees are also insur- (c) Persons or organizations eds, but only with respect to making claims or bringing their duties as trustees. "suits"; (2) Each of the following is also an (d) Acts, errors or omissions; or insured: (e) Benefits included in your (a) Each of your "employees" "employee benefit program". who is or was authorized to administer your "employee (2) The Aggregate Limit shown in benefit program". Section B. Limits of Insurance, 1. Employee Benefit Liability (b) Any persons, organizations Coverage of this endorsement is or "employees" having the most we will pay for all dam- proper temporary authorize- ages because of ads, errors or tion to administer your "em- omissions negligently committed ployee benefit program" if in the "administration" of your you die, but only until your "employee benefit program". legal representative is ap- pointed. (3) Subject to the limit described in (2) above, the Each Employee (c) Your legal representative if Limit shown in Section B. Limits you die, but only Wth respect of Insurance, 1. Employee to duties as such. That rep- Benefit Liability Coverage of resentative will have all your this endorsement is the most we rights and duties under this will pay for all damages sus- Coverage Part. tained by any one "employee", (3) Any organization you newly ac- including damages sustained by such "employee's" dependents quire or form, other than apart- and beneficiaries, as a result of: nership, joint venture or limited liability company, and over which (a) An act, error or omission; or you maintain ownership or major- ity interest, will qualify as a (b) A series of related ads, er- Named Insured if no other similar rors or omissions, regard- insurance applies to that organi- less of the amount of time zabon. However, coverage un- that lapses between such der this provision: ads, errors or omissions, (a) Is afforded only until the negligently committed in the 180th day after you acquire "administration" of your "em- or form the organization or ployee benefit program". the end of the policy period, However, the amount paid under whichever is earlier; and this endorsement shall not ex- (b) Does not apply to any ad, teed, and will be subject to the error or omission that was limits and restrictions that apply committed before you ac- to the payment of benefits in any quired or formed the organi- plan included in the "employee zaticn. benefit program". GA 210 02 07 Page 4 of 12 (4) Deductible Amount a. You must see to it that (a) Our obligation to pay dam- we are notified as soon as practicable of an ad, ages on behalf of the in- error or omission which sured applies only to the may result in a claim. amount of damages in ex- To the extent possible, cess of the deductible notice should include: amount stated in the Decla- rations as applicable to Each (1) What the ad, error Employee. The limits of in- or omission was surance shall not be reduced and when it oc- by the amount of this de- curred: and dudible. (2) The names and (b) The deductible amount addresses of any- stated in the Declarations one who may suf- applies to all damages sus- fer damages as a tained by any one "em- result of the act, er- ployee", including such "em- ror or omission. ployee's" dependents and beneficiaries, because of all b. If a claim is made or ads, errors or omissions to "suit" is brought against which this insurance applies. any insured, you must: (c) The terms of this insurance, (1) Immediately record including those with respect the specifics of the to: claim or "suit" and the date received; 1) Our right and duty to de- and fend the insured against any "suits" seeking {2) Notify us as soon those damages; and as practicable. 2) Your duties, and the du- You must see to it that ties of any other in- we receive written no- volved insured, in the tice of the claim or "suit" event of an act, error or as soon as practicable. omission, or claim, c. You and any other in- apply irrespective of the ap- volved insured must: plication of the deductible (1) Immediately send amount. us copies of any (d) We may pay any part or all demands, notices, of the deductible amount to summonses or le- effect settlement of any gal papers re- claim or "suit' and, upon no- ceived in connec- tification of the action taken, lion with the claim you shall promptly reimburse or "suit"; us for such part of the de- (2) Authorize us to ob- ductible amount as we have tain records and paid. other information; d. Additional Conditions (3) Cooperate with us As respects Employee Benefit Li- in the investigation ability Coverage, SECTION IV - or settlement of the COMMERCIAL GENERAL LIABIL- claim or defense ITY CONDITIONS is amended as fol- against the "suit; lows and (1) Item 2. Duties in the Event of (4) Assist us, upon our Occurrence, Offense, Claim or request, in the en- Suit is deleted in its entirety and forcement of any replaced by the folloWng right against any person or organi- 2. Duties in the Event of an zation which may Act, Error or Omission, or be liable