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HomeMy WebLinkAboutInsurance Certificate: Rubenstein's Contract Carpet LLC (3) Client#:1785091 RUBENCON ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 10/11/2023 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(les)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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Lori Andrews NAME: USI Insurance Services NW PHONE 503 224-8390 FAX 610 362-8130 (A/C,No,Ext): (A/C,No): 825 NE Multnomah Suite 1500 ADDRESS: Lori.Andrews@usi.com Portland,OR 97232 INSURER(S)AFFORDING COVERAGE NAIC# 503 226-3801 INSURER A:Middlesex Insurance Company 23434 INSUREDINSURER B:SAIF Corporation 36196 Rubenstein's Contract Carpet LLC INSURER C: 160 Cleveland Street INSURER D: Eugene OR 97402 INSURER E . INSURER F: COVERAGES CERTIFICATE NUMBER: 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. INSRADDLOF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY AO148707004 03/15/2023 03/15/2024 EACH OCCURRENCE $1,000,000 E CLAIMS-MADE X OCCUR PREMISES(Ea occurrDence) $500,000 MED EXP(Any one person) $10,000 • PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 • POLICY X JECCT LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY A0148707001 03/15/2023 03/15/2024 CEaOMBaccidenINEDt)SINGLE LIMIT � ,000,000 1 ( X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X AUTOS ONLY X NAI UUTOS ONLY (Per a c PEdent)AMAGE • A X UMBRELLA LIAB X OCCUR A0148707005 03/15/2023 03/15/2024 EACH OCCURRENCE $10,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $10,000,000 DED X RETENTION$0 $ B WORKERS COMPENSATION 794537 10/01/2023 10/01/2024 X STATUTE EOTH AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) ' E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under ' DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 A Installation: A0148707003 03/15/2023 03/15/2024 Limit$1,000,000 Temp Storage/ Limit$500,000 Transit Deductibles$1,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Re:All Projects When Required by Written Contract The City of Ashland and its elected officials,officers and employees are included as additional insureds with primary and non-contributory wording and waiver of subrogation when required•by written contract. • • CERTIFICATE HOLDER CANCELLATION City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 East Main Street ACCORDANCE WITH •THE POLICY PROVISIONS. Ashland,OR 97520-0000 AUTHORIZED REPRESENTATIVE • . ice ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S42251066/M41723082 RYEZP This page has been left blank intentionally. A0148707004 • COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION . • This endorsement modifiesinsurance provided under the following: COMMERCIAL GENERAL LIABILITY.COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2) You have agreed in writing in a contract or Condition and supersedes any provision to the agreement that this insurance would be contrary; - primary and would .not seek contribution Primary And Noncontributory Insurance from any other insurance available to the . • This insurance is primary to and will not seek additional insured. contribution from any other insurance available to an additional insured" under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and • • • • • • I " • CG 20 01 04 13 • ©Insurance Services Office, Inc., 2012 Page 1 of 1. This page has been left blank intentionally. POLICY NUMBER:A0148707005 COMMERCIAL.EXCESS/UMBRELLA • EU 70 91 0515 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT OF OTHER INSURANCE CONDITION This endorsement modifies the coverage provided under the following: COMMERCIAL EXCESS/UMBRELLA COVERAGE PART With respect to the coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. SCHEDULE Name Of Person Or Organization: Any Additional Insured as required by written contract or written agreement executed prior to loss (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) The following is added to Paragraph H. Other (4) Affords indemnification and/or defense of Insurance of Section IV-Conditions: the designated person or organization to • 1. This insurance is primary to and will not seek the extent permitted by law. contribution from any other insurance available 2. This condition does not apply to: to the person or organization shown in the a. Other insurance, not included in Paragraph 1. Schedule above, provided that such designated above, that may be available to the person or organization: designated person or organization outside of a. Is identified as an additional insured in the your written contract or agreement;or ) "underlying insurance"; b. Liability which: b. Is a Named Insured under such other - (1) May attach to the designated person or insurance;and . organization and is not assumed by your c. Has agreed with you in a written contract or written contract or agreement;or agreement that: (2) Is assumed by the designated person or (1) Is signed and effective prior to an organization under any other written "occurrence" to which this insurance contract assuming the obligations of applies; another. (2) This insurance would be primary and would not seek contribution from such other insurance identified in Paragraphs 1.a.and 1.b.above; (3) Agrees -to indemnify or defend the designated person or organization for • liability and damages covered by the "underlying insurance";and EU 70 91 05 15 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 A0148707 with its permission. 