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HomeMy WebLinkAboutCertificate of Insurance_City of RentonINSR ADDLSUBRLTRINSRWVD DATE (MM/DD/YYYY) PRODUCER CONTACTNAME: FAXPHONE(A/C, No):(A/C, No, Ext): E-MAILADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY)(MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE INSURER(S) AFFORDING COVERAGE NAIC # Y / N N / A (Mandatory in NH) ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED? EACH OCCURRENCE $ DAMAGE TO RENTED $PREMISES (Ea occurrence)CLAIMS-MADE OCCUR MED EXP (Any one person)$ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ $ PRO- OTHER: LOCJECT COMBINED SINGLE LIMIT $(Ea accident) BODILY INJURY (Per person)$ANY AUTO OWNED SCHEDULED BODILY INJURY (Per accident)$AUTOS ONLY AUTOS AUTOS ONLYHIRED PROPERTY DAMAGE $AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE $ CLAIMS-MADE AGGREGATE $ DED RETENTION $$ PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMIT $DESCRIPTION OF OPERATIONS below POLICY NON-OWNED SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 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. 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 any rights to the certificate holder in lieu of such endorsement(s). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORDACORD 25 (2016/03) ACORDTM CERTIFICATE OF LIABILITY INSURANCE National Union Fire Ins Co of Pittsburg Navigators Insurance Company Continental Casualty Company Axis Surplus Insurance Company Homesite Insurance Company 6/07/2023 Propel Insurance 1201 Pacific Avenue; Suite 1000 COM Construction Tacoma, WA 98402-4321 Casondra Mossuto 800 499-0933 866 577-1326 casondra.mossuto@propelinsurance.com Northwest Cascade Inc. dba Honey Bucket; North Bay Portables; Liberty Site Service & Altitude Waste Solutions PO Box 73399, Puyallup, WA 98373 19445 42307 20443 26620 A X X X GL3296838 05/01/2023 05/01/2024 1,000,000 300,000 5,000 1,000,000 2,000,000 2,000,000 A X X X CA2507760 05/01/2023 05/01/2024 1,000,000 B E X X X 0 SE23EXCZ0346EIC CXP00023202 05/01/2023 05/01/2023 05/01/2024 05/01/2024 5,000,000 10,000,000 2nd Layer $5,000,000 A N WC48240166 - AOS WC48240167 - CA WC048241069 - OR Stop Gap Included 05/01/2023 05/01/2023 05/01/2023 05/01/2024 05/01/2024 05/01/2024 X 1,000,000 1,000,000 1,000,000 C D D Pollution Leased & Rented Inst. Floater CP002899062023 CP002899062023 7037189578 05/01/2023 05/01/2023 05/01/2023 05/01/2024 05/01/2024 05/01/2024 $1M Occ/Agg. $25k Ded. $600k / $5k Ded. $100k /$25K $5k Ded. RE: Satori Elementary School Underground Power and Park Ave N. The City of Renton is Primary and Non-Contributory Additional Insured. City of Renton 1055 South Grady Way Renton, WA 98057 1 of 1 #S5961640/M5939714 NORTCASC1Client#: 12831 SMH01 1 of 1 #S5961640/M5939714 This page has been left blank intentionally. POLICY NUMBER: COMMERCIAL GENERAL LIABILITYCG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CG 20 37 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 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 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 toinclude as an additional insured the person(s) ororganization(s) shown in the Schedule, but onlywith respect to liability for "bodily injury" or"property damage" caused, in whole or in part, by"your work" at the location designated anddescribed in the Schedule of this endorsementperformed for that additional insured andincluded in the "products-completed operationshazard". However: 1. The insurance afforded to such additionalinsured only applies to the extent permittedby law; and 2. If coverage provided to the additional insuredis required by a contract or agreement, theinsurance afforded to such additional insuredwill not be broader than that which you arerequired by the contract or agreement toprovide for such additional insured. B.With respect to the insurance afforded to theseadditional insureds, the following is added toSection III – Limits Of Insurance: If coverage provided to the additional insured isrequired by a contract or agreement, the most wewill pay on behalf of the additional insured is theamount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits ofInsurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. ANY PERSON OR ORGANIZATION WHO YOU BECOME OBLIGATED TO INCLUDE AS AN ADDITIONAL INSURED AS A RESULT OF ANY CONTRACT OR AGREEMENT YOU HAVE ENTERED INTO. PER THE CONTRACT OR AGREEMENT GL 329-68-38 POLICY NUMBER: COMMERCIAL GENERAL LIABILITYCG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 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 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 toinclude as an additional insured the person(s) ororganization(s) shown in the Schedule, but onlywith respect to liability for "bodily injury", "propertydamage" or "personal and advertising injury"caused, in whole or in part, by: 1. Your acts or omissions; or 2.The acts or omissions of those acting on yourbehalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additionalinsured only applies to the extent permitted bylaw; and 2. If coverage provided to the additional insured