to the in- Claim or Suit sured because of GA 210 02 07 Page 5 of 12 an ad, error or c. No Coverage omission to which ' this insurance may This insurance shall not also apply. cover any loss for which the insured is entitled to d. No insured will, except recovery under any at that insured's own other insurance in force cost, voluntarily make a previous to the effective payment, assume any date of this Coverage obligation, or incur any Part. expense without our consent. e. Additional Definitions (2)' Item 5. Other Insurance is de- As respects Employee Benefit Li- leted in its entirety and replaced ability Coverage, SECTION V - by the following: DEFINITIONS' is amended as follows: 5. Other Insurance (1) The following definitions are added: If other valid and collectible _ . insurance is available to the 1 • "Admirstration" means insured for a loss we cover a. Providing information to under this Coverage Part, "employees", including our obligations are limited as their dependents and follows: ' benefidaries, with re- a. Primary Insurance spect to eligibility for or scope of "employee This insurance is pri- benefit programs"; mary except when c. below applies. If this in- b. Interpreting the "em- surance is primary, our ployee benefit pro- obligations are not af- grams"; fected unless any of the c. Handling records in other insurance is also connection with the primary. Then, ve will "employee benefit pro- share with all that other grams"; or insurance by the method described In b. d. Effecting, continuing or below. terminating any "em- b. Method of Sharing ployees" participation in any benefit included in If all of the other insur- the "employee benefit ance permits contribu- program". tion by equal shares, we " will follow this method However, administration also. Under this ap- does not irxaude: proach each insurer a. Handling payroll deduc- contributes equal tions; or amounts until it has paid its applicable limit of in- b. The failure to effect or surance or none of the maintain any insurance loss remains, whichever or adequate limits of comes first coverage of insurance, including but not limited If any of the other insur- to unemployment insur- ance does not permit an*` social security contribution by equal benefits; workers' com- shares, we will contrib- pensation and disability ute by limits. Under this benefits, method, each insurer's share is based on the 2. "Cafeteria plans" means ratio of its applicable plans authorized by applica- limit of insurance to the ble law to allow "errplvyees" total applicable limits of to elect to pay for certain insurance of all insur- benefits with pre-tax dollars. ers. GA 210 02 07 Page 6 of 12 3. "Employee benefit pro- ages are claimed and to grams" means a program which the insured must providing some or all of the submit or does submit following benefits to "ern- with our consent; ployees", whether provided through a "cafeteria plan" or b. Any other alternative otherwise: dispute resolution pro- ceeding in which such a. Group life insurance; damages are claimed group accident or health and to which the insured insurance; dental, vision submits with our con- and hearing plans; and sent; or flexible spending ac- counts; provided that no c. An appeal of a civil pro- one other than an "em- ceeding. ployee" may subscribe $ "Employed" means a person to such benefits and actively employed. fformerly such benefits are made generally available to ~o'Y'~' on leave of ab- sence or disabled, or retired. those "employees" who Employee" satisfy the plan's eligibil- 'leased vm "F~ ity requirements; ployee" does not include a b. Profit sharing plans, "temporary wortker". employee savings 2. Unintentional Failure to Disclose Haz- plans, employee stock ards ownership plans, pen- sion plans and stock SECTION IV - COMMERCIAL GENERAL subscription plans, pro- LIABILITY CONDITIONS, 7. Representa- vided that no one other tions is hereby amended by the addition than an "employee" may of the following: subscribe to such bene- fits and such benefits Based on our dependence upon your rep- are made generally resentations as to existing hazards, if un- available to all "employ- intentionally you should fail to disclose all ees" who are eligible such hazards at the inception date of your under the plan for such policy, we will not reject coverage under benefits; this Coverage Part based solely on such failure. c. Unemployment insur- ance, social security 3. Damage to Premises Rented to You benefits, workers' com- a. The last Subparagraph of SECTION pensation and disability - COVERAGES, COVERAGE A benefits; and BODILY INJl1RY AM PROPERTY d. Vacation plans, indud- QAAitAGE LIABILITY, 2. Exclusions ing buy and sell pro- is hereby deleted and replaced by the grams; leave of ab- following: senoe programs, indud- Exclusions c. through q. do not apply ing military, matemity, to damage by fire, explosion, light- family, and civil leave; ning, smoke or soot to premises while tuition assistance plans; rented to transportation and you or