HomeMy WebLinkAboutCAG2019-469 - Amendment - #1 - RailPros Field Services, Inc. - S 212th Street Pavement Preservation Project - 11/18/2019Agreement Routing Form
KENT For Approvals, Signatures and Records Management
This form combines & replaces the Request for Mayor's Signature and Contract Cover Sheet forms.
(Print on pink or cherry colored paper)WasHrNcroN
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Originator:
Nancy Yoshitake for Drew Holcomb
Department:
Public Works
Date Sent:
12116t20
Date Required
12t21t20
Authorized to Sign:
E Director or Designee E Mayor
Date of Council Approval
N/A
Budget Account Number:
R901 1 3
Budget? EYes ENo
Grant? EYes E No
Type:
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Vendor Name:
RailPros Field Services
Category:
Contract
Vendor Number:Sub-Category:
Amendment 1
Project Name: 212th Street Pavement Preservation
Projecr Details:Extend the time of completion to December 31 ,2021
Agreement Amount: $0
Srart Date: 12115120
Basis for Selection of Contractor:
Termination Date: 12131121
Local Business? EYes El No*
*lf meets requirements per KCC 3.70.100, please complete "Vendor Purchase-Local Exceptions" form on Atyspace.
Notice required prior to disclosure?
EYes EI No
Contract Number:
cAG2019-469
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Date Received by City Attorney:Comments:
Date Routed to the Mayor! Office:
Date Routed to the City Clerk's Offce:
ad(W22l7l I 20 Visit Documents.KentwA.gov to obtain copies of all agreements
KENT
WaSHtNGToN
AMENDMENT NO. 1
NAME OF CONSULTANT OR VENDOR:RailPros Field Services, Inc.
CONTRACT NAME & PROJECT NUMBER:S. 212th Street Pavement Preservation
ORIGINAL AGREEMENT DATE:November 18, 2019
This Amendment is made between the City and the above-referenced Consultant or
Vendor and amends the original Agreement and all prior Amendments. All other provisions of
the original Agreement or prior Amendments not inconsistent with this Amendment shall remain
in full force and effect. For valuable consideration and by mutual consent of the parties,
Consultant or Vendor's work is modified as follows:
1. Section I of the Agreement, entitled "Description of Work," is hereby modified to
add additional work or revise existing work as follows:
In addition to work required under the original Agreement and any
prior Amendments, the Consultant or Vendor shall:
No change to the scope of work, however an amendment is
needed to extend the time of completion to December 31, 2O2L
due to the project will not be completed by the time of contract
completion.
2. The contract amount and time for performance provisions of Section II "Time of
Completion," and Section III, "Compensation," are modified as follows:
Original Contract Sum,
includ ing applicable WSST
$g,olz
Net Change by Previous Amendments
includ ing appl icable WSST
$o
Current Contract Amount
including all previous amendments
$g,olz
Current Amendment Sum $o
Applicable
Amendment
WSST Tax on this $o
Revised Contract Sum $9,032
AMENDMENT-1OF2
Original Time for Completion
(insert date)
12l3u20
Revised Time for Completion under
prior Amendments
(insert date)
nla
Add'l Days Required (+) for this
Amendment
365 calendar days
Revised Time for Completion
(insert date)
t2t3U2t
The Consultant or Vendor accepts all requirements of this Amendment by signing below,
by its signature waives any protest or claim it may have regarding this Amendment, and
acknowledges and accepts that this Amendment constitutes full payment and final settlement of
all claims of any kind or nature arising from or connected with any work either covered or
affected by this Amendment, including, without limitation, claims related to contract time,
contract acceleration, onsite or home office overhead, or lost profits, This Amendment, unless
otherwise provided, does not relieve the Consultant or Vendor from strict compliance with the
guarantee and warranty provisions of the original Agreement.
All acts consistent with the authority of the Agreement, previous Amendments (if any),
and this Amendment, prior to the effective date of this Amendment, are hereby ratified and
affirmed, and the terms of the Agreement, previous Amendments (if any), and this Amendment
shall be deemed to have applied,
The parties whose names appear below swear under penalty of perjury that they are
authorized to enter into this Amendment, which is binding on the parties of this contract.
IN WITNESS, the pafties below have executed this Amendment, which will
become effective on the last date written below,
RallPros - 212th Pavement Preseruation Amd 1/Holcomb
coNSULTANT/VENDOR:
Ki&.*
By
(signature)
Print Name:Gary Killion
[[g Business Operations Manager
(titte)
DATE: 12t14t2020
(signature)
Print Name: Carla Malonev. P.E.
Its
DATEI
ATTEST:
l/,* t'/*r,fu
Kent City Clerk
APPROVED AS TO FORM:
(applicable if Mayor's signature required)
Kent Law Department
AMENDMENT-2OF2
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYYI
2t3t2020
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 TNSURANCE DOES NOT CONSTTTUTE A CONTRACT BETWEEN THE |SSU|NG TNSURER(S), AUTHORTZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: lf the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
lf SUBROGATION lS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER
lMA, lnc. - Colorado Division
1705 17th Street, Suite 100
Denver CO 80202
IMA Denver Team
303-534-4567
INSURERTST AFFORDING COVERAGE NAIC f
rNsuRERA, Liberfu Mutual Fire lnsurance Comoanv 23035
INSURED
RailPros Holdings, LLC
1320 Greenway Drive
lrving, TX 75038
RAILPRO rNsuRER B: Westchester Surplus Lines lnsurance Co 10172
rNsuRERc : Liberty lnsurance Corporation 42404
rNsuRER D: RSUI lndemnity Companv 22314
INSURER E:
INSURER F :
COVERAGES CERTIFICATE NUMBER: 1025614003 UMBER
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTMCT OR OTHER DOCUMENT WTH RESPECT TO ffiICH 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 SHO\A/N MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSRtn TYPE OF INSURANCE POLICY NUMBER
POLIGY EFFtMMrnn/Yvwl POLICY EXPIMM'NDMI LIMITS
EACH OCCURRENCE $ 1,000,000
$ 1 00,000
irED EXP (Any one person)$ 15,000
PERSONAL & ADV INJURY $ t,000,000
GENERAL AGGREGATE $ 2,000,000
PRODUCTS . COMP/OP AGG $ 2.000.000
COMMERCIAL GENERAL LIABILITY
X
GEN'L AGGREGATE LIMIT APPLIES PER:
X
X
sol
PRO-JECT I I
X
X
POLICY LOC
OCCUR
$5,000 Ded.
CLAIMS.MADE
182291470138020 21112020 2t1t2021
$
$ 1,000,000
BODILY INJURY (Per person)$
BODILY INJURY (P€r accident)$
$
AUTOMOBILE LIABILITY
ANY AUTO
OVVNED
AUTOS ONLY
HIRED
AUTOS ONLY
SCHEDULED
AUTOS
NON-Otl/t\ED
AUTOS ONLY
X
X X
AS2Z91 4701 380'l 0 2t1t2020 21112021
$
X EACH OCCURRENCE $ 9,000,000
X
UMBRELLA LIAB
EXCESS LIAB
OCCUR
cLAilVlS-t\rADE AGGREGATE $ 9,000,000
B
DED RETENTION S
G71488573002 211t2020 21112021
$
X PER Israrr rrF I
OTH.FR
E,L. EACH ACCIDENT $ 1.000.000
E.L, DISEASE. EA EMPLOYEE $ 1.000.000
c WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANYPROPRI ETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory in NHI
lf y€s, describe under
DFSCRIPTION OF OPFRATIONS hclM
N N'A
wc72914701 38030 2t1t2020 2111202'l
E.L. DISEASE. POLICY LIMIT s 1.000.000
D Exc€ss 2nd Layer NH424871 5 2t1t2020 21112021 Each Occunence
Aggregate
$1 0,000,000
$1 0,000,000
DESCRIPTION OF OPERATIONS , LOCATIONS / VEHICLES (ACORD l0l, Additional RomarkE Schedule, may be attachod if more Epace is Equlredl.Railroads Contractual Liability lncluded on the General Liability.
Professional Coverage: Policy #03105773
Effective Dates: 02101/2020 -0210112021 lnsurer: Allied World Surplus Lines lns. Co.
$10,000,000 Each Claim; $10,000,000 Aggregate; $350,000 SIR
Pollution Coverage: Policy #03105773
Effective Dates: 02101/2020 - 02101 12021 lnsurer: Allied World Surplus Lines lns. Co.
See Attached...
LDER CANCELLA
@ 1988-2015 AGORD CORPORATION. All rights reserved.
ACORD 25 (2016/,031 The ACORD name and logo are registered marks of ACORD
THIS CERTIFICATE SUPERSEDES PREVIOUSLY ISSUED CERTIFICATE
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.City of Kent, Washington
220 Fourth Avenue South
Kent WA 98032
USA
AUTHORIZED REPRESENTATIVE
/ //,
AGENCY CUSTOMER lD: RAILPRO
LOC #:
lMA, lnc. - Colorado Division
AGENCY
POLICY NUMBER
NAMED INSURED
RailPros Holdings, LLC
1320 Greenway Drive
lrving, TX 75038
CARRIER NAIC CODE
EFFECTIVE DATE:
ADDITIONAL REMARKS SCHEDULE Page 1 of 1
@ 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: 25 FORMTITLE:CERTIFICATE OF LIABILITY INSURANCE
$10,000,000 Limit; $350,000 SIR
Cyber Liability Coverage: Policy #03121993
Effective Dales: 0111712020 - 0210112021 lnsurer: Allied World Assurance (US) lnc
$2,000,000 Privacy & Network Security Liability; $25,000 SIR
$2,000,000 Media Liability; $25,000 SIR
$2,000,000 Aggregate
Ci$ of Kent, Washington is included as Additional lnsured on the General, Automobile, and Umbrella Liability Policies if required by written contract or
agreement and _with respect to work performed by lnsured subject to the policy terms and conditions. A Waiver of Subrogation is piovided in favor of Additional
lnsured on lhe General, Automobile, Umbrella Liability and Workers CompenSation Policies if required by written contraCt or agre'ement and with respect to work
performed by lnsured.subject to the policy terms and conditions. This lnsurance is Primary and Non-Coniributory on the Geneial Liability Policy subject to the
policy terms and conditions.
ACORD 101 (2008/01)
Policy Numb er T 8.2-291 -47 01 38-020
lssued by Liberly Mutual Fire lnsurance Co.
This endorsement modifies insurance provided under the following
COMMERCIAL GENERAL LIABILITY COVERAGE PART
lndex of modified items:
Item 1.
Item 2.
Item 3.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
COMMERCIAL GENERAL LIABILITY
ADDITIONAL INSURED ENHANCEMENT FOR CONTRACTORS
Blanket Additional lnsured Where Required By Written Agreement
Lessors of Leased Equipment
Managers or Lessors of Premises
Mortgagees, Assignees or Receivers
Owners, Lessees or Contractors
Architects, Engineers or Surveyors
Any Person or Organization
Blanket Additional lnsured - Grantor Of Permits
Other Insurance Amendment
Item 1. Blanket Additional lnsured Where Required By Written Agreement
Paragraph 2. of Section ll - Who ls An lnsured is amended to add the following:
Additional lnsured By Written Agreement
The following are insureds under the Policy when you have agreed in a written agreement to provide them coverage
as additional insureds under your policy:
1. Lessors of Leased Equipment The person(s) or organization(s) from whom you lease equipment, but only
with respect to liability for "bodily inju$', "property damage" or "personal and advertising injuf' caused, in
whole or in part, by your maintenance, operation or use of equipment leased to you by such person(s) or
organization(s).
This insurance does not apply to any "occurrence" which takes place after the equipment lease expires.
2. Managers or Lessors of Premises: Any manager(s) or lessor(s) of premises leased to you in which the written
lease agreement obligates you to procure additional insured coverage.
The coverage afforded to the additional insured is limited to liability in connection with the ownership,
maintenance or use of the premises leased to you and caused, in whole or in part, by some negligent act(s) or
omission(s) of you, your "employees", your agents or your subcontractors. There is no coverage for the
additional insured for liability arising out of the sole negligence of the additional insured or those acting on
behalf of the additional insured, except as provided below.
lf the written agreement obligates you to procure additional insured coverage for the additional insured's sole
negligence, then the coverage for the additional insured shall conform to the agreement, but only if the
applicable law would allow you to indemnify the additional insured for liability arising out of the additional
insured's sole negligence.
@ 2018 Liberty Mutual lnsurance
lncludes copyighted material of lnsurance SeMces Office, lnc., with its permission.
LC2058 11 18 Page 1 of 4
This insurance does not apply to:
a. Any "occurrence" which takes place after you cease to be a tenant in that premises or to lease that land;
b. Structural alterations, new construction or demolition operations performed by or on behalf of that manager
or lessor; or
c. Any premises for which coverage is excluded by endorsement.
3. Mortgagees, Assignees or Receivers: Any person(s) or organization(s) with respect to their liability as
mortgagee, assignee or receiver and arising out of your ownership, maintenance or use of the premises.
This insurance does not apply to structural alterations, new construction and demolition operations performed
by or on behalf of such person(s) or organization(s).
4. Owners, Lessees or Contractors: Any person(s) or organization(s) to whom you are obligated to procure
additional insured coverage, but only with respect to liability for "bodily injuff', "property damage" or "personal
and advertising injun/' caused, in whole or in part, by your act(s) or omission(s) or the act(s) or omission(s) of
your "employees", your agents, or your subcontractors, in the performance of your ongoing operations.
This insurance does not apply to "bodily inju{', "properly damage", or "personal and advertising injury/' arising
out of "your work" included in the "products-completed operations hazard" unless you are required to provide
such coverage for the additional insured by the written agreement, and then only for the period of time required
by the written agreement and only for liability caused, in whole or in part, by your act(s) or omission(s) or the
act(s) or omission(s) of your "employees", your agents, or your subcontractors.
There is no coverage for the additional insured for liability arising out of the sole negligence of the additional
insured or those acting on behalf of the additional insured, except as provided below.
lf the written agreement obligates you to procure additional insured coverage for the additional insured's sole
negligence, then the coverage for the additional insured shall conform to the agreement, but only if the
applicable law would allow you to indemnify the additional insured for liability arising out the additional insured's
sole negligence.
This insurance does not apply to "bodily inju$', "property damage" or "personal and advertising injut'' arising
out of the rendering of, or failure to render, any professional architectural, engineering or survelng seMces,
including:
a. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys,
field orders, change orders or drawings and specifications; or
b. SupeMsory, inspection, architectural or engineering activities.
This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the
supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which
caused the "bodily injut'' or "property damage", or the offense which caused the "personal and advertising
injury", involved the rendering of or failure to render any professional services.
5. Architects, Engineers or Surveyors: Any architect, engineer, or surveyor engaged by you but only with
respect to liability for "bodily injut'', "property damage" or "personal and advertising injury/' caused, in whole or
in part, by your act(s) or omission(s) or the act(s) or omission(s) of those acting on your behalf:
a. ln connection with your premisesl or
b. ln the performance of your ongoing operations.
This insurance does not apply to "bodily injuS', "property damage" or "personal and advertising injun/' arising
out of the rendering of or failure to render any professional services by or for you, including:
@ 2018 Liberty Mutual lnsurance
lncludes copyrighted material of lnsurance SeMces Office, lnc., with its permission.
LC 20 58 11 18 Page 2 of 4
a.The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys,
field orders, change orders or drawings and specifications; or
b. Supervisory, inspection, architectural or engineering activities
This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the
supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which
caused the "bodily injuS' or "property damage", or the offense which caused the "personal and advertising
injury", involved the rendering of or failure to render any professional services by or for you.
