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17-064.03 Belsby Engineering: On-Call Surveying
10210 E Sprague Avenue• Spokane Valley WA 99206 Tpame Milky Phone: (509)720-5000♦Fax:(509)720-5075 ♦www.spokanevalley.org Email:cityhall@spokanevalley.org November 18,2019 Contract No.17-064.03 Brian Belsby Belsby Engineering 1325 W. 1'Avenue, Suite 204 Spokane,WA 99201 Re: Implementation of 2020 option year,Agreement for On-Call Surveying for Capital Improvement Projects17-064, executed June 1, 2017 Dear Mr.Belsby: The City executed an Agreement for provision of On-Call Surveying for Capital Improvement Projects on June 1, 2017, by and between the City of Spokane Valley, hereinafter "City", and Belsby Engineering hereinafter "Contractor" and jointly referred to as"Parties." The original Agreement states that it was for one year,with three optional one-year terms possible if the parties mutually agree to exercise the options each year. This is the third of three possible option years that can be exercised and runs through December 31,2020. The City would like to exercise the 2020 option year of the Agreement. The Compensation includes the labor and material cost negotiated and shall not exceed $18,947.42. The history of the annual renewals, including dollar amounts, is set forth as follows: Original contract amount $50,000.00 2018 Renewal .. $49,500.00(remaining funds) 2019 Renewal $40,174.07(remaining funds) 2020 Renewal $18,947.42(remaining funds) All of the other contract provisions contained in the original Agreement shall remain in place and remain unchanged in exercising this option year. If you are in agreement with exercising the 2020 option year, please sign below to acknowledge the receipt and concurrence to perform the 2020 option year. Please return two copies to the City for execution, along with current insurance information. A fully executed original copy will be mailed to you for your files. CITY OF SPOKANE VALLEY BELSBY ENGINEERING P- 14SLN/N YvC � . Mark Calhoun, City Manager //O r10,2 d Namer-Piti NW.PA 4- Title ATTES • hit 15i/t;v—N4 hristine Bainbridge, City Clerk APPROVED AS TO FORM: Offic'f the ti ttorney DOCUMENTS REQUIRING THIRD-PARTY NOTIFICATION PRIOR TO PUBLIC DISCLOSURE This page has been inserted in place of the page(s) entitled "2020 Schedule of Hourly Surveying Fees" of a contract document which sets forth the rates charged by the contracting entity. Pursuant to the Washington Public Records Act (RCW 42.56), the City has determined that this record may be available for disclosure upon request for review by a third party. However, pursuant to RCW 42.56.520 and RCW 42.56.540, the City has determined it is appropriate to provide the contracting entity notification of any request for this record to allow them time to determine if they wish to seek to obtain a court order requiring the record to be withheld. Please contact the City Public Records Officer at (509) 720-5000 or visit our website at www.spokanevallev.org to complete a Public Record Request to receive a copy of this record. HORRENG-01 SBARKER ACORO" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) �-� 12/12/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Shauna Barker NAME: American Insurance&Investment Corp. PHONE 448 South 400 East (a/c,No,Ext):(801)364-3434 643 I(Arc,No):(801)355-5234 Salt Lake City,UT 84111 ni ' Ess:Shauna.Barker@american-ins.com INSURER(S)AFFORDING COVERAGE NAIC>a' INSURER A:Charter Oak Fire Ins Co 25615 INSURED INSURER B:Travelers Prop Cas Co of America 25674 Horrocks Engineers,Inc dba Belsby Engineering INSURER C:Travelers Indemnity Company 25658 2162 West Grove Parkway,Suite 400 INSURER D:XL Specialty Insurance Company 37885 Pleasant Grove,UT 84062 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD (MM/DD/YYYYI IMM/DD/YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE g 1,000,000 CLAIMS-MADE X OCCUR X 6802J925302 7/1/2019 7/1/2020 PREMISES(Ea o TErrencal S 1,000,000 MED EXP(Any one person) S 5,000 PERSONAL 8 ADV INJURY g 1,000,000 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE g 2,000,000 POLICY n fi n LOC PRODUCTS-COMP/OP AGO $ 2,000,000 OTHER: S B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ X ANY AUTO X 8104J319844 7/1/2019 7/1/2020 BODILY INJURY(Per person) $ OWNED SCHEDULED _ AUTOS ONLY _ AUTOSS pBOODILYINJUpRY(Peraccident) S X AUTOS ONLY X AUTOS ONLY {Pe�sEcdR i)AMAGE S S C X UMBRELLA LIAB X OCCUR EACH OCCURRENCE g 10,000,000 EXCESS LIAB CLAIMS-MADE CUP6667Y094 7/1/2019 7/1/2020 AGGREGATE g 10,000,000 DED X RETENTIONS 10,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? N/A (Mandatory fin NFH) E.L DISEASE-EA EMPLOYEE S If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POUCY LIMIT $ D Prof Liab Claim Made DPR9944952 7/1/2019 ' 7/1/2020 Per Claim Limit 10,000,000 D Reto Date 01/01/1965 DPR9944952 7/1/2019 7/1/2020 Aggregate Limit 10,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If mar?space Is required) Project: On-Call Surveying and Consultant Services.The City of Spokane Valley is listed as an additional insured with respects to General and Auto Liability which are Primary and Non-Contributory. • CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityof SpokaneTHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Valley ACCORDANCE WITH THE POLICY PROVISIONS. 10210 East Sprague Ave Spokane,WA 99206 AUTHORIZED REPRESENTATIVE Q . ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO EXTENSION ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GENERAL DESCRIPTION OF COVERAGE—Thls endorsement broadens coverage.However,coverage for any injury, damage or medical expenses described In any of the provisions of this endorsement may be excluded or limited by another endorsement to the Coverage Part,and these coverage broadening provisions do not apply to the extent that coverage Is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages.Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights,duties,and what is and is not covered. A. BROAD FORM NAMED INSURED H. HIRED AUTO PHYSICAL DAMAGE-LOSS OF • B. BLANKET ADDITIONAL INSURED USE-INCREASED LIMIT PHYSICALC. EMPLOYEE HIRED AUTO I. EXPENSES DNCRE4SED LAMAGE - IMITSPORTATION D. EMPLOYEES AS INSURED J. PERSONAL PROPERTY E. SUPPLEMENTARY PAYMENTS - INCREASED K. AIRBAGS LIMITS L. NOTICE AND KNOWLEDGE OF ACCIDENT OR F. HIRED AUTO - LIMITED WORLDWIDE COV- LOSS ERAGE-INDEMNITY BASIS M. BLANKET WAIVER OF SUBROGATION G. WAIVER OF DEDUCTIBLE-GLASS N. UNINTENTIONAL ERRORS OR OMISSIONS PROVISIONS A. BROAD FORM NAMED INSURED this insurance applies and only to the extent that The following is added to Paragraph A.1.,Who Is person or organization qualifies as an "insured" An Insured, of SECTION II-COVERED AUTOS under the Who Is An Insured provision contained • LIABILITY COVERAGE: in Section II. Any organization you newly acquire or form dur- C. EMPLOYEE HIRED AUTO ing the policy period over which you maintain 1. The following is added to Paragraph A.1., 50% or more ownership interest and that is not Who Is An Insured, of SECTION II -COV- separately insured for Business Auto Coverage. ERED AUTOS LIABILITY COVERAGE: Coverage under this provision Is afforded only un- An "employee" of yours Is an "insured" while tit the 180th day after you acquire or form the or- operating an "auto" hired or rented under a ganization or the end of the policy period, which- contract or agreement in an "employee's" ever is earlier. name,with your permission, while performing • duties related to the conduct of your busi- B. BLANKET ADDITIONAL INSURED ness. 1 The following is added to Paragraph c. in A.1., 2. The following replaces Paragraph b. in B.5., Who Is An Insured,of SECTION II-COVERED Other Insurance, of SECTION IV - BUSI- AUTOS LIABILITY COVERAGE: NESS AUTO CONDITIONS: Any person or organization who Is required under b. For Hired Auto Physical Damage Cover- a written contract or agreement between you and age,the following are deemed to be coy- that person or organization, that is signed and ered"autos"you own: executed by you before the "bodily injury" or (1) Any covered "auto" you lease, hire, • "property damage" occurs and that is in effect rent or borrow;and during the policy period, to be named as an adds- (2) Any covered"auto"hired or rented by tional insured is an "insured" for Covered Autos your "employee" under a contract In Liability Coverage, but only for damages to which an "employee's" name, with your CA T3 53 02 15 ®2015 The Travelers Indemnity Company.All rights reserved. Page 1 of 4 Includes copyrighted material of Insurance Services Office,Inc.with Its permission. COMMERCIAL AUTO permission, while performing duties (a) With respect to any claim made or"suit" related to the conduct of your busi- brought outside the United States of • , ness. America, the territories and possessions However, any"auto"that is leased, hired, of the United States of America, Puerto rented or borrowed with a driver is not a Rico and Canada: covered"auto". (I) You must arrange to defend the "in- D. EMPLOYEES-AS INSURED sured"against,and investigate or set- tle any such claim or"suit"and keep The following is added to Paragraph Al.,Who Is us advised of all proceedings and ac- An Insured,of SECTION ii—COVERED AUTOS tions. LIABILITY COVERAGE: (ii) Neither you nor any other involved Any"employee"of yours is an "insured"while us- "Insured" will make any settlement ing a covered"auto"you don't own,hire or borrow without our consent. 1 in your business or your personal affairs. i (iii)We may, at our discretion, participate . E. SUPPLEMENTARY PAYMENTS — INCREASED in defending the"insured" against, or LIMITS in the settlement of, any claim or 1. The following replaces Paragraph A.2.a.(2), "suit". ' of SECTION Ii—COVERED AUTOS LIABIL- (iv)We will reimburse the "insured" for ITY COVERAGE:• sums that the "insured" legally must (2) Up to $3,000 for cost of bail bonds (in- pay as damages because of "bodily . ciuding bonds for related traffic law viola- injury" or"property damage"to which tions) required because of an "accident" this insurance applies, that the "in- we cover. We do not have to furnish sured" pays with our consent, but these bonds. only up to the limit described in Para- • 2. The following replaces Paragraph A.2.a.(4), graph C., Limits Of Insurance, of of SECTION iI—COVERED AUTOS LIABIL- SECTION. 11 — COVERED AUTOS ITY COVERAGE: LIABILITY COVERAGE. (4) All reasonable expenses incurred by the (v) We will reimburse the "insured" for "insured" at our request, including actual the reasonable expenses incurred loss of earnings up to $500 a day be- with our consent for your investiga- cause of time off from work tion of such claims and your defense of the "insured" against any such F. HIRED AUTO — LIMITED WORLDWIDE COV- "suit", but only up to and Included ERAGE—INDEMNITY BASIS within the limit described In Para- ' The following replaces Subparagraph(5) in Para- graph C., Limits Of Insurance, of graph B.7., Policy Period, Coverage Territory, SECTION iI — COVERED AUTOS of SECTION IV — BUSINESS AUTO CONDi- LIABILITY COVERAGE, and not In TIONS: addition to such limit. Our duty to (5) Anywhere in the world, except any country or make such payments ends when we jurisdiction while any trade sanction, em- have used up the applicable limit of bargo, or 'similar regulation imposed by the insurance in payments for damages, United States of America applies to and pro- settlements or defense expenses. hibits the transaction of business with or (b) This insurance is excess over any valid within such country or jurisdiction, for Cov- and collectible other insurance available ered Autos Liability Coverage for any covered to the "insured" whether primary, excess, "auto" that you lease, hire, rent or borrow contingent or on any other basis. without a driver for a period of 30 days or less (c) This insurance is not a substitute for re- and that is not an "auto"you lease, hire, rent quired or compulsory insurance in any or borrow from any of your "employees", country outside the United States, its ter- partners (if you are a partnership), members ritories and possessions, Puerto Rico and (if you are a limited liability company) or Canada. members of their households. Page 2 of 4 ©2015 The Travelers indemnity Company.All rights reserved. CA T3 53 0215 Includes copyrighted material of insurance Services Office,inc.with Its permission. • COMMERCIAL AUTO You agree to maintain all required or (2) In or on your covered"auto". compulsory insurance in any such coun- This coverage applies only In the event of a total try up to the minimum limits required by theft of your covered"auto". local law. Your failure to comply with No deductibles apply to this Personal Property compulsory insurance requirements will coverage. not invalidate the coverage afforded by this policy,but we will only be liable to the K. AIRBAGS same extent we would have been liable The following is added to Paragraph B.3., Exclu- had you complied with the compulsory in- sions, of SECTION III — PHYSICAL DAMAGE surance requirements. COVERAGE: • (d) It Is understood that we are not an admit- Exclusion 3.a. does not apply to "loss"to one or ted or authorized insurer outside the more airbags in a covered"auto"you own that In- United States of America, Its territories flate due to a cause other than a cause of"loss" and possessions, Puerto Rico and