The URL can be used to link to this page

15-102.00 AM Landshaper 02— Contract THIS AGREEMENT,made and entered into this 29 day of Se9-1-ern Sep-1-enber . 2015, between the City of Spokane Valley under and by virtue of Title 35 RCW,as amended and AM Landshaper, Inc. 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: Stormwater Utility 2015 Small Works Projects SVPW Contract#15-102 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. W. 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. V. The project was awarded for the bid amount of$79,073.75. 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 September 14 ,2015. Date Tye C. McGee Printed Name Sec/Treasurer Title j22—t Signature City of Spokane Valley Mike Jackson Printed Name City Manager • 4116 / gnature Revised 6.19.13 BID TABULATION 2015 Stormwater Small Works SpOgn'ooge BID 15-102 4.00Valley` BIDS DUE-11:00 a.m.,Wednesday,September 9th,2015 Vd Engineer's Estimate AM Landshaper ITEM TOTAL ITEM Unit QUANTITY Unit Price Total Cost Unit Price Total Cost BID'SCHEDULE`AN14TH&"EASTERN.' .. - .Y B'` '. VOW: kifeAMta,a„ .4. .'3at `,4 a Lv.. r- e' °,w ! 1 MOBILIZATION LS _ 1 $2,500.00 $ 2,500.00 $440.00 $ 440.00 2 CONSTRUCTION SURVEYING LS 1 $500.00 $ 500.00 $1,100.00 $ 1,100.00 3 PROJECT TEMPORARY TRAFFIC CONTROL LS 1 $3,000.00 $ 3,000.00 $215.00 $ 215.00 4 SPCC PLAN LS _ 1 $200.00 $ 200.00 $270.00 $ 270.00 5 SAWCUT ASPHALT CONCRETE PAVEMENT LF-IN 754 $1.00 $ 754.00 $0.46 $ 346.84 6 REMOVE PCC CURB LF 25 $10.00 $ 250.00 $28.36 $ 709.00 7 REMOVE ASPHALT CONCRETE PAVEMENT SY 32 $15.00 $ 480.00 $37.50 $ 1,200.00 REPLACE EXISTING FRAME&GRATE WITH 8 COMBINATION INLET(HOOD IN CURB) EACH 3 $600.00 $ 1,800.00 $1,050.00 $ 3,150.00 9 CEMENT CONCRETE CURB,TYPE A LF 25 $20.00 $ 500.00 $52.00 $ 1,300.00 10 CRUSHED SURFACING TOP COURSE,4 IN.DEPTH SY 37 $20.00 $ 740.00 $37.43 $ 1,384.91 11 CEMENT CONCRETE SIDEWALK/DRIVEWAY APPROACH SY 28 $25.00 $ 700.00 $153.25 $ 4,291.00 12 HMA CL.'I-INCH,PG 64-28,0.33 FT.DEPTH SY 62 $50.00 $ 3,100.00 $203.70 $ 12,629.40 Bid Schedule A Total; -__ .. -- . $ * 14,524.00; $'' 27,03 BIDSCHEDULEB L'orig&'6th,.>._ H s.,..,, '" . _1 v *.l_.�.at -, :..�`:: .,. .:. x '��:."'. . . 1 MOBILIZATION LS 1 $5,000.00 $ 5,000.00 $295.00 $ 295.00 2 CONSTRUCTION SURVEYING LS 1 $500.00 $ 500.00 $1,105.00 $ 1,105.00 3 PROJECT TEMPORARY TRAFFIC CONTROL LS 1 $15,000.00 $ 15,000.00 $1,723.00 $ 1,723.00 4 SPCC PLAN LS 1 $200.00 $ 200.00 $295.00 $ 295.00 5 SAWCUT ASPHALT CONCRETE PAVEMENT LF-IN 1016 $1.00 $ 1,016.00 $0.54 $ 548.64 6 REMOVE ASPHALT CONCRETE PAVEMENT SY 28 $15.00 $ 420.00 $21.00 $ 588.00 7 ROADWAY EXCAVATION INCL.HAUL CY 24 $50.00 $ 1,200.00 $101.50 $ 2,436.00 8 POROUS SHOULDER DRAIN SY 36 $70.00 $ 2,520.00 $100.00 $ 3,600.00 Bid Schedule B Total $ 25,856:00. $ _ 10,590..64' BID SCHEDULE C;CaLS1 Ide&'Willoww ';�_,_ +' .r r 'rle, ~? +( G$ 2,500.00 $ 2,500.00 Z ,^ , $445.00 $ 445.00 MOBILIZATION1 2 CONSTRUCTION SURVEYING LS 1 $ 500.00 $ 500.00 $1,110.00 $ 1,110.00 3 PROJECT TEMPORARY TRAFFIC CONTROL LS 1 $ 5,000.00 $ 5,000.00 $1,725.00 $ 1,725.00 4 SPCC PLAN LS 1 $ 200.00 $ 200.00 $295.00 $ 295.00 5 SAWCUT ASPHALT CONCRETE PAVEMENT LF-IN 584 $ 1.00 $ 584.00 $0.92 $ 537.28 6 REMOVE ASPHALT CONCRETE PAVEMENT SY 8 $ 15.00 $ 120.00 $69.40 $ 555.20 7 ROADWAY EXCAVATION INCL.HAUL CY 36 $ 50.00 $ 1,800.00 $79.35 $ 2,856.60 8 POROUS SHOULDER DRAIN SY 18 $ 70.00 $ 1,260.00 $162.22 $ 2,919.96 9 ASPHALT CURB,TYPE C LF 146 $ 25.00 $ 3,650.00 $59.86 $ 8,739.56 10 CRUSHED SURFACING TOP COURSE,2 IN DEPTH SY 25 $ 20.00 $ 500.00 $54.48 $ 1,362.00 Bid Schedule.0 Tota' _._ -. „ _.. - . $... _ _ „16;114.00; '$7 20,545:60 BID SCHEDULED;C``ain®fielf8'Kahyiia 7 - . , 'A> :t4 F .�i:.... ..-.". .._._.. .-tt �. .V, , ;. 1 MOBILIZATION LS 1 $ 3,600.00 $ 3,600.00 $443.00 $ 443.00 2 CONSTRUCTION SURVEYING LS 1 $ 500.00 $ 500.00 $1,100.00 $ 1,100.00 3 PROJECT TEMPORARY TRAFFIC CONTROL LS 1 $ 10,000.00 $ 10,000.00 $2,590.00 $ 2,590.00 4 SPCC PLAN LS 1 $ 200.00 $ 200.00 $295.00 $ 295.00 5 SAWCUT ASPHALT CONCRETE PAVEMENT LF-IN 1278 $ 1.00 $ 1,278.00 $0.92 $ 1,175.76 6 REMOVE ASPHALT CONCRETE PAVEMENT SY 8 $ 15.00 $ 120.00 $214.50 $ 1,716.00 I 7 ASPHALT CURBING,TYPE C IF 213 $ 25.00 $ 5,325.00 $55.00 $ 11,715.00 8 CRUSHED SURFACING TOP COURSE,41N.DEPTH SY 51 $ 20.00 $ 1,020.00 $36.60 $ 1,866.60 Bid ScheduleDTotal . _ _.':: ...$:: ::a _ ... 22 .__ ,0. 1 $,_ �_ , . ' - 43`00 `.. . ,. _.201 0'9 :36 TOTAL OF SCHEDULES A,B,C,D $78,537.00 $79,073.75 • Proposal Form Y Contractor's Administrative Information Y Bidder Qualification Y Bid Deposit Form Y Bid Deposit Surety Bond Form(only if submitting Bond or Bid Deposit) Y Representations and Certifications Y Non-Collusion Declaration Y 9/23/2015 Spokane �'QlleyK 2200083 BOND NO: CONTRACTOR'S PERFORMANCE BOND to City of Spokane Valley,Washington The City of Spokane Valley, Washington, in Spokane County, has awarded to AM Landshaper, Inc. (Contractor), as Principal,a contract for the construction of the project designated as Stormwater Utility 2015 Small Works,Project No. 15- ]02 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 North American Specialty 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$79,073.75 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 from any defects in the 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 bond,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 the Principal shall automatically increase the obligation of the Surety on this bond and notice to Suretyis 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. PRINCIPAL(CONTRACTO ) A.M. Landshaper, Inc. S /TY North 'i/A €*( ' an cialty Insurance Company C v/'r�i9/14/2015 Ty � / 9/14/2015 Princ. al Signature Date Surety Signature Date Tye C. McGee Diana R.Williams Printed Name Printed Name Sec/Treasurer Attorney-in-Fact • Title Title Name,address,and telephone of local office/agent of Surety Company is: Wells Fargo Insurance Services USA, Inc., 601 W. First Ave., Suite 800, Spokane,WA 99201 (509)358-3800 �� .14.13 Spokane Valley} 2200083 BOND NO: CONTRACTOR'S PAYMENT BOND(NON-FEDERALLY FUNDED PROJECT) to City of Spokane Valley,Washington The City of Spokane Valley, Washington, in Spokane County, has awarded to AM Landshaper, Inc. (Contractor), as Principal,a contract for the construction of the project designated as Stormwater Utility 2015 Small Works,Project No.15- 102 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). The Principal, and North American Specialty Insurance Company (Surety), a corporation organized under the laws 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$79,073.75 total Contract amount(including Washington State sales tax), subject to the provisions herein. 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 and 39.12 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; 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 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 the 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. PRINCIPAL(CONTRACTOR)A.M. Landshaper, Inc. S TY North A ii9an S /ialty Insurance Company 0-793-e--- 9/14/2015 ,-//(/ ./i� � L' /14/2015 i nature Date Suretysignature Date ci Prm p g Tye C. McGee Diana R. Williams Printed Name Printed Name Sec/Treasurer Attorney-in-Fact Title Title Name,address,and telephone of local office/agent of Surety Company is: Wells Fargo Insurance Services USA, Inc.,601 W. First Ave., Suite 800, Spokane,WA 99201 (509)358-3800 Revised i.14.13 NAS SURETY GROUP NORTH AMERICAN SPECIALTY INSURANCE COMPANY WASHINGTON INTERNATIONAL INSURANCE COMPANY GENERAL POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS,THAT North American Specialty Insurance Company,a corporation duly organized and existing under laws of the State of New Hampshire,and having its principal office in the City of Manchester,New Hampshire,and Washington International Insurance Company,a corporation organized and existing under the laws of the State of New Hampshire and having its principal office in the City of Schaumburg,Illinois,each does hereby make,constitute and appoint: GEORGE C.SCHROEDER,KATHY GURLEY,CHRIS LARSON,ERIN L.REPP,H.KEITH McNALLY, DIANA R.WILLIAMS and HEATHER ANDERSON JOINTLY OR SEVERALLY Its true and lawful Attomey(s)-in-Fact,to make,execute,seal and deliver,for and on its behalf and as its act and deed,bonds or other writings obligatory in the nature of a bond on behalf of each of said Companies,as surety,on contracts of suretyship as are or may be required or permitted by law,regulation,contract or otherwise,provided that no bond or undertaking or contract or suretyship executed under this authority shall exceed the amount of: FIFTY MILLION($50,000,000.00)DOLLARS This Power of Attorney is granted and is signed by facsimile under and by the authority of the following Resolutions adopted by the Boards of Directors of both North American Specialty Insurance Company and Washington International Insurance Company at meetings duly called and held on the 9'h of May,2012: "RESOLVED,that any two of the Presidents,any Managing Director,any Senior Vice President.any Vice President,any Assistant Vice President, the Secretary or any Assistant Secretary be,and each or any of them hereby is authorized to execute a Power of Attorney qualifying the attorney named in the given Power of Attorney to execute on behalf of the Company bonds,undertakings and all contracts of surety,and that each or any of them hereby is authorized to attest to the execution of any such Power of Attorney and to attach therein the seal of the Company; and it is FURTHER RESOLVED,that the signature of such officers and the seal of the Company may be affixed to any such Power of Attorney or to any certificate relating thereto by facsimile,and any such Power of Attorney or certificate bearing such facsimile signatures or facsimile seal shall be binding upon the Company when so affixed and in the future with regard to any bond,undertaking or contract of surety to which it is attached." �G%hu rl-j�/��i�� nmam:n 'yS pONgX.1 N 'Qoi;t•.. a-CZ— Q aao••.s rF: By .Go.. RgT�G �.. SEAL n= Steven P.Anderson,Senior Vice President of Washington International Insurance Company s r SEAL 'Vt.