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HomeMy WebLinkAboutCAG2019-032 - Insurance Certificate - Krazan & Associates, Inc. - Updated Liability Coverage with Endorsement - 01/01/2021SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 12/17/2020 (WC)Heffernan Insurance Brokers 1350 Carlback Avenue Walnut Creek CA 94596 Shelaine Gonsalves 925-934-8500 925-934-8278 ShelaineG@heffins.com Travelers Property Casualty Company of America 25674 KRAZ&AS-01 Krazan &Associates,Inc. 215 West Dakota Avenue Clovis CA 93612 1136744950 A X 1,000,000 X 100,000 5,000 X Deductible $0 1,000,000 2,000,000 X X Stop Gap Y 6600F55445ATIL20 10/1/2020 10/1/2021 2,000,000 WA Stop Gap ELL 1,000,000 A 1,000,000 X X X Y 8106N8697512043G 10/1/2020 10/1/2021 A XUB9H9483652143G1/1/2021 1/1/2022 1,000,000 1,000,000 1,000,000 A WA STOP GAP EMPLOYERS LIABILITY UB9H9483652143G 1/1/2021 1/1/2022 LIMIT $1,000,000 CEO (Dean Alexander)is excluded. Re:KA Project #066-19017,Project #16-3012,640 Pressure Zone Booster Station,13300 SE 236th Place,Kent,WA.The City of Kent is included as an additional insured (primary and non-contributory)and includes product &completed operations on General Liability policy and additional insured (primary and non-contributory)on Automobile Liability policy per the attached endorsements,if required.The Umbrella Liability follows the General Liability policy for Additional Insured coverage as per policy forms,if required.Per project aggregate is included on General Liability policy per the attached endorsement,if required.Cancellation notice endorsements for General Liability and Automobile Liability policies are attached,if required. City of Kent Attn:Phil McConnell 220 4th Avenue S. Kent,WA 98032 POLICY NUMBER:6600F55445ATIL20 «AI_Name» POLICY NUMBER: 8106N8697512043G The City of Kent P O L IC Y NUM BER: 6 6 0 0 F 5 5 4 45A T IL 2 0 C O M M E R C IA L G E N E RA L LI A B ILI T Y IS S U E D A T E : THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONA L IN SURE D (C ONT RA C TORS O PERA T ION S) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART NAME OF PERSON (S) OR ORGANIZATION(S): SCHEDULE PROJECT/LOCATION OF COVERED OPERATIONS: 1. WHO IS AN INSURED - (Section II) is amended to include the person or organization shown in the Schedule above, but: a) Only with respect to liability for "bodily injury", "property damage" or "personal injury"; and b) If, and only to the extent that, the injury or damage is caused by acts or omissions of you or your subcontractor in the performance of "your work" on or for the project, or at the location, shown in the Schedule. The person or organization does not qualify as an addi• tional insured with respect to the independent acts or omissions of such person or organiza• tion. 2. The insurance provided to the additional insured by this endorsement is limited as follows: a) In the event that the Limits of Insurance of this Coverage Part shown in the Declarations exceed the limits of liability required by a "written contract requiring insurance" for that additional insured, the insurance provided to the additional insured shall be limited to the limits of liability required by that "written con• tract requiring insurance". This endorsement shall not increase the limits of insurance de• scribed in SECTION Ill - LIMITS OF INSUR• ANCE. b) The insurance provided to the additional in• sured does not apply to "bodily injury", "prop• erty damage" or "personal injury" arising out of the rendering of, or failure to render, any professional architectural, engineering or sur• veying services, including: i. The preparing, approving, or failing to prepare or approve, maps, shop draw• ings, opinions, reports, surveys, field or• ders or change orders, or the preparing, approving, or failing to prepare or ap• prove, drawings and specifications; and CG D3 69 09 05 ©2005 The St. Paul Travelers Companies, Inc. Page 1 of 2 The City of Kent KA Project #066-19017, Project #16-3012, 640 Pressure Zone Booster Station, 13300 SE 236th Place, Kent, WA. COMMERCIAL GENERAL LIABILITY ii. Supervisory, inspection, architectural or engineering activities. c) The insurance provided to the additional in• sured does not apply to "bodily injury" or "property damage" caused by "your work" and included in the "products-completed opera• tions hazard". 3. The insurance provided to the additional insured by this endorsement is excess over any valid and collectible "other insurance", whether primary, ex• cess, contingent or on any other basis, that is available to the additional insured for a loss we cover under this endorsement. However, if a "writ• ten contract requiring insurance" for that addi• tional insured specifically requires that this insur• ance apply on a primary basis or a primary and non- contributory basis, this insurance is primary to "other insurance" available to the additional in• sured which covers that person or organization as a named insured for such loss, and we will not share with that "other insurance". But the insur• ance provided to the additional insured by this endorsement still is excess over any valid and collectible "other insurance", whether primary, ex• cess, contingent or on any other basis, that is available to the additional insured when that per• son or organization is an additional insured under such "other insurance". 