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HomeMy WebLinkAboutInsurance Certificate: DOWL, LLC l AFCERTIFICATE LIABILITY LAI {Rftrt>7D;YYYY} /3012£126 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 INSUREH(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 dates not canter rights to the certificate holder in lieu of such endorsement(s). PRODUCER CEI =— NCACT I u1A Cetifgate Team NAt_ -- — - - --- —----- Parker Smith Feek insurance LLC PHONE E i FAX N a: 104t00 NE 4th St E MAIL u Suite 900 Beilevue VA/A 98004m51 74 iNSUREfT(s}AFFetRGINC COVERAGE—_______ — NAtc _ .-. . -.. INSURER A:The'Charter Oak Fire Insurance Company _--26615 INSURED DOW LI C r.1 INSURER 8: The Travelers Indemnity Company 25658 DC VL, LLC — ---- -- ---- 920 Country Club Road; Suite 100E INSURER C_Travel Rrope Casual fnmpany of America 25674 -- r-- Eugene, OR 97401 INSURERD INSURER E: INSIMER F COVERAGES CERTIFICATE NUMBER:1288335562 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 REOUIREMENT, 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 SHONJN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSFi i ACSt7L SUf3R' _ ROLiBY EFF POLICY EXP LTR TYPE CIFINSURANGE ItN D WVDI POLICY NUMBER 1{d+9i4IIDONYYY ILMMfDD/YYYY LIMITS A `{ COMMERCIAL GENERAL LIA8ILITY ! Y 6305W324",8}COF20 l 5J11202G I 5/1/2027 , EACH OCCURRENCE i G1,0K000 DAMAGE�RENTED CLAIMS-MADE X I OCCUR RRE ,L E,S{ a ccni,r rtec} 300( fl _.-. MED EXR(Any one person) 0 O 70 t PERSONAL&AGv INJURY 1 000 000 i I GEN'L AGGREGATE Ut,111 APPLIES PER ; GENERAL AGGREGATE � 2 GGD flt p Pno- xICCT LOCI ; PRODUCTS,-COMP/Or'AG C "2,000,000 % ----- B AUTOMOBILE LIABILITY 1 Y 81 G5W'3264''S264GG 5J112C}20 51112427 CC,MB NEG SINGE LWIT d a $ QGG O 0 {E, x d.,nri,.- X ANY AUTO ? - BODILY INJURY(PeePerson] E.., OWNED SCHEDULED BOGI JURY,Peramkjent}! _ AUTOS ONLY 1 1AUT aw -- — -- --- I HIKED 1 NON OWNED � I i RrUPERTY PAMACE - �g AUT(36ONLY ®i AUTOS ONLY i tf't tc .dt>nr,l. C UMSRELLALIAB E—X ' GLaR Y i CJP5VV33Q5r7'a54' 5111202r5 5r112G27 EACH OCCURRENCE 10,000,300 -- } I EXCESS LIAa t i,\r',IS-MADE AGGREGATE ,.. _.. DEC i X = RETENTi JN Q.i nn A WORKEP,SCOMPENSATION LI[313 37 37 1 0 3 2C43G = 511J202E 5r11202'1 X GF X O?H• AND EMPLOYERS'LIABILITY YIN N I i -._ :T�rUTL ' ER i_WA� �fY uI�P Ga1T-- ANYPROPPIETORiPARTNER,EXECUTIVE ht N t A j E,L EACH ACCIDENT W 1,000,000 FFICEr?h1EMHEREXC UGED" _ {(Mandatory in NH) C E.L DISEASE EA EPAPLO'r EEI$1.GG0,000 It pea,desc ne under — -- ___-- OBS4RIPIICN OF OPERATIONS bBl 1r F_.L.DISFAFE-POLICY LIMIT µ 1,000,00 i i I I I DESCRIPTION OF OPERATIONS t LOCATIONS/VEHICLES (ACORD 101,Additional Retnsrks Schedute,may be attanhed i(more space is required) RE: Project No:2023.15141.02. IFF_for FFY 2022 Construction ITVV Rehab). City of Ashland,Oregon,Its elected officials, officers and employees are included as Additional Insured on the General Liability,Automobile Lrab lity and Excess Liability Policies,if required by vrrrtten contract cr aggi Ent, subject to tI e policy terms and conditions.This insurance is Primary&Non-Conti-ibutory on the General Liability,Automobile Liability and Excess Liability Policies, if required by vJritten contract or agreement,subject to the policy terms and conditions, General Liability,Automobile Liability, Excess Liability and Workers Compensation Coverage(s)include 30 clay notice of cancellation,subject to the policy terms and conditions. Excess Liability policy is in excess of the General Liability, Automobile Liability and Employers Liability Policies, subject to the policy terms and conditions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Ashland,. Oregon 20 East Main Sireet AUTHORIZED REPRESENTATIVE Ashland CAR 97020 ILL 9)1988.2015 ACORN CORPORATION. All rights reserved. ACORD 26(2 16l8 ) The ACORD name and loges are registered marks of ACORD 3452: 2 ' of 15 UMBRELLA 2. We have no duty to defend any 'insured applicable limit of insurance. If we do not against any"suit". pay part of the judgment for any reason a. Seeking damages to which this insurance other than it is more than the applicable does not apply; or limit of insurance, we will not pay any interest that accrues on that portion of the b. It any other insurer has a duty to defend. 