temporarily occupied health cub subsidies. by you with permission of the owner. (2) The following definitions are de- b. The insurance provided under SEC- leted in their entirety and re- TION I - COVERAGE placed by the following: A BODILY INJURY AND PROP- ERTY DAMAGE LIABILITY applies 21. "Suit" means a civil proceed- to "property damage" arising out of ing in which money dam- water damage to premises that are ages because of an ad, er- both rented to and occupied by you. ror or omission to which this (1) As respects Water Damage Le- insuranoe applies are al- "Suit" iridudes gal Liability, as provided in Para- le~' graph 3.b. above: a. An arbitration proceed- ing in which such dam- GA 210 02 07 Page 7 of 12 The exclusions under SECTION I a) Foundations, walls, - COVERAGES, COVERAGE A. floors or paved sur- BODILY INJURY AND PROP- faces; ERTY DAMAGE LIABILITY, 2. Exclusions, other than 1. War b) Basements, and the Nuclear Energy Liabil- whether paved or ity Exclusion, are deleted and not; or the following are added: c) Doors, windows or This insurance does not apply to: other openings. (a) "Property dain'iaW': (c) Loss caused by or resulting from water that leaks or 1) Assumed in any con- flaws from plumbing, heat- tract; or ing, air conditioning, or fire 2 Loss caused b or re- protection systems caused by by or resulting from freezing, sulting from any of the unless: following: Wear and tear; 1) You did your best to a maintain heat in the b) Rust, corrosion, building or structure; or fungus, decay, de- 2) You drained the equip- terioration, hidden ment and shut off the or latent defect or water supply if the heat any quality in prop- was not maintained. erty that causes it to damage or de- (d) Loss to or damage to: stroy itself; 1) Plumbing, heating, air c) Smog; conditioning, fire protec- tion systems, or other equipment or appli- down including rup- anoes; or ture or bursting caused by cen- 2) The interior of any build- trifugal force; ing or structure, or to e) Settling, cracking, personal property in the building or structure shrinking or ex- caused by or resulting pansion; or from rain, snow, sleet or f) Nesting or infesta- ice, whether driven by tion, or discharge wind or not. or release of waste c. Limit of Insurance products or secre- tions, by insects, The Damage to Premises Rented to birds, rodents or You Limit as shown in the Declara- other animals. tions is amended as follows: (b) Loss caused directly or indi- (2) Paragraph 6. of SECTION III - rectly by any of the following: LIMITS OF INSURANCE is 1) Earthquake, volcanic the heireby deleted and replaced by eruption, landslide or any other earth move- 6. Subject to 5. above, the ment; Damage to Premises Rented to You Umit is the 2) Water that backs up or most we will pay under overflows from a sewer, COVERAGE A. BODILY IN- drain or sump; JURY AND PROPERTY 3) Water under the ground DAMAGE LIABILITY for surface pressing on, or damages because of "prop- flowing or seeping erty damage" to premises through: while rented to you or tem- porarily occupied by you with permission of the owner, arising out of any one "oc- GA 210 02 07 Page 8 of 12 curence" to which this in- Us is hereby amended by the addition of seance applies. the following: (3) The amount we will pay is limited We waive any right of recovery we may as described in Section B. Limits have because of payments we make for of Insurance, 3. Damage to injury or damage arising out of your ongo- Premises Rented to You of this ing operations or "your work" done under a endorsement. written contract requiring such waiver with 4. Supplementary Payments that person or organization and included in the "products-completed operations haz- Under SECTION I - COVERAGE SUP- ard". However, our rights may only be PLEMENTARY PAYMENTS - COVER- waived prior to the "occurrence" giving rise AGES A AND B: to the injury or damage for which we make payment under this Coverage Part. The a. Paragraph 2. is replaced by the fol- insured must do nothing after a loss to im- lowing pair our rights. At our request, the insured will bring "suit" or transfer those rights to Up to the limit shown in Section B. us and help us enforce those rights. Limits of Insurance, 4.a. Bail Bonds of this endorsement for cost of bail 8. Automatic Additional Insured - Speci- bonds required because of accidents fied Relationships or traffic law violations arising out of the use of any vehicle to which the a. The following is hereby added to Bodily Injury Liability Coverage ap- SECTION II - WHO IS AN INSURED: plies. We do not have to furnish (1) Any person or organization de- these bonds. scribed in Paragraph 8.a.