HomeMy WebLinkAboutCAG2021-542 - Insurance Certificate - Rainier Valley Corps - Mujer Al Volante - Liability Coverage - 07/13/2022Client#:1284547 RVCSEA
ACORD^ CERTIFICATE OF LIABILITY INSURANCE
COVERAGES CERTIFICATE NUMBER:REVISION NUMBER:
DATE (MMiDDITYYY}
7t25t2022
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: lf the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
lf SUBROGATION lS WAIVED, subiect to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer any rights to the certiticate holder in lieu of such endorsement(s).
PRODUCER
USI lnsurance Services LLC
601 Union Street, Suite 1000
seattle, wA 98101
206 441-6300
ftRilIl"' Select NW Resion
fll8.NruEo. e,,r, 877 678-5842 610-362-8530
Fil?#!*., Select@usi.com
INSUBER(S} AFFORDING COVERAGE NAIC#
tNsuRER A , Great American lnsurance Company 16691
INSURED
RVC Seattle
1225 S Weller St, Suite 400
Seattle, WA 98144
INSURER B :
INSURER C
INSURER D :
INSURER E :
INSURER F:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVEBEENISSUED TOTHE INSURED NAMEDABOVE FORTHE POLICYPERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITIONOF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSRITR TYPE OF INSURANCE POLICY NUMBER
POLICY EFF(MM/DD/YYYY'I FOLICY EXP
IMM/DD/YYYY)LIMITS
A COMMERCIAL GENERAL LIABILITY
CLAIMS.MADE OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:
X f--l PRo-poLrcvl lJEcr Loc
OTHER:
x
x PAC410388407 3t2022 07t13t2023 EACH OCCURRENCE $1.000.000
$100.000
MED EXP (Anv one person)$5.000
PERSONAL & ADV INJURY s1.000.000
GENERAL AGGREGATE s3.000.000
PRODUCTS - COMP/OP AGG s3.000.000
$
A AUTOMOBILE LIABILITY
ANY AUTO
OWNED
AUTOS ONLY
HIRED
AUTOS ONLY
SCHEDULED
AUTOS
NON-OWNED
AUTOS ONLYxx
PAC410388407 07t13t2022 07t13t2023 *1.000.000
BODILY INJURY (Per person)$
BODILY INJURY (Per accident)$
$
$
UMBRELLA LIAB
EXCESS LIAB
OCCUR
CLAIMS.MADE
EACH OCCUFRENCE s
AGGREGATE $
DFD RETFNTION S $
A WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
(Mandatory in NH)
lf yes, describe under
DESCRIPTION OF OPERATIONS below
N/A
PAC410388407
WA Stop Gap
07t13t2022 07t13t2023 PERqTATI ITtr X OTH-tra
E.L. EACH ACCIDENT s1.000.000
E.L. DISEASE. EA EMPLOYEE s1.000.000
E.L. DISEASE - POLICY LIMIT s1.000.000
A Prol Liab
Abuse Molestation
PAC410388407 ,7t13t2022 07t13t2023 $lmil eal $2mil agg
$1mil eal $3mil agg
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Addltional Remarks Schedule, may be attached il more space is required)
The General Liability policy includes an automatic Additional lnsured endorsement that provides Additional
lnsured status to the Certificate Holder, only when there is a written contract that requires such status,
and only with regard to work performed on behalf of the named insured.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City ol Kent
Housing and Human Services
220 Fourth Ave So
Kent, WA 98118
4h^#.P. tWmdn
AUTHORIZED REPRESENTATIVE
ACORD 25 (2016t03) 1 of 1
#s3681 31 82lM36808579
O 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks ot ACORD
AXYZP
This page has been left blank intentionally.
GREAT AiTERICAN AS$i|,JR.ANCE CQMPANYD/B' ?6042273e 2*306
cG as 70 {Ed. 11/'i4}
THIS ENDOFSEINEHT CHAHGES TT€ FOLICY. PI.€ASE REAN |T CAREFULLY,
SreNAruffi GETGNAT LIIABLIYY BHOADE}I{G ETSQR€ETUET{T
This Hndorsernent modiliee arrd i$ €ubj€ct to the in*urance provided under tha lollow*ng form:
CCMMERCIAL GEN€NAL U,qEilTY SOVERAGE PART
The lollowlng exiansion onty spFlies in thE eveltl that no athef specilic coverage fsr the indioated loss
expcsur€ h prouided under lhis Policy, ll olher specilic csverage aplies, ths t€nn$, conditionE and
linats of *rat Govarags arg ltg sxclusive esverage applicable under this Fo{*y. unless olhsrwise noted inthk Endorsernent" Thls ls a surnnlary of the various additional cov6rsg6s ard cov*rage modifications
Pro*ided by this Endorsarne*t, For corfiplete deten$ on specifir csversges, ccnsult the ach,ral policy
wording.
Coverage Degcriplion Limil ol *nsurnnc:Fsge
Non-0wned Aireraft lnclsded ?