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 we defend or "suit", In all other cases, we may, at our under COVERAGE A — EXCESS FOLLOW- discretion, participate in the investigation, FORM LIABILITY, these payments will not defense and settlement of any claim or "Suit" reduce the applicable limits of insurance, but for damages to which this insurance may only it the applicable "underlying insurance" apply. If we exercise such right to participate, provides for such payments in addition to its all expenses we incur in doing so will not limits of insurance. With respect to a claim we reduce the applicable limits of insurance. investigate or settle, or "suit" against an 4. Our duty to defend ends when we have used insured we defend under COVERAGE B — up the applicable limit of insurance in the UMBRELLA LIABILITY, these payments will payment of judgments or settlements, or not reduce the applicable limits of insurance. defense expenses it such expenses are within SECTION If—WHO IS AN INSURED the lit-nits of insurance of this policy, A. COVERAGE A — EXCESS FOLLow-rORM 5. We will pay, with respect to a claim we LIABILITY investigate or settle, or "suit" against art insured we defend: With respect to Coverage A, the following persons a. All expenses we incur. and organizations qualify as insureds: b. The cost of: 1. The Named Insured shown in the Declarations; and (1) Bail bonds required because of 2. Any other person or organization qualifying as accidents or traffic law violations an insured in the "underlying insurance", If arising out of the use of any vehicle to you have agreed to provide insurance for that which this insurance applies; or person or organization in a written 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 of insurance. We do not have to furnish these bonds. (1) The arnount 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 suit", including actual loss of earnings up all applicable "underlying insurance"; to $1,000 a day because of time off from or work. (2) The limits of insurance of this policy; d. All court costs taxed against the insured whichever is less; and in the"suit". However, these payments do 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 e. Prejudgment interest awarded against the minimum limits of insurance you agreed insured on that part of the judgment we to provide such person or organization in pay. If we make an offer to pay the that written contract or agreement are applicable lit-nit of insurance, we will not wholly within the total limits Of insurance pay any prejudgment interest 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, 1. The Named Insured shown in the offered to pay or deposited in court the Declarations is an insured. part of the judgment that is within the 2. If you are: Page 4 of 22 2016"The Travelers Indemnity Company.All rights reserveo. ED 00 01 07 16 3452: 3 of-15 POLICY NUMBER: ISSUE DATE: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION OR NONRENEWAL PROVIDED BY US This endorsement modifies insurance provided Linder the following: ALL. COVERAGE PARTS INCLUDED IN THIS POLICY SCHEDULE CANCELLATION: Number of Days Notice: 60 WHEN WE DO NOT RENEW(Nonrenewal)- Number of Days Notice: 60 PROVISIONS B. If we do not renew this policy for any legally A. If we cancel this policy for any legally permitted permitted reason other than nonpayment of reason other than nonpayment of premium, and a premium, and a number of days is shown for number of days is shown for Cancellation in the When We Do Not Renew (Nonrenewal) in the Schedule above, we will mail notice of Schedule above, we will mail notice of cancellation at least the number of days shown nonrenewal at least the number of days shown for for Cancellation in such Schedule before the When We Do Not Renew (Nonrenewal) in such effective date of cancellation. Schedule before the effective date of nonrenewal. IL T3 20 05 19 02019 The Tr•aveles Indernnity Company. All rights reserved, Page 1 of 1 3452: 4 of 15 Policy Number: 8105W3264352643G ISSUE DATE: 05/01/2026 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED PERSON OR ORGANIZATION - NOTICE OF CANCELLATION PROVIDED BY US This endorsement modifies insurance provided under the following-, ALL COVERAGE PARTS INCLUDED IN THIS POLICY SCHEDULE CANCELLATION: Number of Days Notice: 30 PERSON OR ORGANIZATION: ANY PERSON OR ORGANIZATION TO WHOM YOU HAVE AGREED IN A WRITTEN CONTRACT THAT NOTICE OF CANCELLATION OF THIS POLICY WILL BE GIVEN, BUT ONLY IF: 1. YOU SEND US A WRITTEN REQUEST TO PROVIDE SUCH NOTICE, INCLUDING THE NAME AND ADDRESS OF SUCH PERSON OR ORGANIZATION, AFTER THE FIRST NAMED INSURED RECEIVES NOTICE FROM US OF THE CANCELLATION OF THIS POLICY; AND 2. WE RECEIVE SUCH WRITTEN REQUEST AT LEAST 14 DAYS BEFORE THE BEGINNING OF THE APPLICABLE NUMBER OF DAYS SHOWN IN THIS SCHEDULE. ADDRESS: THE ADDRESS FOR THAT PERSON OR ORGANIZ- ATION INCLUDED IN