10-043.00 Sargent Engineers: Sullivan Rd West BridgeSA* RGENT
Sargent Engineers, Inc.
320 Ronlee Lane NW
Olympia, Washington 98502 -9241
Tel 360 867 -9284
Fax 360 867 -9318
www.sargentengineers.com
April 8, 2010
Mr. Steve Worley, P.E.
City of Spokane Valley
11707 E. Sprague, Suite 106
Spokane Valley, WA 99206
RE: Sullivan Road Road West Bridge
Project No.: A10100.00
Dear Mr. Worley:
Attached is a copy of the contract that you sent me with the insurance certificates. We
look forward to assisting you with this project.
Sincerely,
Sargent Engineers, Inc.
Monte Smith
Principal
MJS
\\Served \files\MonteS \My Documents \Spokane Valley \SullivanRoadContTrans.doc
AGREEMENT FOR PROFESSIONAL SERVICES
Sargent Engineers, Inc.
Sullivan Road West Bridge #4508 Replacement Cost Estimate
PW Contract #10 -018
THIS AGREEMENT is made by and between the City of Spokane Valley, a code City of the State of
Washington, hereinafter "City" and Sargent Engineers, Inc. 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 The Consultant will provide all labor, services and material to
satisfactorily complete the attached Engineering Services Proposal.
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 Work, 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 Work, stop work
and promptly cure any failure in performance under this agreement.
B. Representations The City has relied upon the qualifications of the 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 Work. No substitutions of agreed upon personnel shall be made
without the written consent of the City.
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. Modifications The City may modify this agreement and order changes in the work
whenever necessary or advisable. The Consultant will accept modifications when ordered in writing by the
City Manager or designee. Compensation for such modifications or changes shall be as mutually agreed
between the parties. The Consultant shall make such revisions in the work as are necessary to correct errors or
omissions appearing therein when required to do so by the 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 has been met.
Either party may terminate this agreement by ten days written notice to the other party. In the
event of such termination, the City shall pay the Consultant for all work previously authorized and
satisfactorily performed prior to the termination date.
3. Compensation The City agrees to pay the Consultant on a time and materials basis up to
$8,012 per the attached Engineering Services Proposal. An additional Management Reserve Fund (MRF) in
the amount of $800 is hereby established making the Total Contract Amount $8,812 as full compensation for
everything done under this agreement. The Consultant shall not start any work requiring payment from the
Sargent Engineers, Inc. — Sullivan Rd Bridge #4508 Replacement Cost Estimate Contract Page 1 of 5
MRF without prior written approval from the City.
4. Payment The Consultant shall be paid monthly upon presentation of an invoice to the City.
Applications for payment shall be sent to the City Clerk at the below stated address.
The City reserves the right to withhold payment under this agreement which is determined in the
reasonable judgment of the City Manager or designee to be noncompliant with the Scope of Work, City
Standards, City ordinances and federal or state standards.
5. Notice Notice shall be given in writing as follows:
TO THE CITY TO THE CONSULTANT
Name: Christine Bainbridge, City Clerk Name: Erik Martin, S.E., P.E.
Phone Number: (509)921 -1000 Phone Number: (360) 867 -9284
Address: 11707 East Sprague Ave, Suite 106 Address: 320 Ronlee Lane NW
Spokane Valley, WA 99206 Olympia, WA 98502
6. Applicable Laws and Standards The parties, in the performance of this agreement, agree
to comply with all applicable Federal, State, local laws, ordinances, and regulations.
7. Relationship of the Parties It is understood, agreed and declared that the Consultant shall be
an independent Consultant and not the agent or employee of the City, that the 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 the Consultant. Any and all employees who provide
services to the City under this agreement shall be deemed employees solely of the 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.
8. Ownership of Documents All drawings, plans, specifications, and other related documents
prepared by the Consultant under this agreement are and shall be the property of the City, and may be subject
to disclosure pursuant to RCW 42.56 or other applicable public record laws.
9. 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 the Consultant's records with respect to all
matters covered in this contract. Such representatives shall be permitted to audit, examine and make excerpts
or transcripts from such records and to make audits of all contracts, invoices, materials, payrolls and record of
matters covered by this contract for a period of three years from the date final payment is made hereunder.
10. Insurance The 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 the Consultant, its agents, representatives, or employees.
No Limitation. Consultant's maintenance of insurance as required by the agreement shall not be construed to
limit the liability of the Consultant to the coverage provided by such insurance, or otherwise limit the City's
recourse to any remedy available at law or in equity.
A. Minimum Scope of Insurance Consultant shall obtain insurance of the types
described below:
Sargent Engineers, Inc. — Sullivan Rd Bridge #4508 Replacement Cost Estimate Contract Page 2 of 5
1. Automobile Liability insurance covering all owned, non - owned, hired and
leased vehicles. Coverage shall be written on Insurance Services Office (ISO) form
CA 00 01 or a substitute form providing equivalent liability coverage. If necessary,
the policy shall be endorsed to provide contractual liability coverage.
2. Commercial General Liability insurance shall be written on ISO occurrence
form CG 00 01 and shall cover liability arising from premises, operations,
independent contractors and personal injury and advertising injury. The City shall be
named as an insured under the Consultant's Commercial General Liability insurance
policy with respect to the work performed for the City.
3. Workers' Compensation coverage as required by the Industrial Insurance
laws of the State of Washington.
4. Professional Liability insurance appropriate to the Consultant's profession.
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 $1,000,000 each occurrence, $2,000,000 general aggregate.
3. Professional Liability insurance shall be written with limits no less than
$1,000,000 per claim and $1,000,000 policy aggregate limit.
C. Other Insurance Provisions The insurance policies are to contain, or be endorsed to
contain, the following provisions for Automobile Liability, Professional Liability and
Commercial General Liability insurance:
1. The Consultant's insurance coverage shall be primary insurance as respect
the City. Any insurance, self-insurance, or insurance pool coverage maintained by
the City shall be excess of the Consultant's insurance and shall not contribute with it.
2. Cancellation of Consultant's insurance shall be governed by either:
a. the policy shall be endorsed to state that coverage shall not be cancelled by
either party, except after thirty days prior written notice by certified mail,
return receipt requested, has been given to the City, or
b. the Consultant shall provide at least 30 days prior written notice by
certified mail, return receipt requested of a cancellation.
D. Acceptability of Insurers Insurance is to be placed with insurers with a current A.M.
Best rating of not less than ANN.
Sargent Engineers, Inc. — Sullivan Rd Bridge #4508 Replacement Cost Estimate Contract Page 3 of 5
E. Evidence of Coverage. As evidence of the insurance coverages required by this
contract, the Consultant shall furnish acceptable insurance certificates to the City at the time
the Consultant returns the signed contract. The certificate shall specify all of the parties who
are additional insureds, and will include applicable policy endorsements, and the deduction or
retention level. Insuring companies or entities are subject to City acceptance. If requested,
complete copies of insurance policies shall be provided to the City. The Consultant shall be
financially responsible for all pertinent deductibles, self - insured retentions, and/or self-
insurance.
11. Indemnification and Hold Harmless The Consultant shall defend, indemnify and hold the
City, its officers, officials, employees and volunteers harmless from any and all claims, injuries, damages,
losses or suits including attorney fees, arising out of or in connection with the performance of this agreement,
except for injuries and damages caused by the sole negligence of the City.
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 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 purposes of this
indemnification. This waiver has been mutually negotiated by the parties. The provisions of this section shall
survive the expiration or termination of the agreement.
12. 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. No waiver in one
instance shall be held to be 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.
13. Assignment and Delegation Neither party shall assign, transfer or delegate any or all of the
responsibilities of this agreement or the benefits received hereunder without first obtaining the written consent
of the other party.
14. Subcontracts Except as otherwise provided herein, the Consultant shall not enter into
subcontracts for any of the work contemplated under this agreement without obtaining prior written approval of
the City.
15. Confidentiality Consultant may, from time to time, receive information which is deemed by
the City to be confidential. Consultant shall not disclose such information without the express written consent
of the City or upon order of a Court of competent jurisdiction.
16. Jurisdiction and Venue This agreement is entered into in Spokane County, Washington.
Venue shall be in Spokane County, State of Washington.
17. Cost and Attorney's Fees In the event a lawsuit is brought with respect to this agreement,
the prevailing party shall be awarded its costs and attorney's fees in the amount to be determined by the Court
as reasonable. Unless provided otherwise by statute, Consultant's attorney fees payable by the City shall not
Sargent Engineers, Inc. — Sullivan Rd Bridge #4508 Replacement Cost Estimate Contract Page 4 of 5
z7p%op
exceed the total sum amount paid under this agreement. %400 E l y
18. Entire Agreement This written agreement constitutes the entire and complete agreement
between the parties and supercedes any prior oral or written agreements. This agreement may not be changed,
modified or altered except in writing signed by the parties hereto.
19. Anti - kickback No officer or employee of the 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.
20. Business Registration Prior to commencement of work under this agreement, Consultant
shall register with the City as a business.
21. 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.
22. Exhibits Exhibits attached and incorporated into this agreement are:
1. Engineering Proposal dated April 1, 2010
2. Insurance Certificates
�N' NE WHEREOF, the pa have t this t this / f
J �Z SS O e pa es ve execu ed h s agreemen s ! day o
2010.
F POKANE VALLEY: Consultant:
ike Jacks cting City Manager Owner"
Tax ID No. _ , REDACTED
ATTEST APPROVED AS TO FORM:
Christine Bainbridge, City Clerk Office ol e City Attorney
This document contains confidential tax information and
has been redacted pursuant to RCW 82.32.330.
You may petition for a review of our findings pertaining to any
redacted or withheld documents pursuant to Spokane Valley
Municipal Code (SVMC) 2.75.080; and obtain judicial review
pursuant to RCW 42.56.550.
Sargent Engineers, Inc. — Sullivan Rd Bridge #4508 Replacement Cost Estimate Contract Page 5 of 5
SA. RGENT
Sargent Engineers, Inc.
320 Ronlee Lane NW
Olympia, Washington 98502
Tel 360 867 -9284
Fax 360 867 -9318
www.sargentengineers.com
April 1, 2010
Century West Engineering
Attn: Mr. Bryan Hicks, P.E.
1825 N Hutchinson Rd, 2nd Floor
Spokane Valley, WA 99212
RE: Sullivan Road West Bridge Grant Assistance
Engineering Services Proposal
Project No.: A10100.00
Dear Mr. Hicks:
On behalf of Sargent Engineers, I am pleased to present to you our proposal for providing
structural engineering services related to the replacement of the Sullivan Road West Bridge over
the Spokane River. Based on information provided to us, our proposed scope of work would
include the following:
1. Review existing plans and inspection reports for the east and west half of the Sullivan
Road Bridge.
2. Conduct a site visit to observe the existing condition of the bridge. This work would
include travel time and expenses for one site visit. The observation is limited to a walk
around of the bridge only and will not include a detailed inspection.
3. Develop a preliminary bridge plan and section. The plan and section would be very
basic drawings of an appropriate cross section and plan for the length of spans and the
proposed bridge width.
4. Prepare detailed programming level cost estimate for the replacement of the west half
of the Sullivan Road Bridge. This estimate would also include the costs of TS &L
study, Preliminary Engineering and Bid Documents, Construction Management. This
would also include the costs of demolition of the existing structure, and construction of
the new substructure and superstructure for the bridge. This estimate will only include
the structural items for the bridge, it will not include items such as utilities, roadway,
etc.
5. Review of the programming level cost estimate listed in Item 4 with City staff via
conference call.
6. Prepare final programming level cost estimate for use in FHBP grant application. This
work would include minor modifications to the cost estimate based on revisions
requested in Item 5.
7. Assist City staff in preparing the grant application. This work would include providing
additional information to the City as requested to complete the grant application.
SA RGENT
Mr. Bryan Hicks
Page 2
April 1, 2010
To complete the scope of work as outlined, we propose a maximum fee of $8,012 to be
billed at the hourly rates in effect at the time services are provided. Any work performed outside
of the scope of work will be billed at our current hourly rates. Please find the attached cost -per-
task breakdown for your review.
If the scope and fee are acceptable, we can begin work immediately following receipt of a
completed contract. Thank you for this opportunity to be of assistance to you and we look
forward to a successful project working with Century West Engineering and the City of Spokane
Valley.
Respectfully,
Sargent Engineers, Inc.
Erik C. Martin, S.E., P.E.
Principal
ECM/encl.
PA09Files\Proposals\Spokane Valley - Sullivan Rd Bridge\Sullivan Estimate PropIdoc
DOCUMENTS EXEMPT FROM PUBLIC DISCLOSURE
The page entitled " Sargent / Engineering Services Proposal contains confidential cost and rate
data and is withheld from public disclosure pursuant to 23 USC 112(2)(F).
