HomeMy WebLinkAboutCertificate of Insurance (3)AC"R6r CERTIFICATE OF LIABILITY INSURANCE
DATE(MM/DD/YYYY)
5/27/2022
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).
PRODUCERCONTACT
Woodruff Sawyer
2 Park Plaza, Suite 500
Irvine CA 92614
Audre Curtis
PHONE
A/C No Ext): 949-435-7345 FAx
AIC No
ADDRESS: acurtis woodruffsaw er.com
INSURERS AFFORDING COVERAGE NAIC #
INSURER A: Continental Casualty Company 20443
INSURED HDLCORE-01
HdL Coren & Cone
120 S. State College Blvd., Suite 200
Brea CA 92821
INSURER B: Valley Fore Insurance Company 20508
INSURER C:
INSURER D:
INSURER E:
INSURER F:
VVVCI[WVCJ GEKIiFiCA1E NUMBEK:2125871521 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.
INSR
LTR
I TYPE OF INSURANCE
A D D L
D
I SUBR
WVD
POLICY NUMBER
MM DD/YYYY
MM DDNYYY
LIMITS
A
X COMMERCIAL GENERAL LIABILITY
F _V1
CLAIMS -MADE OCCUR
B6025253592
6/15/2022
6/15/2023
EACH OCCURRENCE $ 2,000,000
DA E TO RENT
PREM SES (Ea occurrence) $ 1,000,000
MED EXP (Any one person) $ 10,000
PERSONAL &ADV INJURY $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
X PRO -
POLICY ❑ JECT PRO LOC
GENERAL AGGREGATE $ 4,000,000
PRODUCTS - COMP/OP AGG $ 4,000,000
$
OTHER:
A
AUTOMOBILE
LIABILITY
86025253592
6/15/2022
6/15/2023
Ea BINEDtSINGLE LIMIT $1,000,000
ANY AUTO
BODILY INJURY (Per person) $
OWNED SCHEDULED
AUTOS ONLY AUTOS
BODILY INJURY (Per accident) $
X
HIRED X NON -OWNED
AUTOS ONLY AUTOS ONLY
PROPERTY DAMAGE
Per accident $
A
X
UMBRELLA LIAR
I X
OCCUR
86025253611
6/15/2022
6/15/2023
EACH OCCURRENCE $1,000,000
EXCESS LIAB
CLAIMS -MADE
AGGREGATE $1,000,000
DED I X I RETENTION $ in on
$
g
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANYPROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBEREXCLUDED?
N/A
WC625253608
6/15/2022
6/15/2023
X STATUTE OERH
E.L. EACH ACCIDENT $ 1,000,000
E.L. DISEASE - EA EMPLOYEE $ 1,000,000
(Mandatory in NH)
If yes, describe under
E.L. DISEASE - POLICY LIMIT $ 1,000,000
DESCRIPTION OF OPERATIONS below
A
Professional Liability
Cyber Liability
652117825
6/15/2022
6/15/2023
Each Claim $2,000,000
Aggregate $2,000,000
DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
City of Los Altos Hills its officers, employees and agents are included as Additional Insured as respects General Liability and Auto Liability on a Primary and
Non-contributory basis with a waiver of subrogation to the extent provided in the attached forms.