4. As a condition of coverage provided to the addi• tional insured by this endorsement: a) The additional insured must give us written notice as soon as practicable of an "occur• rence" or an offense which may result in a claim. To the extent possible, such notice should include: i. How, when and where the "occurrence" or offense took place; ii. The names and addresses of any injured persons and witnesses; and iii. The nature and location of any injury or damage arising out of the "occurrence" or offense. b) If a claim is made or "suit" is brought against the additional insured, the additional insured must: i. Immediately record the specifics of the claim or "suit" and the date received; and ii. Notify us as soon as practicable. The additional insured must see to it that we receive written notice of the claim or "suit" as soon as practicable. c) The additional insured must immediately send us copies of all legal papers received in con• nection with the claim or "suit", cooperate with us in the investigation or settlement of the claim or defense against the "suit", and oth• erwise comply with all policy conditions. d) The additional insured must tender the de• fense and indemnity of any claim or "suit" to any provider of "other insurance" which would cover the additional insured for a loss we cover under this endorsement. However, this condition does not affect whether the insur• ance provided to the additional insured by this endorsement is primary to "other insurance" available to the additional insured which cov• ers that person or organization as a named insured as described in paragraph 3. above. 5. The following definition is added to SECTION V. - DEFINITIONS: "Written contract requiring insurance" means that part of any written contract or agreement under which you are required to include a person or organization as an additional in• sured on this Coverage Part, provided that the "bodily injury" and "property damage" oc• curs and the "personal injury" is caused by an offense committed: a. After the signing and execution of the contract or agreement by you; b. While that part of the contract or agreement is in effect; and c. Before the end of the policy period. Page 2 of 2 © 2005 The St. Paul Travelers Companies, Inc. CG D3 69 09 05 P O LI C Y N U M B E R : 6 600 F 5 5445A T IL 2 0 COMMERCIAL GENERAL LIABILITY ISSUE DATE: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY DESIGNATED PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Designated Proj ec t(s ): S C HE DUL E Desig nated P roject Ge ne ra l A gg regate (s ): A. For all sums which the insured becomes legally obligated to pay as damages caused by "occur• rences" under C OVERAG E A . (SECT ION I), and for all medical expenses caused by accidents un• der C OVERAG E C (SECTIO N I), which can be attributed only to operations at a single desig• nated "project" shown in the Schedule above: 1. A separate Designated Project General Ag• gregate Limit applies to each designated "pro• ject". and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations, unless separate D esig n a te d Proje c t Ge ne ral A g g regate(s) are sched• uled above. 2. The Designated Project General Aggregate Limit is the most we will pay for the sum of all damages under C OVERAG E A ., except damages because of "bodily injury" or "prop• erty damage" included in the "products• completed operations hazard", and for medi• cal expenses under C OVERA GE C , regard• less of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits". 3. Any payments made under C OVERAGE A . for damages or under COVERA GE C . for medical expenses shall reduce the Desig• nated Project General Aggregate Limit for that designated "project" Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they re• duce any other Designated Project General Aggregate Limit for any other designated "project" shown in the Schedule above. 4. The limits shown in the Declarations for Each O ccu rrence, D am age To Premises Rented To You and Medical Ex pense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Designated Project General Ag• gregate Limit. B . For all sums which the insured becomes legally obligated to pay as damages caused by "occur• rences" under C OVERA G E A . (SEC TION I), and for all medical expenses caused by accidents un• der CO VERA GE C . (SEC TIO N I), which cannot be attributed only to operations at a single desig• nated "project" shown in the Schedule above: CG D 2 1 1 01 0 4 Copyright, The Travelers Indemnity Company, 2004 Page 1 of 2 KA Project #066-19017, Project #16-3012, 640 Pressure Zone Booster Station, 13300 SE 236th Place, Kent, WA. COM M E R C IA L G ENERA L LI ABILITY 1. Any paym ents m ade under C OVER AG E A . fo r dam ages or unde r CO VERA GE C. fo r m edica l expens e s shall redu ce the am ount a v a ilable under th e G e n era l Aggregate Li m it o r th e Products-Com p leted Opera tio ns A g• g regate Li m it, whichev e r is applicable ; and 2. Suc h paym ents s hall not reduce any Des ig• nated Project G en era l A ggregate Li m it. C. Part 2. o f SECT ION Ill - LIM ITS OF INSU RANCE is d elete d and replac e d b y the fo llow ing: 2. The Gen er a l Aggregate Limit is the m ost we will pay fo r the sum of: a. Dam ages unde r Coverage B: and b. D a m ages from "occurrences " unde r CO VERA G E A (SECT ION I) and for all m e dica l e x