SUCH WRITTEN REQUEST FROM YOU TO US. PROVISIONS It we cancel this policy for any legally permitted reason other than nonpayment of premium, and a number of days is shown for Cancellation in the Schedule above. we will mail notice of cancellation to the person or organization shown in Such Schedule, We will mail such notice to the address shown in the Schedule above at least the number of days shown for Cancellation in such Schedule before the effective date of cancellation. IL T4 OS OS 19 0 2019 The Travelers Indemnity Company.All rights reserved. Page 1 of 1 3452: 5 of 15 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY WITH OTHER INSURANCE This endorsement rnodifies 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 Al.c., Who Insurance of SECTION Its — BUSINESS AUTO Is An Insured, of SECTION 11 — LIABILITY CONDITIONS: COVERAGE: Regardless of the provisions of paragraph a. and This includes any person or organization who you Faragraphd. of this part 5. Other Insurance, this i are required under a written contract or insurance s primary to and non-contributory with agreement between you and that person or applicable other insurance under which an organization, that is signed by you before the additional insured person or organization is the "bodily injury" or "property damage" occurs and first named insured when the written contract or that is in effect during the policy period, to name agreement between you and that person or as an additional insured for Liability Coverage, organization, that is signed by You before the but only for damages to which this insurance "bodily injury" or "property damage" occurs and that is in effect during the policy period, requires applies and only to the extent of that person's or this insurance to be primary and non_Con r tributory. organization's liability for the conduct of another "insured", CA T4 74 08 17 2016 The Travelers indemnify Company. All rights reserved. Page 1 of I Includes copyrighted material of Insurance services Office, Inc.with it;permission. 3452: 6 of 15 i COMMERCIAL GENERAL LIABILITY c. Method Of Sharing a. The statements in the Declarations are If all of the other insurance permits contribution accurate and complete; by equal shares, we will follow this method also. b. Those statements are based upon Under this approach each insurer contributes representations you made to us; and equal amounts until it has paid its applicable c. We have issued this policy in reliance upon limit of insurance or none of the loss remains, your representations. whichever comes first. The unintentional omission of, or unintentional error If any of the other insurance does not permit in, any information provided by you which we relied contribution by equal shares, we will contribute upon in issuing this policy will not prejudice your by limits. Under this method, each insurer's rights under this insurance. However, this provision share is based on the ratio of its applicable limit does not affect our right to collect additional of insurance to the total applicable limits of premium or to exercise our rights of cancellation or insurance of all insurers, nonrenewal in accordance with applicable insurance d. Primary And Non-Contributory Insurance If laws or regulations. Required By Written Contract 7. Separation Of Insureds If you specifically agree in a written contract or Except with respect to the Limits of Insurance, and agreement that the insurance afforded to an any rights or duties specifically assigned in this insured under this Coverage Part must apply on Coverage Part to the first Named Insured, this a primary basis, or a primary and non- insurance applies: contributory basis, this insurance is primary to a. As if each Named Insured were the only other insurance that is available to such insured Named Insured; and which covers such insured as a named insured, and we will not share with that other insurance, b. Separately to each insured against whom claim provided that: is made or"suit" is brought. (1) The "bodily injury" or"property damage" for 8. Transfer Of Rights Of Recovery Against Others which coverage is sought occurs; and To Us (2) The "personal and advertising injury" for If the insured has rights to recover all or part of any which coverage is sought is caused by an payment we have made under this Coverage Part, offense that is committed; those rights are transferred to us. The insured must subsequent to the signing of that contract or do nothing after loss to impair them. At our request, agreement by you. the insured will bring "suit" or transfer those rights to us and help us enforce them. 5. Premium Audit 9. When We Do Not Renew a. We will compute all premiums for this Coverage If we decide not to renew this Coverage Part, we will Part in accordance with our rules and rates. mail or deliver to the first Named Insured shown in b. Premium shown in this Coverage Part as the Declarations written notice of the nonrenewal advance premium is a deposit premium only. At not less than 30 days before the expiration date, the close of each audit period we will compute If notice is mailed, proof of mailing will be sufficient the earned premium for that period and send proof of notice. notice to the first Named Insured. The due date for audit and retrospective premiums is the date SECTION V—DEFINITIONS shown as the due date on the bill. If the sum of I. "Advertisement" means a notice that is broadcast or the advance and audit premiums paid for the published to the general public or specific market policy period is greater than the earned segments about your goods, products or services premium, we will return the excess to the first for the purpose of attracting customers or Named Insured. supporters. For the purposes of this definition: c. The first Named Insured must keep records of a. Notices that are published include material the information we need for premium placed on the Internet or on similar electronic computation, and send us copies at such times means of communication; and as we may request. b. Regarding websites, only that part of a website 6. Representations that is about your goods, products or services By accepting this policy, you agree: for the purposes of attracting customers or supporters is considered an advertisement. Page 16 of 21 ©2017 The Travelers Indemnity Company,All rights reserved. CG T1 00 02 19 Includes copyrighted material of Insurance Services Office, Inc. with its permission. 3452: 7 of 15 i COMMERCIAL GENERAL LIABILITY occupational therapist or occupational that is available to any of your "employees" therapy assistant, physical therapist or for "bodily injury" that arises out of providing speech-language pathologist; or or failing to provide "incidental medical (b) First aid or "Good Samaritan services" services" to any person to the extent not by any of your"employees" or"volunteer subject to Paragraph 2.a.(1) of Section 11 — workers", other than an employed or Who Is An Insured, volunteer doctor. Any such "employees" K. MEDICAL PAYMENTS— INCREASED LIMIT or"volunteer workers" providing or failing The following replaces Paragraph 7. of to provide first aid or "Good Samaritan SECTION III —LIMITS OF INSURANCE: services" during their work hours for you will be deemed to be acting within the 7. Subject to Paragraph 5. above, the Medical scope of their employment by you or Expense Limit is the most we will pay under performing duties related to the conduct Coverage C for all medical expenses of your business. because of "bodily injury" sustained by any 3. The following replaces the last sentence of one person, and will be the higher of; Paragraph 5. of SECTION III — LIMITS OF a. $10,000; or INSURANCE: For the purposes of determining the b. The amount shown in the Declarations of applicable Each Occurrence Limit, all related this Coverage Part for Medical Expense acts or omissions committed in providing or Limit. failing to provide "incidental medical L. AMENDMENT OF EXCESS INSURANCE services", first aid or "Good Samaritan CONDITION— PROFESSIONAL LIABILITY services" to any one person will be deemed to be one "occurrence". The following is added to Paragraph 4.b., Excess Insurance, of SECTION IV — 4. The following exclusion is added to COMMERCIAL GENERAL LIABILITY Paragraph 2., Exclusions, of SECTION I — CONDITIONS: COVERAGES — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE This insurance is excess over any of the other LIABILITY: insurance, whether primary, excess, contingent Sale Of Pharmaceuticals or on any other basis, that is Professional Liability or similar coverage, to the extent the "Bodily injury" or "property damage" arising loss is not subject to the professional services out of the violation of a penal statute or exclusion of Coverage A or Coverage B. ordinance relating to the sale of M BLANKET WAIVER OF SUBROGATION — pharmaceuticals committed by, or with the WHEN REQUIRED BY WRITTEN CONTRACT knowledge or consent of the insured, OR AGREEMENT 5. The following is added to the DEFINITIONS Section: The following is added to Paragraph 8., Transfer Of Rights Of Recovery Against Others