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14-160.00 Cameron Reilly: Sidewalk Infill Ph 2 Contract THIS AGREEMENT, made and entered into this lQ day of �etv.bf , 2014, between the Cityof Spokane Valleyunder and byvirtue of Title 35 RCW, a� amended and p Cameron Reilly, LLC Hereinafter called the Contractor. WITNESSETH: That in consideration of the terms and conditions contained herein and attached and made a part of this agreement, the parties hereto covenant and agree as follows: I. The Contractor shall do all work and furnish all tools, materials, and equipment for: Sidewalk Infill Project-Phase 2 SVPW Contract 12-014 in accordance with and as described in the project plans and specification, and the standard specification of the Washington State of Department of Transportation which are by this reference incorporated herein and made part hereof and, shall perform any changes in the work in accord with the Contract Documents. The Contractor shall provide and bear the expense of all equipment, work and labor, of any sort whatsoever that may be required for the transfer of materials and for constructing and completing the work provided for in these Contract Documents except those items mentioned therein to be furnished by the City of Spokane Valley. II. The City of Spokane Valley hereby promises and agrees with the Contractor to employ, and does employ the Contractor to provide the materials and to do and cause to be done the above described work and to complete and finish the same in accord with the project plans and specification and the terms and conditions herein contained and hereby contracts to pay for the same according to the referenced specifications and the schedule of unit or itemized prices at the time and in the manner and upon the conditions provided for in this contract. III. The Contractor for himself/herself, and for his/hers heirs, executors, administrators, successors, and assigns, does hereby agree to full performance of all covenants required of the Contractor in the contract. IV, It is further provided that no liability shall attach to the City of Spokane Valley by reason of entering onto this contract, except as provided herein. CITY OF SPOKANE VALLEY CONTRACT SIDEWALK INFILL PROJECT-PHASE2 22 BID NO: 14-012 C,O -1 (,O V. The project was awarded for the bid amount of$208,937.20 IN WITNESS WHEREOF, the Contractor has executed this instrument, on the day and year first below written and the City of Spokane Valley has caused this instrument to be executed by and in the name of the said City of Spokane Valley the day and year first above written. Executed by Contractor LJ./� /14,/,1,G , 2014. Date Printed N- Title S , re City of Sp, ane Valley mark CaJw(irt Printed Name I Title ( (4Signature CITY OF SPOKANE VALLEY CONTRACT SIDEWALK INFILL PROJECT-PI1ASE2 23 BID NO:14-012 QTl'Or Spokane ,,,,,�FValleyx BOND NO: 023017858 CONTRACTOR'S PERFORMANCE BOND to City of Spokane Valley,Washington The City of Spokane Valley, Washington, in Spokane County, has awarded to Cameron-Reilly, L.L.C. (Contractor),as Principal, a contract for the construction of the project designated as Sidewalk Infill Project—Phase2.Project No.0149 in Spokane Valley,Washington,and said Principal is required under the terms of the Contract to furnish a performance bond in accordance with chapter 39.08 Revised Code of Washington(RCW). The Principal, and The Ohio Casualty Insurance Company (Surety), a corporation, organized under the laws of New Hampshire and licensed to do business in the State of Washington as surety and named in the current list of"Surety Companies Acceptable in Federal Bonds"as published in the Federal Register by the Audit Staff Bureau of Accounts,U.S.Treasury Dept,are jointly and severally held and firmly bound to the City of Spokane Valley,as Obligee,in the sum of$208,937.00 total Contract amount(including Washington State sales tax),subject to the provisions herein. This performance bond shall become null and void,,if and when the Principal,its heirs,executors,administrators,successors,or assigns shall well and faithfully perform all of the Principal's obligations under the Contract and fulfill all the terms and conditions of all duly authorized modifications,additions,and changes to said Contract that may hereafter be made, at the time and in the manner therein specified;shall warranty the work as provided in the Contract and shall indemnify and hold harmless the Obligee froth any defects)Athe lie workmanship and materials incorporated into the work for the period identified in the Contract,and if such performance obligations have not been fulfilled,this bond shall remain in full force and effect. The Surety for value_'received agrees that no change,extension of time, alteration or addition to the terms of the Contract, the specifications accompanying.,the Contract,or to the work to be performed under the Contract shall in any way affect its obligation on this bori1d;and waives notice of any change,extension of time,alteration or addition to the terms of the Contract or the work performed.The Surety agrees that modifications and changes to the terms and conditions of the Contract that increase the total amount to be paid tate Principal shall automatically increase the obligation of the Surety on this bond and notice to Surety is not required for such increased obligation. This bond may be executed in two original counterparts,and shall be signed by the parties'duly authorized officers.This bond will only be accepted,if it is accompanied by a fully executed and original power of attorney for the officer executing on behalf of the surety. PM•P CONTRACTOR) SURE J� 9-10-14 tJ.j Qa.A.Q-10-14 Princi ignature Date Surety Signature Date • , II- • Shawn M.Wilson Printed w ame Printed Name Manager Attorney-in-Fact Title Title Name,address,and telephone of local office/agent of Surety Company is: PayneWest Insurance, Inc. 7903 E Broadway,Spokane Valley,WA 99212/509-789-7431/Nicholas W. Paget,Agent crtv of Spokane .000ValleyR BOND NO: 023017858 CONTRACTOR'S PAYMENT BOND(FEDERALLY FUNDED PROJECT) to City of Spokane Valley,Washington The City of Spokane Valley, Washington, in Spokane County, has awarded to Cameron-Reilly, L.L.C. (Contractor),as Principal,a contract for the construction of the project designated as Sidewalk Infill Project—Phase2,Project No. 0149 in Spokane Valley, Washington,and said Principal is required under the terms of the Contract to furnish a payment bond in accordance with chapter 39.08 Revised Code of Washington(RCW)and chapter 60.28 RCW. The Principal, and The Ohio Casualty Insurance Company (Surety), a corporation organized under the laws of New Hampshire and licensed to do business in the State of Washington as surety and named in the current list of"Surety Companies Acceptable in Federal Bonds"as published in the Federal Register by the Audit Staff Bureau of Accounts,U.S.Treasury Dept.,are jointly and severally held and firmly bound to the City of Spokane Valley,as Obligee,in the sum of$208,937.20. total Contract amount,subject to the provisions herein. This payment bond shall cover any and all taxes incurred pursuant to Titles 50.and 51 RCW,taxes imposed on the Principal pursuant to Title 82 RCW,and any additional sales taxes. • This payment bond shall become null and void, if and when the Principal, its heirs, executors, administrators, successors, or assigns shall pay all persons in accordance with chapters 39.08, 39.12, and 6028 RCW, including all workers, laborers, mechanics, subcontractors,and materialmen, and all persons who shall supply such contractor or subcontractor with provisions and supplies for the carrying on of such work;shall pay all taxes due pursuant to Titles 50,51,and 82 RCW;and shall indemnify and hold harmless the Obligee from all loss,cost or damage which Obligee may suffer by reason of the failure of Principal to make such required payments; and if such payment obligations have not been fulfilled,this bond shall remain in full force and effect. • The Surety for value received agrees that no change, extension of time, alteration or addition to the terms of the Contract, the specifications accompanying the Contract,or to the work to be performed under the Contract shall in any way affect its obligation on this bond,except as provided herein,and waives notice of any change,extension of time,alteration or addition to the terms of es that modifications and changes to the terms and conditions of the Contract the Contract or the work performed.The Surety agrees that increase the total amount to be paid the Principal shall automatically increase the obligation of the Surety on this bond and obligation. to Surety is not required for such increased This bond may be executed in two original counterparts,and shall be signed by the parties'duly authorized officers.This bond will only be accepted if it is accompanied by a fully executed and original power of attorney for the officer executing on behalf of the surety. PRINCIPAL 'ONT . CTO S TY 9-10-14 1 V`1 KVS X10-14 Principal S ,I attire Date Surety Signature Date Jim•Came on Shawn M.Wilson Printed Name Printed Name Manager Attorney-in-Fact Title Title Name,address,and telephone of local office/agent of Surety Company is: PayneWest Insurance, Inc. 7903 E Broadway,Spokane Valley,WA 99212/509-789-7431/Nicholas W. Paget,Agent THIS POWER OF ATTORNEY IS NOT VALID UNLESS ITIS PRINTED ON-RED BACKGROUND: 1:1.11.:P-9 wer ofAttorney limit_s the acts of those named herein fated theyhave-no autho'nty to_b nd#he Company except in the manner and to the extent herein stated _ = • = --Certificate=No 6435796 - Ame.....:;,.:7- can Fire and Casualty Company - Liberty Mutual Insurance Company _ The Ohio Casualty Insurance Company West American Insurance Company _ - POWER OF'ATTORNEY = KNOWN ALL PERSONS BY_THESE PRESENTS That American Fire&Casualty Company and The Ohio Casualty Insurance Company are corporations duly organized under the laws of the State of New Hampshire,that Liberty Mutual Insurance Company is a corporation duly organized under the la"ws of the State of Massachusetts;and WestAmencan Insurance.Company _ is a coiporattonduly organized under laws of the State of Indiana(herein collectively c la led the Comp es) pursuant to,and by authority herein set forth does hereby name;constitute; and appoint= ="James E Maie'skev Ili'Judith A=Ra p;Judith C Kaiser Smith Nicholas`:W Paget Shavun.M Wilson Shelly Donovan Walter W Wolf _ _ - - '; �^ '...--,-,::-.--::..--"Z''.:•-•:".".-:. .y^ ^✓h•. ..f.;,_-.,-3-2,,-; all of the city of Spokane Valley state`of WA- each individually if there be more than one:nam`ed;its true and lawful attorney inn fact to make'execute seal acknowledge; and deliver for and on its behalf as surety and as its act and deed any and all undertakings bonds recog izances and other surety"obligations;m pursuance of these presents en d shall be as binding upon the Companies as if'they have been duly signed by the president and attested by ttje�secretary of the Companies in their wn peeper persons i ., :,----...-----,-7:-,::::_,:_, �..^ r = ��ski f _ �� . h-� -;'....:"--.2..',7-2"-----•7 IN WITNESS WHEREOF this Power ofAttomey,fas been subscribed by an authorized"`officeror official of the Companies and the corporate sealso_f the Companies have been affixed thereto this 3rd day of- February -E 2014: �= ^�_ ^. '' t - >+ American Fireand Casualty Company ,i)';'1';' ..;4^,. �� xf _ 'rt`�Y - �/- The Ohlo Casuaffylnsurance Company ��v r 4 ,< % r - v • Liberty Mutuallnsurance Company ed }<• ' , '" - ' ''• West mencan Insurance Company ^-C +% ' David M,Care,Assistant Secretary _ `G, STATE OF RENNSYLVANIA ss, ; z........-7-- _ =�_- r: COUNTY OF MONTGOMERY ti� On this13ro dayof February = 2014. before me personally appeared David M Carey who acknowledged himself to be the Assistant Secre•e ary of American Fire_and = v'as Casualty Company,Liberty Mutual Insurance Company The Ohio Casualty Insurance Company and WestAmencan Insurance Company,and that he as such;being authorized so to do -,'--_-:.7 ui_ "" execute the fore oin mstniriient for the u oses therein containedP11,-,9=snin on behalf of the co orations b hrmseff as a dui authorized officer - a. p_� _ 9 _ 9 P rP _ 9 rP Y �� Y - L- d > IN WITNESS WHEREOF I have hereunto subsc tied a and affixed my.notanal seal of Plymouth Meeting,Pennsylvania on the day and year first above written `'Cc._Q _R c t� =� oa lotuw iris a1 r�>Nn-"Y VAraLa Q M- C'a - f .:, ..--, ^, rY �3.a in 'V... '4 r't:t By . -C•:" 7.5.6,:f1412 i r "Prvlt t-'3,_ man 1, 'st Ur`: Teresa Pastella;Notary Public °C _._t. O -,ai Oat^ H s"�, Xrnre i,a�cn2i i0r! _ d;0 - y ', ,---7- ::1:14.1=5:!'-_-7,..- ','V a r nrti-ap't -i.'s :.ai+n4`hc' '':. -.::::---.5:- i .Q;E- ra; c.:ea .This Power ofA::::F.ey is made and execute purl nt o a tfforityof the f•ollowing By-laws and Authonzations.ofAmencah Fireand Casualty Company She Ohto Casualty Insurance �i p, m_N Company Liberty Mutual Insurance Company andesAt33ertinsurance Company whictiresoiutions are now in full force and effect reading as follows _ �,, e-0?-._a ARTICLE IV OFFICERS_Section 12"..7. owgrofAttomey Anyofficerorotherofficial ofthe Corporation authonzed.forthat purpose in writing by the Chairman orfihe President and subject O ==1 -�; to succi limdation.as the Chairman or the Presideni may prescribe shall appoint such ettomeys in fact;as maybe necessary to actin behalf of the Corporation to make execute;seal --.-3:1=,- C. o C acknowledge and-deliver as surety any and all undertakings bonds recognizances'andother suretyobligations-Such attorneys m fact,subject fo the limitations set forth in their respective ". E powersof attorney,'shell have full to bindthe Corporation by their signature"and execution of.any succi instruments and o...-'-- attach thereto the seal.of the Corporation When so .'��: p? executed such instruments shall be as binding if signed by the President and attested to by the Secretary Any or authoritygranted to any representative orattomey in fact under >:o_ " `' the provisions of this,article m`a be revoked at an:time b the Board the Chairman the President oc b the officer or officers-dr-jilting such ower o�autho Y Y Y _ y 9 9 P My: = sem: .'614ARTICLE 7411 Execution of Contracts SECTION 5 Surety Bonds and Undertakings Any officer of he:Companyauthonzed_for that purpose in writing by the chairman dr-the president E N >'"�? and'subjecttosuch limitations as the chairman or_the president may prescribe shall"appoint such attorneys in fact,as maybe necessary o act in behalf of the Companyto make execute; 47 tn. 0;:� seal acknowledge_and deliver assurety,any:and all undertakings bonds recognisances and other surety obligations Such'attomeys in fact subject to the limitations set forth-in their =a?= Z v respective powersof attorney shall have full power to bind the Company ley their signatur--:iii d execution:of any such instruments and to attach thereto the s_eal of theCoompany When so g-vim; executed such instiurnents shall be as bindm as if si ned b ttie resident P-.9.4.::...-='!'- nd a tested�b the secreta �- y _ �_ 9 9 Y^ p Y ry p : Certificate of Designalion---"7-'The-z--President o the Company;`acting pursuant t`o the Bylaws of the G mpany,authorizes David M Carey,Assistant Secretary to appTT'oint such attorney`s in = fact as mag be necessary to actor behalf of the.Company. make execute seat;acknowledge a`nd deliver assurety any and all,undertaking`s bonds recogmzances and other surety obligations _ - `e. ✓ - --• 7--....;;_: - !� - Authonzation By unanimous consent of the�Companys Board of Directors the Company consents that facsimile or me mechanically •reproduced signature of any assistant secretary of the - Company wherever appearing upon acer ified copy of any p wee of attgm y issued by the Compare in:connection with surety bonds,shall be u_alid,and•xnding upon the Company with the same force and.effect 0-011°11g-111:11-:."-- s though manually affixxeed�� -y;� J ; J I Gregory W Davenport the=undersignned AssistenfSecretary,ofAmencan Fire aro Gasualty.Company;The OhioTCasuaity Insurance Company Liberty Mutual lInsurance Company and .i- -ms ��: =: WestA7nencan Insurance Company do hereby certify t that the original power•of atto_mey of which the foregoirig.is a full true and correct copy of the Power of Attorney executed^by-,tier,::::, Companies 1s rn full force and effect and_has not been revoked IN TESTIMONY WHEREOF I have hereunto set my hand and_affixed the=seals of said Companies this 10 dayof September y 2U 14 ''::::,$>",.- °'777,-W."';",_ /v .�,�.::- _s,,,. ,?..-4...cs e, -0;‹,. . ^,f,:7",.*::-.' w�•"Ica yf - _ - tir 3 04 : i93--7"-...-;.1.),,,f.77:_. ��, 1 sl "333 • BY•' _ E 35- -.V.-.:*:.Q., r - r f 5 ^ K Gregory W Davenport Assistant Secretary LMS-12873:122013 " - = 91 of:'7-•5-.--0:'''.':-.-:'i-' 50 -- r ` N. �77"."IN CAMELLC-03 SSTROH JAW. REY DATE(MM/DD/YYYY) 44.......----- CERTIFICATE OF LIABILITY INSURANCE 9/10/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Spokane-Downtown Office PHONE 509 455-6767 FAX PayneWest Insurance,Inc. (A/C.No.Ext):( ) (NC,No): 827 West 1st Avenue Suite 225 E-MAIL ADDRESS: Spokane,WA 99201 INSURER(S)AFFORDING COVERAGE I NAIC# INSURER A:The Cincinnati Insurance Co. 10677 INSURED INSURER B:Cincinnati Insurance Companies 110677 Cameron-Reilly,LLC INSURER C: 309 N Park Rd INSURER D: I I Spokane Valley,WA 99212INSURER E INSURER F: 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. INSR TYPE OF INSURANCE ADDL'SUBR POLICY EFF POLICY EXP LIMITS LTR INSD I W /Y VD POLICY NUMBER (MM/DD/YYYY) (MM/DDYYY) A X I COMMERCIAL GENERAL LIABILITY I I EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCURX I ENP0056339 12/31/2013 12/31/2014 DAMAGE TO RENTED 500,000 PREMISES(Ea occurrence) $ _ X PD Deductible: 1000 1 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X jeCOT- LOC PRODUCTS-COMP/OP AGG $ 2,000,000 ' OTHER: WA STOP GAP $ 1,000,000 AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT $ , 1,000,000 (Ea accident) B X I ANY AUTO ENP0056339 12/31/2013 12/31/2014 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ :AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS X AUTOS (Per accident) I i $ X 1 UMBRELLA LIAB X OCCUR 1 EACH OCCURRENCE $ 4,000,000 B I EXCESS LIAB CLAIMS-MADE I ENP0056339 12/31/2013 12/31/2014 AGGREGATE $ 4,000,000 DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY ! STATUTE ERH ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N j E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N I A (Mandatory in NH) EL DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) SVPW Contract 10-014,Sidewalk Infill Project-Phase 2 City of Spokane Valley is included as additional insured as required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Spokane Valley ACCORDANCE WITH TTATE THEREOF,HE WILL BE DELIVERED IN HE PO ICY PROVISIONS.11707 E Sprague Spokane,WA 99206 AUTHORIZED REPRESENTATIVE i ii, ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD • THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS' COMMERCIAL GENERAL LIABILITY BROADENED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Endorsement-Table of Contents: Coverage: Begins on Page: 1. Employee Benefit Liability Coverage 2 2. Unintentional Failure to Disdose Hazards 7 3. Damage to Premises Rented to You 8 4. Supplementary Payments 9 5. Medical Payments 9 6. Voluntary Property Damage(Coverage a.) and Care, Custody or Control Liability Coverage(Coverage b.) 9 7. 