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HomeMy WebLinkAboutCertificate of Insurance 2016CALISUR-02 JRODRIGUEZ AC`C7RC!° CERTIFICATE OF LIABILITY INSURANCE DAT 12/28/20 /28/20Y6 116 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(les) 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). PRODUCER Warren G. Bender Co. 516 Gibson Drive Suite 240 Roseville, CA 95678 COME;NTACT NA PHONE (A/MC, No, Exq: (916) 380-5300_ _ jn/c, No): (916) 3$0-5206 _ FADDRESS: -- -- INSURER(S) AFFORDING COVERAGE NAIC # _________ ___ ___ _________ __. ' INSURER A: Travelers Property Casualty_ 25674 INSURED INSURER B DAMAGETORENTED PREMISES (Ea occurrence)___ INSURER C California Surveying And Drafting Supply INSURER0 4733 Auburn Blvd. Sacramento, CA 95841 --INSURER— --- INSURER E $ 1,000,000 INSURER F: GENERAL AGGREGATE_ $ 2,000,000 COVERAGES 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 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. INSR7YpE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF YL POLICY EXPLTR (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS-MADEX OCCUR X 6303FO61592-17 01/01/2017 01/01/2018 EACH OCCURRENCE $ 1,000,000 DAMAGETORENTED PREMISES (Ea occurrence)___ 100,000 $ MED EXPny one person) $ 10,000 PERSONAL &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY [ jE�T [J LOC OTHER: GENERAL AGGREGATE_ $ 2,000,000 PRODUCTS - COMPIOPAGG $ 2,000,000 A AUTOMOBILE -1 Li.ABILITY �^ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS AUTOS ONLY AUTOS ONLY 81031.061592-17 01/01/2017 01/01/2018 OM�BINNED SINGLE LIMIT (EaX $ 1,000,000 BODILY INJURY (Perperson__$ BODILY INJURY (Per accldenQ $ PPe�accRdent�AMAGE— $ — -- A X UMBRELLA LAB EXCESS LIAB� X OCCUR CLAIMS -MADE EX -7H534610.17 01/01/2017 01/01/2018 EACH OCCURRENCE $ 4,000,000 _ AGGREGATE $ 4,000,000 � DED X RETENTION $ 0 $ A WORKERS COMPENSATION ANDEMPLOYTOR/P RTNEY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN 0pFICEE/MEMBER EXCLUDED? (Manda ory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N I A UB-3FO61592-17 01/01/2017 01/01/2018 X STA LITE TH E.L. EACH ACCIDENT $ 1,000,000 _ E.L. DISEASE - EA EMPLOYEE $ 1'000'000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Additional Insured per attached endorsem ent: Town of Los Altos Hills Town of Los Altos Hills 26379 Fremont Rd SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE *0"44L,6411- ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY 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 riot covered, A. Broadened Named Insured B. Blanket Additional Insured — Broad Form Vendors C. Damage To Premises Rented To You 0 Perils of fire, explosion, lightning, smoke, water 0 Limit increased to $300,000 D. Blanket Waiver Of Subrogation E. Blanket Additional Insured — Owners, Managers Or Lessors Of Premises F.: Blanket Additional Insured — Lessors Of Leasqd Equipment G. Incidental Medical Malpractice H. Personal Injury — Assumed By Contract PROVISIONS A. BROADENED NAMED INSURED 11. The following is added to SECTION 11— WHO IS AN INSURED: Any organization, other than a partnership or joint venture, over which you maintain owner- ship or majority interest on the effective date of the policy qualities as a Named Insured. However, coverage for any such organization will cease as of the date during the policy pe- riod that you no longer maintain ownership of, or majority interest in, such organization. 2. The following replaces Paragraph 4.a. of SECTION 11 —WHO IS AN INSURED: a. Coverage under this provision is afforded only until the 180th day after you acquire or form the organization or the end of the policy period, whichever Is earlier, unless reported in writing to us within 180 days. 1. Amended Bodily Injury Definition J. Bodily Injury To Co -Employees And Co -Volunteer Workers K. Aircraft Chartered With Crew L. Non -Owned Watercraft — Increased From 25 Feet To 50 Feet M. Increased Supplementary Payments Cost of ball bonds increased to $2,500 Loss of earnings increased to $500 per day N. Knowledge And Notice Of Occurrence Or Offense O. Unintentional Omission P. Reasonable Force — Bodily Injury Or Property Damage B. BLANKET ADDITIONAL INSURED — BROAD FORM VENDORS The following is added to SECTION 11 — WHO IS AN INSURED: Any person or organization that is a vendor and that you have agreed in a written contract or agreement to include as an additional insured on this Coverage Part Is an Insured, but only with re- spect to liability for "bodily injury" or "property damage" that: a. Is caused by an "occurrence" that takes place after you have signed and executed that con- tract or agreement; and b. Arises out of "your products" which are dis- tributed or sold In the regular course of such vendors business. The insurance provided to such vendor is subject to the following provisions: a. The limits of insurance provided to such ven- dor will be the limits which you agreed to prow CG D4 67 0713 0 2013 The Travelers Indemnity Company. All right reserved. Page 1 of 7 Includes copyrighted material of Insurenco Services Office, Inc. with Its permission. vide in the written contract or agreement, or the limits shown in the Declarations of this Coverage Part, whir, , hever are less. b. The Insurance provided to such vendor does not apply to: (1) "Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or, agreement; (2) Any express warranty unauthorized by you; (3) Any physical or chemical change in "your products" made intentionally by such vendor; (4) Repackaging, unless unpacked solely for the purpose of Inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; (6) Any failure to make such inspections, ad- justments, tests or