Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
City of Renton [175462] [LIAB].pdf
1 of 10 (DCP00) CERTIFICATE HOLDER © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) AUTHORIZED REPRESENTATIVE CANCELLATION DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE LOCJECTPRO-POLICY GEN'L AGGREGATE LIMIT APPLIES PER: OCCURCLAIMS-MADE COMMERCIAL GENERAL LIABILITY GENERAL LIABILITY PREMISES (Ea occurrence)$DAMAGE TO RENTED EACH OCCURRENCE $ MED EXP (Any one person)$ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $RETENTIONDED CLAIMS-MADE OCCUR $ AGGREGATE $ EACH OCCURRENCE $UMBRELLA LIAB EXCESS LIAB DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) INSRLTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)LIMITS WC STATU-TORY LIMITS OTH-ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ $ ANY PROPRIETOR/PARTNER/EXECUTIVE If yes, describe underDESCRIPTION OF OPERATIONS below (Mandatory in NH)OFFICER/MEMBER EXCLUDED? WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED HIRED AUTOS NON-OWNEDAUTOSAUTOS AUTOS COMBINED SINGLE LIMIT BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE $ $ $ $ THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL WVD SUBR N / A $ $ (Ea accident) (Per accident) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). The ACORD name and logo are registered marks of ACORD COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: INSURED PHONE(A/C, No, Ext): PRODUCER ADDRESS:E-MAIL FAX(A/C, No): CONTACTNAME: NAIC # INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : INSURER(S) AFFORDING COVERAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 10/27/2021 Parker, Smith & Feek, Inc. 2233 112th Avenue NE Bellevue, WA 98004 425-709-3600 425-709-7460 Valley Forge Insurance Company Powell Construction Company dba Powell RYKA, Inc. 2625 Northup Way Bellevue, WA 98004 Indian Harbor Insurance Company A X 1,000,000 8 X 8 8 6079507387 10/31/2021 10/31/2022 500,000 15,000 1,000,000 2,000,000 2,000,000 A 1,000,000 8 X X 8 8 6079507423 10/31/2021 10/31/2022 A 810/31/2021 10/31/2022 1,000,000 6079507387 ** Washington Stop Gap 1,000,000 1,000,000 B Pollution Liability PEC005538002 10/31/2021 10/31/2022 $1,000,000 - Each Pollution Incident; $1,000,000 - Aggregate$5,000 Deductible 20-12-0011 Ace Aviation 287 City of Renton is an additional insured on the general liability and ... (See Attached Description) City of Renton Attn: Jonathan Chavez 1055 South Grady Way Renton, WA 98057 2 of 10 (DCP00) DESCRIPTIONS (Continued from Page ) 1 automobile policies per the attached endorsements/forms. Coverage is primary and non-contributory on the general liability and automobile policies per the attached endorsements/forms. Waiver of subrogation applies on the general liability and automobile policies per the attached endorsements/forms. 3 of 10 (DCP00) - - - CNA CNA PARAMOUNT General Aggregate Limit - Per Project Endorsement This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART It is understood and agreed as follows: l. For each single construction or service project away from premises the Named lnsured owns or rents, a separate Project General Aggregate Limit, equal to the amount of the General Aggregate Limit shown in the Declarations, is the most the lnsurer will pay for the sum of: A. all damages under Coverage A, except damages because of bodily injury or property damage included in the products-completed operations hazard; and B. all medical expenses under Goverage C; that arise from occurrences or accidents which can be attributed solely to ongoing operations at that project. Such payments shall not reduce the General Aggregate Limit shown in the Declarations, nor the Project General Aggregate Limit applicable to any other project. [, Ail: A. damages under Coverage B, regardless of.the number of locations or projects involved; B. damages under Coverage A, caused by occurrences which cannot be attributed solely to ongoing operations at a single project, except damages because of bodily injury or property damage included in the products- completed operations hazard; and C. medical expenses under Coverage C, caused by accidents which cannot be attributed solely to ongoing operations at a single project, will reduce the General Aggregate Limit shown in the Declarations. lll. The limits shown in the Declarations for Each Occurrence, for Damage To Premises Rented To You and for Medical Expense continue to apply, but will be subject to either the Project General Aggregate Limit or the General Aggregate Limit shown in the Declarations, depending on whether the occurrence can be attributed solely to ongoing operations at a particular project. lV. 