penses caus ed by accidents u nder CO VERA GE C (SECT IO N I) which c annot be att ributed only to operatio ns at a s ingle designat e d "projec t" show n in the SCHED ULE abov e . D. W hen co verage fo r liability arising out of the "p ro duc ts-com plete d oper a tions hazard" is pro- vided, any payments for damages because of "bodily injury " or "property damage" inclu ded in the "pro ducts-com pleted o p erations hazard" w ill reduce the Pro duct s-Co m pleted Operatio ns A g• gregate Limit, and not reduce the General A ggre• gate Limit nor the Designated Project Genera l Aggregate Li mit. E . For the purposes of this endo rsement the D efini• tions Section is am ended by the addition of the fo llo win g d efinitio n: "Project" means an area away from premises owned by or rented to you at which you are per• fo rm ing operations pursuant to a contract or agreem ent. For the purposes of determining the applicable aggregate lim it of insurance, each "project" that incl udes prem ises involving the same or connecting lots, or prem ises whose con• nectio n is interrupted only by a street, ro adw ay, waterw ay or right-of-way o f a railroad shall be con s idered a single "project". F. The provisions of SECTIO N Ill - LIMITS OF IN S U RA N C E not otherw ise m odified by this en• dorsement shall continue to apply as stipulated. Pag e 2 of 2 Copyrig ht, The Trave lers Indem nity C om pany, 2004 C G D211 01 04 POLICY NUMBER:6600F55445ATIL20 16 POLICY NUMBER: 6600F55445ATIL20 COMMERCIAL GENERAL LIABILITY committed by any of your "employees" who is employed by you as a registered nurse, li- censed practical nurse, emergency medical technician or paramedic, in providing or failing to provide "incidental medical services" or "Good Samaritan services" to a person. 2. The following is added to the DEFINITIONS Section: a. "Incidental medical services" means medical, surgical, dental, laboratory, x-ray or nursing service, treatment, advice or instruction; the related furnishing of food or beverages; the furnishing or dispens- ing of drugs or medical supplies or appli- ances; or first aid. b. "Good Samaritan services" means those medical services rendered or provided in C. an emergency and for which no remu- neration is demanded or received. 3. The following is added to Paragraph 2.a.(1) of SECTION II — WHO IS AN INSURED Paragraphs (1) (a), (b), (c) and (d) above do not apply to any of your "employees" who are employed by you as a registered nurse, li- censed practical nurse, emergency medical technician or paramedic but only while per- forming the services described in Paragraph 1. above and while acting within the scope of their employment by you. Any such "employ- ees" rendering "incidental medical services" or "Good Samaritan services" will be deemed to be acting within the scope of their employ- ment by you. 4. The following exclusion is added to Para- graph 2. Exclusions of SECTION I — COV- ERAGES — COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY: Sale of Pharmaceuticals "Bodily injury" or "property damage" arising out of the willful violation of a penal statute or ordinance relating to the sale of pharmaceuti- cals committed by or with the knowledge or consent of the insured. 5. The following is added to Paragraph 4.b., Ex- cess Insurance, of SECTION IV — COM- MERCIAL GENERAL LIABILITY CONDI- TIONS: This insurance is excess over any valid and collectible "other insurance", whether primary, excess, contingent or on any other basis, that is available to you or any of your "employees" for "bodily injury" that arises out of providing or failing to provide "incidental medical ser- vices" or "Good Samaritan services", except for insurance purchased specifically by you to apply in excess of the Limits of Insurance shown in the Declarations for this Coverage Part. 6. The following is added to Paragraph 5. of SECTION III — LIMITS OF INSURANCE: For the purposes of determining the applica- ble Each Occurrence Limit, all related acts or omissions committed by any of your "employ- ees" in providing or failing to provide "inciden- tal medical services" or "Good Samaritan ser- vices" to anyone person will be deemed to be one "occurrence". REASONABLE FORCE PROPERTY DAMAGE — EXCEPTION TO EXPECTED OR INTENDED IN- JURY EXCLUSION The following replaces Exclusion a., Expected Or Intended Injury, in Paragraph 2. of SECTION I — COVERAGES — COVERAGE A BODILY IN- JURY AND PROPERTY DAMAGE LIABILITY: a. Expected Or Intended Injury Or Damage "Bodily injury" or "property damage" expected or intended from the standpoint of the in- sured. This exclusion does not apply to "bod- ily injury" or "property damage" resulting from the use of reasonable force to protect any person or property. D. NON -OWNED WATERCRAFT — INCREASED TO UP TO 75 FEET 1. The following replaces Paragraph (2) of Ex- clusion g., Aircraft, Auto Or Watercraft, in Paragraph 2. of SECTION I — COVERAGES — COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY: (2) A watercraft you do not own that is: (a) Less than 75 feet long; and (b) Not being used to carry any person or property for a charge. 