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Insurance Certificate for King County AFIS lab C18000069.pdf
ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED? INSR ADDL SUBRLTRINSDWVD 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 AGGJECT 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 LIMITDESCRIPTION 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.ACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) $ $ $ $ $ The ACORD name and logo are registered marks of ACORD RBEEBE 10/18/2018 WESTVEN-01 B CUP-1L875046-18-26 B BA-9K374275-18-26-G A DT-CO-1L400772-PHX-18 A DT-CO-1L400772-PHX-18 B QT-660-3L216417-TIL-18 1,000,000 1,000,000 1,000,000 10,000 4,000,000 4,000,000 2,000,000 1,000,000 2,000,000 STOP GAP - $1MM 10,000 300,000 1,000,000 1,000,000 X X X X X X X X X C EGL0006064 08/15/2018 08/15/2019 08/15/2018 08/15/2019 11/05/2018 07/03/2019 08/15/2018 08/15/2019 08/15/2018 08/15/2019 10/17/2018 10/17/2019 RE: Contract #C01187C17; Regional AFIS Laboratory Replacement King County, its officers, officials, employees, agents, and representatives are included as an Additional Insured, coverage is primary and non-contributory and waiver of subrogation applies per the attached form(s)/endorsement(s). Hub International Northwest LLC 12100 NE 195th Street, Suite 200 Bothell, WA 98011 (425) 485-8489(425) 489-4500 King County Procurement & Payables Section Chinook Building, 3rd Floor 401 Fifth Avenue Seattle, WA 98104-1598 Western Ventures Construction, Inc. P.O. Box 298 Mountlake Terrace, WA 98043-0298 The Phoenix Insurance Company Travelers Property Casualty Company of America Mt. Hawley Insurance Company 25623 25674 37974 X X X X now.info@hubinternational.com X X X LIMIT: OCC/AGGREGATE: 6,193,000 2,000,000 BUILDERS RISK POLLUTION '311)6'-%0 +)2)6%0 0-%&-0-8= 8,-7 )2(367)1)28 ',%2+)7 8,) 430-'= 40)%7) 6)%( -8 '%6)*900= &0%2/)8 %((-8-32%0 -2796)( '3286%'8367 8LMW IRHSVWIQIRX QSHMJMIW MRWYVERGI TVSZMHIH YRHIV XLI JSPPS[MRK '311)6'-%0 +)2)6%0 0-%&-0-8= '3:)6%+) 4%68 G ;,3 -7 %2 -2796)( 7IGXMSR -- MW EQIRHIH 8LI MRWYVERGI TVSZMHIH XS XLI EHHMXMSREP MR XS MRGPYHI ER] TIVWSR SV SVKERM^EXMSR XLEX ]SY WYVIH HSIW RSX ETTP] XS FSHMP] MRNYV] SV EKVII MR E [VMXXIR GSRXVEGX VIUYMVMRK MRWYVERGITVSTIVX] HEQEKI GEYWIH F] ]SYV [SVO XS MRGPYHI EW ER EHHMXMSREP MRWYVIH SR XLMW 'SZIVERH MRGPYHIH MR XLI TVSHYGXWGSQTPIXIH ST EKI 4EVX FYX IVEXMSRW LE^EVH YRPIWW XLI [VMXXIR GSRXVEGX VIUYMVMRK MRWYVERGI WTIGMJMGEPP] VIUYMVIW ]SYE 3RP] [MXL VIWTIGX XS PMEFMPMX] JSV FSHMP] MRNYV]XS TVSZMHI WYGL GSZIVEKI JSV XLEX EHHMXMSREPTVSTIVX] HEQEKI SV TIVWSREP MRNYV] ERH MRWYVIH ERH XLIR XLI MRWYVERGI TVSZMHIH XS F -J ERH SRP] XS XLI I\XIRX XLEX XLI MRNYV] SV XLI EHHMXMSREP MRWYVIH ETTPMIW SRP] XS WYGL HEQEKI MW GEYWIH F] EGXW SV SQMWWMSRW SJ FSHMP] MRNYV] SV TVSTIVX] HEQEKI XLEX SG ]SY SV ]SYV WYFGSRXVEGXSV MR XLI TIVJSVQERGI GYVW FIJSVI XLI IRH SJ XLI TIVMSH SJ XMQI JSV SJ]SYV[SVOXS[LMGLXLI[VMXXIRGSRXVEGX [LMGL XLI [VMXXIR GSRXVEGX VIUYMVMRK MRWYV VIUYMVMRK MRWYVERGI ETTPMIW 8LI TIVWSR SV ERGI VIUYMVIW ]SY XS TVSZMHI WYGL GSZIVEKI SVKERM^EXMSR HSIW RSX UYEPMJ] EW ER EHHMXMSREP SV XLI IRH SJ XLI TSPMG] TIVMSH [LMGLIZIV MW MRWYVIH [MXL VIWTIGX XS XLI MRHITIRHIRX EGXW IEVPMIV SV SQMWWMSRW SJ WYGL TIVWSR SV SVKERM^EXMSR8LI MRWYVERGI TVSZMHIH XS XLI EHHMXMSREP MRWYVIH 8LI MRWYVERGI TVSZMHIH XS XLI EHHMXMSREP MRWYVIH F] XLMW IRHSVWIQIRX MW I\GIWW SZIV ER] ZEPMH ERH F] XLMW IRHSVWIQIRX MW PMQMXIH EW JSPPS[W GSPPIGXMFPI SXLIV MRWYVERGI [LIXLIV TVMQEV] I\GIWW GSRXMRKIRX SV SR ER] SXLIV FEWMW XLEX MWE -R XLI IZIRX XLEX XLI 0MQMXW SJ -RWYVERGI SJ EZEMPEFPI XS XLI EHHMXMSREP MRWYVIH JSV E PSWW [IXLMW 'SZIVEKI 4EVX WLS[R MR XLI (IGPEVEXMSRW GSZIV YRHIV XLMW IRHSVWIQIRX ,S[IZIV MJ XLII\GIIH XLI PMQMXW SJ PMEFMPMX] VIUYMVIH F] XLI [VMXXIR GSRXVEGX VIUYMVMRK MRWYVERGI WTIGMJMGEPP][VMXXIR GSRXVEGX VIUYMVMRK MRWYVERGI XLI MR VIUYMVIW XLEX XLMW MRWYVERGI ETTP] SR E TVMQEV]WYVERGI TVSZMHIH XS XLI EHHMXMSREP MRWYVIH FEWMW SV E TVMQEV] ERH RSRGSRXVMFYXSV] FEWMWWLEPP FI PMQMXIH XS XLI PMQMXW SJ PMEFMPMX] VI XLMW MRWYVERGI MW TVMQEV] XS SXLIV MRWYVERGIUYMVIH F] XLEX [VMXXIR GSRXVEGX VIUYMVMRK MR EZEMPEFPI XS XLI EHHMXMSREP MRWYVIH [LMGL GSZIVWWYVERGI 8LMW IRHSVWIQIRX WLEPP RSX MR XLEX TIVWSR SV SVKERM^EXMSR EW E REQIH MRWYVIHGVIEWI XLI PMQMXW SJ MRWYVERGI HIWGVMFIH MR JSVWYGLPSWWERH[I[MPPRSXWLEVI[MXLXLEX7IGXMSR0MQMXW 3J -RWYVERGI--- SXLIV MRWYVERGI &YX XLI MRWYVERGI TVSZMHIH XSF 8LI MRWYVERGI TVSZMHIH XS XLI EHHMXMSREP MRXLI EHHMXMSREP MRWYVIH F] XLMW IRHSVWIQIRX WXMPP MWWYVIH HSIW RSX ETTP] XS FSHMP] MRNYV] TVSTI\GIWW SZIV ER] ZEPMH ERH GSPPIGXMFPI SXLIV MRIVX] HEQEKI SV TIVWSREP MRNYV] EVMWMRK SYX WYVERGI [LIXLIV TVMQEV] I\GIWW GSRXMRKIRX SVSJ XLI VIRHIVMRK SJ SV JEMPYVI XS VIRHIV ER]SR ER] SXLIV FEWMW XLEX MW EZEMPEFPI XS XLI EHHMTVSJIWWMSREP EVGLMXIGXYVEP IRKMRIIVMRK SV WYVXMSREP MRWYVIH [LIR XLEX TIVWSR SV SVKERM^EXMSR MWZI]MRK WIVZMGIW MRGPYHMRK ER EHHMXMSREP MRWYVIH YRHIV WYGL SXLIV MRWYV M8LI TVITEVMRK ETTVSZMRK SV JEMPMRK XS ERGI TVITEVI SV ETTVSZI QETW WLST HVE[%W E GSRHMXMSR SJ GSZIVEKI TVSZMHIH XS XLIMRKW STMRMSRW VITSVXW WYVZI]W JMIPH SVEHHMXMSREP MRWYVIH F] XLMW IRHSVWIQIRX HIVW SV GLERKI SVHIVW SV XLI TVITEVMRK E 8LI EHHMXMSREP MRWYVIH QYWX KMZI YW [VMXXIRETTVSZMRK