isrequired by a contract or agreement, theinsurance afforded to such additional insuredwill not be broader than that which you arerequired by the contract or agreement toprovide for such additional insured. B.With respect to the insurance afforded to theseadditional insureds, the following additionalexclusions apply: This insurance does not apply to "bodily injury" or"property damage" occurring after: 1. All work, including materials, parts orequipment furnished in connection with suchwork, on the project (other than service,maintenance or repairs) to be performed by oron behalf of the additional insured(s) at thelocation of the covered operations has beencompleted; or 2. That portion of "your work" out of which theinjury or damage arises has been put to itsintended use by any person or organizationother than another contractor or subcontractorengaged in performing operations for aprincipal as a part of the same project. GL 329-68-38 Any person or organization whom you become obligated to include as an additional insured as a result of any contract or agreement you have entered into. Per the written contract or agreement. Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 10 04 13 C.With respect to the insurance afforded to theseadditional insureds, the following is added toSection III – Limits Of Insurance: If coverage provided to the additional insured isrequired by a contract or agreement, the most wewill pay on behalf of the additional insured is theamount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits ofInsurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. POLICY NUMBER: GL 329-68-38 COMMERCIAL GENERAL LIABILITY CG 20 01 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART 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 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. CG 20 01 12 19 Insurance Services Office, Inc., 2018 Page 1 of 1 Name Of Person(s) Or Organization(s): Information required to complete this Schedule, if not shown above, will be shown in the Declarations. POLICY NUMBER: GL 329-68-38 COMMERCIAL GENERAL LIABILITY CG 24 04 12 19 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS SCHEDULE Pursuant to applicable written contract or agreement you enter into. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV – Conditions: We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above. CG 24 04 12 19 Insurance Services Office, Inc., 2018 Page 1 of 1 ENDORSEMENT This endorsement, effective 12:01 A.M. 05/01/2023 forms a part of Policy No. 250-77-60 issued to NORTHWEST CASCADE , I NC . by NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM Section IV -Business Auto Conditions, A. -Loss Conditions, 5. -Transfer of Rights of Recovery Against Others to Us, is amended to add: However, we will waive any right of recover we have against any person or organization with whom you have entered into a contract or agreement because of payments we make under this Coverage Form arising out of an "accident" or " loss" if: ( 1)The "accident" or "loss" is due to operations undertaken in accordance with the contract existing between you and such person or organization; and (2)The contract or agreement was entered into prior to any "accident" or "loss". No waiver of the right of recovery will directly or indirectly apply to your employees or employees of the person or organization, and we reserve our rights or lien to be reimbursed from any recovery funds obtained by any injured employee. AUTHORIZED REPRESENTATIVE 62897 (6/95) Includes copyrighted material of Insurance Services Office, Inc. with its permission. Page 1 of 1 ENDORSEMENT This endorsement, effective 12:01 A.M. 05/01/2023 forms a part of Policy No. 250-77-60 issued to NORTHWEST CASCADE , I NC . by NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA. INSURANCE PRIMARY AS TO CERTAIN ADDITIONAL INSUREDS This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM Section IV -Business Auto Conditions, B., General Conditions, 5., Other Insurance, c., is amended by the addition of the following sentence: The insurance afforded under this policy to an additional insured will apply as primary insurance for such additional insured where so required under an agreement executed prior to the date of accident. We will not ask any insurer that has issued other insurance to such additional insured to contribute to the settlement of loss arising out of such accident. All other terms and conditions remain unchanged. Authorized Representative or Countersignature (in States Where Applicable) 74445 (10/99) Includes copyrighted material of Insurance Services Office, Inc. with its permission. Page 1 of 1 ENDORSEMENT This endorsement, effective 12:01 A.M. 05/01/2023 forms a part of Policy No. 250-77-60 issued to NORTHWEST CASCADE , I NC . by NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA. ADDITIONAL INSURED - WHERE REQUIRED UNDER CONTRACT OR AGREEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM SCHEDULE ADDITIONAL INSURED: ANY PERSON OR ORGANIZATION FOR WHOM YOU ARE CONTRACTUALLY BOUND TO PROVIDE ADDITIONAL INSURED STATUS BUT ONLY TO THE EXTENT