servicing as vendors agree to perform or normally undertake to perform In the regular course of business, in connection with the distribution or sale T f "your products"; (6) Demonstration, Installation, servicing or repair operations, except such operations performed at such vendor's premises In connection with the sale of "your prod- ucts"; -or (7) "Your products" which, after distribution or sale by you, have been labeled or re- labeled or used as a container, part or In- gredient of any other thing or substance by or for such vendor. Coverage under this provision does not apply to: a. Any person or organization from whorn you have acquired "your productsor any Ingre- dient, part or container entering into, accom- panying or containing such products; or b. Any vendor for which coverage as an addi- tional Insured specifically Is scheduled by en- dorsement. C. DAMAGE TO PREMISES RENTED TO YOU following replaces the last paragraph of Paragraph 2., Exclusions, of SECTION I — COVERAGES — COVERAGE A BODILY IN- JURY AND PROPERTY DAMAGE LIABIL- ITY: Exclusions c. through n. do not apply to dam- age to premises while rented to you, or tem- porarily occupied by you with permission of the owner, caused by: a. Fire; b. Explosion; c. Lightning; d. Smoke resulting from such fire, explosion, or lightning; or e. Water. A separate limit of insurance applies to such damage to premises as described in Para- graph 6. of Section III — Limits Of insurance, This Insurance does not apply to damage to promises while rented to you, or temporarily occupied by you with permission of the owner, caused by: a. Rupture, bursting, or operation of pres- sure relief devices; lb. Rupture or bursting due to expansion or swelling of the contents of any building or structure, caused by or resulting from wa- ter; c. Explosion of stearn boilers, steam pipes, steam engines, or steam turbines. 2. The following replaces Paragraph 6, of SEC- TION III — LIMITS OF INSURANCE: Subject to 6. above, the Damage To Prem- ises Rented To You Limit is the most we will pay under Coverage A for damages because of "property damage" to any one premises while rented to you, or temporarily occupied by you with permission of the owner, caused by fire; explosion; lightning; smoke resulting from such fire, explosion, or lightning; or wa- ter. The Damage To Premises Rented To You Limit will apply to all damage proximately caused by the same "occurrence", whether such damage results from fire; explosion; lightning; smoke resulting from such fire, ex- plosion, or lightning; water; or any combina- tion of any of these. The Damage To Premises Rented To You Limit will be the higher of: a. $300,000; or b. The amount shown on the Declarations of this Coverage Part for Damage To Prom- Ises Rented To You Limit. Page 2 of 7 0 7.013 The Travelers Indemnity Company. All right reserved. CG D4 67 07 13 Includes copyrighted material of Insurance Services Office, Inc. with Its permission, 004144 3. 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 damage to premises while rented to you, or tempo- rarily occupied by you with permission of the owner, caused by: (1) Fire; COMMERCIAL GENERAL LIABILITY a. Is "bodily injury" or "property damage" caused by an "occurrence" that takes place, or "per- sonal injury" or "advertising injury" caused by an offense that Is committed, after you have signed and executed that contract, or agree- ment; 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: (2) Explosion; a. The limits of insurance provided to such (3) Lightning; premises owner, manager or lessor will be (4) Smoke resulting from such fire, ex- the limits which you agreed to provide in the plosion, or lightning; or written contract or agreement, or the limits shown on the Declarations of this Coverage (5) Water. Part, whichever are less. 4. The following replaces Paragraph 4.b.(11)(b) of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: (b) That is insurance for premises rented to you, or ternporarily occupied by you with the permission of the owner; D. 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: We waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of premises owned or occupied by or rented or loaned to you; ongoing operations perforTned by you or on your behalf, done under a contract with that person or organization; "your work"; or 11your products". We waive this right where you have agreed to do so as part of a written contract, executed by you prior to loss. E. BLANKET ADDITIONAL INSURED — OWNERS, MANAGERS OR LESSOR$ OF PREMISES The following is added to SECTION If — WHO IS ANINSURED: Any person or organization that is a premises owner, manager or lessor and that you have agreed in a written contract or agreement to name as an additional insured on this Coverage Part is an Insured, but only with respect to liability for "bodily injury", "property darnage", ""personal injury" or"advertising Injury" that: b. The insurance provided to such premises owner, manager or lessor does not apply to: (1) "Bodily injury" or "property damage" caused by an "occurrence" that takes place, or "personal injury" or "advertising injury" caused by an offense that is com- mitted, 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 promises owner, manager or lessor. 