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 shown in the Declarations, regardless of the number of projects involved. V. lf a single construction or service project away from premises owned by or rented to the Named lnsured has been abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, such project will still be deemed to be the same project. Vl. The provisions of LIMITS OF INSURANCE not othenrise modified by this endorsement shall continue to apply as stipulated. All other terms and conditions of the Policy remain unchanged This endorsement, which forms a part of and is for attachment to the Policy issued by the designated lnsurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy. CNA75061XX (1-15) Policy No: 607e507387 Page 1 of 1 Endorsement No: 4 VALLEY FORGE INSI.]RANCE COMPANY EffECtiVE DAIE: 70/31,/2019 InsuTed Name: POWELL CONSTRUCTION COMPANY Copyright CNA All Rights Reserved. lncludes copyrighted material of lnsurance Services Office, lnc., with its permission. 4 of 10 (DCP00) - CNA CNA PARAMOUNT Blanket Additional lnsured - Owners, Lessees or Gontractors - with Products-Completed Operations Goverage Endorsement This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART It is understood and agreed as follows: l. WHO lS AN INSURED is amended to include as an lnsured any person or organization whom you are required by written contract to add as an additional insured on this coverage part, 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: A. in the performance of your ongoing operations subject to such written contract; or B. in the performance of your work subject to such written contract, but only with respect to bodily injury or property damage included in the products-completed operations hazard, and only if: 1. the written contract requires you to provide the additional insured such coverage; and 2. this coverage part provides such coverage. ll. But if the written contract requires: A. additional insured coverage under the 11-85 edition, 10-93 edition, or 10-01 edition of CG2010, or under the 10- 01 edition of CG2037; or B. additional insured coverage with "arising out of' language; or C. additional insured coverage to the greatest extent permissible by law; then paragraph l. above is deleted in its entirety and replaced by the following: WHO lS AN INSURED is amended to include as an lnsured any person or organization whom you are required by written contract to add as an additional insured on this coverage part, but only with respect to liability for bodily injury, property damage or personal and advertising injury arising out of your work that is subject to such written contract. lll. Subject always to the terms and conditions of this policy, including the limits of insurance, the lnsurer will not provide such additional insured with: A. coverage broader than required by the written contract; or B. a higher limit of insurance than required by the written contract. lV. The insurance granted by this endorsement to the additional insured does not apply to bodily injury, property damage, or personal and advertising injury arising out of: A. 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 or drawings and specifications; and 2. supervisory, inspection, architectural or engineering activities; or B. any premises or work for which the additional insured is specifically listed as an additional insured on another endorsement attached to this coverage part. V. Under GOMMERCIAL GENERAL LIABILITY CONDITIONS, the Condition entitled Other Insurance is amended to add the following, which supersedes any provision to the contrary in this Condition or elsewhere in this coverage part: CNA75079XX (10-16) Policy No: 6oieso73l7 Pagel of2 Endorsement No: s VALLEY FORGE INSURANCE COMPANY EffCCtiVEDAtC: 1O/31/2OI9 InsuTed Name: POWELL CONSTRUCTION COMPANY Copyright CNA All Rights Reserved. lncludes copyrighted material of lnsurance Services Office, lnc., with its permission. 