OF SUCH PERSON'S OR ORGANIZATION'S LIABILITY ARISING OUT OF THE USE OF A COVERED "AUTO". I.SECTION II -COVERED AUTOS LIABILITY COVERAGE, A. Coverage, 1 . -Who Is Insured, is amended to add: d.Any person or organization, shown in the schedule above, to whom you become obligated to include as an additional insured under this policy, as a result of any contract or agreement you enter into which requires you to furnish insurance to that person or organization of the type provided by this policy, but only with respect to liability arising out of use of a covered "auto". However, the insurance provided will not exceed the lesser of: ( 1)The coverage and/or limits of this policy, or (2)The coverage and/or limits required by said contract or agreement. AUTHORIZED REPRESENTATIVE 87950 (9/14) Includes copyrighted material of Insurance Services Office, Inc. with its permission. Page 1 of 1 ENDORSEMENT This endorsement, effective 12:01 A.M. 05/01/2023 forms a part of Policy No. 250-77-60 issued to NORTHWEST CASCADE , I NC . by NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA. LIMITED ADVICE OF CANCELLATION PROVIDED VIA E-MAIL TO ENTITIES OTHER THAN THE FIRST NAMED INSURED This policy is amended as follows: In the event that the Insurer cancels this policy for any reason other than non-payment of premium, and 1.the cancellation effective date is prior to this policy's expiration date; 2.the First Named Insured is under an existing contractual obligation to notify a certificate holder when this policy is canceled (hereinafter, the "Certificate Holder(s) ") and has provided to the Insurer, either directly or through its broker of record, the email address of a contact at each such entity; and 3.the Insurer received this information after the First Named Insured receives notice of cancellation of this policy and prior to this policy's cancellation effective date, via an electronic spreadsheet that is acceptable to the Insurer, the Insurer will provide advice of cancellation (the "Advice") via e-mail to each such Certificate Holders withi n 3Q days after the First Named Insured provides such information to the Insurer; provided, however, that if a specific number of days is not stated above, then the Advice will be provided to such Certificate Holder(s) as soon as reasonably practicable after the First Named Insured provides such information to the Insurer. Proof of the Insurer emailing the Advice, using the information provided by the First Named Insured, will serve as proof that the Insurer has fully satisfied its obligations under this endorsement. This endorsement does not affect, in any way, coverage provided under this policy or the cancellation of this policy or the effective date thereof, nor shall this endorsement invest any rights in any entity not insured under this policy. The following Definitions apply to this endorsement: 1 . First Named Insured means the Named Insured shown on the Declarations Page of this policy. 2.Insurer means the insurance company shown in the header on the Declarations page of this policy. All other terms, conditions and exclusions shall remain the same. Authorized Representative 107414 (3/11) Includes copyrighted material of Insurance Services Office, Inc. with its permission. Page 1 of 1 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement changes the policy to which it is attached effective on inception date of the policy unless a different date is indicated below. This endorsement, effective 12:01 AM 05/01 / 2023 Issued to NORTHWEST CASCADE , I NC . forms a part of Policy No. WC 048-24-0166 By NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA. We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us. This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. Schedule ANY PERSON OR ORGANIZATION TO WHOM YOU BECOME OBLIGATED TO WAIVE YOUR RIGHTS OF RECOVERY AGAINST, UNDER ANY WRITTEN CONTRACT OR AGREEMENT YOU ENTER INTO PRIOR TO THE OCCURRENCE OF LOSS. This form is not applicable in Kansas for private construction contracts as defined in K.S.A. 16-1801 through K.S.A 16-1807 or public construction contracts as defined in K.S.A. 16-1901 through 16-1908, except where permitted by statute or other applicable law, such as for use in wrap-up insurance programs. Any person or organization for which the employer has agreed by written contract, executed prior to loss, may execute a waiver of subrogation. However, for purposes of work performed by the employer in Missouri, this waiver of subrogation does not apply to any construction group of classifications as designated by the waiver of right to recover from others (subrogation) rule in our manual. This form is not applicable in California, Kentucky, New Hampshire, New Jersey, Texas, or Utah. WC 00 0313 (Ed. 04/84) Countersigned by ----------------------- Authorized Representative BLANKET WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy). This endorsement, effective 12:01 AM 05/01 / 2023 Issued to NORTHWEST CASCADE , I NC . forms a part of Policy No. WC 048-24-0167 By NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA. We have a right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against any person or organization with whom you have a written contract that requires you to obtain this agreement from us, as regards any work you perform for such person or organization. The additional premium for this endorsement shall be 2. 