City of Los Altos Hills
26379 Fremont Road
Los Altos Hills CA 94022
VAIYVLLL/-11
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
v -IU00-ZU"I0 AwKLJ t;OKNUKA TION. All rights reserved,
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
CNA 86025253592
SB146932G
(Ed. 10-19)
BLANKET ADDITIONAL INSURED AND LIABILITY EXTENSION ENDORSEMENT
This endorsement modifies insurance provided under the following:
BUSINESSOWNERS LIABILITY COVERAGE FORM
BUSINESSOWNERS COMMON POLICY CONDITIONS
I. BLANKET ADDITIONAL INSURED PROVISIONS
A. ADDITIONAL INSURED — BLANKET VENDORS
Who Is An Insured is amended to include as an additional insured any person or organization (referred to below
as vendor) with whom you agreed under a "written contract" to provide insurance, but only with respect to
"bodily injury" or "property damage" arising out of "your products" which are distributed or sold in the regular
course of the vendor's business, subject to the following additional exclusions:
1. The insurance afforded the vendor does not apply to:
m
a. "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;
b. Any express warranty unauthorized by you;
c. Any physical or chemical change in the product made intentionally by the vendor;
d. Repackaging, except when 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;
e. Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make
or normally undertakes to make in the usual course of business, in connection with the distribution or sale
of the products;
f. Demonstration, installation, servicing or repair operations, except such operations performed at the
vendor's premises in connection with the sale of the product;
g. Products which, after distribution or sale by you, have been labeled or relabeled or used as a container,
part or ingredient of any other thing or substance by or for the vendor; or
516146932CU (10-19)
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Page —10 f 7
TABLE OF CONTENTS
I. Blanket Additional Insured Provisions
A.
Additional Insured — Blanket Vendors
B.
Miscellaneous Additional Insureds
C.
Additional Provisions Pertinent to Additional Insured Coverage
1.a. Primary — Noncontributory provision
1.b. Definition of "written contract"
2. Additional Insured — Extended Coverage
II. Liability Extension Coverages
A.
Bodily Injury — Expanded Definition
B.
Broad Knowledge of Occurrence
C.
Estates, Legal Representatives and Spouses
D.
Fellow Employee First Aid
E.
Legal Liability — Damage to Premises
F.
Personal and Advertising Injury — Discrimination or Humiliation
G.
Personal and Advertising Injury — Broadened Eviction
H.
Waiver of Subrogation — Blanket
I. BLANKET ADDITIONAL INSURED PROVISIONS
A. ADDITIONAL INSURED — BLANKET VENDORS
Who Is An Insured is amended to include as an additional insured any person or organization (referred to below
as vendor) with whom you agreed under a "written contract" to provide insurance, but only with respect to
"bodily injury" or "property damage" arising out of "your products" which are distributed or sold in the regular
course of the vendor's business, subject to the following additional exclusions:
1. The insurance afforded the vendor does not apply to:
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a. "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;
b. Any express warranty unauthorized by you;
c. Any physical or chemical change in the product made intentionally by the vendor;
d. Repackaging, except when 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;
e. Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make
or normally undertakes to make in the usual course of business, in connection with the distribution or sale
of the products;
f. Demonstration, installation, servicing or repair operations, except such operations performed at the
vendor's premises in connection with the sale of the product;
g. Products which, after distribution or sale by you, have been labeled or relabeled or used as a container,
part or ingredient of any other thing or substance by or for the vendor; or
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B6025253592
SB146932G
(Ed. 10-19)
h. "Bodily injury" or "property damage" arising out of the sole negligence of the vendor for its own acts or
omissions or those of its employees or anyone else acting on its behalf. However, this exclusion does not
apply to:
(1) The exceptions contained in Subparagraphs d. or f.; or
(2) Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally
undertakes to make in the usual course of business, in connection with the distribution or sale of the
products.
2. This insurance does not apply to any insured person or organization, from whom you have acquired such
products, or any ingredient, part or container, entering into, accompanying or containing such products.
3. This provision 2. does not apply to any vendor included as an insured by an endorsement issued by us and
made a part of this Policy.
4. This provision 2. does not apply if "bodily injury" or "property damage" included within the "products -
completed operations hazard" is excluded either by the provisions of the Policy or by endorsement.
B. MISCELLANEOUS ADDITIONAL INSUREDS
1. Who Is An Insured is amended to include as an insured any person or organization (called additional
insured) described in paragraphs 3.a. through 3.1. below whom you are required to add as an additional
insured on this policy under a "written contract."