SV JEMPMRK XS TVITEVI SV ET RSXMGI EW WSSR EW TVEGXMGEFPI SJ ER SGGYVTVSZI HVE[MRKW ERH WTIGMJMGEXMSRW ERH VIRGI SV ER SJJIRWI [LMGL QE] VIWYPX MR EMM7YTIVZMWSV] MRWTIGXMSR EVGLMXIGXYVEP SV GPEMQ 8S XLI I\XIRX TSWWMFPI WYGL RSXMGIIRKMRIIVMRK EGXMZMXMIWWLSYPH MRGPYHI '+ ( 8LI 7X 4EYP 8VEZIPIVW 'SQTERMIW -RG4EKI SJ Policy #CO-1L400772 '311)6'-%0 +)2)6%0 0-%&-0-8= ER] TVSZMHIV SJ SXLIV MRWYVERGI [LMGL [SYPHM,S[ [LIR ERH [LIVI XLI SGGYVVIRGI GSZIV XLI EHHMXMSREP MRWYVIH JSV E PSWW [ISV SJJIRWI XSSO TPEGI GSZIV YRHIV XLMW IRHSVWIQIRX ,S[IZIV XLMWMM8LI REQIW ERH EHHVIWWIW SJ ER] MRNYVIH GSRHMXMSR HSIW RSX EJJIGX [LIXLIV XLI MRWYVTIVWSRW ERH [MXRIWWIW ERH ERGI TVSZMHIH XS XLI EHHMXMSREP MRWYVIH F] MMM8LI REXYVI ERH PSGEXMSR SJ ER] MRNYV] SV XLMW IRHSVWIQIRX MW TVMQEV] XS SXLIV MRWYV HEQEKI EVMWMRK SYX SJ XLI SGGYVVIRGI SV ERGI EZEMPEFPI XS XLI EHHMXMSREP MRWYVIH SJJIRWI[LMGL GSZIVW XLEX TIVWSR SV SVKERM^EXMSR EW E REQIH MRWYVIH EW HIWGVMFIH MR TEVEKVETL F -J E GPEMQ MW QEHI SV WYMX MW FVSYKLX EKEMRWX EFSZIXLI EHHMXMSREP MRWYVIH XLI EHHMXMSREP MRWYVIH QYWX 8LI JSPPS[MRK HIJMRMXMSR MW EHHIH XS 7)'8-32 : ()*-2-8-327 M-QQIHMEXIP] VIGSVH XLI WTIGMJMGW SJ XLI GPEMQ SV WYMX ERH XLI HEXI VIGIMZIH ERH ;VMXXIR GSRXVEGX VIUYMVMRK MRWYVERGI QIERW XLEX TEVX SJ ER] [VMXXIR GSRXVEGX SV EKVIIQIRXMM2SXMJ] YW EW WSSR EW TVEGXMGEFPI YRHIV [LMGL ]SY EVI VIUYMVIH XS MRGPYHI E8LI EHHMXMSREP MRWYVIH QYWX WII XS MX XLEX [I TIVWSR SV SVKERM^EXMSR EW ER EHHMXMSREP MRVIGIMZI [VMXXIR RSXMGI SJ XLI GPEMQ SV WYMX EW WYVIH SR XLMW 'SZIVEKI 4EVX TVSZMHIH XLEXWSSR EW TVEGXMGEFPIXLI FSHMP] MRNYV] ERH TVSTIVX] HEQEKI SG G 8LI EHHMXMSREP MRWYVIH QYWX MQQIHMEXIP]GYVW ERH XLI TIVWSREP MRNYV] MW GEYWIH F] ER WIRH YW GSTMIW SJ EPP PIKEP TETIVW VIGIMZIH MR SJJIRWI GSQQMXXIH GSRRIGXMSR [MXL XLI GPEMQ SV WYMX GSSTIVEXI E%JXIV XLI WMKRMRK ERH I\IGYXMSR SJ XLI[MXL YW MR XLI MRZIWXMKEXMSR SV WIXXPIQIRX SJ GSRXVEGX SV EKVIIQIRX F] ]SY XLI GPEMQ SV HIJIRWI EKEMRWX XLI WYMX ERH F;LMPI XLEX TEVX SJ XLI GSRXVEGX SVSXLIV[MWI GSQTP] [MXL EPP TSPMG] GSRHMXMSRW EKVIIQIRX MW MR IJJIGX ERHH 8LI EHHMXMSREP MRWYVIH QYWX XIRHIV XLI HI G&IJSVI XLI IRH SJ XLI TSPMG] TIVMSHJIRWI ERH MRHIQRMX] SJ ER] GPEMQ SV WYMX XS 4EKI SJ 8LI 7X 4EYP 8VEZIPIVW 'SQTERMIW -RG'+ ( COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS XTEND ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE – This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to this Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. Aircraft Chartered With Pilot B. Damage To Premises Rented To You C. Increased Supplementary Payments D. Incidental Medical Malpractice E. Who Is An Insured – Newly Acquired Or Formed Organizations F. Who Is An Insured – Broadened Named Insured – Unnamed Subsidiaries G. Blanket Additional Insured – Owners, Managers Or Lessors Of Premises H. Blanket Additional Insured – Lessors Of Leased Equipment I. Blanket Additional Insured – States Or Political Subdivisions – Permits J. Knowledge And Notice Of Occurrence Or Offense K. Unintentional Omission L. Blanket Waiver Of Subrogation M. Amended Bodily Injury Definition N. Contractual Liability – Railroads PROVISIONS A. AIRCRAFT CHARTERED WITH PILOT The following is added to Exclusion g., Aircraft, Auto Or Watercraft, in Paragraph 2. of SECTION I – COVERAGES – COVERAGE A BODILY IN- JURY AND PROPERTY DAMAGE LIABILITY: This exclusion does not apply to an aircraft that is: (a) Chartered with a pilot to any insured; (b) Not owned by any insured; and (c) Not being used to carry any person or prop- erty for a charge. B. DAMAGE TO PREMISES RENTED TO YOU 1.The first paragraph of the exceptions in Ex- clusion j., Damage To Property, in Para- graph 2. of SECTION I – COVERAGES – COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY is deleted. 2.The following replaces the last paragraph of Paragraph 2., Exclusions, of SECTION I – COVERAGES – COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LI- ABILITY: Exclusions c. and g. through n. do not apply to "premises damage". Exclusion f.(1)(a) does not apply to "premises damage" caused by: a.Fire; b.Explosion; c.Lightning; d.Smoke resulting from such fire, explosion, or lightning; or e.Water; unless Exclusion f. of Section I – Coverage A – Bodily Injury And Property Damage Liability is replaced by another endorsement to this Coverage Part that has Exclusion – All Pollu- tion Injury Or Damage or Total Pollution Ex- clusion in its title. A separate limit of insurance applies to "premises damage" as described in Para- graph 6. of SECTION III – LIMITS OF IN- SURANCE. CG D3 16 11 11 © 2011 The Travelers Indemnity Company. All rights reserved. Page 1 of 6 Policy #CO-1L400772 COMMERCIAL GENERAL LIABILITY 3.The following replaces Paragraph 6. of SEC- TION III – LIMITS OF INSURANCE: Subject to 5. above, the Damage To Prem- ises Rented To You Limit is the most we will pay under Coverage A for damages because of "premises damage" to any one premises. The Damage To Premises Rented To You Limit will apply to all "property damage" proximately caused by the same "occur- rence", whether such damage results from: fire; explosion; lightning; smoke resulting from such fire, explosion, or lightning; or water; or any combination of any of these causes. The Damage To Premises Rented To You Limit will be: a.The amount shown for the Damage To Premises Rented To You Limit on the Declarations of this Coverage Part; or b.