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HomeMy WebLinkAboutCertificate of Liability InsuranceClient#: 121565 IOHAFXCA ACORD. CERTIFICATE OF LIABILITY INSURANCEDAIEtMIWDD/ryrT) 1/28/2016 THIS cERTIFIcaTE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CER I IFIcA I E DOES NO I AFI-IRMA I IvEEY OR NEGATIVELY AMEND, EXTEND OR ALTER THE cOVERAGE AFFORDED BY THE POLICIES uECuw. 1 ITIS t;EK I II-IL;A I E uF INSuRANt;E uuES Nu 1 uuRS I I 10- 1 E A t;UN I HAL; I Be I WEEN I RE ISSUING INSURER(S), AUTRORIZED -PRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. _IPuR I AN 1: IT 016 riyrtitii;Bto FlUldcr ;s an ADDI I IUNAE INsuRtD, Vie policy(les) mast be endorsed. It SUBROUATIOR 15 WAIVED, subject to the terms and conditions of the policy, certain pOli%ira may rii an endorurnam. A statement un THIS CEFUTiUMv duns nut conn rigfiits to the certificate Holder in lieu of such endorsement(s). PnuOER;ER Propel Insarancc CONTACT RAMS: Lisa Anderson PRUNE 800 499-0933 F A/C No E.:INC,A/CNo : 6.577.1326 Tacoma Commercial Insurance 1201 Pacific Ave, Suite 1 OOO TaCvm-a, WA 984uz F- AIE Lisa.Anderson@propelinsurance.com INSURER(51 AFFuRuIriG �uvERAGE MAIC u I I ne Phoenix Insurance Company 25623 i INSURER A : P Y INSURED iNauRER B: Travelers Property Casualty Coo 25674 Johansen Excavating, Inc INSURER C : Hartfurd Fire Insurance Company 19682 P.O. Box 674 INSURER 0: Travelers Indemnity Company of 25666 Buuklay, WA 9ss3zi INsGREH E: INSURER F: ][ cvvERAuES CERTIFICATE NUMBER: REVISION NUMBER: 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 CONTRACTOR 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. LTRR TYPE OF INSURANCE ND RL WVD POLICY NUMBER MMIBRI DDY EFF 1P0/LDIC P LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE .00CUR X, PD Ded:5,000 X X KITCO713235301 PHX16 DT8107G235301 TIA16 DTSMCUP7G235301TIL 02/01/2016 02/01/2017 __I!aMrUbINGLt: 02/01/2016 02/01/2017 EACHOCCURRENCE $100 0 000 PREMISES EappoNccTu ranee 000,000 MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000 GENERALAGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X E 6 LOC PRODUCTS - COMP/OP AGG $2,000,000 $ Au I OR-USIrr MOICI I T X ANr Au Iu A[L uvvNE0 SCREDUCED AUTOS AUTOS RIRED AD I U5 X NON -OWNED RD I US P52K Ded. X Coll S51K Ded. ][ X LIMIT Ea accident $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ $ PeraxidentComp $ B X UMBRELLA LIAR EXCESS LIAR' X OCCUR CLAIMS -MADE X X 2/01/2016 02/01/201 EACH OCCURRENCE $4,000,000 AGGREGATE $4 000 000 DED I X RETENTION 10 000 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N BFFICER/MEMBER EXCLUD�N/AWA ED? (Mandatory In NH) It yes, describe under DESCRIPTION OF OPERATIONS below KITC07G235301PHX76 Stop Gap Only 2/01/2016 02/01/201 WCSTATU- OTH- E.EACH ACCIDENT $11,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 C Leased/Rent Equip Scheduled Equip 52UUMZN6555 2/01/2016 02/01/2017 $250,000 / $1,000 See Below / $1,000 Ded DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, It more space Is required) RE: Logan Avenue N - Airport Way to N 6th Street Project, Project No. CAG -15-134. The City of Renton, its officers, elected officials, employees, agents and volunteers, Perteet Inc., HWA GeoSciences Inc., and Widener and Associates Inc. are named as additional per the attached endorsements. City �f RCnt�n SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1055 South Grady Way ACCORL)ANCE WITH THE POLICY PROVISIONS. Renton, WA 98057 AUTROHIZFD REPRESENTATIVE Uc 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 1 of 1 The ACORD name and I.go are regi.-tcrcd marks OT ACORD #S2045614/M2045593 1MA00 This page has been left blank intentinnally. m COMMERCIAL GtNERAC LiAbiLl I Y THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAKBfUILY BLANKET ADDITIONAL INSURED (CONTRACTORS) This enduisenient modifies insurance provided under the following: GUMMERUAL (iEIQERAC LIABICI I Y t;ovERAVE PAR I 1. WHO IS AN INSURED — (Section II) is amended to include any person v, uryanicatiun that you agree in a "written contract requiring insurance" to include as an additional fisuied on this Cuvei- aye Part, but: a) O,ily with respect to liability for "boaily injury", "property darnaya" or "pearunal injur-y"; and b) If, and only to the extent that; the hijdry or damage is caused by acts or omissions of you or your subcontractor in the performance of "yuui wurk" iu which the "wiittCi, contract requiring insurance" applies. The person or organization does not qualify as an additional insured with respect to the independent acts or omissions of such person or organization. 