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HomeMy WebLinkAboutCAG2022-197 - Insurance Certificate - FieldTurf USA, Inc. - Liability Coverage - 05/01/2023 ^ Page 1 of 2 A�RDA DATE(MM/D2023 ) �J CERTIFICATE OF LIABILITY INSURANCE 11/09/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Willis Towers Watson Certificate Center NAME: Willis Towers Watson Northeast, Inc. c/o 26 Century Blvd PHONE 1-877-995-7378 FAX 1-888-467-2378 A/C No Ext: A X No P.O. Box 305191 ADDRESS: certificates@willis.com Nashville, TN 372305191 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: XL Insurance America Inc 24554 INSURED INSURERB: Travelers Property Casualty Company of Ame 25674 Fieldtur£ USA Inc c/o Sports Division INSURER C: Tarkett Inc. INSURER D: 7445 Cote-de-Liesse Road, Suite 200 Montreal, QC H4T 1G2 CAN INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:W31049970 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DDIYYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE � OCCUR PREM SES DAMAGE TOEa occur RENTED nte $ 500,000 A MED EXP(Any one person) $ 10,000 Y US00010327LI23A 05/01/2023 05/01/2024 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑ JECT PRO- ❑ LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 5,000,000 X ANY AUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED Y TC2JCAP-823K312A-TIL-23 05/01/2023 05/01/2024 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 11000,000 EXCESS LIAB CLAIMS-MADE US00010615LI23A 05/01/2023 05/01/2024 AGGREGATE $ 1,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER B ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? No N/A UB-BP793539-23-51-K OS/O1/2023 OS/O1/2024 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B Workers Compensation & UB-8P760619-23-51-R 05/01/2023 05/01/2024 E.L. Each Accident $1,000,000 Employer's Liability E.L. Disease-Pol Lint $1,000,000 Work Comp - Per Statute E.L. Disease-Each Em $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Project: Wilson Fields/Hogan Park AC Maintenance & GMAX WC Policies: Policy # UB-8P793534-23-51-K - covers all other states. Policy # UB-8P760619-23-51-R - covers AZ, MA, OR, WI only. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Kent AUTHORIZED REPRESENTATIVE 220 Fourth Avenue South Kent, WA 98032 ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD SR ID: 24946657 13ATCH: 3205211 AGENCY CUSTOMER ID: LOC#: ,a`oRo ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Willis Towers Watson Northeast, Inc. Fieldturf USA Inc c/o Sports Division POLICY NUMBER Tarkett Inc. See Page 1 7445 Cote-de-Liesse Road, Suite 200 Montreal, QC H4T 1G2 CAN CARRIER NAIC CODE See Page 1 See Page 1 EFFECTIVE DATE: See Page 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance The City of Kent is included as Additional Insured on the General Liability and Automobile Liability policy, as respects to the liability arising out of ongoing and completed operations performed on the project specified in the construction contract for the period of time required within the contract. It is further agreed that such insurance as is afforded shall be Primary and Non-contributory with any other insurance in force for or which may be purchased by the Additional Insured, where required by written contract executed prior to loss and permitted by law. ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 24946657 BATCH: 3205211 CERT: W31049970 Policy Number: TC2J-CAP-823K312A-TIL-23 : FDD<I : @C8LKF J>*I ; D: EHI ; C; DJ 9>7D= ; I J> ; FEB?90( 1`13; 71 ; H; 7 : ?J 971-1; <KBBO( 8B7DA; J7 : : 2) �ED7BDIKH; : nFH�C7HO7D: DED' 9EDJHTKJEHOM ?J > EJ > ; H DI KH7D9 ; K[\f XaVWbd X Xag` bWWO(f \af heTa\/X cdbi\VMMaVXe j X`t5 bj \aZ5 9LJ@<JJ 8LKF : FM<I 8>< =F1 D F H E L? TE D I ( K[X`r5 bj \aZ \f TVVWW J) GTeTZeTc[ 8(/(' E cKQb +( K[X 10 bj \aZ \f TVVXN I) GTeIZeTc[ 7(+(S(' M X "r c e bQ'SU by I ; 9 J�E D I n 8 K I V; I I 7 K J E 'b 7^ ?^cebUT' by I ; 9J .ED \\ n 9EL; H; 9ED: 21 D1 5 7 KJ E I B7 8 Z?J O 9EL; H7=; 5 1 XZTdW f bYd X cdbi\f\baf bYcTeTZeTc[ T) TaW K[\f \aVhV1y(f Tat cXd ba be ba7Ta\nT�ba j [b I bh cTeTZeTc[ T( bYj\f cTeg/( EcKQb?^cebQ`SU&d\f TeX Wdh\eXW haVXe T j dg)(a \/bag)TVg be \af heTa\X\f c6 Td cb TaWaba(Vba*Lhq)d j \1 TZeXX' Xag UXg XXa I bh TaW d Tg cXd ba be Tcc\VfUX bj Xe \af heTa\/X' haVXe j [A4 Ta ba7Ta\rnToba' j Tg \f f\ZaXW U I bh MEX I X TVW/WgbaT \af heXW cXd ba be ba7Ta\ff�ba \f d X LbVVI \a]hd be cdbcXej VT TZX b\/Vhd TaW Yd g aT XW\af hd Nj [Xa d X j dWKa \/bag:TVg be j Tg\f \a XMg WdaZ j X cb\M cXdbW 4) aT X TZ&W Xag LV4 XXa I bh TaW j Tg cXd ba be Tf Ta TVWbaT \af hdXW `t5e : bi X&M 8 h!j)f baETa\rrT4ba' d Tg \f f\ZaXW U I bh I.D\b X d X G1TLA_ : bi XeTZX L.hg ba I `rye VCf' TZX J)j [AV WNI \a]hd be cdbcXa,] VT TZX bVvhd TaW d\f \af heTa\/X Tcc W TaW ba I J) d X ANg by TO\f \a XV /g VWhdaZ X cb\\A cXdbW eKrJh\e\(f \t Tg cXd bTa X baf heMT�ba'f \TU,\Ad `rye d X d\f \af heTa\/X J) UX cd� Td TaWaba(\/bagALf4d ) VbaVWhVgbYTab�Xe \af heKW) 9 7 J. 1. *, +0 t -+ 1 K[X KeTi XXEf @NW aI4 : b' cTal )8_d\Z1 I e4 Xa X/V GTZX, bY, CaVb\:f \ibcI e\Z[gXM T&7 by f heTaVX J Xe\VXf F W& aM j \d \d cM \f f\ba) Policy Number: TC2J-CAP-823K312A-TIL-23 FDD<I @C8LKF J>? ; D: EHI ; C; DJ 9>7D= ; I J>; FEBTO( FB; 71 ; H; 7: T 971-1; <KBBO( 8B7DA; J7 : : OJ �ED7BUKH; : n FHA 7HO7D: DE D' 9 E DJ HT KJ E HO M ?J > EJ > ; H U KH7D9 ; K[\f XaVYbd X Xag' bVVW \af heTaVX cdbi\VMMaVXel X`r5 bj \aZ5 9LJ@<JJ 8LKF : FM<I 8>< =F1 D F H E L? TE D I ( K[X`t5 bj \aZ \f TVWKW J) GTeTZeTc[ 8(/(' E cKLb +( K[X 115 bj \aZ \f TVVWW q) GTeIZeTc[ 7(+(S(' M X ?°c e bQ`SU by I ; 9 J T D I n 8 K I D; I I 7 K J E 7^ ?^ceU3' by I ; 9JT-D 'An BT8T?J0 9ED: ?J EDI 5 9 E L; H7=; 5 1 XZTdW f bYd X cdbi \f\baf bYcTeTZeTc[ Q TaW K[\f \aV hVN Tat cXd ba be bEZ ra\ffT ba j [b I bh cTeTZeTc[ T( by j\f cTeg/( E cK b?