Loading...
HomeMy WebLinkAboutInsurance Certificate: Pacific Paving, Inc. • • DATE(MWDD/YYYY) Aco o® CERTIFICATE OF LIABILITY INSURANCE 9/25/2023 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 HUB International Northwest, LLC PHONE Mary-Beth bloomer FAX PO Box 10167 • (A/C.No.Extt:541-687-1117 (A/c.No):541-342-8280 Eugene OR 97440 ADDRESS: marybeth.woomer@hubinternational.com • INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Cincinnati Casualty 28665 INSURED PACIPAV-02 INSURER B: • Pacific Paving, Inc PO Box 2370 INSURER C: Medford OR 97501 INSURERD: INSURER E: • INSURERF: \% COVERAGES CERTIFICATE NUMBER:2142751187 • 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. INSRLTYPE OF INSURANCE ADDLNSUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS {MMIDD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY Y Y EPP0567282 3/20/2023 3/20/2024 EACH OCCURRENCE $1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED 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 $2000,000 POLICY X JECT X LOC PRODUCTS-COMP/OPAGG $2,000,000 _ OTHER: $ A AUTOMOBILE LIABILITY Y Y EPP0567282 3/20/2023 3/20/2024 COMBINED SINGLE LIMIT $1,000,000 (Ea accident) ANY AUTO • BODILY INJURY(Per person) $ OWNED X SCHEDULED BODILY INJURYPer accident $ AUTOS ONLY AUTOS INJURY(Per x HIRED x NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) A X UMBRELLA LIAB X OCCUR EPP0567282 3/20/2023 3/20/2024 EACH OCCURRENCE _ $1,000,000 • EXCESS LIAB CLAIMS-MADE AGGREGATE $1,000,000 DED X RETENTION$n $ • 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-EAEMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ • 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 insureds on a primary and non-contributory basis with waiver of subrogation with respects to the general liability and auto liability as required by written contract per attached endorsements.Umbrella is Excess over General Liability,Auto and Employers Liability.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 • Ashland OR 97520 AUTHORIZED REPRESENTATIVE • I 9 . • -. ©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. • b. Loss Of Earnings:$ 500 • 5. Medical Payments CONTRACTORS'COMMERCIAL GENERAL LIABILITYMedical Expense Lmit:$10,000 • BROADENED ENDORSEMENT • 9. Property Damage To Borrowed Equipment Each Commence Limit $10,000 This endorsement modifies insurance provided under the following: . Deductii a Amount: $ 250 • 16. Voluntary Property Damage Coverage(Coverage a.)And Care,Custody Or Control Liability COMMERCIAL GENERAL LIABILITY COVERAGE PART • Coverage(Coverage b.) Limits Of Insurance • A. Endorsement-Table of Contents: • Coverage a. • $1,000 Each Occurrence Coverage: Begins on Page: $5,000 Aggregate 1. Employee Benefit Liability Coverage 3 • Coverage b.$5,000 Each Occurrence unless otherwise stated$ 2. Unintentional Failure To Disclose Hazards..................._..............._.....................:._....._......9 Deductible Amount(Each Occurrence) 3. Damage To Premises Rented To You ........................._.9 Coverage a.$250 4. Supplementary Payments 10 Coverage b.$250 unless otherwise stated$ 5. Medical Payments..... ............._..._..............._........_..._..............._.............................._...10 PREMIUM BASIS RATE • ADVANCE PREMIUM 6.. 180 Day Coverage For Newly Formed Or Acquired Organizations.............._:.._..._..._....10 COVERAGE • 7. Waiver Of Subrogation 11 • (a) Area (For Limits in Excess of (For Limits in Excess of 8., Automatic Additional Insured-Specified Relationships:.............._..._......... ............... 11 (b) Payroll $5,000) $5,000) • Managers Or Lessors Of Premises; (cGross Sales • Lessor Of Leased Equipment; (d) Units Vendors; (e) Other _ • State Or Governmental Agency Or Subdivision Or Political Subdivision-Permits b. Care, Custody Or • Or Authorizations Relating To Premises;and Control $ • Mortgagee,Assignee Or Receiver TOTAL ANNUAL PREMIUM $ 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 r • b;•$500,000 unless otherwise stated$ 4. Supplementary Payments • a. Bail Bonds: $2,500 • Includes copyrighted material of Insurance • Includes copyrighted material of Insurance GA 233 0917 Services Office,Inc,with its permission. Page 1 of 17 GA 233 0917 Services Office,Ina,with its permission. Page 2 of 17 • C. Coverages this endorsement pro-( d) insufficiency Of Funds (I) Taxes,Fines Or Penalties • 1. Employee Benefit LiabilityCoverage vided: Daina es arisingout of an Taxes,fines or 9 penalties,in- a)s. The following is added to Section I- You did not have insufficiency of funds to ,cluding those imposed un • - Coverages: knowledge of a meet any obligations under der the Internal Revenue claim or"suit"on or. any plan induded in the Code or any similar state or Employee Benefit Liability Cover- before the'first ef- 'employee benefit program". - local law. age fective date"of this - - endorsement. (e) Inadequacy Of Perfor- ) (J) Employment-Related Prac- (1) Insuring Agreement mance C Of Invest- tices You will be ment/Advice •Given With (a) We will pay those sums that deemed to have Respect To Participation Any liability arising out of the insured becomes legally knowledge of a • any: obligated to pay as damag- • claim or "suit' • Any daim based upon: es caused by any act,error when any"author (1) Refusal to employ; or omission of the insured, • 'zed re resents- 1) Failure of any invest P mart to perform; (2) Temnination of employ or of any other person for . five"; mart; • whose acts the insured is 2) Errors in providing in- leall liable, to which this 1) Reports all, or (3) Coercion, demotion, • legally formation on past per- insurance applies. We will • _ _ any part,of the- formance of investment evaluation, reassign- have the right and dutyto act, error or ment, disciire, defa- g defend the insured against , omission to us' vehicles;or - motion, harassment, ' any "suit" seeking those or any other . 3) Advice given to any • humiliation, disctimina- . • ' • damages. However,we will insurer, - person with respect to ' 'tion or other employ- have no duty to defend • that person's decision to ment-related practices, - II) Receives a . against any "suit' seeking written or ver participate or not to par- ads or omissions;or damages to which this in- tidpate in any plan in- surance doesnotapply.We bol demand or cluded in the"employee - - (4) Consequential liability may, at our ion, in- claim for dam- benefit program as a result of(1),(2)or ages because (3)above. vestigate any report of an .- of the act, er- (f) Workers' Compensation ad, error or omission and ror or oris And Similar Laws This exclusion applies settle any daim or"suit'that• shorn;and . whether the insured may be may result.But: - Any claim arising out of your held liable as an employer 1) The amount we will pay b) There is no other failure to comply with the or in any other capacity and for dages is limited applicable insur- mandatory provisions of any to any obligation to share ama d omed in Section anon. . — workers' compensation,un- damages with or. repay aIII - Limits Of Insur- (2) Exclusions ' employment compensation someone else who must pay • once;and insurance,social security or damages because of the in • - This insurance does not apply to: disability benefits law or any jury: • 2) Our right and duty to simlar law. defend ends when we • _ (a) Bodily Injury, Property - (3) Supplementary Payments- ' have used upthe li- Damage Or Personal And (g) ERISA PP Section I - Coverages, Sup- . cable limit of insurance Advertising Injury Damages for which any in- plementary Payments-Cover- ' . • in the payment of judg- t3odily injury', '"properly sured is liable because of li- ages A And B also apply to this ments or settlements. damage" or "personal and ' ability imposed on a fidud- Coverage. No other obligation or debit- advertising injury'. ary by the Employee Re b. Who IS An Insured ity to pay sums.or perform tirement Income Security (b) Dishonest, Fraudulent, - Act of 1974, as now or ads or services is covered As respects Employee Benefit ola- CriminalOrMallclousAct hereafter amended, or by unless explicitly provided for • An Insured Coverage,Section II-Who Is • any similar federal,state or under. Supplementary 'Damages arising out of any An is replaced by the follow local laws. Payments. - intentional, dishonest, ing: • - - fraudulent, criminal or mali-. . (h) Available Benefits Ifyou are designated (b) This insurance applies to (1) .in the Dec- cions act,errorbyor omission, damages only if the act,er- Mydaim for benefits to the larations as ror or omission;is negligent- indudingcommittedbyany insured, the willful or redc- extent that such benefits are (a) individual,you and your ly committed in the"admin- less violation of any statute. spouse available, with. reasonable spouse are insureds,baton- . • istratiorf'of your"employee effort and cooperation of the ly with respect to thents. • . - intentionand (c) Failure To Perform A Con- insured,from the applicable - duct of a business of which • 1) Occurs during the policy tract funds accrued or other cd- you are the sole owner. period;or Damages arising out of fail- lectible insurance. ure of performance of con- (b) A partnership or joint ven- . 