$300,000 if no amount is shown for the Damage To Premises Rented To You Limit on the Declarations of this Coverage Part. 4.The following replaces Paragraph a. of the definition of "insured contract" in the DEFINI- TIONS Section: a.A contract for a lease of premises. How- ever, that portion of the contract for a lease of premises that indemnifies any person or organization for "premises damage" is not an "insured contract"; 5.The following is added to the DEFINITIONS Section: "Premises damage" means "property dam- age" to: a.Any premises while rented to you or tem- porarily occupied by you with permission of the owner; or b.The contents of any premises while such premises is rented to you, if you rent such premises for a period of seven or fewer consecutive days. 6.The following replaces Paragraph 4.b.(1)(b) of SECTION IV – COMMERCIAL GENERAL LIABILITY CONDITIONS: (b) That is insurance for "premises damage"; or 7.Paragraph 4.b.(1)(c) of SECTION IV – COMMERCIAL GENERAL LIABILITY CON- DITIONS is deleted. C. INCREASED SUPPLEMENTARY PAYMENTS 1.The following replaces Paragraph 1.b. of SUPPLEMENTARY PAYMENTS – COVER- AGES A AND B of SECTION I – COVER- AGE: b.Up to $2,500 for the cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to fur- nish these bonds. 2.The following replaces Paragraph 1.d. of SUPPLEMENTARY PAYMENTS – COVER- AGES A AND B of SECTION I – COVER- AGES: d.All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or "suit", including actual loss of earnings up to $500 a day because of time off from work. D. INCIDENTAL MEDICAL MALPRACTICE 1.The following is added to the definition of "oc- currence" in the DEFINITIONS Section: "Occurrence" also means an act or omission committed in providing or failing to provide "incidental medical services", first aid or "Good Samaritan services" to a person. 2.The following is added to Paragraph 2.a.(1) of SECTION II – WHO IS AN INSURED: Paragraph (1)(d) above does not apply to "bodily injury" arising out of providing or fail- ing to provide: (i) "Incidental medical services" by any of your "employees" who is a nurse practi- tioner, registered nurse, licensed practical nurse, nurse assistant, emergency medi- cal technician or paramedic; or (ii) First aid or "Good Samaritan services" by any of your "employees" or "volunteer workers", other than an employed or vol- unteer doctor. Any such "employees" or "volunteer workers" providing or failing to provide first aid or "Good Samaritan ser- vices" during their work hours for you will be deemed to be acting within the scope of their employment by you or performing duties related to the conduct of your busi- ness. Page 2 of 6 © 2011 The Travelers Indemnity Company. All rights reserved. CG D3 16 11 11 COMMERCIAL GENERAL LIABILITY 3.The following is added to Paragraph 5. of SECTION III – LIMITS OF INSURANCE: For the purposes of determining the applica- ble Each Occurrence Limit, all related acts or omissions committed in providing or failing to provide "incidental medical services", first aid or "Good Samaritan services" to any one per- son will be deemed to be one "occurrence". 4.The following exclusion is added to Para- graph 2., Exclusions, of SECTION I – COV- ERAGES – COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY: Sale Of Pharmaceuticals "Bodily injury" or "property damage" arising out of the willful violation of a penal statute or ordinance relating to the sale of pharmaceuti- cals committed by, or with the knowledge or consent of, the insured. 5.The following is added to the DEFINITIONS Section: "Incidental medical services" means: a.Medical, surgical, dental, laboratory, x-ray or nursing service or treatment, advice or instruction, or the related furnishing of food or beverages; or b.The furnishing or dispensing of drugs or medical, dental, or surgical supplies or appliances. "Good Samaritan services" means any emer- gency medical services for which no compen- sation is demanded or received. 6.The following is added to Paragraph 4.b., Ex- cess Insurance, of SECTION IV – COM- MERCIAL GENERAL LIABILITY CONDI- TIONS: The insurance is excess over any valid and collectible other insurance available to the in- sured, whether primary, excess, contingent or on any other basis, that is available to any of your "employees" or "volunteer workers" for "bodily injury" that arises out of providing or failing to provide "incidental medical ser- vices", first aid or "Good Samaritan services" to any person to the extent not subject to Paragraph 2.a.