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23-196.00EllerCorporationOnCallRoadGradersSnowRemovalContract No. 23-196 AGREEMENT FOR SERVICES Eller Corporation On Call Road Graders for Snow Removal 2023-2024 Snow Season THIS AGREEMENT is made by and between the City of Spokane Valley, a code City of the State of Washington, hereinafter "City" and Eller Corporation., hereinafter "Consultant," jointly referred to as "Parties." IN CONSIDERATION of the terms and conditions contained herein, the Parties agree as follows: 1. Work to Be Performed. Consultant shall provide all labor, services, and material to satisfactorily complete the Scope of Services, attached as Exhibit A. A. Administration. The City Manager or designee shall administer and be the primary contact for Consultant. Prior to commencement of work, Consultant shall contact the City Manager or designee to review the Scope of Services, schedule, and date of completion. Upon notice from the City Manager or designee, Consultant shall commence work, perform the requested tasks in the Scope of Services, stop work, and promptly cure any failure in performance under this Agreement. B. Representations. City has relied upon the qualifications of Consultant in entering into this Agreement. By execution of this Agreement, Consultant represents it possesses the ability, skill, and resources necessary to perform the work and is familiar with all current laws, rules, and regulations which reasonably relate to the Scope of Services. No substitutions of agreed -upon personnel shall be made without the prior written consent of City. Consultant represents that the compensation as stated in paragraph 3 is adequate and sufficient for the timely provision of all professional services required to complete the Scope of Services under this Agreement. Consultant shall be responsible for the technical accuracy of its services and documents resulting therefrom, and City shall not be responsible for discovering deficiencies therein. Consultant shall correct such deficiencies without additional compensation except to the extent such action is directly attributable to deficiencies in City -furnished information. C. Standard of Care. Consultant shall exercise the degree of skill and diligence normally employed by professional consultants engaged in the same profession, and performing the same or similar services at the time such services are performed. D. Modifications. City may modify this Agreement and order changes in the work whenever necessary or advisable. Consultant will accept modifications when ordered in writing by the City Manager or designee, so long as the additional work is within the scope of Consultant's area of practice. Compensation for such modifications or changes shall be as mutually agreed between the Parties. Consultant shall make such revisions in the work as are necessary to correct errors or omissions appearing therein when required to do so by City without additional compensation. 2. Term of Contract. This Agreement shall be in full force and effect upon execution and shall remain in effect until completion of all contractual requirements have been met as determined by City. Consultant shall complete its work by April 30, 2024, unless the time for performance is extended in writing by the Eller Corporation Page 1 of 8 Contract No. 23-196 Parties. Either Party may terminate this Agreement for material breach after providing the other Party with at least 10 days' prior notice and an opportunity to cure the breach. City may, in addition, terminate this Agreement for any reason by 10 days' written notice to Consultant. In the event of termination without breach, City shall pay Consultant for all work previously authorized and satisfactorily performed prior to the termination date. 3. Compensation. City agrees to pay Consultant an agreed upon hourly rate up to a maximum amount of $120,000 as full compensation for everything done under this Agreement, as set forth in Exhibit A. Consultant shall not perform any extra, further, or additional services for which it will request additional compensation from City without a prior written agreement for such services and payment therefore. 4. Payment. Consultant shall be paid monthly upon presentation of an invoice to City. Applications for payment shall be sent to the City Finance Department at the below -stated address. City reserves the right to withhold payment under this Agreement for that portion of the work (if any) which is determined in the reasonable judgment of the City Manager or designee to be noncompliant with the Scope of Services, City standards, City Code, and federal or state standards. 5. Notice. Notices other than applications for payment shall be given in writing as follows: TO THE CITY: Name: Marci Patterson, City Clerk Phone: (509) 720-5000 Address: 10210 East Sprague Avenue Spokane Valley, WA 99206 TO THE CONSULTANT: Name: Eller Corporation Phone: 509-226-0333 Address: 8102 N. Starr Rd Newman Lake, WA 99025 6. Applicable Laws and Standards. The Parties, in the performance of this Agreement, agree to comply with all applicable federal, state, and local laws and regulations. Consultant warrants that its designs, construction documents, and services shall conform to all federal, state, and local statutes and regulations. 7. Certification Reizardint! Debarment, Suspension, and Other Responsibility Matters — Primary Covered Transactions. A. By executing this Agreement, the Consultant certifies to the best of its knowledge and belief that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any federal department or agency; 2. Have not within a three-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, state, or local) transaction or contract under a public transaction; violation of federal or state antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or Eller Corporation Page 2 of 8 Contract No. 23-196 destruction of records, making false statements, or receiving stolen property; 3. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (A)(2) of this certification; and 4. Have not within a three-year period preceding this application/proposal had one or more public transactions (federal, state, or local) terminated for cause or default. B. Where the prospective primary participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this Agreement. 8. Relationship of the Parties. It is understood and agreed that Consultant shall be an independent contractor and not the agent or employee of City, that City is interested in only the results to be achieved, and that the right to control the particular manner, method, and means in which the services are performed is solely within the discretion of Consultant. Any and all employees who provide services to City under this Agreement shall be deemed employees solely of Consultant. The Consultant shall be solely responsible for the conduct and actions of all its employees under this Agreement and any liability that may attach thereto. 9. Ownership of Documents. All drawings, plans, specifications, and other related documents prepared by Consultant under this Agreement are and shall be the property of City, and may be subject to disclosure pursuant to chapter 42.56 RCW or other applicable public record laws. The written, graphic, mapped, photographic, or visual documents prepared by Consultant under this Agreement shall, unless otherwise provided, be deemed the property of City. City shall be permitted to retain these documents, including reproducible camera-ready originals of reports, reproduction quality mylars of maps, and copies in the form of computer files, for the City's use. City shall have unrestricted authority to publish, disclose, distribute, and otherwise use, in whole or in part, any reports, data, drawings, images, or other material prepared under this Agreement, provided that Consultant shall have no liability for the use of Consultant's work product outside of the scope of its intended purpose. 10. Records. The City or State Auditor or any of their representatives shall have full access to and the right to examine during normal business hours all of Consultant's records with respect to all matters covered in this Agreement. Such representatives shall be permitted to audit, examine, make excerpts or transcripts from such records, and to make audits of all contracts, invoices, materials, payrolls, and record of matters covered by this Agreement for a period of three years from the date final payment is made hereunder. 11. Insurance. Consultant shall procure and maintain for the duration of the Agreement, insurance against claims for injuries to persons or damage to property which may arise from or in connection with the performance of the work hereunder by Consultant, its agents, representatives, employees, or subcontractors. A. Minimum Scope of Insurance. Consultant's required insurance shall be of the types and coverages described below: 1. Automobile liability insurance covering all owned, non -owned, hired, and leased vehicles. Coverage shall be at least as broad as Insurance Services Office (ISO) form CA 0001. 2. Commercial general liability insurance shall be at least as broad as ISO occurrence form CG 00 01 and shall cover liability arising from premises, operations, stop -gap independent Eller Corporation Page 3 of 8 Contract No. 23-196 contractors and personal injury, and advertising injury. City shall be named as an additional insured under Consultant's commercial general liability insurance policy with respect to the work performed for the City using an additional insured endorsement at least as broad as ISO CG 20 26. 3. Workers' compensation coverage as required by the industrial insurance laws of the State of Washington. B. Minimum Amounts of Insurance. Consultant shall maintain the following insurance limits: 1. Automobile liability insurance with a minimum combined single limit for bodily injury and property damage of $1,000,000 per accident. 2. Commercial general liability insurance shall be written with limits no less than $2,000,000 each occurrence, and $2,000,000 general aggregate. C. Other Insurance Provisions. The Consultant's policies are to contain, or be endorsed to contain, the following provisions for automobile liability and commercial general liability insurance: 1. Consultant's insurance coverage shall be primary insurance with respect to the City. Any insurance, self-insurance, or self -insured pool coverage maintained by City shall be in excess of Consultant's insurance and shall not contribute with it. 2. Consultant shall provide City and all additional insured for this work with written notice of any policy cancellation within two business days of their receipt of such notice. 3. If Consultant maintains higher insurance limits than the minimums shown above, City shall be insured for the full available limits of commercial general and excess or umbrella liability maintained by Consultant, irrespective of whether such limits maintained by Consultant are greater than those required by this Agreement or whether any certificate of insurance furnished to the City evidences limits of liability lower than those maintained by Consultant. 4. Failure on the part of Consultant to maintain the insurance as required shall constitute a material breach of the Agreement, upon which the City may, after giving at least five business days' notice to Consultant to correct the breach, immediately terminate the Agreement, or at its sole discretion, procure or renew such insurance and pay any and all premiums in connection therewith, with any sums so expended to be repaid to City on demand, or at the sole discretion of the City, offset against funds due Consultant from the City. D. Acceptability of Insurers. Insurance is to be placed with insurers with a current A.M. Best rating of not less than A:VII. E. Evidence of Coverage. As evidence of the insurance coverages required by this Agreement, Consultant shall furnish the City with original certificates and a copy of the amendatory endorsements, including but not necessarily limited to the additional insured endorsement, evidencing the insurance requirements of the Agreement before commencement of the work. Eller Corporation Page 4 of 8 Contract No. 23-196 12. Indemnification and Hold Harmless. Consultant shall, at its sole expense, defend, indemnify, and hold harmless City and its officers, agents, and employees, from any and all claims, actions, suits, liability, loss, costs, attorney's fees, costs of litigation, expenses, injuries, and damages of any nature whatsoever relating to or arising out of the wrongful or negligent acts, errors, or omissions in the services provided by Consultant, Consultant's agents, subcontractors, subconsultants, and employees to the fullest extent permitted by law, subject only to the limitations provided below. However, should a court of competent jurisdiction determine that this Agreement is subject to RCW 4.24.115, then, in the event of liability for damages arising out of bodily injury to persons or damages to property caused by or resulting from the concurrent negligence of the Consultant and the City, its officers, officials, employees, and volunteers, the Consultant's liability, including the duty and cost to defend, hereunder shall be only to the extent of the Consultant's negligence. It is further specifically and expressly understood that the indemnification provided herein constitutes the Consultant's waiver of immunity under Industrial Insurance, Title 51, RCW, solely for the purpose of this indemnification. This waiver has been mutually negotiated by the parties. The provisions of this section shall survive the expiration or termination of this Agreement. 13. Waiver. No officer, employee, agent, or other individual acting on behalf of either Party has the power, right, or authority to waive any of the conditions or provisions of this Agreement. A waiver in one instance shall not be held to be a waiver of any other subsequent breach or nonperformance. All remedies afforded in this Agreement or by law shall be taken and construed as cumulative and in addition to every other remedy provided herein or by law. Failure of either Party to enforce at any time any of the provisions of this Agreement or to require at any time performance by the other Party of any provision hereof shall in no way be construed to be a waiver of such provisions nor shall it affect the validity of this Agreement or any part thereof. 14. Assignment and DeleEation. Neither Party may assign, transfer, or delegate any or all of the responsibilities of this Agreement or the benefits received hereunder without prior written consent of the other Party. 15. Subcontracts. Except as otherwise provided herein, Consultant shall not enter into subcontracts for any of the work contemplated under this Agreement without obtaining prior written approval of City. 16. Confidentiality. Consultant may, from time -to -time, receive information which is deemed by City to be confidential. Consultant shall not disclose such information without the prior express written consent of City or upon order of a court of competent jurisdiction. 17. Jurisdiction and Venue. This Agreement is entered into in Spokane County, Washington. Disputes between City and Consultant shall be resolved in the Superior Court of the State of Washington in Spokane County. Notwithstanding the foregoing, Consultant agrees that it may, at City's request, be joined as a party in any arbitration proceeding between City and any third party that includes a claim or claims that arise out of, or that are related to Consultant's services under this Agreement. Consultant further agrees that an arbitrator's decision therein shall be final and binding on Consultant and that judgment may be entered upon it in any court having jurisdiction thereof. 18. Cost and Attorney's Fees. The prevailing party in any litigation or arbitration arising out of this Agreement shall be entitled to its attorney's fees and costs of such litigation (including expert witness fees). 19. Entire Agreement. This written Agreement constitutes the entire and complete agreement between the Parties and supersedes any prior oral or written agreements. This Agreement may not be changed, Eller Corporation Page 5 of 8 Contract No. 23-196 modified, or altered except in writing signed by the Parties hereto. 20. Anti -kickback. No officer or employee of City, having the power or duty to perform an official act or action related to this Agreement shall have or acquire any interest in this Agreement, or have solicited, accepted, or granted a present or future gift, favor, service, or other thing of value from any person with an interest in this Agreement. 21. Assurance of Compliance with Applicable Federal Law. During the performance of this Agreement, the Consultant, for itself, its assignees, and successors in interest agrees as follows: A. Compliance with Regulations. Consultant shall comply with the federal laws set forth in subsection G, below ("Pertinent Non -Discrimination Authorities") relative to non-discrimination in federally -assisted programs as adopted or amended from time -to -time, which are herein incorporated by reference and made a part of this Agreement. B. Non-discrimination. Consultant, with regard to the work performed by it during this Agreement, shall not discriminate on the grounds of race, color, or national origin in the selection and retention of subcontractors, including procurements of materials and leases of equipment. Consultant shall not participate directly or indirectly in the discrimination prohibited by the Acts and the Regulations, including employment practices when the contract covers any activity, project, or program set forth in Appendix B of 49 CFR Part 21. C. Solicitations for Subcontracts Including Procurements of Materials and Equipment. In all solicitations, either by competitive bidding, or negotiation made by Consultant for work to be performed under a subcontract, including procurements of materials, or leases of equipment, each potential subcontractor or supplier shall be notified by Consultant of Consultant's obligations under this Agreement and the Acts and the Regulations relative to non-discrimination on the grounds of race, color, or national origin. D. Information and Reports. Consultant shall provide all information and reports required by the Acts, the regulations, and directives issued pursuant thereto, and shall permit access to its books, records, accounts, other sources of information, and its facilities as may be determined by the City or the WSDOT to be pertinent to ascertain compliance with such Acts, regulations, and instructions. Where any information required of Consultant is in the exclusive possession of another who fails or refuses to furnish the information, Consultant shall so certify to the City or the WSDOT, as appropriate, and shall set forth what efforts it has made to obtain the information. E. Sanctions for Noncompliance. In the event of a Consultant's noncompliance with the non- discrimination provisions of this Agreement, the City will impose such contract sanctions as it or the WSDOT may determine to be appropriate, including, but not limited to: 1. Withholding payments to Consultant under the Agreement until Consultant complies; and/or 2. Cancelling, terminating, or suspending the Agreement, in whole or in part. F. Incorporation of Provisions. Consultant shall include the provisions of paragraphs of these Contract Clauses in every subcontract, including procurements of materials and leases of equipment, unless exempt by the Acts, regulations and directives issued pursuant thereto. Consultant shall take action with respect to any subcontract or procurement as the City or the Eller Corporation Page 6 of 8 Contract No. 23-196 WSDOT may direct as a means of enforcing such provisions, including sanctions for noncompliance. Provided, that if Consultant becomes involved in, or is threatened with litigation by a subcontractor or supplier because of such direction, Consultant may request that the City enter into any litigation to protect the interests of the City. In addition, Consultant may request the United States to enter into the litigation to protect the interests of the United States. G. Pertinent Non -Discrimination Authorities: During the performance of this Agreement, the Consultant agrees to comply with the following non-discrimination statutes and authorities; including but not limited to: Title VI of the Civil Rights Act of 1964 (42 U.S.C. §2000d et seq., 78 stat. 252), (prohibits discrimination on the basis of race, color, national origin); and 49 CFR Part 21; and 49 Part 26; The Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970, (42 U.S.C. §4601), (prohibits unfair treatment of persons displaced or whose property has been acquired because of Federal or Federal -aid programs and projects); Federal -Aid Highway Act of 1973, (23 U.S.C. §324 et seq.), (prohibits discrimination on the basis of sex); Section 504 of the Rehabilitation Act of 1973, (29 U.S.C. §794 et seq.), as amended, (prohibits discrimination on the basis of disability); and 49 CFR Part 27; The Age Discrimination Act of 1975, as amended, (42 U.S.C. §6101 et seq.), (prohibits discrimination on the basis of age); Airport and Airway Improvement Act of 1982, (49 U.S.C. §471, Section 47123), as amended, (prohibits discrimination based on race, creed, color, national origin, or sex); The Civil Rights Restoration Act of 1987, (PL 100-209), (Broadened the scope, coverage and applicability of Title VI of the Civil Rights Act of 1964, The Age Discrimination Act of 1975 and Section 504 of the Rehabilitation Act of 1973, by expanding the definition of the terms "programs or activities" to include all of the programs or activities of the Federal - aid recipients, sub -recipients and contractors, whether such programs or activities are Federally funded or not); Titles II and III of the Americans with Disabilities Act, which prohibit discrimination on the basis of disability in the operation of public entities, public and private transportation systems, places of public accommodation, and certain testing entities (42 U.S.C. §§ 12131- 12189) as implemented by Department of Transportation regulations at 49 C.F.R. parts 37 and 38; The Federal Aviation Administration's Non-discrimination statute (49 U.S.C. §47123) (prohibits discrimination on the basis of race, color, national origin, and sex); Executive Order 12898, Federal Actions to Address Environmental Justice in Minority Populations and Low -Income Populations, which ensures Non-discrimination against minority populations by discouraging programs, policies, and activities with Eller Corporation Page 7 of 8 Contract No. 23-196 disproportionately high and adverse human health or environmental effects on minority and low-income populations; Executive Order 13166, Improving Access to Services for Persons with Limited English Proficiency, and resulting agency guidance, national origin discrimination includes discrimination because of Limited English proficiency (LEP). To ensure compliance with Title VI, you must take reasonable steps to ensure that LEP persons have meaningful access to your programs (70 Fed. Reg. at 74087 to 74100); and Title IX of the Education Amendments of 1972, as amended, which prohibits you from discriminating because of sex in education programs or activities (20 U.S.C. § 1681 et seq.). 