% 1973 rycn e &Senior Vice President of North American Specialty Insurance Company .rtt .1:_K- ��e;oma �~ta ONdti � By David M.Layman,Vice President of Washington International Insurance Company &Vice President of North American Specially Insurance Company IN WITNESS WHEREOF,North American Specialty Insurance Company and Washington International Insurance Company have caused their official seals to be hereunto affixed,and these presents to be signed by their authorized officers this 13th day of January .2014 • North American Specialty Insurance Company Washington International Insurance Company State of Illinois County of Cook ss: On this 13th day of January ,2014 before me,a Notary Public personally appeared Steven P.Anderson ,Senior Vice President of Washington International Insurance Company and Senior Vice President of North American Specialty Insurance Company and David M.Layman, Vice President of Washington International Insurance Company and Vice President of North American Specialty Insurance Company, personally known to me,who being by me duly sworn,acknowledged that they signed the above Power of Attorney as officers of and acknowledged said instrument to be the voluntary act and deed of their respective companies. "OFFICIAL SEAL" kam. DONNA D.SKLENS Notary Public,State of Illinois Donna,D.Sklens,Notary Public My Commission Expires 10/0612015 _ I, Jeffrey Goldberg , the duly elected Assistant Secretary of North American Speciaffy,Insurance Company and Washington International Insurance Company,do hereby certify that the above and foregoing is a true and correct copy:of a Power of Attorney given by said North American Specialty Insurance Company and Washington International Insurance Company,which is still in full force and effect. IN WITNESS WHEREOF,I have set my hand and affixed the seals of the Companies this 14thtlay of= . Septeniber,s ,20 15 • Jeffrey Goldberg.Vice President&Assistant Secretary of Washington International Insurance Company&North American Specialty Insurance Company AC:OROS DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 9/11/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must 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 Office PHONE 509 FAX Paynewest insurance,Inc. ow,No_Ext:( )838-3501 ( ,No):(509)838-3511 501 N.Riverpoint Blvd.,Ste 403 E-MAADDRESS: Spokane,WA 99202 INSURER(S)AFFORDING COVERAGE NAIC s INSURER A:The Cincinnati Insurance Co. 10677 INSURED INSURER B: A.M.Landshaper,Inc. INSURERC: Mark Albin 8004 North Market INSURER D: Spokane,WA 99217 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 ADM SUBR POLICY EFF POLICY EXP LIAAIts LTR INSD WVD POLICY NUMBER (MWDD/Y (M YYY) M/DIYYYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR X X EPP0128051 02/24/2015 02/24/2016 DAMAGE TO RENTED 500,000 PREMISES(Ea occurrence) $ � 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 JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: WA STOP GAP $ 1,000,000 AUTOMOBILE LIABILITY (CEO B ED SINGLE LIMIT $ 1,000,000 A X ANY AUTO EPP0128051 02/24/2015 02/24/2016 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ X AUTOS X NUTOS ON-OWNED PROPERTY DAMAGE $ HIRED AUTOS _ AUTOS (Per accident) X UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE EPP0128051 02/24/2015 02242016 AGGREGATE $ 1,000,000 DED X RETENTION S 0 $ 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 $ A Equipment Floater EPP0128051 0224/2015 02/24/2016 Leased and Rented 225,000 A EPP0128051 0224/2015 0224/2016 Deductible 1,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached it more space is required) RE:Stormwater Utility 2015 Small Works Projects SVPW Contract 15-102 The City of Spokane Valley and its Officers,Officials,Elected Officials,Employees,Agents and Volunteers,The State of Washington and its Officers,Officials, Elected Officials,Employees,Agents and Volunteers are Primary and Non-Contributory Blanket Additional Insured per endorsment#GA233 02/07 including Waiver of Subrogation and Completed Operations if required by contract or agreement,attached. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The of Spokane ValleyTHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City ACCORDANCE WITH THE POLICY PROVISIONS. 11707 E Sprague Ave,Suite 106 Spokane,WA 99206 AUTHORIZED REPRESENTATIVE Atalt IAN leoo 4n4A Af'ADl1 ATIAI,l All.L.I0...w..........1 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 Disclose 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 ap- plicable inf 1. Employee Benefit LiabilityCoverage once 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 (b) This insurance applies to in- sured, or of any other per- damages only if the act, er- ror or omission, is negli- son for whose acts the gently committed in the sured is legally liable, to „ 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- 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 2) Our right and duty to "authorized repre- defend ends when we sentative"; 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 orris- and Similar Laws sion;and Any claim arising out of b) There is no other your failure to comply with applicable insur- the mandatory provisions of ance. any workers'compensation, unemployment compensa- (2) Exclusions tion insurance, social secu- rity or disability benefits law This insurance does not apply or any 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 liability imposed on a fiduci- "Bodilyinjury", "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 committed by any insured, are available, with reason- including the willful or reck- able effort and cooperation less violation of any statute. of the insured, from the ap- (c) Failure to Perform a Con- plicable funds accrued or tract other collectible 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 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 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- : Consequential liability in- sureds, but only with re- (44) q spect to their duties as as a result of(1), (2) or trustees. (3)above. (2) Each of the following is also an This exclusion 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 authori- (3) Supplementary Payments zation to administer your SECTION I - COVERAGES, "employee benefit program" SUPPLEMENTARY PAY- if youdie, but onlyuntil your MENTS - COVERAGES A AND legalnl representative tive 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 (3) Any organization you newly Declarations as: 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 which you maintain ownership conduct of a business of or majority interest, will qualify which you are the sole as a Named Insured if no other owner. similar insurance applies to that organization. However, cover- (b) A partnership or joint ven- age under this provision: ture, you are an insured. Your members, your part- (a) Is afforded only until the ners, and their spouses are 180th day after you acquire also insureds but only with or form the organization or respect to the conduct of the end of the policy period, your business. whichever is earlier;and (c) A limited liability company, (b) Does not apply to any act, you are an insured. Your error or omission that was members are also insureds, committed before you ac- but only with respect to the quired or formed the or- conduct of your business. ganization. Your managers are in- c. Limits of Insurance sureds, but only with re- spect to their duties as your As respects Employee Benefit Liabil- managers. ity Coverage, SECTION III - LIMITS (d) An organization other than OF INSURANCE is deleted in its en- a partnership, joint venture tirety and replaced by the following: or limited liability company, (1) The Limits of Insurance shown you are an insured. Your in Section B. Limits of Insur- "executive officers" and di- ance, 1. Employee Benefit Li- rectors are insureds, but ability Coverage and the rules only with respect to their below fix the most we will pay duties as your officers or di- regardless of the number of: rectors. Your stockholders are also insureds, but only (a) Insureds; with respect to their liability as 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 applies to all damages (c) Persons or organizations sustained by any one "em- making claims or bringing ployee", including such "suits''; "employee's" dependents (d) Acts,errors or omissions;or and beneficiaries, because of all acts, errors or omis- (e) Benefits included in your sions to which this insur- "employee benefit pro- ance applies. gram". (c) The terms of this insurance, (2) The Aggregate Limit ehown in including those with respect Section B. Limits of Insurance, to: 1. Employee Benefit Liability 1) Our right and duty to Coverage of this endorsement is the most we will pay for all defend the insured damages because of acts, er- against any "suits" rors or omissions negligently seeking those dam- committed in the "administra- ages; and tion" of your "employee benefit 2) Your duties, and the program". 