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HomeMy WebLinkAboutInsurance Certificate: Masala Mastee LLC Accmc.® CERTIFICATE OF LIABILITY INSURANCE DATE E(MMID 2) 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 Ward Insurance Agency, Inc. PHONE Lynn Wray FAX P.O. Box 10167 (NC.No.Ext):541 -687-1117 (NC,No):541-342-8280 Eugene OR 97440-2167 ADDRESS: Iynn@wardinsurance.net INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Cincinnati Specialty Underwriters Insurance Compan 13037 INSURED MASAMAS-02`INSURER B Masala Mastee LLC Masala Bistro and Bar INSURER C: 258 A St.,Ste.3B INSURER D: Ashland OR 97520-1947 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:466079686 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 wLIMITS LTR INSD VD POLICY NUMBER (MMIDD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY Y V ECP0494340 6/26/2021 6/26/2022 EACH OCCURRENCE $1,000,000 CLAIMS-MADE X OCCUR DQE TO RENTED PREMISES(Ea occurrence) $1,000,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY 'ECOT LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: _ A AUTOMOBILE LIABILITY ECP0494340. 6/26/2021 6/26/2022 COMBINED SINGLE LIMIT $1,000,000 CO accident) ANY AUTO BODILY INJURY(Per person) $ OWNED 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 ECP0494340 6/26/2021 6/26/2022 EACH OCCURRENCE _ $1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $1,000,000 DER RETENTION$ EXCLUDES LIQUOR $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ • A Liquor Liability ECP0494340 6/26/2021 6/26/2022 Each Common Cause $1,000,000 Aggregate $2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate Holder and all entities required by written contract are included as Additional Insured on a Primary and Noncontributory basis with Waiver of Subrogation with respects to the General Liability as required by written contract per attached endorsement.Subject to policy limits,terms,conditions and exclusions. 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 20 E. Main St. • AUTHORIZED REPRESE TATIVE Ashland OR 97520-1814 ©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. C. Coverages this endorsement pro- CinciPak'"" 1. Employee Benefit Liability Coverage vided: a) You did not have COMMERCIAL GENERAL LIABILITY BROADENED a. The following is added to Section I- Coverages: knowledge of a claim or"suit"on or ENDORSEMENT Employee Benefit Liability Cover- before the"first ef- age fective date"of this endorsement. This endorsement modifies insurance provided under the following: (1) Insuring Agreement You will be (a) We will pay those sums that deemed to have COMMERCIAL GENERAL LIABILITY COVERAGE PART the insured becomes legally knowledge of a obligated to pay as damag- claim or "suit" es caused by any act,error when any"author- A. Endorsement-Table of Contents: or omission of the insured, ized representa- orCoveraae: Begins on Page; of any other person for tive"; whose acts the insured is 1. Employee Benefit Liability Coverage .2 legally liable, to which this i) Reports all, or 2. Unintentional Failure To Disclose Hazards insurance applies. We will any part,of the 3. Supplementary Payments have the right and duty to act, error or 4. Medical Payments defend the insured against omission to us 5. 180 Day Coverage For Newly Formed Or Acquired Organizations any "suit" seeking those or any other 6. Waiver Of Subrogation damages. However,we will insurer, 7. Automatic Additional Insured-Specified Relationships: have no duty to defend P P ii) Receives a • Managers Or Lessors Of Premises; against any 'suit" seeking written or ver- • Lessor Of Leased Equipment; damages to which this in- bal demand or • Vendors; surance does not apply.We claim for dam- • State Or Governmental Agency Or Subdivision Or Political Subdivision-Permits may, at our discretion, in- ages because Or Authorizations Relating To Premises;and vestigate any report of an of the act, er- • Mortgagee,Assignee Or Receiver act, error or omission and ror or omis- 8. Property Damage To Borrowed Equipment 11 settle any claim or"suit"that sion;and 9. Employees As Insureds-Specified Health Care Services And Good Samaritan may result.But: Services 12 1) The amount we will pay b) There is no other a applicable insur- 10. Broadened Notice Of Occurrence 12 for damages is limited 11. Nonowned Aircraft 12 as described in Section antnc e. 12. Bodily Injury Redefined 13 III - Limits Of Insur- (2) Exclusions 13. Expected Or Intended Injury Redefined 13ante;and 14. Former Employees As Insureds 13 This insurance does not apply to: 2) Our right and duty to B. Limits Of Insurance: defend ends when we (a) BodilDamage