00 % of the total estimated workers compensation premium for this policy. WC 04 03 61 (Ed. 11/90) Countersigned by __________________ ��� � �� Authorized Representative TEXAS WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) This endorsement, effective 12:01 AM 05/01/2023 Issued to NORTHWEST CASCADE , I NC . forms a part of Policy No. WC 048-24-0166 By NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA. This endorsement applies only to the insurance provided by the policy because Texas is shown in Item 3.A. of the Information Page. We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule where you are required by a written contract to obtain this waiver from us. This endorsement shall not operate directly or indirectly to benefit anyone not named in the Schedule. The premium for this endorsement is shown in the Schedule. Schedule 1.( ) Specific Waiver Name of person or organization ( X)Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2.Operations: ALL TEXAS OPERATIONS 3.Premium: The premium charge for this endorsement shall be � percent of the premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described. 4.Advance Premium: WC 42 03 04 B (Ed. 6-14) $ 3 , 607 Countersigned by _________________ -������ Authorized Representative 4)Copyright 2014 National Council on Compensation Insurance, Inc. All Rights Reserved. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy). This endorsement, effective 12:01 AM 05/01/2023 Issued to NORTHWEST CASCADE , I NC . forms a part of Policy No. WC 048-24-0167 By NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA. LIMITED ADVICE OF CANCELLATION PROVIDED VIA E-MAIL TO ENTITIES OTHER THAN THE NAMED INSURED (WORKERS' COMPENSATION ONLY) This policy is amended as follows: In the event that the Insurer cancels this policy for any reason other than non-payment of premium, and 1.the cancellation effective date is prior to this policy's expiration date; 2.the Named Insured or, if applicable, any other employers named in Item 1 of the Information Page is under an existing contractual obligation to notify a certificate holder when this policy is canceled {hereinafter, the "Certificate Holder(s)") and the Named Insured has provided to the Insurer, either directly or through its broker of record, the email address of a contact at each such entity; and 3.the Insurer received this information after the Named Insured receives notice of cancellation of this policy and prior to this policy's cancellation effective date, via an electronic spreadsheet that is acceptable to the Insurer, the Insurer will provide advice of cancellation (the "Advice") via e-mail to each such Certificate Holders within 30 days after the Named Insured provides such information to the Insurer; provided, however, that if a specific number of days is not stated above, then the Advice will be provided to such Certificate Holder(s) as soon as reasonably practicable after the Named Insured provides such information to the Insurer. Proof of the Insurer emailing the Advice, using the information provided by the First Named Insured, will serve as proof that the Insurer has fully satisfied its obligations under this endorsement. This endorsement does not affect, in any way, coverage provided under this policy or the cancellation of this policy or the effective date thereof, nor shall this endorsement invest any rights in any entity not insured under this policy. The following definitions apply to this endorsement: 1.Named Insured means the insured first named employer in Item 1 of the Information Page of this policy. 2.Insurer means the insurance company shown in the header on the Information Page of this policy. All other terms, conditions and exclusions shall remain the same. WC 99 00 56 (Ed. 04/11) AUTHORIZED REPRESENTATIVE NAV-EXC-001 (04/10) Page 1 of 7 Navigators Specialty Insurance Company Contains copyrighted material of the Insurance Services Office, Inc. with its permission. Commercial Excess Liability Coverage Part Various provisions of this policy restrict coverage. Read the entire policy carefully to determine your rights, duties and what is and is not covered. Throughout the policy the words “you” and “your” refer to the Named Insured. The words “we,” “us” and “our” refer to the company providing this insurance. The word “insured” means any other person or organization qualifying as such under SECTION II – WHO IS AN INSURED. Other words and phrases that appear in quotations in this policy have special meanings. Refer to SECTION V - DEFINITIONS. SECTION I – COVERAGE Insuring Agreement Excess Liability We will pay on behalf of the insured and in excess of “underlying limits” those sums the insured becomes legally obligated to pay as damages for “loss” to which this insurance applies. This insurance applies only if: 1. a. the “loss” is caused by an “event” that takes place in the coverage territory; b. the “loss” occurs during the “policy period;” and c. the “controlling underlying insurance” applies to the “loss.” If an aggregate limit of “controlling underlying insurance” is exhausted by the payment of judgments or settlements to which this insurance applies, or would have applied but for the amount of the damages, this insurance will apply in place of the “controlling underlying insurance” until we have paid our applicable Limits of Insurance. 