HomeMy WebLinkAboutInsurance Certificate: McKinstry Essention, LLC MCKICO.-Ol RBHASKAR,
CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYY
2/281202
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.TI
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POI IC
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZ__
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).
CONTACT
PRODUCER I
NAME:
Hub International Northwest LLC ! PHONE FAX -8489
PO Box 3018 _LAXyo,_Ext):(425)489-4500 (X)1�. No J�2�)485
_L __L
Bothell,WA 98041 E-MAIL :now.info@hubinternational.com
_INSURER SS�FFORDINGCOVERAGE__ _ NAIC#
-----INSURER A:The Travelers Indemnity Company_-----25658
INSURED INSURER B:The,Travelers Indemnity Company of America 25666
McKinstry Essention,LLC 1 INSURER C:SAIF Corpomflon—_ 36196
16790 NE Mason St.Suite 100 I INSURER D:Vantage Risk Specialty Insurance Company 16275
Portland,OR 97230 �INSURER EE
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.
INSR A-15DL�SUBRI POLICY NUMBER POLICY POLICY EXP
LTR TYPE OF INSURANCE INSD WVD I M/DDffYYY) (MM/DDrC*(YYI LIMITS
A X COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE $ 2,000,000
i CLAIMS-MADE OCCUR DAMAGE TO RENTED 300,000
1 — X] PRE IS S $
I X X VTC2K-CO-5643B901-IND-26 3/112026 3/1/2027 M E__(E�
X WA Stop Gap
N 4EDEXP(A $ 10,060-
ny one person)__;
PERSONAL&ADV INJURY 1$ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 4,000,000
PRO- 4-,-6-0-0,NO 6
POLICY JECT LOC PRODUCTS-COMP/OP A
NGG
$
OTHER: I
!WA Stop Gap 1,000,000
i
COMBINED SINGLE LIMIT $
B [AUTOMOBILE LIABILITY Ea accident 2,000,000
ANY AUTO VTC2H-CAP-5643B913-TIA-26 3/1/2026 3/1/2027 BODIL.'(INJuRKLPer ep son) $
OWNED SCHEDULED
AUTOS ONLY AUTOS BODILY INJURY r accident $
HIRED C NON-OWNED PROPERTY DAMAGE
,HAUTOS ONLY AUTOS ONLY Per accident
$
$
UMBRELLA LIAB OCCUR EACH OCCURRENCE
EXCESS LIAB MS-MADE�_1CIAI AGGREGATE
$
[A7DED :, RETENTION$ $
C WORKERS COMPENSATION OTH-
!AND EMPLOYERS'LIABILITY [STATUTE
ER
[STA
Y/N X 780794 10/1/2025 10/112026 $ 1,60700,
ANY PROPRIETOR/PARTNER/EXECUTIVE F—.-.-1 NIA L.EACH ACCIDENT '000
OFFICER/MEMBERLNJI 1,000006
(Mandatory in NH)EXCLUDED? E.L.DISEASE-EA EMPLOYEE $
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000
D Professional Liab :P03CP00000996 3/112026 3/1/2027 :PER CLAIM/AGG:10 2,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS i VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
RE:MCK Job#209211
City of Ashland is included as Additional Insured,coverage is primary and non-contributory and waiver of subrogation applies per the attached
forms/endorsements.
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 St
Ashland,OR 97520
AUTHORIZED REPRESENTATIVE
t!44V A2 jlijil�j kn"4K_
ACORD 25(2016/03) @ 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
Policy Number VTC2K-CO-5843B801-|ND-26 COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ XT CAREFULLY.
��U ������ �����U�Kn��� �U INSURED AUTOMATIC
STATUS
������o����� x ADDITIONAL x��u�x~��� mu�����n����� �� ���� x ��u�n�� n u��
U� ���d��U���� ��� ����U����� ����������� ���o����� ����x�����
un un.�~"�|��uu����� �� u WRITTEN n ��m� CONTRACT n�x�.�� m (CONTRACTORS)
x�x���* x ��u����
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
The following is added to SECTION U —VVHQ IS AN (a) The Additional Insured — Owners, Les-
INSURED: sees or Contractors — Scheduled Person
Any person or organization that: or Organization endorsement Cg 20 10
a. You agree in a written O4 orC(� 2O 10 O4 13en contract or agreement to ` the Additional
includeInsured — Owners,' Lessees or Contna*
Ped� and
tom — Completed Operations endorse-
ment mentCG2O37O7O4orCG2O37O412.
b. Has not been added as an additional insured for or both of such endorsements with either
the name project by attachment of an endorse- of those edition da1eenr
ment under this Coverage Part which includes '
(b) Either or both of the following: the Addi-
auohporsonororAonizotinnintheendosement's �
hona| |nsunod—Ovvnom LmsuoosorCon-
oohedu|e� '
' trodom — Sohedu|ed Person 0rDrgani-
iaan insured, but: zetion endorsement CG2O 10' or the Ad-
m. Only with respect to liability for "bodily injury' or diUona| Insured — Owners, Lessees or
.,property damage" that occurs. or for "personal Controutons — Comp|eted Operations en-
injury" caused by an offense that is committed, donsementCG 20 37, without on edition
subsequent to the signing of that contract or date cf such endorsement specified;
agreement and while that part of the contract or the person or organization is an additional in-
agreement is in affect; and sunad only if the injury or damage is caused,
b' Only as described in Paragraph (1). (2) or be- in whole or in parl. by acts or omissions of
|ovv' whichever applies: you or your subcontractor in the performance
(1) |f the written contract or agreement mpecifioa|- of"your work"to which the written contract ur
|y requires you to provide additional insured agreement applies; or
coverage to that person or organization by (3) |f neither Paragraph(1) nor(2) above applies:
the use of�
of: (a) The person o/ organization is an oddi-
(o) The Additional Insured — Ovvnom. Len- tiona| insured only if, and to the extent
noea or Contractors — (Form B) endorse- that, the injury or damage is caused by
mentCG2O1O1185; nr acts or omissions o/you or your aubcon'
(b) Either or both of the following: the Addi- tractor in the performance of "your vvorK'
bona| Insured—Owners, Lessees orCon- to which the written contract or agree-
tractors — Scheduled Person Or 0rgani- ment applies; and
zation endorsement CG2O 10 10 01. or (b) Such person or organization does not
the Additional Insured—Owmom. Lessees qualify as on additional insured with re'
or Contractors — Completed Operations opoct to the independent acts or omis'
endomamontCG2O3710O1; sionoof such person ororganization.
the person or organization is an additional in- The insurance provided to such additional insured is
oured only if the injury or damage arises out subject to the following provisions:
of"your work" to which the written ountneot or e. If the Limits of Insurance of this Coverage part
agreement applies; shown in the Declarations exceed the minimum
(2) |f the written contract or agreement mpenifica|- limits required by the written contract oregree'
|y requires you to provide additional insured meni. the insurance provided iothe additional in-
coverage to that person or organization by nured will be limited to such minimum required
the use of: limits. For the purposes of determining whether
CG DG 04U2 19 @zo17 The Travelers indemnity Company.All rights reserved. Page 1 of
COMMERCIAL GENERAL LIABILITY
Pei
this limitation apdins, the minimum limits required result in a claim. To the extent poouib|a, such
by the vvhMon contract or agreement will be con- notice should include:
skjared to include the minimum limits of any Um-
(a) How, when and where the "occurrence"
UnmUaor Excess liability coverage required for the or offense took place;
additional insured by that written contract or
(h) The names and addresses of any injured
agreement. This provision will not increase the
persons and witnesses; and
limits of insurance described in Section III—Limits
Of Insurance. (c) The nature and location of any injury or
b. The insurance provided tosuch additional insured damage arising out of the "oocunonoe" or
does not apply to: offense.