04/27/2020 Middlesex Insurance Company 1 00001 000000000020118 0 N 4051e411-42de-4b29-a2f6-5ded6242c814 • This page has been left blank intentionally. J • POLICY NUMBER: A0148707001 COMMERCIAL AUTO CA 76 01 0615 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED PRIMARY AND NONCONTRIBUTORY - COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM AUTO DEALERS COVERAGE FORM • With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s)or organization(s)who are"insureds"for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated. Named Insured: Endorsement Effective Date: • SCHEDULE � Name Of Person(s)Or Organization(s): 0 • Information required to complete this Schedule, if not shown above,will be shown in the Declarations. A. Each person or organization shown in the B. Primary And Noncontributory Insurance Schedule is an "insured" for Covered. Autos This insurance is primary to and will not seek Liability Coverage, but only to the extent that contribution from any other auto insurance issued person or organization qualifies as an "insured" to the person or organization in the schedule under the Who Is An Insured provision contained under your policy provided that: in: (1) Paragraph A.1. of Section. II - Covered Autos (1) The person or organization is a Named Insured Liability Coverage in the Business Auto and under such other insurance; and Motor Carrier Coverage Forms;or (2) Prior to the "accident" you have agreed in (2) Paragraph D.2. of Section I - Covered Autos writing in a contract or agreement that this � insurance would be primary and would not Coverages of the Auto Dealers Coverage Form. seek contribution from any other insurance available to the person or organization. • CA 76 01 0615 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 A0148707 with its permission. 03/14/2023 Middlesex Insurance Company 1 00001 0000000000 23073 0 N 88d0d581-bc9d-4fa6-9177-b4c54dde6509 • POLICY NUMBER: A0148707001 COMMERCIAL AUTO CA 04 44 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY • AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of.the policy unless another date is indicated below. • Named Insured: Rubenstein's Contract Carpet LLC Endorsement Effective Date: 03/15/2023 • SCHEDULE Name(s)Of Person(s)Or Organization(s): Any person or organization you are required to add as an additional insured under a written contract or written agreement in effect prior to any loss or damage. Information required to complete this Schedule, if not shown above,will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization: • • • CA 04 4410 13 ©Insurance Services Office, Inc., 2011 Page 1o 1 A0148707 03/14/2022 Middlesex Insurance Company . 1 00001 0000000000 22073 0 N d990c3d1-5159-4312-830d-28213592bd4f POLICY NUMBER: A0148707001 Sentry ADDITIONAL INTEREST SUPPLEMENTAL DECLARATIONS The following additional interests apply to this policy. Any person or organization you are required to add as an additional insured under a written contract orlwritten agreement in effect prior to any loss or damage PO Box 80544 Seattle, WA 98108-0544 CA 76 01 06 15 Designated Insured - Primary and Noncontributory - Covered Autos Liability Coverage . . l • CA 89 04 10 14 Page 1 of 1 A0148707 03/14/2023 Middlesex Insurance Company 1 00001 0000000000 23073 0 N 1db45c6a4820-4804-9fbc-7858fadb21d6 • This page has been left blank intentionally. • • A0148707004 COMMERCIAL GENERAL LIABILITY CG 71 18 06 20 • THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. • EACH CONSTRUCTION PROJECT GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE. Policy Maximum Each Construction Project General Aggregate Limit: Not Applicable . Designated Construction Project(s): All construction projects away from premises owned by or rented by insured Information required to complete this Schedule, if not shown above; will be shown in the Declarations. • A. For all sums which the insured becomes legally b. Claims made or"suits" brought; or • obligated topay as damages caused by c. Persons or organizations making claims or "occurrences" under Section I - Coverage A, bringing "suits". and for all medical expenses caused by accidents under Section I - Coverage C, which can be 4. Subject to Paragraph 2.above, any payments . attributed.only to ongoing operations at