(1) of Section II – Who Is An Insured. E. WHO IS AN INSURED – NEWLY ACQUIRED OR FORMED ORGANIZATIONS The following replaces Paragraph 4. of SECTION II – WHO IS AN INSURED: 4.Any organization you newly acquire or form, other than a partnership, joint venture or lim- ited liability company, of which you are the sole owner or in which you maintain the ma- jority ownership interest, will qualify as a Named Insured if there is no other insurance which provides similar coverage to that or- ganization. However: a.Coverage under this provision is afforded only: (1) Until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier, if you do not report such organization in writing to us within 180 days after you acquire or form it; or (2) Until the end of the policy period, when that date is later than 180 days after you acquire or form such organization, if you report such organization in writing to us within 180 days after you acquire or form it, and we agree in writing that it will con- tinue to be a Named Insured until the end of the policy period; b.Coverage A does not apply to "bodily injury" or "property damage" that occurred before you acquired or formed the organization; and c.Coverage B does not apply to "personal in- jury" or "advertising injury" arising out of an offense committed before you acquired or formed the organization. F. WHO IS AN INSURED – BROADENED NAMED INSURED – UNNAMED SUBSIDIARIES The following is added to SECTION II – WHO IS AN INSURED: Any of your subsidiaries, other than a partnership, joint venture or limited liability company, that is not shown as a Named Insured in the Declara- tions is a Named Insured if you maintain an own- ership interest of more than 50% in such subsidi- ary on the first day of the policy period. No such subsidiary is an insured for "bodily injury" or "property damage" that occurred, or "personal injury" or "advertising injury" caused by an of- fense committed after the date, if any, during the policy period, that you no longer maintain an ownership interest of more than 50% in such sub- sidiary. CG D3 16 11 11 © 2011 The Travelers Indemnity Company. All rights reserved. Page 3 of 6 COMMERCIAL GENERAL LIABILITY G. BLANKET ADDITIONAL INSURED – OWNERS, MANAGERS OR LESSORS OF PREMISES The following is added to SECTION II – WHO IS AN INSURED: Any person or organization that is a premises owner, manager or lessor and that you have agreed in a written contract or agreement to in- clude as an additional insured on this Coverage Part is an insured, but only with respect to liability for "bodily injury", "property damage", "personal injury" or "advertising injury" that: a.Is "bodily injury" or "property damage" that occurs, or is "personal injury" or "advertising injury" caused by an offense that is commit- ted, subsequent to the execution of that con- tract or agreement; and b.Arises out of the ownership, maintenance or use of that part of any premises leased to you. The insurance provided to such premises owner, manager or lessor is subject to the following pro- visions: a.The limits of insurance provided to such premises owner, manager or lessor will be the minimum limits which you agreed to pro- vide in the written contract or agreement, or the limits shown on the Declarations, which- ever are less. b.The insurance provided to such premises owner, manager or lessor does not apply to: (1) Any "bodily injury" or "property damage" that occurs, or "personal injury" or "adver- tising injury" caused by an offense that is committed, after you cease to be a tenant in that premises; or (2) Structural alterations, new construction or demolition operations performed by or on behalf of such premises owner, lessor or manager. c.The insurance provided to such premises owner, manager or lessor is excess over any valid and collectible other insurance available to such premises owner, manager or lessor, whether primary, excess, contingent or on any other basis, unless you have agreed in the written contract or agreement that this in- surance must be primary to, or non- contributory with, such other insurance, in which case this insurance will be primary to, and non-contributory with, such other insur- ance. H. BLANKET ADDITIONAL INSURED – LESSORS OF LEASED EQUIPMENT The following is added to SECTION II – WHO IS AN INSURED: Any person or organization that is an equipment lessor and that you have agreed in a written con- tract or agreement to include as an insured on this Coverage Part is an insured, but only with re- spect to liability for "bodily injury", "property dam- age", "personal injury" or "advertising injury" that: a.Is "bodily injury" or "property damage" that occurs, or is "personal injury" or "advertising injury" caused by an offense that is commit- ted, subsequent to the execution of that con- tract or agreement; and b.Is caused, in whole or in part, by your acts or omissions in the maintenance, operation or use of equipment leased to you by such equipment lessor. The insurance provided to such equipment lessor is subject to the following provisions: a.The limits of insurance provided to such equipment lessor will be the minimum limits which you agreed to provide in the written contract or agreement, or the limits shown on the Declarations, whichever are less. b.The insurance provided to such equipment lessor does not apply to any "bodily injury" or "property damage" that occurs, or "personal injury" or "advertising injury" caused by an of- fense that is committed, after the equipment lease expires. c.The insurance provided to such equipment lessor is excess over any valid and collectible other insurance available to such equipment lessor, whether primary, excess, contingent or on any other basis, unless you have agreed in the written contract or agreement that