2. However, subject always to the terms and conditions of this policy, including the limits of insurance, we will
not provide the additional insured with:
a. A higher limit of insurance than required by such "written contract;"
b. Coverage broader than required by such "written contract" and in no event greater than that described
by the applicable paragraph a. through k. below; or
c. Coverage for "bodily injury" or "property damage" included within the "products -completed
operations hazard." But this paragraph c. does not apply to the extent coverage for such liability is
provided by paragraph 3.j. below.
Any coverage granted by this endorsement shall apply only to the extent permitted by law.
3. Only the following persons or organizations can qualify as additional insureds under this endorsement:
a. Controlling Interest
Any persons or organizations with a controlling interest in you but only with respect to their liability arising
out of:
(1) such person or organization's financial control of you; or
(2) Premises such person or organization owns, maintains or controls while you lease or occupy these
premises;
provided that the coverage granted to such additional insureds does not apply to structural alterations,
new construction or demolition operations performed by or for such additional insured.
b. Co-owner of Insured Premises
A co-owner of a premises co -owned by you and covered under this insurance but only with respect to the
co-owners liability for "bodily injury," "property damage" or "personal and advertising injury" as co-
owner of such premises.
c. Grantor of Franchise
Any person or organization that has granted a franchise to you, but only with respect to such person or
organization's liability for "bodily injury," "property damage," or "personal and advertising injury" as
grantor of a franchise to you.
SB146932G (10-19)
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Page 2of7
B6025253592
d. Lessor of Equipment
SB146932G
(Ed. 10-19)
Any person or organization from whom you lease equipment, but only with respect to liability for "bodily
injury," "property damage" or "personal and advertising injury" caused in whole or in part by your
maintenance, operation or use of such equipment, provided that the "occurrence" giving rise to such
"bodily injury" or "property damage" or the offense giving rise to such "personal and advertising
injury" takes place prior to the termination of such lease.
e. Lessor of Land
Any person or organization from whom you lease land, but only with respect to liability for "bodily injury,"
"property damage" or "personal and advertising injury" arising out of the ownership, maintenance or
use of that specific part of the land leased to you, provided that the "occurrence" giving rise to such
"bodily injury" or "property damage" or the offense giving rise to such "personal and advertising
injury," takes place prior to the termination of such lease. The insurance hereby afforded to the additional
insured does not apply to structural alterations, new construction or demolition operations performed by,
on behalf of or for such additional insured.
f. Lessor of Premises
An owner or lessor of premises leased to you, or such owner or lessor's real estate manager, but only
with respect to liability for "bodily injury," "property damage" or "personal and advertising injury"
arising out of the ownership, maintenance or use of such part of the premises leased to you, and
provided that the "occurrence" giving rise to such "bodily injury" or "property damage" or the offense
giving rise to such "personal and advertising injury," takes place prior to the termination of such lease.
The insurance hereby afforded to the additional insured does not apply to structural alterations, new
construction or demolition operations performed by, on behalf of or for such additional insured.
g. Mortgagee, Assignee or Receiver
A mortgagee, assignee or receiver of premises but only with respect to such mortgagee, assignee, or
receiver's liability for "bodily injury," "property damage" or "personal and advertising injury" arising
out of the ownership, maintenance, or use of a premises by you.
This insurance does not apply to structural alterations, new construction or demolition operations
performed by, on behalf of or for such additional insured.
h. State or Political Subdivisions
A state or government agency or subdivision or political subdivision that has issued a permit or
authorization, but only with respect to such government agency or subdivision or political subdivision's
liability for "bodily injury," "property damage" or "personal and advertising injury" arising out of:
m (1) The following hazards in connection with premises you own, rent, or control and to which this
N insurance applies:
(a) The existence, maintenance, repair, construction, erection, or removal of advertising signs,
awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoistaway
a openings, sidewalk vaults, street banners, or decorations and similar exposures; or
(b) The construction, erection, or removal of elevators; or
(c) The ownership, maintenance or use of any elevators covered by this insurance; or
(2) The permitted or authorized operations performed by you or on your behalf. But the coverage granted
by this paragraph does not apply to:
(a) "Bodily injury", "property damage" or "personal and advertising injury" arising out of
operations performed for the state or government agency or subdivision or political subdivision;
or
(b) "Bodily injury" or "property damage" included within the "products -completed operations
hazard."