H*n-Owtred Walercraft lncludad 2
Bodily lnjury - h*ental lnjury, Mentpl Snguish, Hrfiiliation or Silsck lnclilded 3
Medical Paymerrts $ 20,000 3
Daruraga to Premisss Fefitsd ts you s 1.c00,000 3
$uppternentary PayrnenaE - Eail Bonda S 3,ooo I
Supplarngntary f*y*ent* * Loss of Farnings $ 1,0S0 per day 4
Newly Formed or A*quired Organiaations lnclrrded 4
unintentional Failsre to Diselose Hazards lnduded e
Knowhdge ol Occurrence, Claim or S$il lncluded 5
Property *arnage Uability - Eleval**lncluded 5
Property Darnage Liabifity - Bsrrowed Equipment lnsluded t
LEreralizalion Clause lncluded 6
Arnendmant sf Foltution Exelusion {Prornises}lneludad 6
LhllitFd PrCIperty Darnap to Property cf ethers $ 5,ooo 6
Addllion*l lnsured - Managgr s Lessor sf Fremises lncluded 7
s 8e 70 {Ed 11/14}{FaSe I of t2}
Goverage Description Llrnit ol lnstrs**Page
Additianal lnsr.red - Funding Sources lncluded 7
Additional lnsurad - $ Contraet lnciuded I
Prirnary ard Nan-Ccntrlbutory Additianal lngursd Exlension lnsluded 10
Additional lnsurede * Prataction oi Ycur L*mits lncluded 10
Blanket Waiver ol Tranrfsr ol Fighte cf Recovery Against Qthers
to Lb {Subrcgat*n}
lncludad 'tl
Property Damage Extenslon With Vcluntary Payments $ '1,0s0/s $,sQo 11
Who ls An lnsured - Fellaw Enrployee Extetxlon " Management
Employo**
lncl*ded
12
Broadened Personaf and I'dvertiatng *njury lncluded 12
c * sl * 05/11/2020. PAC 4103884 6 GREA'T AMERICAN ASSURAI{CE COIPAIIYnOrE" 26S422738 253306
ORIGINAL CCPY
i. l'lpn-Swncd Aircraft
Under paragr*ph a Erclr.reions of geGTlol{ I - CGVEA*GE A - Eodily lnlury and Prop€rty
Bamage Liellity, exclusisn g Alrcraft, *trts or Water*€ft does nci apply to an alrcratl provided:
1 it E nst ourned by any insured;
e n is hired, chartered er lsened with a trained paid qrsw;
g; the pilol in command holds a currenlly effectiva certificate, iss$Ed h'y ths dt-ily constituted
authority 0l the United States of America or Canad& designating him or her a commarcial or
airlina pilo{ ard
4. it b nat being used lo carry perssns or praperty for a eharge'
However, the innuranca alfqrded by this provi*ion doea not apply it there is avatrable to the lr:sured
other valid ard sBllactible inEurance, wh*lher primary, ex*ess (ather it-an in&5ancs written to *pply
sp*cificelly in sxcesE sf this Poliey|, cantingant or 0n any cther baciE, lhat wculd alxo apply te the
less ccver*d undEr lhis pr<lvlsion.
A lton*Orrned ll$rtercraft
Under paragfaph 2, Exslusisns of SECTIOII I - COI|ERAG€ A * Bodily lniury and Property
Oamage tiability, $ilbparggraph pJ ci exclusion g. Aircraft, *uto or Watcicrslt is replaced by lhe
following;
Thls excluiian do*s nct apply to:
F) A uratercralt you do not own that i*
(a) less ttsn 60 feet *ong; ard
cG 89 70 (Fd 11f 14t {Page 2 of 12}
C' Sl '05/1112020 " PAC 4103884 05 GREAT Al4ERtcAN AsSuR.At{CE COtvlPAt{y OR|G|NAL COFY'D/8. ?504227S 253306
{bl not being us*d to carry petsons or property fsr a charge,
c- Bodily tniury * M*nial hjrry" Mental Anguieh, llumiliEtion or $hock
Under SEGTION V - DEFINITIONS, Definition S. is re$aced by the following:
e "BCIdity lnjury" rneans physicaf injury, sicknessn or diseasg, lncluding death of a person. .Bodily
lnjury' aka tn€ans mentat injury, msntal angui*h, humiliation. or shcck if directly resulting from
physicel injury, sickness" sr disease to thet person.
D. illedical Ptymtlltg
lf Cnverage e ldgdlcrl psyments is not otlorwise sxcludEd, lha Msdicai Payrnents pravided by
thie Pclicy frre arneflded as foll*ws:
T}e Meclical *xpense Limit h paragraph L cf SEGTION lll - LIMITS OF INSURANCE b reptaced by
the following l,ledkal axpensa Lirsrifs
The Medical Expenne Limit pr*vided by this Pollcy shall bE the greater o{:
t $20,OO0: sr
h' thts arnount shorr*n in the Deelaration$ for il4edical Fxponsa Limlt
Th;is provision 7. is subjeet to all tha t*rrns ct sHcTlGI{ lg - LtMtTs tr tHsuRAHcE
E ilarnag* tc Prernkr* Hg{ad to yfi-l
lf Damage to Prerniees *ented to Ycn is not otherwise *xcludad from this Covera$e part
'1" Undar pstegiq$ 2. €xelusian* cl SECTIC!{ I - COVffiAcE A - Borlily lnjury ad Frcpcrty
Fanrage Li*Slity;
3' The last paragraph of paragraph ?- Exclurinns is deleted in its entirety and replaced by lhe
fall*wirrg:
Exclusions c. through n dn not apdy to damage ay fire, lightning, exploaion, smoke,
Fakage lrcrn ar: automatic fire protection *ystem or water to pr6mi$es white rBfltsd tD you
eir lemporarlly oc*upied by you with permissicn 91 lh* swner. 4 separata Unnlt cf
Insur*nce sppties to this so\rerags * described ln SECTITON lll - LillilTS OF INSIIHAHC€.