22. Business Registration. Prior to commencement of work under this Agreement, Consultant shall register with the City as a business if it has not already done so. 23. Severability. If any section, sentence, clause, or phrase of this Agreement should be held to be invalid for any reason by a court of competent jurisdiction, such invalidity shall not affect the validity of any other section, sentence, clause, or phrase of this Agreement. 24. Exhibits. Exhibits attached and incorporated into this Agreement are: A. Scope of Services B. Fee proposal C. Insurance Certificates The Parties have executed this Agreement this / 1rday of ^/yve • % pr• — . 20 2.3. CITY OF SPOKANE VALLEY Z4 C Jo Hohman, City Manager APPROVED AS TO FORM: F4.' F _504 _•of the City Attorney Eller Corporation Page 8 of 8 Consultant: c 1lee L' or porA+on7 By: b nj&)A W. f too Its: Authorized Representative ATTACHMENT "A" EQUIPMENT AND PRICING 2023-2024 SNOW SEASON ON -CALL ROAD GRADERS FOR SNOW REMOVAL Name: •ni /!O Signature: w Date: + 0 Ll 9 f a ROAD GRADER EQUIPMENT DESCRIPTION all equipment rates to include operator labor MODEL YEAR QUANTITY AVAILABLE RATE PER HOUR J/D -�- r gt�tlZ� �o �! t44 E o D ANY OTHER CHARGES (if not Included In above rates, such as travel time o ID 00O � 10 ATTACHMENT B - SCOPE OF SERVICES SCOPE OF SERVICES The scope of Services will include, but is not limited to, the following: 1. The Contractor shall have a motor road grader 140G or equivalent with no larger than a 14' moldboard and be able to supply themselves tire chains and replacements. 2. The Contractor shall provide grader operators for 12-hour shifts. Generally, a full city residential plow takes 48 hours to complete. 3. Road Graders must be able to work on city streets with lights and a flashing hazard (work light). Road Graders shall be able to work continuously until the snow emergency event ends and released by the City. DESCRIPTION OF WORK REQUIRED Work required includes activities described in the Scope of Services and may include, but not be limited to, the following description list: 1. The City will instruct Contractor/Operator on which routes/areas are to be plowed. 2. The Contractor shall perform work in compliance with requirements of all applicable codes and standards of governing authorities having jurisdiction, including provision for adequate protection to persons and property by means of insurance, bonding, traffic, etc. RESPONSE TIME EXPECTATIONS 1. The Contractor shall provide a 24 hour a day contact number, name, and be able to report with 12-hour advance notice. 2. Contractor shall call back within 30 minutes after initial call is made from the City requesting their services. After 30 minutes, the next Contractor on the list will be contacted. 3. The Contractor shall have grader fully fueled and ready to work. ELLECOR-01 SSIMPSON1 ACORO; `,� CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 12/28/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) 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 Hub International Northwest LLC PO Box 3144 Spokane, WA 99220 NAMEACT Stacia Simpson PAHicNNo, Ext): (509) 319-2912 (FAX No): E-MAIL ADD Ess: Stacia.Simpson@hubinternational.com INSURERS AFFORDING COVERAGE NAIC # INSURER A: Cincinnati Insurance Company 10677 INSURED INSURER B : INSURER C : Eller Corporation INSURER D : PO Box 117 Newman Lake, WA 99025 INSURER E INSURER F : I`A\/CD A!_CC (_1=0T1PIC-ATE NILIMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS A COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE �X OCCUR X X EPP0563496/EBA0563496 12/31/2022 12/31/2023 DAM AGE TO RENTED PRE ES Ea occurrence 500,000 $ MED EXP (Anyone erson $ 1 O,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY FX] jER(?r LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 WA STOP GAP $ 1,000,000 A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1,000,000 $ BODILY INJURY Perperson) $ X ANY AUTO X X EPP0563496/EBA0563496 12/31/2022 12/31/2023 BODILY INJURY Per accident $ OWNED SCHEDULED AUTOS ONLY AUTOS X HIRED X NON -AWNED AUTOS ONLY AUTOS ONLY PerracEcidentDAMAGE $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 EXCESS LIAB CLAIMS -MADE X X EPP0563496/EBA0563496 12/31/2022 12/31/2023 AGGREGATE $ 2,000,000 DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N / A PTATUTE ERH E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE -POLICY LIMIT $ If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CONTRACT #20-188: 2022-2023 SNOW SEASON ON -CALL ROAD GRADERS FOR SNOW REMOVAL PRIMARY/NONCONTRIBUTORY ADDITIONAL INSURED STATUS AND WAIVER OF SUBROGATION AS IT RELATES TO GENERAL LIABILITY IS GIVEN TO THE CITY OF SPOKANE VALLEY, ITS OFFICERS, AGENTS AND EMPLOYEES PER ENDORSEMENTS ATTACHED. CITY OF SPOKANE VALLEY 10210 E SPRAGUE AVENUE SPOKANE VALLEY, WA 99206 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reservea. The ACORD name and logo are registered marks of ACORD 10/25123, 12:40 PM ELLER CORPORATION STATE OF WAS"ING70N Department of Labor & Industries Certificate of Workers' Compensation Coverage WA UBI No. L&I Account ID Legal Business Name Doing Business As Workers' Comp Premium Status: Estimated Workers Reported (See Description Below) Account Representative Licensed Contractor? License No. License Expiration October 25, 2023 600 184 764 642,062-00 ELLER CORPORATION ELLER CORP Call L&I account representative for account status. Incomplete premium report received. Employer Services Help Line, (360) 902-4817 Yes ELLERC*242C3 10/01 /2024 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:llsecure.ini.wa.gov/verify/Details/liabi lityCertificate.aspx?U B 1=600184764&LI C=ELLERC*242C3&VIO=&SAW=false&ACCT=64206200 1 /1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CinciPlus® BUSINESS AUTO XC+® (EXPANDED COVERAGE PLUS) ENDORSEMENT This endorsement modifies insurance provided by the following: BUSINESS AUTO COVERAGE FORM With respect to the coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. A. Blanket Waiver of Subrogation SECTION IV - BUSINESS AUTO CONDI- TIONS, A. Loss Conditions, 5. Transfer of Rights of Recovery Against Others to Us is amended by the addition of the following: We waive any right of recovery we may have against any person or organization because of payments we make for "bodily injury" or "property damage" arising out of the operation of a covered "auto" when you have assumed liability for such "bodily injury" or "property damage" under an "insured contract", provid- ed the "bodily injury" or "property damage" oc- curs subsequent to the execution or the "in- sured contract". B. Noncontributory Insurance SECTION IV - BUSINESS AUTO CONDI- TIONS, B. General Conditions, 5. Other In- surance c. is replaced by the following: c. Regardless of the provisions of Par- agraph a. above, this Coverage Form's Liability Coverage is primary and we will not seek contribution from any other insurance for any lia- bility assumed under an "insured contract" that requires liability to be assumed on a primary noncontributo- ry basis. This provision does not apply unless the valid written contract has been: 1. Executed prior to the accident causing "bodily injury" or "property damage"; and 2. Is still in force at the time of the "accident" causing "bodily injury" or "property dam- age". D. Employee Hired Auto 1. Changes in Liability Coverage The following is added to the Section II - Liability Coverage, A. Coverage, 1. Who is an Insured: An "employee" of yours is an "insured" while operating an "auto" hired or rented under a contract or agreement in that "employee's" name, with your permission, while performing duties related to the conduct of your business. 2. Changes in General Conditions SECTION IV - BUSINESS AUTO CON- DITIONS, B. General Conditions, S. Other Insurance is amended by replac- ing Paragraph 5.b. with the following: b. For Hired Auto Physical Damage Coverage the following are deemed to be covered "autos" you own: C. Additional Insured by Contract (1) Any covered "auto" you lease, SECTION it - LIABILITY COVERAGE, A. hire, rent or borrow; and Coverage, 1. Who is an Insured is amended (2) Any covered "auto" hired or to include as an insured any person or organi- zation with which you have agreed in a valid rented by your "employee" under written contract to provide insurance as is af- a contract in that individual "em- forded by this policy. ployee's" name, with your per- mission, while performing duties This provision is limited to the scope of the related to the conduct of your valid written contract. business. Includes copyrighted material of ISO AA 288 01 16 Properties, Inc., with its permission. Page 1 of 4 However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". E. Audio, Visual and Data Electronic Equip- ment SECTION III - PHYSICAL DAMAGE COV- ERAGE, C. Limit of Insurance is amended by adding the following: 4. The most we will pay for all "loss" to au- dio, visual or data electronic equipment and any accessories used with this equipment as a result of any one "acci- dent" is the lesser of: a. The actual cash value of the dam- aged or stolen property as of the time of the "accident'; b. The cost of repairing or replacing the damaged or stolen property with oth- er property of like kind and quality; or c. $2,500. Provided the equipment, at the time of the . "loss" is: a. Permanently installed in or upon the covered "auto" in a housing, opening or other location that is not normally used by the "auto" manufacturer for the installation of such equipment; b. Removable from a permanently in- stalled housing unit as described in Paragraph 2.a. above; or c. An integral part of such equipment. F. Who is an Insured - Amended SECTION II - LIABILITY COVERAGE, A. Coverage, 1. Who is an Insured is amended by adding the following: The following are "insureds": 1. Any subsidiary which is a legally incorpo- rated entity of which you own a financial interest of more than 50% of the voting stock on the effective date of this cover- age form. However, the insurance afforded by this provision does not apply to any subsidiary that is an "insured" under any other au- tomobile liability policy, or would be an "insured" under such policy but for termi- nation of such policy or the exhaustion of such policy's limits of insurance. 2. Any organization that is newly acquired or formed by you and over which you main- tain majority ownership. The insurance provided by this provision: a. Is effective on the date of acquisition or formation, and is afforded for 180 days after such date; b. Does not apply to "bodily injury" or "property damage" resulting from an "accident" that occurred before you acquired or formed the organization; c. Does not apply to any newly acquired or formed organization that is a joint venture or partnership; and d. Does not apply to an insured under any other automobile liability policy, or would be an insured under such a policy but for the termination of such policy or the exhaustion of such poli- cy's limits of insurance. 3. Any of your "employees" while using a covered "auto" in your business or your personal affairs, provided you do not own, hire or borrow that "auto". G. Liability Coverage Extensions - Supple- mentary Payments - Higher Limits SECTION 11 - LIABILITY COVERAGE, A. Coverage, 2. Coverage Extensions, a. Sup- plementary Payments is amended by: 1. Replacing the $2,000 Limit of Insurance for bail bonds with $4,000 in (2); and 2. Replacing the $250 Limit of Insurance for reasonable expenses with $500 in (4). H. Amended Fellow Employee Exclusion SECTION II - LIABILITY COVERAGE, B. Ex- clusions, 5. Fellow Employee is modified as follows: Exclusion 5. Fellow Employee is deleted. I. Hired Auto - Physical Damage If hired "autos" are covered "autos" for Liability Coverage, then Comprehensive and Collision Physical Damage Coverages as provided un- der SECTION III - PHYSICAL DAMAGE COVERAGE of this Coverage Part are ex- tended to "autos" you hire, subject to the fol- lowing: 1. The most we will pay for "loss" to any hired "auto" is $50,000 or the actual cash value or cost to repair or replace, which- ever is the least, minus a deductible. 2. The deductible will be equal to the largest deductible applicable to any owned "auto" for that coverage, or $1,000, whichever is less. Hired Auto - Physical Damage coverage is excess over any other collectible insur- ance. Includes copyrighted material of ISO AA 288 0116 Properties, Inc., with its permission. Page 2 of 4 4. Subject to the above limit, deductible, and excess provisions we will provide cover- age equal to the broadest coverage appli- cable to any covered "auto" you own in- sured under this policy. Coverage includes loss of use of that hired au- to, provided it results from an "accident" for which you are legally liable and as a result of which a monetary loss is sustained by the leasing or rental concern. The most we will pay for any one "accident" is $3,000. If a limit for Hired Auto - Physical Damage is shown in the Schedule, then that limit replac- es, and is not added to, the $50,000 limit indi- cated above. J. Rental Reimbursement SECTION III - PHYSICAL DAMAGE is amended by adding the following: 1. We will pay for rental reimbursement ex- penses incurred by you for the rental of an "auto" because of a "loss" to a covered "auto". Payment applies in addition to the otherwise applicable amount of each cov- erage you have on a covered "auto". No deductible applies to this coverage. 2. We will pay only for those expenses in- curred during the policy period beginning 24 hours after the "loss" and ending, re- gardless of the policy's expiration, with the lesser of the following number of days: a. The number of days reasonably re- quired to repair the covered "auto". If "loss" is caused by theft, this number of days is added to the number of days it takes to locate the covered "auto" and return it to you; or b. 30 days. 3. Our payment is limited to the lesser of the following amounts: a. Necessary and actual expenses in- curred; or b. $50 per day. 4. This coverage does not apply while there are spare or reserve "autos" available to you for your operations. K. Transportation Expense - Higher Limits SECTION 111 - PHYSICAL DAMAGE COV- ERAGE, A. Coverage, 4. Coverage Exten- sions is amended by replacing $20 per day with $50 per day, and $600 maximum with $1,500- maximum in Extension a. Transpor- tation Expenses. L. Airbag Coverage SECTION III - PHYSICAL DAMAGE COV- ERAGE, B. Exclusions, 3.a. is amended by adding the following: However, the mechanical and electrical breakdown portion of this exclusion does not apply to the accidental discharge of an airbag. This coverage for airbags is excess over any other collectible insurance or warranty. M. Loan or Lease Gap Coverage 1. SECTION III - PHYSICAL DAMAGE COVERAGE, C. Limit of Insurance is deleted in its entirety and replaced by the following, but only for private passenger type "autos" with an original loan or lease, and only in the event of a "total loss" to such a private passenger type "auto": a. The most we will pay for "loss" in any one "accident" is the greater of: (1) The amount due under the terms of the lease or loan to which your covered private passenger type "auto" is subject, but will not include: (a) Overdue lease or loan pay- ments; (b) Financial penalties imposed under the lease due to high mileage, excessive use or abnormal wear and tear; (c) Security deposits not re- funded by the lessor; (d) Costs for extended warran- ties, Credit Life Insurance, Health, Accident or Disabil- ity Insurance purchased with the loan or lease; and (e) Carry-over balances from previous loans or leases, or 5. We will pay under this coverage only that (2) Actual cash value of the stolen amount of your rental reimbursement ex- penses which is not already provided for or damaged property. under SECTION III - PHYSICAL DAM- b. An adjustment for depreciation and AGE COVERAGE, A. Coverage, 4. physical condition will be made in de - Coverage Extensions. termining actual cash value at the time of "loss". Includes copyrighted material of ISO AA 288 01 16 Properties, Inc., with its permission. Page 3 of 4 2. SECTION V - DEFINITIONS is amended by adding the following, but only for the purposes of this Loan or Lease Gap Coverage: "Total loss" means a 'loss" in which the cost of repairs plus the salvage value ex- ceeds the actual cash value. N. Glass Repair -Waiver of Deductible SECTION III - PHYSICAL DAMAGE COV- ERAGE, D. Deductible is amended by adding the following: No deductible applies to glass damage if the glass is repaired in a manner acceptable to us rather than replaced. O. Duties in the Event of an Accident, Claim, Suit or Loss - Amended SECTION IV - BUSINESS AUTO CONDI- TIONS, A. Loss Conditions, 2. Duties in the Event of Accident, Claim, Suit or Loss, a. is amended by adding the following: This condition applies only when the "acci- dent" or "loss" is known to: 1. You, if you are an individual; 2. A partner, if you are a partnership; 3. An executive officer or insurance manag- er, if you are a corporation; or 4. A member or manager, if you are a lim- ited liability company. P. Unintentional Failure to Disclose Hazards SECTION IV - BUSINESS AUTO CONDI- TIONS, B. General Conditions, 2. Conceal- ment, Misrepresentation or Fraud is amended by adding the following: However, if you unintentionally fail to disclose any hazards existing on the effective date of this Coverage Form, we will not deny cover- age under this Coverage Form because of such failure. Q. Mental Anguish Resulting from Bodily Inju- ry SECTION V - DEFINITIONS, C. "Bodily inju- ry" is deleted in its entirety and replaced by the following: "Bodily injury" means bodily injury, sickness or disease sustained by a person, including men- tal anguish and death sustained by the same person that results from such bodily injury, sickness or disease. "Bodily injury" does not include mental anguish or death that does not result from bodily injury, sickness or disease. R. Coverage for Certain Operations in Con- nection with Railroads With respect to the use of a covered "auto" in operations for or affecting a railroad: 1. Section V - Definitions, H. 'Insured con- tract", 1.c. is amended to read: c. An easement or license agreement; 2. Section V - Definitions, H. 'Insured con- tract", 2.a. is deleted. Includes copyrighted material of ISO AA 288 01 16 Properties, Inc., with its permission. Page 4 of 4 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WASHINGTON - TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL UMBRELLA LIABILITY COVERAGE PART PROFESSIONAL UMBRELLA LIABILITY COVERAGE PART PROFESSIONAL UMBRELLA LIABILITY COVERAGE PART - CLAIMS -MADE Paragraph 13. Transfer of Rights of Recovery Against Others to Us of Section IV - Conditions is revised by the addition of the following: We shall be entitled to a recovery only after the insured has been fully compensated for damages. Includes copyrighted material of Insurance US 4068 WA 06 07 Services Office, Inc., with its permission. gate Limit of Insurance, Paragraph 2.b., or the Construction Project General Ag- gregate Limit of Insurance, Paragraph 2.c. applies. b. A separate Location General Aggregate Limit of Insurance, equal to the amount of the General Aggregate Limit shown in the 3. Declarations, shall apply to each location owned by, or rented or leased to you and is the most we will pay for the sum of: (1) Damages under COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY, except dam- ages because of "bodily injury" or 4. "property damage" included in the "products -completed operations hazard"; and (2) Medical expenses under COVER- AGE C. MEDICAL PAYMENTS, which can be attributed to operations at only a single location owned by, or rented or leased to you. c. A separate Construction Project General Aggregate Limit of Insurance, equal to the amount of the General Aggregate Limit shown in the Declarations, shall ap- ply to each construction project and is the most we will pay for the sum of: your behalf at the same location for the same persons or organizations, no matter how often or under how many different contracts, will be deemed to be a single construction project. The Products -Completed Operations Aggre- gate Limit is the most we will pay under COW ERAGE A. BODILY INJURY AND PROP- ERTY DAMAGE LIABILITY for damages be- cause of "bodily injury" and "property dam- age" included in the "products -completed op- erations hazard". Subject to 2.a. above, the Personal and Ad- vertising Injury Limit is the most we will pay under COVERAGE B. PERSONAL AND AD- VERTISING INJURY LIABILITY for the sum of all damages because of all "personal and ad- vertising Injury" sustained by any one person or organization. 