To Us, "Incidental medical services" means: of SECTION IV — COMMERCIAL GENERAL a. Medical, surgical, dental, laboratory, x- LIABILITY CONDITIONS: ray or nursing service or treatment, If the insured has agreed in a written contract or advice or instruction, or the related agreement to waive that insured's right of furnishing of food or beverages; or recovery against any person or organization, we b. The furnishing or dispensing of drugs or waive our right of recovery against such person medical, dental, or surgical supplies or or organization, but only for payments we make appliances, because of: 6. The following is added to Paragraph 4.b., a. "Bodily injury" or "property damage" that Excess Insurance, of SECTION IV — occurs; or COMMERCIAL GENERAL LIABILITY CONDITIONS: b. "Personal and advertising injury" caused by This insurance is excess over any valid and an offense that is committed; collectible other insurance, whether primary, subsequent to the signing of that contract or excess, contingent or on any other basis, agreement. CG D3 79 02 19 O 2017 The Travelers Indemnity Company.All rights reserved. Page 5 of 6 Includes copyrighted material of Insurance Services Office, Inc.with its permission. 3452; 8 of 15 1111 Umbrella coverage premium summary Policy Number: CUP5W3305772643 Underlying schedule POLICY NUMBER COVERAGE COMPANY LIMIT 810- Auto Liabilit 005W326435 y Policy Limit 1,000,000 UB - Employers Policy Limit 1,000,000 005W330669 Liability Each Accident 1,000,000 Each Employee 1,000,000 630- Employee Each Employee 1,000,000 5W324780 Benefits Aggregate 2,000,000 General Aggregate 2,000,000 Products-Completed 2,000,000 630- General Liability Ops Aggregate 5W324780 Personal & 19000,000 Advertising Injury Each Occurrence 1,000,000 DOWL,LLC- Policy Period 05/01/2026—05/01/20207 3452: 9 of 15 Policy Number CUP5W3305772643 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED PERSON OR ORGANIZATION - NOTICE OF CANCELLATION PROVIDED BY US This endorsement modifies insurance provided under the fallowing: ALL COVERAGE PARTS INCLUDED IN THIS POLICY SCHEDULE CANCELLATION: Number of Days Notice, 30 PERSON OR ORGANIZATION: ANY PERSON OR ORGANIZATION TO WHOM YOU HAVE AGREED IN A WRITTEN CONTRACT THAT NOTICE OF CANCELLATION OF THIS POLICY WILL BE GIVEN, BUT ONLY IF: I. YOU SEND ITS A WRITTEN REQUEST TO PROVIDE SUCH NOTICE, INCLUDING THE NAME AND ADDRESS OF SUCH PERSON OR ORGANIZATION, AFTER THE FIRST NAMED INSURED RECEIVES NOTICE FROM ITS OF THE CANCELLATION OF THIS POLICY; AND 2 . WE RECEIVE SUCH WRITTEN REQUEST AT LEAST 14 DAYS BEFORE THE BEGINNING OF THE APPLICABLE NUMBER OF DAYS SHOWN IN THIS SCHEDULE. ADDRESS- THE ADDRESS FOR THAT PERSON OR ORGANIZ- ATION INCLUDED IN SUCH WRITTEN REQUEST FROM YOU TO US PROVISIONS If we cancel this policy for any legally permitied rea-ion otl-1,-,r than nonpayment of premiLini, and a number of days is shovvii for Cancellation in the Schedule above. we will wail notice of cancellation to the person or organization shown in such Schedule. We will mail such notice to the address shown in the Schedule above at least the number of days shown for Cancellation in such Schedule before the effective date of cancellation. IL T4 05 05 19 �,2019 the Tt,ivelerF,InO,,nini!y Cur porl'i Afl rem,rvux,; Page I of 1 3452: 10 oflq COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO EXTENSION ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. GENERAL DESCRIPTION OF COVERAGE —This endorsement broadens coverage. However, 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 to the 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. Limitations and exclusions may apply to these coverages. 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. BROAD FORM NAMED INSURED H. HIRED AUTO PHYSICAL DAMAGE — LOSS OF B. BLANKET ADDITIONAL INSURED USE— INCREASED LIMIT I. PHYSICAL DAMAGE — TRANSPORTATION C. EMPLOYEE HIRED AUTO EXPENSES—INCREASED LIMIT D. EMPLOYEES AS INSURED J. PERSONAL EFFECTS E. SUPPLEMENTARY PAYMENTS — INCREASED K. AIRBAGS LIMITS L. NOTICE AND KNOWLEDGE OF ACCIDENT OR F. HIRED AUTO — LIMITED WORLDWIDE LOSS COVERAGE —INDEMNITY BASIS M. BLANKET WAIVER OF SUBROGATION G.WAIVER OF DEDUCTIBLE—GLASS N. UNINTENTIONAL ERRORS OR OMISSIONS PROVISIONS A. BROAD FORM NAMED INSURED as an additional insured for Liability Coverage, The following is added to Paragraph A.1., Who Is but only for damages to which this insurance An Insured, of SECTION 11 — LIABILITY applies and only to the extent of that person's or COVERAGE: organization's liability for the conduct of another "insured". Any