^ce bC P SU&J\f TeX EMh\eKW haVlyCe T j dgKa Vbag)TVg be \af heTaVX \f cd` Td 4) TaWaba(Vba*Lhq)d j \1 TZOOC Xag UXg XXa I bh TaW j Tg cXd ba be Tcc\VTUX bd Xe \af heTaVX haVVCe j [A4 Ta ba7Ta\rrT(jba' j Tg \f f\ZaXW U I bh LKtdX d X TV baT_\af heXW cXd ba be be7Ta\rrT(jba \f d X LbVVI \a]hd be cdbcXej VW TZX bVVhd TaW Yd 9 aT XW\af heXWj [Xa d X j dW<a \/bag)TVg be Tg\f \a XY4�C\/g VYhdaZ X cb\VI cXdbVV aT X TZ60( Xag � XXa I bh TaW j Tg cXd ba be Tf Ta TV baT \af heKW`rye G1TU\Ad : bi MTZk ba7Ta\rrToba' Tg \f f\ZaXW U I bh UXllSeX X lhg ba I `rye VT TZXf J) j [A4 1\f \af heTaVX UbWI \a]hd be cdbcXej VT TZX Mfid TaW Tcc\Xf TaWba I J) j X ANg bYd Tg cXd ba'f be j Tg\f \a X\ff\Vg VIOdaZ j X cb\M cXdbVV dMhW ba7Ta\rrT(jba'f \TUA `bbe d X Vba\/bVg bYTabj Xe j V \af heTaVX 4) UX cd' Td TaWaba(\/ba*t-hq)d ) \af hEXW) 9 7 J. 1. *2 +1 t -+ 1 K[X KeTi XXd ate' aI4 : b' cTal )8_dZ1 I e4 Xa X/I GTZX, bY, @/bVN Mod dZ[JcW TNT_bY(g heTaVX J M\VXf F WVX CW j \d \1 cM \f f\ba) GFC@P ELD9<1 5TC2J-CAP-823K312A-TIL-23 @JL< ; 8K<505-09-23 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DEJT ; E < 97D9 ; BB7J �ED EH DEDH; D; M7B FHE L? ; : 8 O KI K[\f XaV9bEf X Xag' bVVW \af heTa\/X cEbi \VMMaMJ X'b bj \aZ5 8OC: F W 1 8>< G81 KJ @: CL; <; @ K?@GFC@P 1 9>; : KB; 9 7 D9; BB7 J T D4 De] RLb_V: Q c D_d&A 6 0 M>; D M; : E D E J H; D; M #D_^bU^Lk Q% De] RLb_V: Q c D_d&A 60 FHEL3 BDI 8( @j X Vt abg EVa)q d\f cb\M `tSe Tal _XZT 1 7( @j X VTaVX d\f cb\VI `t'ie Tat _XZT I cM \g�(W cXe \gg\W eKTf ba bd Xe d Ta abacTl ' Xag by &XTf ba bd Xe d Ta abacll ' Xag bYCEK \h' ' TaWT cPX \h' ' TaW T ah' IDCe by VAl f \f f[bj a `t'ie ah' LD(e bY\N l f \f f[ bj a to : TaVX Tuba \a d X N[Xa N X ; b E bg I Xa)q #E baeXa)q T$ \a d X J\4 XVVh X TLbi X j X j \ T\ ab4VX by J\4 XVVh X TLbi X j X j \ ' T\ ab4VX by VTaVX_T4ba Tg XTf g d X ah' LXe bYVT f f[ bj a abad a)q T_Tg XTf g�X ah' LD(e bYVCfI f f[ bj a `t5e \be : TaVX Tuba \a f h\[ J\i XVVb X LX16EX d X N[Xa N X ; b E bg I XaX� #;E bae�CaX� T$ \a f h\[ XYwoj X VCTj(bYVTa\X Tuba) J\[M X LD\b&X d X XW\Vci X VTcy bYabaaxa)q T_j B J- , * */ +3 t -+,4 K[X KeTi XXEF @�W a\4 : b' cTal)8_dZ[g W Xa X V GTZX, bY, POLICY NUMBER: US00010327LI23A COMMERCIAL GENERAL LIABILITY CG20100413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s)Of Covered Operations Any person or organization that you are required in As required per written contract a written contract or written agreement to include as an additional insured provided the "Bodily Injury" or "Property Damage" occurs subsequent to the execution of the written contract or written agreement. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for "bodily injury', "property This insurance does not apply to "bodilyinjury" or damage" or "personal and advertising injury" pp y "property damage,,occurring after: caused, in whole or in part, by: 1. Your acts or omissions;or 1. All work, including materials, parts or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the location(s) location of the covered operations has been designated above. completed; or However: 2. That portion of "your work" out of which the injury or damage arises has been put to its 1. The insurance afforded to such additional intended use by any person or organization insured only applies to the extent permitted by other than another contractor or subcontractor law; and engaged in performing operations for a 2. If coverage provided to the additional insured is principal as a part of the same project. required by a contract or agreement, the C. With respect to the insurance afforded to these insurance afforded to such additional insured additional insureds, the following is added to will not be broader than that which you are Section III—Limits Of Insurance: required by the contract or agreement to provide for such additional insured. CG 20 10 04 13 ©Insurance Services Office, Inc., 2012 Page 1 of 2 If coverage provided to the additional insured is 2. Available under the applicable Limits of required by a contract or agreement, the most we Insurance shown in the Declarations; will pay on behalf of the additional insured is the amount of insurance: whichever is less. 1. Required by the contractor agreement; or This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 ©Insurance Services Office, Inc., 2012 CG 20 10 04 13 ENDORSEMENT# This endorsement, effective 12:01 a.m., May 01, 2023 forms a part of Policy No. US00010327LI23A issued to Tarkett Finance Inc. by XL Insurance America, Inc. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY INSURANCE CLAUSE ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS COVERAGE PART It is agreed that to the extent that insurance is afforded to any Additional Insured under this policy, this insurance shall apply as primary and not contributing with any insurance carried by such Additional Insured, as required by written contract. All other terms and conditions of this policy remain unchanged. XI L 424 0605 ©, 2005, XL America, Inc. POLICY NUMBER: US00010327LI23A COMMERCIAL GENERAL LIABILITY Effective date: May 1, 2023 CG 20 37 04 13 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/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations Any person or organization that you are required in As required per written contract a written contract or written agreement to include as an additional insured provided the "Bodily Injury" or"Property Damage" occurs subsequent to the execution of the written contract or written agreement. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II—Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) additional insureds, the following is added to or organization(s) shown in the Schedule, but Section III— Limits Of Insurance: only with respect to liability for "bodily injury" or If coverage provided to the additional insured is "property damage" caused, in whole or in part, required by a contract or agreement,the most we will by "your work" at the location designated and pay on behalf of the additional insured is the amount described in the Schedule of this endorsement of insurance: performed for that additional insured and included in the "products-completed operations 1. Required by the contract or agreement; or hazard". 