Prenotification; confidentiality of data A recipient of funds requesting or using the cost
and rote data shall notify any affected firm before such request or use. Such data shall be
confidential and shall not be accessible or provided, in whole or in part, to another firm or to any
government agency which is not part of the group of agencies sharing cost data under this
paragraph, except by written permission of the audited firm. If prohibited by law, such cost and
rate data shall not be disclosed under any circumstances.
You may petition for a review of our findings pertaining to any redacted or withheld documents
pursuant to Spokane Valley Municipal Code (SVMC) 2.75.080; and obtain judicial review
pursuant to RCW 42.56.550.
Acoo® CERTIFICATE OF LIABILITY INSURANCE OP ID CU °ATE(MMI °DIYYYY)
SARGE -4 04/08/10
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIO
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Western States - The Dalles HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
101 E. Third St., PO Box 1940 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW
The Dalles OR 97058
Phone: 541- 296 -2268 Fax:541- 296 -9427 INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURER A: U.S. Specialty Insurance Cc
- I NSURER B: The Hartford Insurance
Sargent Engineers Inc INSURER C:
320 Ronlee Lane INSURER D:
Olympia WA 98502
INSURER E:
COVERAGES
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR "ADD
LTR INSR
TYPE OF INSURANCE
POLICY NUMBER POLICY EFFECTIVE
DATE MM /DD /YYYY
POLICY EXPIRATION
DATE MM /DD/YYYY
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
•
X
X COMMERCIAL GENERAL LIABILITY
52SBAVW7185SC 02/21/10
02/21/11
PREMISES(Eaoccurence )
$ 1,000,000
CLAIMS MADE 1XI OCCUR
MED EXP (Any one person)
$ 10,000
PERSONAL & ADV INJURY
$1,000,000
GENERAL AGGREGATE
$2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP /OP AGG
s2,000,000
POLICY jEa 7 LOC
WA STP GA
1,000,000
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
$1,000,000
X
•
ANY AUTO
52UECIV4082SC
02/21/10
02/21/11
(Ea accident)
BODILY INJURY
ALL OWNED AUTOS
$
SCHEDULED AUTOS
(Per person)
•
X
HIRED AUTOS
52UECIV4082SC
02/21/10
02/21/11
BODILY INJURY
NON -OWNED AUTOS
(Per accident)
$
X
PROPERTY DAMAGE
$
(Per accident)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
ANY AUTO
$
AUTO ONLY: AGG
$
EXCESS / UMBRELLA LIABILITY
EACH OCCURRENCE
$2,000,000
B
X OCCUR 71 CLAMS MADE
52SBAVW7185SC
02/21/10
02/21/11
$2,000,000
AGGREGATE
I
$
DEDUCTIBLE
$
RETENTION $
WORKERS COMPENSATION
VVG 51A - H.
TORY LIMITS ER
AND EMPLOYERS' LIABILITY YIN
E.L. EACH ACCIDENT
$ 1,000,000
$ ANY PROPRIETOR/PARTNER/EXECUTIVE
52WECZ08094
05/01/09
05/01/10
OFFICERIMEMBER EXCLUDED?
(Mandatory In NH)
E.L. DISEASE - EA EMPLOYEE
$1,000,000
If es, describe under
SPECIAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT
$1,000,000
OTHER
A PROF LIABILITY
US081136704 08/16/09 08/16/10
EA CLAIM 2,000,000
ANN AGG 2,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
Please see additional notes on Page 3.
CERTIFICATE HOLDER CANCELLATION
City of Spokane Valley
Attn: Christine Bainbridge
11707 East Sprague Avenue,
Suite 106
Spokane Vallev. WA 99206
r_r6TiT 1_1wM' wb11ITIL'N11a
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
ON. All rights reserved.
The ACORD name and logo are registered marks of ACORD
11 ' 0 R E ►
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
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).
DISCLAIMER
This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized
representative or producer, and the certificate holder, nor does it affirmatively or negatively amend,
extend or alter the coverage afforded by the policies listed thereon.
RD
HOLDER CODE SARGE -4 PAGE 3
NOTEPAD:
INSUREUSNAME Sargent Engineers, Inc OP ID CU DATE 04/08/10
The certificate holder is an additional insured on the General Liability
and Automobile Policies policy per attached Hartford Form# SS 00 08 04 05,
Pages 11 -13.
A waiver of subrogation applies to the General Liability, Auto Liability
in favor of the additional insured per attached Hartford Form# SS 00 08 04
05, Page 17.
This insurance is primary and non - contributory.
BUSINESS LIABILITY COVERAGE FORM
(b) Rented to, in the care, custody or
control of, or over which physical
control is being exercised for any
purpose by you, any of your
"employees ", "volunteer workers ",
any partner or member (if you are
a partnership or joint venture), or
any member (if you are a limited
liability company).
b. Real Estate Manager
Any person (other than your "employee" or
"volunteer worker "), or any organization
while acting as your real estate manager.
c. Temporary Custodians Of Your
Property
Any person or organization having proper
temporary custody of your property if you
die, but only:
(1) With respect to liability arising out of the
maintenance or use of that property; and
(2) Until your legal representative has
been appointed.
d. Legal Representative If You Die
Your legal representative if you die, but
only with respect to duties as such. That
representative will have all your rights and
duties under this insurance.
e. Unnamed Subsidiary
Any subsidiary and subsidiary thereof, of
yours which is a legally incorporated entity
of which you own a financial interest of
more than 50% of the voting stock on the
effective date of this Coverage Part.
The insurance afforded herein for any
subsidiary not shown in the Declarations
as a named insured does not apply to
injury or damage with respect to which an
insured under this insurance is also an
insured under another policy or would be
an insured under such policy but for its
termination or upon the exhaustion of its
limits of insurance.
3. Newly Acquired Or Formed Organization
Any organization you newly acquire or form,
other than a partnership, Joinnt venture or
limited liability company, and over which you
maintain financial IincicSt of iiivie uian .iv% of
the voting stock, will qualify as a Named
Insured if there is no other similar insurance
available to that organization. However:
a. Coverage under this provision is afforded
only until the 180th day after you acquire
or form the organization or the end of the
policy period, whichever is earlier; and
b. Coverage under this provision does not
apply to_
(1) 'Bodily injury" or "property damage"
that occurred; or
(2) 'Personal and advertising injury"
arising out of an offense committed
before you acquired or formed the
organization.
4. Operator Of Mobile Equipment
With respect to "mobile equipment" registered in
your name under any motor vehicle registration
law, any person is an insured while driving such
equipment along a public highway with your
permission. Any other person or organization
responsible for the conduct of such person is
also an insured, but only with respect to liability
arising out of the operation of the equipment, and
only if no other insurance of any kind is available
to that person or organization for this liability.
However, no person or organization is an insured
with respect to:
a. 'Bodily injury" to a co- "employee" of the
person driving the equipment; or
b. "Property damage" to property owned by,
rented to, in the charge of or occupied by
you or the employer of any person who is
an insured under this provision.
5. Operator of Nonowned Watercraft
With respect to watercraft you do not own that
is less than 51 feet long and is not being used
to carry persons for a charge, any person is an
insured while operating such watercraft with
your permission. Any other person or
organization responsible for the conduct of
such person is also an insured, but only with
respect to liability arising out of the operation
of the watercraft, and only if no other
insurance of any kind is available to that
person or organization for this liability.
However, no person or organization is an
insured with respect to:
a. 'Bodily injury" to a co- "employee" of the
person operating the watercraft; or
b. "Property damage" to property owned by,
renters to, in the charges of or orrvipiarl by
��� you or the employer of any person who is
an insured finder this provision.
6. Additional insureds When Required By
Written Contract, Written Agreement Or
Permit
The person(s) or organization(s) identified in
Paragraphs a. through f. below are additional
Insureds when you have agreed, in a written
Form SS 00 08 04 05 Page 11 of 24
BUSINESS LIABILITY COVERAGE FORM
contract, written agreement or because of a
permit issued by a state or political
subdivision, that such person or organization
be added as an additional insured on your
policy, provided the injury or damage occurs
subsequent to the execution of the contract or
agreement, or the issuance of the permit.
A person or organization is an additional
insured under this provision only for that
period of time required by the contract,
agreement or permit.
However, no such person or organization is an
additional insured under this provision if such
person or organization is included as an
additional insured by an endorsement issued
by us and made a part of this Coverage Part,
including all persons or organizations added
as additional insureds under the specific
additional insured coverage grants in Section
F. — Optional Additional Insured Coverages.
a. Vendors
Any person(s) or organization(s) (referred to
below as vendor), but only with respect to
"bodily injury" or "property damage" arising
out of "your products" which are distributed
or sold in the regular course of the vendor's
business and only if this Coverage Part
provides coverage for "bodily injury" or
"property damage" included within the
"products - completed operations hazard ".
(1) The insurance afforded to the vendor
is subject to the following additional
exclusions:
This insurance does not apply to:
(a) 'Bodily injury" or "property
damage" for which the vendor is
obligated to pay damages by
reason of the assumption of
liability in a contract or agreement.
This exclusion does not apply to
liability for damages that the
vendor would have in the absence
of the contract or agreement;
(b) Any express warranty
unauthorized by you;
(c) Any physical or chemical change
in the product made intentionally
by the vendor;
(d) Repackaging, except when
unpacked solely for the purpose of
inspection, demonstration, testing,
or the substitution of parts under
instructions from the manufacturer,
and then repackaged in the
original container;
(e) Any failure to make such
inspections, adjustments, tests or
servicing as the vendor has
agreed to make or normally
undertakes to make in the usual
course of business, in connection
with the distribution or sale of the
products;
(f) Demonstration, installation,
servicing or repair operations,
except such operations performed
at the vendor's premises in
connection with the sale of the
product;
(g) Products which, after distribution
or sale by you, have been labeled
or relabeled or used as a
container, part or ingredient of any
other thing or substance by or for
the vendor; or
(h) "Bodily injury" or "property
damage" arising out of the sole
negligence of the vendor for its
own acts or omissions or those of
its employees or anyone else
acting on its behalf. However, this
exclusion does not apply to:
(P) The exceptions contained in
Subparagraphs (d) or (f); or
(ii) Such inspections, adjustments,
tests or servicing as the vendor
has agreed to make or normally
undertakes to make in the usual
course of business, in
connection with the distribution
or sale of the products.
(2) This insurance does not apply to any
insured person or organization from
whom you have acquired such products,
or any ingredient, part or container,
entering into, accompanying or
containing such products.
b. Lessors Of Equipment
(1) Any person or organization from
whom you lease equipment; but only
with respect to their liability for "bodily
injury", "property damage" or
"personal and advertising injury"
caused, in whole or in part, by your
maintenance, operation or use of
equipment leased to you by such
person or organization.
Page 12 of 24 Form SS 00 08 04 05
BUSINESS LIABILITY COVERAGE FORM
(2) With respect to the insurance afforded
e. Permits Issued By State Or Political
to these additional insureds, this
Subdivisions
insurance does not apply to any
"occurrence"
(1) Any state or political subdivision, but
which takes place after
only with respect to operations
you cease to lease that equipment.
performed by you or on your behalf for
c. Lessors Of Land Or Premises
which the state or political subdivision
(1) Any person or organization from
has issued a permit.
whom you lease land or premises, but
(2) With respect to the insurance afforded
only with respect to liability arising out
to these additional insureds, this
of the ownership, maintenance or use
insurance does not apply to:
of that part of the land or premises
(a) "Bodily injury", "property damage"
leased to you.
or "personal and advertising
(2) With respect to the insurance afforded
injury" arising out of operations
to these additional insureds, this
performed for the state or
insurance does not apply to:
municipality; or
(a) Any "occurrence" which takes
(b) "Bodily injury" or "property damage"
place after you cease to lease that
included within the "products -
land or be a tenant in that
completed operations hazard ".
premises; or
f. Any Other Party
(b) Structural alterations, new
(1) Any other person or organization who
construction or demolition
is not an insured under Paragraphs a.
operations performed by or on
through e. above, but only with
behalf of such person or
respect to liability for "bodily injury",
organization.
"property damage" or "personal and
d. Architects, Engineers Or Surveyors
advertising injury" caused, in whole or
(1) Any architect, engineer, or surveyor, but
in part, by your acts or omissions or
only with respect to liability for "bodily
the acts or omissions of those acting
injury", "property damage" or "personal
on your behalf:
and advertising injury" caused, in whole
(a) In the performance of your
or in part, by your acts or omissions or
ongoing operations;
the acts or omissions of those acting on
(b) In connection with your premises
your behalf
owned by or rented to you; or
(a) In connection with your premises;
(c) In connection with "your work" and
or
included within the "products -
(b) In the performance of your
completed operations hazard ", but
ongoing operations performed by
only if
you or on your behalf.