organization you newly acquire or form during the policy period over which you maintain C. EMPLOYEE HIRED AUTO 50% or more ownership interest and that is not 1. The following is added to Paragraph A.1., separately insured for Business Auto Coverage, Who Is An Insured, of SECTION II — Coverage under this provision is afforded only LIABILITY COVERAGE: until the 180th day after you acquire or form the organization or the end of the policy period, An "employee" of yours is an "insured" while whichever is earlier. operating an "auto" hired or rented under a B. BLANKET ADDITIONAL INSURED contract or agreement in that "employee's" name, with your permission, while performing The following is added to Paragraph c. in A.1., duties related to the conduct of your Who Is An Insured, of SECTION 11 — LIABILITY business. COVERAGE: 2. The following replaces Paragraph b. in B.5., This includes any person or organization who you Other Insurance, of SECTION IV — are required under a written contract or BUSINESS AUTO CONDITIONS: agreement between you and that person or b, For Hired Auto Physical Damage organization, that is signed by you before the "bodily injury" or "property damage" occurs and Coverage, the following are deemed to be that is in effect during the policy period, to name covered "autos" you own: CA T3 53 08 17 0 2016 The Travelers Indemnity Company.All rights reserved. Page 1 of 4 Includes copyrighted material of Insurance Services Office, Inc.with its permission 3452: 11 of 1 Policy #GUP5W3305772643 UMBRELLA b. You have paid all premiums due for this b. To sue us on this insurance unless all of policy at 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 a. Are not payable under the terms of this received your request for the Extended insurance; or Reporting Period endorsement for this insurance. That additional premium is not b. Are in excess of the applicable limit of subject to any limitation stated in the insurance. "underlying insurance" on the amount or An agreed settlement means a settlement percentage of additional premium that and release of liability signed by us, the may be charged for the "extended insured and the claimant or the claimant's reporting period" in such "underlying legal representative. insurance"; and d. That Extended Reporting L. MAINTENANCE OF UNDERLYING INSURANCE Periodendorsement is issued by us and 1. The insurance afforded by each policy of made a part of this policy. "underlying insurance" will be maintained for 3. Any Extended Reporting Period endorsement the full policy period of this Excess Follow- for this insurance will not reinstate or increase Form And Umbrella Liability Insurance. This the Limits of Insurance or extend the policy provision does not apply to the reduction or period, exhaustion of the aggregate limit or limits of such "underlying insurance" solely by 4. Except with respect to any provisions to the payments as permitted in Paragraphs 4.a.(1), contrary contained in Paragraphs 1., 2. or 3. (2) and (3) of COVERAGE A — EXCESS above, all provisions of any option to FOLLOW-FORM LIABILITY of SECTION I — purchase an "extended reporting period" COVERAGES. As such policies expire, you granted to you in the "underlying insurance" will renew them at limits and with coverage at apply to this insurance. least equal to the expiring limits of insurance. J. INSPECTIONS AND SURVEYS If you fail to comply with the above 1. We have the right but are not obligated to: requirements, Coverage A is not invalidated. However, in the event of a loss, we will pay a. Make inspections and surveys at any only to the extent that we 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 C. Recommend changes. any change in the "underlying insurance" as respects: 2. Any inspections, surveys, reports or a. Coverage; recommendations relate only to insurability and the premiums to be charged. We do not b. Limits of insurance; make safety inspections. We do not C. 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 or healthful; or comply with any term or condition of the b. Comply with laws, regulations, codes or "underlying insurance", Coverage A is not invalidated. However, we will pay for any loss standards. only to the extent that we would have paid had K. LEGAL ACTION AGAINST US you complied with that term or condition in 1. No person or organization has a right under that "underlying insurance". this insurance: M. OTHER INSURANCE a. To join us as a party or otherwise bring us This insurance is excess over any valid and into a "suit" asking for damages from an collectible "other insurance" whether such "other insured; or insurance" is stated to be primary, contributing, Page 14 of 22 ©2016 The Travelers Indemnity company.All rights reserved. EU 00 0107 16 3452; 12 of 15� UMBRELLA excess, contingent or otherwise. This provision P. PROHIBITED COVERAGE — UNLICENSED does not apply to a policy bought specifically to INSURANCE apply as excess of this insurance. 