(2) If claim is made or "suit" is brought against
,
(1) Any "bodily injury', "property damage" or
the �ddhiona| ineurud�
"personal injury' arising out of the pnuviding,
or failure to pvovide, any professional erchi- (a) Immediately record the specifics of the
tociunei engineering or surveying s*nvioen, claim or"sud" and the date received; and
including: (b) Notify us as soon as practicable and see
(m) The preparing, appnnving, or failing to to it that we receive written notice of the
prepare or epprov*, maps, shop draw- claim or"suit" us soon aapracticable.
inga, opinions, reporto, aurveyn, field op (3) Immediately send us copies of all legal po-
dora or change ondem, or the preparing, pers received in connection with the claim or
approving, or failing to prepare o/ ap- "ouit". cooperate with us in the investigation
prnve, drawings and specifications; and or settlement of the claim or defense against
(b) Suparvisory, innpection, architectural or the"suit", and otherwise comply with all policy
engineering activities. conditions.
(2) Any "bodily injury' or "property damage" (4) Tender the defense and indemnity of any
caused by "your vvorK' and included in the claim or "suit" to any provider of other inour-
"pnoducto-oomp|e{ed operations hazard" un- anoe which would cover such additional in-
less the written contract or agreement speoifi- sured fora loss we cover. However, this oon-
oa||y requires you to provide such coverage dition does not affect whether the insurance
for that additional insured during the policy provided tosuch additional insured is primary
period. to other insurance available to such additional
o. The additional insured must comply with the fo|- insured which covers that person orurganiza-
|owingduties: Uon as a named insured as described in Pe�
aqnoph 4 �Vh�r |nsunanco of8eotion |V
(1) '�iwa uowri�en nc�ioo ooaoon om pmdicab|e '' ' —
of an "occurrence" or an offense which may Commercial General Liability Conditions.
Page 2of2 @zu1,The Travelers Indemnity Company.All rights reserved, CQD6D4O219
POLICY NUMBER:VTC2KCO5643B901 IND26 COMMERCIAL GENERAL LIABILITY
s.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
OTHER INSURANCE - DESIGNATED ADDITIONAL
INSUREDS - PRIMARY WITH RESPECT TO CERTAIN
OTHER INSURANCE
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE OF DESIGNATED ADDITIONAL INSUREDS
Any person or organization that qualifies as an additional insured
under such other
endorsement to this Coverage Part, if you agree in a written contract
to include such
person or organization as an additional insured on this Coverage Part
and such
written contract:
a. Specifically requires that this insurance apply on a primary basis
or a primary and
non-contributory basis; and
b. Was signed and executed by you before, and is in effect when, the
"bodily injury"
or "property damage" occurs or the "personal injury" or "advertising
injury" offense
is committed
PROVISIONS Designated Additional Insureds is primary to any of
The following is added to Paragraph 4.a., Primary the other insurance, whether primary, excess,
Insurance, of SECTION IV — COMMERCIAL contingent or on any other basis, that is available to
GENERAL LIABILITY CONDITIONS: such additional insured which covers such additional
insured as a named insured, and we will not share
The insurance afforded under this Coverage Part to with that other insurance.
any additional insured shown in the Schedule Of
CG D4 26 02 19 @ 2017 The Travelers Indemnity Company.All rights reserved. Page 1 of 1
Includes copyrighted material of Insurance Services Office,Inc,with its permission.
POLICY
' COMMERCIAL GENERAL LIABILITY mr.'
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
������ ����������K���� �o�� �������� ����^���
�� n ��u��* ENDORSEMENT FOR CONTRACTORS
o��—v�� . ��o`�~�
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
GENERAL DESCRIPTION OF COVERAGE—Thisendursementbroadenscovemge. Howover. covarageforany
irjury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or
limited by another endorsement to this Coverage Part, and these coverage broadening provisions do not apply to
the extent that coverage is excluded or limited by such an endorsement. The following listing is a general
coverage description only. Read all the provisions of this endorsement and the rest of your policy carefully to
determine rights, duties, and what is and is not covered.
A. Who |sAn Insured—Unnamed Subsidiaries C. Incidental Medical Malpractice
B. Blanket Additional Insured — Governmental D. Blanket Waiver OfSubrogation
Entities — permits Or Authorizations Relating To E. Contractual Liability—Railroads
Operations
F. Damage To Premises Rented To You
PROVISIONS a. An organization other than a partnership,joint
'
ventur�ur|imi�ed liability company; or
A. WHO |� AN |NSU8�D — UNNAMED
SUBSIDIARIES 6. Atmst;
The following is added to SECTION || —VVHO IS as indicated in its name or the documents that
AN |NSURED: govern its structure.
Any of your subsidiaries, other than a partnership, B. BLANKET ADDITIONAL INSURED —
joint venture or limited liability company' that is GOVERNMENTAL ENTITIES — PERMITS OR
not shown as a Named Insured in the
AUTHORIZATIONS RELATING TO OPERATIONS
Declarations is a Named Insured if:
The following �s added to SECTION || — VVH(] |�
a. You are the sole owner of, or maintain an
ownership interest of more than 5096 in, such AN INSURED:
subsidiary on the first day of the policy period; Any governmental entity that has issued opermit
and or authorization with respect to operations
b. Such subsidiary is not an insured under performed by you or on your behalf and that you
similar other insunance
are required by any ondinance |aw, building code
' ' 'or written contract or agreement to include as an
No such subsidiary isan insured for"bodily injury" additional insured on this Coverage Part is an
or "property damage" that occurred, or "personal insured, but only with respect to|iabi|iiy for"bodily
and advertising injury" caused by an offense injury", "property damage" or "personal and
committed: advertising injury"arising out of such operations.
a. Before you maintained an ownership interest The insurance provided to such governmental
of more than 5OY6 in such subsidiary; or entity does not apply to:
b. After the date' if any, during the policy period a. Any "bodily injury", "property damage" or
that you no longer maintain an ownership "personal and advertising injury" arising out of
interest of more than 50Y6 in such subsidiary. operations performed for the governmental
For purposes of Paragraph 1. of Section If —Who entity;�y� or
Is An Insured, each such subsidiary will be b^ Any "bodily injury' or "property damage"
deemed tobe designated in the Declarations as: included in the "products-completed
operations hazard".