5 of 10 (DCP00) CT{A CNA PARAMOUNT Blanket Additional lnsured - Owners, Lessees or Contractors - with Products-Completed Operations Goverage Endorsement Primary and Noncontributory lnsurance With respect to other insurance available to the additional insured under which the additional insured is a named insured, this insurance is primary to and will not seek contribution from such other insurance, provided that a written contract requires the insurance provided by this policy to be: 1. primary and non-contributing with other insurance available to the additional insured; or 2. primary and to not seek contribution from any other insurance available to the additional insured. But except as specified above, this insurance will be excess of all other insurance available to the additional insured. Vl. Solely with respect to the insurance granted by this endorsement, the section entitled COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: The Condition entitled Duties ln The Event of Occurrence, Offense, Claim or Suit is amended with the addition of the following: Any additional insured pursuant to this endorsement will as soon as practicable: 1. give the lnsurer written notice of any claim, or any occurrence or offense which may result in a claim; 2. send the lnsurer copies of all legal papers received, and otherwise cooperate with the lnsurer in the investigation, defense, or settlement of the claim; and 3. make available any other insurance, and tender the defense and indemnity of any claim to any other insurer or self-insurer, whose policy or program applies to a loss that the lnsurer covers under this coverage part. However, if the written contract requires this insurance to be primary and non-contributory, this paragraph 3. does not apply to insurance on which the additional insured is a named insured. The lnsurer has no duty to defend or indemnify an additional insured under this endorsement until the lnsurer receives written notice of a claim from the additional insured. Vll. Solely with respect to the insurance granted by this endorsement, the section entitled DEFINITIONS is amended to add the following definition: Written contract means a written contract or written agreement that requires you to make a person or organization an additional insured on this coverage part, provided the contract or agreement: A. is currently in effect or becomes effective during the term of this policy; and B. was executed prior to: 1. the bodily injury or property damage; or 2. the offense that caused the personal and advertising injury; for which the additional insured seeks coverage. Any coverage granted by this endorsement shall apply solely to the extent permissible by law. All other terms and conditions of the Policy remain unchanged This endorsement, which forms a part of and is for attachment to the Policy issued by the designated lnsurers, takes effect on the effective date of said Pol at the hour stated in said Policy, unless another effective date is shown below, and with said CNA75079XX (10-16) Policy No: 607e507387 Page2of 2 Endorsement No: s VALLEY FORGE INSURANCE COMPANY EffECtiVE DAIE: 10/31/2079 Insured Name: POWELL CONSTRUCTION COMPANY Copyright CNA All Rights Reserved. lncludes copyrighted material of lnsurance Services Oflice, lnc., with its permission. 6 of 10 (DCP00) CNA CNA PARAMOUNT Contractors' General Liability Extension Endorsement a. the Named Insured's acts or omissions; or b. the acts or omissions of those acting on the Named lnsured's behalf, in the performance of the Named lnsured's ongoing operations at the trade show event premises during the trade show event. 2. The coverage granted by this paragraph does not apply to bodily injury or property damage included within the products-completed operations hazard. 2" ADDITIONAL INSURED . PRIMARY AND NON.CONTRIBUTORY TO ADDITIONAL INSURED'S INSURANCE The Other lnsurance Condition in the COMMERCIAL GENERAL LIABILITY CONDITIONS Section is amended to add the following paragraph: lf the Named lnsured has agreed in writing in a contract or agreement that this insurance is primary and non- contributory relative to an additional insured's own insurance, then this insurance is primary, and the lnsurer wiil not seek contribution from that other insurance. For the purpose of this Provision 2., the additional insured's own insurance means insurance on which the additional insured is a named insured. Otherwise, and notwithstanding anything to the contrary elsewhere in this Condition, the insurance provided to such person or organization is excess of any other insurance available 1o such person or organization. 3. BODILY INJURY- EXPANDED DEFINITION Under DEFINITIONS, the delinition of bodily injury is deleted and replaced by the following: Bodilyinjury,means physical injury, sicknessordiseasesustained by a person, including death, humiliation, shock, mental anguish or mental injury sustained by that person at any time which resulls as a consequence of the physical injury, sickness or disease. 