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 Benefit Liability Coverage of application 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 notification of the action (a) An act, error or omission;or taken, you shall promptly (b) A series of related acts, er- reimburse us for such part rors or omissions, regard- of the deductible amount as we have paid. less of the amount of time that lapses between such d. Additional Conditions acts, errors or omissions, ne li entl committed in the As respects Employee Benefit Li- negligently i- g 9 Y ability Coverage, SECTION IV - "administration" of your "em- COMMERCIAL GENERAL LIABIL- ployee benefit program". ITY CONDITIONS is amended as However, the amount paid un- follows: der this endorsement shall not (1) Item 2. Duties in the Event of exceed, and will be subject to Occurrence, Offense, Claim or the limits and restrictions that. Suit is deleted in its entirety and apply to the payment of benefits replaced by the following: in any plan included in the "em- ployee 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 darn- 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 (2) The names and addresses of reduced by the amount of anyone who may suffer dam- this 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 claim 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 claim 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 re- mit contribution by ceived in connection with the equal shares, we will claim or"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- ap- gation or settlement of the claim plicablealimits the totalmits of insur- or ur- 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 insured because of an act, error entitled to recovery un- or omission to which this insur- der any other insur- ance may also apply. ance in force previous d. No insured will, except at that in- to the effective date of this Coverage Part. sured's own cost, voluntarily make a 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- 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 d. Effecting, continuing or method described in b. terminating any below. "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 sence programs, in- ductions;or cluding military, mater- b: The failure to effect or nity, family, and civil leave; tuition assis- maintain any insurance transpor- or adequate limits of tattante plans;coverage of insurance, ubsi and health club s including but not limited subsidies. to unemployment in- (2) The following definitions are surance, social security deleted in their entirety and re- benefits, workers' com- placed by the following: pensation and disability benefits. 21. "Suit" means a civil pro- ceeding2. "Cafeteria plans" means in which money damages because of an plan authorized by applica- act, error or omissionto ble law to allow "employ- which this insurance applies ees" to elect to pay for cer- are alleged. "Suit"includes: tain benefits with pre-tax dollars. a. An arbitration pro- ceeding in which such 3. "Employee benefit pro- damages are claimed grams" means a program and to which the in- providing some or all of the sured must submit or following benefits to "em- does submit with our ployees", whether provided consent; 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 other than an "em- proceeding. 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 those "employees" who of absence or disabled, or satisfy the plan's eligi- retired. "Employee" in- cludes a "leased worker". bility requirements; "Employee" does not in- b. Profit sharing plans, dude a"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, LIABILITY CONDITIONS, 7. Represen- provided that no one tations is hereby amended by the addi- other than an "em- tion of the following: ployee" may subscribe to such benefits and Based on our dependence upon your such benefits are made representations as to existing hazards, if generally available to unintentionally you should fail to disclose all "employees" who all such hazards at the inception date of are eligible under the your policy, we will not reject coverage plan for such benefits; under this Coverage Part based solely on c. Unemployment insur- such 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 e) Settling, cracking, shrinking a. The last Subparagraph of Paragraph pans on; oror ex- 2. SECTION I - COVERAGES, COVERAGE A. - BODILY INJURY f) Nesting or infesta- AND PROPERTY DAMAGE, 2. LI- tion, or discharge ABILITY Exclusions is hereby de- or release of leted and replaced by the following: waste products or Exclusions c.throughdo not I secretions,s, birds, io- 9 q. apply sects, ro- to damage by fire, explosion, light- dents or other ning, smoke or soot to premises animals. while rented to you or temporarily occupied by you with permission of (b) Loss caused directly or indi- the owner. rectly by any of the follow- b. The insurance provided under SEC- mg. TION I - COVERAGES, COVERAGE 1) Earthquake, volcanic A. BODILY INJURY AND PROP- eruption, landslide or ERTY DAMAGE LIABILITY applies any other earth move- to "property damage" arising out of ment; water damage to premises that are 2) Water that backs upor both rented to and occupied by you. overflows from a (1) As respects Water Damage Le- sewer,drain or sump; gal Liability, as provided in Paragraph 3.b.above: 3) Water under the ground surface press- The exclusions under SECTION ing on, or flowing or I - COVERAGES, COVERAGE seeping through: A. BODILY INJURY AND a) Foundations, PROPERTY DAMAGE LIABIL- walls, floors or ITY, 2. Exclusions, other than i. surfaces; War and the Nuclear Energy paved Liability Exclusion, are deleted b) Basements, and the following are added: whether paved or This insurance does not apply not;or to: c) Doors, windows or (a) "Property damage": other openings. 1) Assumed in any con- (c) Loss caused by or resulting. tract;or from water that leaks or flows from plumbing, heat- 2) Loss caused by or re- ing, air conditioning, or fire suiting from any of the protection systems caused following: by or resulting from freez- a) Wear and tear; ing, unless: 1) You did your best to b) Rust, corrosion, maintain heat in the fungus, decay, building or structure;or deterioration, hid- den or latent de- 2) You drained the fect or any quality equipment and shut off in property that the water supply if the causes it to dam- heat was not main- age or destroy it- tained. self; (d) Loss to or damage to: c) Smog; 1) Plumbing, heating, air d) Mechanical conditioning, fire pro- breakdown in- tection systems, or cluding rupture or other equipment or ap- bursting caused pliances;or by centrifugal force; 2) The interior of any building or structure, or to personal property in the building or structure Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 8 of 15 caused by or resulting 5. Medical Payments rain, snow, sleet or ice, The Medical Expense Limit of AnyOne or whether driven P by wind or not. Person as stated in the Declarations is amended to the limit shown in Section B. c. Limit of Insurance Limits of Insurance, 5. Medical Pay- The Damage to Premises Rented to ments of this endorsement. You Limit as shown in the Declare- 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 "property damage" to With your consent, we will make premises while rented to these payments regardless of fault. you or temporarily occupied by you with permission of b. Care, Custody or Control Liability the owner, arising out of Coverage any one "occurrence" to SECTION I - COVERAGES, COV- which this insurance ap- ERAGE A. BODILY INJURY AND plies. PROPERTY DAMAGE LIABILITY, 2. (3) The amount we will pay is lim- Exclusions,j. Damage to Property, ited as described in Section B. Subparagraphs (3), (4) and (5) do Limits of Insurance, 3. Dam- not apply to "property damage" to age to Premises Rented to the property of others described You of this endorsement. therein. 4. Supplementary Payments With respect to the insurance provided by this section of the endorsement, the fol- Under SECTION I - COVERAGE, SUP- lowing additional provisions apply: PLEMENTARY PAYMENTS - COVER- AGES A AND B: a. The Limits of Insurance shown in the Declarations are replaced by the lim- a. Paragraph 2. is replaced by the fol- its designated in Section B.Limits of lowing: Insurance, 6. Voluntary Property Up to the limit shown in Section B. Damage and Care, Custody or Limits of Insurance, 4.a. Bail Bonds Control Liability Coverage of this cover- of this endorsement for cost of bail aendorsement with respect to bonds required because of accidents Thesehe provided by this ve of and endorsement. bondsq limits are inclusive of and not or traffic law violations arising out of in addition to the limits being re- the use of any vehicle to which the placed. The Limits of Insurance Bodily Injury Liability Coverage ap- shown in Section B. Limits of Insur- plies. We do not have to furnish ance, 6. Voluntary Property Dam- these bonds. age and Care, Custody or Control b. Paragraph 4. is replaced by the fol- Liability Coverage of this endorse- lowing: ment fix the most we will pay in any one "occurrence" regardless of the All reasonable expenses incurred by number of: the insured at our request to assist us in the investigation or defense of (1) Insureds; the claim or "suit", including actual (2) Claims made or "suits" brought; loss of earnings up to the limit shown or in Section B. Limits of Insurance, 4.b. Loss of Earnings of this en- (3) Persons or organizations mak- dorsement per day because of time ing claims or bringing "suits". off from work. Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 9 of 15 b. Deductible Clause 9. Automatic Additional Insured - Speci- (1) Our obligation to pay damages fled Relationships on your behalf applies only to a. The following is hereby added to the amount of damages for each SECTION II-WHO IS AN INSURED: "occurrence" which are in ex- cess of the deductible amount (1) Any person or organization de- stated in Section B. Limits of scribed in Paragraph 9.a.