2. When paragraph 2. above applies, ending the “controlling underlying insurance” obligations to investigate and settle claims or defend suits against the insured, we have the right and duty to investigate claims and defend suits which seek damages to which this insurance applies. Our right and duty to defend end when we have paid our applicable Limits of Insurance. 3. When paragraph 2. above does not apply, we have the right, but not the duty, to participate in the investigation or settlement of any claim or the defense of any suit against any insured. 4. We have the right, at our discretion, to settle any claim to which this insurance applies. 5. As respects paragraphs 3. and 4. above, “defense expenses” we incur in the investigation of any claim or defense of any suit will be paid in addition to the Limits of Insurance except when such costs reduce the limits of “controlling underlying insurance,” in which case they will reduce our Limits of Insurance. 6. The amount we pay is limited. See SECTION III – LIMITS OF INSURANCE. 7. A. 1. NAV-EXC-001 (04/10) Page 2 of 7 Navigators Specialty Insurance Company Contains copyrighted material of the Insurance Services Office, Inc. with its permission. However, in no case will coverage be excluded by the “controlling underlying insurance” and not excluded by this policy. This insurance does not apply to any liability: to which ”controlling underlying insurance” does not apply; 1. for which coverage is provided by “controlling underlying insurance” at limits less than the limits of insurance applicable to other coverage provided by the “controlling underlying insurance” and less than “underlying limits;” 2. for “loss” which commenced prior to this “policy period,” whether or not such “loss” continues, progresses, changes or resumes during this “policy period;” 3. for damage to property you own, rent or occupy, including any costs or expenses incurred by you or any other person, organization or entity, for repair, replacement, enhancement, restoration or maintenance of such property for any reason, including the prevention of injury to a person or damage to another’s property; 4. for damage to personal property in the care, custody or control of any insured; 5. arising out of any “aircraft products;” 6. arising out of the actual, alleged, suspected or threatened inhalation of, ingestion of, contact with, exposure to, existence of, or presence of “asbestos;” 7. arising out of the actual, alleged, suspected or threatened inhalation of, ingestion of, contact with, exposure to, existence of, or presence of “fungi” or bacteria; 8. arising out of the actual, alleged, suspected or threatened inhalation of, ingestion of, contact with, exposure to, existence of, or presence of “silica” or “silica related dust;” 9. arising out of any “employment practices” of any insured; 10. arising out of: 11. war, including undeclared or civil war; a. warlike action by a military force, including action in hindering or defending against an actual or expected attack, by any government, sovereign or other authority using military personnel or other agents; or b. c. insurrection, rebellion, revolution, usurped power, or action taken by governmental authority in hindering or defending against any of these; imposed under: 12. an uninsured or underinsured motorist, uninsured or underinsured boater, Medical Payments, Personal Injury Protection, No-Fault or any similar law; a. a workers compensation, disability benefits, unemployment compensation or any similar law; b. c. the Employee Retirement Income Security Act of 1974, any amendments thereto or any similar law. Exclusions The EXCLUSIONS sections of the “controlling underlying insurance” are made part of this policy. If an inconsistency or contradiction exists between an Exclusion of this policy and an Exclusion of the “controlling underlying insurance” the Exclusion of this policy will apply. 2. NAV-EXC-001 (04/10) Page 3 of 7 Navigators Specialty Insurance Company Contains copyrighted material of the Insurance Services Office, Inc. with its permission. SECTION III – LIMITS OF INSURANCE The Limits of Insurance shown in the Declarations and the rules below fix the most we will pay regardless of the number of insureds, claims made or suits brought, or persons or organizations making claims or bringing suits. The General Aggregate Limit is the most we will pay for the sum of all damages to which this insurance applies, except: 1. damages because of bodily injury or property damage included within any applicable products-completed operations hazard; or a. damages arising out of the ownership, operation, maintenance or use of an automobile; b. The Products-Completed Operations Aggregate Limit is the most we will pay for the sum of all damages included within any applicable products-completed operations hazard; 2. Subject to paragraphs 1. and 2. above, the Each Event Limit is the most we will pay for all damages that arise out of any one “event.” 