5. Subject to 2. or S. above, whichever applies, the Each Occurrence Limit is the most we will pay for the sum of: (1) Damages under COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY, except dam- 6. ages because of "bodily in ury" or "property damage" include In the "products -completed operations hazard"; and (2) Medical expenses under COVER- AGE C. MEDICAL PAYMENTS; which can be attributed only to ongoing operations and only at a single construc- tion project. d. Only for the purpose of determining which General Aggregate Limit of Insurance, 2.a., 2.b., or 2.c., applies: (1) Location means premises involving the same or connecting lots, or premises, whose connection Is inter- rupted only by a street, roadway, waterway or right of -way of a rail- road. (2) Construction project means a loca- tion you do not own, rent or lease where ongoing improvements, al- terations, installation, demolition or maintenance work is performed by you or on your behalf. All connected ongoing improvements, alterations, installation, demolition or mainte- nance work performed by you or on a. Damages under COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LI- ABILITY; and b. Medical expenses under COVERAGE C. MEDICAL PAYMENTS; because of all "bodily injury" and "property damage" arising out of any one "occurrence". - Subject to 5. above, the Damage to Premises Rented to You Limit is the most we will pay under COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY for dam- ages because of "property damage" to any one premises, while rented to you, or in the case of damage by fire or explosion, while rented to you or temporarily occupied by you with permission of the owner. 7. Subject to 5. above, the Medical Expense Limit is the most we will pay under COVER- AGE C. MEDICAL PAYMENTS for all medical expenses because of "bodily injury" sustained by any one person. The Limits of Insurance of this Coverage Part ap- ply separately to each "coverage term". SECTION IV - COMMERCIAL GENERAL LI- ABILITY CONDITIONS 1. Bankruptcy Bankruptcy or insolvency of the Insured or of the insured's estate will not relieve us of our obligations under this Coverage Part, 2. Duties in the Event of Occurrence, Offense, Claim or Suit a. You must see to it that we are notified as soon as practicable of an "occurrence" or Includes copyrighted material of insurance GA 10112 04 Services Office, Inc., with its permission. 'Page 13 of 22 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AUTOMATIC NON-CONTRIBUTORY COVERAGE ENDORSEMENT - WHERE_ REQUIRED BY WRITTEN CONTRACT This endorsement modifies insurance provided under the following: COMMERCIAL UMBRELLA LIABILITY COVERAGE PART SCHEDULE LIMITS OF INSURANCE: $ 2 ,000,000 Each Occurrence Limit $ 2 000,000 Aggregate Limit COMMERCIAL UMBRELLA LIABILITY COVERAGE FORM, US 101 and US 101 UM, is amended as follows: A. SECTION III - LIMITS OF INSURANCE is It is agreed that this condition does not amended to add the following: apply to the "non-contributory additional 7. For the purposes of this endorsement on- insured's" own insurance program. ly, the Limits of Insurance stated in the This exception to the Other Insurance Schedule of this endorsement and de- Condition shall only apply if the applicable scribed below will apply on a "non- "underlying insurance" applies on a "non- contributory basis" within the parameters contributory basis" for such "non - set forth in SECTION III - LIMITS OF IN- contributory additional insured" and only SURANCE of the Coverage Part to which to the extent of the specific limits of insur- this endorsement is attached: ance required in a written contract or agreement on a "non-contributory basis" We will not a more on behalf of a "non- pay that is in excess of the nunderlying insur- contributory additional insured" than the ance". lesser of: 2• The following condition is added: a. The Limits of Insurance stated in the Schedule of this endorsement; or 15. As a precedent to the receipt of in- b. The limits of insurance required in a surance coverage hereunder, the non-contributory additional insured written contract on a "non- must give written notice of such claim contributory basis" for such "non- ry or "suit", including a demand for de - contributory additional insured", but fense and indemnity, to any other in - only to the extent the required limits surer who had coverage for the claim of insurance are in excess of the or "suit" under its policies. Such no - "underlying insurance"; or tice must demand the full coverage c. The Limits of Insurance available of available and the "non-contributory ter the payment of "ultimate net loss" additional insured" shall not waive or on any insured's behalf from any limit such other available coverage. claim or "suit". This condition does not apply to the This provision is included within and does "non-contributory additional insureds" not act to incrgase the Limits of Insurance own insurance program. stated in the Declarations. C. SECTION IV - DEFINITIONS is amended to B. SECTION IV - CONDITIONS is amended as add the following: follows; 30. "Non-contributory additional insured" 1. Condition 9. Other Insurance is amended means any person or organization: to add the following: a. Qualifying as an additional insured under SECTION 11 - WHO IS AN IN- SURED, Paragraph 3, of the Cover - Includes copyrighted material of ISO US 4096 1116 Properties, Inc., with its permission. Page 1 of 2 age Part to which this endorsement is (2) The written contract or agree - attached; and ment requires a specific limit of insurance on a "non-contributory b. Being granted additional insured sta- basis" that is in excess of "un- tus on a "noncontributory basis" in derlying insurance". the "underlying insurance" as re- quired in a written contract between 31. "Non-contributory basis" means that the an additional insured and a Named limits of insurance of the Coverage Partto Insured provided: which this endorsement is attached apply to insured loss on behalf of the "non- (1) The written contract or agree- contributory additional insured" prior to ment is executed before the "oc- limits of insurance from other insurance in currence" resulting in "bodily in- which the "non-contributory additional in- jury", "personal and advertising sured" is a named insured. injury" or "property damage" for which coverage is being sought under this endorsement; and Includes copyrighted material of ISO US 4096 1116 Properties, Inc., with its permission. Page 2 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS' COMMERCIAL GENERAL LIABILITY BROADENED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Endorsement - Table of Contents: Coverage: Begins on Page: 1. Employee Benefit Liability Coverage.................................................................................................2 2. Unintentional Failure to Disclose Hazards.........................................................................................7 3. Damage to Premises Rented to You................................................................................................. 8 4. Supplementary Payments..................................................................................................................9 5. Medical Payments..............................................................................................................................9 6. Voluntary Property Damage (Coverage a.) and Care, Custody or Control Liability Coverage (Coverage b.).......................................................................................................9 7. 180 Day Coverage for Newly Formed or Acquired Organizations...................................................10 8. Waiver of Subrogation.....................................................................................................................10 9. Automatic Additional Insured - Specified Relationships: ...............................................................10 • Managers or Lessors of Premises; • Lessor of Leased Equipment; • Vendors; • State or Political Subdivisions - Permits Relating to Premises; • State or Political Subdivisions - Permits; and • Contractors' Operations 10. Broadened Contractual Liability -Work Within 50' of Railroad Property.........................................14 11. Property Damage to Borrowed Equipment......................................................................................14 12. Employees as Insureds - Specified Health Care Services: ...........................................................14 • Nurses; • Emergency Medical Technicians; and • Paramedics 13. Broadened Notice of Occurrence....................................................................................................14 B. Limits of Insurance: The Commercial General Liability Limits of Insurance apply to the insurance provided by this endorse- ment, except as provided below: 1. Employee Benefit Liability Coverage Each Employee Limit: $ 1,000,000 Aggregate Limit: $ 3,000,000 Deductible: $ 1,000 3. Damage to Premises Rented to You The lesser of: a. The Each Occurrence Limit shown in the Declarations; or b. $500,000 unless otherwise stated $ 4. Supplementary Payments a. Bail bonds: $ 1,000 b. Loss of earnings: $ 350 5. Medical Payments Medical Expense Limit: $ 10,000 Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission. Page 1 of 15 6. Voluntary Property Damage (Coverage a.) and Care, Custody or Control Liability Coverage (Coverage b.) Limits of Insurance (Each Occurrence) Coverage a. $1,000 Coverage b. $5,000 unless otherwise stated $ Deductibles (Each Occurrence) Coverage a. $250 Coverage b. $250 unless otherwise stated $ COVERAGE PREMIUM BASIS RATE ADVANCE PREMIUM a Area b Payroll (For Limits in Excess of (For Limits in Excess of c Gross Sales $5,000) $5,000) d Units e Other b. Care, Custody $ or Control ALANNUAL PREMIUM 11. Property Damage to Borrowed Equipment Each Occurrence Limit: $ 10,000 Deductible: $ 250 C. Coverages: have used up the appli- cable limit of insurance 1. Employee Benefit Liability Coverage in the payment of a. The following is added to SECTION 1 judgments or settle- - COVERAGES: Employee Benefit ments. Liability Coverage. No other obligation or liabil- (1) Insuring Agreement ity to pay sums or perform ads or services is covered (a) We will pay those sums that unless explicitly provided for the insured becomes legally under Supplementary Pay - obligated to pay as dam- ments. ages caused by any ad, er- the in- (b) This insurance applies to ror or omission of sured, or of any other per- damages only if the ad, er- son for whose acts the in- ror or omission, is negli- sured is legally liable, to gently gently committed in the which this insurance ap- "administration„ of your employee benefit pro - plies. We will have the right and duty to defend the in- sured against any "suit' 1) Occurs during the pol- seekdng those damages. icy period; or However, we will have no duty to defend against any 2) Occurred prior to the "suit" seeking damages to effective date of this which this insurance does endorsement provided: not apply. We may, at our discretion, investigate any a) You did not have report of an ad, error or knowledge of a omission and settle any claim or "suit" on claim or "suit" that may re- or before the ef- sult. But: fective date of this endorsement. 1) The amount we will pay for damages is limited You will be as described in SEC- deemed to have TION III - LIMITS OF knowledge of a INSURANCE; and claim or "suit" when any "author- 2) Our right and duty to ized representa- defend ends when we tive'; Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission. Page 2 of 15 i) Reports all, or formance of investment any part, of the vehicles; or act, error or 3) Advice given to any omission to us person with respect to or any other that person's decision insurer; to participate or not to participate in any plan ii) Receives a included in the "em- written or ver- bal demand or ployee benefit pro- claim for dam- gram". ages because (f) Workers' Compensation of the act, er- and Similar Laws ror or omis- sion; and Any claim arising out of your failure to comply with the b) There is no other mandatory provisions of any applicable iother workers' compensation, un- ance. employment compensation insurance, social security or (2) Exclusions disability benefits law or any This insurance does not apply similar law. to: (g) ERISA (a) Bodily Injury, Property Damage or Personal and Damages for which any in - li- Injury sured is liable because of Advertising ability imposed on a fiduci- 'Bodily injury", "property damage" or "personal and ary by the Employee Re - tirement Income Security advertising injury". Act of 1974, as now or hereafter amended, or by (b) Dishonest, Fraudulent, any similar federal, state or Criminal or Malicious Act local laws. Damages arising out of any (h) Available Benefits intentional, dishonest, fraudulent, criminal or mali- Any claim for benefits to the cious act, error or omission, by any insured, extent that such benefits are available, with reasonable committed including the willful or reck- effort and cooperation of the less violation of any statute. insured, frorn funds accrued hor applicable er col- (c) Failure to Perform a Con- lectible insurance. tract (i) Taxes, Fines or Penalties Damages arising out of fail- ure of performance of con- axes, fines penalties, s, trail by any insurer. mpoe under the those e Internal Revenue (d) Insufficiency of Funds Code or any similar state or Damages arising out of an local taw. insufficiency of funds to (j) Employment -Related meet any obligations under Practices any plan included in the "employee benefit pro- Any liability arising out of gram". any: (e) Inadequacy of Perform- (1) Refusal to employ; ante of Investment / Ad- 2 Termination of em- () vice Given With Respect ployment; to Participation Any claim based upon: (3) Coercion, demotion, evaluation, reassign- 1) Failure of any invest- ment, discipline, defa- mation, harassment, ment to perform; humiliation, discrimina- 2) Errors in providing in- tion or other employ - formation on past per - Includes copyrighted material of Insurance Page 3 of 15 GA 233 02 07 Services Office, Inc., with its permission. 9 ment related practices, acts or omissions; or (e) A trust, you are an insured. Your trustees are also in- (4) Consequential liability sureds, but only with ye- as a result of (1), (2) or spect to their duties as trus- (3) above. tees. This exclusion applies (2) Each of the following is also an whether the insured may be insured: held liable as an employer (a) Each of your "employees" or in any other capacity and to any obligation to share who is or was authorized to damages with or repay administer your "employee benefit program". someone else who must pay damages because of (b) Any persons, organizations the injury. or "employees" having (3) Supplementary Payments proper temporary authoriza- tion to administer your em- SECTION I - COVERAGES, ployee benefit program" if SUPPLEMENTARY PAY- you die, but only until your MENTS - COVERAGES A AND legal representative is ap- B also apply to this Coverage. pointed. b. Who is an Insured (c) Your legal representative if you die, but only with re - As respects Employee Benefit Liabil- spect to duties as such. ity Coverage, SECTION II - WHO IS That representative will AN INSURED is deleted in its en- have all your rights and du- tirety and replaced by the following: ties under this Coverage (1) If you are designated in the Dec - Part. larations as: (3) Any organization you newly ac- (a) An individual, you and your quire or form, other than a part - nership, joint venture or limited spouse are insureds, but only with respect to the con- liability company, and over which you maintain ownership or duct of a business of which majority interest, will qualify as a you are the sole owner. Named Insured if no other simi- (b) A partnership or joint ven- lar insurance applies to that or- ture you are an insured. ganization. However, coverage under this provision: Your members, your part - ners, and their spouses are (a) Is afforded only until the also insureds but only with 180th day after you acquire respect to the conduct of or form the organization or your business. the end of the policy period, (c) A limited liability company, whichever is earlier; and you are an insured. Your (b) Does not apply to any act, members are also insureds, but only with respect to the error or omission that was conduct of your business. committed before you ac- quired or formed the organi- Your managers are insur- zation. eds, but only with respect to their duties as your manag- c. Limits of Insurance ers. As respects Employee Benefit Liabil- (d) An organization other than a ity Coverage, SECTION III - LIMITS partnership, joint venture or OF INSURANCE is deleted in its en - limited liability company, tirety and replaced by the following: you are an insured. Your "executive officers" and di- (1) The Limits of Insurance shown rectors are insureds, but in Section B. Limits of Insur- only with respect to their du- ance, 1. Employee Benefit Li - ties as your officers or direc- ability Coverage and the rules tors. Your stockholders are below fix the most we will pay also insureds, but only with regardless of the number of: respect to their liability as (a) Insureds; stockholders. Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission. Page 4 of 15 (b) Claims made or "suits" (b) The deductible amount brought; stated in the Declarations applies to all damages sus- (c) Persons or organizations tained by any one "em- making claims or bringing ployee", including such "em- "suits"; ployee's" dependents and beneficiaries, because of all (d) Acts, errors or omissions; or acts, errors or omissions to (e) Benefits included in your which this insurance ap- "employee benefit pro- plies. gram". (c) The terms of this insurance, (2) The Aggregate Limit shown in including those with respect Section B. Limits of Insurance, to: 1. Employee Benefit Liability 1) Our right and duty to Coverage of this endorsement defend the insured is the most we will pay for all against any "suits" damages because of acts, errors seeking those dam - or omissions negligently commit- ages; and ted in the "administration" of your "employee benefit pro- 2) Your duties, and the gram". duties of any other in Subject to the limit described in volved insured, in the event of an act, error or (2) above, the Each Employee omission, or claim, Limit shown in Section B. Limits of Insurance, 1. Employee apply irrespective of the ap- Benefit Liability Coverage of pfcation of the deductible this endorsement is the most we amount. will pay for all damages sus- tained by any one "employee", (d) We may pay any part or all including damages sustained by of the deductible amount to such "employee's" dependents effect settlement of any and beneficiaries, as a result of claim or "suit" and, upon no- tification of the action taken, (a) An act, error or omission; or you shall promptly reim- burse us for such part of the (b) A series of related acts, er- deductible amount as we rors or omissions, regard- have paid. less of the amount of time that lapses between such d. Additional Conditions ads, errors or omissions, As respects Employee Benefit Li - negligently committed in the ability Coverage, SECTION N - "administration" of your "em- COMMERCIAL GENERAL LIABIL- ployee benefit program". ITY CONDITIONS is amended as fol- However, the amount paid under lows: this endorsement shall not ex- (1) Item 2. Duties in the Event of ceed, and will be subject to the Occurrence, Offense, Claim or limits and restrictions that apply Suit is deleted in its entirety and to the payment of benefits in any replaced by the following: plan included in the "employee benefit program". 2. Duties in the Event of an Act, Error or Omission, or Claim or Suit (4) Deductible Amount a. You must see to it that we are noti- (a) Our obligation to pay dam- fied as soon as practicable of an act, ages on behalf of the in- error or omission which may result in sured applies only to the a claim. To the extent possible, no - amount of damages in ex- tice should include: cess of the deductible amount stated in the Decla- (1) What the act, error or omission rations as applicable to was and when it occurred; and Each Employee. The limits of insurance shall not be re- (2) The names and addresses of duced by the amount of this anyone who may suffer dam - ages as a result of the act, error deductible. or omission. Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission. Page 5 of 15 b. If a claim is made or "suit" is brought b. Method of Sharing against any insured, you must: If all of the other insur- (1) Immediately record the specifics ance permits contribu- of the claim or "suit" and the tion by equal shares, date received; and we will follow this method also. Under ()2 Notify us as soon as practicable. fY P this approach each in - You must see to it that we receive surer contributes equal written notice of the claim or "suit" as amounts until it has soon as practicable. paid its applicable limit of insurance or none of c. You and any other involved insured the loss remains, must: whichever comes first. (1) Immediately send us copies of If any of the other in - any demands, notices, sum- surance does not per- monses or legal papers received mit contribution by in connection with the claim or equal shares, we will "suit"; contribute by limits. Under this method, (2) Authorize us to obtain records each insurer's share is and other information; based on the ratio of its (3) Cooperate with us in the investi- applicable limit of in- surance to the total ap- gation or settlement of the claim plicable limits of insur- or defense against the "suit'; ance of all insurers. and (4) Assist us, upon our request, in c. No Coverage the enforcement of any right This insurance shall not against any person or organiza- cover any loss for tion which may be liable to the which the insured is en - insured because of an act, error titled to recovery under or omission to which this insur- any other insurance in ance may also apply. force previous to the ef- d. No insured will, except at that in- fective date of this Coverage Part. sured's own cost, voluntarily make a payment, assume any obligation, or e. Additional Definitions incur any expense without our con- sent. As respects Employee Benefit Li- ability Coverage, SECTION V - (2) Item 5. Other Insurance is de- DEFINITIONS is amended as fol- leted in its entirety and replaced lows: by the following: (1) The following definitions are 5. Other Insurance added If other valid and collectible 1. "Administration" means: insurance is available to the insured for a loss we cover a. Providing information to under this Coverage Part, "employees", including our obligations are limited their dependents and as follows: beneficiaries, with re- spect to eligibility for or a. Primary Insurance scope of "employee This insurance is pri- benefit programs"; mary except when c. b. Interpreting the "em- below applies. If this ployee benefit pro - insurance is primary, grams"; our obligations are not affected unless any of c. Handling records in the other insurance is connection with the also primary. Then, we "employee benefit pro - will share with all that grams"; or other insurance by the method described in b. d. Effecting, continuing or below. terminating any "em- ployee's" participation Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission. Page 6 of 15 GA 233 02 07 in any benefit included benefits, workers' com- in the "employee bene- pensation and disability fit program". benefits; and However, "administration" d. Vacation plans, includ- does not include: ing buy and sell pro- grams; leave of ab- a. Handling payroll deduc- senoe programs, in- tions; or cluding military, mater- b. The failure to effect or nity, family, and civil leave; tuition assis- maintain any insurance tance plans; transporta- or adequate limits of and health dub tioncoverage of insurance, b subsidies. s including but not limited to unemployment in- (2) The following definitions are de- suranoe, social security leted in their entirety and re - benefits, workers' com- placed by the following: pensation and disability benefits. 21. "Suit' means a civil pro- ceeding in which money 2. "Cafeteria plans" means damages because of an act, plan authorized by applica- error or omission to which ble law to allow "employ- this insurance applies are ees" to elect to pay for cer- alleged. "Suit' includes: tain benefits with pre-tax dollars. a. An arbitration proceed- ing in which such dam- 3. "Employee benefit pro- ages are claimed and grams" means a program to which the insured providing some or all of the must submit or does following benefits to "em- submit with our con- ployees", whether provided sent; through a "cafeteria plan" or otherwise: b. Any other alternative dispute resolution pro - a. Group life insurance; ceeding in which such group accident or damages are claimed health insurance; den- and to which the in- tal, vision and hearing sured submits with our plans; and flexible consent; or spending accounts; provided that no one c. An appeal of a civil pro - other than an em- ceeding. ployee" may subscribe to such benefits and 8. "Employee" means a per - such benefits are made son actively employed, for- generally available to merly employed, on leave of who those "employees" who absence or disabled, or re - "Employee" satisfy the Alan's satisati tired. includes "leased worker". "Em- bility requirements; a ployee does not include a b. Profit sharing plans, "temporary worker". employee savings plans, employee stock 2. Unintentional Failure to Disclose Haz- ownership plans, pen- ands sion plans and stock SECTION IV -COMMERCIAL GENERAL subscription plans, pro- LIABILITY CONDITIONS, 7. Represen- vided that no one other tations is hereby amended by the addi- than an "employee" tion of the following: may subscribe to such benefits and such Based on our dependence upon your rep - benefits are made gen- resentations as to existing hazards, if un- erally available to all intentionally you should fail to disclose all "employees" who are such hazards at the inception date of your eligible under the plan policy, we will not reject coverage under for such benefits; this Coverage Part based solely on such failure. c. Unemployment insur- ance, social security Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 7 of 15 3. Damage to Premises Rented to You f) Nesting or infesta- tion, or discharge a. The last Subparagraph 9 P or release of 2. SECTION I - COVERAGES, waste products or COVERAGE A. - BODILY INJURY secretions, by in - AND PROPERTY DAMAGE, 2. LI- sects, birds, ro- ABILITY Exclusions is hereby de- dents or other leted and replaced by the following: animals. Exclusions c. through q. do not apply (b) Loss caused directly or indi- to damage by fire, explosion, light- rectly by any of the follow- ning, smoke or soot to premises ing: while rented to you or temporarily oc- cupied by you with permission of the 1) Earthquake, volcanic owner. eruption, landslide or any other earth move- b. The insurance provided under SEC- ment; TION I - COVERAGES, COVERAGE A. BODILY INJURY AND PROP- 2) Water that backs up or ERTY DAMAGE LIABILITY applies overflows from a sewer, to 'property damage" arising out of drain or sump; water damage to premises that are both rented to and occupied by you. 3) Water under the ground surface pressing on, or (1) As respects Water Damage Le- flowing or seeping gal Liability, as provided in through: Paragraph 3.b. above: a) Foundations, The exclusions under SECTION walls, floors or - COVERAGES, COVERAGE paved surfaces; A. BODILY INJURY AND PROPERTY DAMAGE LIABIL- b) Basements, ITY, 2. Exclusions, other than I. whether paved or War and the Nuclear Energy not; or Liability Exclusion, are deleted c) Doors, windows or and the following are added: other openings. This insurance does not apply (c) Loss caused by or resulting to: from water that leaks or (a) "Property damage": flows from plumbing, heat- ing, air conditioning, or fire 1) Assumed in any con- protection systems caused tract; or by or resulting from freez- ing, unless: 2) Loss caused by or re- suiting from any of the 1) You did your best to following: maintain heat in the building or structure; or a) Wear and tear; 2) You drained the b Rust, corrosion, equipment and shut off fungus, decay, de- the water supply if the terioration, hidden heat was not main - or latent defect or tained. any quality in property that (d) Loss to or damage to: causes it to dam- age or destroy it- 1) Plumbing, heating, air self; conditioning, fire pro- tection systems, or c) Smog; other equipment or ap- pliances; or d) Mechanical break down including 2) The interior of any rupture or bursting building or structure, or caused by cen- to personal property in trifugal force; the building or structure caused by or resulting e) Settling, cracking, from rain, snow, sleet shrinking or ex- or ice, whether driven pansion; or by wind or not. Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission. Page 8 of 15 c. Limit of Insurance The Damage to Premises Rented to You Limit as shown in the Declara- tions is amended as follows: (2) Paragraph 6. of SECTION III - LIMITS OF INSURANCE is hereby deleted and replaced by the following: 6. Subject to 5. above, the Damage to Premises Rented to You Limit is the most we will pay under COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY, for damages because of "prop- erty damage" to premises while rented to you or tem- porarily occupied by you with permission of the owner, arising out of any one "occurrence" to which this insurance applies. (3) The amount we will pay is lim- ited as described in Section B. Limits of Insurance, 3. Dam- age to Premises Rented to You of this endorsement. 4. Supplementary Payments Under SECTION I - COVERAGE, SUP- PLEMENTARY PAYMENTS - COVER- AGES A AND B: a. Paragraph 2. is replaced by the fol- lowing: Up to the limit shown in Section B. Limits of Insurance, 4.a. Bail Bonds of this endorsement for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage ap- plies. We do not have to furnish these bonds. b. Paragraph 4. is replaced by the fol- lowing: All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or "suit", including actual loss of earnings up to the limit shown in Section B. Limits of Insurance, 4.b. Loss of Earnings of this en- dorsement per day because of time off from work. 5. Medical Payments Limits of Insurance, 5. Medical Pay- ments of this endorsement. 6. Voluntary Property Damage and Care, Custody or Control Liability Coverage a. Voluntary Property Damage Cov- erage We will pay for 'property damage" to property of others arising out of op- erations incidental to the insured's business when: (1) Damage is caused by the in- sured; or (2) Damage occurs while in the in- sured's possession. With your consent, we will make these payments regardless of fault. b. Care, Custody or Control Liability Coverage SECTION I - COVERAGES, COV- ERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY, 2. Exclusions, j. Damage to Pro - erty, Subparagraphs (3), (4) and (9) do not apply to "property damage" to the property of others described therein. With respect to the insurance provided by this section of the endorsement, the fol- lowing additional provisions apply: a. The Limits of Insurance shown in the Declarations are replaced by the lim- its designated in Section B. Limits of Insurance, 6. Voluntary Property Damage and Care, Custody or Control Liability Coverage of this endorsement with respect to cover- age provided by this endorsement. These limits are inclusive of and not in addition to the limits being re- placed. The Limits of Insurance shown in Section B. Limits of Insur- ance, 6. Voluntary Property Dam- age and Care, Custody or Control Liability Coverage of this endorse- ment fix the most we will pay in any one "occurrence" regardless of the number of: (1) Insureds; (2) Claims made or "suits" brought; or (3) Persons or organizations making claims or bringing "suits". b. Deductible Clause The Medical Expense Limit of Any One (1) Our obligation to pay damages Person as stated in the Declarations is on your behalf applies only to amended to the limit shown in Section B. the amount of damages for each "occurrence" which are in ex - Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission. Page 9 of 15 cess of the deductible amount (1) Any person or organization de - stated in Section B. Limits of scribed in Paragraph 9.a.(2) be - Insurance, 6. Voluntary Prop- low (hereinafter referred to as ertyy Damage and Care, Cus- additional insured) whom you tody or Control Liability Cov- are required to add as an addi- erage of this endorsement. The tional insured under this Cover - limits of insurance will not be re- age Part by reason of. duced by the application of such deductible amount. (a) A written contract or agree- ment; or (2) Condition 2. Duties in the Event of Occurrence, Offense, (b) An oral agreement or con - Claim or Suit, applies to each Arad where a certificate of claim or "suit" irrespective of the insurance showing that per - amount. son or organization as an additional insured has been (3) We may pay any part or all of issued, the deductible amount to effect settlement of any claim or "suit" is an insured, provided: and, upon notification of the ac- (a) The written or oral contract tion taken, you shall promptly re- or agreement is: imburse us for such part of the deductible amount as has been 1) Currently in effect or paid by us. becomes effective dur- 7. 180 Day Coverage for Newly Formed or ing the policy period; and Acquired Organizations SECTION - WHO IS AN INSURED is 2) Executed prior to an "occurrence" or offense amended ass follows: to which this insurance Subparagraph a. of Paragraph 4. is would apply; and hereby deleted and replaced by the fol- (b) They are not specifically lowing: named as an additional in - a. Insurance under this provision is af- sured under any other pro - forded only until the 180th day after vision of, or endorsement you acquire or form the organization added to, this Coverage or the end of the policy period, Part. whichever is earlier; (2) Only the following persons or 8. Waiver of Subrogation organizations are additional in- sureds under this endorsement, SECTION IV -COMMERCIAL GENERAL and insurance coverage pro - LIABILITY CONDITIONS, 9. Transfer of vided to such additional insureds Rights of Recovery Against Others to is limited as provided herein: Us is hereby amended by the addition of the following: (a) The manager or lessor of a premises leased to you with We waive any right of recovery we may whom you have agreed per have because of payments we make for Paragraph 9.a.(1) above to injury or damage arising out of your ongo- provide insurance, but only ing operations or "your work" done under with respect to liability aris- a written contract requiring such waiver ing out of the ownership, with that person or organization and in- maintenance or use of that cluded in the "products -completed opera- part of a premises leased to tions hazard". However, our rights may you, subject to the following only be waived prior to the "occurrence" additional exclusions: giving rise to the injury or damage for which we make payment under this Cov- This insurance does not ap- erage Part. The insured must do nothing ply to: after a loss to impair our rights. At our "suit" 1) Any "occurrence which request, the insured will bring or takes place after you transfer those rights to us and help us en- cease to be a tenant in force those rights. that premises. 9. Automatic Additional Insured - Speci- 2) Structural alterations, fied Relationships new construction or a. The following is hereby added to demolition operations SECTION 11-WHO IS AN INSURED: performed by or on be - Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission. Page 10 of 15 GA 233 02 07 half of such additional solely for the pur- insured. pose of inspection, demonstration, (b) Any person or organization testing, or the from which you lease substitution of equipment with whom you parts under in - have agreed per Paragraph structions from the 9.a.(1) above to provide in- manufacturer, and suranoe. Such person(s) or then repackaged organization(s) are insureds in the original con - solely with respect to their tainer; liability arising out of the maintenance, operation or e) Any failure to use by you of equipment make such inspec- leased to you by such per- tions, adjustments, son(s) or organizations(s). tests or servicing However, this insurance as the vendor has does not apply to any "oc- agreed to make or currence which takes place normally under - after the equipment lease takes to make in expires. the usual course of business, in (c) Any person or organization connection with (referred to below as ven- the distribution or dor) with whom you have sale of the prod - agreed per Paragraph ucts; 9.a.(1) above to provide in- surance, but only with re- f) Demonstration, in- spect to "bodily injury" or stallation, servic- "property damage" arising ing or repair op - out of "your products" which erations, except are distributed or sold in the such operations regular course of the ven- performed at the does business, subject to vendor's premises the following additional ex- in connection with clusions: the sale of the product; 1) The insurance afforded the vendor does not g) Products which, apply to: after distribution or sale by you, have a) "Bodily injury" or been labeled or re - "property damage" labeled or used as for which the ven- a container, part or dor is obligated to ingredient of any pay damages by other thing or sub - reason of the as- stance by or for sumption of liabil- the vendor. ity in a contract or agreement. This 2) This insurance does exclusion does not not apply to any in - apply to liability for sured person or organk damages that the zation: vendor would have a) From whom you in the absence of have acquired the contract or such products, or agreement; any ingredient, b) Any express war- part or container, ranty unauthorized entering into, ac- by you; companying or containing such c) Any physical or products; or chemical change in the product b) When liability in - made intentionally cluded within the by the vendor; "products - completed opera- d) Repackaging, tions hazard" has unless unpacked Includes copyrighted material of Insurance Services Office, Ina, with its permission. Page 11 of 15 been excluded (f) Any person or organization under this Cover- with which you have agreed age Part with re- per Paragraph 9.a.(1) above spect to such to provide insurance, but products. only with respect to liability d An state or political subdi- () Y P arising out of "your work" performed for that additional vision with which you have insured by you or on your agreed per Paragraph behalf. A person or organi- 9.a.(1) above to provide in- zation's status as an insured surance, subject to the fol- under this provision of this lowing additional provision: endorsement continues for This insurance applies only only the period of time re - with respect to the following quired by the written con - hazards for which the state tract or agreement, but in no or political subdivision has event beyond the expiration issued a permit in connec- date of this Coverage Part. tion with premises you own, If there is no written contract rent or control and to which or agreement, or if no pe- this insurance applies: riod of time is required by the written contract or 1) The existence, mainte- agreement, a person or or- nance, repair, construc- ganization's status as an in- tion, erection, or re- sured under this endorse- moval of advertising ment ends when your op - signs, awnings, cano- erations for that insured are pies, cellar entrances, completed. coal holes, driveways, manholes, marquees, (3) Any insurance provided to an hoist away openings, additional insured designated under Paragraph 9.a.(2): sidewalk vaults, street banners, or decorations (a) Subparagraphs (e), and (f) and similar exposures; does not apply to bodily in - or jury" or "property damage" 2) The construction, erec- included within the "prod- tion, or removal of ele- ucts-completed operations vators; or hazard"; 3) The ownership, main- (b) Subparagraphs (a), (b), (d), tenance, or use of any (e) and (f) does not apply to elevators covered by bodily injury", property this insurance. d "personal ande r " damage" opr advertising injury„ arising (e) Any state or political subdi- out of the sole negligence or vision with which you have willful misconduct of the ad - agreed per Paragraph ditional insured or their 9.a.(1) above to provide in- agents, "employees" or any surance, subject to the fol- other representative of the lowing provisions: additional insured; or 1) This insurance applies (c) Subparagraph (f) does not only with respect to op- apply to "bodily injury", erations performed by "property damage" or "per - you or on your behalf sonal and advertising injury" for which the state or arising out of: political subdivision has issued a permit. 1) Defects in design fur - Wished by or on behalf 2) This insurance does of the additional in - not apply to "bodily in- sured; or jury", property am - age" or "personal and 2) The rendering of, or advertising injury" aris- failure to render, any professional architec- ing out of operations performed for the state tural, engineering or or political subdivision. surveying services, in- cluding: Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission. Page 12 of 15 a) The preparing, primary to other insurance approving or fail- available to the additional ing to prepare or insured except: approve maps, shop drawings, 1) As otherwise provided opinions, reports, in SECTION IV - COMMERCIAL GEN- surveys, field or- ders, change or- ERAL LIABILITY ders or drawings CONDITIONS, 5. and specifications; Other Insurance, b. and Excess Insurance; or b) Supervisory, in- 2) For any other valid and spection, architec- collectible insurance tural or engineer- available to the addi- ing activities. tional insured as an additional insured by 3) "Your work" for which a attachment of an en - consolidated (wrap-up) dorsement to another insurance program has insurance policy that is been provided by the written on an excess primecontractor-project basis. In such case, manager or owner of the coverage provided the construction project under this endorsement in which you are in- shall also be excess. volved. (2) Condition 11. Conformance to b. Only with regard to insurance pro- Specific Written Contract or vided to an additional insured desig- Agreement is hereby added: nated under Paragraph 9.a.(2) Sub- 11. Conformance to Specific paragraph (f) above, SECTIONIII - Written Contract or LIMITS OF INSURANCE is amended Agreement to include: The limits applicable to the additional With respect to additional insured are those specified in the insureds described in Para - graph 9.a.