(2) Insurance, 6. Voluntary Prop- below (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 (a) A written contract or deductible amount. agreement; or (2) Condition 2. Duties in the Event (b) An oral agreement or con- of Occurrence, Offense, Claim tract where a certificate of or Suit, applies to each claim or insurance showing that per- suit irrespective of the amount. son or organization as an (3) We may pay any part or all of additional insured has been the deductible amount to effect issued, settlement of any claim or "suit" is an insured, provided: and, upon notification of the ac- tion taken, you shall promptly (a) The written or oral contract reimburse us for such part of the or agreement is: deductible amount as has been paid by us. 1) Currently in effect or becomes effective 7. 180 Day Coverage for Newly Formed or during the policy pe- Acquired Organizations hod;and SECTION II - WHO IS AN INSURED is 2) Executed prior to an amended as follows: "occurrence" or offense which this Subparagraph a. of Paragraph 4. is would apply; ansd urance hereby deleted and replaced by the fol- lowing: (b) They are not specifically is af- named as an additional in- a. Insurance under this provisionsured 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; 8. Waiver of Subrogation (2) Only the following persons or organizations are additional in- SECTION IV- COMMERCIAL GENERAL sureds under this endorsement, LIABILITY CONDITIONS, 9. Transfer of and insurance coverage pro- Rights of Recovery Against Others to vided to such additional in- Us is hereby amended by the addition of sureds is limited as provided the following: herein: We waive any right of recovery we may (a) The manager or lessor of a have because of payments we make for premises leased to you with injury or damage arising out of your on- whom you have agreed per going operations or"your work" done un- Paragraph 9.a.(1) above to der a written contract requiring such provide insurance, but only waiver with that person or organization with respect to liability aris- and included in the "products-completed ing out of the ownership, operations hazard". However, our rights maintenance or use of that may only be waived prior to the "occur- part of a premises leased to rence" giving rise to the injury or damage you, subject to the following for which we make payment under this additional exclusions: Coverage Part. The insured must do This insurance does not nothing after a loss to impair our rights. apply to: At our request,the insured will bring "suit" or transfer those rights to us and help us 1) Any "occurrence" enforce those rights, which takes place after Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 10 of 15 you cease to be a ten- c) Any physical or ant in that premises. chemical change in the product 2) Structural alterations, made intentionally new construction or by the vendor; demolition operations performed by or on be- d) Repackaging, un- half of such additional less unpacked insured. solely for the pur- pose or organization of inspection, (b) Any persong demonstration, from which you lease testing, or the equipment with whom you substitution of have agreed per Paragraph parts under in- 9.a.(1) above to provide in- structions from the surance. Such person(s)or manufacturer, and organization(s)are insureds then repackaged solely with respect to their in the original liability arising out of the container; maintenance, operation or use by you of equipment e) Any failure to leased to you by such per- make such in- son(s) or organizations(s). spections, adjust- However, this insurance ments, tests or does not apply to any "oc- servicing as the currence"which takes place vendor has after the equipment lease agreed to make or expires. normally under- takesAnyperson or organization uo makecoin (c) 9 the usual course (referred to below as ven- of business, in dor) with whom you have connection with agreed per Paragraph the distribution or 9.a.(1) above to provide in- sale of the prod- surance, but only with re- ucts; spect to "bodily injury" or "property damage" arising f) Demonstration, in- out of"your products"which stallation, servic- are distributed or sold in the ing or repair op- regular course of the ven- erations, except dor's business, subject to such operations the following additional ex- performed at the clusions: vendor's premises 1) The insurance afforded inh connection with the sale of the the vendor does not product; apply to: g) Products which, a) "Bodily injury" or after distribution or "property damage" sale by you, have for which the ven- been labeled or dor is obligated to relabeled or used pay damages by as a container, reason of the as- part or ingredient sumption of liabil- of any other thing ity in a contract or or substance by or agreement. This for the vendor. exclusion does not apply to liability for 2) This insurance does damages that the not apply to any in- vendor would sured person or or- have in the ab- ganization: sence of the con- tract or agree- a) From whom you ment; have acquired such products, or b) Any express war- any ingredient, ranty unauthorized part or container, by you; entering into, ac- Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 11 of 15 companying or 2) This insurance does containing such not apply to "bodily in- products; or jury", "property dam- age" or "personal and b) When liability in- advertising injury" aris- cluded within the ing out of operations "products- performed for the state completed opera- or political subdivision. tions hazard" has been excluded (f) Any person or organization under this Cover- with which you have agreed age Part with re- per Paragraph 9.a.(1) spect to such above to provide insurance, products. but only with respect to li- ability arising out of "your (d) Any state or political subdi- work" performed for that vision with which you have additional insured by you or agreed per Paragraph on your behalf. A person or 9.a.(1) above to provide in- organization's status as an surance, subject to the fol- insured under this provision lowing additional provision: of this endorsement contin- This insurance applies only ues for only the period of with respect to the following time required by the written hazards for which the state contract or agreement, but or political subdivision has in no event beyond the ex- issued a permit in connec- piration date of this Cover- tion with premises you own, age Part. If there is no written contract or agree- rent or control and to which this insurance applies: ment, or if no period of time is required by the written 1) The existence, mainte- contract or agreement, a nance, repair, con- person or organization's struction, erection, or status as an insured under removal of advertising this endorsement ends signs, awnings, cano- when your operations for pies, cellar entrances, that insured are completed. coal holes, driveways, (3) Any insurance provided to an manholes, marquees, hoist away openings, additional insured designated sidewalk vaults, street under Paragraph 9.a.(2): banners, or decora- (a) Subparagraphs (e) and (f) tions and similar expo- does not apply to "bodily sures; or injury"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 "property(e)and (f)does not apply to elevators covered by "bodily injury", this insurance. damage" or "personal and advertising injury" arising (e) Any state or political subdi- out of the sole negligence vision with which you have or willful misconduct of the agreed per Paragraph additional 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 1) Defects in design fur- issued a permit. nished by or on behalf Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 12 of 15 of the additional in- spects any other insurance sured; or policy issued to the addi- tional2 The renderingof, insured, and such or other insurance policy shall. failure to render, any be excess and /or noncon- professional architec- tributing, whichever applies, tural, engineering or with this insurance. surveying services, in- cluding: (b) Any insurance provided by this endorsement shall be 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.Other and specifications; Insurance, b. Excess and Insurance;or b) Supervisory, in- 2) For any other valid and spection, archi- collectible insurance tectural or engi- available to the addi- fleeting activities. tional insured as an 3) "Your work" for which a additional insured by 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 endorse- in which you are in- ment shall also be ex- volved. cess.. b. Only with regard to insurance pro- (2) Condition 11. Conformance to vided to an additional insured desig- Specific Written Contract or nated under Paragraph 9.a.(2) Sub- Agreement is hereby added: paragraph (f) above, SECTION III - LIMITS OF INSURANCE is amended 11. Conformance to Specific to include: Written Contract or The limits applicable to the additional Agreement insured are those specified in the With respect to additional written contract or agreement or in insureds described in Para- the Declarations of this Coverage graph 9.a.(2)(f)above only: Part,whichever are less. If no limits are specified in the written contract If a written contract or or agreement, or if there is no written agreement between you contract or agreement, the limits ap- and the additional insured plicable to the additional insured are specifies that coverage for those specified in the Declarations of the additional insured: this Coverage Part. The limits of in- a. Be provided by the In- surance are inclusive of and not in surance Services Of- addition to the limits of insurance Tice additional insured shown in the Declarations. form number CG 20 10 c. SECTION IV - COMMERCIAL GEN- or CG 20 37 (where ERAL LIABILITY CONDITIONS is edition specified);or hereby amended as follows: b. Include coverage for (1) Condition 5. Other Insurance is completed operations; amended to include: (a) Where required by a written c. Include coverage for contract or agreement, this "your work"; insurance is primary and / and where the limits or cov- or noncontributory as re- erage provided to the addi- Includes copyrighted material of Insurance GA 233 02 07 Services Office,Inc.,with its permission. Page 13 of 15 tional insured is more re- 11. of this endorsement fix the strictive than was specifi- most we will pay in any one "oc- cally required in that written currence" regardless of the contract or agreement, the number of: terms of Paragraphs 9.a.