3. SECTION IV – CONDITIONS The CONDITIONS sections of the “controlling underlying insurance” are made part of this policy. If an inconsistency or contradiction exists between the Conditions of this policy and the Conditions of the “controlling underlying insurance,” the Conditions of this policy will apply. Appeals At our discretion we may appeal any judgment which would result in a payment under this policy. When we do appeal, we will pay all costs associated with the appeal in addition to the Limits of Insurance. Any such appeal will not increase our Limits of Insurance. 1. Bankruptcy or Insolvency Bankruptcy or insolvency of the insured or the insured’s estate will not relieve us of our obligations under this policy. Bankruptcy or insolvency of any company providing “controlling underlying insurance” will not reduce the “underlying limits” or increase our obligations under this policy. We will not be required to drop down or replace “controlling underlying insurance.” Cancellation The first Named Insured may cancel this policy at any time by providing us advanced written notice of the cancellation date. We may cancel this policy at any time by providing the first Named Insured written notice of cancellation: i. at least 10 days in advance if we cancel for non-payment of premium; or ii. at least 30 days in advance if we cancel for any other reason: 2. 3. a. b. SECTION II – WHO IS AN INSURED The WHO IS AN INSURED section of the “controlling underlying insurance” is made part of this policy. Any person or organization that is an insured in “controlling underlying insurance” is an insured in this policy to the same extent. NAV-EXC-001 (04/10) Page 4 of 7 Navigators Specialty Insurance Company Contains copyrighted material of the Insurance Services Office, Inc. with its permission. Non-Renewal We are not obligated to renew this policy. However, should we decide not to renew, we will provide the first Named Insured written notice of our decision at least 30 days prior to the expiration date shown in the Declarations. We will not restrict the terms or increase premium of this policy at renewal unless we have given the first Named Insured at least 30 days advanced notice of any such changes. However, no notice will be provided or required if a restriction in this policy results from a restriction applicable to “controlling underlying insurance.” The first Named Insured may non-renew this policy by: i. providing advance written notice to us; ii. rejecting our offer to renew; or iii. failing to reply to our offer to renew. Proof of mailing will be proof of notice. Changes This policy contains all of the agreements between you and us. This policy may only be changed by endorsements we issue. Duties When There is an “Event,” Claim or Suit You must see to it that we and any other insurers who could provide coverage are notified as soon as practicable of any “event” which may be reasonably expected to result in a claim under this policy. To the extent possible, notice should include: i. how, when and where the “event” took place; ii. the names and addresses of any injured persons and witnesses; and iii. the nature and location of any injury or damage arising out of the “event.” If a claim is made or suit is brought against any insured which may be reasonably expected to result in a claim under this policy, you must: i. immediately record the specifics of the claim or suit and the date received; and ii. notify us, and any other insurers who could provide coverage, as soon as practicable. c. You and any other involved insured must: i. immediately send us, and any other insurers who could provide coverage, copies of any demands, notices, summonses or legal papers received in connection with a claim or suit which may be reasonably expected to result in a claim under this policy; ii. authorize us to obtain records and other information; iii. cooperate with us in the investigation or settlement of the claim, issues relating to coverage under this policy or defense against the suit; and iv. assist us, upon our request, in the enforcement of any right against any person or organization which may be liable to the insured because of the injury or damage to which this insurance may apply. 4. a. b. c. 5. 