Press Alt + R to read the document text or Alt + P to download or print.
This document contains no pages.
HomeMy WebLinkAboutCity of Renton COIANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
INSR ADDL SUBR
LTR INSD WVD
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)
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
EACH OCCURRENCE $
DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence)
MED EXP (Any one person)$
PERSONAL & ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $
PRO-POLICY LOC PRODUCTS - COMP/OP AGG $JECT
OTHER:$
COMBINED SINGLE LIMIT $(Ea accident)
ANY AUTO BODILY INJURY (Per person)$
OWNED SCHEDULED BODILY INJURY (Per accident)$AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE $AUTOS ONLY 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
INSURER(S) AFFORDING COVERAGE NAIC #
COMMERCIAL GENERAL LIABILITY
Y / N
N / A
(Mandatory in NH)
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 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)
CERTIFICATE OF LIABILITY INSURANCE
Lockton Companies, LLC
DBA Lockton Insurance Brokers, LLC in CA
CA license #0F15767
8110 E Union Ave., Ste. 100
Denver CO 80237
denver-certs@lockton.com
Heartland Construction LLC
10900 NE 8th St., STE 1200
Bellevue, WA 98004
Hartford Casualty Insurance Company 29424
Hartford Fire Insurance Company 19682
Trumbull Insurance Company 27120
X
X
X $10,000 BI/PD DEDUCT
1,000,000
500,000
10,000
1,000,000
2,000,000
2,000,000
X X
1,000,000
XXXXXXX
XXXXXXX
XXXXXXX
XXXXXXX
X X
X 10,000
10,000,000
10,000,000
XXXXXXX
N
X
1,000,000
1,000,000
1,000,000
B 52UEACI1922 8/10/2024 8/10/2025
A 52UEABF5A9X 8/10/2024 8/10/2025
C 52RHABF5AMW 8/10/2024 8/10/2025
A 52UEABF5A9X 8/10/2024 8/10/2025AWA STOP GAP 8/10/2024 8/10/2025
8/10/2025
1530930
Y Y
N N
N N
N
4/16/2025
21650952
21650952 XXXXXXX
City of Renton
Attn: Michael Sippo
1055 South Grady Way
Renton WA 98057
City of Renton is an additional insured on the general liability policy per the attached endorsement/form.
Coverage is primary and non-contributory on the general liability policy per the attached endorsement/form.
Waiver of subrogation applies on the general liability policy per the attached endorsement/form.
Notice of cancellation for the general liability policy per the attached form.
X
See Attachments
1 . ALIENATED PREMISES COVERAGE
Exclusion j. Damage To Property of Section I -
Coverage A is amended as follows:
a.The following exception to the exclusion is
deleted:
Paragraph (2) of this exclusion does not apply
if the premises are "your work" and were never
occupied, rented or held for rental by you.
b.This exception is replaced by the following:
Paragraph (2) of this exclusion does not apply if
the premises are "your work".
2. DAMAGE TO YOUR WORK
A. Section I - Coverage A - Bodily Injury And
Property Damage Liability, Paragraph 1.
Insuring Agreement is amended to add the
following:
f. Damages because of "property damage"
include damages the insured becomes
legally obligated to pay because of
"property damage" to "your work" or
caused by "your work", and such "property
damage" shall be deemed to be caused by
of the insured , regardless of whether the
"property damage" arises from breach of
contract.
B. Exclusion I. Damage To Your Work of Section
I - Coverage A is replaced by the following:
I.Damage to Your Work
"Property damage" to that particular part of
"your work" that must be restored, repaired
or replaced because "your work" was
incorrectly performed and included in the
"products-completed operations hazard".
This exclusion does not apply if the damaged work
or the work performed incorrectly was performed
on your behalf by a subcontractor.
This Paragraph 2.B. does not apply if Exclusion I.
Damage To Your Work has been otherwise modified
by endorsement.
3. THAT PARTICULAR PART
This Paragraph 3. applies to Exclusion j. Damage
to Property, subparagraphs (5), and (6),
Exclusion k. Damage to Your Product, and
Exclusion I. Damage to Your Work.
an "occurrence", if not intended or
expected from the standpoint
Form HS 24 50 12 20 © 2020, The Hartford Page 1 of 7
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CONTRACTORS BROAD FORM ENDORSEMENT
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
INDEX
1. Alienated Premises Coverage ....................................................................................................................... 1
2.Damage To Your Work ................................................................................................................................. 1
3.That Particular Part ....................................................................................................................................... 1
4.Contractors Limited Professional Liability ......................................................................................................2
5. Per Project and Per Location General Aggregate Limits Of Insurance .......................................................... 2
6. Medical Payments Coverage - Including Products - Completed Operations .................................................. 3
7. Injury To Employee's Reputation With Respect To Incidental Medical Malpractice ....................................... 3
8. Bodily Injury Employee Suits .......................................................................................................................... 4
9. Consolidated Insurance (Wrap-Up) Programs. .............................................................................................. 4
10. Access Or Disclosure Of Confidential Or Personal Information And Data-Related Liability ....................... 5
11. Supplementary Payments ............................................................................................................................ 5
12. Two Or More Coverage Parts Or Policies Issued By Us .............................................................................. 6
13. Notice of Cancellation to Certificate Holders ................................................................................................ 6
14. Contractual Liability Coverage For Personal And Advertising Injury ............................................................ 6
15. Insured Contract Definition ............................................................................................................................6
Attachment Code: D633212 Master ID: 1530930, Certificate ID: 21650952
LIABILITY
The following exclusion is added to Paragraph 2.,
Exclusions of Section I - Coverage A - Bodily
Injury And Property Damage Liability, and to
Paragraph 2., Exclusions of Section I Coverage
B - Personal And Advertising Injury Liability:
This insurance does not apply to "bodily injury",
"property damage" or "personal and advertising
injury" arising out of the rendering of or failure to
render any professional services by you with
respect to your providing engineering,
architectural or surveying services in your capacity
as an engineer, architect or surveyor.
Professional services include:
(1) The preparing, approving, or failing to prepare
or approve, maps, shop drawings, opinions,
reports, surveys, field orders, change orders, or
drawings and specifications; and
(2) Supervisory or inspection activities performed
4.
as a part of any related architectural or
CONTRACTORS
engineering activities.