2) Occurred prior to the lure, are an insured.red. - 'first'effective date" of tract by any insurer. members,members, your part- - Includes copyrighted material of Insurance Includes copyrighted material of Insurance GA 233 09.17 • Services Office,Inc,with its permission. Page 3 of 17 GA 233 0917 Services Office,Inc,with its permission. Page 4 of 17 . • ners,and their spouses are • zation.However,coverage under (b) A series of related acts,er- tification of the action taken, also insureds but only with this provision: rors or omissions, regard- -- . you shall promptly reim- -respect to the conduct of less of the amount of time burse us for such part of the your business. (a) Is afforded only until the. that lapses between such Deductible Amount as we 180th day after you acquire acts,errors or omissions; have paid. (c) A limited liability company, or form the organization or ' you are an insured. Your the end of the policy period, negligently committed in the' d. Additional Conditions members are also insureds, whichever Is earlier,and "administration"of your"employ- . employ As respects Employee Benefit Lia- but only with respect to the ee benefit program'.' • conduct of your business. . (b) Does not.apply to any act, blllty Coverage,Section IV-Com- Your managers are in- - error or omission that was However,the amount paid under merclal General Liability Condi- sureds,but only with respect committed before you ao- this endorsement shall not ex- tions is amended as follows: . to their duties as your man- quired or formed the organi- ceed,and will be sut ect to the agars. • zation. limits and restrictions that apply (1) Item 2.Duties In The Event Of C. Limits Of Insurance to the payment of benefits in any Occurrence, ccurren e,Offense,tire lai mOr (d) An organization other than a plan included in the"employee replacedby following: • partnership,joint venture or As respects Employee Benefit Lia- benefit program." 2. Duties In The Event Of An limited liability company,'youbility Coverage.Section III Limits ' (4) Deductible Amount .. Act,Error Or Omission,Or ' are an insured.Your"execu- Of Insurance is replaced by the fol- Claim Or Suit five officers" and directors lowing: • (a) Our obligation to pay dam- • • are insureds, but only with ages on behalf of the in- a. You must see to it that respect to their duties as (1) The Limits of Insurance shown in sured applies only.to the we are notified as soon your officers or directors. Section B.Limits Of Insurance, • amount of damages in ex- as practicable of an act, - Your stockholders are also 1. Employee Benefit Liability cess of the Deductible error or omission which insureds, but only with re- Coverage and the rules below fix • Amount stated in the Deda- may result in a daim. sped to their liability as • the most we will pay regardless rations as applicable to To the extent possible, stockholders. of the number of . Each Employee. The limits • notice should indude: . (e) A trust,you are an insured. (a) Insureds; of insurance shall not'be re- • (1) What the act,error. Your trustees are also in- • duced by the amount of this or omission was sureds,but only with respect - (b) Claims made or 'suits' deductible. - J o-and when it c • to their duties as trustees. • brought; curred;and (b) The Deductible Amount . (2) Each of the following is also an (c) Persons or organizations , stated In the Declarations - . (2) The names and insured: - making dalms or bringing - applies to all damages sus- addresses of any- - 'Suits"; tamed by any one"employ- • one who may suf • (a) Each of your "employees" ee",induding such"employ- far damages as a (d)• Acts,errors or omissions;or g who is or was authorized to eel's"dependents and bene result of the ad, • administer your "employee .(e) Benefits included in your fidaries,because of all ads, error or omission. ' • • benefit program"; "employee benefit program". - errors or omissions to which . (b) Any persons, organizations this insurance applies. b. If a daim is made or or"employees"Flavin g (2) The Aggregate Limit shown in "suit'is brought against prop- . Section B.Limits Of Insurance, (c) The terms of this-insurance, • any insured,you must: er temporary authorization including those with respect 1..Employee,Benefit Liability to administer your"employ- Coverage of this endorsement is _ to: (1) Immediately record • ee benefit program" if you the most we will pay for all dam- specifics die,but until le al1) Our right and duty to cir of the only yourg ages because of acts, errors or claim or"suit'and representative is appointed; omissions negligentlycommitted defend the insured the date received; or in the "administration" of your against _any "suits" and (c) Your legal representative if "employee benefit program". es;and those damag- esand (2) Notify us as soon you die,,but only with re- (3) Subject-to the limit described inas practicable. • spect to duties as such.That (2) above, the Each Employee 2) ties r of Ian and other in- You must see to it that representative will have all Limit shown in Section B.Limits - volved insured, in the • • we receive written no- your rights and duties under Of Insurance, 1. Employee this Coverage Part. event of an act,error or lice of the claim or"suit' • Benefit Liability Coverage of omission,or claim; as soon as practicable. (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- apply irrespective of the ap- c. You and any other in- nership,Joint venture or limited tained by any one "employee", - plication of the Deductible volved insured must: liability company,and over which including damages sustained by ,Amount. you mainta n-ownership or major- such "employee's" dependents (1) Immediately send ity interest, will qualify as.a and benefrdaries,as a result of. (d) We may pay any part or all. us copies of any aed Insured if no other similar of the Deductible Amount to demands, notices, Nmaedce applies to that organa-. (a)- d An a ,error or omission;or . effect settlement of any • summonses or le • - inur — claim or"suit'and,upon no- gal papers re- • • Includes copyrighted material of Insurance • Indudes copyrighted material of Insurance GA 233 0917 Services Office,Inc,with its permission. Page 5 of 17 GA 233 0917• Services Office,Inc,with its permission. Page 6 of 17 • o • n . N W •O •• t0 V N N -9..,-6: ' tf $3 Q d oc.O7" s . • �' • c c 0 _ �. O m g El �c oS N-, m.g3g'zN3ONv'z7 ln��o.�� 7A°r�o»a �N.. 8�- g a8g--1cmN-0�xN 3 mist-8 s am Yt m mUg2 3•8 m RuP, 6 N `02g.m gg m omNo• V a70: nimao .4.g.1" ocm .� ma a s'gg'8.cm�»e a 8nm9a 2 sw "8_a_'»5 0CN,32- 3, Cm a •m, go °g NmID. mg. i,m 9 cglid. =zg m. ran m°g6,S m �'� fom'a 'm°3o•aaa 20,ac non4-q gm N. Fd— a ff. aso0u °Oc5.m8 = mmN• g_86 mf, 8w3- mm om3»gN gom�m 0 m Fd- gn 8N 8m 3. agm_`o'mw' nm 3 3.mmmg m .»3y q- 30ago�o3oga CDa*SDag am'„, m 8 3 o v 0 20 8 m �m3ym 8 0 4 o foo 3v gg m • agNs3.9 ' '°m0 co- 13, `gm rc 03 vim m4 0 0 'a3 vy a�m3gAoo3o'3 awg 5' oaw0 3? 3mwm0o c,3 two w,0 8 C yt 0 N. m m C` m `G `3G`3G ' -18m=0 0 c, �Pm9'�a4'89' 3m o $ 7.00�w coc �.`-`='m3N aY 39 3 3 -0 Pa g.co gm - . 12O m-• . g m . ?8 co-� m' m a . am P. P F 'd D 0-3 3 A A = P a o 0 N p -0 m m m 0 2 .0. 0•m N 0•g m- 3. am m ®, V av o'm g 8-i Z m.�o-•m-m 3 c N o m- 3 g 0 0 m m a O 3 C. !IU mo �pm�°?.3a 3 �• mm3 g m°i t3g m<? o �Nyr. m�..,,.-22 3'` m t'5 8 Z-§i y 3 a- -o �m s m 8 N n c os Emag N •d :1 0 A- a K fo w In- o' CSCSp� yE ^.f0 _. Q .O Om'pm�<0 O a cam N ",y N.Z970 co 8•'g.2,72-8.=:0305 Opp N�•Ow pyo' y-.8H 0 9N.3.a Sp-,Q •1 .6.,2-. 3 •W �m Nm N.�-+ 27 gdCa112 .y m 61C G1 nN N•m3mg flNg.�3N[mi62C 0] - O' 0 3 w _Q- a o 3 m g3341 o m 2.$m NL1? g. Nm ° O Sg m m ()1st �°fo »g 3m m o <3 nmBamNm .0303. C_ao 3 E -OVa --_ 4ga m w9. 5.0.., m N OM Nm3m�oN . ...=-120 .15� 7 �oS f,=0.6_. ,- 5 c m F v'3om'•mom 7 a a MIN =r @g°ma?- coo� . 3,-;4:20 �n'0-'.m 3.2 Wm ' -1 g o 4m3 �, . mm0 35 m 3 rm< 3 z_. c »3 c m m �a01O m �d m08` O�'� �ymmmNmg�?