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HomeMy WebLinkAboutM_COI_20230126_v11/25/2023 Leavitt Group Northwest PO Box 833 Jason Grill Auburn WA 98071 Marianne Jackson (800)726-8771 (866)728-9168 marianne-jackson@leavitt.com PGH Excavating Inc PO Box 1151 Advantageous, LLC; PGH NW LLC Enumclaw WA 98022 Western National Mutual Insurance Company15377 Navigators Specialty Insurance Company 36056 22/23 Liability A X X X X CPP120942703 4/1/2022 4/1/2023 1,000,000 100,000 5,000 1,000,000 2,000,000 2,000,000 A X X X X CPP120751603 4/1/2022 4/1/2023 1,000,000 Medical payments 5,000 A X X X 10,000 X UMB104811600 4/1/2022 4/1/2023 1,000,000 1,000,000 A N WA Stop Gap CPP120942703 4/1/2022 4/1/2023 X 1,000,000 1,000,000 1,000,000 B Excess Liability SF22EXCZ04TP8IC 4/1/2022 4/1/2023 Exess of $1,000,000 underlying $1,000,000 City of Renton is named as additional insured per written contract and the terms & conditions of forms attached. City of Renton 1055 South Grady Way Renton, WA 98057 kternes@rentonwa.gov Jason Grill/MAJACK The ACORD name and logo are registered marks of ACORD CERTIFICATE HOLDER ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25 (2014/01) AUTHORIZED REPRESENTATIVE CANCELLATION DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE LOCJECTPRO-POLICY GEN'L AGGREGATE LIMIT APPLIES PER: OCCURCLAIMS-MADE COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence)$DAMAGE TO RENTED EACH OCCURRENCE $ MED EXP (Any one person)$ PERSONAL &ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $RETENTIONDED CLAIMS-MADE OCCUR $ AGGREGATE $ EACH OCCURRENCE $UMBRELLA LIAB EXCESS LIAB DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) INSRLTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)LIMITS PERSTATUTE OTH-ER E.L.EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ $ ANY PROPRIETOR/PARTNER/EXECUTIVE Ifyes,describe underDESCRIPTION OF OPERATIONS below (Mandatory in NH)OFFICER/MEMBER EXCLUDED? WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED HIRED AUTOS NON-OWNEDAUTOSAUTOS AUTOS COMBINED SINGLE LIMIT BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE $ $ $ $ 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. INSD ADDL WVD SUBR N / A $ $ (Ea accident) (Per accident) OTHER: 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 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). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: INSURED PHONE(A/C, No, Ext): PRODUCER ADDRESS:E-MAIL FAX(A/C, No): CONTACTNAME: NAIC # INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : INSURER(S)AFFORDING COVERAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INS025 (201401) COMMERCIAL GENERAL LIABILITY WN GL 139 06 18 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WN GL 139 06 18 Page 1 of 2 Includes copyrighted material of Insurance Services Office, Inc., with its permission. ADDITIONAL INSURED – CONTRACTORS – OPERATIONS AND COMPLETED OPERATIONS – WITH ADDITIONAL INSURED REQUIREMENT IN CONSTRUCTION CONTRACT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. Additional Insured – Operations A. Section II – Who Is An Insured is amended to include as an additional insured: (1) Any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy; and (2) Any other person or organization you are required to add as an additional insured under the contract or agreement de- scribed in Paragraph 1. above. Such person(s) or organization(s) is an add- tional insured only with respect to liability for "bodily injury", "property damage" or "per- sonal and advertising injury" caused, in whole or in part, by: a. Your acts or omissions; or b. The acts or omissions of those acting on your behalf; in the performance of your ongoing opera- tions for the additional insured. B. With respect to Additional Insured - Opera- tions, coverage is limited as follows: This insurance does not apply to “bodily in- jury” or “property damage” occurring after: (1) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than ser- vice, maintenance or repairs) to be per- formed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or (2) That portion of “your work” out of which the injury or damage arises has been put to its intended use by any person or or- ganization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. 2. Additional Insured – Completed Operations A. Section II – Who Is An Insured is amended to include as an additional insured: (1) Any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy; and (2) Any other person or organization you are required to add as an additional insured under the contract or agreement de- scribed in Paragraph 1. above. Such person(s) or organization(s) is an addi- tional insured only with respect to liability for "bodily injury", "property damage" or "per- sonal and advertising injury" caused, in whole or in part, by: a. Your acts or omissions; or b. The acts or omissions of those acting on your behalf; and included in the “products-completed op- erations hazard”. WN GL 139 06 18 Page 2 of 2 Includes copyrighted material of Insurance Services Office, Inc., with its permission. B. With respect to Additional Insured – Com- pleted Operations, coverage is limited as fol- lows: (1) A person or organization’s status as an in- sured under Additional Insured – Com- pleted Operations continues only for the period of time required by any written con- tract or agreement. (2) The insurance provided to the additional insured does not apply to “bodily injury”, “property damage” or “personal and ad- vertising injury” arising out of “your work” for which a consolidated (wrap-up) insur- ance program has been provided by the prime contractor-project manager or owner of the construction project in which you are involved. 