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, unless you have agreed .in a written contract for this insurance to apply on a primary or contributory basis, F. BLANKET ADDITIONAL INSURED — LESSONS OF LEASED EQUIPMENT The following is added to SECTION 11 — WHO IS ANINSURED: 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 additional in- sured on this Coverage Part is an insured, but only with respect to liability for "bodily injury", "property damage", "personal Injury" or "advertis- ing injury" that: a. Is "bodily injury" or "property damage" caused by an "occurrence" that takes place, or "per- sonal injury" or "advertising injury" caused by an offense that is committed, after you have CG D4 67 07 13 0 2013 The Travelers Indemnity Company, All right reserved. Page 3 of 7 Inoludes, copyrighted material of Insurance Services Office, Inc. with Its permission. 004145 COMMERCIAL GENERAL LIABILITY signed and executed that contract or agree- ment; and b. Is caused, in whole or in part, by your acts or omissions in the maintenance, operation or use by you of equipment leased to you by such equipment lessor. The insurance provided to such equipment lessor is subject to the following provisions: a. The firrilts of insurance provided to such equipment lessor will be the limits which you agreed to provide in the written contract or agreement, or the limits shown on the Decla- rations of this Coverage Pad, whichever are less. b. The Insurance provided to such equipment lessor does not apply to any "bodily injury" or "property damage" caused by an "occur- rence" that takes place, or "personal injury" or "advertising injury" caused by an offense that is committed, after the equipment lease ex- pires. c. The Insurance provided to such equipment lessor Is excess over any valid and collectible other insurance available to such equipment lessor, unless you have agreed in a written contract for this insurance to apply on a pri- rnary or contributory basis. G. INCIDENTAL MEDICAL MALPRACTICE 1. The following is added to the definition of "oc- currence" In the DEFINITIONS Section: Unless you are in the business or occupation of providing professional health care services, f"occurrence"" also means an act or omission committed in providing or failing to provide "Incidental medical services" to a person. 2. 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; b. The furnishing or dispensing of drugs or medical, dental, or surgical supplies or appliances; c. First aid; or d. "Good Samaritan services". "Good Samaritan services" means any emer- gency medical services for which no compen. sation is demanded or received. 3. The following is added to Paragraph 2.a.(1) of SECTION 11 —WHO IS AN INSURED: Unless you are in the business or occupation of providing professional health care services, Paragraphs (1)(a), (b), (c) and (d) above do not apply to any "bodily injury" arising out of any providing or failing to provide "Incidental medical services" by any of your "employ- ees", other than an employed doctor. Any such "employees" providing or failing to pro- vide "Incidental medical services" during their work hours for you will be deemed to be act- ing within the scope of their employment by you or performing duties related to the con- duct of your business. 4. The following exclusion is added to Para- graph 2., Exclusions, of SECTION I — COV- ERAGE$ — COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY: "Bodily injury" or "property darnage" arising out of the willful violation of a penal statuteor 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 Paragraph SECTION III — LIMITS OF INSURANCE. For the purposes of determining the applica- ble Each Occurrence Limit, all related acts or omissions committed In the providing or fall- ing to provide "incidental medical services" to any one person will be considered one currence". 6. The following is added to Paragraph 4.b., Ex- cess Insurance, of SECTION IV — COM- MERCIAL GENERAL LIABILITY CONDI- TIONS: This insurance is excess over any valid and collectible other Insurance, whether primary, excess, contingent or on any other basis, that is available to any of your "employees" for "bodily injury" that arises out of providing or failing to provide "Incidental medical services" to any person to the extent not subject to Paragraph Za.(I) of SECTION 11 — WHO IS ANINSURED. Page 4 of 7 0 2013 The Travelers Indemnity Company. All right reserved, CG D4 67 07 13 Includes copyrighted material of Insurance Services Office, Inc. with Its permission. a. Contractual Liability "Personal injury" or "advertising injury" for which the insured Is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to: (1) Liability for damages that the Insured would have in the absence of the contractor agreement; or (2) Liability for damages because of "personal injury" assumed in a con- tract or agreement that is an "Insured contract", provided that the "personal injury" is caused by an offense com- mitted subsequent to the execution of the contract or agreement. Solely for the purposes of liability assumed in an "insured contract", reasonable at- torneys fees and necessary litigation expenses incurred by or for a party other than an insured will be deemed to be damages because of "personal injury", provided that: (a) Liability to such party for, or for the Cost of, that party's defense has also been assumed In the same "Insured contract"; and (b) Such attorney fees and litigation expenses are for defense of that party against a civil or alternative dispute resolution proceeding in which damages to which this In- surance applies are alleged. 2. The following replaces the third sentence of Paragraph 2. of SUPPLEMENTARY PAY- MENTS — COVERAGES A AND B: Notwithstanding the provisions of Paragraph 2.b.