�•3i NO3.NN m•4 N C • D . N N W O w V 4f N • • • �$ °9��013 °mmy F m o0 ccmw c3g<,mmov 'U NgfmN0v00CCC € C) a'n"<5.3-O »moumm vvcmmo3-I c.= m vgm m3m< 0 nc'o' m`� , nyomc X30 3y _0 0003°E.2'0s o < 3 • 3 a N m 3 4 2 0 0-3 3,° N 3 `G m a c C m 8 S y.= N A 6 C 3. 3 3 3 C ,m 3 j O m m gal �°1m3'N .' mNo3' �,�,m�g•2Boyc3•'m-oD mw-" '038 f ogw ''''-ii nE 9,a �' y c o•m vvl- �< c _mc mm3 m 0mo c» ln.m, 0 0 n'gg-m `nvw3mamm •gm m= g"• RSV- a�amm g moi 3m�$ �m a _ 30°3 ' 0 w 3.wi 0 0 � �G 3 �D 3.�$= 3 3 3 .O� �••$ 3 y� 0 Z" C m i(4. v0oaa� 3?`3-o a mg'owg�wgs-6m'am0 mgCC 0 �P< Ego-417c03.° m ma Via'"'. . 8a (7/1 88 mamCmm° m `°G �p a7`°G 03 •Om.7. 3.�.NRmm y-e3 N aW aa3 C 1 �. 8l n"2i C Q 0 0"3 m0-m° g'�nO- nm m N'u m..E1—....9,8 m q m a g§ O RA-O XO a.8ETN B.N()3 3 Qd y p�A g Ogel !TR(aD • 8p g0� T g'�m QJC 3i .TNN T(i5 m2Lo.392.35- 'Oam34 •5 :�N KG,a_ 9,800, 4 = tim 3' P a -.m • g y N mo o.@ . p •g . . - m v m-i A - P • F m 9,N O y j a 6 3 N m w R" 2=T25,1 a CI • cyoomc �2°o0i32va3 0-3� m2 .mm • n 0mma((�p//tea 10-8023. N3(wpg "t((3]]3 f8N"v8o�v 2 21u0,�0** 3 cw3ymg< 00 CC g� N aa 3 n C K ,g 3 g N g•�..P.•p.O 9,n?m m�;�O a m� m f° N°"��N c»o"' m(°3��o 3•`m 00-8 3m 9,3 38 8 0 f -2 :12°21°,5 0 pCp gm54 C3m8-m Z3 ejOV. omm - �ja•C rhm2 0.3p�frailm3•-pOy,E go' p`$O O 03� y .Oo0I`�A N9,OO,oy a1-N3.°<-N 4a7 UU 8 ° 3o 30 m i 3 aw 'i, c' m��,m oa,. a 3 a m 3$ 3 N�8y 0 �m .y a 3 (015.0- m m o _, 3 m am 80.8g,8 m 8m 0 0 3c'Oa 0-3,18 m'N 3 43�c min 9 m !^m w3a •oa go2a a m .�w Ym 'ma a �< 0-w c �3.0 .4 .5 ��agom 3 0 a a? 4i, $ _ma .7im RAY TRm7m n0,04i19 .27. 2. Unintentional Failure To Disclose Haz- 2) Rust or other cor- 2) Basements, you with permission of ands rosion, decay, de- whether paved or the owner, terioration, hidden .not;or Section IV-Commercial General LIabil- or latent defect or b. In the case of damage ity Conditions, 7. Representations is • - - any quality in 3) Doors,windows or by fire,explosion; light- amended by the addition of the following: property that taus- other openings. ping, smoke or soot, Based on our dependence upon your rep- es it to damage or (c) Property damage" caused while rented to you;or resentations as to existing hazards,if un- destroy itself, • _ by or resulting from water c. In the case of damage intentionally you should fail to disdose all 3) Smog; • that leaks or flows from by water, while rented such hazards at the inception date of your plumbing,heating,air condi- to and occupied by you. policy,we will not reject coverage under 4) Mechanical break- tioning, fire protection sys- this Coverage Part based solely on such down, including terns, or other equipment, • (2) The most we will pay is limited as failure. rupture or bursting caused by or resulting from described in Section B. Limits caused by centrif- freezing,unless: Of Insurance, 3. Damage To . 3. Damage To Premises Rented To You ugal force; Premises Rented To You of this (I) You did your best to endorsement. • a. The last Paragraph of 2.Exclusions 5) Settling, cracking, maintain heat in the under Section I-Coverage A-Bad- 'shrinking or ex- building or structure;or 4. Supplementary Payments ily Injury And Property Damage U- • pansion; • Under Section I-Supplementary Pay- ability is replaced by the following: (II) You drained the equip- pP rY y- 6) Nesting or infesta- ment and shut off the ments-Coverages A And B: ' Exdusions c.through q.do not apply tion, or discharge water supply if the heat • to"property damage"by fire,explo- - or release of waste ' was not maintained. a. Paragraph 2.is replaced by the fd- sion, lightning, smoke or soot to. lowing: products or secre- premises while rented to you or tem- tions, by insects, (d) Property damage"to: Up to the limit shown in Section B. porarily occupied by you with pennis- birds, rodents or Limits Of Insurance,4.a.Bail Bonds sion of the owner, for which the (I) Plumbing, heating, air • amount we will pay is limited to the other animals;or conditioning,fire protea bf this endorsement for cost of bail • Damage To Premises Rented To 7) Presence, growth, tion systems, or other bonds required because of accidents You Limit as described in Section III proliferation, equipment or appliano- or traffic law violations arising out of -Limits Of Insurance. spread or any oro- es;a the use of any vehicle to which the tivity of fungus,in- Bodily Injury Liability Coverage ap- b. The insurance provided under Sec eluding mold or (Ii) The interior- of any plies.We do not have to furnish these tion I-Covera e.A-Bodil u building or structure,or bonds. 9 Y In 1 ry mildew, and any • topersonal property in And Property Damage Liability ap- mycotoxins, p p y b. Paragraph plies to'property damage"arising out y the building or structure, 4.is replaced by the fit- ofwater damage to premises that are spores, scents or caused by or resulting lowing: both rented to and occupied by you. • byproducts pro- • from rain,snow,sleet or All reasonable expenses incurred by duced or released • (1) As respects Water Damage Le- by fungi. ice,whether driven by - the insured at our request to assist us p gwind or not. in the investigation or defense of the gal Liability,as provided in Para- • (b) 'Property damage" caused claim or"suit',including actual loss of graph 3.b.above: directly or indirectly by any c. Limit Of Insurance earnings up to the limit shown in Seo- The exclusions under Section I- of the following: With respect to the insurance afford- tion B. Limits Of Insurance, 4.b. . Coverage A-Bodily Injury And • t Earth Earthquake, v•olcanic ed in Paragraphs 3.a.and 3.b.above, Loss Of Earnings of this endorsement Property Damage Liability, 2. (� eruption, landslide or the Damage To Premises Rented per day because of time off from Exclusions, other than I. War To You Limit as shown in the Decla- work and the Nuclear EnergyLiabil- any other earth move- rations is amended as follows: ment 5. Medical Payments ity Exclusion(Broad Form),are (1) Paragraph 6. of Section III - deleted and the following are (II) Water that backs up or Limits Of insurance is replaced The Medical Expense Limit of Any One added: overflows or is other- - by the following: Person as stated in the Declarations is • •This insurance does not wise discharged from a amended to the limit shown in Section B. apply to: sewer, drain, sump, 6. Subject to Paragraph 5. Limits Of Insurance, 5. Medical Pay- • (a) 'Property damage": • sump pump or related above, the Damage To ments of this endorsement. equipment; • . Premises Rented To You 6. 180.DayCoverage For Nevin Formed • ' (I) Assumed in any con- • Limit is the most we will pay 9 Y tract or agreement;or (iii)Water under the ground under Coverage A-Bodily Or Acquired Organizations surface pressing on,or Injury And Property Dam- Section II - Who Is An Insured is pi) Caused by or resulting flowing or seeping from any of the follow- through: age Liability fordamages amended as follows: becausee oof "property darn- ing: age"to anyone premises: Subparagraph a. of Paragraph 3. is re- 1) Foundations,walls, 1) Wear and tear; floors or paved placed by the following: a. While rented to you, or surfaces; temporarily occupied by a. Insurance under this provision is af- forded only unti the 180th day after . Includes copyrighted material of Insurance ' Includes copyrighted material of Insurance ' GA 233 0917 Services Office,Inc,with is permission. Page 9 of 17 GA 233 0917 Services Office,Inc,with is permission. Page 10 of 17 • f you acquire or form the organization use of that part of the prem- vendor's business, subject or repair opera- ' or the end of the policy period, . ises leased toyou, subject". . to the following additional tions, except such • whichever is earlier, • to the,following additional exdusions: operations per- Waiver Of Subrogation exclusions (I) The insurance afforded . formed at the yen- 7. IV-Commercial General Llabg- This insurance does not ap- • the vendor does not dors premises in ity Section IVans,9.Transfer Of Rights Of ply to: 'apply to: sale o the n with the sale of product; Recovery Against Others To Us is • (q Any"occurrence"which • 1) "Bodily injury" or . 7) Products which,af- amended by the addition of the following: • , takes place after you . 