With respect to this provision's requirement that additional insured status must be requested under a
"written contract," we will treat as a "written contract" any governmental permit that requires you to add
the governmental entity as an additional insured.
SB146932G (10-19)
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Page 3 of 7
B6025253592
SB146932G
(Ed. 10-19)
I. Trade Show Event Lessor
With respect to your participation in a trade show event as an exhibitor, presenter or displayer, any
person or organization whom you are required to include as an additional insured, but only with respect to
such person or organization's liability for "bodily injury," "property damage," or "personal and
advertising injury" caused by:
a. Your acts or omissions; or
b. Acts or omissions of those acting on your behalf;
in the performance of your ongoing operations at the trade show premises during the trade show event.
j. Other Person or Organization
Any person or organization who is not an additional insured under paragraphs a. through i. above. Such
additional insured is an insured solely for "bodily injury," "property damage" or "personal and
advertising injury" for which such additional insured is liable because of your acts or omissions.
The coverage granted by this paragraph does not apply to any person or organization:
(1) For "bodily injury," "property damage," or "personal and advertising injury" arising out of the
rendering or failure to render any professional services;
(2) For "bodily injury" or "property damage" included in the "products -completed operations
hazard." But this provision (2) does not apply to such "bodily injury" or "property damage" if:
(a) It is entirely due to your negligence and specifically results from your work for the additional
insured which is the subject to the "written contract"; and
(b) The "written contract" requires you to make the person or organization an additional insured for
such "bodily injury" or "property damage"; or
(3) Who is afforded additional insured coverage under another endorsement attached to this policy.
C. ADDITIONAL PROVISIONS PERTINENT TO ADDITIONAL INSURED COVERAGE
1. With respect only to additional insured coverage provided under paragraphs A. and B. above:
a. The BUSINESSOWNERS COMMON POLICY CONDITIONS are amended to add the following to the
Condition entitled Other Insurance:
This insurance is excess of all other insurance available to an additional insured whether primary,
excess, contingent or on any other basis. However, if a "written contract" requires that this insurance be
either primary or primary and noncontributing, then this insurance will be primary and non-contributory
relative solely to insurance on which the additional insured is a named insured.
b. Under Liability and Medical Expense Definitions, the following definition is added:
"Written contract" means a written contract or agreement that requires you to make a person or
organization an additional insured on this policy, provided the contract or agreement:
(1) Is currently in effect or becomes effective during the term of this policy; and
(2) Was executed prior to:
(a) The "bodily injury" or "property damage;" or
(b) The offense that caused the "personal and advertising injury";
for which the additional insured seeks coverage.
2. With respect to any additional insured added by this endorsement or by any other endorsement attached to
this Coverage Part, the section entitled Who Is An Insured is amended to make the following natural persons
insureds.
If the additional insured is:
a. An individual, then his or her spouse is an insured;
SB146932G (10-19) Page 4 of 7
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B6025253592
SB146932G
(Ed. 10-19)
b. A partnership or joint venture, then its partners, members and their spouses are insureds;
c. A limited liability company, then its members and managers are insureds;
d. An organization other than a partnership, joint venture or limited liability company, then its executive
officers, directors and shareholders are insureds; or
e. Any type of entity, then its employees are insureds;
but only with respect to locations and operations covered by the additional insured endorsement's provisions,
and only with respect to their respective roles within their organizations. Furthermore, employees of
additional insureds are not insureds with respect to liability arising out of:
(1) "Bodily injury" or "personal and advertising injury" to any fellow employee or to any natural person
listed in paragraphs a. through d. above;
(2) "Property damage" to property owned, occupied or used by their employer or by any fellow employee; or
(3) Providing or failing to provide professional health care services.
II. LIABILITY EXTENSION COVERAGES
It is understood and agreed that this endorsement amends the Businessowners Liability Coverage Form. If any
other endorsement attached to this policy amends any provision also amended by this endorsement, then that other
endorsement controls with respect to such provision, and the changes made by this endorsement to such provision do
not apply.
