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HomeMy WebLinkAboutInsurance Certificate: Pacific Paving 1 ® DATE (MM/DD/YYYY) ACC )RD" CERTIFICATE OF LIABILITY INSURANCE 9/9/2019 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 NAME: Terry Friend Protectors Insurance, LLC PHONE FAX P.O. Box 4669 WC. No, •541-842-2958 we No): 541-772-1906 Medford OR 97504 ADORess: teW@Protectorsins.com INSURERS AFFORDING COVERAGE NAIC # INSURER A : 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: 339529034 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 MM/DD/YYYY (MM/DDfYYYY) A X COMMERCIAL GENERAL LIABILITY EPP0529033 3/20/2019 3/20/2022 EACH OCCURRENCE $1,000,000 F_V~ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES Ea occurrence) $ 500,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY [K] JECOT 7 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 ROrPERTnDAMAGE $ AUTOS ONLY AUTOS ONLY A X UMBRELLA LIAB X OCCUR EPP 0529033 3/20/2019 3/20/2022 EACH OCCURRENCE $1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ -TIED RETENTION $ $ B WORKERS COMPENSATION 812919 10/1/2019 10/1/2020 PER X OTH- STATUTE ER AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE N /A E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBEREXCLUDED9 (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 I LOCATIONS I 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 t ooo . i CERTIFICATE HOLDER ew '%W 1 11 MW ow a It 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 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD I 2. SECTION V - DEFINITIONS is amended P. Unintentional Failure to Disclose Hazards by adding the following, but only for; the - purposes of this Loan or Lease Gap SECTION IV - BUSINESS AUTO CONDI- Coverage: I TIONS, B. General Conditions, 2. Conceal- ment, Misrepresentation or Fraud is 'Total loss" means a "loss" in which,the amended by adding the following: cost of repairs plus the salvage valuefex- ceeds the actual cash value. However, if you unintentionally fail to disclose any,hazards existing on the effective date of N. Glass Repair-Waiver of Deductible this Coverage Form, we will not deny cover- SECTION. 111 -PHYSICAL DAMAGE ChV- age under this Coverage Form because of such failure. ERAGE, D. Deductible is amended by adding the following: O. 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 0. Duties in the Event of an Accident, Claim, the following: Suit or Loss - Amended "Bodily injury"means bodily injury, sickness or SECTION N -BUSINESS AUTO CONDI- disease sustained by a person, including men- TIONS, A. Loss Conditions, 2. Duties in the pal anguish and death sustained by the same Event of Accident, Claim, Suit or Loss, a. is person that results from such bodily injury, amended by adding the following:. include or disease. "Bodily injury" does not nclude ude mental anguish or death that does not ' This condition applies only when the "acct- result from bodily injury, sickness or disease. dent" or loss" is mown 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 3. An executive officer or insurance mariag- operations for or affecting a railroad: er, if you are a corporation; or f 1. Section V - Definitions, H. "Insured con- 4. A member or manager,.if you are a lim- tract", 1.c. is amended to read: ited liability company. I C. An easement-or license agreement; 2. Section V - Definitions, H. "Insured con- tract", 2a. is deleted. r i c ~ i < r i 1 i l Includes. copyrighted material of ISO AA 288 01 16 Properties, Inc., with its permission. Page 4 of 4 ll 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: i Coverage: Begins on Page- 1 . Employee Benefit Liability Coverage I........... ..........-----°--..3 9 2. Unintentional Failure To Disclose Hazards 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: mm 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 ....................................i............... 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 60" 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 i 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 3 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 (b) Payroll (For Limits in Excess of (c) Gross Sales $5,000) -$5,000) (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 • i C. Coverages i this endorsement pro- f. Employee Benefit Liability Coverage vided: a. The following is added to Section I - a) You did not have 9 i + knowledge of a Coverages: claim or "suit" on or Employee Benefit Liability Cover- before the "first ef- f festive date" of this age endorsement. (1) Insuring Agreement i You will be (a) We will pay those sums that deemed to have the insured becomes legally j 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 ads the insured is legally liable, to which this i) Reports all, e 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 I or any other -damages. However, we will i 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, Br- act, error or omission and ror or omis- settle any claim or "suit' that ! Sion; and may result. But: b) 1 The amount we will pay, applicable insur- for damages is limited ance.. as described in Section 111 - 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- I "Bodily injury", "property ments or settlements. f damage" or "personal and No other obligation or liabil- advertising injury". ity to pay sums or perform (b) Dishonest, Fraudulent, ads or services is covered I Criminal Or Malicious Act unless explicitly provided for under Supplementary Damages arising out of any Payments. intentional, dishonest, (b) This insurance applies to ( fraudulent, criminal or mali- 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 j (c) Failure To Perform A Con- 1) Occurs during the policy tract period; or Damages arising out of fail- ure of performance of con- 2) Occurred prior to the ; tract by any insurer. 