'property damage" ter distribution or • cease to be a tenant in for which the ven- We waive any right of recovery we may sale by you,have that premises; • dor is obligated to •have against any person or organization been labeled or res • against whom you have agreed to waive . (II) Structural alterations, pay damages by labeled or used as reason of the as - r such right of recovery in a written contract new construction or ingredient container,part y sumption of liability of an • or-agreement because of payments we demolition operationsY in a contract or • make.for injury or damage arising out of performed by or on be- - other thing or sub- agreement This vendor, b or for the your ongoing operations or"your work' • half of such additional • exclusion does not • Y done under a written'contract or agree- - insured. vendor,or ment with that person or organization and apply to liability for included in the'products•completed aper- (b) Lessor Of Leased Equip- • damages that the 8) "Bodily injury.' or ations hazard".However,our rights may ment • vendor would have ' "property damage" in the absence of arising out of the only be waived prior to the"occurrence" Any person or organization the contract or. • sole negligence of giving rise to the injury or damage for from whom you lease - agreement; the vendor for its which we make payment under this Cov- equipment when you and own ads or omis- erage Part The insured must do nothing such person(s)or organize- 2) Any express war- sions or those of . after a loss to impair our rights At our re- fico s have agreed per Par- ranty unauthorized the insured will bring () 9its employees or quest, "suit'or trans- a ra h 8.a.(1) of this en- by you; anyone elseaacting far those rights to us and help us enforce 9 p those rights. dorsement to provide insur- 3) Any physical or on its behalf.How ante.Such person(s)or or- ever,this exclusion 8. Automatic Additional Insured -Sed- ganization(s) are Insureds chemical change in • does not apply the product made' pp y to: fled Relationships only with respect to liability • intentionally by the - for"bodily injury', "property vendor,- a) The excep- a. The following is added to Section II- . damage" or "personal and ' tons co contained • Who Is An Insured: - advertising injury"caused,in 4) Repackaging, ex- . in Paragraphs whole or in part, by your cept when un- (c)(I)4)or 6) (1) Any person(s)or organization(s) maintenance, operation or • packed solely for of this ' en- described in Paragraph 8.a.(2)of use of equipment leased to ' the purpose of in- dorsement;or • this endorsement(hereinafter re- • you by such person(s)or or- spedion,' .demon- ferred to as additional insured) ganization(s).A person's or ' -, station,testing,or b)_ Such iaspeo whom you are required to add as organization's status as an • the substitution of •tions, .aclust- an additional insured under this mems,tests or Coverage Part by reason of a addinsured under this parts under in- servidng as , wrtten contract, written agree- endorsement ends when manufacturer, ns from the the vendor has ment, written permit or written their contract or agreement manufacturer, and agreed to authorization. • with you for such leased then repackaged in make or nor- • equipment ends. However, the original con- ' malt • (2) Only the following persons or or- this insurance does not ap- .tainer, takes to under-make ganizations are additional in- • ply to any "occurrence" • shreds under this endorsement, which takes place after the . 5) Any failure to make in the usual such inspections, course of and insurance coverage provided equipment lease aopires. • business, in to such additional insureds is lira- adjustments, tests (c) Vendors � or servidng as the connection iced as provided herein: vendor has agreed ' ' with the distil- Anysale (a) Managers Or Lessors Of (referred rrred to below as yen-person or oanization - to make or normal- of butithe n rrod- Premises dor) with whom you have • ly undertakes to • uds pr• od- Premises manager or lessor of a ' agreed per Paragraph make in the usual • 9 course of bush- • premises leased to you with 8.a.(1) of this endorsement nessin connection (II) 'This insurance does not whom you have agreed per to provide insurance,but on with the distribution apply to any insured ly with respect to'bodily in- Paragraph 8.a.(1)of this en- � or sale of the person or organization: dorsement to provide insur- jury",or "property damage" products; • 1) From whom you • ante, but onlywith respect 'arising out of"your products" Pehave acquired to liability arising out of the which are distributed or sold 6) Demonstration, in- such products, or ownership, maintenance or in the regular course of the' stallation,servidng any ingredient,part Includes copyrighted-material of Insurance • - • Includes copyrighted material of Insurance - GA 233 0917 Services Office,Inc,with its permission. • Page 11 of 17 GA 233 0917 Services Office,Inc,with its permission. Page 12 of 17 • • • or container,enter- (e) Mortgagee, Assignee Or in Paragraph 8.a.(1)of this en- tion I-Coverage A-Bodily Injury ing into,accompa- Receiver • dorsement;or And Property Damage Liability: flying or containing • such products;or Any person or organization (2) Available under the applicable Paragraphs(3)and(4)of this exclu- with whom you have agreedLimits of Insurance shown in the sion do not apply to tools or equip- . 2) When liability in- - per Paragraph 8.a.(1)of this Dedarations; • ment loaned to you,provided they are duded within the endorsement to provide in- , not being used to perform operations "products-• surance, but only with re- whichever is less. - at the time of loss. . • completed opera- spect to their liability as This endorsement shall not Inaease tions hazard" has mortgagee,assignee,or re- the applicable Limits of Insurance b. With respect to the insurance dovid- . been excluded un- cover and arising out of the ed by this section of the endorse this Coverage ownership,maintenance, or shown in the Declarations, ment, the following additional provi- der Part with respect to use of the premises by you. c. Section IV - Commercial General sions apply: ,, such products. However, this Insurance Liability Conditions is amended to (1) The Limits of Insurance shown in State Or Governmental does not apply to structural ._include the following: the Dedaratices are replaced by (d) alterations,new construction • the limits designated in Section . Agency Or Subdivision Or • and demolition operations .Automatic Additional insured Pro- g Political Subdivision - performed by or for that per- vision B. Limits Of Insurance, 9. Permits Or Authorizations ton or organization. , Damage To Borrowed • Relating To Premises This insurance applies only if the Equipment of this endorsement (3) The insurance afforded to addi- 'bodily Injury'or"property damage" with respect to coverage provid- Any state or governmental tional insureds described in Par- ocarrs,or the"personal and advertis- ed by this endorsement These agency or subdivision or po-- agraph 8.a.(1) of this endorse- • Ing Injury'offense is committed: limits are indusive of arid not in litical subdivision with which ment have agreedper Para- (1) During the policy period;and additionla . to the limitssf being re- you9 placed.The Limits of Insurance - . • graph 8.a.(1) of this en- (a) Only applies to the extent (2) Subsequent to your execution of shown in Section B. Limits Of dorsement to provide insur- permitted by law;and the written contract or written Insurance,9.Property Damage ansa, subject to the follow- agreement,ar the issuance of a To Borrowed Equipment of this, (b) Will not be broader than that 9 ing additional provision: endorsement fix the most we will which you are required by written permit or written authori- This insurance applies only the written contract,written - zation, described in Paragraph pay in any one"occurrence"re- . with respect to the following agreement,written permit or 8.a.(1). gardless of the number of: hazards for which the state written authorization to pro- d. Section IV - Commercial General (a) Insureds; or governmental agency or vide for such additional in- - subdivision or political sub- cured;and followLiabils: Conditions Is amended as (b) Claims made or "suits" . division has issued a permit' ' • follows: brought;or • • or authorization,in conneo- (c) Does not apply to any per- Condition 5. Other Insurance is ton with premises you own, • son, organization, vendor, amended to indude: •(c) Persons or organizations rent or control and to which state, governmental agency - making claims or bringing this insurance applies: ' • or subdivision or political Primary And Noncontributory In- 'Suits'. subdivision, specifically surance (2) Deductible Clause ' (I) The existence, mainte- named as an additional in- . nance,repair,censtruc- ' • sured under anyother provi- This•insurance Is primary to and will P • (a) Our obligation to pay dam- lion,erection or removal ' sion of, or endorsement not seek contribution from any other, • ages on your behalf applies - of advertising signs, - added to, this Coverage insurance available to an additional only to the amount of dam- awnings,canopies,cal- Part, provided such other insured per Paragraph 8.a.