A. Bodily injury— Expanded Definition
Under Liability and Medical Expenses Definitions, the definition of "Bodily injury" is deleted and replaced by
the following:
"Bodily injury" means physical injury, sickness or disease sustained by a person, including death, humiliation,
shock, mental anguish or mental injury by that person at any time which results as a consequence of the physical
injury, sickness or disease.
B. Broad Knowledge of Occurrence
Under Businessowners Liability Conditions, the Condition entitled Duties In The Event of Occurrence, Offense,
Claim or Suit is amended to add the following:
Paragraphs a. and b. above apply to you or to any additional insured only when such "occurrence," offense,
claim or "suit" is known to:
(1) You or any additional insured that is an individual;
M
0
(2) Any partner, if you or an additional insured is a partnership;
0
(3) Any manager, if you or an additional insured is a limited liability company;
(4) Any "executive officer" or insurance manager, if you or an additional insured is a corporation;
(5) Any trustee, if you or an additional insured is a trust; or
(6) Any elected or appointed official, if you or an additional insured is a political subdivision or public entity.
This paragraph applies separately to you and any additional insured.
C. Estates, Legal Representatives and Spouses
The estates, heirs, legal representatives and spouses of any natural person insured shall also be insured under
this policy; provided, however, coverage is afforded to such estates, heirs, legal representatives and spouses only
for claims arising solely out of their capacity as such and, in the case of a spouse, where such claim seeks
damages from marital common property, jointly held property, or property transferred from such natural person
insured to such spouse. No coverage is provided for any act, error or omission of an estate, heir, legal
representative or spouse outside the scope of such person's capacity as such, provided however that the spouse
of a natural person Named Insured and the spouses of members or partners of joint venture or partnership
Named Insureds are insureds with respect to such spouses' acts, errors or omissions in the conduct of the Named
Insured's business.
SB146932G (10-19)
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Page 5of7
B6025253592 SB146932G
(Ed. 10-19)
D. Fellow Employee First Aid Coverage
In the section entitled Who Is An Insured, paragraph 2.a.1. is amended to add the following:
The limitations described in subparagraphs 2.a.1 .(a), (b) and (c) do not apply to your "employees" for "bodily
injury" that results from providing cardiopulmonary resuscitation or other first aid services to a co -"employee" or
"volunteer worker" that becomes necessary while your "employee" is performing duties in the conduct of your
business. Your "employees" are hereby insureds for such services. But the insured status conferred by this
provision does not apply to "employees" whose duties in your business are to provide professional health care
services or health examinations.
E. Legal Liability — Damage To Premises
1. Under B. Exclusions, 1. Applicable to Business Liability Coverage, Exclusion k. Damage To Property, is
replaced by the following:
k. Damage To Property
"Property damage" to:
1. Property you own, rent or occupy, including any costs or expenses incurred by you, or any other
person, organization or entity, for repair, replacement, enhancement, restoration or maintenance of
such property for any reason, including prevention of injury to a person or damage to another's
property;
2. Premises you sell, give away or abandon, if the "property damage" arises out of any part of those
premises;
3. Property loaned to you;
4. Personal property in the care, custody or control of the insured;
5. That particular part of any real property on which you or any contractors or subcontractors working
directly or indirectly in your behalf are performing operations, if the "property damage" arises out of
those operations; or
6. That particular part of any property that must be restored, repaired or replaced because "your work"
was incorrectly performed on it.
Paragraph 2 of this exclusion does not apply if the premises are "your work" and were never occupied,
rented or held for rental by you.
Paragraphs 1, 3, and 4, of this exclusion do not apply to "property damage" (other than damage by fire
or explosion) to premises:
(1) rented to you:
(2) temporarily occupied by you with the permission of the owner, or
(3) to the contents of premises rented to you for a period of 7 or fewer consecutive days.