a single • made under Coverage A for damages or designated construction project shownin the under Coverage C for medical expenses shall Schedule above: . reduce the Each Construction Project • 1. Subject to Paragraph 2. below, a separate General Aggregate Limit for that designated construction project. Such payments shall not Each Construction Project General reduce the General Aggregate Limit shown Aggregate Limit applies to each designated construction project, and that limit is equal to in the Declarations nor shall they reduce any other Each Construction Project General the amount of the General Aggregate Limit., shown the Declarations. Aggregate Limit for any other designated •• construction project shown in the Schedule 2. If shown in the Schedule, the Policy above. Maximum Each Construction Project 5. •Subject to Paragraph 2. above, the limits General Aggregate Limit is the most we will. shown 'in the Declarations for Each pay for the sum of all damages paid under all Occurrence, Damage To Premises Rented Each Construction Project General To You and Medical Expense continue to Aggregate Limits included in this policy. apply. However, instead of .being subject to 3. Subject to Paragraph 2. above, the Each the General Aggregate Limit shown in the Construction Project General Aggregate Declarations, such limits will be subject to the • Limit is the most we will pay for the sum of all applicable Each Construction Project damages under Coverage A, except damages General Aggregate Limit. because of "bodily injury" or "property . damage" included in the"products-completed' operations hazard", and for medical expenses under Coverage C regardless of the number of: . a. Insureds; . CG 71 18 06 20 Includes copyrighted material of Insurance Services Office, Inc., • Page 1 of 2 A0148707 with its permission. 03/14/2023 Middlesex Insurance Company 1 00001 0000000000 23073 0 N b615be40-23ad-4e3f-86d-9c9222789cc3 B. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under Section I - Coverage A, and for all medical expenses caused by accidents under Section I - Coverage C, which cannot be attributed only to ongoing operations at a single designated construction project shown in the Schedule above: 1. Any payments made under Coverage A for. damages or under Coverage C for medical expenses shall reduce the amount available under the General Aggregate Limit or the Products-completed Operations Aggregate Limit,whichever is applicable; and 2. Such payments shall not reduce any Each • Construction Project General Aggregate • Limit provided under this policy. C. When coverage for liability arising out of the "products-completed . operations hazard" is provided, any payments for damages because of "bodily injury" or "property damage" included in the "products-completed operations hazard" will reduce the Products-completed Operations Aggregate Limit, and not reduce the General • Aggregate Limit nor any Each Construction Project General Aggregate Limit provided under • this policy. D. If the applicable designated construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same construction project. E. The provisions of Section III - Limits Of Insurance not otherwise modified by this endorsement shall continue to apply as stipulated. Page 2 of 2 • Includes copyrighted material of Insurance Services Office,.Inc., CG 71 18 06 20 A0148707 l with its permission. 03/14/2023 Middlesex Insurance Company • A0148707004 COMMERCIAL GENERAL LIABILITY • CG 71 24 06 22 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSUREDS, PRIMARY & NONCONTRIBUTORY, WAIVER OF SUBROGATION This endorsement modifies the coverage provided under the following Coverage Form(s): COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Coverage enhancements are listed below. For details of each coverage, please read the corresponding policy provisions in the body of this endorsement. 1. Additional Insureds-Automatic Status for 12 Additional Insured Types A. Automatic Status When Required In Written Contract Or Agreement(for Acts or Omissions In The Performance of Your Operations) B. Lessor of Leased Equipment C. Owners or Other Interests From Whom Land Has Been Leased D. Manager or Lessor of Premise E. Mortgagee,Assignee, or Receiver F. Controlling Interest G. Co-owner Of Insured Premises H. Executors, Administrators,Trustees Or Beneficiaries I. State Or Governmental.Agency Or Subdivision Or Political Subdivision- Permits Or Authorizations Relating To Premises J. Any Person Or Organization You Are Performing Work For K. Vendors L. Grantor of Franchise 2. Primary and Noncontributory-Other Insurance Condition 3. Waiver Of Transfer Of Rights Of Recovery Against Others To Us(Waiver Of Subrogation)- Automatic With respect to the coverage provided by this endorsement,the provisions of the Coverage Form apply unless modified by the endorsement. 