[GD316OJ19 2o1r The Travelers indemnity Company.All rights reserved. Page 1of]
Includes copyrighted material of Insurance Services Office, Inc.,with its permission,
COMMERCIAL GENERAL LIABILITY
C. INCIDENTAL MEDICAL MALPRACTICE pharmaceuticals committed by, or with the
1^ The following replaces Paragraph b. of the knowledge or consent of,the insured.
definition of "occurrence" in the S. The following is added tothe DEFINITIONS
DEFINITIONS Section: Section:
6. An act or omission committed in providing "Incidental medical services" means:
or failing to provide "incidental medical
services", �c� �d or "Good Samaritan a �Wed�sd. surgical, dertailaboratory, x-ray
services" 0o a person, unless you are in or nursing service or treatment, advice or
the business o/ occupation of providing instruction, or the related furnishing of
professional health care services. food o/beverages; or
2. The following replaces the last paragraph of b. The furnishing or dispensing of drugs or
Paragraph 2,a.(1) of SECTION U — WHO IS medical, dental, or surgical supplies or
A0 |NSURED: appliances.
Unless you are in the business or occupation 6. The following is added to Paragraph 4,6.,
of providing professional health care services, Excess Insurance, of SECTION K/ —
Paragraphs (1)(a). (b). (c) and (d) above do [OK8K8ER[|AL GENERAL LIABILITY
not apply to "bodily injury" arising out of CONDITIONS:
providing or failing toprovide: This insurance is excess over any valid and
(a) "Incidental medical services" by any of collectible other insurance, whether primary,
your "employees" who is a nume, nurse excess, contingent or on any other basis, that
assistant emergency medical technician is available to any of your "employees" for
or paramedic; or "bodily injury" that arises out of providing or
(6) First aid or "Good Samaritan services" by failing to provide "incidental medical services"
any of your "employees" or "volunteer to any person to the extent not subject to
workers", other than on employed or Paragraph 2.a.(1) of Section || — VVho Is An
volunteer doctor. Any such "employees" Insured.
or "volunteer workers" providing or failing D. BLANKET WAIVER OF SUBROGATION
to provide first aid or "Good Samaritan
services" during their work hours for you The following is added to Paragraph 8.. Transfer
will be deemed to be acting within the Of Rights Of Recovery Against Others To Us'
scope of their employment by you or of SECTION !V — C0Y0YNER[|AL GENERAL
performing dudes related to the conduct LIABILITY CONDITIONS:
of your business. If the insured has agreed in a contract or
3. The following replaces the last sentence of agreement to waive that insu/ed's right of
Paragraph S. of SECTION ||| — LIMITS OF recovery against any person o/ organization, we
INSURANCE: waive our right of recovery against such person or
For the purposes of determining the organizadon, but only for payments we make
applicable Each Occurrence Limit, all related because of:
acts or omissions committed in providing or a, "Bodily injury" or "property damage" that
failing to provide "incidental medical occurs; or
servces", first aid or ''Good Samaritan
services"to any one person will be deemed tn b. "Personal and advertising injury" caused by
be one "occu/rence" an offense that is committed;
4. The following exclusion is added to subsequent to the execution of the contract or
Paragraph 2.. Exclusions, of SECTION | — agreement.
COVERAGES — COVERAGE A — BODILY
E. CONTRACTUAL LIABILITY—RA|LRD/\DS
INJURY AND PROPERTY DAMAGE '
LIABILITY: 1. The following replaces Paragraph c of the
Sale Of Pharmaceuticals definition of "insured contract" in the
"Bodily injury" or "property damage" arising DEFINITIONS Section:
out of the violation of a penal statute or c. Any easement or license agreement;
ordinance relating to the sale of
Page of @zn1/The Travelers Indemnity Company.All rights reserved. CG D3 16 02 19
COMMERCIAL GENERAL LIABILITY
2. Paragraph t(1) of the definition of "insured a Any premises while rented to you or
contract' in the DEFINITIONS Section is temporarily occupied by you with permission
deleted. of the owner; cx
F. DAMAGE TO PREMISES RENTED TOYOU b' The contents of any premises while such
The following replaces the definition of "premises premises is rented to you, if you rent such
damage�' in the DEFINITIONS Section: premises for o period of seven or fewer
"Premises damage" means "property damage"to: consecutive days.
CGD21GO219 (Dzol7 The Travelers indemnity Company.All rights reserved. Page 3of]
Includes copyrighted material of Insurance Services Office,Inc.,with its permission.
POLICY NUMBER:VTC2KC05643B901 IN D26
COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
TOTAL AGGREGATE LIMIT OTHER THAN PROJECTS
AND DESIGNATED PROJECT AND LOCATION
AGGREGATE LIMITS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE—LIMITS OF INSURANCE AND DESIGNATED PROJECTS AND LOCATIONS
LIMITS OF INSURANCE
Total Aggregate Limit $ 25,000,000
(Other Than Projects and Products-Completed Operations)
Designated Location Aggregate Limit $ 4,000,000
(Other Than Products-Completed Operations)
Designated Project Aggregate Limit $ 4,000,000
(Other Than Products-Completed Operations)
General Aggregate Limit $ 4,000,000
(Other Than Products-Completed Operations)
Designated Projects:
Each "project" away from premises owned by or rented to you
Designated Locations: Each premises owned by or rented to you
Designated Locations:
Each premises owned by or rented to you
PROVISIONS
1. The General Aggregate Limit (Other Than 1. The Limits of Insurance shown in the
Products-Completed Operations) shown in the Declarations or the Schedule — Limits Of
Declarations is replaced by the Limits of Insurance And Designated Projects And
Insurance shown in the Schedule — Limits Of Locations, whichever apply, and the rules
Insurance And Designated Projects And below fix the most we will pay regardless of
Locations. the number of:
2. The following replaces Paragraph 1. of SECTION a. Insureds;
III—LIMITS OF INSURANCE:
b. Claims made or"suits" brought;
CG D4 69 02 19 OO 2017 The Travelers Indemnity Company.All rights reserved. Page 1 of 3
Includes copyrighted material of Insurance Services Office,Inc.with its permission.
COMMERCIAL GENERAL LIABILITY
c. Persons or organizations making claims under Coverage B. |nstead, the
or bringing "suits";or General Aggregate Limit described in
Paragraph �d
d, "Projects" or"locations". ' ` below applies tosuch
damages.
3. The �|��ng �p�o� Pa��aph2. �SECTION
III—LIMITS OFINSURANCE: (5) Any payments made for damages or
medical expenses to which the
2. a, The Total Aggregate Limit shown in the Designated Project Aggregate Limit
Schedule — Limits C� Insurance And
applies will reduce the Designated
Designated Projects And Locations isthe
Project Aggregate Limit for the
most we will pay for the sum of all applicable "pnojeci" Such payments
amounts under the Designated Location will not reduce the Total Aggregate
Aggregate Limit and all amounts under Umk. the General Aggregate Limit
the General Aggregate Lim it. This described in Paragraph 2.d. below,
includes: the Designated Project Aggregate
(1) Damages under Coverage A. except Limit for any other "project" or the
damages because of"bodily injury" or Designated Location Aggregate Limit.