Can- set forth in Paragraphs A.1.b. and A.1.c., but • ada.We assume no responsibility for the only: furnishing of certificates of Insurance, or a. If that"auto" is a covered "auto"for Compre- for compliance in any way with the laws hensive Coverage under this policy; • of other countries relating to insurance. b. The airbags are not covered under any war- ' G. WAIVER OF DEDUCTIBLE—GLASS • ranty;and The following is added to Paragraph D., Deducti- c. The airbags were not intentionally inflated. ble, of SECTION III — PHYSICAL DAMAGE We will pay up to a maximum of$1,000 for any COVERAGE: one"loss". No deductible for a covered "auto" will apply to L. NOTICE AND KNOWLEDGE OF ACCIDENT OR glass damage if the glass is repaired rather than LOSS replaced. • The following is added to Paragraph A.2.a., of H. HIRED AUTO PHYSICAL DAMAGE—LOSS OF SECTION IV—BUSINESS AUTO CONDITIONS: USE—INCREASED LIMIT Your duty to give us or our authorized representa- The following replaces the last sentence of Para- tive prompt notice of the "accident" or"loss" ap- graph A.4.b., Loss Of Use Expenses, of SEC- plies only when the "accident" or"loss" is known TION III—PHYSICAL DAMAGE COVERAGE: to: However, the most we will pay for any expenses (a) You (if you are an individual); for loss of use is $65 per day, to a maximum of (b) A partner(if you are a partnership); $750 for any one"accident". (c) A member (If you are a limited liability com- l. PHYSICAL DAMAGE — TRANSPORTATION pany); EXPENSES—INCREASED LIMIT (d) An executive officer, director or insurance The following replaces the first sentence in Para- manager(if you are a corporation or other or- graph A.4.a., Transportation Expenses, of ganization);or • SECTION III — PHYSICAL DAMAGE COVER- (e) Any"employee"authorized by you to give no- AGE: . ' tice of the"accident"or"loss". We will pay up to $50 per day to a maximum of M. BLANKET WAIVER OF SUBROGATION $1,500 for temporary transportation expense in- The following replaces Paragraph A.5., Transfer curred by you because of the total theft of a coy- Of Rights Of Recovery Against Others To Us, ered"auto"of the private passenger type. of SECTION IV — BUSINESS AUTO CONDI- J. PERSONAL PROPERTY TIONS: The following is added to Paragraph A.4., Cover- 5. Transfer Of Rights Of Recovery Against age Extensions, of SECTION III — PHYSICAL Others To Us DAMAGE COVERAGE: We waive any right of recovery we may have Personal Property against any person or organization to the ex- tent required of you by a written contract We will pay up to $400 for"loss"to wearing ap- signed and executed prior to any "accident" parel and other personal property which is: or"loss",provided that the"accident"or"loss" (1) Owned by an"insured';and arises out of operations contemplated by CA T3 53 02 15 ®2015 The Travelers Indemnity Company.All rights reserved. Page 3 of 4 Includes copyrighted material of Insurance Services Office,Inc.with Its permission. • • COMMERCIAL AUTO such contract. The waiver applies only to the The unintentional omission of, or unintentional person or organization designated in such error in, any information given by you shall not contract. - prejudice your rights under this insurance. How- N. UNINTENTIONAL ERRORS OR OMISSIONS ever this provision does not affect our right to col- The following is added to Paragraph B.2., Con- lect additional premium or exercise our right of cealment, Misrepresentation, Or Fraud, of cancellation or non-renewal. SECTION IV-BUSINESS AUTO CONDITIONS: • • • • Page 4 of 4 ©2015 The Travelers Indemnity Company.All rights reserved. CA T3 33 02 15 Includes copyrighted material of Insurance Services Office,Inc.with Its permission. COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY WITH OTHER INSURANCE This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM PROVISIONS 2. The following is added to Paragraph B.5., Other 1. The following is added to Paragraph A.1.c.,Who Insurance of SECTION IV — BUSINESS AUTO Is An Insured, of SECTION Il — COVERED CONDITIONS: AUTOS LIABILITY COVERAGE: Regardless of the provisions of paragraph a. and This includes any person or organization who you paragraph d.of this part 5.Other Insurance,this are required under a written contract or insurance is primary to and non-contributory with agreement between you and that person or applicable other insurance under which an organization, that is signed by you before the additional Insured person or organization Is the "bodily Injury" or "property damage" occurs and first named insured when the written contract or that is in effect during the policy period, to name agreement between you and that person or as an additional insured for Covered Autos organization, that is signed by you before the Liability Coverage, but only for damages to which "bodily injury" or "property damage" occurs and this insurance applies and only to the extent of that is in effect during the policy period, requires that person's or organization's liability for the this insurance to be primary and non-contributory. conduct of another"insured". • CA T4 74 02 16 ©2016 The Travelers Indemnity Company.All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office,Inc.with Its permission. COMMERCIAL GENERAL LIABILITY • c. Method Of Sharing a. The statements in the Declarations are If all of the other insurance permits contribution accurate and complete; by equal shares, we will follow this method also. b. Those statements are based upon . Under this approach each insurer contributes representations you made to us;and equal amounts until it has paid its applicable , c. . We have issued this policy in reliance upon limit of insurance or none of the loss remains, your representations. whichever comes first. The unintentional omission of, or unintentional error If any of the other insurance does not permit in, any information provided by you which we relied contribution by equal shares, we will contribute upon in issuing this policy will not prejudice your by limits. Under this method, each insurer's rights under this insurance. However, this provision share is based on the ratio of its applicable limit does not affect our right to collect additional of insurance to the total applicable limits of premium or to exercise our rights of cancellation or insurance of all insurers. nonrenewal in accordance with applicable insurance d. Primary And Non-Contributory Insurance if laws or regulations. Required'By Written Contract 7. Separation Of Insureds If you specifically agree in a written contract or Except with respect to the Limits of Insurance, and agreement that the insurance afforded to an any rights or duties specifically assigned in this insured under this Coverage Part must apply on Coverage Part to the first Named Insured, this a primary basis, or a primary and non- insurance applies: . contributory basis, this insurance is primary to a. As if each Named Insured were the only • other insurance that is available to such insured Named Insured;and • which covers such insured as a named insured, b. Separately to each insured against whom claim and we will not share with that other insurance, is made or"suit"is brought. provided that: (1) The "bodily injury" or"property damage" for 8. Transfer Of Rights Of Recovery Against Others which coverage is sought occurs;and To Us (2) The "personal and advertising injury" for If the insured has rights to recover all or part of any which coverage is sought is caused by an payment we have made under this Coverage Part, offense that is committed; those rights are transferred to us. The insured must do nothing after loss to impair them. At our request, subsequent to the signing of that contract or the insured will bring "suit" or transfer those rights agreement by you. to us and help us enforce them. 5. Premium Audit 9. When We Do Not Renew a. We will compute all premiums for this Coverage if we decide not to renew this Coverage Part,we.wiill • Part in accordance with our rules and rates. mail or deliver to the first Named Insured shown in b. Premium shown in this Coverage Part as the Declarations written notice of the nonrenewal advance premium is a deposit premium only. At not less than 30 days before the expiration date. the close of each audit period we will compute If notice is mailed, proof of mailing will be sufficient the earned premium for that period and send proof of notice. notice to the first Named Insured. The due date SECTION V—DEFINITIONS for audit and retrospective premiums is the date 1. "Advertisement"means a notice that is broadcast or shown as the due date on the bill. If the sum of published to the general public or specific market the advance and audit premiums paid for the segments about your goods, products or services policy period is greater than the earned for the purpose of attracting customers or premium, we will return the excess to the first supporters. For the purposes of this definition: Named Insured. a. Notices that are published include material c. The first Named insured must keeprecordsof placed on the Internet or on similar electronic the information we • need for premium means of communication; and computation, and send us copies at such times as we may request. b. Regarding websites, only that part of a website that is about your goods, products or services 6. Representations for the purposes of attracting customers or By accepting this policy,you agree: supporters is considered an advertisement. • Page 16 of 21 ®2017 The Travelers Indemnity Company.All rights reserved. CG T1 00 02 19 Includes copyrighted material of insurance Services Office,Inc.with Its permission. • • TABLE OF CONTENTS COMMERCIAL GENERAL LIABILITY COVERAGE FORM CG T1 00.0219 SECTION I—COVERAGES ' Beginning on Page • Coverage A— Bodily Injury and Property Insuring Agreement 1 Damage Liability Exclusions 2 Coverage B— Personal and Advertising Insuring Agreement 6 Injury Liability Exclusions 6 Coverage C— Medical Payments Insuring Agreement 9 Exclusions 9 Supplementary Payments 10 SECTION 11—WHO IS AN INSURED - 11 SECTION III—LIMITS OF INSURANCE 13 SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS 13 Bankruptcy 13 Duties In The Event Of Occurrence,Offense,Claim Or Suit 13 Legal Action Against Us 14 Other Insurance 15 Premium Audit 16 • Representations 16 Separation Of Insureds 16 Transfer Of Rights Of Recovery Against Others To Us 16 When We Do Not Renew 16 SECTION V—DEFINITIONS 16 • CG TO 34 0219 COMMERCIAL GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY COVERAGE FORM Various provisions in this policy restrict coverage. Read (1) The "bodily injury" or "property damage" is the entire policy carefully to determine rights, duties and caused by an"occurrence"that takes place what is and is not covered. in the"coverage territory"; Throughout this policy the words "you"and "your" refer .(2) The "bodily injury" or "property damage" to the Named Insured shown in the Declarations, and occurs during the policy period;and any other person or organization qualifying as a Named Insured under this policy. The words "we", "us" and (3) Prior to the policy period, no insured listed "our'refer to the company providing this insurance. under Paragraph 1. of Section II —Who Is The word "insured" means any person or organization An Insured and no "employee" authorized as such under Section II — Who Is An by you to give or receive notice of an qualifying "occurrence" or claim knew that the"bodily Insured. injury" or"property damage" had occurred, Other words and phrases that appear in quotation In whole or in part. If such a listed insured marks have special meaning. Refer to Section V — or authorized"employee" knew, prior to the Definitions. policy period, that the "bodily injury" or "property damage" occurred, then any SECTION I—COVERAGES continuation, change or.resumption of such • "bodily injury" or"property damage" during COVERAGE A— BODILY INJURY AND PROPERTY or after the policy period will be deemed to DAMAGE LIABILITY have been known prior to the policy period. 