1. Additional Insureds-Automatic Status for 12 A. Automatic Status When Required In Written Additional Insured Types - Contract Or Agreement (for Acts or Section II - Who Is An Insured is amended to Omissions In The Performance of Your include the following as additional insureds when. Operations) you have agreed to add that person or 1) A person or organization with respect to organization as an Additional Insured on your liability for: policy in a written contract or written agreement a. "Bodily injury" or "property damage" with that person or organization, or because of a not included in the "products- permit issued by a state or political subdivision; completed operations hazard"; or provided the injury or damage occurs,subsequent b. "Personal and advertising injury"; to the execution of the contract or agreement or issuance of the permit and while the contract, caused by, in whole or in part, your acts or. agreement or permit remains in effect. omissions or the acts or omissions of those acting on your behalf in the performance of your operations. CG 71 24 06 22 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 5 A0148707 with its permission. 03/14/2023 Middlesex Insurance Company 1 00003 0000000000 23073 0 N f57ab156-d968-405e-93dc-923c80fa5036 2) With respect to insurance afforded to . This exclusion applies even if the claims these additional insureds, the following against any insured allege negligence or additional exclusion applies: other wrongdoing in the supervision, This insurance does, not apply to "bodily hiring, employment, training or injury", "property damage". or "personal monitoring of others by that insured, if and advertising injury" due to rendering of the "occurrence" which caused the or failure to render any professional "bodily injury" or "property damage", or service. This includes but is not limited to: ' , , the offense which caused the"personal a. Legal, accounting or advertising and advertising injury", involved the services; rendering of or failure to render any b. Preparing, approving, or failing to professional service. prepare or approve, maps, shop B. Lessor of Leased Equipment drawings, opinions, reports, surveys, 1) Anyperson(s) or organization(s) with field orders, change orders or drawings respect to liability for "bodily injury", or specifications; "property damage" or "personal and c. Inspection, supervision, quality control, advertising injury" caused, in whole or in architectural or engineering activities part, by your maintenance, operation or done by or for you on a project on use of equipment leased to you by such which you serve as construction person(s) or organization(s). manager; 2) With respect to the insurance afforded to d. Engineering services, including related _ these additional insureds, this insurance supervisory or inspection services; does not apply to any "occurrence" which e. Medical, surgical, dental, X-ray or takes place after the equipment lease nursing services treatment, advice or expires. instruction; C. Owners or 'Other Interests From Whom f. Any health or therapeutic service Land Has Been Leased treatment, advice or instruction; 1) Any person(s) or organization(s) with g. Any service, treatment, advice or respect to liability for "bodily injury", instruction for the purpose of "property damage" or "personal and appearance or skin enhancement, hair advertising injury" caused, in whole or in removal or replacement, or personal part, by you or those acting on your behalf grooming or therapy; in connection' with the ownership, h. Any service, treatment, advice or maintenance or use of that part of the land ' instruction relating to physical fitness, leased to you by the additional insured including service,-treatment, advice or person(s) or organization(s). instruction in connection with diet, 2) With. respect to the insurance afforded to cardiovascular fitness, bodybuilding or these additional insureds, the following physical training programs; additional exclusions apply: i. Optometry or optical or hearing aid This insurance does not apply to: services including the prescribing, preparation, fitting, demonstration or a. Any "occurrence" which takes place distribution of ophthalmic lenses and after you cease to lease that land; similar products or hearing aid devices; b. Structural alterations, new construction j. Body piercing services; or,demolition operations performed by k. Services in the practice of pharmacy; or on behalfof the additional insured I. Law enforcement or firefighting person(s) or organization(s). services;and . m. Handling, embalming, disposal, burial, cremation or disinterment of dead bodies. . Page 2 of 5 Includes copyrighted material of Insurance Services Office, Inc., CG 71 24 06 22 A0148707 with its permission. 