2. Available under the applicable Limits of However: Insurance shown in the Declarations; 1. The insurance afforded to such additional whichever is less. insured only applies to the extent permitted This endorsement shall not increase the applicable by law; and Limits of Insurance shown in the Declarations. 2. If 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. CG 20 37 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 ENDORSEMENT This endorsement, effective 12:01 a.m., May 01, 2023 forms a part of Policy No. US00010327LI23A issued to Tarkett Finance Inc. by XL Insurance America, Inc. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CANCELLATION NOTIFICATION TO OTHERS ENDORSEMENT In the event coverage is cancelled for any statutorily permitted reason, other than nonpayment of premium, advanced written notice will be mailed or delivered to person(s)or entity(ies)according to the notification schedule shown below: Number of Days Name of Person(s)or Entity(ies) Mailing Address: Advanced Notice of Cancellation: As required by a written contract or 30 written agreement. All certificate All other 10 for holders on file with the Insured. nonpayment All other terms and conditions of the Policy remain unchanged. IXI 405 0910 08/01/18 sg ©2010 X.L. America, Inc. All Rights Reserved. May not be copied without permission. TRAVELERS J� E >A: 5AB 3>< ?5=B1 Cam= 1 =4 CB9 HCK9 F GE 1 5 F 9 5< ?; >G5 A B ; 9129 9CG?>; MG <5FH: CF8 7H *0+2- 5=4>AB5< 5=CE3 // &, A) !&&' $**+ EDMMCI B7: F41 6' 2D10*0+3' , -' / +' F NOTICE OF CANCELLATION TO DESIGNATED PERSONS OR ORGANIZATIONS HURSWdTTV NQMQA E6FHGt j 8DC9*I�:DCG4 =V[W>N31 LIMS[(WU CV 4 WC{DUI [M- ?K/hZVUZ>Y>\01 U®1 [(WUZ �:Sd R Fig[ PRY�tJV ]\\0 S_N[f RN\ [ \A-R A-I\[ [\['] Nf Z R[a\S] RZ VbZ C f f\ b&d Rd Vfl \ OCR[\4R\S' bRJ Fig{ PRM[ A F\PU] R_\[ \_\ TN[\4 NW[ CR V[ N RQ T RJR GPIJRCb`R CRY d( K R d\WZ W_C R b PU [\5R A WU] R \[ \_\ TN[\ANW[ Nab ` eRQ NM R ' NbM adJ CR[ bZ R \SC U U d[ S_dJNb] R_\[ \_\ TN[\�N eV[ CRS R A.1R PIS[ PRIM[ V A "R RMF-4 U b N R R] \ ['VIR S_] \00[T b' d\AJ dJR T S Z NAY[ [ RFR' N f A NPFb NF'f R Z] Y?z2 dJR GRYU R CRY d �:6dRPN[ [\aZN\K1_CAR N[\APR\SPIN[ R:;M[[ A NMV[ NRQ] R'\[ \_\ TNT[\ NW[ Cam' REtJR[ NZR\ NQQR - \S-bRJ CR\T[ NERQ] R:\[ \_\ TN[\�NW[ ] \c\EMA b' V [\aNPPb W _R Z] rJR&dR UNcR [\ R] \ [ 'DU A Z N%C R \_\A-JR d V R[\M ' b PU CR V[ N RQ] R'\ [ \_\ TN[Y NW[ \SA-R PN[ PR1nw[ B3854D; 5 =I T MI UL 1 LLVXZ VN4 NVP(MA [M- ?MTZVUZ VY>10I UQI [(VUZO =\T J MYVN4 I ' Z=V[(KM ANY PERSON OR ORGANIZATION WITH WHOM YOU HAVE AGREED IN A