A separate limit of insurance applies to Damage To Premises Rented To You as described in Section D —
Liability and Medical Expenses Limits of Insurance.
Paragraphs 3, 4, 5, and 6 of this exclusion do not apply to liability assumed under a sidetrack agreement.
Paragraph 6 of this exclusion does not apply to "property damage" included in the "products -
completed operations hazard."
2. Under B. Exclusions, 1. Applicable to Business Liability Coverage, the following paragraph is added, and
replaces the similar paragraph, if any, beneath paragraph (14) of the exclusion entitled Personal and
Advertising Injury:
Exclusions c, d, e, f, g, h, i, k, I, m, n, and o, do not apply to damage by fire to premises while rented to you
or temporarily occupied by you with permission of the owner or to the contents of premises rented to you for a
period of 7 or fewer consecutive days. A separate limit of insurance applies to this coverage as described in
Section D. Liability And Medical Expenses Limits Of Insurance.
SB146932G (10-19)
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Page 6 of 7
B6025253592
SB146932G
(Ed. 10-19)
3. The first Paragraph under item 5. Damage To Premises Rented To You Limit of the section entitled
Liability And Medical Expenses Limits Of Insurance is replaced by the following:
The most we will pay under Business Liability for damages because of "property damage" to any one
premises, while rented to you or temporarily occupied by you with the permission of the owner, including
contents of such premises rented to you for a period of 7 or fewer consecutive days, is the Damage to
Premises Rented to You Limit. The Damage to Premises Rented to You Limit is the greater of:
a. $1,000,000; or
b. The Damage to Premises Rented to You Limit shown in the Declarations.
F. Personal and Advertising Injury— Discrimination or Humiliation
1. Under Liability and Medical Expenses Definitions, the definition of "personal and advertising injury" is
amended to add the following:
h. Discrimination or humiliation that results in injury to the feelings or reputation of a natural person, but only
if such discrimination or humiliation is:
(1) Not done intentionally by or at the direction of:
(a) The insured; or
(b) Any "executive officer," director, stockholder, partner, member or manager (if you are a limited
liability company) of the insured; and
(2) Not directly or indirectly related to the employment, prospective employment, past employment or
termination of employment of any person or person by any insured.
2. Under B. Exclusions, 1. Applicable to Business Liability Coverage, the exclusion entitled Personal and
Advertising Injury is amended to add the following additional exclusions:
(15) Discrimination Relating to Room, Dwelling or Premises
Caused by discrimination directly or indirectly related to the sale, rental, lease or sub -lease or prospective
sale, rental, lease or sub -lease of any room, dwelling or premises by or at the direction of any insured.
(16) Employment Related Discrimination
Discrimination or humiliation directly or indirectly related to the employment, prospective employment
past employment or termination of employment of any person by any insured.
(17) Fines or Penalties
N
m Fines or penalties levied or imposed by a governmental entity because of discrimination.
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3. This provision (Personal and Advertising Injury — Discrimination or Humiliation) does not apply if
Personal and Advertising Injury Liability is excluded either by the provisions of the Policy or by
0
endorsement.
a
G. Personal and Advertising Injury - Broadened Eviction
Under Liability and Medical Expenses Definitions, the definition of "Personal and advertising injury" is
amended to delete Paragraph c. and replace it with the following:
c. The wrongful eviction from, wrongful entry into, or invasion of the right of private occupancy of a room
dwelling or premises that a person or organization occupies committed by or on behalf of its owner, landlord
or lessor.
H. Waiver of Subrogation — Blanket
We waive any right of recovery we may have against:
a. Any person or organization with whom you have a written contract that requires such a waiver.
All other terms and conditions of the Policy remain unchanged.
SB146932G (10-19)
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Page 7of7
SB146902G
(Ed. 6-16)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
HIRED AUTO AND NON -OWNED AUTO LIABILITY
This endorsement modifies insurance provided under the following:
BUSINESSOWNERS LIABILITY COVERAGE FORM
BUSINESSOWNERS COMMON POLICY CONDITIONS
SCHEDULE
Insurance is provided only with respect to those coverages for which a specific limit is shown:
COVERAGE LIMIT
Hired Auto Liability: $
Non -owned Auto Liability: $
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations as
applicable to this endorsement.)