Hswever, this insuranc* dses not apply to darrrage to prefii$es white rEnted lo ycg, &r
tarnp*rarily occupied by you with the Bprmission of the o{uner. caused by
i. rupture, bursting, or cperation of presrurs relief deviee*;
ii' rupttge or bursting dus la axFension or ew*lling ol the eontents of any building or
struclure, caused by or rasulting from water;
iii. explocion cf staarn boiler*, $tiaarfi pip6s, staArn *ngine*, or stsam lurbine*; ar
Ir_ flaod
2. ParaSaph 6 Under SECTIOI{ lll - LiltITS tr INSURANCE is delete{ h its antirety and
replaced with the fellawing:
cG 89 70 (Rr f 1l'r 4){kge 3 ol 1?}
C' S,1 * O5f11I2O2O' PAC 41O3SS4 OS GREAT AI€RiCAN ASSURAhEE GOMPANY ORIGINAL COPY
"DrB 2SS422738 353306
6. Subject lo paragnaph 5. abeve, lhe m*si we wlll pay under Coveragc A far damages
because of "property damage' tc arry one prsmlses, while rented lo yo{, or n the case cl
damage caused by llre, Ilghtning, explosien, smake. teakage from eulornalic lirg protection
systoril or watsr while rented to y*u or temporarily occupied by you with the pornission
at ttrE ownett {or all such damago ca{rsad by flre, lightaing, explosion, smoke, leakage lrom
automatic lire protection systems or water prcximalely callsed by ihs sarns evsnt, whether
such damage results lrom fire, lightning, explosion, srloke, leakage {rom autsltatis fire
protection systens or water or any csmbinatlsn sl the slx, is the hlgher of $1'O8O,000 or
tha amaunt shown h the Daclaration$ for the Da$ags to Frsmi*es Renled to You Lbnit'
3. Under SECTIOIT nr - COICIME*CIAL GEilfHAL LIABILITY COHDITIOI{S, subsection {. Other
ln$uraftee, paragraph b, Fxcass lnsrranes wherB the words 'Fire insurance' app?ar they srB
ehangsd to 'iniurance fsr ftre, lightning, exploslon, $moks, leakage lrom En sutor*atic fire
prot*clion systen sr waler"o
4. As regards cilvsrags provided by this provlsion l. Dameg* ts Fremiret Henkd to You -
paragraph 9;a. sl Definitistts is re$acad with the follcwlng:
9" r. * s$niraci for a lease sl prernise$, How*ver, lhat portlon sl tfie sontract lor a lease of
premises ihat indem*ifie$ any person or organizallon for dgmaga by llre' lightning,
explosion, smoks, leakaga from el,ltcmatb {lre protaction $ysl€m$ or wal€r to
premlses whife rented to you or tempor*r:ly occuplsd by you with the p8rmission ot
the *rffner h not gt "lnsured cuntra*tn;
F. Suppl*raantary Fayrnent=
1. h tha Supplam*ntary Fayrnants - Govtrage* A and B prilvisi€n, paragraph 1.b' is r€placsd
wlth:
h Up to $ A-000 for the cnst of batl borrdn requirad b*causs ol asckJents cr tralfic hw
vlclationa arising or.rt o{ llm use of any vehiclE to which th* Eodily lnfury Liabi{ity Gev*rags
app$es" Vt/e da not havt lo furnlsh these bsnds.
2- Paragraph 1.d.'s replacsd @ the follcwing:
rt All reasonable Bxpenses insurrad hy the lnsured at our rique$t tq €s$ist us iB the
lnve*iigation pr dpfsn$a of th* clalrn or *sult," including aclual loss ol earuings up to $
1,01!0 a day beceuse ol tirNe of{ work"
G. l,lcuuly Fornnad ar Acquir*d Organirttient
Faragraph & cf SECTIO}I ll' ltfHO IS AH IIIISURED is replaced by the following:
g, Any organizatlcn you newly ecquire or form arrd over which yau rnaintakt ownership or majority
intireot, will qualify aa a narned insured il thera lg no siher sirnilar insursncs avallablE to that
arganizatinn. l'lowaver:
s. covErage und*r this prcvisioR k afiorded only until the expir*tion of ths policy period h
which tha entlty ,rva$ agquked or tarmpd by ysul
b- soveragE A does not apply to 'bodily injury' or property dam*ge tflat gccurrsd bafora you
acqulred or farmed the argankatlsn; and
c. coverage E doE$ ilol *ppty lo 'persgnal arrd advertlsing iniury' arising ost ol an olfensE
committed belore you acquired or {arrned the organieation"
oG 8e 70 Fd. 11114){Page 4 of 12}
C * 31* S511TI2O2O * PAG 4103884 05 GREAT AMERICAN ASSURANOE COMPANY ORISF.IAL COPY
'DrB* 2m42?738 953306
ct records and dsscriptions of opsretion$ must be maintainerd by the firsl naned insured.