(3)(a), 9.a.(3)(b) or 9.b. (a) Insureds; above, or any combination (b) Claims made or "suits" thereof, shall be interpreted brought; or as providing the limits or coverage required by the (c) Persons or organizations terms of the written contract making claims or bring or agreement, but only to "suits". the extent that such limits or coverage is included within (2) Deductible Clause the terms of the Coverage Part to which this endorse- (a) Our obligation to pay dam- ment is attached. If, how- ages on your behalf applies only to the amount of dam- ever, the written contract or agreement specifies the In- ages for each "occurrence" surance Services Office which are in excess of the additional insured form Deductible amount stated in number CG 20 10 but does Section B. Limits of Insur- not specify which edition, or ance, 11. of this endorse- specifies an edition that ment. The limits of insur- does not exist, Paragraphs ance will not be reduced by the application of such De- 9.a.(3)(a) and 9.a.(3)(b) of this endorsement shall not ductible amount. apply and Paragraph 9.b. of (b) Condition 2. Duties in the this endorsement shall ap- Event of Occurrence, Of- ply fense, Claim or Suit, ap- 10. Broadened Contractual Liability-Work plies to each claim or "suit" irrespective of the amount. Within 50'of Railroad Property It is hereby agreed that Paragraph f.(1) of (c) We may pay any part or all of t to Definition 12. "Insured contract" (SEC- effect deductible ement ofunany TION V-DEFINITIONS)is deleted, claim or "suit" and, upon 11. Property Damage to Borrowed Equip- notification of the action ment taken, you shall promptly reimburse us for such part a. The following is hereby added to Ex- of the deductible amount as clusion j. Damage to Property of has been paid by us. Paragraph 2., Exclusions of SEC- TION I - COVERAGES, COVERAGE 12. Employees as Insureds - Specified A. BODILY INJURY AND PROP- Health Care Services ERTY DAMAGE LIABILITY: It is hereby agreed that Paragraph Paragraphs (3) and (4) of this exclu- 2.a.(1)(d) of SECTION II - WHO IS AN sion do not apply to tools or equip- INSURED, does not apply to your "em- ment loaned to you, provided they ployees" who provide professional health are not being used to perform opera- care services on your behalf as duly li- tions at the time of loss. censed: b. With respect to the insurance pro- a. Nurses; vided by this section of the en- b. Emergency Medical Technicians;or dorsement, the following additional provisions apply: c. Paramedics, (1) The Limits of insurance shown in the jurisdiction where an "occurrence" in the Declarations are replaced or offense to which this insurance applies by the limits designated in Sec- takes place. tion B. Limits of Insurance, 11. of this endorsement with respect 13. Broadened Notice of Occurrence to coverage provided by this endorsement. These limits are Paragraph a. of Condition 2. Duties in inclusive of and not in addition to the Event of Occurrence, Offense, the limits being replaced. The Claim or Suit (SECTION IV - COMMER- Limits of Insurance shown in CIAL GENERAL LIABILITY CONDI- Section B. Limits of Insurance, Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 14 of 15 TIONS) is hereby deleted and replaced (2) The names and addresses of by the following: any injured persons and wit- nesses;a. You must see to it that we are noti- fied and as soon as practicable of an (3) The nature and location of any "occurrence" or an offense which injury or damage arising out of may result in a claim. To the extent the"occurrence"or offense. possible, notice should include: This requirement applies only when (1) How, when and where the "oc- the "occurrence" or offense is known currence"or offense took place; to an "authorized representative". Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 15 of 15 A M LANDSHAPER INC Page 1 of 1 STATE OF WASH1NG7ON Department of Labor& Industries Certificate of Workers' Compensation Coverage September 23, 2015 WA UBI No. 1601 701 273 L&I Account ID 816,368-01 Legal Business Name A M LANDSHAPER INC Doing Business As A M LANDSHAPER INC Workers' Comp Premium Status: Account is current. Estimated Workers Reported Quarter 2 of Year 2015"7 to 10 (See Description Below) Workers" Account Representative TO/CAROLYN CRAWFORD(360) 902-4715-Email: CRAI235@Ini.wa.gov Licensed Contractor? Yes License No. AMLANI*971D0 License Expiration 02/24/2016 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). https://secure.lni.wa.gov/verify/Details/liabilityCertificate.aspx?UBI=601701273&LIC=A... 9/23/2015 ��....1.11 AMLANDS-01 MWHITNEY ,A ` CERTIFICATE OF LIABILITY INSURANCE DATE z3/ 20D16) �.---- 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 j 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 NAMEACT Matina Whitney 'Spokane Office PHONE (509)838-3501 Fax 509 838-3511 Pa newest Insurance,Inc. (SVC.No.ExU: (arc,No( ) 501 N.Riverpoint Blvd.,Ste 403 ADDAIL RESS: Spokane,WA 99202 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A;The Cincinnati Insurance Co. 10677 INSURED INSURER B: A.M.Landshaper,Inc. INSURERC: Mark Albin 8004 North Market INSURER D: Spokane,WA 99217 INSURER : 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 POUCY EXP UNITS LTRINSD WVD POLICY NUMBER (MM/DDIYYYY) (MM/DO/YYYY) A X COMMERCIAL GENERAL LIABIUTY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR X X EPP0128051 02/24/2016 02/2412017 PDRMGEOERa toNcTcuED nce) $ 500,000 { { MED EXP(Any one person) $ 10,000 PERSONALS ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 POLICY X LOC PRODUCTS-COMP/OP AGG S 2,000,000 JEC OTHER: WA STOP GAP (s 1,000,000 AUTOMOBILE UABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) A X ANY AUTO EBA0128051 02/2412016 02/24/2017 BODILY INJURY(Per person} $ ALL OWNED —SCHEDULED BODILY INJURY(Per accident) S II AUTOS AUTOS X HIRED AUTOS X AUTNOSWNED (PRer accideent)DGE $ S X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESSUAB CLAIMS-MADE EPP0128051 02/24/2016 02/24/2017 AGGREGATE 5 1,000,000 1 DED X RETENTIONS 0 s WORKERS COMPENSATION PER OTH- AND EMPLOYERS'UY/N ABIUTY STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N I A (Mandatory M NH) E.L.DISEASE-EA EMPLOYEE S tf yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S A Equipment Floater EPP0128051 02/2412016 02/24/2017 Leased and Rented 225,000 A EPP0128051 02124/2016 02/24/2017 Deductible 1,000 DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached If more space is required) !The RE:Stormwater Utility 2015 Small Works Projects SVPW Contract 16-102 City of Spokane Valley and its Officers,Officials,Elected Officials,Employees,Agents and Volunteers,The State of Washington and its Officers,Officials, ;Elected Officials,Employees,Agents and Volunteers are Primary and Non-Contributory Blanket Additional Insured per endorsment#GA233 02107 including Waiver of Subrogation and Completed Operations if required by contract or agreement,attached. CERTIFICATE HOLDER CANCELLATION III! SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The Cityof Spokane Valley THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ffff ACCORDANCE WITH THE POLICY PROVISIONS. 11707 E Sprague Ave,Suite 106 Spokane,WA 99206 AUTHORIZED REPRESENTATIVE I ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD tb -102— 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 Pane: 1. Employee Benefit Liability Coverage 2 2. Unintentional Failure to Disclose 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 ) 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 ap- 1 plicable limit of insur- 1. Employee Benefit Liability Coverage ance 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 (1) Insuring Agreement 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- (b) This insurance applies to ror or omission of the in- damages only if the act, er- sured, or of any other per- ror or omission, is negli- son for whose acts the in- gently committed in the sured is legally liable, to "administration" of your which this insurance ap- plies. We will have the right gram";and 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 a) You did not have discretion, investigate any knowledge of a report of an act, error or claim or "suit" on omission and settle any 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 Ill - LIMITS OF knowledge of a INSURANCE;and claim or "suit" when any 2) Our right and duty to "authorized repro- defend ends when we sentative"; 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 orris- and Similar Laws sion;and Any claim arising out of b) There is no other your failure to comply with applicable incur- the mandatory provisions of ante. any workers'compensation, unemployment compensa- (2) Exclusions tion insurance, social secu- rityThis insurance does nota l or disability benefits law apply or any 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 liability 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 mall- Any claim for benefits to the cious act, error or omission, extent that such benefits committed by any insured, are available, with reason- including the willful or reck- able effort and cooperation less violation of any statute. of the insured, from the ap- (c) Failure to Perform a Con- plicable funds accrued or tract other collectible insurance. Damages arising out of fait- (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 (j) Employment-Related