180 Day Coverage for Newly Formed or Acquired Organizations 10 8. Waiver of Subrogation 10 9. Automatic Additional Insured-Specified Relationships: 10 • Managers or Lessors of Premises; • Lessor of Leased Equipment; • Vendors; • State or Political Subdivisions-Permits Relating to Premises; • State or Political Subdivisions-Permits;and • Contractors' Operations 10. Broadened Contractual Liability-Work Within 50'of Railroad Property 14 11. Property Damage to Borrowed Equipment 14 12. Employees as Insureds-Specified Health Care Services: 14 • Nurses; • Emergency Medical Technicians;and • Paramedics 13. Broadened Notice of Occurrence 14 B. Limits of Insurance: The Commercial General Liability Limits of Insurance apply to the insurance provided by this endorse- ment, except as provided below: 1. Employee Benefit Liability Coverage Each Employee Limit: $ 1,000,000 Aggregate Limit: $ 3,000,000 Deductible: $ 1,000 3. Damage to Premises Rented to You The lesser of: a. The Each Occurrence Limit shown in the Declarations;or b. $500,000 unless otherwise stated$ 4. Supplementary Payments a. Bail bonds: $ 1,000 b. Loss of earnings: $ 350 5. Medical Payments Medical Expense Limit: $ 10,000 Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 1 of 15 r , , 6. Voluntary Property Damage(Coverage a.) and Care,Custody or Control Liability Coverage (Coverage b.) Limits of Insurance (Each Occurrence) Coverage a.$1,000 Coverage b.$5,000 unless otherwise stated $ Deductibles(Each Occurrence) Coverage a.$250 Coverage b.$250 unless otherwise stated $ COVERAGE PREMIUM BASIS RATE ADVANCE PREMIUM a Area (For Limits in Excess of (For Limits in Excess of b Payroll $5,000) $5,000) c Gross Sales d Units (e Other b. Care, Custody $ or Control TOTAL ANNUAL PREMIUM $ 11. Property Damage to Borrowed Equipment Each Occurrence Limit: $ 10,000 Deductible: $ 250 • C. Coverages: have used up the appli- cable limit of insurance 1. Employee Benefit Liability Coverage in the payment of a. The following is added to SECTION I judgments or settle- -COVERAGES: Employee Benefit ments. Liability Coverage. No other obligation or liabil- ity to pay sums or perform acts or services is covered (a) We will pay those sums that unless explicitly provided for the insured becomes legally under Supplementary Pay- obligated to pay as dam- ments. ages caused by any act, er- ror or omission of the in- (b) This insurance applies to sured, or of any other per damages only if the act, er son for whose acts the ror or omission, is negli in- sured is legally liable, to gently committed in the which this insurance ap administration' of your plies. We will have the right "employee benefit pro- and duty to defend the in- sured against any "suit' 1) Occurs during the pol- seeking those damages. icy period;or However, we will have no duty to defend against any 2) Occurred prior to the "suit" seeking damages to effective date of this which this insurance does endorsement provided: not apply. We may, at our discretion, investigate any a) You did not have report of an act, error or knowledge of a omission and settle any claim or "suit" on claim or "suit" that may re- or before the ef- suit. But: fective date of this endorsement. 1) The amount we will pay for damages is limited You will be as described in SEC- deemed to have TION III - LIMITS OF knowledge of a INSURANCE; and claim or "suit" when any "author- 2) Our right and duty to ized representa- defend ends when we tive"; Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 2 of 15 r i) Reports all, or formance of investment any part, of the vehicles;or act, error or omission to us 3) Advice given to any or any other person with respect to insurer; that person's decision to participate or not to ii) Receives a participate in any plan written or ver- included in the "em- bal demand or ployee benefit pro- claim for dam- gram". ages because of the act, er- (f) Workers' Compensation Censation ror or orris- and Similar Laws sion;and Any daim arising out of your b) There is no other failure to comply with the applicable insur- mandatory provisions of any ance. workers' compensation, un- employment compensation (2) Exclusions insurance, social security or This insurance does nota I disability benefits law or any apply similar law. to: (a) Bodily Injury, Property (g) ERISA Damage or Personal and Damages for which any in- Advertising Injury sured is liable because of"Bodil injury", "property li- ability imposed on a fidud- Y 1 ry" p p y ary by the Employee Re- damage" or "personal and tirement Income Security advertising injury". Act of 1974, as now or (b) Dishonest, Fraudulent, hereafter amended, or by Criminal or Malicious Act any similar federal, state or local laws. Damages arising out of any (h) Available Benefits intentional, dishonest, fraudulent, criminal or mali- Any claim for benefits to the cious act, error or omission, extent that such benefits are committed by any insured, available, with reasonable including the willful or reck- effort and cooperation of the less violation of any statute. insured, from the applicable (c) Failure to Perform a Con- funds accrued or other col- tract lectible insurance. Damages arising out of fail (i) Taxes, Fines or Penalties ure of performance of con- Taxes, fines or penalties, tract by any insurer. including those imposed (d) Insufficiency of Funds under the Internal Revenue Code or any similar state or Damages arising out of an local law. insufficiency of funds to ent-Related p Emloymloym meet any obligations under (j) Ep any plan included in the "employee benefit pro- Any liability arising out of ram . 9 " any: (e) Inadequacy of Perform- (1) Refusal to employ; ance of Investment / Ad- vice Given With Respect (2) Termination of em- to Participation ployment; Any daim based upon: (3) Coercion, demotion, reassign- 1) Failure of anyinvest- evaluation,ment, discipline, defa- ment to perform; mation, harassment, 2) Errors in providing in- humiliation, discrimina formation on past per tion or other employ Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 3 of 15 ment-related practices, (e) A trust, you are an insured. acts or omissions;or Your trustees are also in- sureds, re- (4) Consequential liability but only with�I spect to their duties as trus- as a result of (1), (2) or tees. (3)above. This exclusion applies (2) Each of the following is also an PP insured: whether the insured may be held liable as an employer (a) Each of your "employees" or in any other capacity and who is or was authorized to to any obligation to share administer your "employee damages with or repay benefit program". someone else who must pay damages because of (b) Any persons, organizations the injury. or employees" having proper temporary authoriza- (3) Supplementary Payments tion to administer your SECTION I - COVERAGES, "em- ployee benefit program" if SUPPLEMENTARY PAY- you die, but only until your MENTS -COVERAGES A AND legal representative is ap B also apply to this Coverage. pointed. b. Who is an Insured (c) Your legal representative if you die, but only with re- As respects Employee Benefit Liabil- spect to duties as such. ity Coverage, SECTION II -WHO IS That representative will AN INSURED is deleted in its en- have all your rights and du- ties under this Coverage tirety and replaced by the following: g Part. (1) If you are designated in the Dec- larations as: (3) Any organization you newly ac- quire or form, other than a part- (a) An individual, you and your nership, joint venture or limited spouse are insureds, but liability company, and over only with respect to the con- which you maintain ownership or duct of a business of which majority interest, will qualify as a you are the sole owner. Named Insured if no other simi- lar insurance applies to that or- (b) A partnership or joint ven- ganization. However, coverage ture, you are an insured. under this provision: Your members, your part= ners, and their spouses are (a) Is afforded only until the also insureds but only with 180th day after you acquire respect to the conduct of or form the organization or your business. the end of the policy period, whichever is earlier; and (c) A limited liability company, you are an insured. Your (b) Does not apply to any act, members are also insureds, error or omission that was but only with respect to the committed before you ac- conduct of your business. quired or formed the organi- Your managers are insur- zation. eds, but only with respect to their duties as your manag c. Limits of Insurance ers. As respects Employee Benefit Liabil- (d) An organization other than a ity Coverage, SECTION III - LIMITS partnership, joint venture or OF INSURANCE is deleted in its en- limited liability company, tirety and replaced by the following: you are an insured. Your (1) The Limits of Insurance shown "executive officers" and di- in Section B. Limits of Insur- rectors are insureds, but ance, 1. Employee Benefit Li- only with respect to their du- ability Coverage and the rules ties as your officers or direc- below fix the most we will pay tors. Your stockholders are regardless of the number of: also insureds, but only with respect to their liability as (a) Insureds; stockholders. Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 4 of 15 f (b) Claims made or "suits" (b) The deductible amount brought; stated in the Declarations c Persons or organizations applies to all damages sus- ( ) 9 tained by any one "em- making claims or bringing ployee", induding such "em- "suits"; ployee's" dependents and beneficiaries, because of all (d) Acts,errors or omissions;or acts, errors or omissions to (e) Benefits induded in your which this insurance ap- "employee benefit pro- plies. gram". (c) The terms of this insurance, (2) The Aggregate Limit shown in including those with respect Section B. Limits of Insurance, to: 1. Employee Benefit Liability Coverage of this endorsement 1) Our right and duty to is the most we will pay for all defend the insured damages because of acts, errors against any suits' or omissions negligently commit seeking those dam ted in the "administration" of ages; and your "employee benefit pro- 2) Your duties, and the gram". duties of any other in- (3) Subject to the limit described in volved insured, in the (2) above, the Each Employee event of an act, error or Limit shown in Section B.Limits omission,or daim, of Insurance, 1. Employee apply irrespective of the ap- Benefit Liability Coverage of plication of the deductible this endorsement is the most we amount. will pay for all damages sus- tained by any one "employee", (d) We may pay any part or all including damages sustained by of the deductible amount to such "employee's" dependents effect settlement of any and beneficiaries, as a result of: claim or"suit"and, upon no- tification(a) An act, error or omission;or of the action taken, you shall promptly reim- (b) A series of related acts, er- rors burse us for such part of the rors or omissions, regard- less amount as we less of the amount of time have paid. that lapses between such d. Additional Conditions acts, errors or omissions, As respects Employee Benefit Li- negligently committed in the ability Coverage, SECTION IV - "administration" of your "em- COMMERCIAL GENERAL LIABIL- ployee benefit program". ITY CONDITIONS is amended as fol- However,the amount paid under lows: this endorsement shall not ex- (1) Item 2. Duties in the Event of ceed, and will be subject to the Occurrence, Offense, Claim or limits and restrictions that apply Suit is deleted in its entirety and to the payment of benefits in any replaced by the following: plan induded in the "employee benefit program". 2. Duties in the Event of an Act, Error or (4) Deductible Amount Omission,or Claim or Suit Our obligation to paydarn- a. You must see to it that we are noti- (a) 9 fied as soon as practicable of an act, ages on behalf of the in- error or omission which may result in sured applies only to the a daim. To the extent possible, no- amount of damages in ex- tice should include: cess of the deductible amount stated in the Decla- (1) What the act, error or omission rations as applicable to was and when it occurred;and Each Employee. The limits of insurance shall not be re- (2) The names and addresses of duced by the amount of this anyone who may stiffer dam- deductible. ages as a result of the act, error or omission. • Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 5 of 15 • b. If a daim is made or"suit" is brought b. Method of Sharing against any insured, you must: If all of the other insur- (1) Immediately record the specifics ance permits contribu- of the daim or "suit" and the tion by equal shares, date received;and we will follow this (2) Notifyus as soon aspracticable. method also. eachUnin- this approach in- You must see to it that we receive surer contributes equal written notice of the claim or"suit"as amounts until it has soon as practicable. paid its applicable limit of insurance or none of c. You and any other involved insured the loss remains, must: whichever comes first. (1) Immediately send us copies of If any of the other in- any demands, notices, sum- surance does not per- monses or legal papers received mit contribution by in connection with the claim or equal shares, we will "suit"; contribute by limits. Under this method, (2) Authorize us to obtain records each insurer's share is and other information; based on the ratio of its (3) Cooperate with us in the investi- applicable limit of ap- gationin- (3) or settlement of the claim plisurance to the total or defense against the "suit"; ancecable limits1ns reof insur and of all insurers. (4) Assist us, upon our request, in c. No Coverage the enforcement of any right This insurance shall not against any person or organiza- cover any loss for tion which may be liable to the which the insured is en- insured because of an act, error titled to recovery under or omission to which this insur- any other insurance in ance may also apply. force previous to the ef- d. No insured will, except at that in- fectiedate of this Cover sured's own cost, voluntarily make a Coverr age Part. payment, assume any obligation, or e. Additional Definitions incur any expense without our con- sent. As respects Employee Benefit Li- ability Coverage, SECTION V - (2) Item 5. Other Insurance is de- DEFINITIONS is amended as fol- leted in its entirety and replaced lows: by the following: 5. Other Insurance (1) added:following definitions are If other valid and collectible 1. "Administration" means: insurance is available to the insured for a loss we cover a. Providing information to under this Coverage Part, "employees", including our obligations are limited their dependents and as follows: beneficiaries, with re- spect to eligibility for or a. Primary Insurance scope of "employee This insurance is pri- marybenefit programs"; except when c. b. Interpreting the "em- below applies. If this ployee benefit pro- insurance is primary, grams"; our obligations are not affected unless any of C. Handling records in the other insurance is connection with the also primary. Then, we "employee benefit pro- will share with all that grams";or other insurance by the method described in b. d. Effecting, continuing or below terminating any "em- ployee's" participation Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 6 of 15 in any benefit included benefits, workers' corn- in the "employee bene- pensation and disability fit program". benefits;and However, "administration" d. Vacation plans, includ- does not include: ing buy and sell pro- grams; leave of ab- a. Handling payroll deduc- sence programs, in- tions; or cluding military, mater- b. The failure to effect or nity, family, and civil maintain any insurance leave; tuition assis or adequate limits of tance plans;transporta- coverage of insurance, tion and health dub including but not limited subsidies. to unemployment in- (2) The following definitions are de- surance, social security leted in their entirety and re- benefits, workers' corn- placed by the following: pensation and disability benefits. 