6. Any Person or Organization Other Than a Joint Venture: Any person(s) or organization(s) (other than a joint
venture of which you are a member) for whom you are obligated to procure additional insured coverage, but
only with respect to liability for "bodily injury'', "property damage" or "personal and advertising injury/' caused, in
whole or in part, by your act(s) or omission(s) or the act(s) or omission(s) of those acting on your behalf:
a. ln the performance of your ongoing operations; or
b. ln connection with premises owned by or rented to you.
This insurance does not apply to:
a. Any person(s) or organization(s) more specifically covered in Paragraphs 1. through 5. above;
b. Any construction, renoration, demolition or installation operations performed by or on behalf of you, or
those operating on your behalf; or
c. Any person(s) or organization(s) whose profession, business or occupation is that of an architect, surveyor
or engineer with respect to liability arising out of the rendering of, or failure to render, any professional
architectural, engineering or survelng services, including :
(1) The preparing, approMng or failing to prepare or approve, maps, drawings, opinions, reports, surveys,
field orders, change orders, designs and specifications; or
(2) SupeMsory, inspection, architectural or engineering activities
This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the
supeMsion, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which
caused the "bodily injut'' or "property damage", or the offense which caused the "personal and advertising
injury", involved the rendering of or failure to render any professional services by or on behalf of you, or those
operating on your behalf.
The insurance afforded to any person(s) or organization(s) as an insured under this ltem 1.:
1. Applies to the ercent permitted by law:
2. Applies only to the scope of coverage and the minimum limits of insurance required by the written agreement,
but in no event exceeds either the scope of coverage or the limits of insurance provided by this Policy;
3. Does not apply to any person(s) or organization(s) for any "bodily inju$', "property damage' or "personal and
advertising injury'' if any other additional insured endorsement attached to this Policy applies to such person(s)
or organization(s) with regard to the "bodily injut'', "property damage" or "personal and advertising injury";
4. Applies only if the "bodily injury/' or "property damage" occurs, or the offense giving rise to the "personal and
advertising injury/' is committed, subsequent to the execution of the written agreement; and
5. Applies only if the written agreement is in effect at the time the "bodily inju$' or "property damage" occurs, or at
the time the offense giving rise to the "personal and advertising injun/' is committed.
O 2018 Liberty Mutual lnsurance
lncludes copyighted material of lnsurance SeMces Office, lnc., with its permission.
LC 20 58 11 18 Page 3 of 4
1
Item 2. Blanket Additional Insured - Grantor Of Permits
Paragraph 2. of Section ll - Who ls An lnsured is amended to add the following:
Any state, municipality or political subdivision that has issued you a permit in connection with any operations
performed by you or on your behalf, or in connection with premises you own, rent or control, and to which this
insurance applies, but only to the extent that you are required to provide additional insured status to the state,
municipality or political subdivision as a condition of receiving and maintaining the permit. Such state, municipality or
political subdivision that has issued you a permit is an insured only with respect to their liability as grantor of such
permit to you.
However, with respect to the state, municipality or political subdiMsion:
1. Coverage will be no broader than required; and
2. Limits of insurance will not exceed the minimum limits of insurance required as a condition for receiving or
maintaining the permit;
but neither the scope of coverage nor the limits of insurance will exceed those provided by this Policy.
This insurance does not apply to:
"Bodily injuff', "property damage" or "personal and advertising injury" arising out of operations performed for
the state, municipality or political subdivision;
2. Any "bodily injury'' or "property damage" included within the "prducts-completed operations hazard", except
when required by written agreement initiated prior to loss; or
3. "Bodily injuS', "property damage" or "personal and advertising injury", unless negligently caused, in whole or in
part, by you or those acting on your behalf.
Item 3. Other Insurance Amendment
lf you are obligated under a written agreement to provide liability insurance on a primaryr, excess, contingent, or any
other basis for any person(s) or organization(s) that qualifies as an additional insured on this Policy, this Policy will
apply solely on the basis required by such written agreement and Paragraph 4. Other Insurance of Section lV -
Commercial General Liability Conditions will not apply. Where the applicable written agreement does not specify
on what basis the liability insurance will apply, the proMsions of Paragraph 4. Other Insurance of Section lV -
Commercial General Liability Conditions will apply. However, this insurance is excess over any other insurance
awilable to the additional insured for which it is also covered as an additional insured for the same "occurrence",
claim or "suit".
@ 2018 Liberty Mutual lnsurance
lncludes copyrighted material of lnsurance SeMces Office, lnc., with its permission
LC 20 58 11 18 Page 4 of 4
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
GONTRACTORS - COMPLETED OPERATIONS
This endorsement modifies insurance provided under the following
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABI LITY COVERAG E PART
SCHEDULE
POLICY NUMBER: TB2-291 -4701 38-020
A. Section ll - Who ls An lnsured is amended to
include as an additional insured the person(s) or
organization(s) shown in the Schedule, but only
with respect to liability for "bodily injury" or
"property damage" caused, in whole or in part, by
"your work" at the location designated and
described in the Schedule of this endorsement
performed for that additional insured and
included in the "products-completed operations
hazard".
However:
1. The insurance afforded to such additional
insured only applies to the extent permitted
by law; and
2. lf coverage provided to the additional insured
is required by a contract or agreement, the
insurance 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.
COMMERCIAL GENERAL LIABILITY
cG 20 37 04 13
B. With respect to the insurance afforded to these
additional insureds, the following is added to
Section lll - Limits Of Insurance:
lf 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:
l. Required by the contract or agreement; or
2. Available under the applicable Limits of
lnsurance shown in the Declarations;
whichever is less.
This endorsement shall not increase the applicable
Limits of lnsurance shown in the Declarations.
Name Of Additional lnsured Person(s)
Or Orqanization(s)Location And Description Of Completed Ooerations
All persons or organizations with whom you have
entered into a written contract or agreement, prior to an
"occurrence" or offense, to provide additional insured
status.
All locations as required by a written contract or
agreement entered into prior to an "occurrence" or
offense.
lnformation required to complete this Schedule, if not shown above, will be shown in the Declarations.
cG 20 37 04 13 @ lnsurance Services Office, lnc.,2012 Page ,l of 1
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
PRIMARY AND NONCONTRIBUTORY -OTHER INSURANCE CONDITION
This endorsement modifies insurance provided under the following
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILIry COVERAGE PART
COMMERCIAL GENERAL LIABILITY
cG 20 01 04 13
(2) You have agreed in writing in a contract or
agreement that this insurance would be
primary and would not seek contribution
from any other insurance available to the
additional insured.
The following is added to the Other lnsurance
Condition and supersedes any provision to the
contrary:
Primary And Noncontributory lnsurance
This insurance is primary to and will not seek
contribution from any other insurance availableto an additional insured under your policy
provided that:
(1) The additional insured is a Named lnsured
under such other insurance; and
cG 20 01 04 13 @ lnsurance Services Office, \nc.,2012 Page I of I
Policy Numb er T 82-291 -47 01 38-020
lssued by Liberty Mutual Fire lnsurance Co.
This endorsement modifies insurance provided under the following
COMMERCIAL GENERAL LIABILITY COVERAGE PART
lnde"r of modified items:
Reasonable Force
Non-Owned Watercraft Extension
Damage To Premises Rented To You - Expanded Coverage
Bodily lnjury To Co-Employees
Health Care Professionals As Insureds
Knowledge Of Occurrence Or Offense
Notice Of Occurrence Or Offense
Unintentional Failure To Disclose
Bodily lnjury Redefined
Supplementary Payments - Increased Limits
Property ln Your Care, Custody Or Control
M obile Equipment Redefined
Newly Formed Or Acquired Entities
Waiver Of Right Of Recovery By Written Contract Or Agreement
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
COMMERCIAL GENERAL LIABILITY ENHANCEMENT FOR CONTRACTORS
Item 1.
Item 2.
Item 3.
Item 4.
Item 5.
Item 6.
Item 7.
Item 8.
Item 9.
Item 10.
Item 11.
Item 12.
Item 13.
Item 14.
Item 1. Reasonable Force
Exclusion a. of Section | - Coverage A - Bodily lnjury And Property Damage Liability is replaced by the
folloruing:
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 injuV' or "propefi damage" resulting from the use of reasonable force to protect
persons or properly.
Item 2. Non-Owned Watercraft Extension
Paragraph (2) of Exclusion g. of Section | - Coverage A - Bodily tnjury And Property Damage Liabitity is
replaced by the following:
(2) A watercraft you do not own that is:
(a) Less than 55 feet long; and
(b) Not being used to carry persons or properly for a charge;
Item 3. Damage To Premises Rented To You - Expanded Coverage
A. The final paragraph of 2. Exclusions of Section I - Coverage A - Bodily Injury And property Damage
Liability is replaced bythe following:
@ 2018 Liberty Mutual lnsurance
lncludes copyrighted material of lnsurance SeMces Office, lnc., with its permission.
LC 32 199 11 18 Page 1 of 5
Exclusions c. through n. do not apply to damage by fire, lightning or explosion or subsequent damages resulting
from such fire, lightning or explosion including water damage to premises while rented to you or temporarily
occupied by you with permission of the owner. A separate limit of insurance applies to this coverage as
described in Section lll - Limits Of lnsurance.
B. Paragraph 6. of Section lll - Limits Of Insurance is replaced by the following
6. Subject to Paragraph 5. above, the Damage To Premises Rented To You Limit is the most we will pay
under Coverage Afordamages because of "property damage" toanyone premises, while rented toyou, or
in the case of damage byfire, lightning, explosion or subsequent damages resulting from such fire, lightning
or explosion including water damage to premises while rented to you or temporarily occupied by you with
permission of the owner.
The Damage To Premises Rented To You Limit is the greater of:
a. $300,000: or
b. The Damage To Premises Rented To You Limit shown on the Declarations.
C. Paragraph 9.a. of the definition of "insured contract" in Section V - Definitions is replaced by the following:
a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that
indemnifies any person or organization for damage by fire, lightning, explosion or subsequent damages
resulting from such fire, lightning or explosion including water damage to premises while rented to you or
temporarily occupied by you with permission of the owner is not an "insured contract";
D. The paragraph immediately following Paragraph (6) of Exclusion j. of Section | - Coverage A - Bodily Injury
And Property Damage Liabilitlt is replaced by the following:
Paragraphs (1), (3) and (4) of this exclusion do not apply to "property damage" (other than damage by fire,
lightning or orplosion or subsequent damages resulting from such fire, lightning or explosion including water
damage) to premises, including the contents of such premises, rented to you for a period of seven or fewer
consecutive days. A separate limit of insurance applies to Damage To Premises Rented To You as described in
Section lll - Limits of Insurance.
Item 4. Bodily Injury To Co-Employees
A. Paragraph 2. of Section ll - Who ls An Insured is amended to include:
Each of the following is also an insured:
Your "employees" (other than either your "executive officers" (if you are an organization other than a
partnership, joint venture or limited liability company) or your managers (if you are a limited liability company))
or "volunteer workers" are insureds while in the course of their employment or while performing duties related to
the conduct of your business with respect to "bodily injur/':
(1) Toyou;
(2) To your partners or members (if you are a partnership or joint venture);
(3) To your members (if you are a limited liability company); or
(4) To a co"employee" or "volunteer worker" while that co"employee' or "volunteer worker" is either in the
course of his or her employment by you or while performing duties related to the conduct of your business
(including participation in any recreational activities sponsored by you).
Paragraph 2.a.(1Xa) of Section ll- Who ls An Insured does not apply to "bodily injury/' for which insurance is
provided by this paragraph.
@ 2018 Liberty Mutual lnsurance
lncludes copyighted material of lnsurance SeMces Office, lnc., with its permission
LC 32 199 11 18 Page 2 of 5
B. The insurance provided by this ltem 4. for "bodily inju$' to a co-"employee" or "volunteer worker" will not apply
if the injured co-"employee's" or "volunteer worker's" sole remedy for such injury is provided under a workers'
compensation law or any similar law.
C. Other Insurance
The insurance provided by this ltem 4. is excess over any other valid and collectible insurance available to the
insured, whether primary, excess, contingent or on any other basis.
Item 5. Health Care Professionals As Insureds
A. Paragraph 2.a.(1Xd) of Section ll - Who ls An Insured is replaced by the following:
(d) Arising out of his or her providing or failure to provide professional health care services. However, any
"employee" or "volunteer worker" of the Named lnsured who is acting as a Good Samaritan in response to
a public or medical emergency or who is a "designated health care provider" is an insured with respect to
"bodily injury" and "personal and advertising injury/' that:
(i) Arises out of the providing of or failure to provide professional health care seMces; and
(ii) Occurs in the course of and within the scope of such "employee's" or "volunteer worker's" employment
by the Named lnsured.
B. With respect to "employees" and "volunteer workers" providing professional health care services, the follovrling
exclusions are added to Paragraph 2. Exclusions of Section I - Coverage A - Bodily lnjury And Property
Damage Liability and Paragraph 2. Exclusions of Section I - Coverage B - Personal And Advertising
lnjury Liability:
This insurance does not apply to:
(1) Liability assumed under an "insured contract" or any other contract or agreement;
(2) Liability arising out of the providing of professional health care services in Molation of law;
(3) Liability arising out of the providing of any professional health care services while in any degree under the
influence of intofcants or narcotics;
(4) Liability arising out of any dishonest, fraudulent, malicious or knowingly wrongful act or failure to act; or
(5) Punitive or exemplaryr damages, fines or penalties.
C. The following definition is added to Section V - Definitions:
"Designated health care provider" means any "employee" or "volunteer worker" of the Named lnsured whose
duties include providing professional health care seMces, including but not limited to doctors, nurses,
emergency medical technicians or designated first aid personnel.
D. Other lnsurance
The insurance provided by this ltem 5. is excess over any other ralid and collectible insurance available to the
insured, whether primary, excess, contingent or on any other basis.
Item 6. Knowledge Of Occurrence Or Offense
Knowledge of an "occurrence" or offense by your agent, senant or "employee" will not in itself constitute knowledge
by you unless your "executive officer" or "employee' designated by you to notify us of an "occurrence" or offense
has knowledge of the "occurrence" or offense.
@ 2018 Liberty Mutual lnsurance
lncludes copyrighted material of lnsurance SeMces Office, lnc., with its permission
LC 32 199 11 18 Page 3 of 5
Item 7. Notice Of Occurrence Or Offense
For purposes of Paragraph 2.a. of Section lV - Commercial General Liability Conditions, you refers to your
"executive officer" or "employee" that you have designated to give us notice.
Item 8. Unintentional Failure To Disclose
Unintentional failure of the Named lnsured to disclose all hazards existing at the inception of this Policy shall not be
a basis for denial of any coverage afforded by this Policy. However, you must report such an error or omission to us
as soon as practicable after its discovery.
This provision does not affect our right to collect additional premium or exercise our right of cancellation or
non-renewal.
Item 9. Bodily Injury Redefined
The definition of "bodily injuf in Section V - Definitions is replaced by the following:
"Bodily injury/' me:ns:
a. Bodily injury, sickness or disease sustained by a person, including death resulting from any of these at any time;
and
b. Mental anguish, shock or humiliation arising out of injury as defined in Paragraph a. above. Mental anguish
meins anytype of mental or emotional illness or distress.
Item 10. Supplementary Payments - Increased Limits
Paragraphs 1.b. and 1.d. of Section I - Supplementary Payments - Coverages A And B are replaced by the
following:
b. Up to $3,000 for the cost of bail bonds required because of accidents or traffic law violations arising out of the
use of any vehicle to which Bodily lnjury Liability Coverage applies. We do not have to furnish these bonds.
d. All reasonable expenses incurred by the insured at our request to assist 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.
