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HomeMy WebLinkAboutInsurance Certificate: Liberty Lumberjack LLC (2) AccPRD® CERTIFICATE OF LIABILITY INSURANCE DATE(MM!DDWYYYY) 04/20/2022 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 rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Hart Insurance Agency PHONE Kylie M Thornley FAX PO Box 1240 (AIC.No.Extt: (541) 479-5521 (A/C,No):(541) 474-1890 E-MAIL Grants Pass OR 97528 ADDRESS: kthornley@hartinsurance.com INSURERS)AFFORDING COVERAGE NAIC# INSURER A:Employers Mutual Casualty Compan 21415 INSURED (530) 598-0916 INSURER B:SAIF Corporation 36196 Liberty Lumberjack LLC INSURER C: 379 Oxford Street INSURERD: Ashland OR 97520 INSURERE: • INSURER F: COVERAGES CERTIFICATE NUMBER:Cert ID 22408 REVISION NUMBER: • THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY EFF I POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 AGE TO RENTED CLAIMS-MADE X OCCUR Y 6X27763 01/01/2022 01/01/2023 PRREMSES(Ea occurrence) $ 500,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA MB OCCUR EACH OCCURRENCE $ _ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ — B NDWORKERSMEMPLOYERTIONS' YIN 100044138 04/23/2022 05/01/2023 PER ERH - -AND EMPLOYERS'LWBILITY ANYPROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT $, 1,000,000 OFFICER/MEMBEREXCLUDEDT N/A — (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 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 included as Additional Insured. See attached CG7578. • CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. 20 East Main Street AUTHORIZED REPRESENTATIVE Ashland OR 97520 . ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Page 1 of 1 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. GENERAL LIABILITY ELITE EXTENSION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM The COMMERCIAL GENERAL LIABILITY COVERAGE FORM is amended to include the following clarifications and extensions of coverage.The provisions of the Coverage Form apply unless modified by endorsement. A. EXPECTED OR INTENDED INJURY The aggregate limit listed above is the most we will Section I — Coverage A, Exclusion a. is amended Pay for all damages because of"property damage" as follows: to property in the care custody and control of or property loaned to an insured during the policy a. "Bodily injury" or `property damage" expected period. or intended from the standpoint of an insured. This exclusion does not apply to "bodily injury" Any payment we make for damages because of or "property damage" resulting from the use of "property damage" to property in the care, custody reasonable force to protect persons or property. and control of or property loaned to an insured will B. NON-OWNED WATERCRAFT apply against the General Aggregate Limit shown in the declarations. Section I — Coverage A, Exclusion g.(2) is b. Our obligation to,pay damages on your behalf amended as follows: applies only to the amount of damages in (2) A watercraft you do not own that is: excess of the deductible amount listed above. (a) Less than 60 feet long; and We may pay any part or all of the deductible amount listed above. We may pay any part or (b) Not being used to carry person(s) or all of the deductible amount to effect settlement property for a charge; of any claim or "suit" and upon notification by C. EXTENDED PROPERTY DAMAGE COVERAGE us, you will promptly reimburse us for that part Section I—Coverage A, Exclusions j.(3) and (4) is of the deductible we paid: amended to add the following: c. If two or more coverages apply under one Paragraphs (3) and (4) of this exclusion do not "occurrence", only the highest per claim apply to tools or equipment loaned to you, provided deductible applicable to these coverages will they are not being used to perform operations at apply. the time of loss. d. Insurance provided by this provision is excess over any other insurance, whether primary, SCHEDULE excess, contingent or any other basis. Since Limits Of Insurance Deductible insurance.. provided by this endorsement is excess, we will have no duty to defend any $5,000 Each Occurrence $250 Per Claim claim or "suit" to which insurance provided by $10,000 Annual Aggregate this endorsement applies if any other insurer has a duty to defend such a claim or "suit". If a. The each occurrence limit listed above is the no other insurer defends, we will undertake to most we will pay for all damages because of do so, but we will be entitled to the insured's "property damage" to property in the care, rights against all those other insurers. custody and control of or property loaned to an D. PROPERTY DAMAGE—ELEVATORS insured as the result of any one "occurrence", regardless of the number of: Section I—Coverage A.2. Exclusions paragraphs (1) insureds; j.(3), j.(4), j.