(2)(f) above only: written contract or agreement or in the Declarations of this Coverage If a written contract or Part, whichever are less. If no limits agreement between you are specified in the written contract or and the additional insured agreement, or if there is no written specifies that coverage for contract or agreement, the limits ap- the additional insured: plicable to the additional insured are those specified in the Declarations of a. Be provided by the In - this Coverage Part. The limits of in- surance Services Office surance are inclusive of and not in additional insured form addition to the limits of insurance number CG 20 10 or shown in the Declarations. CG 20 37 (where edi- tion specified); or t. SECTION IV - COMMERCIAL GEN- ERAL LIABILITY CONDITIONS is b. Include coverage for hereby amended as follows: completed operations; (1) Condition 5.Other Insurance is or amended to include: c. Include coverage for your work"; (a) Where required by a written contract or agreement, this and where the limits or cov- insurance is primary and / erage provided to the addi- or noncontributory as re- tional insured is more re- spects any other insurance strictive than was specifi- policy issued to the addi- cally required in that written tional insured, and such contract or agreement, the other insurance policy shall terms of Paragraphs be excess and / or noncon- 9.a.(3)(a), 9.a.(3)(b) or 9.b. tributing, whichever applies, above, or any combination with this insurance. thereof, shall be interpreted as providing the limits or (b) Any insurance provided by coverage required by the this endorsement shall be terms of the written contract Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission. Page 13 of 15 or agreement, but only to the extent that such limits or coverage is included within the terms of the Coverage Part to which this endorse- ment is attached. If, how- ever, the written contract or agreement specifies the In- surance Services Office ad- ditional insured form num- ber CG 20 10 but does not specify which edition, or specifies an edition that does not exist, Paragraphs 9.a.(3)(a) and 9.a.(3)(b) of this endorsement shall not apply and Paragraph 9.b. of this endorsement shall ap- ply. 10. Broadened Contractual Liability - Work Within 50' of Railroad Property It is hereby agreed that Paragraph .(1) of Definition 12. "Insured contract" SEC- TION V - DEFINITIONS) is deleted. 11. Property Damage to Borrowed Equip- ment a. The following is hereby added to Ex- clusion j. Damage to Property of Paragraph 2., Exclusions ofSEC- TION I - COVERAGES, COVERAGE A. BODILY INJURY AND PROP- ERTY DAMAGE LIABILITY: Paragraphs (3) and (4) of this exclu- sion do not apply to tools or equip- ment loaned to you, provided they are not being used to perform opera- tions at the time of loss. b. With respect to the insurance pro- vided by this section of the endorse- ment, the following additional provi- sions apply: (1) The Limits of insurance shown in the Declarations are replaced by the limits designated in Section B. Limits of Insurance, 11. of this endorsement with respect to coverage provided by this en- dorsement. These limits are in- clusive of and not in addition to the limits being replaced. The Limits of Insurance shown in Section B. Limits of Insurance, 11. of this endorsement fix the most we will pay in any one "oc- currence" regardless of the number of: (a) Insureds; (b) Claims made or "suits" brought; or (c) Persons or organizations making claims or bring "suits". (2) Deductible Clause (a) Our obligation to pay dam- ages on your behalf applies only to the amount of dam- ages for each "occurrence" which are in excess of the Deductible amount stated in Section B. Limits of Insur- ance, 11. of this endorse- ment. The limits of insur- ance will not be reduced by the application of such De- ductible amount. (b) Condition 2. Duties in the Event of Occurrence, Of- fense, Claim or Suit, ap- plies to each claim or "suit" irrespective of the amount. (c) We may pay any part or all of the deductible amount to effect settlement of any claim or "suit" and, upon no- tification of the action taken, you shall promptly reim- burse us for such part of the deductible amount as has been paid by us. 12. Employees as Insureds - Specified Health Care Services It is hereby agreed that Paragraph 2.0i(djof SECTION 11 - WHO IS AN INSUURRE , does not apply to your "em- ployees" who provide professional health care services on your behalf as duly li- censed: a. Nurses; b. Emergency Medical Technicians; or c. Paramedics, in the jurisdiction where an "occurrence" or offense to which this insurance applies takes place. 13. Broadened Notice of Occurrence Paragraph a. of Condition 2. Duties in the Event of Occurrence, Offense, Claim or Suit (SECTION IV - COMMER- CIAL GENERAL LIABILITY CONDI- TIONS) is hereby deleted and replaced by the hollowing: a. You must see to it that we are noti- fied as soon as practicable of an "oc- currence" or an offense which may result in a claim. To the extent pos- sible, notice should include: (1) How, when and where the "oc- currence" or offense took place; Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission. Page 14 of 15 (2) The names and addresses of any injured persons and wit- nesses; and (3) The nature and location of any injury or damage arising out of the 'occurrenoe" or offense. This requirement applies only when the 'occurrence" or offense is known to an "authorized representative". Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission. Page 15 of 15 2 r9� ELLECOR-01 SSIMPSON1 .44COR17- CERTIFICATE OF LIABILITY INSURANCE �-"'� DATE 12/18/2023Y) 12/18/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must 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 Hub International Northwest LLC PO Box 3144 Spokane, WA 99220 CONTACT Stacia Simpson NAME: PHONE FAX (A/C, No, Ext): (509) 319-2912 (AIC, No): E-MAIL Stacia.Simpson@hubinternational.com INSURERS AFFORDING COVERAGE NAIC # INSURER A: Cincinnati Insurance Company 10677 INSURED INSURER B : INSURER C : Eller Corporation INSURER D : PO BOX 117 Newman Lake, WA 99025 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 ITRA TYPE OF INSURANCE ADDL SUBR POLICY NUMBER IPOLIICY EFF POLICY EXP LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR X X EPP0563496 12/31/2023 12/31/2024 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence 500,000 $ MED EXP (Any oneperson) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY � JECT LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 WA STOP GAP 1,000,000 A AUTOMOBILE X X LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS AUTOS ONLY X AUUTOS ONLY X X EBA0563496 12/31/2023 12/31/2024 COMBINED SINGLE LIMIT Ea accident 1,000,000 $ BODILY INJURY Per person)$ BODILY INJURY Per accident $ Pe�accidentDAMAGE $ A X UMBRELLA LIAB EXCESS LIAB I X I OCCUR CLAIMS -MADE X X EPP0563496 12/31/2023 12/31/2024 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 DED I I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) CONTRACT #20-188: 2022-2023 SNOW SEASON ON -CALL ROAD GRADERS FOR SNOW REMOVAL PRIMARY/NONCONTRIBUTORY ADDITIONAL INSURED STATUS AND WAIVER OF SUBROGATION AS IT RELATES TO GENERAL LIABILITY IS GIVEN TO THE CITY OF SPOKANE VALLEY, ITS OFFICERS, AGENTS AND EMPLOYEES PER ENDORSEMENTS ATTACHED. CITY OF SPOKANE VALLEY 10210 E SPRAGUE AVENUE SPOKANE VALLEY, WA 99206 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016103) @ 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Policy #EPP0563496 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WASHINGTON - TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL UMBRELLA LIABILITY COVERAGE PART PROFESSIONAL UMBRELLA LIABILITY COVERAGE PART PROFESSIONAL UMBRELLA LIABILITY COVERAGE PART - CLAIMS -MADE Paragraph 13. Transfer of Rights of Recovery Against Others to Us of Section IV - Conditions is revised by the addition of the following: We shall be entitled to a recovery only after the insured has been fully compensated for damages. Includes copyrighted material of Insurance US 4068 WA 06 07 Services Office, Inc., with its permission. Policy #EPP0563496 gate Limit of Insurance, Paragraph 2.b., or the Construction Project General Ag- gregate Limit of Insurance, Paragraph 2.c. applies. b. A separate Location General Aggregate Limit of Insurance, equal to the amount of the General Aggregate Limit shown in the 3. Declarations, shall apply to each location owned by, or rented or leased to you and Is the most we will pay for the sum of: (1) Damages under COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY, except dam- ages because of "bodily injury" or 4. "property damage" included In the "products -completed operations hazard'; and (2) Medical expenses under COVER- AGE C. MEDICAL PAYMENTS, which can be attributed .to operations at only a single location owned by, or rented or leased to you. c. A separate Construction Project General Aggregate Limit of Insurance, equal to the amount of the General Aggregate Limit shown in the Declarations, shall ap- ply to each construction project and Is the most we will pay for the sum of: your behalf at the same location for the same persons or organizations, no matter how often or under how many different contracts, will be deemed to be a single construction project The Products -Completed Operations Aggre- gate Limit is the most we will pay under COV- ERAGE A. BODILY INJURY AND PROP- ERTY DAMAGE LIABILITY for damages be- cause of "bodily Injury" and "property dam- age" Included in the "products -completed op- erations hazard". Subject to 2.a, above, the Personal and Ad- vertising Injury Limit Is the most we will pay under COVERAGE B. PERSONAL AND AD- VERTISING INJURY LIABILITY for the sum of all damages because of all "personal and ad- vertIsing injury" sustained by any one person or organization. 5. Subject to 2. or 3. above, whichever applies, the Each Occurrence Limit is the most we will pay for the sum of: a. Damages under COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LI. ABILITY; and (1) Damages under COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY, except dam- ages because of "bodily injury" or 5• "property damage" included in the "products -completed operations hazard"; and (2) Medical expenses -under COVER- AGE C. MEDICAL PAYMENTS; which can be attributed only to ongoing operations and only at a single construc- tion project. d. Only for the purpose of determining which General' Aggregate Limit of Insurance, 2.a., 2.1b., or 2.c., applies: (1) Location means premises involving the same or connecting lots, or premises, whose connection is Inter- rupted only by a street, roadway, waterway or right-of-way of 'a rail- road. (2) Construction project means a loca- tion you do not own, rent or lease where ongoing Improvements, al- terations, Installation, demolition or maintenance work is performed by you or on your behalf. All connected ongoing improvements, alterations, Installation, demolition or mainte- nance work performed by you or on b. Medical expenses under COVERAGE C. MEDICAL PAYMENTS; because of all "bodily Injury" and "property damage" arising out of any one "occurrence".. Subject to 5. above, the Damage to Premises Rented to You Limit Is the most we will pay under COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY for dam- ages because of "property damage" to any one premises, while rented to you, or In the case of damage by fire or explosion, while rented to you or temporarily occupied by you with permission of the owner. 7. Subject to S. above, the Medical Expense Limit Is the most we will pay under COVER- AGE C. MEDICAL PAYMENTS for all medical expenses because of "bodily injury" sustained by any one person. The Llmits of Insurance of this Coverage Part ap- ply separately to each "coverage term". SECTION IV - COMMERCIAL GENERAL LI- ABILITY CONDITIONS 1. Bankruptcy Bankruptcy or Insolvency of the insured or of the Insured's estate will not relieve us of our obligations under this Coverage Part. 2. Duties in the Event of Occurrence, Offense, Claim or Suit a. You must see to It that we are notified as soon as practicable of an "occurrence" or Includes copyrighted material of Insurance GA 10112 04 Services Office, Inc., with Its permission. 'Page 13 of 22 Policy #EPP0563496 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS' COMMERCIAL GENERAL LIABILITY BROADENED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Endorsement -Table of Contents: Coverage: Begins on Page: 1. Employee Benefit Liability Coverage.......................................................................................3 2. Unintentional Failure To Disclose Hazards............................................................................a 3. Damage To Premises Rented To You......................................................................................9 4. Supplementary Payments......................................................................................................10 5. Medical Payments...................................................................................................................10 6. 180 Day Coverage For Newly Formed Or Acquired Organizations...................................10 7. Waiver Of Subrogation...........................................................................................................11 8. Automatic Additional Insured -Specified Relationships: .................................................. 11 • Managers Or Lessors Of Premises; • Lessor Of Leased Equipment; • Vendors; • State Or Govemmental Agency Or Subdivision Or Political Subdivision - Permits Or Authorizations Relating To Premises; and • Mortgagee, Assignee Or Receiver 9. Property Damage To Borrowed Equipment.........................................................................14 10. Employees As Insureds - Specified Health Care Services And Good Samaritan Services...................................................................................................................................15 11. Broadened Notice Of Occurrence.........................................................................................15 12. Nonowned Aircraft..................................................................................................................15 13. Bodily Injury Redefined..........................................................................................................15 14. Expected Or Intended Injury Redefined...............................................................................15 15. Former Employees As Insureds............................................................................................15 16. Voluntary Property Damage Coverage And Care, Custody Or Control Liability Coverage..................................................................................................................................16 17. Broadened Contractual Liability -Work Within 50' Of Railroad Property .........................17 18. Alienated Premises.................................................................................................................17 B. Limits Of Insurance: The Commercial General Liability Limits of Insurance apply to the insurance provided by this endorse- ment, except as provided below: 1. Employee Benefit Liability Coverage Each Employee Limit: $1,000,000 Aggregate Limit: $3,000,000 Deductible Amount: $ 1,000 3. Damage To Premises Rented To You The lesser of: a. The Each Occurrence Limit shown in the Declarations; or b. $500,000 unless otherwise stated $ 4. Supplementary Payments a. Bail Bonds: $2,500 Includes copyrighted material of Insurance GA 233 0917 Services Office, Inc., with its permission. Page 1 of 17 b. Loss Of Earnings: $ 500 5. Medical Payments Medical Expense Limit: $ 10,000 9. Property Damage To Borrowed Equipment Each Occurrence Limit: $10,000 Deductible Amount: $ 250 16. Voluntary Property Damage Coverage (Coverage a.) And Care, Custody Or Control Liability Coverage (Coverage b.) Limits Of Insurance Coverage a. $1,000 Each Occurrence $5,000 Aggregate Coverage b. $5,000 Each Occurrence unless otherwise stated $ Deductible Amount (Each Occurrence) Coverage a. $250 Coverage b. $250 unless otherwise stated $ COVERAGE PREMIUM BASIS RATE ADVANCE PREMIUM (a) Area (For Limits in Excess of (For Limits in Excess of (b) Payroll $5,000) $5,000) (c) Gross Sales (d) Units e Other b. Care, Custody Or $ Control TOTAL ANNUAL PREMIUM Includes copyrighted material of Insurance GA 233 0917 Services Office, Ina, with its permission. Page 2 of 17 C. Coverages this endorsement pro- 1. Employee Benefit Liability Coverage vided: a) You did not have a. The following is added to Section I - knowledge of a Coverages: g claim or "suit' on or Employee Benefit Liability Cover- before the "first ef- age fective date" of this endorsement. (1) Insuring Agreement You will be (a) We will pay those sums that deemed to have the insured becomes legally knowledge of a obligated to pay as damag- claim or "suit' es caused by any act, error when any "author - or omission of the insured, ized representa- or of any other person for tine'; whose acts the insured is legally liable, to which this 1) Reports all, or insurance applies. We will any part, of the have the right and duty to act, error or defend the insured against omission to us any "suit' seeking those or any other damages. However, we will insurer; have no duty to defend ii) Receives a against any suit' seeking written or ver- damages to which this in- bal demand or surance does not apply. We claim for dam - may, at our discretion, in- ages because vestigate any report of an of the act, er- ad, error or omission and ror or omis- settle any claim or "suit' that sion; and may result. But: b) There is no other 1 The amount we will pay p y applicable insur- for damages is limited ance. as described in Section III - Limits Of Insur- (2) Exclusions since; and This insurance does not apply to: 2) Our right and duty to defend ends when we (a) Bodily Injury, Property have used up the appli- Damage Or Personal And cable limit of insurance Advertising Injury in the payment of judg- 'Bodily injury", "property ments or settlements. damage" or "personal and No other obligation or liabil- advertising injury". ity to pay sums or perform (b) Dishonest, Fraudulent, ads or services is covered Criminal Or Malicious Act unless explicitly provided for under Supplementary Damages arising out of any Payments. intentional, dishonest, ( b) This insurance applies to fraudulent, criminal or mali- cious ad, error or omission, damages only if the act, er- committed by any insured, ror or omission, is negligent- including the willful or reck- ly committed in the "admin- less violation of any statute. istration" of your "employee benefit program'; and (c) Failure To Perform A Con- tract 1) Occurs during the policy period; or Damages arising out of fail- ureprior of performance of con- 2) p tract by any insurer. "first effective date" of Includes copyrighted material of Insurance GA 233 0917 Services Office, Ina, with its permission. Page 3 of 17 GA 233 0917 (d) Insufficiency Of Funds (1) Taxes, Fines Or Penalties Damages arising out of an Taxes, fines or penalties, in - insufficiency of funds to cluding those imposed un- meet any obligations under der the Internal Revenue any plan included in the Code or any similar state or "employee benefit program". local law. (e) Inadequacy Of Perfor- (j) Employment -Related Prac- mance Of Invest- tices ment/Advice Given With Respect To Participation Any liability arising out of any: Any claim based upon: (1) Refusal to employ; 1) Failure of any invest - to perform; Termination of employment (2) y ment; 2) Errors in providing in- formation on past per- (3) Coercion, demotion, formance of investment evaluation, reassign - vehicles; or ment, discipline, defa- mation, harassment, 3) Advice given to any humiliation, discrimina- person with respect to tion or other employ - that person's decision to ment - related practices, participate or not to par- acts or omissions; or ticipate in any plan in- cluded in the "employee (4) Consequential liability benefit program". as a result of (1), (2) or (3) above. (f) Workers' Compensation And Similar Laws This exclusion applies whether the insured may be Any claim arising out of your held liable as an employer failure to comply with the or in any other capacity and mandatory provisions of any to any obligation to share workers' compensation, un- damages with or repay employment compensation someone else who must pay insurance, social security or damages because of the in - disability benefits law or any jury. similar law. (3) Supplementary Payments (g) ERISA Section I -Coverages, Sup - Damages for which any in- plementary Payments - Cover- sured is liable because of li- ages A And B also apply to this ability imposed on a fiduci- Coverage. ary by the Employee Re- tirement Income Security b. Who Is An Insured Act of 1974, as now or As respects Employee Benefit Lia- hereafter amended, or by bility Coverage, Section II - Who Is any similar federal, state or An Insured is replaced by the follow - local laws. ing: (h) Available Benefits (1) If you are designated in the Dec - Any claim for benefits to the larations as: extent that such benefits are (a) An individual, you and your available, with reasonable spouse are insureds, but on - effort and cooperation of the ly with respect to the non- insured, from the applicable duct of a business of which funds accrued or other col- you are the sole owner. lectible insurance. (b) A partnership or joint ven- ture, you are an insured. Your members, your part - Includes copyrighted material of Insurance Services Office, Ina, with its permission. Page 4 of 17 ners, and their spouses are zation. However, coverage under also insureds but only with this provision: respect to the conduct of your business. (a) Is afforded only until the 180th day after you acquire (c) A limited liability company, or form the organization or you are an insured. Your the end of the policy period, members are also insureds, whichever is earlier; and but only with respect to the conduct of your business. (b) Does not apply to any act, Your managers are in- error or omission that was sureds, but only with respect committed before you ac- to their duties as your man- quired or formed the organi- agers. zation. (d) An organization other than a c. Limits Of Insurance partnership, joint venture or As respects Employee Benefit Lia- limited liability company, you bility Coverage, Section III - Limits are an insured. Your "execu- Of Insurance is replaced by the fol- tive officers" and directors lowing: are insureds, but only with respect to their duties as (1) The Limits of Insurance shown in your officers or directors. Section B. Limits Of Insurance, Your stockholders are also 1. Employee Benefit Liability insureds, but only with re- Coverage and the rules below fix spect to their liability as the most we will pay regardless stockholders. of the number of (e) A trust, you are an insured. (a) Insureds; Your trustees are also in- sureds, but only with respect (b) Claims made or "suits" to their duties as trustees. brought; (2) Each of the following is also an (c) Persons or organizations insured: making claims or bringing "suits"; (a) Each of your "employees" who is or was authorized to (d) Acts, errors or omissions; or administer your "employee (e) Benefits included in your benefit program"; "employee benefit program". (b) Any persons, organizations (2) The Aggregate Limit shown in or "employees" having prop- Section B. Limits Of Insurance, er temporary authorization 1. Employee Benefit Liability to administer your employ- Coverage of this endorsement is ee benefit program if you the most we will pay for all dam - die, but only until your legal ages because of acts, errors or representative is appointed; omissions negligently committed or in the "administration" of your (c) Your legal representative if "employee benefit program". you die, but only with re- (3) Subject to the limit described in spect to duties as such. That (2) above, the Each Employee representative will have all Limit shown in Section B. Limits your rights and duties under Of Insurance, 1. Employee this Coverage Part. Benefit Liability Coverage of (3) Any organization you newly ac- this endorsement is the most we quire or form, other than a part- will pay for all damages sus- nership, joint venture or limited tained by any one "employee", liability company, and over which including damages sustained by you maintain ownership or major- such "employee's" dependents ity interest, will qualify as a and beneficiaries, as a result of: Named Insured if no other similar (a) An act, error or omission; or insurance applies to that organi- Includes copyrighted material of Insurance GA 233 0917 Services Office, Inc, with its permission. Page 5 of 17 (b) A series of related acts, er- tification of the action taken, rors or omissions, regard- you shall promptly reim- less of the amount of time burse us for such part of the that lapses between such Deductible Amount as we ads, errors or omissions; have paid. negligently committed in the d. Additional Conditions "administration" of your "employ- ee benefit program. As respects Employee Benefit Lia- bility Coverage, Section IV - Com- However, the amount paid under mercial General Liability Condi- this endorsement shall not ex- tions is amended as follows: ceed, and will be subject to the limits and restrictions that apply (1) Item 2. Duties In The Event Of to the payment of benefits in any Occurrence, Offense, Claim Or plan included in the "employee Suit is replaced by the following: benefit program" 2. Duties In The Event Of An (4) Deductible Amount Act, Error Or Omission, Or Claim Or Suit (a) Our obligation to pay dam- ages on behalf of the in- a. You must see to it that sured applies only to the we are notified as soon amount of damages in ex- as practicable of an act, cess of the Deductible error or omission which Amount stated in the Deda- may result in a claim. rations as applicable to To the extent possible, Each Employee. The limits notice should include: of insurance shall not be re- (1) What the act, error duoed by the amount of this or omission was deductible. and when it oc- (b) The Deductible Amount curred; and stated in the Declarations (2) The names and applies to all damages sus- addresses of any- tained by any one "employ- one who may suf- ee", including such "employ- fer damages as a ee's" dependents and bene- result of the ad, ficiaries, because of all acts, error or omission. errors or omissions to which this insurance applies. b. If a claim is made or "suit' is brought against (C) The terms of this insurance, any insured, you must: including those with respect to: (1) Immediately record the specifics of the 1 Our right and du to g claim or suit' and defend the insured the date received; against any "suits" and seeking those damag- es; and (2) Notify us as soon as practicable. 2) Your duties, and the du- ties of any other in- You must see to it that volved insured, in the we receive written no - event of an act, error or tioe of the claim or "suit" omission, or claim; as soon as practicable. apply irrespective of the ap- c. You and any other in- plication of the Deductible volved insured must: Amount. (1) Immediately send (d) We may pay any part or all us copies of any of the Deductible Amount to demands, notices, effect settlement of any summonses or le - claim or "suit' and, upon no- gal papers re - Includes copyrighted material of Insurance GA 233 0917 Services Office, Inc., with its permission. Page 6 of 17 ceived in connec- tion by equal shares, tion with the claim we will follow this meth - or "suit; od also. Under this ap- ap- proach each insurer t Authorize us to ob- () contributes equal tain records and amounts until it has other information; paid its applicable limit (3) Cooperate with us of insurance or none of in the investigation the loss remains, or settlement of the whichever comes first. claim or defense If any of the other in - against the "suit; surance does not permit and contribution by equal (4) Assist us, upon our shares, we will contrib- request, in the en- ute by limits. Under this forcement of any method, each insurer's right against any share is based on the person or organi- ratio of its applicable zation which may limit of insurance to the be liable to the in- total applicable limits of sured because of insurance of all insur- an act, error or ers. omission to which c. No Coverage this insurance may also apply. This insurance shall not cover any loss for which d. No insured will, except the insured is entitled to at that insured's own recovery under any cost, voluntarily make a other insurance in force payment, assume any previous to the effective obligation, or incur any date of this Coverage expense without our Part. consent. e. Additional Definitions (2) Item 5. Other Insurance is re- placed by the following: As respects Employee Benefit Lia- bility Coverage, Section V - Defini- tions is amended as follows: If other valid and collectible (1) The following definitions are insurance is available to the added: insured for a loss we cover under this Coverage Part, 1. "Administration" means: our obligations are limited as follows: a. Providing information to "employees", including a. Primary Insurance their dependents and beneficiaries, with re - This insurance is prima- spect to eligibility for or ry except when c. below scope of "employee applies. If this insurance benefit programs'; is primary, our obliga- tions are not affected b. Interpreting the "em- unless any of the other ployee benefit pro - insurance is also prima- grams'; ry. Then, we will share with all that other insur- c. Handling records in ance by the method de- connection with the scribed in b. below. "employee benefit pro- grams"; or b. Method Of Sharing d. Effecting, continuing or If all of the other insur- terminating any "em- ance permits contribu- ployee's" participation in Includes copyrighted material of Insurance GA 233 0917 Services Office, Ina, with its permission. Page 7 of 17 any benefit included in c. Unemployment insur- the "employee benefit anoe, social security program". benefits, workers' com- pensation and disability However, 'administration benefits; and does not include: d. Vacation plans, includ- a. Handling payroll deduc- ing buy and sell pro- tions; or grams; leave of ab- b. The failure to effect or senoe programs, includ- maintain any insurance ing military, maternity, or adequate limits of family, and civil leave; coverage of insurance, tuition assistance plans; including but not limited transportation and to unemployment insur- health dub subsidies. ance, social security 4, "First effective date" means benefits, workers' com- the date upon which cover- pensation and disability age was first effected in a benefits. series of uninterrupted re- 2. "Cafeteria plans" means newals of insuranoe cover - plans authorized by applica- age. ble law to allow "employees" (2) The following definitions are de - to elect to pay for certain leted in their entirety and re - benefits with pre-tax dollars. placed by the following: 3. "Employee benefit pro- 8, "Employee" means a person grams means a program actively employed, formerly providing some of all of the employed, on leave of ab- following benefits to "em- sence or disabled, or retired. ployees", whether provided "Employee" includes a through a "cafeteria plan" or 'leased worker". "Employee" otherwise: does not include a "tempo - a. Group life insurance; rary worker". group accident or health 21. "Suit" means a civil proceed - insurance; dental, vision ing in which money damag- and hearing plans; and es because of an act, error flexible spending ac- or omission to which this in - counts; provided that no surance applies are alleged. one other than an "em- "Suit" includes: ployee" may subscribe to such benefits and a. An arbitration proceed - such benefits are made ing in which such dam - generally available to ages are claimed and to those "employees" who which the insured must satisfy the plan's eligibil- submit or does submit ity requirements; with our consent; b. Profit sharing plans, b. Any other alternative employee savings dispute resolution pro - plans, employee stock ceeding in which such ownership plans, pen- damages are daimed sion plans and stock and to which the in - subscription plans, pro- sured submits with our vided that no one other consent; or than an "employee" may subscribe to such c. appeal of a civil pro - benefits and such bene- ceeding. ce fits are made generally available to all "employ- ees" who are eligible under the plan for such benefits; Includes copyrighted material of Insurance GA 233 0917 Services Office, Inc., with its permission. Page 8 of 17 2. Unintentional Failure To Disclose Haz- 2) Rust or other cor- ards rosion, decay, de - Section IV - Commercial General Liabil- or laation, hidden latent defect or ity Conditions 7. Representations is of a any quality in amended by the addition the following: property that caus- Based on our dependence upon your rep- es it to damage or resentations as to existing hazards, if un- destroy itself; intentionally you should fail to disclose all 3) Smog; such hazards at the inception date of your policy, we will not reject coverage under 4) Mechanical break - this Coverage Part based solely on such down, including failure. rupture or bursting caused centrif- 3. Damage a To Premises Rented To You ugal force; e; a. The last Paragraph of 2. Exclusions 5) Settling, cracking, under Section I - Coverage A - Bod- shrinking or ex- ily Injury And Property Damage Li- pansion; ability is replaced by the following: 6) Nesting or Exclusions c. through q. do not apply char e discharge to "property damage" by fire, explo- or r a or release of waste sion, lightning, smoke or soot to products or secre- premises while rented to you or tem- tions, by insects, porarily occupied by you with permis- birds, rodents or sion of the owner, for which the other animals; or amount we will pay is limited to the Damage To Premises Rented To 7) Presence, growth, You Limit as described in Section III proliferation, - Limits Of Insurance. spread or any ac- fungus, in- tivityb. The insurance provided under Sec- cui g luding mold or tion I - Coverage A - Bodily Injury mildew, and any And Property Damage Liability ap- myootoxins, plies to "property damage" arising out spores, scents or of water damage to premises that are byproducts pro - both rented to and occupied by you. duoed or released (1) As respects Water Damage Le- by fungi. gal Liability, as provided in Para- (b) "Property damage" caused graph 3.b. above: directly or indirectly by any The exclusions under Section 1 - of the following: Coverage A - Bodily Injury And (1) Earthquake, volcanic Property Damage Liability, 2. eruption, landslide or Exclusions, other than 1. War any other earth move - and the Nuclear Energy Liabil- ment; ity Exclusion (Broad Form), are deleted and the following are (IQ Water that backs up or added: overflows or is other- wise discharged from a This insurance does not apply to: sewer, drain, sump, (a) "Property damage": sump pump or related equipment; (i) Assumed in any con- tract or agreement; or (iiQ Water under the ground surface pressing on, or (11) Caused by or resulting flowing or seeping from any of the follow- through: ing: 1) Foundations, walls, 1) Wear and tear; floors or paved surfaces; Includes copyrighted material of Insurance GA 233 0917 Services Office, Ina, with is permission. Page 9 of 17 2) Basements, whether paved or not; or 3) Doors, windows or other openings. (c) "Property damage" caused by or resulting from water that leaks or flows from plumbing, heating, air condi- tioning, fire protection sys- tems, or other equipment, caused by or resulting from freezing, unless: (� You did your best to maintain heat in the building or structure; or (ii) You drained the equip- ment and shut off the water supply if the heat was not maintained. (d) 'Property damage" to: (i) Plumbing, heating, air conditioning, fire protec- tion systems, or other equipment or applianc- es; or (IQ The interior of any building or structure, or to personal property in the building or structure, caused by or resulting from rain, snow, sleet or ice, whether driven by wind or not. c. Limit Of Insurance With respect to the insurance afford- ed in Paragraphs 3a. and 3.b. above, the Damage To Premises Rented To You Limit as shown in the Decla- rations is amended as follows: (1) Paragraph 6. of Section III - Limits Of Insurance is replaced by the following: 6. Subject to Paragraph 5. above, the Damage To Premises Rented To You Limit is the most we will pay under Coverage A - Bodily Injury And Property Dam- age Liability for damages because of "property dam- age" to any one premises: a. While rented to you, or temporarily occupied by you with permission of the owner; b. In the case of damage by fire, explosion, light- ning, smoke or soot, while rented to you; or c. In the case of damage by water, while rented to and occupied by you. (2) The most we will pay is limited as described in Section B. Limits Of Insurance, 3. Damage To Premises Rented To You of this endorsement. 4. Supplementary Payments Under Section 1 - Supplementary Pay- ments - Coverages A And B: a. Paragraph 2. is replaced by the fol- lowing: Up to the limit shown in Section B. Limits Of Insurance, 4.a. Bail Bonds of this endorsement for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage ap- plies. We do not have to furnish these bonds. b. Paragraph 4. is replaced by the fol- lowing: All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or "suit', including actual loss of earnings up to the limit shown in Sec- tion B. Limits Of Insurance, 4.b. Loss Of Earnings of this endorsement per day because of time off from work. 5. Medical Payments The Medical Expense Limit of Any One Person as stated in the Declarations is amended to the limit shown in Section B. Limits Of Insurance, 5. Medical Pay- ments of this endorsement. 6. 180 Day Coverage For Newly Formed Or Acquired Organizations Section 11 - Who Is An Insured is amended as follows: Subparagraph a. of Paragraph 3. is re- placed by the following: a. Insurance under this provision is af- forded only until the 180th day after Includes copyrighted material of Insurance GA 233 0917 Services Office, Inc., with its permission. Page 10 of 17 you acquire or form the organization use of that part of the prem- or the end of the policy period, ises leased to you, subject whichever is earlier; to the following additional exclusions: 7. Waiver Of Subrogation This insurance does not ap- Section IV - Commercial General Liabil- to: plyity Conditions, 9. Transfer Of Rights Of Recovery Against Others To Us is (i) Any "occurrence" which amended by the addition of the following: takes place after you cease to be a tenant in We waive any right of recovery we may that premises; have against any person or organization against whom you have agreed to waive (IQ Structural alterations, such right of recovery in a written contract new construction or or agreement because of payments we demolition operations make for injury or damage arising out of performed by or on be - your ongoing operations or 'your work" half of such additional done under a written contract or agree- insured. ment with that person or organization and included in the "products -completed oper- (b) Lessor Of Leased Equip- ations hazard". However, our rights may ment only be waived prior to the "occurrence" Any person or organization giving rise to the injury or damage for from whom you lease which we make payment under this Cov- equipment when you and erage Part. The insured must do nothing such person(s) or organiza- after a loss to impair our rights. At our re- tion(s) have agreed per Par - quest, the insured will bring "suit" or trans- agraph 8.a.(1) of this en- fer those rights to us and help us enforce dorsement to provide insur- those rights. ance. Such person(s) or or- 8. Automatic Additional Insured - Speci- ganization(s) are insureds fied Relationships only with respect to liability for "bodily injury', "property a. The following is added to Section II - damage" or "personal and Who Is An Insured: advertising injury' caused, in 1 An person(s) or organization(s)whole () y p () or in part, by your maintenance, operation or described in Paragraph 8.a.(2) of use of equipment leased to this endorsement (hereinafter re- you by such person(s) or or- ferred to as additional insured) ganization(s). A person's or whom you are required to add as organization's status as an an additional insured under this additional insured under this Coverage Part by reason of a endorsement ends when written contract, written agree- their contract or agreement ment, written permit or written with you for such leased authorization. equipment ends. However, (2) Only the following persons or or- this insurance does not ap- "occurrence" ganizations are additional in- ply to any sureds under this endorsement, which takes place after the and insurance coverage provided equipment lease expires. to such additional insureds is lim- (c) Vendors ited as provided herein: Any person or organization (a) Managers 9 Or Lessors Of (referred to below as ven- Premises dor) with whom you have The manager or lessor of a agreed per Paragraph premises leased to you with 8.a.(1) of this endorsement whom you have agreed per to provide insurance, but on - Paragraph 8.a.(1) of this en- ly with respect to 'bodily in- 'property dorsement to provide insur- jury" or damage" anoe, but only with respect arising out of "your products" to liability arising out of the which are distributed or sold ownership, maintenance or in the regular course of the Includes copyrighted material of Insurance GA 233 0917 Services Office, Ina, with its permission. Page 11 of 17 GA 233 0917 vendor's business, subject or repair opera - to the following additional tions, except such exclusions: operations per - The insurance () nsurance a formed at the ven- does in the vendor does not premises connection with the apply t°: sale of the product; 1) "Bodily injury' or "property 7) Products which, af- damage" ter distribution or for which the ven- sale by you, have dor is obligated to been labeled or re- pay damages by labeled or used as reason of the as- a container, part or sumption of liability ingredient of any in a contract or other thing or sub - agreement. This stance by or for the exclusion does not vendor; or apply to liability for damages that the 8) "Bodily injury' or vendor would have "property damage" in the absence of arising out of the the contract or sole negligence of agreement; the vendor for its own ads or omis- 2) Any express war- sions or those of ranty unauthorized its employees or by you; anyone else acting 3) Any physical or on its behalf. How - chemical change in ever, this exclusion the product made does not apply to: intentionally by the a) The excep- vendor; tions contained 4) Repackaging, ex- in Paragraphs cept when un- (c) (1) 4) or 6) packed solely for of this en - the purpose of in- dorsement; or spection, demon- b) Such inspec- stration, testing, or tions, acijust- the substitution of ments, tests or parts under in- servicing as structions from the the vendor has manufacturer, and agreed to then repackaged in make or nor - the original con- mally under- tainer; takes to make 5) Any failure to make in the usual such inspections, course of adjustments, tests business, in or servicing as the connection vendor has agreed with the distri- to make or normal- bution or sale ly undertakes to of the prod - make in the usual ucts. course of busi- (N) This insurance does not ness, in connection apply to any insured with the distribution person or organization: or sale of the products; 1) From whom you have acquired 6 Demonstration, in- such products, or stallation, servicing any ingredient, part Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 12 of 17 or container, enter- (e) Mortgagee, Assignee Or ing into, accompa- Receiver nying or containing such products; or Any person or organization with whom you have agreed 2) When liability in- per Paragraph 8.a.