meet any obligations under Practices any plan included in the "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 claim based upon: (3) Coercion, demotion, reassign- 1) Failure of anyinvest- evaluation,meat, discipline, defa- ment to perform; mation, harassment, 2) Errors in providing in- humiliation, employ- formationdiscrimina- on past per- Includes tion or other 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,Consequential liability but only with re- (4) q spect to their duties as as a result of(1), (2) or trustees. (3)above. (2) Each of the following is also an This exclusion 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 (b) Any persons, organizations pay damages because ofor "employees" having the injury. proper temporary authori- (3) Supplementary Payments zation to administer your "employee benefit program SECTION I - COVERAGES, if you die,but only until your SUPPLEMENTARY PAY- legal representative is ap- MENTS - COVERAGES A AND pointed. B also apply to this Coverage. (c) Your legal representative if b. Who is an Insured 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 1ave all your rights and du- 1 AN INSURED is deleted in its en- haunder this Coverage tirety and replaced by the following: ties (1) If you are designated in the (3) Any organization you newly Declarations as: 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 which you maintain ownership conduct of a business of or majority interest, will qualify which you are the sole as a Named Insured if no other owner. similar insurance applies to that organization. However, cover- (b) A partnership or joint ven- age under this provision: ture, you are an insured. Your members, your part- (a) Is afforded only until the ners, and their spouses are 180th day after you acquire also insureds but only with or form the organization or respect to the conduct of the end of the policy period, your business, whichever is earlier;and (c) A limited liability company, (b) Does not apply to any act, you are an insured. Your error or omission that was members are also insureds, committed before you ac- but only with respect to the quired or formed the or- conduct of your business. ganization. Your managers are in- sureds, Insurance but only with re- spect to their duties as your As respects Employee Benefit Liabil- managers. ity Coverage, SECTION III - LIMITS (d) An organization other than OF INSURANCE is deleted in its en- a partnership, joint venture tirety and replaced by the following: or limited liability company, (1) The Limits of Insurance shown you are an insured. Your in Section B. Limits of Insur- "executive officers" and di- ante, 1. Employee Benefit Li- rectors are insureds, but ability Coverage and the rules only with respect to their below fix the most we will pay duties as your officers or di- regardless of the number of: rectors. Your stockholders are also insureds, but only (a) Insureds; with respect to their liability as stockholders. Includes copyrighted material of Insurance GA 233 02 07 Services Office,Inc.,with its permission. Page 4 of 15 i (b) Claims made or "suits" (b) The deductible amount brought; stated in the Declarations (c) Persons or organizations applies to all damages g sustained by any one "em- making claims or bringing ployee", including such "suits"; 'employee's" dependents (d) Acts,errors or omissions;or and beneficiaries, because of all acts, errors or omis- (e) Benefits included in your sions to which this insur- "employee benefit pro- ance applies. 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 1) Our right and duty to Coverage of this endorsement defend the insured is the most we will pay for all against any "suits" damages because of acts, er- seeking those dam- rors or omissions negligently committed in the "administra- tion" of your "employee benefit 2) Your duties, and the program". 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 omission,or claim, in Section B.Limits Limit shown of Insurance, 1. Employee apply irrespective of the Benefit Liability Coverage of application 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 notification of the action (a) An act,error or omission;or taken, you shall promptly (b) A series of related acts, er- reimburse us for such part rocs or omissions, regard- of the deductible amount as we have paid. less of the amount of time that lapses between such d. Additional Conditions acts,errors or omissions, e !i entl committed in the As respects Employee Benefit Li- negligently i- ny ability Coverage, SECTION IV - "administration"g administration of your "em- COMMERCIAL GENERAL LIABIL- ployee benefit program". ITY CONDITIONS is amended as However, the amount paid un- follows: der this endorsement shall not (1) Item 2. Duties in the Event of exceed, and will be subject to Occurrence, Offense, Claim or the limits and restrictions that Suit is deleted in its entirety and apply to the payment of benefits replaced by the following: in any plan included in the "em- ployee 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 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 (2) The names and addresses of reduced by the amount of anyone who may suffer dam- this 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 claim 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 claim 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 re- mit contribution by ceived in connection with the equal shares, we will claim or"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- suranceation or settlement of the claim limits the total ap- gation plicable lmits 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 organize- cover any loss for tion which may be liable to the which the insured is insured because of an act, error entitled to recovery un- or omission to which this insur- der any other insur- ance may also apply. ance in force previous t at that in- to the effective date of d. No insured will, except this Coverage Part. sured's own cost, voluntarily make a 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 foi- 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. "Administrations 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 d. Effecting, continuing or method described in b. 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 ab- a. pro- Handlingpayroll de- grams; leave of sence programs, in- ductions;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; transpor- coverage of insurance, talion and health club including but not limited subsidies. to unemployment in- (2) The following definitions are surance, social security deleted in their entirety and re- benefits, workers' corn- placed by the following: pensation and disability benefits. 21. "Suit" means a civil pro- ceedin2. "Cafeteria plans" means damagein money s because of a plan authorized by applica- act, error or omission to ble law to allow "employ- which this insurance applies ees" to elect to pay for cer- are alleged. "Suit"includes: tain benefits with pre-tax dollars. a. An arbitration pro- ceeding in which such 3. "Employee benefit pro- damages are claimed grams" means a program and to which the in- providing some or all of the sured must submit or following benefits to "em- does submit with our ployees , whether provided consent; 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 other than an "em- proceeding. ployee" may subscribe 8. "Employee" means aper- to such benefits andson actively employed, for- generally available to such benefits are made merly employed, on leave of those"employees"who retired.ence�orEdisabled,einr satisfy the plan's eligi- eludes a "leased worker". bility requirements; "Employee" does not in- b. Profit sharing plans, dude a"temporary worker". employee savings plans, employeeastock 2. Unintentional Failure to Disclose Haz- ownership plans, pen- ards sion plans and stock SECTION IV- COMMERCIAL GENERAL subscription plans, LIABILITY CONDITIONS, 7. Represen- provided that no one tations is hereby amended by the addi- other than an "em- tion of the following: ployee" may subscribe to such benefits and Based on our dependence upon your such benefits are made representations as to existing hazards, if generally available to unintentionally you should fail to disclose all "employees" who all such hazards at the inception date of are eligible under the your policy, we will not reject coverage plan for such benefits; under this Coverage Part based solely on c. Unemployment insur- such 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 e) Settling, cracking, a. The last Subparagraph of Paragraph pnsnor ex- 2. SECTION I - COVERAGES, pension;or COVERAGE A. - BODILY INJURY f) Nesting or infesta- AND PROPERTY DAMAGE, 2. LI- tion, or discharge ABILITY Exclusions is hereby de- or release of feted and replaced by the following: waste products or secretions, by in- Exclusions c.through q.do not apply sects, birds, ro- to damage by fire, explosion, light- dents or other ping, smoke or soot to premises animals. while rented to you or temporarily occupied by you with permission of (b) Loss caused directly or indi- the owner. rectly by any of the follow- ing:b. The insurance provided under SEC- TION I-COVERAGES, COVERAGE 1) Earthquake, volcanic A. BODILY INJURY AND PROP- eruption, landslide or ERTY DAMAGE LIABILITY applies any other earth move- - to "property damage" arising out of ment; water damage to premises that are 2) Water that backs up or both rented to and occupied by you. overflows from a (1) As respects Water Damage Le- sewer,drain or sump; gal Liability, as provided in 3) Water under the Paragraph 3.b,above: ground surface press- The exclusions under SECTION ing on, or flowing or I - COVERAGES, COVERAGE seeping through: A. BODILY INJURY AND PROPERTY DAMAGE LIABIL- a) Foundations,n, floors or ITY,2.Exclusions,other than i. paved surfaces; War and the Nuclear Energy Liability Exclusion, are deleted b) Basements, and the following are added: whether paved or This insurance does not apply not;or to: c) Doors,windows or (a) "Property damage": other openings. 