21. "Suit' means a civil lans" means pro- ceeding in which money 2. "Cafeteria P damages because of an act, plan authorized by applica- error or omission to which ble law to allow "employ- this insurance applies are ees" to elect to pay for cer- alleged. "Suit" includes: tain benefits with pre-tax dollars. a. An arbitration proceed- ing in which such dam- 3. "Employee benefit pro- ages are claimed and grams" means a program to which the insured providing some or all of the must submit or does following benefits to "em- submit with our con- ployees", whether provided sent; through a"cafeteria plan" or otherwise: b. Any other alternative pro- a. Grouplife insurance; dispute resolution ceeding in which such group accident or damages are claimed health insurance; den- and to which the in- tal, vision and hearing sured submits with our plans; and flexible consent;or spending accounts; provided that no one c. An appeal of a civil pro- other than an "em- ceeding. ployee" may subscribe to such benefits and 8. "Employee" means a per- such benefits are made son actively employed, for- generally available to merly employed, on leave of those "employees" who absence or disabled, or re- satisfy the plan's eligi- tired. "Employee" includes bility requirements; a "leased worker". "Em- ployee" does not indude a b. Profit sharing plans, "temporary worker". employee savings plans, employee stock 2. Unintentional Failure to Disclose Haz- ownership plans, pen- ards sion plans and stock SECTION IV-COMMERCIAL GENERAL subscription plans, pro- LIABILITY CONDITIONS, 7. Represen- vided that no one other tations is hereby amended by the addi- than an "employee" tion of the following: may subscribe to such benefits and such Based on our dependence upon your rep- benefits are made gen- resentations as to existing hazards, if un- erally available to all intentionally you should fail to disdose all "employees" who are such hazards at the inception date of your eligible under the plan policy, we will not reject coverage under for such benefits; this Coverage Part based solely on such c. Unemployment insur- failure. ance, social security Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 7 of 15 3. Damage to Premises Rented to You f) Nesting or infesta- tion, or discharge a. The last Subparagraph 9 P or release of 2. SECTION I - COVERAGES, waste products or COVERAGE A. - BODILY INJURY secretions, by in- AND PROPERTY DAMAGE, 2. LI- sects, birds, ro- ABILITY Exclusions is hereby de- dents or other leted and replaced by the following: animals. Exdusions c.through q.do not apply (b) Loss caused directly or indi- to damage by fire, explosion, light- rectly by any of the follow- ning, smoke or soot to premises ing: while rented to you or temporarily oc- cupied by you with permission of the 1) Earthquake, volcanic owner. eruption, landslide or move- b. aThe insurance provided under SEC- ment other earth TION I -COVERAGES, COVERAGE A. BODILY INJURY AND PROP- 2) Water that backs up or ERTY DAMAGE LIABILITY applies overflows from a sewer, to "property damage" arising out of drain or sump; water damage to premises that are both rented to and occupied by you. 3) Water under the ground surface pressing on, or (1) As respects Water Damage Le- flowing or seeping gal Liability, as provided in through: Paragraph 3.b.above: a) Foundations, The exdusions under SECTION walls, floors or I - COVERAGES, COVERAGE paved surfaces; A. BODILY INJURY AND PROPERTY DAMAGE LIABIL- b) Basements, ITY,2. Exclusions, other than i. whether paved or War and the Nuclear Energy not; or Liability Exclusion, are deleted c) Doors, windows or and the following are added: other openings. This insurance does not apply (c) Loss caused by or resulting to: from water that leaks or (a) "Property damage": flows from plumbing, heat- ing, air conditioning, or fire 1) Assumed in any con- protection systems caused tract;or by or resulting from freez- • 2) Loss caused by or re- ing, unless: sulting from any of the 1) You did your best to following: maintain heat in the a) Wear and tear; building or structure;or b) Rust, corrosion, 2) You drained the equipment and shut off fungus, decay, de- the water supply if the terioration, hidden heat was not main- or latent defect or tained. any quality in property that (d) Loss to or damage to: causes it to dam- age or destroy it- 1) Plumbing, heating, air self; conditioning, fire pro- tection systems, or C) Smog; other equipment or ap- d) Mechanical break pliances; or down including 2) The interior of any rupture or bursting building or structure, or caused by Gen- to personal property in trifugal force; the building or structure e) Settling, cracking, caused by or resulting from rain, snow, sleet shrinking or ex- or ice, whether driven pansion;or • by wind or not. Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 8 of 15 • • c. Limit of Insurance Limits of Insurance, 5. Medical Pay- ments of this endorsement. The Damage to Premises Rented to You Limit as shown in the Declara- 6. Voluntary Property Damage and Care, tions is amended as follows: Custody or Control Liability Coverage (2) Paragraph 6. of SECTION III - a. Voluntary Property Damage Cov- LIMITS OF INSURANCE is erage hereby deleted and replaced by the following: We will pay for "property damage" to property of others arising out of op- 6. Subject to 5. above, the erations incidental to the insured's Damage to Premises business when: Rented to You Limit is the most we will pay under (1) Damage is caused by the in- COVERAGE A. BODILY sured; or INJURY AND PROPERTY (2) Damage occurs while in the in- DAMAGE LIABILITY, for sured's possession. damages because of "prop- erty damage" to premises With your consent, we will make while rented to you or tem- these payments regardless of fault. porarily occupied by you with permission of the b. Care, Custody or Control Liability owner, arising out of any Coverage one "occurrence" to which SECTION I - COVERAGES, COV- this insurance applies. ERAGE A. BODILY INJURY AND (3) The amount we will pay is lim- PROPERTY DAMAGE LIABILITY, ited as described in Section B. 2. Exclusions, j. Damage to Prop- Limits of Insurance, 3. Dam- erty, Subparagraphs (3), (4) and (5) age to Premises Rented to do not apply to "property damage"to You of this endorsement. the property of others described therein. 4. Supplementary Payments With respect to the insurance provided by Under SECTION I - COVERAGE, SUP- this section of the endorsement, the fol- PLEMENTARY PAYMENTS - COVER- lowing additional provisions apply: AGES A AND B: a. The Limits of Insurance shown in the a. Paragraph 2. is replaced by the fol- Declarations are replaced by the lim- lowing: its designated in Section B. Limits of Up to the limit shown in Section B. Insurance, 6. Voluntary Property Limits of Insurance, 4.a. Bail Bonds Comaoe and Care, Custodyor of this endorsement for cost of bail Control Liability Coverrageageoff this cover- bonds required because of accidents aendorsement with respect to or traffic law violations arising out of Thesege limitssd by this inenclusive of andent. the use of anyvehicle to which the intoare incl limits being ne- in addition the re- Bodily Injury Liability Coverage ap- placed. The Limits of Insurance plies. We do not have to furnish shown in Section B. Limits of Insur- these bonds. ance, 6. Voluntary PropertyDam- b. Paragraph 4. is replaced by the fol- age and Care, Custody or ontrol lowing: Liability Coverage of this endorse- ment fix the most we will pay in any All reasonable expenses incurred by one "occurrence" regardless of the the insured at our request to assist number of: us in the investigation or defense of the daim or "suit", including actual (1) Insureds; loss of earnings up to the limit shown (2) Claims made or "suits" brought; in Section B. Limits of Insurance, or 4.b. Loss of Earnings of this en- dorsement per day because of time (3) Persons or organizations making off from work. claims or bringing "suits". 5. Medical Payments b. Deductible Clause The Medical Expense Limit of Any One (1) Our obligation to pay damages Person as stated in the Declarations is on your behalf applies only to amended to the limit shown in Section B. the amount of damages for each "occurrence" which are in ex- Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 9 of 15 • cess of the deductible amount (1) Anyperson or organization de- stated in Section B. Limits of scribed in Paragraph 9.a.(2) be- Insurance, 6. Voluntary Prop- low (hereinafter referred to as erty Damage and Care, Cus- additional insured) whom you tody or Control Liability Coy- are required to add as an addi- erage of this endorsement. The tional insured under this Cover- limits of insurance will not be re- age Part by reason of: duced by the application of such deductible amount. (a) A written contract or agree- ment; or (2) Condition 2. Duties in the Event of Occurrence, Offense, (b) An oral agreement or con- Claim or Suit, applies to each tract where a certificate of claim or"suit" irrespective of the insurance showing that per- amount. son or organization as an additional insured has been (3) We may pay any part or all of issued, the deductible amount to effect settlement of any claim or "suit" is an insured, provided: and, upon notification of the ac- (a) The written or oral contract tion taken, you shall promptly re- or agreement is: imburse us for such part of the deductible amount as has been 1) Currently in effect or paid by us. becomes effective dur- ing7. 180 Day Coverage for Newly Formed or the policy period; Acquired Organizations SECTION II - WHO IS AN INSURED is 2) Executed prior to an amended as follows: "occurrence" or offense to which this insurance Subparagraph a. of Paragraph 4. is would apply;and hereby deleted and replaced by the fol- (b) They are not specifically lowing: named as an additional in- a. Insurance under this provision is af- sured under any other pro- forded only until the 180th day after vision of, or endorsement you acquire or form the organization added to, this Coverage or the end of the policy period, Part. whichever is earlier; (2) Only the following persons or 8. Waiver of Subrogation organizations are additional in- sureds under this endorsement, SECTION IV-COMMERCIAL GENERAL and insurance coverage pro- LIABILITY CONDITIONS, 9. Transfer of vided to such additional insureds Rights of Recovery Against Others to is limited as provided herein: Us is hereby amended by the addition of the following: (a) The manager or lessor of a premises leased to you with We waive any right of recovery we may whom you have agreed per have because of payments we make for Paragraph 9.a.(1) above to injury or damage arising out of your ongo- provide insurance, but only ing operations or "your work" done under with respect to liability aris- a written contract requiring such waiver ing out of the ownership, with that person or organization and in- maintenance or use of that cluded in the "products-completed opera- part of a premises leased to tions hazard". However, our rights may you, subject to the following only be waived prior to the "occurrence" additional exclusions: giving rise to the injury or damage for which we make payment under this Coy- This insurance does not ap- erage Part. The insured must do nothing ply to: after a loss to impair our rights. At our 1) Any"occurrence" which request, the insured will bring "suit" or takes place after you transfer those rights to us and help us en- cease to be a tenant in force those rights. that premises. 9. Automatic Additional Insured - Speci- 2) Structural alterations, fled Relationships new construction or a. The following is hereby added to demolition operations SECTION II-WHO IS AN INSURED: performed by or on be- Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 10 of 15 half of such additional solely for the pur- insured. pose of inspection, demonstration,(b) Any person or organization testing, or the from which you lease substitution of equipment with whom you parts under in- have agreed per Paragraph structions from the 9.a.(1) above to provide in- manufacturer, and surance. Such person(s) or then repackaged organization(s) are insureds in the original con- solely with respect to their tainer; liability arising out of the maintenance, operation or e) Any failure to use by you of equipment make such inspec- leased to you by such per- tions, adjustments, son(s) or organizations(s). tests or servicing However, this insurance as the vendor has does not apply to any "oc- agreed to make or currence"which takes place normally under- after the equipment lease takes to make in expires. the usual course of business, in (C) Any person or organization connection wih (referred to below as yen- the distribution or dor) with whom you have sale of the prod- agreed per Paragraph ucts; 9.a.(1) above to provide in- surance, but only with re- f) Demonstration, in- spect to "bodily injury" or stallation, servic- "property damage" arising ing or repair op- out of "your products" which erations, except are distributed or sold in the such operations regular course of the yen- performed at the dors business, subject to vendor's premises the following additional ex- in connection with clusions: the sale of the 1) The insurance afforded product; the vendor does not g) Products which, apply to: after distribution or a) "Bodilyinjury" or sale by you, have been labeled or re- "property damage" labeled or used as for which the ven- a container, part or dor is obligated to ingredient of any pay damages by other thing or sub- reason of the as- stance by or for sumption of liabil- the vendor. ity in a contract or agreement. This 2) This insurance does exclusion does not not apply to any in- apply to liability for sured person or organi- - damages that the zation: vendor would have in the absence of a) From whom you the contract or have acquired agreement; such products, or any ingredient, b) Any express war- part or container, ranty unauthorized entering into, ac- by you; companying or containing such C) Any physical or products;or chemical change in the product b) When liability in- made intentionally cluded within the by the vendor; "products- completedd Repackaging, opera- tions hazard" has unless unpacked Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 11 of 15 been excluded (f) Any person or organization under this Cover- with which you have agreed age Part with re- per Paragraph 9.a.(1)above spect to such to provide insurance, but products. only with respect to liability (d) Anystate orpolitical subdi- arising out of "your work" performed for that additional vision with which you have insured by you or on your agreed per Paragraph behalf. A person or organi- 9.a.(1) above to provide in- zation's status as an insured surance, subject to the fol- under this provision of this lowing additional provision: endorsement continues for This insurance applies only only the period of time re with respect to the following quired by the written con hazards for which the state tract or agreement,but in no or political subdivision has event beyond the expiration issued a permit in connec date of this Coverage Part. tion with premises you own, If there is no written contract rent or control and to which or agreement, or if no pe this insurance applies: riod of time is required by the written contract or 1) The existence, mainte- agreement, a person or or- nance, repair,construe- ganization's status as an in- tion, erection, or re- sured under this endorse- moval of advertising ment ends when your op- signs, awnings, cano- erations for that insured are pies, cellar entrances, completed. coal holes, driveways, manholes, marquees, (3) Any insurance provided to an hoist away openings, additional insured designated sidewalk vaults, street under Paragraph 9.a.(2): banners, or decorations (a) Subparagraphs (e) and (f) and similar exposures; does not apply to "bodily in- or jury" or "property damage" 2) The construction, erec included within the "prod tion, or removal of ele ucts-completed operations vators;or hazard"; 3) The ownership, main- (b) Subparagraphs (a), (b), (d), tenance, or use of any (e)and (f)does not apply to elevators covered by 'bodily injury", "property this insurance. damage" or "personal and advertising injury" arising (e) Any state or political subdi- out of the sole negligence or vision with which you have willful misconduct of the ad- agreed per Paragraph ditional insured or their 9.a.(1) above to provide in- agents, "employees" or any surance, subject to the fol- other representative of the lowing provisions: additional insured;or 1) This insurance applies (C) Subparagraph (f) does not only with respect to op- apply to "bodily injury", erations performed by 'property damage" or "per- you or on your behalf sonal and advertising injury" for which the state or arising out of: political subdivision has issued a permit. 1) Defects in design fur- nished by or on behalf 2) This insurance does of the additional in- not apply to "bodily in- sured; or jury", "property dam 2) The rendering of, or age" or "personal and advertising injury" anis failure to render, any ing out of operations professional arch itec performed for the state tural, engineering or or political subdivision. surveying services, in eluding: Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 12 of 15 ., . a) The preparing, primary to other insurance approving or fail- available to the additional ing to prepare or insured except: approve maps, shop drawings, 1) As otherwise provided opinions, reports, in SECTION IV - surveys, field or- COMMERCIAL GEN- ders, change or- ERAL LIABILITY ders or drawings CONDITIONS, 5. and specifications; Other Insurance, b. and Excess Insurance; or b) Supervisory, in- 2) For any other valid and spection, architec- collectible insurance tura) or engineer- available to the addi- ing activities. tional insured as an additional insured by 3) "Your work" for which a attachment of an en- consolidated (wrap-up) dorsement to another insurance program has insurance policy that is been provided by the written on an excess primecontractor-project basis. In such case, manager or owner of the coverage provided the construction project under this endorsement in which you are in- shall also be excess. volved. (2) Condition 11. Confomiance to b. Only with regard to insurance pro- Specific Written Contract or vided to an additional insured desig- Agreement is hereby added: nated under Paragraph 9.a.(2) Sub- paragraph (f) above, SECTION III - 11. Conformance to Specific LIMITS OF INSURANCE is amended Written Contract or to include: Agreement The limits applicable to the additional With respect to additional insured are those specified in the insureds described in Para- written contract or agreement or in graph 9.a.(2)(f)above only: the Declarations of this Coverage If a written contract or Part, whichever are less. If no limits agreement between you are specified in the written contract or and the additional insured agreement, or if there is no written specifies that coverage for contract or agreement, the limits ap- the additional insured: plicable to the additional insured are those specified in the Dedarations of a. Be provided by the In- this Coverage Part. The limits of in- surance Services Office surance are inclusive of and not in additional insured form addition to the limits of insurance number CG 20 10 or shown in the Declarations. CG 20 37 (where edi- c. SECTION IV -COMMERCIAL GEN- tion specified);or ERAL LIABILITY CONDITIONS is b. Include coverage for hereby amended as follows: completed operations; (1) Condition 5. Other Insurance is or amended to include: c. Include coverage for (a) Where required by a written "your work"; contract or agreement, this and where the limits or cov- insurance is primary and / erage provided to the addi- or noncontributory as re- tional insured is more re- spects any other insurance strictive than was specifi- policy issued to the addi- cally required in that written tional insured, and such contract or agreement, the other insurance policy shall terms of Paragraphs be excess and /or noncon- 9.a.