This exclusion applies even if the claims against
any insured allege negligence or other wrongdoing
in the supervision, hiring, employment, training or
monitoring of others by that insured, if the
"occurrence" which caused the "bodily injury" or
"property damage", or the offense which caused
the "personal and advertising injury", involved the
rendering of or failure to render any professional
services by you with respect to your providing
engineering, architectural or surveying services in
your capacity as an engineer, architect or surveyor.
This exclusion does not apply to your operations in
connection with construction work performed by
you or on your behalf.
However, this exception to the exclusion will not
apply if you are in the business or profession of
providing the professional services described
above independent from the construction work
performed by you or on your behalf.
In the event this insurance applies to any injury,
damage, loss, cost or expense covered by
Professional Liability insurance issued by a
company unaffiliated with us, then the insurance
LIMITED PROFESSIONAL
When performing operations as a "general
contractor", the term that particular part shall not
mean the entire construction, improvement or
renovation project. For purposes of this provision,
the term "general contractor" means the contractor
signing the prime construction contract for a
construction, erection, improvement or renovation
project and that has main responsibility for such
project including hiring all of the subcontractors
and suppliers.
afforded under this Coverage Part is excess over
such other valid and collectible Professional
Liability insurance (including any deductible or self-
insured retention portion thereof), and any other
valid and collectible insurance available to the
insured whether primary, excess, contingent or on
any other basis.
5. PER PROJECT AND PER LOCATION GENERAL
AGGREGATE LIMITS OF INSURANCE
A. For all sums which the insured becomes legally
obligated to pay as damages caused by
"occurrences" under Section I - Coverage A,
and for all medical expenses caused by
accidents under Section I - Coverage C, which
can be attributed only to ongoing operations at
a single "project" or a single "location";
1. A separate Per Project General Aggregate
Limit or a separate Per Location General
Aggregate Limit applies to each "project"
or "location", whichever is applicable.
The Per Project General Aggregate Limit
and Per Location Aggregate Limit is
equal to the amount of the General
Aggregate Limit shown in the
Declarations.
2. The Per Project General Aggregate Limit or
the Per Location General Aggregate Limit,
whichever applies, is the most we will pay
for the sum of all damages under
Coverage A. except damages because of
"bodily injury" or "property damage"
included in the "products-completed
operations hazard", and for medical
expenses under Coverage C regardless of
the number of;
a.Insureds;
b.Claims made or "suits" brought; or
c.Persons or organizations making
claims or bringing "suits".
3. Any payments made under Coverage A for
damages or under Coverage C for medical
expenses shall reduce the Per Project
General Aggregate Limit for that "project"
or the Per Location General Aggregate for
that "location", whichever applies. Such
payments shall not reduce the General
Aggregate Limit shown in the
Declarations, the Per Project General
Aggregate Limit for any other "project", or
the Per Location General Aggregate Limit
for any other "location".
4. The limits shown in the Declarations for Each
Occurrence, Damage To Premises Rented
To You and Medical Expense continue to
apply. However, instead of
Page 2 of 7 Form HS 24 50 12 20
Attachment Code: D633212 Master ID: 1530930, Certificate ID: 21650952
Limits Of
being subject to the General Aggregate Limit
shown in the Declarations, such limits will be
subject to the applicable Per Project General
Aggregate Limit if attributable only to
ongoing operations at a single "project" or
the Per Location General Aggregate if
attributable only to ongoing operations at a
single "location".
B. For all sums which the insured becomes legally
obligated to pay as damages caused by
"occurrences" under Section I - Coverage A
and for all medical expenses caused by
accidents under Section I - Coverage C , which
cannot be attributed only to ongoing operations
at a single "project" or a single "location";
1.Any payments made under Coverage A for
damages or under Coverage C for medical
expenses shall reduce the amount available
under the General Aggregate Limit or the
Products-Completed Operations Aggregate
Limit, whichever is applicable; and
2.Such payments shall not reduce any Per
Project General Aggregate Limit or any Per
Location General Aggregate Limit.
C. When coverage for liability arising out of the
"products-completed operations hazard" is
provided, any payments for damages because of
"bodily injury" or "property damage" included in
the "products-completed operations hazard" will
reduce the Products-Completed Operations
Aggregate Limit, and not reduce the General
Aggregate Limit,or any Per Project General
Aggregate Limit or any Per Location General
Aggregate Limit.
D.
Insurance not otherwise modified by this
The provisions
endorsement shall continue to apply as
of
stipulated.
E. For the purposes of Paragraph 5., the following
definitions apply:
"Project" means a premises an insured does
not own or rent and where such insured
performs construction-related operations.
Each "project" involving the same or
connecting lots, or premises whose connection
is separated by a street, roadway, waterway,
railroad or right-of-way shall be considered a
single "project".
1. If a "project" has been abandoned and then
restarted, or if the authorized contracting
parties deviate from plans, blueprints,
designs, specifications or timetables, the
"project" shall be considered a single
"project". "Project" does not include a
premises that is a "location".
Section III -
(3) The injured person submits to
Location General
examination,at our expense,by
Aggregate
physicians of our choice as often as we
reasonably require.
7. INJURY TO EMPLOYEES REPUTATION WITH
Limit
RESPECT TO INCIDENTAL MEDICAL
has
MALPRACTICE
A. The following is added to Paragraph 1.e. of the
Insuring Agreement - Coverage A:
been
(3) With respect to incidental medical
2. "Location" means a premises an insured owns
or rents and where such insured performs
business operations other than construction-
related operations. Each "location" involving
the same or connecting lots, or premises
whose connection is separated by a street,
roadway, waterway or right-of-way railroad
shall be considered a single "location."
"Location" does not include a premises that
is a "project".
This provision does not apply if the Per Project and the
malpractice, "bodily injury" includes
damages claimed for injury to emotions or
reputation of an "employee" arising out of the
rendering or failure to render professional
health care services as a physician, dentist,
nurse, emergency medical technician or
paramedic services.
otherwise modified by endorsement.