No porson or organization ie rr insured with raspect tg the conduct of any eurrenl or past
partnerehp, ioint venture or limited liability compa*y that is not shcwn fl$ * named lnsured in lhe
Declarations cl qualilbs 6 afi insurad under fiis provision.
K Unint*ntional Failura to Diselose Hazsrd$
Under gECTlOl'l lV * CO[tf{fRClAL GFNERAL LIABILITY COI{D|T|ONS' the lollowing is edded to
Conditicn 5. Hepresentations:
Failure si the lns$sd ts disclosB ell hazarde existing ae af the incep$on date ol lhis Policy shall not
preiudice the irsurance wath rB6psct to the ccverage a{forded by lhis PoEcy, pr*vid*d such lailure
or o:ni**i+a in not ir*enlierel cn the parl ol the lnsured"
L Knawtodge of dccurr*rce, €lalm or Suit
Under SErfloil I V * CCildittEHClAL GEHERAL LIAEIUTY COI{OITION$, the lollowing is added to
*endition 2- $uti6s ln ths Evgrt af Ocsurrencf, $flsne*, Glalm or $uil:
Kno$ledgc ol arry $ccurrFnc6, clairyt, sr 6uil by *ty egent sarvant or *mplcyee o{ the Named
lnsured doe* not *n itsell canstilut* knowtedg* by the lnsursd unlass nalice ol *uch injury, claim or
suit shall lrave been received by
J,
s. you, il you are xt individusl;
b. a parlnar, 1{ yeu aro * partnership
c. trr sx€cutive ollicer Er lnsurarna manag€r! il you sr8 a eorForatioil.
Praperty Damags l-iability - Elevators
t. lJnder paragraph l. Ex*lssionr al SEGTION I - COVERAGE A - Eodily tniury and Prop:rty
trsmtgc Liab'ility, subparagr€phs {9}, $} and {5f ol exclusion i, Damrgc ts Propdty do nst
apply if silch property darnage resull$ frorn lhe tss of elevatore.
t. The iailowing is added ra *EcTlofrl lv - coMnERclAL GENERAL LlAgLlTy cot'rBtTtoNs,
Gonditiorr lt. Olhsr Insursncc, palagrsph b, Exc*ss lneurance:
Ths insurance afforded by thi* provision of this Endaraernenl b excess over any property
in$uranc€r rnhether primary, exe€ss, contingent or an any oth6r ba{*c,
K Fropsrty Demagc LiabilFty - Borr*wed Eq*ripnnanl
t. {Jnder paragraph 2, Exchr*iona oi $ECTtOtrl I - COVEFAGE * - Bodily lnjury and Proponty
DErn&gs Liebllity, cubp*ragr*pft (tt) o{ exclusisn j" Famag* to prsp*rty does nsl apply t0
'prope11y d*nrag ' lc borr*wed equipment whilF nol being usett to perlorm operations d e job
site-
a Th* loilswing is added to sEcTtaN ff - cofrilrl=FclAl. GFI'IEFAL LIABILITY condirions.
Gonditien i[, Other ln:urahc*, paragraph b" ExcEa* lnarrane*:
The insurance af{orded by thie provisian cl this €ndsrsement b excess over arry property
insrrance, whethar primary, excessr contingent or 6n any cthar basis"
CIG 8S 70 {Ed 11/14}{Page s af '12}
c * st r 0511't/202$. FAc 4103884 05 GREAT AhJIERICAN ASSURANCE COMP.{I'{Y
'Djg* 2fiS422738 253306
ORIGINAL COPY
L. Libarelizction Gleues
ll we rpvlse thls Slgnature General Uability Broadenlng Endorsement to provlde more coverage
without additional premium chsrge, your policy wll: automatically provide the sovsrage €s of the
date ths revision is effEciive ln your stale,
M, A*rendnent of Follurion Exclusion (Frernises)
t The lotlowing b added to paragr*ph tfial ot Ex*luslen f" sl $ECTION ;' COYERAGE A -
Bodily lnSrry ard Fropariy Dsmage Liabifty:
Cvt 'Bod*ly iniury, of 'prsp61"1y damage' arising oul of ihe actr.ral disct16lgs, disp*rsal, $e€Fags,
migrati*n, relaase or esoapa ct 'pQllutants.o
Ae ueed in this Endorsannent, tle aetual discharge, dispersal, Eaepagq migralion, rehase sr
essape *l Follutants rnusl;
@ cornmence on a clearly idenlifiabla day during the p*l**y period; ard
SFI end, ln its entiretyr wilhin seventy-two {72} hsr"rs of the corfirnencement of the
dissfiargg" dlspersal, sespage, r$igration, relnase cr ssf*ps ol 'pollutants*; and
{cr} be discovered and reportad to rs withln tlftsen {1S} days of the clearly identl{lab{e d*y
il1at lhe discharge, dispergcl, eeopage, migration, releaEe or escspn ol 'pdlutants'
commelrces; ard
tddl be neither expecied nor iniended frsm the standpoint nf any insured; and
tcs) be unrelaled to any prevaous discharge, dirpargal, seepage, mi$FEtion, lelease or
esc*pe; ard
(ffl nol originatB d or from a otorage tarrk or cther container, duct er piping whieh:
& h belcw th* surfacs Ef the graund or uater; or
h d any frr1e h&s basn buried ilnd€r ths surtace of the gr*und or r,lrater and then is
sub**quantly exposed.