2. The following is added to SECTION II —WHO IS AN INSURED: Any person who, with your expressed or im- plied consent, either uses or is responsible for the use of a nonowned watercraft that is less than 75 feet and not being used to carry per- son or property for a charge is included as an insured under this Coverage Part. Page 2 of 8 0 2008 The Travelers Companies, Inc. CG D4 15 05 08 (Rev. 10-08) COMMERCIAL GENERAL LIABILITY E. AIRCRAFT CHARTERED WITH PILOT The following is added to Exclusion g., Aircraft, Auto Or Watercraft, in Paragraph 2. of SECTION I — COVERAGES — COVERAGE A BODILY IN- JURY AND PROPERTY DAMAGE LIABILITY: This exclusion does not apply to an aircraft that is: (a) Chartered with a pilot to any insured; and (b) Not owned by any insured. F. EXTENSION OF COVERAGE — DAMAGE TO PREMISES RENTED TO YOU 1. The following replaces the last paragraph of SECTION I — COVERAGES — COVERAGE A BODILY INJURY AND PROPERTY DAM- AGE LIABILITY: Exclusions c. through n. do not apply to dam- age to premises while rented to you, or tem- porarily occupied by you with permission of the owner, caused by: a. Fire; b. Explosion; c. Lightning; d. Smoke resulting from such fire, explosion, or lightning; or e. Water. A separate limit of insurance applies to this coverage as described in SECTION III — LIM- ITS OF INSURANCE 2. The insurance under this Provision F. does not apply to damage to premises while rented to you, or temporarily occupied by you with permission of the owner, caused by: a. Rupture, bursting, or operation of pres- sure relief devices; b. Rupture or bursting due to expansion or swelling of the contents of any building or structure, caused by or resulting from wa- ter; or c. Explosion of steam boilers, steam pipes, steam engines, or steam turbines. 3. The following replaces Paragraph 6. of SEC- TION III — LIMITS OF INSURANCE of the owner, caused by: fire; explosion; light- ning; smoke resulting from such fire, explo- sion, or lightning; or water. The Damage To Premises Rented To You Limit will apply to all "property damage" proximately caused by the same 'occurrence", whether such damage results from: fire; explosion; lightning; smoke resulting from such fire, explosion, or light- ning; or water; or any combination of any of these causes. The Damage To Premises Rented To You Limit will be the higher of: a. $300,000; or b. The amount shown for the Damage To Premises Rented To You Limit in the Declarations for this Coverage Part. 4. The following replaces Paragraph a. of the definition of "insured contract" in the DEFINI- TIONS Section: a. A contract for a lease of premises. How- ever, that portion of the contract for a lease of premises that indemnifies any person or organization for damage to premises while rented to you, or tempo- rarily occupied by you with permission of the owner, caused by: fire; explosion; lightning; smoke resulting from such fire, explosion, or lightning; or water is not an "insured contract"; G. PERSONAL INJURY — ASSUMED BY CON- TRACT The following replaces Exclusion e., Contractual Liability in Paragraph 2. of SECTION I — COV- ERAGES — COVERAGE B PERSONAL AN❑ ADVERTISING INJURY LIABILITY: "Advertising injury" for which the insured has as- sumed liability in a contract or agreement. This exclusion does not apply to liability for damages that the insured would have in the absence of the contract or agreement. H. INCREASED SUPPLEMENTARY PAYMENTS 1. The following replaces Paragraph 1.b. of SUPPLEMENTARY PAYMENTS — COVER- AGES A AND B of SECTION I — COVER- AGES: Subject to 5. above, the Damage To Prem- b. Up to $2,500 for cost of bail bonds re- ises Rented To You Limit is the most we will quired because of accidents or traffic law pay under Coverage A for the sum of all violations arising out of the use of any damages because of "property damage" to vehicle to which the Bodily Injury Liability any one premises while rented to you, or Coverage applies. We do not have to fur - temporarily occupied by you with permission nish these bonds. CG D4 15 05 08 (Rev. 10-08) C 2008 The Travelers Companies, Inc. Page 3 of 8 COMMERCIAL GENERAL LIABILITY 2. The following replaces Paragraph 1.d. of SUPPLEMENTARY PAYMENTS — COVER- AGES A AND B of SECTION I — COVER- AGES: 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. I. ADDITIONAL INSURED — OWNER, MANAGER OR LESSOR OF PREMISES 1. The following is added to SECTION II — WHO IS AN INSURED: Any person or organization that you have agreed in a "written contract requiring insur- ance" to include as an additional insured on this Coverage Part is an insured, but: a. Only with respect to liability for "bodily in- jury" or "property damage" that occurs, or "personal injury" caused by an offense committed, after you have entered into that "written contract requiring insurance"; and performed by or on behalf of such additional insured; or (3) Any premises for which coverage is excluded by another endorsement to this Coverage Part. 3. This Provision I. does not apply on any basis to any person or organization for which cov- erage as an additional insured specifically is added by another endorsement to this Cover- age Part. J. ADDITIONAL INSURED — LESSOR OF LEASED EQUIPMENT 1. The following is added to SECTION II —WHO IS AN INSURED: Any person or organization that you have agreed in a "written contract requiring insur- ance" to include as an additional insured on this Coverage Part is an insured, but: a. Only with respect to liability for "bodily in- jury" or "property damage" that occurs, or "personal injury" caused by an offense committed, after you have entered into that "written contract requiring insurance"; and b. Only if the "bodily injury", "property dam- b. Only if the "bodily injury", "property dam- age" or "personal injury" is caused, in age" or "personal injury" is caused, in whole or in part, by acts or omissions of whole or in part, by acts or omissions of you or any person or organization per- you or any person or organization per- forming operations on your behalf, and forming operations on your behalf, in the arises out of the ownership, maintenance maintenance, operation or use of equip - or use of that part of any premises leased ment leased to you by such additional in- to you under that "written contract requir- sured. ing insurance". 