(i) The written contract or written
(2) With respect to the insurance afforded
agreement requires you to
to these additional insureds, the
provide such coverage to
following additional exclusion applies:
such additional insured; and
This insurance does not apply to
(ii) This Coverage Part provides
"bodily injury", "property damage" or
coverage for "bodily injury" or
"personal and advertising injury"
"property damage" included
arising out of the rendering of or the
within the "products -
failure to render any professional
completed operations hazard ".
services by or for you, including:
(2) With respect to the insurance afforded
(a) The preparing, approving, or
to these additional insureds, this
failure to prepare or approve,
insurance does not apply to:
maps, shop drawings, opinions,
"Bodily injury", "property damage" or
reports, surveys, field orders,
"personal and advertising injury"
change orders, designs or
arising out of the rendering of, or the
drawings and specifications; or
failure to render, any professional
(b) Supervisory, inspection,
architectural, engineering or surveying
architectural or engineering
services, including:
activities.
Form SS 00 08 04 05
Page 13 of 24
BUSINESS LIABILITY COVERAGE FORM
(6) When You Are Added As An
Additional Insured To Other
Insurance
That is other insurance available to
you covering liability for damages
arising out of the premises or
operations, or products and completed
operations, for which you have been
added as an additional insured by that
insurance: or
(7) When You Add Others As An
Additional Insured To This
Insurance
That is other insurance available to an
additional insured.
However, the following provisions
apply to other insurance available to
any person or organization who is an
additional insured under this Coverage
Part:
(a) Primary Insurance When
Required By Contract
This insurance is primary if you
have agreed in a written contract,
written agreement or permit that
this insurance be primary. If other
insurance is also primary, we will
share with all that other insurance
by the method described in c.
below.
(b) Primary And Non - Contributory
To Other Insurance When
Required By Contract
If you have agreed in a written
contract, written agreement or
permit that this insurance is
primary and non - contributory with
the additional insured's own
insurance, this insurance is
primary and we will not seek
contribution from that other
insurance.
Paragraphs (a) and (b) do not apply to
other insurance to which the additional
insured has been added as an
additional insured.
When this insurance is excess, we will
have no duty under this Coverage Part to
defend the insured against any "suit" if any
other insurer has a duty to defend the
insured against that "suit ". If no other
insurer defends, we will undertake to do
so, but we will be entitled to the insured's
rights against all those other insurers.
Form SS 00 08 04 05
When this insurance is excess over other
insurance, we will pay only our share of
the amount of the loss, if any, that
exceeds the sum of:
(1) The total amount that all such other
insurance would pay for the loss in the
absence of this insurance; and
(2) The total of all deductible and self -
insured amounts under all that other
insurance.
We will share the remaining loss, if any, with
any other insurance that is not described in
this Excess Insurance provision and was not
bought specifically to apply in excess of the
Limits of Insurance shown in the
Declarations of this Coverage Part.
c. Method Of Sharing
If all the other insurance permits
contribution by equal shares, we will follow
this method also. Under this approach,
each insurer contributes equal amounts
until it has paid its applicable limit of
insurance or none of the loss remains,
whichever comes first.
If any of the other insurance does not permit
contribution by equal shares, we will
contribute by limits. Under this method, each
insurer's share is based on the ratio of its
applicable limit of insurance to the total
applicable limits of insurance of all insurers.
8. Transfer Of Rights Of Recovery Against
,Others To Us
By / a. Transfer Of Rights Of Recovery
If the insured has rights to recover all or
part of any payment, including
Supplementary Payments, we have made
under this Coverage Part, those rights are
transferred to us. The insured must do
nothing after loss to impair them. At our
request, the insured will bring "suit" or
transfer those rights to us and help us
enforce them. This condition does not
apply to Medical Expenses Coverage.
b. Waiver Of Rights Of Recovery (Waiver
Of Subrogation)
If the insured has waived any rights of
recovery against any person or
organization for all or part of any payment,
including Siap0ementa y Payments, we
have made under this Coverage Part, we
also waive that right, provided the insured
waived their rights of recovery against
such person or organization in a contract,
agreement or permit that was executed
prior to the injury or damage.
Page 17 of 24
Verify Workers' Comp Premium Status - Account Information https: // fortress. wa. gov/ lni /crpsi /Acctlnfo.aspx ?Accomtld= 20211100...
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Did you know ...
...that under Washington State law`, you may be liable for the unpaid workers' compensation (industrial insurance)
premiums of any business you hire or contract with? ('See RCW 51.12.070)
In the construction industry, you can protect yourself from liability for your subcontractor's unpaid premiums. Click here to
see what you have to do.
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If this is a contractor whose premiums and license are current, a "Submit Contractor Tracking Request" link will appear in
the certificate below. Click it to fill out a Tracking Request. If the contractor fails to pay workers' comp premiums or renew
their contractor registration or if their electrical contractor license is suspended or revoked within one year of the
start-date on your tracking request, I-Ed will send you a notification letter.
Department of Labor and Industries
Employer Liability Certificate
Date: 04/13/2010
UBI #: 600 560 818 -- Check for active Department of Revenue tax account.
Business Name: SARGENT ENGINEERS INC
Legal Business Name: SARGENT ENGINEER INC
Account #: 202,111 -00
'Doing Business As' Name: SARGENT ENGINEERS INC
Estimated Workers Reported: Quarter 4 of Year 2009 11 to 20 Workers"
(See Description Below)
Workers' Comp Premium Status: Account is current. Firm has voluntarily reported and paid their premiums.
Licensed Contractor? No
Risk Classification: Get risk classification information.
Experience Factor: Get experience factor history.
Account Representative: T2 / ANNA COLEMAN (360)902 -5634 - Email: N0RN235@lni.wa.gov
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).
Access
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omm$wf a W'Imeni. K41, W, Access Agree Pri vacy and se curity statement Intended use /ex ternal cont poli Staff onl link
1 of 1 4/13/2010 11:25 AM I
-1 1— 1- DATE (MM /DD/YYYY)
.j "00 CERTIFICATE OF LIABILITY INSURANCE OP ID 4 08/ 23/1 0
PRODUCE THIS CERTIFICATE IS ISSUED AS A 4 OF INFORMATIOI�
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Western States - The Dalles HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
101 E. Third St., PO Box 1940 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW
The Dalles OR 97058
Phone: 541- 296 -2268 Fax: 541-296-9427 INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURER A: U.S. Specialty Insurance Co
INSURER B:
Sar ent Engineers, Inc
Mong & Jan Smith INSURER C:
320 Ronlee Lane NW INSURER D:
Olympia WA 98502
INSURER E.
COVERAGES
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR
NSR
TYPE OF INSURANCE
POLICY NUMBER
DATE MM DD/YYYY MM
DATE /DD/YYY
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$
KLN
PREMISES (Ea occurence)
$
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE F-1 OCCUR
MED EXP (Any one person)
$
PERSONAL& ADV INJURY
$
GENERAL AGGREGATE
$
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP /OP AGG
$
POLICY 7 PEC LOC
AUTOMOBILE
LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT
(Ea accident)
$
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per accident)
$
HIRED AUTOS
NON -OWNED AUTOS
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
EXCESS / UMBRELLA LIABILITY
EACH OCCURRENCE
$
OCCUR F1 CLAIMS MADE
AGGREGATE
$
$
$
DEDUCTIBLE
$
RETENTION $
WORKERS COMPENSATION
-
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR /PARTNER/EXECUTIVEI
TORY LIMITS ER
E.L. EACH ACCIDENT
$
OFFICER /MEMBER EXCLUDED? u
E.L. DISEASE - EA EMPLOYE
$
(Mandatory In NH)
If yes, describe under
E.L. DISEASE - POLICY LIMIT
$
SPECIAL PROVISIONS below
OTHER
A
PROF LIABILITY
US091136705
08/16/10
08/16/11
EA CLAIM 2,000,000
ANN AGG 2,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
CERTIFICATE HOLDER CANCELLATION
City of Spokane Valley
Attn: Christine Bainbridge
11707 E. Sprague Ave., Ste 106
Spokane Vallev. WA 99206
25 (2009/01)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
The ACORD name and logo are registered marks of ACORD ao 1 0 -- O L 4 3
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
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).
DISCLAIMER
This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized
representative or producer, and the certificate holder, nor does it affirmatively or negatively amend,
extend or alter the coverage afforded by the policies listed thereon.
r
4
CERTIFICATE OF LIABILITY INSURANCE OP ID Srr
SARGE-4 02/28/11
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Western States - The Dalles HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
101 E. Third St., PO Box 1940 ALTER THE COVERAGE AFFORDED BY THE PO_ LICIES BELOW.
The Dalles OR 97058
Phone:541- 296 -2268 Fax:541- 296 -9427 INSURERS AFFORDING COVERAGE NAIC#
INSURED - INSURERA: The Hartford Casualty Co
...... e: The Hartford Insurance
Sargent Engineers Inc INSURER C: U.S. Specialty Insurance Co
320 Ronlee Lane INSURER D:
Olympia WA 98502
INSURER E:
COVERAGES
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR
NSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MM /DD/YYYY
POLICY EXPIRATION
DATE MM /DDIYYYY _
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1000000
PREMISES(Eao rence )
$ 1000000
A
X
COMMERCIAL GENERAL LIABILITY
52SBAVW7185
02/21/11
02/21/12
MED EXP (Any one person)
$ 10000
CLAIMS MADE F OCCUR
PERSONAL & ADV INJURY
$ 1000000
X Business Owners
GENERAL AGGREGATE
$ 2000000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP /OPAGG
$ 2000000
PRO- LOC
X POLICY JECT
A
X
AUTOMOBILE
LIABILITY
ANY AUTO
52UECIV4082
02/21/11
02/21/12
COMBINED SINGLE LIMIT
(Ea accident)
$
X
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
X
BODILY INJURY
(Per accident)
$
A
HIRED AUTOS
NON -OWNED AUTOS
52UECIV4082
02/21/11
02/21/12
X
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
EXCESS / UMBRELLA LIABILITY
EACH OCCURRENCE
$
OCCUR F—I CLAIMS MADE
AGGREGATE
$
$
DEDUCTIBLE
$
RETENTION $
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE d
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
52WECZ08094
05/01/10
05/01/11
X TORY LIMITS ER
E.L. EACH ACCIDENT
$ 1000000
E.L. DISEASE- EA EMPLOYE
$ 1000000
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT
$ 1000000
OTHER
C
PROF LIABILITY
USS1020769
08/16/10
08/16/11
Ea Claim 2,000,000
Aggregate 2 000 000
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
City of Spokane Valley is an additional insured as per written contract or
agreement between the insured and their client (City of Spokane Valley)
on the general liability policy and automobile liability as respects
to liability arising out of activities by or on behalf of the named
insured per attached Hartford Form# SS 00 08 04 05,Pages 11 -13.
CERTIFICATE HOLDER CANCELLATION
City of Spokane Valley
11707 E. Sprague Ave. Ste. 106
25 (2009/01)
All rights reserved.
the ACORD name and logo are registered marks of AGURD
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
� I 0 -0�3
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
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).
DISCLAIMER
This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized
representative or producer, and the certificate holder, nor does it affirmatively or negatively amend,
extend or alter the coverage afforded by the policies listed thereon.
ACORD 25
n
BUSINESS LIABILITY COVERAGE FORM
Various provisions in this policy restrict coverage. Read the entire policy carefully to determine rights, duties and what
is and is not covered.
Throughout this policy the words "you" and "your" refer to the Named Insured shown in the Declarations. The words
"we ", "us" and "our" refer to the stock insurance company member of The Hartford providing this insurance.
The word "insured" means any person or organization qualifying as such under Section C. - Who Is An Insured.
.-1 Other words and phrases that appear in quotation marks have special meaning. Refer to Section G. - Liability And
n Medical Expenses Definitions.
0
A. COVERAGES
0
c 1. BUSINESS LIABILITY COVERAGE (BODILY
m INJURY, PROPERTY DAMAGE, PERSONAL
m AND ADVERTISING INJURY)
N Insuring Agreement
in a. We will pay those sums that the insured
C14 becomes legally obligated to pay as
Ln damages because of "bodily injury",
° "property damage" or "personal and
= advertising injury" to which this insurance
applies. We will have the right and duty to
defend the insured against any "suit"
seeking those damages. However, we will
have no duty to defend the insured against
any "suit" seeking damages for "bodily
injury", "property damage" or "personal and
advertising injury" to which this insurance
does not apply.