a OruP rs Personal have used up the appli- 9 The Commercial General Liability Limits of Insurance apply to the insurance provided by this endorse- cable limit of insurance Advertising Injury ment,except as provided below: in the payment of judg- "Bodily injury", "property ments or settlements. damage" or "personal and 1. Employee Benefit Liability Coverage advertisinginjury". No other obligation or liabil- Each Employee Limit $1,000,000 ity to pay sums or perform (b) Dishonest, Fraudulent, Aggregate Limit: $3,000,000 acts or services is covered Criminal Or Malicious Act Deductible Amount: $ 1.000 unless explicitly provided for 3. Supplementary Payments under Supplementary Damages arising out of any Payments. intentional, dishonest, Bail Bonds: $2,500fraudulent, criminal or(b) This insurance applies. to mali- cious act,error or omission, 4. Medical Payments damages only if the act,er- committed by any insured, ror or omission,is negligent- induding the willful or reck- Medical Expense Limit:$10,000 ly committed in the"admin- less violation of any statute. istratio8. Property Damage To Borrowed Equipment p of your"employee benefit program";and (c) Failure To Perform A Con- Each Occurrence Limit $10.000tract Deductible Amount $ 250 1) Occurs during the policy period;or Damages arising out of fail- 2) Occurred prior to the ure of performance of con- tract by any insurer. "first effective date" of Includes copyrighted material of Insurance Includes copyrighted material of Insurance GCP 203 0917 Services Office,Inc.,with its permission. Page 1 of 13 GCP 203 0917 Services Office,Inc.,with its permission. Page 2 of 13 • (d) Insufficiency Of Funds (i) Taxes,Fines Or Penalties ners,and their spouses are zation.However,coverage under also insureds but only with this provision: Damages arising out of an Taxes,fines or penalties,in- respect to the conduct of insufficiency of funds to cluding those imposed un- your business. (a) Is afforded only until the meet any obligations under der the Internal Revenue 180th day after you acquire any plan included in the Code or any similar state or (c) A limited liability company, or form the organization or "employee benefit program". local law. you are an insured. Your the end of the policy period, (e) Inadequacy Of Pertor- members are also insureds, whichever is earlier,and q y (j) Employment-Related Prac- but only,with respect to the mance Of Invest- tices conduct of your business. (b) Does not apply to any act, ment/Advice Given WithYour managers are in- error or omission that was Respect To Participation Any liability arising out of in- sureds,but only with respect committed before you ac- any: quired or formed the organi- Any claim based upon: to their duties as your man- zation. (1) Refusal to employ; agers. 1) Failure of any invest- ment to perform; (2) Termination of employ (d) An organization other than a c. Limits Of Insurance menta partnership,joint venture or As respects Employee Benefit Lia- 2) Errors in providing in- limited liability company,you bilityCoverage,Section III-Limits formation on pastper- (3) Coercion, demotion, are an insured.Your"execu- g. evaluation, reassign- lowing:Insurance is replaced by the fol- fonmaes; of investment ment, discipline, defa- areve officers" and directors vehicles;or P insureds, but only with mation, harassment, respect to their duties as (1) The Limits of Insurance shown in 3) Advice given to any humiliation, discrimina- your officers or directors. Section B.Limits Of Insurance. person with respect to tion or other employ- Your stockholders are also 1. Employee Benefit Liability that person's decision to ment-related practices, insureds, but only with re- Coverage and the rules below fix participate or not to par- acts or omissions;or spect to their liability as the most we will pay regardless ticipate in any plan in- stockholders. of the number of luded in the"employee (4) Consequential liability benefit program". as a result of(1).