2. 1 he insurance provided to the additional insured by thin cndurse,iient is limited as folluws: a) In the event that the Limits of Insurance of tnis Coverage Part shown in the Declarations exceed the limits of liability required by the "written contract requiring insurance", the in- surance provided to the additimidl ni5wed shall be limited to the limits of liability re- quired by that "w6twn contract rcquiriny in- surance". I his endorsement snail not in- crease the limits of insurance descmbed in Section III - Limits of Insurance. b) The insurance provided to the additional in- sured due. nut apply to "bodily injury", "prup- erty damage" or "personal injury" arising out of the f—undering of, ur f—ailare to rwidGr, airy prutessivnal architectural, engineering or sur- veying services, including: L The preparing, approving, or failing to prepare ur appiovG, maps, shup draw- ings, opinions, reports, surveys, field or- ders or change orders, or the preparing, approving, or failing to pepare ur ap- prove; drawings and specifications: and iii_ Supervisory, inspection, architectural or engineering activities. c) The insurance provided to the additional in- sured does not apply to "bodily injury" or "property damage" caused by "your wink" and included in the "products -completed op- erations hazard" unless the "written contract requiring insurance" specifically requires you topiuvide such covuraye for that additional insured, and then the insurance provided to the additional insured applies only to such "bodily injury" or "property damage" that oc- curs before the end of the period of time for which the "written contract squiring 015ui- mice" requires you to provide such coverage or the end of the policy period, whichever is earlier. 3. The insurance provided to the additional insured by this endorsement is excess over any valid and collectible 'other insurance", whether primary, excess, contingent or on any other basis, that is available to the additional insured for a loss we cover under this endorsement. However, if the "written contract regain"" insaianuC" specifically requires that this insurance apply on a primary basis or a primary and non-contributory basis, this insurance is primary to 'other insurance" available to the additional insured which covers that person or oryar-tization as a named insutcd fur such loss and we will not share witn that "other insurance". But the insurance provided to the additional insured by this endorsement still is excess over any valid and uullcctiblu "other in- surance", whether primary, excess, contingent or on any other basis, that is available to the addi- tional insured when that person or organization is an additional insured under such 'other insur- ance". 4. As a condition of coverage provided tv the additional insured by this endorsement: a) The additional insured must give us written notice as soon as practicable of an "occur - re, Acte" or an offcnsc which may result in a claim. lo the extent possible, such notice should include: Co D2 46 08 05 V 2005 The St. Paul Travelers Companies, Inc. Page 1 of 2 COMMERCIAL GENERAL LIABILITY L How, when and where the "occurrence" or offense took place; ii. Thi- namac and arldressac of any injured persons and witnesses; and iii. The nature and location of any injury or damage arising out of the "occurrence" nr offense. b) If a claim is made or "suit" is brought against the additional insured, the additional insured roust: I. Immediately record the specifics of the rlaiM or "cult' and the data rPrPiVPd: and ii_ Notify us as soon as practicable. The additinnal insured must RPP to it that wP receive written notice of the claim or "suit" as soon as practicable. c) the additional insured must immediately send Us copies of all legal papers received in connection with the claim or "suit'. cooperate with us in the investigation or settlement of the nlaim nr r1PfPncP against the "cUit", and otherwise comply with all policy conditions. d) The additional insured must tender the de- fense and indemnity of any claim or "suit" to any provider of "other insurance" which Would cover the additional insured for a loss we cover under this endorsement. However, this condition does not affect whether the insur- ance provided to the additional insured by this endorsement is primary to "other insur- ance" available to the additional insured which covers that person or organizatino as a named insured as described in paragraph 3. above. 