2. For ths purFases of this coverage, the follo,rring i* added to lhe definition rf "praperty
danagre' of SESTlOf'l V - FEFINITION$ and applies ordy as rsspect€ this eaveragei
Lard cr water, whether below ground level or nbt, b not tangible Frnperty"
g. $over*ge provided hereunder daes not apply to any discharge, dlspereal, seepage. migratbn-
falsass or *s6epe that is merely threalened or atrfegsd rather than shown to lsve actualty
OCCurred-
t* Lirnited Property llan'ege b Frryerry of Oftars
The follnwing ie added undar SEGTIO!{ I - ST FFLEMENTAEY PAYII{EHT$ * COVEHACFS * qrd E
A, We rrvill pey up ts$ 5.0t)0 f*r loss ts pEr$onel property ol otlers while in the ternporaly carer
su$tsdy or conttol sf an insured caused by any perscn particlpating in yaur organized activities.
For the purpose of thiE supplementary payment, lcss sllall mean damage or destructisn bltt
doea nol inch-rde rnysterious disappearaace sr loss of use. h the event ol a thelt, a police
reForl must be fllad. This supplemantary payment does nst apply if:
a. covarage is othenr*ise provided by the Prop*rty Coverage part (if ary) +l this Polisy; or
m 89 70 (Ed 11/14){PaUa 6 of 12}
c' st" 05/1'v8020'PAc 4103884 ffi C'REAT AI,{ERICAN ASSL S{ANCE COMPANY
"DlB' 2m432738 253mS
ORIGINAL gOPY
b. the loss is covered blr any cther iasuransc you have gr by €ny insuranEe o{ such perssn
who causes such loss.
These Faymgnts rryilt nsl r*d*cs the l*tmits cl lnsurance.
O, Additl6nsl lnsrsEd - Mrnager or L*scor of Premige*
t SECTION ll- Wt{O lg Al-l IN$UREB is amended to includs ss €n additiorxl insured any par$on
or organizatio* frorn ryhorn you lea*e ff rent propsrty and which requirea you to add eudr
person or organizalion as an additianal lnsured on this Folicy under:
tal a nrritten coniract; or
{b} an oral agrtsernent cr csntract whers a Certificate ol lnsurance shcwing that person or
crganization *s an ad*lional insured has baen issued;
but the writl*n or oral csclract or agrsgmgnt must be fft 'insured ccnlract,' and,
{0 furrently hi el{eet &r bacolne ef{ective during the terin ol thle Pclicy; and
{ii} execuled prior to the "bodlly injuryr' 'propsrty darn€96," 'pe.sonal sr* advsrtislng iniury-"
2. Wlth respeet F the insurancs affcrded to lhe Additioeal lns,ured id*ntified in paragraph 1.
abovq tfre fo**ruing addiUonal provisions apply:
{*} Tfis insurance applies or*y with respoet to thc liabilily arlslng out of the cwnership,
rnaintenancs or use of that part o{ lhe pramises hased tCI you.
{e} The Limits sf Insuraflce applisable to the Additienal lnsured are th$ leeeEr nl lhase
apeeified in the writien ccntra$l sr agreemenl or in ths Daclarations {or this Polby ard
tubiect to sll the terfis. conditions ard exclusio*a lsr thi* Pc*cy. Tl'rs Limits cl lnsurancp
apFticable to ths Additional lnoured ana incLesive of afld nol in addEicn tc the Limits of
lnsurance ghown h the Dedaratbts,
{cl h no eveni Ehall the eovsages or Llmits st lneurance rn this Ccvarage Form b* increasad
hy such eontract,
tdl Goverage providad herein is exsess ov6r any oth*r vaEd ard callectible insurance evailable
tc the Additional lnsursd vrrh€iher the othar insuranc€ is primgry" excess, eontingent or an
any sther bagig unles$ a written contractuat arrangernsrlt specitically reqilire$ thls lnsuranc*
ts be prirnary"
{E} ThiS Insufance *pplie* only to tha exlenl psrrnittod by law.
3. This insuranee dges not apply t6:
{a} Ar*y 'oscurrence' or offenss which takes placa aft*r you *€as€ lo be a tenant in thet
premises"
tb) $tructursl aheralions, ne$/ con$truction or demolition operstions p*rfarmed by or on bshall
ol the Additlanal lnsurad.
p, Additional lnssred - Furding SsLncoB
t, SECTION I I - WllO lS AN INSURED is arnended to inolude as ar additbnal insured any Fmding
Sourca which req*ires you h a writien contrast to natlx the Funding Source as ff additional
insured but only \trith lssO*"t tc liability arising out of:
cG Be 70 {Ed 11114}{Page 7 of 1?}
c* s1 *05/11/2020* PAC 4103884 S5 C*EAT AMERICAN A$SURANCE SOIvIPANY
EJE* !60422739 !53306
ORIGINAL COPY
a. your premises: or
b. 'your work' {or such additional insured; or
e. acls or omissiorls ef such additlsnal insured in c*nnestion with the general elpervi$isn of
'ysur wQrk-
arrd only to the extent sel forth as {ollows:
t The Limits nf lnsurance applicable tc the Addilional tnsured ard the leseer ol those
specifled in the written contracl or agreement ot h the Dechralione lor thia Polity ard
sr.lUlect to dl the terrns, ccndtionr ard exclusions lor this Policy. The Limits of lnsurancg
appiisable ts the Additional lrwured are inclusive of ard nst in addition lo ihe Lirnits ol
lneurance ehown in the Seclaratriong.