(2)or (e) A trust,you are an insured. (a) Insureds; (3)above. Your trustees are also in- (f) Workers' Compensation (b)exclusion applies sureds,but only with respell (b) Claims made or "suits" And Similar Laws PP to their duties as trustees. brought; whether the insured may be Any claim arising out of your held liable as an employer (2) Each of the following is also an (c) Persons or organizations failure to comply with the or in any other capacity and insured: making claims or bringing mandatory provisions of any to any obligation to share "suits'; workers' compensation, un- damages with or repay (a) Each of your "employees" employment compensation someone else who must pay who is or was authorized to (d) Acts,errors or omissions;or insurance,social security or damages because of the in- administer your "employee (e) Benefits included in your disability benefits law or any jury. benefit program"; "employee benefit program". similar law. (g) ERISA (3) Supplementary Payments (b) Any persons, organizations (2) The Aggregate Limit shown in or"employees"having prop- Section B.Limits Of Insurance. Section I - Coverages, Sup- er temporary authorization Damages for which any in- plementary Payments-Cover- to administer your"employ- C Coverage of tee Benefit Liabilityt sured is liable because of Ii- ages A and B also apply to this Coverage we fwill payfor all at is g PP Y benefit program" if you the most we will for dam- ability imposed on a fiduci- Coverage. die,but onlyuntilyour legal ary by the Employee Re- re resentave is ages because of acts, rrors or tirement Income Security b. Who Is An Insured Or in appointed; omissions negligently committed in the "administration" of your Act of 1974, as now or As respects Employee Benefit Lia- hereafter amended, or by (c) Your legal representative if any similar federal,state or bility Coverage.Section II-Who Is you die, but only with re- local laws. An Insured is replaced by the follow- sped to duties as such.That (3) Subject to the limit described in sped (2) above, the Each Employee (h) Available Benefits representative will have all Limit shown in Section B.Limits (1) If you are designated in the Dec- your rights and duties under Of Insurance, 1. Employee Any claim for benefits to the larations as: this Coverage Part. Benefit Liability Coverage of extent that such benefits arethis endorsement is the most we available, with reasonable (a) An individual,you and your (3) Any organization you newly ac- will pay for all damages sus spouse are insureds,but on- quire or form,other than a part- effort and cooperation of the ly with respect to the con- nership,joint venture or limited tained by any one "employee", insured,from the applicable dud of a business of which liability company,and over which including damages sustained by funds accrued or other col- you are the sole owner. you maintain ownership or major- such "employee's" dependents lectible insurance. ity interest, will qualify as a and beneficiaries,as a result of: (b) A partnership or joint ven- Named Insured if no other similar ture, you are an insured. insurance applies to that organi- Your (a) An act,error or omission;or members, your part- Indudes copyrighted material of Insurance Includes copyrighted material of Insurance GCP 203 0917 Services Office,Inc..with its permission. Page 3 of 13 GCP 203 0917 Services Office,Inc..with its permission. Page 4 of 13 r (b) A series of related acts,er- tification of the action taken, ceived in connec- tion by equal shares, rors or omissions, regard- you shall promptly reim- tion with the claim we will follow this meth- less of the amount of time burse us for such part of the or"suit"; od also.Under this ap- that lapses between such Deductible Amount as we proach each insurer • acts,errors or omissions; have paid. (2) Authorize us to ob- contributes equal fain records and amounts until it has negligently committed in the d. Additional Conditions other information; paid its applicable limit "administration"of your"employ- ee benefit program'. As respects Employee Benefit Lia- (3) Cooperate with us of insurance or none of bility Coverage,Section IV-Corn- • in the investigation the loss remains, However,the amount paid under mercial General Liability Condi- or settlement of the whichever comes first. this endorsement shall not ex- tions is amended as follows: daim or defense If any of the other in- ceed,and will be subject to the against the "suit": surance does notermit limits and restrictions that apply (1) Item 2.Duties In The Event Of and p to the payment of benefits in any Occurrence,Offense,Claim Or contribution by equal plan included in the "employee Suit is replaced by the following: (4) Assist us.upon our shares,we will contrib- benefitprogram:' 2. Duties In The Event Of An request,in the en- ute by limits.Under s method, each insurer's forcement of any (4) Deductible Amount Act,Error Or Omission,Or • right against any share is based on the Claim Or Suitperson or organi- ratio of its applicable (a) Our obligation to pay dam- limit of insurance to the ages on behalf of the in- a. You must see to it that zation which may total a livable limits of sured applies only to the we are notified as soon be liable to the in- insurance of all insur- aspracticable of an