5. The following definition is added to SECTION V. _ DFFINITIONs- "Written contract requiring insurance" means that part of any written contract or agreement under which you are required to include a percnn nr nrgani7ntinn ac an additinnal in- sured on this Coverage Part, provided that the "bodily injury" and "property damage" or - curs and the "personal injury" is caused by an offense committed: a. After the signing and execution of the contract or agreement by vou; b_ While that part of the contract or agreement is in effect; and c. Before the end of the policy period. Pages 9 of 2 0 21711715 Thg Sfi_ Paul Iravelerc (nmpaniPc, Inr_ rG D2 46 08 0R c;UI0 MER(;IAL UENEKAI CIABICI I Y THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTFtACTORS XTEND ENDORSEMENT I his endorsement modities insurance provided under the following: L;L)M DIEKCIAC uENERAC CIABICI I Y CUvERAuE PAR I GENERAL DESCRIPTION OF COVERAGE — I his endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may Be excluded vi limited By another endorsement to this Coverage Part, a, id these coverage broadening provisions do not apply to the extent that uoveraye is excluded or limited 6y such an endorsement. I he 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 cmufully to determine rights; duties; and what is and is not covered. A. Aircraft Chamfered 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 PRVVISIONS A. AIRCRAFT CHARTERED wl I R PILO 1 The following is added to Exclusion y.; Aircraft, Auto Or Watercraft, in Parayraph 2. of SECTION I — COVERAGES — COVERAGE A BODILY IN- JURY AND PROPERTY DAMAGE LIABILITY: I his exclusion does not apply to an aircraft that is: (a) Chaffered with a pilot to any insured; (b) Not owned by any insured; and (c) Not being used to can y any person or prop- erty for a charge. B. DAMAGE TO PREMISES RENTED TO YOU 1 _ I he 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. H. Blanket Additional Insured — Lessors UT Ceased Equipment I. Blanket Additional Insured — States Or Political Subdivisions — Permits J. Knowledye And Notice Of Occurrence Or Uttense K. Unintentional Omission E. Blanket waiver Ut Subrogation M. Amended Bodily Injury Detinition N. Contractual Liability — Railroads INJURY AND PROPERTY DAMAGE LI- ABILITY: Exclusions c. and g. through n= do not apply to "premises damage". Exclusion t_(1)(a) does not apply to "premises damage" caused By: a. Fire; b. Explosion; c. Lightning; a. Smoke resulting trom such tire, explosion, or lightning; or e. water; unless Exclubion f. of Section I — Coverage A — Bodily Injury And PropeFly 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. 2. 1 he tollowing replaces the last paragraph of A separate limit of insdrar,ce applies to Paragraph 2., Exclusions, of SECTION I — "premises damage" as described in Para - COVERAGES — COVERAGE A. BODILY graph 6. of SECTION III — LIMITS OF IN- SURANCE. CG D3 16 11 11 C 2011 The Travelers Indemnity Company. All rights r6arv.a. Page 1 of 6 ( 0MMFRCIAI rFNFRAI I IARII ITY 3. the following rPplacec Paragraph R. of SFr-. 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 namage To Premises Rented To You I imit 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 rnmhioatino of any of these causes. The Damage Io Premises Rented To You I imit will he: 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. A. The following replarP-, Paragraph a_ pf tha definition of "inGurPd contract" in tha nFEINI- IIONS Section: a. A contract for a lease of premises. Elow- 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 DEFINIIIONS Section: "Premises damage" means "property dam- age" tn: 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: (h) That is incUrnnra for "premises damage' nr Z. Paragraph A.b.(1)(c) of SECTION IV — COMMERCIAL GENERAL LIABILITY CON- DITIONS is deleted. C. INCRFASFD SUPPI FMENIARY PAYMFNIS 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 reguired because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Inf ury Liability Coverage applies. We do not have to fur- nish these bonds. 2. The following replaces Paragraph 1.d. of SUPPLEMENTARY PAYMENIS — COVER- AGFS A AND R of SFCIInN 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 9. The following is added to the definition of 'oc- currence" in the DEFINITIONS Section: "Occurrence" also means an act nr omission committed in providing or failing to provide "incidental medical services", fir -qt aid or "rood Samaritan services" to a person. 