(1)of this ages for each"occurrence" lar entrances, coal - provision or endorsement endorsement provided that: which are in excess of the holes, driveways, man- covers the injury or damage (1) The additional insured is a Deductible Amount stated in holes, marquees, hoist . for which this insurance ap- Named Insured under such other Section B.Limits Of Incur- 'away openings, side- - - plies. . Insurance;and ance,9.Property Damage walk vaults,street ban- To Borrowed Equipment of . ners or decorations and b.: With respect to the insurance afford- - (2) You have agreed in writing in a this endorsement The limits. similar exposures;or ed to the addtional insureds de- contract, agreement, permit or of insurance will not be re • - soed in Paragraph 8.a.(1)of this scribed authorization described in 8.a.(2) duced by the application of - (ii) The oonstrudion, erec- endorsement,the following is added of this endorsement that this in- such deductible amount don or removal of eleva- to Section III-Limits Of Insurance: surance would be primary and tors;or • The most we will pay on behalf of the would not seek contribution from (b) Section IV - Commercial (II)The ownership,mainte- additional insured is the amount of In- any other insurance available to General .Liability Candi- the additional insured. tions, 2. Duties In The mance or use of any el- surence: • Event Of Occurrence, Of- evators covered by this • insurance • (1) Required by the written contract, 9. Property Damage To Borrowed Equip- fense, Claim Or Suit, aP- written agreement,written permit ment plies to each daim or"suit" or written authorization described irrespective of the amount. a. The folbwing is added to Exclusion 24.Damage To Property under Sec- ' Incudes copyrighted materiel of Insurance Includes copyrighted material of Insurance . GA 233 0917 Services Office,Inc.,with its permission. Page 13 of 17 GA 233 0917 Services Office,Inc.,with its permission. Page 14 of 17 • • (c) We may pay any part or all ' 12. Nonowned Aircraft 16. Voluntary.Property Damage Coverage . (2) Exclusions ' of effectthe deductible erre amount to The followingis added to Exclusion 2.g. a. Coverage D -VoluntaryPropertyThis insurance does not I to settlement of any 9 apply daim or"suit'and,upon no- Aircraft,Auto Or Watercraft under Sec- • Damage Coverage "property damage that would be • • tification of the action taken, tion I-Coverage A-Bodily Injury And excluded by Coverage A-Bodl- ou shall promptly reim- Property Damage Liability: Section I-Coverages is amended to ly Injury And Property Damage Y P P N indude the following: burse us for such part of the Liability,2.Exclusions,except This excldoinn does not apply to an air- foil.Damage To Property, ar- been tiblepaid amount as has craft you do not own,'provided that: (1) Insuring Agreement agrphs 3, 4,(5)and 6, k. • been paid by us. We will paythe cost to re- Damage To Your Product,)and 10. Employees As Insureds - Specified • a. The pilot in command holds a anent (a) pair_ or rlace 'propertyI.Dama a To Your Work. P effective certificate,issued by a duly • P 9 Health Cam Services And Good Samar- constituted authority of the United damage"to property of oth- • 3 Definitions itan Services States of America or Canada,desig- • ers arising out of operations (3) Paragraph 2.a.1 d under Section II - nating that person as a commercial or incidental to your business • For purposes of Voluntary Who Is An Insured oes not apply to: airline transport pilot; when: • Property Damage Coverage a a. Your"employees who provide pro- b. The aircraft is rented with a trained, 1) Damage is caused by only,the following definitions un- der Section V-Definitions are . fessional health care services on your paid crew;and you;or replaced by the following: - behalf as a duly licensed nurse, c. The aircraft does not transport per- 2) Damage occurs while in emergency medical technician or sorts or cargo for a dna e. your possession. 16. 'Occurrence"•means an in- paramedic in the jurisdiction where an r9 cident, including continuous occurrence"or offense to which this 13. Bodily Injury Redefined At your written request,we or repeated exposure to insurance applies takes place;or • - will make this payment re- substantially the same gen- Section V-Definitions,4."Bodily Injury' gardless of whether you are eral harmful conditions that b. Your"employees"or"volunteer work- is replaced by the following: at fault for the "property result in'property damage". ers",other than an employed or vol- damage". . unteer doctor, providing first aid or 4. "Bodily injury"means bodily harm or 20. 'Property damage" means good samaritan services during their injury, sickness, disease, disability, • If you, at.our request, re- physical injury to tangible work hours for you will be deemed to • humiliation,shock,fright,mental an- place, or make any repairs property."Electronic data"Is be acting within the scope of their • guish or mental injury,including care, _ to, damaged property of not-tangible property, and employment by you or performing du- loss of services or death resulting . • others, the amount we will 'property damage"does not ties related to the conduct of your from any of these at any lime. • pay under Voluntary Prop- indude disappearance, ab- busoasis 14. Expected Or In u Redefined arty Damage Coverage will olfaction or theft. P injury be determined by your adu- 11. Broadened Notice Of Occurrence The last sentence of Exclusion 2.a.Ex- al cost to replace or repair - b. Care,Custody Or Control Liability acted Or Intended Injury under Sec- • the damaged property, ex- Coverage • TPhe Eventh a. of Occurrence, Condition Duties In P J ry duding any profit or over-The Of Offense, tion I-Coverage A-Bodily injury AndFor purposes of the coverage provid- Prc a Damage Liabilityis replaced byhead. ed Claim Or Suit under Section IV-Corn- Property 9 P by Care,Custody Or Control Li- Claim General Liability Conditions is the following: Any payment we make un- ability Coverage in this endorsement replaced by the following: This exclusion does not apply to'bodily. der Voluntary Property only: a. You must see to it that we are notified . injury"or"property damage"resulting'from • Damage Coverage shall not (1) Section I-Coverage A-Bodily the use of reasonable force toprotectbe interpreted as an admis- as soon as practicable of an"occur-. per- Injury And Property Damage sons or ro sion of liability by you or by rence"or an offense which may result property. uaLiability, 2, Exclusions, J. in a daim.To the extent possible,no- 15. Former Employees As Insureds Damage To Property,Subpara- graphstice should include: It shall be your duty,not our • (3),(4)and(5)do not ap- How,when and where the"so- The following Is added to Paragraph 2. • duty,to defend any daim or • ply to pr ofd"property damage"escribes (1) under Section II-Whois An Insured: "suit'to which this insurance property • • currence"or offense took place; applies. therein. 2. Each of the following Is also an in- (2) The names and addresses of sured: No other obligation or habil- (2) It shall be your duty,not our duty, • any injured persons and wit- ity to pay sums or perform to defend any daim or"suit'to nesses;and Any of your former"employees', di- acts or services is covered. which this insurance applies, • rectors, managers, members, part- (3) The nature and location of any ners or"executive officers",including (b) This insurance applies to No other obligation or liability to injury or damage arising out of but not limited to retired,disabled or 'property damage"only it pay sums or perform acts or ser- the"occurrence"or offense. those on leave of absence,but only vices is covered. This requirement applies onlywhen for acts within the soope of their em- 1) The"property damage" q PP takesplace in the"coy- This Paragraph (2) supersedes the "authorized "occurrence"or offense is known to the nt by you or for duties related anyprovision in the Coverage to an"authorized representative". to the conduct of your business. • erage territory;and 9 Part to the contrary. 