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CONTRACT COVER SHEET
This is to be completed by the Contract Manager prior to submission
to City Clerks Office. All portions are to be completed.
If you have questions, please contact City Clerk's Office.
Vendor Name: R. F. Duncan & Associates, Inc.
Vendor Number:
JD Edwards Number
Contract Number:
This is assigned by City Clerk's Office
Project Name: S. 224th St. East Lea - Dougherty Propel
Description: ❑ Interlocal Agreement ❑ Change Order ❑ Amendment ® Contract
❑ Other:
Contract Effective Date: 11/22/17 Termination Date: 12/31/17
Contract Renewal Notice (Days):
Number of days required notice for termination or renewal or amendment
Contract Manager: Dee Martindale Department: Engineering
Contract Amount: $500.00
Approval Authority: (CIRCLE ONE) Department Director Mayor City Council
Detail: (i.e. address, location, parcel number, tax id, etc.):
Provide a determination of value for the Dougherty property.
As of: 08/27/14
NT
PROFESSIONAL SERVICES AGREEMENT
between the City of Kent and
R. F. Duncan & Associates, Inc.
THIS AGREEMENT is made between the City of Kent, a Washington municipal corporation
(hereinafter the "City"), and R. F. Duncan & Associates, Inc. organized under the laws of the State of
Washington, located and doing business at PO Box 12300, Olympia, WA 98503, Phone: (360) 951-8258,
Contact: Rich Duncan (hereinafter the "Contractor").
I. DESCRIPTION OF WORK.
Contractor shall perform the following services for the City:
The Contractor shall provide a determination of value for the S. 2241" St. East
Leg - Dougherty property. For a description, see the Contractor's Scope of
Work whichi is attached as Exhibit A and incorporated by this reference.
Contractor further represents that the services furnished under this Agreement will be performed in
accordance with generally accepted professional practices within the Puget Sound region in effect at the
time those services are performed.
II. TIME OF COMPLETION. The parties agree that work will begin on the tasks described in
Section I above immediately upon the effective date of this Agreement, and Contractor shall complete the
work by December 31, 2017.
III. COMPENSATION. The City shall pay Contractor a total amount not to exceed Five
Hundred Dollars ($500.00) for the services described in this Agreement. The Contractor shall invoice the
City monthly based on time and materials incurred during the preceding month. The hourly rates charged
for Contractor's services shall be as delineated in the attached and incorporated Exhibit A. All hourly rates
charged shall remain locked at the negotiated rates throughout the term of this Agreement.
IV. INDEPENDENT CONTRACTOR. The parties intend that an Independent Contractor-
Employer Relationship will be created by this Agreement. By their execution of this Agreement, and in
accordance with Ch. 51.08 RCW, the parties make the following representations:
A„ The Contractor has the ability to control and direct the performance and details of its
work, the City being interested only in the results obtained under this Agreement.
B. The Contractor maintains and pays for its own place of business from which
Contractor's services under this Agreement will be performed.
C. The Contractor has an established and independent business that is eligible for a
business deduction for federal income tax purposes that existed before the City
retained Contractor's services, or the Contractor is engaged in an independently
established trade, occupation, profession, or business of the same nature as that
involved under this Agreement.
D„ The Contractor is responsible for filing as they become due all necessary tax
documents with appropriate federal and state agencies, including the Internal
Revenue Service and the state Department of Revenue.
PROFESSIONAL SERVICES AGREEMENT - 1
($20,000 or Less)
E„ The Contractor has registered its business and established an account with the state
Department of Revenue and other state agencies as may be required by Contractor's
business, and has obtained a Unified Business Identifier (UBI) number from the
State of Washington.
i
F, The Contractor maintains a set of books dedicated to the expenses and earnings of
its business.
V. TERMINATION. Either party may terminate this Agreement, with or without cause, upon
providing the other party seven (7) calendar days written notice at its address set forth on the signature
block of this Agreement.
VI. DISCRIMINATION. In the hiring of employees for the performance of work under this
Agreement or any subcontract, the Contractor, its subcontractors, or any person acting on behalf of the
Contractor or subcontractor shall not discriminate against any person who is qualified and available to
perform the work to which the employment relates as provided for by the City of Kent's Equal
Employment Opportunity Policy. Contractor shall execute the attached City of Kent Equal Employment
Opportunity Policy Declaration, Comply with City Administrative Policy 1.2, and upon completion of the
contract work, file the attached Compliance Statement.
VII. INDEMNIFICATION. Contractor shall defend, indemnify and hold the City, its officers,
officials, employees, agents and volunteers harmless from any and all claims, injuries, damages, losses or
suits, including all legal costs and attorney fees, arising out of or in connection with the Contractor's
performance of this Agreement, except for that portion of the injuries and damages caused by the City's
negligence. The City's inspection or acceptance of any of Contractor's work when completed shall not be
grounds to avoid any of these covenants of indemnification. The provisions of this section shall survive
the expiration or termination of this Agreement.
In the event Contractor refuses tender of defense in any suit or any claim, if that tender was made
pursuant to this indemnification clause, and if that refusal is subsequently determined by a court having
jurisdiction (or other agreed tribunal) to have been a wrongful refusal on the Contractor's part, then
Contractor shall pay all the City's costs for defense, including all reasonable expert witness fees and
reasonable attorneys' fees, plus the City's legal costs and fees incurred because there was a wrongful
refusal on the Contractor's part.
VIII. INSURANCE. The Contractor shall procure and maintain for the duration of the
Agreement, insurance of the types and in the amounts described in Exhibit B attached and incorporated by
this reference.
IX. CONTRACTOR'S WORK AND RISK. The Contractor agrees to comply with all federal,
state, and municipal laws, rules, and regulations that are now effective or in the future become applicable
to Contractor's business, equipment, and personnel engaged in operations covered by this Agreement or
accruing out of the performance of those services. All work shall be done at Contractor's own risk, and
Contractor shall be responsible for any loss of or damage to materials, tools, or other articles used or held
for use in connection with the work.
X. MISCELLANEOUS PROVISIONS.
A. Recyclable Materials. Pursuant to Chapter 3.80 of the Kent City Code, the City requires its
contractors and consultants to use recycled and recyclable products whenever practicable. A price
preference may be available for any designated recycled product.
B. Non-Waiver of Breach. The failure of the City to insist upon strict performance of any of the
covenants and agreements contained in this Agreement, or to exercise any option conferred by this
Agreement in one or more instances shall not be construed to be a waiver or relinquishment of those
covenants, agreements or options, and the same shall be and remain in full force and effect.
PROFESSIONAL SERVICES AGREEMENT - 2
,/$20,000 or Less)
C. Resolution of Disputes and Gpverning Law. This Agreement shall be governed by and
construed in accordance with the laws of the State of Washington. If the parties are unable to settle any
dispute, difference or claim arising from the parties' performance of this Agreement, the exclusive means
of resolving that dispute, difference or claim, shall only be by filing suit exclusively under the venue, rules
and jurisdiction of the King County Superior Court, King County, Washington, unless the parties agree in
writing to an alternative dispute resolution process. In any claim or lawsuit for damages arising from the
parties' performance of this Agreement, each party shall pay all its legal costs and attorney's fees incurred
in defending or bringing such claim or lawsuit, including all appeals, in addition to any other recovery or
award provided by law; pLo%tlded, however, nothing in this paragraph shall be construed to limit the City's
right to indemnification under Section VII of this Agreement.
D. Written Notice. All communications regarding this Agreement shall be sent to the parties at
l the addresses listed on the signature page of the Agreement, unless notified to the contrary. Any written
notice hereunder shall become effective three (3) business days after the date of mailing by registered or
certified mail, and shall be deemed sufficiently given if sent to the addressee at the address stated in this
Agreement or such other address as may be hereafter specified in writing.
E. Assignmenk. Any assignment of this Agreement by either party without the written consent
of the non-assigning party shall be void.
F. Modification. No waiver, alteration, or modification of any of the provisions of this
Agreement shall be binding unless in writing and signed by a duly authorized representative of the City
and Contractor.
G. Entire Agreement. The written provisions and terms of this Agreement, together with any
Exhibits attached hereto, shall supersede all prior verbal statements of any officer or other representative
of the City, and such statements shall not be effective or be construed as entering into or forming a part
of or altering in any manner this Agreement. Should any language in any of the exhibits to this
Agreement conflict with any language contained in this Agreement, the terms of this Agreement shall
prevail.
H. Public Records Act. The Contractor acknowledges that the City is a public agency subject to
the Public Records Act codified in Chapter 42.56 of the Revised Code of Washington and documents,
notes, emails, and other records prepared or gathered by the Contractor in its performance of this
Agreement may be subject to public review and disclosure, even if those records are not produced to or
possessed by the City of Kent, As such, the Contractor agrees to cooperate fully with the City in satisfying
the City's duties and obligations under the Public Records Act.
I. City Business License Required. Prior to commencing the tasks described in Section I,
Contractor agrees to provide proof of a current city of Kent business license pursuant to Chapter 5.01 of
the Kent City Code.
PROFESSIONAL SERVICES AGREEMENT - 3
($20,000 or Less)
J. Counterparts and Signatures by Fax or _Emawil. This Agreement may be executed in any
number of counterparts, each of which shall constitute an original, and all of which will together constitute
this one Agreement. Further, upon executing this Agreement, either party may deliver the signature page
to the other by fax or email and that signature shall have the same force and effect as if the Agreement
bearing the original signature was received in person.
IN WITNESS, the parties below execute this Agreement, which shall become effective on
the last date entered below. All acts consistent with the authority of this Agreement and prior
I
to its effective date are ratified and affirmed, and the terms of the Agreement shall be deemed
to have applied.
.—
CONTRACTOR CITY F KENT:
srgfa l��re) "°'� (signature)
f
Print Name. Print Name: Carla Maloney, P.E.
Its: aLt + • .''' Its: pNu puDesign Engineering Manager
DATE: �N DATE: � d
�....._ ..... .............�....__. __..m..
NOTICES TO BE SENT TO: NOTICES TO BE SENT TO:
CONTRACTOR: CITY OF KENT:
Rich Duncan Timothy J. LaPorte, P.E.
R. F. Duncan & Associates, Inc. City of Kent
PO Box 12300 220 Fourth Avenue South
Olympia, WA 98503 Kent, WA 98032
(360) 951-8258 (telephone) (253) 856-5500 (telephone)
(253) 856-6500 (facsimile)
PROFESSIONAL SERVICES AGREEMENT - 4
($20,000 or Less)
DECLARATION
CITY OF KENT EQUAL EMPLOYMENT OPPORTUNITY POLICY
The City of Kent is committed to conform to Federal and State laws regarding equal opportunity.
As such all contractors, subcontractors and suppliers who perform work with relation to this
Agreement shall comply with the regulations of the City's equal employment opportunity
policies.
The following questions specifically identify the requirements the City deems necessary for any
contractor, subcontractor or supplier on this specific Agreement to adhere to. An affirmative
response is required on all of the following questions for this Agreement to be valid and binding.
If any contractor, subcontractor or supplier willfully misrepresents themselves with regard to the
directives outlines, it will be considered a breach of contract and it will be at the City's sole
determination regarding suspension or termination for all or part of the Agreement;
The questions are as follows:
1. I have read the attached City of Kent administrative policy number 1.2.
2, During the time of this Agreement I will not discriminate in employment on the basis of
sex, race, color, national origin, age, or the presence of all sensory, mental or physical
disability.
1 During the time of this Agreement the prime contractor will provide a written statement to
all new employees and subcontractors indicating commitment as an equal opportunity
employer.
4. During the time of the Agreement I, the prime contractor, will actively consider hiring and
promotion of women and minorities.
5, Before acceptance of this Agreement, an adherence statement will be signed by me, the
Prime Contractor, that the Prime Contractor complied with the requirements as set forth
above.
By signing below, I agree to fulfill the five requirements referenced above.
Dated this . day of E'�� �a 1. , 20 .�
By:
For: ..�(� ` GJ .ti ,-. .�.,.
Title:
Date: �,....-,
EEO COMPLIANCE DOCUMENTS - 1
CITY OF KENT
ADMINISTRATIVE POLICY
NUMBER: 1.2 EFFECTIVE DATE: January 1, 1998
SUBJECT: MINORITY AND WOMEN SUPERSEDES: April 1, 1996
CONTRACTORS APPROVED BY Jim White, Mayor
POLICY:
Equal employment opportunity requirements for the City of Kent will conform to federal and
state laws. All contractors, subcontractors, consultants and suppliers of the City must guarantee
equal employment opportunity within their organization and, if holding Agreements with the City
amounting to $10,000 or more within any given year, must take the following affirmative steps:
1. Provide a written statement to all new employees and subcontractors indicating
commitment as an equal opportunity employer.
2. Actively consider for promotion and advancement available minorities and women.
Any contractor, subcontractor, consultant or supplier who willfully disregards the City's
nondiscrimination and equal opportunity requirements shall be considered in breach of contract
and subject to suspension or termination for all or part of the Agreement.
Contract Compliance Officers will be appointed by the Directors of Planning, Parks, and Public
Works Departments to assume the following duties for their respective departments.
1. Ensuring that contractors, subcontractors, consultants, and suppliers subject to these
regulations are familiar with the regulations and the City's equal employment opportunity
policy.
2. Monitoring to assure adherence to federal, state and local laws, policies and guidelines.
EEO COMPLIANCE DOCUMENTS - 2
CITY OF KENT
EQUAL EMPLOYMENT OPPORTUNITY COMPLIANCE STATEMENT
This form shall be filled out AFTER COMPLETION of this project by the Contractor awarded the
Agreement.
I, the undersigned, a duly represented agent of
Company, hereby acknowledge and declare that the before-mentioned company was the prime
contractor for the Agreement known as that was entered into on
the (date), between the firm I represent and the City of
Kent.
I declare that I complied fully with all of the requirements and obligations as outlined in the City
of Kent Administrative Policy 1.2 and the Declaration City of Kent Equal Employment Opportunity
Policy that was part of the before-mentioned Agreement.
Dated this day of v_ 20_,
By:
For:
Title:
Date:
EEO COMPLIANCE DOCUMENTS - 3
EXHIBIT A
Martindale, Delores
From: Richard Duncan <Duncanappraisal@comcast.net>
Sent: Monday, November 06, 2017 12:20 PM
To: Martindale, Delores
Subject: RE: DV ? regarding 224th East Leg Ph II/Dougherty property
Hi Dee: Yes I can do this. It it was just the land, I could do it in a couple of days with minimal cost maybe about an hour
r of my time. However, this revision will require a site visit to ascertain how many additional trees and other site
improvements may be impacted unless the city has that information-which would preclude me from having to drive up
there and count the trees.-Given my present workload, if a site visit is required, this may take me about 7-8 days to
complete.The fee would be $500(4 hours at$125/hour). Thanks Rich
From: Martindale, Delores [nlailterDMartbrdaieffkeritwlrovj
Sent: Monday, November 6,2017 11:19 AM
To: 'Richard Duncan'e rr7cyrrapkpra'VSaV ntcomT.r7t>
Cc: Martindale, Delores<DMartlndalet"@kentwa.I:ov>;Anderson, Philip<PRAnderson+ kentwa,rzov>; Novak, Michelle
<M Nova&[akenkwa.gov>
Subject: DV? regarding 224th East Leg Ph II/Dougherty property
Rich,
Based on the attached legal description and map, are you able to do a DV for the 'changes' made to the previous review
(6-24-17) done for the Dougherty Property?
We changed the amount of square footage for both the fee take and the TCE.
Thank you
Dee
pre
1
EXHIBIT B
INSURANCE REQUIREMENTS FOR
CONSULTANT SERVICES AGREEMENTS
Insurance
The Consultant shall procure and maintain for the duration of the Agreement,
insurance against claims for injuries to persons or damage to property which
may arise from or in connection with the performance of the work hereunder
by the Consultant, their agents, representatives, employees or
subcontractors.
A. Minimum Scope of Insurance
Consultant shall obtain insurance of the types described below:
1. Automobile Liability insurance covering all owned, non-owned,
hired and leased vehicles. Coverage shall be written on Insurance
Services Office (ISO) form CA 00 01 or a substitute form providing
equivalent liability coverage. If necessary, the policy shall be
endorsed to provide contractual liability coverage.
2. Commercial, General Lia ility insurance shall be written on ISO
occurrence form CG 00 01 and shall cover liability arising from
premises, operations, independent contractors, products-completed
operations, personal injury and advertising injury, and liability
assumed under an insured contract. The City shall be named as an
insured under the Consultant's Commercial General Liability
insurance policy with respect to the work performed for the City
using ISO additional insured endorsement CG 20 10 11 85 or a
substitute endorsement providing equivalent coverage.
3. Workers' Compensation coverage as required by the Industrial
Insurance laws of the State of Washington.
4. Professional Liability insurance appropriate to the Consultant's
profession.
B. Minimum Amounts of Insurance
Consultant shall maintain the following insurance limits:
1. Automobile Liabili insurance with a minimum combined single
limit for bodily injury and property damage of $1,000,000 per
accident.
2. Commercial General Liabilitv insurance shall be written with limits
no less than $1,000,g00 each occurrence, $2,000,000 general
aggregate and a $1,000,000 products-completed operations
aggregate limit.
EXHIBIT B (Continued)
3. Professional Liability insurance shall be written with limits no less
than $1,000,000 per claim and $1,000,000 policy aggregate limit.
C. Other Insurance Provisions
The insurance policies are to contain, or be endorsed to contain, the following
provisions for Automobile Liability and Commercial General Liability
insurance:
1. The Consultant's insurance coverage shall be primary insurance as
respect the City. Any Insurance, self-insurance, or insurance pool
coverage maintained by the City shall be excess of the Consultant's
insurance and shall not contribute with it.
2. The Consultant's insurance shall be endorsed to state that coverage
shall not be cancelled by either party, except after thirty (30) days
prior written notice by certified mail, return receipt requested, has
been given to the City.
3. The City of Kent shall be named as an additional insured on all
policies (except Professional Liability) as respects work performed
by or on behalf of the Consultant and a copy of the endorsement
naming the City as additional insured shall be attached to the
Certificate of Insurance. The City reserves the right to receive a
certified copy of all required insurance policies. The Consultant's
Commercial General Liability insurance shall also contain a clause
stating that coverage shall apply separately to each insured against
whom claim is made or suit is brought, except with respects to the
limits of the insurer's liability.
D. Acceptability of Insurers
Insurance is to be placed with insurers with a current A.M. Best rating of not
less than ANII.
E. Verification of Coverage
Consultant shall furnish the City with original certificates and a copy of the
amendatory endorsements, including but not necessarily limited to the
additional insured endorsement, evidencing the insurance requirements of
the Contractor before commencement of the work.
F. Subcontractors
Consultant shall include all subcontractors as insureds under its policies or
shall furnish separate certificates and endorsements for each subcontractor.
All coverages for subcontractors shall be subject to all of the same insurance
requirements as stated herein for the Consultant.
Ac e CERTIFICATE OF LIABILITY INSURANCE BA"'MMIDDY"Y'
1011612017
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 AFFORUED BY THE POLICIES
BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(5),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 terme and conditions of the policy,certain policies may require an endorsement A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement s
PRODUCER PI lamas Provencher
Duncan 6 Associates Insurance Brokers p"�N°^',p,Ero _360-352 7586 yAy rt 1 360r443.690a
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P.O. Box 1458 •2111 Harrison Ave NW -nBoaeag�; „�DmnYse uncanlns.Bom
Olympia, WA 98502 .... - - --,,.—..... nAlce
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R. F.Duncan&Associates,Inc NauRER e:
P O Box 12300 rzasull�R o, .....,. _-.. ........ . .-. ..,, ._......._.
Olympia, WA 98508
M SUREA F
COVERAGES CERTIFICATE NUMBER: 00000000-54201 REVISION(NUMBER: 7
THIS IS TO CERTIFY'THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEO 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 15 SUBJECT TO ALL THE TERMS,
EXCLUSIONS AIN CO._NDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
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DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 191,AddSlo,Ml RerMHle SchxduN,m F BS aaAanSd a mon apace ie n,Ired)
RE:AII projects under contract between Insured and certificate holder
City of Kent is named as an addidoinal insured in regard to the General Liability coverages above per form CG 88 10 04 13
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE
THE TION DATE THEREF,NOTICE WILL
City Of Kent ACCORDANCE WITH THE POLICY PROVISIONS. BE DELIVERED IN
400 West Gowe
EO REPRESENTATM12
Kent,WA 98032 Au � IDEP)
01988.2015 ACORD CORPORATION. All rights reserved.
ACORD 26(2016103) The ACORD name and logo are registered marks of ACORD
Printed by DEP on October 16,2017 at 03'.33PM
Liaerty MAR i 2018
BaBURAMCM
BY: .......................
Policy Number: BLS 56696377 Prior Polley: NOT AVAILABLE
Coverage is Provided In The OWo Security Insurance Company _..