3. Primary and Noncontributory The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek con- tribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured un- der such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be pri- mary and would not seek contribution from any other insurance available to the additional insured. 4. Other Provisions Applicable to Additional In- sured – Operations and Additional Insured – Completed Operations A. The Amendment of Insured Contract Defini- tion (Endorsement CG 24 26) does not apply to an additional insured. B. The coverage provided under Paragraph f. of the definition of “insured contract” under Sec- tion V – Definitions does not apply to an ad- ditional insured under this endorsement un- less required by a written contract or agreement. C. The insurance afforded to such additional in- sured only applies to the extent permitted by law; and If coverage provided to the additional insured is required by a contract or agreement, the in- surance afforded to such additional insured will not be broader than that which you are re- quired by the contract or agreement to provide for such additional insured. D. With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is: (1) The minimum amount required by the contract or agreement; or (2) The Limits of Insurance shown in the Dec- larations; whichever is less. This endorsement shall not increase the ap- plicable Limits of Insurance shown in the Dec- larations. E. With respect to the insurance afforded to these additional insureds, the following addi- tional exclusion applies: This insurance does not apply to: "Bodily injury", "property damage" or "per- sonal and advertising injury" arising out of the rendering of, or the failure to render, any pro- fessional architectural, engineering or survey- ing services, including: (1) The preparing, approving, or failing to prepare or approve, maps, shop draw- ings, opinions, reports, surveys, field or- ders, change orders or drawings and specifications; or (2) Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against an additional insured allege negli- gence or other wrongdoing in the supervision, 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 profes- sional services by you with respect to your providing engineering, architectural or survey- ing services in your capacity as an engineer, architect or surveyor. Policy #CPP120942703 Description CPP 1207516 03 PGH EXCAVATING INC QUOTE DECLARATION Commercial Auto IL0123 (11/13)WA Changes - Defense Costs Commercial Auto IL0146 (08/10)WA Common Policy Conditions Commercial Auto IL0198 (09/08)Nuclear Energy Liab Excl Endt Commercial Auto CA0001 (10/13)Business Auto Coverage Form Commercial Auto CA0135 (10/13) WA Changes Commercial Auto CA0302 (10/13)Deductible Liability Ins Commercial Auto CA2134 (10/13)Washington Underinsured Motor Commercial Auto CA2392 (10/13)WA-Exclusion of Terrorism Commercial Auto CA9903 (10/13)Auto Medical Payments Coverage Commercial Auto CA9989 (05/01)WA Loss Payable Form Commercial Auto MCS90 (04/00)Motor Carrier Filing Commercial Auto WNCA11 (07/10)Punitive Damage Exclusion Commercial Auto WNCA27 (06/16)Business Auto Enhancement Endt Commercial Auto WNCA43 (06/16)Abuse Or Molestation Exclusion Commercial Auto WNCA71 (06/16)Addl Insd-Designated Person/Or Commercial Auto WNCA72 (12/16)Exclusion - Asbestos Commercial Auto WNCA73 (03/20) Choice of Law Page03/22/2022 AGENT COPYWN IL 26 07 07 Description CPP 1209427 03 PGH EXCAVATING INC QUOTE DECLARATION Commercial Fire IL0123 (11/13)WA Changes - Defense Costs Commercial Fire IL0146 (08/10)WA Common Policy Conditions Commercial Fire IL0157 (07/02)WA Changes Actual Cash Value Commercial Fire IL0935 (07/02)Excl of Certain Computer Relat Commercial Fire IL0953 (01/15)Exclusion of Cert Acts Terror Commercial Fire IL0983 (01/08)WA Amendment of Terrorism Excl Commercial Fire IL0995 (01/07)Conditional Excl of Terrorism Commercial Fire CP0010 (10/12)Bldg and Pers Prop Cvg Form Commercial Fire CP0090 (07/88)Commercial Property Conditions Commercial Fire CP0126 (10/12) WA Changes Commercial Fire CP0140 (07/06)Excl Loss due to Virus or Bact Commercial Fire CP0160 (12/98)WA Chgs-Domestic Abuse Commercial Fire CP0179 (10/12)WA Changes-Excl Causes of Loss Commercial Fire CP1030 (10/12)Cause of Loss - Special Form Commercial Fire WNCP01 (08/19)Property Enhancement Endt Commercial Fire WNCP08 (10/16)Equipment Breakdown Coverage Commercial Fire WNCP10 (10/16)Equipment Breakdown Schedule Commercial Fire WNCP15 (10/16)WA Amendatory Endorsement General Liability IL0123 (11/13)WA Changes - Defense Costs General Liability IL0146 (08/10)WA Common Policy Conditions General Liability IL0198 (09/08)Nuclear Energy Liab Excl Endt General Liability CG0001 (04/13)Comml Gen Liab Coverage Form General Liability CG0197 (12/07)WA Chgs-Empl-Related Practices General Liability CG0435 (12/07)Employee Benefits Liab Co General Liability CG0437 (05/14)Electronic Data Liability General Liability CG0442 (11/03)Stop Gap-Employers Liab-WA General