(2) of Section I — Coverage A — Bodily In- jury And Property Damage Liability or Para- graph 2.s. of Section I — Coverage B — Per- sonal and Advertising Injury Liability, such payments will not be deemed to be damages because of "bodily Injury", "property damage" or "personal Injury", and will not reduce the limits of insurance. COMMERCIAL GENERAL LIABILITY 3. The following replaces Paragraph 2.d. of SUPPLEMENTARY PAYMENTS — COVER- AGES A AND B: d. The allegations in the "suit" and the in- formation we know about the "occur- rence" or offense are such that no conflict appears to exist between the interests of the insured and the interests of the in- demnitee; 4. The following replaces the first subparagraph of Paragraph f. of the definition of "Insured contract" in the DEFINITIONS Section: f. That part of any other contract or agree- ment pertaining to your business (Includ- Ing an indemnification of a municipality In connection with work performed for a municipality) under which you assume the tort liability of another party to pay for "bodily Injury," "property damage" or "per- sonal injury" to a third person or organiza- tion. Tort liability means a liability that would be Imposed by law in the absence of any contract or agreement. 1. AMENDED BODILY IrIJURT DEFIft-ITION The following replaces the definition of "bodily in- jury" In the DEFINITIONS Section: "Bodily injury" means bodily injury, mental an- guish, mental injury, shock, fright, disability, hu- miliation, sickness or disease sustained by a per- son, including death resulting from any of these at any time. J. BODILY INJURY TO CO -EMPLOYEES AND CO -VOLUNTEER WORKERS The following is added to Paragraph 2.a.(I) of SECTION 11 —WHO IS AN INSURED: Paragraph (1)(a) above does not apply to "bodily Injury" to a co -"employee" in the course of the co - "employee's" employment by you or performing duties related to the conduct of your business, or tR "bodily Injury" to your other "volunteer workers!' while performing duties related to the conduct of your business, K. AIRCRAFT CHARTERED WITH CREW 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: CG D4 67 07 13 0 2013 The Travelers Indemnity Company. All right reserved. Page 5 of 7 includes copyrighted material ofInsurance Services Office, Inc, with Its permission. 004146 (a) Chartered with crew to any insured; (b) Not owned by any Insured; and (c) Not being used to carry any person or prop. erty for a charge, following replaces Paragraph (2) of Ex- clusion g., Aircraft, Auto Or Watercraft, in Paragraph 2. of SECTION I — COVERAGES — COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY: (2) A watercraft you do not own that Is: (a) Fifty feet long or less; and (b) Not being used to carry any person or property for a charge. 2. The following is added to Paragraph 2. of SECTION 11 — WHO IS AN INSURED: Any person or organization that, with your ex- press or implied consent, either uses or is re- sponsible for the use of a watercraft that you do not own that is: (1) Fifty feet long or less; and (2) Not being used to carry any person or property for a charge. M. INCREASED SUPPLEMENTARY PAYMENTS following replaces Paragraph SUPPLEMENTARY PAYMENTS — COVER- AGES A AND B of SECTION I — COVER- AGE& b. Up to $2,500 for cost of bail bonds re- quIred because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to fur- nish these bonds. 2. The following replaces Paragraph SUPPLEMENTARY PAYMENTS — COVER- AGE$ A AND B of SECTION I — COVER- AGE$: d. All reasonable expenses incurred by the insured at our request to assist us In the investigation or defense of the claim or including actual loss of earnings up to $500 a day because of time off from work. N. KNOWLEDGE AND NOTICE OF OCCUR- RENCE OR OFFENSE The following is added to Paragraph 2.j Duties In The Event ofOccurrence, Offense, Claim or Suit, of SECTIONCOMMERCIAL 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 11 — 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 to 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 trustees who is an Individual (if you are a trust), any of your "executive officers" or directors (if you are an organization other than a partnership, joint venture, limited liability company or trust) or any "employee" authorized by you to give notice of an "occurrence" or offense. (2) If you are a partnership, joint venture, lim- Ited liability company or trust, and none of your partners, joint venture members, managers or trustees are individuals, no- tice to us of such "occurrence" or offense must be given as soon as practicable only after the "occurrence" or offense is known by: (a) Any individual who Is: (i) A partner or member of any part- nership or joint venture; (h) A manager of any limited liability company; (iii) A trustee of any trust; or (Iv) An executive officer or director of any other organization; that Is your partner, joint venture member, manager or trustee; or (b) Any "employee" authorized by such partnership, joint venture, limited li- ability kability company, trust or other organi- zation to give notice of an "occur. rence" or offense. (3) Notice to us of such "occurrence" or of- fense will be deemed to be given as soon as practicable if it Is given in good faith as soon as practicable to your workers' compensation insurer. This applies only if you subsequently give notice to us of the "occurrence" or offense as soon as prac- ticable after any of the persons described Page 6 of 7 02013 The Travelers Indemnity Company. All right reserved, CG D4 67 07 13 Includes copyrighted material of Insurance Services Office, Inc. with its permission, in Paragraphs e.