1. Insuring Agreement c. "Bodily injury" or "property damage" which a. We will pay those sums that the insured occurs during the policy period and was not, • becomes legally obligated to pay as damages prior to the policy period, known to have because of"bodily injury"or"property damage" occurred by any insured listed under Paragraph to which this insurance applies. We will have 1. of Section II — Who Is An Insured or any the right and duty to defend the insured against "employee"authorized by you to give or receive P any "suit" seeking those damages. However, notice of an"occurrence"or claim, includes any we will have no duty to defend the insured continuation, change or resumption of that against any "suit" seeking damages for "bodily "bodily injury" or "property damage" after the. injury" or "property damage" to which this end of the policy period. insurance does not apply. We may, at our discretion, investigate any "occurrence" and d. "Bodily injury" or "property damage" will be settle any claim or"suit"that may result. But: deemed to have been known to have occurred at the earliest time when any insured listed (1) The amount we will pay for damages is under Paragraph 1, of Section 11 — Who Is An limited as described in Section III — Limits Insured or any"employee"authorized by you to Of Insurance;and give or receive notice of an "occurrence" or (2) Our right and duty to defend end when we claim: • have used up the applicable limit of (1) Reports all, or any part, of the "bodily insurance in the payment of judgments or injury" or "property damage" to us or any settlements under Coverages A or B or other insurer; medical expenses under Coverage C. (2) Receives a written or verbal demand or No other obligation or liability to pay sums or claim for damages because of the "bodily perform acts or services is covered unless injury"or"property damage";or . explicitly provided for under Supplementary Payments. •(3) Becomes aware by any other means that b. This insurance applies to "bodily injury" and "bodily injury" or "property damage" has "property damage"only if: occurred or has begun to occur. CG T1 00 0219 ©2017 The Travelers Indemnity Company.All rights reserved. Page 1 of 21 Includes copyrighted material of Insurance Services Office,Inc.with its permission. COMMERCIAL GENERAL LIABILITY e. Damages because of "bodily injury" include (3) Any statute, ordinance or regulation relating damages claimed by any person or organization to the sale, gift, distribution or use of for care, loss of services or death resulting at alcoholic beverages. an• y time from the"bodily injury". This exclusion applies only if you are in the 2. Exclusions business of manufacturing, distributing, selling, 1 This insurance does not apply to: serving or furnishing alcoholic beverages. For pp y the purposes of this exclusion, permitting a a. Expected Or Intended Injury person to bring alcoholic beverages on your "Bodily injury"or"property damage"expected or premises, for consumption on your premises, intended from the standpoint of the insured, whether or not a fee is charged or a license is • This exclusion does not apply to "bodily injury" required for such activity, is not by itself I or "property damage" resulting from the use of considered the business of selling, serving or furnishing alcoholic beverages. reasonable force to protect persons or property. b. Contractual Liability d. Workers'Compensation And Similar Laws "Bodily injury" or "property damage" for which Any obligation of the insured under a workers' the insured is obligated to pay damages by compensation, disability benefits or reason of the assumption of liability in a unemployment compensation law or any similar contract or agreement. This exclusion does not law. apply to liability for damages: e. Employer's Liability (1) That the insured would have in the absence "Bodily injury"to: of the contract or agreement;or (1) An "employee" of the insured arising out of (2) Assumed in a contract or agreement that is and in the course of: an "insured contract", provided that the (a) Employment by the insured;or "bodily injury" or "property damage" occurs subsequent to the execution of the contract (b) Performing duties related to the or agreement. Solely for the purposes of conduct of the insured's business;or liability assumed in an "insured contract", (2) The spouse, child, parent, brother or sister reasonable attorneys' fees and necessary of that "employee" as a consequence of litigation expenses incurred by or for a party Paragraph(1)above, other than an insured will be deemed to be damages because of "bodily injury" or This exclusion applies whether the insured may "property damage",provided that: be liable as an employer or in any other capacity and to any obligation to share damages with or (a) Liability to such party for, or for the repay someone else who must pay damages cost of, that party's defense has also because of the injury. been assumed in the same "insured This exclusion does not apply to liability contract";and assumed by the insured under an "insured (b) Such attorneys' fees and litigation contract". expenses are for defense of that party f. Pollution against a civil or alternative dispute • resolution proceeding in which (1) "Bodily injury" or "property damage" arising damages to which this insurance out of the actual, alleged or threatened applies are alleged. discharge, dispersal, seepage, migration, c. Liquor Liability release or escape of"pollutants": "Bodily injury" or "property damage" for which (a) At or from any premises, site or location which is or was at any time any insured may be held liable by reason of.• owned or occupied by, or rented or (1) Causing or contributing to the intoxication loaned to, any insured. However, this of any person; subparagraph does not apply to: (2) The furnishing of alcoholic beverages to a (I) "Bodily injury" if sustained within a person under the legal drinking age or building and caused by smoke, under the influence of alcohol;or fumes, vapor or soot produced by or originating from equipment that Page 2 of 21 ©2017 The Travelers Indemnity Company.All rights reserved. CG T1 00 02 19 Includes copyrighted material of Insurance Services Office,Inc.with Its pennisslon. s • COMMERCIAL GENERAL LIABILITY • • is used to heat, cool or dehumidify to perform the normal electrical, the building, or produced by or hydraulic or mechanical functions originating from equipment that is necessary for the operation of used to heat water for personal "mobile equipment" or its parts, if use by the building's occupants or such fuels, lubricants or other their guests; operating fluids escape from a vehicle part designed to hold, store (Ii) "Bodily injury" or "property or receive them. This exception damage" for which you may be does not apply if the "bodily injury" held liable, if you are a contractor or "property damage" arises out of and the owner or lessee of such the intentional discharge, dispersal premises, site or location has been or release of the fuels, lubricants added to your policy as an or other operating fluids, or if such additional insured with respect to fuels, lubricants or other operating your ongoing operations performed fluids are brought on or to the for that additional insured at that premises, site or location with the premises, site or location and such intent that they be discharged, premises, site or location is not dispersed or released as part of and never was owned or occupied the operations being performed by • by, or rented or loaned to, any such insured, contractor or insured, other than that additional subcontractor; insured;or (iii)"Bodily injury" or "property (ii) "Bodily injury" or "property damage" arising out of heat, damage" sustained within a smoke or fumes from a "hostile building and caused bythe release fire"; of gases, fumes or vapors from materials brought into that building (b) At or from any premises, site or in connection with operations being location which is or was at any time performed by you or on your behalf used by or for any insured or others for the handling, storage, disposal, by a contractor or subcontractor; or processing or treatment of waste; (iii)"Bodily injury" or "property (c) If such "pollutants" are or were at any damage" arising out of heat, time transported, handled, stored, smoke or fumes from a "hostile treated, disposed of, or processed as fire";or • waste by or for. (i) Any insured;or (e) At or from any premises, site or (ii) Any person or organization for location on which any insured or any you may be legally contractors or subcontractors working whomdirectly or indirectly on any insured's responsible; behalf are or were at any time (d) At or from any premises, site or performing operations to test for, location on which any insured or any monitor, clean up, remove, contain, contractors or subcontractors working treat, detoxify or neutralize, or in any directly or indirectly on any insured's way respond to, or assess the effects behalf are performing operations if the of,"pollutants". • "pollutants" are brought on or to the premises, site or location in connection (2) Any loss, cost or expense arising out of with such operations by such insured, any: contractor or subcontractor. However, this subparagraph does not apply to: (a) Request, demand, order or statutory or regulatory requirement that any insured (i) "Bodily injury" or "property or others test for, monitor, clean up, damage" arising out of the escape remove, contain, treat, detoxify, or of fuels, lubricants or other neutralize, or in any way respond to, or operating fluids which are needed assess the effects of, "pollutants";or • CG Ti 00 02 19 ©2017 The Travelers Indemnity Company.All rights reserved. Page 3 of 21 Includes copyrighted material of Insurance Services Office,Inc.with Its permission. I • • COMMERCIAL GENERAL LIABILITY (b) Claim or suit by or on behalf of any (b) The operation of any of the machinery governmental authority or any other or equipment listed in Paragraph f.(2) person or organization because of or f.(3) of the definition of "mobile testing for, monitoring, cleaning up, equipment"; or removing, containing, treating, detoxifying or neutralizing, or in any (6) An aircraft that.is: way responding to, or assessing the (a) Chartered with a pilot to any insured; effects of, "pollutants". (b) Not owned by any insured; and g. Aircraft,Auto Or Watercraft • (c) Not being used to carry any person or "Bodily injury" or"property damage" arising out property for a charge. . of the ownership, maintenance, use or h. Mobile Equipment entrustment to others of any aircraft, "auto" or watercraft owned or operated by or rented or "Bodily injury" or"property damage" arising out loaned to any insured. Use includes operation of: . and loading or unloading". (1) The.transportation of "mobile equipment" This exclusion applies even if the claims by an "auto" owned or operated by or against any insured allege negligence or other rented or loaned to any insured;or wrongdoing in the supervision, hiring, (2) The use of "mobile equipment" irr, or while employment,training or monitoring of others by in practice for, or while being prepared for, that insured, if the "occurrence" which caused any prearranged racing, speed, demolition, the"bodily injury"or"property damage" involved or stunting activity the ownership, maintenance, use or entrustment to others of any aircraft, "auto" or I. War watercraft that is owned or operated by or "Bodily injury" or"property damage" arising out rented or loaned to any insured, of: This exclusion does not apply to: (1) War, including undeclared or civil war; (1) A watercraft while ashore on premises you (2) Warlike action by a military force, including own or rent; action in hindering or defending against an (2) A watercraft you do not own that is: actual or expected attack, by any government, sovereign or other authority (a) 50 feet long or less;and using military personnel or other agents;or (b) Not being used to carry any person or (3) Insurrection, rebellion, revolution, usurped property for a charge; power, or action taken by governmental (3) Parking an "auto" on, or on the ways next authority in hindering or defending against to, premises you own or rent, provided the any of these. "auto" is not owned by or rented or loaned J. Damage To Property to you or the insured; "Property damage"to: (4) Liability assumed under any "insured (1) Property you own, rent, or occupy, contract"for the ownership, maintenance or including any costs or expenses incurred use of aircraft or watercraft; by you,or any other person, organization or (5) "Bodily injury" or "property damage" arising entity, for repair, replacement, out of: enhancement, restoration or maintenance of such property for any reason, including (a) The operation of machinery or prevention of injury to a person or damage equipment that is attached to, or part to another's property; of, a land vehicle that would qualify as "mobile equipment" under the definition (2) Premises you sell,give away or abandon, if of "mobile equipment" if such land the "property damage" arises out of any vehicle were not subject to a part of those premises; compulsory or financial responsibility (3) Property loaned to you; law, or other motor vehicle insurance law, where It is licensed or principally (4) Personal property in the care, custody or garaged;or control of the insured; • Page 4 of 21 ©2017 The Travelers Indemnity Company.All rights reserved. CG T1 00 02 19 Includes copyrighted material of Insurance Services Office,Inc.with its permission. • COMMERCIAL GENERAL LIABILITY (5) That particular part of real property on accidental physical injury to "your product" or which you or any contractors or "your work" after it has been put to its intended subcontractors working directly or indirectly use. on your behalf are performing operations, if n. Recall Of Products,Work Or Impaired the "property damage" arises out of those Property operations;or Damages claimed for any loss, cost or expense (6) That particular part of any property that incurred by you or others for the loss of use, must be restored, repaired or replaced withdrawal, recall, inspection, repair, because "your work" was incorrectly replacement, adjustment, removal or disposal performed on It, of: Paragraphs (1), (3) and (4) of this exclusion do (1) "Your product"; not apply to "premises damage". A separate limit of insurance applies to "premises damage" (2) "Your work";or as described in Paragraph 6, of Section III — (3) "Impaired property"; Limits Of Insurance. Paragraph (2) of this exclusion does not apply if if such product, work, or property is withdrawn