6. a. b. c. If the “controlling underlying insurance” is cancelled for any reason, this policy is also cancelled. Reinstatement of the “controlling underlying insurance” does not reinstate this policy unless reinstatement is endorsed hereon. Return premium, if any, will be calculated per Condition 11. Premium. Proof of mailing will be proof of notice. NAV-EXC-001 (04/10) Page 5 of 7 Navigators Specialty Insurance Company Contains copyrighted material of the Insurance Services Office, Inc. with its permission. Maintenance of Controlling Underlying Insurance During the “policy period” you must maintain “controlling underlying insurance” with “underlying limits” at least equal to the amounts shown in the Declarations. The “underlying limits” must be unimpaired at the beginning of this “policy period.” If you fail to maintain the “controlling underlying insurance” this policy will be invalid. If you fail to maintain “underlying limits,” we will only be liable to the extent we would have been liable had you maintained the “underlying limits.” Reduction of “underlying limits” by the payment of judgments or settlements for “loss” to which this insurance applies, or would have applied but for the amount of the damages, will not be considered a failure to maintain “underlying limits.” 8. Other Insurance This insurance is excess over any insurance available to the insured except insurance purchased specifically to apply in excess of this policy. 9. Payment of Damages When the amount of damages payable under this policy has been determined by final judgment or a written settlement agreement between the claimant and us, we will pay that amount, up to our applicable Limits of Insurance, after the “controlling underlying insurance” or the insured has paid the full amount of the “underlying limits.” 10. Premium The Premium shown in the Declarations is the premium for the coverage we provide for the “policy period.” The first Named Insured is responsible for the payment of all premiums under this policy. If this policy is cancelled prior to its expiration date return premium will be calculated as follows: 11. if cancelled by us: [{(Premium) – (Minimum Earned Premium)} x (Pro Rata factor)] if cancelled by you: [{(Premium) – (Minimum Earned Premium)} x {(Pro Rata factor) x (.90)}]. Separation of Insureds Except with respect to the Limits of Insurance and any rights or duties specifically assigned in this policy to the first Named Insured, this insurance applies: 12. as if each Named Insured were the only Named Insured; and separately to each insured against whom claim is made or suit is brought. Transfer of Rights of Recovery Against Others If an insured has rights to recover all or part of any payment we have made under this insurance, the insured must preserve those rights and, at our request, pursue or transfer those rights to us. The insured must do nothing after an “event” to impair them. 13. a. b. a. b. Legal Action Against Us No person or organization has a right under this insurance: to join us as a party or otherwise bring us into a suit asking for damages from an insured; or to sue us on this insurance unless all of its terms have been fully complied with. 7. a. b. No insured will, except at that insured’s own cost, voluntarily make a payment, assume any obligation or incur any expense, other than first aid, without our consent. Notice to us may be sent to our address shown in the Declarations. d. NAV-EXC-001 (04/10) Page 6 of 7 Navigators Specialty Insurance Company Contains copyrighted material of the Insurance Services Office, Inc. with its permission. and we are prevented by law from paying such damages on behalf of the insured, we will reimburse the insured, in U.S currency at the prevailing exchange rate at the time the damages were paid, for such damages. SECTION V – DEFINITIONS The DEFINITIONS sections of the “controlling underlying insurance” are made part of this policy, and apply to words or phrases used in this policy provided always that words or phrases in quotations in this policy will have the meaning given them in this policy. “Aircraft products” means: an aircraft; ground control or support equipment; or any article, component or device made, sold, licensed, handled or distributed by any insured that is used to achieve, control or maintain flight or landing of an aircraft. “Asbestos” means the mineral in any form. “Controlling underlying insurance” means the policy listed in the Schedule of Underlying Insurance shown in the Declarations, or its renewal or replacement, which applies to the “loss,” or would have applied but for: an exclusion in that policy; or the exhaustion or erosion of an aggregate limit of insurance; If more than one policy is listed in the Schedule, the “controlling underlying insurance” is the policy which applies to the “loss” or would have applied but for the reasons a. or b. listed above. “Defense expenses” means expenses we incur to investigate a claim or defend a suit. Defense expenses include interest which accrues on our portion of a judgment, after entry of that judgment and after the insured or any underlying insurer has paid the full amount of their portion of the judgment but before we have paid, offered to pay or deposited in the court the part of the judgment that is within our applicable Limits of Insurance. “Employment practices” means: a. b. c. a. b. Reformation of Underlying If the “controlling underlying insurance” is reformed after an “event” to provide coverage for a “loss,” the terms of such reformation do not apply to this policy. 