Liability CG0450 (05/08)WA Changes - Who Is An Insured General Liability CG2109 (06/15)Exclusion-Unmanned Aircraft General Liability CG2116 (04/13)Excl-Designated Prof Service General Liability CG2154 (01/96)Ex-Desig Op Covrd/Cons Ins Pro General Liability CG2160 (09/98)Excl-Yr 2000 Computer Rel & Ot General Liability CG2175 (01/15)Excl CAT and Other Outside US General Liability CG2186 (12/04)Excl-Exterior Insul & Fin Sys General Liability CG2426 (04/13)Amendment of Ins. Contract Def General Liability CG2503 (05/09)Designated Construction Proj General Liability CG2677 (12/04)WA-Fungi or Bacteria Exclusion General Liability CG3199 (12/04)Nuclear Energy Liab Excl Endt General Liability CG3220 (01/15)WA-Cond Excl of Terrorism General Liability WNGL02 (07/10)Punitive Damages Exclusion General Liability WNGL10 (01/04)Excl-Lead Liability Endt General Liability WNGL104 (03/16)Cyber Liability General Liability WNGL139 (06/18)Addl Insd-Contractors-Ops And General Liability WNGL145 (12/18)Cyber Crime Coverage Endt-WA General Liability WNGL15 (12/16)Exclusion-Asbestos General Liability WNGL21 (07/14)Abuse or Molestation Excl General Liability WNGL32 (01/04)Excl Mult Unit Resident Const General Liability WNGL39 (08/18)Comm Gen Liab Enhancement Endt Page03/22/2022 AGENT COPYWN IL 26 07 07 Description UMB 1048116 00 PGH EXCAVATING INC QUOTE DECLARATION Commercial Umbrella IL0123 (11/13)WA Changes - Defense Costs Commercial Umbrella IL0146 (08/10)WA Common Policy Conditions Commercial Umbrella IL0198 (09/08)Nuclear Energy Liab Excl Endt Commercial Umbrella CU0001 (04/13)Comm Liab Umbrella Cvg Form Commercial Umbrella CU0121 (09/00) WA Changes Commercial Umbrella CU0186 (01/15)WA Cond Excl of Terrorism Commercial Umbrella CU2117 (09/00)Excl-Designated Operations Commercial Umbrella CU2118 (09/00)Excl-Yr 2000 Computer Commercial Umbrella CU2124 (06/15)Excl-Non-Owned Aircraft Commercial Umbrella CU2135 (01/15)Excl of CAT and Oth Outside US Commercial Umbrella CU2142 (12/04)Excl-Exterior Insulation Commercial Umbrella CU2150 (03/05)Silica or Silica Related Dust Commercial Umbrella CU2155 (06/08)Amended Terrorism Coverage Commercial Umbrella CU2171 (06/15)Exclusion-Unmanned Aircraft Commercial Umbrella CU2186 (05/14)Excl-Acc. or Disc of Confident Commercial Umbrella CU2430 (04/13)Amendment of Insured Contract Commercial Umbrella CU2677 (12/04)WA-Fungi or Bacteria Excl Commercial Umbrella WNCU11 (07/14)Abuse or Molestation Excl Commercial Umbrella WNCU114 (07/15)Who is an Insured Amended Commercial Umbrella WNCU116 (04/18)Designated Project-Agg Limit Commercial Umbrella WNCU117 (04/18)Primary Noncontributory AI Commercial Umbrella WNCU47 (07/14)Occupational Disease Exclusion Commercial Umbrella WNCU79 (07/15)Total Liquor Liability Excl Commercial Umbrella WNCU91 (07/10)Excl-Punitive Damages Commercial Umbrella WNCU92 (01/04)Excl-Lead Liability Commercial Umbrella WNCU93 (12/16) Excl-Asbestos Commercial Umbrella WNCU99 (01/04)Excl-Multi-Unit Residential Page03/22/2022 AGENT COPYWN IL 26 07 07 POLICY NUMBER: COMMERCIAL AUTO WN CA 71 06 16 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED – DESIGNATED PERSON OR ORGANIZATION – PRIMARY AND NONCONTRIBUTORY 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. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: Endorsement Effective Date: SCHEDULE Name of Person(s) or Organization(s): CPP 1207516 03 PGH EXCAVATING INC 04/01/2022 AS REQUIRED BY WRITTEN CONTRACT Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A.Each person or organization shown in the Schedule is an “insured” for Liability Coverage, but only to the extent that person or organization qualified as an “insured” under the Who is An Insured provision contained in paragraph A.1. of SECTION II – COVERED AUTOS LIABILITY COVERAGE in the Business Auto and Motor Carrier Coverage Forms and paragraph D.2. of SECTION I – COVERED AUTOS COVERAGE of the Auto Dealers Coverage Form. B.The following is added to the Other Insurance Condition in the Business Auto Coverage Form and the Other Insurance – Primary And Excess Insurance Provisions in the Motor Carrier Coverage Form and supersedes any provision to the contrary: This Coverage Form’s Covered Autos Liability Coverage is primary and will not seek contribution from any other insurance available to an “insured” under your policy provided that: 1.Such “insured” is a Named Insured under such other insurance; and 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 such “insured”. C.The following is added to the Other Insurance Condition in the Auto Dealers Coverage Form and supersedes any provision to the contrary: This Coverage Form’s Covered Autos Liability Coverage and General Liability Coverages are primary and will not seek contribution from any other insurance available to an “insured” under your policy provided that: 1.Such “insured” is a Named Insured under such other insurance; and 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 such “insured”. WN CA 71 06 16 Includes copyrighted material of Insurance Services Office, Inc., with its permission.Page 1 of 1 WN CA 27 06 16 BUSINESS AUTO ENHANCEMENT ENDORSEMENT The Business Auto Enhancement Endorsement is an optional endorsement that provides coverage enhancements. The following is a summary of broadened coverages provided by this endorsement. No coverage is provided by this summary, refer to