Btllln c. I3iract Bali �,_.__,.m__—
Named Insured and Mulling Address: Agent:
R F DUNCAN & ASSOCIATES, INC DUNCAN &ASSOCIATES INC
PO BOX 12300 PO BOX 1458
OLYMPIA, WA 98508 OLYMPIA,WA 98507-1458
Agent Cade: 466104
Agent Phane: (360)352-7588
Policy Declarations, Forms and Endorsements
This page intentionally left blank.
I
46 6104
BLS
56696377 DUNCAN&ASSOCIATES INC
05/08/2017
PO Box 1458
OLYMIPIA, WA 98507-1458
Nrinlnl'�rhl,ll„J„JIIML,I,1IdJ� I
We strive to produce a quality product for our agents to deliver to the policyholder. In doing so,
we ask that you assist us by taking time to review the enclosed policy accuracy, If there are any
modifications that need to be made, we request that you return this letter to the Business Center
cuffirung what is io error,
Named Insured: R P DUNCAN & ASSOCIATES, INC
Corrections needed to be made on this policy(This form is not for routine change requests):
Thank you for your assistance.
Please send to: Liberty Mutual Insurance
ATTENTION%C.S.I. UNIT
cnu:
NONE
This page intentionally left blank.
wk=.
Policyholder Information
- e
Named Insured&Nulling Address Agent Melling Address&PYone Na.
R F DUNCAN&ASSOCIATES, INC (360) 352-7588
PO BOX 12300 DUNCAN&ASSOCIATES INC
OLYMPIA, WA 98508 Po BOX 1458
OLYMPIA, WA 98507-1458
Dear Policyholder:
We know you work hard to build your business. We work together with your agent,
DUNCAN& ASSOCIATES INC (360) 352.7588
to help protect the things you care about. Thank you for selecting us.
Enclosed are your Insurance documents consisting of:
• General Liability
To find your specific coverages, limits of liability, and premium, please refer to your
Declarations page(s).
If you have any questions or changes that may affect your insurance needs, please
contact your Agent at(360) 352-7588
U Verify that all information is correct
If you have any changes, please contact your
Agent at(360) 352-7588
Reminders In case of a claim, call your Agent or I-800-362-0000
You Need To Know
CONTINUED ON NEXT PAGE
To rspad a claft call yoerApeaf or 1-800-302-aw
DS 70 20 0108
You Need To Know - continued
. NOTICE(S)TO POLICYHOLDER(S)
The Important Notice(s) to Policyholder(s)provide a general explanation of changes in coverage to your policy, The
Important Notice(s) to Polleyholder(s) is not a part of your insurance policy and it does not alter policy provisions or
conditions, Only the provisions of your policy determine the scope of your insurance protection. It is important that you
read your policy carefully to determine your rights, duties and what is and is not covered,
FORM NUMBER TITLE
NP 72 42 Ol 15 Terrorism Insurance Premium Disclosure And Opportunity To Reject
NP 74 44 09 06 U.S. Treasury Department's Office of Foreign Assets Control(OFAC) Advisory
Notice to Policyholders
NP 74 50 O1 07 Important Audit Information
NP 89 7109 10 Important Policyholder Information Concerning Billing Practices Liberty
Northwest
NP 96 00 10 14 General Liability Access Or Disclosure Of Confidential Or Personal Information
]exclusions Advisory Notice To Policyholders
This policy will be direct billed. You may choose to combine any number of policies on one bill with your billing
account, Please contact your agent for more information.
I
03/14/16
R F DUNCAN b ASSOCIATES, INC OLS (17) 56 69 63 77
From 05/08/2016 To 05/08/2017
PO BOX 12300
OLYMPIA. WA 98508
(360) 352-7588
DUNCAN 6 ASSOCIATES INC
Po Box 1458
OLYMPIA, WA 98507-145B
jEfIRORISM INSURANCE PREMIUM DISCLiBUFE
AND OPPORTUNITY TO REJECT
This notice contains important information about the Terrorism Risk Insurance Act and its effect on your
policy. Please read it carefully.
THE 19HROISM 13159 INWHANC9T
The Terrorism Risk Insurance Act, including all amendments("TRIA" or the "Act"),establishes a program
to spread the risk of catastrophic losses from certain acts of terrorism between Insurers and the federal
government. If an Individual Insurer's losses from certified acts of terrorism exceed a specified deductible
amount,the government will reimburse the insurer for a percentage of losses(the "Federal Share") paid In
excess of the deductible, but only if aggregate Industry losses from such acts exceed the "Program Trig-
ger". An insurer that has met Its Insurer deductible Is not liable for any portion of losses In excess of$100
billion per year. Similarly,the federal government is not liable for any losses covered by the Act that exceed
this amount. If aggregate Insured losses exceed$100 billion,losses up to that amount may be pro-rated,as
determined bythe Secretary of the Treasury.
The Federal Share and Program Trigger by calendar year are:
Calendar Year Federal Share Program Trigger
2016 86% $100,000,000
2016 84% $120,000,000
2017 83% $140,000,000
2018 62% $160,000,000
2019 81% $160,000,000
2020 80% $200,000,000
MANDATORY Qffffli GE COVERAGE "CERTIFIED A " AND D
PRE-
MIUM
TRIA requires Insurers to make coverage available for any loss that occurs within the United States (or
outside of the U.S. In the case of U.S. missions and certain air carriers and vessels), results from a "certified
act of terrorism"AND that Is otherwise covered under your policy.
A"certified art of terrorism" means:
[Alny act that Is certified by the Secretary [of the Treasury] , In consultation with the Secretary of
Homeland Security,and the Attorney General of the United States.
(1) to bean act of terrorism;
NP 72 42 01 15 0 205 Liberty Mutual Insurance Page 1 of 2
(ii) to be a violent actor an act that Is dangerous to-
(q human life;
(II) property; or
(III) infrastructure;
(ill) to have resulted In damage within the United States,or outside of the United States In the case of-
(1) an air carrier(as defined in section 40102 of title 49, United States Code) or United States flag
vessel (or a vessel based principally In the United States,on which United States Income tax Is
paid and whose Insurance coverage is subject to regulation in the United States);or
(II) the premises of a United States mission; and
(iv) to have been committed by an Individual or Individuals as part of an effort to coerce the civilian
population of the United States or to influence the policy or affect the conduct of the United States
Government by coercion.
REJECTINO TEAAOAISNI tN&URANCE COVERAGE-WHAT YO()MUST OO
We have included In your policy coverage for losses resulting from "certified acts of terrorism" as defined
above.
THE PREMIUM CHARGE FOR THIS COVERAGE APPEARS ON THE DECLARATIONS PAGE OF THE POLICY
AND DOES NOT INCLUDE ANY CHARGES FOR THE PORTION OF LOSS COVERED BY THE FEDERAL GOV-
ERNMENT UNDER THE ACT. If we are providing you with a quote,the premium charge will also appear on
your quote as a separate line item charge.
IF YOU CHOOSE TO REJECT THIS COVERAGE, PLEASE CHECK THE BOX BELOW, SIGN THE ACKNOWL-
EDGMENT, AND RETURN THIS FORM TO THE ADDRESS BELOW: Please ensure any reieotien is reoelved
within thirty 130)days of the effective date Qf your poll"
Before making a decision to reject terrorism Insurance, refer to the Disclaimer for Standard Fire Policy
States located at the end of this Notice,
❑ I hereby reject this offer of coverage. I understand that by rejecting this offer,I will have no coverage for
losses arising from "certified acts of terrorism"and my policy will be endorsed accordingly.
Policyholder/Applicant's Signature Print Name Date Signed
Named Insured Policy Number
R F DUNCAN b ASSOCIATES, INC BLS (17) 56 69 63 77
Policy Effective/Expiration Date
From 05/08/2016 To 05/08/2017
IF YOU REJECTED THIS COVERAGE,PLEASE RETURN THIS FORM T0:
Attn: Commercial Lines Division-Terrorism
PO Box 66400
London,KY 40742-6400
Note: Certain states (currently CA, GA, IA, IL, ME, MO, NY, NC, NJ, OR, RI, WA, WI and WV) mandate
coverage for loss caused byfire following a "certified act of terrorism" In certain types of Insurance policies.
If you reject TRIA coverage in these states on those policies, you will not be charged any additional
premium for that state mandated coverage.
The summary of the Act and the coverage under your policy contained In this notice is necessarily general
In nature. Your policy contains specific terms, definitions, exclusions and conditions. In case of any
conflict,your policy language will control the resolution of all coverage questions.Please read your policy
carefully.
If you have any questions regarding this notice,please contectyour agent.
NP 72 42 01 15 0 2015 Liberty Mutual Insurance Page 2 of 2
NP 74 44 09 0e
U.S. TREASURY DEPARTMENT'S OFFICE OF FOREIGN
ASSETS CONTROL ("OFAC")
ADVISORY NOTICE TO POLICYHOLDERS
No coverage Is provided by this Policyholder Notice nor can It be construed to replace any provisions of
your policy„You should read your policy and review your Declarations page for complete Information on the
coverages you are provided.
This Notice provides Information concerning possible Impact on your Insurance coverage due to directives
Issued by OFAC.Please road this Notice carefully.
Please refer any questions you may have to your Insurance agent.
The Office of Foreign Assets Control (OFAC) administers and enforces sanctions policy, based on Presiden-
tial declarations of"national emergency".OFAC has Identified and listed numerous:
• Foreign agents;
a Front organizations;
• Terrorists;
• Terrorist organizations; and
• Narcotics traffickers;
as "Specially Designated Nationals and Blocked Persons". This list can be located on the United States
Treasury's web site-http//www.treas.gov/ofac,
In accordance with OFAC regulations, If It is determined that you or any other Insured, or any person or
entity claiming the benefits of this Insurance has violated U,S. sanctions law or Is a Specially Designated
National and Blocked Person, as Identified by OFAC, this Insurance will be considered a blocked or frozen
contract and all provisions of this Insurance are Immediately subject to OFAC. When an Insurance policy Is
considered to be such a blocked or frozen contract, no payments nor premium refunds may be made
without authorization from OFAC.Other limitations on the premiums and payments also apply.
® 2011 Uberty Mutual Insurance.All rights reserved.
NP 74 44 09 06 Includes copyrighted material of Insurance Services office,Ina,with Its permission. Page 1 011
NP 74 50 0107
Important Notice
Notice to Policyholders
This explanation is not a part of your insurance policy, and It does not alter any of Its provisions or
conditions,
Please refer any questions you may have to your Insurance agent.
We would like to thank you for being a policyholder.We appreciate your business.
If your policy contains a condition stating It Is subject to a premium audit we would like to take this
opportunity to explain how the audit process works and answer the most common questions we receive
from our policyholders.The Information In this notice will make it easier for you to prepare for your audit.
Insurance Premium Audit Facts
Audits can benefit our policyholders by allowing us to collect the appropriate amount of premium for each
policy.
Most commercial policies are written based on estimated or fluctuating exposure bases.At the end of the
policy term an audit will determine the actual exposure bases and the premium will be adjusted accord-
Ingly.A company representative will conduct the audit.
The premium auditor will examine and audit records that relate to your policy, The records necessary to
complete the audit will vary, based on the coverages you have. Types of records that may be requested for
your audit Include,but are not limited to:
• Payroll Records,Including 941 forms
• Sales Journals or Income statements
• General Ledger
• Cash Disbursements Journal
• , Subcontractor Certificates
Keepin6 accurate and complete records will allow the auditor to properly classify and allocate your expo-
sures correctly, Often there are allowable credits available according to insurance manual classification and
rating rules. The premium auditor will be able to give you the credits, to which you are entitled, if your
records provide the necessary details. Providing the records your auditor needs can save you time and
money as well as expedite the audit process.
How Audits are Conducted
Audits are handled In different ways, depending on the types of coverages you may have. We conduct
audits In the following ways:
Physical Audit - An auditor will contact you and set up a convenient time to personally come to your
business and review your records.
Phone Audit -Forms will be mailed to you, explaining what is necessary to complete a phone audit. The
phone auditor will contact you or your bookkeeper for this Information.
Voluntary Audit- Forms will be mailed to you for completion. We will provide you with contact Information
if you need assistance in completing the forms.
NP 74 50 0107
Completing the audit
Many states have enacted legislation that governs the time In which an audit must be completed, billed and
paid. This applies to audits for cancelled policies as well as regular audits. In order to comply with state
regulations, It Is Important to make your records available for audit when our representative contacts you.
We will make every effort to complete the audit within a reasonable time after the close of the policy period
stated In your policy.
Frequently Asked Questions
Q:What If 1 use subcontractors?
A: Subcontractors are factored In to the audit process. Subcontractors who do not have insurance are
treated as though they are your employees at the time of the audit. If your subcontractor furnishes you with
a certificate of Iiability or workers' compensation Insurance, your Insurance cost for that subcontractor
could be less. See your policy for details on limits of insurance required for certificates.
0:1 have no employees and work alone.Does the insurance company still need to complete an audit?
A: Yes, The auditor will need to verify you worked alone by examining business records that may Include
tax filings,disbursements,and check stubs.
Q:Do I need an audit if I have cancelled my policy or am no longer Insured with you?
A: An audit may still be necessary even If you no longer have an active policy with us. The audit would
cover the time period for which you were Insured by us. Other factors that may determine if an audit Is
necessary include the time the policy was In effect and the amount of premium Involved.
Q: If I use leased employees but the leasing company carries the liability, are the leased employees
excluded from my General Liability policy?
A: No.The manual rules stipulate that all leased employees are covered on the Insured's policy.
Q:Is it necessary to keep records on any casual labor 1 use?
A: Yes. Casual labor payroll Is examined during the audit.
Q:What happens if I do not comply with the audit and fail to provide all necessary records and verifica-
tion?
A: It's important to provide the necessary Information In order to complete the audit. If you fall to do so,
your policy may be cancelled or nonrenewed.You may also receive an estimated audit statement based on
Increased policy exposure estimates due to non-compliance of audit.
If you would like additional Information about the policy audit process, your Independent agent can assist
you. The Premium Audit Department Is also available to answer any questions you may have regarding this
process.
Please contact us at 1-888-224-9246 or via E-mall at PremiumAuditSorvlces@llbertymutuaI.com
N P 74 50 01 07
NP89710910
I
IMPORTANT POLICYHOLDER INFORMATION
CONCERNING BILLING PRACTICES
Dear Valued Policyholder: This Insert provides you with important Information about our policy billing
practices that may effect you.Please review it carefully end contact your agent If you have any questions.
l Premium Notice: We will mail you a policy Premium Notice separately. The Premium Notice will provide
you with specifics regarding your agent, the account and policy billed,the billing company, payment plan,
policy number,transaction dates,description of transactions,charges/credits,policy amount balance, minl-
mum amount, and payment due date. This insert explains fees that may apply to and be shown on your
Premium Notice,
Available Premium Payment Plana:
• Annual Payment Plan: When this plan applies, you have elected to pay the entire premium amount
balance shown on your Premium Notice In full. No Installment billing fee applies when the Annual
Payment Plan applies.
e Installment Payment Plan: When this plan applies, you have elected to pay your policy premium In
Installments (e.g.: quarterly or monthly Installments - Installment Payment Plans vary by state). As
noted below,an Installment fee may apply when the Installment Payment Plan applies.
The Premium Payment Plan that applies to your policy is shown on the top of your Premium Notice, Please
contact your agent if you want to change your Payment Plan election.
Installment Payment Plan Fee: If you elected to pay your premiums In installments using the Installment
Premium Payment Plan, an Installment billing fee applies to each installment bill. The installment billing
charge will not apply, however, if you pay the entire balance due when you receive the bill for the first
Installment. Because the amount of the Installment charge varies from state to state, please consult your
Premium Notice for the actual fee that applies.
Dishonored Payment Fee: Your financial Institution may refuse to honor the premium payment withdrawal
request you submit to us due to Insufficient funds in your account or for some other reason. If that is the
case, and your premium payment withdrawal request Is returned to us dishonored, a payment return fee
will apply. Because the amount of the return fee varies from state to state, please consult your Premium
Notice for the actual fee that applies.
Late Payment Fee:If we do not receive the minimum amount due on or before the date or time the payment
Is due, as Indicated on your Premium Notice, you will receive a policy cancellation notice effective at a
future date that will also reflect a late payment fee charge. Issuance of the cancellation notice due to
non-payment of a scheduled Installment(s) may result in the billing and collection of all or part of any
outstanding premiums due for the policy period. Late Payment Fees vary from state to state and are not
applicable in some states.
Special Note: Please note that some states do not permit the charging of certain fees, Therefore, if your
state does not allow the charging of an Installment Payment Plan, Dishonored Payment or Late Payment
Fee,the disallowed fee will not be charged and will not he included on your Premium Notice.
EFT-Automatic Withdrawals Payment Option: When you select this option,you will not be sent Premium
Notices and, in most cases, will not be charged Installment fees. For more information on our EFT-Auto-
matic Withdrawals payment option,refer to the attached policyholder plan notice and enrollment sheet.
Once again, please contact your agent if you have any questions about the above billing practice informa-
tion.
Thank you for selecting us to service your insurance needs.
NP 89 7109 10 0 2010 Liberty Mutual Insuranos Company.All rights reserved. Page 1 of 1
NP 96 00 10 14
I
GENERAL LIABILITY ACCESS OR DISCLOSURE OF
CONFIDENTIAL OR PERSONAL INFORMATION
EXCLUSIONS
ADVISORY NOTICE TO POLICYHOLDERS
Dear Valued Policyholder,
Thank you for selecting us as your carrier for your commercial insurance. Your renewal policy contains an
exclusion regarding access or disclosure of personal Information. There to more them one version of the
exclusion and each Is described below, Please note that mot ali of the forms or changes noted may apply to
your specific policy.Any of the forms described In this notice may have comparable state specific forms in
lieu of the forms mentioned below. In those situations, the title of the state forms on your policy will
generally be very similar to one or more titles mentioned In this notice.
The changes described below would also apply to those state Specific forms, unless noted otherwise. In
addition, this notice does not reference every change made to the endorsements or coverage forms, only
material(or significant)changes.
Please read your policy and review your declarations page for complete coverage information.No coverage
is provided by this notice, nor can It be construed to reptace any provisions of your policy. If there are
discrepancies between your policy and this notice, the provisions of the policy shall prevail. Should you
have tluesllons after reviewing the changes outlined below, please contact your broker or agent.Thank you
for your business.
With respect to bodily Injury and property damage arising out of access or disclosure of confidential or
personal Information, these changes are a reinforcement of coverage Intent. Damages related to data
breaches, and certain data-related liability, are not Intended to be covered by various liability coverage
parts. These types of damages may be more appropriately covered under certain coverage endorsements
providing data compromise,attack and extortion and network security liability.
CG 2106 0514-Exclusion-Access Or Disclosure Of Confidential Or Personal Information And Data-related
Liability-With Limited Bodily Injury Exception (For Use With The Commercial General Liability Coverage
Part)
When this endorsement Is attached to your policy:
• Under Coverage A-Bodily Injury And Property Damage Liability,coverage Is excluded for damages
arising out of any access to or disclosure of confidential or personal Information.This Is a reinforce-
ment of coverage.
• Under Coverage 8-Personal And Advertising Injury Liability,coverage is excluded for personal and
advartising Injury arising out of any access to or disclosure of confidential'or personal Information.
To the extent that any access or disclosure of confidential or personal Information results In an oral
or written publication that violates a person's right of privacy, this may result In a reduction In
coverage.
CG 2107 05 14-Exclusion-Access Or Disclosure Of Confidential Or Personal Information And Data-related
Liability - Limited Bodily Injury Exception Not Included (For Use With The Commercial General Liability
Coverage Part)
When this endorsement Is attached to your policy:
as Under Coverage A-Bodily Injury And Property Damage Liability,coverage is excluded for damages
arising out of any access to or disclosure of confidential or personal Information.This Is a reinforce-
ment of coverage. However, when this endorsement Is attached, It will result In a reduction of
coverage due to the deletion of an exception with respect to damages because of bodily Injury
arising out of loss of, loss of use of, damage to, corruption of, Inability to access, or Inability to
manipulate electronic data.
0 20141.Iberty Mutual Insurance
NP 95 00 10 14 Includes copyrighted ma orisI of Insure nos Soryloom Office,Inc.,with its perm[solon. Page 1 of 2
• Under Coverage B-Personal And Advertising Injury Liablllty,coverage Is excluded for personal and
advertising Injury arising out of any access to or disclosure of confidential or personal Information.
To the extent that any access or disclosure of confidential or personal Information results in an oral
or written publication that violates a person's right of privacy, this may result In a reduction In
coverage.
CG 21 08 05 14 - Exclusion - Access Or Disclosure Of Confidential Or Personal Information (Coverage B
Only)(For Use With The Commercial General Liability Coverage Part)
When this endorsement Is attached to your policy,coverage Is excluded for personal and advertising Injury
arising out of any access to or disclosure of confidential or personal information. To the extent that any
access or disclosure of confidential or personal Information results In an oral or written publication that
violates a person's right of privacy,this may result In a reduction in coverage.