the premises are "your work" and were never or recalled from the market or from use by any occupied, rented or held for rental by you. • person or organization because of a known or suspected defect, deficiency, inadequacy or • Paragraphs (3), (4), (5) and (6) of this dangerous condition in it. exclusion do not apply to-liability assumed o. Personal And Advertising Injury under a sidetrack agreement. Paragraph (6) of this exclusion does not apply "Bodily injury" arising out of "personal and to "property damage" included in the "products- advertising injury". completed operations hazard". p. Electronic Data k. Damage To Your Product Damages arising out of the loss of, loss of use • "Property damage" to "your produCt" arising out of, damage to, corruption of, inability to access, of it or any part of it. or inability to manipulate"electronic data". I. Damage To Your Work However, this exclusion does not apply to liability for damages because of"bodily injury". "Property damage" to "your work" arising out of Unsolicited Communication it or any part of it and included in the"products- q• completed operations hazard". "Bodily injury" or"property damage" arising out This exclusion does not apply if the damaged of any actual or alleged violation of any law that work or the work out of which the damage restricts or prohibits the sending, transmitting arises was performed on your behalf by a or distributing of"unsolicited communication". subcontractor. r. Access Or Disclosure Of Coriidfenital Or m, Damage To Impaired Property Or Property Personal information Not Physically Injured "Bodily injury" or"property damage" arising out "Property damage" to "impaired property" or of any access to or disclosure of any person's property that has not been physically injured, or organization's confidential or personal arising out of: information. (1) A defect, deficiency, inadequacy or . s. -Asbestos • dangerous condition in "your product" or• (1) "Bodily injury" or"property damage"arising "your work";or out of the actual or alleged presence or (2) A delay or failure by you or anyone acting actual, alleged or threatened dispersal of on your behalf to perform a contract or asbestos, asbestos fibers or products • agreement in accordance with its terms. containing asbestos, provided that the "bodily injury" or "property damage" is This exclusion does not apply to the loss of use caused or contributed to by the hazardous of other property arising out of sudden and properties of asbestos. . • CG T1 00 02 19 ©2017 The Travelers Indemnity Company.All rights reserved. Page 5 of 21 Includes copyrighted material of Insurance Services Office,Inc.with Its permission. COMMERCIAL GENERAL LIABILITY (2) "Bodily injury" or "property damage" arising employment-related practices described in out of the actual or alleged presence or Paragraph(a), (b),or(c)above is directed. actual, alleged or•threatened dispersal of This exclusion applies whether the insured may any solid, liquid, gaseous or thermal irritant be liable as an employer or in any other capacity . or contaminant, including smoke, vapors, and to any obligation to share damages with or soot, fumes, acids, alkalis, chemicals and repay someone else who must pay damages waste, and that are part of any claim or because of the"bodily injury". "suit" which also alleges any "bodily injury" Exclusions c. through n. do not apply to "premises or "property damage" described in damage". A separate limit of insurance.applies to Paragraph(1)above. "premises damage" as described in Paragraph 6. of (3) Any loss, cost or expense arising out of Section III—Limits Of Insurance. any: COVERAGE B—PERSONAL AND ADVERTISING (a) Request, demand, order or statutory or INJURY LIABILITY regulatory requirement that any insured 1. Insuring Agreement • or others test far, monitor, clean up, a. We will pay those sums' that the insured remove, contain, treat, detoxify or becomes legally obligated to pay as damages neutralize, or in any way respond to, or because of "personal and advertising injury" to assess the effects of, asbestos, • which this insurance applies. We will have the asbestos fibers or products containing right and duty to defend the insured against any asbestos;or "suit" seeking those damages. However, we will (b) Claim or suit by or on behalf of any have no duty to defend the insured against any governmental authority or any other "suit" seeking damages for "personal and advertising injury" to which this insurance does person or organization because of testing for, monitoring,, cleaning up, not apply. We may, at our discretion, investigate any offense and settle any claim or removing, containing, treating, "suit"that may result. But: detoxifying or neutralizing, or in any way responding to, or assessing the (1) The amount we will pay for damages is effects of, asbestos, asbestos fibers or limited as described in Section III — Limits products containing asbestos. • Of Insurance; and t. Employment-Related Practices (2) Our right and duty to defend end when we "Bodily injury"to: have used up the applicable limit of insurance in the payment of judgments or (1) A person arising out of any: settlements under Coverages A or B or (a) Refusal to employ that person; medical expenses under Coverage C. (b) Termination of that person's No other obligation or liability to pay sums or . employment;or perform acts or services is covered unless (c) Employment-related practice, policy, explicitly provided for under Supplementary act or omission, such as coercion, Payments. demotion, evaluation, reassignment, b. This insurance applies to "personal and discipline, failure to promote or advertising injury" caused by an offense arising advance, harassment, humiliation, out of your business but only if the offense was discrimination, libel, slander, violation committed in the "coverage territory" during the of the person's right of privacy, policy period. malicious prosecution or false arrest, 2. Exclusions detention or imprisonment applied to or This insurance does not apply to: directed at that person, regardless of whether such practice, policy, act or a. Knowing Violation Of Rights Of Another omission occurs, is applied or is "Personal and advertising injury" caused by or • committed before, during or after the at the direction of the insured with the time of that person's employment; or knowledge that the act would violate the rights (2) The spouse, child, parent, brother or sister of another and would inflict "personal and of that person as a consequence of "bodily advertising injury". injury" to that person at whom any of the Page 6 of 21 ©2017 The Travelers Indemnity Company.All rights reserved. CG T1 00 02 19 Includes copyrighted material of Insurance Services Office,Inc,with its permission. • COMMERCIAL GENERAL LIABILITY This exclusion does not apply to "personal against a civil or alternative dispute injury"caused by malicious prosecution. resolution proceeding in which • b. Material Published With Knowledge Of damages to which this insurance Falsity applies are alleged. "Personal and advertising injury" arising out of f. Breach Of Contract oral or written publication, including publication "Advertising injury" arising out of a breach of by electronic means,of material,if done by or at contract. the direction of the insured with knowledge of g. Quality Or Performance Of Goods - Failure its falsity. To Conform To Statements c. Material Published Or Used Prior To Policy "Advertising injury" arising out of the failure of Period goods, products or services to conform with (1) "Personal and advertising injury" arising out any statement of quality or performance made of oral or written publication, including in your"advertisement". publication by electronic means, of material h. Wrong Description Of Prices • whose first publication took place before "Advertising injury" arising out of the wrong the beginning of the policy period;or description of the price of goods, products or (2) "Advertising injury" arising out of - services stated in your"advertisement". infringement of copyright, "title" or"slogan" in your "advertisement" whose first i, Intellectual Property infringement in your "advertisement" was "Personal and advertising injury" arising out of committed before the beginning of the any actual or alleged infringement or violation of policy period. any of the following rights or laws, or any other "personal and advertising injury" alleged in any d. Criminal Acts claim or "suit" that also alleges any such "Personal and advertising injury"arising out of a infringement or violation: criminal act committed by orat the direction of (1) Copyright; the insured. (2) Patent; e. Contractual Liability "Personal and advertising injury" for which the (3) Trade dress; insured has assumed liability in a contract or • (4) Trade name; agreement. This exclusion does not apply to (5) Trademark; liability for damages: (6) Trade secret;or. (1) That the insured would have in the absence (7) Other intellectual property rights or laws. of the contract or agreement; or .(2) Because of "personal injury" assumed by This exclusion does not apply to: you in a contract or agreement that is an (1) "Advertising injury"arising out of any actual "insured contract", provided that the or alleged infringement or violation of "personal injury" is caused by an offense another's copyright, "title" or "slogan" in committed subsequent to the execution of your"advertisement"; or the contract or agreement. Solely for the purposes of liability assumed by you in an (2) Any other"personal and advertising injury" "insured contract", reasonable attorneys' alleged in any claim or "suit" that also fees and necessary litigation expenses alleges any such infringement or violation ' incurred by or for a party other than•an of another's copyright, "title" or "slogan" in insured will be deemed to be damages your"advertisement". because of"personal injury",provided that: j. Insureds In Media And Internet Type (a) Liabcostllity to of, thatuch party for, or party's defense has the also Businesses "Personal and advertising injury" caused by an been assumed by you in the same offense committed by an insured whose "insured contract";and business is: (b) Such attorneys' fees and litigation (1) Advertising, "broadcasting"or publishing; expenses are for defense of that party CG T1 00 02 19 ©2017 The Travelers Indemnity Company.All rights reserved. Page 7 of 21 Includes copyrighted material of Insurance Services Office,Inc.with Its permission. • COMMERCIAL GENERAL LIABILITY (2) Designing or determining content of neutralizing, or in any way responding to,or websites for others;or assessing the effects of, "pollutants". (3) An Internet search, access, content or o. War service provider. "Personal and advertising injury"arising out of: However, this exclusion does not apply to (1) War, including undeclared or civil war, Paragraphs a.(1), (2) and (3)of the definition of "personal injury". (2) Warlike action by a military force, including For the purposes of this exclusion: action in hindering or defending against an actual or expected attack, by any (1) Creating and producing correspondence government, sovereign or other authority written in the conduct of your business, using military personnel or other agents;or bulletins, financial or annual reports, or (3) Insurrection, rebellion, revolution, usurped newsletters about your goods, products or power, or action taken by governmental services will not be considered the authority in hindering or.defending against business of publishing;and any of these. (2) The placing of frames, borders or links, or p, Unsolicited Communication advertising, for you or others anywhere on the Internet will not, by itself, be considered i "Personal and advertising injury" arising out of the business of advertising, "broadcasting" any actual or alleged violation of any law that or publishing. restricts or prohibits the sending, transmitting or distributing of"unsolicited communication". k. Electronic Chatrooms Or Bulletin Boards q. Access Or Disclosure Of Confidenital Or • "Personal and advertising injury" arising out of Personal information an electronic chatroom or bulletin board the "Personal and advertising injury" arising out of insured hosts or owns, or over which the insured exercises control. any access to or disclosure of any persons or organization's confidential or personal I. Unauthorized Use Of Another's Name Or information. Product r. Asbestos "Personal and advertising injury" arising out of (1) "Personal and advertising injury"arising out the unauthorized use of another's name or , of the actual or alleged presence or actual, product in your e-mail address, domain name or alleged or threatened dispersal of asbestos, metatag, or any other similar tactics to mislead asbestos fibers or products containing another's potential customers. asbestos, provided that the "personal and m. Pollution advertising injury" is caused or contributed to by the hazardous properties of asbestos. "Personal and advertising injury" arising out of "Personal and advertising injury"arising out(2) the actual, alleged or threatened discharge,dispersal, seepage, migration, release or of the actual or alleged presence or actual, escape of"pollutants"at any time. alleged or threatened dispersal of any solid, liquid, gaseous