6. MEDICAL PAYMENTS COVERAGE - INCLUDING
PRODUCTS-COMPLETED OPERATIONS
Paragraph 1.a. of the Insuring Agreement -
Coverage C is replaced by the following:
1. Insuring Agreement
a. We will pay medical expenses as described
below for "bodily injury" caused by an
accident:
(1) On premises you own or rent;
(2) On ways next to premises you own or
rent;
(3) Because of your operations; or
(4) Included within the definition of the
"products-completed operations
hazard;"
provided that:
(1) The accident takes place in the
"coverage territory" and during the
policy period;
(2) The expenses are incurred and
reported to us within three years of the
date of the accident; and
Per
Form HS 24 50 12 20 Page 3 of 7
Attachment Code: D633212 Master ID: 1530930, Certificate ID: 21650952
9.
A.Products-Completed Operations Hazard
CONSOLIDATED
Exception
"Bodily injury" or "property damage" arising out
of an "insured's operations" at or in connection
with a "wrap project or premises" when such
"bodily injury" or "property damage" commences
after the "products-completed operations
hazard" coverage or any completed operations
extension coverage provided by the applicable
"consolidated insurance (wrap-up) program"
has ended or is no longer in effect.
B.Off-Site Location Exception
"Bodily injury" or "property damage" resulting
from an "insured's operations" at or in connection
with a "wrap project or premises" at a location to
which the applicable "consolidated insurance
(wrap-up) program" does not apply.
INSURANCE (WRAP-UP)
B. The following exclusion is added to Coverage
B - Personal and Advertising Injury:
"Personal and advertising injury arising out of
the rendering or failure to render professional
health care services as a physician, dentist,
nurse, emergency medical technician or
paramedic.
8. BODILY INJURY EMPLOYEE SUITS
A."Bodily injury" as listed in Paragraph 2.a.(1) of
Section II - Who Is An Insured, does not apply
to 2.a.(1)(a) through 2.a.(1)(c).
B.Part a. of Paragraph 4. Nonowned Watercraft
in Section II - Who Is An Insured does not
apply.
PROGRAMS
The following exclusion is added to Section I
Coverage A:
This insurance does not apply to any "bodily injury"
or "property damage" arising out of any "wrap
project or premises" where an insured under this
policy is or was also an insured under one or more
commercial general liability (CGL) policies
(including any umbrella or excess policies that
include the commercial general liability policy(ies)
as underlying insurance) included within a
"consolidated insurance (wrap-up) program." This
exclusion applies even if the limits of insurance for
such "consolidated insurance (wrap-up) program"
are exhausted or not collected for any reason,
including bankruptcy or insolvency of the insurer
providing coverage for the "consolidated insurance
(wrap-up) program". This exclusion also applies if
the CGL coverage afforded under the "consolidated
insurance (wrap-up) program" is narrower in scope
than the coverage provided by this policy.
This exclusion does not apply to:
of Paragraph 9,the following
coverage
definitions apply:
"Consolidated insurance (wrap-up) program" means
any agreement or arrangement, including
provided
any contractor-controlled,owner-controlled,
under
project-specific or similar insurance program under
which one or more contractor(s) working on a
specified project are insured under one or more
commercial general liability (CGL) policies (including
any umbrella or excess policies that include the
commercial general liability policy(ies) as underlying
insurance) issued by a specified carrier for injury or
damage arising out of operations conducted in
connection with or necessary or incidental to the
project.
"Insured's operations" means all operations
performed by a named insured (and not sub-
contracted or performed by others on the insured's
behalf).
"Punch list work" means the "insured's operations"
at or in connection with a "wrap project or premises"
in order to complete the work called for in an
insured's contract for the "wrap project or premises".
"Repair work" means the "insured's operations" that
are service, maintenance, correction, repair,
Paragraphs
replacement work,or periodic
9.A
inspection performed by an insured at or in
connection with a "wrap project or premises", in
order to replace or repair an insured's completed
work.
"Wrap project or premises" means any premises or
construction, erection, improvement or renovation
project subject to a "consolidated insurance (wrap-
up) program".
10. ACCESS OR DISCLOSURE OF CONFIDENTIAL
"Bodily injury" or "property damage" resulting
from "repair work" or "punch list work" at a "wrap
project or premises" but only when the
applicable "consolidated insurance (wrap-up)
program" does not apply or no longer applies to
such "repair work" or "punch list work".
This exception does not apply to the cost of
performing such "repair work" or "punch list
work", or to the "repair work" or "punch list work"
itself.
D.Additional Insured Extension
"Bodily injury" or "property damage" for which
you are solely an additional insured under the
"consolidated insurance (wrap-up) program".
OR PERSONAL INFORMATION AND DATA-
through 9.D. above is subject to all terms, conditions
and exclusions of this policy.
RELATED LIABILITY
The
For purposes
C.Repair Work And Punch List Work
Exception
Page 4 of 7 Form HS 24 50 12 20
Attachment Code: D633212 Master ID: 1530930, Certificate ID: 21650952
is
A. Exclusion p. of Section I - Coverage A Bodily
replaced by the following:
p. Access Or Disclosure Of Confidential
Or Personal Information And Data-
Related Liability
Damages arising out of:
(1) Any access to or disclosure of any
person's or organization's confidential
or personal information, including
patents, trade secrets, processing
methods, customer lists, financial
information, credit card information,
health information or any other type of
nonpublic information; or
(2) the loss of, loss of use of, damage to,
corruption of, inability to access, or
inability to manipulate "electronic data"
that does not result from physical injury to
tangible property.
This exclusion applies even if damages are
claimed for notification costs, credit
monitoring expenses, forensic expenses,
public relations expenses or any other loss,
cost or expense incurred by you or others
arising out of that which is described in
Paragraph (1) or (2) above.
However, unless Paragraph (1) above
applies, this exclusion does not apply to
liability for damages because of "bodily
injury".
B. Exclusion w. of Section 1 - Coverage B Personal
Injury
and Advetising Injury is replaced by the
And
following: :
w. Access Or Disclosure Of Confidential Or
Personal Information
"Personal and advertising injury" arising out
of any access to or disclosure of any
person's or organization's confidential or
personal information, including patents,
trade secrets, processing methods,
customer lists, financial information, credit
card information, health information or any
other type of nonpublic information.