CG 04 37 05 14-Electronic Data Liability(For Use With The Commercial General Liability Coverage Part)
With respect to damages arising out of access or disclosure of confidential or personal Information,when
this endorsement is attached to your policy:
♦ Under Coverage A- Bodily Injury And Property Damage Liability,coverage Is excluded for damages
arising out of any access to or disclosure of confidential or personal information.This Is a reinforce-
ment of coverage.
• Under Coverage B-Personal And Advertising Injury Liability,coverage Is excluded for personal and
advertising Injury arising out of any access to or disclosure of confidential or personal Information.
To the extent that any access or disclosure of confidential or personal Information results In an oral
or written publication that violates a person's right of privacy, this may result In a reduction In
coverage.
CG 33 53 05 14-Exclusion-Access Or Disclosure Of Confidential Or Personal Information And Data-related
Liability - With Limited Bodily Injury Exception (For Use With The Owners And Contractors Protective
Liability Coverage Part and Products/Completed Operations Coverage Part)
When this endorsement Is attached to your policy, coverage Is excluded for damages arising out of any
access to or disclosure of confldentlal or personal Information.This Is a reinforcement of coverage.
CG 33 59 05 14-Exclusion-Access Or Disclosure Of Confidential Or Personal Information And Data-related
Liability-Limited Bodily Injury Exception Not Included (For Use With The Owners And Contractors Protec-
tive Liability and Products/Completed Operations Liability Coverage Parts)
When this endorsement Is attached to your policy, coverage Is excluded for damages arising out of any
access to or disclosure of confidential or personal information.This Is a reinforcement of coverage.
However, when this endorsement is attached,it will result In a reduction of coverage due to the deletion of
an exception with respect to damages because of bodily injury arising out of loss of, loss of use of,damage
to,corruption of,Inability to access,or inabllltyto manipulate electronicdata.
CG 33 83 05 14-Exclusion-Access,Disclosure Or Unauthorized Use Of Electronic Data(For Use With The
Electronic Data Liability Coverage Part)
With respect to damages arising out of access or disclosure of confidential or personal information, when
this endorsement Is attached to your policy coverage is excluded for damages arising out of any access to or
disclosure of confidential or personal Information.This Is a relnforcementof coverage.
However,to the extent that damages arising out of theft or unauthorized viewing,copying, use,corruption,
manipulation or deletion, of electronic data by any Named Insured, past or present employee, temporary
worker or volunteer worker of the Named Insured may extend beyond loss of electronic data arising out of
such theft or the other listed Items,this revision may be considered a reduction In coverage.
® 2014 Liberty Mutual Insurance
NP 96 00 10 14 Includes copyrighted material of Insurance Services O(aae,Ina„with its permission. Page 2 of 2
'ov Coverage Is Provided In: Palicy Number:
Ohio SecurlryInsurance Company BLS (11
1 go696377
= Policy Period:
faeuRAnce Fran OSM016 To 0111114 011
Common Policy Declarations 12::01 am Standard Time
at Insured MallIng Locatlon
Rained Insured&Maillne Address Agent Meiling Address I Phone No.
R F DUNCAN & ASSOCIATES, INC (360)352-7588
PO BOX 12300 DUNCAN&ASSOCIATES INC
OLYMPIA, WA 98508 PO BOX 1458
OLYMPIA,WA 98507-1458
Named Insured Is:CORPORATION
Named Insured Business Is: REAL ESTATE APPRAISER
Li return far the payment of tie premium, and subject to at the ternu of this policy, we agree wifft you to
provide the innounce as stated in this policy.
SUMMARY OF COVERAGE PARTS AND CHARGES
This policy consists of this Common Policy Declarations page, Common Policy Conditions, Coverage Parts
(which consist of coverage forms and other applicable forme and endorsements, if any, issued to form a part of
them) and any other forms and endorsements issued to be part of this policy.
COVERAGE PART CHARGES
Commercial General Liability $250.00
Total Charges for all of the alcove cover-age pparty- $250.00
Certified Acts of Terrorism Coverage: WOO (Included)
Note: 79ris is not a bill
IMPORTANT MESSAGES
. This policy is auditablo. Please refer to the conditions of the policy for details or contact your agent.
Servicing Office Western Washington Authorhed Representative
and Issue Date 014/18
To roped a claim,call your Agent or I.OW 02-MM
DB70210108
03tl4/16 56696377 110260220 235 NCAOPPNO AGENT COPY OOCa27 PAGE 15 of 16
Coverage la Provided In: Policy Number:
1�1CILy Ohio Security Insurance Company BLS (17) 50696377
. Policy Period:
eneuaAacA From GSMWGToMM8=7
Common Polley Declarations 12.•01 am Standard Time
at Insured Malling Location
Rained Insured Agent
R F DUNCAN& ASSOCIATES, INC (360) 352-7588
DUNCAN& ASSOCIATES INC
POLICY FORDS AND ENDORSEMENTS
This section lists the Forms and Endorsements for your policy, Refer to these documents as needed for detailed
information concerning your coverage.
FORM NUMBER TITLE
CO 00 01 04 13 Commercial General Liability Coverage Form- Occurrence
CG Ol 8105 08 Washington Changes
CG Ol 97 12 07 Washington Changes- Employment-Related Practices Exclusion
CG 2106 05 14 Exclusion- Access Or Disclosure Of Confidential Or Personal Information And
Data-Related Liability-With Limited Bodily Injury Hxcepton
CO 21 70 01 15 Cap on Losses from Certified Acts of Terrorism
CG 21 76 Ol 15 Exclusion of Punitive Damages Related to a Certified Act of Terrorism
CG 22 24 04 13 Exclusion- Inspection, Appraisal and Survey Companies
CG 24 26 04 13 Amendment of Insured Contract Definition
CO 26 77 12 04 Washington- Fungi or Bacteria Exclusion
CO 84 99 08 09 Non-Cumulation Liability Limits Same Occurrence
CG 88 10 04 13 Commercial General Liability Extension
CG 88 77 12 08 Medical Expense At Your Request Endorsement
CG 89 27 10 09 Washington Exclusion-Asbestos
IL Ol 23 11 13 Washington Changes- Defense Costs
IL Ol 46 08 10 Washington Common Policy Conditions
IT,0198 09 08 Nuclear Energy Liability Exclusion Endorsement(Broad Form)
In witness whereof, we have caused tins policy to be signed by our authorized officers.
Dt'x* 9. kjj
Dexter Legg Paul Cnndrin
Secretary President
7o report a c/01%call rear Agent or 1•880-802-0
D3 70 210108
o3n4116 566M77 W00220 235 NCAOPPNO AGENT COPY 000827 PAGE 16 OF 18
Coverage Is Provided In.' Policy Number.
] �� Ohio Securlly Insurance ComDany BLS (17) 56 59 63 77
Nutria=, Policy Period:
rusuanuC® Commercial General Liability From 051100AMSTo 05t0M17
12:01 am Standard 77me
Declarations at Insured Mailing Location
Basis:Occurreuce
Named Insured Agent
R F DUNCAN &ASSOCIATES, INC (360) 352-7588
DUNCAN&ASSOCIATES INC
SUMMARY OF LIMITS AND CHARGES
Commercial DESCRIPTION LIMIT
general Each Occurrence Limit 1,000,000
Liability Damage To Premises Rented To You Limit(Any One Prcmtses) 1,000,000
Ia of
Insurance Medical Expense Limit (Any One Person) 15,000
..... ._ _ _
Personal and Advertising bury Limit 1,000,000
General Aggregate Limit (Other than Products -Completed Operations) 2,000,000
Products - Completed Operations Aggregate Limit 2,000,000
Explanation of DESCRIPTION PREMIUM
Cbargec General Liability Schedule Totals 169.00
Polity Writing Minimum PremivarAdjudment _ HIM)
Certified Acts of Terrorism Coverage 1.00
Total Advance Charges: $250.00
Note: This Is not a bill
To report a claim,call year Agent or Y-llg0 JOZ-00i30
DS 70 22 0108
OY14/16 5W377 ND280220 216 NCAOPPNO AGM COPY 00DR21 PAGE 17 OF 16
91
Coverage Is Provided In.- Policy Number.
Ift U13ertX Ohio Security Insurance Company BLS (171 66 6963 77
Mutual. Policy Period:
IMaaRANCa Commercial General Liability" From 051G0=5ToOS/0012017
Declarations Schedule 12.01 am Standard Tlme
at Insured Mailing Location
Named Insured Agent
R F DUNCAN& ASSOCIATES, INC (360) 352-7588
DUNCAN &ASSOCIATES INC
SUMMARY OF CLASSIFICATIONS - BY LOCATION
0001 009 West gay Or NW, OLYMPIA, WA 88502
Insured: R P DUNCAN& ASSOCIATES, INC
CLASSIFICATION- 96317
Inspection And Appraisal Companies- Inspecting For
Insurance Or Valuation Purposes
Products-Completed Operations Are Subject To The General
Aggregate Limit. .
RATED IPER
COVERAGE DESCRIPTION PREMIUM BASED ON- Executive Officers 1,000 PREMIUM
Premise/Operatiooa 17,800 Dollars Of Payroll 8,646 $154.00
Minimum Premium Adjustment $15.00
Total; Included
CLASSIFICATION- 96317
Inspection And Appraisal Companies- Inspecting For
Insurance Or Valuation Purposes
Products-Completed Operations Are Subject To The General
Aggregate Limit.
RATED/PER
COVERAGE DESCRIPTION PREMIUM BASED ON- Employees Payroll 1,000 PREMIUM
Premise/Operations Dollars OF Payroll- If any 8.646
Total:
Commercial General Liability Schedule Total $169.00
To report a clalm,call your Agent or 1-800.302.0000
DS 70 23 0108
03/14/16 56696377 W280220 235 NCAOPPNO MEN7 COPY OW827 PAGE 18 OF 18
COMMERCIAL GENERAL LIABILITY
CG 00 01 04 13
COMMERCIAL GENERAL LIABILITY COVERAGE FORM
Vadcus provisions in this policy restrict coverage. b. This insurance applies to "bodily injury"
Read the entire policy carefully to determine and "property damage" only fF:
rights, duties and what Is and is not covered. (1) The "bodily Injury" or "property
Throughout this policy the words 'you" and damage" is caused by an "occur- I
_ "your" refer to the Named Insured shown in the rence" that takes place in the "cov-
Declarations, and any other person or organize- erage territory";
lion qualifying as a Named Insured under this (2) The "bodily injury" or "property
policy. The words ''we", "us" and "our' refer to damage" occurs during the policy
the company providing this insurance. period; and
The word "insured" means any person or organl- (3) Prior to the policy period, no Insured
5000 zatfon qualifying as such under Sectlon II -Who Is listed under Paragraph 1. of Section
An Insured. II - Who Is An Insured and no "em-
am Other words and phrases that appear in quotation ployee" authorized by you to give or
wiliffli
marks have special meaning. Refer to Section V - receive notice of an "occurrence" or
EM Definitions, claim, knew that the "bodily injury'
or "property damage" had occurred,
SECTION I - COVERAGES in whole or in part. If such a listed
COVERAGE A - BODILY INJURY AND PROPERTY insured or authorized "employee"
DAMAGE LIABILITY knew, prior to the policy period, that
1. Insuring Agreement the "bodily injury" or "property dam-
age" occurred, then any continu-
a. We will pay those sums that the insured ation, change or resumption of such
becomes legally obligated to pay as dam- "bodily injury" or "property dam-
ages because of "bodily injury" or "prop- age" during or after the policy period
arty damage" to which this insurance sp- will be deemed to have been known
piles. We will have the right and duty to prior to the policy period.
defend the Insured against any "suit" c. "Bodily injury" or "property damage"
seeking those damages. However, we which occurs during the policy period
will have no duty to defend the insured and was not, prior to the policy period,
against any "suit" seeking damages for known to have occurred by any insured
'bodily injury" or "property damage" to listed under Paragraph 1. of Section II -
whlch this insurance does not apply. We Who Is An Insured or any "employee" au-
may, at our discretion, investigate any thorized by you to give or receive notice
"occurrence" and settle any claim or of an "occurrence' or claim, includes any
suit" that may result. But: continuation, change or resumption of
(1) The amount we will pay for damages that "bodily injury" or "property dam-
Is limited as described In Section III - age" after the end of the policy period.
Limits Of Insurance; and d. "Bodily injury" or "property damage"
(2) Our right and duty to defend ends will be deemed to have been known to
when we have used up the applica- have occurred at the earliest time when
ble limit of insurance in the payment any insured listed under Paragraph 1. of
of judgments or settlements under Section II - Who Is An Insured or any
Coverages A or B or medical ex- "employee" authorized by you to give or
penses under Coverage C. receive notice of an "occurrence' or
No other obligadon or liability to pay claim;
sums or perform acts or services is ccv- (1) Reports all, or any part, of the "bod-
ered unless explicitly provided for under ily Injury" or "property damage" to
Supplementary Payments - Coverages A us or any other insurer;
and B.
(2) Receives a written or verbal demand
or claim for damages because of the
"bodily injury" or "property dam-
age"; or
CG 00 01 04 13 0 Insurance Services Office, Inc., 2012 Page 1 of 17
I
I
(3) Becomes aware by any other means c. Liquor Liability
that "bodily injury" or "property "Bodily injury" or "property damage' for
damage" has occurred or has begun which any insured may be held liable by
to occur. reason of:
e. Damages because of "bodily injury" in- (1) Causing or contn'buting to the intoxi-
clude damages claimed by any person or cation of any person;
organization for care, loss of services or (2) The furnishing of alcoholic bever-
death resulting at any time from the ages to a person under the legal
"bodily injury'. drinking age or under the influence
2. Exclusions of alcohol; or
This insurance does not apply to: (3) Any statute, ordinance or regulation
a. Expected Or intended Injury relating to the sale, gift, distribution
"Bodily injury" or 'Property damage" ex-
or use of alcoholic beverages.
pected or intended from the standpoint of This exclusion applies even if the claims
the insured. This exclusion does not ap- against any insured allege negligence or
ply to "bodily injury" resulting from the other wrongdoing- in:
use of reasonable force to protect per- (a) The supervision, hiring, employ-
sans or property. ment, training or monitoring of
b. Contractual Liability others by that Insured; or
"Bodily injury" or "property damage" for (b) Providing or failing to provide
which the Insured is obligated to pay transportation with respect to
damages by reason of the assumption Of any person that may be under
liability in a contract or agreement. This the Influence of alcohol;
exclusion does not apply to liability for if the "occurrence" which caused the
damages: "bodily injury" or "property damage", in-
(1) That the insured would have In the volved that which is described in Para-
absence of the contract or agree- graph (1), (2)or (3) above.
ment; or However, this axclusion applies only if
(2) Assumed in a contract or agreement you are in the business of manufacturing,
that is an "insured coptract", pro- distributing, selling, serving or furnishing
vided the "bodily Injury" or "proper- alcoholic beverages. For the purposes of
ty damage" occurs subsequent to the this exclusion, permitting a person to
execution of the contract or agree- bring alcoholic beverages on your prern
ment. Solely for the purposes of li- ises, for consumption on your premises,
ability assumed in an "insured con- whether or not a fee is charged or a li-
tract°", reasonable attorneys' fees cense is required for such activity, is not
and necessary litigation expenses in- by itself considered the business of sell-
curred by or for a party other than an ing, serving or furnishing alcoholic bev-
insured are deemed to be damages erages,
$ because of "bodily injury" or "prop- d„ Workers' Compensation And Similar
arty damage", provided: Laws
(a) Liability to such party for, or for Any obligation of the insured under a
the cast of, that parry's defense workers' compensation, disability bene-
has also been assumed in the fits or unemployment compensation law
same "insured contract"I and or any similar law.
(b) Such attorneys' 'fees and litiga- e. Employer's Liability
tion expenses are for defense of "Bodily Injury" to:
that party against a civil or alter-
native dispute resolution pro- (1) An "employee" of the insured all ing out of and in the course of:
ceeding in which damages to
which this insurance applies are (a) Employment by the insured; or
alleged. (b) Performing duties related to the
conduct of the insured's busi-
ness; or
Page 2 of 17 ® Insurance Services Office, Inc., 2012 CG 00 01 04 13
(2) The spouse, child, parent, brother or (III) "Bodily injury" or "property
sister of that "employee' as a con- damage" arising out of heat,
sequence of Paragraph (1) above. smoke or fumes from a
This exclusion applies whether the in- "hostile fire";
sured may be liable as an employer or in (b) At or from any premises, site or
any other capacity and to any obligation location which is or was at any
to share damages with or repay someone time used by or for any Insured
else who must pay damages because of or others for the handling, star-
the injury. age, disposal, processing or
treatment of waste;
This exclusion does not apply to liability
assumed by the insured under an "in- (c) Which are or were , any time
transported,
sured contract". , handled, stored,
treated,
f. Pollution disposed of, or pro-
f. as waste by or for
m (1) 'bodily Injury" or "property dam-
MM age" arising out of the actual, al- (I) Any insured; or
Mill leged or threatened discharge, (ii) Any person or organization
dispersal, seepage, migration, re- for whom you may be legal-
lease or escape of "pollutants": ly responsible; or
(a) At or from any premises, site or (d) At or from any premises, site or
location which is or was at any location on which any insured or
time owned or occupied by, or any contractors or subcontrac-
_ rented or loaned to, any insured. tors working directly or indirect-
However, this subparagraph ly on any insured's behalf are
does not apply to: performing operations if the
(i) "Bodily injury" if sustained "pollutants" are brought on or to
within a building and caused the premises, site or location in
by smoke, fumes, vapor or connection with such operations
soot produced by or origi- by such Insured, contractor or
noting from equipment that subcontractor. However, this
is used to heat, cool or de- subparagraph does not apply to:
humidify the building, or (i) "Bodily injury" or "property
equipment that is used to damage" arisfng out of the
heat water for personal use, escape of fuels, lubricants or
by the building's occupants other operating Fluids which
or their guests; are needed to perform the
"Bodilyinjury" or "propertynormal electrical, hydraulic
damage"
(u) 1 for which you may or mechanical functions
be held liable, if you are a necessary for the operation
contractor and the owner or of "mobile equipment" or
lessee of such premises, site its parts, if such fuels,
or location has been added lubricants or other operating
to your policy as an addi- fluids escape from a vehicle
tional insured with respect part designed to hold, store
to your ongoing operations or receive them. This excep-
tion does not apply if the
performed for that addition- i
al insured at that premises, "bodily injury" or "property
site or location and such damage" arises out of the
premises, site or location is intentional discharge,
not and never was owned or dispersal or release of the
occupied by, or rented or fuels, lubricants or other op-
loaned to, any insured, other orating fluids, or if such fu-
than that additional insured;. els, lubricants or other oper-
or ating fluids are brought on
or to the premises, site or lo-
cation with the intent that
they be discharged, dis-
persed or released as part of
CG 00 01 04 13 C Insurance Services Office, Inc., 2012 Page 3 of 17
the operations being per- g, Aircraft, Auto Or Watercraft
formed by such insured, "Bodily injury" or "property damage"
contractor or subcontractor; arising out of the ownership, maintain-
(H) "Bodily injury" or "property ante, use or entrustment to others of any
damage" sustained within a aircraft, "auto' or watercraft owned or
building and caused by the operated by or rented or loaned to any
release of gases, fumes or insured. Use includes operation and
vapors from materials "loading or unloading".
brought into that building in This exclusion applies even if the claims
connection with operatlons against any insured allege negligence or
being performed by you or other wrongdoing in the supervision, hir-
on your behalf by a contrac-
[or or subcontractor, or ing, employment, training or monitoring
of others 6y that insured, if the "occur-
(III) "Bodily injury" or "property rence" which caused the 'bodily injury"
damage" arising out of heat, or "property damage" involved the own-
smoke or fumes from a ership, maintenance, use or entrustment
"hostile fire". to others of any aircraft, "auto" or water-
(e) At or from any premises, site or craft that is owned or operated by or
location on which any Insured or rented or loaned to any insured.
any contractors or subcontrac- This exclusion does not apply to:
tors working directly or indirect- (1) A watercraft while ashore on prem-
ly on any insured's behalf are ises you own or rent;
performing operations if the op-
erations are to test for, monitor, (2) A watercraft you do rot own that is:
clean up, remove, contain, treat, (a) Less than 25 feet long; and
detoxify or neutralize, or In any (b) Not being used to carry persons
way respond to, or assess the ef- or property for a charge;
fects of, "pollutants". (3) Parking an "auto" on, or on the ways
(2) Any loss, cost or expense arising out next to, premises you own or rent,
of any: provided the "auto" Is not owned by
(a) Request, demand, order or statu- or rented or loaned to you or the in-
tory or regulatory requirement sured;
that any insured or others test (4) Liability assumed under any "in-
for, monitor, clean up, remove, sured contract" for the ownership,
contain, treat, detoxify or neu- maintenance or use of aircraft or
tralize, or in any way respond to, watercraft; or
or assess the effects of, "pcllu- (5) "Bodily Injury" or "property dam-
tents"; or age" arising out of.