following endorsement for changes in your policy. SUMMARY OF COVERAGES PAGE Accidental Airbag Deployment Coverage 4 Auto Loan/Lease Gap Coverage 4 Blanket Additional Insured 2 Blanket Waiver of Subrogation 5 Broadened Definition of Insured includes: Newly Acquired Organizations for up to 180 Days 2 Employees as Insureds 2 Subsidiaries in Which You Own 50% or More 2 Deductible Waiver for Glass Repair 3 Employee Hired Auto 2, 5 Fellow Employee Coverage 3 Hired Auto Physical Damage Coverage 4 Knowledge of Accident, Claim, Suit or Loss 5 Loss Of Use Expenses - Amended 3 Personal Effects 3 Rental Reimbursement Coverage 4 Supplementary Payments - Amended: Bail Bonds up to $5,000 2 Loss of Earnings up to $500/Day 2 Transportation Expense Limits – Amended 3 Unintentional Failure to Disclose Hazards 5 WN CA 27 06 16 Includes copyrighted material of Insurance Services Office, Inc., with its permission.Page 1 of 5 SECTION II – COVERED AUTOS LIABILITY COVERAGE AMENDMENTS A.Who Is An Insured SECTION II – COVERED AUTOS LIABILITY COVERAGE, A. Coverage, 1. Who Is An Insured is amended to add: d.Any legally incorporated subsidiary of yours in which you own more than 50% of the voting stock on the effective date of this coverage form. However, “insured” does not include any subsidiary of yours that is an “insured” under any other automobile liability policy, or would be an “insured” under such policy but for termination of such policy or the exhaustion on such policy’s limits of insurance. e.Any organization which is newly acquired or formed by you and over which you maintain majority ownership. However, coverage under this provision: (1)is afforded only for the first 180 days after you acquire or form the organization or until the end of the policy period, whichever comes first; (2)does not apply to “bodily injury” or “property damage” that results from an “accident” that occurred before you formed or acquired the organization; (3)does not apply to any newly acquired or formed organization that is a joint venture or partnership; and (4)does not apply to an “insured” under any other automobile liability policy, or would be an “insured” under such a policy but for termination of such policy or the exhaustion of such policy’s limits of insurance. f.Any “employee” of yours is an “insured” while using a covered “auto” you don’t own, hire or borrow in your business or your personal affairs. g.Any “employee” of yours is an “insured” while operating a covered “auto” hired or rented under a contract or agreement in the “employee’s” name, with your permission, while performing duties related to the conduct of your business. B.Blanket Additional Insured SECTION ll – COVERED AUTOS LIABILITY COVERAGE, A. Coverage, 1. Who Is An Insured, paragraph c. is amended to add the following: Any person or organization who is required under a written contract or agreement between you and that person or organization, that is signed and executed by you before the “bodily injury” or “property damage” occurs and that is in effect during the policy period, to be named as an additional insured is an “insured” for Liability Coverage, but only for damages to which this insurance applies and only to the extent that persons or organization qualifies as an “insured” under the Who Is An Insured provision contained in Section ll. C.Liability Coverage Extensions – Supplementary Payments SECTION II – COVERED AUTOS LIABILITY COVERAGE, A. Coverage, 2. Coverage Extensions, a. Supplementary Payments is amended by replacing subparagraphs (2) and (4) with the following: (2)Up to $5,000 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. WN CA 27 06 16 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BUSINESS AUTO ENHANCEMENT ENDORSEMENT This endorsement modifies the insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to the coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. The SECTIONS of the Business Auto Coverage Form identified in this endorsement will be amended as shown below. WN CA 27 06 16 Includes copyrighted material of Insurance Services Office, Inc., with its permission.Page 2 of 5 D.Fellow Employee Coverage SECTION II – COVERED AUTOS LIABILITY COVERAGE, B. Exclusions, 5. Fellow Employee, the following is added: Co-Employee Lawsuit Defense Cost Reimbursement If a suit seeking damages for “bodily injury” to any fellow “employee” of the “insured” arising out of and in the course of the fellow “employee’s” employment or while performing duties related to the conduct of your business, or a suit seeking damages brought by the spouse, child, parent, brother or sister of that fellow “employee”, is brought against you, we will reimburse reasonable costs that you incur in the defense of such matters. Any reimbursement made pursuant to this sub-section will be in addition to the limits of liability set forth in the Declarations. SECTION III – PHYSICAL DAMAGE COVERAGE AMENDMENTS A.Transportation Expense – Limits Amended SECTION III – PHYSICAL DAMAGE COVERAGE, A. Coverage, 4. Coverage Extensions, a. Transportation Expenses is amended by replacing $20 per day/$600 maximum limit with $50 per day/$1000 maximum. B.Hired Auto Physical Damage – Loss Of Use Expenses – Limits Amended SECTION III – PHYSICAL DAMAGE COVERAGE, A. Coverage, 4. Coverage Extensions, b. Loss of Use Expenses is amended by replacing the $20 per day/$600 maximum limit