(6) and k. do not apply to use of elevators. This insurance afforded by this provision (2) claims made or"suits"brought; is excess over any valid and collectible property (3) persons or organizations making claims or insurance (including any deductible) available to bringing"suits". the insured and Section IV—Commercial General Liability Conditions Paragraph 4. Other Insurance is changed accordingly. CG7578(2-19) Includes copyrighted material of ISO Properties,Inc.with its permission. Page 1 of 6 E. FIRE,LIGHTNING OR EXPLOSION DAMAGE a. Currently in effect or becomes effective Except where it is used in the term "hostile fire", the during the policy period; and word fire includes fire, lightning or explosion wherever b. Executed prior to an "occurrence" or it appears in the Coverage Form. offense to which this insurance would Under Section I — Coverage A, the last paragraph apply. (after the exclusions)is replaced with the following: However, the insurance afforded to such Exclusions c. through n. do not apply to damage by additional insured: fire, smoke or leakage from automatic fire protection a. Only applies to the extent permitted by law; systems to premises while rented to you or and temporarily occupied by you with permission of the b. Will not be broader than that which you are owner. A separate limit of insurance applies to this required by the contract or agreement to coverage as described in Section III — Limits of Insurance. provide for such additional insured;and F. MEDICAL PAYMENTS c. Applies only if the person or organization is not specifically named as an additional If Section I — Coverage C. Medical Payments insured under any other provision of, or Coverage is not otherwise excluded from this endorsement added to, Section II — Who Coverage Form: Is An Insured of this policy. The requirement, in the Insuring Agreement of 2. As provided herein, the insurance coverage Coverage C., that expenses must be incurred and provided to such additional insureds is limited reported to us within one year of the accident date is to: changed to three years. G. SUPPLEMENTARY PAYMENTS a. Any Controlling Interest, but only with respect to their liability arising out of their Supplementary Payments — Coverages A and B financial control of you; or premises they Paragraphs 1.b. and 1.d. are replaced by the own, maintain; or control while you lease or following: occupy these premises. 1.b.Up to $5,000 for cost of bail bonds required This insurance does not apply to structural because of accidents or traffic law violations alterations, new construction and arising out of the use of any,vehicle to which the demolition operations performed by or for Bodily Injury Liability Coverage applies. We do that person or organization. not have to furnish these bonds. b. Any architect, engineer, or surveyor 1.d.All reasonable expenses incurred by the insured engaged by you but only with respect to at our request to assist us in the investigation or liability for "bodily injury", "property defense of the claim or "suit", including actual damage" or "personal and advertising loss of earnings up to $500 a day because of injury" caused, in whole or in part, by your time off from work. acts or omissions or the acts or omissions H. SUBSIDIARIES AS INSUREDS of those acting on your behalf: Section II —Who Is An Insured is amended to add (1) In connection with your premises;or the following: . (2) In the performance of your ongoing 1.f. Any legally incorporated subsidiary in which you operations. own mpre.,than 50%opf the voting stock on the With,respect to the insurance afforded to effective date 'of this policy. However, insured these additional insureds,the following does not include any subsidiary that is an insured additional exclusion applies: under any other general liability policy, or would This insurance does not apply to "bodily have been an insured under such a policy but for injury", "property damage" or"personal and termination of that policy or the exhaustion of that advertising injury" arising out of the policy's limits of liability. rendering of or the failure to render any I. BLANKET ADDITIONAL INSUREDS — AS - professional services by or for you, REQUIRED BY CONTRACT including: • 1. Section II —Who Is An Insured is amended to (1) The preparing, approving, or failing to include as an additional insured any person(s) or prepare or approve, maps, shop organization(s)subject to provisions in Paragraph drawings, opinions, reports, surveys, 2. below; (hereinafter referred to as additional field orders, change orders or drawings insured) when you and such person(s) or and specifications;or organization(s) have agreed in a written contract (2) Supervisory, inspection, architectural or or written agreement that such person(s) or engineering activities. organization(s)be added as an additional insured on your policy provided that the written contract or agreement is: CG7578(2-19) Includes copyrighted material of ISO Properties,Inc.with its permission. Page 2 of 6 This exclusion applies even if the claims This insurance does not apply to: against any insured allege- negligence or (a) "Bodily injury", "property damage" or other wrongdoing in the supervision, hiring, "personal and advertising injury" employment, training or monitoring of arising out of operations performed others by that insured, if the "occurrence" for the federalovernment, state or which caused the "bodily injury" or g municipality;or cproperty damage", or the offense which aused the "personal and advertising (b) "Bodily injury" or "property