act, sured because of amount of damages in ex- an act, error or ers. cess of the Deductible error or omission which Amount stated in the Deda- may result in a daim. omission to which c. No Coverage rations as applicable to To the extent possible, this insurance may Each Employee. The limits notice should include: also apply. This insurance shall not of insurance shall not be re- d. No insured will, except cover any loss for which duced by the amount of this (1) What the act,error at that.insured's own the insured is entitled to deductible. or omission was cost,voluntarilymake a recovery under any and when it oc- other insurance in force (b) The Deductible Amount cured;and payment, assume any previous to the effective stated in the Declarations obligation,or. incur any date of this Coverage applieseto all damages sus- (2) The names and expense without our Part. addresses of any- consent. twined by any one"employ- ee",including such"employ- one who may sof- 2 Item 5. Other Insurance is re- e. Additional Definitions fer damages as a (2) ee's"dependents and bene- result of the act, placed by the following: As respects Employee Benefit Lia- fidaries,because of all acts, error or omission. bility Coverage,Section V-Defini- errors or omissions to which 5. Other Insurance tions is amended as follows: this insurance applies. b. If a claim is made or If other valid and collectible (c) The terms of this insurance, "suit"is brought against insurance is available to the (1) The following definitions are any insured,you must: insured for a loss we cover added: induding those with respect under this Coverage Part, 1. Administration"means: to: (1) Immediately record g the specifics of the our obligations are limited as • 1) Our right and duty todaim or"suit"and follows: a. Providing information to defend the insured "employees", including the date received; a. PrimaryInsurance their dependents and against any "suits" and p re- seeking those damag- This insurance is prima- beneficiaries, with es;and (2) Notify us as soonsped to eligibility for or ry except when c.below scope of "employee 2) Your duties,and the du- as practicable. applies.If this insurance ties of any other in- You must see to it that is primary, our obliga- volved benefit programs";; insured, in the we receive written no- tions are not affected b. Interpreting the "em- event of an act,error or Lice of the claim or"suit" unless any of the other ployee benefit pro- omission,or claim; as soon as practicable. insurance is also prima- grams"; ry.Then,we will share apply irrespective of the ap- c. You and any other in- with all that other insur- c. Handling records in plication of the Deductible volved insured must: ance by the method de- connection with the Amount. scribed in b.below. employee benefitpro- (1) Immediately send grams";or (d) We may pay any part or all us copies of any b. Method Of Sharing d. Effecting,the Deductible Amount to demands, notices, continuiri g or effect settlement of any summonses or le- If all of the other insur- terminating any "em- daim or"suit"and,upon no- gal papers re- ance permits contribu- ployee's"participation in Includes copyrighted material of Insurance Includes copyrighted material of Insurance GCP 203 09 17 Services Office,Inc.,with its permission. Page 5 of 13 GCP 203 0917 Services Office.Inc.,with its permission. Page 6 of 13 any benefit included in c. Unemployment insur- 2. Unintentional Failure To Disclose Haz- We waive any right of recovery we may the "employee benefit ance, social security ards have against any person or organization program". benefits, workers' corn- against whom you have agreed to waive pensation and disability Section IV-Commercial General Liabil- such right of recovery in a written contract However, "administration" benefits;and ity Conditions, 7. Representations is or agreement because of payments we does not indude: amended by the addition of the following: make for injury or damage arising out of d. Vacation plans, includ- a. ongoing operations or work" Handling payroll deduc- ingbuyand sellpro- Based on our dependence upon your rep- yourg g' p "your tions;or resentations as to existinghazards,if un- done under a written contract or agree- grams; leave of ab- ment with that person oro anization and Bence programs,indud- intentionally you should fail to disdose all b. The failure to effect or p g such hazards at the inception date of your included in the"products-completed oper- maintain any insurance ing military, maternity, p family, and civil leave; policy,we will not reject coverage under ations hazard". However,our rights may or adequate