WRITTEN CONTRACT THAT NOTICE OF CANCELLATION OF THIS POLICY WILL BE - * GIVEN, BUT ONLY IF: 1. YOU SEE TO IT THAT WE RECEIVE A WRITTEN REQUEST TO PROVIDE SUCH NOTICE, INCLUDING THE NAME AND ADDRESS OF SUCH PERSON OR ORGANIZATION, AFTER THE FIRST NAMED INSURED RECEIVES NOTICE FROM US OF THE CANCELLATION OF THIS POLICY, AND 2. WE RECEIVE SUCH WRITTEN REQUEST AT LEAST 14 DAYS BEFORE THE BEGINNING OF THE APPLICABLE NUMBER OF DAYS SHOWN IN THIS ENDORSEMENT 6YAeLJR eRZ' N[QR [ CMY[ \&LV ]\1`Pf RZNf b[ R-N(TRC( HUV Fq Q_ RZ K aPUNS[TR A] \`Ff A d UWU\0V NaWLMN[QV RSPMR\ [ RJR MR V' bRQb[W \A-JR d VR !CPMW/Yf I [(WU J MB/^ (Z11VK QM- VUS ^ PMJ[PCZ MJLVYZMF MJ[ (7 9Z\ M- Z\ J ZN/K MJ[ [V V%NW Y [(WU VN [PMVW, % : [Q_ RZR[a: S1%PWR E\1`Pf C\( [Q= RZFgaC\( J ' b_RQ E_RZ VbZ J ' bN[ PR8\Z] N(f 8\ b[d:;_V[ RQClf 9 6 H: D; -GGI : 4 */ ' *3' , - GH 6 GGX C4 ENTR + \S+ ©2013 The Travelers Indemnity Company.All rights reserved. TRAVELERS J� L DG@ GH 8 DBE: CH6 I �C 6 C9 DC: I DL: G HFJ 6G: B EADN: GH A�6 7*1 N EDA*N =60 ; DG9 81 *0+2- : C9 DGH: B: CI L 8 44 +1 G. $++O/d **+ EDMMCI B7: F4J7' 2E13-/ - . ' , -' / +' @ NOTICE OF CANCELLATION TO DESIGNATED PERSONS OR ORGANIZATIONS HVSif 7TeWJ\&/CRRSRQ E6FHGt 18DC9*iceCG4 C"ORT DU8P] RT[[PcX`] I A 9TbM PcTS ETab"] b DaDaVP] XPO)(`] b >Te S(D CSZfJVW"] Mtj T' O g 'SC a]\ ] WS' kiJO \] \'"Ck[ S\ b] T"'S[ \64 Pg g] c&e S e\E"'] d\AS\] bffi] TacQ/ (D CBMW q SCOJ A&a] \ ] ' ] 'UO VvCW RSa\U\ CtSR VV b,/S GOJSF k Z PS4 e( K S e\N-[ QPq ' R� ac Q/\] bffi q SCQ/A 9 a] \ ] ' ] 'UO VvCW CUM ZA SR CRR Saa Cb Wab ft/S\c[ Pa ] TRQja aM e\ T' b,/Cb"9 a] \ ] ] 'UO,U10 W PST,SbjScDC6Mw VV q LCYS STF04 MJ c O S 'Sa"]\a\RB lT' '] dWW c a e\IY/ft/S Wq'[ OW \SC SaaO g q OCR,CkSzj q [ A L S IVS GQ/SF;b Z PS4 e >Te S QD\] b[ QEJ ' RSM' O\] bffi] TCD CBMW q O RSa\U CtSR A 9 a]\ ] ' ] 'UO ACW PSQD�aS b,/S\q S ] CRF2 Saa ] T ac Q/ RSaW C1SR "S a] \ ] ' ] 'UO MW "] d\NSR q ca VV\] b CJI'M ] q [ "Bf3&e S VOdS \] 'Sal]\aVMN Q [ OILFE ' ] ' ] b S'e\\] fM ac Q/RSa\M MR"S'a]\ ] ] 'UCU AM ] Tfj,/S(D c BMW H8=: 9J A: CR T P] S 6 SSaTbb A U9 Tb)q PcTS ETab"] b A a DaVP] X PcXl b5 Cd\ QTa"U9 Phb CA 0RT THE CITY AND COUNTY OF SAN FRANCISCO, DEPT. OF PUBLIC WORK - * 1155 MARKET STREET, 4TH FLOOR SAN FRANCISCO CA 94103 621 ft/9 [3'[ a O RCS\ R W a] Tb/W A] ZG j 'S[ OA/c\Q/O, USR( HVW S\ Fj 'aS[ S\bQ/O USa tVS"] Mg q e VG/\NW CJfWSR O R\A/STMAS]\ WS ROS mac SR c\Baa] 1A/9 e\bS af1DSR $ \&T)I Ueh PDX`] OT["f Xb aT- 05TS"] [h f Wr] cr/Vb T] S"abll T] c)b )bbdTS bdCbT dT] cc" _aT_PapOxl] "U d/W_"[>[;f1)% : \ Fj 'aS[ S\b: TG06A6 E] Mg C] ( : \ Fj 'aS[ S\bC] A ac'SR E'S[ \4 A ac'O C 6 8] [ "O g 8] c\t&a\U SR Pg 9 6 H: D; -GGI : 4 */ ' *3' , - GH 6 GGx C4 ECUS + ] T+ ©2013 The Travelers Indemnity Company.All rights reserved. TRAVELERS J� L DG@ GH 8 DBE: CH6 I �C 6 C9 DC: I DL: G HFJ 6G: B EADN: GH A�6 7*1 N EDA*N =60 ; DC9 81 *0+2- : C9 DGH: B: CI L 8 44 +1 G. $++°/d EDMMCI B7: F4J7' 