2. The following is added to Paragraph 2-a.(1) of SECIION 11 —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 "rood Samaritan services" by acy of your "employees" or "volunteer workers", other than an employed or vol- unteer doctor. Any such "employees" or "vnliiptaar wnrkarg" prnvidiog or failing to provide first aid or "Good Samaritan ser- vices" during their work hours for you will ha de-pMP_d to him_ artiog within the scope of their employment by you or performing duties related to the conduct of your husi- ness. Page 2 of 6 n 2011 The Travelers Indemolty Company, All rights reserved. CG D3 16 11 11 3. 1 Fie following is added to Paragraph 5. of SEC I ION Ili — EIMI 15 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 Nu lowing cxolusiun 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 willtul violation of a penal statute or ordinance relating to the sale of pharmaceuti- cals committed 6y, or with the knowledge or consent ot, the insured. 6. 1 he following is added to the DEFINI I IONS Section: "Incidental medical services" means: a. Medical, surgical, dental, laburatui y. x-ray or nursing service or treatme,it'advice or instruction, or the related famishing of food or bcveraycs; or 6_ 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. b. The following is added to Paragraph 4.6., Ex- F cess Insurance, of SEc; I IUR Iv — cOM- MERCIAL tjENERAE EIABIEI I Y CONDI- I IONS: 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 I he following replaces Paragraphs 4. of SECTION 11— WHO 15 AN INSURED: GUMMERGIAL GENERAL LIABILITY 4. Any uiyanization 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 quality as a Famed Insured it there is no other insurance which provides similar coverage to that or- ganization. Rowever: a. Coverage under this provision is afforded only: (1) Uiitil 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 1 du days atter you acquire or form it; or (2) U,itil the end of the policy period, when that date is later than mu days atter you acquire or form such organization, if you report such organization in writing to us within itsu days atter you acquire or torm it, and we agree in writing that it will con- tinue to be a Named Insured until the end OT the policy period; 5. 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. WHO IS AN INSURED — BROADENED NAMED INSURED — UNNAMED SUBSIDIARIES I he following is added to SECTION II — WHO IS AN IN5URED: 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 Famed Inscied if yua maintain an own- ership interest of more than 5u%u in such subsiai- ary on the tlrst day of the policy period. No SUCH subsidiary is an insured for "bodily injury" or "property damage" that occurred, or "personal injury" or "aavertising injury" caused 5y an ot- tense committed after the date, if any, during the policy period, that you no lunger maintain an ownership interest of more than 5u% in such sub- sidiary. CG D3 16 11 11 0 zui -i i Pie i ravr1urs Inacmnity t;Gmpany. All riyyfitz, rustim a. Page 3 of t3 COMMERCIAL GENERAL LIABILITY G. BLANKEI ADDITIONAL INSURED — OWNERS, MANAGERS OR LESSORS OF PREMISES The following is added to SECTION II — WHO IS AN INSURED: Any person or orgaui7ntion 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 io—red on this Coverage Part is an insured, but only with respect to liability for "hodily injury', "property damage". "personal injury' or "advertising injury' that: a. Is "hodily injury' or "property damage" that occurs, or is "personal injury' or "advertising injury' caused by an offense that is commit- ted, suhsequent 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: (9) Any "hodily injury' or "property damage" that niccurs. or "personal injury' or "adver- tising injury' caused by an offense that is committed, after you cease to he a tenant in that premises; or (2) Structural alterations, new construction or demolition operations performed by or on hehalf of such pre-misec nwngr. lessor or manager. c. The insurance provided to such premises owner, manager or lessor is excess over any valid and collectihlP other insurance available to such premises owner, manager or lessor, whether primary, excess, contingent or on any other hasiq, unleCq you have agreed in the