(1) or (2) above discov- ers that the "occurrence" or offense may result in SLIMS to which the insurance provided under this Coverage Part may apply. However, if this policy includes an endorse- ment that provides limited coverage for "bod- ily injury" or "property damage" or pollution costs arising out of a discharge, release or escape of "pollutants" which contains a re- quirement that the discharge, release or es- cape of "pollutants" must be reported to us within a specific number of days after its abrupt commencement, this Paragraph e. does not affect that requirement, O. UNINTENTIONAL OMISSION COMMERCIAL GENERAL LIABILITY relied upon In issuing this policy will not prejudice your rights under this insurance. However, this provision does not affect our right to collect addi- tional premium or to exercise our rights of cancel- lation or nonrenewal in accordance with applica- ble insurance laws or regulations. P. REASONABLE FORCE — BODILY INJURY OR PROPERTY DAMAGE The following replaces Exclusion a., Expected Or Intended Injury, in Paragraph 2. of SECTION I — COVERAGE$ — COVERAGE A BODILY IN- JURY AND PROPERTY DAMAGE LIABILITY: a. Expected or Intended Injury or Damage "Bodily injury" or "property damage" expected or Intended from the standpoint of the In- sured. This exclusion does not apply to "bod- ily injury" or "property damage" resulting from the use of reasonable force to protect any person or property. CG D4 67 07 13 0 2013 The Travelers indemnity Company. All right reserved, Page 7 of 7 Includes copyrighted material of Insurance Services Offles, Inc, with Its permission, Nil This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A 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 riot covered, A. Broadened Named insured I, Amended Bodily Injury Definition B. Blanket Additional Insured — Broad Form Vendors J. Bodily Injury To Co -Employees And Co -Volunteer C. Damage To Premises rented To You Workers " Perils of fire, explosion, lightning, smoke, K. Aircraft Chartered With Crew water L. Non -Owned Watercraft — Increased From 25 Feet a Limit increased to $300,000 To 50 Feet D. Blanket Waiver Of Subrogation M. Increased Supplementary Payments E. Blanket Additional Insured — Owners, Managers • Cost of bail bonds increased to $2,500 Or Lessors Of Premises 0 Loss of earnings increased to $500 per day F. Blanket Additional Insured — Lessors Of Leased N. Knowledge And Notice Of Occurrence Or Offense Equipment O. Unintentional Omission G. Incidental Medical Malpractice P. Reasonable Force —Bodily Injury Or Property H. Personal Injury — Assumed By Contract Damage PROVISIONS BLANKET ADDITIONAL INSURE _ BROAD A. BROADENED NAMED INSURED FORM VENDORS 1. The following is added to SECTION II —WINO The following is added to SECTION II — WHO IS AN INSPIRED: IS AN INSURED: Any person or organization that is a vendor and Any organization, other than a partnership or that you have agreed in a written contract or joint venture, over which you maintain owner- agreement to include as an additional insured on ship or majority interest on the effective date this Coverage Part is an insured, but only with re - of the policy qualifies as a Named Insured. spect to liability for "bodily injury" or "property However, coverage for any such organization damage" that: will cease as of the date during the policy pe- a. Is caused by an "occurrence" that takes place riod that you no longer maintain ownership of, after you have signed and executed that Con- or majority interest in, such organization, tract or agreement; and 2. The following replaces Paragraph Ca. of b. Arises out of "your products" which are di - SEC` ION II —WHO IS AN INSURED: tributed or sold in the regular course of such vendors business. a. Coverage under this provision is afforded only until the 150th day after you acquire The insurance provided to such vendor is subject or form the organization or the end of the to the following provisions: policy period, whichever is earlier, unless a. The limits of insurance provided to such ven- reported in writing to us within 180 days, dor will be the limits which you agreed to pro - CG D4 67 07 13 0 2013 The Travelers Indemnity Company. All right reserved, Page 1 of 7 Includes oopyrighted material of Insurance Services Office, Inc, with Its permission. 004144 vide in the written contract or agreement, or the limits shown in the Declarations of this Coverage Part, whichever are less. b. The Insurance provided to such vendor does not apply to: (1) "Bodily injury" or "property damage" for which the vendor Is obligated to pay damages by reason of the assumption of liability In a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; (2) Any express warranty unauthorized by you; (3) Any physical or chemical change in "your products" made intentionally by such vendor; (4) Repackaging, unless unpacked solely for the purpose of Inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; (6) Any failure to make such inspections, ad- justments, tests or servicing as vendors agree to perform or normally undertake to perform In the regular course of business, in connection with the distribution or sale of "your products"; (6) Demonstration, Installation, servicing repair operations, except such operation performed at such vendor's premises I connection with the sale of "your pro ucts";. or (7) "Your products" which, after distributio or sale by you, have been labeled or r. labeled or used as a container, part or in gredient of any other thing or substanc by or for such vendor. Coverage under this provision does not apply to: a. Any person or organization from whom yo have acquired "your products", or any ingre dient, part or container entering Into, accom panying or containing such products; or b. Any vendor for which coverage as an add! tional insured specifically Is scheduled by en dorsement. C. DAMAGE TO PREMISES RENTED TO YOU 1. The following replaces the last paragraph o Paragraph 