with $50 per day/$750 maximum limit. C.Personal Effects Coverage SECTION lll – PHYSICAL DAMAGE COVERAGE, A. Coverage, 4. Coverage Extensions is amended by adding the following: c.Personal Effects We will pay up to $500 for “loss” to personal effects, which are: (1)Owned by an “insured”; and (2)In or on your covered “auto.” This coverage applies only in the event of the total theft of your covered “auto.” No deductible applies to this coverage D.Glass Repair – Deductible Waiver SECTION III – PHYSICAL DAMAGE COVERAGE, A. Coverage, 3. Glass Breakage – Hitting A Bird Or Animal – Falling Objects Or Missiles, is amended by adding the following: No deductible will apply to glass breakage if such glass is repaired, in a manner acceptable to us, rather than replaced. E.Hired Auto Physical Damage SECTION III – PHYSICAL DAMAGE COVERAGE, A. Coverage is amended by adding the following: 5.Hired Auto Physical Damage If hired “autos” are covered “autos” for Liability Coverage and if Comprehensive, Specified Causes of Loss, or Collision coverages are provided under this coverage form for any “auto” you own, then the Physical Damage Coverages provided are extended to “autos” you hire of like kind and use, subject to the following: a.The most we will pay for any one “loss” is $50,000 or the actual cash value or cost to repair or replace, whichever is less, minus a deductible; b.The deductible will be equal to the largest deductible applicable to any owned “auto” for that coverage. Any Comprehensive deductible does not apply to “loss” caused by fire or lightening; c.Hired Auto Physical Damage coverage is excess over any other collectible insurance; and d.Subject to the above limit, deductible and excess provisions we will provide coverage equal to the broadest coverage applicable to any covered “auto” you own. If a limit for Hired Auto Physical Damage is indicated in the Declarations, then that limit replaces, and is not added to, the $50,000 limit indicated above. WN CA 27 06 16 Includes copyrighted material of Insurance Services Office, Inc., with its permission.Page 3 of 5 F.Rental Reimbursement SECTION III – PHYSICAL DAMAGE COVERAGE A. Coverage, is amended by adding the following: 6.Rental Reimbursement This coverage applies only to a covered “auto” of the private passenger or light truck type as follows: a.We will pay for rental reimbursement expenses incurred by you for the rental of a private passenger or light truck type “auto” because of “loss” to a covered private passenger or light truck type “auto”. Payment applies in addition to the otherwise applicable amount of each coverage you have on a covered private passenger or light truck type “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, regardless of the policy’s expiration, with the lesser of the following number of days: (1)The number of days reasonably required to repair or replace the covered private passenger or light truck type “auto”. If “loss” is caused by theft, this number of days is added to the number of days it takes to locate the covered private passenger or light truck type “auto” and return it to you; or (2)30 days. c.Our payment is limited to the lesser of the following amounts: (1)Necessary and actual expenses incurred, or (2)$50 per day, up to a maximum of $1,000. d.This coverage does not apply while there are spare or reserve private passenger or light truck type “autos” available to you for your operations. e.If “loss” results from the total theft of a covered “auto” of the private passenger or light truck type, we will pay under this coverage only that amount of your rental reimbursement expenses which is not already provided for under SECTION III – PHYSICAL DAMAGE COVERAGE, A. Coverage, 4. Coverage Extensions. For the purposes of this Rental Reimbursement coverage, light truck is defined as a truck with a gross vehicle weight of 10,000 lbs. or less as defined by the manufacturer as the maximum loaded weight the auto is designed to carry. G.Accidental Airbag Deployment Coverage SECTION III – PHYSICAL DAMAGE COVERAGE, A. Coverage is amended by adding the following: 7.Accidental Airbag Deployment Coverage We will pay to reset or replace factory installed airbag(s) in any covered “auto” for accidental discharge, other than discharge due to a collision loss. This coverage is applicable only if comprehensive coverage applies to the covered “auto”. This coverage is excess over any other collectible insurance or reimbursement by manufacturer’s warranty. H.Auto Loan/Lease Gap Coverage SECTION III PHYSICAL DAMAGE COVERAGE, Item A., Coverage, is amended by adding the following: 8.Auto Loan/Lease Gap Coverage This coverage applies only to a covered “auto” described or designated in the Schedule or in the Declarations as including physical damage coverage. In the event of a covered total “loss” to a covered “auto” described or designated in the Schedule or in the Declarations, we will pay any unpaid amount due on the lease or loan for a covered “auto” less: a.The amount paid under the Physical Damage Coverage Section on the policy; and b.Any: (1)Overdue lease/loan payments at the time of the “loss”; (2)Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage; (3)Security deposits not returned by the lessor; (4)Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance purchased with the loan or lease; and (5)Carry-over balances from