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HomeMy WebLinkAboutInsurance Certificate: Pacific Paving Inc. CC) DATE(MM/DD/YYYY) `./ CERTIFICATE OF LIABILITY INSURANCE 4/12/2019 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 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 Protectors Insurance, LLC PHONE Terry Friend FAX P.O. Box 4669 - ., (A/c.No.Ext): 541-842-2958 (A/C,No):541-772-1906 Medford OR 97504 ADDRESS: terryf @protectorsins.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:The Cincinnati Insurance Co 10677 INSURED PACIF07 INSURER B:SAIF Corporation 524113 Pacific Paving Inc PO Box 2370 INSURER C: White City OR 97502 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1977333162 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP w LIMITS LTR INSD VD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY EPP 0529033 3/20/2019 3/20/2022 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $500,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRO X POLICY JECT LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY EBA 0529033 3/20/2019 3/20/2020 COMBINED SINGLE LIMIT $1,000,000 (Ea accident) _ ANY AUTO BODILY INJURY(Per person) $ OWNED x SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED x NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accident) A X UMBRELLA LIAB X OCCUR EPP 0529033 3/20/2019 3/20/2022 EACH OCCURRENCE $1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION 812919 10/1/2018 10/1/2019 PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBEREXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate holder is listed as additional insured with primary&noncontributory when required by written contract per GA472 0917 with Waiver of Subrogation when required by written contract per GA233 0917 as respects General Liability and Additional insured,Primary&Noncontributory&Waiver of subrogation when required by written contract per AA288 0116 per respects Auto Liability CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Ashland 90 N Mountain Ave AUTHORIZED REPRESENTATIVE Ashland OR 97520 J IA144 ,t_.n V ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS ADDITIONAL INSURED - AUTOMATIC STATUS WHEN REQUIRED IN WRITTEN CONTRACT, AGREEMENT, PERMIT OR AUTHORIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Additional Insured - Owners, Lessees Or (1) The Coverage Part to which this Contractors - Automatic Status For Other endorsement is attached pro- Parties When Required In Written Contract vides coverage for"bodily injury" Or Agreement With You or "property damage" included 1. Section II - Who Is An Insured is within the "products-completed operations hazard"; and amended to include as an additional in- sured any person or organization you (2) The written contract or written have agreed in writing in a contract or agreement requires you to pro- agreement to add as an additional in- vide additional insured coverage sured on this Coverage Part. Such per- included within the "products- son(s) or organization(s) is an additional completed operations hazard" insured only with respect to liability for: for that person or organization. a. "Bodily injury", "property damage" or If the written contract or written "personal and advertising injury" agreement requires you to provide caused, in whole or in part, by the additional insured coverage included performance of your ongoing opera- within the "products-completed oper- tions by you or on your behalf, under ations hazard" for a specified length that written contract or written of time for that person or organiza- agreement.Ongoing operations does tion, the "bodily injury" or "property not apply to "bodily injury"or"proper- damage" must occur prior to the ex- ty damage"occurring after: piration of that period of time in order (1) All work, including materials, for this insurance to apply. parts or equipment furnished in If the written contract or written connection with such work, on agreement requires you to provide the project (other than service, additional insured coverage for a maintenance or repairs) to be person or organization per ISO addi- performed by or on behalf of the tional insured endorsement form additional insured(s) at the loca- number CG 20 10, without specifying tion of the covered operations an edition date, this Paragraph b. has been completed; or does not apply to that person or or- (2) That portion of "your work"out of ganization. which the injury or damage aris- 2. If the written contract or written agree- es has been put to its intended ment described in Paragraph 1. above use by any person or organiza- specifically requires you to provide addi- tion other than another contrac- tional insured coverage to that person or tor or subcontractor engaged in organization: performing operations for a prin- cipal as a part of the same pro- a. Arising out of your ongoing opera- ject; and tions or arising out of'your work"; or b. "Bodily injury" or "property damage" b. By way of an edition of an ISO addi- caused, in whole or in part, by"your tional insured endorsement that in- work" performed under that written cludes arising out of your ongoing contract or written agreement and in- operations or arising out of "your cluded in the "products-completed work'; operations hazard", but only if: Includes copyrighted material of Insurance GA 472 0917 Services Office, Inc.,with its permission. Page 1 of 3 However, any "auto" that is leased, a. Is effective on the date of acquisition hired, rented or borrowed with a driver or formation, and is afforded for 180 is not a covered "auto". days after such date; E. Audio, Visual and Data Electronic Equip- b. Does not apply to "bodily injury" or ment "property damage" resulting from an SECTION III - PHYSICAL DAMAGE COV- "accident" that occurred before you ERAGE, C. Limit of Insurance is amended acquired or formed the organization; by adding the following: c. Does not apply to any newly acquired 4. The most we will pay for all "loss" to au- or formed organization that is a joint p Y venture or partnership;and dio, visual or data electronic equipment and any accessories used with this d. Does not apply to an insured under equipment as a result of any one "acci- any other automobile liability policy, dent" is the lesser of: or would be an insured under such a a. The actual cash value of the dam- policy but for the termination of such policy or the exhaustion of such poli- aged or stolen property as of the time cys limits of insurance. of the "accident"; 3. Any of your "employees" while using a b. The cost of repairing or replacing the covered "auto" in your business or your damaged or stolen property with oth- personal affairs, provided you do not own, er property of like kind and quality; or hire or borrow that "auto". c. $2,500. G. Liability Coverage Extensions - Supple- Provided the equipment,at the time of the mentary Payments-Higher Limits "loss" is: SECTION II - LIABILITY COVERAGE, A. a. Permanently installed in or upon the Coverage, 2. Coverage Extensions, a. Sup- covered "auto" in a housing, opening plementary Payments is amended by: or other location that is not normally 1. Replacing the $2,000 Limit of Insurance used by the "auto" manufacturer for for bail bonds with $4,000 in(2); and the installation of such equipment; b. Removable from a permanently in- 2. Replacing the $250 Limit of Insurance for reasonable expenses with $500 in (4). stalled housing unit as described in Paragraph 2.a.above; or H. Amended Fellow Employee Exclusion c. An integral part of such equipment. SECTION II - LIABILITY COVERAGE, B. Ex- clusions,Who is an Insured-Amended clusions, 5. Fellow Employee is modified as follows: SECTION II - LIABILITY COVERAGE, A. Exdusion 5. Fellow Employee is deleted. Coverage, 1.Who is an Insured is amended by adding the following: I. Hired Auto-Physical Damage The following are "insureds": If hired "autos"are covered "autos"for Liability 1. Any subsidiary which is a legally incorpo- Coverage, then Comprehensive and Collision Y Y 9 Y p Physical Damage Coverages as provided un- rated entity of which you own a financial der SECTION III - PHYSICAL DAMAGE interest of more than 50% of the voting COVERAGE of this Coverage Part are ex- stock on the effective date of this cover- tended to "autos" you hire, subject to the fol- age form. lowing: However, the insurance afforded by this 1. The most we will pay for "loss" to any provision does not apply to any subsidiary hired "auto" is $50,000 or the actual cash that is an "insured" under any other au- value or cost to repair or replace, which- tomobile liability policy, or would be an ever is the least, minus a deductible. "insured" under such policy but for termi- nation of such policy or the exhaustion of 2. The deductible will be equal to the largest such policy's limits of insurance. deductible applicable to any owned "auto" for that coverage, or$1,000, whichever is 2. Any organization