2., Exclusions, of SECTION I COVERAGE$ — COVERAGE A BODILY 111-141 JURY AND PROPERTY DAMAGE LIABIL ITY: I Exclusions c. through n. do not apply to dam- age to premises while rented to you, or tem- porarily occupied by you with permission of the owner, caused by: a. Fire; b. Explosion; c. Lightning; d. Smoke resulting from such fire, explosion, or lightning; or e. Water. A separate limit of insurance applies to such damage to premises as described in Para- graph 6. of Section III — Limits Of Insurance, This insurance does not apply to damage to premises while rented to you, or temporarily occupied by you with permission of the owner, caused by: a. Rupture, bursting, or operation of pres- sure relief devices; b. Rupture or bursting due to expansion or swelling of the contents of any building or structure, caused by or resulting from wa- ter; c. Explosion of steam boilers, steam pipes, steam engines, or steam turbines. 2. 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 "property damage" to any one premises while rented to you, or temporarily occupied by you with permission of the owner, caused by fire; explosion; lightning; smoke resulting from such fire, explosion, or lightning; or wa- ter. The Damage To Premises Rented To You Limit will apply to all damage proximately caused by the same "occurrence", whether such damage results from fire; explosion; lightning; smoke resulting from such fire, ex- plosion, or lightning; water; or any combina- tion of any of these. The Damage To Promises Rented To You Limit will be the higher of., a. $300,000; or b. The amount shown on the Declarations of this Coverage Part for Damage To Prem- ises Rented To You Limit, Page 2 of 7 0 2013 The Travelers Indemnity Company. All tight reserved. CG 04 67 07 13 Includes copyrighted material of Insurance Services Office. Inc. with Its permission, 3. 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 damage to promises while rented to you, or tempo- rarily occupied by you with permission of the owner, caused by: (1) Fire; (2) Explosion; (3) Lightning; (4) Smoke resulting from such fire, ex- plosion, or lightning; or (6) Water. is not an "insured contract"; 4. The following replaces Paragraph 4.b.(1)(b) of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: (b) That is insurance for premises rented to you, or temporarily occupied by you with the permission of the owner, D. BLANKET WAIVER OF SUBROGATION The following is added to Paragraph 0., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV — COMMERCIAL GENERAL LI- ABILITY CONDITIONS: We waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of promises owned or occupied by or rented or loaned to you; ongoing operations performed by you or on your behalf, done under a contract with that person or organization; "your work"; or 11your products". We waive this right where you have agreed to do so as part of a written contract, executed by you prior to loss. E. BLANKET ADDITIONAL INSURED — OWNERS, MANAGERS OR LESSORS +r, PREMISES The following is added to SECTION 11 — WHO IS ANINSURED: Any person or organization that is a premises owner, manager or lessor and that you have agreed in a written contract or agreement to name as an additional insured on this Coverage Part is an Insured, but only with respect to liability for "bodily injury", "property darnage", "persoi.)al injury" or "advertising injury" that: a. Is "bodily injury" or "property damage" caused by an "occurrence" that takes place, or "per- sonal injury" or "advertising injury" caused by an offense that Is committed, after you have signed and executed that contract or agree- ment; 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 limits which you agreed to provide in the written contract or agreement, or the limits shown on the Declarations of this Coverage Part, whichever are less. b. The Insurance provided to such premis-Om owner, manager or lessor does not apply to: (1) "Bodily injury" or "property damag caused by an "occurrence" that tak place, or "personal injury" or "advertis! injury" caused by an offense that Is co mitted, after you cease to be a tenant that premises; or I (2) Structural alterations, new construction or demolition operations performed by or on behalf of such premises owner, manager or lessor. c. The insurance provided to such promises owner, manager or lessor is excess over any valid and collectible other insurance available to such premises owner, manager or lessor, unless you have agreed in a written contract for this insurance to apply on a primary or contributory basis. F. BLANKET ADDITIONAL INSURED — LESSORS OF LEASED EQUIPMENT The following Is added to SECTION 11 — WHO IS ANINSURED: 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 additional in- sured on this Coverage Part is an insured, but only with respect to liability for "bodily injury", "property damage", "personal injury" or "advertis- ing injury" that: a. Is "bodily injury" or "property damage" caused by an "occurrence" that takes place, or "per- sonal injury" or "advertising injury" caused by an offense that is committed, after you have CG D4 67 07 13 0 2013 The Travelers Indemnity Company. All right reserved. Page 3 of 7 Includes copyrighted material of Insurance Services Office, Inc, with b permission. Na== 004146 signed and executed that contract or agree- ment; and b. Is caused, in whole or in part, by your acts or omissions in the maintenance, operation or use by you 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 limits which you agreed to provide in the written contract or agreement, or the limits shown on the Decla- rations of this Coverage Part, whichever are less. b. The