(3)(a), 9.a.(3)(b) or 9.b. tributing, whichever applies, above, or any combination with this insurance. thereof, shall be interpreted (b) Any insurance provided by as providing the limits or this endorsement shall be termscoveage required by the of the written contract Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 13 of 15 • or agreement, but only to (C) Persons or organizations the extent that such limits or making claims or bring coverage is included within "suits". the terms of the Coverage Deductible Clause Part to which this endorse- (2) ment is attached. If, how- (a) Our obligation to pay darn- ever, the written contract or ages on your behalf applies agreement specifies the In- only to the amount of dam- surance Services Office ad- ages for each "occurrence" ditional insured form num- which are in excess of the ber CG 20 10 but does not Deductible amount stated in specify which edition, or Section B. Limits of Insur- specifies an edition that ance, 11. of this endorse- does not exist, Paragraphs ment. The limits of insur- 9.a.(3)(a) and 9.a.(3)(b) of ance will not be reduced by this endorsement shall not the application of such De- apply and Paragraph 9.b. of ductible amount. this endorsement shall ap- ply. (b) Condition 2. Duties in the Event of Occurrence, Of- 10. Broadened Contractual Liability-Work fense, Claim or Suit, ap- Within 50'of Railroad Property plies to each claim or "suit" It is hereby agreed that Paragraph f.(1)of irrespective of the amount. Definition 12. "Insured contract" (SEC- (C) We may pay any part or all TION V-DEFINITIONS) is deleted. of the deductible amount to 11. Property Damage to Borrowed Equip- effect settlement of any ment claim or"suit"and, upon no- tification of the action taken, a. The following is hereby added to Ex- you shall promptly reim- clusion j. Damage to Property of burse us for such part of the Paragraph 2., Exclusions of SEC- deductible amount as has TION I -COVERAGES, COVERAGE been paid by us. A. BODILY INJURY AND PROP- ERTY DAMAGE LIABILITY: 12. Employees as Insureds Specified Health CServices Paragraphs (3) and (4) of this exclu- sion do not apply to tools or equip- It is hereby agreed that Paragraph ment loaned to you, provided they 2.a.(1)(d) of SECTION II - WHO IS AN are not being used to perform opera- INSURED, does not apply to your "em- tions at the time of loss. ployees" who provide professional health care services on your behalf as duly li- b. With respect to the insurance pro- censed: vided by this section of the endorse- ment, the following additional provi- a. Nurses; sions apply: b. Emergency Medical Technicians;or (1) The Limits of insurance shown in c. Paramedics, the Declarations are replaced by the limits designated in Section in the jurisdiction where an "occurrence" B. Limits of Insurance, 11. of or offense to which this insurance applies this endorsement with respect to takes place. coverage provided by this en- dorsement. These limits are in- 13. Broadened Notice of Occurrence clusive of and not in addition to Paragraph a. of Condition 2. Duties in the limits being replaced. The the Event of Occurrence, Offense, Limits of Insurance shown in Claim or Suit (SECTION IV-COMMER- Section B. Limits of Insurance, CIAL GENERAL LIABILITY CONDI- 11. of this endorsement fix the TIONS) is hereby deleted and replaced most we will pay in any one "oc- by the following: currence" regardless of the number of: a. You must see to it that we are noti- fied Insureds; as soon as practicable of an "oc- (a) currence" or an offense which may (b) Claims made or "suits" result in a daim. To the extent pos- brought;or sible, notice should include: (1) How, when and where the "oc- currence"or offense took place; Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 14 of 15 • M '• (2) The names and addresses of This requirement applies only when any injured persons and wit- the "occurrence" or offense is known nesses;and to an "authorized representative". (3) The nature and location of any injury or damage arising out of the"occurrence"or offense. Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 15 of 15 II �__ -';.a� Y'.'—_'moi..t..:.. -t .�x_- �G"{,u -..:as x-v..`°s.. as'ti -..,z+, ��y'".': - 'Tx`?#;,,.,^'3i.�r'`e,- :. ="-,u....L=L: .-`� ryz.'�--Y`T-«n- ".Y .-: :4. - ��,` `R" - STATg 6':ii BUSINESS LICENSE c,11889.0- �' i STATE OF j to WASHINGTON it Unified Business ID #: 602 633 401 ` Domestic Limited Liability Company Business ID #: 1 I Location: '1 IA �' CAMERON - REILLY, L.L.C. Expires: 07-31-2015 , . CAMERON-REILLY, L.L.C. ,{ iti' 309 N PARK RD SPOKANE VALLEY WA 99212 1128 _ TAX REGISTRATION L., INDUSTRIAL INSURANCE tiz, UNEMPLOYMENT INSURANCE i_ ,fis . i7 ,. " CITY LICENSES/REGISTRATIONS: SPOKANE GENERAL BUSINESS #T11049806BUS LIBERTY LAKE GENERAL BUSINESS - r SPOKANE VALLEY GENERAL BUSINESS14 1081 LICENSING RESTRICTIONS: ii, Not licensed to hire minors without a Minor Work Permit. ,itl c REGISTERED TRADE NAMES: 1 CAMERON-REILLY, L.L.C. �a t d IF, f NI P CV -VE W+im kil f , 11 f# ' d jrti - ii ti ,f_ rtill t N IA This document lists the registrations,endorsements,and licenses authorized for the businesseillt-- ,,,i, .---� ''.2, :ii named above.By acceptingthis document,the licensee certifies the information on the application Vi=i, was complete,true,and accurate to the best of his or her knowledge,and that business will be r i �` conducte� d indcompliance with all applicable Washington state,county,and city regulations. tt ' Director,Department of Revenue ra --7?.:-._. ,..-s.ye-_ `iu-�---,. '. , m '',`�"`-. --'v;�' '41 . :K .) .. L _17'; � `7—'''- ,. _ +'.Liavet t • I CAMERON REILLY LLC https://secure.lni.wa.gov/verify/Details/liabilityCertificate.aspx?UB... 'gym:. STATE OEWASHINGTON Department of Labor& Industries Certificate of Workers' Compensation Coverage September 19, 2014 WA UBI No. 602 633 401 L&I Account ID 119,442-00 Legal Business Name CAMERON REILLY LLC Doing Business As CAMERON REILLY LLC Workers'Comp Premium Status: Account is current. Estimated Workers Reported Quarter 2 of Year 2014"51 to 75 (See Description Below) Workers" Account Representative TO/CAROLYN CRAWFORD (360)902-4715-Email: CRAI235@lni.wa.gov Licensed Contractor? Yes License No. CAMERRL942NU License Expiration 08/31/2016 What does "Estimated Workers Reported" mean? Estimated workers reported represents the number of full time position requiring at least 480 hours of work per calendar quarter. A single 480 hour position may be filled by one person, or several part time workers. Industrial Insurance Information Employers report and pay premiums each quarter based on hours of employee work already performed, and are liable for premiums found later to be due. Industrial insurance accounts have no policy periods, cancellation dates, limitations of coverage or waiver of subrogation (See RCW 51.12.050 and 51.16.190). 1 of 1 9/19/2014 8:16 AM CAMELLC-03 SSTROH AG-ORO' DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 12/30/2014 THIS CERTIFICi TE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTII=ICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Spokane Valley Office PHONE 509 FAX PayneWest Insurance,Inc. (A/C.No,Ext):( )455-6767 (NC,No): 7903 E.Broadway ADDRESS: Spokane,WA 99212 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Cincinnati Insurance Companies 10677 INSURED INSURER B: . Cameron-Reilly,LLC • INSURER C: 309 N Park Rd INSURER D: Spokane Valley,WA 99212 INSURER E: INSURER F: 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP WLIMITS LTR INSD VD POLICY NUMBER (MD/ M/DYYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR X EPP0299206 12/31/2014 12/31/2015 DAMAGE TO RENTED PREMISES(Ea occurrence) $ 500 000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GE 'L AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: WA STOP GAP $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) A X ANY AUTO EPP0299206 12/31/2014 12/31/2015 BODILYINJURY(Perperson) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS XX NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) — X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB CLAIMS-MADE EPP0299206 12/31/2014 12/31/2015 AGGREGATE $ 5,000,000 DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N • STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Project:Sidewalk Infill Project—Phase 2 " Federal Aid Project No.CM-9932(040),SVPW Bid No.:14-012,Spokane Valley Capital Improvement Project No.0149 City of Spokane Valley is included as additional insured as required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityof Spokane ValleyTHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN p ACCORDANCE WITH THE POLICY PROVISIONS. 11707 E Sprague Spokane,WA 99206 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD • "I THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS' COMMERCIAL GENERAL LIABILITY BROADENED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Endorsement-Table of Contents: Coverage: Begins on Page: 1. Employee Benefit Liability Coverage 2 2. Unintentional Failure to Disdose Hazards 7 3. Damage to Premises Rented to You 8 4. Supplementary Payments 9 5. Medical Payments 9 6. Voluntary Property Damage(Coverage a.) and Care, Custody or Control Liability Coverage(Coverage b.) 9 7. 180 Day Coverage for Newly Formed or Acquired Organizations ....10 8. Waiver of Subrogation 10 9. Automatic Additional Insured-Specified Relationships: 10 • Managers or Lessors of Premises; • Lessor of Leased Equipment; • Vendors; • State or Political Subdivisions Permits Relating to Premises; • State or Political Subdivisions-Permits; and • Contractors' Operations 10. Broadened Contractual Liability-Work Within 50' of Railroad Property 14 11. Property Damage to Borrowed Equipment 14 12. Employees as Insureds-Specified Health Care Services: 14 • Nurses; • Emergency Medical Technicians; and • Paramedics 13. Broadened Notice of Occurrence .14 B. Limits of Insurance: The Commercial General Liability Limits of Insurance apply to the insurance provided by this endorse- ment, except as provided below: 1. Employee Benefit Liability Coverage Each Employee Limit: $ 1,000,000 Aggregate Limit: $ 3,000,000 Deductible: $ 1,000 3. Damage to Premises Rented to You The lesser of: a. The Each Occurrence Limit shown in the Declarations;or b. $500,000 unless otherwise stated $ 4. Supplementary Payments a. Bail bonds: $ 1,000 b. Loss of earnings: $ 350 5. Medical Payments Medical Expense Limit: $ 10,000 Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 1 of 15 6. Voluntary Property Damage(Coverage a.) and Care,Custody or Control Liability Coverage (Coverage b.) ' Limits of Insurance (Each Occurrence) Coverage a.$1,000 Coverage b.$5,000 unless otherwise stated $ Deductibles(Each Occurrence) Coverage a.$250 Coverage b.$250 unless otherwise stated $ COVERAGE PREMIUM BASIS RATE ADVANCE PREMIUM (a Area (For Limits in Excess of (For Limits in Excess of (b Payroll $5,000) $5,000) (c Gross Sales (d) Units (e) Other b. Care, Custody $ or Control TOTAL ANNUAL PREMIUM $ 11. Property Damage to Borrowed Equipment Each Occurrence Limit: $ 10,000 Deductible: $ 250 C. Coverages: have used up the appli- cable limit of insurance 1. Employee Benefit Liability Coverage in the payment of a. The following is added to SECTION I judgments or settle- - COVERAGES: Employee Benefit ments. Liability Coverage. No other obligation or liabil- ity to pay sums or perform acts or services is covered (a) We will pay those sums that unless explicitly provided for the insured becomes legally under Supplementary Pay- obligated to pay as dam- ments. ages caused by any act, er- ror or omission of the in- (b) This insurance applies to sured, or of any other per- damages only if the act, er- son for whose acts the in- ror or omission, is negli- sured is legally liable, to gently committed in the which this insurance ap- administration' of your plies. We will have the right employee benefit pro- and duty to defend the in- gram"; and sured against any "suit" 1) Occurs during the pol- seeking those damages. icy period;or However, we will have no duty to defend against any 2) Occurred prior to the "suit" seeking damages to effective date of this which this insurance does endorsement provided: not apply. We may, at our discretion, investigate any a) You did not have report of an act, error or knowledge of a omission and settle any claim or "suit" on claim or "suit" that may re- or before the ef- sult. But: fective date of this endorsement. 1) The amount we will pay for damages is limited You will be as described in SEC- deemed to have TION III - LIMITS OF knowledge of a INSURANCE; and claim or "suit" when any "author- 2) Our right and duty to ized representa- defend ends when we tive"; • Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 2 of 15 i) Reports all, or formance of investment any part, of the vehicles; or act, error or a omission to us 3) Advice given to any or any other person with respect to insurer; that person's derision to participate or not to ii) Receives a participate in any plan written or ver- induded in the "em- bal demand or ployee benefit pro- claim for dam- gram". ages because of the act, er- (f) Workers' Compensation ror or orris- and Similar Laws sion; and Any daim arising out of your b) There is no other failure to comply with the applicable insur- mandatory provisions of any ance. workers' compensation, un- employment compensation (2) Exclusions insurance, social security or This insurance does nota I disability benefits law or any apply similar law. to: (a) Bodily Injury, Property (g) ERISA Damage or Personal and Damages for which any in- Advertising Injury sured is liable because of li- ability imposed on a fiduci- "Bodily injury", "property ary by the Employee Re- damage" or "personal and tirement Income Security advertising injury". Act of 1974, as now or (b) Dishonest, Fraudulent, hereafter amended, or by Criminal or Malicious Act any similar federal, state or local laws. Damages arising out of any (h) Available Benefits intentional, dishonest, fraudulent, criminal or mali- Any claim for benefits to the cious act, error or omission, extent that such benefits are committed by any insured, available, with reasonable including the willful or reck- effort and cooperation of the less violation of any statute. insured, from the applicable (c) Failure to Perform a Con- funds accrued or other col- tract lectible insurance. Damages arising out of fail- (i) Taxes, Fines or Penalties ure of performance of con- Taxes, fines or penalties, tract by any usurer. including those imposed (d) under the Internal Revenue Insufficiency of Funds Code or any similar state or Damages arising out of an local law. insufficiency of funds to (j) Employment-Related meet any obligations under Practices any plan included in the "employee benefit pro- Any liability arising out of ram . 9 " any: (e) Inadequacy of Perform- (1) Refusal to employ; ance of Investment / Ad- vice Given With Respect (2) Termination of em- to Participation ployment; Any claim based upon: (3) Coercion, demotion, reassign- 1) Failure of anyinvest- evaluation,ment, discipline, defa- ment to perform; mation, harassment, 2) Errors in providing in- humiliation, discrimina- formation on past per- tion or other employ- Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission. Page 3 of 15 ment-related practices, (e) A trust, you are an insured. acts or omissions; or Your trustees are also in- sureds, but only with re- (4) Consequential liability spect to their duties as trus- as a result of(1), (2) or tees. (3)above. This exdusion applies (2) Each of the following is also an pP insured: whether the insured may be held liable as an employer (a) Each of your "employees" or in any other capacity and who is or was authorized to to any obligation to share administer your "employee damages with or repay benefit program". someone else who must pay damages because of (b) Any persons, organizations the injury. or "employees" having proper temporary authorize- (3) Supplementary Payments tion to administer your SECTION I - COVERAGES, "em- ployee benefit program" if SUPPLEMENTARY PAY- you die, but only until your MENTS -COVERAGES A AND legal representative is ap- B also apply to this Coverage. pointed. b. Who is an Insured (c) Your legal representative if you die, but only with re- As respects Employee Benefit Liabil- spect to duties as such. ity Coverage, SECTION II -WHO IS That representative will AN INSURED is deleted in its en- have all your rights and du- tirety and replaced by the following: ties under this Coverage Part. (1) If you are designated in the Dec- larations as: (3) Any organization you newly ac- quire or form, other than a part- (a) An individual, you and your nership, joint venture or limited spouse are insureds, but liability company, and over only with respect to the con- which you maintain ownership or duct of a business of which majority interest, will qualify as a you are the sole owner. Named Insured if no other simi- lar insurance applies to that or- (b) A partnership or joint yen- ganization. However, coverage ture, you are an insured. under this provision: Your members, your part- ners, and their spouses are (a) Is afforded only until the also insureds but only with 180th day after you acquire respect to the conduct of or form the organization or your business. the end of the policy period, whichever is earlier; and (c) A limited liability company, you are an insured. Your (b) Does not apply to any act, members are also insureds, error or omission that was but only with respect to the committed before you ac- conduct of your business. quired or formed the organi- Your managers are insur- zation. eds, but only with respect to c. Limits of Insurance their duties as your manag- ers. As respects Employee Benefit Liabil- (d) An organization other than a ity Coverage, SECTION III - LIMITS partnership, joint venture or OF INSURANCE is deleted in its en- limited liability company, tirety and replaced by the following: you are an insured. Your (1) The Limits of Insurance shown "executive officers" and di- in Section B. Limits of Insur- rectors are insureds, but ance, 1. Employee Benefit Li- only with respect to their du- ability Coverage and the rules ties as your officers or direc- below fix the most we will pay tors. Your stockholders are regardless of the number of: also insureds, but only with respect to their liability as (a) Insureds; stockholders. Includes copyrighted ri hted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 4 of 15 (b) Claims made or "suits" (b) The deductible amount brought; stated in the Declarations applies to all damages sus- ;-- (c) Persons or organizations tained by any one "em- making daims or bringing to ee", includingsuch 'em- "suits"; ployee 's" depenents and (d) Acts, errors or omissions;or beneficiaries, because of all acts, errors or omissions to (e) Benefits induded in your which this insurance ap- "employee benefit pro- plies. gram". (c) The terms of this insurance, (2) The Aggregate Limit shown in including thosewith respect Section B. Limits of Insurance, to: 1. Employee Benefit Liability Coverage of this endorsement 1) Our right and duty to is the most we will pay for all defend the insured damages because of acts, errors against any suits" or omissions negligently commit- seeking those dam- ted in the "administration" of ages; and your "employee benefit pro- 2) Your duties, and the gram". duties of any other in- (3) Subject to the limit described in volved insured, in the (2) above, the Each Employee event of an act, error or Limit shown in Section B. Limits omission,or daim, of Insurance, 1. Employee apply irrespective of the ap- Benefit Liability Coverage of plication of the deductible this endorsement is the most we amount. will pay for all damages sus- tained by any one "employee", (d) We may pay any part or all including damages sustained by of the deductible amount to such "employee's" dependents effect settlement of any and beneficiaries, as a result of claim or"suit"and, upon no- tification of the action taken, (a) An act, error or omission; or you shall promptly reim- (b) A series of related acts, er- burse us for such part of the rors or omissions, regard- deductible amount as we less of the amount of time have paid. that lapses between such d. Additional Conditions acts, errors or omissions, As respects Employee Benefit Li- negligently committed in the ability Coverage, SECTION IV - administration of your "em- COMMERCIAL GENERAL LIABIL- ployee benefit program". ITY CONDITIONS is amended as fol- However, the amount paid under lows: this endorsement shall not ex- (1) Item 2. Duties in the Event of ceed, and will be subject to the Occurrence, Offense, Claim or limits and restrictions that apply Suit is deleted in its entirety and to the payment of benefits in any replaced by the following: plan induded in the "employee benefit program". 