(b) Claim or suit by or on behalf of a (a) The operation of machinery or
governmental authority for dam- equipment that is attached to, or
ages because of testing for, part of, a land vehicle that would
monitoring, cleaning up, remov- qualify under the definition of
ing, containing, treating, detox- "mobile equipment" if it were
ifying or neutralizing, or in any not subject to a compulsory or
way responding to, or assessing flnancial responsibility law or
the effects of, "pollutants". other motor vehicle insurance
However, this paragraph does not law where it is licensed or princi-
apply to liability for damages be- pally garaged; or
cause of "property damage" that the (b) The operation of any of the me-
insured would have in the absence of chinery or equipment listed in
such request, demand, order or stat- Paragraph f.(2) or f.(3) of the
utory or regulatory requirement, or definition of "mobile equip-
such claim or "suit" by or on behalf ment".
of a governmental authority.
Page 4 of 17 ® Insurance Services Office, Inc., 2012 CG 00 01 04 13
h. Mobile Equipment (6) That particular part of any property
"Bodily Injury" or "property damage' that must be restored, repaired or re-
arising out of: placed because "your work" was in-
correctly performed on it.
ment" byy an(1) The tran of "mobile equip- Paragraphs (1), (3) and (4) of this exclu-
an 'auto" owned or oper-
ated by or rented or loaned to any sion do not apply to "property damage"
insured; or (other than damage by fire) to premises,
Including the contents of such premises,
(2) The use of"mobile equipment" in, or rented to you for a period of seven or
while in practice for, or while being fewer consecutive days. A separate limit
prepared for, any prearranged rac- of insurance applies to Damage To Prem-
Ing, speed, demolition, or stunting ises Rented To You as described in Sec-
activity. tlon III -Limits Of Insurance.
i. War Paragraph (2) of this exclusion does not
Bodily
Ieo !d nl the
ju�emises
are 'your work'
however c ed, arising, deoy or l and wereneveroccupiedren@ad or bald
MM really, out of: for rental by you. 8
__ (1) War, Including undeclared or civil Paragraphs (3), (4), (5) and (6) of this ex-
war, clusion do not apply to liability assumed
(2) Warlike action by a military force, in- under a sidetrack agreement.
eluding action in hindering or de- Paragraph (6) of this exclusion does not
fending against an actual or expect- apply to "property damage" included in
ed attack, by any government, the "productsrompleted operations haz-
sovereign or other authority using and".
military personnel or other agents; k. Damage To Your Product
or
"Property damage" to "your product"
(3) Insurrection, rebellion, revolution, arising out of it or any part of it.
usurped power, or action taken by
governmental authority in hindering I. Damage To Your Work
or defending against any of these. "Property damage" to "your work" ads-
Damage To Property
ing out of it or any part of it and included
in"Property damage" to: the "products-cornpleted operations
hazard".
(1) Property you own, rent, or occupy, This exclusion does not apply it the
including any costs or expenses in- damaged work or the work out of which
curred by you, or any other person; the damage arises was performed on
organization or entity, for repair, re- your behalf by a subcontractor.
placement, enhancement, restora-
tion or maintenance of such property m. Damage To Impaired Property Or Prop-
for any reason, including prevention erty Not Physically Injured
of injury to a person or damage to "Property damage" to "impaired proper-
another's property; ty" or property that has not been phys-
(2) Premises you sell, give away or ically injured, arising out of:
abandon, if the "property damage" (1) A defect, deficiency, inadequacy or
arises out of any part of those prem- dangerous condition in "your prod-
ises; uct" or "your work"; or
(3) Property loaned to you; (2) A delay or failure by you or anyone ']
(4) Personal property in the care, custo- acting on your behalf to perform a
dy or control of the insured; contract or agreement in accordance
with its terms.
(5) That particular part of real property
on which you or any contractors or This exclusion does not apply the lass
subcontractors working directly or of use of other property arising out of
indirectly on, your behalf are per- sudden and accidental physical injury to
forming operations, if the "property "your product" or "your work" after it
damage" arises out of those oper- has been put to its intended use. I
ations; or
CG 00 01 04 13 0 Insurance Services Office, Inc., 2012 Page 5 of 17
cal
tute, or-
n. Recall Of Products, Work Or Impaired (4) Any federal,
lrstate orlootherathan the
Property dinance or
TCPA, CAN-SPAN Act of 2003 or
Damages claimed for any loss, cost or ex- FCRA and their amendments and ad-
pense incurred by you or others for the ditiens, that addresses, prohibits, or
loss of use, withdrawal, recall„ insp c- Iimlts the printing, dissemination,
lion, repair, replacement, adjustment, re- disposal, collecting, recording, send-
move[ or disposal of: ing, transmitting, communicating or
(1) "Your product"; distribution of material or informa-
(2) "Your work"; or lion.
(3) 'Impaired property"; Exclusions c. through n. do not apply to dam-
if such product, work, or property is with- age by ire to premises whole rented to you of
drawn or recalled from the market or temporarily occupied by you with permission
from. use by any person or organization of the
o ner. coverage separate asllmit descn ofInsurance
because of a known or suspected defect, applies
Sec-
deficiency, inadequacy or dangerous tion III -Limits Of Insurance.
condition in it.
COVERAGE B - PERSONAL AND ADVERTISING
o. Personal And Advertising Injury INJURY LIABILITY
"Bodily injury" arising out of "personal 1 Insuring Agreement
and advertising Injury".
a. We will pay those sums that the insured
p. Electronic Data becomes legally obligated to pay as dam-
Damages arising out of the loss of, loss ages because of "personal and advertis-
of use of, damage to, corruption of, in- ing injury" to which this insurance ap-
ability to access, or inability to manipu- plies, We will have the right and duty to
late electronic data. defend the insured against any rsuit"
However, this exclusion does not apply seeking those damages. However, we
to liability for damages because of `bad- will have no duty to defend the Insured
ily injury", against any "suit" seeking damages for
As used in this exclusion, electronic data "personal and advertising injury" to
means information, facts or programs which this insurance does not apply. We
stored as or on, created or used on, or may, at our discretion, investigate any of-
transmitted to or from computer soft- fense and settle any claim or "suit" that
ware, including systems and applications may result. But:
software, hard or floppy disks, CD-ROMs.. (1) The amount we will pay for damages
tapes, drives, calls, data, processing de- is limited as described in Section III -
vices or any other media which are used Limits Of Insurance; and
with electronically controlled equipment. (2) Our right and duty to defend end
q, Recording And Distribution Of Material when we have used up the applica-
Or Information In Violation Of Law ble limit of insurance in the payment
$ 'Bodily injury" or "property damage" of judgments or settlements under
arising directly or indirectly out of any ac- Coverages A or B or medical ex-
lion or omission that violates or is al- penses under Coverage C.
leged to violate: No other obligation or liability, to pay
a (1) The Telephone Consumer Protection sums or perform acts or services is cov-
Act (TCPA,), Including any amend- ered unless explicitly provided for under
ment of or addition to such Paw; Supplementary Payments - Coverages A
(2) The CAN-SPAN Act of 2003, includ-
and B.
ing any amendment of or addition to b This insurance s applies to 'Personalby an an
such law; adverg injury
11 nse
arising out of your business but only If
(3) They Fair Credit Reporting Act (FCRA.), the offense was committed in the "cov-
andd any amendment of or addition to erage territory" during the policy period.
such law, including the Fair and Ac-
curate Credit Transactions Act
(FACTA); or
Page 5 of 17 ® Insurance Services Office, Inc., 2012 CG 00 01 04 13
2. Exclusions I. Infringement Of Copyright, Patent,
This insurance does not apply to: Trademark Or Trade Secret
a. Knowing Violation Of Rights Of Mother "Personal and advertising injury" arising
Personal and advertising injury" caused out of the infringement of copyright, pat-
et the direction of the insured with ent. trademark, trade secret or other in-
by or pat-
"Personal
the knowledge that the a would violate tellectual property rights. Under this ex-
the rights of another and would inflict dusion, such other intellectual property
rights do not include the use of anothers
"personal and advertising Injury". advertising idea in your "advertisement".
b. Material Published With Knowledge Of However, this exclusion does not apply
Falsity to infringement, in your "advertisement",
"Personal and advertising injury" arising of copyright, trade dress or slogan.
cut of oral or written publication, In any j. Insureds In Media And Internet Type
manner, of material, if done by or at the
Businesses
direction of the insured with knowledge
of its falsity. "Personal and advertising injury" com-
mitted by an insured whose business is:
G. Material Published Prior To Policy Period
(1) Advertising, broadcasting, publish-
"Personal and advertising injury" arising ing or telecasting;
out of oral or written publication, in any
manner, of material whose first publics- (2) Designing or determining content of
lion tack place before the beginning of web sites for others; or
the policy period. (3) An Internet search, access, content
d. Criminal Acts or service provider.
"Personal and advertising injury" arising However, this exclusion does not apply
out of a criminal act committed by or at to Paragraphs 14.a., b. and c, of "person-
the direction of the insured. al and advertising injury" under the Defi-
nitions section.
e. Contractual Liability
"Personal and advertising injury" for For the purposes o this or links,
the
which the insured has assumed liability verplating of frames, borders or links, a on
in a contract or agreement. This exclu- the Internet,
for you or others anywhere on
sion does not apply to liability for dam- the Intemet, is not e itself, considered
ages that the insured would have in the the business of advertising, broadcast-
absence of the contract or agreement, ing, publishing or telecasting.
k. Electronic Chatrooms Or Bulletin Boards
f. Breach Of Contract
"Personal and advertising injury" arising
"Personal and advertising injury" arising
out of a breach of contract, except an im- board
of an electronic oats,chatr om or bulletin
plied contract to use another's advertis- board the insured hosts, owns, 1. over
which the insured exercises control.
ing idea in your "advertisement".
I. Unauthorized Use Of Another's Name Or
g. Quality Or Performance Of Goods - Fall- Product
ure To Conform To Statements
"Personal and advertising injury" arising
"Personal and advertising injury" arising
out of the unauthorized use of anothers
out of the failure of goods, products or name or product in your e-mail address,
services to conform with any statement domain name or metatag, or any other
of quality or performance made in your similar tactics to mislead another's po-
"advertisement". tential customers.
h. Wrong Oescription Of Prices m. Pollution
"Personal and advertising injury" arising "Personal and advertising injury" arising
out of the wrong description of the price out of the actual, alleged or threatened
of goods, products or services stated in discharge, dispersal, seepage, migration,
your "advertisement', release or escape of "pollutants" at any
time.
CG 00 01 04 13 C, Insurance Services Office, Inc., 2012 Page 7 of 17
n. Pollution-related (4) Any federal, state or local statute, or-
Any loss, cost or expense arising out of dinance or regulation, other than the
any: TCPA, CAN-SPAM Act of 2003 or
(1) Request, demand, order or statutory FCRA and their amendments and ad-
or
or regulatory requirement that any limits, that addresses, prohibits, ,
insured or others test for, monitor, limits the collecprintiting,
dissemination,
clean up, remove, contain, .treat, de- disposal, collecting, recording, send-
clean or neutralize, or In any way re- ins, transmitting, communicating or
spond to, or assess the effects of, distribution of material or info ma-
"pollutants"; or tlon.
(2) Claim or suit by or on behalf of a COVERAGE C-MEDICAL PAYMENTS
governmental authority for damages 1. Insuring Agreement
because of testing for, monitoring, a- We will pay medicpl expenses as de-
clearing up, removing, containing, scribed below for "bodily injury" caused
treating, detoxifying or neutralizing, by an accident:
or In any way responding to, or as- (1) On premises you own or rent;
sessing the effects of, "pollutants". (2) On ways, next to premises you own
o. War or rent; or
"Personal and advertising injury", how- (3) Because of your operations.-
ever caused, arising, directly or indirect- provided that:
ly, out of:
(1) War, including undeclared or civil (a) The accident takes place in the
"coverage territory" and during
war;
She policy period;
(2) Wariike action by a military force, in- (b) The expenses are incurred and
eluding action in hindering or de
fending against an actual or expect- reported to us within one year of
e the date of the accident; and
d attack, by any government,
sovereign or other authority using (c) The Injured person submits to
military personnel or other agents; examination, at our expense, by
or physicians of our choice as often
(3) Insurrection, rebellion, revolution, as we reasonably require.
usurped power, or action taken by b. We will make these payments regardless
governmental authority in hindering - of fault- These payments will not exceed
or defending against any of these. the applicable limit of insurance. We will
p. Recording And Distribution Of Material pay reasonable expenses for:
Or Information In Violation Of Law (1) First aid administered at the time of
"Personal and advertising injury" arising an accident;
directly or indirectly out of any action or (2) Necessary medical, surgical, X-ray
omission that violates or is alleged to vio- and dental services, including pros-
late: thetic devices; and
(1) The Telephone Consumer Protection (3) Necessary ambulance, hospital, pro-
Act (TCPA), including any amend- fessional nursing and funeral ser-
ment of or additlon to such law, vices.
(2) The CAN-SPAM Act of 2003, includ- 2. Exclusions
ing any amendment of or addition to We will not pay expenses for "bodily injury':
such law; a. Any Insured
(3) The Fair Credit Reporting Act (FCRA), To any insured, except "volunteer
and any amendment of or addition to workers".
such law, including the Fair and Ac- b. Hired Person
curate Credit Transactions Act
(FACTA); or To a person hired to do work for or on
behalf of any insured or a tenant of any
insured.
Page 3 of 17 m Insurance Services Office, Inc., 2012 CC 00 01 04 13
c. Injury On Normally occupied Premises g. Afl interest on the full amount of any
art of judgment that accrues after entry of the
To a person injured on that ► 1 rem- judgment and before we have paid, of
ises you own or rent that the person nor- fared to pay, or deposited in court the
many occupies, part of the judgment that is within the ap-
t. Workers' Compensation And Similar plicable limit of insurance.
Laws These payments will not reduce the limits of
To a person, whether or not an "employ- insurance,
as' of any insured, if benefits for the 2. If we defend an insured against a "suit' and
bodily injury" are payable Of Trust be an indemnitee of the insured Is also named as
provided under a workers` compensation a party to the "suit", we will defend that
or disability benefits law or a similar iaw. indemnitee if all of the following conditions
e. Athletics Activities are met:
To a person injured while practicing, in- a. The "suit" against the indemnitea seeks
strutting or participating in any physical damages for which the insured has as- Ali
exercises or games, sports, or athletics sumed the liability of the indemnitee in a
W_= contests. contract or agreement that is an "insured '
Mil f. Products-Completed Operations Hazard contract";
Included within the "products-completed b. This insurance applies to such liability
operations hazard". assumed 6y the insured;
g. Coverage A Exclusions c. The obligation to defend, or the cost of
s Excluded under Coverage A. the defense of, that indemnitee, has also
been assumed by the insured in the same
SUPPLEMENTARY PAYMENTS . COVERAGES A "insured contract,
AND B d. The allegations in the "suit" and the in-
1. We will pay, with respect to any claim we in- formation we know about the "occur-
vestigate or settle, or any 'suit" against an rence" are such that no conflict appears
insured we defend: to exist between the interests of the in-
a. All expenses we incur. sured and the interests of the
b. Up to $250 for cost of bail bonds required indemnitee;
because of accidents or traffic law viola- e. The indemnitee and the insured ask us to
tions arising out of the use of any vehicle conduct and control the defense of that
to which the Bodily Injury Liability Cov- indemnitee against such "suit" and agree
erage applies. We do not have to furnish that we can assign the same counsel to
these bonds. defend the insured and the indemnitee;
c. The cost of bonds to release attachments, and
but only for bond amounts within the up- f. The indemnitee: V
plicable limit of insurance. We do not (1) Agrees in writing to: ps
have to furnish these bonds. 0
(a) Cooperate with us In the inves- Y
d. All reasonable expenses incurred by the tigation, settlement or defense
insured at our request to assist us in the of the "suit";
investigation or defense of the claim or (b) Immediately send us copies of
"suit", including actual loss of earnings any demands, notices,up to $250 a day because of time off from sum-
monses or legal papers received
work,
in connection with the "suit";
e. All court costs taxed against the insured (c) Notify any other insurer whose
in the "suit". However, these payments coverage is available to the
do not include attorneys' fees or attor- indemnitee; and
neys' expenses taxed against the in-
sured. (d) Cooperate with us with respect
f. Prejudgment interest awarded against to coordinating other applicable
the insured on that part of the judgment insurance available to the
we pay. If we make an offer to pay the indemnitee; and
applicable limit of insurance, we will not "
pay any prejudgment interest based on
that period of time after the offer.
l
CG 00 01 04 13 m Insurance Services Office, Inc., 2012 Page 9 of 17
(2) Provides us with written authorize- e. A trust, you are an insured. Your trustees
tion to: are also insureds, but only with respect
(a) Obtain records and other infor- to their duties as trustees.
mation related to the "suit'; and 2. Each of the following is also an insured:
(b) Conduct and control the defense a. Your "volunteer workers' only while per-
of the indemnitee in such "suit". forming duties related to the conduct of
So long as the above conditions are met, at- your business, or your "employees", oth-
tomeys' fees incurred by us in the defense of er than either your "executive officers" (if
that indemnitee, necessary litigation ex- you are an organization other than a part-
penses Incurred by us and necessary litiga- nership, joint venture or limited liability
tion expenses incurred by the indemnitee at company) or your managers (if you are a
-our request will be paid as Supplementary limited liability company), but only for
Payments. Notwithstanding the provisions of acts within the scope of their . employ-
Paragraph 2.b.(2) of Section I - Coverage A - mart by you or while performing duties
Bodily Injury And Property Damage Liability, related to the conduct of your business.
such payments will not be deemed to be However, none of these "employees" or
damages for "bodily injury" and "property "volunteer workers" are insureds for:
damage" and will not reduce the limits of in- (1) "Bodily injury" or "personal and ad-
surance, vertising injury":
Our obligation to defend an insured's (a) To you, to your partners or
indamnites and to pay for attorneys' fees and members (if you are a partner-
necessary litigation expenses as Supplemen- ship or Joint venture), to your
tary Payments ends when we have used up members (if you are a limited li-
the applicable limit of insurance in the pay- ability company), to a co-"em-
ment of judgments or settlements or the con- ployee' while in the course of
ditions set forth above, or the terms of the his or her employment or per-
agreement described in Paragraph f. above, forming duties related to the
are no longer met conduct of your business, or to
SECTION II -WHO IS AN INSURED your other 'volunteer workers"
while performing duties related
1. If you are designated in the Declarations as: to the conduct of your business;
a. An individual, you and your spouse are (b) To the spouse, child, parent,
insureds; but only with respect to the brother or sister of that co- 'em-
conduct of a business of which you are ployee" or "volunteer worker"
the sole owner. as a consequence of Paragraph
b. A partnership or joint venture, you are an (1)(a) above;
insured. Your members, your partners, (c) For which there is any obligation
and their spouses are also insureds, but to share damages with or repay
only with respect to the conduct of your someone else who must pay
business. damages because of the injury
r c. A limited liability company, you are an described in. Paragraph (1)(a) or
insured. Your members are also in- (b) above; or
sureds, but only with respect to the con- (d) Arising out of his or her provid-
duct of your business. Your managers are ing or failing to provide profes-
insureds, but only with respect to their sional health care services.
duties as your managers.
(2) "Property damage" to property:
d, An organization other than a partnership, (a) Owned, occupied or used by;
joint venture or limited liability company,
you are an insured. Your "executive of- (b) Rented to, in the care, custody or
flcers" and directors are Insureds, but control of, or over which phys-
only with respect to their duties as your ical control is being exercised for
officers or directors. Your stockholders any purpose by;
are also insureds, but only with respect you, any of your "employees", "vol-
to their liability as stockholders, unteer workers", any partner or
member (If you are a partnership or
joint venture), or any member (if you
are a limited liability company).
Page 10 of 17 ® Insurance Services Office, Inc., 2012 CG 00 01 04 13
i
b. Any person (other than your "employee" b. Damages under Coverage A, except dam-
or "volunteer worker"), or any organize- ages because of"bodily injury" or "prop-
tion while acting as your real estate man- erty damage" included in the "products-
ager. completed operations hazard"; and
c. Any person or organization having prop- c. Damages under Coverage B.
er temporary custody of your property if 3. The Products-Completed Operations Aggre-
you die, but only: gate Limit is the most we will pay under
(1) With respect to liability arising out of Coverage A for damages because of "bodily
_ the maintenance or use of that prop- injury" and 'property damage" . included in
arty; and the 'products-completed operations hazard".
(2) Until your legal representative has 4. Subject to Paragraph 2. above, the Personal
been appointed. And Advertising Injury Limit is the most we
d. Your legal representative if you die, but will pay under Coverage B for the sum of all
only with respect to duties as such. That damages because of all "personal and adver-
representative will have all your rights tising injury" sustained by any one person or
and duties under this Coverage Part. organization.