Item 11. Property In Your Care, Custody Or Control
A. Paragraphs (3) and (4) of Exclusion j. of Section I - Coverage A - Bodily lnjury And Property Damage
Liability are deleted.
B. Additional Exclusion
Coverage provided by this endorsement does not apply to "properly damage" to property while in transit.
C. Limits of Insurance
Subject to Paragraphs 2., 3., and 5. of Section lll- Limits Of lnsurance, the most we will pay for insurance
provided by Paragraph A. above is:
$10,000 Each Occurrence Limit
$75,000 Aggregate Limit
The Each Occurrence Limit for this coverage applies to all damages as a result of any one "occurrence"
regardless of the number of persons or organizations who sustain damage because of that "occurrence".
The Aggregate Limit is the most we will pay for the sum of all damages under this ltem 1 1.
@ 2018 Liberty Mutual lnsurance
lncludes copyighted material of lnsurance SeMces Office, lnc., with its permission.
LC 32 199 11 18 Page 4 of 5
D. Other Insurance
This insurance does not apply to any portion of a loss for which the insured has arailable any other rnalid and
collectible insurance, whether primary, excess, contingent, or on any other basis, unless such other insurance
was specifically purchased by the insured to apply in excess of this Policy.
Item 12. Mobile Equipment Redefined
The definition of "mobile equipment" in Section V - Definitions is amended to include self-propelled vehicles with
permanently attached equipment less than 1000 pounds gross vehicle weight that are primarily designed for:
(1) Snow remoral;
(2) Road maintenance, but not construction or resurfacing; or
(3) Street cleaning.
However, "mobile equipment" does not include land vehicles that are subject to a compulsory or financial
responsibility law or other motor vehicle insurance law where such vehicles are licensed or principally garaged.
Land vehicles subject to a compulsory or financial responsibility law or other motor vehicle insurance law are
considered "autos".
Item 13. Newly Formed Or Acquired Entities
A. Paragraph 3. of Section ll - Who ls An Insured is replaced by the following
3. Any organization you newly acquire or form, other than a partnership or joint venture, and over which you
maintain majority ownership or majority interest, will qualify as a Named lnsured if there is no other similar
insurance available to that organization. However:
a. Coverage under this provision is afforded only until:
(1) The 180th day after you acquire or form the organization;
(2) Separate coverage is purchased for the organization; or
(3) The end of the policy period
whichever is earlier;
b. Section | - Coverage A - Bodily lnjury And Propertlr Damage Liability does not apply to "bodily
inju$' or "property damage" that occurred before you acquired or formed the organization; and
c. Section l- Coverage B - Personal And Advertising lnjury Liability does not apply to "personal and
advertising injut'' arising out of an offense committed before you acquired or formed the organization.
B. The insurance afforded to any organization as a Named lnsured under this ltem 13. does not apply if a Broad
Form Named lnsured endorsement attached to this Policy applies to that organization.
Item 14. Waiver Of Right Of Recovery By Written Contract Or Agreement
The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section lV -
Commercial General Liability Conditions:
We waive any right of recoveryr because of payments we make under this Policy for injury or damage arising out of
your ongoing operations or "your work" included in the "products-completed operations hazard" that we may have
against any person or organization with whom you have agreed in a written contract or agreement to waive your
rights of recovery but only if the "bodily injun/' or "property damage" occurs, or offense giving rise to "personal and
advertising injury'' is committed subsequent to the execution of the written contract or agreement.
@ 2018 Liberty Mutual lnsurance
lncludes copyighted material of lnsurance SeMces Office, lnc., with its permission.
LC 32 199 11 18 Page 5 of 5
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
LIMITED CONTRACTUAL LIABILITY - RAILROADS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
POLICY NUMBER: TB2-Z91-4701 38-020
With respect to operations performed for, or affecting,
a Scheduled Railroad at a Designated Job Site, the
definition of "insured contract" in the Definitions
section is replaced by the following:
9. "lnsured contract" means:
a. A contract for a lease of premises. However,
that portion of the contract for a lease of
premises that indemnifies any person or
organization for damage by fire to premises
while rented to you or temporarily occupied by
you with permission of the owner is not an
"insured contract";
b. A sidetrack agreement;
c. Any easement or license agreement;
d. An obligation, as required by ordinance, to
indemnify a municipality, except in connection
with work for a municipality;
e. An elevator maintenance agreement;
f. That part of any other contract or agreement
pertaining to your business (including an
indemnification of a municipality in connection
with work performed for a municipality) under
which you assume the tort liability of another
party to pay for "bodily injury" or "property
damage" to a third person or organization,
provided the "bodily injury" or "property
damage" is caused, in whole or in part, by you
or those acting on your behalf. However, such
part of a contract or agreement shall only be
considered an "insured contract" to the extent
your assumption of the tort liability is permitted
by law. Tort liability means a liability that would
be imposed by law in the absence of any
contract or agreement.
COMMERCIAL GENERAL LIABILITY
cG 24 27 04 13
Paragraph f. does not include that part of any
contract or agreement:
(1) That indemnifies an architect, engineer or
surveyor for injury or damage arising out of:
(a) Preparing, approving or failing to
prepare or approve maps, shop
drawings, opinions, reports, surveys,
field orders, change orders or drawings
and specifications; or
(b) Giving directions or instructions, or
failing to give them, if that is the primary
cause of the injury or damage;
(2) Under which the insured, if an architect,
engineer or surveyor, assumes liability for
an injury or damage arising out of the
insured's rendering or failure to render
professional services, including those listed
in Paragraph (,l) above and supervisory,
inspection, architectural or engineering
activities.
Any railroad for which you are performing operations and for which no Railroad
Scheduled Railroad: Protective Liability Policy has been purchased for the railroad by you, or any railroad for
which "your work" has been completed or put to its intended use.
Designated Job Site:Alljobsites
lnformation required to complete this Schedule, if not shown above, will be shown in the Declarations.
cG 2427 0413 @ lnsurance Services Office, l,nc.,2012 Pagelofl tr
Policy Number T 8.2-291 -47 0138-020
lssued by Libefi Mutual Fire lnsurance Co.
This endorsement modifies insurance provided under the following
COMMERCIAL GENERAL LIABILITY COVERAGE PART
lndex of modified items:
Item 2.
Item 3.
Blanket Additional Insured Where Required By Written Agreement
Lessors of Leased Equipment
Managers or Lessors of Premises
Mortgagees, Assignees or Receivers
Owners, Lessees or Contractors
Architects, Engineers or Surveyors
Any Person or Organization
Blanket Additional lnsured - Grantor Of Permits
Other I nsurance Amendment
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
COM M ERCIAL GENERAL LIABILITY
ADDITIONAL INSURED ENHANCEMENT FOR CONTRACTORS
Item 1.
Item 1. Blanket Additional lnsured Where Required By Written Agreement
Paragraph 2. of Section ll - Who ls An Insured is amended to add the following:
Additional lnsured By Written Agreement
The following are insureds under the Policy when you have agreed in a written agreement to provide them coverage
as additional insureds under your policy:
1. Lessors of Leased Equipment: The person(s) or organization(s) from whom you lease equipment, but only
with respect to liability for "bodily injut'', "property damage" or "personal and advertising inju$' caused, in
whole or in part, by your maintenance, operation or use of equipment leased to you by such person(s) or
organization(s).
This insurance does not apply to any "occurrence" which takes place after the equipment lease expires.
2. Managers or Lessors of Premises: Any manager(s) or lessor(s) of premises leased to you in which the written
lease agreement obligates you to procure additional insured coverage.
The coverage afforded to the additional insured is limited to liability in connection with the ownership,
maintenance or use of the premises leased to you and caused, in whole or in part, by some negligent act(s) or
omission(s) of you, your "employees", your agents or your subcontractors. There is no coverage for the
additional insured for liability arising out of the sole negligence of the additional insured or those acting on
behalf of the additional insured, except as provided below.
lf the written agreement obligates you to procure additional insured coverage for the additional insured's sole
negligence, then the coverage for the additional insured shall conform to the agreement, but only if the
applicable law would allow you to indemnify the additional insured for liability arising out of the additional
insured's sole negligence.
@ 2018 Liberty Mutual lnsurance
lncludes copyighted material of lnsurance SeMces Office, lnc., with its permission
LC 20 58 11 18 Page 1 of 4
This insurance does not apply to:
a. Any "occurrence" which takes place after you cease to be a tenant in that premises or to lease that land;
b. Structural alterations, new construction or demolition operations performed by or on behalf of that manager
or lessorl or
c. Any premises for which coverage is excluded by endorsement.
3. Mortgagees, Assignees or Receivers: Any person(s) or organization(s) with respect to their liability as
mortgagee, assignee or receiver and arising out of your ownership, maintenance or use of the premises.
This insurance does not apply to structural alterations, new construction and demolition operations performed
by or on behalf of such person(s) or organization(s).
4. Owners, Lessees or Contractors: Any person(s) or organization(s) to whom you are obligated to procure
additional insured coverage, but only with respect to liability for "bodily injut'', "property damage" or "personal
and advertising injury/' caused, in whole or in part, by your act(s) or omission(s) or the act(s) or omission(s) of
your "employees", your agents, or your subcontractors, in the performance of your ongoing operations.
This insurance does not apply to "bodily injut'', "property damage", or "personal and advertising inju{' arising
out of "your work" included in the "products-completed operations hazard" unless you are required to provide
such coverage for the additional insured by the written agreement, and then only for the period of time required
by the written agreement and only for liability caused, in whole or in part, by your act(s) or omission(s) or the
act(s) or omission(s) of your "employees", your agents, or your subcontractors.
There is no coverage for the additional insured for liability arising out of the sole negligence of the additional
insured or those acting on behalf of the additional insured, except as provided below.
lf the written agreement obligates you to procure additional insured coverage for the additional insured's sole
negligence, then the coverage for the additional insured shall conform to the agreement, but only if the
applicable law would allow you to indemnify the additional insured for liability arising out the additional insured's
sole negligence.
This insurance does not apply to "bodily injun/', "property damage" or "personal and advertising inju$' arising
out of the rendering of, or failure to render, any professional architectural, engineering or surveying services,
including:
a. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys,
field orders, change orders or drawings and specifications; or
b. Supervisory, inspection, architectural or engineering actiMties.
This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the
supeMsion, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which
caused the "bodily injun/' or "propefty damage", or the offense which caused the "personal and advertising
injury", involved the rendering of or failure to render any professional services.
5. Architects, Engineers or Surveyors: Any architect, engineer, or surveyor engaged by you but only with
respect to liability for "bodily injun/', "property damage" or "personal and advertising inju$' caused, in whole or
in part, by your act(s) or omission(s) or the act(s) or omission(s) of those acting on your behalf:
a. ln connection with your premises; or
b. ln the performance of your ongoing operations.
This insurance does not apply to "bodily inju$', "property damage" or "personal and advertising injury" arising
out of the rendering of or failure to render any professional services by or for you, including:
@ 2018 Liberty Mutual lnsurance
lncludes copyighted material of lnsurance Services Office, lnc., with its permission
LC 20 58 11 18 Page 2 of 4
a. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys,
field orders, change orders or drawings and specifications; or
b. SupeMsory, inspection, architectural or engineering activities.
This o<clusion applies even if the claims against any insured allege negligence or other wrongdoing in the
supeMsion, hiring, emplryment, training or monitoring of others by that insured, if the "occurrence" which
caused the "bodily injury/' or "properly damage", or the offense which caused the "personal and advertising
injury", involved the rendering of or failure to render any professional services by or for you.
6. Any Person or Organization Other Than a Joint Venture: Any person(s) or organization(s) (other than a joint
venture of which you are a member) for whom you are obligated to procure additional insured coverage, but
only with respect to liability for "bodily injuf', "property damage" or "personal and advertising injury/' caused, in
whole or in part, byyour act(s) or omission(s) or the act(s) or omission(s) of those acting on your behalf:
a. ln the performance of your ongoing operations; or
b. ln connection with premises owned by or rented to you.
This insurance does not apply to:
a. Any person(s) or organization(s) more specifically covered in Paragraphs 1. through 5. above;
b. Any construction, renoration, demolition or installation operations performed by or on behalf of you, or
those operating on your behalf; or
c. Any person(s) or organization(s) whose profession, business or occupation is that of an architect, surveyor
or engineer with respect to liability arising out of the rendering of, or failure to render, any professional
architectural, engineering or survelng seMces, including:
(1) The preparing, approMng or failing to prepare or approve, maps, drawings, opinions, reports, surveys,
field orders, change orders, designs and specifications; or
(2) Supervisory, inspection, architectural or engineering activities
This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the
supeMsion, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which
caused the "bodily injury/' or "property damage", or the offense which caused the "personal and advertising
injury", involved the rendering of or failure to render any professional services by or on behalf of you, or those
operating on your behalf.
The insurance afforded to any person(s) or organization(s) as an insured under this ltem 1.:
1. Applies to the odent permitted by law;
2. Applies only to the scope of coverage and the minimum limits of insurance required by the written agreement,
but in no event exceeds either the scope of coverage or the limits of insurance provided by this Policy;
3. Does not apply to any person(s) or organization(s) for any "bodily inju$', "property damage" or "personal and
advertising injuf if any other additional insured endorsement attached to this Policy applies to such person(s)
or organization(s) with regard to the "bodily injuS', "property damage" or "personal and advertising injury";
4. Applies only if the "bodily inju$' or "properly damage" occurs, or the offense giVng rise to the "personal and
advertising inju{' is committed, subsequent to the execution of the written agreement; and
5. Applies only if the written agreement is in effect at the time the "bodily inju$' or "property damage" occurs, or at
the time the offense giving rise to the "personal and advertising injuf is committed.
@ 2018 Libefi Mutual lnsurance
lncludes copyighted material of lnsurance SeMces Office, lnc., with its permission.
LC205811 18 Page 3 of 4
1
Item 2. Blanket Additional Insured - Grantor Of Permits
Paragraph 2. of Section ll - Who ls An lnsured is amended to add the following:
Any state, municipality or political subdivision that has issued you a permit in connection with any operations
performed by you or on your behalf, or in connection with premises you own, rent or control, and to which this
insurance applies, but only to the extent that you are required to provide additional insured status to the state,
municipality or political subdivision as a condition of receiving and maintaining the permit. Such state, municipality or
political subdivision that has issued you a permit is an insured only with respect to their liability as grantor of such
permit to you.
However, with respect to the state, municipality or political subdiMsion:
1. Coverage will be no broader than requiredt and
2. Limits of insurance will not exceed the minimum limits of insurance required as a condition for receiving or
maintaining the permit;
but neither the scope of coverage nor the limits of insurance will exceed those proMded by this Policy.
This insurance does not apply to:
"Bodily injuS', "properly damage" or "personal and advertising injury" arising out of operations performed for
the state, municipality or political subdiMsion;
2. Any "bodily inju$' or "property damage" included within the "products-completed operations hazard", except
when required by written agreement initiated prior to loss; or
3. "Bodily injuf', "property damage" or "personal and advertising injury", unless negligently caused, in whole or in
part, by you or those acting on your behalf.