'first effective date" of Includes copyrighted matefial of Insurance GA 233 0917 Services Office, Inc,, with? Is permission. Page 3 of 17 3 I (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 included 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 daim based upon: 1) Failure of an (1) Refusal to employ; any invest- ment to perform; (2) Termination of employ- ment; 2) Errors in providing' in- formation on past per- (3) Coercion, demotion, fornance 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". I 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 ~our 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 1 - 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 11 - Who Is any similar federal, state or An Insured is replaced by the follow- 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 pol- 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 Opiice, Inc., with its permission. Page 4 of 17 i I i 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- error 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 j As respects Employee Benefit Lia- limited liability company, you bility Coverage, Section III - Limits are an insured. Your "execu- I 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. I Section B. Limits Of Insurance, Your stockholders are also 1 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 daims 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 included in your benefit program"; "employee benefit program". (b) Any persons, organizations I (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 t the most we will pay for all dam- die, but only until your legal ! ages because of ads, errors or representative is appointed; omissions negligently committed or in the "administration" of your ! (c) Your legal representative if S "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- nership, joint venture or limited tained by any one employee", liability company, and over which i including damages sustained by you maintain ownership or major- such "employee's" dependents illy interest, will qualify as a and beneficiaries, as a result of: Named Insured if no other similar insurance applies to that organi- (a) An act, error or omission; or i Includes copyrighted material of Insurance GA 233 0917 Services Office, Inc., with its permission. Page 5 of 17 (b) A series of related ads, 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 ads, errors or omissions; have paid. negligently committed in the d. Additional Conditions "administration" of your "employ- ee benefit program". As respects Employee Benefit Lia- bility Coverage, Section IV - Com- 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 deductible. or omission was and when it oc- (b) The Deductible Amount curred; and stated in the Declarations applies to all damages sus- (2) The names and tained by any one "employ- addresses of any- ee", including such "employ- one who may su fer damages as a a ee's" dependents and bane- result of the ad, ficiades, 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 defend the inslrred claim or "suit" and against any "suits" the date received; and seeking those darfmag- 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 thd 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 i ceived in connec- tion by equal shares, tion with the claim we will follow this meth- or "suit"; od also. Under this ap- proach each insurer (2) Authorize us to ob- contributes equal fain records and amounts until it has other information; i paid its applicable limit (3) Cooperate with us I of insurance or none of in the investigation the loss remains, or settlement of the 3 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 I shares, we will contrib- Assist 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 zation which may limit of insurance to the be liable to the in- total applicable limits of insurance of all insur- sured because of l _ an act, error or ers. omission to which , c. No Coverage this insurance may also apply. This insurance shall not cover any loss d. No insured will, except 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 I date of this Coverage expense without our Part. consent. e. Additional Definitions (2) Item. 5. Other Insurance is re- ~ placed by the following: I As respects Employee Benefit Lia- 5. Other Insurance bility Coverage, Section V - Defini- tions is amended as follows: If other valid and collectible I (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 J follows: { a. Providing information to i "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 i 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- i 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. j "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- ployeds" 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 ante soda) security program". benefits, workers' com- However, "administration" pensation and disability benefits; and does not include: d. Vacation plans, includ- a. Handling payroll deduc- ing buy and sell pro- 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 q, "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 newals of insurance cover- plans authorized by applica- age. ble law to allow "employees" (2) The following definitions are de- to elect to pay for certain leted in their entirety and re- benefits with pre-tax dollars. placed by the following: 3. "Employee benefit fro- 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 insuraece; rary worker". group accident or health 21. "Suit" means a civil proceed- insurance; dental, vi? ion 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 suranoe 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 %odk 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 s I , I 2. Unintentional Failure To Disclose Haz- 2) Rust or other cor- ards I rosion, decay, de- terioration, hidden Section IV - Commercial General Liabil- I or latent defect or ity Conditions, 7. Representations is I any quality in amended by the addition of the following: S property that caus- Based on our dependence upon your rep- es it to damage or resentations as to existing hazards, if un- intentionally you should fail to disclose 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 j down, including failure. I rupture or bursting 3. Damage To Premises Rented To You u9aal caused centrif- i 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: 1 6) Exclusions c. through q. do not apply lionNesting or char e to "property damage" by fire, a lo- 1 , or discharge Y ~W or release of waste sion, lightning, smoke or soot to products or secre- premises while rented to you or tem- f tions, by insects, porarily occupied by you with permis- j birds, rodents or sion of-the owner, for which the f other animals; or amount we will pay is limited