3. Any organization you newly acquire or form, 5. Subject to Paragraph 2. or 3. above, which-
MEM other than a partnership, jolnt venture or ever applies, the Each Occurrence Limit is the
limited liability company, and over which you most we will pay for the sum of:
maintain ownership or majority interest, will a. Damages under Coverage A;and
qualify as a Named Insured if there is no oth- b. Medical expenses under Coverage C
or similar insurance available to that organs- because of all "bodily injury" and "property
zation. However. damage" arising out of any one "occur-
a. Coverage under this provision is afforded Fence".
only until the 90th day after you acquire 6. Subject to Paragraph 5. above, the Damage
or form the organization or the end of the To Premises Rented To You Limit is the most
policy period, whichever Is earlier; we will pay under Coverage A for damages
b. Coverage A.does not apply to "bodily in- because of "property damage" to any one
jury" or"property damage" that occurred premises, while rented to you, or In the case
before you acquired or formed the orga- of damage by fire, while rented to you or tem-
nization; and poradly occupied by you with permission of
c. Coverage B does not apply to "personal the owner.
and advertising injury" arising out of an 7. Subject to Paragraph 5. above, the Medical
offense committed before you acquired Expense Limit is the most we will pay under
or formed the organization. Coverage C for all medical expenses because
No person or organization is an insured with re- of "bodily injury" sustained by any one per-
spect to the conduct of any current or past part- son.
nership. joint venture or limited liability company The Limits of Insurance of this Coverage Part ap-
that is not shown as a Named Insured in the Dec- ply separately to each consecutive annual period
larations. and to any remaining period of less than 12
SECTION III -LIMITS OF INSURANCE months, starting with the beginning of the policy
1. The Limits of Insurance shown in the Declare- period shown In the Declarations, unless the poli-
tions and the rules below fix the most we will cy period is extended after issuance for an addi-
pay regardless of the number of. tional period of less than 12 months. In that case,
a. Insureds; the additional period will be deemed part of the
last preceding period for purposes of determining
b. Claims made or "suits" brought; or the Limits of Insurance. - R
G. Persons or organizations making claims SECTION IV - COMMERCIAL GENERAL
or bringing "suits". LIABILITY CONDITIONS
2. The General Aggregate Limit is the most we 1. Bankruptcy
will pay for the sum of: Bankruptcy or insolvency-of'the insured or of
a. Medical expenses under Coverage C; the insured's estate will not relieve us of our
obligations under this Coverage Part.
CG 00 01 04 13 ® Insurance Services Office, Inc., 2012 Page 11 of 1T
2. Duties In The Event Of Occurrence, Offense, A person or organization may sue us to re-
Claim Or Suit cover on an agreed settlement or on a final
a. You must see to it that we are notified as judgment against an insured; but we will not
soon as practicable of an "occurrence" or be liable for damages that are not payable on-
an offense which may result in a claim. car the terms of this Coverage Part or that are
To the extent possible, notice should In- in excess of the applicable limit of insurance.
clude: An agreed settlement means a settlement
and release of liability signed by us, the in-
(1) How, when and where the "occur- sured and the claimant or the claimant's legal
rence" or offense took place; representative.
(2) The names and addresses of any In- 4. Other Insurance
jured persons and witnesses; and If
(3) The nature and location of any injury
available other valid and collectible
or damage arising out of the "occur- available insurance is
a a loss w cover
under Coverages
the insured for
rages A or B of this Coverage
e Part,
rence" or offense. our obligations are limited as follows:
b. If a claim is made or "suit" is brought a. Primary Insurance
against any insured, you must:
This insurance is primary except when
(1) Immediately record the specifics of Paragraph b. below applies. If this insur-
the claim or "suit" and the data re- ance is primary, our obligations are not
ceived; and affected unless any of the other insur-
(2) Notify us as soon as practicable. once is also primary. Then, we will share
You must see to it that we receive written with all that other Insurance by the meth-
notice of the claim or "suit" as soon as od described in Paragraph c. below.
practicable. to. Excess Insurance
c. You and any other involved insured (1) This Insurance is excess over
must: (a) Any of the other insurance,
(1) Immediately send us copies of any whether primary, excess, contin-
demands, notices, summonses or le- gent or on any other basis:
gal papers received in connection (I) That is Fire, Extended Cov-
with the claim or "suit"; erage, Builders Risk, Instal-
(2) Authorize us to obtain records and lation Risk or similar
other information; coverage for "your work";
(3) Cooperate with us in the investiga- (if) That is Fire insurance for
tion or settlement of the claim or de- premises rented to you or
fense against the "suit", and temporarily occupied by you
(4) Assist us, upon our request, in the with permission of the own-
enforcement of any right against any er
person or organization which may be (!if) That is insurance purchased
liable to the insured because of In- by you to cover your liability
r jury or damage to which this insur- as a tenant for "property
" once may also apply, damage" to premises rented
d. No insured will, except at that insured's to you or temporarily cccu-
own cost, voluntarily make a payment, pied by you with permission
assume any obligation, or incur any ex- of the owner, or
pense, other than for first aid, without our (iv) If the loss arises out of the
consent. maintenance or use of air-
3. Legal Action Against Us craft, "autos" or watercraft
No person or organization has a right under to the extent not subject to
this Coverage Part: Exclusion g. of Section I -
Coverage A - Bodily Injury
a. To join us as a party or otherwise bring And Property Damage Li-
us into a "suit" asking for damages from ability.
an insured; or
b'. To sue us on this Coverage Part unless all
of its terms have been fully complied
with.
Page 12 of 17 0 Insurance Services Office, Inc., 2012 CG 00 01 04 13
(b) Any other primary insurance b. Premium shown in this Coverage Part as
available to you covering Iiabil- advance premium Is a deposit premium
ity for damages arising out of the only. At the close of each audit period we
premises or operations, or the will compute the earned premium for
products and completed oper- that period and send notica to the first.
aliens, for which you have been Named Insured. The due date for audit
added as an additional insured. and retrospective premiums is the date A
(2) When this insurance is excess, we shown as the due date on the bill, If the
will have no duty under Coverages A sum of the advance and audit premiums
or 3 to defend the insured against paid for the policy period is greater than
any "suit" if any other Insurer has a the earned premium, we will return the
duty to defend the insured against excess to the first Named Insured.
that "suit". If no other insurer de- c. The first Named Insured must keep
fends, we will undertake to do so, but records of the information we need for
we will be entitled to the insured's premium computation, and send us -
rights against all those other insur- copies at such times as we may request.
ers. 6- Representations
(3) When this insurance is excess over By accepting this policy, you agree: l
other insurance,. we will pay only our a. The statements in the Declarations are
share of the amount of the loss, if accurate and complete;
any, that exceeds the sum of:
(a) The total amount that all such b. Those statements are based upon repre-
sentations you made to us; and
other insurance would pay for
the loss in the absence of this in- c. We have issued this policy in reliance
surance; and upon your representations.
(b) The total of all deductible and 7. Separation Of Insureds
self-insured amounts under all Except with respect to the Limits of Insur-
that other insurance. ante, and any rights or duties specifically as-
(4) We will share the remaining loss, if signed In this Coverage Part to the first
any, with any other insurance that is Named Insured, this insurance applies:
not described in this Excess Insur- a. As if each Named Insured were the only
once provision and was not bought Named Insured; and
specifically to apply in excess of the b. Separately to each insured against whom
Limits of Insurance shown in the claim is made or "suit" Is brought.
Declarations of this Coverage Part. 8. Transfer Of Rights Of Recovery Against Oth-
c. Method Of Sharing ers To Us
If all of the other Insurance permits con- If the insured has rights to recover all or part
hlbution by equal shares, we will fallow of any payment we have made under this
this method also. Under this approach Coverage Part, those rights are transferred to
each insurer contributes equal amounts us. The insured must do nothing after loss to
until it has paid its applicable limit of in- impair them. At our request, the insured will
surance or none of the loss remains, bring "suit" or transfer those rights to us and
whichever comes first. help us enforce them.
If any of the other insurance does not per- g. When We Do Not Renew
mit contribution by equal shares, we will If we decide not to renew this Coverage Part,
contribute by limits. Under this method, we will mail or deliver to the first Named In-
each insurers share is based on the ratio sured shown in the Declarations written no-
of its applicable limit of insurance to the tice of the nonrenewal not less than 30 days
total applicable limits of insurance of all before the expiration date.
insurers.
If notice is mailed, proof of mailing will be
S. Premium Audit sufficient proof of notice.
a. We will compute all premiums for this
Coverage Part in accordance with our
r
rules and rates.
i
CG 00 01 04 13 m Insurance Services office, Inc., 2012 Page 13 of 17
SECTION V - DEFINITIONS (3) "Personal and advertising Injury'
1. "Advertisement' means a notice that is offenses that take place through the
broadcast or published to the general public Internet or similar electronic means
or specific market segments about your of communication;
goods, products or services for the purpose of provided the insured's responsibility to pay
attracting customers or supporters. For the damages is determined in a "suit" on the
purposes of this definition: merits, in the territory described in Paragraph
a. Notices that are published include mate- a, above or in a settlement we agree to,
rial placed on the Internet or on similar 5. "Employee" includes a "leased worker".
electronic means of communication; and "Employee" does not Include a "temporary
In, Regarding web sites, only that part of a worker".
web site that is about your goods, pro- 6. "Executive officer' means a person holding
ducts or services for the purposes of at- any of the officer positions created by your
tracting customers or supporters is con- charter, constitution, bylaws or any other
sidered an advertisement. slmllar governing document.
2. "Auto" means: 7. "Hostile fire" means one which becomes un-
a. A land motor vehicle, trailer or controllable or breaks out from where it was
semitrailer designed for travel on public Intended to be.
roads, including any attached machinery B. "Impaired property" means tangible proper-
or equipment; or ty, other than "your product" or "your work",
b- Any other land vehicle that is subject to a that cannot be used or is less useful because:
compulsory or financial responsibility a. It incorporates "your product" or "your
law or other motor vehicle insurance law work" that is known or thought to be de-
where It is licensed or principally ga- fective, deflcient, Inadequate or danger-
raged. ous; or
However "auto" does not include "mobile b. You have failed to fulfill the terms of a
equipment". contract or agreement;
3. "Bodily injury" means bodily injury, sickness if such property can be restored to use by the
or disease sustained by a person, including repair, replacement, adjustment or removal
death resulting from any of these at any time. of "your product" or "your work' or your ful-
4. "Coverage territory" means: filling the terms of the contract or agreement.
a. The United States of America (including B. "Insured contract" means:
Its territories and possessions), Puerto a. A contract for a lease of premises. How-
Rico and Canada; ever, that portion of the contract for a
b. International waters or airspace, but only lease of premises that indemnifies any
if the injury or damage occurs in the person or organization for damage by fire
course of travel or transportation be- to premises while rented to you or tem-
tween any places included in Paragraph porarily occupied by you with permission
a. above; or of the owner Is not an "insured contract";
C. All other parts of the world if the injury or b. A sidetrack agreement;
damage arises out of. c. Any easement or license agreement, ex-
(1) Goods or products made or sold by cept In connection with construction or
you in the territory described in Para- demolition operations on or within 50
graph a, above; feet of a railroad;
(2) The activities of a person whose d. An obligation, as required by ordinance,
home is in the territory described In to indemnify a municipality, except in
—Paragraph a. above, but is away for a connection with work for a municipality;
short time on your buslness; or e. An elevator maintenance agreement;
i
Page 14 of 17 0 Insurance Services Office, Inc., 2012 CG 00 01 04 13
r
f. That part of any other contract or agree- b. While it is in or on an aircraft, watercraft
ment pertaining to your business (includ- or "auto"; or
ing an indemnification of a municipality c. While It is being moved from an aircraft,
in connection with work performed for a watercraft or "auto" to the place where it
municipality) under which you assume is finally delivered;
the tort liability of another party to pay but "loading or unloading" does not include
for "bodily injury" or "property damage" the movement of property by means of a me-
to a third person or organization. Tort Ilk chanical device, other than a hand truck, that
ability means a liability that would be Im- Is not attached to the aircraft, watercraft or p
posed by law in the absence of any con- "auto".
tract or agreement.
12. "Mobile equipment" means any of the fol-
lowing types of land vehicles, including any
any contract or agreement: attached machinery or equipment:
(1) That indemnities a railroad for "bod- a, Bulldozers, farm machinery, forklifts and
ily Injury" or "property damage"
other vehicles designed for use principal- i
arising out of construction or ly off public roads;
demolition operations, within 50 feet
of any railroad property and affecting b. Vehicles maintained for use solely on or
any railroad bridge or trestle, tracks,
next to premises you own or rent;
road-beds, tunnel, underpass or c. Vehicles that travel on crawler treads;
crossing; d. Vehicles, whether self-propelled or not,
(2) That indemnifies an architect, engi- maintained primarily to provide mobility
neer or surveyor for injury or dam- to permanently mounted:
age arising out of: (1) Power cranes, shovels, loaders, dig-
(a) Preparing, approving, or failing gars or drills; or
to prepare or approve, maps, (2) Road construction or resurfacing
shop drawings, opinions, re- equipment such as graders, scrapers
ports, surveys, field orders, or rollers;
change orders or drawings and e. Vehicles not described in Paragraph a.,
specifications; or b., c. or d. above that are not self-
(b) Giving directions or instructions, propelled and are maintained primarily to
or failing to give them, if that is provide mobility to permanently attached
the primary cause of the injury equipment of the following types:
or damage; or (1) Air compressors, pumps and gener-
(3) Under which the insured, if an archi- ators, including spraying, welding,
tect, engineer or surveyor, assumes building cleaning, geophysical ex-
liability for an injury or damage aris- ploration, lighting and well servicing
ing out of the insured's rendering or equipment; or
failure to render professional ser- (2) Cherry pickers and similar devices
vices, including those listed in (2) used to raise or lower workers;
above and supervisory, inspection,
architectural or engineering acgvi- f. Vehicles not described in Paragraph a.,
ties. b., c. or d. above maintained primarily for
purposes other than the transportation of
10. "Leased worker" means a person leased to persons or cargo.
you by a labor leasing firm under an agree
ment between you and the labor leasing firm, However, self-propelled vehicles with the
following types of permanently attached
to perform duties related to the conduct of
your business. "Leased worker' does not in- equipment are not "mobile equipment"
but will be considered "autos":
clude a"temporary worker".
11. "Loading- or unloading" means the handling (1) Equipment designed primarily for:
of property: (a) Snow removal;
a. After it is moved from the place where it (b) Road maintenance, but not con-
is accepted for movement into or onto an struction or resurfacing; or
aircraft, watercraft or "auto"; (c) Street cleaning;
i
cG o0 01 04 13 m Insurance Services Office, Inc., 2012 Page 15 of 17
i
j (2) Cherry pickers and similar devices 16_ "Products-completed operations hazard
mounted on automobile or truck a. Includes all "bodily injury" and "property
chassis and used to raise or lower damage" occurring away from premises
workers; and you own or rent and arising out of "your
(3) Air compressors, pumps and goner- product" or "your work" except:
ators, including spraying, welding, (1) Products that are still in your phys-
building cleaning, geophysical ex- ical possession; or
planation, lighting and well servicing (2) Work that has not yet been complet-
equipment, ed or abandoned. However, "your
However, "mobile equipment" does not in- work" will be deemed completed at
dude any land vehicles that are subject to a the earliest of the following times:
compulsory or financial responsibility law or (a) When all of the work called for in
other motor vehicle insurance law where it is your contract has been complet-
licensed or principally garaged. Land vehicles ed.
subject to a compulsory or financial respon- (b) When all of the work to be done
sibility law or other motor vehicle insurance at the job site has been complet-
law are considered "autos". ed if your contract calls for work
13. "Occurrence" means an accident, including at more than one job site.
continuous or repeated exposure to substan- (c) When that part of the work done
Bally the same general harmful conditions. at a job site has been put to Its
14. "Personal and advertising injury" means in- intended use by any person or
jury, including consequential "bodily injury", organization other than another
arising out of one or more of the following contractor or subcontractor
offenses: working on the same project.
a. False arrest, detention or imprisonment; Work that may need service, main-
b. Malicious prosecution; tenance, correction, repair or ro-
c. The wrongful eviction from, wrongful en- placement, but which Is otherwise
try into, or invasion of the right of private complete, will be treated as complet-
occupancy of a room, dwelling or prem- ed.
ises that a person occupies, committed J. Does not include "bodily injury" or
by or on behalf of its owner, landlord or "property damage" arising out of:
lessor; (1) The transportation of property, Lin-
d. Oral or written publication, in any man- less the injury or damage arises out
nor, of material that slanders or libels a of a condition in or on a vehicle not
person or organization or disparages a owned or operated by you, and that
person's or organization's goods, pro- condition was created by the "load-
ducts or services; ing or unloading" of that vehicle by
e. Oral or written publication, in any man- any Insured;
ner, of material that violates a. person's (2) The existence of tools, uninstalled
right of privacy; equipment or abandoned or unused
f. The use of another's advertising idea in materials; or
your "advertisement", or (3) Products or operations for which the
g. Infringing upon another's copyright, classification, listed in the Declara-
trade dress or slogan in your "advertise- tions or in a policy Schedule, states
ment". that products-completed operations
15. "Pollutants" mean any solid, liquid, gaseous are subject to the General Aggregate
or thermal irritant or contaminant, including
Limit.
smoke, vapor, soot, fumes, acids, alkalis, 17. "Property damage" means:
chemicals and waste. Waste includes mated- a. Physical injury to tangible property, in-
als to be recycled, reconditioned or re- cluding all resulting loss of use of that
claimed. property. All such loss of use shall be
deemed to occur at the time of the phys-
ical injury that caused it; or
Page 16 of 17 ® Insurance Services Office, Inc., 2012 CG 00 01 04 13
b. Loss of use of tangible property that is 21. "Your product":
not physically injured. All such loss of a. Means:
use shall be deemed to occur at the time (1) Any goods or products, other than
of the "occurrence" that caused it. real property, manufactured, sold,
For the purposes of this insurance, electronic handled, distributed or disposed of
data is not tangible property. by;
As used in this definition, electronic data (a) You;
means information, facts or programs stored (b) Others trading under your name;
_ as or on, created or used on, or transmitted to
or from computer software, including sys- or
terns and applicef ons software, hard or flop- (c) A person or organization whose
data
business or assets you have ac-
D- O tapes, drives cells,disks C R Ms
Py , � P
processing devices or any other media which quired; and
2 Containers other than vehicles ma- "
� are used with electronically controlled equip- O ( )� 8
ment, terials, parts or equipment furnished
18. "Suit" means a civil ng In which in connection with such goods or
proceeding i
damages because of "bodily injury', "prop- products.
any damage", or "personal and advertising b. Includes:
injury' to which this insurance applies are al-
1 rY" PP (1) Warranties or representations made
[aged. "Suit' Includes: at any time with respect to the fit-
= a. An arbitration proceeding in which such ness, quality, durability, perfor-
�_ damages are claimed and to which the manca or use of "your product` and
insured must submit or does submit with (2) The providing of or failure to provide 9
our consent; or warnings or instructions.
b. Any other alternative dispute resolution c. Does not include vending machines or
proceeding in which such damages are other property rented to or located for the
claimed and to which the insured sub- use of others but not sold.
units with our consent. 22. "Your work":
19. "Temporary worker" means a person who is
furnished to you to substitute for a permanent a. Means:
"employee" on leave or to meet seasonal or (1) Work or operations performed by
short-term workload conditions. you or on your behalf; and
20. "Volunteer worked' means a person who is (2) Materials, parts or equipment fur-
not your "employee", and who donates his or nished in connection with such work
her work and acts at the direction of and with- or operations.
in the scope of duties determined by you, and b. Includes:
Is not paid a fee, salary or other compensa- (1) Warranties or representations made
tion by you or anyone else for their work per- at any time with respect to the fit-
formed for you. ness, quality, durability, perfor-
mance or use of"your work"; and
(2) The providing of or failure to provide
warnings or Instructions.