tr The inEurapce allorded to tlre Add*ionat lnsured only applies te the sxteil! permitted $y law
a ll covarage provided to the Addilional lnssrod is required by a contrast cr agrssmanl. llte
iftsuranre al{orded lo $Jch additianal irnured ulll not be broeder than lhet which you ars
required ry fbe contr*ct rr agreeruent to provide lor such addit&,xel ineured,
* ln no evefit ehall the ccveragea or Limits of lnzurance 'rn this Goverage Form be increased
4 such ccxtkact.
Q" Additionsl lneured* * Ey Cqntract
i. sgc?loH u - llvHo ls Ar.l NSURED ie arnended to includp * an insured any per$oG or
org*ngetion whom you have agreed to add aB *r additicnsl ineured fr a writte* contfaet, wrjtten
agreeffient or perrnit. Such peraon or *rgaaizatlon is an additional insurad but only with respsct
ta tiaUltity tor 'badily i*jury,' "property damag** or npersonal and advertisiHs iniury' arising oui
ei:
a your scls gr omiseions. or the acts er omissione Ol thoss acling on yo$r behalf, h the
perlarmance ol your angoing *perati*rns lsr the Additional lncurEd that are subject f,{ the
wrliien *onlrac! or written agr*ernenl provided tlrat the "bodily injury* or tproperty darrage
s6firrg, or the 'parsonal *nd adver*ielng infr*ry' is committed, subsequent 10 ths sign{ng of
such writien ssfitract or written agre€ffier}t ol
6u lhe yrlaintenanse, operation or use hy you ol equipment renled or leassd ta ys-t by wtctl
persan or organieatipn; or
c. tho Additicfial lnsur€ds linancial cEntrsl ol ycu; or
{. cparali*ne performed hy ysrr or on your bch*lt fsr which lhe slate cr political subdivision
l"ras lesued a permii
1{owever;
1. the insurance elforded to such addtional insured anly applies 10 the exlent permitted by
law; and
Z if cov*rsge provided to the Additional lneured b required by contracl or agreement- the
inslrance afforded la auch addtional insured will not be brsader &an thal rrhich you are
required by tlN6 contrect sr agreement ?o provide srrh additional insured.
With respBct to paragraph La. abow, a person'$ or organizalion'g stafus as an addtional insured
under this €*dorsgRerrt ends whe*:
QG 8s, 70 {#. 11t14J (Page I of 12)
c " s1 '05/1112828 * pAg 4103884 05 GRSAT AMER|CA}{ A$$r',RANCE COMPAN\r OR|GhIAL COpy
"stsr 26s422rc8 253306
(1) dl wcrk, irreluding materials, parts or equipment furnished in collnectian with such work, ffr
the projact (other than 3ervic€, maintenEnce or repairs) to be performed for or on behalf
af the Additionaf lrcwed(s) * ihe krcation ol the covered nparations llas been completed;
ol
{4 Sral Forticn cf "your yyork" orJt of which the injury cr danrage arig6g les be€n put to it$
htended uae by arry per$on or *rganFaation other than another co*traetor or subcontractcr
engaged h performlng cperations fcr a principal as a part sf the $ame prDject.
With respact to pfr.agraph 1.b. abave, thb insuranse dces nat epply tCI any "cccilrrence' which
takes place after the equlprnent r$tal or leaae agteement lss expired or you harr€ returned
such equipment ta tha lassor.
Tho in*rarce pravided by this Endorsemer* applie* only lf the writtsn contraci or writtan
sgreement b signed prior t* the "bodily i*Jury'' or "property damage."
Ws have rn duty tn def*rrd at &dditl$al heured undar this Endsr,serr*nt untll w* reeeiye
ilrrlttsn nntice of a uguitu by &a AddBional lnsursd re r*quired i'l paragraph b. sf *sndition *"
&.lticr h thc Evsrt cf Occlrrence, Offenae, Claim or $uil under SECTION lV
GOHMERCIAL GEHER&L LIABTUTY CONDITION"
e With rcsp*et to ths krsurancc prcvided by thie Fndsrssmenl. Fre iollowing ara added to
paragraph 3. Exalsaians undsr SECTIOH I - COVERAAE A - Bodily lnlury and Prop*ty
Danrage Lietiility:
This ln$urance does nal apply to:
s. 'Eodlly inllryl or *prcperty damage" tlet oc*ur,e prior ta y*ur *Gr$rnancing npsrslion$ Ht
thg location where euch "bodily injuryu or "prnperty damaga" oseuts.
b, "Bodily lniury,' *property damage" cr "psrssnal and advartising injury" arising out oi the
rendering nf, pr failure tc render, any professianal architectural engineering 6r survsying
servic€s, lnsludkrg:
(tl the preparingi apprsying, cr failing !o prepare ar appr$v6- rnapa, ahop drawingq
strinia*a, rspcrts, surveys, field erders, chsnge srders or dr€wings and *pecificaticns;
or
{2) supervisory, in*pectian, architectural or engineering acliuilise.