1. With respect to loss sustained by any insured However, if you specifically agree in a written in a country or jurisdiction in which we 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 a primary and non-contributory regulations of such country or jurisdiction. basis, then insurance provided under Coverage A 2. We do not assume responsibility for: is subject to the following provisions: 1. This insurance will apply before any "other a. The payment of any fine, fee, penalty or other charge that may be imposed on any insurance" that is available to such additional person or organization in any country or insured which covers that person or jurisdiction because we are not licensed organization as a named insured, and we will to provide insurance in such country or not share with that "other insurance", provided jurisdiction; or that the injury or damage for which coverage is sought is caused by an "event" 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 by you, jurisdiction in which we are not licensed to 2. This insurance is still excess over any valid provide insurance. and collectible "other insurance", whether Q. PROHIBITED COVERAGE — TRADE OR primary, excess, contingent or otherwise, ECONOMIC SANCTIONS which covers that person or organization as We will provide coverage for any loss, or an additional insured or as any other insured otherwise will provide any benefit, only to the that does not qualify as a named insured. extent that providing such coverage or benefit N. PREMIUM does not expose us or any of our affiliated or parent companies to: 1. The first Named Insured shown in the 1. Any trade or economic sanction under any law Declarations is responsible for the payment of or regulation of the United States of America; all premiums and will be the payee for any return premiums. or 2. If the premium is a flat charge, it is not subject 2. Any other applicable trade or economic to adjustment except as provided in sanction, prohibition or restriction. Paragraph 4. below. R. REPRESENTATIONS 3. If the premium is other than a flat charge, it is 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 end of the subsequent notice relating to "underlying policy period, or at the end of each year of the insurance" are accurate and complete; policy period if the policy period is two years 2. Those statements are based upon or longer, at the rate shown in the representations you made to us; and Declarations, subject to the Minimum Premium. 3. We have issued this insurance in reliance upon 4. Additional premium may become payable your representations. when coverage is provided for additional S. SEPARATION OF INSUREDS insureds under the provisions of SECTION II Except with respect to the Limits of Insurance, —WHO IS AN INSURED. and any rights or duties specifically assigned in 0. PREMIUM AUDIT this policy to 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 a Named Insured; and flat charge unless it is specified in the Declarations as adjustable. 2. Separately to each insured against whom claim is made or"suit" is brought. EU 00 0107 16 O 2016 The Travelers Indemnity Company.All rights reserved. Page 15 of 22 3452: 13 of 1 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - WRITTEN CONTRACTS (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1, The following is added to SECTION 11 — WHO IS plies only to such "bodily injury" or "property ANINSURED: damage" that occurs before the end of the pe- Any person or organization that you agree in a riod of time for which the "written contract re- written contract requiring insurance"to include as quiring insurance" requires you to provide an additional insured on this Coverage Part, but: Such coverage or the end of the policy period, a. Only with respect to liability for. "bodily injury", whichever is earlier. "property damage" or "personal injury"; and 2. The following is added to Paragraph 4.a. of SEC- TION IV — COMMERCIAL GENERAL LIABILITY b. If, and only to the extent that, the injury or CONDITIONS: damage is caused by acts or omissions of The insurance provided to the additional insured you or your subcontractor in the performance is excess over any