This exclusion applies even if damages are
claimed for notification costs, credit
monitoring expenses, forensic expenses,
public relations expenses or any other loss,
cost or expense incurred by you or others
arising out of any access to or disclosure of
any person's or organization's confidential
Property Damage Liability
C. The following Paragraph is added to Section III -
Limits Of Insurance:
Subject to Paragraph 5. Each Occurrence Limit,
the most we will pay under Coverage A for
"property damage" because of all loss of
"electronic data" arising out of any one
"occurrence" is $100,000, unless modified by
endorsement.
D. The following definition is added to Section V -
Definitions:
"Electronic data" means information, facts or
programs:
a.Stored as or on;
b.Created or used on; or
c.Transmitted to or from;
computer software, (including systems and
applications software) hard or floppy disks, CD-
ROMS, tapes, drives, cells, data processing
devices or any other media which are used with
electronically controlled equipment.
E. For the purposes of the coverage provided by this
provision, the definition of "property damage" in
Section V - Definitions is replaced by the
following:
"Property damage" means:
including all resulting loss of use of that
property. All such loss of use shall be
deemed to occur at the time of the physical
injury that caused it;
b.Loss of use of tangible property that is not
physically injured. All such loss of use shall be
a.
deemed to occur at the time of the
Physical
"occurrence" that caused it; or
injury
c.Loss of,loss of use of,damage to,
to
corruption of, inability to access, or
inability to properly manipulate "electronic
data", resulting from physical injury to
tangible property. All such loss of
"electronic data" shall be deemed to occur
at the time of the "occurrence" that caused
it.
For the purposes of this insurance, "electronic
data" is not tangible property.
11. SUPPLEMENTARY PAYMENTS
In the Supplementary Payments - Coverages A
and B provision:
The limit for the cost of bail bonds is increased to
$2,500.
tangible property,
or personal information.
Form HS 24 50 12 20 Page 5 of 7
Attachment Code: D633212 Master ID: 1530930, Certificate ID: 21650952
COVERAGE FOR
policy is subject to the following
PERSONAL AND ADVERTISING INJURY
additional
Exclusion e.of SECTION I -COVERAGE B
12. TWO OR MORE COVERAGE PARTS OR
POLICIES ISSUED BY US
If this policy and any other policy issued to an
insured by us or any affiliated company provides
coverage that applies to the same claim or
damages, the maximum applicable limit(s) of
liability or limit of insurance under all the policies will
not exceed the highest applicable limit of liability or
limit of insurance under any one policy. This
condition does not apply to any policy issued by us
or an affiliated company specifically written to apply
as excess insurance over this policy.
13. NOTICE OF CANCELLATION TO CERTIFICATE
HOLDER(S)
Conditions:
A.If this policy is cancelled by the Company, other
than for nonpayment of premium, notice of such
cancellation will be provided at least thirty (30)
days in advance of the cancellation effective
date to the certificate holder(s) with mailing
addresses on file with the agent of record or the
Company.
B.If this policy is cancelled by the Company for
nonpayment of premium, or by the insured,
notice of such cancellation will be provided
within (10) days of the cancellation effective
date to the certificate holder(s) with mailing
addresses on file with the agent of record or the
Company.
If notice is mailed, proof of mailing to the last known
mailing address of the certificate holder(s) on file
with the agent of record or the Company will be
sufficient proof of notice.
Any notification rights provided by this endorsement
apply only to active certificate holder(s) who were
issued a certificate of insurance applicable to this
policy's term.
Failure to provide such notice to the certificate
holder(s) will not amend or extend the date the
cancellation becomes effective, nor will it negate
cancellation of the policy. Failure to send notice shall
impose no liability of any kind upon the Company or
its agents or representatives.
PERSONAL AND ADVERTISING INJURY
This
LIABILITY is replaced by the following:
This insurance does not apply to:
e. Contractual Liability
"Personal and advertising injury" for which the
insured has assumed liability in a contract or
agreement. This exclusion does not apply to
liability for damages:
(1) That the insured would have in the absence
14.CONTRACTUAL LIABILITY
and litigation
in
expenses are for defense of that party
against a civil or alternative dispute
resolution proceeding in which
damages to which this insurance
applies are alleged.
15. INSURED CONTRACT DEFINITION
a. INSURED CONTRACT-CONSTRUCTION
OPERATIONS AND MUNICIPAL WORK
Paragraph d. of the definition of "insured contract"
in Section V - Definitions is deleted and replaced
by the following:
the
An obligation,as required by ordinance,to
same
indemnify a municipality.
b. CONTRACTUAL LIABILITY
"insured
Paragraph f.of the definition of "insured
(2) Assumed in a contract or agreement that is
an "insured contract", provided the
"personal and advertising injury" occurs
subsequent to the execution of the contract
or agreement. Solely for the purposes of
liability assumed in an "insured contract",
reasonable attorney fees and necessary
litigation expenses incurred by or for a
party other than an insured are deemed to
be damages because of "personal and
advertising injury", provided:
(a)Liability to such party for, or for the cost
of, that party's defense has also been
contract"; and
contract"is deleted and replaced by the
assumed
following:
That part of any other contract or agreement
pertaining to your business (including an
indemnification of a municipality in connection with
work performed for a municipality) under which
you assume the tort liability of another party to pay
for "bodily injury", "property damage", or "personal
and advertising injury" to a third person or
organization. Tort liability means a liability that
would be imposed by law in the absence of any
contract or agreement.
Paragraph f. includes that part of any contract
or agreement that indemnifies a railroad for
"bodily injury", "property damage", or "personal
and advertising injury" arising out of
construction or demolition operations, within 50
feet of any railroad property and affecting any
railroad bridge or trestle, tracks, road-beds,
tunnel, underpass or crossing.
However, Paragraph f. does not include that
part of any contract or agreement:
(b)
(1) That indemnifies an architect,
Such
engineer or surveyor for injury or
damage arising out of:
attorney fees
of the contract or agreement; or
Form HS 24 50 12 20
Page 6 of 7
Attachment Code: D633212 Master ID: 1530930, Certificate ID: 21650952
drawings,
orders or drawings and
opinions,
specifications; or
(b) Giving directions or instructions, or
failing to give them, if that is the
primary cause of the injury or
reports,
(a) Preparing, approving, or failing to
prepare or approve, maps, shop
surveys, field orders, change
if an (2)
architect, engineer or surveyor,
assumes liability for an injury or
damage arising out of the insured's
rendering or failure to render
professional services, including those
listed in (1) above and supervisory,
Under
inspection,architectural or
which
engineering activities.
the insured,
damage; or
All other terms and conditions in the policy remain
unchanged.