this insurance must be primary to, or non-contributory with, such other insurance, in which case this insurance will be primary to, and non-contributory with, such other in- surance. I. BLANKET ADDITIONAL INSURED – STATES OR POLITICAL SUBDIVISIONS – PERMITS The following is added to SECTION II – WHO IS AN INSURED: Any state or political subdivision that has issued a permit in connection with operations performed by you or on your behalf and that you are required Page 4 of 6 © 2011 The Travelers Indemnity Company. All rights reserved. CG D3 16 11 11 COMMERCIAL GENERAL LIABILITY by any ordinance, law or building code to include as an additional insured on this Coverage Part is an insured, but only with respect to liability for "bodily injury", "property damage", "personal in- jury" or "advertising injury" arising out of such op- erations. The insurance provided to such state or political subdivision does not apply to: a.Any "bodily injury," "property damage," "per- sonal injury" or "advertising injury" arising out of operations performed for that state or po- litical subdivision; or b.Any "bodily injury" or "property damage" in- cluded in the "products-completed operations hazard". J. KNOWLEDGE AND NOTICE OF OCCUR- RENCE OR OFFENSE The following is added to Paragraph 2., Duties In The Event of Occurrence, Offense, Claim or Suit, of SECTION IV – COMMERCIAL GEN- ERAL LIABILITY CONDITIONS: e.The following provisions apply to Paragraph a.above, but only for the purposes of the in- surance provided under this Coverage Part to you or any insured listed in Paragraph 1. or 2. of Section II – Who Is An Insured: (1) Notice to us of such "occurrence" or of- fense must be given as soon as practica- ble only after the "occurrence" or offense is known by you (if you are an individual), any of your partners or members who is an individual (if you are a partnership or joint venture), any of your managers who is an individual (if you are a limited liability company), any of your "executive offi- cers" or directors (if you are an organiza- tion other than a partnership, joint venture or limited liability company) or any "em- ployee" authorized by you to give notice of an "occurrence" or offense. (2) If you are a partnership, joint venture or limited liability company, and none of your partners, joint venture members or man- agers are individuals, notice to us of such "occurrence" or offense must be given as soon as practicable only after the "occur- rence" or offense is known by: (a) Any individual who is: (i) A partner or member of any part- nership or joint venture; (ii) A manager of any limited liability company; or (iii) An executive officer or director of any other organization; that is your partner, joint venture member or manager; or (b) Any "employee" authorized by such partnership, joint venture, limited li- ability company or other organization to give notice of an "occurrence" or offense. (3) Notice to us of such "occurrence" or of an offense will be deemed to be given as soon as practicable if it is given in good faith as soon as practicable to your work- ers' compensation insurer. This applies only if you subsequently give notice to us of the "occurrence" or offense as soon as practicable after any of the persons de- scribed in Paragraphs e. (1) or (2) above discovers that the "occurrence" or offense may result in sums to which the insurance provided under this Coverage Part may apply. However, if this Coverage Part includes an en- dorsement that provides limited coverage for "bodily injury" or "property damage" or pollution costs arising out of a discharge, release or es- cape of "pollutants" which contains a requirement that the discharge, release or escape of "pollut- ants" must be reported to us within a specific number of days after its abrupt commencement, this Paragraph e. does not affect that require- ment. K. UNINTENTIONAL OMISSION The following is added to Paragraph 6., Repre- sentations, of SECTION IV – COMMERCIAL GENERAL LIABILITY CONDITIONS: The unintentional omission of, or unintentional error in, any information provided by you which we relied upon in issuing this policy will not preju- dice your rights under this insurance. However, this provision does not affect our right to collect additional premium or to exercise our rights of cancellation or nonrenewal in accordance with applicable insurance laws or regulations. L. BLANKET WAIVER OF SUBROGATION The following is added to Paragraph 8., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV – COMMERCIAL GENERAL LI- ABILITY CONDITIONS: CG D3 16 11 11 © 2011 The Travelers Indemnity Company. All rights reserved. Page 5 of 6 COMMERCIAL GENERAL LIABILITY Page 6 of 6 © 2011 The Travelers Indemnity Company. All rights reserved. CG D3 16 11 11 If the insured has agreed in a contract or agree- ment to waive that insured's right of recovery against any person or organization, we waive our right of recovery against such person or organiza- tion, but only for payments we make because of: a."Bodily injury" or "property damage" that oc- curs; or b."Personal injury" or "advertising injury" caused by an offense that is committed; subsequent to the execution of that contract or agreement. M. AMENDED BODILY INJURY DEFINITION The following replaces the definition of "bodily injury" in the DEFINITIONS Section: 3."Bodily injury" means bodily injury, mental anguish, mental injury, shock, fright, disability, humiliation, sickness or disease sustained by a person, including death resulting from any of these at any time. N. CONTRACTUAL LIABILITY – RAILROADS 1.The following replaces Paragraph c. of the definition of "insured contract" in the DEFINI- TIONS Section: c.Any easement or license agreement; 2.Paragraph f.