or thermal irritant or n. Pollution-Related • contaminant, including smoke, vapors, Any loss,cost or expense arising out of any: soot, fumes, acids, alkalis, chemicals and waste, and that are part of any claim or (1) Request, demand, order or statutory or "suit"which also alleges any "personal and regulatory requirement that any insured or advertising injury" described in Paragraph • others test for, monitor, clean up, remove, (1)above. contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects (3) Any loss, cost or expense arising out of .of,"pollutants";or any: (2) Claim or suit by or on behalf of any (a) Request, demand, order or statutory or governmental authority or any other person regulatory requirement that any insured or organization because of testing for, or others test for, monitor, clean up, monitoring, cleaning up, removing, remove, contain, treat, detoxify or containing, treating, detoxifying or •neutralize, or in any way respond to, or Page 8 of 21 ©2017 The Travelers Indemnity Company.All rights reserved. CG T1 00 0219 Includes copyrighted material of Insurance Services Office,Inc.with its permission. COMMERCIAL GENERAL LIABILITY assess the effects of, asbestos, (3) Because of your operations; asbestos fibers or products containing provided that: asbestos;or (a) The accident takes place in the "coverage (b) Claim or suit by or on behalf of any territory"and during the policy period; governmental authority or any other person or organization because of (b) The expenses are incurred and reported to testing for, monitoring, cleaning up, us within one year of the date of the removing, containing, treating, accident; and detoxifying or neutralizing, or in any. (c) The injured person submits to examination, way responding to, or assessing the at our expense, by physicians of our choice • effects of, asbestos, asbestos fibers or as often as we reasonably require. products containing asbestos. b. We will make these payments regardless of s. Employment-Related Practices fault. These payments will not exceed the "Personal injury"to: applicable limit of insurance. We will pay reasonable expenses for: (1) A person arising out of any: • (1) First aid administered at the time of an (a) Refusal to employ that person; accident; (b) Termination -of that person's (2) Necessary medical, surgical, X-ray and employment;or dental services, induding prosthetic devices;and (c) Employment-related practice, policy, act or omission, such as coercion, (3) Necessary ambulance, hospital, demotion, evaluation, reassignment, professional nursing and funeral services. discipline, failure to promote or 2. Exclusions advance, harassment, humiliation,discrimination, libel, slander, violation We will not pay expenses for"bodily injury": of the person's right of privacy, a. Any Insured malicious prosecution or false arrest,• To any insured,except"volunteer workers". detention or imprisonment applied to or directed at that person, regardless of b. • Hired Person whether such practice, policy, act or To a person hired to do work for or on behalf of omission occurs, is applied or is any insured or a tenant of any insured. committed before, during or after the c. Injury On NormallyOccupied Premises time of that person's employment;or 7 rY p ' (2) The spouse, child, parent, brother or sister To a person injured on that part of premises of that person as a consequence of you own or rent that the person normally • "personal injury" to that person at whom occupies. any of the employment-related practices d. Workers'Compensation And Similar Laws described in Paragraph (a), (b), or (c) To a person, whether or not an "employee" of above is directed. any insured, if benefits for the"bodily injury"are This exclusion applies whether the insured may payable or must be provided under a workers' be liable as an employer or in any other capacity compensation or disability benefits law or a and to any obligation to share damages with or similar law. repay someone else who must pay damages e. Athletics Activities because of the"personal injury". To a person injured while practicing, instructing COVERAGE C—MEDICAL-PAYMENTS or participating in any physical exercises or 1. Insuring Agreement games,sports,or athletic contests. a. We will pay medical expenses as described f. Products-Completed Operations Hazard below for "bodily injury" caused by an accident: Included within the "products-completed • (1) On premises you own or rent; operations hazard". (2) On ways next to premises you own or rent; g. Coverage A Exclusions or Excluded under Coverage A. CG T1 00 02 19 ©2017 The Travelers Indemnity Company.All rights reserved. Page 9 of 21 Includes copyrighted material of Insurance Services Office,Inc.with its permission. COMMERCIAL GENERAL LIABILITY SUPPLEMENTARY PAYMENTS assumed by the insured in the same "insured contract"; 1. We will pay, with respect to any claim we investigate or settle, or any"suit" against an insured d. The allegations in the"suit" and the information we defend: we know about the"occurrence" or offense are such that no conflict appears to exist between a. All expenses we incur. the interests of the insured and the interests of b. Up to$2,500 for the cost of bail bonds required the indemnitee; because of accidents or traffic law violations e. The indemnitee and the insured ask us to arising out of the use of any vehicle to which conduct and control the defense of that the Bodily Injury Liability Coverage applies. We indemnitee against such "suit" and agree that do not have to furnish these bonds. we can assign the same counsel to defend the c. The cost of bonds to release attachments, but insured and the indemnitee;and only for bond amounts within the applicable limit f. The indemnitee: of insurance. We do not have to furnish these • (1) Agrees in writing to: bonds. d. All reasonable expenses incurred by the (a) Cooperate with us in the investigation, . settlement or defense of the"suit"; insured at our request to assist us in the investigation or defense of the claim or "suit", (b) Immediately send us copies of any including actual loss of earnings up to $500 a demand , notices, summonses or legal day because of time off from work. papers received in connection with the "suit"; e. All court costs taxed against the insured in the "suit". However, these payments do not include (c) Notify any • other insurer whose attorneys' fees or attorneys' expenses taxed coverage is available to the indemnitee; against the insured. and f. Prejudgment interest • awarded against the (d) Cooperate with us with respect to insured on that part of the judgment we pay. If coordinating other applicable insurance we make an offer to pay the applicable limit of available to the indemnitee;and insurance, we will not pay any prejudgment (2) Provides us with written authorization to: interest based on that period of time after the offer. (a) Obtain records and other information related to the"suit"; and g. All interest on the full amount of any judgment that accrues after entry of the judgment and (b) Conduct and control the defense of the before we have paid, offered to pay, or indemnitee In such"suit". deposited in court the part of the judgment that So long as the above conditions are met, attorneys' is within the applicable limit of insurance. • fees incurred by us in the defense of that These payments will not reduce the limits of indemnitee, necessary litigation expenses incurred insurance. by us and necessary litigation expenses incurred by the indemnitee at our request will be paid as . 2. If we defend an insured against a "suit" and an Supplementary Payments. Notwithstanding the indemnitee of the insured is also named as a party provisions of Paragraph 2.b.(2) of Section 1 — to the "suit", we will defend that indemnitee if all of Coverages — Coverage A — Bodily Injury And the following conditions are met: Property Damage Liability or Paragraph 2.e. of a. The "suit" against the indemnitee seeks Section I — Coverages — Coverage B — Personal damages for which the insured has assumed And Advertising Injury Liability, such payments will the liability of the indemnitee in a contract or not be deemed to be damages for "bodily injury", agreement that is an"insured contract"; "property damage"or"personal injury", and will not reduce the limits of insurance. b. This insurance applies to such liability assumed Our obligation to defend an insured's indemnitee by the insured; and to pay for attorneys' fees and necessary c. The obligation to defend, or the cost of the litigation expenses as Supplementary Payments defense of, that indemnitee, has also been ends when: • Page 10 of 21 a 2017 The Travelers Indemnity Company.All rights reserved. CG T1 00 02 19 Includes copyrighted material of Insurance Services Office,Inc.with its permission. COMMERCIAL GENERAL LIABILITY a. We have Used up the applicable limit of workers" while performing duties insurance in . the payment of judgments, related to the conduct of your settlements or medical expenses;or business; b. The conditions set forth above, or the terms of (b) To the spouse, child, parent, brother or the agreement described in Paragraph f.above, sister of that co-"employee" or are no longer met. "volunteer worker" as a consequence SECTION II—WHO IS AN INSURED of Paragraph(1)(a)above; 1. If you are designated in the Declarations as: (c) For which there is any obligation to share damages with or repay someone a. An individual, you and your spouse are else who must pay damages because insureds, but only with respect to the conduct of the injury described in Paragraph of a business of which you are the sole owner. (1)(a)or(b)above;or • b. A partnership or Joint venture, you are an Arisingout of his or her providingor insured. Your members, your partners, and (d) iiing to provide professional l health their spouses are also insureds, but only with respect to the conduct of your business, care services. c. A limited liability company, you are an insured. Unless you are in the business or Your members are also insureds, but only with occupation of providing professional health respect to the conduct of your business. Your care services, Paragraphs (1)(a),'(b), (c) • managers are insureds, but only with respect to and(d)above do not apply to"bodily injury" their duties as your managers. arising out of providing or failing to provide first aid or "Good Samaritan services" by d. An organization other than a partnership, joint any of your "employees" or "volunteer venture or limited liability company, you are an workers", other than an employed or insured. Your"executive officers"and directors volunteer doctor. Any such "employees" or are insureds, but only with respect to their "volunteer workers" providing or failing to duties as your officers or directors. Your provide first aid or "Good Samaritan stockholders are also insureds, but only with • services" during their work hours for you respect to their liability as stockholders; will be deemed to be acting within the e. A trust, you are an insured. Your trustees are scope of their employment by you or also insureds, but only with respect to their performing duties related to the conduct of duties as trustees. your business. 2. Each of the following is also an insured: (2) "Property damage"to property: a. Your "volunteer workers" only while performing (a) Owned, occupied or used by; duties related to the conduct of your business, (b) Rented to, in the care, custody or or your "employees", other than either your control of, or over which physical "executive officers" (if you are an organization control is being exercised for any other than a partnership,joint venture or limited purpose by; liability company) or your managers(if you are a of "employees", "volunteer • limited liability company), but only for acts you, any your within the scope of their employment by you or workers",any partner.or member(if you are while performing duties related to the conduct a partnership or joint venture), or any of your business. However, none of these member (if you are a limited liability "employees" or "volunteer workers" are company). insureds for: b. Any person (other than your "employee" or (1) "Bodily injury"or"personal injury": "volunteer worker"), or any organization, while (a) To you, to your partners or members (if acting as your real estate manager. you are a partnership or joint venture), c. Any person or organization having proper to your members (if you are a limited temporary custody of your property if you die, - liability company), to a co-"employee" but only: while in the course of his or her (1) With respect to liability arising out of the employment or performing duties maintenance or use of that property;and related to the conduct of your business, or to your other "volunteer (2) Until your legal representative has been appointed. • CG T1 00 02 19 ®2017 The Travelers Indemnity Company.All rights reserved. Page 11 of 21 Includes copyrighted material of insurance Services Office,Inc.with Its permission. COMMERCIAL GENERAL LIABILITY d. Your legal representative if you die, but only b. Arises out of the ownership, maintenance or with respect to duties as such. That use of that part of any premises leased to you. representative will have all your rights and The insurance provided to such premises owner, duties under