2) The"property damage" • occurs during the policy (3) "Property damage" for which - period. • Cam,Custody Or Control Lia- • bility Coverage provides cover- Includes copyrighted material of Insurance Includes copyrighted material of Insurance GA 233 0917 Services Office,Inc,with its permission. Page 15 of 17 GA 233 0917 Services Office,Inc.,with its permission. Page 160117 • age shall be deemed to be (3) The Voluntary Property Dam- caused by an "ocarrrence"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"coy- bies erage term". . 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 indude the following: which are in excess of the (1) The Limits of Insurance shown in forrdthehde applicablent 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 daim or"suit' . pay regardless of the number of: irrespective of the amount. (a) Insureds; . (c) We may pay any part or all . (b) Claims made or "suits" of the Deducible Amount to brought;or • effect settlement of any • 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 I • • Deductible Amount as has (2) (a) Subject to (3) below, the been paid by us Vlutary Property Dam- 17. Broadened Contractual Liabilit Work aggC e overage,Each occur- Y- rence Limit Of Insurance is Within 50'Of Railroad Property 'the most we will pay for tile 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 fd- lowing:(b) The Care,Custody Or Con- 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 24. 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 09.17 Services Office,Inc,with its permission. Page 17 of 17 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. b. By way of an edition of an ISO addi- 2. With respect to the insurance afforded to tional insured endorsement that in- the additional insureds described in Para- cludes arising out of your ongoing graph B.1..the following additional exclu- CONTRACTORS ADDITIONAL INSURED -AUTOMATIC STATUS operations or arising out of "your sionsapply: • work"; This insurance does not apply to: AND AUTOMATIC WAIVER OF SUBROGATION then the phrase caused, in whole or in• • WHEN REQUIRED IN WRITTEN CONTRACT,AGREEMENT, part by in Paragraph A.1.a.and/or Para- a. "Bodily injury","property damage"or . graph A.1.b.above,whichever applies,is "personal and advertising injury'aris- PERMIT OR AUTHORIZATION replaced by the phrase arising out of. ing out of operations performed for . the federal government,state or mu- 3. With respect to the insurance afforded to nicipality;or • This endorsement modifies insurance provided under the following: ' • the additional insureds described in Para- b.b. "Bodily injury"or""property damage" graph Al.,. thefollowing additional exclu- . Sion applies: included within the "products- COMMERCIAL GENERAL LIABILITY COVERAGE PART completed operations hazard." This insurance does not apply to"bodily injury", "property damage" or "personal C. The insurance afforded to additional insureds A. Additional Insured-Owners,Lessees Or cluded in the "products-completed and advertising injury"arising out of the described in Paragraphs A.and B.: Contractors-Automatic Status For Other operations hazard",but only if: rendering of,or the failure to render,any 1. Only applies to the-extent permitted by •Parties When Required In Written Contract - professional architectural,engineering or . law;and Or Agreement With You , (1) The Coverage Part to which this surveying services,including: endorsement is attached pro- • 2. Will not be broader'than that which you 1. Section II - Who Is An Insured is vides coverage for"bodily injury" a. The preparing,approving or failing to are required by the written contract,writ- amended to include as an additional in- or "property damage" included prepare or approve, maps, shop ten agreement,written permit or written sured any person or. organization you within the "products-completed drawings,opinions,reports,surveys, authorization to provide for such addition- have agreed in writing in a contract or operations hazard";and • field orders,change orders or draw• al insured;and agreement to add as an additional in- _ ings and specifications;or • sured on this Coverage Part. Such per- (2) The written,contract or written 3. Does not apply to any person,organiza- son(s)or brganization(s)is an additional agreement requires you to pro- b. Supervisory,inspection,architectural tion,state,governmental.agency or sub- insured only with respect to liability for: vide additional insured coverage or engineering activities. • division or political subdivision specifically included within the "products- named as an additional insured for the injury", This exclusion applies even if the claims a. "Bodily "property damage°or • completed operations hazard" against any insured allege negligence or same project in the schedule of an en- causenal and advertising injury" - for that person or organization. other wrongdoing in the supervision,hir- dorsement added to this Coverage Part. caused, in whole or in part,by the performance of your ongoing opera- If the written contract or written ing,employment,training or monitoring of D. With respect to the insurance afforded to the tions by you or on your behalf,under agreement requires you to provide others by that insured,if the"occurrence" additional insureds described in Paragraphs that- written contract or written. additional insured coverage included which caused the"bodily injury"or"prop- A.and B.,the following is added to Section III agreement.Ongoing operations does within the"products-completed aper- _ erty- damage", or the offense which Limits Of Insurance: not apply to"bodily injury"or"proper- ations hazard"for a specified length caused the"personal and advertising•inju- ty damage"occurring after. . of time for that person or organiza- ry",involved the rendering of,or the fail- The most we will pay on behalf of the addi • - Z • tion, the "bodily injury"or"property ure to render,any professional architec- tional insured is the amount of insurance: (1) All work, including materials, damage"must occur prior to the ex- . tural,engineering or surveying services. 1. Required by the written contract,written parts or equipment furnished in for this of that period of time in order 4. -This Paragraph A.does not apply to addi- agreement,written permit or written au- the pr connection with such work, on for this insurance to apply. tional insureds described in Paragraph B. thorization described in Paragraphs A. the project (other than service, . maintenance or repairs) to be If the written contract or written and B.For the purpose of determining the agreement requiresyou to B. Additional Insured-State Or Governmental • q y performed by or on behalf of the 9 q provide Agency Or Subdivision Or Political Subdi re wired amount of insurance only,we will additional insured(s)at the loca- additional insured coverage for a g y include the minimum amount of any Um- tion of the covered operations personorganizationperonly vision-Automatic Status When Required brella Liability or ISO or Excess Liability cover- PIn Written Permits Or Authorizations - has been completed;or additional insured endorsement form age required for that additional insured in number CG 20 10.without specifying 1. Section-II - Who Is An Insured is that written contract, written agreement, (2) That portion of"your work"out of an edition date,and without specifi- amended to include as an additional in- writtenpermit or written authorization;or which the injury or damage aris- catty requiring additional insured sured any state or governmental agency 2. .Available under the applicable limits of in- es has been put to its intended - 'coverage included within the"prod- or subdivision'or political subdivision you surance; use by any person or organiza- ucts-completed operations hazard", - have agreed in writing in a permit or au- tion other than another contrac- ' this Paragraph b.does not apply to thorization to add as an additional insured • whichever is less. for or subcontractor engaged in that person or organization. on this Coverage Part.Such state or gov- performing operations for a prin- ernmental agency or subdivision or politi- This endorsement shall not increase the appli- cipal as a part of the same pro- 2. If the written contract or written agree- cal subdivision is an additional insured cable limits of insurance. ment described in Para ra h 1. above ject;and specifically requires you to provide addi- only with respect to operations performed E. Section IV-Commercial General Liability • b. "Bodily injury"or"property damage" tional insured coverage to that person or by you or on your behalf for which the Conditions is amended to add the following: caused,in whole or in part,by"your organization: state