Form HS 24 50 12 20 Page 7 of 7
Attachment Code: D633212 Master ID: 1530930, Certificate ID: 21650952
Name Of Additional Insured Person(s)
Or Organization(s):
Designated Project(s) Or Location(s)
Of Covered Operations:
All, except Additional Insureds that
are insured under a separate additional
insured endorsement on this policy
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. With respect to those person(s) or organization(s)
shown in the Schedule above when you have
agreed in a written contract or written agreement to
provide insurance such as is afforded under this
policy to them, Subparagraph f., Any Other Party,
under the Additional Insureds When Required
By Written Contract, Written Agreement Or
Permit Paragraph of Section II —Who Is An
Insured is replaced with the following:
f. Any Other Party
Any other person or organization who is not an
insured under Paragraphs a. through e. above,
but only with respect to liability for "bodily
injury", "property damage" or "personal and
advertising injury" caused, in whole or in part,
by your acts or omissions or the acts or
omissions of those acting on your behalf:
(1) In the performance of your ongoing
operations for such additional insured at
the project(s) or location(s) designated in
the Schedule;
(2) In connection with your premises owned by
or rented to you and shown in the
Schedule; or
Form HS 24 80 07 13
(0)In connection with "your work"
for the additional insured at the project(s)
or location(s) designated in the Schedule
and included within the "products-
completed operations hazard", but only if:
(a) The written contract or written
agreement requires you to provide
such coverage to such additional
insured at the project(s) or location(s)
designated in the Schedule; and
(b) This Coverage Part provides
coverage for "bodily injury" or "property
damage" included within the
"products-completed operations
hazard".
The insurance afforded to the additional
insured shown in the Schedule applies:
(1) Only if the "bodily injury" or "property
damage"occurs,or the "personal and
advertising injury" offense is committed:
(a) During the policy period; and
(b) Subsequent to the execution of such
written contract or written agreement;
and
Page 1 of 2
© 2013, The Hartford
(Includes copyrighted material of Insurance Services Office, Inc., with its permission.)
POLICY NUMBER: 52UEABF5A9X
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - OPTION I
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Attachment Code: D633215 Master ID: 1530930, Certificate ID: 21650952
(c) Prior to the expiration of the period of
time that the written contract or written
agreement requires such insurance be
provided to the additional insured.
(2) Only to the extent permitted by law; and
(3) Will not be broader than that which you are
required by the written contract or written
agreement to provide for such additional
insured.
With respect to the insurance afforded to the
person(s) or organization(s) that are additional
insureds under this endorsement, the following
additional exclusion applies:
This insurance does not apply to "bodily injury",
"property damage" or "personal and
advertising injury" arising out of the rendering
of, or the failure to render, any professional
architectural, engineering or surveying
services, including:
(1) The preparing, approving, or failing to
prepare or approve maps, shop drawings,
opinions, reports, surveys, field orders,
change orders, designs or specifications;
or
(2) Supervisory, inspection, architectural or
engineering activities.
The limits of insurance that apply to the additional
insured shown in the Schedule are described in the
Limits Of Insurance section.
How this insurance applies when other insurance is
available to the additional insured is described in the
Other Insurance Condition in Section IV —
Commercial General Liability Conditions, except as
otherwise amended below.
B. With respect to insurance provided to the person(s)
or organization(s) that are additional insureds under
this endorsement, the When You Add Others As
An Additional Insured To This Insurance
subparagraph, under the Other Insurance
Condition of Section IV — Commercial General
Liability Conditions is replaced with the following:
Required By
When You Add Others As An Additional
Insured To This Insurance
Contract
This insurance is primary if you have agreed in
a written contract or written agreement that this
insurance be primary. If other insurance is also
primary, we will share with all that other
insurance by the method described in
Paragraph (c) below. This insurance does not
apply to other insurance to which the additional
insured in the Schedule has been added as an
additional insured.
(b) Primary And Non-Contributory To Other
Insurance When Required By Contract
This insurance is primary to and will not seek
contribution from any other insurance available
to an additional insured under your policy
provided that:
(i)The additional insured in the Schedule is a
(a)
Named Insured under such other
Primary
insurance; and
(ii) You have agreed in a written contract or
written agreement that this insurance
would be primary and would not seek
contribution from any other insurance
available to the additional insured in the
Schedule.
(c) 'Method Of Sharing
If all of the other insurance permits contribution
by equal shares, we will follow this method
also. Under this approach, each insurer
contributes equal amounts until it has paid its
applicable limit of insurance or none of the loss
remains, whichever comes first.
If any of the other insurance does not permit
contribution by equal shares, we will contribute
by limits. Under this method, each insurer's
share is based on the ratio of its applicable limit
of insurance to the total applicable limits of
insurance of all insurers.
All other terms and conditions in the policy remain
unchanged.
Insurance When
Page 2 of 2 Form HS 24 80 07 13
Attachment Code: D633215 Master ID: 1530930, Certificate ID: 21650952
POLICY NUMBER: 52UEABF5A9X COMMERCIAL GENERAL LIABILITY
CG 24 04 12 19
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
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
Name Of Person(s) Or Organization(s):
ANY PERSON OR ORGANIZATION FOR WHOM YOU ARE REQUIRED AND WHEN YOU HAVE AGREED IN
WRITING, BY WRITTEN CONTRACT OR AGREEMENT, TO OBTAIN THIS WAIVER FROM US
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
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
Attachment Code: D633216 Master ID: 1530930, Certificate ID: 21650952
This policy is subject to the following additional
Conditions:
A.If this policy is cancelled by the Company, other
than for nonpayment of premium, notice of such
cancellation will be provided at least thirty (30)
days in advance of the cancellation effective date
to the certificate holder(s) with mailing addresses
on file with the agent of record or the Company.