CG 00 01 04 13 ® Insurance Services Office, Inc., 2012 Page 17 of 17
3
COMMERCIAL GENERAL LIABILITY
CG 01 81 05 08
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WASHINGTON CHANGES
This endorsement modifie's insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
With respect to "employees" of the insured
A. Exclusion e. of Coverage A-Bodily Injury And whose employment is subject to the Indus-
Property Damage Liability (Section I - Cover- trial Insurance Act of Washington, the refer-
ages) applies only to "bodily injury" to any ence to "volunteer workers" is removed from
"employee" of the insured whose employ- Paragraph 2.(a) of Section II - Who Is An In-
ment Is not subject to the Industrial Insurance sured and Paragraph 2.a.(1) of Section II Is
Act of Washington (Washington Revised replaced with the following:
Cade Title 51). 2_ Each of the following is also an insured:
With respect to -bodily injury" to "employ- a. Your "employees", other than either
ass" of the insured whose employment Is your "executive offlcers" (if you are
subject to the Industrial Insurance Act of an organization other than a partner-
Washington, Exclusion e. is replaced with the ship, joint venture or limited lability
following: company) or your managers Qf you
This insurance does not apply to: are a limited liability company), but
only for acts within the scope of their
1. "Bodily injury" to an 'employee" of the employment by you or while per-
insured analog out of and in the course forming duties related to the conduct
of: of your business. However, none of
a. Employment by the insured; or these 'employees" is an Insured for:
b. Performing duties related to the con- (1) "Bodily injury" Or "personal and
duct of the insured's business; or advertising injury":
2. Any obligation to share damages with or (a) To you, to your partners or
repay someone else who must pay dam- members (if you are a part-
ages because of the injury. nership or joint venture), to
This exclusion does not apply to liability as- your members (it you are a
sumed by the insured under an "insured con- limited liability company),
tract". or to a co-"employes" while
B. Paragraphs 2.a.(1)(a), (b) and (c) of Section II- that co-"employee" is either
Who Is An Insured apply only to 'employees" in the course of his or her
of the insured whose employment is not sub- employment or performing
ject to the Industrial Insurance Act of Wash- duties related to the conduct
ington (Washington Revised Code Title 51). of your business;
(b) For which there is any obli-
gation to share damages
with or repay someone else
who must pay damages be-
cause of the injury described
In Paragraph (1)(a) above; or
(c) Arising out of his or her pro-
viding or failing to provide
professional health care ser-
vices.
CG 01 31 05 08 ® ISO Properties, Inc., 2007 Page 1 of 1
COMMERCIAL GENERAL LIABILITY
CG 01 97 12 07
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY,.
WASHINGTON CHANGES - EMPLOYMENT- RELATED
PRACTICES EXCLUSION
_ This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
A. The following exclusion is added to Para- B. The following exclusion is added to Para-
graph 2., Exclusions of Coverage A - Bodily graph 2„ Exclusions of Coverage B Personal
MIER Injury And Property Damage Liability (Sec- Injury And Advertising Injury Liability (Sec-
tion I Coverages): tton I-Coverages):
jew This insurance does not apply to: This insurance does not apply to:
'Bodily injury" to: "Personal and advertising injury" to:
1. A person arising out of any: 1. A person arising out of any:
a. Refusal to employ that person; a. Refusal to employ that person;
b. Termination of that person's employ- b. Termination of that person's employ-
ment; or ment; or
c. Employment-related practices, pol- G. Employment-related practices, poli-
icies, acts or omissions, such as des, acts or omissions, such as
coercion, demotion, evaluation, rea- coercion, demotion, evaluation,
ssignment, discipline, defamation, reassignment, discipline, defama-
harassment, humiliation, discdmina- lion, harassment, humiliation, dis-
tion or malicious prosecution direct- crimination or malicious prosecution
ad at that person; or directed at that person; or
2. The spouse, child, parent, brother or sis- 2. The spouse, child, parent, brother or sis-
ter of that person as a consequence of ter of that person as a consequence of
"bodily Injury" to that person at whom "personal and advertising injury" to that
any of the employment- related practices person at whom any of the employment-
described in Paragraphs a., b. and c. related practices described in Paragraphs
above is directed. a., b. and c.above is directed. I
This exclusion applies: This exclusion applies:
1. Whether the injury-causing event de- 1. Whether the injury-causing event de-
scribed in Paragraphs a., b. or c. above scribed in Paragraphs a., b. or c. above
occurs before employment, during em- occurs before employment, during em-
ployment or after employment of that ployment or after employment of that
person; person;
2. Whether the insured may be liable as an 2. Whether the insured may be liable as an
employer or in any other capacity; and employer or in any other capacity; and
3. To any obligation to share damages with 3. To any obligation to share damages with
or repay someone else who must pay or repay someone else who must pay
damages because of the injury. damages because of the injury.
However. Paragraphs 1.a. and 2. of this exclu- However, Paragraphs 1.a. and 2. of this exclu-
sion do not apply if such "bodily injury" is sion do not apply if such "personal and ad-
sustained by any "employee" of the insured verlising injury" is sustained by any "employ-
whose employment is subject to the Indus- ee" of the insured whose employment is
trial Insurance Act of Washington (Washing- subject to the Industrial Insurance Act of
ton Revised Code Title 51). Washington (Washington Revised Code Title
51).
CG 01 97 12 07 0 ISO Properties, Inc., 2006 Page 1 of 1
COMMERCIAL GENERAL LIABILITY
CG 21 06 05 14
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
EXCLUSION - ACCESS OR DISCLOSURE OF
CONFIDENTIAL OR PERSONAL INFORMATION AND
DATA-RELATED LIABILITY - WITH
LIMITED BODILY INJURY EXCEPTION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
A. Exclusion 2.p. of Section I-Coverage A-Bod- As used in this exclusion, electronic
ily Injury And Property Damage Liability is data means information, facts or pro-
replaced by the following: grams stored as or on, created or
2. Exclusions used on, or transmitted to or from
computer software, Including sys-
This insurance does not apply to:
isms and applications software, hard
p. Access Or Disclosure Of Confiden- or floppy disks, CD-ROMs, tapes,
tial Or Personal Information And drives, cells, data processing devices
Data-related Liability or any other media which are used
Damages arising out of: with electronically controlled equip-
(1) Any access to or disclosure of ment.
any person's or organization's B. The following is added to Paragraph 2. Exclu-
confidential or personal Informa- sions of Section I-Coverage B-Personal And
tlon, Including patents, trade se- Advertising Injury Liability:
crets, processing methods, cus- 2. Exclusions
tomer lists, financial This insurance does not apply to:
information, credit card informa-
tion, health information or any Access Or Disclosure Of Confidential Or
other type of nonpublic informa- Personal Information
tion; or "Personal and advertising injury" arising
(2) The loss of, loss of use of, dam- out of any access to or disclosure of any
age to, corruption of, inability to person's or organ ization's confidential or
access, or inability to manipulate personal information, including patents,
electronic data. trade secrets, processing methods, cus-
tomer lists, financial information, credit
ages are claimed for notification card information, health information or
any other type of nonpublic information.
costs, credit monitoring expenses,
forensic expenses, public relations This exclusion applies even if damages
expenses or any other loss, cost or are claimed for notification costs, credit
expense incurred by you or others monitoring expenses, forensic expenses,
arising out of that which is described public relations expenses or any other
in Paragraph (1) or (2) above. loss, cost or expense incurred by you or
However, unless Paragraph (1) above others arising out of any access to or dis-
applies, this exclusion does not ap- closure of any person's or organization's
confidential or personal information,
ply to damages because of "bodily
injury".
CG 21 06 05 14 ® Insurance Services Office, Inc., 2013 Page 1 of 1
COMMERCIAL GENERAL LIABILITY
I
CG 21 70 01 08
THIS ENDORSEMENT CHANCES THE POLICY, PLEASE READ IT CAREFULLY.
CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM
I
This endorsement modifies insurance provided under the following:
_ COMMERCIAL GENERAL LIABILITY COVERAGE PART
LIQUOR LIABILITY COVERAGE PART
OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART
POLLUTION LIABILITY COVERAGEPART
MIN PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
RAILROAD PROTECTIVE LIABILITY COVERAGEPART
UNDERGROUND STORAGE TANK POLICY
am
SEE If aggregate Insured losses attributable to terrorist "Certified act of terrorism" means an act that is
?EM M acts certified under the federal Terrorism Risk In- certified by the Secretary of the Treasury, in con-
h surance Act exceed $100 billion in a Program Year currence with the Secretary of State and the Attor-
(January 1 through December 31) and we have ney General of the United Slates, to be an act of
met our insurer deductible under the Terrorism terrorism pursuant to the federal Terrorism Risk
Risk Insurance Act, we shall not be liable for the Insurance Act. The criteria contained in the Ter-
payment of any portion of the amount of Such rodsm Risk Insurance Act for a "certified act of
losses that exceeds $100 billion, and in such case terrorism" include the following:
insured losses up to that amount are subject to 1. The act resulted in insured losses in excess of
pro rate allocation in accordance with procedures $5 million in the aggregate, attributable to all
established by the Secretary of the Treasury. types of insurance subject to the Terrorism
Risk Insurance Act; and
2. The act is a violent act or an act that is dan-
gerous to human life, property or infrastruc-
tura and is committed by an individual or
individuals as part of an effort to coerce the
civilian population of the United States or to
influence the policy or affect the conduct of
the United States Government by coercion.
r
CG 21 70 01 08 ® ISO Properties, Inc., 2007 Page 1 of 1
COMMERCIAL GENERAL LIABILITY
CG 21 76 01 08
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY,
EXCLUSION OF PUNITIVE DAMAGES
RELATED TO A CERTIFIED ACT OF TERRORISM
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
LIQUOR LIABILITY COVERAGE PART
OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART
POLLUTION LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
RAILROAD PROTECTIVE LIABILITY COVERAGEPART
UNDERGROUND STORAGE TANK POLICY
A. The following exclusion is added: 2. The act is a violent act or an act that Is
This Insurance does not apply to: dangerous to human life, property or in-
frastructure and is committed by an in-
TERRORISM PUNITIVE DAMAGES dividual or individuals as part of an effort
to coerce the civilian population of the
Damages arising, directly or Indirectly, out of
United States or to Influence the policy or
a"certified act of terrorism" that are awarded affect the conduct of the United States
as punitive damages_ Government by coercion.
B. The following definition is added:
"Certified act of terrorism" means an act that
is certified by the Secretary of the Treasury,
in concurrence with the Secretary of State
and the Attorney General of the United
States, to be an act of terrorism pursuant to
the federal Terrorism Risk Insurance Act. The
criteria contained in the Terrorism Risk Insur-
ance Act for a "certified act of terrorism" in-
clude the following:
1. The act resulted in insured losses in ex-
cess of $5 million in the aggregate,
attributable to all types of Insurance sub-
ject to the Terrorism Risk Insurance Act;
and
CG 21 76 01 08 ® ISO Properties, Inc., 2007 Page 1 of f
COMMERCIAL GENERAL LIABILITY
CG 22 24 04 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
EXCLUSION - INSPECTION, APPRAISAL AND
SURVEY COMPANIES
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
The following exclusion is added to Paragraph 2. This exclusion appiles even if the claims against
Exclusions of Section I - Coverage A - Bodily In. any insured allege negligence or other wrongdo-
10801 And Property Damage Liability and Para- Ing in the supervision, hiring, employment, train-
IFM 2. Exclusions of Section I - Coverage B - ing or monitoring of others by that insured, if the
Personal And Advertising Injury Liability: "occurrence" which caused the 'bodily injury" or
This insurance does not apply to "bodily injury", property damage", or the offense which caused
"property damage" or "personal and advertising the "personal and advertising injury", involved
injury" for which the Insured may be held liable the rendering of or failure to render professional
� because of the rendering of or failure to render
services in the performance of any claim, inves-
MOM
professional services in the performance of any tigation, adjustment, engineering, inspection, ap-
claim, investigation, adjustment, engineering, in- praisal, survey or audit services.
spection, appraisal, survey or audit services.
CG 22 24 04 13 ® Insurance Services Office, Inc., 2012 Page 1 of 1 pC
I
COMMERCIAL GENERAL LIABILITY
CG 24 26 04 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASEREAD IT CAREFULLY.
AMENDMENT OF INSURED CONTRACT DEFINITION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE
PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
The definition of "insured contract" in the Definl- Paragraph f. does not include that part of
tlons section is replaced by the following: any contract or agreement
"Insured contract" means: (1) That indemnifies a railroad for "bod-
e. A contract for a lease of premises. How- ily Injury" or "property damage"
ever, that portion of the contract for a arising out of construction or
lease of premises that indemnifies any demolition operations, within 50 feet
person or organization for damage by fire of any railroad property and affecting
to premises while rented to you or term- any railroad bridge or trestle, tracks,
porarily aocuplad by you with permission road-beds, tunnel, underpass or
crossing;
of the owner is not an "'Insured contract";
b. A sidetrack agreement; (2) That indemnities an architect, engt-
neer or surveyor for injury or dam-
e. Any easement or license agreement, ex- age arising out ef:
cept in connection with construction or (a) Preparing, approving, or failing
demolition operations on or within 50 to prepare or approve, maps,
feet of a railroad; shop drawings, opinions, re-
d. An obligation, as required by ordinance, ports, surveys, field orders,
to indemnify a municipality, except in change orders or drawings and
connection with work for a municipality; specifications; or
e. An elevator maintenance agreement; (b) Giving directions or instructions,
f. That part of any other contract or agree- or failing to give them, if that is
ment pertaining to your business Qnclud- the primary cause of the injury
ing an indemnification of a municipality or damage; or
in connection with work performed for a (3) Under which the insured, if an archi-
municipality) under which you assume tect, engineer or surveyor, assumes
the tort liability of another party to pay liability for an injury or damage aris-
for "bodily Injury" or "property damage" ing out of the insured's rendering or
to a third person or organization, pro- failure to render professional ser-
vided the "bodily injury" or "property vices, including those listed in (2)
damage" is caused, In whole or in part, above and supervisory, inspection,
by you or by those acting on your behalf. architectural or engineering activi-
However, such part of a contract or ties.
agreement shall only be considered an
"Insured contract" to the extent your as-
sumption of the tort liability is permitted
by law. Tart liability means a liability that
would be Imposed by law in the absence
of any contract or agreement.
CG 24 26 04 13 0 Insurance Services Office, Inc., 2012 Page 1 of 1
I
I
I
COMMERCIAL GENERAL LIABILITY
CG 26 T7 12 04
THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY.
I
WASHINGTON - FUNGI OR BACTERIA EXCLUSION
s
a
This endorsement modifies insurance provided under the following:
i
75551
COMMERCIAL GENERAL LIABILITY COVERAGE PART
A. The following exclusion Is added to Para- B. The following exclusion is added to Para-
2111111111111 graph 2., Exclusions of Section I - Coverage graph 2., Exclusions of Section I - Coverage
A - Bodily Injury And Property Damage Ll- B - Personal And Advertising Injury Liabil-
ability: ity:
2. Exclusions 2. Exclusions
This insurance does not apply to: This insurance does not apply to:
Fungi Or Bacteria Fungi Or Bacteria
a. "Bodily injury" or "property dam- a. "Personal and advertising injury'
age" which would not have cc- which would not have taken place,
curred, in whole or in part, .but for in whole or In part, but for the ac-
the actual, alleged or threatened in- tual, alleged or threatened inhale-
halation of, ingestlon of, contact tlon of, ingestion of, contact with
with, exposure to, existence of, or exposure to, existence of, or pres-
presence of, any "fungi" or bacteria ence of any "fungi" or bacteria on
on or within a building or structure, or within a building or structure,
including its contents. including its contents.
b. Any loss, cost or expenses arising b. Any loss, cost or expense arising
out of the abating, testing for, man- out of the abating, testing for, mon-
toring, cleaning up, removing, con- itoring, cleaning up, removing, con-
taining, treating, detoxifying, neu- taining, treating, detoxifying, neu-
tralizing. remediating or disposing tralizing, remediating or disposing k
of, or in any way responding to, or of, or in any way responding to, or
assessing the effects of, "fungi" or assessing the effects of, "fungi" or
bacteria, by any insured or by any bacteria, by any insured or by any
other person or entity. other person or entity.
This exclusion does not apply to any C. The following definition is added to the
"fungi" or bacteria that are, are on, or Definitions Section: 1,
are contained In, a good or product in-
tended for bodily consumption. "Fungi" means any type or form fungus,
a
including mold or mildew and any
mycotoxins, spores, scents or byproducts
produced or released by fungi.
CG 26 77 12 04 m ISO Properties, Inc., 2003 Page 1 of 1 P.
I
i
COMMERCIAL GENERAL LIABILITY
CIS 32 21 01 07
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WASHINGTON CONDITIONAL EXCLUSION OF
TERRORISM INVOLVING NUCLEAR, BIOLOGICAL OR
CHEMICAL TERRORISM (RELATING TO DISPOSITION OF
FEDERAL TERRORISM RISK INSURANCE ACT)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
LIQUOR LIABILITY COVERAGE PART
OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART
POLLUTION LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
RAILROAD PROTECTIVE LIABILITY COVERAGE PART
UNDERGROUND STORAGE TANK POLICY
A. Applicability Of The Provisions Of This En- (2) Decrease the federal govern-
dorsement ment's statutory percentage
share In potential terrorism
1. The provisions of this endorsement be- losses above such deductible;
come applicable commencing on the or
date when any one or more of the fol-
lowing first occurs. But If your policy (3) Redefine terrorism or make in-
(meaning the policy period in which surance coverage for terrorism
this endorsement applies) begins after subject to provisions or re.
such date, then the provisions of this quirements that differ from
endorsement become applicable on the those that apply to other types
date your policy begins. of events or occurrences under
this policy.
a. The federal Terrorism Risk Insur-
ance Program ('Program"), estab- 2. If the provisions of this endorsement
fished by the Terrorism Risk Insur- become applicable, such provisions:
ante Act, has terminated with a. Supersede any terrorism endorse-
respect to the type of insurance ment already endorsed to this poll-
provided under this Coverage Part cy that addresses "certified acts of
or Policy; or terrorism" and/or "other acts of
b. A renewal, extension or replace- terrorism", but only with respect
ment of the Program has become to an Incident(s) of terrorism (how-
effective without a requirement to ever defined) which results in in-
make terrorism coverage available jury or damage that occurs on or
`,o you and with revisions that: after the date when the provisions
of this endorsement become appii-
(1) Increase our statutory percent- cable (for claims made policies,
age deductible under the Pro- such an endorsement Is supersed-
gram for terrorism losses. ed only with respect to an incident
(That deductible determines of terrorism (however defined) that
the amount of all certified ter- results in a claim for injury or dam- HHH
rorism losses we must pay in a age first being made on or after 4
calendar year, before the fed- the date when the provisions of c
eral government shares In sub- this endorsement become appiica-
sequent payment of certified bra); and
terrorism losses.); or
CG 32 21 01 07 0 ISO Properties, Inc., 2005 Page 1 of 2
1
b. Remain applicable unless we notify c. The following exclusion Is added:
you of changes in these provisions, EXCLUSION OF TERRORISM
In response to federal law. We will not pay for "any injury or damage"
3, If the provisions of this endorsement caused directly or indirectly by "karrodsm",
do NOT become applicable, any terror- inctuding action in hindering or defending
ism endorsement already endorsed to against an actual or expected incident of
this policy, that addresses "certified "[orronsm". But this exclusion applies only
acts of terrorism" and/or "other acts of when one or more of the following are
terrorism", will continue in effort un- attributed to an incident of "terrorism":
less we notify you of changes to that 1. The ''tarrodsm" is carried out by rneans
endorsement in response to federal of the, dispersal or application of radio-
law. active material, or through the use of a
B. The following definitions are added and ap- nuclear weapon or device that involves
ply under this endorsement wherever the or produces a nuclear reaction, nuclear
term terrorism, or the phrase any injuryor radiation or radioactive contamination;
damage, are enclosed in quotation marks: or
Fil
Will 1. "Terrorism" means activities against 2. Radioactive material is released, and it
persons, organizations or property of appears that one purpose of the. "terror-
on any nature: Ism" was to ratease such material? or
� a. That involve the fallowing or prep- 3. The "terrorism" is carried out by means
aration for the following: of the dispersai or application of pathe-
(1) Use or threat of force or vio- genic or poisonous biological or chemi-
lence; or cal materials; or
(2) Commission or threat of a dan- 4. Pathogenic or poisonous biotogicall or
gereus act; or chemical materials are released,
commission an act it
appears that one purpose of the "terror-
(3) Commthat interferes with or or threat of disropts ism" was to release such materials.
In the event of any incident of 'term sm"
an electronic, communication,
information, or mechanical sYs- that sdn of not object t to this Exclusion,
jurY on, clam-.
tern; and
b. When one or bath of the following ago"' that is othurwise excluded under this
Coverage Part or Policy.
applies:
(1) The effect is to intimidate or
coerce a govemment or the 6
vilian population or any seg-
ment thereof, or to disrupt any
segment of the economy; or
(2) It appears that the intent is to
intimidate or coerce a govern-
ment, or to further political,
ideological, religious, social or
economic objectives or to ex-
press (or express opposition to)
a philosophy or ideology.
2. "Any injury or damage" means any in-
jury or damage covered under any COY-
erage Part or Policy to which this en-
dorsement is applicable, and includes
but is not limited to °bodily injury",
"property damage°, "personal and ad-
vertising injury°, "injury' or "environr
mental damage" as may be defined in
any applicable Coverage Part or Policy.