written contract or agreement that this in- surance must he primary to, or non- contrihutory With, such nther 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 SFCIInN II — WHn IS AN INSURFn: Any person or organization that is an eguipment lessor and that you have agreed in a written con- tract or agreement to include as ao insured on this Coverage Part is an insured, but only with re- spect to liability for "hodily injurry", "property dam- age", "personal injury" or "advertigiog injury' that: a. Is "hodily injury" or "property damage" that occurs, or is "personal injury' or "advertising injury' caused by an offense that is commit- ted, suhsPqu_eat to the execution of that con- tract or agreement; and In. Is caused, in whole or in part, by your acts or omissions in the maintenance, nparatioo or use of equipment leased to you by such equipment lessor. The insurance provided to such equipment lessor is suhject to the following provisions: a- The limits of insurnoce 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 "hodily injury' or "property damage" that occurs, or "personal injury' or "advertising injury' caused by an of- fense that is committed, after the equipment lease expirP-Q. c. the insurance provided to such eguipment lessor is excess over any valid and collectible other insurance availahle to such equip—ot Ieccnr. 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 he pri-ary to, and non-contributory with, such other in- surance. I_ BLANKEI ADDITIONAL INSURED — SIAIFS OR POLITICAL SUBDIVISIONS — PFRMIIS The following is added to SFCIInN 11 — WHO IS AN INSURED: Any state or political suhdivision that has issued a permit in connection with operations performed by you or on your behalf and that you are reguired Page 4 of 6 © 2011 The Travelers Indemnity CnmpanV. All rights reserved. CG D3 16 11 11 by any ordinance, law or building code to include as an additional insured on this Coverage Pari is an insured, but only with respect to liability for "bodily injury", "property damage", "personal in- jury" or "adverffising injury" arising out of such op- erat;u, is. I he insurance provided to such state or political subdivision does not apply to: a. Any "bodily ii ijw y," "property damage," "per- sonal injury'' or "aavertising injury'' arising out of operations perfformed for that state or po- litical subdivision: or b. Any "bodily injury" or "property damage" in- cluded in the "produrts-uumpletcd operations ha4ard". J. KNOWLEDGE AND NOTICE OF OCCUR- RENCE OR OFFENSE I he 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. I he tollowing 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 - tense 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 (it you are a limited liability company), any of your "executive offi- cers" or directors (it 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 parffners, joint venture members or man- agers are individuals; notice to us of such "occurrence" or otrense must 5e given as soon as practicable only atter the "occur- cnue" or offense is known by: COIR MERCIAC uEIgERAC CIASICI I Y (ii) A manager of any limited liability company; or (iii) An executive officer or director of any other organization; that 15 your partner; joint venture membe, or manager, or (b) Any "employee" authorized by such paFfnership, joint venture, limited li- ability company or other organization to give iotice 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- scri6ea 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 Parff may apply. Rowever, it 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- antz," most be reported to us within a specific number of days atter its abrupt commencement, this Paragraph e. does not affect that require- ment. K. UNINTENTIONAL OMISSION I he following is added to Paragraph 6., Repre- sentations, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: I he unintentional omission of, or uni,iteittiunal 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 nunienewal in accordance with applicable insurance laws or regulations. L. BLANKET WAIVER OF SUBROGATION (a) Any individual who is: The following is added to Paragraph B., Transfer (i) A partner or member of any part- Of Rigf-its Of Recovery Against Others To Us, nership or joint venture: of SECTION IV — COMMERCIAL GENERAL LI- ABILITY CONDITIO195: CG 03 16 11 11 (0 2011 The Travelers Indemnity Company. All rights reserved. Page b of b COMMERCIAL GENERAL LIABILITY 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 fnr 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; suhsequent to the execution of that contract or agreement. M. AMFNnFn BOnp Y INJURY nEEINlIlObl The following replaces the definitinn of "hodily iniury" in the DEFINIIIONS Section: 3. "Bodily injury" means hodily injury, mental anguish, mental injury, shock, fright, disahility, 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 easAmAnt or lir,Pnse agreement; ?. Paragraph f.