(1) of this cluded within the endorsement to provide in- "products- surance, but only with re - completed opera- spect to their liability as tions hazard" has mortgagee, assignee, or re - been excluded un- ceiver and arising out of the der this Coverage ownership, maintenance, or Part with respect to use of the premises by you. such products. However, this insurance (d) State Or Governmental does not apply to structural alterations, new construction Agency Or Subdivision Or and demolition operations Political Subdivision - performed by or for that per - Permits Or Authorizations son or organization. Relating To Premises (3) The insurance afforded to addi- Any state or governmental tional insureds described in Par - agency or subdivision or po- agraph 8.a.(1) of this endorse- litical subdivision with which ment: you have agreed per Para- graph 8.a.(1) of this en- (a) Only applies to the extent dorsement to provide insur- permitted by law; and ance, subject to the follauv ing additional provision: (b) Will not be broader than that which you are required by This insurance applies only the written contract, written with respect to the following agreement, written permit or hazards for which the state written authorization to pro - or governmental agency or vide for such additional in - subdivision or political sub- sured; and division has issued a permit or authorization in connec- (c) Does not apply to any per- tion with premises you own, son, organization, vendor, rent or control and to which state, governmental agency this insurance applies: or subdivision or political subdivision, specifically (i) The existence, mainte- named as an additional in- nance, repair, construc- sured under any other provi- tion, erection or removal sion of, or endorsement of advertising signs, added to, this Coverage awnings, canopies, cel- Part, provided such other lar entrances, coal provision or endorsement holes, driveways, man- covers the injury or damage holes, marquees, hoist for which this insurance ap- away openings, side- plies. walk vaults, street ban- ners or decorations and b. With respect to the insurance afford - similar exposures; or ed to the additional insureds de- scribed in Paragraph 8.a.(1) of this (i) The construction, erec- endorsement, the following is added tion or removal of eleva- to Section III - Limits Of Insurance: tors; or The most we will pay on behalf of the (ii) The ownership, mainte- additional insured is the amount of in- nance or use of any el- surance: evators cornered by this insurance. (1) Required by the written contract, written agreement, written permit or written authorization described Includes copyrighted material of Insurance GA 233 0917 Services Office, Ina, with its permission. Page 13 of 17 in Paragraph 8.a.(1) of this en- dorsement; or (2) Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. c. Section IV - Commercial General Liability Conditions is amended to include the following: Automatic Additional Insured Pro- vision This insurance applies only if the "bodily injury" or "property damage" occurs, or the "personal and advertis- ing injury' offense is committed: (1) During the policy period; and (2) Subsequent to your execution of the written contract or written agreement, or the issuance of a written permit or written authori- zation, described in Paragraph 8.a.(1). d. Section IV - Commercial General Liability Conditions is amended as follows: Condition 5. Other Insurance is amended to include: Primary And Noncontributory In- surance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured per Paragraph 8.a.(1) of this endorsement provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract, agreement, permit or authorization described in 8.a.(2) of this endorsement that this in- surance would be primary and would not seek contribution from any other insurance available to the additional insured. 9. Property Damage To Borrowed Equip- ment a. The following is added to Exclusion 2.j. Damage To Property under Sec- tion I - Coverage A - Bodily Injury And Property Damage Liability: Paragraphs (3) and (4) of this exclu- sion do not apply to tools or equip- ment loaned to you, provided they are not being used to perform operations at the time of loss. b. With respect to the insurance provid- ed by this section of the endorse- ment, the following additional provi- sions apply: (1) The Limits of Insurance shown in the Declarations are replaced by the limits designated in Section B. Limits Of Insurance, 9. Property Damage To Borrowed Equipment of this endorsement with respect to coverage provid- ed by this endorsement. These limits are inclusive of and not in addition to the limits being re- placed. The Limits of Insurance shown in Section B. Limits Of Insurance, 9. Property Damage To Borrowed Equipment of this endorsement fix the most we will pay in any one "occurrence" re- gardless of the number of: (a) Insureds; (b) Claims made or "suits" brought; or (c) Persons or organizations making claims or bringing "suits". (2) Deductible Clause (a) Our obligation to pay dam- ages on your behalf applies only to the amount of dam- ages for each "occurrence" which are in excess of the Deductible Amount stated in Section B. Limits Of Insur- ance, 9. Property Damage To Borrowed Equipment of this endorsement. The limits of insurance will not be re- duced by the application of such deductible amount. (b) Section IV - Commercial General Liability Condi- tions, 2. Duties In The Event Of Occurrence, Of- fense, Claim Or Suit, ap- plies to each claim or "suit' irrespective of the amount. Includes copyrighted material of Insurance GA 233 0917 Services Office, Ina, with Is permission. Page 14 of 17 (c) We may pay any part or all of the deductible amount to effect settlement of any claim or "suit" and, upon no- tification of the action taken, you shall promptly reim- burse us for such part of the deductible amount as has been paid by us. 10. Employees As Insureds - Specified Health Care Services And Good Samar- itan Services Paragraph 2.a.(1xd) under Section 11 - Who Is An Insured does not apply to: a. Your "employees" who provide pro- fessional health care services on your behalf as a duly licensed nurse, emergency medical technician or paramedic in the jurisdiction where an "occurrence" or offense to which this insurance applies takes place; or b. Your "employees" or "volunteer work- ers", other than an employed or vol- unteer doctor, providing first aid or good samaritan services during their work hours for you will be deemed to be acting within the scope of their employment by you or performing du- ties related to the conduct of your business. 11. Broadened Notice Of Occurrence Paragraph a. of Condition 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit under Section IV - Com- mercial General Liability Conditions is replaced by the following: a. You must see to it that we are notified as soon as practicable of an "occur- rence" or an offense which may result in a claim. To the extent possible, no- tice should include: (1) How, when and where the "oc- currence" or offense took place; (2) The names and addresses of any injured persons and wit- nesses; and (3) The nature and location of any injury or damage arising out of the "occurrence' or offense. This requirement applies only when the "occurrence" or offense is known to an "authorized representative". 12. Nonowned Aircraft The following is added to Exclusion 2.g. Aircraft, Auto Or Watercraft under Sec- tion 1 - Coverage A - Bodily Injury And Property Damage Liability: This exclusion does not apply to an air- craft you do not own, provided that: a. The pilot in command holds a current effective certificate, issued by a duly constituted authority of the United States of America or Canada, desig- nating that person as a commercial or airline transport pilot; b. The aircraft is rented with a trained, paid crew; and c. The aircraft does not transport per- sons or cargo for a charge. 13. Bodily Injury Redefined Section V - Definitions, 4. "Bodily injury' is replaced by the following: 4. "Bodily injury' means bodily harm or injury, sickness, disease, disability, humiliation, shock, fright, mental an- guish or mental injury, including care, loss of services or death resulting from any of these at any time. 14. Expected Or Intended Injury Redefined The last sentence of Exclusion 2.a. Ex- pected Or Intended Injury under Sec- tion I - Coverage A - Bodily Injury And Property Damage Liability is replaced by the following: This exclusion does not apply to 'bodily iryury" or "property damage" resulting from the use of reasonable force to protect per- sons or property. 15. Former Employees As Insureds The following is added to Paragraph 2. under Section II -Who Is An Insured: 2. Each of the following is also an in- sured: Any of your former "employees", di- rectors, managers, members, part- ners or "executive officers", including but not limited to retired, disabled or those on leave of absence, but only for acts within the scope of their em- ployment by you or for duties related to the conduct of your business. Includes copyrighted material of Insurance GA 233 0917 Services Office, Ina, with its permission. Page 15 of 17 16. Voluntary Property Damage Coverage a. Coverage D Voluntary Property Damage Coverage Section I - Coverages is amended to include the following: GA 233 0917 (1) Insuring Agreement (a) We will pay the cost to re- pair or replace "property damage" to property of oth- ers arising out of operations incidental to your business when: 1) Damage is caused by you; or 2) Damage occurs while in your possession. At your written request, we will make this payment re- gardless of whether you are at fault for the "property damage". If you, at our request, re- place, or make any repairs to, damaged property of others, the amount we will pay under Voluntary Prop- erty Damage Coverage will be determined by your actu- al cost to replace or repair the damaged property, ex- cluding any profit or over- head. Any payment we make un- der Voluntary Property Damage Coverage shall not be interpreted as an admis- sion of liability by you or by US. It shall be your duty, not our duty, to defend any claim or "suit' to which this insurance applies. No other obligation or liabil- ity to pay sums or perform ads or services is covered. (b) This insurance applies to "property damage" only if: 1) The "property damage" takes place in the "cov- erage territory; and (2) Exclusions This insurance does not apply to "property damage" that would be excluded by Coverage A - Bodi- ly Injury And Property Damage Liability, 2. Exclusions, except for j. Damage To Property, par- agraphs (3), (4), (5) and (6), k. Damage To Your Product, and I. Damage To Your Work. (3) Definitions For purposes of Voluntary Property Damage Coverage only, the following definitions un- der Section V - Definitions are replaced by the following: 16. "Occurrence" means an in- cident, including continuous or repeated exposure to substantially the same gen- eral harmful conditions that result in 'property damage". 20. "Property damage" means physical injury to tangible property. "Electronic data" is not tangible property, and "property, damage" does not include disappearance, ab- straction or theft. b. Care, Custody Or Control Liability Coverage For purposes of the coverage provid- ed by Care, Custody Or Control Li- ability Coverage in this endorsement only: (1) Section I - Coverage A - Bodily Injury And Property Damage Liability, 2. Exclusions, j. Damage To Property, Subpara- graphs (3), (4) and (5) do not ap- ply to 'property damage" to the property of others described therein. (2) It shall be your duty, not our duty, to defend any claim or "suit" to which this insurance applies. No other obligation or liability to pay sums or perform acts or ser- vices is covered. This Paragraph (2) supersedes any provision in the Coverage Part to the contrary. 2) The "property damage" occurs during the policy (3) "Property damage" for which period. Care, Custody Or Control Lia- bility Coverage provides cover - Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 16 of 17 age shall be deemed to be (3) The Voluntary Property Dam - caused by an "occurrence" but age Coverage, Aggregate Limit shall not serve to limit or restrict Of Insurance is the most we will the applicability of any exclusion pay for the sum of all damages for "property damage" under this under Voluntary Property Coverage Part. Damage Coverage. This limit applies separately to each "cov- c. Limits Of Insurance And Deducti- erage term". bles (4) Deductible Clause For purposes of the coverage provid- ed by Voluntary Property Damage (a) Our obligation to pay dam - Coverage and Care, Custody Or ages on your behalf applies Control Liability Coverage, Section only to the amount of dam - III - Limits Of Insurance is amended ages for each "occurrence" to include the following: which are in excess of the Deductible Amount stated (1) The Limits of Insurance shown in for the applicable coverage the Declarations are replaced by in the Schedule. The limits the limits designated in Section of insurance will not be re- B. Limits Of Insurance, 16. duoed by the application of Voluntary Property Damage such Deductible Amount. Coverage And Care, Custody Or Control Liability Coverage, (b) Section IV - Commercial in this endorsement. These limits General Liability Condi- are inclusive of, and not in addi- tions, 2. Duties In The tion to, the limits being replaced. Event Of Occurrence, Of - The Limits of Insurance shown in fense, Claim Or Suit, ap- the Schedule fix the most we will plies to each claim or "suit" pay regardless of the number of: irrespective of the amount. (a) Insureds; (c) We may pay any part or all of the Deductible Amount to (b) Claims made or "suits" effect settlement of any brought; or claim or "suit' and, upon no- (c) Persons or organizations tification of the action taken, making claims or bringing you shall promptly reim- "suits". burse us for such part of the Deductible Amount as has (2) (a) Subject to (3) below, the been paid by us. Voluntary Properly Dam- Dam- age Coverage, Each Occur- 17. Broadened Contractual LiabilityWork rence Limit Of Insurance is Within 50' Of Railroad Property the most we will pay for the Section V - Definitions, 12. "Insured con - sum of damages under Vol- trail" is amended as follows: untary Property Damage Coverage; a. Paragraph c. is replaced by the fol- lowing: (b) The Care, Custody Or Con - trol Liability Coverage, c. Any easement or license agree - Each Occurrenoe Limit Of ment; Insurance is the most we will pay for the sum of damages b. Paragraph f.(1) is deleted in its entire - under Care, Custody Or ty. Control Liability Coverage; 18. Alienated Premises because of all "property damage" Exclusion 2j. Damage to Property, arising out of any one "occur- Paragraph (2) under Section 1 - Cover- rence". age A - Bodily Injury And Property Damage Liability does not apply if the premises are 'your work". Includes copyrighted material of Insurance GA 233 0917 Services Office, Inc., with its permission. Page 17 of 17 Policy #EPP0563496 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS ADDITIONAL INSURED - AUTOMATIC STATUS AND AUTOMATIC WAIVER OF SUBROGATION WHEN REQUIRED IN WRITTEN CONTRACT, AGREEMENT, PERMIT OR AUTHORIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Additional Insured - Owners, Lessees Or Contractors - Automatic Status For Other Parties When Required In Written Contract Or Agreement With You 1. Section II - Who Is An Insured is amended to include as an additional in- sured any person or organization you have agreed in writing in a contract or agreement to add as an additional in- sured on this Coverage Part. Such per- son(s) or organization(s) is an additional insured only with respect to liability for: a. "Bodily injury', "property damage" or "personal and advertising injury" caused, in whole or in part, by the performance of your ongoing opera- tions by you or on your behalf, under that written contract or written agreement. Ongoing operations does not apply to 'bodily injury" or "proper- ty damage" occurring after: (1) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the loca- tion of the covered operations has been completed; or (2) That portion of 'your work" out of which the injury or damage aris- es has been put to its intended use by any person or organiza- tion other than another contrac- tor or subcontractor engaged in performing operations for a prin- cipal as a part of the same pro- ject; and b. "Bodily injury' or "property damage" caused, in whole or in part, by 'your work" performed under that written contract or written agreement and in- cluded in the "products -completed operations hazard", but only if: (1) The Coverage Part to which this endorsement is attached pro- vides coverage for "bodily injury" or "property damage" included within the "products -completed operations hazard'; and (2) The written contract or written agreement requires you to pro- vide additional insured coverage included within the "products - completed operations hazard" for that person or organization. If the written contract or written agreement requires you to provide additional insured coverage included within the "products -completed oper- ations hazard" for a specified length of time for that person or organiza- tion, the "bodily injury" or "property damage" must occur prior to the ex- piration of that period of time in order for this insurance to apply. If the written contract or written agreement requires you to provide additional insured coverage for a person or organization per only ISO additional insured endorsement form number CG 2010, without specifying an edition date, and without specifi- cally requiring additional insured coverage included within the "prod- ucts -completed operations hazard", this Paragraph b. does not apply to that person or organization. 2. If the written contract or written agree- ment described in Paragraph 1. above specifically requires you to provide addi- tional insured coverage to that person or organization: a. Arising out of your ongoing opera- tions or arising out of 'Your work'; or Includes copyrighted material of Insurance GA 472 05 20 Services Office, Inc., with its permission. Pagel of 3 b. By way of an edition of an ISO addi- tional insured endorsement that in- cludes arising, out of your ongoing operations or arising out of 'your work'; then the phrase caused, in whole or in part, by in Paragraph A.1.a. and/or Para- graph A.1.b. above, whichever applies, is replaced by the phrase arising out of. 3. With respect to the insurance afforded to the additional insureds described in Para- graph A.1., the following additional exclu- sion applies: This insurance does not apply to "bodily injury', "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: a. The preparing, approving or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or draw- ings and specifications; or b. Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hir- ing, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "prop- erty damage", or the offense which caused the "personal and advertising inju- ry", involved the rendering of, or the fail- ure to render, any professional architec- tural, engineering or surveying services. 4. This Paragraph A. does not apply to addi- tional insureds described in Paragraph B. B. Additional Insured -State Or Governmental Agency Or Subdivision Or Political Subdi- vision - Automatic Status When Required In Written Permits Or Authorizations 1. Section II - Who Is An Insured is amended to include as an additional in- sured any state or governmental agency or subdivision or political subdivision you have agreed in writing in a permit or au- thorization to add as an additional insured on this Coverage Part. Such state or gov- ernmental agency or subdivision or politi- cal subdivision is an additional insured only with respect to operations performed by you or on your behalf for which the state or governmental agency or subdivi- sion or political subdivision has issued, in writing, a permit or authorization. 