Thb exeh$ion applies even if the claims against gny insured *llege negtigence cr ather
wrangdcing h the suparvisicn" hiring, ernploymentr trelning or moniloring af others b'y tlet
ln$ur*d, if th6 uocsurtrenc€" whish ceusad th* nbedily injury" cr "preperty d*maga"" nr lhe
ol{*nse which causBd the "per$onal ard advartising injury,'' inyolved the rendering of, or failure
to render, any praleasigral architectural, engin+ering or surveying $ervices,
c, 'Bodily injuryu ar 'prop€rty d*nrags'occurring altsr:
{1 all wsrk, including materlalq parts or aquipn'lent furnished in canneetion with such
tivork, cn the project {other than saryice, rnalntsnan€ *r .epairs} tn bs psrformsd for
sr fi behalf *f tlre AdditioBal lnsurad(s1 at the location of the cover*d aperations lras
been cornpleted; $r
{q that pcrtion of nyour work" out ol whish the inpry or damage arisas t€s been put to its
intanded uge by any Bereoo or organization clhar than a*other ccntrsctor or
subcontraetcr engaged ir perlarrning aperations lcr a principal ss a part of th* same
prcjBct.
cG 89 70 Fd 11114){Fage I of 12}
c * sl '05/111:020' FAc 4103884 05 GREAT AMERICAN ASSURANCE COMPANY
"DlB. ?fs/.22'T3A 253306
ORIGINAL CSY
c[ Any parson or organization sFecifically desigralsd as rr additional insured fcr angoing
speratiofi$ h, a separatB additional insured endorsemant issuBd S ua and made part of thb
Po$cy-
3, With resp€+t to the hsurance al{crded tc thes€ Additional lnsursds, lhF following b added ro
$ECTION lll - LlfllTS OF IN$URANC€: I
lf caverage prcvided ta the Additicnal lnsured b required by a contraat or agreement, the rnoat
we rvill pay on hehalf ol gta Additional hsured b the amoilnt ol ins(ranss:
r required by the contrast or aEr€Bmenq ar
b. avalabl€ under tha applicable Limits of lnsuranqe shorryn in tlp Daclarativts;
whichavar b bss.
Thb Endars€ment shaB not increase fte ap@abla Limit* cl lnsuranc€ ahown ir tha Declaralierw.
R Primary snd I'lon-Cenlributory *dditional ln*uled Erttneipn
Thb provis'ion applies to any Fgrso* *r orgenizattrn whs qualifies m fl additional insured undar xry
torm sr endorsement under this Pdby.
Condtinn 4. Othar lnerranse ol SESTISI{ lll- COt*ltERClAL GEHERAL LlAglLlTY CONDITIONS
b smendad s follot'fe:
a The following h added to paragra$r a. Primery lnsurance:
Tlrh inerrance b prirnary lo ard wlll **t s*ak contribulion tr*m ar;y oth*r ineurenc€ availahh to
ar additisral insursd undar y*ur policy provided fiat:
ft' the Additienaf insured b a narrsd insured uader suefi cther inaursnee; ard
tA y{*, tHve agreed }n rdriting h a *ontract or asreement $at thi* in*ur*nes $/autd he prir*ary
sd r*ould not s€6k dcntrbution frnm any other inruranea gvadablo ts the Addifional
hsured.
b. The follo*ving b added to paragraptr b. Excee* tns*rance:
When a rarriltsn cantract cr writlpn agraxnant, other than a prernisee laass, fa*ilities rsntal
contract or agrneffent, at cquipra*nt r€r*al or ldaca e€ntract or agre€msnt or permil issued hy
a state or politica* aubdivision batwasn yor ard rr additiorpl insured daes not r*quire thi*
ireurance ttl k prirnaty ar prirnary erd non-contributaryi this insurancs b sxcess ov€r a!'ry
*lher ineurance f sr whlch the Additipnal lnsured is designated r a named itrsured
Ragardless of trr* writlen agr€Brnent bettareen yw ard rt addit*:nal insurs4 this insuranoa b
excess cver any other inslrance u{hether prinr*ary, excE$*, contingeflt or trr afiy other basis fsr
whi*h fle Addiiional lnexired les been added as m additianal hsilred trr oth6r pol*cies.
S. AdditiEnal lrsmeds - Protectisn *f Your Limltc
Th's provieion applies to any per$on cr organhatisn who qualilies as a additimal inaured under any
iorrn or endor*sment under this Falicy,
1 The toltowing b added to Condition 2- grltle8 in the Ever* of Ocs.rrenee, Offense, Claim s
$uft:
An addrtisnal insured unds lhis Endsrser*ent will as sosn as F{acticabl€:
sG 89 70 (E{ r1/r4}fage 10 of 13)
c. s1 'Q5111/2020 * pAC {103884 05 CfrEAT AMERICAI{ ASSIRANCE COMFANYD/B* 2&4*738 253806
CIRIGINAL trY
a. give writlen notice ef an "octrutrense" sr sr nffense &at mey result in a claim cr 'suitn
under this insurancg lo usi
b tender the defanse and indarnnlty r:f any claim or osuito to all lnsurers whom aho have
insuranse available to the Addirianal lnsured; and
c. agree lo make auababb any other insurance whieh the Additlonal lnsured tras lor a loss ws
eovgr ilnder thia Goverage Part
d. ws have no duly to defend or indemnify an additional insured under this Endorsement until
we refeiv* writtEn *otlce ol a "srlit'' by lhe Addilional lngursd.