that is newly acquired or less. formed by you and over which you main- tain majority ownership. The insurance 3. Hired Auto - Physical Damage coverage provided by this provision: is excess over any other collectible insur- ance. Includes copyrighted material of ISO AA 288 01 16 Properties, Inc., with its permission. Page 2 of 4 4. Subject to the above limit,deductible, and K. Transportation Expense- Higher Limits , . excess provisions we will provide cover- age equal to the broadest coverage appli- SECTION III - PHYSICAL DAMAGE COV- cable to any covered "auto" you own in- ERAGE, A. Coverage, 4. Coverage Exten- sured under this policy. sions is amended by replacing $20 per day . with $50 per day, and $600 maximum with Coverage includes lass of use of that hired au- $1,500 maximum in Extension a. Transpor- to, provided it results from an "accident" for tation Expenses. which you are legally liable and as a result of which a monetary loss is sustained by the L. Airbag Coverage leasing or rental concern. The most we will SECTION III - PHYSICAL DAMAGE COV- payfor any one "accident"is $3,000. ERAGE, B. Exclusions, 3.a. is amended by If a limit for Hired Auto - Physical Damage is adding the following: shown in the Schedule, then that limit replac- However, the mechanical and electrical es, and is not added to, the $50,000 limit indi- breakdown portion of this exclusion does not cated above. apply to the accidental discharge of an airbag. J. Rental Reimbursement This coverage for airbags is excess over any other collectible insurance or warranty. SECTION III - PHYSICAL DAMAGE is amended by adding the following: M. Loan or Lease Gap Coverage 1. We will pay for rental reimbursement ex- 1. SECTION III - PHYSICAL DAMAGE penses incurred by you for the rental of COVERAGE, C. Limit of Insurance is an "auto"because of a "loss"to a covered deleted in its entirety and replaced by the "auto". Payment applies in addition to the following, but only for private passenger otherwise applicable amount of each coy- type "autos"with an original loan or lease, erage you have on a covered "auto". No and only in the event of a 'total loss" to deductible applies to this coverage. such a private passenger type "auto": 2. We will pay only for those expenses in- a. The most we will pay for"loss" in any curred during the policy period beginning one "accident"is the greater of: - - - _ 24 hours after the-"loss" and ending, re- (1)-The amount due under the terms gardless of the policys expiration, with of the lease or loan to which the lesser of the following number of your covered private passenger days: type "auto" is subject, but will not a. The number of days reasonably re- include: quired to repair the covered "auto". If (a) Overdue lease or loan pay- "loss" is caused by theft,this number ments; of days is added to the number of days it takes to locate the covered (b) Financial penalties imposed "auto"and return it to you; or under the lease due to high b. 30 days. mileage, excessive use or abnormal wear and tear; 3. Our payment is limited to the lesser of the (c) Security deposits not re- following amounts: funded by the lessor; a. Necessary and actual expenses in- (d) Costs for extended warran- curred; or ties, Credit Life Insurance, b. $50 per day. Health, Accident or Disabil- ity Insurance purchased 4. This coverage does not apply while there with the loan or lease; and are spare or reserve "autos" available to you for your operations. (e) Carry-over balances from previous loans or leases, or 5. We will pay under this coverage only that amount of your rental reimbursement ex- (2) Actual cash value of the stolen penses which is not already provided for or damaged property. under SECTION III - PHYSICAL DAM- b. An adjustment for depreciation and AGE COVERAGE, A. Coverage, 4. physical condition will be made in de- Coverage Extensions. termining actual cash value at the time of"loss". Includes copyrighted material of ISO AA 288 01 16 Properties, Inc., with its permission. Page 3 of 4 • 2. SECTION V - DEFINITIONS is amended P. Unintentional Failure to Disclose Hazards by adding the following, but only for the SECTION IV - BUSINESS AUTO CONDI- purposes of this Loan or Lease Gap TIONS, B. General Conditions, 2. Conceal- Coverage: ment, Misrepresentation or Fraud is "Total loss" means a 'loss" in which the amended by adding the following: cost of repairs plus the salvage value ex- ceeds the actual cash value. However, if you unintentionally fail to disdose any hazards existing on the effective date of N. Glass Repair-Waiver of Deductible this Coverage Form, we will not deny cover- SECTION III - PHYSICAL DAMAGE COV- age under this Coverage Form because of such failure. ERAGE, D. Deductible is amended by adding the following: 0. Mental Anguish Resulting from Bodily Inju- No deductible applies to glass damage if the ry glass is repaired in a manner acceptable to us SECTION V - DEFINITIONS, C. "Bodily inju- rather than replaced. ry" is deleted in its entirety and replaced by the following: O. Duties in the Event of an Accident, Claim, Suit or Loss-Amended "Bodily injury" means bodily injury,sickness or disease sustained by a person, including men- SECTION IV - BUSINESS AUTO CONDI- tal anguish and death sustained by the same TIONS, A. Loss Conditions, 2. Duties in the person that results from such bodily injury, Event of Accident,Claim, Suit or Loss,a.is sickness or disease. "Bodily injury" does not amended by adding the following: include mental anguish or death that does not This condition applies only when the "acci- result from bodily injury, sickness or disease. dent"or "loss" is known to: R. Coverage for Certain Operations in Con- 1. You,if you are an individual; nection with Railroads 2. A partner, if you are a partnership; With respect to the use of a covered "auto" in operations for or affecting a railroad: 3. An executive officer or insurance manag- er, if you are a corporation; or 1. Section V- Definitions, H. "Insured con- tract", 1.c. is amended to read: 4. A member or manager, if you are a lim- ited liability company. c. An easement or license agreement; 2. Section V- Definitions, H. "Insured con- tract', 2.a. is deleted. Includes copyrighted material of ISO AA 288 01 16 Properties, Inc., with its permission. Page 4 of 4 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS ADDITIONAL INSURED - AUTOMATIC STATUS WHEN REQUIRED IN WRITTEN CONTRACT, AGREEMENT, PERMIT OR AUTHORIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Additional Insured - Owners, Lessees Or (1) The Coverage Part to which this Contractors - Automatic Status For Other endorsement is attached pro- Parties When Required In Written Contract vides coverage for "bodily injury" Or Agreement With You or "property damage" included 1. Section II - Who Is An Insured is within the "products-completed amended to include as an additional in- sured operations hazard"; and any person or organization you (2) The written contract or written have agreed in writing in a contract or agreement requires you to pro- agreement to add as an additional in- vide additional insured coverage sured on this Coverage Part. Such per- included within the "products- son(s) or organization(s) is an additional completed operations hazard" insured only with respect to liability for: for that person or organization. a. "Bodily injury", "property damage" or If the written contract or written "personal and advertising injury" agreement requires you to provide caused, in whole or in part, by the additional insured coverage included performance of your ongoing opera- within the "products=completed oper- tions by you or on your behalf, under ations hazard" for a specified length that written contract or written of time for that person or organiza- agreement. Ongoing operations does tion, the "bodily injury" or "property not apply to "bodily injury"or"proper- damage" must occur prior to the ex- ty damage"occurring after: piration of that period of time in order (1) All work, including materials, for this insurance to apply. parts or equipment furnished in If the written contract or written connection with such work, on agreement requires you to provide the project (other than service, additional insured coverage for a maintenance or repairs) to be person or organization per ISO addi- performed by or on behalf of the tional insured endorsement form additional insured(s) at the loca- number CG 20 10, without specifying tion of the covered operations an edition date, this Paragraph b. has been completed; or does not apply to that person or or- (2) That portion of "your work"out of ganization. which the injury or damage aris- 2. If the written contract or written agree- es has been put to its intended ment described in Paragraph 1. above use by any person or organiza- specifically requires you to provide addi- tion other than another contrac- tional insured coverage to that person or