We may, at our discretion, investigate any
"occurrence" or offense and settle any claim
or "suit" that may result. But:
(1) The amount we will pay for damages is
limited as described in Section D. -
Liability And Medical Expenses Limits
Of Insurance; and
(2) Our right and duty to defend ends when
we have used up the applicable limit of
r� insurance in the payment of judgments,
settlements or medical expenses to which
this insurance applies.
s
lid No other obligation or liability to pay sums or
perform acts or services is covered unless
explicitly provided for under Coverage
Extension - Supplementary Payments.
b. This insurance applies:
(1) To "bodily injury" and "property
damage" only if:
(a) The "bodily injury" or "property
damage" is caused by an
"occurrence" that takes place in the
"coverage territory";
(b) The "bodily injury" or "property
damage" occurs during the policy
period; and
(c) Prior to the policy period, no insured
listed under Paragraph 1. of Section
C. — Who Is An Insured and no
"employee" authorized by you to give
or receive notice of an "occurrence"
or claim, knew that the "bodily injury"
or "property damage" had occurred,
in whole or in part. If such a listed
insured or authorized "employee"
knew, prior to the policy period, that
the "bodily injury" or "property
damage" occurred, then any
continuation, change or resumption
of such "bodily injury" or "property
damage" during or after the policy
period will be deemed to have been
known prior to the policy period.
(2) To "personal and advertising injury"
caused by an offense arising out of your
business, but only if the offense was
committed in the "coverage territory"
during the policy period.
c. "Bodily injury" or "property damage" will be
deemed to have been known to have
occurred at the earliest time when any
insured listed under Paragraph 1. of Section
C. — Who Is An Insured or any "employee"
authorized by you to give or receive notice
of an "occurrence" or claim:
(1) Reports all, or any part, of the "bodily
injury" or "property damage" to us or
any other insurer;
Form SS 00 08 04 05 Page 1 of 24
0 2005, The Hartford
BUSINESS LIABILITY COVERAGE FORM
(2) Receives a written or verbal demand or
b. We will make these payments regardless of
claim for damages because of the "bodily
fault. These payments will not exceed the .
injury" or "property damage "; or
applicable limit of insurance. We will pay
(3) Becomes aware by any other means that
reasonable expenses for:
"bodily injury" or "property damage" has
(1) First aid administered at the time of an
occurred or has begun to occur.
accident;
d. Damages because of "bodily injury" include
(2) Necessary medical, surgical, x -ray and
damages claimed by any person or
dental services, including prosthetic
organization for care, loss of services or
devices; and
death resulting at any time from the "bodily
(3) Necessary ambulance, hospital,
injury".
professional nursing and funeral
e. Incidental Medical Malpractice
services.
(1) "Bodily injury" arising out of the
3. COVERAGE EXTENSION -
rendering of or failure to render
SUPPLEMENTARY PAYMENTS
professional health care services as a
a. We will pay, with respect to any claim or
physician, dentist, nurse, emergency
"suit" we investigate or settle, or any "suit"
medical technician or paramedic shall
against an insured we defend:
be deemed to be caused by an
"occurrence ", but only it
(1) All expenses we incur.
(a) The physician, dentist, nurse,
(2) Up to $1,000 for the cost of bail bonds
emergency medical technician or
required because of accidents or traffic
paramedic is employed by you to
law violations arising out of the use of
provide such services; and
any vehicle to which Business Liability
Coverage for "bodily injury" applies. We
(b) You are not engaged in the
do not have to fumish these bonds.
business or occupation of providing
such services.
(3) The cost of appeal bonds or bonds to
release attachments, but only for bond
(2) For the purpose of determining the
amounts within the applicable limit of
limits of insurance for incidental medical
insurance. We do not have to furnish
malpractice, any act or omission
these bonds.
together with all related acts or
omissions in the furnishing of these
(4) All reasonable expenses incurred by the
services to any one person will be
insured at our request to assist us in the
considered one "occurrence'.
investigation or defense of the claim or
"suit ", including actual loss of earnings
2. MEDICAL EXPENSES
up to $500 a day because of time off
Insuring Agreement
from work.
a. We will pay medical expenses as described
(5) All costs taxed against the insured in
below for "bodily injury" caused by an
the "suit ".
accident:
(6) Prejudgment interest awarded against
(1) On premises you own or rent;
the insured on that part of the judgment
(2) On ways next to premises you own or
we pay. If we make an offer to pay the
rent; or
applicable limit of insurance, we will not
pay any prejudgment interest based on
(3) Because of your operations;
that period of time after the offer.
provided that:
(7) All interest on the full amount of any
(1) The accident takes place in the
judgment that accrues after entry of the
"coverage territory" and * during the
judgment and before we have paid,
policy period;
offered to pay, or deposited in court the
(2) The expenses are incurred and reported
part of the judgment that is within the
to us within three years of the date of
applicable limit of insurance.
the accident; and
Any amounts paid under (1) through (7)
(3) The injured person submits to
above will not reduce the limits of insurance.
examination, at our expense, by
physicians of our choice as often as we
reasonably require.
Page 2 of 24 Form SS 00 08 04 05
BUSINESS LIABILITY COVERAGE FORM
Form SS 00 08 04 05 Page 3 of 24
b. If we defend an insured against a "suit"
So long as the above conditions are met,
and an indemnitee of the insured is also
attorneys' fees incurred by us in the
named as a party to the "suit ", we will
defense of that indemnitee, necessary
defend that indemnitee if all of the
litigation expenses incurred by us and
following conditions are met:
necessary litigation expenses incurred
(1) The "suit" against the indemnitee
by the indemnitee at our request will be
seeks damages for which the insured
paid as Supplementary Payments.
has assumed the liability of the
Notwithstanding the provisions of
indemnitee in a contract or agreement
Paragraph 1.b.(b) of Section B. —
that is an "insured contract ";
Exclusions, such payments will not be
(2) This insurance applies to such liability
deemed to be damages for "bodily
assumed by the insured;
injury" and "property damage" and will
N
n
not reduce the Limits of Insurance.
(3) The obligation to defend, or the cost of
14
the defense of, that indemnitee, has
Our obligation to defend an insured's
also been assumed by the insured in
indemnitee and to pay for attorneys' fees
1.4
the same "insured contract ";
and necessary litigation expenses as
CD
Supplementary Payments ends when:
(4) The allegations in the suit " and the
information we know about the
(1) We have used up the applicable limit
"occurrence" are such that no conflict
of insurance in the payment of
N appears
to exist between the interests
judgments or settlements; or
N
of the insured and the interest of the
(2) The conditions set forth above, or the
Ln
indemnitee;
emnitee;
terms
tes of the agreement described in
c
(5) The indemnitee and the insured ask
Paragraph (6) above, are no longer met.
us to conduct and control the defense
B. EXCLUSIONS
of that indemnitee against such "suit"
1. Applicable To Business Liability Coverage
_
and agree that we can assign the
same counsel to defend the insured
This insurance does not apply to:
and the indemnitee; and
a. Expected Or Intended Injury
�
(6) The indemnitee:
(1) "Bodily injury" or "property damage"
(a) Agrees in writing to:
e x p ected or intended from the
(i) Cooperate with us in the
standpoint of the insured. This
"bodily
investigation, settlement or
exclusion not apply to
defense of the "suit ";
" does
injury or property damage resulting
from the use of reasonable force to
(ii) Immediately send us copies of
protect persons or property; or
t�
any demands, notices,
(2) "Personal and advertising injury" arising
summonses or legal papers
out of an offense committed by, at the
received in connection with
direction of or with the consent or
the "suit ";
acquiescence of the insured with the
(iii) Notify any other insurer whose
expectation of inflicting "personal and
coverage is available to the
advertising injury".
indemnitee; and
b. Contractual Liability
(iv) Cooperate with us with
(1) "Bodily injury" or "property damage "; or
m
respect to coordinating other
applicable insurance available
(2) "Personal and advertising injury"
to the indemnitee; and
for which the insured is obligated to pay
(b) Provides us with written
damages by reason of the assumption of
authorization to:
liability in a contract or agreement.
(i) Obtain records and other
This exclusion does not apply to liability
information related to the
for damages because of.
"suit "; and
(a) "Bodily injury", "property damage" or
(ii) Conduct and control the
"personal and advertising injury" that
defense of the indemnitee in
the insured would have in the
such "suit ".
absence of the contract or
agreement; or
Form SS 00 08 04 05 Page 3 of 24
BUSINESS LIABILITY COVERAGE FORM
(b) "Bodily injury" or "property damage"
assumed in a contract or agreement
that is an "insured contract ",
provided the "bodily injury" or
"property damage" occurs
subsequent to the execution of the
contract or agreement. Solely for
the purpose of liability assumed in
an "insured contract", reasonable
attorneys' fees and necessary
litigation expenses incurred by or for
a party other than an insured are
deemed to be damages because of
"bodily injury" or "property damage"
provided:
(i) Uabiliity to such party for, or for
the cost of, that party's defense
has also been assumed in the
same "insured contract", and
(ii) Such attorneys' fees and
litigation expenses are for
defense of that party against a
civil or attemative dispute
resolution proceeding in which
damages to which this
insurance applies are alleged.
c. Liquor Liability
"Bodily injury" or "property damage" for
which any insured may be held Gable by
reason of:
(1) Causing or contributing to the
intoxication of any person;
(2) The furnishing of alcoholic beverages to
a person under the legal drinking age or
under the influence of alcohol; or
(3) Any statute, ordinance or regulation
relating to the sale, gift, distribution or
use of alcoholic beverages.
This exclusion applies only if you are in the
business of manufacturing, distributing,
selling, serving or furnishing alcoholic
beverages.
d. Workers' Compensation And Similar
Laws
Any obligation of the insured under a
workers' compensation, disability benefits
or unemployment compensation law or
any similar law.
e. Employer's Liability
"Bodily injury" to:
(1) An "employee" of the insured arising
out of and in the course of
(a) Employment by the insured; or
(b) Performing duties related to the
conduct of the insured's business, or .
(2) The spouse, child, parent, brother or
sister of that "employee" as a
consequence of (1) above.
This exclusion applies:
(1) Whether the insured may be liable as
an employer or in any other capacity;
and
(2) To any obligation to share damages
with or repay someone else who must
pay damages because of the injury.
This exclusion does not apply to liability
assumed by the insured under an "insured
contract ".
f. Pollution
(1) "Bodily injury", "property damage" or
"personal and advertising injury"
arising out of the actual, alleged or
threatened discharge, dispersal,
seepage, migration, release or escape
of "pollutants ":
(a) At or from any premises, site or
location which is or was at any
time owned or occupied by, or
rented or loaned to any insured.
However, this subparagraph does
not apply to:
(i) "Bodily injury" if sustained within
a building and caused by
smoke, fumes, vapor or soot
produced by or originating from
equipment that is used to heat,
cool or dehumidify the building,
or equipment that is used to
heat water for personal use, by
the building's occupants or their
guests;
(ii) "Bodily injury" or "property
damage" for which you may be
held liable, if you are a
contractor and the owner or
lessee of such premises, site or
location has been added to your
policy as an additional insured
with respect to your ongoing
operations performed for that
additional insured at that
premises, site or location and
such premises, site or location
is not and never was owned or
occupied by, or rented or
loaned to, any insured, other
than that additional insured; or
Page 4 of 24 Form SS 00 08 04 05
BUSINESS UABILITY COVERAGE FORM
Form SS 00 08 04 05 Page 5 of 24
(iii) "Bodily injury" or "properly
released as part of the
damage" arising out of heat,
operations being performed
smoke or fumes from a
by such insured, contractor or
"hostile fire ";
subcontractor;
(b) At or from any premises, site or
(ii) "Bodily injury" or "property
location which is or was at any
damage" sustained within a
time used by or for any insured or
building and caused by the
others for the handling, storage,
release of gases, fumes or
disposal, processing or treatment
vapors from materials brought
of waste;
into that building in connection
(c) Which are or were at any time
with operations being performed
transported, handled, stored,
by you or on your behalf by a
Ln
treated, disposed of, or processed
contractor or subcontractor, or
c
as waste by or for:
(iii) "Bodily injury" or "property
(i) Any insured; or
damage" arising out of heat,
smoke or fumes from a
T-1
(ii) Any person or organization for
" hostile fire " ; or
CD
r-
whom you may be legally
responsible;
(e) At or from any premises, site or
location on which any insured or any
a
(d) At or from any premises, site or
contractors or subcontractors
N
location on which any insured or
working directly or indirectly on any
Ln
any contractors or subcontractors
insured's behalf are performing
C4
working directly or indirectly on
operations if the operations are to
o any
insured's behalf are
test for, monitor, clean up, remove,
performing operations if the
contain, treat, detoxify or neutralize,
_
"pollutants" are brought on or to
or in any way respond to, or assess
=
the premises, site or location in
the effects of, "pollutants ".
connection with such operations
(2) Any loss, cost or expense arising out
e
by such insured, contractor or
subcontractor. However, this
of any:
subparagraph does not apply to:
(a) Request, demand, order or statutory
(i) "Bodily injury" or "property
r regulatory requirement
damage , arising out of the
orory ot#�e monitor,
escape of fuels, lubricants or
clean up, remove, contain, treat,
other operating fluids which are
detoxify or neutralize, or in any way
needed to perform the normal
respond to, or assess t h e e ffects of,
electrical, hydraulic or
"pollutants "; or
mechanical functions
(b) Claim or suit by or on behalf of a
necessary for the operation of
governmental authority for
"mobile equipment" or its parts,
damages because of testing for,
if such fuels, lubricants or other
monitoring, cleaning up, removing,
operating fluids escape from a
containing, treating, detoxifying or
vehicle part designed to hold,
neutralizing, or in any way
store or receive them. This
responding to, or assessing the
exception does not apply if the
effects of, "pollutants ".