previous loans or leases. WN CA 27 06 16 Includes copyrighted material of Insurance Services Office, Inc., with its permission.Page 4 of 5 SECTION IV – BUSINESS AUTO CONDITIONS AMENDMENTS A.Duties In The Event Of Accident, Claim, Suit Or Loss Amended SECTION IV – BUSINESS AUTO CONDITIONS, A. Loss Conditions, 2. Duties In The Event Of Accident, Claim, Suit Or Loss, a. is amended by adding the following: This condition applies only when the “accident” or “loss” is known to: (1)You, if you are an individual; (2)A partner, if you are a partnership; (3)An executive officer or insurance manager, if you are a corporation; or (4)A member or manager, if you are a limited liability company. But, this section does not amend the provisions relating to notification of police, protection or examination of the property which was subject to the “loss”. B.Blanket Waiver of Subrogation Section IV – BUSINESS AUTO CONDITIONS, A. Loss Conditions, 5. Transfer of Rights of Recovery Against Others to Us, is amended by adding the following exception: However, we waive any right of recovery we may have against any person or organization to the extent required of you by a written contract signed and executed prior to any “accident” or “loss”, provided that the “accident” or “loss” arises out of operations contemplated by such contract. The waiver applies only to the person or organization designated in such contract. C.Unintentional Failure to Disclose Hazards SECTION IV – BUSINESS AUTO CONDITIONS, B. General Conditions, 2. Concealment, Misrepresentation Or Fraud, is amended by adding the following paragraph: If you unintentionally fail to disclose any hazards existing at the inception date of the policy, or during the policy period in connection with any additional hazards, we will not deny coverage under this Coverage Part because of such failure. D.Employee Hired Auto SECTION IV – BUSINESS AUTO CONDITIONS, B. General Conditions, 5. Other Insurance, paragraph b. is deleted and replace by the following: b.For Hired Auto Physical Damage Coverage, the following are deemed to be a covered “autos” you own: (1)Any covered “auto” you lease, hire, rent or borrow. (2)Any covered “auto” hired or rented by your “employee” under a contract in that individual “employee’s” name, with your permission, while performing duties related to the conduct of your business. However, any “auto” that is leased, hired, rented or borrowed with a driver is not a covered “auto”. WN CA 27 06 16 Includes copyrighted material of Insurance Services Office, Inc., with its permission.Page 5 of 5 IL 01 46 08 10 WASHINGTON COMMON POLICY CONDITIONS All Coverage Parts included in this policy are subject to the following conditions. The conditions in this endorsement replace any similar conditions in the policy that are less favorable to the insured. A.Cancellation 1.The first Named Insured shown in the Declarations may cancel this policy by notifying us or the insurance producer in one of the following ways: a.Written notice by mail, fax or e-mail; b.Surrender of the policy or binder; or c.Verbal notice. Upon receipt of such notice, we will cancel this policy or any binder issued as evidence of coverage, effective on the later of the following: a.The date on which notice is received or the policy or binder is surrendered; or b.The date of cancellation requested by the first Named Insured. 2.We may cancel this policy by mailing or delivering to the first Named Insured and the first Named Insured's agent or broker written notice of cancellation, including the actual reason for the cancellation, to the last mailing address known to us, at least: a.10 days before the effective date of cancellation if we cancel for non- payment of premium; or b.45 days before the effective date of cancellation if we cancel for any other reason; except as provided in Paragraphs 3. and 4. below. 3.We may cancel the Commercial Property Coverage Part and the Capital Assets Program (Output Policy) Coverage Part, if made a part of this policy, by mailing or delivering to the first Named Insured and the first Named Insured's agent or broker written notice of cancellation at least five days before the effective date of can- cellation for any structure where two or more of the following conditions exist: a.Without reasonable explanation, the structure is unoccupied for more than 60 consecutive days, or at least 65% of the rental units are unoccupied for more than 120 consecutive days, un- less the structure is maintained for sea- sonal occupancy or is under construc- tion or repair; b.Without reasonable explanation, prog- ress toward completion of permanent repairs to the structure has not occur- red within 60 days after receipt of funds following satisfactory adjustment or adjudication of loss resulting from a fire; c.Because of its physical condition, the structure is in danger of collapse; d.Because of its physical condition, a vacation or demolition order has been issued for the structure, or it has been declared unsafe in accordance with applicable law; e.Fixed and salvageable items have been removed from the structure, indicating an intent to vacate the structure; f.Without reasonable explanation, heat, water, sewer and electricity are not fur- nished for the structure for 60 con- secutive days; or g.The structure is not maintained in substantial compliance with fire, safety