damage" injury", involved the rendering of or the included within the "products- failure to render any professional services completed operations hazard". by or for you. e. Any vendor, but only with respect to "bodily c. Any manager or lessor of, a premises injury" or "property damage" arising out of leased to you, but only with respect to "your products" which are distributed or sold liability arising out of the ownership, in the regular course of the vendor's maintenance or use of that part of a business. premises leased to you, subject to the With respect to the insurance afforded to following additional exclusions: these vendors, the following additional This insurance does not apply to: exclusions apply: (1) Any "occurrence" which takes place (1) The insurance afforded any.vendor does after you cease to be a tenant in that not apply to: premises. (a) "Bodily injury" or "property damage" (2) Structural alterations, new construction - for which any vendor is obligated to or demolition operations performed by pay damages by reason of the or on behalf of such additional insured. assumption of liability in a contract or d. Any state or governmental agency or agreement. This exclusion does not apply to liability for damages that any subdivision or political subdivision, subject to vendor would have in the absence of the following: . . the contract or agreement; (1) This insurance applies only with respect • (b) Any express warranty unauthorized to the following hazards for which any by you; state or governmental agency or subdivision or political subdivision has (c) Any physical or chemical change in issued a permit or authorization in the product made intentionally by connection with premises you own, rent any vendor; or control and .to which this insurance (d) Repackaging, except when applies: unpacked solely for the purpose of (a) The existence, maintenance, repair, inspection, demonstration, testing, construction, erection or removal of or the substitution of parts under advertising signs, awnings, , instructions from the manufacturer, canopies, cellar entrances, coal and then repackaged in the original holes, driveways, manholes, container; marquees, hoist away openings, (e) Any failure to make such _.._. _ sidewalk vaults, street banners or - inspections, adjustments, tests or decorations and similar exposures; • servicing as any vendor has or , agreed to make or normally (b) The construction, erection or undertakes' to make in the usual removal of elevators;or course of business, in connection (c) The ownership, maintenance or use with the distribution or sale of the products; of any elevators covered by this insurance. . (f) Demonstration, installation, (2) This insurance applies only with respect servicing or repair operations, except such operations performed to operations performed by you or on - at any vendor's premises in your behalf for which any state or connection with the sale of the governmental agency or subdivision or product; . political subdivision has issued a permit or authorization. (g) Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for any vendor; or CG7578(2-19) Includes copyrighted material of ISO Properties,Inc.with its permission. Page 3 of 6 • (h) "Bodily injury" or "property A person's or organization's status as an damage" arising out of the sole additional insured under this endorsement negligence of any vendor for its ends when their contract or agreement with own acts or omissions or those of you for such leased equipment ends. its employees or anyone else With respect to the insurance afforded to acting on its behalf. However, this these additional insureds, thisinsurance exclusion does not apply to: does not apply to any "occurrence" which (i) The exceptions contained in takes place after the equipment lease Subparagraphs(d)or(f); or expires. (ii) Such inspections, adjustments, i. Any Owners, Lessees, or Contractors for tests or servicing as any whom you are performing operations, but vendor has agreed to make or only with respect to liability for "bodily normally undertakes to make in injury", "property damage"or"personal and the usual course of business, advertising injury" caused, in whole or in in connection with the part, by: distribution or sale of the '(1) Your acts or omissions; or products. (2) This insurance does not apply to any (2) The acts or omissions of those acting insured person or organization, from onyoor behalf; whom you have acquired such in the performance of your ongoing products, or any ingredient, part or operations for the additional insured. container, entering into, accompanying A person's or organization's status as an or containing such products. additional insured under this endorsement f. Any Mortgagee, Assignee Or Receiver, but ends when your operations for that only with respect to their liability as additional insured are completed. mortgagee, assignee, or receiver and With respect to the insurance afforded to arising out of the ownership, maintenance, these additional insureds,the following or use of the premises by you. additional exclusions apply: This insurance does not apply to structural This insurance does not apply to: alterations, new