2. The insurance provided to such additional in- 2. The insurance provided to such additional in- sured under this Provision J. is subject to the sured under this Provision I. is subject to the following provisions: following provisions: a. The limits of insurance afforded to such a. The limits of insurance afforded to such additional insured shall be the limits additional insured shall be the limits which you agreed to provide in the "writ - which you agreed to provide in the "writ- ten contract requiring insurance", or the ten contract requiring insurance", or the limits shown in the Declarations for this limits shown in the Declarations for this Coverage Part, whichever are less; and Coverage Part, whichever are less; and b. The insurance afforded to such additional b. The insurance afforded to such additional insured does not apply: insured does not apply to: (1) Any "bodily injury" or "property dam- (1) To any "bodily injury" or "property damage" that occurs or "personal in - age" that occurs, or "personal injury" jury" caused by an offense commit - caused by an offense committed, af- ted, after the equipment lease ex - ter you cease to be a tenant in that pires; or premises; (2) If the equipment is leased with an (2) Any structural alterations, new con- operator. struction or demolition operations Page 4 of 8 © 2008 The Travelers Companies, Inc. CG D4 15 05 08 (Rev. 10-08) COMMERCIAL GENERAL LIABILITY 3. This Provision J. does not apply on any basis to any person or organization for which cov- erage as an additional insured specifically is added by another endorsement to this Cover- age Part. K. ADDITIONAL INSURED — STATE OR POLITI- CAL SUBDIVISIONS — PERMITS RELATING TO PREMISES The following is added to SECTION Ii — WHO IS AN INSURED: Any state or political subdivision that has issued a permit in connection with premises owned or oc- cupied by, or rented or loaned to, you, is an in- sured, but only with respect to "bodily injury", "property damage", "personal injury" or "advertis- ing injury" arising out of the existence, ownership, use, maintenance, repair, construction, erection or removal of advertising signs, awnings, cano- pies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, side- walk vaults, elevators, street banners or decora- tions for which that state or political subdivision has issued such permit. L. ADDITIONAL INSURED — STATE OR POLITI- CAL SUBDIVISIONS — PERMITS RELATING TO OPERATIONS The following is added to SECTION II — WHO IS AN INSURED: Any state or political subdivision that has issued a permit is an insured, but only with respect to "bod- ily injury", "property damage", "personal injury" or "advertising injury" arising out of operations per- formed by you or on your behalf for which that state or political subdivision has issued such permit. However, no such state or political subdi- vision is an insured for: 1. "Bodily injury", "property damage", "personal injury" or "advertising injury" arising out of op- erations performed for that state or political subdivision; or 2. "Bodily injury" or "property damage" included within the "products — completed operations hazard". M. WHO IS AN INSURED — NEWLY ACQUIRED OR FORMED ORGANIZATIONS The following replaces Paragraph 4.a. of SEC- TION II — WHO IS AN INSURED: riod, whichever is earlier. Any such newly ac- quired or formed organization that you report in writing to us within 180 days after you ac- quire or form the organization will be covered under this provision until the end of the policy period, even if there are more than 180 days remaining until the end of the policy period. N. INJURY TO CO -EMPLOYEES AND CO - VOLUNTEER WORKERS The following is added to SECTION II — WHO IS AN INSURED: 1. Your "employees" are insureds with respect to "bodily injury" to a co -"employee" in the course of the co -"employee's" employment by you, or to your "volunteer workers" while per- forming duties related to the conduct of your business, provided that this coverage for your "employees" does not apply to acts outside the scope of their employment by you or while performing duties unrelated to the conduct of your business. 2. Your "volunteer workers" are insureds with respect to "bodily injury" to a co -"volunteer worker" while performing duties related to the conduct of your business, or to your "employ- ees" in the course of the "employee's" em- ployment by you, provided that this coverage for your "volunteer workers" does not apply while performing duties unrelated to the con- duct of your business. 3. Subparagraphs 2.a.