"bodily injury" or "property
However, this paragraph does not
damage" arises out of the
apply to liability for damages because
intentional discharge, dispersal
of "property damage" that the insured
or release of the fuels,
would have in the absence of such
lubricants or other operating
request, demand, order or statutory or
fluids, or if such fuels,
regulatory requirement, or such claim
lubricants or other operating
or "suit" by or on behalf of a
=
fluids are brought on or to the
governmental authority.
premises, site or location with
the intent that they be
discharged, dispersed or
Form SS 00 08 04 05 Page 5 of 24
BUSINESS LIABILITY COVERAGE FORM
g. Aircraft, Auto Or Watercraft
"Bodily injury" or "property damage" arising
out of the ownership, maintenance, use or
entrustment to others of any aircraft, "auto"
or watercraft owned or operated by or rented
or loaned to any insured. Use includes
operation and "loading or unloading ".
This exclusion applies even if the claims
against any insured allege negligence or
other wrongdoing in the supervision, hiring,
employment, training or monitoring of others
by that insured, if the "occurrence" which
caused the "bodily injury" or "property
damage" involved the ownership,
maintenance, use or entrustment to others of
any aircraft, "auto" or watercraft that is
owned or operated by or rented or loaned to
any insured.
This exclusion does not apply to:
(1) A watercraft while ashore on premises
you own or rent;
(2) A watercraft you do not own that is:
(a) Less than 51 feet long; and
(b) Not being used to carry persons
for a charge;
(3) Parking an "auto" on, or on the ways
next to, premises you own or rent,
provided the "auto" is not owned by or
rented or loaned to you or the insured;
(4) Liability assumed under any "insured
contract" for the ownership,
maintenance or use of aircraft or
watercraft;
(5) "Bodily injury" or "property damage"
arising out of the operation of any of
the equipment listed in Paragraph f.(2)
or f.(3) of the definition of "mobile
equipment "; or
(6) An aircraft that is not owned by any
insured and is hired, chartered or loaned
with a paid crew. However, this
exception does not apply if the insured
has any other insurance for such "bodily
injury" or "property damage ", whether
the other insurance is primary, excess,
contingent or on any other basis.
h. Mobile Equipment
"Bodily injury" or "property damage"
arising out of:
(1) The transportation of "mobile equipment"
by an "auto" owned or operated by or
rented or loaned to any insured; or
(2) The use of "mobile equipment" in, or
while in practice or preparation for, a _
prearranged racing, speed or
demolition contest or in any stunting
activity.
i. War
"Bodily injury", "property damage" or
"personal and advertising injury", however
caused, arising, directly or indirectly, out of:
(1) War, including undeclared or civil war;
(2) Warlike action by a military force,
including action in hindering or
defending against an actual or
expected attack, by any government,
sovereign or other authority using
military personnel or other agents; or
(3) Insurrection, rebellion, revolution,
usurped power, or action taken by
governmental authority in hindering or
defending against any of these.
I Professional Services
"Bodily injury", "property damage" or
"personal and advertising injury" arising
out of the rendering of or failure to render
any professional service. This includes
but is not limited to:
(1) Legal, accounting or advertising
services;
(2) Preparing, approving, or failing to
prepare or approve maps, shop
drawings, opinions, reports, surveys,
field orders, change orders, designs or
drawings and specifications;
(3) Supervisory, inspection, architectural
or engineering activities;
(4) Medical, surgical, dental, x -ray or
nursing services treatment, advice or
instruction;
(5) Any health or therapeutic service
treatment, advice or instruction;
(6) Any service, treatment, advice or
instruction for the purpose of
appearance or skin enhancement, hair
removal or replacement or personal
grooming;
(7) Optical or hearing aid services
including the prescribing, preparation,
fitting, demonstration or distribution of
ophthalmic lenses and similar
products or hearing aid devices;
Page 6 of 24 Form SS 00 08 04 05
BUSINESS LIABILITY COVERAGE FORM
(8) Optometry or optometric services
including but not limited to examination
of the eyes and the prescribing,
preparation, fitting,demonstration or
distribution of ophthalmic lenses and
similar products;
(9) Any:
(a) Body piercing (not including ear
piercing);
(b) Tattooing, including but not limited
to the insertion of pigments into or
a under the skin; and
Ln
'^
0 (c) Similar services;
(10) Services in the practice of pharmacy;
and
(11) Computer consulting, design or
programming services, including web
co site design.
N Paragraphs (4) and (5) of this exclusion do
eq not apply to the Incidental Medical
CD
Malpractice coverage afforded under
CD Paragraph 1.e. in Section A. - Coverages.
Ln
° k. Damage To Property
"Property damage" to:
(1) Property you own, rent or occupy,
including any costs or expenses
incurred by you, or any other person,
organization or entity, for repair,
replacement, enhancement,
restoration or maintenance of such
property for any reason, including
prevention of injury to a person or
damage to another's property;
(2) Premises you sell, give away or
abandon, if the "property damage" arises
out of any part of those premises;
(3) Property loaned to you;
(4) Personal property in the care, custody
or control of the insured;
(5) That particular part of real property on
which you or any contractors or
subcontractors working directly or
ea=
indirectly on your behalf are performing
operations, if the "property damage"
arises out of those operations; or
(6) That particular part of any property
that must be restored, repaired or
replaced because "your work" was
a incorrectly performed on it.
Paragraphs (1), (3) and (4) of this
exclusion do not apply to "property
damage" (other than damage by fire) to
premises, including the contents of such
premises, rented to you for a period of 7 or
fewer consecutive days. A separate Limit
of Insurance applies to Damage To
Premises Rented To You as described in
Section D. - Limits Of Insurance.
Paragraph (2) of this exclusion does not
apply if the premises are "your work" and
were never occupied, rented or held for
rental by you.
Paragraphs (3) and (4) of this exclusion do
not apply to the use of elevators.
Paragraphs (3), (4), (5) and (6) of this
exclusion do not apply to liability assumed
under a sidetrack agreement.
Paragraphs (3) and (4) of this exclusion do
not apply to "property damage" to
borrowed equipment while not being used
to perform operations at a job site.
Paragraph (6) of this exclusion does not
apply to "property damage" included in the
"products - completed operations hazard ".
I. Damage To Your Product
"Property damage" to "your product"
arising out of it or any part of ft.
m. Damage To Your Work
"Property damage" to "your work" arising
out of ft or any part of it and included in the
"products- completed operations hazard ".
This exclusion does not apply if the
damaged work or the work out of which
the damage arises was performed on your
behalf by a subcontractor.
n. Damage To Impaired Property Or
Property Not Physically Injured
"Property damage" to "impaired property"
or property that has not been physically
injured, arising out of:
(1) A defect, deficiency, inadequacy or
dangerous condition in "your product"
or "your work "; or
(2) A delay or failure by you or anyone
acting on your behalf to perform a
contract or agreement in accordance
with its terms.
This exclusion does not apply to the loss
of use of other property arising out of
sudden and accidental physical injury to
"your product" or "your work" after it has
been put to its intended use.
Form SS 00 08 04 05 Page 7 of 24
BUSINESS LIABILITY COVERAGE FORM
o. Recall Of Products, Work Or Impaired
(c) Title of any literary or artistic work;
Property
(8) Arising out of an offense committed by -
Damages claimed for any loss, cost or
an insured whose business is:
expense incurred by you or others for the
(a) Advertising, broadcasting,
loss of use, withdrawal, recall, inspection,
publishing or telecasting;
repair, replacement, adjustment, removal
(b) Designing or determining content
or disposal of:
of web sites for others; or
(1) "Your product ";
(c) An Internet search, access,
(2) "Your work "; or
content or service provider.
(3) "Impaired property ";
However, this exclusion does not
if such product, work or property is
apply to Paragraphs a., b. and c.
withdrawn or recalled from the market or
under the definition of "personal and
from use by any person or organization
advertising injury" in Section G. —
because of a known or suspected defect,
Liability And Medical Expenses
deficiency, inadequacy or dangerous
Definitions.
condition in it.
For the purposes of this exclusion,
p. Personal And Advertising Injury
placing an "advertisement" for or
"Personal and advertising injury":
linking to others on your web site, by
(1) Arising out of oral, written or electronic
itself, is not considered the business
publication of material, if done by or at
of advertising, broadcasting,
the direction of the insured with
publishing or telecasting;
knowledge of its falsity;
(9) Arising out of an electronic chat room
(2) Arising out of oral, written or electronic
or bulletin board the insured hosts,
publication of material whose first
owns, or over which the insured
publication took place before the
exercises control;
beginning of the policy period;
(10) Arising out of the unauthorized use of
(3) Arising out of a criminal act committed
another's name or product in your e-mail
by or at the direction of the insured;
address, domain name or metatags or
any other similar tactics to mislead
(4) Arising out of any breach of contract,
another's potential customers;
except an implied contract to use
"advertising
(11) Arising out of the violation of a
another's idea" in your
"advertisement ";
person's right of privacy created by
any state or federal act.
(5) Arising out of the failure of goods,
However, this exclusion does not
products or services to conform with
apply to liability for damages that the
any statement of quality or
insured would have in the absence of
performance made in your
such state or federal act;
"advertisement ";
(6) Arising out of the wrong description of
(12) Arising out of.
the price of goods, products or services;
(a) An "advertisement" for others on
(7) Arising out of any violation of any
your web site;
intellectual property rights such as
(b) Placing a link to a web site of
copyright, patent, trademark, trade
others on your web site;
name, trade secret, service mark or
(c) Content from a web site of others
other designation of origin or
displayed within a frame or bonier
authenticity.
on your web site. Content includes
However, this exclusion does not
information, code, sounds, text,
apply to infringement, in your
graphics or images; or
"advertisement ", of
(d) Computer code, software or
(a) Copyright;
programming used to enable:
(b) Slogan, unless the slogan is also
(1) Your web site; or
a trademark, trade name, service
(ii) The presentation or functionality
mark or other designation of origin
of an "advertisement" or other
or authenticity; or
content on your web site;
Page 8 of 24 Form SS 00 08 04 05
BUSINESS LIABILITY COVERAGE FORM
(13) Arising out of a violation of any anti-
(a) May be awarded or incurred by
trust law;
reason of any claim or suit
(14) Arising out of the fluctuation in price or
alleging actual or threatened injury
value of any stocks, bonds or other
or damage of any nature or kind to
securities; or
persons or property which would
not have occurred in whole or in
(15) Arising out of discrimination or
part but for the "asbestos hazard ";
humiliation committed by or at the
direction of any "executive officer",
(b) Arise out of any request, demand,
director, stockholder, partner or
order or statutory or regulatory
member of the insured.
requirement that any insured or
others test for, monitor, clean up,
q. Electronic Data
remove, encapsulate, contain,
Ln
Ln Damages arising out of the loss of, loss of
treat, detoxify or neutralize or in
Ln C) use of, damage to, corruption of, inability
any way respond to or assess the
V-1 to access, or inability to manipulate
effects of an "asbestos hazard "; or
"electronic data ".
(c) Arise out of any claim or suit for
V-4 r. Employment - Related Practices
damages because of testing for,
"Bodily injury" or "personal and advertising
monitoring, cleaning up, removing,
0°, injury" to:
encapsulating, containing, treating,
ao
(1) A person arising out of any:
detoxifying or neutralizing or in any
N
way responding 10 or assessing the
Ln (a) Refusal to employ that person;
effects of an "asbestos hazard ".
o (b) Termination of that person's
t. Violation Of Statutes That Govern E-
Ln employment; or
Mails, Fax, Phone Calls Or Other
(c) Employment - related practices,
Methods Of Sending Material Or
policies, ads or omissions, such as
Information
coercion, demotion, evaluation,
"Bodily injury", "property damage ", or
reassignment, discipline,
"personal and advertising injury" arising
defamation, harassment, humiliation
directly or indirectly out of any action or
or discrirnination directed at that
omission that violates or is alleged to
person; or
Pe
violate:
(2) The spouse, child, parent, brother or
(1) The Telephone Consumer Protection
sister of that person as a
Ad (TCPA), including any amendment
consequence of "bodily injury" or
of or addition to such law;
, personal and advertising injury to the
(2) The CAN -SPAM Ad of 2003, including
person at whom any of the
any amendment of or addition to such
employment - related practices
law; or
described in Paragraphs (a), (b), or (c)
Rim above is directed.