B.If this policy is cancelled by the Company for
nonpayment of premium, or by the insured, notice
of such cancellation will be provided within (10)
days of the cancellation effective date to the
certificate holder(s) with mailing addresses on file
with the agent of record or the Company.
If notice is mailed, proof of mailing to the last known
mailing address of the certificate holder(s) on file with
the agent of record or the Company will be sufficient
proof of notice.
Any notification rights provided by this endorsement
apply only to active certificate holder(s) who were
issued a certificate of insurance applicable to this
policy's term.
Failure to provide such notice to the certificate holder(s)
will not amend or extend the date the cancellation
becomes effective, nor will it negate cancellation of the
policy. Failure to send notice shall impose no liability of
any kind upon the Company or its agents or
representatives.
Form IH 03 13 06 11 Page 1 of 1
© 2011, The Hartford
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
NOTICE OF CANCELLATION TO CERTIFICATE HOLDER(S)
Attachment Code: D633217 Master ID: 1530930, Certificate ID: 21650952
1. BROAD FORM INSURED
Paragraph .1. - WHO IS AN INSURED - of Section
II - Liability Coverage is amended to add the
following:
d. Subsidiaries and Newly Acquired or Formed
Organizations
The Named Insured shown in the Declarations
is amended to include:
(1) Any legal business entity other than a
partnership or joint venture, formed as a
subsidiary in which you have an ownership
interest of more than 50% on the effective
date of the Coverage Form. However, the
Named Insured does not include any
subsidiary that is an "insured" under any
other automobile policy or would be an
"insured" under such a policy but for its
termination or the exhaustion of its Limit of
Insurance.
(2) Any organization that is acquired or formed
by you and over which you maintain
majority ownership. However, the Named
Insured does not include any newly formed
or acquired organization:
(a) That is a partnership or joint venture,
(b) That is an "insured" under any other
policy,
(c) That has exhausted its Limit of
Insurance under any other policy, or
(d) 180 days or more after its acquisition or
formation by you, unless you have
given us notice of the acquisition or
formation.
Coverage does not apply to "bodily injury"
or "property damage" that results from an
e. Employees as Insureds
(1). Any "employee" of yours while using a
covered "auto" you don't own, hire or
borrow in your business or your personal
affairs.
f. Lessors as Insureds
(1). The lessor of a covered "auto" while the
"auto" is leased to you under a written
agreement if:
(a) The agreement requires you to provide
direct primary insurance for the lessor
and
(b) The "auto" is leased without a driver.
Such a leased "auto" will be considered a
covered "auto" you own and not a covered
"auto" you hire.
g. Additional Insured if Required by Contract
(1) When you have agreed, in a written
contract or written agreement, that a
person or organization be added as an
additional insured on your business auto
policy, such person or organization is an
"insured", but only to the extent such
person or organization is liable for "bodily
injury" or "property damage" caused by
the conduct of an "insured" under
paragraphs a. or b. of Who Is An Insured
with regard to the ownership, maintenance
or use of a covered "auto."
The insurance afforded to any such
additional insured applies only if the "bodily
injury" or "property damage" occurs:
(a) During the policy period, and
(b) Subsequent to the execution of such
written contract, and
"accident" that occurred before you formed
or acquired the organization.
Form HA 99 16 12 21 Page 1 of 5
© 2021, The Hartford
(Includes copyrighted material of Insurance Services Office, Inc. with its permission.)
COMMERCIAL AUTOMOBILE
HA 99 16 12 21
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
COMMERCIAL AUTOMOBILE BROAD FORM
ENDORSEMENT
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
To the extent that the provisions of this endorsement provide broader benefits to the "insured" than other
provisions of the Coverage Form, the provisions of this endorsement apply.
Attachment Code: D633218 Master ID: 1530930, Certificate ID: 21650952
(c) Prior to the expiration of the period of
time that the written contract requires
such insurance be provided to the
additional insured.
(2) How Limits Apply
If you have agreed in a written contract or
written agreement that another person or
organization be added as an additional
insured on your policy, the most we will pay
on behalf of such additional insured is the
lesser of:
(a) The limits of insurance specified in the
written contract or written agreement;
or
(b) The Limits of Insurance shown in the
Declarations.
Such amount shall be a part of and not in
addition to Limits of Insurance shown in the
Declarations and described in this Section.
(3) Additional Insureds Other Insurance
If we cover a claim or "suit" under this
Coverage Part that may also be covered by
other insurance available to an additional
insured, such additional insured must
submit such claim or "suit" to the other
insurer for defense and indemnity.
However, this provision does not apply
to the extent that you have agreed in a
written contract or written agreement
that this insurance is primary and non-
contributory with the additional insured's
own insurance.
(4) Duties in The Event Of Accident, Claim, Suit
or Loss
If you have agreed in a written contract or
written agreement that another person or
organization be added as an additional
insured on your policy, the additional
insured shall be required to comply with the
provisions in LOSS CONDITIONS 2. -
DUTIES IN THE EVENT OF ACCIDENT,
CLAIM , SUIT OR LOSS - OF SECTION IV
- BUSINESS AUTO CONDITIONS, in the
same manner as the Named Insured.
2. Primary and Non-Contributory if Required by
Contract
Only with respect to insurance provided to an
additional insured in A.1.g. - Additional Insured
If Required by Contract, the following
provisions apply:
all such other
This insurance is primary if you have
agreed in a written contract or written
agreement that this insurance be primary.
If other insurance is also primary, we will
share with all that other insurance by the
method described in Other Insurance 5.d.
(2) Primary And Non-Contributory To Other
Insurance When Required By Contract
If you have agreed in a written contract or
written agreement that this insurance is
primary and non-contributory with the
additional insured's own insurance, this
insurance is primary and we will not seek
contribution from that other insurance.
Paragraphs (1) and (2) do not apply to other
insurance to which the additional insured has
been added as an additional insured.
When this insurance is excess, we will have no
duty to defend the insured against any "suit" if
any other insurer has a duty to defend the
insured against that "suit". If no other insurer
defends, we will undertake to do so, but we will
be entitled to the insured's rights against all
those other insurers.