tor or subcontractor engaged in organization: performing operations for a prin- cipal as a part of the same pro- a. Arising out of your ongoing opera- ject; and tions or arising out of"your work"; or b. "Bodily injury" or "property damage" b. By way of an edition of an ISO addi- caused, in whole or in part, by "your tional insured endorsement that in- work" performed under that written cludes arising out of your ongoing contract or written agreement and in- operations or arising out of "your cluded in the "products-completed work'; operations hazard", but only if: Includes copyrighted material of Insurance GA 472 0917 Services Office, Inc.,with its permission. Page 1 of 3 ' then the phrase caused, in whole or in This insurance does not apply to: • part, by in Paragraph A.1.a. and/or Para- graph A.1.b. above, whichever applies, is a. "Bodily injury", "property damage" or replaced by the phrase arising out of. "personal and advertising injury" aris ing out of operations performed for 3. With respect to the insurance afforded to the federal government, state or mu- the additional insureds described in Para- nicipality; or graph A.1., the following additional exclu- sion applies: b. "Bodily injury" or "property damage" included within the "products- This insurance does not apply to "bodily completed operations hazard." injury', "property damage" or "personal and advertising injury" arising out of the C. The insurance afforded to additional insureds rendering of, or the failure to render, any described in Paragraphs A.and B.: professional architectural, engineering or 1. Only applies to the extent permitted by surveying services, induding: law; and a. The preparing, approving or failing to 2. Will not be broader than that which you prepare or approve, maps, shop are required by the written contract, writ- drawings, opinions, reports, surveys, ten agreement, written permit or written field orders, change orders or draw- authorization to provide for such addition- ings and specifications; or al insured; and b. Supervisory, inspection, architectural 3. Does not apply to any person, organiza- or engineering activities. tion, state, governmental agency or sub- This exdusion applies even if the claims division or political subdivision specifically against any insured allege negligence or named as an additional insured for the other wrongdoing in the supervision, hir- same project in the schedule of an en- ing, employment,training or monitoring of dorsement added to this Coverage Part. others by that insured, if the "occurrence" D. With respect to the insurance afforded to the which caused the "bodily injury" or "prop- additional insureds described in Paragraphs erty damage", or the offense which A.and B., the following is added to Section III caused the "personal and advertising inju- -Limits Of Insurance: ry", involved the rendering of, or the fail- ure to render, any professional architec- The most we will pay on behalf of the addi- tural, engineering or surveying services. tional insured is the amount of insurance: 4. This Paragraph A. does not apply to addi- 1. Required by the written contract, written tional insureds described in Paragraph B. agreement, written permit or written B. Additional Insured -State Or Governmental au- thor annd d B.;B ; on described in Paragraphs A. or Agency Or Subdivision Or Political Subdi- vision - Automatic Status When Required 2. Available under the applicable Limits of In Written Permits Or Authorizations Insurance shown in the Declarations; 1. Section II - Who Is An Insured is whichever is less. amended to include as an additional in- sured any state or governmental agency This endorsement shall not increase the appli- or subdivision or political subdivision you cable Limits of Insurance shown in the Decla- have agreed in writing in a contract, rations. agreement, permit or authorization to add E. Section IV - Commercial General Liability as an additional insured on this Coverage Conditions is amended to add the following: Part. Such state or governmental agency or subdivision or political subdivision is an Automatic Additional Insured Provision additional insured only with respect to op- erations performed by you or on your be- This insurance applies only if the "bodily inju- half for which the state or governmental ry" or "property damage" occurs, or the "per- agency or subdivision or political subdivi- sonal and advertising injury" offense is com- sion issued, in writing, a contract, agree- mitted: ment, permit or authorization. 1. During the policy period; and 2. With respect to the insurance afforded to 2. Subsequent to your execution of the writ- the additional insureds described in Para- ten contract or written agreement, or the graph B.1., the following additional exclu- issuance of a written permit or written au- sions apply: thorization, described in Paragraphs A. and B. Includes copyrighted material of Insurance GA 472 0917 Services Office, Inc., with its permission. Page 2 of 3 • F. Except when G.below applies, the following is 1. The additional insured is a Named In- added to Section IV - Commercial General sured under such other insurance; and Liability Conditions, 5. Other Insurance, • and supersedes any provision to the contrary: 2. You have agreed in writing in a contract, agreement, permit or authorization de- When Other Additional Insured Coverage scribed in Paragraph A. or B.that this in- Applies On An Excess Basis surance would be primary to any other in- surance available to the additional in- This insurance is primary to other insurance sured. available to the additional insured described in Paragraphs A.and B.except: As used in this endorsement, wrap-up insur- ance means any insurance provided by a con- 1. As otherwise provided in Section IV - solidated (wrap-up) insurance program. Commercial General Liability Condi- tions, 5. Other Insurance, b. Excess In- Primary And Noncontributory Insurance surance; or When Required By Written Contract, 2. For any other valid and collectible insur- Agreement, Permit Or Authorization ance available to the additional insured as Except when wrap-up insurance applies to the an additional insured by attachment of an claim or "suit" on behalf of the additional in- endorsement to another insurance policy sured, this insurance is primary to and will not that is written on an excess basis. In such seek contribution from any other insurance case,this insurance is also excess. available to the additional insured described in G. The following is added to Section IV - Com- Paragraphs A and B.provided that: mercial General Liability Conditions, 5. 1. The additional insured is a Named In- Other Insurance, and supersedes any provi- sured under such other insurance; and sion to the contrary: 2. You have agreed in writing in a contract, Primary Insurance When Required By Writ- agreement, permit or authorization de- ten Contract, Agreement, Permit Or Au- scribed in Paragraph A. or B.that this in- thorization surance would be primary and would not seek contribution from any other insur- Except when wrap-up insurance applies to the ance available to the additional insured. claim or "suit' on behalf of the additional in- sured, this insurance is primary to any other As used in this endorsement, wrap-up insur- insurance available to the additional insured ance means any insurance provided by a con- described in Paragraphs A. and B. provided solidated (wrap-up) insurance program. that: Includes copyrighted material of Insurance GA 472 0917 Services Office, Inc.,with its permission. Page 3 of 3 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS' 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 Coverage 3 2. Unintentional Failure To Disclose Hazards 9 3. Damage To Premises Rented To You 9 4. Supplementary Payments 10 5. Medical Payments 10 6. 180 Day Coverage For Newly Formed Or Acquired Organizations 10 7. Waiver Of Subrogation 11 8. Automatic Additional Insured-Specified Relationships: 11 • Managers Or Lessors Of Premises; • Lessor Of Leased Equipment; • Vendors; • State Or Governmental Agency Or Subdivision Or Political Subdivision - Permits Or Authorizations Relating To Premises; and • Mortgagee, Assignee Or Receiver 9. Property Damage To Borrowed Equipment ...........14 10. Employees As Insureds - Specified Health Care Services And Good Samaritan Services .... 15 11. Broadened Notice Of Occurrence 15 12. Nonowned Aircraft 15 13. Bodily Injury Redefined 15 14. Expected Or Intended Injury Redefined 15 15. Former Employees As Insureds 15 16. Voluntary Property Damage Coverage And Care, Custody Or Control Liability Coverage ..