or governmental agency or subdivi- • work" performed under that mitten sion or political subdivision has issued,in Automatic Additional Insured Provision contract or written agreement and in- a. Arising out of your ongoing opera- writing,a permit or authorization. tions or arising out of'your work";or . Includes copyrighted material of Insurance Includes copyrighted material of Insurance GA 472 05 20 Services Office,Inc.,with its permission. Page 1 of 3 GA 472 05 20 • Services Office,Inc.,with its permission. Page 2 of 3 • • This insurance applies only if the"bodily inju- .scribed in Paragraph A.or B.that this in- ry"or"property damage"occurs,or the"per- surance would be primary to any other in- sonal and advertising injury"offense is corn- surance available to the additional in- miffed: sured. • • 1. During the policy period;and As used in this endorsement,wrap-up insur- 2. Subsequent to your execution of the writ- ance means a centralized insurance program ten contract or written agreement, the under which one party has secured either in • - en issuancet of a writtenpermite or agreement, or the surance or self-insurance covering some or all of the contractors or subcontractors perform- thorization, described in Paragraphs A. ing work on one or more specific project(s). • and B. Primary And Noncontributory Insurance F. Except when G.below applies,the following is When Required By Written Contract, added to Section IV-Commercial General Agreement,Permit Or Authorization • Liability Conditions, Other Insurance, and supersedes any provision to the contrary: Except when wrap-up insurance applies to the • Other Additional Insured Coverage. claim or"suit"on behalf of the additional in- When9 cured,this insurance is primary to and will not Applies On An Excess Basis seek contribution from any other insurance This insurance is primary to other insurance available to the additional insured described in • available to the additional insured described in Paragraphs A.and B.provided that: Paragraphs A.and B.except: - 1. The additional insured is a Named In- 1. As otherwise provided in Section IV- cured under such other insurance;and Commercial General Liability Condi- 2. You have agreed in writing in a contract, tions, Other Insurance, b. Excess In- agreement, permit or authorization de- .surance;or scribed in Paragraph A.or B.that this in- 2. For any other valid and collectible insur- surance would be primary and would not ance available to the additional insured as seek contribution from.any other incur- an additional insured on another incur- ance available to the additional insured. •• ance policy that is written on an excess As used in this endorsement,wrap-up incur- basis.In such case,this insurance is also ance means a centralized insurance program • excess. under which one party has secured either in- G. The following is added to Section IV-Com- surance or self-insurance covering some or all • mercial General Liability Conditions,Other of the contractors or subcontractors perform- Insurance;and supersedes any provision to ing work on one or more specific project(s). • the contrary: H. Section IV-Commercial General Liability Primary Insurance When Required By Writ- Conditions,Transfer Of Rights Of Recov • - ten Contract, Agreement, Permit Or Au- . ery Against Others To Us-is amended by the thorization addition of the following: , • Except when wrap-up insurance applies to the Waiver of Subrogation claim or"suit"on behalf of the additional in- We waive any right of recovery against any • cured,this insurance is primary to any other additional insured under this endorsement, insurance available to the additional insured because of any payment we make under this described in Paragraphs A. and B. provided endorsement, to whom the insured has that: waived its right of recovery in a written con • - 1. The additional insured is a Named In- tract,written agreement,written permit or writ- cured under such other insurance;and ten authorization.Such waiver by us applies only to the extent that the insured has waived 2. You have agreed in writing in a contract, its right of recovery against such additional in- agreement, permit or authorization de- cured prior to loss. . • • Includes copyrighted material of Insurance GA 472 05 20 Services Office,Inc..with its permission. Page 3 of 3 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. 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; CinciPlus® E. Audio, Visual and Data Electronic Equip- b. Does nota I to "bodilyinjury'or - BUSINESS AUTO XC+® • ment q. P "property damage"resultig from an SECTION III - PHYSICAL DAMAGE COV- "accident" that occurred before you • (EXPANDED.COVERAGE PLUS). ERAGE,C.Limit of Insurance is amended acquired or formed the organization; ENDORSEMENT • by adding the following: c. Does not apply to any newly acquired or formed organization that is a joint • • 4. The most we will pay for all"loss"to au- venture or partnership;and • dio,visual or data electronic equipment This endorsement modifies insurance provided by the following: and any accessories used with this d. Does not apply to an insured under equipment as a result of any "acci- any other automobile liability policy or BUSINESS AUTO COVERAGE FORM dent"is the lesser of would be an insured under such a policy but for the termination of such a. The actual cash value of the dam- aged or stolen property as of the time policy or the exhaustion of such poli- With respect to the coverage provided by this endorsement,the provisions of the Coverage Form apply unless of the"accident"; cy's limits of insurance. • modified by this endorsement. • 3. Any of your"employees" while using a • b. The cost of repairing or replacing the covered"auto"in your business or your • ' A. Blanket Waiver of Subrogation This provision does not apply unless the valid damaged or-stolen property with oth- personal affairs,provided you do not own, • SECTION IV - BUSINESS AUTO' CONDI- written contract has been: er property of like kind and quality;or hire or borrow that"auto". TIONS,A.Loss Conditions,5.Transfer of. 1. Executed prior to the accident causing c. $2,500. G. Liability Coverage Extensions - Supple- • Rights of Recovery Against Others to Us is "bodily injury"or"property damage";and Provided the equipment,at the time of the ' mentary Payments-Higher Limits • • amended by the addition of the following: "loss"is: 2. Is still in force at the time of the"accident" SECTION II - LIABILITY COVERAGE, A. We waive any right of recovery we may have causing"bodily injury"or"property dam- a. Permanently installed in or upon the' Coverage,2.Coverage Extensions,a.Sup- against any person or organization because of age". • covered"auto"in a housing,opening plementary Payments is amended by: payments we make for "bodily injury" or - - or other location that is not normally • "propertydamage",arisin out of the operation' D. Employee Hired Auto1. for bail Replacing the with$$2,000 Limit of)Insurance 9 P used by the"auto"manufacturer for for bail bonds $4,000 in(2);and of a covered"auto"when you have assumed 1. Changes in Liability Coverage the installation of such equipment; • liability for such "bodily injury" or"property 2. Replacing the$250 Limit of Insurance for damage"under an"insured contract",provid- The following is added to the SECTION II b. Removable from a permanently in- reasonable expenses with$500 in(4). ed the"bodily injury"or,"property damage"oc-' -LIABILITY COVERAGE,A.Coverage, stalled housing unit as described in curs subsequent to the execution'or the"in- - 1.Who is an Insured: Paragraph 2.a.above;or H. Amended Fellow Employee Exclusion • • cured contract". An "employee" of yours is an "insured" c. An integral part of such equipment. SECTION II-LIABILITY COVERAGE,B.Ex- B. Noncontributory Insurance while operating an"auto"hired or rented •F. Who is an Insured-Amended elusions,5.Fellow Employee is modified as SECTION IV • BUSINESS AUTO CONDI- under a contract or agreement in that - - follows: "employee's"name,with your permission,_ • SECTION II - LIABILITY COVERAGE, A. TIONS,B.General Conditions,5.Other In- Exclusion 5.Fellow Employee is deleted. ' while,performing duties related to the Coverage,1.Who is an Insured is amended • surance c. is deleted in its entirety and re- conduct of your business. by adding the following: I. Hired Auto-Physical Damage placed by the following: . . c. Regardless of the provisions of Par- Coverage, Changes in General Conditions The following are"insureds": . If hired"autos"are covered"autos"for.Liability ' agraph a. above, this Coverage SECTION IV-BUSINESS AUTO CON- Coverage,then Comprehensive and Collision 9 P 9 1. Any subsidiary which is a legally incorpo- Physical Damage Coverages as provided un • - Form's Liability.Coverage is primary DITIONS, B. General Conditions, 5. rated entity of which you own a financial der SECTION III - PHYSICAL DAMAGE and we will not seek contribution Other Insurance is deleted in its entirety interest of more than 50% of the voting COVERAGE of this Coverage Part are ex- from any other insurance for any Iia- . and replaced by the following: stock on the effective date of this cover- tended to"autos"you hire,subject to the fol- bnlnty assumed under an "insured age form. contract"that requires liability to be b. For Hired-Auto Physical Damage. g lowing: assumed on a primarynoncontributo- Coverage the following are deemed However,the insurance afforded by this . 