(1)(a), (b) and (c) and 3.a. of SECTION II — WHO IS AN INSURED do not apply to "bodily injury" for which insur- ance is provided by paragraph 1. or 2. above. 0. MEDICAL PAYMENTS LIMIT The following replaces paragraph 7. of SECTION III — LIMITS OF INSURANCE: Subject to 5. above, the Medical Expense Limit is the most we will pay under Coverage C for all medical expenses because of "bodily injury" sus- tained by any one person, and will be the higher of: a. $10,000; or b. The amount shown on the Declarations for Medical Expense Limit. P. KNOWLEDGE AND NOTICE OF OCCUR- RENCE OR OFFENSE a. Coverage under this provision is afforded only The following is added to Paragraph 2. Duties In until the 180th day after you acquire or form The Event of Occurrence, Offense, Claim Or the organization or the end of the policy pe- CG D415 05 08 (Rev. 10-08) © 2008 The Travelers Companies, Inc. Page 5 of 8 COMMERCIAL GENERAL LIABILITY Suit of SECTION IV — COMMERCIAL GENERAL ance" by the method described in c. LIABILITY CONDITIONS: below. Notice of an "occurrence" or of an offense which b. Excess Insurance may result in a claim must be given as soon as This insurance is excess over any of practicable after knowledge of the "occurrence" or the "other insurance", whether pri- offense has been reported to you, one of your mary, excess, contingent or on any "executive officers" (if you are a corporation), one other basis: of your partners who is an individual (if you are a (1) That is Fire, Extended Coverage, partnership), one of your managers (if you are a Builder's Risk, Installation Risk, limited liability company), one of your trustees or similar coverage for "your who is an individual (if you are a trust), or an work"; "employee" (such as an insurance, loss control or (2) That Fire insurance for prem- risk manager or administrator) designated by you ises rented to you or temporarily to give such notice. occupied by you with permission Knowledge by any other "employee" of an "occur- of the owner; rence" or offense does not imply that you also (3) That is insurance purchased by have such knowledge. you to cover your liability as a Notice of an "occurrence" or of an offense which tenant for "property damage" to may result in a claim will be deemed to be given premises rented to you or tempo - as soon as practicable to us if it is given in good rarily occupied by you with per - faith as soon as practicable to your workers' com- mission of the owner; or pensation, accident, or health insurer. This ap- (4) If the loss arises out of the main - plies only if you subsequently give notice of the tenance or use of aircraft, "occurrence" or offense to us as soon as practi- "autos", or watercraft to the ex - cable after you, one of your "executive officers" (if tent not subject to Exclusion g. of you are a corporation), one of your partners who Section I — Coverage A — Bodily is an individual (if you are a partnership), one of Injury And Property Damage Li - your managers (if you are a limited liability com- ability; or pany), one of your trustees who is an individual (if (5) That is available to the insured you are a trust), or an "employee" (such as an in- when the insured is an additional surance, loss control or risk manager or adminis- insured under any other policy, trator) designated by you to give such notice dis- including any umbrella or excess covers that the "occurrence" or offense may in- policy. volve this policy. When this insurance is excess, we Q. OTHER INSURANCE CONDITION will have no duty under Coverages A 1. The following replaces Paragraph 4., Other or B to defend the insured against "other Insurance"suit" Insurance of SECTION IV — COMMERCIAL if any provider of in - surance" has a duty to defend the in- sured against that "suit". If no pro- 4. Other Insurance vider of 'other insurance" defends, If valid and collectible "other insurance" is we will undertake to do so, but we will available to the insured for a loss we be entitled to the insured's rights cover under Coverages A or B of this against all those providers of "other Coverage Part, our obligations are limited insurance". as follows: When this insurance is excess over a. Primary Insurance "other insurance", we will pay only our share of the amount of the loss, if This insurance is primary except any, that exceeds the sum of: when b. below applies. if this insur- ance is primary, our obligations are (1) The total amount that all such not affected unless any of the 'other "other insurance" would pay for insurance" is also primary. Then, we the loss in the absence of this in - will share with all that "other insur- surance; and Page 6 of 8 © 2008 The Travelers Companies, Inc. CG D4 15 05 08 (Rev. 10-08) COMMERCIAL GENERAL LIABILITY (2) The total of all deductible and self -insured amounts under that "other insurance". We will share the remaining loss, if any, with any "other insurance" that is not described in this Excess Insur- ance provision. c. Method Of Sharing If all of the 'other insurance" permits contribution by equal shares, we will follow this method also. Under this approach each provider of insurance contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, which- ever comes first. If any of the "other insurance" does not permit contribution by equal shares, we will contribute by limits. Under this method, the share of each provider of insurance is based on the ratio of its