limits of ty this Coverage Part based solelyon such only be waived prior to the"occurrence" coverage of insurance, tuition assistance plans; failure. g giving rise to the injury or damage for induding but not limited transportation and which we make payment under this Cov- to unemployment health dub subsidies. p yment insur- 3. Supplementary Payments erage Part.The insured must do nothing ance, social security after a loss to impair our rights.At our re- benefits, workers' corn- 4. "First effective date"means Under Section I-Supplementary Pay- the date upon which cover- ments-Coverages A and B: quest, e insuredts twill bring"suit" ar trans- benefits, pensation and disability age was first effected in a g fer those rights to us and help us enforce benefits. series of uninterrupted re- Paragraph 2.is replaced by the following: those rights. 2. "Cafeteria plans" means newels of insurance cover- Up to the limit shown in Section B.Limits 7. Automatic Additional Insured - Sped- plans authorized by applica- age. Of Insurance,3. Bail Bonds of this en- fled Relationships ble law to allow"employees" (2) The following definitions are de- dorsement for cost of bail bonds required to elect to pay for certain leted in their entirety and re- because of accidents or traffic law viola- a. The following is added to Section II- benefits with pre-tax dollars. placed by the following: tions arising out of the use of any vehicle Who Is An Insured: 3. "Employee benefit pro- to which the Bodily Injury Liability Cover- age over- (1) Any person(s)or organization(s) 8. "Employee"means a person a e applies.We do not have to furnish described in Paragraph 7.a.(2)of grams" means a program actively employed, formerly 8 bP re- providing some of all of the employed, on leave of ab- fethese bonds. this endorsement ts (hereinafteradditional followingbenefits to "em- whom to a euinsured) sence or disabled,or retired. This amendment of the Supplementary whom you are required to add as ployees", whether provided "Employee" includes a Payments—Bail Bonds limit replaces,and an additional insured under this through a"cafeteria plan"or "leased worker"."Employee" is not in addition to,the amendment of the Coverage Part by reason of a otherwise: does not include a "tempo- Supplementary Payments -r Bail Bonds written contract, written agree- a. Group life insurance; raryworker". limit(II.A.2.) in the CinciPak Commer- ment, written permit or written group accident or health 21. "Suit"means a civil proceed- cial General Liability Amendatory En- authorization. insurance;dental,vision ing in which money damag- dorsement. • (2) Only the following persons or or- and hearing plans; and es because of an act,error 4. Medical Payments spending ac- y ganizations are additional in- flexibleP 8 or omission to which this in- sureds under this endorsement, counts;provided that no surance applies are alleged. The Medical Expense Limit of Any One one other than an"em- pp g Person as stated in the Declarations is and insurance coverage provided "Suit"includes: to such additional insureds is lim- ployee" may subscribe amended to the limit shown in Section B. iced as provided herein: to such benefits and a. An arbitration proceed- Limits Of Insurance, 4. Medical Pay- ited as provided herein: such benefits are made ing in which such dam- ments of this endorsement. (a) Managers Or Lessors Of generally available to ages are claimed and to Premises those"employees"who which the insured must 5. 180 Day Coverage For Newly Formed satisfy the plan's eligibil- submit or does submit Or Acquired Organizations The manager or lessor of a ity requirements; with our consent; Section II - Who Is An Insured is premises leased to you with b. Profit sharing plans, b. Any other alternative amended as follows: whom Paragraph 7.a(1)ou have aof this reed per savings dispute resolution pro- Subparagraph a. of Paragraph 3. is re- dorsement to provide insur- plans, employee stock ceeding in which such placed by the following: ance, but only with respect ownership plans, pen- damages are claimed to liability arising out of the sion plans and stock and to which the in- a. Insurance under this provision is af- ownership, maintenance or subscription plans, pro- sured submits with our forded only until.the 180th day after use of that part of the prem- vided that no one other consent;or you acquire or form the organization ises leased to you, subject than an "employee" or the end of the policy period, to the following additional may subscribe to such c. An appeal of a civil pro- whichever is earlier, exclusions: benefits and such bene- ceeding. fits are