insurance provided to such equipment lessor does not apply to any "bodily injury" or "property damage" caused by an "occur- rence" that takes place, or "personal injury" or "advertising injury" caused by an offense that is committed, after the equipment lease ex- pires. c. The Insurance provided to such equipment lessor is excess over any valid and collectible other Insurance available to such equipment lessor, unless you have agreed In a written contract for this insurance to apply on a inary or contributory basis. G. INCIDENTAL MEDICAL MALPRACTICE 1. The following Is added to the definition of '*oc- currence" In the DEFINITIONS Section: Unless you are in the business or occupation of providing professional health care services, ffoccurrence" also means an act or omission committed in providing or failing to provide "Incidental medical services" to a person. 2. 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; b, The furnishing or dispensing of drugs or medical, dental, or surgical supplies or appliances; c. First aid; or "Good Samaritan services" means any emer- gency medical services for which no compen. sation is demanded or received. 3. The following is added to Paragraph 2.a.(1) of SECTION 11 —WHO IS AN INSURED: Unless you are in the business or occupation of providing professional health care services, Paragraphs (1)(a), (b), (c) and (d) above do not apply to any "bodily injury" arising out of any providing or failing to provide "Incidental medical services" by any of your "employ- ees", other than an employed doctor. Any such "employees" providing or failing to pro- vide "Incidental medical services" during their work hours for you will be deemed to be act- ing within the scope of their employment by you or performing duties related to the con- duct of your business, 4. The following exclusion is added to Para- graph 2., Exclusions, of SECTION I — COV- ERAGE — COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY: "Bodily Injury" or "property clarnage" 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 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 the providing or fall - Ing to provide "Incidental medical services" to any one person will be considered one "oc- currence". 6. The following is added to Paragraph 4.b., Ex- cess Insurance, of SECTION IV — COM- MERCIAL GENERAL LIABILITY CONDI- TIONS: This insurance Is excess over any valid and collectible other Insurance, whether primary, excess, contingent or on any other basis, that is available to any of your "employees" for "bodily injury" that arises out of providing or failing to provide "Incidental medical services" to any person to the extent not subject to Paragraph 2.a.(1) of SECTION 11 — WHO IS ANINSURED, Page 4 of 7 0 2013 The Travelers Indemnity Company. All right reserved. CG D4 67 07 13 Includes copyrighted material of Insurance Services Office, Inc. with its permission. a. Contractual Liability "Personal injury" or "advertising injury" for which the insured Is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to: (1) Liability for damages that the Insured would have in the absence of the contract or agreement; or (2) Liability for damages because of "personal injury" assumed in a con- tract or agreement that Is an "insured contract", provided that the "personal Injury" is caused by an offense com- mitted subsequent to the execution of the contract or agreement. Solely for 'the purposes of liability aSSUrTled In an "insured contract", reasonable at- torneys fees and necessary litigation expenses incurred by or for a party other than an insured will be deemed to be damages because of "personal injury", provided that: (a) Liability to such party for, or for the cost of, that party's defense has also been assumed In the same "Insured contract"; and (b) Such attorney fees and litigation expenses are for defense of that party against a evil or alternative dispute resolution proceeding In which damages to which this in- surance applies are alleged. 2. The following replaces the third sentence of Paragraph 2. of SUPPLEMENTARY PAY- MENTS — COVERAGES A AND B: Notwithstanding the provisions of Paragraph 2.b.(2) of Section I — Coverage A — Bodily In- jury And Property Damage Liability or Para- graph 2.e. of Section I — Coverage B — Per- sonal and Advertising Injury Liability, such payments will not be deemed to be damages because of "bodily injury", "property damage" or "personal Injury", and will not reduce the limits of Insurance. 3. The following replaces Paragraph 2.d. of SUPPLEMENTARY PAYMENTS — COVER- AGES A AND B: d. The allegations in the "suit" and the in- formation we know about the "occur- rence" or offense are such that no conflict appears to exist between the interests of the insured and the interests of the in- demnitee; 4. The following replaces the first subparagraph of Paragraph f. of the definition of "Insured contract" in the DEFINITION$ Section: f. That part of any other contract or agree- ment pertaining to your business (includ- ing an indemnification of a municipality In connection with work performed for a municipality) under which you assume the tort liability of another party to pay for "bodily Injury," "property damage" or "per- sonal injury" to a third person or organiza- tion. Tort liability means a liability that would be imposed by law in the absence of any contract or agreement, 1. AMENDED BODILY INJURY DEFINITION The following replaces the definition of "bodily in- jury" in the DEFINITION$ Section: "Bodily injury" means bodily injury, mental an- guish, mental injury, shock, fright, disability, hu- miliation, sickness or disease sustained by a per- son, Including death resulting from any of these at any time. J. BODILY INJURY TO CO -EMPLOYEES AND +r O' WORKERS The following is added to Paragraph 2.a.