PROVISIONS
A. COVERAGE
With respect only to the Coverage(s) for which a limit is shown in the SCHEDULE above, the insurance provided
under Coverage A.I. Business Liability for "bodily injury" and "property damage" also applies to "bodily injury" or
"property damage" arising out of the maintenance or use of a:
• "Hired auto" used by you or your "employee" in the course of your business; and/or
• "Non -owned auto" used in the course of your business. Maintenance or use of a "non -owned auto" includes test
driving in connection with an "auto business."
With respect only to the coverage provided by this endorsement, under Coverages, coverage A.1. Business Liability
is amended to:
1. Delete paragraph A.1.b.(1)(b) and replace it with the following:
b. This insurance applies:
(1) To "bodily injury" and "property damage" only if:
(b) The "occurrence" occurs during the policy period; and
2. Delete paragraph A.1.b.(2),.
B. LIMITS OF INSURANCE
With respect only to the coverage provided by this endorsement, SECTION D. Liability And Medical Expenses
Limits of Insurance is deleted in its entirety and replaced with the following:
D. Limits Of Insurance
1. Regardless of the number of:
a. Insureds;
b. Claims made or "suits" brought;
c. Persons or organizations making claims or bringing "suits"; or
d. "Autos,"
the applicable Hired Auto Liability limit or Non -Owned Auto Liability limit shown in the Declarations is the most
we will pay for damages under SECTION A. Coverages because of all "bodily injury" and "property damage"
resulting from any one 'occurrence" arising out of the maintenance or use of a "hired auto" or "non -owned
auto."
SB146902G (Ed. 6-16)
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CNA S (Ed. 6-2G
(Ed. 6-16)
C. EXCLUSIONS
With respect only to the insurance provided by this endorsement:
1. Under Exclusions, the paragraph entitled Applicable to Business Liability Coverage is amended to delete all
exclusions except exclusions a., b., d., e., f. and i. and to add the following exclusions:
This insurance does not apply to:
• Fellow Employee
"Bodily injury" to:
(1) Any fellow "employee" of the insured arising out of and in the course of employment by the insured or
while performing duties related to the conduct of the insured's business; or
(2) The spouse, child, parent, brother or sister of that fellow "employee" while as a consequence of
Paragraph (1) above.
• Care, Custody or Control
"Property Damage" to:
(1) Property owned or being transported by, or rented or loaned to the insured; or
(2) Property in the care, custody or control of the insured.
D. WHO IS AN INSURED
With respect only to the insurance provided by this endorsement, Who Is An Insured is replaced by the following:
Each of the following is an insured under this insurance to the extent set forth below:
1. You;
2. Subject to paragraph 3.c. below, your "employee" while operating an "auto" hired or rented under a contract or
agreement, with your permission, in that "employee's" name, while performing duties related to the conduct of
your business.
3. Anyone else including any partner or "executive officer" of yours while using with your permission a "hired auto" or
a "non -owned auto" except:
a. The owner or lessee (of whom you are a sublessee) of a "hired auto" or the owner or lessee of a "non -owned
auto" or any agent or "employee" of any such owner or lessee;
m
b. Your "employee" if the covered "auto" is owned by that "employee" or a member of his or her household;
c. Your "employee" if the covered "auto" is leased, hired or rented by him or her or a member of his or her
household under a lease or rental agreement for a period of 180 days or more;
N
N
N d. Any partner or "executive officer" with respect to any "auto" owned by such partner or officer or a member of
his or her household;
e. Any partner or "executive officer" with respect to any "auto" leased or rented to such partner or officer or a
member of his or her household under a lease or rental agreement for a period of 180 days or more;
f. Any person while employed in or otherwise engaged in duties in connection with an "auto business," other
than an "auto business" you operate;
g. Anyone other than your "employees," partners, a lessee or borrower or any of their "employees," while
moving property to or from a "hired auto" or a "non -owned auto"; or
4. Any other person or organization, but only with respect to their liability because of acts or omissions of an insured
under 1., 2. or 3. above.