1) Assumed in any con- (c) Loss caused by or resulting tract;or from water that leaks or flows from plumbing, heat- 2) Loss caused by or re- ing, air conditioning, or fire suiting from any of the protection systems caused following: by or resulting from freez- ing,unless: a) Wear and tear; 1) You did your best to b) Rust, corrosion, maintain heat in the fungus, decay, building or structure;or deterioration, hid- den or latent de- 2) You drained the fect or any quality equipment and shut off in property that the water supply if the causes it to dam- heat was not main- age or destroy it- tained. self; (d) Loss to or damage to: c) Smog; 1) Plumbing, heating, air d) Mechanical conditioning, fire pro- breakdown in- tection systems, or cluding rupture or other equipment or ap- bursting caused pliances;or by centrifugal 2) The interior of any force; building or structure, or to personal property in the building or structure Includes copyrighted material of Insurance GA 233 02 07 Services Office,Inc.,with its permission. Page 8 of 15 caused by or resulting 5. Medical Payments from rain,hetheher driven snow, sleet oricThe Medical Expense Limit of Any One , wPerson as stated in the Declarations is byy win, or not. amended to the limit shown in Section B. c. Limit of Insurance Limits of Insurance, 5. Medical Pay- The Damage to Premises Rented to ments of this endorsement. You Limit as shown in the Declare- 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 Coy- LIMITS OF INSURANCE is erage hereby deleted and replaced by We will pay for"property damage"to the following: 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 1 Damage is caused bythe most we will pay under ( ) 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 "property damage" to With your consent, we will make premises while rented to these payments regardless of fault. you or temporarily occupied by you with permission of b. Care, Custody or Control Liability the owner, arising out of Coverage any one "occurrence" to SECTION 1 - COVERAGES, COV- which this insurance ap- ERAGE A. BODILY INJURY AND plies. PROPERTY DAMAGE LIABILITY,2. (3) The amount we will pay is lim- Exclusions,j. Damage to Property, ited as described in Section B. Subparagraphs (3), (4) and (5) do Limits of insurance, 3. Dam- not apply to "property damage" to age to Premises Rented to the property of others described You of this endorsement. therein. 4. Supplementary Payments With respect to the insurance provided by this section of the endorsement, the fol- Under SECTION I - COVERAGE, SUP- lowing additional provisions apply: PLEMENTARY PAYMENTS - COVER- AGES A AND B: a. The Limits of Insurance shown in the Declarations are replaced by the lim- a. Paragraph 2. is replaced by the fol- its designated in Section B.Limits of lowing: Insurance, 6. Voluntary Property Upto the limit shown in Section B. Damage and Care, Custody or Control Liability Coverage of this Limits of Insurance,4.a. Bail Bonds endorsement with respect to cover- of this endorsement for cost of bail age provided by this endorsement. bonds required because of accidents These limits are inclusive of and not or traffic law violations arising out of in addition to the limits being re- the use of any vehicle to which the placed. The Limits of insurance Bodily Injury Liability Coverage ap- shown in Section B. Limits of Insur- plies. We do not have to furnish ance, 6. Voluntary Property Dam- these bonds. age and Care, Custody or Control b. Paragraph 4. is replaced by the fol- Liability Coverage of this endorse- lowing: meet fix the most we will pay in any one "occurrence" regardless of the All reasonable expenses incurred by number of: the insured at our request to assist (1) Insureds; us in the investigation or defense of the claim or "suit", including actual (2) Claims made or "suits" brought; loss of earnings up to the limit shown or in Section B. Limits of Insurance, 4.b. Loss of Earnings of this en- (3) Persons or organizations mak- dorsement per day because of time ing claims or bringing"suits". off from work. Includes copyrighted material of Insurance GA 233 02 07 Services Office,Inc.,with its permission. Page 9 of 15 b. Deductible Clause 9. Automatic Additional Insured - Speci- fied Relationships (1) Our obligation to pay damages on your behalf applies only to a. The following is hereby added to the amount of damages for each SECTION II-WHO IS AN INSURED: "occurrence" which are in ex- cess of the deductible amount (1) Any person or organization de- stated in Section B. Limits of scribed in Paragraph 9.a.(2) Insurance, 6. Voluntary Prop- below(hereinafter referred to as 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 (a) A written contract or deductible amount, agreement;or (2) Condition 2.Duties in the Event (b) An oral agreement or con- of Occurrence, Offense, Claim tract where a certificate of or Suit, applies to each claim or insurance showing that per- "suit"irrespective of the amount, son or organization as an (3) We may pay any part or all of additional insured has been the deductible amount to effect issued, settlement of any claim or "suit" is an insured,provided: and, upon notification of the ac- tion taken, you shall promptly (a) The written or oral contract reimburse us for such part of the or agreement is: deductible amount as has been paid by us. 1) Currently in effect or becomes effective 7. 180 Day Coverage for Newly Formed or during the policy pe- Acquired Organizations riod;and SECTION II - WHO IS AN INSURED is 2) Executed prior to an amended as follows: "occurrence"or offense a. of Paragraph 4. is to which this insurance Subparagraph would apply;and hereby deleted and replaced by the fol- lowing: (b) They are not specifically is af- named as an additional in- a. insurance under this provisionsured 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; 8. Waiver of Subrogation (2) Only the following persons or g organizations are additional in- SECTION IV-COMMERCIAL GENERAL sureds under this endorsement, LIABILITY CONDITIONS, 9. Transfer of and insurance coverage pro- Rights of Recovery Against Others to vided to such additional in- Us is hereby amended by the addition of sureds is limited as provided the following: herein: We waive any right of recovery we may (a) The manager or lessor of a you with leased to have because of payments we make for premises injury or damage arising out of your on- whom you have agreed per going operations or"your work"done un- Paragraph 9.a.(1) above to der a written contract requiring such provide insurance, but only waiver with that person or organization with respect to liability arls- and included in the "products-completed ing out of the ownership, or use of that operations hazard". However, our rights maintenance may only be waived prior to the "occur- part of a premises leased to rence" you, subject to the following giving rise to the injury or damage additional exclusions: for which we make payment under this Coverage Part. The insured must do This insurance does not nothing after a loss to impair our rights. apply to: At our request,the insured will bring"suit" or transfer those rights to us and help us 1) Any "occurrence" enforce those rights. which takes place after Includes copyrighted material of Insurance GA 233 02 07 Services Office,Inc.,with its permission. Page 10 of 15 you cease to be a ten- c) Any physical or ant in that premises. chemical change 2) Structural alterations, in the productn made intentionally new construction or by the vendor; demolition operations performed by or on be- d) Repackaging, un- half of such additional less unpacked insured. solely for the pur- (b) Any person or organization demonstration, derationtion,,inspection, from which you lease testing, or the equipment with whom you substitution of have agreed per Paragraph parts under in- 9.a.(1) above to provide in- structions from the surance. Such person(s)or manufacturer, and organization(s)are insureds then repackaged solely with respect to their in the original liability arising out of the container; maintenance, operation or use by you of equipment e) Any failure to leased to you by such per- make such in- son(s) or organizations(s). spections, adjust- However, this insurance ments, tests or does not apply to any "oc- servicing as the currence"which takes place vendor has after the equipment lease agreed to make or expires. normally under- takes to make in (c) Any person or organization the usual course (referred to below as ven- of business, in dor) with whom you have connection with agreed per Paragraph the distribution or 9.a.(1) above to provide in- sale of the prod- surance, but only with re- ucts; spect to "bodily injury" or "property damage" arising f) Demonstration, in- out of"your products"which stallation, servic- are distributed or sold in the ing or repair op- regular course of the ven- erations, except don's business, subject to such operations the following additional ex- performed at the clusions: vendor's premises in connection with 1) The insurance afforded the sale of the the vendor does not product; apply to: g) Products which, a) "Bodily injury" or after distribution or "property damage" sale by you, have for which the ven- been labeled or dor is obligated to relabeled or used pay damages by as a container, reason of the as- part or ingredient sumption of Habil- of any other thing ity in a contract or or substance by or agreement. This for the vendor. exclusion does not apply to liability for 2) This insurance does damages that the not apply to any in- vendor would sured person or or- have in the ab- ganization: sence of the con- a) From whom you tract or agree- have acquired meet; such products, or b) Any express war- any ingredient, ranty unauthorized part or container, by you; entering into, ac- Includes copyrighted material of Insurance GA 233 02 07 Services Office,Inc.,with its permission. Page 11 of 15 companying or 2) This insurance does containing such not apply to "bodily in- products;or jury", "property dam- age"b When liability in- or "personal and advertising injury" ads- eluded within the ing out of operations "products- performed for the state completed opera- or political subdivision. tions hazard" has been excluded (f) Any person or organization under this Cover- with which you have agreed age Part with re- per Paragraph 9.a.