Item 3. Other Insurance Amendment
lf you are obligated under a written agreement to provide liability insurance on a primary, excess, contingent, or any
other basis for any person(s) or organization(s) that qualifies as an additional insured on this Policy, this Policy will
apply solely on the basis required by such written agreement and Paragraph 4. Other lnsurance of Section lV -
Commercial General Liability Conditions will not apply. Where the applicable written agreement does not specify
on what basis the liability insurance will apply, the proMsions of Paragraph 4. Other Insurance of Section lV -
Commercial General Liability Conditions will apply. However, this insurance is excess over any other insurance
alailable to the additional insured for which it is also covered as an additional insured for the same "occurrence",
claim or "suit".
@ 2018 Liberty Mutual lnsurance
lncludes copyrighted material of lnsurance SeMces Office, lnc., with its permission
LC 20 58 11 18 Page 4 of 4
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - COMPLETED OPERATIONS
This endorsement modifies insurance provided under the following
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COM PLETED OPERATIONS LIABI LITY COVERAGE PART
SCHEDULE
POLICY NUMBER: T8.2-2914701 38-020
A. Section ll - Who ls An lnsured is amended to
include as an additional insured the person(s) or
organization(s) shown in the Schedule, but only
with respect to liability for "bodily injury" or
"property damage" caused, in whole or in part, by
"your work" at the location designated and
described in the Schedule of this endorsement
performed for that additional insured and
included in the "products-completed operations
hazard".
However:
1. The insurance afforded to such additional
insured only applies to the extent permitted
by law; and
2. lf coverage provided to the additional insured
is required by a contract or agreement, the
insurance 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.
COMMERCIAL GENERAL LIABILITY
cG 20 37 04 13
B. With respect to the insurance afforded to these
additional insureds, the following is added to
Section lll - Limits Of lnsurance:
lf 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:
L Required by the contract or agreement; or
2. Available under the applicable Limits of
lnsurance shown in the Declarations;
whichever is less.
This endorsement shall not increase the applicable
Limits of lnsurance shown in the Declarations.
Name Of Additional lnsured Person(s)
Or Orqanization(s)Location And Description Of Completed Operations
All persons or organizations with whom you have
entered into a written contract or agreement, prior to an
"occurrence" or offense, to provide additional insured
status.
All locations as required by a written contract or
agreement
offense.
entered into prior to an "occurrence" or
lnformation required to complete this Schedule, if not shown above, will be shown in the Declarations.
cG 20 37 04 13 @ lnsurance Services Office, |nc.,2012 Page 1 of I
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
AMENDMENT OF INSURED CONTRACT DEFINITION
This endorsement modifies insurance proMded under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETE D OPE RATIONS LIABI LITY COVERAGE PART
The definition of "insured contract" in the Definitions
section is replaced by the following:
"lnsured contract" means:
a. A contract for a lease of premises. However,
that portion of the contract for a lease of
premises that indemnifies any person or
organization for damage by fire to premises
while rented to you or temporarily occupied by
you with permission of the owner is not an
"insured contract";
b. A sidetrack agreement;
c. Any easement or license agreement, ercept in
connection with construction or demolition
operations on or within 50 feet of a railroad;
d. An obligation, as required by ordinance, to
indemnify a municipality, except in connection
with work for a municipality;
e. An elevator maintenance agreement;
f. That part of any other contract or agreement
pertaining to your business (including an
indemnification of a municipality in connection
with work performed for a municipality) under
which you assume the tort liability of another
paAy to pay for "bodily injut'' or "propefi
damage" to a third person or organization,
proVded the "bodily inju$' or "property
damage" is caused, in whole or in part, by you
or by those acting on your behalf. However,
such part of a contract or agreement shall only
be considered an "insured contract" to the
extent your assumption of the tort liability is
permitted by law. Tort liability means a liability
that would be imposed by law in the absence of
any contract or agreement.
COMMERCIAL GENERAL LIABILITY
cc24260413
Paragraph f. does not include that part of any
contract or agreement:
(1) That indemnifies a railroad for "bodily inju$'or "property damage" arising out of
construction or demolition operations, within
50 feet of any railroad property and
affecting any railroad bridge or trestle,
tracks, road-beds, tunnel, underpass or
crossing;
(2) That indemnifies an architect, engineer or
surveyor for injury or damage arising out of:
(a) Preparing, approving, or failing to
prepare or approve, maps, shop
drawings, opinions, reports, surveys,
field orders, change orders or drawings
and specifications;or
(b) Giving directions or instructions, or
failing to give them, if that is the primary
cause of the injury or damaget or
(3) Under which the insured, if an architect,
engineer or surveyor, assumes liability for
an injury or damage arising out of the
insured's rendering or failure to render
professional seMces, including those listed
in (2) above and supervisory, inspection,
architectural or engineering activities.
cG24260413 @ lnsurance SeMces Office, |nc..2012 Page 1 of 1
Policy N umb er T B.2-Z,91 -47 0138-020
lssued by Liberty Mutual Fire lnsurance Co.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
DESIGNATED CONSTRUCTION PROJECT OR DESIGNATED LOCATION
COMBINED AGGREGATE LIMITS - WITH TOTAL AGGREGATE LIMIT
FORALL PROJECTS AND LOCATIONS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
A. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under
Section I - Coverage A, and for all medical expenses caused by accidents under Section I - Coverage C, which
can be attributed only to ongoing operations at a single designated construction pro.iect or a single designated
"location":
1. A separate Designated General Aggregate Limit applies to each designated construction project and to
each designated "location", and that limit is equal to the amount of the General Aggregate Limit shown in
the Declarations.
2. The Designated General Aggregate Limit is the most we will pay for the sum of all damages under Section I- Coverage A, except damages because of "bodily inju{' or "property damage" included in the
"products-completed operations hazard", and for medical o(penses under Section I - Coverage C
regardless of the number of:
a. lnsureds;
b. Claims made or "suits" brought; or
c. Persons or organizations making claims or bringing "suits"
3. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall
reduce the Designated General Aggregate Limit for that designated construction prqject or designated
"location". Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor
shall they reduce any other Designated General Aggregate Limit for any other designated construction
pro.iect or designated " location".
4. The limits shown in the Declarations for Each Occurrence, Damage to Premises Rented to You and
Medical Expense 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 General Aggregate Limit
and the Total Aggregate Limit for all Projects and Locations.
5. The Total Aggregate Limit for all Projects and Locations shown in the Schedule of this endorsement is the
most we will pay for the sum of all damages caused by "occurrences" under Section I - Coverage A and all
medical expenses caused by accidents under Section I - Coverage C which can be attributed only to
ongoing operations at a designated construction pro.iect or designated "location" shown in the Schedule of
this endorsement, regardless of the number of construction prqjects, "locations", "occurrences" or
accidents.
6. Each Designated General Aggregate Limit is subject to the Total Aggregate Limit for all Pro.iects and
Locations shown in the Schedule of this endorsement.
B. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under
Section I - Coverage A, and for all medical o<penses caused by accidents under Section I - Coverage C,
which cannot be attributed only to ongoing operations at a single designated construction prqject or single
designated "location" :
LC 25 19 01 15 @ 2014 Liberty Mutual lnsurance page 1 of 2
lncludes copyrighted material of lnsurance Services Office, lnc., with its permission.
Any payments made under Coverage A for damages or under Coverage C for medical expenses shall
reduce the amount aviailable under the General Aggregate Limit or the Products-Completed Operations
Aggregate Limit, whichever is applicable; and
2. Such payments shall not reduce any Designated GeneralAggregate Limit.
C. When coverage for liability arising out of the "products-completed operations hazard" is proMded, any payments
for damages because of "bodily inju$' or "properly damage" included in the "products-completed operations
hazard" will reduce the Products-Completed Operations Aggregate Limit, and not reduce the General
Aggregate Limit nor the Designated General Aggregate Limit.
D. lf the applicable construction pro.ject has been abandoned, delayed, or abandoned and then restarted, or if the
authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project
will still be deemed to be the same construction project.
E. For the purposes of this endorsement, the Definitions Section is amended by the addition of the following
definition:
"Location" means any premise that you occupy for permanent operations as part of your business, but does not
include any premises at which you are performing operations as part of a construction project. All premises
involving the same or connecting lots, or premises whose connection is interrupted only by a street, roadway,
waterway or right-of-way of a railroad shall be considered a single "location".
F. The proMsions of Section lll - Limits Of lnsurance not otherwise modified by this endorsement shall continue to
apply as stipulated.
Schedule
Desi g nated Construction Project(s) or Desig nated Location(s):
All "locations" and all construction projects at which you are performing ongoing operations
Total Aggregate Limit for all Projects and Locations: $ 10,000,000
@2O14 Libertlr Mutual lnsurance
lncludes copyrighted material of lnsurance SeMces Office, lnc., with its permission.
LC 25 19 01 15 Page 2 of 2
Policy Number T 8.2-291 -4701 38-020
lssued by Liberty Mutual Fire lnsurance Co.
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
lndex of modified items
Reasonable Force
Non-Owned Watercraft Extension
Damage To Premises Rented To You - Expanded Coverage
Bodily Injury To Co-Employees
Health Care Professionals As lnsureds
Knowledge Of Occurrence Or Offense
Notice Of Occurrence Or Offense
Unintentional Failure To Disclose
Bodily Injury Redefined
Supplementary Payments - lncreased Limits
Property ln Your Care, Custody Or Control
Mobile Equipment Redefi ned
Newly Formed Or Acquired Entities
Waiver Of Right Of Recovery By Written Contract Or Agreement
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
COMMERCIAL GENERAL LIABILITY ENHANCEMENT FOR CONTRACTORS
Item 1.
Item 2.
Item 3.
Item 4.
Item 5.
Item 6.
Item 7.
Item 8.
Item 9.
Item 10.
Item 11.
Item 12.
Item 13.
Item 14.
Item 1. Reasonable Force
Exclusion a. of Section | - Coverage A - Bodily Injury And Property Damage Liability is replaced by the
following:
a. Expected Or Intended Injury
"Bodily injut'' or "propertlr damage" expected or intended from the standpoint of the insured. This exclusion
does not apply to "bodily injur/' or "properly damage" resulting from the use of reasonable force to protect
persons or property.
Item 2. Non-Owned Watercraft Extension
Paragraph (2) of Exclusion g. of Section | - Coverage A - Bodily lnjury And Property Damage Liability is
replaced by the following:
(2) A watercraft you do not own that is:
(a) Less than 55 feet long; and
(b) Not being used to carry persons or property for a charge;
Item 3. Damage To Premises Rented To You - Expanded Coverage
A. The final paragraph of 2. Exclusions of Section | - Coverage A - Bodily Injury And Property Damage
Liability is replaced by the following:
@ 2018 Liberty Mutual lnsurance
lncludes copyighted material of lnsurance Services Office, lnc., with its permission
LC 32 199 11 18 Page 'l of 5
Exclusions c. through n. do not apply to damage by fire, lightning or explosion or subsequent damages resulting
from such fire, lightning or explosion including water damage to premises while rented to you or temporarily
occupied by you with permission of the owner. A separate limit of insurance applies to this coverage as
described in Section lll - Limits Of lnsurance.
B. Paragraph 6. of Section lll - Limits Of lnsurance is replaced by the following:
6. Subject to Paragraph 5. above, the Damage To Premises Rented To You Limit is the most we will pay
under Coverage Afor damages because of "propefty damage" to any one premises, while rented to you, or
in the case of damage by fire, lightning, explosion or subsequent damages resulting from such fire, lightning
or explosion including water damage to premises while rented to you or temporarily occupied by you with
permission of the owner.
The Damage To Premises Rented To You Limit is the greater of:
a. $300,000; or
b. The Damage To Premises Rented To You Limit shown on the Declarations.
C. Paragraph 9.a. of the definition of "insured contract" in Section V - Definitions is replaced by the following
a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that
indemnifies any person or organization for damage by fire, lightning, explosion or subsequent damages
resulting from such fire, lightning or explosion including water damage to premises while rented to you or
temporarily occupied by you with permission of the owner is not an "insured contract";
D. Theparagraph immediately following Paragraph (6)of Exclusionj.of Sectionl-CoverageA-Bodilylnjury
And Propertlr Damage Liability is replaced by the following:
Paragraphs (1), (3) and (4) of this exclusion do not apply to "property damage" (other than damage by fire,
lightning or e"xplosion or subsequent damages resulting from such fire, lightning or o<plosion including water
damage) to premises, including the contents of such premises, rented to you for a period of seven or fewer
consecutive days. A separate limit of insurance applies to Damage To Premises Rented To You as described in
Section lll - Limits of lnsurance
Item 4. Bodily Injury To Co-Employees
A. Paragraph 2. of Section ll - Who ls An lnsuredis amended to include:
Each of the following is also an insured:
Your "employees" (other than either your "executive officers" (if you are an organization other than a
partnership, joint venture or limited liability company) or your managers (if you are a limited liability company))
or "volunteer workers" are insureds while in the course of their employment or while performing duties related to
the conduct of your business with respect to "bodily injury/':
(1) Toyou;
(2) To your partners or members (if you are a partnership or joint venture);
(3) To your members (if you are a limited liability company); or
(4) To a co"employee" or "volunteer worker" while that ce"employee" or "volunteer worker" is either in the
course of his or her employment by you or while performing duties related to the conduct of your business
(including participation in any recreational activities sponsored by you).
Paragraph 2.a.(1Xa) of Section ll - Who ls An lnsured does not apply to "bodily injut'' for which insurance is
provided by this paragraph.
@ 2018 Liberty Mutual lnsurance
lncludes copyrighted material of lnsurance SeMces Office, lnc., with its permission
LC 32 199 11 18 Page 2 of 5
B. The insurance provided by this ltem 4. for "bodily injuff' to a co-"employee" or "volunteer worker" will not apply
if the injured ce"employee's" or "volunteer worker's" sole remedy for such injury is provided under a workers'
compensation law or any similar law.
C. Other Insurance
The insurance proMded by this ltem 4. is excess over any other ralid and collectible insurance available to the
insured, whether primary, excess, contingent or on any other basis.
Item 5. Health Care Professionals As lnsureds
A. Paragraph 2.a.(1Xd) of Section ll - Who ls An lnsured is replaced by the following:
(d) Arising out of his or her providing or failure to proMde professional health care seMces. However, any
"employee" or "volunteer worker" of the Named lnsured who is acting as a Good Samaritan in response to
a public or medical emergency or who is a "designated health care provider" is an insured with respect to
"bodily injury" and "personal and advertising injuS'that:
(i) Arises out of the proMding of or failure to provide professional health care seMces; and
(ii) Occurs in the course of and within the scope of such "employee's" or "volunteer worker's" emplolment
bythe Named lnsured.
B. With respect to "employees" and "volunteer workers" providing professional health care services, the following
exclusions are added to Paragraph 2. Exclusions of Section | - Coverage A - Bodily lnjury And Propertlr
Damage Liability and Paragraph 2. Exclusions of Section | - Coverage B - Personal And Advertising
Injury Liability:
This insurance does not apply to:
(1) Liability assumed under an "insured contract" or any other contract or agreement;
(2) Liability arising out of the proMding of professional health care services in violation of law;
(3) Liability arising out of the providing of any professional health care services while in any degree under the
influence of intoxicants or narcotics;
(a) LiabiliV arising out of any dishonest, fraudulent, malicious or knowingly wrongful act or failure to act; or
(5) Punitive or exemplary damages, fines or penalties.
C. Thefollowing definition is added to Section V- Definitions:
"Designated health care provider" means any "employee" or "volunteer worker" of the Named lnsured whose
duties include providing professional health care services, including but not limited to doctors, nurses,
emergency medical technicians or designated first aid personnel.
D. Other Insurance
The insurance provided by this ltem 5. is excess over any other valid and collectible insurance available to the
insured, whether primary, excess, contingent or on any other basis.