When this insurance is excess over other
insurance, we will pay only our share of the
amount of the loss, if any, that exceeds the sum
of:
insurance would pay for the loss in the
absence of this insurance; and
(2) The total of all deductible and self-insured
amounts under all that other insurance.
We will share the remaining loss, if any, by the
method described in SECTION IV-Business
Auto Conditions, B. General Conditions, Other
Insurance 5.d.
3. AUTOS RENTED BY EMPLOYEES
Any "auto" hired or rented by your "employee" on
your behalf and at your direction will be considered
an "auto" you hire.
The SECTION IV- Business Auto Conditions, B.
(1) The
General Conditions,5.OTHER INSURANCE
total
Condition is amended by adding the following:
e. If an "employee's" personal insurance also
applies on an excess basis to a covered "auto"
hired or rented by your "employee" on your
behalf and at your direction, this insurance will
be primary to the "employee's" personal
insurance.
amount that
(1) Primary Insurance When Required By
Contract
Page 2 of 5 Form HA 99 16 12 21
Attachment Code: D633218 Master ID: 1530930, Certificate ID: 21650952
6. PHYSICAL
Under SECTION III -PHYSICAL DAMAGE
DAMAGE
COVERAGE, in the event of a total "loss" to a
covered "auto", we will pay your additional legal
- ADDITIONAL
4. AMENDED FELLOW EMPLOYEE EXCLUSION
EXCLUSION 5. - FELLOW EMPLOYEE - of
SECTION II - LIABILITY COVERAGE does not
apply if you have workers' compensation
insurance in-force covering all of your
"employees".
Coverage is excess over any other collectible
insurance.
5. HIRED AUTO PHYSICAL DAMAGE COVERAGE
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 or borrow, subject to
the following limit.
The most we will pay for "loss" to any hired "auto"
is:
(1) $100,000;
(2) The actual cash value of the damaged or stolen
property at the time of the "loss"; or
(3) The cost of repairing or replacing the damaged
or stolen property,
whichever is smallest, minus a deductible. The
deductible will be equal to the largest deductible
applicable to any owned "auto" for that coverage.
No deductible applies to "loss" caused by fire or
lightning. Hired Auto Physical Damage coverage is
excess over any other collectible insurance. 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.
We will also cover loss of use of the hired "auto" if it
results from an "accident", you are legally liable and
the lessor incurs an actual financial loss, subject to
a maximum of $1000 per "accident".
This extension of coverage does not apply to any
"auto" you hire or borrow from any of your
"employees", partners (if you are a partnership),
members (if you are a limited liability company), or
members of their households.
TEMPORARY TRANSPORTATION EXPENSE
COVERAGE
Paragraph A.4.a. of SECTION III - PHYSICAL
DAMAGE COVERAGE is amended to provide a
limit of $50 per day and a maximum limit of $1,000.
7. LOAN/LEASE GAP COVERAGE
obligation for any difference between the actual
cash value of the "auto" at the time of the "loss" and
the "outstanding balance" of the loan/lease.
"Outstanding balance" means the amount you owe
on the loan/lease at the time of "loss" less any
amounts representing taxes; overdue payments;
penalties, interest or charges resulting from
overdue payments; additional mileage charges;
excess wear and tear charges; lease termination
fees; security deposits not returned by the lessor;
costs for extended warranties, credit life
Insurance, health, accident or disability insurance
purchased with the loan or lease; and carry-over
balances from previous loans or leases.
8.AIRBAG COVERAGE
Under Paragraph B. EXCLUSIONS - of SECTION
following is added:
The exclusion relating to mechanical breakdown
does not apply to the accidental discharge of an
airbag.
9.ELECTRONIC EQUIPMENT - BROADENED
COVERAGE
a. The exceptions to Paragraphs B.4 EXCLUSIONS
III
-of SECTION III -PHYSICAL DAMAGE
-
COVERAGE are replaced by the following:
Exclusions 4.c. and 4.d. do not apply to
equipment designed to be operated solely by
use of the power from the "auto's" electrical
system that, at the time of "loss", is:
(1) Permanently installed in or upon the
covered "auto";
(2) Removable from a housing unit which is
permanently installed in or upon the covered
"auto";
(3) An integral part of the same unit housing any
PHYSICAL
electronic equipment described in
DAMAGE
Paragraphs (1) and (2) above; or
(4) Necessary for the normal operation of the
covered "auto" or the monitoring of the
covered "auto's" operating system.
b. Section III, Physical Damage Coverage, Limit of
Insurance, Paragraph C.2. is amended to add
the following:
$1,500 is the most we will pay for "loss" in any
one "accident" to all electronic equipment (other
than equipment designed solely for the
reproduction of sound, and accessories used
with such equipment) that reproduces, receives
or transmits audio, visual or data signals which,
at the time of "loss", is:
COVERAGE,the
Form HA 99 16 12 21 Page 3 of 5
Attachment Code: D633218 Master ID: 1530930, Certificate ID: 21650952
or is an integral part of that
in
equipment; or
(3) An integral part of such equipment.
c. For each covered "auto", should loss be limited
to electronic equipment only, our obligation to
pay for, repair, return or replace damaged or
stolen electronic equipment will be reduced by
the applicable deductible shown in the
Declarations, or $250, whichever deductible is
less.
10. EXTRA EXPENSE - BROADENED COVERAGE
Under Paragraph A. - COVERAGE - of SECTION
III - PHYSICAL DAMAGE COVERAGE, we will pay
for the expense of returning a stolen covered "auto"
to you.
11. GLASS REPAIR - WAIVER OF DEDUCTIBLE
Under Paragraph D. - DEDUCTIBLE - of SECTION
or
III -PHYSICAL DAMAGE COVERAGE,the
upon
following is added:
No deductible applies to glass damage if the glass
is repaired rather than replaced.
12. TWO OR MORE DEDUCTIBLES
Under Paragraph D. - DEDUCTIBLE - of SECTION
the
III -PHYSICAL DAMAGE COVERAGE,the
(1) Permanently
following is added:
If another Hartford Financial Services Group, Inc.
company policy or coverage form that is not an
automobile policy or coverage form applies to the
same "accident", the following applies:
(1) If the deductible under this Business Auto
Coverage Form is the smaller (or smallest)
deductible, it will be waived;
(2) If the deductible under this Business Auto
Coverage Form is not the smaller (or smallest)
deductible, it will be reduced by the amount of
the smaller (or smallest) deductible.