(1) spect to such above to provide insurance, products. but only with respect to li- ability(d) Anystate orpolitical subdi- arising out of "your work" performed for that vision with which you have additional insured by you or agreed per Paragraph on your behalf. A person or 9.a.(1) above to provide in- organization's status as an surance, subject to the fol- insured under this provision lowing additional provision: of this endorsement contin- This insurance applies only ues for only the period of with respect to the following time required by the written hazards for which the state contract or agreement, but or political subdivision has in no event beyond the ex- issued a permit in connec- piration date of this Cover- tion with premises you own, age Part. If there is no written contract or agree- rent or control and to which this insurance applies: merit, or if no period of time is required by the written 1) The existence, mainte- contract or agreement, a nance, repair, con- person or organization's struction, erection, or status as an insured under removal of advertising this endorsement ends signs, awnings, cano- when your operations for pies, cellar entrances, that insured are completed. coal holes, driveways, (3) Any insurance provided to an manholes, marquees, additional insured designated hoist away openings, sidewalk vaults, street under Paragraph 9.a.(2): banners, or decora- (a) Subparagraphs (e) and (f) tions and similar expo- does not apply to "bodily sures;or injury"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), tenan (e)and (f)does not apply to elevators or use df any "bodily njury", "property elevators covered by damage" or "personal and this insurance. advertising injury" arising (e) Any state or political subdi- out of the sole negligence vision with which you have or willful misconduct of the agreed per Paragraph additional 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 erations performed by "property damage" or "per- you or on your behalf onal and advertising injury" for which the state or arising out of: political subdivision has 1) Defects in design issued a permit. fur- nished by or on behalf Includes copyrighted material of Insurance GA 233 02 07 Services Office,Inc.,with its permission. Page 12 of 15 of the additional in- spects any other insurance sured;or policy issued to the addi- tional2 The renderingof, insured, and such or other insurance policy shall failure to render, any be excess and/or noncon- professional architec- tributing,whichever applies, tural, engineering or with this insurance. surveying services, in- cluding: (b) Any insurance provided by this endorsement shall be 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.Other and specifications; Insurance, b. Excess and Insurance;or b) Supervisory, in- 2) For any other valid and spection, archi- collectible insurance tectural or engi- available to the addi- neering activities. tional insured as an 3) Your work"for which a additional insured by 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 endorse- in which you are in- ment shall also be ex- volved. cess. b. Only with regard to insurance pro- (2) Condition 11. Conformance to vided to an additional insured desig- Specific Written Contract or nated under Paragraph 9.a.(2) Sub- Agreement is hereby added: paragraph (f) above, SECTION III - LIMITS OF INSURANCE is amended 11. Conformance to Specific to include: Written Contract or The limits applicable to the additional Agreement insured are those specified in the With respect to additional written contract or agreement or in insureds described in Para- the Declarations of this Coverage graph 9.a.(2)(f)above only: Part,whichever are less. If no limits are specified in the written contract If a written contract or or agreement,or if there is no written agreement between you contract or agreement, the limits ap- and the additional insured plicable to the additional insured are specifies that coverage for those specified in the Declarations of the additional insured: this Coverage Part. The limits of in- a. Be provided by the In- surance are inclusive of and not in surance Services Of- addition to the limits of insurance fice additional insured shown in the Declarations, form number CG 20 10 c. SECTION IV- COMMERCIAL GEN- or CG 20 37 (where ERAL LIABILITY CONDITIONS is edition specified);or hereby amended as follows: b. Include coverage for (1) Condition 5. Other insurance is completed operations; amended to include: or (a) Where required by a written c. Include coverage for contract or agreement, this your work"; insurance is primary and / and where the limits or coy- 1 or noncontributory as re- erage provided to the addi- Includes copyrighted material of Insurance GA 233 02 07 Services Office,Inc.,with its permission. Page 13 of 15 tional insured is more re- 11. of this endorsement fix the strictive than was specifi- most we will pay in any one "oc- cally required in that written currence" regardless of the contract or agreement, the number of: terms of Paragraphs 9.a.(3)(a), 9.a.(3)(b) or 9.b. (a) Insureds; above, or any combination (b) Claims made or "suits" thereof, shall be interpreted brought;or 1 as providing the limits or coverage required by the (c) Persons or organizations terms of the written contract making claims or bring or agreement, but only to "suits". the extent that such limits or coverage is included within (2) Deductible Clause the terms of the Coverage (a) Our obligation to pay dam- Part to which this endorse- ages on your behalf applies meet is attached. If, how- only to the amount of dam- ever, the written contract or ages for each "occurrence" agreement specifies the In- which are in excess of the surance Services Office Deductible amount stated in additional insured form Section B. Limits of Insur- number CG 20 10 but does ance, 11. of this endorse- not specify which edition,or ment. The limits of insur- specifies an edition that ance will not be reduced by does not exist, Paragraphs the will of such 9.a.(3)(a) and 9.a.(3)(b) of De- ductible amount. this endorsement shall not apply and Paragraph 9.b.of (b) Condition 2. Duties in the this endorsement shall ap- Event of Occurrence, Of- ply. fense, Claim or Suit, ap- 10. Broadened Contractual Liability-Work plies to each claim or "suit" irrespective of the amount. Within 50'of Railroad Property It is hereby agreed that Paragraph f.(1)of (c) We may pay any part or all of the deductible amount to Definition 12. "insured contract" (SEC- TION V-DEFINITIONS)is deleted. effect settlement of any claim or "suit" and, upon 11. Property Damage to Borrowed Equip- notification of the action ment taken, you shall promptly reimburse us for such part a. The following is hereby added to Ex- of the deductible amount as elusion j. Damage to Property of has been paid by us. Paragraph 2., Exclusions of SEC- TION 1- COVERAGES, COVERAGE 12. Employees as Insureds - Specified A. BODILY INJURY AND PROP- Health Care Services ERTY DAMAGE LIABILITY: It is hereby agreed that Paragraph Paragraphs(3) and (4) of this exclu- 2.a.(1)(d) of SECTION II - WHO IS AN sion do not apply to tools or equip- INSURED, does not apply to your "em- ment loaned to you, provided they ployees"who provide professional health are not being used to perform opera- care services on your behalf as duly Ii- tions at the time of loss. tensed: b. With respect to the insurance pro- a. Nurses; vided by this section of the en- b. Emergency Medical Technicians;or dorsement, the following additional provisions apply: c. Paramedics, (1) The Limits of insurance shown in the jurisdiction where an "occurrence" in the Declarations are replaced or offense to which this insurance applies by the limits designated in Sec- takes place. tion B. Limits of Insurance, 11. of this endorsement with respect 13. Broadened Notice of Occurrence to coverage provided by this endorsement. These limits are Paragraph a. of Condition 2. Duties in inclusive of and not in addition to the Event of Occurrence, Offense, the limits being replaced. The Claim or Suit(SECTION IV- COMMER- Limits of Insurance shown in CIAL GENERAL LIABILITY CONDI- Section B. Limits of Insurance, Includes copyrighted material of Insurance GA 233 02 07 Services Office,Inc.,with its permission. Page 14 of 15 TIONS) is hereby deleted and replaced (2) The names and addresses of by the following: any injured persons and wit- nesses;and a. You must see to it that we are noti- fied as soon as practicable of an (3) The nature and location of any "occurrence or an offense which injury or damage arising out of may result in a claim. To the extent the"occurrence"or offense. possible,notice should include: This requirement applies only when (1) How, when and where the "oc- the"occurrence"or offense is known currence"or offense took place; to an"authorized representative". Includes copyrighted material of Insurance GA 233 02 07 Services Office,Inc.,with its permission. Page 15 of 15