4. BROAD KNOWLEDGE OF OCCURRENCE/ NOTICE OF OCCURRENCE Under CONDITIONS, the condition entitled Duties in The Event of Occurrence, Offense, Claim or Suit is amended to add the following provisions: A. BROADKNOWLEDGEOFOCCURRENCE The Named lnsured must give the lnsurer or the lnsurer's authorized representative notice of an occurrence, offense or claim only when the occurrence, offense or claim is known to a natural person Named lnsured, to a partner, executive officer, manager or member of a Named lnsured, or an employee designated by any of the above to give such notice. B. NOTICE OF OCCURRENCE The Named lnsured's rights under this Coverage Part will not be prejudiced if the Named lnsured fails to give the lnsurer notice of an oceurrence, offense or claim and that failure is solely due to the Named lnsured's reasonable belief that the bodily injury or property damage is not covered under this Coverage Part. However, the Named lnsured shall give written notice of such occurrence, offense or claim to the lnsurer as soon as the Named lnsured is aware that this insurance may apply to such occurrence, offense or claim. 5. BROAD NAMED INSURED WHO lS AN INSURED is amended to delete its Paragraph 3. in its entirety and replace it with the following: 3. Pursuant to the limitations described in Paragraph 4. below, any organization in which a Named lnsured has management control. a. on the effective date of this Coverage Part; or CNA74705XX (1-15) Policy No: Page 4 of 17 Endorsement No: vALr,Ey FoRcE rNsuRANcE coMpANy Effective Date: InsuTed NAME: POWEI,L CONSTRUCTION COMPAIT{Y Copyright CNA All Rights Roserved. lncludes crpyrighted material of lnsurance Services Oilice, lnc., with ils permission. 6079s0738? 3 10/3:_/207e 7 of 10 (DCP00) CT(A CNA PARAMOUNT Contractors' General Liability Extension Endorsement B. Solely for the purpose of the coverage provided by this PROPERTY DAMAGE - ELEVATORS Provision, the Other lnsurance conditions is amended to add the following paragraph: This insurance is excess over any of the other insurance, whether primary, excess, contingent or on any other basis that is Property insurance covering property of others damaged'from the use of elevators. 23. SUPPLEMENTARY PAYMENTS The section entitled SUPPLEMENTARY PAYMENTS - COVERAGES A AND B ls amended as fottows: A. Paragraph 1.b. is amended to delete the $250 limit shown for the cost of bail bonds and replace it with a $5,000.limit;and B' far9g1aph 1.d. is amended to delete the limit of $250 shown for daily loss of earnings and replace it with a $1,000, limit. 24. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS lf the Named lnsured unintentionally fails to disclose all existing hazards at the inception date of the Namedlnsured's Coverage Part, the lnsurer will nol deny coverage under this Coverage Part becbuse of such failure. 25. WAIVER OF SUBROGATION . BLANKET Under CONDITIONS, the condition entitled Transfer Of Rights Of Recovery Against Others To Us is amended to add the following: The lnsurer waives any right of recovery the lnsurer may have against any person or organization because of payments the lnsurer makes for injury or damage arising out of: 1. the Named lnsured's ongoing operations; or 2. your work included in the products-completed operations hazard. However, this waiver applies only when the Named lnsured has agreed in writing to waive such rights of recovery in a written contract or written agreement, and only if such contract or agreement: f . is in effecl or becomes effective during the term of this Coverage part; and 2. was executed prior to the bodily injury, property damage or personal and advertising injury giving rise to the claim. 26. WRAP-UP EXTENSION: OCIP, CCIP, OR CONSOLIDATED (WRAP-UP)INSURANCE PROGRAMS Note: The following provision does not apply to any public construction project in the state of Oklahoma, nor to any construction project in the state of Alaska, that is not permitted to be insured under a consolidated (wrap-up) insurance program by applicable state statute or regulation. lf lhe endorsement EXCLUSION - CONSTRUCTION WRAP-UP is attached to this policy, or another exctusionary endorsement pertaining to Owner Controlled lnsurance Programs (O.C.I.P.) or Contractor Controlled lnsurance Programs (C.C.l.P.) is attached, then the following changes apply: A. The following wording is added to the above-referenced endorsement: With respect to a consolidated (wrap-up) insurance program project in which the Named lnsured is or was involved, this exclusion does not apply to those sums the Named lnsured become legally obligated to pay as damages because of: 1. Bodily injury, property damage, or personal or advertising injury that occurs during the Named lnsured's ongoing operations at the project, or during such operations of anyone acting on the Named lnsured's behalf; nor CNA74705XX (1-1s) Page 16 of 17 Policy No: Endorsernent No: 607950738? 