2E13-/ - . ' , -' / +' @ NOTICE OF CANCELLATION TO DESIGNATED PERSONS OR ORGANIZATIONS HVSif 7TeWJ\&/CRRSRQ E6FHGt 18DC9*iceCG4 CAORT DU8P] RT[[PcX`] I A 9TbM PcTS ETebA] b DaDaVP] XPcX] b >Te S(D CS7IJVWA] Mtj T' O g 'SCa]\ ] WS' kiJO \] \'^CYj[ S\ b] T"'S[ \64 Pg g] c&e S e\RA ] d\AS\] bffi] TacQ/ (D CBMW q SOQ/A&a] \ ] ' ] 'UO VvCW RSa\U\ CtSR VV b,/S GOJSF;b',Z PS4 e( K S e\N-[ GPq ' R� ac Q/\] bffi q SOCV A 9 a] \ ] ' ] 'UU VvCW CUM ZA SR CRR Saa Cb Wab ft/S\c[ Pa ] TRQja aV] e\ T' b,/CbA 9 a] \ ] ] 10 Ul0 W PST'SbjScDC6Mw VV q LCYS STF04 MJ c O S 'SaA]\a\RB if' A'] dWW c a e\IY/ft/S Wq'[ OW \SC SaaO g q OCR,CkSzj q [ A L S fA/S GQ/SF;bZ PS4 e >Te S QD\] b[ GZj ' RSM' O\] bffi] TCD CBMW q O RSa\U CtSR A 9 a]\ ] ' ] 'UO ACW PSQD�aS b,/S\q S ] CRF2 Saa ] T ac Q/ RSaW CkSR A&a] \ ] ' ] 'UO TCW A'] d\NSR q ca VV\] b O I'M ] q [ A BLS&e S VO1S \] 'SaA]\aNN j Q [ OILFE ' ] ' ] fj S'e\\] fM ac Q/RSa\M MR A S'a]\ ] ] 10 AM ] Tfj,/S(D c BMW H8=: 9J A: CPS T P] S 6SSaTbb AU9TbM PcTS ET2bA] b AaDaVP] XPO)(`] b5 Cd\ QTaAU9 Phb C^ORT ANY PERSON OR ORGANIZATION WITH WHOM YOU HAVE AGREED IN A WRITTEN CONTRACT THAT NOTICE OF CANCELLATION OF THIS POLICY WILL BE - * GIVEN, BUT ONLY IF: 1. YOU SEE TO IT THAT WE RECEIVE A WRITTEN REQUEST TO PROVIDE SUCH NOTICE, INCLUDING THE NAME AND ADDRESS OF SUCH PERSON OR ORGANIZATION, AFTER THE FIRST NAMED INSURED RECEIVES NOTICE FROM US OF THE CANCELLATION OF THIS POLICY, AND 2. WE RECEIVE SUCH WRITTEN REQUEST AT LEAST 14 DAYS BEFORE THE BEGINNING OF THE APPLICABLE NUMBER OF DAYS SHOWN IN THIS ENDORSEMENT 621 ft/9 [S'[ a O R q\ R W a] Tom/A] ZG j 'S[ OA/c\Q/O, USR( HVW S\ Fj 'aS[ S\bQ/O USa tVS A] Mg q e VG/\NW C JfWSR O R\A/STMAS]\ WS FUS mac SR c\Baa] 1A/9 e\b5 af1DSR $ \&T)I Ueh PDX`] OT[^f Xb aT- 05TS^] [h f Wr] cr/Vb T] SAebll T] c)b )bbdTS bdCbT dT] cc" _aT_PapOxl] AU d/W_^[>[;f1)% : \ Fj 'aS[ S\b: TG06A6 E] Mg C] ( : \ Fj 'aS[ S\bC] A ac'SR E'S[ \4 A ac'O C 6 8] [ AG g 8] c\t&a\U SR Pg 9 6 H: D; -GGI : 4 */ ' *3' , - GH 6 GGx C4 ECUS + ] T+ ©2013 The Travelers Indemnity Company.All rights reserved. TRAVELERS J� L DG@ GH 8 DBE: CH6 I �C 6 C9 DC: I DL: G HFJ 6G: B EADN: GH A�6 7*1 N EDA*N =60 ; DC9 81 *0+2- : C9 DGH: B: CI L 8 44 +1 G. $++°/d EDMMCI B7: F4J7' 2E13-/ - . ' , -' / +' @ NOTICE OF CANCELLATION TO DESIGNATED PERSONS OR ORGANIZATIONS HVSif 2TeWJ\&/CRRSRQ E6FHGt 18DC9*iceCG4 CAORT DU8P] RT[[PcX`] I A 9TbM PcTS ETabA] b DaDaVP] XPcX] b >Te S(D CS7IJVWA] Mtj T' O g 'SCa]\ ] WS' kiJO \] \'^CYj[ S\ b] T"'S[ \64 Pg g] c&e S e\RA ] d\AS\] bffi] TacQ/ (D CBMW q SCOJ A&a] \ ] ' ] 'UO VvCW RSa\U\ CtSR VV b,/S GOJSRc Z PS4 e( K S e\N-[ GPq ' R� ac Q/\] bffi q SOCV A 9 a] \ ] ' ] 'UU VvCW CUM ZA SR CRR Saa Cb Wab ft/S\c[ Pa ] TROja aV] e\ T' b,/CbA 9 a] \ ] ] 10 Ul0 W PST'SbjScDC6Mw VV q LCYS STF04 MJ c O S 'SaA]\a\RB if' A'] dWW c a e\la(/ft/S Wq'[ OW \SC SaaO g q OCR,CkSzj q [ A L S fA/S GQ/SFbZ PS4 e >Te S QD\] b[ GZj ' RSM' O\] bffi] TCD