CG 32 21 01 07 0 SiI Properties, Inc., 2005 Page 2 of 2
COMMERCIAL GENERAL LIABILITY
CG 84 99 OS 09
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
NON-CUMULATION OF LIABILITY LIMITS
(SAME OCCURRENCE)
This endorsement modifies Insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
The following is added to Paragraph 5. under Section ill •Limits Of Insurance:
Non-Cumulation of Liability - Same Occurrence - If one 'occurrence" causes "bodily injury" or "property
damage" during the policy period and during the policy period of ore or more prior, or future, general
liability policies issued to you by us, then this policy's Each Occurrence Limit will be reduced by the
amount of each payment made by us under the other policies because of such "occurrence."
For purposes of this endorsement, the term "us" also includes all policies issued by any company within
the Liberty Mutual Agency Markets division of Liberty Mutual Group.
l
MZ10 Liberty Mutual Insurance Company.All rights reserved.
CG 84 99 08 09 Includes copyrighted material of Insurance Services Office,Inc.,with Its permission . Page 1 of t
i
COMMERCIAL GENERAL LIABILITY
CG 88 10 04 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. '
COMMERCIAL GENERAL LIABILITY EXTENSION I
This endorsement modifles insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
INDEX
SUBJECT PAGE
NON-OWNED AIRCRAFT 2
OW NON-OWNED WATERCRAFT 2
ME PROPERTY DAMAGE LIABILITY-ELEVATORS 2
EXTENDED DAMAGE TO PROPERTY RENTED TO YOU (Tenant's Property Damage) 2
MEDICAL PAYMENTS EXTENSION 3
EXTENSION OF SUPPLEMENTARY PAYMENTS -COVERAGES AAND B 3
ADDITIONAL INSUREDS -BY CONTRACT, AGREEMENT OR PERMIT 3
PRIMARY AND NON-CONTRIBUTORY- ADDITIONAL INSURED EXTENSION 5
ADDITIONAL INSUREDS -EXTENDED PROTECTION OF YOUR "LIMITS OF INSURANCE" 6
WHO IS AN INSURED -INCIDENTAL MEDICAL ERRORSlMALPRACTICE AND WHO IS AN
INSURED -FELLOW EMPLOYEE EXTENSION -MANAGEMENT EMPLOYEES 6
NEWLY FORMED ORADDITIONALLY ACQUIRED ENTITIES 7
FAILURE TO DISCLOSE HAZARDS AND PRIOR OCCURRENCES 7
KNOWLEDGE OF OCCURRENCE, OFFENSE, CLAIM OR SUIT 7
LIBERALIZATION CLAUSE 7
BODILY INJURY REDEFINED 7
EXTENDED PROPERTY DAMAGE 8
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US - 8
WHEN REQUIRED IN A CONTRACT OR AGREEMENT WITH YOU
0 2013 Liberty Mutual Insurance
CG 88 10 0413 Includes copyrighted material of Insurance Services Office,Inc.,wth fts permission, Page 1 of 8
With respect to coverage afforded by this endorsement, the provisions of the policy apply unless modified by
the endorsement
A. NON-OWNED AIRCRAFT
Under Paragraph 2. Exclusions of Section I - Coverage A - Bodily Injury And Property Damage Liability,
exclusion g.Aircraft, Auto Or Watercraft does not apply to an aircraft provided:
1. It is not owned by any insured;
2. It is hired, chartered or loaned with a trained paid crew;
3. The pilot in command holds a currently effective certificate, issued by the duly constituted authority of
the United States of America or Canada, designating her or him a commercial or airline pilot; and
4. It is not being used to carry persons or property for a charge.
However, the insurance afforded by this provision does not apply if there Is available to the insured other
valid and collectible insurance, whether primary, excess (other than insurance written to apply specifically
In excess of this policy), contingent or on any other basis, that would also apply to the loss covered under
this provision.
B. NON-OWNED WATERCRAFT
Under Paragraph 2. Exclusions of Section I-Coverage A- Bodily Injury And Property Damage Liability,
Subparagraph (2) of exclusion g. Aircraft, Auto Or Watercraft is replaced by the following:
This exclusion does not apply to:
(2) A watercraft you do not own that is:
(a) Less than 52 feet long; and
(b) Not being used to carry persons or property for a charge.
C. PROPERTY DAMAGE LIABILITY -ELEVATORS
1. Under Paragraph 2. Exclusions of Section I - Coverage A- Bodily Injury And Property Damage Llabil-
Ity, Subparagraphs (3). (4) and (6) of exclusion j• Damage To Property do not apply if such "property
damage" results from the use of elevators. For the purpose of this provision, elevators do not Include
vehicle Ilfts. vehicle lifts are lifts or hoists used in automobile service or repair operations.
2. The following is added to Section IV - Commercial General Liability Conditions, Condition 4. Other
Insurance, Paragraph b. Excess Insurance:
The insurance afforded by this provision of this endorsement is excess over any property Insurance,
whether primary, excess, contingent or on any other basis.
D. EXTENDED DAMAGE TO PROPERTY RENTED TO YOU (Tenant's Property Damage)
If Damage To Premises Rented To You is not otherwise excluded from this Coverage Part:
1. Under Paragraph 2_ Exclusions of Section I -Coverage A-Bodily Injury and Property Damage Liability:
a. The fourth from the last paragraph of exclusion j. Damage To Property is replaced by the follow-
inT
Paragraphs (1), (3) and (4) of this exclusion do not apply to "property damage" (other than damage
by fire, lightning, explosion, smoke, or leakage from an automatic fire protection system) to:
(i) Premises rented to you for a period of 7 or fewer consecutive days; or
(4) Contents that you rent or lease as part of a premises rental or lease agreement fora period of
more than 7 days.
Paragraphs (1), (3) and (4) of this exclusion do not apply to "property damage' to contents of
premises rented to you for a period of 7 or fewer consecutive days.
A separate limit of insurance applies to this coverage as described in Section III - Limits of
Insurance_
m 2013Liberty Mutual lnsurenca
GG 88 10 04 13 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 2 of B
b. The last paragraph of subsection 2. Exclusions is replaced by the following:
Exclusions c. through p. do not apply to damage by fire, lightning, explosion, smoke or leakage
j from automatic tire protection systems to premises while rented to you or temporarily occupied by
you with permission of the owner. A separate limit of insurance applies to Damage To Premises
Rented To You as described in Section III -Limits Of Insurance.
2. Paragraph 6.under Section III -Limits Of Insurance is replaced by the fallowing:
6. Subject to Paragraph S. above, the Damage To Premises Rented To You Llmlt is the most we will
_ pay under Coverage A for damages because of"property damage" to:
a. Any one premise:
(1) While rented to you; or
(2) While rented to you or temporarily occupied by you with permission of the owner for
damage by fire, lightning, explosion, smoke or leakage from automatic protection sys-
tems; or
b. Contents that you rent or lease as part of a premises rental or lease agreement.
ME
110 3. As regards coverage provided by this provision D. EXTENDED DAMAGE TO PROPERTY RENTED TO
=a= YOU (Tenant's Property Damage) -Paragraph 9.a. of Definitions is replaced with the following:
9.a. A contract for a lease of premises. However, that portion of the contract for a lease of premises
that indemnifes any person or organization for damage by fire, lightning, explosion, smoke, or
leakage from automatic fire protection systems to premises while rented to you or temporarily
occupied by you with the permission of the owner, or for damage to contents of such premises
that are included in your promises rental or lease agreement, is not an "insured contract".
E. MEDICAL PAYMENTS EXTENSION
If Coverage C Medical Payments is not otherwise excluded, the Medical Payments provided by this policy
are amended as follows:
Under Paragraph 1. Insuring Agreement of Section I -Coverage C -Medical Payments, Subparagraph
(b) of Paragraph a. is replaced by the following:
(b) The expenses are incurred and reported within three years of the date of the accident; and
F. EXTENSION OF SUPPLEMENTARY PAYMENTS -COVERAGES A AND B
1. Under Supplementary Payments -Coverages A and B, Paragraph 1.b, is replaced by the following:
In. up to $3,00o for cost of bail bonds required because of accidents or traffic law violations arising
out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have
to furnish these bonds.
2. Paragraph 1.d. is replaced by the following:
d. All reasonable expenses Incurred by the insured at our request to assist us in the investigation or
defense of the claim or "suit", including actual loss of earnings up to $500 a day because of time
off from work.
G. ADDITIONAL INSUREDS -BY CONTRACT, AGREEMENT OR PERMIT
1. Paragraph 2. under Section 11 -Who is An Insured is amended to include as an insured any person or
organization whom you have agreed to add as an additional Insured in a written contract, written
agreement or permit. Such person or organization is an additional insured but only with respect to
liability for "bodily injury", "property damage" or "personal .and advertising injury" caused in whole
or in part by:
a. Your acts or omissions, or the acts or omissions of those acting on your behalf, in the performance
of your on going operations for the additional insured that are the subject of the written contract or
written agreement provided that the "bodily injury" or "property damage" occurs, or the "per- r
sonal and advertising injury" is committed, subsequent to the signing of such written contract or
written agreement; or
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b. Premises or facilities rented by you or used by you; or
c, The maintenance, operation or use by you of equipment rented or leased to you by such person or
organization; or
d. Operations performed by you or on your behalf for which the state or political subdivision has
Issued a permit subject to the following additional provisions:
(1) This insurance does not apply to "bodily Injury", "property damage", or "personal and ad-
vertising injury" arising out of the operations performed for the state or political subdivision;
(2) This insurance does not apply to "bodily injury" or "property damage" included within the
"completed operations hazard".
(3) Insurance applies to premises you own, rent, or control but only with respect to the following
hazards:
(a) The existence, maintenance, repair, construction, erection, or removal of advertising
signs, awnings, canopies, cellar entrances, coal hales, driveways, manholes, marquees,
hoist away openings, sidewalk vaults, street banners, or decorations and similar expo-
sures; or
(b) The construction, erection, or removal of elevators; or
(c) The ownership, maintenance, or use of any elevators covered by this insurance.
However:
1. The insurance afforded to such additional insured only applies to the extent permitted by law, and
2. If coverage provided to the additional insured is required by a contract or agreement, the insur-
ance afforded to such additional insured will not be broader than that which you are required by
the contract or agreement to provide for such additional insured.
With respect to Paragraph 1.a. above, a person's or organization's status as an additional insured
under this endorsement ends when:
(1) All work, including materials, parts or equipment furnished in connection with such work, on
the project (other than service, maintenance or repairs) to be performed by or on behalf of the
additional insureds) at the location of the covered operations has been completed; or
(2) That portion of "your work" out of which the injury or damage arises has been put to its
intended use by any person or organization other than another contractor or subcontractor
engaged In performing operations for a principal as apart of the same project.
With respect to Paragraph 1.b. above, a person's or organization's status as an additional insured
under this endorsement ends when their written contract or written agreement with you for such
premises or facilities ends.
With respects to Paragraph 1.c. above, this insurance does not apply to any "occurrence" which takes
place after the equipment rental or lease agreement has expired or you have retumed such equipment
to the lessor.
The insurance provided by this endorsement applies only if the written contract or written agreement
is signed prior to the "bodily injury" or"property damage".
We have no duty to defend an additional insured under this endorsement until we receive written
notice of a "suit" by the additional insured as required in Paragraph b. of Condition 2. Duties In the
Event Of Occurrence, Offense, Claim Or Suit under Section IV - Commercial General Liability Cori
Mons.
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I
2. With respect to the insurance provided by this endorsement, the following are added to Paragraph 2.
Exclusions under Section I-Coverage A-Bodily Injury And Property Damage Liability:
This insurance does not apply to:
a. "Bodily injury" or"property damage" arising from the sole negligence of the additional insured.
b. "Bodily injury" or "property damage" that occurs prior to you commencing operations at the
location where such "bodily injury" or "property damage" occurs. ,
c. "Bodily injury", 'property damage" or "personal and advertising injury" arising out of the render-
ing of, or the failure to render, any professional architectural, engineering or surveying services„
_ including:
(1) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions,
reports, surveys, field orders, change orders or drawings and specifications; or
im—� (2) Supervisory, inspection, architectural or engineering activities.
MM This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in
MMM the supervision, hiring, employment, training or monitoring of others by that Insured, if the 'Occur-
ence" which caused the "bodily injury' or "property damage", or the offense which caused the
°personal and advertising injury", involved the rendering of, or the failure to render, any professional
architectural, engineering or surveying services.
_ d. "Bodily injury" or "property damage" occurring after
(1) All work, including materials, parts or equipment furnished in connection with such work, on
the project (other than service, maintenance or repairs) to be performed by or on behalf of the
additional insured(s) at the location of the covered operations has been completed; or
(2) That portion of 'your work" out of which the Injury or damage arises has been put to its
Intended use by any parson or organization other than another contractor or subcontractor
engaged in performing operations for a principal as a part of the same project. ,
e- Any person or organization specifically designated as an additional insured for ongoing operations
by a separate ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS endorsement is-
sued by us and made a part of this policy.
3. With respect to the insurance afforded to these additional insureds, the following is added to Section III
-Limits Of Insurance:
If coverage provided to the additional insured is required by a contract or agreement, the most we will
pay on behalf of the additional Insured is the amount of insurance:
a. Required by the contract or agreement; or
J. Available under the applicable Limits of Insurance shown in the Declarations;
whichever is less.
This endorsement shall not increase the applicable Limits of Insurance shown in the Declaratio ns.
H. PRIMARY AND NON-CONTRIBUTORY ADDITIONAL INSURED EXTENSION
This provision applies to any person or organization who qualifies as an additional insured under any farm
or endorsement under this policy. ,
Condition 4. Other Insurance of SECTION IV -COMMERCIAL GENERAL LIABILITY CONDITIONS Is amend-
ed as follows:
a. The following is added to Paragraph a. Primary Insurance:
If an additional insured's policy has an Other insurance provision making its policy excess, and you
have agreed in a written contract or written agreement to provide the additional insured coverage on a
primary and noncontributory basis, this policy shall be primary and we will not seek contribution from
the additional insured's policy for damages we cover.
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b. The following is added to Paragraph Is. Excess Insurance:
When a written contract or written agreement, other than a premises lease, facilities rental contract or
agreement, an equipment rental or lease contract or agreement, or permit issued by a state or political
subdlvision between you and an additional insured does not require this insurance to be primary or
primary and non-contributory, this insurance is excess over any other insurance for which the sock
tional insured is designated as a Named Insured.
Regardless of the written agreement between you and an additional insured, this insurance is excess
over any other insurance whether primary, excess, contingent or on any other basis for which the
additional insured has been added as an additional insured on other policies.
I, ADDITIONAL INSUREDS -EXTENDED PROTECTION OF YOUR "LIMITS OF INSURANCE"
This provision applies to any person or organization who qualifies as an additional insured under any form
or endorsement under this policy.
1. The following is added to Condition 2. Duties In The Event of occurrence, Offense, Claim or Suit:
An additional insured under this endorsement will as soon as practicable:
a. Give written notice of an "occurrence" or an offense that may result in a claim or "suit' under
this insurance to us;
b. Tender the defense and Indemnity of any claim or "suit" to all insurers whom also have
insurance available to the additional insured; and
c. Agree to make available any other Insurance which the additional insured has for a loss we
cover under this Coverage Part.
d. We have no duty to defend or indemnify an additional insured under this endorsement until
we receive written notice of a"suit" by the additional insured.
2. The limits of Insurance applicable to the additional insured are those specified in a wdtten contract
or written agreement or the limits of insurance as stated In the Declarations of this policy and
defined in Section III - Limits of Insurance of this policy, whichever are less. These limits are
inclusive of and not in addition to the limits of insurance available under this policy.
1 WHO IS AN INSURED -INCIDENTAL MEDICAL ERRORS(MALPRACTICE
WHO IS AN INSURED -FELLOW EMPLOYEE EXTENSION -MANAGEMENT EMPLOYEES
Paragraph 2.a.(1) of Section 11 -Who Is An Insured is replaced with the following:
(1) "Bodily injury" or "personal and advertising injury":
(a) To you, to your partners or members (if you are a partnership or joint venture), to your members (if
you are a limited liability company), to a co-"employee" while in the course of his or her employ-
ment or performing duties related to the conduct of your business, or to your other "volunteer
workers" while performing duties related to the conduct of your business;
(b) To the spouse, child, parent, brother or sister of that co-"employee" or "volunteer worker" as a
consequence of Paragraph (1) (a) above;
(c) For which there is any obligation to share damages with or repay someone else who must pay
damages because of the injury described in paragraphs (1) (a) or (b) above; or
(d) Arising out of his or her providing or failing to provide professional heatlth care services. However,
if you are not in the business of providing professional health care services or providing profas-
sfonai health care personnel to others, or if coverage for providing professional health care ser-
vices is not otherwise excluded by separate endorsement, this provision (Paragraph (d))does not
apply.
Paragraphs (a) and (b) above do not apply to "bodily injury" or "personal and advertising Pnjury" caused by
an "employee' who Is acting in a supervisory capacity for you. Supervisory capacity as used herein means
the "employee's* job responsibilities assigned by you, includes the direct supervision of other 'employ,
ees" of yours. However, none of these 'employees" are insureds for "bodily injury" or "personal and
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CG 88 10 04 13 Includes copyrighted material of Insurance Services Office,Inc.,with its permission, Page 5 of 8
advertising injury" arising out of their willful conduct, which Is defined as the purposeful or willful intent to
cause "bodily Injury" or "personal and advertising injury", or caused in whole or in part by their Intoxica-
tion by liquor or controlled substances.
The coverage provided by provision J. is excess over any other valid and collectable insurance available to
your "employee".
K. NEWLY FORMED OR ADDITIONALLY ACQUIRED ENTITIES
Paragraph 3. of Section II -Who Is An Insured is replaced by the following:
3. Any organization you newy acquire or form and over which you maintain ownership or majority
interest, will qualify as a Named Insured if there is no other similar insurance available to that
organization. However.
a. Coverage under this provision is afforded only until the expiration of the policy period In
which the entity was acquired or formed by you;
b. Coverage A does not apply to "bodily injury" or "property damage" that occurred before you
acquired or formed the organization; and
c. Coverage B does not apply to "personal and advertising injury" arising out of an offense
gem committed before you acquired or formed the organization.
JIM
� d. Records and descriptions of operations must be maintained by the first Named Insured.
No person or organization is an insured with respect to the conduct of any current or past partnership, joint
venture or limited liability company that is not shown as a Named Insured in the Declarations or qualifles
as an insured under this provision.
L. FAILURE TO DISCLOSE HAZARDS AND PRIOR OCCURRENCES
Under Section IV -Commercial General Liability Conditions, the following is added to Condition 6. Repre-
sentations:
Your failure to disclose all hazards or prior "occurrences" existing as of the inception date of the policy
shall not prejudice the coverage afforded by this policy provided such failure to disclose all hazards or
prior "occurrences" is not intentional.
M. KNOWLEDGE OF OCCURRENCE, OFFENSE, CLAIM OR SUIT
Under Section IV -Commercial General Liability Conditions, the following is added to Condition 2.Duties
In The Event of Occurrence, Offense, Claim Or Suit:
Knowledge of an "occurrence", offense, claim or "suit" by an agent, servant or "employee" of any
insured shall not in Itself constitute knowledge of the insured unless an insured listed under Paragraph
1. of Section II -Who Is An Insured or a person who has been designated by them to receive reports of
"occurrences", offenses, claims or "suits" shall have received such notice from the agent, servant or
"employee".
N. LIBERALIZATION CLAUSE
If we revise this Commercial General Liability Extension Endorsement to provide more coverage without
additional premium charge, your policy will automatically provide the coverage as of the day the revision is
effective in your state.
0. BODILY INJURY REDEFINED
Under Section V-Definitions, Definition 3. is replaced by the following:
3. "Bodily Injury" means physical injury, sickness or disease sustained by a person. This includes
mental anguish, mental injury, shock, fnghl or death that results from such physical injury, sick-
ness or disease.
w
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i P, EXTENDED PROPERTY DAMAGE
Exclusion a. of COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY Is replaced by the
following;
I
a. Expected Or Intended Injury
"Bodily injury" or "property damage" expected or intended from the standpoint of the insured_
This exclusion does not apply to "bodily injury" or "property damage" resulting from the use of
reasonable force to protect persons or property.
Q, WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US - WHEN REQUIRED IN A
CONTRACT OR AGREEMENT WITH YOU
Under Section IV - Commercial General Liability Conditions, the following is added to Condition 8. Trans-
fer Of Rights Of Recovery Against Others To Us:
We waive any right of recovery we may have against a person or organization becausa of payments we
make for injury or damage arising out of your ongoing operations or "your work" done under a
contract with that person or organization and included in the "products-completed operations hazard"
provided:
1. You and that person or organization have agreed in writing in a contract or agreement that you
waive such rights against that person or organization; and
2. The injury or damage occurs subsequent to the execution of the written contract or written agree-
ment.
a
8
s
0 2013 Liberty Mutual Insurance Pa e B of 8
CG 88 10 04 13 Includes copyrighted materiel of Insurance Services Office,Inc with Its pennfssion, 9.