"property damage" included in
c. Subject to the Total Aggregate Limit
the "products-completed operations described in Paragraph 2.a. above' the
hazard"; Designated Location Aggregate Limit
(2) Damages under Coverage B; and shown in the Schedule — Limits Of
(3) Medical expenses under Coverage C. Insurance And Designated projects And
Locations applies and isfu�hersu�ecLto
b. The Designated Project Aggregate Limit
all �of provisions:
shown in the Schedule — Limits C�
Insurance And Designated Projects And (1) The Designated Location Aggregate
Locations applies and is further subject to Limit is the most we will pay for the
all of the following provisions: sum of:
(1) The Designated Project Aggregate (a) Damages under Coverage A
Limb is the most we will pay for the because of "bodily injury" and
sum of: "property damage' caused by
(a) Damages under Coverage /k "occurrences"; and
because of ''bndik/ injury" and (b) Medical expenses under
'.property damage" caused by Coverage C for "bodily injury'
"occunences'' and
' caused byaccidents;
(b) Medical expenses under that can be attributed only to
Coverage [ for "bodily injury'
operations atasingle "location".
caused by accidents;
that can be attributed only to (2) The Designated Location Aggregate
Limit applies separately to each
operationsa�asing|e"pn�ec1"
"location".
(2) The Designated Project Aggregate
Limit applies separately to each
(3) The Designated Location Aggregate
"project". Limitdoes not apply to damages
because of"bodily injury" or"property
(3) The Designated Project Aggregate Limit does not apply to damages damage" included in the "products-
because of"bodily injury' or"property operations hazard".
damage" included in the "products- Instead, the Products-Completed
completed operations hazard" Operations Aggregate Limit
h �' below
P i described n Paragraph Instead, the Products-Completed
Operations Aggregate Limit applies to such damages.
described in Paragraph 3, below (4) The Designated Location Aggregate
applies to such damages. Limit does not apply to damages
(4) The Designated Project Aggregate ssunder Coverage B. Instead, the
Limit does not apply to damages General Aggregate Limit described in
Page 2of3 Cm/r The Travelers Indemnity Company.All rights reserved. [GQ469O219
Includes copyrighted material of Insurance Services omcc,Inc.with its permission.
COMMERCIAL GENERAL LIABILITY
Paragnaph2,d. below applies tusuch General Aggregate Limit applies will
damages. reduce:
(5) Any payments made for damages or (a) The Total Aggregate Limit;and
medical expenses to which the
Designated Location Aggregate Limit (6) The General Aggregate Limit.
applies will reduce: Such payments will not reduce the
(a) The Total Aggregate Limit; and Designated Project Aggregate Limit
(b) The Designated Location for any "project" or the Designated
Aggregate Limitfortheapplicable Location Aggregate Limit for any
"location".
.
Such payments will not reduce the 4` The following replaces paragraph I of SECTION
General Aggregate Limit described in U|—L|yN\TS OF INSURANCE:
Paragraph Z.d. below, the 3. The Products-Completed Operations Aggre'
Designated Project Aggregate Limit gate Limit shown in the Declarations is the
or the Designated Location most we will pay under Coverage A for
Aggregate Limit for any other damages because of "bodily injury" or
"location". "property damoge" included in the "pnnducts
d. Subject to the Total Aggregate Limit completed operations hazand^ Any payments
described in Paragraph 2.a. above, the made for such damages will not reduce the
General Aggregate Limit shown in the Total Aggregate Limit,the General Aggregate
Schedule — Limits Of Insurance And Limit, the Designated Project Aggregate Limit
Designated Projects And Locations for any "project" or the Designated Location
applies and is further subject to all of the Aggregate Limit for any"|ocotion"
following provisions: S. The following is added to the DEFINITIONS
�
(1) The General Aggregate Limit is i� the
most wewill pay for the sum of: "Location" means any designated location shown
(a) Damages under Coverage Ain the Schedule — Limits Of Insurance And
because of "bodily injury" and Designated Projects and Locations that isowned
"property damage" caused by �
by or rented to you For the purposes of
"occurrences", and medical determining the applicable aggregate limitof
expenses under [overage C for
insurance' each "location" that includes a
"bodily injury" caused by
premises involving the same nrconnecting lots,
accidents' that cannot be or premises whose connection is interrupted only
byastneet roadway orbya right-of-
single attributed on� �onperationsa� a ' '
"project" or a single way of a /ai|»oad, will be considered a single
"location"; and "location".
(b) Damages under Coverage B. "Project" a means any project shown in
the Schedule — Limits Of Insurance And
(2) The General Aggregate Limit does Designated Projects And Locations that is away
not apply to damages for "bodily from premises owned byo/ rented to you and at
injury" or "property damage" included which you are performing operations pursuant to
in the "pooducts-cnmp|eted opep a contract or agreement. For the purposes of
abnns hazard" |nstead, the determining the applicable aggregate limit of
Products-Completed Operations insurance, each "pnojeci''that includes apremises
Aggregate Limit described in involving the same or connecting lots, or
Paragraph 3. below applies to such premises whose connection is interrupted only by
damages. astee1. roadway or waterway, or by right-of-
(3) Any payments made for damages or way of a rai|road, will be considered a single
medical expenses to which the "project".
CGQ4690Z19 m2m/The Travelers Indemnity Company.All rights reserved. Page ] of3
Includes copyrighted material m Insurance Services Office,Inc.with its permission.
POL|CYNUMBER:V7C2H-CAP-5643BQ13-TK\-28 COMMERCIAL AUTO
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
����U���� ���n� ��������n�� �����n����U�����
������un�����w� AUTO�* EXTENSION ENDORSEMENT
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
GENERAL DESCRIPTION OF COVERAGE—Thie endorsement broadens coverage. Howevor, coverage for any
injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or
limited by another endorsement tothe Coverage Part, and these coverage broadening provisions do not apply to
the extent that coverage is excluded or limited by such an endorsement. The following listing is o general cover-
age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en-
dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered.
A. BROAD FORM NAMED INSURED H. HIRED AUTOPHYS|CALOAMAGE — LOSGOF
B. BLANKET ADDITIONAL INSURED USE—INCREASED LIMIT
|. PHYSICAL �/�K8AC@� — T��08POF���OON
C. �K8PL<]`/�� H|R�DAUT{�' EXPENSES—INCREASED L|K8|T
D. �K8�L������ AS |N�U��D' J. PERSONAL PROPERTY
E. SUPPLEMENTARY PAYMENTS — INCREASED K. AIRBAGS
LIMITS
L. NOTICE AND KNOWLEDGE OF ACCIDENT OR
F. HIRED AUTO — LIMITED WORLDWIDE CC3V- LOSS
ER&GE |�O�K8N|TKB&S1S
— M. BLANKET WAIVER OF SUBROGATION
G. WAIVER 0F DEDUCTIBLE—GLASS N. UNINTENTIONAL ERRORS C}ROMISSIONS
PROVISIONS
A. BROAD FORM NAMED INSURED this insurance oppUoo and only to the extent that
The following is added to panmgraphA.1.. Who Is person or organization qualifies as on "insured"
An Insured, of SECTION || —CC}VEDED AUTOS under the Who Is An Insured provision contained
inSeotion0
LIABILITY COVERAGE: .