2. Duties in the Event of an Act, Error or (4) Deductible Amount Omission,or Claim or Suit Our obligation to paydam- a. You must see to it that we are noti- (a) 9 fled as soon as practicable of an act, ages on behalf of the in- error or omission which may result in sured applies only to the a daim. To the extent possible, no- amount of damages in ex- tice should indude: cess of the deductible amount stated in the Decla- (1) What the act, error or omission rations as applicable to was and when it occurred;and Each Employee. The limits of insurance shall not be re- (2) The names and addresses of duced by the amount of this anyone who may suffer dam- deductible. ages as a result of the act, error or omission. Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 5 of 15 • b. If a daim is made or"suit" is brought b. Method of Sharing against any insured, you must: If all of the other insur- „ f (1) Immediately record the specifics ance permits contribu- of the daim or "suit" and the tion by equal shares, date received;and we will follow this method also. Under (2) Notify us as soon as practicable. this approach each in- You must see to it that we receive surer contributes equal amounts until it has written notice of the claim or"suit"as soon as practicable. paid its applicable limit of insurance or none of c. You and any other involved insured the loss remains, must: whichever comes first. (1) Immediately send us copies of If any of the other in- any demands, notices, sum- surance does not per- monses or legal papers received mit contribution by in connection with the claim or equal shares, we will "suit"; contribute by limits. Under this method, (2) Authorize us to obtain records each insurer's share is and other information; based on the ratio of its (3) Cooperate with us in the investi- applicable limit of in- surance or settlement of the daim ae the total ap- gation plicable limits of insur- or defense against the "suit"; ance of all insurers. and (4) Assist us, upon our request, in c. No Coverage the enforcement of any right This insurance shall not against any person or organiza- cover any loss for tion which may be liable to the which the insured is en- insured because of an act, error titled to recovery under or omission to which this insur- any other insurance in ance may also apply. force previous to the ef- fective d. No insured will, except at that in- date of this Cover sured's own cost, voluntarily make a Coverage Part. payment, assume any obligation, or e. Additional Definitions incur any expense without our con- sent. As respects Employee Benefit Li- ability Coverage, SECTION V - (2) Item 5. Other Insurance is de- DEFINITIONS is amended as fol- leted in its entirety and replaced lows: by the following: (1) The following definitions are 5. Other Insurance added: If other valid and collectible 1. "Administration" means: insurance is available to the insured for a loss we cover a. Providing information to under this Coverage Part, "employees", including our obligations are limited their dependents and as follows: beneficiaries, with re- spect to eligibility for or a. Primary Insurance scope of "employee This insurance is pri- benefit programs"; mary except when c. b. Interpreting the "em- below applies. If this ployee benefit pro- insurance is primary, grams"; our obligations are not affected unless any of c. Handling records in the other insurance is connection with the also primary. Then, we "employee benefit pro- will share with all that grams"; or other insurance by the method described in b. d. Effecting, continuing or terminating any "em- below. ployee's" participation Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 6 of 15 in any benefit induded benefits, workers' corn- in the "employee bene- pensation and disability fit program". benefits; and However, "administration" d. Vacation plans, indud- does not include: ing buy and sell pro- grams; leave of ab- a. Handling payroll deduc- sence programs, in- tions; or cluding military, mater- b. The failure to effect or nity, family, and civil maintain any insurance leave; tuition assis- or adequate limits of tance plans; transports- coverage of insurance, tion and health dub including but not limited subsidies. to unemployment in- (2) The following definitions are de- surance, social security leted in their entirety and re- benefits, workers' com- placed by the following: pensation and disability benefits. 21. "Suit" means a civil lans" means pro- ceeding in which money 2. "Cafeteria P damages because of an act, plan authorized by applica- error or omission to which ble law to allow "employ- this insurance applies are ees" to elect to pay for cer- alleged. "Suit" includes: tain benefits with pre-tax dollars. a. An arbitration proceed- ing in which such dam- 3. "Employee benefit pro- ages are daimed and grams" means a program to which the insured providing some or all of the must submit or does following benefits to "em- submit with our con- ployees", whether provided sent; through a "cafeteria plan"or otherwise: b. Any other alternative dispute resolution pro- a. Group life insurance; ceeding in which such group accident or damages are claimed health insurance; den- and to which the in- 1 tal, vision and hearing sured submits with our plans; and flexible consent;or spending accounts; provided that no one c. An appeal of a civil pro- other than an "em- ceeding. ployee" may subscribe to such benefits and 8. "Employee" means a per- such benefits are made son actively employed, for- generally available to merly employed, on leave of those "employees"who absence or disabled, or re- satisfy the plan's eligi- tired. "Employee" includes bility requirements; a "leased worker". "Em- ployee" does not include a b. Profit sharing plans, "temporary worker". employee savings plans, employee stock 2. Unintentional Failure to, Disclose Haz- ownership plans, pen- ards sion plans and stock SECTION IV-COMMERCIAL GENERAL subscription plans, pro- LIABILITY CONDITIONS, 7. Represen- vided that no one other tations is hereby amended by the addi- than an "employee" tion of the following: may subscribe to such benefits and such Based on our dependence upon your rep- benefits are made gen- resentations as to existing hazards, if un- erally available to all intentionally you should fail to disdose all "employees" who are such hazards at the inception date of your eligible under the plan policy, we will not reject coverage under for such benefits; this Coverage Part based solely on such C. Unemployment insur- failure. ance, social security Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission. Page 7 of 15 3. Damage to Premises Rented to You f) Nesting or infesta- tia. The last Subparagraph of Paragraph oon, or discharge 46 I • 2. SECTIOI - COVERAE , waste release of COVERAGE A. - BODILY INJURY productsbyin- ANDo- PROPERTY DAMAGE, 2. LI- secretions,s, birds, ro- ABILITY Exclusions is herebyde- dents, dents or other leted and replaced by the following: animals. Exdusions c. through q. do not apply (b) Loss caused directly or indi- to damage by fire, explosion, light- rectly by any of the follow- ning, smoke or soot to premises ing: while rented to you or temporarily oc- cupied by you with permission of the 1) Earthquake, volcanic owner. eruption, landslide or anb. The insurance provided under SEC- ment;other earth move- TION I -COVERAGES, COVERAGE A. BODILY INJURY AND PROP- 2) Water that backs up or ERTY DAMAGE LIABILITY applies overflows from a sewer, to "property damage" arising out of drain or sump; water damage to premises that are both rented to and occupied by you. 3) Water under the ground surface pressing on, or (1) As respects Water Damage Le- flowing or seeping gal Liability, as provided in through: Paragraph 3.b.above: a) Foundations, The exclusions under SECTION walls, floors or I - COVERAGES, COVERAGE paved surfaces; A. BODILY INJURY AND PROPERTY DAMAGE LIABIL- b) Basements, ITY, 2. Exclusions, other than i. whether paved or War and the Nuclear Energy not; or Liability Exclusion, are deleted c) Doors, windows or and the following are added: other openings. This insurance does not apply (c) Loss caused by or resulting to: from water that leaks or (a) "Property damage": flows from plumbing, heat- ing, air conditioning, or fire 1) Assumed in any con- protection systems caused tract;or by or resulting from freez- 2) Loss caused by or re- ing, unless: sulting from any of the 1) You did your best to following: maintain heat in the a) Wear and tear; building or structure;or b) Rust, corrosion, 2) You drained the equipment and shut off fungus, decay, de- the water supply if the terioration, hidden heat was not main- or latent defect or tained. any quality in property that (d) Loss to or damage to: causes it to dam- age or destroy it- 1) Plumbing, heating, air self, conditioning, fire pro- tection systems, or c) Smog; other equipment or ap- d) Mechanical break pliances; or down including 2) The interior of any rupture or bursting building or structure, or caused by cen- to personal property in trifugal force; the building or structure caused by or resulting e) Settling, cracking, from rain, snow, sleet shrinking or ex- or ice, whether driven pansion;or by wind or not. Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 8 of 15 c. Limit of Insurance • Limits of Insurance, 5. Medical Pay- ments of this endorsement. The Damage to Premises Rented to You Limit as shown in the Declara- 6. Voluntary Property Damage and Care, tions is amended as follows: Custody or Control Liability Coverage (2) Paragraph 6. of SECTION III - a. Voluntary Property Damage Cov- LIMITS OF INSURANCE is erage hereby deleted and replaced by the following: We will pay for "property damage"to property of others arising out of op- 6. Subject to 5. above, the erations incidental to the insured's Damage to Premises business when: Rented to You Limit is the most we will pay under (1) Damage is caused by the in- COVERAGE A. BODILY sured; or INJURY AND PROPERTY (2) Damage occurs while in the in- DAMAGE LIABILITY, for sured's possession. damages because of "prop- erty damage" to premises With your consent, we will make while rented to you or tern- these payments regardless of fault. porarily occupied by you with permission of the b. Care, Custody or Control Liability owner, arising out of any Coverage one "occurrence" to which SECTION I - COVERAGES, COV- this insurance applies. ERAGE A. BODILY INJURY AND (3) The amount we will pay is lim- PROPERTY DAMAGE LIABILITY, ited as described in Section B. 2. Exclusions, j. Damage to Prop- Limits of Insurance, 3. Dam- erty, Subparagraphs (3), (4) and (5) age to Premises Rented to do not apply to "property damage' to You of this endorsement. the property of others described therein. 4. Supplementary Payments With respect to the insurance provided by Under SECTION I - COVERAGE, SUP- this section of the endorsement, the fol- PLEMENTARY PAYMENTS - COVER- lowing additional provisions apply: AGES A AND B: a. The Limits of Insurance shown in the a. Paragraph 2. is replaced by the fol- Declarations are replaced by the lim- lowing: its designated in Section B. Limits of Up to the limit shown in Section B. Insurance, 6. Voluntary Property Limits of Insurance, 4.a.Bail Bonds Damage and Care, Custody or Bonds of this endorsement for cost of bailControl Liability Coverage of this because of accidents endorsement with respect to cover- bonds required age provided by this endorsement. or traffic law violations arising out of These limits are inclusive of and not the use of any vehicle to which the in addition to the limits being re- Bodily Injury Liability Coverage ap- placed. The Limits of Insurance plies. We do not have to furnish shown in Section B. Limits of Insur- these bonds. ance, 6. Voluntary Property Dam- b. Paragraph 4. is replaced by the fol- age and Care, Custody or Control lowing: Liability Coverage of this endorse- ment fix the most we will pay in any All reasonable expenses incurred by one "occurrence" regardless of the the insured at our request to assist number of: us in the investigation or defense of the claim or "suit", induding actual (1) Insureds; loss of earnings up to the limit shown (2) Claims made or "suits" brought; in Section B. Limits of Insurance, or 4.b. Loss of Earnings of this en- dorsement per day because of time (3) Persons or organizations making off from work. claims or bringing"suits". 5. Medical Payments b. Deductible Clause The Medical Expense Limit of Any One (1) Our obligation to pay damages Person as stated in the Declarations is on your behalf applies only to amended to the limit shown in Section B. the amount of damages for each "occurrence" which are in ex- Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission. Page 9 of 15 • cess of the deductible amount (1) Any person or organization de- stated in Section B. Limits of scribed in Paragraph 9.a.(2) be- Insurance, 6. Voluntary Prop- low (hereinafter referred to as T ' erty Damage and Care, Cus- additional insured) whom you tody or Control Liability Cov- are required to add as an addi- erage of this endorsement. The tional insured under this Cover- limits of insurance will not be re- age Part by reason of: duced by the application of such deductible amount. (a) A written contract or agree- ment; or (2) Condition 2. Duties in the Event of Occurrence, Offense, (b) An oral agreement or con- Claim or Suit, applies to each tract where a certificate of claim or"suit" irrespective of the insurance showing that per- amount. son or organization as an additional insured has been (3) We may pay any part or all of issued, the deductible amount to effect settlement of any claim or "suit" is an insured, provided: and, upon notification of the ac- (a) The written or oral contract tion taken,you shall promptly re- or agreement is: imburse us for such part of the deductible amount as has been 1) Currently in effect or paid by us. becomes effective dur- ing7. 180 DayCoverage for NewlyFormed or the policy period; Acquird Organizations and 2) Executed prior to an SECTION II - WHO IS AN INSURED is "occurrence" or offense amended as follows: to which this insurance Subparagraph a. of Paragraph 4. is would apply;and hereby deleted and replaced by the fol- (b) They are not specifically lowing: named as an additional in- a. Insurance under this provision is af- sured under any other pro- forded only until the 180th day after vision of, or endorsement you acquire or form the organization added to, this Coverage or the end of the policy period, Part. whichever is earlier; (2) Only the following persons or 8. Waiver of Subrogation organizations are additional in- sureds under this endorsement, SECTION IV-COMMERCIAL GENERAL and insurance coverage pro- LIABILITY CONDITIONS, 9. Transfer of vided to such additional insureds Rights of Recovery Against Others to is limited as provided herein: Us is hereby amended by the addition of the following: (a) The manager or lessor of a premises leased to you with We waive any right of recovery we may whom you have agreed per have because of payments we make for Paragraph 9.a.(1) above to injury or damage arising out of your ongo- provide insurance, but only ing operations or "your work" done under with respect to liability aris- a written contract requiring such waiver ing out of the ownership, with that person or organization and in- maintenance or use of that cluded in the "products-completed opera- part of a premises leased to tions hazard". However, our rights may you, subject to the following only be waived prior to the "occurrence" additional exclusions: giving rise to the injury or damage for which we make payment under this Coy- This insurance does not ap- erage Part. The insured must do nothing ply to: after a loss to impair our rights. At our 1) Any"occurrence" which request, the insured will bring "suit" or takes place after you transfer those rights to us and help us en- cease to be a tenant in force those rights. that premises. 