03/14/2023 Middlesex Insurance Company J , D. Manager or Lessor of Premise ' I. State Or, Governmental Agency . Or Any person(s) or organization(s) with respect Subdivision Or Political Subdivision - to liability for "bodily injury", "property Permits Or' Authorizations Relating To damage" or "personal and advertising injury" Premises caused, in whole or in part, by you or those Any state or governmental agency or acting on your behalf in connection with the subdivision or political subdivision, subject to ownership,maintenance or use of that part of the following additional provision: the premises leased to you by the additional This insurance applies only with respect to the insured person(s).or organization(s), subject to following hazards for which the state or the following additional exclusions: governmental agency or subdivision or This insurance does not apply to: political subdivision has issued a permit or 1) Any "occurrence" which takes place after authorization in connection with premises you you cease to be a tenant in that premises.. own, rent or control and to which this insurance applies: 2) Structural alterations, new construction or 1) The existence, maintenance, repair, demolition operations performed by or on behalf of the person(s) or organization(s) construction, erection or removal of shown in the Schedule. - advertising signs, awnings, canopies,cellar entrances, coal holes, driveways, E. Mortgagee,Assignee,or Receiver manholes, marquees, hoist away openings, Any person(s) or organization(s) with respect sidewalk. vaults, street banners or to their liability as mortgagee, assignee or decorations and similar exposures; or receiver and arising out of the. ownership, 2) The construction, erection or removal of maintenance or use of a premises by you. . elevators;or This insurance does not apply to structural 3) The ownership, maintenance or use of any, alterations, new construction and demolition elevators covered by this insurance. operations performed by or for such additional insured person(s) or organization(s). J. Any Person Or Organization You Are F. Controlling Interest Performing Work For Any person(s) or organization(s) with respect - 1) Any person(s) or organization(s) with • to liability for "bodily injury", "property respect to their liability arising out of: damage" or "personal and advertising injury" a. Their financial control of you; or . caused, in whole or in part, by your acts or b. Premises they own, maintain or control omissions or the acts or omissions of those while you lease or occupy these acting on your behalf: premises. 1) In the performance of your ongoing 2) This insurance does not apply to structural operations;or alterations, new construction and 2) In connection with your premises owned demolition operations performed by'or for by or rented to you. that person or organization. K. Vendors G. Co-owner Of Insured Premises 1) Any person(s)or organization(s) (referred to Any person(s) or organization(s) with respect throughout this endorsement as vendor), to their liability as'co-owner of a premises but only with respect to liability for."bodily coowned by you and covered under this • injury" or "property damage" arising out of insurance. "your products" ,which are distributed or H. Executors, Administrators, Trustees Or sold in the regular course of the vendor's Beneficiaries " business. • Any executor, administrator, trustee or However: beneficiary of your estate or living trust while a. The insurance afforded to such vendor acting within the scope of their duties as such. only applies to the extent permitted by law; and • CG 71 24 06 22 • Includes copyrighted material of.Insurance Services Office, Inc., Page 3 of 5 A0148707 with its permission. 03/14/2023 Middlesex Insurance Company 3 00003 0000000000 23073 0 N f57ab156-d968-405e-93dc-923c80fa5036 b. If coverage provided to the vendor is 8) "Bodily injury" or"property damage" required by a contract or agreement, arising out of the sole negligence of the insurance afforded to such vendor the vendor for its own acts or will not be broader than that which you omissions or those of its employees are required by the contract or or.anyone else acting on its behalf. agreement to provide for such vendor. However, this exclusion does not 2) With respect to the insurance afforded to apply to: • these vendors, the following additional • (1) The exceptions contained . in exclusions apply: Subparagraphs d.or f.;or a. The insurance afforded the vendor (2) Such inspections, adjustments, does not apply to: tests or servicing as the vendor 1) "Bodily injury" or"property damage" has agreed to make or normally for which the vendor is obligatedto undertakes to make in the usual pay damages by reason of the course of business, in assumption of liability in a contract connection with the distribution or agreement. This exclusion does or sale of the products. not apply to liability for damages b. This insurance does not apply to any that the vendor would have in the insured person or organization, from absence of the contract or . whom you have acquired such agreement; products, or any ingredient, part or 2) Any express warranty unauthorized container, entering into, accompanying by you; or containing such products. 