applicable limit of insur- ance to the total applicable limits of insurance of all providers of insur- ance. 2. The following definition is added to SECTION V — DEFINITIONS: "Other insurance": a. Means insurance, or the funding of losses, that is provided by, through or on behalf of: (1) Another insurance company; (2) Us or any of our affiliated insurance companies, except when the Non cumulation of Each Occurrence Limit section of Paragraph 5. of LIMITS OF INSURANCE (Section III) or the Non cumulation of Personal and Advertis- ing Injury limit sections of Paragraph 4. of LIMITS OF INSURANCE (Sec- tion III) applies; (3) Any risk retention group; (4) Any self-insurance method or pro- gram, other than any funded by you and over which this Coverage Part Insurance shown on the Declarations of this Coverage Part. R. UNINTENTIONAL OMISSION 1. The following is added to Paragraph 6. Rep- resentations of SECTION IV — COMMER- CIAL GENERAL LIABILITY CONDITIONS: The unintentional omission of, or uninten- tional error in, any information provided by you which we relied upon in issuing this policy shall not prejudice your rights under this in- surance. 2. This Provision R. does not affect our right to collect additional premium or to exercise our right of cancellation or nonrenewal in accor- dance with applicable insurance laws or regu- lations. S. WAIVER OF TRANSFER OF RIGHTS OF RE- COVERY AGAINST OTHERS TO US WHEN REQUIRED BY CONTRACT The following is added to Paragraph 8. Transfer of Rights of Recovery Against Others to Us of SECTION IV — COMMERCIAL GENERAL LI- ABILITY CONDITIONS: We waive any rights of recovery we may have against any person or organization because of payments we make for "bodily injury", "property damage", "personal injury" or "advertising injury" arising out of: 1. Premises owned by you, temporarily occu- pied by you with permission of the owner, or leased or rented to you; 2. Ongoing operations performed by you, or on your behalf, under a contract or agreement with that person or organization; 3. "Your work"; or 4. "Your products". We waive these rights only where you have agreed to do so as part of a "written contract re- quiring insurance" entered into by you before, and in effect when, the "bodily injury" or "property damage" occurs, or the "personal injury" offense or "advertising injury" offense is committed. T. AMENDED BODILY INJURY DEFINITION applies; or The following replaces the definition of "bodily (5) Any similar risk transfer or risk man- injury" in the DEFINITIONS Section: agement method. b. Does not include umbrella insurance, or "Bodily injury" means bodily injury, mental an - excess insurance, that you bought spe- guish, mental injury, shock, fright, disability, hu- cifically to apply in excess of the Limits of miliation, sickness or disease sustained by a per- CG D415 05 08 (Rev.10-08) 0 2008 The Travelers Companies, Inc. Page 7 of 8 COMMERCIAL GENERAL LIABILITY son, including death resulting from any of these at any time. U. AMENDED INSURED CONTRACT DEFINITION — RAILROAD EASEMENT 1. Subparagraph c. of the definition of "insured contract" in the DEFINITIONS Section is re- placed by the following: c. Any easement or license agreement; 2. Subparagraph f.(1) of the definition of "in- sured contract" in the DEFINITIONS Section is deleted. V. ADDITIONAL DEFINITION — WRITTEN CON- TRACT REQUIRING INSURANCE The following definition is added to the DEFINI- TIONS Section: "Written contract requiring insurance" means that part of any written contract or written agreement under which you are required to include a person or organization as an additional insured on this Coverage Part, provided that the "bodily injury" and "property damage" occurs, and the "personal injury" is caused by an offense committed: a. After the signing and execution of the contract or agreement by you; b. While that part of the contract or agreement is in effect; and c. Before the end of the policy period Page 8 of 8 C 2008 The Travelers Companies, Inc. CG D4 15 05 08 (Rev. 10-08) POLICY NUMBER:6600F55445ATIL20 premiums and minimum premiums. The pre- mium shown in the Declarations was com- puted based on rates and rules in effect at the time the policy was issued. On each renewal continuation or anniversary of the effective date of this policy, we will compute the pre- mium in accordance with our rates and rules then in effect. F. TRANSFER OF YOUR RIGHTS AND DUTIES UNDER THIS POLICY Your rights and duties under this policy may not be transferred without our written consent except in the case of death of an individual named in- sured. If you die, your rights and duties will be trans- ferred to your legal representative but only while acting within the scope of duties as your legal representative. Until your legal representative is appointed, anyone having proper temporary cus- tody of your property will have your rights and du- ties but only with respect to that property. G. WHEN WE DO NOT RENEW If we decide not to renew this policy we will mail or deliver to the first Named Insured shown in the Declarations written notice of the nonrenewal not less than 60 days before the expiration date. H. DELUXE PROPERTY COVERAGE PART - REFERENCE TO FORMS AND ENDORSE- MENTS In some instances, the Deluxe Property Declara- tions may list endorsements included in the De- luxe Property Coverage