Item 5. Knowledge Of Occurrence Or Offense
Knowledge of an "occurrence" or offense by your agent, sen/iant or "employee" will not in itself constitute knowledge
by you unless your "executive office/' or "employee" designated by you to notify us of an "occurrence" or offense
has knowledge of the "occurrence" or offense.
@ 2018 Liberty Mutual lnsurance
lncludes copyrighted material of lnsurance SeMces Office, lnc., with its permission.
LC 32 199 11 18 Page 3 of 5
Item 7. Notice Of Occurrence Or Offense
For purposes of Paragraph 2.a. of Section lV - Commercial General Liability Conditions, you refers to your
"executive officer" or "employee" that you have designated to give us notice.
Item 8. Unintentional Failure To Disclose
Unintentional failure of the Named lnsured to disclose all hazards existing at the inception of this Policy shall not be
a basis for denial of any coverage afforded by this Policy. However, you must report such an error or omission to us
as soon as practicable after its discovery.
This provision does not affect our right to collect additional premium or exercise our right of cancellation or
non-renewal.
Item 9. Bodily Injury Redefined
The definition of "bodily injury/' in Section V - Definitions is replaced by the following:
"Bodily injury/' means:
a. Bodily injury, sickness or disease sustained by a person, including death resulting from any of these at any time;
and
b. Mental anguish, shock or humiliation arising out of injury as defined in Paragraph a. above. Mental anguish
means any type of mental or emotional illness or distress.
Item 10. Supplementary Payments - Increased Limits
Paragraphs 1.b. and 1.d. of Section | - Supplementary Payments - Coverages A And B are replaced by the
folloruing:
b. Up to $3,000 for the cost of bail bonds required because of accidents or traffic law violations arising out of the
use of any vehicle to which Bodily lnjury Liability Coverage applies. We do not have to furnish these bonds.
d. All reasonable expenses incurred by the insured at our request to assist 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.
Item 11. Property ln Your Care, Custody Or Control
A. Paragraphs (3) and (4) of Exclusion j. of Section | - Coverage A - Bodily lnjury And Propertlr Damage
Liability are deleted.
B. Additional Exclusion
Coverage provided by this endorsement does not apply to "property damage" to property while in transit.
C. Limits of lnsurance
Subject to Paragraphs 2., 3., and 5. of Section lll- Limits Of Insurance, the most we will pay for insurance
proVded by Paragraph A. above is:
$10,000 Each Occurrence Limit
$75,000 Aggregate Limit
The Each Occurrence Limit for this coverage applies to all damages as a result of any one "occurrence"
regardless of the number of persons or organizations who sustain damage because of that "occurrence".
The Aggregate Limit is the most we will pay for the sum of all damages under this ltem 1 1.
@ 2018 Liberty Mutual lnsurance
lncludes copyighted material of lnsurance SeMces Office, lnc., with its permission
LC 32 199 11 18 Page 4 of 5
D. Other lnsurance
This insurance does not apply to any portion of a loss for which the insured has ar,dlade any other ralid and
collectible insurance, whether primary, excess, contingent, or on any other basis, unless such other insurance
was specifically purchased by the insured to apply in excess of this Policy.
Item 12. Mobile Equipment Redefined
The definition of "mobile equipment" in Section V - Definitions is amended to include self-propelled vehicles with
permanently aftached equipment less than 1000 pounds gross vehicle weight that are primarily designed for:
(1) Snow remoral;
(2) Road maintenance, but not construction or resurfacing; or
(3) Street cleaning.
However, "mobile equipment" does not include land vehicles that are subject to a compulsory or financial
responsibility law or other motor vehicle insurance law where such vehicles are licensed or principally garaged.
Land vehicles subject to a compulsory or financial responsibility law or other motor vehicle insurance law are
considered "autos".
Item 13. Newly Formed Or Acquired Entities
A. Paragraph 3. of Section ll - Who ls An lnsured is replaced by the following:
3. Any organization you newly acquire or form, other than a partnership or joint venture, and over which you
maintain majority ownership or majority interest, will qualify as a Named lnsured if there is no other similar
insurance available to that organization. However:
a. Coverage under this provision is afforded only until:
(1) The 180th day after you acquire or form the organization;
(2) Separate coverage is purchased for the organizationt or
(3) The end of the policy period
whichever is earlier;
b. Section | - Coverage A - Bodily Injury And Property Damage Liability does not apply to "bodily
inju$' or "property damage" that occurred before you acquired or formed the organization; and
c. Section l- Coverage B - Personal And Advertising lnjury Liability does not apply to "personal and
advertising injuS' arising out of an offense committed before you acquired or formed the organization.
B. The insurance afforded to any organization as a Named lnsured under this ltem 13. does not apply if a Broad
Form Named lnsured endorsement attached to this Policy applies to that organization.
Item 14. Waiver Of Right Of Recovery By Written Contract Or Agreement
The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section lV -
Commercial General Liability Conditions:
We waive any right of recovery because of payments we make under this Policy for injury or damage arising out of
your ongoing operations or "your work" included in the "products-completed operations hazard" that we may have
against any person or organization with whom you have agreed in a written contract or agreement to waive your
rights of recovery but only if the "bodily injun/' or "property damage" occurs, or offense giving rise to "personal and
advertising injuryl" is committed subsequent to the execution of the written contract or agreement.
@ 2018 Liberty Mutual lnsurance
lncludes copyrighted material of lnsurance SeMces Office, lnc., with its permission.
LC 32 199 11 18 Page 5 of 5
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
PRIMARY AND NONCONTRIBUTORY -OTHER INSURANCE CONDITION
This endorsement modifies insurance provided under the following
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABI LIry COVERAGE PART
COMMERCIAL GENERAL LIABILITY
cG 20 01 04 13
(2) You have agreed in writing in a contract or
agreement that this insurance would be
primary and would not seek contribution
from any other insurance available to the
additional insured.
The following is added to the Other lnsurance
Condition and supersedes any provision to the
contrary:
Primary And Noncontributory lnsurance
This insurance is primary to and will not seek
contribution from any other insurance availableto an additional insured under your policy
provided that:
(1) The additional insured is a Named tnsured
under such other insurance; and
cG 20 01 04 13 @ lnsurance Services Office, lnc.,2012 Page I of I
Policy N umb er TB2-291 -47 01 38-020
lssued by Liberty Mutual Fire lnsurance Co
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
NOTICE OF CANCELLATION TO THIRD PARTIES
This endorsement modifies insurance provided under the following
BUSINESS AUTO COVERAGE PART
MOTOR CARRIER COVERAGE PART
GARAGE COVERAGE PART
TRUCKERS COVERAGE PART
EXCESS AUTOMOBILE LIABILITY INDEMNITY COVERAGE PART
SELF-INSURED TRUCKER EXCESS LIABILITY COVERAGE PART
COMMERCIAL GENERAL LIABILITY COVERAGE PART
EXCESS COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
LIQUOR LIABILITY COVERAGE PART
COMMERCIAL LIABILITY - UMBRELLA COVERAGE FORM
Schedule
A. lf we cancel this policy for any reason other than nonpayment of premium, we will notify the persons or
organizations shown in the Schedule above. We will send notice to the email or mailing address listed above
at least 10 days, or the number of days listed above, if any, before the cancellation becomes effective. ln no
event does the notice to the third party exceed the notice to the first named insured.
B. This advance notification of a pending cancellation of coverage is intended as a courtesy only. Ou r failure to
provide such advance notification will not extend the policy cancellation date nor negate cancellation of the
policy.
All other terms and conditions of this policy remain unchanged.
@ 2011 Liberty Mutual Group of Companies. All rights reserved.
lncludes copyrighted material of lnsurance Services Office, lnc., with
its permission.
Name of Other Person(s) /
Orqanization(s):
EmailAddress or mailing address Number Days Notice:
Per Schedule on File with Company Per Schedule on File with Company 30
LIM 99 01 05 tt Page 1 of 1
Policy Number AS2-291 -4701 38-01 0
lssued by Liberty Mutual Fire lnsurance Co
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
AUTO ENHANCEMENT ENDORSEMENT
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
t.
il.
ilt.
tv.
V.
vt.
vil.
vilt.
tx.
X.
xt.
xil.
xlll.
XIV.
XV.
XVI.
XVII.
XVIII
XIX.
XX.
XXI.
XXII.
XXIII
Newly Acquired or Formed Organizations
Employees as lnsureds
Lessor - Additional lnsured and Loss Payee
Supplementary Payments - lncreased Limits
Fellow Employee Coverage
Personal Property of Others
Additional Transportation Expense and Cost to Recover Stolen Auto
Airbag Coverage
Tapes, Records and Discs Coverage
Physical Damage Deductible - Single Deductible
Physical Damage Deductible - Glass
Physical Damage Deductible - Vehicle Tracking System
Duties in Event of Accident, Claim, Suit or Loss
Unintentional Failure to Disclose Hazards
Worldwide Liability Coverage - Hired and Nonowned Autos
Hired Auto Physical Damage
Auto Medical Payments Coverage lncreased Limits
Drive Other Car Coverage - Broadened Coverage for Designated lndividuals
Rental Reimbursement Coverage
Notice of Cancellation or Nonrenewal
Loan/Lease Payoff Coverage
Limited Mexico Coverage
Waiver of Subrogation
I. NEWLY ACQUIRED OR FORMED ORGANIZATIONS
Throughout this policy, the words you and your also refer to any organization you newly acquire or form, other
than a partnership or joint venture, and over which you maintain ownership of more than 50 percent interest,
provided:
A. There is no similar insurance available to that organization;
B. Unless you notify us to add coverage to your policy, the coverage under this provision is afforded only until
1. The 90th day after you acquire or form the organization; or
2. The end of the policy period, whichever is earlier;and
C. The coverage does not apply to an "accident" which occurred before you acquired or formed the
organization.
@ 2013 Liberty Mutual lnsurance. All rights reserved.
lncludes copyrighted material of lnsurance Services Office, lnc.,
with its permission.
AC 84 07 07 13 Page 1 of 11
II. EMPLOYEES AS INSUREDS
Paragraph A.1. Who ls An lnsured of SECTION ll - LIABILITY COVERAGE is amended to add:
Your "employee" is an "insured" while using with your permission a covered "auto" you do not own, hire or
borrow in your business or your personal affairs.
III. LESSOR - ADDITIONAL INSURED AND LOSS PAYEE
A. Any "leased auto" will be considered an "auto" you own and not an "auto" you hire or borrow. The
coverages provided under this section apply to any "leased auto" until the expiration date of this policy or
until the lessor or his or her agent takes possession of the "leased auto" whichever occurs first.
B. For any "leased auto" that is a covered "auto" under SECTION ll- LIABILITYCOVERAGE, Paragraph A.1.
\Mo lsAn lnsured provision is changed to include as an "insured" the lessor of the "leased auto". However,
the lessor is an "insured" only for "bodily injury" or "property damage" resulting from the acts or omissions
by:
1. You
2. Any of your "employees" or agents; or
3. Any person, exceptthe lessor or any "employee" or agent of the lessor, operating a "leased auto" with
the permission of any of the above.
C. Loss Payee Clause
1. We will pay, as interests may appear, you and the lessor of the "leased auto" for "loss" to the covered
"leased auto".
2. The insurance covers the interest of the lessor of the "leased auto" unless the "loss" results from
fraudulent acts or omissions on your part.
3. lf we make any payment to the lessor of a "leased auto", we will obtain his or her rights against any
other party.
D. Cancellation
1. lf we cancel the policy, we will mail notice to the lessor in accordance with the Cancellation Common
Policy Condition.
2. lf you cancel the policy, we will mail notice to the lessor.
3. Cancellation ends this agreement.
E. The lessor is not liable for payment of your premiums.
F. For purposes of this endorsement, the following definitions apply:
"Leased auto" means an "auto" which you lease for a period of six months or longer for use in your
business, including any "temporary substitute" of such "leased auto".
@2013 Liberty Mutual lnsurance. All rights reserved.
lncludes copyrighted material of lnsurance Services Office, lnc.,
with its permission.
AC 84 07 07 13 Page2 of 11
"Temporary substitute"means an "auto" that is furnished as a substitutefor a covered "auto" when the
covered "auto" is out of service because of its breakdown, repair, servicing, "loss" or destruction.
IV. SUPPLEMENTARY PAYMENTS - INCREASED LIMITS
SubparagraphsA.2.a.(2)and A.2.a.(4)of SECTION ll- L|ABlL|TYCOVERAGEaredeletedand replaced bythe
following:
(2) Up to $3,000 for the cost of bail bonds (including bonds for related traffic law violations) required because
of an "accident" we cover. We do not have to furnish these bonds.
(4) All reasonable expensesincurred by the "insured" at our request, including the actual loss of earnings up to
$500 a day because of time off from work.
V. FELLOWEMPLOYEE COVERAGE
A. Exclusion 8.5. of SECTION ll - LIABILITY COVERAGE does not apply
B. For the purpose of Fellow Employee Coverage only, Paragraph 8.5. of BUSINESSAUTO CONDITIONS is
changed as follows:
This Fellow Employee Coverage is excess over any other collectible insurance.
VI. PERSONAL PROPERTY OF OTHERS
Exclusion 6. in SECTION ll - LIABILITY COVERAGE for a covered "auto" is amended to add:
This exclusion does not apply to "property damage" or "covered pollution cost or expense" involving "personal
property" of your "employees" or others while such proper$ is carried by the covered "auto". The Limit of
lnsurance for this coverage is $5,000 per "accident". Payment under this coverage does not increase the Limit
of lnsurance.
For the purpose of this section of this endorsement, "personal property" is defined as any property that is not
used in the individual's trade or business or held for the production or collection of income.
VII. ADDITIONAL TRANSPORTATION EXPENSE AND COST TO RECOVER STOLEN AUTO
A. Paragraph A.4.a. of SECTION lll - PHYSICAL DAMAGE COVERAGE is amended as follows:
The amount we will pay is increased to $50 per day and to a maximum limit of $1,000.
B. Paragraph A.4.a. of SECTION lll - PHYSICAL DAMAGE COVERAGE is amended to add the following
lf your business is shown in the Declarations as something other than an auto dealership, we will also pay
up to $1 ,000 for reasonable and necessary costs incurred by you to return a stolen covered "auto" from the
place where it is recovered to its usual garaging location.
VIII.AIRBAG COVERAGE
Exclusion 8.3.a. in SECTION lll - PHYSICAL DAMAGE COVERAGE is amended to add
This exclusion does not apply to the accidental discharge of an airbag
@ 2013 Liberty Mutual lnsurance. All rights reserved.
lncludes copyrighted material of lnsurance Services Office, lnc.,
with its permission.
AC 84 07 07 13 Page3of11
IX. TAPES, RECORDS AND DISCS COVERAGE
Exclusion B.4.a. of SECTION lll - PHYSICAL DAMAGE COVERAGE is deleted and replaced by the following
a. Tapes, records, discs or other similar audio, visual or data electronic devices designed for use with audio,
visual or data electronic equipment exceptwhen the tapes, records, discs or other similar audio, visual or
data electronic devices:
X.
(1) Are your property or that of a family member; and
(2) Are in a covered "auto" at the time of "loss".
The most we will pay for "loss" is $200. No Physical Damage Coverage deductible applies to this coverage
PHYSICAL DAMAGE DEDUCTIBLE - SINGLE DEDUCTIBLE
Paragraph D. in SECTION lll - PHYSICAL DAMAGE COVERAGE is deleted and replaced by the following:
D. Deductible
For each covered "auto", our obligation to pay for, repair, return or replace damaged or stolen property will
be reduced by the applicable deductible shown in the Declarations. Any Comprehensive Coverage
deductible shown in the Declarations does not apply to "loss" caused by fire or lightning.