construction and demolition operations performed by or for (1) "Bodily_injury", "property damage" or that person or organization. "personal and advertising injury"arising g. Any Owners Or Other Interests From out of the rendering of, or the failure to Whom Land Has Been Leased, but only render, any professional. architectural, engineering or surveying services, with respect to liability arising out of the including: ownership, maintenance or use of that part of the land leased to you. (a) The preparing, approving, or failing to prepare or approve, maps, shop With respect to the insurance afforded to drawings, opinions, reports, surveys, these additional insureds, the following field orders, change orders or additional exclusions apply: drawings and specifications;or (1) This insurance does not apply to: . (b) Supervisory, inspection, architectural Any "occur`rence" which takes ''` or engineering'activities." place after you cease to lease that This exclusion applies even if the claims land,;or against any insured allege negligence or (b) Structural alterations, new other wrongdoing in the supervision, hiring, construction or demolition employment, training or monitoring of operations performed by or on ' others by that insured, if the "occurrence" behalf of such additional insured. which caused the "bodily injury" or h. Any person or organization from whom you "property damage", or the offense which lease equipment, but only with respect to caused the "personal and advertising liability for "bodily injury", "property injury", involved the rendering of or the damage" or "personal and advertising failure to render any professional injury" caused, in whole or in part by your architectural, engineering or surveying maintenance, operation or use ' of services. equipment leased to you by such person(s) (2) "Bodily injury" or' "property damage" or organization(s). occurring after: CG7578(2-19) Includes copyrighted material of ISO Properties,Inc.with its permission. Page 4 of 6 (a) All work, including materials, parts This endorsement shall not increase the or equipment furnished in applicable Limits of Insurance shown in the connection with such work, on the Declarations. project (other than service, J. COVERAGE FOR INJURY TO CO-EMPLOYEES maintenance -or repairs) to be AND/OR YOUR OTHER VOLUNTEER WORKERS performed by or on behalf of the additional insured(s) at the location Section II—Who is an Insured, Paragraph 2.a.(1)is of the covered operations has been amended to add the following: completed; or e. Paragraphs(a),(b),and (c)do not apply to your (b) That portion of "your work" out of "employees" or"volunteer workers" with respect which the injury or damage arises to "bodily injury" to a co-"employee" or other has been put to its intended use by "volunteer worker". any person or organization other Damages owed to an injured co-"employee" or than another contractor or "volunteer worker" will be reduced by any subcontractor engaged in amount paid or available to the injured co- performing operations for a "employee" or "volunteer worker". under any principal as a part of the same other valid and collectible insurance. project. K. HEALTH CARE SERVICE PROFESSIONALS AS j. Any Grantor of:Licenses to you, but only INSUREDS-INCIDENTAL MALPRACTICE with respect to their liability as grantor of Section II —Who is an Insured, Paragraph 2.a. (1) licenses to you. (d)is amended as follows: Their status as additional insured under This provision does not apply to Nurses, Emergency this endorsement ends when: Medical Technicians, or Paramedics who provide 1. The license granted to you by such professional health care services on your behalf. person(s)or organization(s)expires; or However this exception does not apply if you are in 2. Your license is terminated or revoked the business or occupation of providing any such by such person(s) or organization(s) professional services. prior to expiration of the license as L. NEWLY FORMED OR ACQUIRED stipulated by the contract or ORGANIZATIONS agreement. k. Any Grantor of Franchise, but only with Section II —Who Is An Insured, Paragraph 3.a. is respect to their liability as grantor of a replaced by the following: franchise to you. 3.a. Coverage under this provision is afforded until I. Any Co-owner of Insured Premises, but the end of the policy period. only with respect to their liability as co- This provision does not apply if newly formed or owner of any insured premises. acquired organizations coverage is excluded either by m. Any Concessionaires Trading Under Your the provisions of the Coverage Form or by endorsements. Name, but only with respect to their liability as a concessionaire trading under your M. DAMAGE TO PREMISES RENTED TO YOU name. Section III — Limits of Insurance, Paragraph 6. is 3. Any insurance provided to any additional replaced by the following: insured does not- apply to "bodily injury", Subject to 5.a. above,- the Damage To Premises "property damage"or"personal and advertising Rented To You Limit, or $500,000, whichever is injury" arising out of the sole negligence or higher, is the most we will pay under Coverage A for willful misconduct of the additional