Z Tha Llmits ol lnsuranco applicable tc the Additional lnssed are those specitied in a wrilten
contract cr wrlttsn agr€smenl or the Limits of Insurance stated h the BEclaration$ of lhis Folicy
ard defirrEd h SEgTlOlt lll- LlhdlTS OF II|SURANFE cf thie Fdicy, whlehever are less. These
llmits are inelusive ol and not irn additisn to the Limib ol lnsurance available undar this Fs$c!r.
T- Blpr&et ltYaiv*r ol Trmefrr ol Rights of Recovsy Againet Oth** td Lb {SrSrogaticn}
Under SECTIOff fV - COMILERCIAL GENEFAL LIABIUTY CONDITIOIIS, the fcllowing b aded to
Conditisn & Tranclar of *ightc cf Rxevery Againtt Otlnr* b U*:
lf required by a urrilt*n aonlrapt or $tritten agreement, ws watrve any right ol recovEry iryg rfiay
trave agahet a person or *rgani:ation because of palrnent ure rnak* lor injury or dafnagg arislng oul
ol your ongolng cperaticna or nyoutr r**rku dcne under a $onlract lor that lgrson or org*nie*tlon
ar$ included in the "praducts-complated operaticns hazard' prcv*ded thal the lnjury *r damage
ocgurs siJb*equent to the executisn of the written *trltraet or wrltt€n agreemsnl
tt Property Dsrnage Erlsnsisn rrlth Voluntary F6y66ll15
t The lcllowing ie added lo paragraph L lnsuring Agneement of $EGTlOlrI I - COVEBAGffi. A -
Sodily hriury and Fropxty Damagc Liability:
At your reguest we will Fay far "toss" to property of clhgrs caLtsed blr ysur buBiness
opsrataons for which this Policy provides liability insurance. Such payrnent will be nnadp withsst
regard to y*ur legal obligation la ds so. IIB "lo$s'r must occur during the policy p*ri*d ard
muct take dace h the 'rcovgrage tgrritcry."
2- with re*Fsct to the coverage atforded u6der paragraph 't. ahove, peragraph a ExcluEions sl
$ECTIOH l - COVERAGES A - Bodlly lniury amd Proparty Damagt Liebility is amended s
follcwsr
Exelusians i,tg), i{4} ids} atrd j{F} are delct€d.
3. As respects co\isfage a{forded by this soverage, SECTTOX lll - l-llllllT8 OF II.ISUHANCE is
replaced by ne faNlcwing:
Flegardlese o{ lh* number of lnsureds, claims rfiade or usuits'' broughl Br parsons or
orgaaizations maki*g claims or bring 'st*t$':
t, $ubject to ?. 8elow. lh€ most we tivilt pay lor one or more oloss' arising eut ol any sne
"fccurrence' is $ 1rS00,
t Ths aggregate amounl we will pay lor ihc cilft1 el aff "loss'' in st annual period ls $ 5,000,
This aggregate attount is part ol arrd not in additian lo the Genaral Aggregate Umit
described in paragraph ?- of S€CTION lll - LntlTS S IHSUFAHCE.
G S9 70 {Ed 11/14}(Pase 11 cl 12]r
c' sl '05111/2020 * PAC 4103884 S GREAT AI\ERICAN AS,SURANCE CGMPAHY
'D/S' 26S49738 253306
CIRXSINAL COPY
V- Illho le gr lnsrred - Felbs Employee Exten:ion * Han gelnenl Emplsyees
t. The lolrovring b added to paragraph ei{t of sEGTloN ll- wtto 13 AN INSURED;
Paregraph (4 erd p) abcve do nst apply to "bodily injury" ot 'persoaal md edvertising injury.
saus€d by sr "employee" who b actirg h a supervisory capacity for you Supervisory capacity
ag used herain means the 'employee's" iob reeponsibilitiee assigned by you, including tlle direct
supervieicn of othar *employea'' of yarrs, l'lowevar, none of these '?mpbyoes" arg Insureds
for "bodily injury'' ar 'personel ard advertising injury" arising out of their willful eonduct. which
h defingd e the purposeful or willful intent lo cat.se "bodily injury" cr "personal erd adverlising
iniury," cau$ed h whele cr in part by their intoxigatisn by liquor or controlled subsianpes,
Thb cavarage is exesas ovtr sny otner valid ard collectable irsursnce avaiablE to your
'anployen*'
W, Broadened Per*pnal and Advsrtieiag lniury
L Urdass "Ferson&l ard Advsrtising lnjwy" b exsruded fram this Foli*y, the fsllowing b added to
SECTIOf,{ V - nEFil{lTtQf'l$ ltenr 'l{.:
lr rnental inir.lry, rrentsl anguish, humillalipn, or $h$dt, il diractty resuKing from lleme l*,a.
through 14.e.
oG 8S 70 {Rr. 11/14}{Paqe r2 of 1?}