valid and collectible "other in- of "your work" to which the "written contract surance", whether primary, excess, contingent or requiring insurance" applies. The person or organization does not qualify as an additional on any other basis, that is available to the add; insured with respect to the independent acts tonal insured for a loss we cover. However, if you or omissions of such person or organization. specifically agree in the "written contract requiring insurance" that this insurance provided to the ad- The insurance provided to such additional insured is limited as follows'. ditional insured under this Covet-age Part must apply on a primary basis or a primary and non- C. In the event that the Limits of Insurance of contributory basis, this insurance is primary to this Coverage Part shown in the Declarations "other insurance" available to the additional in- exceed the limits of liability required by the sured which covers that person or organization as "written contract requiring insurance", the in- a named insured for such loss, and we will not surance provided to the additional insured share with that "other insurance". But this insur- shall be limited to the limits of liability required ance provided to the additional insured still is ex- by that "written contract requiring insurance". cess over any valid and collectible "other insur- This endorsement shall not increase the limits ance", whether primary, excess, contingent or an of insurance described in Section III — Limits any other basis, that is available to the additional Of Insurance, insured when that person or organization is an d. This insurance does not apply to the render- additional Insured under any "other insurance". Ing of or failure to render any "professional 3. The following is added to SECTION IV — COM- services" or construction management errors MERCIAL GENERAL LIABILITY CONDITIONS: or omissions. Duties Of An Additional Insured e. This insurance does not apply to "bodily in- As a condition of coverage provided to the addi- jury" or "property damage"" caused by "your tional insured: work" and included in the "products- completed operations hazard" unless the a. The additional insured must give us written "written contract requiring insurance" specifi- notice as soon as practicable of an "occur- cally requires YOU to provide such coverage rence" or an offense which may result in a for that additional insured, and then the incur- claim. To the extent possible, such notice ance provided to the additional insured ap- should include: CG D4 14 04 08 Oc 2008 The Travelers companies, Inc.. Page 1 of 2 3452: 14 of 1 COMMERCIAL GENERAL LIABILITY L How, when and where the "occurrence" any provider of other insurance which would or offense took place; cover the additional insured for a loss we if. The names and addresses of any injured cover. However, this condition does not affect persons and witnesses; and whether this insurance provided to the addi- III. The nature and location of any injury or tional insured is primary to that other insur- damage arising out of the "occurrence" or ante available to the additional insured which offense. covers that person or organization as a named insured, b. If a claim is made or "suit" is brought against the additional insured, the additional insured 4° The following is added to the DEFINITIONS Sec- must, tion: I. Immediately record the specifics of the "Written contract requiring Insurance" means that claim or"suit" and the date received;and part of any written contract or agreement under It. Notify us as soon as practicable, which you are required to include a person or or- ganization as an additional insured on this Cover- The additional insured must see to it that we age Part, provided that the "bodily injury" and receive written notice of the claim or "suit" as "'property damage" occurs and the "personal in- soon as practicable. jury" is caused by an offense committed: c. The additional insured must immediately send a. After the sighing and eXeCUtion of the contract us copies of all legal papers received in con- or agreement by you, nection with the claim or "suit", cooperate with b. While that part of the contract or agreement is us in the investigation or settlement of the in effect; and claim or defense against the "suit", and oth- erwise comply with all policy conditions. C. Before the end of the policy period. d. The additional insured must tender the de- fense and indemnity of any claim or "suit" to Page 2 of 2 ®r, 2008 Th-Travelers Carnpanies, Inc. CG D4 14 04 08 345"; 15 of I