insured or its damages because of "property damage" to any one agents, "employees" or any other premises, while rented to you, or in the case of representative of the additional insured. damage by fire, smoke or leakage from automatic 4. With respect to the insurance afforded to these protection systems,while rented to you or temporarily additional insureds, the following is added to occupied by you with permission of the owner. Section III—Limits of Insurance: N. MEDICAL PAYMENTS—INCREASED LIMITS If coverage provided to any additional insured Section.III — Limits of Insurance, Paragraph 7. is is required by a contract or agreement, the replaced by the following: most we will pay on behalf of the additional 7. Subject to Paragraph 5. above, $10,000 is the insured is the amount of insurance: Medical Expense Limit we will pay under a. Required by the contract or agreement; or Coverage C for all medical expenses because of b. Available under the applicable Limits of "bodily injury" sustained by any one person, Insurance shown in the Declarations; unless the amount shown on the Declarations of whichever is less. this Coverage Part for Medical Expense Limit states: •CG7578(2-19) Includes copyrighted material of ISO Properties,Inc.with its permission. Page 5 of 6 • (a) No Coverage;or Q. UNINTENTIONAL FAILURE TO DISCLOSE (b) $1,000;or EXPOSURES (c) $5,000;or Section IV — Commercial General Liability Conditions Paragraph 6. Representations is (d) A limit higher than$10,000. amended to add the following: O. DUTIES IN THE EVENT OF OCCURRENCE, If you unintentionally fail to disclose any exposures OFFENSE,CLAIM OR SUIT ' existing at the inception date of your policy,we will not Section IV — Commercial General Liability deny coverage under the Coverage Form solely Conditions Paragraph 2. is amended to add the because of such failure to disclose. However, this following: provision does not affect our right to collect additional e. The requirement in Condition 2.a. that you must premium or exercise our right of cancellation or non- see to it that we are notified as soon as renewal. practicable of an "occurrence" or an offense This provision does not apply to any known injury which may result in a claim,applies only when the or damage which is excluded under any other "occurrence"or offense is known to: provision of this policy. (1) You, if you are an individual or a limited R. WAIVER OF TRANSFER OF RIGHTS OF liability company; RECOVERY AGAINST OTHERS TO US (2) A partner, if you are a partnership; Section IV — Commercial General Liability (3) A member or manager, if you are a limited Condition Paragraph 8. Transfer Of Rights Of liability company; Recovery Against Others To Us is amended to add the following: (4) An "executive officer" or insurance manager, We waive any right of recovery we may have if you are a corporation;or against any person or organization because of (5) A trustee, if you are a trust. payments we make for injury or damage arising out f. The requirement in Condition 2.b. that you must of: see to it that we receive notice of a claim or"suit" 1. Your ongoing operations; or as soon as practicable will not be considered breached unless the breach occurs after such 2. "Your work" included in the "products- claim or"suit"is known to: completed operations hazard". (1) You, if you are an individual or a limited However, this waiver applies only when you have liability company; agreed in writing to waive such rights of recovery in a contract or agreement, and only,if the contract or (2) A partner, if you are a partnership; agreement: (3) A member or manager, if you are a limited 1. Is in effect or becomes effective during the term liability company; of this policy; and (4) An "executive officer" or insurance manager, 2. Was executed prior to loss. if you are a corporation;or S. MENTAL ANGUISH (5) A trustee, if you are a trust. P. PRIMARY AND NONCONTRIBUTORY — Section V=Definition 3.is replaced by the following: ADDITIONAL INSURED EXTENSION "Bodily injury" means bodily injury, sickness or disease sustained by a person, including mental Section IV — Commercial General Liability anguish or death resulting from bodily injury, Conditions Paragraph 4. Other Insurance is sickness or disease. amended to add the following: T. LIBERALIZATION This insurance is primary to and will not seek contribution from any other insurance available to an If we revise this endorsement to provide greater additional insured under your policy provided that: coverage without additional premium charge, we will automatically provide the additional coverage to (1) The additional insured is a Named Insured under all endorsement holders as of the day the revision such other insurance;and is effective in your state. (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. However, if the additional insured .has been added as an additional insured on other policies, whether primary, excess, contingent or on any other basis, this insurance is excess over any other insurance regardless of the written agreement between you and an. additional insured. CG7578(2-19) Includes copyrighted material of ISO Properties,Inc.with its permission. Page 6 of 6