2. With respect to the insurance afforded to the additional insureds described in Para- graph B.1., the following additional exclu- sions apply: This insurance does not apply lo: a. "Bodily injury', "property damage" or "personal and advertising injury" aris- ing out of operations performed for the federal government, state or mu- nicipality; or b. "Bodily injury' or "property damage" included within the "products - completed operations hazard." C. The insurance afforded to additional insureds described in Paragraphs A. and B.: 1. Only applies to the extent permitted by law, and 2. Will not be broader than that which you are required by the written contract, writ- ten agreement, written permit or written authorization to provide for such addition- al insured; and 3. Does not apply to any person, organiza- tion, state, governmental agency or sub- division or political subdivision specifically named as an additional insured for the same project in the schedule of an en- dorsement added to this Coverage Part. D. With respect to the insurance afforded to the additional insureds described in Paragraphs A. and B., the following is added to Section III -Limits Of Insurance: The most we will pay on behalf of the addi- tional insured is the amount of insurance: 1. Required by the written contract, written agreement, written permit or written au- thorization described in Paragraphs A. and B. For the purpose of determining the required amount of insurance only, we will include the minimum amount of any Um- brella Liability or Excess Liability cover- age required for that additional insured in that written contract, written agreement, written permit or written authorization; or 2. Available under the applicable limits of in- surance; whichever is less. This endorsement shall not increase the appli- cable limits of insurance. E. Section IV - Commercial General Liability Conditions is amended to add the following: Automatic Additional Insured Provision Includes copyrighted material of Insurance GA 472 05 20 Services Office, Inc., with its permission. Page 2 of 3 This insurance applies only if the "bodily inju- ry" or "property damage" occurs, or the "per- sonal and advertising injury' offense is com- mitted: 1. During the policy period; and 2. Subsequent to your execution of the writ- ten contract or written agreement, or the issuance of a written permit or written au- thorization, described in Paragraphs A. and B. F. Except when G. below applies, the following is added to Section IV - Commercial General Liability Conditions, Other Insurance, and supersedes any provision to the contrary: When Other Additional Insured Coverage Applies On An Excess Basis This insurance is primary to other insurance available to the additional insured described in Paragraphs A. and B. except: 1. As otherwise provided in Section IV - Commercial General Liability Condi- tions, Other Insurance, b. Excess In- surance; or 2. For any other valid and collectible insur- ance available to the additional insured as an additional insured on another insur- ance policy that is written on an excess basis. In such case, this insurance is also excess. G. The following is added to Section IV - Com- mercial General Liability Conditions, Other Insurance, and supersedes any provision to the contrary: Primary Insurance When Required By Writ- ten Contract, Agreement, Permit Or Au- thorization Except when wrap-up insurance applies to the claim or "suit' on behalf of the additional in- sured, this insurance is primary to any other insurance available to the additional insured described in Paragraphs A. and B. provided that: 1. The additional insured is a Named In- sured under such other insurance; and 2. You have agreed in writing in a contract, agreement, permit or authorization de- scribed in Paragraph A. or B. that this in- surance would be primary to any other in- surance available to the additional in- sured. As used in this endorsement, wrap-up insur- ance means a centralized insurance program under which one party has secured either in- suranoe or self-insuranoe covering some or all of the contractors or subcontractors perform- ing work on one or more specific project(s). Primary And Noncontributory Insurance When Required By Written Contract, Agreement, Permit Or Authorization Except when wrap-up insurance applies to the claim or "suit' on behalf of the additional in- sured, this insurance is primary to and will not seek contribution from any other insurance available to the additional insured described in Paragraphs A. and B. provided that: 1. The additional insured is a Named In- sured under such other insurance; and 2. You have agreed in writing in a contract, agreement, permit or authorization de- scribed in Paragraph A. or B. that this in- surance would be primary and would not seek contribution from any other insur- ance available to the additional insured. As used in this endorsement, wrap-up insur- ance means a centralized insurance program under which one party has secured either in- surance or self-insurance covering some or all of the contractors or subcontractors perform- ing work on one or more specific project(s). H. Section IV - Commercial General Liability Conditions, Transfer Of Rights Of Recov- ery Against Others To Us is amended by the addition of the following: Waiver of Subrogation We waive any right of recovery against any additional insured under this endorsement, because of any payment we make under this endorsement, to whom the insured has waived its right of recovery in a written oon- tract, written agreement, written permit or writ- ten authorization. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such additional in- sured prior to loss. Includes copyrighted material of Insurance GA 472 05 20 Services Office, Inc., with its permission. Page 3 of 3 Policy #EBA0563496 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CinciPlusO BUSINESS AUTO XC+® (EXPANDED COVERAGE PLUS) ENDORSEMENT This endorsement modifies insurance provided by the following: BUSINESS AUTO COVERAGE FORM With respect to the coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. A. Blanket Waiver of Subrogation SECTION IV - BUSINESS AUTO CONDI- TIONS, A. Loss Conditions, 5. Transfer of Rights of Recovery Against Others to Us is amended by the addition of the following: We waive any right of recovery we may have against any person or organization because of payments we make for 'bodily injury" or "property damage" arising out of the operation of a covered "auto" when you have assumed liability for such "bodily injury" or "property damage" under an "insured contract", provid- ed the "bodily injury' or "property damage" oc- curs subsequent to the execution or the "in- sured contract". B. Noncontributory Insurance SECTION IV - BUSINESS AUTO CONDI- TIONS, B. General Conditions, 5. Other In- surance c. is deleted in its entirety and re- placed by the following: c. Regardless of the provisions of Par- agraph a. above, this Coverage Form's Liability Coverage is primary and we will not seek contribution from any other insurance for any lia- bility assumed under an "insured contract" that requires liability to be assumed on a primary noncontributo- ry basis. C. Additional Insured by Contract This provision does not apply unless the valid written contract has been: 1. Executed prior to the accident causing "bodily injury"or "property damage'; and 2. Is still in force at the time of the "accident" causing "bodily injury" or "property dam- age". D. Employee Hired Auto 1. Changes in Liability Coverage The following is added to the SECTION II - LIABILITY COVERAGE, A. Coverage, 1. Who is an Insured: An "employee" of yours is an "insured" while operating an "auto" hired or rented under a contract or agreement in that "employee's" name, with your permission, while performing duties related to the conduct of your business. 2. Changes in General Conditions SECTION IV - BUSINESS AUTO CON- DITIONS, B. General Conditions, 5. Other Insurance is deleted in its entirety and replaced by the fallowing: b. For Hired Auto Physical Damage Coverage the following are deemed to be covered "autos" you own: (1) Any covered "auto" you lease, hire, rent or borrow; and SECTION II - LIABILITY COVERAGE, A. Coverage, 1. Who is an Insured is amended (2) Any covered "auto" hired or to include as an insured any person or organi- rented by your "employee" under zation for whom you have agreed in a valid a contract in that individual "pe - written contract to provide insurance as af- mission, name, with your per - forded by this policy. mission, while performing duties related to the conduct of your This provision is limited to the scope of the business. valid written contract. Includes copyrighted material of ISO AA 288 06 20 Properties, Inc., with its permission. Page 1 of 4 However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". E. Audio, Visual and Data Electronic Equip- ment SECTION III - PHYSICAL DAMAGE COV- ERAGE, C. Limit of Insurance is amended by adding the following: 4. The most we will pay for all "loss" to au- dio, visual or data electronic equipment and any accessories used with this equipment as a result of any one "acci- dent" is the lesser of: a. The actual cash value of the dam- aged or stolen property as of the time of the "accident'; b. The cost of repairing or replacing the damaged or stolen property with oth- er property of like kind and quality; or c. $2,500. Provided the equipment, at the time of the "loss" is: a. Permanently installed in or upon the covered "auto" in a housing, opening or other location that is not normally used by the "auto" manufacturer for the installation of such equipment; b. Removable from a permanently in- stalled housing unit as described in Paragraph 2.a. above; or c. An integral part of such equipment. F. Who is an Insured -Amended SECTION II - LIABILITY COVERAGE, A. Coverage, 1. Who is an Insured is amended by adding the following: The following are "insureds": 1. Any subsidiary which is a legally incorpo- rated entity of which you own a financial interest of more than 50% of the voting stock on the effective date of this cover- age form. However, the insurance afforded by this provision does not apply to any subsidiary that is an "insured" under any other au- tomobile liability policy or would be an "in- sured" under such policy but for termina- tion of such policy or the exhaustion of such policy's limits of insurance. 2. Any organization that is newly acquired or formed by you and over which you main- tain majority ownership. The insurance provided by this provision: a. Is effective on the date of acquisition or formation, and is afforded for 180 days after such date; b. Does not apply to "bodily injury' or "property damage" resulting from an "accident" that occurred before you acquired or formed the organization; c. Does not apply to any newly acquired or formed organization that is a joint venture or partnership; and d. Does not apply to an insured under any other automobile liability policy or would be an insured under such a policy but for the termination of such policy or the exhaustion of such poli- cy's limits of insurance. 3. Any of your "employees" while using a covered "auto" in your business or your personal affairs, provided you do not own, hire or borrow that "auto". G. Liability Coverage Extensions - Supple- mentary Payments - Higher Limits SECTION II - LIABILITY COVERAGE, A. Coverage, 2. Coverage Extensions, a. Sup- plementary Payments is amended by: 1. Replacing the $2,000 Limit of Insurance for bail bonds with $4,000 in (2); and 2. Replacing the $250 Limit of Insurance for reasonable expenses with $500 in (4). H. Amended Fellow Employee Exclusion SECTION II - LIABILITY COVERAGE, B. Ex- clusions, 5. Fellow Employee is modified as follows: Exclusion 5. Fellow Employee is deleted. 1. Hired Auto - Physical Damage If hired "autos" are covered "autos" for Liability Coverage, then Comprehensive and Collision Physical Damage Coverages as provided un- der SECTION III - PHYSICAL DAMAGE COVERAGE of this Coverage Part are ex- tended to "autos" you hire, subject to the fol- lowing: 1. The most we will pay for "loss" to any hired "auto" is $50,000 or the actual cash value or cost to repair or replace, which- ever is the least, minus a deductible. 2. The deductible will be equal to the largest deductible applicable to any owned "auto" for that coverage, or $1,000, whichever is less. 3. Hired Auto - Physical Damage coverage is excess over any other collectible insur- ance. Includes copyrighted material of ISO AA 288 06 20 Properties, Inc., with its permission. Page 2 of 4 4. Subject to the above limit, deductible, and excess provisions we will provide cover- age equal to the broadest coverage appli- cable to any covered "auto" you own in- sured under this policy. Coverage includes loss of use of that hired au- to, provided it results from an "accident" for which you are legally liable and as a result of which a monetary loss is sustained by the leasing or rental concern. The most we will pay for any one "accident" is $3,000. If a limit for Hired Auto - Physical Damage is shown in the Schedule, then that limit replac- es, and is not added to, the $50,000 limit indi- cated above and the deductibles shown in the Schedule are applicable. J. Rental Reimbursement SECTION III - PHYSICAL DAMAGE COV- ERAGE is amended by adding the following: 1. We will pay for rental reimbursement ex- penses incurred by you for the rental of an "auto" because of a 'loss" to a covered "auto". Payment applies in addition to the otherwise applicable amount of each cov- erage you have on a covered "auto". No deductible applies to this coverage. 2. We will pay only for those expenses in- curred during the policy period beginning 24 hours after the "loss" and ending, re- gardless of the policy's expiration, with the lesser of the following number of days: a. The number of days reasonably re- quired to repair the covered "auto". If "loss" is caused by theft, this number of days is added to the number of days it takes to locate the covered "auto" and return it to you; or b. 30 days. 3. Our payment is limited to the lesser of the following amounts: a. Necessary and actual expenses in- curred; or b. $50 per day. 4. This coverage does not apply while there are spare or reserve "autos" available to you for your operations. K. Transportation Expense -Higher Limits SECTION III - PHYSICAL DAMAGE COV- ERAGE, A. Coverage, 4. Coverage Exten- sions is amended by replacing $20 per day with $50 per day, and $600 maximum with $1,500 maximum in Extension a. Transpor- tation Expenses. L. Airbag Coverage SECTION III - PHYSICAL DAMAGE COV- ERAGE, B. Exclusions, 3.a. is amended by adding the following: However, the mechanical and electrical breakdown portion of this exclusion does not apply to the accidental discharge of an airbag. This coverage for airbags is excess over any other collectible insurance or warranty. M. Loan or Lease Gap Coverage 1. SECTION III - PHYSICAL DAMAGE COVERAGE, C. Limit of Insurance is deleted in its entirety and replaced by the following, but only for private passenger type "autos" with an original loan or lease, and only in the event of a "total loss" to such a private passenger type "auto% a. The most we will pay for "loss" in any one "accident" is the greater of: (1) The amount due under the terms of the lease or loan to which your covered private passenger type "auto" is subject, but will not include: (a) Overdue lease or loan pay- ments; (b) Financial penalties imposed under the lease due to high mileage, excessive use or abnormal wear and tear; (c) Security deposits not re- funded by the lessor; (d) Costs for extended warran- ties, Credit Life Insurance, Health, Accident or Disabil- ity Insurance purchased with the loan or lease; and (e) Carry-over balances from previous loans or leases, or S. We will pay under this coverage only that (2) Actual cash value of the stolen amount of your rental reimbursement ex- or damaged property. penses which is not already provided for b. An adjustment for depreciation and under SECTION III - PHYSICAL DAM- physical condition will be made in de - AGE COVERAGE, A. Coverage, 4. termining actual cash value at the Coverage Extensions. time of'loss". Includes copyrighted material of ISO AA 288 06 20 Properties, Inc., with its permission. Page 3 of 4 2. SECTION V - DEFINITIONS is amended by adding the following, but only for the purposes of this Loan or Lease Gap Coverage: 'Total loss" means a "loss" in which the cost of repairs plus the salvage value ex- ceeds the actual cash value. N. Glass Repair -Waiver of Deductible SECTION 111 - PHYSICAL DAMAGE COV- ERAGE, D. Deductible is amended by adding the following: No deductible applies to glass damage if the glass is repaired in a manner acceptable to us rather than replaced. O. Duties in the Event of an Accident, Claim, Suit or Loss - Amended SECTION IV - BUSINESS AUTO CONDI- TIONS, A. Loss Conditions, 2. Duties in the Event of Accident, Claim, Suit or Loss, a. is amended by adding the following: This condition applies only when the "acci- dent" or'loss" is known to: 1. You, if you are an individual; 2. A partner, if you are a partnership; 3. An executive offioer or insurance manag- er, if you are a corporation; or 4. A member or manager, if you are a lim- ited liability company. P. Unintentional Failure to Disclose Hazards SECTION IV - BUSINESS AUTO CONDI- TIONS, B. General Conditions, 2. Conceal- ment, Misrepresentation or Fraud is amended by adding the following: However, if you unintentionally fail to disclose any hazards existing on the effective date of this Coverage Form, we will not deny cover- age under this Coverage Form because of such failure. Q. Mental Anguish Resulting from Bodily Inju- ry SECTION V - DEFINITIONS, C. "Bodily inju- ry" is deleted in its entirety and replaced by the following: "Bodily injury" means bodily injury, sickness or disease sustained by a person, including men- tal anguish and death sustained by the same person that results from such bodily injury, sickness or disease. "Bodily injury' does not include mental anguish or death that does not result from bodily injury, sickness or disease. R. Coverage for Certain Operations in Con- nection with Railroads With respect to the use of a covered "auto" in operations for or affecting a railroad: 1. SECTION V - DEFINITIONS, H. "Insured contract", 1.c. is deleted in its entirety and replaced by the following: c. An easement or license agreement; SECTION V - DEFINITIONS, H. "Insured contract", 2.a. is deleted. Includes copyrighted material of ISO AA 288 06 20 Properties, Inc., with its permission. Page 4 of 4 Policy #EPP0563496 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AUTOMATIC PRIMARY AND NON-CONTRIBUTORY COVERAGE ENDORSEMENT - WHERE REQUIRED BY WRITTEN CONTRACT This endorsement modifies insurance provided under the following: COMMERCIAL UMBRELLA LIABILITY COVERAGE PART SCHEDULE LIMITS OF INSURANCE: $ 2 ,000,000 Each Occurrence Limit $ 2 ,000,000 Aggregate Limit COMMERCIAL UMBRELLA LIABILITY COVERAGE FORM, US 101 and US 101 UM, is amended as follows: A. SECTION III - LIMITS OF INSURANCE is It is agreed that this condition does not amended to add the following: apply to the "non-contributory additional 7. For the purposes of this endorsement on- insured's" own insurance program on which they are a named insured. ly, the Limits of Insurance stated in the Schedule of this endorsement and de- However: scribed below will apply on a "primary and non-contributory basis within the parame- a This s exception to the Other Insurance ters set forth in SECTION III - LIMITS OF Condition shall only apply if the appli- INSURANCE of the Coverage Part to cable "underlying insurance" applies which this endorsement is attached: on a "primary and non-contributory basis" for such "non-contributory ad - We will not pay more on behalf of a "non- ditional insured" and only to the ex - contributory additional insured" than the tent of the specific limits of insurance lesser of: required in a written contract or a. The Limits of Insurance stated in the agreement on a "primary and non- contributory basis" that is in excess of Schedule of this endorsement, or the "underlying insurance"; and b. The limits of insurance required in a b. It is understood and agreed that the written contract on a "primary and insurance provided by this Coverage non-contributory basis" for such "non- Part is excess of: contributory additional insured", but only to the extent the required limits (1) "Underlying insurance" listed in of insurance are in excess of the the Schedule of Underlying In - "underlying insurance"; or surance; c. The Limits of Insurance available af- (2) Any other insurance available to ter the payment of "ultimate net loss" the "non-contributory additional on any insured's behalf from any insured" as an additional insured; claim or "suit". and This provision is included within and does (3) Any other insurance available to not act to increase the Limits of Insurance the "non-contributory additional stated in the Declarations. insured" on which they are not a named insured. B. SECTION IV - CONDITIONS is amended as follows: 2. The following condition is added: 1. Condition 9. Other Insurance is amended 15. As a precedent to the receipt of in- to add the following: surance coverage hereunder, the "non-contributory additional insured" must give written notice of such claim or "suit", including a demand for de - Includes copyrighted material of Insurance US 4096 01 21 Services Office, Inc., with its permission. Page 1 of 2 fense and indemnity, to any other in- surer who had coverage for the claim or "suit" under its policies. Such no- tice must demand the full coverage available and the "non-contributory additional insured" shall not waive or limit such other available coverage. This condition does not apply to the "non-contributory additional insured's" own insurance program on which they are a named insured. C. SECTION V - DEFINITIONS is amended to add the following: 30. "Non-contributory additional insured" means any person or organization: a. Qualifying as an additional insured under SECTION II - WHO IS AN IN- SURED, Paragraph 3. of the Cover- age Part to which this endorsement is attached; and b. Being granted additional insured sta- tus on a "primary and non- contributory basis" in the "underlying insurance" as required in a written contract between an additional in- sured and a Named Insured provid- ed: (1) The written contract or agree- ment is executed before the "oc- currence" resulting in "bodily in- jury", "personal and advertising injury" or "property damage" for which coverage is being sought under this endorsement; and (2) The written contract or agree- ment requires a specific limit of insurance on a "primary and non-contributory basis" that is in excess of "underlying insur- ance". 31. "Primary and non-contributory basis" means that the limits of insurance of the Coverage Part to which this endorsement is attached apply to insured loss on behalf of the "non-contributory additional in- sured" prior to limits of insurance from other insurance in which the "non- contributory additional insured" is a named insured. Includes copyrighted material of Insurance US 4096 01 21 Services Office, Inc., with its permission. Page 2 of 2 12/19/23, 9:08 AM ELLER CORPORATION a STATE OF WASHINGTON Department of Labor & Industries Certificate of Workers' Compensation Coverage WA UBI No. L&I Account ID Legal Business Name Doing Business As Workers' Comp Premium Status: Estimated Workers Reported (See Description Below) Account Representative Licensed Contractor? License No. License Expiration December 19, 2023 600 184 764 642,062-00 ELLER CORPORATION ELLER CORP Account is current. Quarter 3 of Year 2023 "51 to 75 Workers" Employer Services Help Line, (360) 902-4817 Yes ELLERC*242C3 10/01 /2024 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:l/secure.ini.wa.gov/verify/DetailsAiabifityCertificate.aspx?UBI=600184764&LIC=ELLERC`242C3&VIO=&SAW=false&ACCT=64206200 1 /1