and building codes. IL 01 46 08 10 © Insurance Services Office, Inc., 2010 Page 1 of 4 4.If: a.You are an individual; b.A covered auto you own is of the "private passenger type"; and c.The policy does not cover garage, auto- mobile sales agency, repair shop, service station or public parking place operations hazards; we may cancel the Commercial Automobile Coverage Part by mailing or delivering to the first Named Insured and the first Named Insured's agent or broker written notice of cancellation, including the actual reason for cancellation, to the last mailing address known to us: a.At least 10 days before the effective date of cancellation if we cancel for nonpayment of premium; or b.At least 10 days before the effective date of cancellation for any other reason if the policy is in effect less than 30 days; or c.At least 20 days before the effective date of cancellation for other than non- payment if the policy is in effect 30 days or more; or d.At least 20 days before the effective date of cancellation if the policy is in effect for 60 days or more or is a renewal or continuation policy, and the reason for cancellation is that your driver's license or that of any driver who customarily uses a covered "auto" has been suspended or revoked during policy period. 5.We will also mail or deliver to any mortgage holder, pledgee or other person shown in this policy to have an interest in any loss which may occur under this policy, at their last mailing address known to us, written notice of cancellation, prior to the effective date of cancellation. If can- cellation is for reasons other than those contained in Paragraph A.3. above, this notice will be the same as that mailed or delivered to the first Named Insured. If cancellation is for a reason contained in Paragraph A.3. above, we will mail or deliver this notice at least 20 days prior to the effective date of cancellation. 6.Notice of cancellation will state the effec- tive date of cancellation. The policy period will end on that date. 7.If this policy is cancelled, we will send the first Named Insured any premium refund due. If we cancel, the refund will be pro rata. If the first Named Insured cancels, the refund will be at least 90% of the pro rata refund unless the following applies: a.For Division Two – Equipment Break- down, if the first Named Insured can- cels, the refund will be at least 75% of the pro rata refund. b.If: (1)You are an individual; (2)A covered auto you own is of the "private passenger type"; (3)The policy does not cover garage, automobile sales agency, repair shop, service station or public parking place operations hazards; and (4)The first Named Insured cancels; the refund will be not less than 90% of any unearned portion not exceeding $100, plus 95% of any unearned por- tion over $100 but not exceeding $500, and not less than 97% of any unearned portion in excess of $500. The cancellation will be effective even if we have not made or offered a refund. 8.If notice is mailed, proof of mailing will be sufficient proof of notice. B.Changes The policy contains all the agreements between you and us concerning the insurance afforded. The first Named Insured shown in the Declara-tions is authorized to make changes in the terms of this policy with our consent. This policy's terms can be amended or waived only by endorsement issued by us and made a part of this policy. C.Examination Of Your Books And Records We may examine and audit your books and records as they relate to this policy at any time during the policy period and up to three years a fterward. D.Inspection And Surveys 1.We have the right to: a.Make inspections and surveys at any time; b.Give you reports on the conditions we find; and c.Recommend changes. Page 2 of 4 © Insurance Services Office, Inc., 2010 IL 01 46 08 10 2.We are not obligated to make any inspec- tions, surveys, reports or recommen- dations, and any such actions we do undertake relate only to insurability and the premiums to be charged. We do not make safety inspections. We do not undertake to perform the duty of any person or organ- ization to provide for the health or safety of workers or the public. And we do not warrant that conditions: a.Are safe or healthful; or b.Comply with laws, regulations, codes or standards. 3.Paragraphs 1. and 2. of this condition apply not only to us, but also to any rating, advisory, rate service or similar organiza- tion which makes insurance inspections, surveys, reports or recommendations. 4.Paragraph 2. of this condition does not apply to any inspections, surveys, reports or recommendations we may make relative to certification, under state or municipal statutes, ordinances or regulations, of boilers, pressure vessels or elevators. E.Premiums The first Named Insured shown in the Declarations: 1.Is responsible for the payment of all pre- miums; and 2.Will be the payee for any return premiums we pay. F.Transfer Of Your Rights And Duties Under This Policy Your rights and duties under this policy may not be transferred without our written consent except in the case of death of an individual Named Insured. If you die, your rights and duties will be trans-ferred to your legal representative but only while acting within the scope of duties as your legal representative. Until your legal represen- tative is appointed, anyone having proper tem- porary custody of your property