9. Automatic Additional Insured - Speci- 2) Structural alterations, fied Relationships new construction or a. The following is hereby added to demolition operations SECTION Il-WHO IS AN INSURED: performed by or on be- Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 10 of 15 half of such additional solely for the pur- insured. pose of inspection, demonstration, ,4� (b) Any person or organization testing, r the from which you lease substitution of equipment with whom you parts under in- have agreed per Paragraph structions from the 9.a.(1) above to provide in- manufacturer, and surance. Such person(s) or then repackaged organization(s) are insureds in the original con- solely with respect to their tainer; liability arising out of the maintenance, operation or e) Any failure to use by you of equipment make such inspec- leased to you by such per- tions, adjustments, son(s) or organizations(s). tests or servicing However, this insurance as the vendor has does not apply to any "oc- agreed to make or currence" which takes place normally under- after the equipment lease takes to make in expires. the usual course of business, in (c) Any person or organization connection with (referred to below as ven- the distribution or dor) with whom you have sale of the prod- agreed per Paragraph ucts; 9.a.(1) above to provide in- surance, but only with re- f) Demonstration, in- spect to "bodily injury" or stallation, servic- "property damage" arising ing or repair op- out of"your products" which erations, except are distributed or sold in the such operations regular course of the ven- performed at the dor's business, subject to vendor's premises the following additional ex- in connection with clusions: the sale of the 1) The insurance afforded product; the vendor does not g) Products which, apply to: after distribution or sale by you, have a) "Bodily injury" or been labeled or re- "property damage" labeled or used as for which the ven- a container, part or dor is obligated to ingredient of any pay damages by other thing or sub- reason of the as- stance by or for j sumption of liabil- the vendor. ity in a contract or agreement. This 2) This insurance does exdusion does not not apply to any in- apply to liability for sured person or organi- damages that the zation: vendor would have in the absence of a) From whom you the contract or have acquired agreement; such products, or any ingredient, b) Any express war- part or container, ranty unauthorized entering into, ac- by you; companying or containing such c) Any physical or products; or chemical change in the product b) When liability in- made intentionally cluded within the by the vendor; "products- completed opera- d) Repackaging,P 9 g, tions hazard" has unless unpacked Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 11 of 15 • been excluded (f) Any person or organization under this Cover- with which you have agreed age Part with re- per Paragraph 9.a.(1)above • spect to such to provide insurance, but products. only with respect to liability (d) Anystate orpolitical subdi- arising out of "your work" performed for that additional vision with which you have insured by you or on your agreed per Paragraph behalf. A person or organi- 9.a.(1) above to provide in- zation's status as an insured surance, subject to the fol- under this provision of this lowing additional provision: endorsement continues for This insurance applies only only the period of time re- with respect to the following quired by the written con- hazards for which the state tract or agreement, but in no or political subdivision has event beyond the expiration issued a permit in connec- date of this Coverage Part. tion with premises you own, If there is no written contract rent or control and to which or agreement, or if no pe- this insurance applies: riod of time is required by the written contract or 1) The existence, mainte- agreement, a person or or- nance, repair, construc- ganization's status as an in- tion, erection, or re- sured under this endorse- moval of advertising ment ends when your op- signs, awnings, cano- erations for that insured are pies, cellar entrances, completed. coal holes, driveways, (3) Any insurance provided to an manholes, marquees, additional insured designated hoist away openings, under Paragraph 9.a.(2): sidewalk vaults, street banners, or decorations (a) Subparagraphs (e) and (f) and similar exposures; does not apply to "bodily in- or jury" or "property damage" 2) The construction, erec- included within the "prod- tion, or removal of ele- ucts-completed operations vators; or hazard"; 3) The ownership, main- (b) Subparagraphs (a), (b), (d), tenance, or use of any (e)and (f) does not apply to elevators covered by bodily injury", "property this insurance. damage" or "personal and advertising injury" arising (e) Any state or political subdi- out of the sole negligence or vision with which you have willful misconduct of the ad- agreed per Paragraph ditional insured or their 9.a.(1) above to provide in- agents, "employees" or any surance, subject to the fol- other representative of the lowing provisions: additional insured; or 1) This insurance applies (c) Subparagraph (f) does not only with respect to op- apply to "bodily injury", erations performed by "property damage" or "per- you or on your behalf sonal and advertising injury" for which the state or arising out of political subdivision has issued a permit. 1) Defects in design fur- nished by or on behalf 2) This insurance does of the additional in- not apply to "bodily in- sured; or jury", "property dam- age" or "personal and 2) The rendering of, or advertising injury" aris- failure to render, any ing out of operations professional architec- performed for the state tural, engineering or or political subdivision. surveying services, in- cluding: Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission. Page 12 of 15 a) The preparing, primary to other insurance approving or fail- available to the additional ing to prepare or insured except: ' approve maps, shop drawings, 1) As otherwise provided opinions, reports, in SECTION IV - surveys, field or- COMMERCIAL GEN- ders, change or- ERAL LIABILITY ders or drawings . CONDITIONS, 5. and specifications; Other Insurance, b. and Excess Insurance; or b) Supervisory, in- 2) For any other valid and spection, architec- collectible insurance tural or engineer- available to the addi- ing activities. tional insured as an additional insured by 3) "Your work" for which a attachment of an en- consolidated (wrap-up) dorsement to another insurance program has insurance policy that is been provided by the written on an excess primecontractor-project basis. In such case, manager or owner of the coverage provided the construction project under this endorsement in which you are in- shall also be excess. volved. (2) Condition 11. Conformance to b. Only with regard to insurance pro- Specific Written Contract or vided to an additional insured desig- Agreement is hereby added: nated under Paragraph 9.a.(2) Sub- paragraph (f) above, SECTION III - ConformancefContract or LIMITS OF INSURANCE is amended to include: Agreement The limits applicable to the additional With respect to additional insured are those specified in the insureds described in Para- written contract or agreement or in graph 9.a.(2)(f)above only: the Declarations of this Coverage If a written contract or Part, whichever are less. If no limits agreement between you are specified in the written contract or and the additional insured agreement, or if there is no written specifies that coverage for contract or agreement, the limits ap- the additional insured: plicable to the additional insured are those specified in the Dedarations of a. Be provided by the In- this Coverage Part. The limits of in- surance Services Office surance are indusive of and not in additional insured form addition to the limits of insurance number CG 20 10 or shown in the Declarations. CG 20 37 (where edi- c. SECTION IV - COMMERCIAL GEN- tion specified); or ERAL LIABILITY CONDITIONS is b. Include coverage for hereby amended as follows: completed operations; (1) Condition 5. Other Insurance is or amended to include: c. Include coverage for (a) Where required by a written "your work"; contract or agreement, this and where the limits or cov- insurance is primary and / erage provided to the addi- or noncontributory as re- tional insured is more re- spects any other insurance strictive than was specifi- policy issued to the addi- cally required in that written tional insured, and such contract or agreement, the other insurance policy shall terms of Paragraphs be excess and / or noncon- 9.a.(3)(a), 9.a.(3)(b) or 9.b. tributing, whichever applies, above, or any combination with this insurance. thereof, shall be interpreted (b) Any insurance provided by as providing the limits or this endorsement shall be coverage required by the terms of the written contract Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission. Page 13 of 15 or agreement, but only to (c) Persons or organizations the extent that such limits or making daims or bring coverage is included within "suits". .4 the terms of the Coverage Part to which this endorse- (2) Deductible Clause ment is attached. If, how- (a) Our obligation to pay dam- ever, the written contract or ages on your behalf applies agreement specifies the In- only to the amount of dam- surance Services Office ad- ages for each "occurrence" ditional insured form num- which are in excess of the ber CG 20 10 but does not Deductible amount stated in specify which edition, or Section B. Limits of Insur- specifies an edition that ance, 11. of this endorse does not exist, Paragraphs ment. The limits of insur- 9.a.(3)(a) and 9.a.(3)(b) of ance will not be reduced by this endorsement shall not the application of such De- apply and Paragraph 9.b. of ductible amount. this endorsement shall ap- ply. (b) Condition 2. Duties in the Event of Occurrence, Of- 10. Broadened Contractual Liability-Work fense, Claim or Suit, ap- Within 50' of Railroad Property plies to each daim or "suit" It is hereby agreed that Paragraph f.(1)of irrespective of the amount. Definition 12. "Insured contract" (SEC- (c) We may pay any part or all TION V-DEFINITIONS) is deleted. of the deductible amount to 11. Property Damage to Borrowed Equip- effect settlement of any ment claim or"suit' and, upon no- tification of the action taken, a. The following is hereby added to Ex- you shall promptly reim- clusion j. Damage to Property of burse us for such part of the Paragraph 2., Exclusions of SEC- deductible amount as has TION I -COVERAGES, COVERAGE been paid by us. A. BODILY INJURY AND PROP- ERTY DAMAGE LIABILITY: 12. Employees as Insureds - Specified Health Care Services Paragraphs (3) and (4) of this exdu- sion do not apply to tools or equip- It is hereby agreed that Paragraph ment loaned to you, provided they 2.a.(1)(d) of SECTION II - WHO IS AN are not being used to perform opera- INSURED, does not apply to your "em- tions at the time of loss. ployees" who provide professional health care services on your behalf as duly li- b. With respect to the insurance pro- censed: vided by this section of the endorse- ment, the following additional provi- a. Nurses; sions apply: b. Emergency Medical Technicians; or (1) The Limits of insurance shown in c. Paramedics, the Declarations are replaced by the limits designated in Section in the jurisdiction where an "occurrence" B. Limits of Insurance, 11. of or offense to which this insurance applies this endorsement with respect to takes place. coverage provided by this en- dorsement. These limits are in- 13. Broadened Notice of Occurrence • clusive of and not in addition to Paragraph a. of Condition 2. Duties in the limits being replaced. The the Event of Occurrence, Offense, Limits of Insurance shown in Claim or Suit (SECTION IV-COMMER- Section B. Limits of Insurance, CIAL GENERAL LIABILITY CONDI- 11. of this endorsement fix the TIONS) is hereby deleted and replaced most we will pay in any one "oc by the following: currence" regardless of the number of: a. You must see to it that we are noti- fied as soon as practicable of an "oc- (a) Insureds; currence" or an offense which may (b) Claims made or "suits" result in a daim. To the extent pos- brought;or sible, notice should include: (1) How, when and where the "oc- currence" or offense took place; Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission. Page 14 of 15 ___..---' CAMELLC-03 SSTROH ACOREY DATE(MM/DD/YYYY) 40......----- CERTIFICATE OF LIABILITY INSURANCE 12/30/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Spokane Valley Office PHONE 455-6767 FAX PayneWest Insurance,Inc. (A/C.No,Ext(:(509) (A/C,No): 7903 E.Broadway ADDRESS: Spokane,WA 99212 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Cincinnati Insurance Companies 10677 INSURED INSURER B: Cameron-Reilly,LLC INSURER C: 309 N Park Rd INSURER D: Spokane Valley,WA 99212 INSURER E: INSURER F: 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP WLIMITS LTR INSD VD POLICY NUMBER (MM/DD/YYYYI IMM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 _ CLAIMS-MADE X OCCUR X EPP0299206 12/31/2014 12/31/2015 pREMSESO(Eaoccurrence) $ 500,000 • MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000_ POLICY X JE? LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: WA STOP GAP $ 1,000,000 AUTOMOBILE LIABILITYCOMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) A X ANY AUTO EPP0299206 12/31/2014 12/31/2015 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED ' PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS (Per accident) $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE _$ 5,000,000 A EXCESS LIAB CLAIMS-MADE EPP0299206 12/31/2014 12/31/2015 AGGREGATE $ 5,000,000 DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y ANY PROPRIETOR/PARTNER/EXECUTIVE n N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Project:Sidewalk Infill Project-Phase 2 Federal Aid Project No.CM-9932(040),SVPW Bid No.:14-012,Spokane Valley Capital Improvement Project No.0149 City of Spokane Valley is included as additional insured as required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityof Spokane ValleyTHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN p ACCORDANCE WITH THE POLICY PROVISIONS. 11707 E Sprague Spokane,WA 99206 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS' COMMERCIAL GENERAL LIABILITY BROADENED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Endorsement-Table of Contents: Coverage: Begins on Page: 1. Employee Benefit Liability Coverage 2 2. Unintentional Failure to Disdose Hazards 7 3. Damage to Premises Rented to You 8 4. Supplementary Payments 9 5. Medical Payments 9 6. Voluntary Property Damage(Coverage a.) and Care, Custody or Control Liability Coverage(Coverage b.) 9 7. 180 Day Coverage for Newly Formed or Acquired Organizations 10 8. Waiver of Subrogation 10 9. Automatic Additional Insured-Specified Relationships: 10 • Managers or Lessors of Premises; • Lessor of Leased Equipment; • Vendors; • State or Political Subdivisions-Permits Relating to Premises; • State or Political Subdivisions-Permits; and • Contractors' Operations 10. Broadened Contractual Liability-Work Within 50'of Railroad Property 14 11. Property Damage to Borrowed Equipment 14 12. Employees as Insureds-Specified Health Care Services: 14 • Nurses; • Emergency Medical Technicians; and • Paramedics 13. Broadened Notice of Occurrence ....14 B. Limits of Insurance: The Commercial General Liability Limits of Insurance apply to the insurance provided by this endorse- ment, except as provided below: 1. Employee Benefit Liability Coverage Each Employee Limit: $ 1,000,000 Aggregate Limit: $ 3,000,000 Deductible: $ 1,000 3. Damage to Premises Rented to You The lesser of: a. The Each Occurrence Limit shown in the Declarations;or b. $500,000 unless otherwise stated$ 4. Supplementary Payments a. Bail bonds: $ 1,000 b. Loss of earnings: $ 350 5. Medical Payments Medical Expense Limit: $ 10,000 Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 1 of 15 6. Voluntary Property Damage(Coverage a.) and Care,Custody or Control Liability Coverage (Coverage b.) Limits of Insurance (Each Occurrence) Coverage a.$1,000 Coverage b.$5,000 unless otherwise stated $ Deductibles(Each Occurrence) Coverage a.$250 Coverage b.$250 unless otherwise stated $ COVERAGE PREMIUM BASIS RATE ADVANCE PREMIUM (a) Area (For Limits in Excess of (For Limits in Excess of (b) Payroll $5,000) $5,000) (c) Gross Sales (d) Units (e) Other b. Care, Custody or Control TOTAL ANNUAL PREMIUM $ 11. Property Damage to Borrowed Equipment Each Occurrence Limit $ 10,000 Deductible: $ 250 C. Coverages: have used up the appli- cable limit of insurance 1. Employee Benefit Liability Coverage in the payment of a. The following is added to SECTION I judgments or settle- -COVERAGES: Employee Benefit ments. Liability Coverage. No other obligation or liabil- ity to pay sums or perform acts or services is covered (a) We will pay those sums that unless explicitly provided for the insured becomes legally under Supplementary Pay- obligated to pay as dam- ments. ages caused by any act, er- ror or omission of the in- (b) This insurance applies to sured, or of any other per- damages only if the act, er- son for whose acts the in- ror or omission, is negli- gently committed in the sured is legally liable, to „ which this insurance ap- plies. We will have the right 'employee benefit pro- and duty to defend the in- gram"; and sured against any "suit' 1) Occurs during the pol- seeking those damages. icy period;or However, we will have no duty to defend against any 2) Occurred prior to the "suit" seeking damages to effective date of this which this insurance does endorsement provided: not apply. We may, at our discretion, investigate any a) You did not have report of an act, error or knowledge of a omission and settle any claim or "suit" on claim or "suit" that may re- or before the ef- sult. But: fective date of this endorsement. 