- 16 17. Broadened Contractual Liability-Work Within 50' Of Railroad Property 17 18. Alienated Premises 17 B. Limits Of Insurance: The Commercial General Liability Limits of Insurance apply to the insurance provided by this endorse- ment, except as provided below: 1. Employee Benefit Liability Coverage Each Employee Limit: $1,000,000 Aggregate Limit: $3,000,000 Deductible Amount: $ 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: $2,500 Includes copyrighted material of Insurance GA 233 0917 Services Office, Inc., with its permission. Page 1 of 17 b. Loss Of Earnings:$ 500 5. Medical Payments Medical Expense Limit:$ 10,000 9. Property Damage To Borrowed Equipment Each Occurrence Limit: $10,000 Deductible Amount: $ 250 16. Voluntary Property Damage Coverage (Coverage a.) And Care, Custody Or Control Liability Coverage(Coverage b.) Limits Of Insurance Coverage a. $1,000 Each Occurrence $5,000 Aggregate Coverage b.$5,000 Each Occurrence unless otherwise stated$ Deductible Amount(Each Occurrence) Coverage a.$250 Coverage b.$250 unless otherwise stated $ COVERAGE PREMIUM BASIS RATE ADVANCE PREMIUM (a) Area (For Limits in Excess of (For Limits in Excess of (b) Payroll $5,000) $5,000) (c) Gross Sales (d) Units (e) Other b. Care, Custody Or Control TOTAL ANNUAL PREMIUM $ Includes copyrighted material of Insurance GA 233 0917 Services Office, Inc.,with its permission. Page 2 of 17 • C. Coverages this endorsement pro- vided: 1. Employee Benefit Liability Coverage a. The following is added to Section I - a) You did not have g knowledge of a Coverages: claim or"suit"on or Employee Benefit Liability Cover- before the "first ef- age fective date" of this endorsement. (1) Insuring Agreement You will be (a) We will pay those sums that deemed to have the insured becomes legally knowledge of a obligated to pay as damag- claim or "suit" es caused by any act, error when any "author- or omission of the insured, ized representa- or of any other person for tive'; whose acts the insured is legally liable, to which this i) Reports all, or insurance applies. We will any part, of the have the right and duty to act, error or defend the insured against omission to us any "suit" seeking those or any other damages. However, we will insurer; have no duty to defend ii) Receives a against any "suit" seeking written or ver- damages to which this in- bal demand or surance does not apply. We claim for dam- may, at our discretion, in- ages because vestigate any report of an of the act, er- act, error or omission and ror or omis- settle any claim or"suit' that sion; and may result. But: 1) The amount we will pay b) There is no other p y applicable insur- for damages is limited ance. as described in Section III - Limits Of Insur- (2) Exclusions ance; and This insurance does not apply to: 2) Our right and duty to defend ends when we (a) Bodily Injury, Property have used up the appli- Damage Or Personal And cable limit of insurance Advertising Injury in the payment of judg- "Bodily injury", "property ments or settlements. damage" or "personal and No other obligation or liabil- advertising injury". ity to pay sums or perform (b) Dishonest, Fraudulent, acts or services is covered Criminal Or Malicious Act unless explidtly provided for under Supplementary Damages arising out of any Payments. intentional, dishonest, b This insurance applies to fraudulent, criminal or mali- (b) pp cious act, error or omission, damages only if the act, er- committed by any insured, ror or omission, is negligent- including the willful or reck- ly committed in the "admin- less violation of any statute. istration" of your "employee benefit program"; and (c) Failure To Perform A Con- 1) Occurs during the policy tract period; or Damages arising out of fail- ure prior to the ure of performance of con- 2) p tract by any usurer. "first effective date" of Includes copyrighted material of Insurance GA 233 0917 Services Office, Inc.,with its permission. Page 3 of 17 ■ (d) Insufficiency Of Funds (i) Taxes, Fines Or Penalties Damages arising out of an Taxes, fines or penalties, in- insufficiency of funds to cluding those imposed un- meet any obligations under der the Internal Revenue any plan induded in the Code or any similar state or "employee benefit program". local law. (e) Inadequacy Of Perfor- (j) Employment-Related Prac- mance Of Invest- tices ment/Advice Given With Respect To Participation Any liability arising out of any: Any claim based upon: (1) Refusal to employ; 1) Failure of any invest- ment to perform; (2) Termination of employ- ment; 2) Errors in providing in- formation on past per- (3) Coercion, demotion, formance of investment evaluation, reassign- vehicles; or ment, discipline, defa- mation, harassment, 3) Advice given to any humiliation, discrimina- person with respect to tion or other employ- that person's decision to ment- related practices, participate or not to par- acts or omissions; or ticipate in any plan in- cluded in the "employee (4) Consequential liability benefit program". as a result of (1), (2) or (3)above. (f) Workers' Compensation And Similar Laws This exclusion applies • whether the insured may be Any claim arising out of your held liable as an employer failure to comply with the or in any other capacity and mandatory provisions of any to any obligation to share workers' compensation, un- damages with or repay employment compensation someone else who must pay insurance, social security or damages because of the in- disability benefits law or any jury. similar law. (3) Supplementary Payments (g) ERISA Section I - Coverages, Sup- Damages for which any in- plementary Payments - Cover- sured is liable because of li- ages A And B also apply to this ability imposed on a fiduci- Coverage. ary by the Employee Re- tirement Income Security b. Who Is An Insured Act of 1974, as now or As respects Employee Benefit Lia- hereafter amended, or by bility Coverage, Section II - Who Is any similar federal, state or An Insured is replaced by the follow- local laws. ing: (h) Available Benefits (1) If you are designated in the Dec- Any claim for benefits to the larations as: extent that such benefits are (a) An individual, you and your available, with reasonable spouse are insureds, but on- effort and cooperation of the ly with respect to the con- insured, from the applicable duct of a business of which funds accrued or other col- you are the sole owner. lectible insurance. (b) A partnership or joint ven- ture, you are an insured. Your members, your part- Includes copyrighted material of Insurance GA 233 0917 Services Office, Inc.,with its permission. Page 4 of 17 ners, and their spouses are zation. However, coverage under also insureds but only with this provision: respect to the conduct of your business. (a) Is afforded only until the 180th day after you acquire (c) A limited liability company, or form the organization or you are an insured. Your the end of the policy period, members are also insureds, whichever is earlier; and but only with respect to the conduct of your business. (b) Does not apply to any act, Your managers are in- or omission that was sureds, but only with respect committed before you ac- to their duties as your man- quired or formed the organi- agers. zation. (d) An organization other than a c. Limits Of Insurance partnership, joint venture or As respects Employee Benefit Lia- limited liability company, you bility Coverage, Section III - Limits are an insured. Your "execu- Of Insurance is replaced by the fol- tive officers" and directors lowing: are insureds, but only with respect to their duties as (1) The Limits of Insurance shown in your officers or directors. Section B. Limits Of Insurance, Your stockholders are also 1. Employee Benefit Liability insureds, but only with re- Coverage and the rules below fix spect to their liability as the most we will pay regardless stockholders. of the number of: (e) A trust, you are an insured. (a) Insureds; Your trustees are also in- sureds, but only with respect (b) Claims made or "suits" to their duties as trustees. brought; (2) Each of the following is also an (c) Persons or organizations insured: making claims or bringing "suits"; (a) Each of your "employees" who is or was authorized to (d) Acts,errors or omissions; or administer your "employee (e) Benefits induded in your benefit program"; "employee benefit program". (b) Any persons, organizations (2) The Aggregate Limit shown in or "employees" having prop- Section B. Limits Of Insurance, er temporary authorization 1. Employee Benefit Liability to administer your "employ- Coverage of this endorsement is ee benefit program" if you the most we will pay for all dam- die, but only until your legal ages because of acts, errors or representative is appointed; omissions negligently committed or in the "administration" of your (c) Your legal representative if "employee benefit program". you die, but only with re- (3) Subject to the limit described in spect to duties as such. That (2) above, the Each Employee representative will have all Limit shown in Section B. Limits your rights and duties under Of Insurance, 1. Employee this Coverage Part. Benefit Liability Coverage of (3) Any organization you newly ac- this endorsement is