made generally 6. Waiver Of Subrogation This insurance does not ap- available to all"employ- ply to: ees" who are eligible Section IV-Commercial General Liabil- 8 ity Conditions,9.Transfer Of Rights Of Against Others To Us is (i) Any"occurrence"which under the plan for such Recovery ry h takes place after you amended by the addition of the following: • Includes copyrighted material of Insurance Includes copyrighted material of Insurance GCP 203 0917 Services Office,Inc.,with its permission. Page 7 of 13 GCP 203 09 17 Services Office,Inc.,with its permission. Page 8 of 13 1. • avvOvEOo°aNv TuNii :°°OoE 'rSE.mE NoeO U LW o.vCaim •N`�O�v'-�,'a3oto gF0 t iO,t 3 vi H U f0 O=Tc r C T.V" W o 2U CCeO o•- e. 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N 43 ov 15,8- 2 Eu: € '• co ovA ��'-o���•�L^ccGovecN3' co3a«Saoo�`m�p NE$ �a t3 E0.toow O u�Lc'�^m�c'`�c CT �: aFro-Egaffl ".2=-E�00N10Yc °00 20 mu, L vwa5vm °0 c>.>, ma 2% 0 W W W fO C " 0. O.n m o•m s a N�Ol�o a N•�C u>E 3 O L a o a�3 W 0 ° O N F.L.N c Of, NcvaL._ u10vv° C T«0 P •oo.? N 0/0, C O O'O o o,o c O1 C N V L 10 N o 07 el'o c W o-•-ZL o- U c`O o,U. r'c L .� E ¢.pvu,•r.0000,02'0 E0To,omv- a.) a3v > <- VUr.$. '.U �>EU �. S u 0 0 N a. u w • • use of the premises by you. c. Section IV - Commercial General ment, the following additional provi- 9. Employees As Insureds - Specified However, this insurance Liability Conditions is amended to sions apply: Health Care Services And Good Samar- does not apply to structural add the following: (1) The Limits of Insurance shown in and demolition operations itan Services alterations,new construction Automatic Additional Insured Pro- the Declarations are replaced by Paragraph 2.a.(1)(d) under Section II - performed by or for that per- vision the limits designated in Section Who Is An Insured does not apply to: son or organization. This insurance applies only if the B. Limits Of Insurance, 8. a. Your "employees" who provide pro- Property Damage To Borrowed (3) The insurance afforded to addi- "bodily injury' or"property damage" Equipment of this endorsement fessional health care services on your tional insureds described in Par- occurs,or the"personal and advertis- with respect to coverage provid- behalf as a duly licensed nurse, agraph 7.a.(1) of this endorse- ing injury'offense is committed: ed by this endorsement. These emergency medical technician or ment: (1) During the policylimits are inclusive of and not in paramedic in the jurisdiction where an period;and addition to the limits being re- "occurrence"or offense to which this (a) Only applies to the extent (2) Subsequent to your execution of placed.The Limits of Insurance insurance applies takes place;or permitted by law;and the written contract or written shown in Section B. Limits Of b. Your"employees"or"volunteer work- (b) Will not be broader than that agreement,or the issuance of a Insurance.8.Property Damage ers",other than an employed or vol- which you are required by written permit or written authori- To Borrowed Equipment of this unteer doctor, providing first aid or the written contract, written zation, described in Paragraph endorsement fix the most we will good samaritan services during their agreement,written permit or 7.a.(1). pay in any one"occurrence"re- work hours for you will be deemed to written authorization to pro- gardless of the number of: be acting within the scope of their vide for such additional in- d. Section IV - CommercialGeneral employment by you or performing du- cured;and Liability Conditioonssiss amended as (a) Insureds; ties related to the conduct of your follows: (b) Claims made or "suits" business. (c) Does not apply to any per- Condition 5. Other Insurance is brought;or son, organization, vendor, amended to indude: 10. Broadened Notice Of Occurrence state, governmental agency (c) Persons or organizations or subdivision or political Primary And Noncontributory In- making claims or bringing Paragraph a. of Condition 2. Duties In subdivision, specifically surance ' "suits". The Event Of Occurrence, Offense, named as an additional in- Claim Or Suit under Section IV-Com- cured under any other provi- This insurance is primary to and will (2) Deductible Clause mercial General Liability Conditions is sion of, or endorsement not seek contribution from any other Our obligation to replaced by the following: added to, this Coverage insurance available to an additional (a) 9 pay dam- Part, provided such other insured per Paragraph 7.a.