1. The most we will pay for"loss" to any ry basis. to be covered"autos"you own: provision does not apply to any subsidiary hired"auto"is$50,000 or the actual cash. Additional Insured byContract (1) Any covered "auto"you that is an"insured"under any other au- value'or cost to repair or replace,which- C. lease. tomobile liability policy or would be an"in- hire,rent or borrow;and . -ever is the least,minus a deductible. SECTION Ir. LIABILITY COVERAGE, A• cured"under such policy but for termina- Coverage,1.Who is an Insured is amended (2) Any covered "auto" hired or • tion of such policy or the exhaustion of 2. The deductible will be equal to the largest to include as an insured any person or organi- rented by your"employee"under such policy's limits of insurance. deductible applicable to any owned"auto" nation for whom you have agreed in a valid a contract in that individual"em- for that coverage,or$1,000.whichever is 9 2. Any organization that is newly acquired or , written contract to provide insurance as af- ployee's" name, with your per- formed by you'and over which you main- less. forded by this policy. mission,while performing duties • tali majority ownership. The insurance 3. Hired Auto-Physical Damage coverage related to the conduct of your provided by this provision: is excess over any other collectible insur- This provision is limited to the scope of the business. once: valid written contract. • Includes copyrighted material of ISO • Includes copyrighted material of ISO AA 288 06 20 Properties,Inc.,with its permission. Page 1 of 4 • AA 288 06 20 ' Properties,Inc.,with its permission. ' Page 2 of 4 i - 4. Subject to the above limit,deductible,and K. Transportation Expense-Higher Limits_ 2. SECTION V-DEFINITIONS is amended P. Unintentional Failure to Disclose Hazards excess provisions we will provide cover- SECTION III- PHYSICAL DAMAGE COV- by adding the following,but only for the SECTION IV - BUSINESS AUTO CONDI- age equal to the broadest coverage appli- purposes of this-Loan or Lease Gap CONDI- cable to any covered"auto"you own in- ERAGE,A.Coverage, 4. Coverage Exten- Coverage: TIONS,B:General Conditions,2.Conceal • - sured under this policy. sions is amended by replacing$20 per day ment, Misrepresentation or Fraud is with $50 per day, and $600 maximum'with "Total loss"means a loss"in which the amended by adding the following: • Coverage includes loss of use of that hired au- $1,500 maximum in Extension a.Transpor- cost of repairs plus the salvage value ex- to,'provided it results from an"accident"for tation Expenses. ceeds the actual cash value. However,if you unintentionally fail to disclose • which you are legally liable and as a result of • any hazards existing on the effective date of which a monetary loss is sustained by the L. Airbag Coverage N. Glass Repair-Waiver of Deductible this Coverage Form,we will not deny cover- leasing or rental concern. The most we will SECTION III - PHYSICAL DAMAGE COV- SECTION III - PHYSICAL DAMAGE COV- age under this Coverage Form because of pay for any one"accident"is$3,000. ERAGE,B.Exclusions,3.a.is amended by . ERAGE,D.Deductible is amended by adding such failure: If a limit for Hired Auto-Physical Damage is adding the following: , the following: . Q. Mental Anguish Resulting from Bodily Inju- shown in the Schedule,then that limit replac- However, the mechanical and electrical. No deductible applies to glass damage if the ry es,and is not added to,the$50,000 limit indi- breakdown portion of this exclusion does not glass is repaired in a manner acceptable to us SECTION V V.DEFINITIONS,C."Bodily inju- cated above and the deductibles shown in the apply to the accidental discharge of an airbag. rather than replaced. ry"is deleted in its entirety and replaced by Schedule are applicable. This coverage for airbags is excess over any the following: • J. Rental Reimbursement other collectible insurance or warranty. O. Duties.in'the Event of an Accident,Claim, • Suit or Loss-Amended "Bodily injury"means bodily injury,sickness or SECTION III - PHYSICAL DAMAGE COV- M. Loan or Lease Gap Coverage SECTION IV - BUSINESS AUTO CONDI- disease sustained by a person,.including men- tal anguish and death sustained by the same ERAGE is amended by adding the following: 1. SECTION III - PHYSICAL DAMAGE TIONS,A.Loss Conditions,2.Duties in the person that results from such bodily injury, 1. We will pay.for rental reimbursement ex- COVERAGE, C. Limit of Insurance is Event of Accident,Claim,Suit or Loss,a.is sickness or disease."Bodily injury"does not • penses incurred by you for the rental of deleted in its entirety and replaced by the - amended by adding the following: include mental anguish or death that does not . • an"auto'because of a"loss"to a covered following,but only for private passenger „ result from bodilyinjury,sickness or disease. , "auto".Payment applies in addition to the type"autos"with an original loan or lease, This condition applies only when the acci- • and onlyin the event of a"total loss"to dent"or"loss"is known to: R. Coverage for Certain Operations in othetwiseapplicable amount of each cov- . 9 P Con- erage you have on a covered"auto".No such a private passenger type"auto": 1. You,if you are an individual; nection with Railroads deductible applies to this coverage. a. The most we will pay for"loss"in any 2. A partner,if you are a partnership; • With respect to the use of a.covered" auto"in 2. We will pay only for those expenses in- • one"accident"is the greater of: • operations for or affecting a railroad: , tuned during the policy period beginning (1) The amount due under the terms 3. An executive officer or insurance manag- 1. SECTION V-DEFINITIONS,H."Insured 24 hours after the"loss"and ending,re- er,if you are a corporation;or gardless of the policy's expiration, with of the lease or loan to which contract",1.c.is deleted in its entirety and P y F your covered private passenger 4. A member or manager,if you are a lim- replaced by the following: the lesser of the following-number of type"auto"is subject,but will not ited liability company. days: include: c. An easement or license agreement; a. The number of days reasonably re- (a) Overdue lease or loan pay- 2. SECTION V-DEFINITIONS,H."Insured • quired to repair the covered"auto".Ifmenu; contract",2.a.is deleted. "loss"is caused by theft,this number of days is added to the number of (b) Financial penalties imposed . days it takes to locate the covered under the lease due to high • "auto"and return it to you;or mileage, excessive use or b. 30 days. • abnormal wear and tear; 3. Our payment is limited to the lesser of the (c) funded Security ydthe lessorosits not re - - following amounts: a. Necessaryand actual expenses in- (d).Costs for extended warran- p ties, Credit Life Insurance, • tuned;or Health,Accident or Disabil- b. $50 per day. ity Insurance purchased with the loan or lease;and • 4. This coverage does not apply while there ' • are spare or reserve"autos"available to (e) Carry-over balances from youfor your operations. previous loans or leases,or 5. We will pay under this coverage only that (2) Actual cash value of the stolen . amount of your rental reimbursement ex- or damaged property_ penses which is not already provided for b. An adjustment for depreciation and under SECTION III- PHYSICAL DAM- physical condition will be made in de- AGE COVERAGE, A. Coverage, 4. termining actual cash value at the Coverage Extensions. time of"loss". • Includes copyrighted material of ISOIncludes copyrighted material of ISO ' AA 288 06 20 Properties,Inc.,with its permission. Page 3 of 4 AA 288 06 20 Properties,Inc.,with its permission. Page 4 of 4