this Coverage Part. manager or lessor is subject to the following e. Any person or organization that, with your provisions: express or implied consent, either uses or is a. The limits of insurance provided to such responsible for the use of a watercraft that you premises owner, manager or lessor will be the do not own that is: minimum limits that you agreed to provide in the (1) 50 feet long or less; and written contract or agreement, or the limits shown in the Declarations,whichever are less. (2) Not being used to carry any person or property for a charge. b. The insurance provided to such premises 3. Any organization you newly acquire or form, other owner, manager or lessor does not apply to: than a partnership, joint venture or limited liability (1) Any "bodily injury" or "property damage" company, and of which you are the sole owner or in that occurs, or "personal and advertising which you maintain an ownership interest of more injury" caused by an offense that is than 50%, will qualify as a Named insured if there is committed,after you cease to be a tenant in no other similar insurance available to that that premises;or • organization.However: (2) Structural alterations, new construction or a. Coverage under this provision is afforded only demolition operations performed by or on until the 180th day after you acquire or form the behalf of such premises owner, manager or organization or the end of the policy period, lessor. whichever is earlier; 5. Any person or organization that is an equipment b. Coverage A does not apply to "bodily injury" or lessor and that you have agreed in a written contract "property damage" that occurred before you or agreement to include as an additional insured on acquired or formed the organization;and this Coverage Part is an insured, but only with respect to liability for "bodily injury", "property c. Coverage B does not apply to "personal and damage",or"personal and advertising injury"that: advertising injury" arising out of an offense committed before you acquired or formed the a. Is "bodily injury" or "property damage" that organization. occurs, or is "personal and advertising injury" caused by an offense that is committed, For the purposes of Paragraph 1. of Section II — subsequent to the signing of that contract or Who Is An Insured, each such organization will be agreement; and deemed to be designated in the Declarations as: • b. Is caused, in whole or in part, by your acts or a. An organization, other than a partnership, joint omissions in the maintenance, operation or use venture or limited liability company;•or of equipment leased to you by such equipment • lessor. b. A trust; The insurance provided to such equipment lessor is as indicated in its name or the documents that subject to the following provisions: govern its structure. a. The limits of insurance provided to such 4. Any person or organization that is a premises equipment lessor will be the minimum limits that owner, manager or lessor and that you have agreed you agreed to provide in the written contract or . in a written contract or agreement to include as an agreement, or the limits shown in the additional insured on this Coverage Part is an Declarations,whichever are less. insured, but only with respect to liability for "bodily . injury", "property damage" or "personal and b. The insurance provided to such equipment advertising injury's that: lessor does not apply to any "bodily injury" or "property damage" that occurs, or "personal a. Is "bodily injury" or "property damage" that and advertising injury" caused by an offense occurs, or is "personal and advertising injury" that is committed, after the equipment lease caused by an offense that is committed, expires. subsequent to the signing of that contract or No person or organization is an insured with respect to agreement;and the conduct of any current or past partnership. joint • .Page 12 of 21 ®2017 The Travelers Indemnity Company.All rights reserved. CG T1 00 02 19 Includes copyrighted material of Insurance Services Office,Inc.with its permission. COMMERCIAL GENERAL LIABILITY venture or limited liability company that is not shown as a. The amount shown for the Damage To a Named Insured in the Declarations. This paragraph Premises Rented To You Limit in the does not apply to any such partnership,joint venture or Declarations of this Coverage Part;or limited liability company that otherwise qualifies as an b; $300,000 if no amount is shown for the insured under Section II—Who Is An Insured. Damage To Premises Rented To You Limit in SECTION iII—LIMITS OF INSURANCE the Declarations of this Coverage Part. • 1. The Limits of Insurance shown in the Declarations 7. Subject to Paragraph 5. above, the Medical and the rules below fix the most we will pay• Expense Limit is the most we will pay under regardless of the number of: Coverage C for all medical expenses because of "bodily injury"sustained by any one person. a. Insureds; The Limits of Insurance of this Coverage Part apply b. Claims made or"suits"brought;or separately to each consecutive annual period and to any c. Persons or organizations making claims or remaining period of less than 12 months, starting with bringing"suits". the beginning of the policy period shown in the Declarations, unless the policy period is extended after 2. The General Aggregate Limit is the most we will pay issuance for an additional period of less than 12 for the sum of: months. In that case, the additional period will be a. Medical expenses under Coverage C; deemed part of the last preceding period for purposes of b. Damages under Coverage A, except damages determining the Limits of Insurance. because of"bodily injury" or "property damage" SECTION IV — COMMERCIAL GENERAL LIABILITY included in the "products-completed operations CONDITIONS hazard"; and 1. Bankruptcy c. Damages under Coverage B. Bankruptcy or insolvency of the insured or of the 3. The Products-Completed Operations Aggregate insured's estate will not relieve us of our obligations Limit is the most we will pay under Coverage A for under this Coverage Part damages because of "bodily injury" and "property 2. Duties in The Event Of Occurrence, Offense, damage" included in the "products-completed Claim Or Suit operations hazard". a. You must see to it that we are notified as soon 4. Subject to Paragraph 2. above, the Personal And as practicable of an "occurrence" or an offense Advertising Injury Limit is the most we will pay which may result In a claim. To the extent under Coverage B for the sum of all damages possible, notice should include: because of all "personal injury" and "advertising injury"sustained by any one person or organization. (1) How,, when and where the "occurrence" or • offense took place; 5. Subject to Paragraph 2. or 3. above, whichever applies, the Each Occurrence Limit is the most we (2) The names and addresses of any injured will pay for the sum of: persons and witnesses;and a. Damages under Coverage A;and (3) The nature and location of any injury or damage arising out of the "occurrence" or b. Medical expenses under Coverage C; offense. because of all "bodily injury" and"property damage" b. if a claim is made or "suit" is brought against arising out of any one"occurrence". any insured,you must: For the purposes of determining the applicable lspecifics of the _ Each Occurrence Limit, all related acts or (1) claim Immediaor tely and record the the date received;and omissions committed in providing or failing to provide first aid or "Good Samaritan services" to (2) Notify us as soon as practicable. any one person• will be deemed to be one You must see to it that we receive written notice "occurrence". • of the claim or"suit"as soon as practicable. 6. Subject to Paragraph 5. above, the Damage To c, You and any other involved insured must: Premises Rented To You Limit is the most we will pay under Coverage A for damages because of (1) Immediately send us copies of any "premises damage" to any one premises. The demands, notices, summonses or legal Damage To Premises Rented To You Limit will be: papers received in connection with the claim or"suit"; • CG T7 00 02 19 a 2017 The Travelers indemnity Company.All rights reserved. Page 13 of 21 Includes copyrighted material of Insurance Services Office,Inc.with its permission. COMMERCIAL GENERAL LIABILITY (2) Authorize us to obtain records and other (iii) An executive officer or director of information; any other organization;or (3) Cooperate with us in the investigation or (iv)A trustee of any trust; settlement of the claim or defense against that is your partner, joint venture the"suit"; and member,manager or trustee;or (4) Assist us; upon our request, in the (b) Any employee authorized by such enforcement of any right against any partnership, joint venture, limited person or organization which may be liable liability company. '•trust or other to the insured because of injury or damage organization to give notice of an to which this insurance may also apply. "occurrence"or offense. • d. No insured will, except at that insured's own (3) Notice to us of such "occurrence" or cost, voluntarily make a payment, assume any offense will be deemed to be given as soon obligation, or incur any expense, other than for as practicable if it is given in good faith as first aid,without our consent soon as practicable to your workers' e. The following provisions apply to Paragraph a. compensation insurer. This.applies only if above, but only for purposes of the insurance you subsequently give notice to us of the j provided under this Coverage Part to you or any "occurrence" or offense as soon as insured listed in Paragraph 1. or 2. of Section Il practicable after any of the persons —Who Is An Insured: described in Paragraph e.(1) or (2) above discovers that the "occurrence" or offense (1) Notice to us of such "occurrence" or may result in sums to which the insurance offense must be given as soon as provided under this Coverage Part may practicable only after the "occurrence" or apply offense is known to you (if you are an However, if this policy includes an endorsement individual), any of your partners or that provides limited coverage for"bodily injury" members who is an individual (if you are a or "property damage" or pollution costs arising partnership or joint venture), any of your out of a discharge, release or escape of managers who is an individual (if you are a "pollutants" which contains a requirement that limited liability company), any of your the discharge, release or escape of "pollutants" • "executive officers" or directors (if you are' must be reported to us within a specific number an organization other than a partnership, of days after its abrupt commencement, this 1 joint venture, or limited liability company), Paragraph e. does not affect that requirement. any of your trustees who is an individual (if you , are a trust) or any "employee" 3. Legal Action Against Us authorized by you to give notice of an No person or organization has a right under this "occurrence"or offense. Coverage Part: (2) If you are a partnership, joint venture, a. To join us as a party or otherwise bring us into limited liability company or trust, and none a"suit"asking for damages from an insured;or of your partners, joint venture members, b. To sue us on this Coverage Part unless all of managers or trustees are individuals, notice its terms have been fully complied with. to us of such "occurrence" or offense must be given as soon as practicable only after A person or organization may sue us to recover on the"occurrence"or offense is known by: an agreed settlement or on a final judgment against an insured; but we will not be liable for damages (a) Any individual who is: that are not payable under the terms of this Coverage Part or that are in excess of the (i) A partner or member of any applicable limit of insurance. An agreed settlement partnership or joint venture; means a settlement and release of liability signed by (ii) A manager of any limited liability us, the insured, and the claimant or the claimant's company; legal representative. • • Page 14 of 21 ©2017 The Travelers Indemnity Company.All rights reserved. CG T1 00 02 19 includes copyrighted material of Insurance Services Office,Inc.with Its permission. COMMERCIAL GENERAL LIABILITY • 4. Other Insurance (ii) That is insurance for "premises If valid and collectible other insurance is available to damage"; the insured for a loss we cover under Coverages A (iii) If the loss arises out of the or B of this Coverage Part, our obligations are maintenance or use of aircraft, limited as described in Paragraphs a.and b. below. "autos" or watercraft to the extent not subject to any exclusion in this As used anywhere in this Coverage Part, other Coverage Part that applies to insurance means insurance, or the funding of aircraft,"autos"or watercraft; losses, that is provided by, through or on behalf of: (i) Another insurance company; (iv)That is insurance available to a premises owner, manager or (ii) Us or any of our affiliated insurance companies, lessor that qualifies as an insured except when the Non cumulation of Each under Paragraph 4. of Section II — Occurrence Limit provision of Paragraph 5. of Who Is An Insured, except when Section III — Limits Of Insurance or the Non Paragraph d.below applies;or cumulation of Personal