(1) of the definition of "insured contract" in the DEFINITIONS Section is de- leted. COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED – PRIMARY AND NON-CONTRIBUTORY WITH OTHER INSURANCE This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM PROVISIONS 2.The following is added to Paragraph B.5.,Other Insurance of SECTION IV – BUSINESS AUTO1.The following is added to Paragraph A.1.c., Who CONDITIONS:Is An Insured, of SECTION Il – LIABILITY COVERAGE:Regardless of the provisions of paragraph a. and paragraph d. of this part 5. Other Insurance, thisThis includes any person or organization who you insurance is primary to and non-contributory withare required under a written contract or applicable other insurance under which anagreement between you and that person or additional insured person or organization is theorganization, that is signed by you before the first named insured when the written contract or"bodily injury" or "property damage" occurs and agreement between you and that person orthat is in effect during the policy period, to name organization, that is signed by you before theas an additional insured for Liability Coverage,"bodily injury" or "property damage" occurs andbut only for damages to which this insurance that is in effect during the policy period, requiresapplies and only to the extent of that person's or this insurance to be primary and non-contributory.organization's liability for the conduct of another "insured". CA T4 74 08 17 ú 2016 The Travelers Indemnity Company. All rights reserved.Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc. with its permission. Policy #BA-9K374275 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO EXTENSION ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GENERAL DESCRIPTION OF COVERAGE – This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. H. HIRED AUTO PHYSICAL DAMAGE – LOSS OF USE – INCREASED LIMIT A. BROAD FORM NAMED INSURED B. BLANKET ADDITIONAL INSURED I. PHYSICAL DAMAGE – TRANSPORTATION EXPENSES – INCREASED LIMIT C. EMPLOYEE HIRED AUTO D. EMPLOYEES AS INSURED J. PERSONAL PROPERTY E. SUPPLEMENTARY PAYMENTS – INCREASED LIMITS K. AIRBAGS L. NOTICE AND KNOWLEDGE OF ACCIDENT OR LOSSF. HIRED AUTO – LIMITED WORLDWIDE COV- ERAGE – INDEMNITY BASIS M. BLANKET WAIVER OF SUBROGATION G. WAIVER OF DEDUCTIBLE – GLASS N. UNINTENTIONAL ERRORS OR OMISSIONS PROVISIONS A. BROAD FORM NAMED INSURED this insurance applies and only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Section II. The following is added to Paragraph A.1.,Who Is An Insured, of SECTION II – COVERED AUTOS LIABILITY COVERAGE: C. EMPLOYEE HIRED AUTOAny organization you newly acquire or form dur- ing the policy period over which you maintain 50% or more ownership interest and that is not separately insured for Business Auto Coverage. Coverage under this provision is afforded only un- til the 180th day after you acquire or form the or- ganization or the end of the policy period, which- ever is earlier. 1.The following is added to Paragraph A.1., Who Is An Insured, of SECTION II – COV- ERED AUTOS LIABILITY COVERAGE: An "employee" of yours is an "insured" while operating an "auto" hired or rented under a contract or agreement in an "employee's" name, with your permission, while performing duties related to the conduct of your busi- ness.B. BLANKET ADDITIONAL INSURED The following is added to Paragraph c. in A.1., Who Is An Insured, of SECTION II – COVERED AUTOS LIABILITY COVERAGE: 2.The following replaces Paragraph b. in B.5., Other Insurance, of SECTION IV – BUSI- NESS AUTO CONDITIONS: b.For Hired Auto Physical Damage Cover- age, the following are deemed to be cov- ered "autos" you own: Any person or organization who is required under a written contract or agreement between you and that person or organization, that is signed and executed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, to be named as an addi- tional insured is an "insured" for Covered Autos Liability Coverage, but only for damages to which (1)Any covered "auto" you lease, hire, rent or borrow; and (2)Any covered "auto" hired or rented by your "employee" under a contract in an "employee's" name, with your CA T3 53 02 15 ú 2015 The Travelers Indemnity Company. All rights reserved.Page 1 of 4 Includes copyrighted material of Insurance Services Office, Inc. with its permission. Policy #BA-9K374275 COMMERCIAL AUTO permission, while performing duties related to the conduct of your busi- ness. (a)With respect to any claim made or "suit" brought outside the United States of America, the territories and possessions of the United States of America, Puerto Rico and Canada:However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto".(i)You must arrange to defend the "in- sured" against, and investigate or set- tle any such claim or "suit" and keep us advised of all proceedings and ac- tions. D. EMPLOYEES AS INSURED The following is added to Paragraph A.1.,Who Is An Insured, of SECTION II – COVERED AUTOS LIABILITY COVERAGE:(ii)Neither you nor any other involved "insured" will make any settlement without our consent. Any "employee" of yours is an "insured" while us- ing a covered "auto" you don't own, hire or borrow in your business or your personal affairs.(iii)We may, at our discretion, participate in defending the "insured" against, or in the settlement of, any claim or "suit". E. SUPPLEMENTARY PAYMENTS – INCREASED LIMITS 1.The following replaces Paragraph A.2.a.(2), of SECTION II – COVERED AUTOS LIABIL- ITY COVERAGE:(iv)We will reimburse the "insured" for sums that the "insured" legally must pay as damages because of "bodily injury" or "property damage" to which this insurance applies, that the "in- sured" pays with our consent, but only up to the limit described in Para- graph C., Limits Of Insurance, of SECTION II – COVERED AUTOS LIABILITY COVERAGE. (2)Up to $3,000 for cost of bail bonds (in- cluding bonds for related traffic law viola- tions) required because of an "accident" we cover. We do not have to furnish these bonds. 2.The following replaces Paragraph A.2.a.(4), of SECTION II – COVERED AUTOS LIABIL- ITY COVERAGE: (v)We will reimburse the "insured" for the reasonable expenses incurred with our consent for your investiga- tion of such claims and your defense of the "insured" against any such "suit", but only up to and included within the limit described in Para- graph C., Limits Of Insurance, of SECTION II – COVERED AUTOS LIABILITY COVERAGE, and not in addition to such limit. Our duty to make such payments ends when we have used up the applicable limit of insurance in payments for damages, settlements or defense expenses. (4)All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $500 a day be- cause of time off from work. F. HIRED AUTO – LIMITED WORLDWIDE COV- ERAGE – INDEMNITY BASIS The following replaces Subparagraph (5) in Para- graph B.7.,Policy Period, Coverage Territory, of SECTION IV – BUSINESS AUTO CONDI- TIONS: (5)Anywhere in the world, except any country or jurisdiction while any trade sanction, em- bargo, or similar regulation imposed by the United States of America applies to and pro- hibits the transaction of business with or within such country or jurisdiction, for Cov- ered Autos Liability Coverage for any covered "auto" that you lease, hire, rent or borrow without a driver for a period of 30 days or less and that is not an "auto" you lease, hire, rent 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. (b)This insurance is excess over any valid and collectible other insurance available to the "insured" whether primary, excess, contingent or on any other basis. (c)This insurance is not a substitute for re- quired or compulsory insurance in any country outside the United States, its ter- ritories and possessions, Puerto Rico and Canada. Page 2 of 4 ú 2015 The Travelers Indemnity Company. All rights reserved.CA T3 53 02 15 Includes copyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL AUTO (2)In or on your covered "auto".You agree to maintain all required or compulsory insurance in any such coun- try up to the minimum limits required by local law. Your failure to comply with compulsory insurance requirements will not invalidate the coverage afforded by this policy, but we will only be liable to the same extent we would have been liable had you complied with the compulsory in- surance requirements. This coverage applies only in the event of a total theft of your covered "auto". No deductibles apply to this Personal Property coverage. K. AIRBAGS The following is added to Paragraph B.3.,Exclu- sions, of SECTION III – PHYSICAL DAMAGE COVERAGE: Exclusion 3.a. does not apply to "loss" to one or more airbags in a covered "auto" you own that in- flate due to a cause other than a cause of "loss" set forth in Paragraphs A.1.b. and A.1.c., but only: (d)It is understood that we are not an admit- ted or authorized insurer outside the United States of America, its territories and possessions, Puerto Rico and Can- ada. We assume no responsibility for the furnishing of certificates of insurance, or for compliance in any way with the laws of other countries relating to insurance. a.If that "auto" is a covered "auto" for Compre- hensive Coverage under this policy; b.The airbags are not covered under any war- ranty; andG. WAIVER OF DEDUCTIBLE – GLASS c.The airbags were not intentionally inflated.The following is added to Paragraph D.,Deducti- ble, of SECTION III – PHYSICAL DAMAGE COVERAGE:We will pay up to a maximum of $1,000 for any one "loss". No deductible for a covered "auto" will apply to glass damage if the glass is repaired rather than replaced. L. NOTICE AND KNOWLEDGE OF ACCIDENT OR LOSS The following is added to Paragraph A.2.a., of SECTION IV – BUSINESS AUTO CONDITIONS:H. HIRED AUTO PHYSICAL DAMAGE – LOSS OF USE – INCREASED LIMIT Your duty to give us or our authorized representa- tive prompt notice of the "accident" or "loss" ap- plies only when the "accident" or "loss" is known to: The following replaces the last sentence of Para- graph A.4.b.,Loss Of Use Expenses, of SEC- TION III – PHYSICAL DAMAGE COVERAGE: (a)You (if you are an individual);However, the most we will pay for any expenses for loss of use is $65 per day, to a maximum of $750 for any one "accident". (b)A partner (if you are a partnership); (c)A member (if you are a limited liability com- pany);I. PHYSICAL DAMAGE – TRANSPORTATION EXPENSES – INCREASED LIMIT (d)An executive officer, director or insurance manager (if you are a corporation or other or- ganization); or The following replaces the first sentence in Para- graph A.4.a.,Transportation Expenses, of SECTION III – PHYSICAL DAMAGE COVER- AGE: (e)Any "employee" authorized by you to give no- tice of the "accident" or "loss". We will pay up to $50 per day to a maximum of $1,500 for temporary transportation expense in- curred by you because of the total theft of a cov- ered "auto" of the private passenger type. M. BLANKET WAIVER OF SUBROGATION The following replaces Paragraph A.5.,Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV – BUSINESS AUTO CONDI- TIONS:J. PERSONAL PROPERTY 5. Transfer Of Rights Of Recovery Against Others To Us The following is added to Paragraph A.4.,Cover- age Extensions, of SECTION III – PHYSICAL DAMAGE COVERAGE:We waive any right of recovery we may have against any person or organization to the ex- tent required of you by a written contract signed and executed prior to any "accident" or "loss", provided that the "accident" or "loss" arises out of operations contemplated by Personal Property We will pay up to $400 for "loss" to wearing ap- parel and other personal property which is: (1)Owned by an "insured"; and CA T3 53 02 15 ú 2015 The Travelers Indemnity Company. All rights reserved.Page 3 of 4 Includes copyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL AUTO such contract. The waiver applies only to the person or organization designated in such contract. The unintentional omission of, or unintentional error in, any information given by you shall not prejudice your rights under this insurance. How- ever this provision does not affect our right to col- lect additional premium or exercise our right of cancellation or non-renewal. N. UNINTENTIONAL ERRORS OR OMISSIONS The following is added to Paragraph B.2.,Con- cealment, Misrepresentation, Or Fraud, of SECTION IV – BUSINESS AUTO CONDITIONS: Page 4 of 4 ú 2015 The Travelers Indemnity Company. All rights reserved.CA T3 53 02 15 Includes copyrighted material of Insurance Services Office, Inc. with its permission. UMBRELLA POLICY NUMBER: ISSUE DATE: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT – OTHER INSURANCE – DESIGNATED PERSONS OR ORGANIZATIONS FOR WHOM YOU HAVE AGREED IN A WRITTEN CONTRACT TO PROVIDE INSURANCE This endorsement modifies insurance provided under the following: COMMERCIAL EXCESS LIABILITY (UMBRELLA) INSURANCE SCHEDULE OF DESIGNATED PERSONS OR ORGANIZATIONS Person or Organization: Project or Location: PROVISIONS The following is added to Paragraph 10., OTHER IN- SURANCE., of SECTION IV – CONDITIONS.: However, for any person or organization shown in the Schedule Of Designated Persons Or Organizations that qualifies as an insured under Paragraph 2.f. of SECTION II – WHO IS AN INSURED for the project or location shown in that schedule, if the written con- tract in which you have agreed to provide insurance for that person or organization specifically requires that this insurance apply on a primary basis or a pri- mary and non-contributory basis, this insurance will apply as if other insurance available to that person or organization under which that person or organization qualifies as a named insured does not exist, and we UM 06 39 02 14 © 2013 The Travelers Indemnity Company. All rights reserved.Page 1 of 2 UMBRELLA will not share with that other insurance. But this insur- ance still is excess over any valid and collectible other insurance, whether such insurance is stated to be primary, contributing, excess, contingent or otherwise, which covers that person or organization as an addi- tional insured or as any other insured that does not qualify as a named insured. Page 2 of 2 © 2013 The Travelers Indemnity Company. All rights reserved.UM 06 39 02 14 Policy #CUP-1L875046 ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS This endorsement modifies insurance provided under the following: CONTRACTORS POLLUTION LIABILITY POLICY ENVIRONMENTAL LIABILITY PACKAGE POLICY ENVIRONMENTAL CONSULTANTS PROFESSIONAL LIABILITY (If no entry appears below, information required to complete this endorsement will be shown in the Declarations as appli- cable to this endorsement.) WHO IS AN INSURED (Section II)is amended to include as an insured the person or organization shown in the Sched- ule, but only with respect to liability arising out of "your work" for that insured by or for you. SCHEDULE Name of Person or Organization: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Policy Number: EGL 333 07 09 ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. Page 1 of 2 EGL0006064 PER WRITTEN CONTRACT Pollution Liability Contains copyrighted material of Insurance Services Office, Inc.