the most we quire or form, other than a part- will pay for all damages sus- nership, joint venture or limited tamed by any one "employee", liability company, and over which including damages sustained by you maintain ownership or major-such "employee's" dependents ity interest, will qualify as a and beneficiaries, as a result of: Named Insured if no other similar (a) An act, error or omission; or insurance applies to that organi- Includes copyrighted material of Insurance GA 233 0917 Services Office, Inc., with its permission. Page 5 of 17 • 4 (b) A series of related acts, er- tification of the action taken, rors or omissions, regard- you shall promptly reim- less of the amount of time burse us for such part of the that lapses between such Deductible Amount as we acts, errors or omissions; have paid. negligently committed in the d. Additional Conditions "administration" of your "employ- ee respects Employ ee Benefit Lia- bility benefit program". P P Y bility Coverage, Section IV - Corn- However, the amount paid under mercial General Liability Condi- this endorsement shall not ex- tions is amended as follows: ceed, and will be subject to the limits and restrictions that apply (1) Item 2. Duties In The Event Of to the payment of benefits in any Occurrence, Offense, Claim Or plan included in the "employee Suit is replaced by the following: benefit program." 2. Duties In The Event Of An (4) Deductible Amount Act, Error Or Omission, Or Claim Or Suit (a) Our obligation to pay dam- ages on behalf of the in- a. You must see to it that sured applies only to the we are notified as soon amount of damages in ex- as practicable of an act, cess of the Deductible error or omission which Amount stated in the Deda- may result in a claim. rations as applicable to To the extent possible, Each Employee. The limits notice should include: of insurance shall not be re- (1) What the act, error duced by the amount of this or omission was deductible. and when it oc- (b) The Deductible Amount curred; and stated in the Declarations (2) The names and applies to all damages sus- addresses of any- tained by any one "employ- one who may suf- ee", including such "employ- fer damages as a ee's" dependents and bene- result of the act, fidaries, because of all acts, error or omission. errors or omissions to which this insurance applies. b. If a claim is made or (c) The terms of this insurance, "suit" is brought against ( ) any insured, you must: including those with respect to: (1) Immediately record 1) Our right and duty to the specifics of the g claim or "suit" and defend the insured the date received; against any "suits" and seeking those damag- es; and (2) Notify us as soon 2) Your duties, and the du- as practicable. ties of any other in- You must see to it that volved insured, in the we receive written no- event of an act, error or tice of the claim or"suit" omission,or claim; as soon as practicable. apply irrespective of the ap- c. You and any other in- plication of the Deductible volved insured must: Amount. (1) Immediately send (d) We may pay any part or all us copies of any of the Deductible Amount to demands, notices, effect settlement of any summonses or le- claim or "suit" and, upon no- gal papers re- Includes copyrighted material of Insurance GA 233 0917 Services Office, Inc.,with its permission. Page 6 of 17 ceived in connec- tion by equal shares, tion with the claim we will follow this meth- or"suit"; od also. Under this ap- proach Authorize us to ob- proach each insurer (2) contributes equal tain records and amounts until it has other information; paid its applicable limit (3) Cooperate with us of insurance or none of in the investigation the loss remains, or settlement of the whichever comes first. claim or defense If any of the other in- against the "suit"; surance does not permit and contribution by equal (4) Assist us, upon our shares, we will contrib- request, in the en- ute by limits. Under this forcement of any method, each insurers right against any share is based on the person or organi- ratio of its applicable nation which may limit of insurance to the be liable to the in- total applicable limits of cured because of insurance of all insur- an act, error or ers. omission to which c. No Coverage this insurance may also apply. This insurance shall not d. No insured will, except cover any loss for which the insured is entitled to at that insured's own recovery under any cost, voluntarily make a other insurance in force -- payment, assume any previous to the effective obligation, or incur any date of this Coverage expense without our Part. consent. (2) Item 5. Other Insurance is re- e. Additional Definitions placed by the following: As respects Employee Benefit Lia- bility Other Insurance bility Coverage, Section V - Defini- tions is amended as follows: If other valid and collectible (1) The following definitions are insurance is available to the added: insured for a loss we cover under this Coverage Part, 1. "Administration"means: our obligations are limited as follows: a. Providing information to "employees", including a. Primary Insurance their dependents and beneficiaries, with re- This insurance is prima- spect to eligibility for or ry except when c. below scope of "employee applies. If this insurance benefit programs"; is primary, our obliga- tions are not affected b. Interpreting the "em- unless any of the other ployee benefit pro- insurance is also prima- grams"; ry. Then, we will share with all that other insur- c. Handling records in ance by the method de- connection with the scribed in b. below. "employee benefit pro- grams"; or b. Method Of Sharing d. Effecting, continuing or If all of the other insur- terminating any "em- ance permits contribu- ployee's" participation in Includes copyrighted material of Insurance GA 233 0917 Services Office, Inc.,with its permission. Page 7 of 17 any benefit included in c. Unemployment insur- the "employee benefit ance, social security program". benefits, workers' com- pensation"administration" benefits; and disability benefits; and does not include: a. Handling payroll deduc- d. Vacation plans, includ- ing buy and sell pro- lions; or grams; leave of ab- b. The failure to effect or sence programs, includ- maintain any insurance ing military, maternity, or adequate limits of family, and civil leave; coverage of insurance, tuition assistance plans; including but not limited transportation and to unemployment insur- health club subsidies. ance, social security 4, "First effective date" means benefits, workers' com- the date upon which cover- pensation and disability age was first effected in a benefits. series of uninterrupted re- 2. "Cafeteria plans" means newels of insurance cover- plans authorized by applica- age. ble law to allow "employees" (2) The following definitions are de- to elect to a for certain to p ay leted in their entire ty and re- benefits with pre-tax dollars. placed by the following: 3. "Employee benefit pro- 8. "Employee" means a person grams" means a program actively employed, formerly providing some of all of the employed, on leave of ab- following benefits to "em- sence or disabled, or retired. ployees", whether provided "Employee" includes a through a "cafeteria plan" or "leased worker". "Employee" otherwise: does not include a "tempo- a. Group life insurance; rary worker". group accident or health 21. "Suit"means a civil proceed- insurance; dental, vision ing in which money damag- and hearing plans; and es because of an act, error flexible spending ac- or omission to which this in- counts; provided that no surance applies are alleged. one other than an "em- "Suit" includes: ployee" may subscribe to such benefits and a. An arbitration proceed- such benefits are made ing in which such dam- generally available to ages are claimed and to those "employees" who which the insured must satisfy the plan's eligibil- submit or does submit ity requirements; with our consent; b. Profit sharing plans, b. Any other alternative employee savings dispute resolution pro- plans, employee stock ceeding in which such ownership plans, pen- damages are claimed sion plans and stock and to which the in- subscription plans, pro- sured submits with our vided that no one other consent;or than an "employee" may subscribe to such c. An appeal of a civil pro- benefits and such bene- ceeding. fits are made generally available to all "employ- ees" who are eligible under the plan for such benefits; Includes copyrighted material of Insurance GA 233 0917 Services Office, Inc.,with its permission. Page 8 of 17 . I 2. Unintentional Failure To Disclose Haz- 2) Rust or other cor- ards rosion, decay, de- Section IV-Commercial General Liabil- o de- terioration,defect o ity Conditions, 7. Representations is or latent aefector Y P any quality in amended by the addition of the following: property that caus- Based on our dependence upon your rep- es it to damage or resentations as