(3) Any statute, ordinance or regulation,
_
This exclusion applies:
other than the TCPA or CAN -SPAM Act
as
of 2003, that prohibits or limits the
(1) Whether the insured may be liable as
sending, transmitting, communicating or
an employer or in any other capacity;
distribution of material or information.
sm and
Damage To Premises Rented To You —
(2) To any obligation to share damages
Exception For Damage By Fire, Lightning
with or repay someone else who must
or Explosion
pay damages because of the injury.
Exclusions c. through h. and k. through o. do
s. Asbestos
not apply to damage by fire, lightning or
(1) "Bodily injury", "property damage" or
explosion to premises rented to you or
"personal and advertising injury"
temporarily occupied by you with permission of
=_ arising out of the "asbestos hazard ".
the owner. A separate Limit of Insurance
(2) Any damages, judgments, settlements,
applies to this coverage as described in
loss, costs or expenses that
Section D. - Liability And Medical Expenses
Limits Of Insurance.
Form SS 00 08 04 05 Page 9 of 24
BUSINESS LIABILITY COVERAGE FORM
2. Applicable To Medical Expenses Coverage
We will not pay expenses for "bodily injury":
a. Any Insured
To any insured, except "volunteer workers ".
b. Hired Person
To a person hired to do work for or on behalf
of any insured or a tenant of any insured.
c. Injury On Normally Occupied Premises
To a person injured on that part of
premises you own or rent that the person
normally occupies.
d. Workers' Compensation And Similar
Laws
To a person, whether or not an
"employee" of any insured, if benefits for
the "bodily injury" are payable or must be
provided under a workers' compensation
or disability benefits law or a similar law.
e. Athletics Activities
To a person injured while practicing,
instructing or participating in any physical
exercises or games, sports or athletic
contests.
f. Products - Completed Operations Hazard
Included with the "products - completed
operations hazard ".
g. Business Liability Exclusions
Excluded under Business Liability Coverage.
C. WHO IS AN INSURED
1. If you are designated in the Declarations as:
a. An individual, you and your spouse are
insureds, but only with respect to the
conduct of a business of which you are the
sole owner.
b. A partnership or joint venture, you are an
insured. Your members, your partners, and
their spouses are also insureds, but only with
respect to the conduct of your business.
c. A limited liability company, you are an
insured. Your members are also insureds,
but only with respect to the conduct of your
business. Your managers are insureds, but
only with respect to their duties as your
managers.
d. An organization other than a partnership,
joint venture or limited liability company, you
are an insured. Your "executive officers" and
directors are insureds, but only with respect
to their duties as your officers or directors.
Your stockholders are also insureds, but only
with respect to their liability as stockholders.
e. A trust, you are an insured. Your trustees
are also insureds, but only with respect to .
their duties as trustees.
2. Each of the following is also an insured:
a. Employees And Volunteer Workers
Your "volunteer workers" only while
performing duties related to the conduct of
your business, or your "employees ", other
than either your "executive officers" (if you
are an organization other than a
partnership, joint venture or limited liability
company) or your managers (if you are a
limited liability company), but only for ads
within the scope of their employment by
you or while performing duties related to
the conduct of your business.
However, none of these "employees" or
"volunteer workers" are insureds for:
(1) "Bodily injury" or "personal and
advertising injury":
(a) To you, to your partners or
members (if you are a partnership
or joint venture), to your members
(if you are a limited liability
company), or to a co- "employee"
while in the course of his or her
employment or performing duties
related to the conduct of your
business, or to your other
"volunteer workers" while
performing duties related to the
conduct of your business;
(b) To the spouse, child, parent,
brother or sister of that co-
"employee" or that "volunteer
worker" as a consequence of
Paragraph (1)(a) above;
(c) For which there is any obligation
to share damages with or repay
someone else who must pay
damages because of the injury
described in Paragraphs (1)(a) or
(b) above; or
(d) Arising out of his or her providing
or failing to provide professional
health care services.
If you are not in the business of
providing professional health care
services, Paragraph (d) does not apply
to any nurse, emergency medical
technician or paramedic employed by
you to provide such services.
(2) "Property damage" to property:
(a) Owned, occupied or used by,
Page 10 of 24 Form SS 00 08 04 05
BUSINESS LIABILITY COVERAGE FORM
(b) Rented to, in the care, custody or
control of, or over which physical
control is being exercised for any
purpose by you, any of your
"employees ", "volunteer workers ",
any partner or member (if you are
a partnership or joint venture), or
any member (if you are a limited
liability company).
b. Real Estate Manager
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Any person (other than your "employee" or
"volunteer worker', or any organization
while acting as your real estate manager.
c. Temporary Custodians Of Your
Property
Any person or organization having proper
temporary custody of your property if you
die, but only:
(1) Wth respect to liability arising out of the
maintenance or use of that property; and
(2) Until your legal representative has
been appointed.
d. Legal Representative If You Die
Your legal representative if you die, but
only with respect to duties as such. That
representative will have all your rights and
duties under this insurance.
e. Unnamed Subsidiary
Any subsidiary and subsidiary thereof, of
yours which is a legally incorporated entity
of which you own a financial interest of
more than 50% of the voting stock on the
effective date of this Coverage Part.
The insurance afforded herein for any
subsidiary not shown in the Declarations
as a named insured does not apply to
injury or damage with respect to which an
insured under this insurance is also an
insured under another policy or would be
an insured under such policy but for its
termination or upon the exhaustion of its
limits of insurance.
3. Newly Acquired Or Formed Organization
Any organization you newly acquire or form,
other than a partnership, joint venture or
limited liability company, and over which you
maintain financial interest of more than 50% of
the voting stock, will qualify as a Named
Insured if there is no other similar insurance
available to that organization. However.
a. Coverage under this provision is afforded
only until the 180th day after you acquire
or form the organization or the end of the
policy period, whichever is earlier, and
Form SS 00 08 04 05
b. Coverage under this provision does not
apply to:
(1) "Bodily injury" or "property damage"
that occurred; or
(2) "Personal and advertising injury"
arising out of an offense committed
before you acquired or formed the
organization.
4. Operator Of Mobile Equipment
With respect to "mobile equipment' registered in
your name under any motor vehicle registration
law, any person is an insured while driving such
equipment along a public highway with your
permission. Any other person or organization
responsible for the conduct of such person is
also an insured, but only with respect to liability
arising out of the operation of the equipment, and
only if no other insurance of any kind is available
to that person or organization for this liability.
However, no person or organization is an insured
with respect to:
a. 'Bodily injury" to a co- "employee" of the
person driving the equipment; or
b. 'Property damage" to property owned by,
rented to, in the charge of or occupied by
you or the employer of any person who is
an insured under this provision.
5. Operator of Nonowned Watercraft
With respect to watercraft you do not own that
is less than 51 feet long and is not being used
to carry persons for a charge, any person is an
insured while operating such watercraft with
your permission. Any other person or
organization responsible for the conduct of
such person is also an insured, but only with
respect to liability arising out of the operation
of the watercraft, and only if no other
insurance of any kind is available to that
person or organization for this liability.
However, no person or organization is an
insured with respect to:
a. 'Bodily injury" to a co- "employee" of the
person operating the watercraft; or
b. "Property damage" to property owned by,
rented to, in the charge of or occupied by
you or the employer of any person who is
an insured under this provision.
6. Additional Insureds When Required By
Written Contract, Written Agreement Or
Permit
The person(s) or organization(s) identified in
Paragraphs a. through f. below are additional
insureds when you have agreed, in a written
Page 11 of 24
BUSINESS LIABILITY COVERAGE FORM
contract, written agreement or because of a
(e) Any failure to make such
permit issued by a state or political
inspections, adjustments, tests or.
subdivision, that such person or organization
servicing as the vendor has
be added as an additional insured on your
agreed to make or normally
policy, provided the injury or damage occurs
undertakes to make in the usual
subsequent to the execution of the contract or
course of business, in connection
agreement, or the issuance of the permit.
with the distribution or sale of the
A person or organization is an additional
products;
insured under this provision only for that
(f) Demonstration, installation,
period of time required by the contract,
servicing or repair operations,
agreement or permit.
except such operations performed
at the vendor's premises in
However, no such person or organization is an
connection with the sale of the
additional insured under this provision if such
product;
person or organization is included as an
additional insured by an endorsement issued
(g) Products which, after distribution
by us and made a part of this Coverage Part,
or sale by you, have been labeled
including all persons or organizations added
or relabeled used a
as additional insureds under the specific
container, part or r i ngredient o of f any
additional insured coverage grants in Section
other thing or substance by or for
F. — Optional Additional Insured Coverages.
the vendor; or
a. Vendors
(h) "Bodily injury" or "property
damage" arising out of the sole
Any person(s) or organization(s) (referred to
negligence of the vendor for its
below as vendor), but only with respect to
own acts or omissions or those of
"bodily injury" or "property damage" arising
its employees or anyone else
out of "your products" which are distributed
acting on its behalf. However, this
or sold in the regular course of the vendor's
exclusion does not apply to:
business and only if this Coverage Part
provides coverage for "bodily injury" or
(i) The exceptions contained in
"property damage" included within the
Subparagraphs (d) or (fl; or
"products- completed operations hazard ".
(ii) Such inspections, adjustments,
(1) The insurance afforded to the vendor
tests or servicing as the vendor
is subject to the following additional
has agreed to make or normally
exclusions:
undertakes to make in the usual
course of business, in
This insurance does not apply to:
connection with the distribution
(a) "Bodily injury" or "property
or sale of the products.
damage" for which the vendor is
(2) This insurance does not apply to any
obligated to pay damages by
insured person or organization from
reason of the assumption of
whom you have acquired such products,
liability in a contract or agreement.
or any ingredient, part or container,
This exclusion does not apply to
entering into, accompanying or
liability for damages that the
containing such products.
vendor would have in the absence
of the contract or agreement;
b. Lessors Of Equipment
(b) Any express warranty
(1) Any person or organization from
unauthorized by you;
whom you lease equipment; but only
with respect to their liability for "bodily
(c) Any physical or chemical change
injury", property damage or
in the product made intentionally
"personal and advertising injury"
by the vendor,
caused, in whole or in part, by your
(d) Repackaging, except when
maintenance, operation or use of
unpacked solely for the purpose of
equipment leased to you by such
inspection, demonstration, testing,
person or organization.
or the substitution of parts under
instructions from the manufacturer,
and then repackaged in the
original container;
Page 12 of 24 Form SS 00 08 04 05
_
BUSINESS LIABILITY COVERAGE FORM
(2) With respect to the insurance afforded
e. Permits Issued By State Or Political
to these additional insureds, this
Subdivisions
insurance does not apply to any
"occurrence"
(1) Any state or political subdivision, but
which takes place after
only with respect to operations
you cease to lease that equipment.
performed by you or on your behalf for
c. Lessors Of Land Or Premises
which the state or political subdivision
(1) Any person or organization from
has issued a permit.
whom you lease land or premises, but
(2) With respect to the insurance afforded
only with respect to liability arising out
to these additional insureds, this
of the ownership, maintenance or use
insurance does not apply to:
of that part of the land or premises
(a) "Bodily injury", "property damage"
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leased to you.
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or personal and advertising
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(2) With respect to the insurance afforded
injury" arising out of operations
to these additional insureds, this
performed for the state or
insurance does not apply to:
municipality; or
c
(a) Any "occurrence" which takes
(b) "Bodily injury" or "property damage"
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place after you cease to lease that
included within the "products -
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land or be a tenant in that
completed operations hazard ".
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premises; or
f. Any Other Party
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(b) Structural alterations, new
(1) Any other person or organization who
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construction or demolition
is not an insured under Paragraphs a.
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operations performed by or on
through e. above, but only with
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behalf of such person or
respect to liability for "bodily injury",
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organization.
"property damage" or "personal and
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d. Architects, Engineers Or Surveyors
advertising injury" caused, in whole or
(1) Any architect, engineer, or surveyor, but
in part, by your acts or omissions or
only with respect to liability for "bodily
the acts or omissions of those acting
injury", "property damage" or "personal
on your behalf:
and advertising injury" caused, in whole
(a) In the performance of your
or in part, by your acts or omissions or
ongoing operations;
the acts or omissions of those acting on
In connection with your premises
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your behalf
owned
owned by or rented to you; or
s
(a) In connection with your premises;
(c) In connection with "your work" and
or
included within the "products-
(b) In the performance of your
completed operations hazard ", but
ongoing operations performed by
only if
:
you or on your behalf.
(i) The written contract or written
(2) With respect to the insurance afforded
agreement requires you to
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to these additional insureds, the
provide such coverage to
following additional exclusion applies:
such additional insured; and
This insurance does not apply to
(ii) This Coverage Part provides
a
"bodily injury", "property damage" or
coverage for "bodily injury" or
"personal and advertising injury"
"property damage" included
arising out of the rendering of or the
within the "products-
_
failure to render any professional
completed operations hazard ".
services by or for you, including:
(2) With respect to the insurance afforded
(a) The preparing, approving, or
to these additional insureds, this
failure to prepare or approve,
insurance does not apply to:
maps, shop drawings, opinions,
'Bodily injury", "property damage" or
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reports, surveys, field orders,
"personal and advertising injury"
change orders, designs or
arising out of the rendering of, or the
drawings and specifications; or
failure to render, any professional
(b) Supervisory, inspection,
architectural, engineering or surveying
architectural or engineering
services, including:
activities.