E. AMENDED DEFINITION
The Definition of "insured contract" in Section F — Definitions is amended by the addition of the following exceptions to
paragraph f.:
SB146902G (Ed. 6-16)
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SB146902G
(Ed. 6-16)
Paragraph f. does not include that part of any contract or agreement:
• That pertains to the loan, lease or rental of an "auto" to you or any of your "employees," if the "auto" is loaned,
leased or rented with a driver; or
• That holds a person or organization engaged in the business of transporting property by "auto" for hire harmless
for your use of a covered "auto" over a route or territory that person or organization is authorized to serve by
public authority.
F. ADDITIONAL DEFINITIONS
Section F. Definitions is amended by the addition of the following definitions:
a. "Auto Business" means the business or occupation of selling, repairing, servicing, storing or parking "autos."
b. "Hired auto" means any "auto" you or your "employee" lease, hire, rent or borrow in the course of your business.
This does not include:
L Any "auto" you lease, hire or rent under a lease or rental agreement for a period of 180 days or more, or
ii. Any "auto" you lease, hire, rent or borrow from any of your "employees," partners, stockholders, or members
of their households.
c. "Non -owned auto" means any "autos" you do not own, lease, hire, rent or borrow that are being used in the
course and scope of your business at the time of the "occurrence." This includes "autos" owned by your
"employees" or partners or members of their households but only while being used in the course and scope of
your business at the time of the "occurrence."
If you are a sole proprietor, "non -owned auto" means any "autos" you do not own, lease, hire, rent or borrow that
are being used in the course and scope of your business or personal affairs at the time of the "occurrence."
G. With respect only to the operation of a "hired auto" or "non -owned auto," Paragraph H, of the Businessowners
Common Policy Conditions is deleted and replaced with the following:
H. Other Insurance
1. Except for any liability assumed under an "insured contract" the insurance provided by this Coverage Form is
excess over any other collectible insurance.
However, if your business is the selling, servicing, repairing, parking or storage of "autos," the insurance
provided by this endorsement is primary when covered "bodily injury" or "property damage" arises out of the
operation of a customer's "auto" by you or your "employee."
2. When this Coverage Form and any other Coverage Form or policy covers on the same basis, either excess or
primary, we will pay only our share. Our share is the proportion that the Limit of Insurance of our Coverage
Form bears to the total of the limits of all the Coverage Forms and policies covering on the same basis.
All other terms and conditions of the Policy remain unchanged.
JL"140�JUZU (La. 6-16)
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Copyright, CNA All Rights Reserved.
CNA Workers Compensation And Employers Liability Insurance
Policy Endorsement
This endorsement changes the policy to which it is attached.
It is agreed that Part One - Workers' Compensation Insurance G. Recovery From Others and Part Two -
Employers' Liability Insurance H. Recovery From Others are amended by adding the following:
We will not enforce our right to recover against persons or organizations. (This agreement applies only to the
extent that you perform work under a written contract that requires you to obtain this agreement from us.)
PREMIUM CHARGE - Refer to the Schedule of Operations
The charge will be an amount to which you and we agree that is a percentage of the total standard premium for
California exposure. The amount is 2%.
All other terms and conditions of the policy remain unchanged.
This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers,
takes effect on the Policy Effective Date of said policy at the hour stated in said policy, unless another
effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy
unless another expiration date is shown below.
Form No: G -19160-B (11-1997) Policy No: WC 6 25253608
Endorsement Effective Date: Endorsement Expiration Date: Policy Effective Date: 06/15/2022
Endorsement No: 2; Page: 1 of 1 Policy Page: 31 of 47
Underwriting Company: American Casualty Company of Reading, Pennsylvania, 151 N Franklin St,
Chicago, IL 60606
Copyright CNA All Rights Reserved,