When two or more covered "autos" sustain "loss" in the same collision, the total of all the "loss" for all the
involved covered "autos" will be reduced by a single deductible, which will be the largest of all the
deductibles applying to all such covered "autos".
XI. PHYSICAL DAMAGE DEDUCTIBLE - GLASS
Paragraph D. in SECTION lll- PHYSICAL DAMAGE COVERAGE is amended to add:
No deductible applies to "loss" to glass if you elect to patch or repair it rather than replace it.
XII. PHYSICAL DAMAGE DEDUCTIBLE - VEHICLE TRACKING SYSTEM
Paragraph D. in SECTION lll- PHYSICAL DAMAGE COVERAGE is amended to add:
Any Comprehensive Coverage Deductible shown in the Declarations will be reduced by 5oo/o for any "loss"
caused by theft if the vehicle is equipped with a vehicle tracking device such as a radio tracking device or a
global positioning device and that device was the method of recovery of the vehicle.
XIII.DUTIES IN EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS
Subparagraphs A.2.a. and A.2.b. of SECTION lV- BUSINESS AUTO CONDITIONS are changed to:
a. lntheeventof "accident",claim, "suit"or"loss",yourinsurancemanageroranyotherpersonyoudesignate
must notify us as soon as reasonably possible of such "accident", claim, "suit" or "loss". Such notice must
include:
(1) How, when and where the "accident" or "loss" occurred;
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AC 84 07 07 13 Page4of11
(2) The "insured's" name and address; and
(3) To the extent possible, the names and addresses of any injured persons and witnesses.
Knowledge of an "accident", claim, "suit" or "loss" by your agent, servant or "employee" shall not be
considered knowledge by you unless you, your insurance manager or any other person you designate has
received notice of the "accident", claim, "suit" or "loss" from your agent, servant or "employee".
b. Additionally, you and any other involved "insured" must:
(1) Assume no obligation, make no payment or incur no expense without our consent, except at the
"insured's" own cost.
(2) lmmediately send us copies of any request, demand, order, notice, summons or legal paper received
concerning the claim or "suit".
(3) Cooperate with us in the investigation or settlement of the claim or defense against the "suit"
(4) Authorize us to obtain medical records or other pertinent information.
(5) Submit to examination, at our expense, by physicians of our choice, as often as we reasonably require
XIV. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS
Paragraph B.2. in SECTION lV - BUSINESS AUTO CONDITIONS is amended to add the following:
Any unintentional failure to disclose all exposures or hazards existing as of the effective date of the Business
Auto Coverage Form or at any time during the policy period will not invalidate or adverselyaffect the coverage
for such exposure or hazard. However, you must report the undisclosed exposure or hazard to us as soon as
reasonably possible after its discovery
XV.WORLDWIDE LIABILITY COVERAGE - HIRED AND NONOWNED AUTOS
Condition B.7. in SECTION lV - BUSINESS AUTO CONDITIONS is amended to include the following
For "accidents" resulting from the use or operation of covered "autos" you do not own, the coverage territory
means all parts of the world subject to the following provisions:
a. lf claim is made or "suit" is brought against an "insured" outside of the United States of America, its
territories and possessions, Puerto Rico and Canada, we shall have the right, but not the duty to investigate,
negotiate, and settle or defend such claim or "suit".
lf we do not exercise that right, the "insured" shall have the duty to investigate, negotiate, and settle or
defend the claim or "suit" and we will reimburse the "insured" for the expenses reasonably incurred in
connection with the investigation,settlement or defense. Reimbursement will be paid in the currency of the
United States of America at the rate of exchange prevailing on the date of reimbursement.
The "insured" shall provide us with such information we shall reasonably request regarding such claim or
"suit" and its investigation, negotiation, and settlement or defense.
The "insured" shall not agree to any settlement of the claim or "suit" without our consent. We shall not
unreasonably withhold consent.
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AC 84 07 07 13 Page5of11
b. We are not licensed to write insurance outside of the United States of America, its territories or possessions,
Puerto Rico and Canada.
We will not furnish certificatesof insurance or other evidence of insurance you may need for the purpose of
complying with the laws of other countries relating to auto insurance.
Failure to comply with the auto insurance laws of other countries may result in fines or penalties. This
insurance does not apply to such fines or penalties.
XVI. HIREDAUTO PHYSICAL DAMAGE
lf no deductibles are shown in the Declarations for Physical Damage Coverage for Hired or Borrowed Autos,
the following will apply:
A. We will pay for "loss" under Comprehensive and Collision coverages to a covered "auto" of the private
passenger type hired without an operator for use in your business:
1. The most we will pay for coverage afforded by this endorsement is the lesser of:
a. The actual costto repair or replace such covered "auto" with other property of like kind and quality;
or
b. The actual cash value of such covered "auto" at the time of the "loss"
2. An adjustment for depreciation and physical condition will be made in determining actual cash value in
the event of a total "loss".
3. lf a repair or replacement results in better than like kind or quality, we will not pay for the amount of the
betterment.
B. For each covered "auto", our obligation to pay for, repair, return or replace the covered "auto" will be
reduced by any deductible shown in the Declarations that applies to private passenger "autos" that you
own. lf no applicable deductible is shown in the Declarations, the deductible will be $250.
lf the Declarations show other deductibles for Physical Damage Coveragesfor Hired or Borrowed Autos,
this Section XVI of this endorsement does not apply.
C. Paragraph A.4.b. of SECTION lll - PHYSICAL DAMAGE COVERAGE is replaced by
b. Loss of Use Expenses
For Hired Auto Physical Damage provided by this endorsement, we will pay expenses for which an
"insured" becomes legally responsible to pay for loss of use of a private passenger vehicle rented or
hired without a driver, under a written rental contract or agreement. We will pay for loss of use
expenses caused by:
(1) Other than collision only if the Declarations indicate that Comprehensive Coverage is provided for
any covered "auto";
(2) Specified Causes of Loss only if the Declarations indicate that Specified Causes of Loss Coverage
is provided for any covered "auto"; or
(3) Collision only if the Declarations indicate that Collision Coverage is provided for any covered
"auto".
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AC 84 07 07 13 Page6of11
However, the most we will pay under this coverage is $30 per day, subject to a maximum of $900
XVII. AUTO MEDICAL PAYMENTS COVERAGE - INCREASED LIMITS
For any covered "loss", the Limit of lnsurance for Auto Medical Paymentswill be double the limit shown in the
Declarations if the "insured" was wearing a seat belt at the time of the "accident". This is the maximum amount
we will pay for all covered medical expenses, regardless of the number of covered "autos", "insureds",
premiums paid, claims made, or vehicles involved in the "accident".
lf no limit of insurance for Auto Medical Payments is shown on the Declarations, this paragraph Section XVll of
this endorsement does not apply.
XVIII. DRIVE OTHER CAR COVERAGE - BROADENED COVERAGE FOR DESIGNATED INDIVIDUALS
A. This endorsement amends only those coverages indicated with an "X" in the Drive Other Car section of the
Schedule to this endorsement.
B. SECTION ll - LIABILITY COVERAGE is amended as follows:
1. Any "auto" you don't own, hire or borrow is a covered "auto" for Liability Coverage while being used by
any individual named in the Drive Other Car section of the Schedule to this endorsement or by his or
her spouse while a resident of the same household except:
a. Any "auto" owned by that individual or by any member of his or her household; or
b. Any "auto" used by that individual or his or her spouse while working in a business of selling,
servicing, repairing or parking "autos".
2. The following is added to Who ls An lnsured
Any individual named in the Drive Other Car section of the Schedule to this endorsement and his or her
spouse, while a resident of the same household, are "insureds" while using any covered "auto"
described in Paragraph 8.1. of this endorsement.
C. Auto Medical Payments, Uninsured Motorist, and Underinsured Motorist Coverages are amended as
follows:
The following is added to Who ls An lnsured:
Any individual named in the Drive Other Car section of the Schedule to this endorsement and his or her
"family members" are "insured" while "occupying" or while a pedestrian when struck by any "auto" you don't
own except:
Any "auto" owned by that individual or by any "family member"
D.SECTION lll - PHYSICAL DAMAGE COVERAGE is changed as follows
Any private passenger type "auto" you don't own, hire or borrow is a covered "auto" while in the care,
custody or control of any individual named in the Drive Other Car section of the Schedule to this
endorsement or his or her spouse while a resident of the same household except:
1. Any "auto" owned by that individual or by any member of his or her household; or
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with its permission.
AC 84 07 07 13 Page7of11
2. Any "auto" used by that individual or his or her spouse while working in a business of selling, servicing,
repairing or parking "autos".
E. For purposes of this endorsement, SECTION V - DEFINITIONS is amended to add the following
"Family member" means a person related to the individual named in the Drive Other Car section of the
Schedule to this endorsement by blood, marriage or adoption who is a resident of the individual's
household, including a ward or foster child.
XIX. RENTAL REIMBURSEMENT COVERAGE
A. For any owned covered "auto" for which Collision and Comprehensive Coveragesare provided, we will pay
for rental reimbursement expenses incurred by you for the rental of an "auto" because of a covered
physical damage "loss" to an owned covered "auto". Such payment applies in addition to the otherwise
applicable amount of physical damage coverage you have on a covered "auto". No deductibles apply to this
coverage.
B. We will pay only for those expenses incurred during the policy period beginning 24 hours after the "loss"
and ending with the earlier of the return or repair of the covered "auto", or the exhaustion of the coverage
limit.
C. Our payment is limited to the lesser of the following amounts:
1. Necessary and actual expenses incurred; or
2. $30 per day with a maximum of $900 in any one period
D. This coverage does not apply:
1. While there are spare or reserve "autos" available to you for your operations; or
2. lf coverage is provided by another endorsement attached to this policy
E. lf a covered "loss" results from the total theft of a covered "auto" of the private passenger type, we will pay
under this coverage only that amount of your rental reimbursement expenseswhich is not already provided
for under Paragraph A.4. Coverage Extensionsof SECTION lll- PHYSICALDAMAGE COVERAGE of the
Business Auto Coverage Form or Section Vll of this endorsement.
XX. NOTICE OF CANCELLATION OR NONRENEWAL
A. Paragraph A.2. of the COMMON POLICY CONDITIONS is changed to:
2. We may cancel or non-renew this policy by mailing written notice of cancellation or non-renewal to the
Named lnsured, and to any name(s) and address(es) shown in the Cancellation and Non-renewal
Schedule:
a. For reasons of non-payment, the greater of
(1) 10 days; or
(2) The number of days specified in any other Cancellation Condition attached to this policy; or
b. For reasons other than non-payment, the greater of:
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AC 84 07 07 13 Page8of11
(1) 60 days;
(2) The number of days shown in the Cancellation and Non-renewal Schedule; or
(3) The number of days specified in any other Cancellation Condition attached to this policy,
prior to the effective date of the cancellation or non-renewal.
B. All other terms of Paragraph A. of the COMMON POLICY CONDITIONS, and any amendments thereto,
remain in full force and effect.
XXI. LOAN/LEASE PAYOFF COVERAGE
The following is added to Paragraph C. Limit of lnsurance of SECTION lll - PHYSICAL DAMAGE COVERAGE:
ln the event of a total "loss" to a covered "auto" of the private passenger type shown in the schedule or
declarations for which Collision and Comprehensive Coverage apply, we will pay any unpaid amount due on
the lease or loan for that covered "auto", less:
1. The amount paid under the PHYSICAL DAMAGE COVERAGE SECTION of the policy; and
2. Any:
a. Overdue lease/loan payments at the time of the "loss";
b. Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage;
c. Security deposits not returned by the lessor;
d. Costsfor extendedwarranties, Credit Life lnsurance, Health, Accidentor Disabilitylnsurancepurchased
with the loan or lease; and
e. Carry-over balances from previous loans or leases.
This coverage is limited to a maximum of $1500 for each covered "auto".
XXII. LIMITED MEXICO COVERAGE
WARNING
AUTOACCIDENTSIN MEXICOARE SUBJECTTO THE LAWS OF MEXICOONLY - NOT THE LAWS OF THE
UNITED STATES OF AMERICA. THE REPUBLIC OF MEXICO CONSIDERS ANY AUTO ACCIDENT A
CRIMINAL OFFENSFAS WELL AS A CIVIL MATTER.
IN SOME CASES THE COVERAGE PROVIDED UNDER THIS ENDORSEMENT MAY NOT BE RECOGNIZED
BY THE MEXIGANAUTHORITIESAND WE MAY NOT BE ALLOWED TO IMPLEMENTTHIS COVERAGE AT
ALL IN MEXICO. YOU SHOULD CONSIDERPURCHASINGAUTO COVERAGE FROMA LICENSEDMEXI
INSURANCE COMPANY BEFORE DRIVING INTO MEXICO.
THIS ENDORSEMENT DOES NOTAPPLY TO ACCIDENTS OR LOSSES WHICH OCCUR BEYOND 25 MILES
FROM THE BOUNDARY OF THE UNITED STATES OF AMERICA.
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AC 84 07 07 13 Page9of11
A. Coverage
1. Paragraph 8.7. of SECTION lV - BUSINESSAUTO CONDITIONS is amended by the addition of the
following:
The coverage territory is extended to include Mexico but only if all of the following criteria are met:
a. The "accidents" or "loss" occurs within 25 miles of the United States border; and
b. \Mile on a trip into Mexico for 10 days or less.
2. For coverage provided by this section of the endorsement, Paragraph B.5. Other lnsurance in
SECTION lV - BUSINESS AUTO CONDITIONS is replaced by the following:
The insurance provided by this endorsement will be excess over any other collectible insurance.
B. Physical Damage Coverage is amended by the addition of the following:
lf a "loss" to a covered "auto" occurs in Mexico, we will pay for such "loss" in the United States. lf the
covered "auto" must be repaired in Mexico in order to be driven, we will not pay more than the actual cash
value of such "loss" at the nearest United States point where the repairs can be made.
C. Additional Exclusions
The following additional exclusions are added:
This insurance does not apply:
1. lf the covered "auto" is not principally garaged and principally used in the United States.
2. To any "insured" who is not a resident of the United States.
XXIII. WAIVER OF SUBROGATION
Paragraph A.5. in SECTION lV - BUSINESS AUTO CONDITIONS does not apply to any person or
organization where the Named lnsured has agreed, by written contract executed prior to the date of
"accident", to waive rights of recovery against such person or organization.
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AC 84 07 07 13 Page 10 of 11
Schedule
Premium
Liability lncluded
Physical Damage lncluded
TotalPremium lncluded
V. Fellow Employee
Schedule of Employees:
Not Applicable
XVlll. Drive Other Car
Name of lndividual
Not Applicable
LIAB MP UM UIM COMP COLL
XX. Notice of Gancellation or Nonrenewal
Name and Address
Not Applicable
This endorsement applies in all states except:
AL, AR, M., CA, CO, CT, DC, DE, GA, ID, KS, KY, LA, MI, MN, MO, MT, NC, ND,
NJ, NY, OK, PA, RI, SD, TX, UT, VA, VT, WA, WI, \AA/, \A/Y
@ 2013 Liberty Mutual lnsurance. All rights reserved.
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with its permission.
Number of Days
AC 84 07 07 13 Page 11 of '11
Policy Number AS2-ZS1 -4701 38-01 0
lssued by Liberty Mutual Fire lnsurance Co.
This endorsement modifies insurance provided under the following
BUSINESS AUTO COVERAGE FORM
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
AUTO ENHANCEMENT ENDORSEMENT
t.
il.
ilt.
tv.