13. AMENDED DUTIES IN THE EVENT OF
ACCIDENT, CLAIM, SUIT OR LOSS
The requirement in LOSS CONDITIONS 2.a. -
DUTIES IN THE EVENT OF ACCIDENT, CLAIM,
SUIT OR LOSS - of SECTION IV - BUSINESS
AUTO CONDITIONS that you must notify us of an
"accident" applies only when the "accident" is
known to:
(1) You, if you are an individual;
covered "auto" in a housing, opening or
other location that is not normally used by
the "auto" manufacturer for the installation
of such equipment;
(2) Removable from a permanently installed
housing unit as described in Paragraph 2.a.
installed
above
(2) A partner, if you are a partnership;
(3) A member,if you are a limited liability
company; or
(4) An executive officer or insurance manager, if
you are a corporation.
14. UNINTENTIONAL FAILURE TO DISCLOSE
HAZARDS
If you unintentionally fail to disclose any hazards
existing at the inception date of your policy, we will
not deny coverage under this Coverage Form
because of such failure.
15. HIRED AUTO - COVERAGE TERRITORY
SECTION IV, BUSINESS AUTO CONDITIONS,
PARAGRAPH B. GENERAL CONDITIONS, 7. -
POLICY PERIOD, COVERAGE TERRITORY - is
added to include the following:
(6) For short-term hired "autos", the coverage
territory with respect to Liability Coverage is
anywhere in the world provided that if the
"insured's" responsibility to pay damages for
"bodily injury" or "property damage" is
determined in a "suit," the "suit" is brought in
the United States of America, the territories
and possessions of the United States of
America, Puerto Rico or Canada or in a
settlement we agree to.
16. WAIVER OF SUBROGATION
Paragraph 5. TRANSFER OF RIGHTS OF
RECOVERY AGAINST OTHERS TO US - of
SECTION IV - BUSINESS AUTO CONDITIONS A.
Loss Conditions is amended by adding the
following:
We waive any right of recovery we may have
against any person or organization with whom you
have a written contract that requires such waiver
because of payments we make for damages under
this Coverage Form.
17. RESULTANT MENTAL ANGUISH COVERAGE
The definition of "bodily injury" in SECTION V-
DEFINITIONS, C. is replaced by the following:
"Bodily injury" means bodily injury, sickness or
disease sustained by any person, including mental
anguish or death resulting from any of these.
18. EXTENDED CANCELLATION CONDITION
Paragraph 2. of the COMMON POLICY
CONDITIONS - CANCELLATION - applies except
as follows:
If we cancel for any reason other than nonpayment
of premium, we will mail or deliver to the first
Named Insured written notice of cancellation at
least 60 days before the effective date of
cancellation.
Page 4 of 5 Form HA 99 16 12 21
Attachment Code: D633218 Master ID: 1530930, Certificate ID: 21650952
19.HYBRID,ELECTRIC,OR NATURAL GAS
VEHICLE PAYMENT COVERAGE
In the event of a total loss to a "non-hybrid" auto for
which Comprehensive, Specified Causes of Loss,
or Collision coverages are provided under this
Coverage Form, then such Physical Damage
Coverages are amended as follows:
a.If the auto is replaced with a "hybrid" auto or an
auto powered solely by electricity or natural
gas, we will pay an additional 10%, to a
maximum of $2,500, of the "non-hybrid" auto's
actual cash value or replacement cost,
whichever is less,
b.The auto must be replaced and a copy of a bill
of sale or new lease agreement received by us
within 60 calendar days of the date of "loss,"
c.Regardless of the number of autos deemed a
total loss, the most we will pay under this
Hybrid, Electric, or Natural Gas Vehicle
Payment Coverage provision for any one "loss"
is $10,000.
For the purposes of the coverage provision,
b. A "hybrid" auto is defined as an auto with an
internal combustion engine and one or more
electric motors; and that uses the internal
combustion engine and one or more electric
motors to move the auto, or the internal
combustion engine to charge one or more
electric motors, which move the auto.
20. VEHICLE WRAP COVERAGE
In the event of a total loss to an "auto" for which
Comprehensive, Specified Causes of Loss, or
Collision coverages are provided under this
Coverage Form, then such Physical Damage
Coverages are amended to add the following:
In addition to the actual cash value of the "auto", we
will pay up to $1,000 for vinyl vehicle wraps which
are displayed on the covered "auto" at the time of
total loss. Regardless of the number of autos
deemed a total loss, the most we will pay under this
Vehicle Wrap Coverage provision for any one "loss"
is $5,000. For purposes of this coverage provision,
signs or other graphics painted or magnetically
affixed to the vehicle are not considered vehicle
wraps.
a. A "non-hybrid" auto is defined as an auto that
uses only an internal combustion engine to
move the auto but does not include autos
powered solely by electricity or natural gas.
Form HA 99 16 12 21 Page 5 of 5
Attachment Code: D633218 Master ID: 1530930, Certificate ID: 21650952
City of Renton Attn: Michael Sippo
1055 South Grady Way
Renton WA 98057
To whom it may concern:
In our continuing effort to provide timely certificate delivery, Lockton Companies is transitioning
to paperless delivery of Certificates of Insurance, thus this is your final hard-copy delivery.
To ensure electronic delivery for future renewals of this certificate, we need your email address.
Please contact us via one of the methods below, referencing Certificate ID 21650952.
Email: mountainwestedelivery@lockton.com
Phone: 303-728-8060
If you received this certificate through an internet link where the current certificate is viewable,
we have your email and no further action is needed.
In the event your mailing address has changed, will change in the future, or you no longer
require this certificate, please let us know using one of the methods above.
The above inbox and phone number is for automating electronic delivery of certificates only.
Please do NOT send future certificate requests to this inbox or contact the phone number
below with email updates.
Thank you for your cooperation and willingness in reducing our environmental footprint.
Lockton Companies
Lockton Companies
8110 E. Union Avenue, Suite 100
Denver, CO 80237
Attachment Code: D644713 Master ID: 1530930, Certificate ID: 21650952