to existing hazards, if un- destroy itself; intentionally you should fail to disdose all 3) Smog; such hazards at the inception date of your policy, we will not reject coverage under 4) Mechanical break- this Coverage Part based solely on such down, including failure. rupture or bursting 3. Damage To Premises Rented To You caused by centrif- 9 ugal force; a. The last Paragraph of 2. Exclusions 5) Settling, cracking, under Section I -Coverage A- Bod- shrinking or ex- ily Injury And Property Damage Li- pansion; ability is replaced by the following: infesta- Exdusions c.through q. do not apply 6) Nesting d icharge to "property damage" by fire, explo- oon, a or discharge sion, lightning, smoke or soot to or release r waste premises while rented to you or tem- products o insects,seers, porarily occupied by you with permis- birds, roby dents ts o sion of the owner, for which the other animals; or amount we will pay is limited to the other animals; or Damage To Premises Rented To 7) Presence, growth, You Limit as described in Section Ill proliferation, -Limits Of Insurance. spread or any ac- tivity The insurance provided under Sec- cluding g fungus, for cluding mold or tion I - Coverage A - Bodily Injury mildew, and any And Property Damage Liability ap- mycotoxins, plies to "property damage"arising out spores, scents or of water damage to premises that are byproducts pro- both rented to and occupied by you. duced or released (1) As respects Water Damage Le- by fungi. gal Liability, as provided in Para- (b) "Property damage" caused graph 3.b.above: directly or indirectly by any The exclusions under Section I - of the following: Coverage A-Bodily Injury And (i) Earthquake, volcanic Property Damage Liability. 2. eruption, landslide or Exclusions, other than i. War any other earth move- and the Nuclear Energy Liabil- ment; ity Exclusion(Broad Form),are deleted and the following are (ii) Water that backs up or added: overflows or is other- This insurance does not apply to: wise discharged from a sewer, drain, sump, (a) "Property damage": sump pump or related equipment; (i) Assumed in any con- tract or agreement or (iii) Water under the ground surface pressing on, or (ii) Caused by or resulting flowing or seeping from any of the follow- through: ing: . 1) Foundations, walls, 1) Wear and tear; floors or paved surfaces; Includes copyrighted material of Insurance GA 233 0917 Services Office, Inc.,with its permission. Page 9 of 17 2) Basements, you with permission of whether paved or the owner; not; or b. In the case of damage 3) Doors, windows or by fire, explosion, light- other openings. ning, smoke or soot, (c) "Property damage" caused while rented to you;or by or resulting from water c. In the case of damage that leaks or flows from by water, while rented plumbing, heating, air condi- to and occupied by you. boning, fire protection sys- tems, or other equipment, (2) The most we will pay is limited as caused by or resulting from described in Section B. Limits freezing, unless: Of Insurance, 3. Damage To Premises Rented To You of this () You did your best to endorsement. maintain heat in the building or structure; or 4. Supplementary Payments (ii) You drained the equip- Under Section I - Supplementary Pay- ment and shut off the ments-Coverages A And B: water supply if the heat a. Paragraph 2. is replaced by the fol- was not maintained. lowing: (d) "Property damage"to: Up to the limit shown in Section B. () Plumbing, heating, air Limits Of Insurance, 4.a. Bail Bonds conditioning, fire protec- of this endorsement for cost of bail tion systems, or other bonds required because of accidents equipment or applianc- or traffic law violations arising out of es; or the use of any vehicle to which the Bodily Injury Liability Coverage ap- (ii) The interior of any plies.We do not have to furnish these building or structure, or bonds. to personal property in the building or structure, b. Paragraph 4. is replaced by the fol- caused by or resulting lowing: from rain,snow, sleet or All reasonable expenses incurred by ice, whether driven by the insured at our request to assist us wind or not. in the investigation or defense of the c. Limit Of Insurance claim or "suit", including actual loss of earnings up to the limit shown in Sec- With respect to the insurance afford- tion B. Limits Of Insurance, 4.b. ed in Paragraphs 3.a. and 3.b.above, Loss Of Earnings of this endorsement the Damage To Premises Rented per day because of time off from To You Limit as shown in the Decla- work. rations is amended as follows: 5. Medical Payments (1) Paragraph 6. of Section III - Limits Of Insurance is replaced The Medical Expense Limit of Any One by the following: Person as stated in the Declarations is amended to the limit shown in Section B. 6. Subject to Paragraph 5. Limits Of Insurance, 5. Medical Pay- above, the Damage To ments of this endorsement. Premises th Rented we To You 6. 180 Day Coverage For Newly Formed Limit is the most we will pay Y 9 Y under Coverage A- Bodily Or Acquired Organizations Injury And Property Dam- Section II - Who Is An Insured is age Liability for damages amended as follows: because of "property dam- ! to any one premises: Subparagraph a. of Paragraph 3. is re- placed by the following: a. While rented to you, or temporarily occupied by a. Insurance under this provision is af- forded only until the 180th day after Includes copyrighted material of Insurance GA 233 0917 Services Office, Inc.,with its permission. Page 10 of 17 /I you acquire or form the organization use of that part of the prem- or the end of the policy period, ises leased to you, subject whichever is earlier; to the following additional 7. Waiver Of Subrogation exclusions: Section IV-Commercial General Liabil- This insurance does not ap- ply Conditions, 9.Transfer Of Rights Of to: Recovery Against Others To Us is () Any "occurrence" which amended by the addition of the following: takes place after you We waive any right of recovery we may cease to a tenant in have against any person or organization that premis ses; against whom you have agreed to waive (i) Structural alterations, such right of recovery in a written contract new construction or or agreement because of payments we demolition operations make for injury or damage arising out of performed by or on be- your ongoing operations or "your work" half of such additional done under a written contract or agree- insured. ment with that person or organization and included in the "products-completed oper- (b) Lessor Of Leased Equip- ations hazard". However, our rights may ment only be waived prior to the "occurrence" Any person or organization giving rise to the injury or damage for from whom you lease which we make payment under this Coy- equipment when you and erage Part. The insured must do nothing such person(s) or organize- after a loss to impair our rights. At our re- tion(s) have agreed per Par- quest,the insured will bring "suit"or trans- agraph 8.a.(1) of this en- fer those rights to us and help us enforce dorsement to provide insur- those rights. ance. Such person(s) or or- -8. -Automatic Additional Insured - Speci- ganization(s) are insureds fled Relationships only with respect to liability for "bodily injury", "property a. The following is added to Section II - - damage" or "personal and Who Is An Insured: advertising injury"caused, in (1) Any person(s) or organization(s) maintenance or in e port, by your maintenance, operation or described in Paragraph 8.a(2)of use of equipment leased to this endorsement (hereinafter re- you by such person(s) or or- ferred to as additional insured) ganization(s). A person's or whom you are required to add as organization's status as an an additional insured under this additional insured under this Coverage Part by reason of a endorsement ends when written contract, written agree- their contract or agreement ment, written permit or written with you for such leased authorization. equipment ends. However, (2) Only the following persons or or- this insurance does not ap- ganizations are additional in- ply to any "occurrence" sureds under this endorsement, which takes place after the and insurance coverage provided equipment lease expires. to such additional insureds is lim- (c) Vendors ited as provided herein: Managers Any person or organization (a) 9 Or Lessors Of (referred to below as ven- Premises dor) with whom you have The manager or lessor of a agreed per Paragraph premises leased to you with 8.a.(1) of this endorsement whom you have agreed per to provide insurance, but on- Paragraph 8.a.