Form SS 00 08 04 05
Page 13 of 24
BUSINESS LIABILITY COVERAGE FORM
(a) The preparing, approving, or
failure to prepare or approve,
maps, shop drawings, opinions,
reports, surveys, field orders,
change orders, designs or
drawings and specifications; or
(b) Supervisory, inspection,
architectural or engineering
activities.
The limits of insurance that apply to additional
insureds are described in Section D. — Limits
Of Insurance.
How this insurance applies when other
insurance is available to an additional insured
is described in the Other Insurance Condition
in Section E. - Liability And Medical Expenses
General Conditions.
No person or organization is an insured with
respect to the conduct of any current or past
partnership, joint venture or limited liability
company that is not shown as a Named Insured in
the Declarations.
D. LIABILITY AND MEDICAL EXPENSES
LIMITS OF INSURANCE
1. The Most We Will Pay
The Limits of Insurance shown in the
Declarations and the rules below fix the most
we will pay regardless of the number of
a. Insureds,
b. Claims made or "suits" brought; or
c. Persons or organizations making claims or
bringing "suits ".
2. Aggregate Limits
The most we will pay for:
a. Damages because of "bodily injury" and
"property damage" included in the
"products - completed operations hazard" is
the Products - Completed Operations
Aggregate Limit shown in the
Declarations.
b. Damages because of all other "bodily
injury", "property damage" or "personal
and advertising injury", including medical
expenses, is the General Aggregate Limit
shown in the Declarations.
This General Aggregate Limit applies
separately to each of your "locations"
owned by or rented to you.
"Location" means premises involving the
same or connecting lots, or premises
whose connection is interrupted only by a
street, roadway or right-of-way of a
railroad.
This General Aggregate limit does not
apply to "property damage" to premises.
while rented to you or temporarily
occupied by you with permission of the
owner, arising out of fire, lightning or
explosion.
3. Each Occurrence Limit
Subject to 2.a. or 2.b above, whichever
applies, the most we will pay for the sum of all
damages because of all "bodily injury",
"property damage" and medical expenses
arising out of any one "occurrence" is the
Liability and Medical Expenses Limit shown in
the Declarations.
The most we will pay for all medical expenses
because of "bodily injury" sustained by any
one person is the Medical Expenses Limit
shown in the Declarations.
4. Personal And Advertising Injury Limit
Subject to 2.b. above, the most we will pay for
the sum of all damages because of all
"personal and advertising injury" sustained by
any one person or organization is the Personal
and Advertising Injury Limit shown in the
Declarations.
5. Damage To Premises Rented To You Limit
The Damage To Premises Rented To You
Limit is the most we will pay under Business
Liability Coverage for damages because of
"property damage" to any one premises, while
rented to you, or in the case of damage by fire,
lightning or explosion, while rented to you or
temporarily occupied by you with permission of
the owner.
In the case of damage by fire, lightning or
explosion, the Damage to Premises Rented To
You Limit applies to all damage proximately
caused by the same event, whether such
damage results from fire, lightning or explosion
or any combination of these.
6. How Limits Apply To Additional Insureds
The most we will pay on behalf of a person or
organization who is an additional insured
under this Coverage Part is the lesser of.
a. The limits of insurance specified in a
written contract, written agreement or
permit issued by a state or political
subdivision; or
b. The Limits of Insurance shown in the
Declarations.
Such amount shall be a part of and not in
addition to the Limits of Insurance shown in
the Declarations and described in this Section.
Page 14 of 24 Form SS 00 08 04 05
0 0
BUSINESS UABILITY COVERAGE FORM
If more than one limit of insurance under this
(1) Immediately send us copies of any
. policy and any endorsements attached thereto
demands, notices, summonses or
applies to any claim or "suit ", the most we will pay
legal papers received in connection
under this policy and the endorsements is the
with the claim or "suit";
single highest limit of liability of all coverages
(2) Authorize us to obtain records and
applicable to such claim or "suit ". However, this
other information;
paragraph does not apply to the Medical Expenses
limit set forth in Paragraph 3. above.
(3) Cooperate with us in the investigation,
settlement of the claim or defense
The Limits of Insurance of this Coverage Part apply
against the "suit "; and
separately to each consecutive annual period and to
( Assist us, upon our request, in the
any remaining period of less than 12 months, starting
enforcement of any right against any
00 with the beginning of the policy period shown in the
person or organization that may be
Ln Declarations, unless the policy period is extended
liable to the insured because of injury
after issuance for an additional period of less than 12
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or damage to which this insurance
months. In that case, the additional period will be
may also apply.
deemed part of the last preceding period for purposes
0 of determining the Limits of Insurance.
d. Obligations At The Insured's Own Cost
° E. LIABILITY AND MEDICAL EXPENSES
No insured will, except at that insured's own
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cost,
cost, voluntarily make a payment, assume
CONDITIONS
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any obligation, or incur any expense, other
c 1. Bankruptcy
than for first aid, without our consent.
C9 Bankruptcy or insolvency of the insured or of
e. Additional Insured's Other Insurance
o the insured's estate will not relieve us of our
If we cover a claim or "suit" under this
� obligations under this Coverage Part.
Coverage Part that may also be covered
°
* 2. Duties In The Event Of Occurrence,
by other insurance available to an
Offense, Claim Or Suit
additional insured, such additional insured
a. Notice Of Occurrence Or Offense
must submit such claim or "suit" to the
other insurer for defense and indemnity.
You or any additional insured must see to
it that we are notified as soon as
However, this provision does not apply to
practicable of an "occurrence" or an
the extent that you have agreed in a
offense which may result in a claim. To
written contract, written agreement or
the extent possible, notice should include:
permit that this insurance is primary and
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non - contributory with the additional
(1) How, when and where the "occurrence"
insured's own insurance.
or offense took place;
f. Knowledge Of An Occurrence, Offense,
(2) The names and addresses of any
Claim Or Suit
injured persons and witnesses; and
_
Paragraphs a. and b. apply to you or to
(3) The nature and location of any injury
any additional insured only when such
or damage arising out of the
"occurrence ", offense, claim or "suit" is
n occurrence or offense.
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known to:
b. Notice Of Claim
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(1) You or any additional insured that is
If a claim is made or "suit" is brought
an individual;
against any insured, you or any additional
(2) Any partner, if you or an additional
insured must:
insured is a partnership;
(1) Immediately record the specifics of the
(3) Any manager, if you or an additional
claim or "suit" and the date received;
insured is a limited liability company;
and
(4) Any "executive officer" or insurance
_ (Z) Notify us as soon as practicable.
manager, if you or an additional
You or any additional insured must see to
insured is a corporation;
it that we receive a written notice of the
(5) Any trustee, if you or an additional
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claim or "suit" as soon as practicable.
insured is a trust; or
c. Assistance And Cooperation Of The
(6) Any elected or appointed official, if you
Insured
or an additional insured is a political
You and any other involved insured must:
subdivision or public entity.
Form SS 00 08 04 05
Page 15 of 24
c •
BUSINESS LIABILITY COVERAGE FORM
This Paragraph f, applies separately to
you and any additional insured.
3. Financial Responsibility Laws
a. When this policy is certified as proof of
financial responsibility for the future under
the provisions of any motor vehicle
financial responsibility law, the insurance
provided by the policy for "bodily injury"
liability and "property damage" liability will
comply with the provisions of the law to
the extent of the coverage and limits of
insurance required by that law.
b. With respect to "mobile equipment" to
which this insurance applies, we will
provide any liability, uninsured motorists,
underinsured motorists, no -fault or other
coverage required by any motor vehicle
law. We will provide the required limits for
those coverages.
4. Legal Action Against Us
No person or organization has a right under
this Coverage Form:
a. To pin us as a party or otherwise bring us
into a "suit" asking for damages from an
insured; or
b. To sue us on this Coverage Form unless
all of its terms have been fully complied
with.
A person or organization may sue us to recover
on an agreed settlement or on a final judgment
against an insured; but we will not be liable for
damages that are not payable under the terms of
this insurance or that are in excess of the
applicable limit of insurance. An agreed
settlement means a settlement and release of
Habilhy signed by us, the insured and the
claimant or the claimant's legal representative.
5. Separation Of Insureds
Except with respect to the Limits of Insurance,
and any rights or duties specifically assigned
in this policy to the first Named Insured, this
insurance applies:
a. As if each Named Insured were the only
Named Insured; and
b. Separately to each insured against whom
a claim is made or "suit" is brought.
6. Representations
a. When You Accept This Policy
By accepting this policy, you agree:
(1) The statements in the Declarations
are accurate and complete;
(2) Those statements are based upon
representations you made to us; and
Page 16 of 24
(3) We have issued this policy in reliance
upon your representations.
b. Unintentional Failure To Disclose
Hazards
If unintentionally you should fail to disclose
all hazards relating to the conduct of your
business at the inception date of this
Coverage Part, we shall not deny any
coverage under this Coverage Part
because of such failure.
7. Other Insurance
If other valid and collectible insurance is
available for a loss we cover under this
Coverage Part, our obligations are limited as
follows:
a. Primary Insurance
This insurance is primary except when b.
below applies. If other insurance is also
primary, we will share with all that other
insurance by the method described in c.
below.
b. Excess Insurance
This insurance is excess over any of the
other insurance, whether primary, excess,
contingent or on any other basis:
(1) Your Work
That is Fire, Extended Coverage,
Builder's Risk, Installation Risk or
similar coverage for "your work ";
(2) Premises Rented To You
That is fire, lightning or explosion
insurance for premises rented to you
or temporarily occupied by you with
perrission of the owner,
(3) Tenant Liability
That is insurance purchased by you to
cover your liability as a tenant for
"property damage" to premises rented
to you or temporarily occupied by you
with permission of the owner,
(4) Aircraft, Auto Or Watercraft
If the loss arises out of the maintenance
or use of aircraft, "autos" or watercraft to
the extent not subject to Exclusion g. of
Section A. — Coverages.
(5) Property Damage To Borrowed
Equipment Or Use Of Elevators
If the loss arises out of "property
damage" to borrowed equipment or
the use of elevators to the extent not
subject to Exclusion k. of Section A. —
Coverages.
Form SS 00 08 04 05
BUSINESS LIABILITY COVERAGE FORM
When this insurance is excess over other
insurance, we will pay only our share of
the amount of the loss, if any, that
exceeds the sum of:
(1) The total amount that all such other
insurance would pay for the loss in the
absence of this insurance; and
(2) The total of all deductible and self -
insured amounts under all that other
insurance.
We will share the remaining loss, if any, with
any other insurance that is not described in
this Excess Insurance provision and was not
bought specifically to apply in excess of the
Limits of Insurance shown in the
Declarations of this Coverage Part.
c. Method Of Sharing
If all the other insurance permits
contribution by equal shares, we will follow
this method also. Under this approach,
each insurer contributes equal amounts
until it has paid its applicable limit of
insurance or none of the loss remains,
whichever comes first.
If any of the other insurance does not permit
contribution by equal shares, we will
contribute by limits. Under this method, each
insurer's share is based on the ratio of its
applicable limit of insurance to the total
applicable limits of insurance of all insurers.
8. Transfer Of Rights Of Recovery Against
Others To Us
a. Transfer Of Rights Of Recovery
If the insured has rights to recover all or
part of any payment, including
Supplementary Payments, we have made
under this Coverage Part, those rights are
transferred to us. The insured must do
nothing after loss to impair them. At our
request, the insured will bring "suit" or
transfer those rights to us and help us
enforce them. This condition does not
apply to Medical Expenses Coverage.
b. Waiver Of Rights Of Recovery (Waiver
Of Subrogation)
If the insured has waived any rights of
recovery against any person or
organization for all or part of any payment,
including Supplementary Payments, we
have made under this Coverage Part, we
also waive that right, provided the insured
waived their rights of recovery against
such person or organization in a contract,
agreement or permit that was executed
prior to the injury or damage.
Form SS 00 08 04 05 Page 17 of 24
(6) When You Are Added As An
Additional Insured To Other
Insurance
That is other insurance available to
you covering liability for damages
arising out of the premises or
operations, or products and completed
operations, for which you have been
added as an additional insured by that
insurance; or
(7) When You Add Others As An
Additional Insured To This
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Insurance
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That is other insurance available to an
additional insured.
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However, the following provisions
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apply to other insurance available to
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any person or organization who is an
additional insured under this Coverage
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Part:
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(a) Primary Insurance When
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Required By Contract
c This
insurance is primary if you
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have agreed in a written contract,
written agreement or permit that
this insurance be primary. If other
insurance is also primary, we will
share with all that other insurance
by the method described in C.