3 to / 3t /201.sVA],],EY FORGE iNsuRANcE COMPANY Effective Date: InsuTed Name: POWALL CONSTRUCTION COMPANY Copyright CNA All Rights ReseNed. Includes copyrlghted nraterial ot lnsurance Servicss Oflico, lnc., with ils permission. 8 of 10 (DCP00) ffi&Business Auto Policy Policy Errdorsenrent THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who ls An lnsured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named lnsured: POWELL CONSTRUCTION COMPANY Endorsement Effective Date: 1 Ol31l2O19 Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who ls An lnsured provision contained in Paragraph A.1. of Section ll - Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section | - Covered Autos Coverages of the Auto Dealers Coverage Form. Name Of Person(sl Or Organization(s) ANY PERSON OR ORGANIZATION THAT THE NAMED INSURED IS OBLIGATED TO PROVIDE INSURANCE WHERE REOUESTD BY A WRITTEN CONTRACT OR AGREEMENT IS AN INSURED, BUT ONLY WITH RESPECT TO LEGAL RESPONSIBILITY FOR ACTS OR OMISSIONS OF A PERSON/ORGANIZATION FOR WHOM LIABILITY COVERAGE IS AFFORDED UNDER THIS POLICY lnformation required to complete this Schedule, if not shown above, will be shown in the Declarations Form No: CA 20 48 10 13 Endorsement Effective Date: Endorsement Expiration Date: Endorsement No:4; Page: 1 of 1 Underwriting Company: The Continental lnsurance Company, 151 N Franklin St, Chicago, lL 60606 Policy No: BUA 6079507423 Policy Effective Date: 10/31/2019 Policy Page: 40 of 86 o Copyright lnsurance Services Office, lnc., 201 1 9 of 10 (DCP00)2 of 4 (SZ000) THIS PAGE INTENTIONALLY LEFT BLANK 10 of 10 (DCP00) ffiffif&Business Auto Policy Policy Endorsenrent (41 Your employees may know of an accident or loss. This will not mean that you have such knowledge, unless such accident or loss is known to you or if you are not an individual, to any of your executive officers or partners or your insurance manager. The following is added to Section lV, Paragraph A.2.b.: (6) Your employees may know of documents received concerning a claim or suit. This will not mean that you have such knowledge, unless receipt of such documents is known to you or if you are not an individual, to any of your executive officers or partners or your insurance manager. B. Transfer Of Rights Of Recovery Against Others To Us The following is added to Section lV, Paragraph A.5. Transfer Of Rights Of Recovery Against Others To Us: We waive any right of recovery we may have, because of payments we make for injury or damage, against any person or organization for whom or which you are required by written contract or agreement to obtain this waiver from us. This injury or damage must arise out of your activities under a contract with that person or organization. You must agree to that requirement prior to an accident or loss. C. Concealment, Misrepresentation or Fraud The following is added to Section lV, Paragraph B.2.: Your failure to disclose all hazards existing on the date of inception of this Coverage Form shall not prejudice you with respect to the coverage afforded provided such failure or omission is not intentional. D. Other Insurance The following is added to Section lV, Paragraph B.5.: Regardless of the provisions of Paragraphs 5.a. and 5.d. above, the coverage provided by this policy shall be on a primary non-contributory basis. This provision is applicable only when required by a written contract. That written contract must have been entered into prior to Accident or Loss. E. Policy Period, Coverage Territory Section lV, Paragraph B. 7.(5).(al. is revised to provide; a. 45 days of coverage in lieu of 30 days. DEFINITIONS Section V. paragraph C. is deleted and replaced by the following: Bodily injury means bodily injury, sickness or disease sustained by a person, including mental anguish, mental injury or death resulting from any of these. @ Copyright CNA All Rights Reserved. lncludes copyrighted material of the lnsurance Services Office, lnc., used with its permission. V Form No: CNA6335gXX (O4-2O121 Endorsement Effective Date: Endorsement Expiration Date: Endorsement No: 1 2; Page: 4 ol 4 Underwriting Company: The Continental lnsurance Company, 151 N Franklin St, Chicago, lL 60606 Policy No: BUA 6079507423 Policy Effective Date: 1O/31/2019 Policy Page: 67 of 86