(1)of this en- ly with respect to 'bodily in- dorsement to provide insur- jury" or "property damage" ance, but only with respect arising out of'your products" to liability arising out of the which are distributed or sold ownership, maintenance or in the regular course of the Includes copyrighted material of Insurance GA 233 0917 Services Office, Inc.,with its permission. Page 11 of 17 vendor's business, subject or repair opera- to the following additional tions, except such exclusions: operations per- formed at the yen- () The insurance afforded dor's premises in the vendor does not connection with the apply to: sale of the product; 1) "Bodily injury' or 7) Products which, af- "property damage" ter distribution or for which the yen- sale by you, have dor is obligated to been labeled or re- pay damages by labeled or used as reason of the as- a container, part or sumption of liability ingredient of any in a contract or other thing or sub- agreement. This stance by or for the exclusion does not vendor; or apply to liability for damages that the 8) "Bodily injury" or vendor would have "property damage" in the absence of arising out of the the contract or sole negligence of agreement; the vendor for its own acts or omis- 2) Any express war- sions or those of ranty unauthorized its employees or by you; anyone else acting 3) Any physical or on its behalf. How- chemical change in ever,this exclusion the product made does not apply to: intentionally by the a) The excep- vendor; tions contained 4) Repackaging, ex- in Paragraphs cept when un- (c) (i) 4) or 6) packed solely for of this en- the purpose of in- dorsement; or spection, demon- b) Such inspec- stration, testing, or tions, ac(ust- the substitution of ments, tests or parts under in- servicing as structions from the the vendor has manufacturer, and agreed to then repackaged in make or nor- the original con- mally under- tainer; takes to make 5) Any failure to make in the usual such inspections, course of adjustments, tests business, in or servicing as the connection vendor has agreed with the distri- to make or normal- bution or sale ly undertakes to of the prod- make in the usual ucts. course of busi- (ii) This insurance does not ness, in connection apply to any insured with the distribution person or organization: or sale of the products; 1) From whom you have acquired 6) Demonstration, in- such products, or stallation, servicing any ingredient, part Includes copyrighted material of Insurance GA 233 0917 Services Office, Inc.,with its permission. Page 12 of 17 or container, enter- (e) Mortgagee, Assignee Or ing into, accompa- Receiver nying or containing such products; or Any person or organization with whom you have agreed 2) When liability in- per Paragraph 8.a.(1) of this cluded within the endorsement to provide in- "products- surance, but only with re- completed opera- spect to their liability as tions hazard" has mortgagee, assignee, or re- been excluded un- ceiver and arising out of the der this Coverage ownership, maintenance, or Part with respect to use of the premises by you. such products. However, this insurance (d) State Or Governmental does not apply to structural ( ) alterations, new construction Agency Or Subdivision Or and demolition operations Political Subdivision - performed by or for that per- - Permits Or Authorizations son or organization. Relating To Premises An state or governmental (3) The insurance afforded to addi- Any 9 tional insureds described in Par- agency or subdivision or po- agraph 8.a.(1) of this endorse- litical subdivision with which ment: you have agreed per Para- graph 8.a.(1) of this en- (a) Only applies to the extent dorsement to provide insur- permitted by law; and ance, subject to the follow- ing additional provision: (b) Will not be broader than that which you are required by This insurance applies only the written contract, written with respect to the following agreement, written permit or hazards for which the state written authorization to pro- or governmental agency or vide for such additional in- subdivision or political sub- sured; and division has issued a permit or authorization in connec- (c) Does not apply to any per- tion with premises you own, son, organization, vendor, rent or control and to which state, governmental agency this insurance applies: or subdivision or political subdivision, specifically () The existence, mainte- named as an additional in- nance, repair, construc- sured under any other provi- tion, erection or removal sion of, or endorsement of advertising signs, added to, this Coverage awnings, canopies, cel- Part, provided such other lar entrances, coal provision or endorsement holes, driveways, man- covers the injury or damage holes, marquees, hoist for which this insurance ap- away openings, side- plies. walk vaults, street ban- ners or decorations and b. With respect to the insurance afford- similar exposures; or ed to the additional insureds de- scribed in Paragraph 8.a.(1) of this (ii) The construction, erec- endorsement, the following is added tion or removal of eleva- to Section III-Limits Of Insurance: tors; or The most we will pay on behalf of the (iii) The ownership, mainte- additional insured is the amount of in- nance or use of any el- surance: evators covered by this insurance. (1) Required by the written contract, written agreement, written permit or written authorization described Includes copyrighted material of Insurance GA 233 0917 Services Office, Inc.,with its permission. Page 13 of 17 r in Paragraph 8.a.(1) of this en- tion I - Coverage A - Bodily Injury dorsement; or And Property Damage Liability: (2) Available under the applicable Paragraphs (3) and (4) of this exclu- Limits of Insurance shown in the sion do not apply to tools or equip- Declarations; ment loaned to you,provided they are whichever is less. not being used to perform operations at the time of loss. This endorsement shall not increase b. With respect to the insurance provid- the applicable Limits of Insurance ed by this section of the endorse- shown in the Declarations. ment, the following additional provi- c. Section IV - Commercial General sions apply: Liability Conditions is amended to (1) The Limits of Insurance shown in include the following: the Declarations are replaced by Automatic Additional Insured Pro- the limits designated in Section vision B. Limits Of Insurance, 9. Property Damage To Borrowed This insurance applies only if the Equipment of this endorsement "bodily injury" or "property damage" with respect to coverage provid- occurs, or the "personal and advertis- ed by this endorsement. These ing injury"offense is committed: limits are inclusive of and not in (1 addition to the limits being re- ef) During the policy period;and placed. The Limits of Insurance (2) Subsequent to your execution of shown in Section B. Limits Of the written contract or written Insurance, 9. Property Damage agreement, or the issuance of a To Borrowed Equipment of this written permit or written authori- endorsement fix the most we will zation, described in Paragraph pay in any one "occurrence" re- 8 a(1) gardless of the number of: d. Section IV - Commercial General (a) Insureds; . _.Liability_Conditions is amended as (b) Claims made or "suits" follows: brought;or Condition 5. Other Insurance is (c) Persons or organizations amended to include: making claims or bringing Primary And Noncontributory In- "suits". surance (2) Deductible Clause This insurance is primary to and will (a) Our obligation to pay dam- not seek contribution from any other ages on your behalf applies insurance available to an additional only to the amount of dam- insured per Paragraph 8.a.(1) of this ages for each "occurrence" endorsement provided that: which are in excess of the (1) The additional insured is a Deductible Amount stated in Named Insured under such other Section B. Limits Of Insur- insurance; and ance, 9. Property Damage To Borrowed Equipment of (2) You have agreed in writing in a this endorsement. The limits contract, agreement, permit or of insurance will not be re- authorization described in 8.a.(2) duced by the application of of this endorsement that this in- such deductible amount. surance would be primary and would not seek contribution from (b) Section IV - Commercial any other insurance available to General Liability Condi- the additional insured. tions, 2. Duties In The Event Of Occurrence, Of- 9. Property Damage To Borrowed Equip- fense, Claim Or Suit, ap- ment plies to each claim or "suit" irrespective of the amount. a. The following is added to Exclusion 2.j.Damage To Property under Sec- Includes copyrighted material of Insurance GA 233 0917 Services Office, Inc.,with its permission. Page 14 of 17 (c) We may pay any part or all 12. Nonowned Aircraft of the deductible amount to effect settlement of any The following is added to Exclusion 2.g. claim or "suit" and, upon no- Aircraft, Auto Or Watercraft under Sec- tification of the action taken, tion I - Coverage A - Bodily Injury And you shall promptly reim- Property Damage Liability: burse us for such part of the This exclusion does not apply to an air- deductible amount as has craft you do not own, provided that: been paid by us. 10. Employees As Insureds - Specified a. The pilot in command holds a current P effective certificate, issued by a duly Health Care Services And Good Samar- constituted authority of the United itan Services States of America or Canada, desig- Paragraph 2.a.