14. When we Defend When we have a duty to defend an insured, the insured will cooperate with us in the transfer of the defense to counsel of our choosing. If the law of the governing jurisdiction permits an insured to select their own counsel to be paid for by us, we shall only be liable for the reasonable and necessary defense costs of one law firm per insured at rates customarily paid by us for the defense of similar claims in the jurisdiction where the claim is pending. 15. Claims outside the U.S.A, it’s Territories, Possessions or Canada When we have the duty to defend an insured and are prevented by law or otherwise from doing so, we will reimburse the insured for any reasonable and necessary expenses incurred in the defense of a suit to which this insurance applies. If the insured becomes legally obligated to pay damages to which this insurance applies 16. NAV-EXC-001 (04/10) Page 7 of 7 Navigators Specialty Insurance Company Contains copyrighted material of the Insurance Services Office, Inc. with its permission. “Fungi” means any type or form of fungus, including mold or mildew and any mycotoxins, spores, scents or byproducts produced or released by fungi. But “fungi” does not include mushrooms cultivated for human consumption. “Loss” means bodily injury, property damage, personal and advertising injury or other loss defined by and to which the “controlling underlying insurance” applies. “Policy period” means the period of time between the effective date shown in the Declarations and the earlier of the expiration date shown in the Declarations or the expiration date shown in an endorsement to this policy. “Silica” means silicon dioxide, occurring in crystalline, amorphous or impure forms, silica particles, silica dust or silica compounds. “Silica related dust” means a mixture or combination of silica and other dust particles. “Underlying limits” means the amounts shown in the Declarations as the minimum limits of insurance to be provided by “controlling underlying insurance.” In Witness Whereof, the issuing Company has caused this policy to be signed officially below, and countersigned on the Declarations page by a duly authorized representative of said Company. Douglas Elliot Kevin Barnett President Secretary dismissal, discharge or termination of employment, whether actual, constructive or retaliatory; failure or refusal to hire or promote; discipline, demotion, coercion or retaliatory treatment; failure to grant tenure; negligent employment evaluation; e. sexual or other workplace harassment, including quid pro quo and hostile work environment; f. employment discrimination; g. invasion of privacy, violation of employment related civil rights, employment related libel, slander or defamation; creating or enforcing or failing to create or enforce employment related policies or procedures; or i. actual or alleged violations of the Family and Medical Leave Act of 1993 or its amendments. j. “Event” means an accident, incident, occurrence, offense, wrongful act or other “loss” causing “event” defined by and to which the “controlling underlying insurance” applies. a. b. c. d. h. NAV-EXC-348A (01/11)Page 1 of 1Navigators Specialty Insurance Company Contains copyrighted material of the Insurance Services Office, Inc. with its permission. COMMERCIAL EXCESS LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT OF CONDITIONS OTHER INSURANCE PRIMARY AND NON-CONTRIBUTING This endorsement modifies insurance provided under the following: COMMERCIAL EXCESS LIABILITY COVERAGE PART SCHEDULE When required by written contract executed before the "loss." A. Section IV - Conditions, 9. Other Insurance is deleted and replaced by the following: 9. This insurance is excess over any other insurance available to the insured except: a. insurance that is purchased specifically to apply in excess of this policy; or b. insurance available to the person or organization shown in the Schedule of this endorsement as an additional insured on the “controlling underlying insurance.” B. When this insurance applies on a primary and non-contributing basis, the Limits of Insurance available for the additional insured will be the lesser of: 1. the amounts shown in item 3 of the Declarations of this policy; or 2. the amount of insurance you are required to provide the additional insured in the written contract or agreement. All other terms of the policy remain unchanged. NAV-ECD-6012 (01/11)Page 1 of 1Navigators Specialty Insurance Company Contains copyrighted material of the Insurance Services Office, Inc. with its permission. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF SUBROGATION SCHEDULE Name of Person or Organization: As required by written contract or agreement. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to SECTION IV - CONDITIONS, 13. Transfer of Rights of Recovery Against Others. We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or “your work” done under a contract with that person or organization. This waiver applies only to the person or organization shown in the Schedule above. All other terms of the policy remain unchanged.