Any organization you newly acquire or form dur- C' EMPLOYEE HIRED AUTO
ing the policy period over which you maintain 1. The following is added to Paragraph Aj..
50% or more ownership interest and that in not Who Is An Insured, of SECTION || — COV-
�R�0AU�O� �|�\�|U�YC�����������
aopenate|y insured for 8uninoaa Auto Coverage.
Coverage under this provision in afforded only un- An "employee" of yours is an "insured" while
ti| the 180(h day after you acquire ur form the or- operating an "auto" hired or rented under
ganizahonor the end of the policy period, which- contract or agreement in an "employee's"
ever inearlier. name, with your permission, while performing
duties related to the conduct of your buoi-
B. BLANKET ADDITIONAL INSURED n*na.
The following is added to Paragraph o. in /4.1.' 2. The following replaces Paragraph b. in B.5..
Who Is An Insured, of SECTION || —C<]VERED Other Insurance, of SECTION |V — BUS|'
AUTO8 LIABILITY COVERAGE: NEGS AUTO CONDITIONS:
Any person nr organization who ia required under b. For Hired Auto Physical Damage Covmr-
a written contract nragreement between you and aQe, the following are deemed to be nov'
that person or organization, that is signed and mned ''aubxo"you own:
executed by you before the "bodily injury" or (1) Any covered ''aub»^ you |emou. hire,
"proporty damage" occurs and that is in offeo1 rent or borrow; and
during the policy period, 1nbe named ananaddi- (2) Any covered "auto" hired or rented by
Uuno| insured is an "insured" for Covered Autos your "employee" under contract in
Liability CoveraOo, but only for damages to which an "employee's" name, with your
CAT353O215 @zo1n The Travelers Indemnity Company.All rights reserved. Page 1of4
Includes copyrighted material m Insurance Services Office,Inc.with its permission.
COMMERCIAL AUTO
penniooion, while performing duties (a) With respect to any claim made or "auit"
related to the conduct of your buei brought outside the United States of
noma. America, the territories and possessions
However, any "auto" that ia |e000d, hined, of the United Siutoe of America, Puerto
�d dCanue
rented or borrowed with a driver is not Rico and �
covered "auto". (i) You must arrange to defend the "in-
D. EMPLOYEES AS INSURED sured"againmL and investigate ormed-
t|a any such claim or "suit" and keep
The following ia added io Paragraph &.1.. Who |a uoadviaedof�|| prooeadingoandAn Insured, of8���|�lN |[ COVERED AUTOS— ac-
tions.
LIABILITY COVERAGE:
(ii) Neither you nor any other involved
"employee"omp|oyee^ ofyoumioan ''inouned" vvhi|eua' "insured" will make any settlement
inQa covered "auto"you don't own, hire orborrow without our consent.
in your business or your personal affairs.
(iii) VVe may.
od our discretion, participate
E. SUPPLEMENTARY PAYMENTS — INCREASED in defending the "insured"
against, or
LIMITS
in the settlement of, any claim or
1. The following replaces Paragraph 4.2.a.(2). ''suit"
of SECTION U —COVERED AUTOS L|AB|L-
(iv)VVe will reimburse the "insured" for
|TY C(]VE�����
� sums that the "insured" legally must
(2) Up to $3.000for cost ofbail bonds (in- pay as damages because of "bodily
u|uding bonds for related traffic law viola- injury" or"property damage" to which
tiono) required because of an "accident" this insurance mpp|iea, that the "in'
we cover. We do not have to furnish aurod" pays with our uonomni, but
these bonds. only uptothe limit described in Para-
2- The following replaces Paragraph A.2.e.(4). graph C.. Limits Of |nnurance, of
of SECTION O SECTION U—C�����D AUTOS L|A�|�- — COVERED AUTOS
L|AB|L|TYCOVERAE�E
|T� �OV�B4��� .
All reasonable expenses incurred by the k) We will reimburse the "insured" for
' ' "insured" at our requeat, including actual the reasonable expenses incurred
|000 of earnings up to $500 a day be- with our consent for your inveohga-
mauoe of time off from work. tion of such claims and your defense
of the "insured" against any such
F. HIRED /\UTC> LIMITED VV�}RLQVV|D� C��- .
' — suit", but only up to and included
ERAGE—INDEMNITY BASIS
within the limit described in Para-
The following n*p|aneo Subparagraph (5) in Para- graph C, Limits Of |nuurenoo, of
graph B.7.. Policy Period, Coverage Territory, SECTION || — COVERED AUTOS
of SECTION |V — BUSINESS AUTO C0NO|- LIABILITY C0VERAGE, and not in
T|ONS: addition ;o such limit. Our duty to
(5) Anywhere in the world, except any country or make such payments ends when we
have used up the applicable limit of
jurisdiction while any trade aonotion, em-
bargo. or similar regulation imposed by the insurance in payments for damages,
United Stohoa of America applies to and pro- settlements or defense expenses.
hibite the transaction of business with or (b) This insurance is ex000e over any valid
within such country or jurisdiction, for Cov- and collectible other insurance available
ered Autos Liability Coverage for any covered to the "insured" whether primary. excess,
"auto" that you |oaua, hin», rent or borrow contingent oron any other basis.
without a driver for a period of3O days urless
(u) This insurance is not e substitute for re-
and that is not an "auto" you |eeae, hipe, rent quired or compulsory insurance in any
or borrow from any of your ^emp|oy*en'', country outside the United Stotoe, its ter-
partners (if you are a partnemhip), members ritorioo and possessions, Puerto Rico and
(if you are a limited liability company) or Canada.
members of their households.
Page 2of4 @un10 The Travelers Indemnity Company.All rights reserved. CAT353 0215
Includes copyrighted material of Insurance Services Office,Inc.with its permission.
COMMERCIAL AUTO
You agree to maintain all required or (2) |noron your covered "auho"
compulsory insurance in any such ooun' This coverage applies only in the event ofa total
try up to the minimum limits required by theft of your covered "auto".
|onn| law. Your failure to comply with
compulsory insurance requirements will No deductibles apply to this Personal Property
ooverage
not invalidate the coverage afforded by �
this pn|ioy, but we will only be liable to the N. AIRBAGS
same extent we would have been liable The following is added to Paragraph 8.3.. Exc|u-
hod you complied with the compulsory in- sions. of SECTION ||| — PHYSICAL DAMAGE
euranoe requirements. COVERAGE:
(d) It in understood that we are not an admit- Exclusion 3.a. does not apply to "|nau" to one or
bed or authorized insurer outside the more airbags 1na covered "eutn" you own that in-
United States of Amerioa, its territories f|ate due to a cause other than a cause of "loss"
and ponauoaiono. Puerto Rico and Con' set forth in Paragraphs /\.1.b. and A.1.u., but
ada. We assume no responsibility for the only:
furnishing of certificates of insunanoe, o/ o. If that "auto" is a covered "auto" for Compru-
for compliance in any way with the |avvo henaive Coverage under this policy;
uf other countries relating to insurance. b. The airbags are not covered under any war-
G. WAIVER OF DEDUCT|BLE—GLASG nanty; and
The following is added to Paragraph D.. Deducti- m. The airbags were not intentionally inflated.
b|e' of SECTION ||| — PH�S|CA� �/ K4��
We will pay up to a maximum nf $1.00O for any
COVERAGE: one "loss".