V.
vt.
vil.
VIII.
tx.
X.
xt.
xil.
xilt.
XIV.
XV.
XVI.
XVII.
XVIII
XIX,
XX.
XXI.
XXII.
XXIII
Newly Acquired or Formed Organizations
Employees as lnsureds
Lessor - Additional lnsured and Loss Payee
Supplementary Payments - lncreased Limits
Fellow Employee Coverage
Personal Property of Others
Additional Transportation Expense and Cost to Recover Stolen Auto
Airbag Coverage
Tapes, Records and Discs Coverage
Physical Damage Deductible - Single Deductible
Physical Damage Deductible - Glass
Physical Damage Deductible - Vehicle Tracking System
Duties in Event of Accident, Claim, Suit or Loss
Unintentional Failure to Disclose Hazards
Worldwide Liability Coverage - Hired and Nonowned Autos
Hired Auto Physical Damage
Auto Medical Payments Coverage lncreased Limits
Drive Other Car Coverage - Broadened Coverage for Designated lndividuals
Rental Reimbursement Coverage
Notice of Cancellation or Nonrenewal
Loan/Lease Payoff Coverage
Limited Mexico Coverage
Waiver of Subrogation
I. NEWLYACQUIRED OR FORMED ORGANIZATIONS
Throughout this policy, the words "yorJ" and "your" also refer to any organization you newly acquire or form,
other than a partnership or joint venture, and over which you maintain ownership of more than 50 percent
interest, provided:
A. There is no similar insurance available to that organization;
B. Unless you notify us to add coverage to your policy, the coverage under this provision is afforded only
until:
1. The 90th day after you acquire or form the organization; or
2. The end of the policy period,
whichever is eadier, and
G. The coverage does not apply to an "accident" which occurred before you acquired or formed the
organization.
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AC 84 07 11 17 Page 1 of 10
II. EMPLOYEES AS INSUREDS
Paragraph A.1. Who ls An Insured of SECTION ll - COVERED AUTOS LIABILITY COVEMGE is
amended to add the following:
Your "employee" is an "insured" while using with your permission a covered "auto" you do not own, hire or
borrow in your business or your personal affairs.
III. LESSOR . ADDITIONAL INSURED AND LOSS PAYEE
A. Any "leased auto" will be considered an "auto" you own and not an "auto" you hire or borrow. The
coverages provided under this section apply to any "leased auto" until the expiration date of this policy or
until the lessor or his or her agent takes possession of the "leased auto" whichever occurs first.
B. For any "leased auto" that is a covered "auto" under SECTION ll - COVERED AUTOS LIABILITY
COVERAGE, Paragraph A.1. Who ls An lnsured provision is changed to include as an "insured" the
lessor of the "leased auto". However, the lessor is an "insured" only for "bodily injury" or "property
damage" resulting from the acts or omissions by:
1. You
2. Any of your "employees" or agents; or
3. Any person, except the lessor or any "employee" or agent of the lessor, operating a "leased auto"
with the permission of any of the above.
C. Loss Payee Glause
1. We will pay, as interests may appear, you and the lessor of the "leased auto" for "loss" to the covered
"leased auto".
2. The insurance covers the interest of the lessor of the "leased auto" unless the "loss" results from
fraudulent acts or omissions on your part.
3. lf we make any payment to the lessor of a "leased auto", we will obtain his or her rights against any
other party.
D. Gancellation
1. lf we cancel the policy, we will mail notice to the lessor in accordance with the Cancellation Common
Policy Condition.
2. lf you cancel the policy, we will mail notice to the lessor
3. Cancellation ends this agreement.
E. The lessor is not liable for payment of your premiums
F. For purposes of this endorsement, the following definitions apply
"Leased auto" means an "auto" which you lease for a period of six months or longer for use in your
business, including any "temporary substitute" of such "leased auto".
"Temporary substitute" means an "auto" that is furnished as a substitute for a covered "auto" when the
covered "auto" is out of service because of its breakdown, repair, servicing, "loss" or destruction.
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AC 8407 11 17 Page 2 of 10
IV. SUPPLEMENTARY PAYMENTS . INCREASED LIMITS
Subparagraphs A.2.a.(2) and A.2.a.(4) of SEGTION ll - COVERED AUTOS LIABILITY COVEMGE are
deleted and replaced by the following:
(2) Up to $3,000 for cost of bail bonds (including bonds for related traffic law violations) required because of
an "accident" we cover. We do not have to furnish these bonds.
(4) All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to
$500 a day because of time off from work.
V. FELLOWEMPLOYEECOVERAGE
A. Exclusion 8.5. of SECTION ll - COVERED AUTOS LIABILITY COVERAGE does not apply.
B. For the purpose of Fellow Employee Coverage only, Paragraph B.5. of SECTION lV - BUSINESS AUTO
CONDITIONS is changed as follows:
This Fellow Employee Coverage is excess over any other collectible insurance.
VI. PERSONAL PROPERTYOF OTHERS
Exclusion 6. in SEGTION ll - COVERED AUTOS LIABILITY COVERAGE for a covered "auto" is amended to
add the following:
This exclusion does not apply to "property damage" or "covered pollution cost or expense" involving "personal
property" of your "employees" or others while such property is carried by the covered "auto". The Limit of
lnsurance for this coverage is $5,000 per "accident". Payment under this coverage does not increase the
Limit of lnsurance.
For the purpose of this section of this endorsement, "personal property" is defined as any property that is not
used in the individual's trade or business or held for the production or collection of income.
VII. ADDITIONAL TRANSPORTATION EXPENSE AND COST TO RECOVER STOLEN AUTO
A. Paragraph A.4.a. of SECTION lll - PHYSICAL DAMAGE COVERAGE is amended as follows:
The amount we will pay is increased to $50 per day and to a maximum limit of $1,000
B. Paragraph A.4.a. of SEGTION Ill - PHYSICAL DAMAGE COVERAGE is amended to add the following
lf your business is shown in the Declarations as something other than an auto dealership, we will also
pay up to $1,000 for reasonable and necessary costs incurred by you to return a stolen covered "auto"
from the place where it is recovered to its usual garaging location.
VIII. AIRBAG COVERAGE
Exclusion B.3.a. in SECTION lll - PHYSICAL DAMAGE COVERAGE is amended to add the following
This exclusion does not apply to the accidental discharge of an airbag.
IX. TAPES, RECORDS AND DISCS COVERAGE
Exclusion B.4.a. of SECTION lll - PHYSICAL DAMAGE COVERAGE is deleted and replaced by the
following:
a. Tapes, records, discs or other similar audio, visual or data electronic devices designed for use with audio,
visual or data electronic equipment except when the tapes, records, discs or other similar audio, visual or
data electronic devices:
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AC 8407 11 17 Page 3 of 10
(1) Are your property or that of a family member; and
(2) Are in a covered "auto" at the time of "loss".
The most we will pay for "loss" is $200. No Physical Damage Coverage deductible applies to this
coverage.
X. PHYSICAL DAMAGE DEDUCTIBLE - SINGLE DEDUCTIBLE
Paragraph D. in SECTION lll - PHYSICAL DAMAGE COVERAGE is deleted and replaced by the following
D. Deductible
For each covered "auto", our obligation to pay for, repair, return or replace damaged or stolen property
will be reduced by the applicable deductible shown in the Declarations. Any Comprehensive Coverage
deductible shown in the Declarations does not apply to "loss" caused by fire or lightning.
When two or more covered "autos" sustain "loss" in the same collision, the total of all the "loss" for all the
involved covered "autos" will be reduced by a single deductible, which will be the largest of all the
deductibles applying to all such covered "autos".
XI. PHYSICAL DAMAGE DEDUCTIBLE - GLASS
Paragraph D. in SECTION lll - PHYSICAL DAMAGE COVERAGE is amended to add the following
No deductible applies to "loss" to glass if you elect to patch or repair it rather than replace it.
XII. PHYSICAL DAMAGE DEDUCTIBLE . VEHICLE TRACKING SYSTEM
Paragraph D. in SECTION lll - PHYSICAL DAMAGE COVERAGE is amended to add:
Any Comprehensive Coverage Deductible shown in the Declarations will be reduced by 5Oo/o for any "loss"
caused by theft if the vehicle is equipped with a vehicle tracking device such as a radio tracking device or a
global positioning device and that device was the method of recovery of the vehicle.
XIII. DUTIES IN EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS
Subparagraphs A.2.a. and A.2.b. of SECTION IV- BUSINESS AUTO CONDITIONS are changed to
a. ln the event of "accident", claim, "suit" or "loss", your insurance manager or any other person you
designate must notiff us as soon as reasonably possible of such "accident", claim, "suit" or "loss". Such
notice must include:
(1) How, when and where the "accident" or "loss" occurred;
(2) The "insured's" name and address, and
(3) To the extent possible, the names and addresses of any injured persons and witnesses.
Knowledge of an "accident", claim, "sr:it" or "loss" by your agent, servant or "employee" shall not be
considered knowledge by you unless you, your insurance manager or any other person you designate
has received notice of the "accident", claim, "suit" or "loss" from your agent, servant or "employee".
b. Additionally, you and any other involved "insured" must:
(1) Assume no obligation, make no payment or incur no expense without our consent, except at the
"insured's" own cost.
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AC 84 07 11 17 Page 4 of 10
(2) lmmediately send us copies of any request, demand, order, notice, summons or legal paper received
concerning the claim or "suit".
(3) Cooperate with us in the investigation or settlement of the claim or defense against the "suit".
(4) Authorize us to obtain medical records or other pertinent information.
(5) Submit to examination, at our expense, by physicians of our choice, as often as we reasonably
require.
XIV. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS
Paragraph 8.2. in SECTION lV - BUSINESS AUTO CONDITIONS is amended to add the following:
Any unintentional failure to disclose all exposures or hazards existing as of the effective date of the Business
Auto Coverage Form or at any time during the policy period will not invalidate or adversely affect the
coverage for such exposure or hazard. However, you must report the undisclosed exposure or hazard to us
as soon as reasonably possible after its discovery.
XV. WORLDWIDE LIABILITY COVERAGE. HIRED AND NONOWNED AUTOS
Condition B.7. in SECTION lV - BUSINESS AUTO CONDITIONS is amended to add the following:
For "accidents" resulting from the use or operation of covered "autos" you do not own, the coverage territory
means all parts of the world subject to the following provisions:
a. lf claim is made or "suit" is brought against an "insured" outside of the United States of America, its
territories and possessions, Puerto Rico and Canada, we shall have the right, but not the duty to
investigate, negotiate, and settle or defend such claim or "suit".
lf we do not exercise that right, the "insured" shall have the duty to investigate, negotiate, and settle or
defend the claim or "suit" and we will reimburse the "insured" for the expenses reasonably incurred in
connection with the investigation, settlement or defense. Reimbursement will be paid in the currency of
the United States of America at the rate of exchange prevailing on the date of reimbursement.
The "insured" shall provide us with such information we shall reasonably request regarding such claim or
"suit" and its investigation, negotiation, and settlement or defense.
The "insured" shall not agree to any settlement of the claim or "suit" without our consent. We shall not
unreasonably withhold consent.
b. We are not licensed to write insurance outside of the United States of America, its territories or
possessions, Puerto Rico and Canada.
We will not furnish certificates of insurance or other evidence of insurance you may need for the purpose
of complying with the laws of other countries relating to auto insurance.
Failure to comply with the auto insurance laws of other countries may result in fines or penalties. This
insurance does not apply to such fines or penalties.
XVI. HIRED AUTO PHYSICAL DAMAGE
lf no deductibles are shown in the Declarations for Physical Damage Coverage for Hired or Borrowed Autos,
the following will apply:
A, We will pay for "loss" under Comprehensive and Collision coverages to a covered "auto" of the private
passenger type hired without an operator for use in your business:
@2017 Liberty Mutual lnsurance
lncludes copyrighted material of lnsurance Services Office, lnc., with its permission
AC 84 07 11 17 Page 5 of 10
1. The most we will pay for coverage afforded by this endorsement is the lesser of:
a. The actual cost to repair or replace such covered "auto" with other property of like kind and
quality; or
b. The actual cash value of such covered "auto" at the time of the "loss"
2. An adjustment for depreciation and physical condition will be made in determining actual cash value
in the event of a total "loss".
3. lf a repair or replacement results in better than like kind or quality, we will not pay for the amount of
the betterment.
B. For each covered "auto", our obligation to pay for, repair, return or replace the covered "auto" will be
reduced by any deductible shown in the Declarations that applies to private passenger "autos" that you
own. lf no applicable deductible is shown in the Declarations, the deductible will be $250.
lf the Declarations show other deductibles for Physical Damage Coverages for Hired or Borrowed Autos,
this Section XVI of this endorsement does not apply.
G. Paragraph A.4.b. of SEGTION lll - PHYSICAL DAMAGE COVERAGE is replaced by the following
b. Loss of Use Expenses
For Hired Auto Physical Damage provided by this endorsement, we will pay expenses for which an
"insured" becomes legally responsible to pay for loss of use of a private passenger vehicle rented or
hired without a driver, under a written rental contract or agreement. We will pay for loss of use
expenses caused by:
(1) Other than collision only if the Declarations indicate that Comprehensive Coverage is provided for
any covered "auto";
(2) Specified Causes of Loss only if the Declarations indicate that Specified Causes of Loss
Coverage is provided for any covered "auto"; or
(3) Collision only if the Declarations indicate that Collision Coverage is provided for any covered
"auto".
However, the most we will pay under this coverage is $30 per day, subject to a maximum of $900
XVII. AUTO MEDICAL PAYMENTS COVERAGE.INCREASED LIMITS
For any covered "loss", the Limit of lnsurance for Auto Medical Payments will be double the limit shown in the
Declarations if the "insured" was wearing a seat belt at the time of the "accident". This is the maximum
amount we will pay for all covered medical expenses, regardless of the number of covered "autos",
"insureds", premiums paid, claims made, or vehicles involved in the "accident".
lf no limit of insurance for Auto Medical Payments is shown on the Declarations, this paragraph Section XVll
of this endorsement does not apply.
XVIII. DRIVE OTHER CAR COVERAGE . BROADENED COVERAGE FOR DESIGNATED INDIVIDUALS
A. This endorsement amends only those coverages indicated with an "X" in the Drive Other Car section of
the Schedule to this endorsement.
B. SECTION ll - COVERED AUTOS LIABILITY COVERAGE is amended as follows
1. Any "auto" you don't own, hire or borrow is a covered "auto" for Liability Coverage while being used
by any individual named in the Drive Other Car section of the Schedule to this endorsement or by his
or her spouse while a resident of the same household except:
4C84071117 @2017 Liberty Mutual lnsurance
lncludes copyrighted material of lnsurance Services Office, lnc., with its permission
Page 6 of 10
a. Any "auto" owned by that individual or by any member of his or her household; or
b. Any "auto" used by that individual or his or her spouse while working in a business of selling,
servicing, repairing or parking "autos".
2. The following is added to Who ls An Insured:
Any individual named in the Drive Other Car section of the Schedule to this endorsement and his or
her spouse, while a resident of the same household, are "insureds" while using any covered "auto"
described in Paragraph 8.1. of this endorsement.