will have your rights and duties but only with respect to that property. G.Nonrenewal 1.We may elect not to renew this policy by mailing or delivering written notice of non- renewal, stating the reasons for non- renewal, to the first Named Insured and the first Named Insured's agent or broker, at their last mailing addresses known to us. We will also mail to any mortgage holder, pledgee or other person shown in this policy to have an interest in any loss which may occur under this policy, at their last mailing address known to us, written notice of nonrenewal. We will mail or deliver these notices at least 45 days before the: a.Expiration of the policy; or b.Anniversary date of this policy if this policy has been written for a term of more than one year. Otherwise, we will renew this policy un- less: a.The first Named Insured fails to pay the renewal premium after we have ex- pressed our willingness to renew, in- cluding a statement of the renewal premium, to the first Named Insured and the first Named Insured's insurance agent or broker, at least 20 days before the expiration date; b.Other coverage acceptable to the in- sured has been procured prior to the expiration date of the policy; or c. The policy clearly states that it is not renewable and is for a specific line, sub- classification, or type of coverage that is not offered on a renewable basis. 2.If: a.You are an individual; b.A covered auto you own is of the "private passenger type"; and c.The policy does not cover garage, auto- mobile sales agency, repair shop, serv- ice station or public parking place operations hazards; IL 01 46 08 10 © Insurance Services Office, Inc., 2010 Page 3 of 4 the following applies to nonrenewal of the Commercial Automobile Coverage Part in place of G.1.: a.We may elect not to renew or continue this policy by mailing or delivering to you and your agent or broker written notice at least 20 days before the end of the policy period, including the actual reason for nonrenewal. If the policy period is more than one year, we will have the right not to renew or con- tinue it only at an anniversary of its original effective date. If we offer to renew or continue and you do not accept, this policy will terminate at the end of the current policy period. Failure to pay the required renewal or continu- ation premium when due shall mean that you have not accepted our offer. b.We will not refuse to renew Liability Coverage or Collision Coverage solely because an "insured" has submitted claims under Comprehensive Coverage or Towing And Labor Coverage. c.If we fail to mail or deliver proper notice of nonrenewal and you obtain other insurance, this policy will end on the effective date of that insurance. Page 4 of 4 © Insurance Services Office, Inc., 2010 IL 01 46 08 10 COMMERCIAL LIABILITY UMBRELLA WN CU 117 04 18 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY – ADDITIONAL INSURED This endorsement modifies insurance provided under the following: COMMERCIAL LIABILITY UMBRELLA COVERAGE PART The following is added to Section IV – Conditions – 5. Other Insurance and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1)The additional insured is a Named Insured under such other insurance; and (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. (3)The order of payment specified by this endorsement only applies to the extent permitted by law. The following is added to: SECTION II – LIMITS OF INSURANCE For the purposes of this endorsement only, we will not pay more on behalf of the additional insured and the lesser of: 1.The minimum limits of insurance required in a written contract on a primary and non-contributory basis for such additional insured, but only to the extent the required Limits of Insurance are in excess of the “underlying insurance,” or 2.The Limits of Insurance available after the payment of “ultimate net loss” on any insured’s behalf from any claim or “suit”. This provision is included within and does not act to increase the limit of insurance stated in the Declarations. Coverage will not be broader than the coverage provided by the underlying insurance listed in the “Schedule of Underlying Coverages.” WN CU 117 04 18 Includes copyrighted material of Insurance Services Office, Inc., with its permission.Page 1 of 1 COMMERCIAL LIABILITY UMBRELLA WN CU 114 07 15 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WHO IS AN INSURED AMENDED This endorsement modifies insurance provided under the following: COMMERCIAL LIABILITY UMBRELLA COVERAGE PART With respect to SECTION II – WHO IS AN IN-SURED, Paragraph 3. is replaced by the follow- ing: 3.Any additional insured under any policy of “underlying insurance” will automati-cally be an insured under this insurance. Subject to Section III – Limits Of In-surance, if coverage provided to the ad- ditional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is: a.The minimum amount of insurance required by the contract or agree- ment, less any amounts payable by any “underlying insurance; or b.The amount of insurance available under the applicable Limits of Insur- ance shown in the Declarations; whichever is less. Additional insured coverage provided by this insurance will not be broader than coverage provided by the “underlying in- surance”. WN CU 114 07 15 Includes copyrighted material of Insurance Services Office, Inc., with its permission.Page 1 of 1