to the S Damage To Premises Rented To 1 7) Presence, growth, You Limit as described in Section 111 r proliferation, - Limits Of Insurance. spread or any ac- b. The insurance provided under Sec- cludi g fungus, in- mold mold or tion I - Coverage A - Bodily Injury mildew, and any And Property Damage Liability ap- mycotobns, plies to "property damage" arising out I 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: 1 directly or indirectly by any The exclusions under Section I - of the following: Coverage A - Bodily Injury And ! Earthquake, volcanic Property Damage Liability, 2. eruption, landslide or Exclusions, other than i. War c any other earth move- and the Nuclear Energy Liabil- ity-Exclusion ment; (Broad Form), are 1 deleted and the following are t (i) Water that backs up or added: overflows or is other- This insurance does not apply to: wise discharged from a j sewer, drain, sump (a) "Property damage": sump pump or related equipment; (1) Assumed in any con- ; tract or agreement; or i (ii) Water under the ground surface pressing on, or (Ii) Caused by or resulting flowing or seeping from any of the follow- through: ing: I 1) Foundations, walls, 1) Wear and tear; floors or paved surfaces; i Includes copyrighted material of Insurance GA 233 0917 Services Office, Inc., with its permission. Page 9 of 17 1 I S S i 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. tioning, 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 Ithe 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, 4a. 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 Iryury Liability Coverage ap- (i) 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 wind or not. the insured at our request to assist us in the investigation or defense of the c. Limit Of Insurance claim or "suit", including actual loss of j 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 Recited 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 111 - 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 Rented You Limit is the most we will :pay 6. 180 Day Coverage For Newly Formed 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- age" to any one premise6: Subparagraph a. of Paragraph 3. is re- a. While rented to you, or placed by the following: temporarily occupied by a. Insurance under this provision is af- i forded only until the 180th day after c Includes copyrighted material of Insurance GA 233 0917 Services Office, Inc., with its permission. Page 10 of 17 I { s 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 exclusions: 7. Waiver Of Subrogation Section IV - Commercial General Liabil- This insurance does not ap- ity Conditions, 9. Transfer Of Rights Of ply 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 ht of recovery we may cease to be a tenant in Y 9 rY Y that premises; have against any person or organization i against whom you have agreed to waive (i) Structural alterations, such right of recovery in a written contract i 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- 1 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" I Any person or organization giving rise to the injury or damage for from whom you lease which we make payment under this Cov- equipment when you and erage Part The insured must do nothing such person(s) or organiza- after a loss to impair our rights. At our re- lion(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 fied 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 whole (1) Any or organization(s) or in part, by your Y person(s) maintenance, operation or described in Paragraph 8.a.(2) of use of equipment leased to _ this.epdorsement (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- I their contract or agreement ment, written permit or written I 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- ited as provided herein: Any person or organization (a) Managers Or Lessors Of I (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.0) of this en- 1 ly with respect to 'bodily in- dorsement to provide insur- jury" or "property damage" { arising out of "your products" ance, but only with respect to liability arising out of the which are distributed or sold ownership, maintenance or in the regular course of the i 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 van- (j) The insurance afforded dor's the vendor does not premises in 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 veto sale by you, have dor pay is obligated to been labeled or re- reason pay damages labeled or used as of the ass- - sumption of liability a container, part or ingredient of any a contract other thing or sub- exclusion This s stance by or for the dusion does not apply to liability for vendor, or 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 2) Any express war- own acts or omis- sions or those of ranty unauthorfied 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 byzthe vendor; a) The excep- tions contained 4) Repackaging, ex- in Paragraphs cept when un- (c) (1) 4) or 6) packed solely] for of this en- the purpose of, in- dorsement; or spection, demon- b) Such inspec- stration, testing, or tions, acjust- the substitutiori 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 bon- _ malty under- 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 undertakesi to of the prod- make in the usual ucts. course of busi- (1) 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 6) Demonstration, in- such products, or have stallation, servicing any ingredient, part r Includes copyrighted material of Insurance GA 233 0917 Services Office, Inc., with its permission. Page 12 of '17 i I i I - or container, enter- (e) Mortgagee, Assignee Or ing into, accompa- Receiver nying or containing Any person or organization such products; or with whom you have agreed 2) When liability in- per Paragraph 8.a.