1) The amount we will pay for damages is limited You will be as described in SEC- deemed to have TION Ill - LIMITS OF knowledge of a INSURANCE; and claim or "suit' when any "author- 2) Our right and duty to ized representa- defend ends when we tive"; Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 2 of 15 i) Reports all, or formance of investment any part, of the vehicles; or act, error or omission to us 3) Advice given to any or any other person with respect to insurer; that person's decision to participate or not to ii) Receives a participate in any plan written or ver- included in the "em- bal demand or ployee benefit pro- claim for dam- gram". ages because of the act, er- (f) Workers' Compensation ror or omis- and Similar Laws sion; and Any daim arising out of your b) There is no other failure to comply with the applicable insur- mandatory provisions of any ance. workers' compensation, un- employment compensation (2) Exclusions insurance, social security or disability benefits law or any This insurance does not apply similar law. to: (a) Bodily Injury, Property (g) ERISA Damage or Personal and Damages for which any in- Advertising Injury sured is liable because of li- ability imposed on a fiduci- "Bodily injury", "property ary by the Employee Re- damage" or "personal and tirement Income Security advertising injury". Act of 1974, as now or (b) Dishonest, Fraudulent, hereafter amended, or by Criminal or Malicious Act any similar federal, state or local laws. Damages arising out of any intentional, dishonest, (h) Available Benefits fraudulent, criminal or mali- Any claim for benefits to the cious act, error or omission, extent that such benefits are committed by any insured, available, with reasonable including the willful or reck- effort and cooperation of the less violation of any statute. insured, from the applicable (c) Failure to Perform a Con- funds accrued or other col- tract lectible insurance. Damages arising out of fail- (i) Taxes, Fines or Penalties ure of performance of con- Taxes, fines or penalties, tract by any usurer. including those imposed (d) Insufficiency of Funds under the Internal Revenue Code or any similar state or Damages arising out of an local law. insufficiency of funds to meet any obligations under (j) Employment-Related any plan included in the Practices "employee benefit pro- Any liability arising out of gram". any: (e) Inadequacy of Perform- (1) Refusal to employ; ance of Investment / Ad- vice Given With Respect (2) Termination of em- to Participation ployment; Any daim based upon: (3) Coercion, demotion, reassign- 1) Failure of anyinvest- evaluation,ment, discipline, defa- ment to perform; mation, harassment, 2) Errors in providing in- humiliation, discrimina- formation on past per- tion or other employ- Indudes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 3 of 15 ment-related practices, (e) A trust, you are an insured. acts or omissions; or Your trustees are also in- sureds, re- (4) Consequential liability but only with spect to their duties as trus- as a result of(1), (2)or tees. (3)above. (2) Each of the following is also an This exdusion applies insured: whether the insured may be held liable as an employer (a) Each of your "employees" or in any other capacity and who is or was authorized to to any obligation to share administer your "employee damages with or repay benefit program". someone else who must pay damages because of (b) Any persons, organizations the injury. or "employees" having proper temporary authoriza- (3) Supplementary Payments tion to administer your SECTION I - COVERAGES, "em- ployee benefit program" if SUPPLEMENTARY PAY- you die, but only until your -COVERAGES A AND legal representative is ap- MENTSpointed. B also apply to this Coverage. b. Who is an Insured (c) Your legal representative if you die, but only with re- As respects Employee Benefit Liabil- spect to duties as such. ity Coverage, SECTION II -WHO IS That representative will AN INSURED is deleted in its en- have all your rights and du- tirety and replaced by the following: ties under this Coverage Part. (1) If you are designated in the Dec- larations as: (3) Any organization you newly ac- quire or form, other than a part- (a) An individual, you and your nership, joint venture or limited 1 spouse are insureds, but liability company, and over only with respect to the con- which you maintain ownership or duct of a business of which majority interest, will qualify as a you are the sole owner. Named Insured if no other simi- lar insurance applies to that or- (b) A partnership or joint yen- ganization. However, coverage ture, you are an insured. under this provision: Your members, your part- ners, and their spouses are (a) Is afforded only until the also insureds but only with 180th day after you acquire respect to the conduct of or form the organization or your business. the end of the policy period, whichever is earlier; and (c) A limited liability company, you are an insured. Your (b) Does not apply to any act, members are also insureds, error or omission that was but only with respect to the committed before you ac- conduct of your business. quired or formed the organi- Your managers are insur- zation. eds, but only with respect to their duties as your manag- c. Limits of Insurance ers. As respects Employee Benefit Liabil- (d) An organization other than a ity Coverage, SECTION III - LIMITS partnership, joint venture or OF INSURANCE is deleted in its en- limited liability company, tirety and replaced by the following: you are an insured. Your (1) The Limits of Insurance shown "executive officers" and di- in Section B. Limits of Insur- rectors are insureds, but ance, 1. Employee Benefit Li- only with respect to their du- ability Coverage and the rules ties as your officers or direc- below fix the most we will pay tors. Your stockholders are regardless of the number of: also insureds, but only with respect to their liability as (a) Insureds; stockholders. Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 4 of 15 (b) Claims made or "suits" (b) The deductible amount brought; stated in the Declarations Persons or organizations applies to all damages sus- (c) g tained by any one "em- making claims or bringing ployee", including such"em- suits"; ployee's" dependents and (d) Acts,errors or omissions; or beneficiaries, because of all acts, errors or omissions to (e) Benefits included in your which this insurance ap- "employee benefit pro- plies. gram". (c) The terms of this insurance, (2) The Aggregate Limit shown in including those with respect Section B. Limits of Insurance, to: 1. Employee Benefit Liability Coverage of this endorsement 1) Our right and duty to is the most we will pay for all defend the insured damages because of acts, errors against any suits' or omissions negligently commit- seeking those dam- ted in the "administration" of ages; and your "employee benefit pro- 2) Your duties, and the gram". duties of any other in- (3) Subject to the limit described in volved insured, in the (2) above, the Each Employee event of an act, error or Limit shown in Section B.Limits omission,or claim, of Insurance, 1. Employee apply irrespective of the ap- Benefit Liability Coverage of plication of the deductible 1 this endorsement is the most we amount. will pay for all damages sus- tained byanyone "employee", (d) We mapayanypart or all Y including damages sustained by of the deductible amount to such "employee's" dependents effect settlement of any and beneficiaries, as a result of. claim or"suit"and, upon no- tification(a) An act, error or omission; or of the action taken, you shall promptly reim- (b) A series of related acts, er- burse us for such part of the rors or omissions, regard- deductible amount as we less of the amount of time have paid. that lapses between such d. Additional Conditions acts, errors or omissions, As respects Employee Benefit Li- negligently committed in the ability Coverage, SECTION IV - administration of your "em- COMMERCIAL GENERAL LIABIL- ployee benefit program". ITY CONDITIONS is amended as fol- However, the amount paid under lows: this endorsement shall not ex- (1) Item 2. Duties in the Event of ceed, and will be subject to the Occurrence, Offense, Claim or limits and restrictions that apply Suit is deleted in its entirety and to the payment of benefits in any replaced by the following: plan induded in the "employee benefit program". 2. Duties in the Event of an Act, Error or (4) Deductible Amount Omission,or Claim or Suit a. You must see to it that we are noti- (a) Our obligation to pay dam- fled as soon as practicable of an act, ages on behalf of the in- error or omission which may result in sured applies only to the a claim. To the extent possible, no- amount of damages in ex- tice should include: cess of the deductible amount stated in the Decla- (1) What the act, error or omission rations as applicable to was and when it occurred;and Each Employee. The limits of insurance shall not be re- (2) The names and addresses of duced by the amount of this anyone who may suffer dam- deductible. ages as a result of the act, error or omission. Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 5 of 15 b. If a daim is made or"suit" is brought b. Method of Sharing against any insured, you must: If all of the other insur- (1) Immediately record the specifics ance permits contribu- of the daim or "suit" and the tion by equal shares, date received; and we will follow this method also. Under (2) Notify us as soon as practicable. this approach each in- You must see to it that we receive surer contributes equal written notice of the claim or"suit"as amounts until it has soon as practicable. paid its applicable limit of insurance or none of c. You and any other involved insured the loss remains, must: whichever comes first. (1) Immediately send us copies of If any of the other in- any demands, notices, sum- surance does not per- monses or legal papers received mit contribution by in connection with the claim or equal shares, we will "suit"; contribute by limits. Under this method, (2) Authorize us to obtain records each insurer's share is and other information; based on the ratio of its in- (3) Cooperate with us in the investi- applicable limit of ap- gation or settlement of the claim plisurance to the total insur- or defense against the "suit"; anceoable limits1ns reof and of all insurers. (4) Assist us, upon our request, in c. No Coverage the enforcement of any right This insurance shall not against any person or organiza- cover any loss for tion which may be liable to the which the insured is en- insured because of an act, error titled to recovery under or omission to which this insur- any other insurance in ance may also apply. force previous to the ef- d. No insured will, except at that in- fectiedate of this Cover sured's own cost, voluntarily make a Coverr age Part. payment, assume any obligation, or e. Additional Definitions incur any expense without our con- sent. As respects Employee Benefit Li- ability Coverage, SECTION V - (2) Item 5. Other Insurance is de- DEFINITIONS is amended as fol- leted in its entirety and replaced lows: by the following: 5. Other Insurance (1) Thefollowingdefinitions are added: If other valid and collectible 1. "Administration" means: insurance is available to the insured for a loss we cover a. Providing information to under this Coverage Part, "employees", including our obligations are limited their dependents and as follows: beneficiaries, with re- spect to eligibility for or a. Primary Insurance scope of "employee benefit programs"; This insurance is pri- mary except when c. b. Interpreting the "em- below applies. If this ployee benefit pro- insurance is primary, grams"; our obligations are not affected unless any of c. Handling records in the other insurance is connection with the also primary. Then, we "employee benefit pro- will share with all that grams"; or other insurance by the method described in b. d. Effecting, continuing or below. terminating any "em- ployee's" participation Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 6 of 15 in any benefit included benefits, workers' corn- in the "employee bene- pensation and disability fit program". benefits; and However, "administration" d. Vacation plans, indud- does not include: ing buy and sell pro- grams; leave of ab- a. Handling payroll sence programs, in- tions; or cluding military, mater- b. The failure to effect or nity, family, and civil maintain any insurance leave; tuition assis- or adequate limits of tance plans;ealth orta- coverage of insurance, tion and health dub including but not limited subsidies. to unemployment in- (2) The following definitions are de- surance, social security leted in their entirety and re- benefits, workers' corn- placed by the following: pensation and disability benefits. 21. "Suit' means a civil tans" means pro- ceeding in which money 2. 'Cafeteria P damages because of an act, plan authorized by applica- error or omission to which ble law to allow "employ- this insurance applies are ees" to elect to pay for cer- alleged. "Suit' includes: tain benefits with pre-tax dollars. a. An arbitration proceed- benefit pro- proceed- ing in which such darn- 3. "Employee ages are daimed and grams" means a program to which the insured providing some or all of the must submit or does following benefits to "em- submit with our con- ployees", whether provided sent; through a"cafeteria plan"or otherwise: b. Any other alternative dispute resolution pro- a. Group life insurance; ceeding in which such group accident or damages are claimed health insurance; den- and to which the In- tal, vision and hearing sured submits with our plans; and flexible consent;or spending accounts; provided that no one c. An appeal of a civil pro- other than an "em- ceeding. ployee" may subscribe to such benefits and 8. "Employee" means a per- such benefits are made son actively employed, for- generally available to merly employed,on leave of those "employees"who absence or disabled, or re- satisfy the plan's eligi- tired. "Employee" includes bility requirements; a "leased worker". "Em- ployee" does not include a b. Profit sharing plans, "temporary worker". employee savings plans, employee stock 2. Unintentional Failure to Disclose Haz- ownership plans, pen- ands sion plans and stock SECTION IV-COMMERCIAL GENERAL subscription plans, pro- LIABILITY CONDITIONS, 7. Represen- vided that no one other tations is hereby amended by the addi- than an "employee" tion of the following: may subscribe to such benefits and such Based on our dependence upon your rep- benefits are made gen- resentations as to existing hazards, if un- erally available to all intentionally you should fail to disclose all "employees" who are such hazards at the inception date of your eligible under the plan policy, we will not reject coverage under for such benefits; this Coverage Part based solely on such c. Unemployment insur- failure. ance, social security Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 7 of 15 3. Damage to Premises Rented to You f) Nesting or infesta- tion, or discharge a. The last Subparagraph 9 p or release of 2. SECTION I - COVERAGES, waste products or COVERAGE A. - BODILY INJURY secretions, by in- AND PROPERTY DAMAGE, 2. LI- sects, birds, ro- ABILITY Exclusions is hereby de- dents or other leted and replaced by the following: animals. Exdusions c.through q.do not apply (b) Loss caused directly or indi- to damage by fire, explosion, light- rectly by any of the follow- ning, smoke or soot to premises ing: while rented to you or temporarily oc- cupied by you with permission of the 1) Earthquake, volcanic owner. eruption, landslide or b. The insurance provided under SEC- any other earth move- TION I -COVEAGES, COVERAGE menta A. BODILY INJURY AND PROP- 2) Water that backs up or ERTY DAMAGE LIABILITY applies overflows from a sewer, to "property damage" arising out of drain or sump; water damage to premises that are both rented to and occupied by you. 3) Water under the ground surface pressing on, or (1) As respects Water Damage Le- flowing or seeping gal Liability, as provided in through: Paragraph 3.b.above: a) Foundations, The exdusions under SECTION walls, floors or I - COVERAGES, COVERAGE paved surfaces; A. BODILY INJURY AND PROPERTY DAMAGE LIABIL- b) Basements, ITY, 2. Exclusions, other than i. whether paved or War and the Nuclear Energy not; or Liability Exclusion, are deleted c) Doors, windows or and the following are added: other openings. This insurance does not apply (c) Loss caused by or resulting to: from water that leaks or (a) "Property damage": flows from plumbing, heat- ing, air conditioning, or fire 1) Assumed in any con- protection systems caused tract;or by or resulting from freez- 2) Loss caused by or re- ing, unless: sulting from any of the 1) You did your best to following: maintain heat in the a) Wear and tear; building or structure;or b) Rust, corrosion, 2) You drained the equipment and shut off fungus, decay, de- the water supply if the terioration, hidden heat was not main- or latent defect or tained. any quality in property that (d) Loss to or damage to: causes it to dam- age or destroy it- 1) Plumbing, heating, air self; conditioning, fire pro- tection systems, or c) Smog; other equipment or ap- d) Mechanical break pliances; or down including 2) The interior of any rupture or bursting building or structure, or caused by cen- to personal property in trifugal force; the building or structure Settling, cracking, caused by or resulting e) from rain, snow, sleet shrinking or ex- or ice, whether driven pansion;or by wind or not. Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 8 of 15 c. Limit of Insurance Limits of Insurance, 5. Medical Pay- ments of this endorsement. The Damage to Premises Rented to You Limit as shown in the Declara- 6. Voluntary Property Damage and Care, tions is amended as follows: Custody or Control Liability Coverage (2) Paragraph 6. of SECTION III - a. Voluntary Property Damage Cov- LIMITS OF INSURANCE is erage hereby deleted and replaced by the following: We will pay for "property damage"to property of others arising out of op- 6. Subject to 5. above, the erations incidental to the insured's Damage to Premises business when: Rented to You Limit is the most we will pay under (1) Damage is caused by the in- COVERAGE A. BODILY sured; or INJURY AND PROPERTY (2) Damage occurs while in the in- DAMAGE LIABILITY, for sured's possession. damages because of"prop- erty damage" to premises With your consent, we will make while rented to you or tern- these payments regardless of fault. porarily occupied by you with permission of the b. Care, Custody or Control Liability owner, arising out of any Coverage one "occurrence" to which SECTION I - COVERAGES, COV- this insurance applies. ERAGE A. BODILY INJURY AND (3) The amount we will pay is lim- PROPERTY DAMAGE LIABILITY, ited as described in Section B. 2. Exclusions, j. Damage to Prop- Limits of Insurance, 3. Dam- erty, Subparagraphs (3), (4) and (5) age to Premises Rented to do not apply to"property damage"to You of this endorsement. the property of others described therein. 