(I) of SECTION 11 — WHO IS AN INSURED: Paragraph (1)(a) above does not apply to "bodily Injury" to a co -"employee" in the course of the co - "employee's" employment by you or performing duties related to the conduct of your business, or to "bodily Injury" to your other "volunteer workers" while performing duties related to the conduct of your business, K. AIRCRAFT CHARTERED WITH CREW 111100MAIN A 11AII 1010111611111SOMN "AN JURY AND PROPERTY DAMAGE LIABILITY: This exclusion does not apply to an aircraft that CG D4 67 07 13 @ 2013 The Travelers Indemnity Company. All right reserved. Page 5 of 7 Includes copyrighted material of Insurance Services Office, Inc. with Its permission, 004140 COMMERCIAL GENERAL LIABILITY (a) Chartered with crew to any insured; (b) Not owned by any insured; and (c) Not being used to carry any person or prop- erty for a charge, 1 . The following replaces Paragraph (2) of elusion g., Aircraft, Auto Or Watercraft, Paragraph 2. of SECTION I — COVERAG — COVERAGE A BODILY INJURY A PROPERTY DAMAGE LIABILITY: (2) A watercraft you do not own that Is: (a) Fifty feet long or less; and If Not being used to carry any person property for a charge. E N 2. The following Is added to Paragraph 2. SECTION 11 —WHO IS AN INSURED: Any person or organization that, with your e,, press or implied consent, either uses or is r sponsible for the use of a waten do not own that is: , (1) Fifty feet long or less; and (2) Not being used to carry any person or property for a charge. M. INCREASED SUPPLEMENTARY PAYMENTS 1. The following replaces Paragraph I.b. of SUPPLEMENTARY PAYMENTS — COVER- AGES A AND B of SECTION I — COVER- AGES: b. Up to $2,500 for cost of ball bonds re- quired because of accidents or traff Ic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies, We do not have to fur- nish these bonds, 2. The following replaces Paragraph I.d. of SUPPLEMENTARY PAYMENTS — COVER- AGE$ A AND B of SECTION I — COVER- AGE$: 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. N. 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 11— 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 to 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 trustees who is an individual (if you are a trust), any of your "executive officers" or directors (if you are an organization other than a partnership, joint venture, limited liability company or trust) or any "employee" authorized by you to give notice of an "occurrence" or offense, (2) If you are a partnership, joint venture, lim- ited liability company or trust, and none of your partners, joint venture members, managers or trustees are Individuals, no- tice to us of such "occurrence" or offense must be given as soon as practicable only after the "occurrence" or offense is known by: (a) Any individual who Is: (i) A partner or member of any part- nership or joint venture; (1i) A manager of any limited liability company; (iii) A trustee of any trust; or (Iv) An executive officer or director of any other organization; that Is your partner, joint venture member, manager or trustee; or (b) Any "employee" authorized by such partnership, joint venture, limited li- ability company, trust or other organi- zation to give notice of an "occur- rence" or offense. (3) Notice to us of such "occurrence" or of- fense will be deemed to be given as soon as practicable If it Is given in good faith as soon as practicable to your workers' compensation insurer. This applies only if you subsequently give notice to us of the "occurrence" or offense as soon as prac- ticable after any of the persons described Page 6 of 7 0 2013 The Travelers Indemnity Company. All right reserved, CG D4 67 07 13 Includes copyrighted material of Insurance Services Office, Inc, with Its permission, in Paragraphs e.(1) or (2) above discov- ers that the "occurrence" or offense may result in sums to which the insurance provided under this Coverage Part may apply. However, if this policy includes an endorse- ment that provides limited coverage for "bod- ily Injury" or "property damage" or pollution costs arising out of a discharge, release or escape of "pollutants" which contains a re- quirement that the discharge, release or es- cape of "pollutants" must be reported to us within a specific number of days after its abrupt commencement, this Paragraph e. does not affect that requirement. The following is added to Paragraph 6., Repre- sentations, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS; The unintentional omission of, or unintentional er- ror in, any information provided by you which we relied upon In issuing this policy will not prejudice your rights under this insurance. However, this provision does not affect our right to collect addi- tional premium or to exercise our rights of cancel- lation or nonrenewal in accordance with applica- ble insurance laws or regulations. P. REASONABLE FORCE — BODILY INJURY OR PROPERTY DAMAGE The following replaces Exclusion a., Expected Or Intended Injury, in Paragraph 2. of SECTION I — COVERAGE$ — COVERAGE A BODILY IN- JURY AND PROPERTY DAMAGE LIABILITY: a. Expected or Intended Injury or Damage "Bodily injury" or "property damage" expected or Intended from the standpoint of the In. sured. This exclusion does not apply to "bod- ily injury" or "property damage" resulting from the use of reasonable force to protect any person or property. CG D4 67 07 13 0 2013 The"rravelers Indemnity Company. All right reserved. Page 7 of 7 Includes copyrighted material of Insurance Services Office, Inc, with Its permission.