(2) be- b. Paragraph 4. is replaced by the fol- low (hereinafter referred to as lowing additional insured) whom you are required to add as an additional All reasonable expenses incurred by insured under this Coverage Part the Insured at our request to assist us by reason of: in the investigation or defense of the claim or "suit", including actual loss of (a) A written contract or agree- earnings up to the limit shown in Seo- ment; or tion B. Limits of Insurance, 4.b. Loss of Earnings of this endorsement (b) An oral agreement or coo- per day because of time off from insurance tract where showing certificate that cate per- work. son or organization as an 5. Medical payments additional insured has been issued, The Medical Expense Limit of Any One is an insured, provided. Person as stated in the Declarations is P amended to the limit shown in Section B. (a) The written or oral contract Limits of Insurance, 5. Medical Pay- or agreement is: ment of this endorsement. 6. 180 Day Coverage for Newly Formed or b 1)ecomt es y effective effect or becomfective dur- Acquired Organizations ing the policy period; SECTION II - WHO IS AN INSURED is and amended as follows: 2) Executed prior to an Subparagraph a. of Paragraph 4. is hereby "occurrence" or offense deleted and replaced by the following: to which this insurance would apply; and a. Insurance under this provision is af- forded only until the 180th day after (b) They are not specifically you acquire or form the organization named as an additional in- or the end of the policy period, which- sured under any other provi- ever is earlier; sion of, or endorsement added to, this Coverage 7. Waiver of Subrogation Part. SECTION IV - COMMERCIAL GENERAL (2) Only the following persons or or- LIABILITY CONDITIONS, 9. Transfer of ganizations are additional insur- Rights of Recovery Against Others to eds under this endorsement, and insurance coverage provided to GA 210 02 07 Page 9 of 12 such additional insureds is lim- a) "Bodily injury' or ited as provided herein: "property carnage" for which the ven- (a) The manager or lessor of a dor is obligated to premises leased to you with pay damages by whom you have agreed per reason of the as- Paragraph 8.a.(1) above to sumption of liability provide insurance, but only in a contract or with respect to liability aris- agreement. This ing out of the ownership, exclusion does not maintenance or use of that apply to liability for part of a premises leased to damages that the you, subject to the following vendor would have additional exdusions: in the absence of This insurance does not ap- the contract or ply to agreement, 1) Any "occurrence" which b) Any express war- takes place after you ranty unauthorized cease to be a tenant in by you; that premises. c) Any physical or 2) Structural alterations, chemical change in new construction or the product made demolition operations intentionally by the performed by or on be- vendor' half of such additional d) Repackaging, un- insured. less unpacked (b) Any person or organization solely for the pur- from which you lease pose of inspection, equipment with whom you demonstration, have agreed per Paragraph testing, or the sub- 8 a.(1) above to provide in-- stitution of parts surance. Such person(s) or under instructions organization(s) are insureds from the manufac- sciely with respect to their li- turer, and then re- ability arising out of the packaged in the maintenance, operation or original container; use by you of equipment e) Any failure to make leased to you by such per- such inspections, son(s) or organizaticn(s). adjustments, tests However, this insurance or servicing as the does not apply to any "oo- vendor has agreed amwice" which takes place to make or nor- after the equipment lease mally undertakes expires. to make in the (c) Any person or organization usual course of (referred to below as vendor) business, in con- with whom you have agreed nection with the per Paragraph 8.a.(1) above distribution or sale to provide insurance, but of the products; only with respect to "bodily f) Demonstration, in- injury" or "property damage" stallation, servicing arising out of "your products" or repair opera- which are distributed or sold tions, except such in the regular course of the operations per- vendor's business, subject to formed at the ven- the following additional ex- dors premises in clusions: connection with the 1) The insurance afforded sale of the product; the vendor does not ap- g) Products which, af- ply to: ter distribution or sale by you, have GA 210 02 07 Page 10 of 12 been labeled or re- elevators covered by labeled or used as this insurance. a container, part or ingredient of any (3) Any insurance provided to an ad- other thing or sub- ditional insured designated under stance by or for the Paragraph 8.a.