and Advertising Injury (v) That is insurance available to an Limit provision of Paragraph 4. of Section III — equipment lessor that qualifies as Limits of Insurance applies because the an insured under Paragraph 5. of Amendment — Non Cumulation Of Each Section it — Who Is An Insured, Occurrence Limit Of Liability And Non except when Paragraph d. below Cumulation Of Personal And Advertising Injury• applies. Limit endorsement is included in this policy; (b) Any of the other insurance, whether (Hi)Any risk retention group;or primary, excess, contingent or on any (iv)Any self-insurance method or program, in other basis, that is available to the which case the insured will be deemed to be insured when the insured is an the provider of other insurance. additional insured, .or is any other • Other insurance does not include umbrella insured that does not qualify as a insurance, or excess insurance, that was bought named insured, under such other insurance. specifically to apply In excess of the Limits of Insurance shown in the Declarations of this (2) When this insurance is excess, we will Coverage Part. have no duty under Coverages A or B to defend the insured against any"suit"if any As used anywhere in this Coverage Part, other other insurer has a duty to defend the insurer means a provider of other insurance. As - insured against that "suit". If no other used in Paragraph c. below, insurer means a insurer defends,we will undertake to do so, provider of insurance. but we will be entitled to the insured's rights a. Primary Insurance against all those other insurers. • This insurance is primary except when (3) When this insurance is excess over other Insurance,we will pay only our share of the Paragraph b. below applies. If this insurance is amount of the loss, if any,that exceeds the primary, our obligations are not affected unless sum of: any of the other insurance is also primary. The total amount•that all such other Then, we will share with all that other insurance (a) ) insurance would pay for the loss in the by the method described in Paragraph c. below, absence of this insurance;and except when Paragraph d. below applies. (b) The total of all deductible and self- b. Excess Insurance insured amounts under all that other • (1) This insurance is excess over: Insurance. (a) Any of the other insurance, whether (4) We will share the remaining loss, if any, primary, excess, contingent or on any with any other insurance that is not described in this Excess Insurance other basis: provision and was not bought specifically to (I) That is Fire, Extended Coverage, apply in excess of the Limits of Insurance Builder's Risk, Installation Risk or shown in the Declarations of this Coverage similar coverage for"your work"; Part. CG T1 00 02 19 ©2017 The Travelers Indemnity Company.All rights reserved. Page 15 of 21 Includes copyrighted material or Insurance Services Office,Inc.with its permission. • COMMERCIAL GENERAL LIABILITY • c. Method Of Sharing - a. The statements in the Declarations are If all of the other insurance permits contribution accurate and complete; by equal shares,we will follow this method also. b. Those statements are based upon Under this approach each insurer contributes representations you made to us;and equal amounts until it has paid its applicable c, We have issued this policy in reliance upon limit of insurance or none of the loss remains, your representations. - whichever comes first. The unintentional omission of, or unintentional error If any of the other insurance does not permit in, any information provided by you which we relied contribution by equal shares, we will contribute upon in issuing this policy will not prejudice your by limits. Under this method, each insurer's rights under this insurance. However, this provision share is based on the ratio of its applicable limit does not affect our right to collect additional of insurance to the total applicable limits of premium or to exercise our rights of cancellation or insurance of all insurers. nonrenewal in accordance with applicable insurance d. Primary And Non-Contributory Insurance If laws or regulations. Required By Written Contract 7. Separation Of Insureds If you specifically agree in a written contract or Except with respect to the Limits of Insurance, and agreement that the insurance afforded to an any rights or duties specifically assigned in this insured under this Coverage Part must apply on Coverage Part to the first Named Insured, this a primary basis, or a primary and non- insurance applies: contributory basis, this insurance is primary to a. As if each Named Insured were the only other insurance that is available to such insured Named Insured;and which covers such insured as a named insured, b. Separately to each insured against whom claim and we will not share with that other insurance, is made or"suit"is brought. provided that: (1) The "bodily injury" or"property damage"for 8. Transfer Of Rights Of Recovery Against Others which coverage is sought occurs;.and To Us (2) The "personal and advertising injury" for If the insured has rights to•recover all or part of any which coverage is sought is caused by an payment we have made under this Coverage Part, offense that is committed; • those rights are transferred to us. The insured must do nothing after loss to impair them. At our request, subsequent to the signing of that contract or the insured will bring "suit" or transfer those rights agreement by you. to us and help us enforce them. 5. Premium Audit 9, When We Do Not Renew a. We will compute all premiums for this Coverage If we decide not to renew this Coverage Part,we will Part in accordance with our rules and rates. mail or deliver to the first Named Insured shown in b. Premium shown in this Coverage Part as the Declarations written notice of the nonrenewal , • advance premium is a deposit premium only. At not less than 30 days before the expiration date. the dose of each audit period we will compute If notice is mailed, proof of mailing will be sufficient the earned premium for that period and send proof of notice. notice to the first Named Insured. The due date SECTION V DEFINITIONS for audit and retrospective premiums is the date 1. "Advertisement"means a notice that is broadcast or shown as the due date on the bill. if the sum of published to the general public or specific market the advance and audit premiums paid for the segments about your goods, products or services policy period is greater than the earned for the purpose of attracting customers or premium, we will return the excess to the first supporters.For the purposes of this definition:• Named Insured. a. • c. The first Named Insured must keep records of Notices that are published include material placed on the Internet or on similar electronic the informationNamed we need' for premium means of communication; and • computation, and send us copies at such times as we may request. b. Regarding websites, only that part of a website that is about your goods, products or services 6. Representations for the purposes of attracting customers or By accepting this policy,you agree: supporters is considered an advertisement. Page 16 of 21 ®2017 The Travelers Indemnity Company.All rights reserved. CG T1 00 02 19 Includes copyrighted material of Insurance Services Office,Inc.with its permission. COMMERCIAL GENERAL LIABILITY 2. "Advertising injury": b. In, by or with any other electronic means of communication, such as the Internet, if that a. Means injury caused by one or more of the material is part of following offenses: (1) Oral or written publication, including (1) Radio or television programming being publication by electronic means, of material transmitted; • in your "advertisement" that slanders or (2) Other entertainment, educational, libels a person or organization or instructional, music or news programming disparages a person's or organization's being transmitted; or goods, products or services, provided that the claim is made or the"suit" is brought by (3) Advertising transmitted with any of such a person or organization that claims to have programming. been slandered or libeled, or that claims to 6. "Coverage territory"means: have had its goods, products or services disparaged; . a. The United States of America (including its (2) Oral or written publication, including territories and possessions), Puerto Rico and publication by electronic means, of material Canada; . in your"advertisement"that: b. International waters or airspace, but only if the (a) Appropriates a person's name, voice, injury or damage occurs in the course of travel photograph or likeness;or or transportation between any places included (b) Unreasonably places a person in a in Paragraph a.above; or false light; or c. All other parts of the world if the injury or • (3) Infringement of copyright, "title" or "slogan" damage arises out of: in your "advertisement", provided that the (1) Goods or products made or sold by you in claim is made or the "suit" is brought by a the territory described in Paragraph a. person or organization that claims above; ownership of such copyright, "title" or "slogan". (2) The activities of a person whose home is in b. Includes "bodily injury" caused by one or more the territory described in Paragraph a. of the offenses described in Paragraph a. above, but is away for a short time on your above. business;or • 3. "Auto"means: (3) "Personal and advertising injury" offenses that take place through the Internet or a. A land motor vehicle, trailer or semitrailer similar electronic means of communication; designed for travel on public roads, including any attached machinery or equipment; or provided the insured's responsibility to pay b. Any other land vehicle that is subject to a damages is determined in a "suit" on the merits in compulsory or financial responsibility law, or the territory described in Paragraph a. above,or in a other motor vehicle insurance law, where it is settlement we agree to, • licensed or principally garaged. 7. "Electronic data" means information, facts or However, "auto" does not include "mobile programs stored as or on, created or used on, or equipment". transmitted to or from computer software (including injur y" systems and applications software), hard or floppy 4. "Bodily J ry disks, CD-ROMs, tapes, drives, cells, data a. Physical harm, including sickness or disease, processing devices or any other media which are sustained by a person;or used with electronically controlled equipment. b. Mental anguish, injury or illness, or emotional 8. "Employee" includes a "leased worker". "Employee" distress, resulting at any time from' such does not include a"temporary worker". physical harm, sickness or disease. 9. "Executive officer" means a person holding any of 5. "Broadcasting" means transmitting any audio or the officer positions created by your charter, visual material for any purpose: constitution, bylaws or any other similar governing a. By radio or television;or document. • CG T1 00 02 19 ©2017 The Travelers Indemnity Company.All rights reserved. Page 17 of 21 Includes copyrighted material of Insurance Services Office,Inc.with Its permission. • COMMERCIAL GENERAL LIABILITY . 10. "Good Samaritan services" means any emergency tracks, roadbeds, tunnel, underpass or medical services for which no compensation is crossing; demanded or received. (2) That indemnifies an architect, engineer or 11. "Hostile fire" means a fire which becomes surveyor for injury or damage arising out of: uncontrollable or breaks out from where it was (a) Preparing, approving, or failing to intended to be. prepare or approve, maps, shop 12. "Impaired property" means tangible property, other drawings, opinions, reports, surveys, • than "your product" or "your work", that cannot be field orders, change orders or drawings used or is less useful because: and specifications; or I a. It incorporates "your product" or "your work" (b) Giving directions or Instructions, or that is known or thought to be defective, failing to give them, if that is the deficient,inadequate or dangerous;or primary cause of the injury or damage; or . b. You have failed to fulfill the terms of a contract• (3) Under which the insured, if an architect, or agreement; engineer or surveyor, assumes liability for if such property can be restored to use by the an injury or damage arising out of the repair, replacement, adjustment or removal of"your insured's rendering or failure to render product" or"your work"or your fulfilling the terms of professional services, including those listed the contract or agreement. in Paragraph (2) above and supervisory, 13. "Insured contract"means: inspection, architectural• or engineering a. A contract for a lease of premises. However, activities. that portion of the contract for a lease of 14. "Leased worker" means a person leased to you by a premises that indemnifies any person or labor leasing firm under an agreement between you organization for "premises damage" is not an and the labor leasing firm, to perform duties related "insured contract"; to the conduct of your business. "Leased workers' does not include a"temporary worker". b. A sidetrack agreement; • 15. "Loading or unloading" means the handling of c. Any easement or license agreement, except in property: connection with construction or demolition operations on