No deductible for a covered "auto" will apply to L. NOTICE AND KNOWLEDGE {]F ACCIDENT C)R
glass damage if the glass is repaired rather than LOSS
replaced. The following is added to Paragraph /4.2.o.. of
H. HIRED AUTO PHYSICAL D&K8/\GE — LOSS OF SECTION |V—BUSINESS AUTO CONDITIONS:
USE—|NCREASEO L|KO|T
Your duty to give unor our authorized repreomnta-
Thafollowing replaces the last sentence of Para- tive prompt notice of the "accident" or "loss" ap-
Araph A.4.b.. Loss Of Use Expenees, of SEC- plies only when the "aooidonY' or ''|oon^ is known
T|ON III—PHYSICAL DAMAGE COVERAGE: to:
However, the most wewill pay for any expenses (a) You (if you are un1ndividua|);
for |000 of use in $65 per day, to a maximum of (b) A partner(if you are a partnership);
$7GO for any one "aocideni"
. (c) A member (if you are a limited liability oom'
k PHYSICAL DAMAGE — TRANSPORTATION pmny);
EXPENSES—|NCHEASED UK8|T
(d) An executive ufficor, director or insurance
The following replaces the first sentence in Para- manager(if you are a corporation or other or-
graph A.4.o, Transportation Expenees, of ganizohon); or
SECTION |0 PHYSICAL DA���� COVER-- (e) Any "employee" authorized by you to give no-
AGE: Uoaof the "aocidunt"or"|oao"
We will pay up to $50 per day to a maximum of M. BLANKET WAIVER C}F SUBROGATION
$1.500 for temporary transportation expense in- The following replaces PonagnaphA.5. Transfer
ourred by you because of the \oie| theft of a nov- Of Rig —htm (�f F�ecove Against Others To Ua,
erod ^autu^mf the private passenger type. of SECTION |V — BUSINESS AUTO CC`ND|'
J. PERSONAL PROPERTY T|ONS:
The following is added to Paragraph A.4., Cover' 5. Transfer Of Rights Of Recovery Against
age Extensions, of SECTION ||| — PHYSICAL Others To Us
DAMAGE COVERAGE: VVe waive any right of recovery wm may have
Personal Property against any person nr organization to the ex-
tent required of you by e written contract
We will pay up to $4O0 for ''|oua'' towearing ap- signed and executed prior to any "accident"
paru| and other personal property which is: or"|oom". provided that the"aooident" nr"|ono"
1) Owned byan "insurod"; and ahp*o out of operations contemplated by
CAT3530216 @on1n The Travelers Indemnity Company.All rights reserved. Page 3of4
Includes copyrighted material m Insurance Services Office,Inc.with its permission.
COMMERCIAL AUTO 01;
such contract. The waiver applies only tothe The unintentional omission of, or unintentional
person or organization designated in such error in, any information given by you shall not
contract.
prejudice your rights under this insurance. How-
N. UNINTENTIONAL ERRORS OR OMISSIONS ever this provision does not affect our right to col-
The following is added to Paragraph B.2.. Con- |ect additional premium or exercise our right of
oea|ment' Misrepresentation, Or Fnmud, of cancellation ornon-nanewm|.
SECTION |V—BUS|NESS AUTO CONDITIONS:
Page 4of4 @zn10 The Travelers Indemnity Company.All rights reserved. CA T3 53 02 15
POLICY NUMBER: 13-TU\-28 COMMERCIAL AUTO
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
BLANKET �����K�k�����U U������� � ��KU�� �� ����
��m�v-v"�m,.�~ n ADDITIONAL"��u�v-vu� on����*������ PRIMARY" x-^x��~
�o����������K����^��� ��8�� ������ INSURANCE NON-CONTRIBUTORY u nn^m���� v ��r� n WITH m " OTHER u n��r� "n�������v-wmm~_�� —
�~������K� ���~��������
~_��om uux���� u ����~�
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
PROVISIONS 2. The following is added to Paragraph B.S., Other
1' The following is added to Paragraph c, in A'1.' Insurance of SECTION |\/ - BUSINESS AUTO
Who Is An Insured, of SECTION U COVERED CONDITIONS:
AUTOS LIABILITY COVERAGE: Regardless of the provisions of paragraph a. and
This includes any person or organization who you paragraph d' of this part S. Other |nsurance, this
are required under a written contract or insurance is primary to and non-contributory with
agreement, that is signed by you before the applicable other insurance under which on
"bodily injury" or "property damage" occurs and additional insured person or organization is a
that is in effect during the policy period, to name named insured when a written contract or
as an additional insured for Covered Autos agreement with you, that is signed by you before
Liability Covenage, but only for damages to which the "bodily injury" or "property damage" occurs
this insurance applies and only to the extent of and that is in effect during the policy periud,
that pecson's or orgonization's liability for the requires this insurance to be primary and non-
conduct of another"insured" contributory.
CA T4880218 (Dzn10 The Travelers Indemnity Company.All rights reserved. Page of
Includes copyrighted material of Insurance Services Office,Inc,with its permission.
UMBRELLA POLICY NUMBER: CUP-4RS31G66-26-2O
2. We have no duty to defend any insured applicable limit of insurance. K we do not
against any^ouit": pay part of the judgment for any namaon
o^ Seeking damages hzwhich this insurance other than it is more than the applicable
does not apply; or limit of inauranoa, we will not pay any
interest that accrues on that portion of the
b. |f any other insurer has o duty todefend. judgment.
3. When we have the duty to defend,we may, at With respect to a claim we investigate or
our discretion, investigate and settle any claim settle, or ''suit^ against an insured wedefend
or "suit". In all other cases, we may, at our under COVERAGE A — EXCESS FOLLOVV-
dieonation, participate in the investigation, F(]RK0 L|/tB(LVTY, these payments will not
defense and settlement of any claim or "suit" naduu* the applicable limits of ineuronoe, but
for damages to which this insurance may only if the applicable "underlying insurance"
apply. |fvvo exercise such right toparticipate, provides for such payments in addition to its
all expenses we incur in doing so will not limits of insurance. With respect to e claim we
reduce the applicable limits ofinsurance. investigate or settle, or "suit" against an
4^ Our duty ho defend ends when vve have used insured we defend under COVERAGE B —
up the applicable limit of insurance in the UMBRELLA L|AB|L|TY, these payments will
payment of judgments or settlements, or not reduce the applicable limits mfinsurance.
defense expenses if such expenses are within SECTION U8—WHO ISANINSURED
the limits of insurance of this policy.