Part that reference: 1. The Commercial Property Coverage Part; 2. The Commercial Inland Marine Coverage Pa rt; 3. Commercial Property forms including, but not limited to, the following; a. Building and Personal Property Coverage Form; b. Business Income Coverage Form; c. Commercial Property Conditions; d. Causes of Loss — Special Form; e. Causes of Loss --- Earthquake Form. 4. Commercial Inland Marine Forms including but not limited to the Transportation Coverage — Special Form Endorsements referencing the Commercial Property Coverage Part, Commercial Inland Marine Coverage Part, Commercial Property Forms, or Commercial Inland Marine Forms apply to the Deluxe Property Coverage Forms in the same manner as they apply to the Forms they reference. I. INSURANCE UNDER TWO OR MORE COVER- AGE PARTS If two or more of this policy's Coverage Parts ap- ply to the same loss or damage, we will not pay more than -the actual amount of the loss or dam- age. This policy consists of the Common Policy Declarations and the Coverage Parts and endorsements listed in that declarations form. In return for payment of the premium, we agree with the Named Insured to provide the insurance afforded by a Coverage Part forming part of this policy. That insurance will be provided by the company indicated as insuring company in the Common Policy Declarations by the abbreviation of its name opposite that Coverage Part. One of the companies listed below (each a stock company) has executed this policy, and this policy is counter- signed by the officers listed below: The Travelers Indemnity Company (IND) The Phoenix Insurance Company (PHX) The Charter Oak Fire Insurance Company (COI=) Travelers Property Casualty Company of America (TIL) The Travelers Indemnity Company of Connecticut (TCT) The Travelers Indemnity Company of America (TIA) Travelers Casually Insurance Company of America (ACJ) Secretary President Page 2 of 2 Includes copyrighted material of insurance Services Office, Inc. with its permission, IL T3 18 05 11 POLICY NUMBER: 8106N8697512043G premiums and minimum premiums. The pre- mium shown in the Declarations was com- puted based on rates and rules in effect at the time the policy was issued. On each renewal continuation or anniversary of the effective date of this policy, we will compute the pre- mium in accordance with our rates and rules then in effect. F. TRANSFER OF YOUR RIGHTS AND DUTIES UNDER THIS POLICY Your rights and duties under this policy may not be transferred without our written consent except in the case of death of an individual named in- sured. If you die, your rights and duties will be trans- ferred to your legal representative but only while acting within the scope of duties as your legal representative. Until your legal representative is appointed, anyone having proper temporary cus- tody of your property will have your rights and du- ties but only with respect to that property. G. WHEN WE DO NOT RENEW If we decide not to renew this policy we will mail or deliver to the first Named Insured shown in the Declarations written notice of the nonrenewal not less than 60 days before the expiration date. H. DELUXE PROPERTY COVERAGE PART - REFERENCE TO FORMS AND ENDORSE- MENTS In some instances, the Deluxe Property Declara- tions may list endorsements included in the De- luxe Property Coverage Part that reference: 1. The Commercial Property Coverage Part; 2. The Commercial Inland Marine Coverage Part; 3. Commercial Property forms including, but not limited to, the following; a. Building and Personal Property Coverage Form; b. Business Income Coverage Form; c. Commercial Property Conditions; d. Causes of Loss — Special Form; e. Causes of Loss -- Earthquake Form. 4. Commercial Inland Marine Forms including but not limited to the Transportation Coverage — Special Form Endorsements referencing the Commercial Property Coverage Part, Commercial Inland Marine Coverage Part, Commercial Property Forms, or Commercial Inland Marine Forms apply to the Deluxe Property Coverage Forms in the same manner as they apply to the Forms they reference. I. INSURANCE UNDER TWO OR MORE COVER- AGE PARTS If two or more of this policy's Coverage Parts ap- ply to the same loss or damage, we will not pay more than 'theactual amount of the loss or dam- age. This policy consists of the Common Policy Declarations and the Coverage Parts and endorsements listed in that declarations form. In return for payment of the premium, we agree with the Named Insured to provide the insurance afforded by a Coverage Part forming part of this policy. That insurance will be provided by the company indicated as insuring company in the Common Policy Declarations by the abbreviation of its name opposite that Coverage Part. One of the companies listed below (each a stock company) has executed this policy, and this policy is counter- signed by the officers listed below: The Travelers Indemnity Company (IND) The Phoenix Insurance Company (PHX) The Charter Oak Fire Insurance Company (COF) Travelers Property Casualty Company of America (TIL) The Travelers Indemnity Company of Connecticut (TCT) The Travelers Indemnity Company of America (TIA) Travelers Casualty Insurance Company of America (ACJ) 4)"Secreta��-��-- ry President Page 2 of 2 Includes copyrighted material of Insurance Services office, Inc. with its permission. IL T3 18 05 11