(1) of this cluded within the 1 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 does not apply to structural (d) State Or Governmental 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- Y 9 i 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: f (b) Will not be broader than that I which you are required by This insurance applies only i 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- son, organization, vendor, tion with premises you own, i state, governmental agency rent or control and to which this insurance applies: or subdivision or political subdivision, specifically The existence, mainte- named as an additional in- nance, repair, oonstruc- sured under any other provi- tion, erection or removal ; sion of, or endorsement of advertising signs, added to, this Coverage awnings, canopies, cel- j 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 j 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- I to Section III -Limits Of Insurance. tors; or ? The most we will pay on behalf of the (ii) 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 I Includes copyrighted material of Insurance GA 233 0917 Services Office, Inc., with its permission. Page 13 of 17 E 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 iri 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- 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) During the policy period; and addition to the limits being re- 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). I gardless of the number of: d. Section IV - Commercial General (a) Insureds; Liability Conditions is amended as (b) Claims made or "suits" follows: I brought; or Condition 5. Other Insurancii is (c) Persons or organizations amended to include: making claims or bringing Primary And Noncontributoryl.In- "suits". surance (2) Deductible Clause This insurance is primary to and will not seek contribution from any other (a) Our obligation pay dam- 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 ante, 9. Property Damage (2) You have agreed in writing in a To Borrowed Equipment of 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. tons, 2. Duties In The Event Of Occurrence, Of- 9. Property Damage To Borrowed Equip- fense, Claim Or Suit, ap- ment I plies to each claim or "suit" a. The following is added to Exclusion irrespective of the amount. 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 1 • i F I (c) We may pay any part or all 12. Nonowned Aircraft of the deductible amount to The following is added to Exclusion 2.g. effect settlement of any Aircraft Auto Or Watercraft under Sec-no- claim or "suit and, upon tion I - Coverage A - Bodily Injury And tification of the action taken, , ' Property Damage Liability: you, shall promptly reim- burse us for such part of the i This exclusion does not apply to an air- deductible amount as has craft you do not awn, provided that: been paid by us. a The pilot in command holds a current 10. Employees As Insureds - Specified 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.(1)(d) under Section II - nating that person as a commercial or Who Is An Insured does not apply to: airline transport pilot b. The aircraft is rented with a trained, a. Your "employees" who provide pro- ; paid crew; and fessional health care services on your behalf as a duly licensed nurse, r~ 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 i 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- guish or mental injury, including care, employment by you or performing du- I loss of services or death resulting lies 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 i The last sentence of Exclusion 2.a. Ex- Paragraph a. of Condition 2. Duties In. petted Or Intended Injury under Sec- The Event Of Occurrence, Offense, tion I - Coverage A - Bodily Injury And Claim Or Suit under Section IV - Com- ) Property Damage Liability is replaced by mercial General Liability Conditions is i 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 "properly 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 1 sons or property. in a claim. To the extent possible, no- i 15. Former Employees As Insureds tice should include: The following is added to Paragraph 2. (1) How, when and where the "oc- under Section 11- Who Is An Insured: currence" or offense took place; t 2- Each of the following is also an in- (2) The names and addresses of k sured: any injured persons and wit- nesses; and Any of your former "employees", di- rectors, managers, members, part- (3) The nature and location of any 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 ads 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. j i Includes copyrighted mateiial of Insurance. GA 233 0917 Services Office, Inc., with. its permission. Page 15 of 17 i 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 Section I - Coverages is amended to excluded by Coverage A - Bodi- iinclude the following: ly Injury And Property Damage Liability, 2. Exclusions, except (1) Insuring Agreement for j. Damage To Property, par- I agraphs (3), (4), (5) and (6), k. (a) We will pay the cost to re- Damage To Your Product, and pair or replace "properly I. Damage To Your Work. damage" to property ofioth- ers arising out of operations (3) Definitions incidental to your business For Purposes of Voluntary when: Property Damage Coverae 1) Damage is caused by only, the following definitions un- you; or i der Section V - Definitions are 2) Damage occurs while in replaced by the following: 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 "properly 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 wei 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 d.g any profit or over- hea 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 as an admis- (1) Section 1- Coverage A - Bodily be interpreted Injury of liability by you or by And Property Damage Liability, 2. Exclusions, j. US. I 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. I (b) This insurance applies to No other obligation or liability to "property damage" only it pay sums`or perform ads or ser- vices is covered. 1) The "property damage" takes place in the "pov_ This Paragraph (2) supersedes erage territory'; and. any provision in the Coverage J Part to the contrary. 2) The "property damage" occurs during the policy (3) "Property damage" for which period. I Care, Custody Or Control Lia- bility Coverage provides cover- Includes copyrighted material of Insurance GA 233 0917 Services Office, Ina, with its permission. Page 16 of 17 • S 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 fense, 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 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 age Coverage, Each Occur- rence Limit Of Insurance is Within 50 Of Railroad Property 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 ty. 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