3) Any physical or chemical change in L. Grantor of Franchise the product made intentionally by Any person(s) or organization(s) with respect the vendor; to their liability as grantor of a franchise to you. 4) Repackaging, except when However: unpacked solely for the purpose of 1. The insurance afforded to such additional inspection, demonstration, testing, insureds only applies to the extent permitted or the substitution of parts under by law; and instructions from the manufacturer, e and then repackaged in the original 2. If coverage provided to the additional insured . container; is required-by a contract or agreement, the 5) Any failure to make . such insurance afforded to such additional insured will not be broader than that which you are inspections, adjustments, tests or required by the contract or agreement to servicing as the vendor has agreed provide for such additional insured. to make or normally undertakes to make in the usual . course of With respect to the insurance afforded to these . . business, in connection with the additional insureds, the following is added to distribution or sale of the products; Section III-Limits Of Insurance: 6) Demonstration, installation, If coverage provided to the additional insured is servicing or repair operations, required by a contract or agreement,the most we except such operations performed will pay on behalf of the additional insured is the at the vendor's premises in • amount of insurance: connection with the sale of the 1. Required by the contract or agreement; or product; 2. Available under the applicable limits of 7) Products which, after distribution or insurance; sale by you, have been labeled or whichever is less, • relabeled or used as a container, part or ingredient of any other thing This endorsement shall not increase the • or substance by or for the vendor; applicable limits of insurance. or If there is any difference in coverage afforded to an additional insured in this endorsement and • Page 4 of 5 Includes copyrighted material of Insurance Services Office, Inc., CG 71 24 06 22 A0148707 with its permission. 03/14/2023 Middlesex Insurance Company that provided. under another additional insured any other insurance available to the additional endorsement attached to this policy, the broader insured. coverage will apply to that additional insured. 3. Waiver) Of Transfer Of Rights• Of Recovery 2. Primary And Noncontributory Insurance Against Others To Us(Waiver Of Subrogation)- The following is added to the Other Insurance Automatic Condition and supersedes. any provision to the The following is added to Paragraph 8. Transfer contrary: Of Rights Of Recovery Against Others To Us of This insurance is primary to and will not seek Section IV-Conditions: contribution from any other insurance available to We waive any right.of recovery against any an additional insured under your policy provided person or organization, because of any payment that: we make under this Coverage Part, to whom the (1) The additional insured is a Named Insured insured has waived its right of recovery in a under such other insurance; and • ' written contract or agreement. Such waiver by us applies only to the extent that the insured has (2)You have agreed in writing in a contract or waived its right of recovery against such person • agreement that this insurance would be or organization prior to loss. primary and would not seek contribution from • • • • • • CG 71 24.06 22 Includes copyrighted material of Insurance Services Office, Inc., Page 5 of 5 A0148707 with its permission. 03/14/2023 Middlesex Insurance Company 5 00003 0000000000 23073 0 N f57ab156-d968.405e-93dc-923c80fa5036 ' This page has been left blank intentionally. POLICY NUMBER: A0148707004 COMMERCIAL GENERAL LIABILITY CG 24 04 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS-OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) • This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS SCHEDULE Name Of Person(s)Or Organization(s): Any person or organization to whom you are required to waive your right to recover by a written contract or agreement executed prior to.loss Information required to complete this Schedule, if not shown above,will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV-Conditions: We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s)or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above. • CG 24 04 12 19 ©Insurance Services Office, Inc., 2018 Page 1 of 1 A0148707 03/14/2023 Middlesex Insurance Company • 1 00001 0000000000 23073 0 N f0f79f98-1499-45ed-a01f-602b9f00febd This page has been left blank intentionally.