COMMERCIAL GENERAL LIABILITY
CG 88 T7 12 08
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
MEDICAL EXPENSE AT YOUR REQUEST ENDORSEMENT
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
The following is added to Section I-Coverage C•Medical Payments:
' If Medical Payments or Medical Expenses are not otherwise excluded from the policy, medical expenses
will be paid only if an insured has requested that we pay such expenses.
a
i
CG 88 77 12 08 Includes Copyrighted Material of ISOProperties,Inc.,with its permission. Page i of 1
r
COMMERCIAL GENERAL LIABILITY
CG 89 27 10 09
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WASHINGTON EXCLUSION - ASBESTOS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
OWNERS AND.CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART
POLLUTION LIABILITY COVERAGE PART
PRODUCTS AND COMPLETED OPERATIONS COVERAGE PART
RAILROAD PROTECTIVE LIABILITY COVERAGE PART
This insurance does not apply to:
1. "Bodily injury", "property damage" or "personal and advertising injury" arising out of alleged or actual
ingestion or inhalation of asbestos or asbestos -containing materials.
We shall not have the duty to defend any such claim or "suit".
r
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CG 89 27 10 09 Includes copyrighted material of Insurance services Office,with Its permisslon. Page 1 of 1
IL 01 23 11 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WASHINGTON CHANGES - DEFENSE COSTS
This endorsement modifies insurance provided under the following:
COMMERCIAL AUTOMOBILE COVERAGE PART
COMMERCIAL GENERAL LIABILITY COVERAGE PART
COMMERCIAL LIABILITY UMBRELLA COVERAGE PART
COMMERCIAL PROP ERTYCOVERAGE PART-LEGAL LIABILITY COVERAGE FORM
COMMERCIAL PROPERTY COVERAGE PART-MORTGAGEHOLDER'S ERRORSAND
OMISSIONS COVERAGE FORM
ELECTRONICOATA LIABILITY COVERAGEPART
FARM COVERAGE PART
EFER FARM UMBRELLA LIABILITY POLICY
an LIQUOR LIABILITY COVERAGE PART
MM MEDICAL PROFESSIONAL LIABILITY COVERAGEPART
OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART
POLLUTION LIABILITY COVERAGEPART
PRODUCT WITHDRAWAL COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGEPART
RAILROAD PROTECTIVE LIABILITY COVERAGEPART
UNDERGROUND STORAGE TANK COVERAGE PART
A. The provisions of Paragraph B. are added to 5. Coverage C - Mortgagehoider's Liability
all Insuring Agreements that set forth a duty under the Mortgageholder's Errors And
to defend under' Omissions Coverage Form.
1. Section I of the Commercial General Li- Paragraph B. also applies to any other provi-
ability, Commercial Liability Umbrella, sion in the policy that sets forth a duty to de-
Electronic Data Liability, Farm, Liquor Li- fend.
ability, Owners And Contractors Protec- B. If we initially defend an insured ("insured") or
tive Liability, Pollution Liability, Pro- pay for an insured's ("Insured's") defense but
ducts/Completed Operations Liability, later determine that none of the claims
Product Withdrawal, Medical Profession- ("claims"), for which we provided a defense
al Liability, Railroad Protective Liability or defense costs, are covered under this in-
and Underground Storage Tank Cover- surance, we have the right to reimbursement
age Parts, Auto Dealers Coverage Form for the defense costs we have incurred.
and the Farm Umbrella Liability Policy; The right to reimbursement under this provi-
2. Section II under the Auto Dealers, Busi- sion will only apply to the costs we have in-
ness Auto and Motor Carrier Coverage curred after we notify you in writing that
Forms; there may not be coverage and that we are
3. Section III under the Auto Dealers and reserving our rights to terminate the defense
Motor Carrier Coverage Forms; or the payment of defense costs and to seek
4. Section A. Coverage under the Legal Li- reimbursement for defense costs.
ability Coverage Form; and
IL 01 23 11 13 m Insurance Services Office, Inc., 2013 Page 1 of 1
N
IL 01 46 08 10
WASHINGTON COMMON POLICY CONDITIONS
Alf Coverage Parts included in this policy are subject to the following conditions.
The conditions in this endorsement replace any 3. We may cancel the Commercial Property
similar conditions in the policy that are less favor- Coverage Part and the Capital Assets Pro-
able to the insured. gram (Output Policy) Coverage Part, if
A. Cancellation made a part of this policy, by mailing or
1. The first Named Insured shown in the delivering to the first Named Insured and
an ad'scelllala agenttion at least five
Declarations may cancel this policy by the first Named I
notifying us or the insurance producer in written notice of cancellation broker
one of the following ways: days before the effective date of ca-
or more
tion for any structure where two or more
a. Written notice by mail, fax or e-mail; of the following conditions exist
b. Surrender of the policy or binder; or a. Without reasonable explanation, the
c. Verbal notice. structure is unoccupied for more
Upon receipt of such notice, we will can- than 60 consecutive days, or at least
cel this policy or any binder issued as evl- 65% of the rental units are unoccu-
dance of coverage, effective cn the later pied for more than 120 consecutive
of the following: days, unless the structure is main-
a. The date on which notice is received tained for seasonal occupancy or is
or the policy or binder is surren- under construction or repair,
dared; or b. Without reasonable explanation,
progress toward completion of per-
b. The date of cancellation requested
by the first Named Insured. manent repairs to the structure has
not occurred within 60 days after re-
2. We may cancel this policy by mailing or celpt of funds following satisfactory
delivering to the first Named Insured and adjustment or adjudication of loss re-
the first Named Insured's agent or broker sulting from afire;
written notice of cancellation, including c. Because of its physical condition, the
the actual reason for the cancellation, to structure Is in danger of collapse;
the last mailing address known to us, at
least: d. Because of its physical condition, a
vacation or demolition order has
a. 10 days before the effective date of
or It
cancellation if we cancel for nonpay- been issued for the structure,
has been declared unsafe in accor-
ment of premium; or dance with applicable law;
b. 45 days before the effective data of e. Fixed and salvageable items have
cancellation if we cancel for any oth- been removed from the structure, fin-
er reason; dicating an intent to vacate the struc-
except as provided in Paragraphs 3. and lure;
4. below. f. Without reasonable explanation,
heat, water, sewer and electricity are
not furnished for the structure for 60
consecutive days; or
g. The structure is not maintained in
substantial compliance with fire,
safety and building codes.
IL 01 46 09 10 ® Insurance Services Office, Inc., 2010 Page 1 of 4
II
4. If: 7. If this policy is cancelled, we will send
a. You are an individual; the first Named Insured any premium re-
fund due. If we cancel, the refund will be
b. A covered auto you own is of the pro rate. If the first Named Insured can- h
"private passenger type"; and cels, the refund will be at least 90% of the
c. The policy does not cover garage, pro rate refund unless the following ap-
automobile sales agency, repair plies:
shop, service station or public park- a. For Division Two - Equipment Break-
ing place operations hazards; dawn, if the first Named Insured can-
we may cancel the Commercial Auto- cels, the refund will be at least 75%
mobile Coverage Part by mailing or of the pro rate refund.
delivering to the first Named Insured and b. If:
the first Named Insured's agent or broker
written notice of cancellation, Including (1) You are an individual;
the actual reason for cancellation, to the (2) A covered auto you own is of the
last mailing address known to us: private passenger type";
j a. At least 10 days before the effective (3) The policy does not cover ga-
date of cancellation if we cancel for rage, automobile sales agency,
nonpayment of premium; or repair shop, service station or
b. At least 10 days before the effective public parking place operations
date of cancellation for any other rea- hazards; and
son if the policy is in effect less than (4) The first Named Insured cancels;
30 days; or the refund will be not less than 90%
c. At least 20 days before the effective of any unearned portion not exceed-
date of cancellation for other than frig $too, plus 95% of any unearned
s
nonpayment If the policy is In effect portion over $100 but not exceeding i
30 days or more; or $500, and not less than 97% of any
d. At least 20 days before the effective unearned portion in excess of$500.
date of cancellation if the policy is in The cancellation will be effective even if
effect for 60 days or more or is a re- we have not made or offered a refund.
newal or continuation policy, and the 8. If notice is mailed, proof of mailing will
reason for cancellation is that your be sufficient proof of notice.
driver's license or that of any driver B. Changes
who customarily uses a covered
"auto" has been suspended or The policy contains all the agreements be-
revoked coning policy period, tween you and us concerning the insurance
afforded. The first Named Insured shown in
5. We will also mail or deliver to any mort- the Declarations is authorized to make
gage holder, pledgee or other person changes in the terms of this policy with our
shown in this policy to have an Interest in consent. This policy's terms can be amended
any loss which may occur under this poli- or waived only by endorsement issued by us
cy, at their last mailing address known to and made a part of this policy.
us, written notice of cancellation, prior to
the effective date of cancellation. If can-
cellation is for reasons other than those We may examine and audit your books and
contained in Paragraph A.3. above, this records as they relate to this policy at any
notice will be the same as that mailed or time during the policy period and up to three
delivered to the first Named Insured. If years afterward.
cancellation is for a reason contained in D. Inspection And Surveys
Paragraph A.3. above, we will mail or de- 1. We have the right to:
liver this notice at least 20 days prior to
the effective data of cancellation. a. Make inspections and surveys at any
6. Notice of cancellation will state the effec-
time;
tive date of cancellation. The policy pe- b. Give you reports on the conditions
nod will end on that date. we find; and
C. Recommend changes.
Page 2 of 4 0 Insurance Services Office, Inc., 2010 IL 01 46 08 10
2. We are not obligated to make any inspec- G. Nonrenewal
tions, surveys, reports or recommends- 1. We may elect not to renew this policy by
dons, and any such actions we do under- mailing or delivering written notice of
take relate only to insurability and the nonrenewal, stating the reasons for
premiums to be charged. We do not nonrenewel, to the first Named insured
make safety inspections. We do not un- and the first Named Insured's agent or
dertake to perform the duty of any person broker, at their last mailing addresses
or organization to provide for the health known to us. We will also mail to any
or safety of workers or the public. And we mortgage holder, pledgee or other per-
du not warrant that conditions: son shown in this policy to have an Inter-
a. Are safe or healthful; or est In any loss which may occur under
b. Comply with laws, regulations, this policy, at their last mailing address
codes or standards, known to us, written notice of
nonrenewal. We will mail or deliver these
3. Paragraphs 1. and 2. of this condition ap-
notices at least 45 days before the:
ply not only to us, but also to any rating,
advisory, rate service or similar organize- a. Expiration of the policy; or
tion which makes insurance Inspections, b. Anniversary date of this policy if this
surveys, reports or recommendations. policy has been written for a term of
4. Paragraph 2. of this condition does not more than one year.
apply to any inspections, surveys, reports Otherwise, we will renew this policy un-
or recommendations we may make rela- less:
tive to certification, under state or mu- a. The first Named Insured fails to pay
nicipal statutes, ordinances or regula- the renewal premium after we have
tions, of boilers, pressure vessels or expressed our willingness to renew,
elevators. including a statement of the renewal
E. Premiums premium, to the first Named Insured
The first Named Insured shown in the Dec- and the first Named Insured's insur-
larations: ance agent or broker, at least 20 days
1, Is responsible for the payment of all pre- before the expiration date;
miums, and b. Other coverage acceptable to the in-
sured has been procured prior to the
2. Will be the payee for any return premi- expiration date of the policy; or
ums we pay.
F. Transfer Of Your Rights And Oldies Under c. The policy clearly states that it is not
renewable and is for a specific line,
This Policy subclassil' ion, or type of coverage
Your rights and duties under this policy may that is not offered on a renewable ba-
not be transferred without our written con- sis.
sent except in the case of death of an individ- 2, If:
ual Named Insured.
a. You are an individual;
If you die, your rights and duties will be trans-
ferred to your legal representative but only It, A covered auto you own is of the
while acting within the scope of dutles as "private passenger type"; and
your legal representative. Until your legal re- c. The policy does not cover garage,
presentative is appointed, anyone having automobile sales agency, repair
proper temporary custody of your property shop, service station or public park-
will have your rights and duties but only with ing place operations hazards;
respect to that property.
IL 01 46 08 10 ® Insurance Services Office, Inc., 2010 Page 3 of 4
the following applies to nonrenewal of b. We will not refuse to renew Liability
the Commercial Automobile Coverage Coverage or Collision Coverage sole-
Part in place of GA.: ly because an "Insured" has submit-
a. We may elect not to renew or con- led claims under Comprehensive
tinue this policy by mailing
Coverage or Towing And Labor Cov- i
P 9 or I
delivering to you and your agent or erage.
broker written notice at least 20 days c. if we fail to mail or deliver proper no-
before the end of the policy period, tice of nonrenewal and you obtain
Including the actual reason for other insurance, this policy will and
nonrenewal. If the policy period is on the effective date of that insur-
more than one year, we will have the ance.
right not to renew or continue it only
at an anniversary of its original affec-
tive dato. If we offer to renew or con- 1
tinue and you do not accept, this
policy will terminate at the end of the
current policy period. Failure to payMER
pi
the required renewal or continuation
MMM
premium when due shall mean that
you have not accepted our offer.
m
Page 4 of 4 ® Insurance Services Office, Inc., 2010 IL 01 46 08 10
IL 01 98 09 09
THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY.
NUCLEAR ENERGY LIABILITY EXCLUSION
ENDORSEMENT
(Broad Farm)
This endorsement modifies insurance provided under the following:
COMMERCIAL AUTOMOBILE COVERAGE PART
COMMERCIAL GENERAL LIABILITY COVERAGE PART
COMMERCIAL LIABILITY UMBRELLA COVERAGE PART
FARM COVERAGE PART
FARM UMBRELLA LIABILITY POLICY
LIQUOR LIABILITY COVERAGE PART
MEDICAL PROFESSIONAL LIABILITY COVERAGE PART
OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART
POLLUTION LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
RAILROAD PROTECTIVE LIABILITY COVERAGE PART
UNDERGROUND STORAGE TANK POLICY
1. The insurance does not apply: B. Under any Medical Payments Coverage,
to expenses incurred with respect to
A. Under any Liability Coverage, to "bodily "bodily injury" resulting from the "haz-
injury" or "property damage": ardous properties" of 'nuclear mated
(1) With respect to which an "insured" al" and arising out of the operation of a
under the policy is also an insured "nuclear facility" by any person or or-
under a nuclear energy liability poli- ganization.
cy issued by Nuclear Energy Liabil- C_ Under any Liability Coverage, to "bodily
ity Insurance .Association, Mutual injury' or "property damage" resulting
Atomic Energy Liability Underwrit- from "hazardous properties"- of "nuclear
ers, Nuclear Insurance Association material", If:
of Canada or any of their succes-
sors, or would be an insured under (1) The "nuclear material" (a) Is at any
any such policy but for its termina- nuclear facility" owned by, or op-
tion upon exhaustion of its limit of erated by or on behalf of, an "in-
liability; or sured" or (b) has been discharged
or dispersed therefrom;
(2) Resulting from the "hazardous
The "nuclear material" is contained
annddwith
i respect to which (a) any in spent a of "nuclear material" O " fuel" or 'Waste" at any
w
person or organization is required time possessed, handled, used, pro-
to maintain financial protection pur- cessed, stared, transported or
suent to the Atomic Energy Act of disposed of, by or on behalf of an
1954, or any law amendatory there- "Insured"; or
of, or (b) the "insured" is, or had
this policy not been issued would
be, entitled to indemnity from the
United States of America, or any
agency thereof, under any agree-
ment entered into by the United
States of America, or any agency
thereof, with any person or organi-
zation.
IL 01 98 09 08 (DISC) Properties, Inc., 2007 Page 1 of 2
n
4{y
1
(3) The "bodily injury" or 'property 'Nuclear facility" means: �y
damage' arises out of the furnish- (a) Any "nuclear reactor';
ing by an "insured' of services,
materials, parts or equipment in (b) Any equipment or device designed
connection with the planning, con- or used for (1) separating the iso-
struction, maintenance, operation or topes of uranium or plutonium, (2)
use of any 'nuclear facility", but if processing or utilizing "spent fuel",
such facility is located within the or (3) handling, processing or pack-
United States of America, its ter- aging "waste";
dtories or possessions or Canada, (c) Any 'equipment or device used for d
this Exclusion (3) applies only to the processing, fabricating or
"property damage" to such "nucle- alloying of "special nuclear mate-
_ ar facllity" and any property dal" if at any time the total amount
thereat. of such material in the custody of
aim 2. As used in this endorsement: the "insured" at the premises
"Hazardous properties" include radioactive, where such equipment or device is i
toxic or explosive properties; located consists of or contains
more than 25 grams of plutonium
o "Nuclear material" means "source materi- or uranium 233 or any combination
al", "Special nuclear material" or "by-prod- thereof, or more than 250 grams of
_
uct material" uranium 235;
'Source material", "special nuclear mate- (d) Any structure, basin, excavation, j
dal", and "by-product material" have the premises or place prepared or used
meanings given them in the Atomic Energy for the storage or disposal of
Act of 1954 or in any law amendatory there- "waste";
of and includes the site on which any of the
"Spent fuel" means any fuel element or fuel foregoing is located, all operations conduct-
component, solid or liquid, which has been ad on such site and all premises used for
used or exposed to radiation in a "nuclear such operations;
reactor"; 'Nuclear reactor" means any apparatus de- t
"Waste' means any waste material (a) contain- signed or used to sustain nuclear fission in
ing "by-product material" other than the tailings a self-supporting chain reaction. or to con-
or wastes produced by the extraction or con- tain a critical mass of fissionable material;
centration of uranium or thorium from any ore "Property damage" includes all forms of ra- V
processed primarily for its 'source material" dioactive contamination of property.
content, and (b) resulting from the operation by
any person or organization of any "nuclear fa-
cility" included under the first two paragraphs
of the deflnition of "nuclear facility".
IL 01 98 09 08 ®ISO Properties, Inc., 2007 Page 2 of 2
i
DATE IMwooYYY)
CERTIFICATE OF LIABILITY INSURANCE n07/24/20t7
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT. If the certificate holder Is an ADOMONAL INSURED„the POOcy(IEa) must ba endorsed. If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,Certain policies may require an endorawamt, A statement on this certificate does not confer rights to the
certificate holder In lieu of such andoresmenysl.
PRODUCER ..T NATALIiE SHORT _
LIA ADMIN.& INSURANCE SERVICES NE FAe 806-963-6624 tiSI 805.9624552
1600 ANACAPA STREET ,, a;NATALtlE LIB kB1LIT'-.COM
-
--
SANTABARBARA, CA 93101 weuRBB1sI AFFORDING COVERAGE xAlaa
.._...._......,A..,....SPEN -._.....__ _-.
INSURER A.ASPEN AMERICAN INSURANCE COMPANY 43460
INauRED DUNCAN, RF AND ASSOCIATES INC. MBJRIO a:
THE GRANGER COMPANY/RI CHARD F. DUNCAN INSURER C:
P.O.BOX 12300 weuRERD;
OLYMPIA,WA 98508 wsuasa E:.
148215 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 REOVIREMENT, 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,
FXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REOUCED BY PAID CLAIMS.
ADDL R .......... .... ......P+WLJfVEf'Fr30liCPg - ..,........._.. .._ ...._..
LTA TYPE OF INBUMXCE DO .A POLICY NOMa'R Y x LIMITS
GENFRALLUBILITY EACH OCCURRENCE f
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POLICY ...,.... PRO. LOC f
AUTOMOBILE LIABILITY pyt
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AUTOS -."- NON-OWNED �AMAQc.. .
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UMBRELLALWB OCCUR EACH OCCURRENCE S
"CEaa LIAB III, CLAIMSMADE AGGREGATE._ 3
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AND EMPLOYERa'LIABILITY EA LIMITS B
ANY PROPRIETORMIIATNEREXECUTIVE Ya NIA El.EACH ACCIDENT f
OFFICeRMEMBEREKCLUOECH .........� ._,_,.,.,. _.__ x..,..
IMAPONA"y IP NNI EL,DISEASE EA EMPLOYEE f
Ilyya YbNLdM UPdda -SE -.___ ...w...
0ESCRIPTION OF OPERATIONS bab E1.018EASE-POLICY LIMIT f
A PROFESSIONAL LIABILITY AA1002412-03 07/2112017P7121/20181$1,000,000 EACH CLAIM
$2,000,000 AGGREGATE
OFSCRIPODN OF OPEMTIONa I LOCAT1ONf(VEHICLES(Am.h ACORD 101,AddRII ANmAHn eclydub,a mon NPNn Y nqulnd)
REAL ESTATE APPRAISERS PROFESSIONAL LIABILITY INSURANCE
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
CITY OF KENT WA ACCORDANCE WITH THE POLICY PROVISIONS.
220 FOURTH AVENUE SOUTH
KENT, WA 98032 AUTHORIZED REPREe ENTATIVE
m 1908.2010 ACORD CORPORATION. All rights reserved.
ACORD 25(20101051 The ACORD name and loan are reciaterad marks of ACORD