(2) Subpara- vendor. graphs (a), (b) and (d) does not apply to "bodily injury, "property 2) This insurance does not damage" or "personal and adver- apply to any insured tising injury" arising out of the person or organization: sole negligence or willful miscon- a) From whom you dud of the additional insured or their agents, "errployees" or any have acquired other representative of the addi such products, or tional insured any ingredient, part or container, enter- b. SECTION IV - COMMERCIAL GEN- ing into, accompa- ERAL LIABILITY CONDITIONS is nying or containing hereby amended as follows: such products; or Condition 5. Other Insurance is b) When liability in- amended to include: cluded within the "products- (1) Where required by a written con- completed opera- tract or agreement, this insur- tions hazard" has ante is primary and / or noncon- been excluded un- tributory as respects any other der this Coverage insurance policy issued to the Part with respect to additional insured, and such such products. other insurance policy shall be excess and / or noncontributing, (d) Any state or political subdivi- whichever applies, with this in- sion with which you have surance. agreed per Paragraph 8.a.(1) above to provide in- (2) Any insurance provided by this surance, subject to the fol- endorsement shall be primary to lowing additional provision: other insurance available to the additional insured except: This insurance applies only with respect to the following (a) As otherwise provided in hazards for which the state SECTION IV - COMMER- or political subdivision has CIAL GENERAL LIABILITY issued a permit in connec- CONDITIONS, 5. Other In- bon with premises you own, surance, b. Excess Insur- r+ent or control and to which ance; or this insurance applies: (b) For any other valid and col- t) The existence, mainte- lectible insurance available nance, repair, construc- to the additional insured as tion, erection, or re- an additional insured by at- moval of advertising tachment of an endorsement signs, awnings, cano- to another insurance policy pies, cellar entrances, that is written on an excess coal holes, driveways, basis. In such case, the manholes, marquees, coverage provided under hoist away openings, this endorsement shall also sidewalk vaults, street be excess. banners, or decorations g, Property Damage to Borrowed Equip- and similar exposures; ment or 2) The construction, erec- a. The following is hereby added to Ex- bon, or removal of ele- clusion j. Damage to Property of vators; or Paragraph 2., Exclusions of SEC- TION I - COVERAGES, COVE 3) The ownership, mainte- A BODILY INJURY AND PROP- nance, or use of any ERTY DAMAGE LIABILITY. GA 210 02 07 Page 11 of 12 Paragraphs (3) and (4) of this exclu- effect settlement of any sion do not apply to tools or equip- claim or "suit" and, upon no- ment loaned to you, provided they are tification of the action taken, not being used to perform operations you shall promptly reimburse at the time of loss. us for such part of the de- ductible amount as has been b. With respect to the insurance pro- paid by us. vided by this section of the endorse- ment, the following additional provi- 10. Employees as Insureds - Specfed sions apply. Health Care Services (1) The Limits of Insurance shown in It is hereby agreed that Paragraph the Declarations are replaced by 2.a.(1)(d) of SECTION 11 - WHO IS AN the limits designated in Section INSURED does not apply to your "em- B. Limits of Insurance, 9. ployees~' who provide professional health Property Damage to Borrowed care services on your behalf as duty li- Equipment of this endorsement mod: with respect to coverage pro- vided by this endorsement. a, Nurses; These limits are inclusive of and b. Emergency Medical Technicians; or not in addition to the limits being replaced. The Limits of Insur- c. Paramedics, ance shown in Section B. Limits in the jurisdiction where an "occurrence" of Insurance, Property Dam- or offense to which this insurance applies age to Borrowed Equipment of this endorsement fix the most we takes place. will pay in any one "occurrence" 11. Broadened Notice of Occurrence regardless of the number of: Paragraph a. of SECTION N - COM- MERCIAL GENERAL LIABILITY CONDI- (b) Claims made or "suits" TIONS, 2. Duties in the Event of Occur- brought; or rence, Offence, Claim or Suit is hereby deleted and replaced by the following: (c) Persons or organizations making claims or bring a. You must see to it that we are notified "suits". as soon as practicable of an "occur- rence" or an offense which may result (2) Deductible Clause in a claim. To the extent possible, no- tine should include: (a) Our obligation to pay dam- ages on your behalf applies (1) How, when and where the "oc- only to the amount of dam- currence" or offense took place; ages for each "occurrence" 2) The names and addresses of any deductible which are in amount excess stated in the ( injured persons and witnesses; and Section B. Limits of Insur- ance, 9. Property Damage (3) The nature and location of any in- to Borrowed Equipment of jury or damage arising out of the this endorsement. The limits "occurrence" or offense. of insurance will not be re- duced by the application of This requirement applies only when such deductible amount. the "occurrence" or offense is known (b) SECTION IV - COMMER- to an "authorized representative". CIAL GENERAL LIABILITY CONDITIONS, 2. Duties in the Event of Occurrence, Offence, Claim or Suit, ap- plies to each claim or "suit" imespective of the amount. (c) We may pay any part or all of the deductible amount to GA 210 02 07 Page 12 of 12