C. Auto Medical Payments, Uninsured Motorist, and Underinsured Motorist Coverages are amended as
follows:
The following is added to Who ls An Insured:
Any individual named in the Drive Other Car section of the Schedule to this endorsement and his or her
"family members" are "insured" while "occupying" or while a pedestrian when struck by any "auto" you
don't own except:
Any "auto" owned by that individual or by any "family member"
D. SECTION Ill- PHYSICAL DAMAGE COVERAGE is changed as fottows:
Any private passenger type "auto" you don't own, hire or borrow is a covered "auto" while in the care,
custody or control of any individual named in the Drive Other Car section of the Schedule to this
endorsement or his or her spouse while a resident of the same household except:
1. Any "auto" owned by that individual or by any member of his or her household; or
2. Any "auto" used by that individual or his or her spouse while working in a business of selling,
servicing, repairing or parking "autos".
E. For purposes of this endorsement, SECTION V - DEFINITIONS is amended to add the following
"Family member" means a person related to the individual named in the Drive Other Car section of the
Schedule to this endorsement by blood, marriage or adoption who is a resident of the individual's
household, including a ward or foster child.
XIX. RENTAL REIMBURSEMENT COVERAGE
A. For any owned covered "auto" for which Collision and Comprehensive Coverages are provided, we will
pay for rental reimbursement expenses incurred by you for the rental of an "auto" because of a covered
physical damage "loss" to an owned covered "auto". Such payment applies in addition to the otherwise
applicable amount of physical damage coverage you have on a covered "auto". No deductibles apply to
this coverage.
B. We will pay only for those expenses incurred during the policy period beginning 24 hours after the "loss"
and ending with the earlier of the return or repair of the covered "auto", or the exhaustion of the coverage
limit.
G. Our payment is limited to the lesser of the following amounts:
1. Necessary and actual expenses incurred; or
2. $30 per day with a maximum of $900 in any one period.
@ 2017 Liberty Mutual lnsurance
lncludes copyrighted material of lnsurance Services Office, lnc., with its permission
AC 84 07 11 17 Page 7 of 10
D. This coverage does not apply
1. While there are spare or reserve "autos" available to you for your operations; or
2. lf coverage is provided by another endorsement attached to this policy
E. lf a covered "loss" results from the total theft of a covered "auto" of the private passenger type, we will
pay under this coverage only that amount of your rental reimbursement expenses which is not already
provided for under Paragraph A.4. Coverage Extensions of SECTION lll - PHYSICAL DAMAGE
COVERAGE of the Business Auto Coverage Form or Section Vll of this endorsement.
XX.NOTICE OF CANCELLATION OR NONRENEWAL
A. Paragraph A.2. of the GOMMON POLICY CONDITIONS is changed to:
2. We may cancel or non-renew this policy by mailing written notice of cancellation or non-renewal to
the Named lnsured, and to any name(s) and address(es) shown in the Cancellation and Non-renewal
Schedule:
a. For reasons of non-payment, the greater of:
(1) 10 days; or
(2) The number of days specified in any other Cancellation Condition attached to this policy; or
b. For reasons other than non-payment, the greater of:
(1) 60 days;
(2) The number of days shown in the Cancellation and Non-renewal Schedule; or
(3) The number of days specified in any other Cancellation Condition attached to this policy,
prior to the effective date of the cancellation or non-renewal.
B. All other terms of Paragraph A. of the GOMMON POLICY CONDITIONS, and any amendments thereto,
remain in full force and effect.
XXI. LOAN/LEASE PAYOFF COVERAGE
The following is added to Paragrapn C. Limits Of Insurance of SEGTION lll - PHYSICAL DAMAGE
COVERAGE:
ln the event of a total "loss" to a covered "auto" of the private passenger type shown in the schedule or
declarations for which Collision and Comprehensive Coverage apply, we will pay any unpaid amount due on
the lease or loan for that covered "auto", less:
1. The amount paid under the PHYSICAL DAMAGE COVERAGE SECTION of the policy; and
2. Any:
a. Overdue lease/loan payments at the time of the "loss";
b. Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high
mileage;
c. Security deposits not returned by the lessor;
d. Costs for extended warranties, Credit Life lnsurance, Health, Accident or Disability lnsurance
purchased with the loan or lease; and
AC 84 07 11 17 @ 2017 Liberty Mutual lnsurance
lncludes copyrighted material of lnsurance Services Office, lnc., with its permission.
Page 8 of 10
e. Carry-over balances from previous loans or leases.
This coverage is limited to a maximum of $1,500 for each covered "auto"
XXII.LIMITED MEXICO COVERAGE
WARNING
AUTO ACCIDENTS IN MEXICO ARE SUBJECT TO THE LAWS OF MEXICO ONLY - NOT THE LAWS OF THE
UNITED STATES OF AMERICA. THE REPUBLIC OF MEXICO CONSIDERS ANY AUTO ACCIDENT A
CRIMINAL OFFENSE AS WELL AS A CIVIL MATTER.
IN SOME CASES THE COVERAGE PROVIDED UNDER THIS ENDORSEMENT MAY NOT BE RECOGNIZED
BY THE MEXICAN AUTHORITIES AND WE MAY NOT BE ALLOWED TO IMPLEMENT THIS COVERAGE AT
ALL IN MEXICO, YOU SHOULD CONSIDER PURCHASING AUTO COVERAGE FROM A LICENSED
MEXICAN INSURANCE COMPANY BEFORE DRIVING INTO MEXICO.
THIS ENDORSEMENT DOES NOT APPLY TO ACCIDENTS OR LOSSES WHICH OCCUR BEYOND 25 MILES
FROM THE BOUNDARY OF THE UNITED STATES OF AMERICA.
A. Goverage
1. Paragraph B.7. of SECTION lV - BUSINESS AUTO CONDITIONS is amended by the addition of the
following:
The coverage territory is extended to include Mexico but only if all of the following criteria are met:
a. The "accidents" or "loss" occurs within 25 miles of the United States border; and
b. \Mile on a trip into Mexico for 10 days or less.
2. For coverage provided by this section of the endorsement, Paragraph B.5. Other lnsurance in
SECTION lV - BUSINESS AUTO CONDITIONS is replaced by the following:
The insurance provided by this endorsement will be excess over any other collectible insurance.
B. Physical Damage Goverage is amended by the addition of the following:
lf a "loss" to a covered "auto" occurs in Mexico, we will pay for such "loss" in the United States. lf the
covered "auto" must be repaired in Mexico in order to be driven, we will not pay more than the actual
cash value of such "loss" at the nearest United States point where the repairs can be made.
C. Additional Exclusions
The following additional exclusions are added:
This insurance does not apply:
1. lf the covered "auto" is not principally garaged and principally used in the United States.
2. To any "insured" who is not a resident of the United States.
XXIII. WAIVER OF SUBROGATION
Paragraph A.5. in SECTION lV - BUSINESS AUTO CONDITIONS does not apply to any person or organization
where the Named lnsured has agreed, by written contract executed prior to the date of "accident", to waive rights
of recovery against such person or organization.
@2017 Liberty Mutual lnsurance
lncludes copyrighted material of lnsurance Services Office, lnc., with its permission
AC 8407 11 17 Page 9 of 10
Premium
Liability lncluded
Physical Damage lncluded
TotalPremium lncluded
XVll. Drive Other Gar
Name of lndividual
Not Applicable
XX. Notice of Cancellation or Nonrenewal
Name and Address
Not Applicable
Schedule
LIAB MP UM UIM COMP COLL
Number of Days
@2017 Liberty Mutual lnsurance
lncludes copyrighted material of lnsurance Services Office, lnc., with its permission
AC 84 07 11 17 Page 10 of 10
Policy Number: As2 -29L- 47 0L38 - o1o
lssued by: Liberty Mutual- F j-re Insurance Co.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
DESIGNATED INSURED . NONCONTRIBUTING
This endorsement modifies insurance provided under the following
BUSINESS AUTO COVERAGE FORM
GARAGE COVERAGE FORM
MOTOR CARRIERS COVERAGE FORM
TRUCKERS COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless
modified by this endorsement.
This endorsement identifies person(s) or organization(s) who are "insureds" under the Who ls An lnsured
Provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage form.
Schedule
Name of Person(s) or Organizations(s):
Where required by contract
Regarding Designated Contract or Project:
Each person or organization shown in the Schedule of this endorsement is an "insured" for Liability Coverage, but
only to the extent that person or organization qualifies as an "insured" under the \A/ho ls An lnsured Provision
contained in Section ll of the Coverage Form.
The following is added to the Other lnsurance Condition:
lf you have agreed in a written agreement that this policy will be primary and without right of contribution
from any insurance in force for an Additional lnsured for liability arising out of your operations, and the
agreement was executed prior to the "bodily injury" or "property damage", then this insurance will be
primary and we will not seek contribution from such insurance.
@ 2010, Liberty Mutual Group of Companies. All rights reserved
lncludes copyrighted material of lnsurance Services Office, lnc.,
with its permission.
AC 84 23 08 11 Page 1 of 1
POLICY NUM BER: AS.2-291 4701 38-01 0 COMMERCIALAUTO
cA 20 70 10 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
COVERAGE FOR CERTAIN OPERATIONS
IN CONNECTION WITH RAILROADS
This endorsement modifies insurance provided under the following
AUTO DEALERS COVERAGE FORM
BUSINESS AUTO COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless
modified by the endorsement.
SCHEDULE
Scheduled Railroad Designated Job Site
Where required by contract Where required by contract
lnformation required to complete this Schedule, if not shown above, will be shown in the Declarations.
With respect to the use of a covered "auto" in
operations for or affecting a railroad designated in the
Schedule at a Designated Job Site, the two exceptions
contained in the definition of "insured contract" relating
to construction or demolition operations performed
within 50 feet of a railroad do not apply.
cA 20 70 10 13 @ lnsurance Services Office, lnc.,2O11 Page I of I
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not
enforce our right against the person or organization named in the Schedule. (This agreement applies only to the
extent that you perform work under a written contract that requires you to obtain this agreement from us.)
This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.
Not applicable in KY, NH and NJ
The waiver does not apply to any right to recover payments which the
Minnesota Workers Compensation Reinsurance Association may have or pursue
under M.S. 79.36.
Schedule
Any person or organization for which the employer has agreed by written contract, executed prior to loss, may
execute a waiver of subrogation. However, for purposes of work performed by the employer in Missouri, this waiver
of subrogation does not apply to any construction group of classifications as designated by the waiver of right to
recover from others (subrogation) rule in our manual.
\A/here required by contract or written agreement prior to loss and allowed
by law.
ln the states of AL, AR, AZ, CO, DC, GA, lD, lL, lN, KS, Ml, MN, MO, MS,
MT, NC, NM, OK, SC, SD and \M/, the premium charge is2.0o/o of the total
manual premium, subject to a minimum premium of $100 per policy.
ln the states of FL, lA, MD, NE and OR, the premium charge is 1.0% of the
total manual premium, subject to a minimum premium of $250 per policy.
ln the state of LA, the premium charge is 2.0%o of the total standard
premium, subject to a minimum premium of $250 per policy.
lssued by Liberty lnsurance Corporation2'|814
For attachment to Policy No. WC7-291-470138-030
lssued to RailPros Holdings LLC
wc 00 0313
Ed.04to1t1984
Effective Date
@ 1983 National Council on Compensation lnsurance.
Premium $
Page 1 of 1
ALTERNATE EMPLOYER ENDORSEMENT
This endorsement applies only with respect to bodily injury to your employees while in the course of special or
temporary employment by the alternate employer in the state named in ltem 2 of the Schedule. Part One (Workers
Compensation lnsurance) and Part Two (Employers Liability lnsurance) will apply as though the alternate employer
is insured. lf an entry is shown in ltem 3 of the Schedule the insurance afforded by this endorsement applies only to
work you perform under the contract or at the project named in the Schedule.
Uhder Part One (Workers Compensation lnsurance) we will reimburse the alternate employer for the benefits
required by the workers compensation law if we are not permitted to pay the benefits directly to the persons entitled
to them.
The insurance afforded by this endorsement is not intended to satisfr the alternate employe/s duty to secure its
obligations under the workers compensation law. We will not file evidence of this insurance on behalf of the
alternate employer with any government agency.
We will not ask any other insurer of the alternate employer to share with us a loss covered by this endorsement.
Premium will be charged for your employees while in the course of special or temporary employment by the
alternate employer.
The policy may be canceled according to its terms without sending notice to the alternate employer.
Part Four (Your Duties lf lnjury Occurs) applies to you and the alternate employer. The alternate employer will
recognize our right to defend under Parts One and Two and our right to inspect under Part Six.
Schedule
1. Alternate Employer Address
lf Any
2. State of Special or Temporary Employment
Any except OK and TX.
3. Gontract or Project
lssued by Liberty lnsurance Corporation21814
For attachment to Policy No. WC7-291-470138-030
lssued to RailPros Holdings LLC
wc000301A
Ed. 02101/1989
Effective Date Premium $
@ 1984, 1988 National Council on Compensation lnsurance.Page 1 of 1
NOTICE OF CANCELLATION TO THIRD PARTIES
A. lf we cancel this policy for any reason other than nonpayment of premium, we will notify the persons or
organizations shown in the Schedule below. We will send notice to the email or mailing address listed below at
least 10 days, or the number of days listed below, if any, before cancellation becomes effective. ln no event
does the notice to the third party exceed the notice to the first named insured.
B. This advance notification of a pending cancellation of coverage is intended as a courtesy only. Our failure to
provide such advance notification will not extend the policy cancellation date nor negate cancellation of the
policy.
Name of Other Person(s) /
Organization(s):
Per Schedule on File With
Company
Schedule
EmailAddress or mailing address:
Per Schedule on File With
Company
Effective Date
Number Days Notice:
Premium $
30
All other terms and conditions of this policy remain unchanged.
lssued by Liberty lnsurance Corporation21814
For attachment to Policy No. WC7-291-470138-030
lssued to RailPros Holdings LLC
wM 9018 06 {1
Ed.06t01t2011
@2011, Liberty MutualGroup. All Rights Reserved Page 1 of 1
ENDORSEMENT NO. 4
ADVICE OF CAIICELLATION TO ENTITIES OTHER THAN THE NAMED INSURED LI1VIITED
TO E.MAIL NOTIFICATION
This Endorsement, effective at 12:01a.m. on February 1,2020, forms part of
Policy No. 0310-5773
Issued to RailPros Holdings, LLC
Issued by Allied World Surplus Lines Insurance Company
In consideration of the premium charged, it is hereby agreed that:
In the event that the Company cancels this Policy for any reason other than nonpayment of premium, and
l. The cancellation effective date is prior to this Policy's expiration date;
2. The First Named Insured is under an existing contractual obligation to notify a certificate holder
when this Policy is canceled (hereinafter, the "Certificate Holder(s)"); and has provided to the
Company, either directly or through its broker of record, the email address of the contact at such
entity; and
3. The Company receives this information after the First Named Insured receives notice of
cancellation of this Policy and prior to this Policy's cancellation effective date, via an electronic
spreadsheet that is acceptable to the Company;
The Company will provide advice of cancellation (the "Advice") via e-mail to such Certificate
Holders.
Proof of the Company emailing the Advice, using the information provided by the First Named
Insured, will serve as proof that the Company has fully satisfied its obligations under this Endorsement.
This Endorsement does not affect, in any way, coverage provided under this Policy or the cancellation of
this Policy or the effective date thereof, nor shall this Endorsement invest any rights in any entity not
insured under this Policy.
Any failure on the Insurer's part to deliver the Advice will not impose liability of any kind upon the
Insurer or invalidate the cancellation.
Any Certificate Holder is not an Insured or a Loss Payee under this Policy. No coverage will be
available under this Policy for any Claim brought by or against any Certificate Holder.
All other terms, conditions and limitations of this Policy shall remain unchanged.
-{t-&l"a*
AE 0002s 00 (06/14)
Authorized Representative