or within 50 feet of a railroad; a. After it is moved from the place where it is accepted for movement into or onto an aircraft, • d. An obligation, as required by ordinance, to ' watercraft or"auto"; indemnify a municipality, except in connection • with work for a municipality; b. While it is in or on an aircraft, watercraft or "auto";or e. An elevator maintenance agreement; c. While it is being moved from an aircraft, f. That part of any other contract or agreement watercraft or "auto" to the place where it •is pertaining to your business (including an finally delivered; indemnification of a municipality in connection with work performed for a municipality) under but loading or unloading" does not include the which you assume the tort liability of another movement of property by means of a mechanical party to pay for "bodily injury", "property device, other than a hand truck,that is not attached damage" or "personal injury" to a third person to the aircraft,watercraft or"auto". or organization.Tort liability means a liability that 16. "Mobile equipment" means any of the following would be imposed by law in the absence of any types of land vehicles, including any attached contract or agreement. machinery or equipment: • Paragraph f. does not include that part of any a. Bulldozers, farm machinery, forklifts and other contract or agreement: vehicles designed for use principally off public (1) That indemnifies a railroad for "bodily roads; injury" or "property damage" arising out of b. Vehicles maintained for use solely on or next to construction or demolition operations, premises you own or rent; within 50 feet of any railroad property and c. Vehicles that travel on crawler treads; affecting any railroad bridge or trestle, Page 18 of 21 ©Z017 The Travelers Indemnity Company.AU rights reserved. CG T1 00 0219 Includes copyrighted material of Insurance Services Office,Inc.with Its permission. • COMMERCIAL GENERAL LIABILITY d. Vehicles, whether self-propelled or not, b. An act or omission committed in providing or maintained primarily to provide mobility to failing to provide first aid or "Good Samaritan permanently mounted: services" to a person, unless you are in the business or occupation of providing (1) Power cranes, shovels, loaders, diggers or professional health care services. drills;or (2) Road construction or resurfacing 18. "Personal and advertising injury" means "personal equipment such as graders, scrapers or injury"or"advertising injury". rollers; 19. "Personal injury": e. Vehicles not described in Paragraph a., b., c. or d, above that'are not self-propelled and are a. Means Injury, other than "advertising injury", maintained primarily to provide mobility to caused by one or more of the following permanently attached equipment of the offenses: following types: (1) False arrest,detention or imprisonment; (1) Air compressors, pumps and generators, • including spraying, welding, building (2) Malicious prosecution; • cleaning, geophysical exploration, lighting and well servicing equipment;or (3) The wrongful eviction from, wrongful entry into, or invasion of the right of private (2) Cherry pickers and similar devices used to occupancy of a room, dwelling or premises raise or lower workers; that a person occupies, provided that the f. Vehicles not described in Paragraph a., b., c. wrongful eviction, wrongful entry or invasion or d, above maintained primarily for purposes of the right of private occupancy is other than the transportation of persons or committed by or on behalf of the owner, cargo. landlord or lessor of that room, dwelling or premises; • However, self-propelled vehicles with the following types of'• permanently attached (4) Oral or written publication, including equipment are not "mobile equipment" but will publication by electronic means, of material be considered"autos": that slanders or libels a person or (1) Equipment designed primarily for: • organization or disparages a person's or organization's goods, products or services, (a) Snow removal; provided that the claim is made or the "suit" (b) Road maintenance, but not is brought by a person or organization that construction or resurfacing;or claims to have been slandered or libeled, or that claims to have had its goods. products (c) Street cleaning; or services disparaged;or (2) Cherry pickers and similar devices (5) Oral or written publication, including mounted on automobile or truck chassis • publication by electronic means, of material and used to raise or lower workers;and that: (3) Alr compressors, pumps and generators, including spraying, welding, building (a) Appropriates a person's name, voice, cleaning, geophysical exploration, lighting photograph or likeness;or and well servicing equipment. (b) Unreasonably places a•person in a However, "mobile equipment" does not include any false light. land vehicle that is subject to a compulsory or , financial responsibility law, or other motor vehicle b. Includes "bodily injury" caused by one or more insurance law, where it is licensed or principally of the offenses described in Paragraph a. garaged. Such land vehicles are considered above. • "autos". 17. "Occurrence"means: 20. "Pollutants" mean any solid, liquid, gaseous or • thermal irritant or contaminant, including smoke, a. An accident, including continuous or repeated vapor, soot, fumes, acids, alkalis, chemicals and exposure to substantially the same general waste. Waste includes materials to be recycled, harmful conditions;or reconditioned or reclaimed. CG T1 00 02 19 ©2017 The Travelers Indemnity Company.All rights reserved. Page 19 of 21 Includes copyrighted material of Insurance Services Office,Inc.with its permission. COMMERCIAL GENERAL LIABILITY 21. "Premises damage"means: contract calls for work at more than a. With respect to the first paragraph of the one job site. exceptions in Exclusion j. of Section 1 — (c) When that part of the work done at a Coverage A — Bodily Injury And Property job site has been put to its intended Damage Liability, "property damage" to any use by any person or organization other premises while rented to you for a period of than another contractor or seven or fewer consecutive days, including the subcontractor working on the same contents of such premises; or project. b. With respect to the exception to Exclusions c. Work that may need service, maintenance, through n. in the last paragraph of Paragraph 2. correction, repair or replacement, but which of Section I — Coverage A — Bodily Injury And is otherwise complete, will be treated as Property Damage Liability, "property damage"to completed. any premises while rented to you for a period of b. Does not Include "bodily injury" or "property more than seven consecutive days, or while damage"arising out of: temporarily occupied by you with permission of (1) The transportation of property, unless the the owner,caused by: injury or damage arises out of a condition in I (1) Fire; or on a vehicle not owned or operated by • • i (2) Explosion; you, and that condition was created by the "loading or unloading" of that vehicle by any (3) Lightning; insured; (4) Smoke resulting from fire, explosion or (2) The existence of tools, uninstalled lightning;or equipment or• abandoned or unused (5) Water. materials.;or But "premises damage" under this Paragraph (3) Products or operations for which the b. does not include "property damage" to any classification, listed in the Declarations or . premises caused by: in a policy Schedule, states that products- 1 completed operations are subject to the ' (1) Rupture, bursting, or operation of pressure General Aggregate Limit. relief devices; 23. "Property damage"means: (2) Rupture or bursting due to expansion or swelling of the contents of any building or a. Physical injury to tangible property, including all structure caused by or resulting from water; resulting loss of use of that property. All such or loss of use will be deemed to occur at the time of the physical injury that caused it;or (3) Explosion of steam boilers, steam pipes, . steam engines or steam turbines. b. Loss of use of tangible property that is not physically injured. All such loss of use will be 22. "Products-completed operations hazard": deemed to occur at the time of the "occurrence" a. Includes all "bodily injury" and "property that caused it. damage" occurring away from premises you For the purposes of this insurance, "electronic data" own or rent and arising out of"your product" or is not tangible property. "your work"except: 24. "Slogan": (1) Products that are still in your physical possession;or a. Means a phrase that others use for the purpose (2) Work that has not yet been completed or of attracting attention in their advertising. abandoned. However, "your work" will be b. Does not include a phrase used as, or in, the deemed completed at the earliest of the name of: following times: (1) Any person or organization, other than you; (a) When all of the work called for in your or contract has been completed. (2) Any business, or any of the premises, (b) When all of the work to be done at the goods, products, services or work, of any job site has been completed if your person or organization,other than you. Page 20 of 21 ©2017 The Travelers Indemnity Company.All rights reserved. CG T1 00 0219 Includes copyrighted material of Insurance Services Office,Inc.with Its permission. COMMERCIAL GENERAL LIABILITY 25. "Suit" means a civil proceeding in which damages (a) You; because of "bodily injury", "property damage" or (b) Others trading under your name;or "personal and advertising injury" to which this insurance applies are alleged. "Suit"includes: (c) A person or organization whose business or assets you have acquired; a. An arbitration proceeding in which such and . damages are claimed and to which the insured must submit or does submit with our consent; (2) Containers (other than vehicles), materials, or parts or equipment furnished in connection with such goods or products. b, Any other alternative dispute . resolution proceeding in which such damages are claimed b. Includes: and to which the insured submits with our .(1) Warranties or representations made at any consent. time with respect to the fitness, quality, 26. "Temporary worker" means a person who is durability, performance or use of "your • furnished to you to substitute for a permanent product';and "employee" on leave or to meet seasonal or short- (2) The providing of or failure to provide term workload conditions. warnings or instructions. 27. "Title"means a name of a literary or artistic work. c. Does not include vending machines or other 28. "Unsolicited communication" means any property rented to or located for the use of communication, in any form, that the recipient of others but not sold. such communication did not specifically request to 31. "Your work": receive. a. Means: 29. 'Volunteer worker" means a person who is not your (1) Work or operations performed by you or on "employee", and who donates his or her work and your behalf;and acts at the direction of and within the scope of duties determined by you, and is not paid a fee, '(2) Materials, parts or equipment furnished in salary or other compensation by you or anyone else connection with such work or operations. for their work performed for you. • b. Includes: • 30. "Your product": (1) Warranties or representations made at any a. Means: time with respect to the fitness, quality, durability, performance or use of "your (1) Any goods or products, other than real work"; and property, manufactured, sold, handled, (2) The providing of or failure to provide distributed or disposed of by: warnings or instructions. • CG T1 00 02 19 ©2017 The Travelers Indemnity Company.All rights reserved. Page 21 of 21 Includes copyrighted material of insurance Services Office,Inc.with its permission. Debarred Contractors List Page 1 of 1 0 Some online services are currently unavailable.See a list of service outages.(httosJ/lnl.wa.00v/aaencv/system-statusl sib Labor&Industries Debarred Contractors List A debarred contractor may not bid on,or have a bid considered on,any public works contract.You can search and filter this list using the options presented below. Company Name4Belsby Engineering 1 WA UBI Number ( License Number Principal4 RCWjAll v From:IMM/DD/YYYY 1 TojMMIDD/YYYY 1 Penalty Due: All v Wage Due: All v 14pply Filters!Resell Download all debarment data® Show®per page Showing 0 records FlrstPrevlousNextLast Company Name UBI License Principals Status RCW Debar Begins Debar Ends Penalty Due Wages Due There are no records that match your search criteria. ShowJ25 Viper page Showing 0 records FI rstPrevious NextLast • https://secure.lni.wa.gov/debarandstrike/ContractorDebarList.aspx 1/2/2020 BELSBY ENGINEERING LLC Page 1 of 2 ,. STATE OF WASHINGTON Department of Labor& Industries Certificate of Workers' Compensation Coverage January 9, 2020 WA UBI No. ?602789933 I L&I Account ID 17797101 ' Legal Business Name ;BELSBY ENGINEERING LLC Doing Business As 1 BELSBY ENGINEERING Workers' Comp Premium Status: !Account is current. I Estimated Workers Reported i Quarter 3 of Year 2019"7 to 10 (See Description Below) {Workers" Account Representative I Employer Services Help Line, (360) I '902-4817 1 Licensed Contractor? ; No 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=602789933&LIC=&V... 1/9/2020