CBMW q O RSa\U CtSR A 9 a]\ ] ' ] 'UO ACW PSQD�aS b,/S\q S ] CRR Saa ] T ac Q/ RSaW CkSR A&a] \ ] ' ] 'UO TCW A'] d\NSR q ca VV\] b O I'M ] q [ A Bf5&e S VO1S \] 'SaA]\aNN j Q [ OILFE ' ] ' ] b S'e\\] fM ac Q/RSa\M MR A S'a]\ ] ] 10 AM ] Tfj,/S M CBMW H8=: 9J A: CPS T P] S 6 SSaTbb A U9 TbM PcTS ETabA] b A a DaVP] X PO)(`] b5 Cd\ QTa A U9 Phb C^6RT NEW ORLEANS CITY PARK IMPROVEMENT ASSOCIATION INC; FRIENDS OF CITY PARK; STATE OF LOUISIANA, CITY OF NEW ORLEANS; - * PEPCO (THE OWNER, ITS OFFICERS, AGENTS, EMPLOYEES AND VOLUNTEERS) ADDRESS: 1 PALM DRIVE NEW ORLEANS, LA 70124 621 ft/9 [5'[ a O R q\ R\W a] Tom/A] ZG j 'S[ OA/c\Q/O, USR( HVW S\ R] 'aS[ S\bQ/O USa tVS A] Mg q e VG/\NW C JfWSR O R\A/STMAS]\ WS FUS mac SR c\Baa] 1A/9 e\b5 af1DSR $ \&T)I Ueh PDX`] OT[^f )b aT- 05TS^] [h f Wr] cr/Vb T] S^abll T] c)b )bbdTS bdCbT dT] cc" _aT_PapOxl] AU d/W_^[>[;f1)% : \ R] 'aS[ S\b: TG06A6 E] Mg C] ( : \ R] 'aS[ S\bC] A ac'SR E'S[ \4 A ac'O C 6 8] [ AG g 8] c\t&a\U SR Pg 9 6 H: D; -GGI : 4 */ ' *3' , - GH 6 GGx C4 ECUS + ] T+ ©2013 The Travelers Indemnity Company.All rights reserved. TRAVELERS J� L DG@ GH 8 DBE: CH6 I �C 6 C9 DC: I DL: G HFJ 6G: B EADN: GH A�6 7*1 N EDA*N =60 ; DC9 81 *0+2- : C9 DGH: B: CI L 8 44 +1 G. $++°/d EDMMCI B7: F4J7' 2E13-/ - . ' , -' / +' @ NOTICE OF CANCELLATION TO DESIGNATED PERSONS OR ORGANIZATIONS HVSif 2TeVW\&/CRRSRQ E6FHGt 18DC9*iceCG4 CAORT DU8P] RT[[PcX`] I A 9TbM PcTS ETebA] b DaDaVP] XPcX] b >Te S M CSZfJVWA] Mtj T' O g 'SCa]\ ] WS' kiJO \] \'^CYj[ S\ b] T"'S[ \64 Pg g] c&e S e WA] d\AS\] bffi] TacQ/ CD CBMW q SOQ/A&a] \ ] ' ] 'UO VvCW RSa\U\ CtSR VV WS GQJSRc L PS4 e( K S e\N-[ GPq ' R� ac Q/\] bffi q SOQJ A 9 a] \ ] ' ] 'UU MW CUM ZA SR CRR Saa CbMabft/S\c[ Pa ] TRQja aV] e\ T' b,/CbA 9 a] \ ] ] 10 Ul0 W PST'SbjScDC6Mw VV q LCYS STF04 MJ c O S 'SaA]\a\RB lT' A'] dW W c a e\IY/ft/S Wq'[ OW \SC SaaO g q OCR,CkSzj q [ A L S fA/S GQ/SF;bZ PS4 e >Te S QD\] b[ GZj ' RSM' O\] bffi] TCD CBMW q O RSa\U CtSR A 9 a]\ ] ' ] 'UO ACW PSCD�aS b,/S\q S ] CRF2 Saa ] T ac Q/ RSaW CkSR A&a] \ ] ' ] 'UO TCW A'] d\NSR q ca VV\] b O I'M ] q [ A BLS&e S VO1S \] 'SaA]\aMM j Q [ OILFE ' ] ' ] bj S'e\\] fM ac Q/RSa\M MR A S'a]\ ] ] 10 AM ] TjJS M CBMW H8=: 9J A: CPS T P] S 6 SSaTbb A U9 TbM PcTS ET2bA] b A a DaVP] X PcX1] b5 Cd\ OTa A U9 Phb C^6RT ARLINGTON COUNTY VIRGINIA OFFICE OF THE PURCHASING AGENT ADDRESS: 2100 CLARENDON BLVD, SUITE 500 ARLINGTON, VA 22201 - * 621 ft/9 [S'[ a O R q\ R W a] Tom/A] ZG j 'S[ OA/c\Q/O, USR( HVW S\ Fj 'aS[ S\bQ/O USa tVS A] Mg q e VG/\NW C JfWSR O R W STMAS]\ WS F S mac SR c\Baa] 1A/9 e\b5 af1DSR $ Wr)I Ueh P&] OT[^f )b aT- 05TS^] [h f Wr] cr/Vb T] SAebll T] c)b )IbbdTS bdCbT dT] cc" _aT_Papcxl] ^U d/W_^[>[;f1)% : \ Fj 'aS[ S\b: TG06A6 E] Mg C] ( : \ Fj 'aS[ S\bC] A ac'SR E'S[ \4 A ac'O C 6 8] [ AG g 8] c\t&a\U SR Pg 9 6 H: D; -GGI : 4 */ ' *3' , - GH 6 GGx C4 ECUS + ] T+ ©2013 The Travelers Indemnity Company.All rights reserved.