(1)of this ages on your behalf applies a. You must see to it that we are notified endorsement rovided that: only to the amount of dam- as soon as practicable of an"occur- provision or endorsement p ages for each "occurrence" rence"or an offense which may result covers the injury or damage (1) The additional insured is a which are in excess of the in a daim.To the extent possible,no- for which this insurance ap- Named Insured under such other Deductible Amount stated.in tice should include: plies. insurance;and Section B.Limits Of Insur- b. With respect to the insurance afford- ance,8.Property Damage (1) How,when and where the "oc- ed to the additional insureds de- (2) You have agreed in writing in a To Borrowed Equipment of currence"or offense took place; contract, agreement, permit or this endorsement.The limits scribed in Paragraph 7.a.(1) of this authorization described in 7.a.(2) (2) The names and addresses of endorsement,the following is added of this endorsement that this in- of insurance will not be re- any injured persons and wit- to Section III-Limits Of Insurance: surance would be primaryand duced by the application of nesses;and such deductible amount. The most we will pay on behalf of the would not seek contribution from (3) The nature and location of any additional insured is the amount of in- any other insurance available to (b) Section IV - Commercial injury or damage arising out of surance: the additional insured. General Liability Condi- the"occurrence"or offense. Property DamageEquip- tions, 2. Duties In The 8. (1) Required by the written contract, ment To Borrowed E ui Event Of Occurrence, Of- This requirement applies only when written agreement,written permitfense, Claim Or Suit,'ap- the"occurrence"or offense is known or written authorization described a. The following is added to Exclusion plies to each claim or"suit" to an"authorized representative". in Paragraph 7.a.(1) of this en- 2.j.Damage To Property under Sec- irrespective of the amount. 11. Nonowned Aircraft dorsement or tion I-Coverage A-Bodily Injury (c) We may pay any part or all (2) Available under the applicable And Property Damage Liability: of the deductible amount to The following is added to Exclusion 2.g. Limits of Insurance shown in the ( Paragraphs 3) sion do not apply to tools or equip- and(4)of this exclu- effect settlement of any Aircraft,Auto Or Watercraft under Sec- Declarations; claim or"suit'and,upon no- tion I Coverage A-Bodily Injury And ment loaned to you,provided they are tification of the action taken, Property Damage Liability: whichever is less. not being used to perform operations you shall promptly reim- This exclusion does not apply to an air- This endorsement shall not increase at the time of loss. burse us for such part of the craft you do not own,provided that: the applicable Limits of Insurance deductible amount as has shown in the Declarations. b. With respect to the insurance provid- been paid by us. a. The pilot in command holds a current ed by this section of the endorse- effective certificate,issued by a duly constituted authority of the United Includes copyrighted material of Insurance Includes copyrighted material of Insurance GCP 203 0917 Services Office,Inc.,with its permission. Page 11 of 13 GCP 203 09 17 Services Office.Inc.,with its permission. Page 12 of 13 I.. • States of America or Canada,desig- Property Damage Liability is replaced by nating that person as a commercial or the following: airline transport pilot; This exclusion does not apply to"bodily b. The aircraft is rented with a trained, injury'or"property damage"resulting from paid crew;and the use of reasonable force to protect per- c. The aircraft does not transport per- sons or property. sons or cargo for a charge. 14. Former Employees As Insureds 12. Bodily Injury Redefined The following is added to Paragraph 2. Section V-Definitions,4."Bodily injury under Section II-Who Is An Insured: is replaced by the following: 2. Each of the following is also an in- 4. "Bodily injury'means bodilyharm or sured: injury, sickness, disease, disability, Any of your former"employees",di- humiliation,shock,fright mental an- rectors, managers, members, part- guish or mental injury,{pcluding care, ners or"executive officers",including loss of services or death resulting but not limited to retired,disabled or • from any of these at any time. those on leave of absence,but only em- 13. Expected Or Intended Injury Redefined for acts within the scope of their ployment by you or for duties related The last sentence of Exclusion 2.a.Ex- to the conduct of your business. pected Or Intended Injury under Sec- tion I-Coverage A-Bodily Injury And Includes copyrighted material of Insurance GCP 203 09 17 Services Office,Inc,with its permission. Page 13 of 13