4. Supplementary Payments With respect to the insurance provided by Under SECTION I - COVERAGE, SUP- this section of the endorsement, the fol- PLEMENTARY PAYMENTS - COVER- lowing additional provisions apply: AGES A AND B: a. The Limits of Insurance shown in the a. Paragraph 2. is replaced by the fol- Declarations are replaced by the lim- lowing: its designated in Section B.Limits of Up to the limit shown in Section B. Insurance, 6. Voluntary Property Limits of Insurance, 4.a. Bail Bonds Comaoe and Care,Coverage Custodyf or of this endorsement for cost of bail Control eLnt witty of this required because of accidents agendorsement with respect ro went. or traffic law violations arising out of Thesee limits by this endorsement. and not tt the use of any vehicle to which the intoare inclusivelimits beingf re- Bodilye- Injury Liability Coverage ap- inl addition the Insurance plies. We do not have to furnish placed. The Limits of these bonds. shown in Section B. Limits of Insur- ance, 6. Voluntary Property Dam- b. Paragraph 4. is replaced by the fol- age and Care, Custody or Control lowing: Liability Coverage of this endorse- ment fix the most we will pay in any All reasonable expenses incurred by one "occurrence" regardless of the the insured at our request to assist number of: us in the investigation or defense of the claim or "suit", including actual (1) Insureds; loss of earnings up to the limit shown (2) Claims made or "suits" brought; in Section B. Limits of Insurance, or 4.b. Loss of Earnings of this en- dorsement per day because of time (3) Persons or organizations making off from work. claims or bringing"suits". 5. Medical Payments b. Deductible Clause The Medical Expense Limit of Any One (1) Our obligation to pay damages Person as stated in the Declarations is on your behalf applies only to amended to the limit shown in Section B. the amount of damages for each "occurrence" which are in ex- Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 9 of 15 cess of the deductible amount (1) Any person or organization de- stated in Section B. Limits of scribed in Paragraph 9.a.(2) be- Insurance, 6. Voluntary Prop- low (hereinafter referred to as erty Damage and Care, Cus- additional insured) whom you tody or Control Liability Coy- are required to add as an addi- erage of this endorsement. The tional insured under this Cover- limits of insurance will not be re- age Part by reason of: duced by the application of such deductible amount. (a) A written contract or agree- ment; or (2) Condition 2. Duties in the Event of Occurrence, Offense, (b) An oral agreement or con- Claim or Suit, applies to each tract where a certificate of claim or"suit" irrespective of the insurance showing that per- amount. son or organization as an additional insured has been (3) We may pay any part or all of issued, the deductible amount to effect settlement of any claim or "suit" is an insured, provided: and, upon notification of the ac- (a) The written or oral contract tion taken,you shall promptly re- or agreement is: imburse us for such part of the deductible amount as has been 1) Currently in effect or paid by us. becomes effective dur- ing7. 180 Day Coverage for Newly Formed or the policy period; Acquired Organizations SECTION II - WHO IS AN INSURED is 2) Executed prior to an amended as follows: occurrenceor offense to which this insurance Subparagraph a. of Paragraph 4. is would apply;and hereby deleted and replaced by the fol- (b) They are not specifically lowing: named as an additional in- a. Insurance under this provision is af- sured under any other pro- forded only until the 180th day after vision of, or endorsement you acquire or form the organization added to, this Coverage or the end of the policy period, Part. whichever is earlier; (2) Only the following persons or 8. Waiver of Subrogation organizations are additional in- sureds under this endorsement, SECTION IV-COMMERCIAL GENERAL and insurance coverage pro- LIABILITY CONDITIONS, 9. Transfer of vided to such additional insureds Rights of Recovery Against Others to is limited as provided herein: Us is hereby amended by the addition of the following: (a) The manager or lessor of a premises leased to you with We waive any right of recovery we may whom you have agreed per have because of payments we make for Paragraph 9.a.(1) above to injury or damage arising out of your ongo- provide insurance, but only ing operations or"your work" done under with respect to liability aris- a written contract requiring such waiver ing out of the ownership, with that person or organization and in- maintenance or use of that cluded in the "products-completed opera- part of a premises leased to tions hazard". However, our rights may you, subject to the following only be waived prior to the "occurrence" additional exclusions: giving rise to the injury or damage for which we make payment under this Coy- This insurance does not ap- erage Part. The insured must do nothing ply to: after a loss to impair our rights. At our 1) Any"occurrence"which request, the insured will bring "suit" or takes place after you transfer those rights to us and help us en- cease to be a tenant in force those rights. that premises. 9. Automatic Additional Insured - Speci- 2) Structural alterations, fied Relationships new construction or a. The following is hereby added to demolition operations SECTION 1I-WHO IS AN INSURED: performed by or on be- Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 10 of 15 half of such additional solely for the pur- insured. pose of inspection, demonstration,(b) Any person or organization testing, or the from which you lease substitution of equipment with whom you parts under in- have agreed per Paragraph structions from the 9.a.(1) above to provide in- manufacturer, and surance. Such person(s) or then repackaged organization(s) are insureds in the original con- solely with respect to their tainer; liability arising out of the maintenance, operation or e) Any failure to use by you of equipment make such inspec- leased to you by such per- tions, adjustments, son(s) or organizations(s). tests or servicing However, this insurance as the vendor has does not apply to any "oc- agreed to make or currence"which takes place normally under- after the equipment lease takes to make in expires. the usual course (c) Anyperson or organization of business, inh 9 connection with (referred to below as ven- the distribution or dor) with whom you have sale of the prod- agreed per Paragraph ucts; 9.a.(1) above to provide in- surance, but only with re- f) Demonstration, in- spect to "bodily injury" or stallation, servic- "property damage" arising ing or repair op- out of"your products" which erations, except are distributed or sold in the such operations regular course of the ven- performed at the dor's business, subject to vendor's premises the following additional ex- in connection with clusions: the sale of the 1) The insurance afforded product; the vendor does not g) Products which, apply to: after distribution or a) "Bodily 'u sale by you, have injury"rY' or been labeled or re- "property damage" labeled or used as for which the ven- a container, part or dor is obligated to ingredient of any pay damages by other thing or sub- reason of the as- stance by or for sumption of liabil- the vendor. ity in a contract or agreement. This 2) This insurance does exclusion does not not apply to any in- apply to liability for sured person or organi- damages that the zation: vendor would have in the absence of a) From whom you the contract or have acquired agreement; such products, or any ingredient, b) Any express war- part or container, ranty unauthorized entering into, ac- by you; companying or containing such c) Any physical or products;or chemical change in the product b) When liability in- made intentionally cluded within the by the vendor; "products- completedRepackaging, opera- d) Re P g g, tions hazard" has unless unpacked Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 11 of 15 been excluded (f) Any person or organization under this Cover- with which you have agreed age Part with re- per Paragraph 9.a.(1)above spect to such to provide insurance, but products. only with respect to liability (d) Anystate orpolitical subdi- arising out of "your work" performed for that additional vision with which you have insured by you or on your agreed per Paragraph behalf. A person or organi- 9.a.(1) above to provide in- zation's status as an insured surance, subject to the fol- under this provision of this lowing additional provision: endorsement continues for This insurance applies only only the period of time re- with respect to the following quired by the written con- hazards for which the state tract or agreement, but in no or political subdivision has event beyond the expiration issued a permit in connec- date of this Coverage Part. tion with premises you own, If there is no written contract rent or control and to which or agreement, or if no pe- this insurance applies: riod of time is required by the written contract or 1) The existence, mainte- agreement, a person or or- nance, repair, construc- ganization's status as an in- tion, erection, or re- sured under this endorse- moval of advertising ment ends when your op- signs, awnings, cano- erations for that insured are pies, cellar entrances, completed. coal holes, driveways, (3) Any insurance provided to an manholes, marquees, additional insured designated hoist away openings, under Paragraph 9.a.(2): sidewalk vaults, street banners, or decorations (a) Subparagraphs (e) and (f) and similar exposures; does not apply to "bodily in- or jury" or "property damage" 2) The construction, erec- included within the "prod- tion, or removal of ele- ucts-completed operations vators; or hazard , 3) The ownership, main- (b) Subparagraphs (a), (b), (d), tenance, or use of any (e)and (f)does not apply to elevators covered by "bodily injury", "property this insurance. damage" or "personal and advertising injury" arising (e) Any state or political subdi- out of the sole negligence or vision with which you have willful misconduct of the ad- agreed per Paragraph ditional insured or their 9.a.(1) above to provide in- agents, "employees" or any surance, subject to the fol- other representative of the lowing provisions: additional insured; or 1) This insurance applies (c) Subparagraph (f) does not only with respect to op- apply to "bodily injury", erations performed by "property damage" or "per- you or on your behalf sonal and advertising injury" for which the state or arising out of political subdivision has issued a permit. 1) Defects in design fur- nished by or on behalf 2) This insurance does of the additional in- not apply to "bodily in- sured; or jury", "property dam- age" or "personal and 2) The rendering of, or advertising injury" aris- failure to render, any ing out of operations professional architec- performed for the state tural, engineering or or political subdivision. surveying services, in- cluding: Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 12 of 15 a) The preparing, primary to other insurance approving or fail- available to the additional ing to prepare or insured except: approve maps, shop drawings, 1) As otherwise provided opinions, reports, in SECTION IV - surveys, field or- COMMERCIAL GEN- ders, change or- ERAL LIABILITY ders or drawings CONDITIONS, 5. and specifications; Other Insurance, b. and Excess Insurance; or b) Supervisory, in- 2) For any other valid and spection, architec- collectible insurance tural or engineer- available to the addi- ing activities. tional insured as an additional insured by 3) "Your work" for which a attachment of an en- consolidated (wrap-up) dorsement to another insurance program has insurance policy that is been provided by the written on an excess primecontractor-project basis. In such case, manager or owner of the coverage provided the construction project under this endorsement in which you are in- shall also be excess. volved. (2) Condition 11. Conformance to b. Only with regard to insurance pro- Specific Written Contract or vided to an additional insured desig- Agreement is hereby added: nated under Paragraph 9.a.(2) Sub- 11. Conformance to S ecific paragraph (f) above, SECTION III - ConfoContract or LIMITS OF INSURANCE is amended to include: Agreement The limits applicable to the additional With respect to additional insured are those specified in the insureds described in Para- written contract or agreement or in graph 9.a.(2)(f)above only: the Declarations of this Coverage If a written contract or Part, whichever are less. If no limits agreement between you are specified in the written contract or and the additional insured agreement, or if there is no written specifies that coverage for contract or agreement, the limits ap- the additional insured: plicable to the additional insured are those specified in the Dedarations of a. Be provided by the In- this Coverage Part. The limits of in- surance Services Office surance are inclusive of and not in additional insured form addition to the limits of insurance number CG 20 10 or shown in the Declarations. CG 20 37 (where edi- c. SECTION IV -COMMERCIAL GEN- tion specified); or ERAL LIABILITY CONDITIONS is b. Include coverage for hereby amended as follows: completed operations; (1) Condition 5. Other Insurance is or amended to include: c. Include coverage for (a) Where required by a written "your work"; contract or agreement, this and where the limits or cov- insurance is primary and / erage provided to the addi- or noncontributory as re- tional insured is more re- spects any other insurance strictive than was specifi- policy issued to the addi- cally required in that written tional insured, and such contract or agreement, the other insurance policy shall terms of Paragraphs be excess and /or noncon- 9.a.(3)(a), 9.a.(3)(b) or 9.b. tributing, whichever applies, above, or any combination with this insurance. thereof, shall be interpreted (b) Any insurance provided by as providing the limits or this endorsement shall be coverage required terms of the written the contract Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 13 of 15 or agreement, but only to (c) Persons or organizations the extent that such limits or making claims or bring coverage is included within "suits". the terms of the Coverage Part to which this endorse- (2) Deductible Clause ment is attached. If, how- (a) Our obligation to pay dam- ever, the written contract or ages on your behalf applies agreement specifies the In- only to the amount of dam- surance Services Office ad- ages for each "occurrence" dilional insured form num- which are in excess of the ber CG 20 10 but does not Deductible amount stated in specify which edition, or Section B. Limits of Insur- specifies an edition that ance, 11. of this endorse- does not exist, Paragraphs ment. The limits of insur- 9.a.(3)(a) and 9.a.(3)(b) of ance will not be reduced by this endorsement shall not the application of such De- apply and Paragraph 9.b. of ductible amount. this endorsement shall ap- ply. (b) Condition 2. Duties in the Event of Occurrence, Of- 10. Broadened Contractual Liability-Work fense, Claim or Suit, ap- Within 50'of Railroad Property plies to each claim or "suit' It is hereby agreed that Paragraph f.(1)of irrespective of the amount. Definition 12. "Insured contract" (SEC- (c) We may pay any part or all TION V-DEFINITIONS) is deleted. of the deductible amount to 11. Property Damage to Borrowed Equip- effect settlement of any ment claim or"suit"and, upon no- tification of the action taken, a. The following is hereby added to Ex- you shall promptly reim- clusion j. Damage to Property of burse us for such part of the Paragraph 2., Exclusions of SEC- deductible amount as has TION I -COVERAGES, COVERAGE been paid by us. A. BODILY INJURY AND PROP- ERTY DAMAGE LIABILITY: 12. Employees as Insureds - Specified Health Care Services Paragraphs (3) and (4) of this exclu- sion do not apply to tools or equip- It is hereby agreed that Paragraph ment loaned to you, provided they 2.a.(1)(d) of SECTION II - WHO IS AN are not being used to perform opera- INSURED, does not apply to your "em- tions at the time of loss. ployees" who provide professional health care services on your behalf as duly li- b. With respect to the insurance pro- censed: vided by this section of the endorse- ment, the following additional provi- a. Nurses; sions apply: b. Emergency Medical Technicians; or (1) The Limits of insurance shown in c. Paramedics, the Declarations are replaced by the limits designated in Section in the jurisdiction where an "occurrence" B. Limits of Insurance, 11. of or offense to which this insurance applies this endorsement with respect to takes place. coverage provided by this en- dorsement. These limits are in- 13. Broadened Notice of Occurrence clusive of and not in addition to Paragraph a. of Condition 2. Duties in the limits being replaced. The the Event of Occurrence, Offense, Limits of Insurance shown in Claim or Suit(SECTION IV-COMMER- Section B. Limits of Insurance, CIAL GENERAL LIABILITY CONDI- 11. of this endorsement fix the TIONS) is hereby deleted and replaced most we will pay in any one "oc by the following: currence" regardless of the number of: a. You must see to it that we are noti- fied(a) Insureds; as soon as practicable of an "oc- currenceor an offense which may (b) Claims made or "suits" result in a claim. To the extent pos- brought;or sible, notice should include: (1) How, when and where the "oc- currence"or offense took place; Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 14 of 15 (2) The names and addresses of This requirement applies only when any personsand wit- the "occurrence" or offense is known injured nesses; and to an"authorized representative". (3) The nature and location of any injury or damage arising out of the"occurrence" or offense. Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 15 of 15 (2) The names and addresses of This requirement applies only when any injured persons and wit- the "occurrence" or offense is known nesses; and to an"authorized representative". (3) The nature and location of any injury or damage arising out of the"occurrence"or offense. Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 15 of 15