(7) of the definition of "insured contract" in the 13EFINIIIONS Section is de- leted. Page 6 of 6 © 2011 The Travelers Indemnity Company. All rights reserved. CG D3 16 11 11 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 fur any injury, damage or medical expenses described in any of the provisions of this endursement may be excluaea or limited by another endorsement to the Coverage Pall, and these coverye bruadeniny pruvisiuns du nut apply to the extent that coverage is excluded or limited by such an endursement. The fulluwiny listiny is a general cuver- age description only. Limitations and exulusiun5 may apply to tHese wverges. Read all the provisions of this en- dursement and the rest of your pulivy carefully to determine riyfits, auties, and what is and is nut covered. A. BRUAu FORM 19ARIED INSURED B. BLANKET ADDITIONAL IN5UKED C. EMPLOYEE RIRED AUTO D. EMPLOYEES AS INSURED E. SUPPLEMENTARY PAYMENTS — INCREASED LIMITS F. MIRED Au I U — [IMI I ED WUKCDWIDE cVv- ERAGE — INDEMNITY BASIS G. WAIVER OF DEDUCTIBLE = GLASS PROVISIONS /_w:3:Z4Z1l17i7 a►TiI►i/_1► I =t> 106i11 d :l 11 I Lie following is added to Paragraph A.1., Who Is An Insured, of SECTION II — COVERED AUTOS LIABILITY COVERAGE: Any uryanizatiun yuu newly auAluire or form aui- ing the policy perioa over which you maintain 50% or more ownership interest and that is not separately insured fur Business Auto CuVerye. Coverage under this provision is afforded only un- til the 1Both1 day after you acquire or form the or- ganization ui the end of the pulivy period, which- ever is earlier. B. BCANKE t ADDITIONAL INSURED The following is added to Paragraph c. in A.1., Whv Is An Insured, of SEC I IUN II — cUvERED AUTOS LIABILITY COVERAGE: Any person or organization who is required under a written contract or agreement between you and that person or uryanizatiun, tfllat is signed and executed by you 5etore the "bodily injury" or "property damage" occurs and that is in effect during the pulivy period, to 5u named as an aaai- tional insured is an "insured" for Covered Autos Liability Coverage, but only for damages to which H. HIRED AUTO PHYSICAL DAMAGE — LOSS OF USE — INCREASED LIMIT I. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES — INCREASED LIMIT J. PERSONAL PROPER I Y K. AIRBAGS L. NOTICE AND KNOWLEDGE OF ACCIDENT OR Cobb M. BLANKET WAIVER OF SUBROGATION N. UNIN I EN I IONAC ERRORS OR uM1155ION5 tHis insurance applies and only to the extent that person or organization qualifies as an "insured" under the Whu Is An Insured pruvisiun uuntained in 5ectiun 11. C. EMPLOYEE HIRED AUTO 1_ I fie tulluwing 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 cuntract or agreement in an "ernployeew' name, with your permission, while perfurminy duties related to the conduct of your busi- ness. 2. The following replaces Para -graph b. in B.5., Other Insurance, of SECTION IV — BU51- NESS AUTO CONDITIONS: D. F-ur Rirea Auto F'flysical Damage Cover- aye, the fulluwiny are deemed to 6e cuv- ered `'autos" you own: (1) Any covered "autu" you lease, Flire, rent or borrow; and (2) Any covered "auto' hired or rented by yuur "empluyee" under a cuntiact in an '�employeeos � name, with your CA T3 53 0215 © 2015 The Travele, 5 IndemnRy company. All rigntt. rm;crvz-d. Page 1 of 4 Includes copyrighted material uf Irruramu SCrvicus umuv, Ino. witR ita pe, , , iis�iun. MURAFRCIAI AUTt) permission, while performing duties related to the rondurt of your hugi- nPss_ Hnwever, any "auto" that is leased, hired, rented or borrowed with a driver is not a cnvprpd "auto". D. EMPLOYEES AS INSURED The follnming is addPd to Paragraph A=1., Who Ic An Inqured, of SECTION II — COVERED AUTOS LIABILITY COVERAGE: Any "employee" of ynurs is an "insured" mthilp us- ing a rnvprpd "ai itn" ynu dnn't own, hire or borrow in your business or your personal affairs. E. SUPPLEMENTARY PAYMENTS — INCREASED LIMITS 1. The following rPplacPs Paragraph A.2=a,(2), of SFCTION II — COVERED AUTOS LIABIL- ITY COVERAGE: (2) Up to $3,000 for cost of hail hnnds (in- cluding hnndq for rplatpd traffic law viola- tinng) required because of an "accident" we cover. We do not have to fumish these honds. The fnlloming rpplacps Paragraph A_2.a.