A. COVERAGE & — EXCESS FOLLOW-FORM
5' We will pay' with respect to u claim we
LIABILITY
investigate or settle, or "suit" against an
insured vvedefend: With respect(o Coverage A, the following persons
o' All expenses weincur. and organizations qualify uoinsureds:
b. The cost of:
1~ The Named Insured shown in the
M\ Oeo|an�ionaand
Bail bonds required because of '
` ' accidents or traffic law violations '� Any other person or organization qualifying as
arising out uf the use of any vehicle tu an insured in the "underlying insurance". U
which this insurance applies; or you have agreed to provide insurance for that
parson or organization in a vvhbon contract or
/2\ Appeal bonds and bonds to release agreement:
attachments;
a. The limits of insurance afforded to such
but only for bond amounts within the person or organization will be:
applicable limit ofinsurance. We do not
have tn furnish these bonds. (1) The amount by which the minimum
limits of insurance you agreed to
c` All reasonable expenses incurred by the provide such person or organization
insured at our request to assist us in the in that written contract or agreement
investigation or defense of such claim or exceed the total limits of insurance of
^nuit''. including actual loss of earnings uP all applicable "underlying insurance";
to $1.OUOa day because of time off from or
work.
(2) The/imiteofineurenoeof\hinpo|ioy�
d. All court costs taxed against the insured '
in the''ouiy' However, these payments dn whichever is less; and
not include attorneys' fees or attorneys' b. Coverage under this policy does not apply
expenses taxed against the insured. to such person or organization if the
m, Prejudgment interest awarded against the minimum limits of insurance you agreed
insured on that pert of the judgment vve to provide such person or organization in
pay. If we make an offer to pay the that written contract or agreement one
applicable limit of inounanoe, we will not wholly within the Urto| limits of insurance
pay any prejudgment inien*ai based on of all available applicable "underlying
that period of time after the offer. insurance".
f. All interest that accrues on the full amount B. COVERAGE B— UMBRELLA LIABILITY
of any judgment after entry of the With respect to Coverage B:
judgment and before we have paid,
offered to pay ordeposited in court the
1. The Named Insured shown in the
partof the judgment that in within the Declarations is an insured.
2. |f you are:
UMBRELLA
b. You have paid all premiums due for this b. To sue us un this insurance unless all of
policy o(the time you make such request; its terms have been fully complied with.
c. You promptly pay the additional premium 2. A person or organization may sue us to
we charge for the Extended Reporting recover on an agreed settlement or on a final
Period endorsement for this insurance judgment against an insured. We will not be
when due. We will determine that liable for damages that:
additional premium after we have
received you/ request for the Extended m. Are not payable under the terms of this
insurance; or
Reporting Period endorsement for this
insurance. That additional premium in not b. Are in excess of the applicable limit of
subject to any limitation stated in the insurance.
^undodyinQ inournnce" on the amount or An agreed settlement means a settlement
percentage of additional premium that and n*|aaae of liability signed by ua, the
may be charged for the "extended insured and the claimant or the claimant's
reporting periud" in such "underlying legal representative.
insurance"; and
L. K8�\|NTENANCECYFUNDERLYUNC� INSURANCE
d. That Extended Reporting Period '
endorsement is issued by us and made u 1. The insurance afforded by each policy of
part of this policy. "underlying insurance" will bo maintained for
the full policy period of this Excess Follow-
for this insurance will not reinstate or increase�. Any Extended Reporting Period endorsement Form And Umbrella Liability Insurance. This
the Limits of Insurance or extend the policy provision does not apply to the reduction or
per1od exhaustion of the aggregate limit or limits of
� such "underlying insurance" solely by
4. Except with respect to any provisions to the payments aopermitted in Panagnapha4.a.(1).
contrary contained in Paragraphs 1` 2. or 3' (2) and /3\ of COVERAGE /\ — EXCESS
above, all provisions of any option to FOLLOW-FORM LIABILITY of SECTION U —
purchase on "extended reporting period" COVERAGES. As such policies oxpin*, you
granted to you in the "underlying ineunmnce" will renew them at limits and with coverage at
apply tnthis insurance. least equal to the expiring limits of insurance.
J. INSPECTIONS AND SURVEYS If you fail to comply with the above
requirements, Coverage A is not invalidated.
1~ We have the right but are not obligated to: However, in the event of a |oee, we will pay
a. Make inspections and surveys at any only bo the extent that vve would have paid had
time; you complied with the above requirements.
b. Give you reports on the conditions we 2. The first Named Insured shown in the
find; and Declarations must give us written notice of
u. Recommend changes. any change in the "underlying insurance" as
respects:
2' Any inspections, eurveys, reports or
a
recommendations relate only to insurability
' Coverage;
'
and the premiums to be charged. We do not b. Limits ofinsurance;
make safety inspections. We do not o. Termination of any coverage; or
undertake to perform the duty of any person
or organization to provide for the health or d~ Exhaustion of aggregate limits.
safety of workers or the public. We do not 3. If you are unable to recover from any
warrant that conditions: "underlying insurer" because you fail to
a. Are safe orhealthful; or onmP|y with any term or condition of the
"underlying insurance", Coverage A is not
b. Comply with |uwm, regu|utiono, codes or invalidated. However, we will pay for any loss
standards.
only to the extent that vve would have paid had
K. LEGAL ACTION AGAINST OS you complied with that term or condition in
1. No person or inouranoe^
on or organization has o right under .
this insurance: M. OTHER INSURANCE
o. To join us as a party or otherwise bring us This insurance is excess over any valid and
into m "suit" asking for damages from an collectible "other insurance" whether such "other
insured; or insurance" is stated to be primary, conihbuting.
Page 14nf22 @ 2o1a The Travelers Indemnity Company.All rights reserved, EUO8010718
UMBRELLA
oxceoo, contingent or otherwise. This provision P. PROHIBITED COVERAGE — UNLICENSED
does not apply to e policy bought specifically to INSURANCE
apply ae excess of this insurance.
1. With respect toloss sustained by any insured
Hovvmver, if you specifically nqnae in a written ina country or jurisdiction in which vve are not
contract or agreement that the insurance provided licensed to provide this insurance, this
to any person or organization that qualifies as an insurance does not apply to the extent that
insured under this insurance must apply on a insuring such loss would violate the laws or
primary basis, or primary and non-contributory regulations of such country orjurisdiction.
basis, then 2 VVmdonoiasoumaraoponeibi|i�yfor�
ieou��octio1hehmUovvingpnoviaiuno� ' �
1' This insurance will apply The payment of any fine,app|y before any "other ` penalty or
inaunznce'' that is available tosuch additionalothorohargethatmayba imposed--
edon any
insured which covers that person or
person or organization in any country or
organization as e named inou»ed, and jurisdiction because we are not licensed
vvm »vi|| to provide insurance in such country or
not share vviththat''ckhorinourenoe^ provided'that the injury nr damage for vvhioh coverage jurisdiction; or
is sought is caused by an ''evonf' that takes b. The furnishing of certificates or other
place or is committed subsequent to the evidence of insurance in any country or
signing of that contract or agreement byyou. jurisdiction in which vve are not licensed to
2. This insurance is still oxoono over any valid provide insurance.
and oo||ortib|o ''other insurance", whether Q. PROHIBITED COVERAGE — TRADE QFK
primary, excene, contingent or othenwise. ECONOMIC SANCTIONS
which covers that person or organization as We will provide coverage for any |ose, or
an additional insured orae any other insured otherwise will provide any benofit, only to the
that does not qualify aaa named insured. extent that providing such coverage or benefit
N. PFlEK8|UK8 does not expose us or any of our affiliated or
parent companies to:
1. The first Named Insured shown in the
Dedanadoneie responsible for the payment of 1. Anytradaoreoonomiooanctionunderany |�w
�/| pnamiumm and will b* the pmye* for any or regulation ofthe United States of America;
or
return premiums.