(1Xd) under Section II - nating that person as a commercial or Who Is An Insured does not apply to: airline transport pilot a. Your "employees" who provide pro- b. The aircraft is rented with a trained, fessional health care services on your paid crew; and behalf as a duly licensed nurse, c. The aircraft does not transport per- emergency medical technician or sons or cargo for a charge. paramedic in the jurisdiction where an "occurrence" or offense to which this 13. Bodily Injury Redefined insurance applies takes place; or Section V- Definitions, 4. "Bodily injury" b. Your "employees" or "volunteer work- is replaced by the following: ers", other than an employed or vol- unteer doctor, providing first aid or 4. "Bodily injury" means bodily harm or good samaritan services during their injury, sickness, disease, disability, work hours for you will be deemed to humiliation, shock, fright, mental an- be acting within the scope of their guish or mental injury, including care, employment by you or performing du- . _ loss of services or death resulting ties related to the conduct of your from any of these at any time. business. 14. Expected Or Intended Injury Redefined 11. Broadened Notice Of Occurrence The last sentence of Exclusion 2a. Ex- Paragraph a. of Condition 2. Duties In pected Or Intended Injury under Sec- The Event Of Occurrence, Offense, tion I - Coverage A- Bodily Injury And Claim Or Suit under Section IV - Corn- Property Damage Liability is replaced by mercial General Liability Conditions is the following: replaced by the following: This exclusion does not apply to "bodily a. You must see to it that we are notified injury"or"property damage" resulting from as soon as practicable of an "occur- the use of reasonable force to protect per- rence"or an offense which may result sons or property. in a claim. To the extent possible, no- 15. Former Employees As Insureds tice should include: (1) How, when and where the "oc- The following is added to Paragraph 2. ( ) under Section II-Who Is An Insured: currence"or offense took place; 2. Each of the following is also an in- (2) The names and addresses of sured: any injured persons and wit- nesses; and Any of your former "employees", di- 3 The nature and of any rectors, managers, members, part- ( ) Th t d l ti f Y ners or "executive officers", including injury or damage arising out of but not limited to retired, disabled or the "occurrence"or offense. those on leave of absence, but only This requirement applies only when for acts within the scope of their em- the "occurrence" or offense is known ployment by you or for duties related • to an "authorized representative". to the conduct of your business. Includes copyrighted material of Insurance GA 233 0917 Services Office, Inc.,with its permission. Page 15 of 17 4. 16. Voluntary Property Damage Coverage (2) Exclusions a. Coverage D - Voluntary Property This insurance does not apply to Damage Coverage "property damage" that would be es is amended to excluded by Coverage A- Bodi- Section I-Coverages ly Injury And Property Damage include the following: Liability, 2. Exclusions, except (1) Insuring Agreement for j. Damage To Property, par- agraphs (3), (4), (5) and (6), k. (a) We will pay the cost to re- Damage To Your Product, and pair or replace "property I. Damage To Your Work. damage" to property of oth- ers arising out of operations (3) Definitions incidental to your business For purposes of Voluntary when: Property Damage Coverage 1) Damage is caused by only, the following definitions un- you; or der Section V - Definitions are replaced by the following: 2) Damage occurs while in your possession. 16. "Occurrence" means an in- cident, including continuous At your written request, we or repeated exposure to will make this payment re- substantially the same gen- gardless of whether you are eral harmful conditions that at fault for the "property result in "property damage". damage". 20. "Property damage" means If you, at our request, re- physical injury to tangible place, or make any repairs property. "Electronic data" is to, damaged property of not tangible property, and others, the amount we will "property damage" does not pay under Voluntary Prop- include disappearance, ab- erty Damage Coverage will straction or theft. be determined by your actu- al cost to replace or repair b. Care, Custody Or Control Liability the damaged property, ex- Coverage cluding any profit or over- For purposes of the coverage provid- head. ed by Care, Custody Or Control Li- Any payment we make un- ability Coverage in this endorsement der Voluntary Property only: Damage Coverage shall not (1) Section I -Coverage A- Bodily be interpreted as an admis- Injury And Property Damage sion of liability by you or by Liability, 2. Exclusions, j. US. Damage To Property, Subpara- It shall be your duty, not our graphs(3),(4) and (5)do not ap- duty, to defend any claim or ply to "property damage" to the "suit"to which this insurance property of others described applies. therein. No other obligation or liabil- (2) It shall be your duty, not our duty, ity to pay sums or perform to defend any claim or "suit" to acts or services is covered. which this insurance applies. (b) This insurance applies to No other obligation or liability to "property damage"only if: pay sums or perform acts or ser- vices is covered. 1) The "property damage" takes place in the "cov- This Paragraph (2) supersedes erage territory"; and any provision in the Coverage Part to the contrary. 2) The "property damage" occurs during the policy (3) "Property damage" for which period. Care, Custody Or Control Lia- bility Coverage provides cover- Includes copyrighted material of Insurance GA 233 0917 Services Office, Inc.,with its permission. Page 16 of 17 j . 1 age shall be deemed to be (3) The Voluntary Property Dam- caused by an "occurrence" but age Coverage, Aggregate Limit shall not serve to limit or restrict Of Insurance is the most we will the applicability of any exclusion pay for the sum of all damages for "property damage" under this under Voluntary Property Coverage Part. Damage Coverage. This limit c. Limits Of Insurance And Deducti- applies separately to each "cov- erage term". bles For purposes of the coverage provid- (4) Deductible Clause ed by Voluntary Property Damage (a) Our obligation to pay dam- Coverage and Care, Custody Or ages on your behalf applies Control Liability Coverage, Section only to the amount of dam- III-Limits Of Insurance is amended ages for each "occurrence" to include the following: which are in excess of the Deductible Amount stated (1) The Limits of Insurance shown in for the applicable coverage the Declarations are replaced by in the Schedule. The limits the limits designated in Section of insurance will not be re- B. Limits Of Insurance, 16. duced by the application of Voluntary Property Damage such Deductible Amount. Coverage And Care, Custody Or Control Liability Coverage, (b) Section IV - Commercial in this endorsement. These limits General Liability Condi- are inclusive of, and not in addi- tions, 2. Duties In The tion to, the limits being replaced. Event Of Occurrence, Of- The Limits of Insurance shown in Tense, Claim Or Suit, ap- the Schedule fix the most we will plies to each claim or "suit" pay regardless of the number of: irrespective of the amount. . - (a) Insureds; (c) We may pay any part or all of the Deductible Amount to (b) Claims made or "suits" effect settlement of any . brought;or - claim or "suit" and, upon no- (c) Persons or organizations no- tification of the action taken, making claims or bringing you shall promptly reim- "suits". burse us for such part of the Deductible Amount as has (2) (a) Subject to (3) below, the been paid by us. Voluntary Property Dam- 17. Broadened Contractual Liability Work Dam- age Coverage, Each Occur- Within 50' Of Railroad Property y rence Limit Of Insurance is the most we will pay for the Section V-Definitions,12. "Insured con- sum of damages under Vol- tract" is amended as follows: untary Property Damage Coverage; a. Paragraph c. is replaced by the fol- (b) The Care,Custody Or Con- lowing: trol Liability Coverage, c. Any easement or license agree- Each Occurrence Limit Of ment; Insurance is the most we will pay for the sum of damages b. Paragraph f.(1)is deleted in its entire- ' under Care, Custody Or W. Control Liability Coverage; 18. Alienated Premises because of all "property damage" Exclusion 2.j. Damage to Property, arising out of any one "occur- Paragraph (2) under Section I - Cover- rence". age A - Bodily Injury And Property Damage Liability does not apply if the premises are "your work". Includes copyrighted material of Insurance GA 233 0917 Services Office, Inc.,with its permission. Page 17 of 17