(d), of SFCTInN II — COVERED AUTOS LIABIL- ITY COVERAGE: (a) With respect to any claim made or "quit" hrnught nutside the United States of America, the territories and possessions of the Ignited States of America, Puprtn Rirn and Canada: (i) You must arrange to defend the "in- sured" against, and jnvPstjg_atP or sPt- tlp any surh claim or "quit" and keep uq advised of all proceedings and ac- tions. (ii) Neither you nor any other involved "insured" will make any-Pflpmpnt without our consent. (iii) We may, at our discretion, participate in defending the "insured" against, or in the-PfIPmP.nt of, any claim or "suit". (iv) We will reimburse the "insured" for sums that the "jnsurPd" legally must pay no damages because of ''bodily injury" or "property damage" to which this insurance applies, that the "in- sured" pays with niir rnngpnt, but only up to the limit described in Para- graph C., Limits Of Insurance, of SFCTION II — COVFRFn AUTOS I IARII ITY CnVERAGE. (4) All reasonshie expenses incurred by the (v) We will reimburse the "insured" for "insured" nt our rPquPgt, including actual the reasonahle expenses incurred loss of earnings up to $500 a day be- with our rnngant fnr yniir invpgtiga- cause of time off from work. tion of such claims and your defense of the "insured" against any surh F_ HIRED AUTO — LIMITED WORLDWIDE COV- "quit", but only up to and jnrl�idpd ERAGE — IpIDEMpIITY BASIS within the limit dpsq-ibed in Para - The fnllnwing rPplar.Ps Suhpnragrnph (5) in Para- graph C., Limits Of Insurance, of graph B.7.. Policy Period, Coverage Territory, SFCTION II — COVFRFn AUTOS of SECTION IV — BUSINESS AUTO CONDI- I JARll ITY r.OVFRArF=, and not in TIONS: addition to such limit. Our duty to (5) Anywhprp in the wnrld, except any country or make such payments ends when we jurisdiction while any trade sanction, Pm- have uspd up the gpplirghlp limit of hargn, or similar rpqulatinn impngPd by the insurance in payments for damages, Unitpd Stntpq of Ampdca applies to and pro- settlements or dpfpnep Pxppnsps. hibits the transaction of business with or (h) This insurancp is P.XCP.gq over any unlid mdthin such country or jurisdiction, for Cnv- and rnllpctible other insurance available Bred Autnq I inhility Cnvpragp fnr any cnuprpd to the "insured" whether primary, excess, "auto" that you lease, hire, rent or borrow contingent or on any nthpr hagjq. without a driver for a period of 30 days or less (r_) This jngi►ranr.P js not a quhgtitute for re - and that is, not nn "nutn" you IPaSP, hire, rent quired or compulsory insurance in any nr hnrrnw from any of your "employees", country outside the United States, its tpr- partners (if you are a partnership), members ritories and possPssinns, Puprtn Rirn and (if you are a limited liahility company) or Canada mpmhprs of their hni igPhnldq. Page 2 of 4 n 209 5 The Travelers Indemnity r.nMpany_ All right, rasPrvad. CA T3 53 02 15 Includes rnpydghtpd material of lnsiirnnr.P gen[ir.Ps Office, lnc, with its PPrmi„inn, COMMERCIAL AUTO Yuu ayree to maintain all required or (2) h i ur un yuur wvered "autu'. cumpulsuly insurance in any such wun- I his coverage applies only in the event of a total Uy up to the minimum limits required by theft of your covered "auto'. lural law. Your failure to comply with cumpulsvey insurance requirenwrits will No deductibles apply to this Personal Property nut invalidate the wveraye affurded by coverage. this pulicy, but we will ur ily be liable to the K. AIRBAGS same extent we wuuld have been liable The fulluwiny is added to Parayraph B.3., Exelu- had yvu cumplied with the cumpulsury in- sions, of SECTION III — PHYSICAL DAMAGE surance requirements. COVERAGE: (d) It is understood that we are not an admit- ted or authorized insurer outside the United States of America_ its territories and possessionb, Puelffv Ricu and Can- ada. Vve 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. G. WAIVER OF DEDUCTIBLE — GLASs The fulluwiny is added to Parayraph D., Deducti- ble, of SECTION III — PHYSICAL DAMAGE COVERAGE: No deductible for a cuvered "autu" will apply to glass damage if the ylass is repaired rather than replaced. R. HIRED AUTO PHYSICAL DAMAGE — LOSS OF USE — INCREASED LIMIT I he following replaces the last sentence of Para- graph A.4.6., Loss Of Use Expenses, of SEC- T IuN III — PHYSICAL DAMAGE COvERAGE: Ruwever, the must we will pay for any expenses for loss of use is $65 per day, to a maximum of $/5U Tor any one "accident". I. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES — INCREASED LIMIT The following replaces the first sentence in Para- graph AA.a., Transportation Expenses, of SECTION III — PHYSICAL DAMAGE COVER- AGE: We will pay up to $5u per day to a maximum of $1,5uo for temporary transportation expense in- curred by you because of the total theft of a cov- ered °,autu'' of the private passenger type. J. PERSONA( PROPER I Y Exclusion 3.a. does not apply to "loss" to one or more aff5ays in a cuvered °iautu" you own that in- flate due to a uause uther than a cause of "loss' set forth in Paragraphs A.1.15. and A.1.c., but only: a. It that "auto" is a covered "auto" for Compre- fiensive C;uverage under this policy; b. The airbags are not covered under any war- ranty; and c. The airbags were not intentionally inflated. Vve will pay up to a maximum at $1,uuu Tor any one "loss". L. NOTICE AND KNuWCEDGE OF ACCIDEN i OR LOSS I he following is added to Paragraph A.2.a., of SECTION IV — BUSINESS AUTO CONDITIONS: Your duty to give us or our authorized representa- tive prumpt nutice uT the '°accident'` or "luss ` ap= plies only when the "accident" or "loss" is know, to: (a) You (if you are an individual); (b) A paliTner (IT you are a paffnership); (c) A member (if you are a limited liability com- pany); (d) An executive officer, director or insurance manager (if you are a corporatiun or other or- ganization); or (e) Any "employee" authorized by you to give no- tice of the "accident" ur "luss'. M. BLANKET WAIVER OF SUBROGATION The following replaces Paragraph A.5., Transfer Of Rights Ot Recovery Against Others To Us, uT SEC I IuN IV — BUSINESS AU 10 CORDI- TIONS: The following is added to Paragraph AA., Cover- 5. I ranster ut Rights Of Recovery Against age Extensions, of SECTION III — PHYSICAL Others To Us DAMAGE COVERAGE: We waive any right of recovery we may have Personal Property ayainst any persun or organization to the ex- tent required of you by a written contract We will pay up to $40U Tor "loss" to wearing ap= signed and executed prior to any "accident'` parei and uther personal property wnich is: or "loss", provided that the "accident" ur "luss" (1) Owned by an "insured"; and arises out of operations contemplated by CA T3 53 0215 © 2015 The Travelers Indemnity Company. All rights reserved. Page 3 of 4 Includes copyrighted material of Insurance Services Office, Inc. with Its permission. COMMFRCIAI AUTO such contract. The waiver applies only to the The unintentional omissinn of, or imintpntinnni pprcnn nr organization designated in such Prmr in, any infnrmatinn given by you shall not contract. prejudice your rights under this insurance. How - N. UblINTFW1IONAL ERRORS OR OMISSIONS ever this provision does not affpr.t our right to rnl- The following is added to Paragraph R,2., Con- Ipr:t additinnal prpmium or exercise our right of realment, Misrepresentation, Or Fraud, of cancellation or non -renewal. sFCTION Iv — R1IRINFSS AUTO CONDITIONS: Page 4 of 4 (c) 2015 The Travelers Indemnity Company. All rights rasprw d. rA T3 53 0215 Includes copVrighted material of InsUmLinp Rewires Offira, lnr. with itc permiscinn. UMBRELLA THIS ENDURSEMEN I CRANuES THE POLICY. PLEASE READ I I CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS This endorsemeni modifies insurmice provided cinder ifie following: wnMMERCIAL EXCESS LIABILITY (UMBRELLA) INSURANCE The followiny i�, added iv Paragraph 11., OUR RIGHT TO RECOVER FROM OTHtRS., of SECTION IV — CONDITIONS.: If the insured has ayreed in a contract or ayreemeni to waive that im urrd',z, right of recovery against any person or organization, we waive our right of recovery against such person or organization. But only for payments we make Because of: a. "Bodily injury' or "property damage" caused By an "occurrence" that takes place; or B. "Perwrial injary" v, "advertiainy injury" caused by an "ottense" that is cvmmii[Cd; subsequent to the execution of the cuntra,_i or dyrEe- ment. UM 04 88 07 08U' ZUUt3 I Fie Iravelers companies. Inc. Page 1 of 1 Includes the copyrighted material of Insurance Services Office. Inc. with its permission. Tbic Page hac been left blank intentinnally. O