2. |f the premium iaa flat charge, itia not subject 2' Any other applicable trade or economic to adjustment except as provided in sanction, prohibition orrestriction.
Paragraph 4. below. R. REPRESENTATIONS
3. |f the premium io other than a flat charge, itia By accepting this insurance, you agree:
an advance premium only. The earned 1. The statements in the Declarations and any
premium will be computed at the and of the subsequent notice n*|ubng to "underlying
policy period, orot the end of each year ofthe insurance" are accurate and complete;
policy period if the policy period is two years
2. Those statements are based upon
or longer, a� the rehm shown in the
representations youmade houe'us; and
Doc|arotiono, subject to the Minimum
Premium. 3. VVe have issued this insurance in reliance upon
4. Additional premium may baonmu payable your representations.
when coverage is provided for additional S. SEPARATION QFINSUREDS
insureds under the provisions of SECTION |D Except with respect to the Limits of |nounenoe.
—WHO IS AN INSURED. and any rights or duties specifically assigned in
0. PREMIUM AUDIT this policy(n the first Named Insured shown in the
Declarations, this insurance applies:
The premium for this policy is the amount stated
1. As if each Named Insured were the only
in Item 5, of the Declarations. The premium is o Named Insured; and
Out charge unless it is specified in the
Declarations aaadjustable. 2. Separately to each insured against whom
claim in made or"auif' iobrought.
UMBRELLA
T. WAIVER OR TRANSFER OF RIGHTS OF provision does not affect our hQhi to collect 01N
RECOVERY AGAINST OTHERS TOUS additional premium or to exercise our rights of
cancellation or nonrenewm| in accordance with
of If the insured has rights to recover all or part
of any payment we have made under this applicable insurance laws orregulations.
ineuxanoo, those rights are transferred to us W. WHEN LOSS IS PAYABLE
and the insured must do nothing after loss to If we are liable under this insurance, we will pay
impair them. /& our n*queat, the insured will for injury, damage or
bring suit or transfer those rights to us and ' �
help us, and with respect to Coverage A. the i. The inaunad'n liability ioestablished by:
"underlying ineurer^. enforce them. a. A court deuisionur
If the insured has agreed in a oon(rooi or '
b
agreement to waive that inuun*d.s right of ~ A written agreement between the
recovery against any person or organization, claimant, the insured, any "underlying
inaure�anduoand
we waive our right of recovery against that '
person or organization, but only for payments 2' The amount of the "applicable underlying
we make because of an "event" that takes limit" or "self-insured retention" is paid by or
place or is committed subsequent to the un behalf of the insured.
execution of that contract or agreement by
SECTION VU—DERN\T|ONS
such insured.
2. Reimbursement of any amount recovered will A. With respect to all coverages of this insurance:
ba made in the following order: 1^ "Applicable underlying limit" means the sum of:
a. Fint, to any person or organization a. The applicable limit of insurance atohad
(including umor the insured)who has paid for the policies of "underlying insurance"
any amount in excess of the applicable in the Schedule Of Underlying Insurance
limit ofinsunenoe�
' subject to the provisions in Paragraphs
b- Next, to us; and 4.e.(I). (2) and (3) of COVERAGE A —
c- Then, to any person or organization EXCESS FOLLOW-FORM LIABILITY of
(including the insured and with respect to SECTION |—COVERAGES; and
Coverage A, the "underlying insuror')that b. The applicable limit of insurance of any
io entitled to claim the remainder, ifany. "other insurance"that applies.
3^ Expenses incurred in the process of recovery The limits of insurance in any policy of
will be divided among all persons or "underlying insurance"will apply even if:
organizations receiving amounts recovered
according to the naUn of their respective a. The "underlying insurer" o|oima the
recoveries. insured failed to comply with any term or
U. TRANSFER OF YOUR RIGHTS AND DUTIES condition of the policy; or
UNDER THIS INSURANCE b' The "underlying insurer" becomes
1~ Your rights and duties under this insurance bankrupt orinsolvent.
may not be transferred without our written 2. "Auto hazard" means all "bodily injury" and
consent except in the oene of death of an "property damage" to which liability insurance
individual Named Insured. afforded under an auto policy of "underlying
2' If you die, your rights and duties will be insurance" would apply but for the exhaustion
transferred to your legal representative but cf its applicable limits ofinsurance.
only while acting within the scope of duties as 3. "Electronic data" means information, facts or
your |agm| representative. Until your legal programs stored as or on, onaaiad or used on,
representative is eppuinted, anyone having or transmitted to or from computer software
proper temporary custody of your property will
(including systems and applications software),
have your rights and duties but only with hard or floppy disks, CO-ROMa. 1opaa. dhven,
respect to that property. oe||a, data processing devices or any other
V. UNINTENTIONAL(]A8U@S|ON OR ERROR media which are used with electronically
The unintentional omission of, or unintentional controlled equipment.
error in, any information provided by you which vve 4. "Event" means an "occurrence", offenae
relied upon in issuing this policy will not prejudice accident, a�� error, omission, wrongful fu| act '
. . ' vv ng u or
your rights under this insurance. However, this loss.
wwwsan.mm
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Work.p��n� � Oregon.
Carrier no: 20001 Endorsement no: VVC000313
(Ed. 430B)
SAIF policy: 780794 McKinstryEsaentionLbC
Waiver of Our Right to Recover from Others Endorsement
We have the right to recover our payments from anyone liable for an injury covered by this policy. We
will not enforce our right against the person or organization named in the Schedule,
This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.
Schedule
Description: ALL OPERATIONS
Contractor name: Persons and/or organizations with whom the insured-employer is required by
written contract to waive subrogation rights.
This endorsement does not alter the rights of an injured worker to pursue recovery from another party
or SAY to receive a statutory share of recoveries by an injured worker, even from the party listed in the
schedule.
The premium charge for this endorsement is based on one (1) percent of your manual premium.
Effective date; October 1. 2025
This endorsement changes the policy to which it is attached and is effective on the date issued unless
otherwise stated.
VVC000313 Chip Terhune
(Ed. 43OB) President and Chief Executive Officer
400 xiux Street SE
Salem,onprolz
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