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below.
(b) Primary And Non - Contributory
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To Other Insurance When
Required By Contract
If you have agreed in a written
°
contract, written agreement or
permit that this insurance is
primary and non - contributory with
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the additional insured's own
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—
insurance, this insurance is
primary and we will not seek
contribution from that other
insurance.
Paragraphs (a) and (b) do not apply to
other insurance to which the additional
insured has been added as an
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additional insured.
When this insurance is excess, we will
have no duty under this Coverage Part to
defend the insured against any "suit" if any
s
other insurer has a duty to defend the
insured against that "suit ". If no other
insurer defends, we will undertake to do
so, but we will be entitled to the insured's
rights against all those other insurers.
When this insurance is excess over other
insurance, we will pay only our share of
the amount of the loss, if any, that
exceeds the sum of:
(1) The total amount that all such other
insurance would pay for the loss in the
absence of this insurance; and
(2) The total of all deductible and self -
insured amounts under all that other
insurance.
We will share the remaining loss, if any, with
any other insurance that is not described in
this Excess Insurance provision and was not
bought specifically to apply in excess of the
Limits of Insurance shown in the
Declarations of this Coverage Part.
c. Method Of Sharing
If all the other insurance permits
contribution by equal shares, we will follow
this method also. Under this approach,
each insurer contributes equal amounts
until it has paid its applicable limit of
insurance or none of the loss remains,
whichever comes first.
If any of the other insurance does not permit
contribution by equal shares, we will
contribute by limits. Under this method, each
insurer's share is based on the ratio of its
applicable limit of insurance to the total
applicable limits of insurance of all insurers.
8. Transfer Of Rights Of Recovery Against
Others To Us
a. Transfer Of Rights Of Recovery
If the insured has rights to recover all or
part of any payment, including
Supplementary Payments, we have made
under this Coverage Part, those rights are
transferred to us. The insured must do
nothing after loss to impair them. At our
request, the insured will bring "suit" or
transfer those rights to us and help us
enforce them. This condition does not
apply to Medical Expenses Coverage.
b. Waiver Of Rights Of Recovery (Waiver
Of Subrogation)
If the insured has waived any rights of
recovery against any person or
organization for all or part of any payment,
including Supplementary Payments, we
have made under this Coverage Part, we
also waive that right, provided the insured
waived their rights of recovery against
such person or organization in a contract,
agreement or permit that was executed
prior to the injury or damage.
Form SS 00 08 04 05 Page 17 of 24
7
BUSINESS LIABILITY COVERAGE FORM
F. OPTIONAL ADDITIONAL INSURED
COVERAGES
If listed or shown as applicable in the Declarations,
one or more of the following Optional Additional
Insured Coverages also apply. When any of these
Optional Additional Insured Coverages apply,
Paragraph S. (Additional Insureds When Required
by Written Contract, Written Agreement or Permit)
of Section C., Who Is An Insured, does not apply
to the person or organization shown in the
Declarations. These coverages are subject to the
terms and conditions applicable to Business
Liability Coverage in this policy, except as
provided below:
1. Additional Insured - Designated Person Or
Organization
WHO IS AN INSURED under Section C. is
amended to include as an additional insured
the person(s) or organization(s) shown in the
Declarations, but only with respect to liability
for "bodily injury", "property damage" or
"personal and advertising injury" caused, in
whole or in part, by your acts or omissions or
the acts or omissions of those acting on your
behalf:
a. In the performance of your ongoing
operations; or
b. In connection with your premises owned
by or rented to you.
2. Additional Insured - Managers Or Lessors
Of Premises
a. WHO IS AN INSURED under Section C. is
amended to include as an additional insured
the person(s) or organization(s) shown in the
Declarations as an Additional Insured -
Designated Person Or Organization; but only
with respect to liability arising out of the
ownership, maintenance or use of that part of
the premises leased to you and shown in the
Declarations.
b. With respect to the insurance afforded to
these additional insureds, the following
additional exclusions apply:
This insurance does not apply to:
(1) Any 'occurrence" which takes place
after you cease to be a tenant in that
premises; or
(2) Structural alterations, new
construction or demolition operations
performed by or on behalf of such
person or organization.
3. Additional Insured - Grantor Of Franchise
WHO IS AN INSURED under Section C. is -
amended to include as an additional insured
the person(s) or organization(s) shown in the
Declarations as an Additional Insured -
Grantor Of Franchise, but only with respect to
their liability as grantor of franchise to you.
4. Additional Insured - Lessor Of Leased
Equipment
a. WHO IS AN INSURED under Section C. is
amended to include as an additional
insured the person(s) or organization(s)
shown in the Declarations as an Additional
Insured — Lessor of Leased Equipment,
but only with respect to liability for "bodily
injury", "property damage" or "personal
and advertising injury" caused, in whole or
in part, by your maintenance, operation or
use of equipment leased to you by such
person(s) or organization(s).
b. With respect to the insurance afforded to
these additional insureds, this insurance
does not apply to any "occurrence" which
takes place after you cease to lease that
equipment.
5. Additional Insured - Owners Or Other
Interests From Whom land Has Been
Leased
a. WHO IS AN INSURED under Section C. is
amended to include as an additional
insured the person(s) or organization(s)
shown in the Declarations as an Additional
Insured — Owners Or Other Interests From
Whom Land Has Been Leased, but only
with respect to liability arising out of the
ownership, maintenance or use of that part
of the land leased to you and shown in the
Declarations.
b. With respect to the insurance afforded to
these additional insureds, the following
additional exclusions apply:
This insurance does not apply to:
(1) Any "occurrence" that takes place
after you cease to lease that land; or
(2) Structural alterations, new
construction or demolition operations
performed by or on behalf of such
person or organization.
6. Additional Insured - State Or Political
Subdivision — Permits
a. WHO IS AN INSURED under Section C. is
amended to include as an additional
insured the state or political subdivision
shown in the Declarations as an Additional
Page 18 of 24 Form SS 00 08 04 05
BUSINESS LIABILITY COVERAGE FORM
Form SS 00 08 04 05 Page 19 of 24
Insured - State Or Political Subdivision -
(e) Any failure to make such
Permits, but only with respect to
inspections, adjustments, tests or
operations performed by you or on your
servicing as the vendor has agreed
behalf for which the state or political
to make or normally undertakes to
subdivision has issued a permit.
make in the usual course of
b. With respect to the insurance afforded to
business, in connection with the
these additional insureds, the following
distribution or sale of the products;
additional exclusions apply:
(t) Demonstration, installation,
This insurance does not apply to:
servicing or repair operations,
(1) "Bodily injury", "property damage" or
except such operations performed
"personal and advertising injury"
at the vendor's premises in
o
arising out of operations performed for
connection with the sale of the
the state or municipality; or
product;
CD
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(2) "Bodily injury" or "property damage"
(g) Products which, after distribution
included in the "product - completed
or sale by you, have been labeled
c
operations" hazard.
or relabeled or used as a
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container, part or ingredient of any
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7. Additional Insured -Vendors
other thing or substance by or for
m
rn
a. WHO IS AN INSURED under Section C. is
the vendor; or
o,
amended to include as an additional
(h) "Bodily injury" or "property
rq insured
the person(s) or organization(s)
damage" arising out of the sole
C4
(referred to below as vendor) shown in the
negligence of the vendor for its
c
Declarations as an Additional Insured -
own acts or omissions or those of
Co
Vendor, but only with respect to "bodily
its employees or anyone else
*
injury" or "property damage" arising out of
acting on its behalf. However, this
"your products" which are distributed or
exclusion does not apply to:
sold in the regular course of the vendor's
(i) The exceptions contained in
business and only if this Coverage Part
Subparagraphs (d) or (17; or
provides coverage for "bodily injury" or
"property damage" included within the
(ii) Such inspections,
"products- completed operations hazard ".
adjustments, tests or servicing
b. The insurance afforded to the vendor is
as the vendor has agreed to
subject to the following additional exclusions:
make or normally undertakes
to make in the usual course of
(1) This insurance does not apply to:
business, in connection with
(a) "Bodily injury" or "property
the distribution or sale of the
damage" for which the vendor is
products.
obligated to pay damages by
(2) This insurance does not apply to any
reason of the assumption of
insured person or organization from
liability in a contract or agreement.
whom you have acquired such
This exclusion does not apply to
products, or any ingredient, part or
liability for damages that the
container, entering into,
vendor would have in the absence
accompanying or containing such
—
of the contract or agreement;
products.
(b) Any express warranty
8. Additional Insured - Controlling Interest
unauthorized by you;
WHO IS AN INSURED under Section C. is
(c) Any physical or chemical change
amended to include as an additional insured
in the product made intentionally
the person(s) or organization(s) shown in the
by the vendor,
Declarations as an Additional Insured -
(d) Repackaging, unless unpacked
Controlling Interest, but only with respect to
solely for the purpose of inspection,
their liability arising out of
°—
demonstration, testing, or the
a. Their financial control of you; or
substitution of parts under
b. Premises they own, maintain or control
instructions from the manufacturer,
while you lease or occupy these premises.
and then repackaged in the original
container,
Form SS 00 08 04 05 Page 19 of 24
0 )v
BUSINESS LIABILITY COVERAGE FORM
This insurance does not apply to structural
alterations, new construction and demolition
operations performed by or for that person or
organization.
9. Additional Insured — Owners, Lessees Or
Contractors — Scheduled Person Or
Organization
a. WHO IS AN INSURED under Section C. is
amended to include as an additional
insured the person(s) or organization(s)
shown in the Declarations as an Additional
Insured — Owner, Lessees Or Contractors,
but only with respect to liability for "bodily
injury", "property damage" or "personal
and advertising injury" caused, in whole or
in part, by your acts or omissions or the
acts or omissions of those acting on your
behalf:
(1) In the performance of your ongoing
operations for the additional
insured(s); or
(2) In connection with "your work"
performed for that additional insured
and included within the "products -
completed operations hazard ", but
only if this Coverage Part provides
coverage for "bodily injury" or
"property damage" included within the
"products - completed operations
hazard ".
b. With respect to the insurance afforded to
these additional insureds, this insurance
does not apply to "bodily injury", "property
damage" or "personal an advertising
injury" arising out of the rendering of, or
the failure to render, any professional
architectural, engineering or surveying
services, including:
(1) The preparing, approving, or failure to
prepare or approve, maps, shop
drawings, opinions, reports, surveys,
field orders, change orders, designs or
drawings and specifications; or
(2) Supervisory, inspection, architectural
or engineering activities.
10. Additional Insured — Co -Owner Of Insured
Premises
WHO IS AN INSURED under Section C. is
amended to include as an additional insured
the person(s) or Organization(s) shown in the
Declarations as an Additional Insured — Co-
Owner Of Insured Premises, but only with
respect to their liability as co-owner of the
premises shown in the Declarations.
Page 20 of 24
The limits of insurance that apply to additional
insureds are described in Section D. — Limits Of .
Insurance.
How this insurance applies when other insurance
is available to an additional insured is described in
the Other Insurance Condition in Section E. —
Liability And Medical Expenses General
Conditions.
G. LIABILITY AND MEDICAL EXPENSES
DEFINITIONS
1. "Advertisement" means the widespread public
dissemination of information or images that
has the purpose of inducing the sale of goods,
products or services through:
a. (1) Radio;
(2) Television;
(3) Billboard;
(4) Magazine;
(5) Newspaper;
b. The Internet, but only that part of a web
site that is about goods, products or
services for the purposes of inducing the
sale of goods, products or services; or
c. Any other publication that is given
widespread public distribution.
However, "advertisement' does not include:
a. The design, printed material, information
or images contained in, on or upon the
packaging or labeling of any goods or
products; or
b. An interactive conversation between or
among persons through a computer network.
2. "Advertising idea" means any idea for an
"advertisement ".
3. "Asbestos hazard" means an exposure or
threat of exposure to the actual or alleged
properties of asbestos and includes the mere
presence of asbestos in any form.
4. "Auto" means a land motor vehicle, trailer or
semi - trailer designed for travel on public
roads, including any attached machinery or
equipment. But "auto" does not include
"mobile equipment ".
5. "Bodily injury" means physical:
a. Injury;
b. Sickness; or
c. Disease
sustained by a person and, if arising out of the
above, mental anguish or death at any time.
6. "Coverage territory" means:
Form SS 00 08 04 05
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BUSINESS LIABILITY COVERAGE FORM
a. The United States of America (including its
territories and possessions), Puerto Rico
and Canada;
b. International waters or airspace, but only if
the injury or damage occurs in the course
of travel or transportation between any
places included in a. above;
c. All other parts of the world if the injury or
damage arises out of.
(1) Goods or products made or sold by you
in the territory described in a. above;
%0 (2) The activities of a person whose home
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is in the territory described in a.
r ' above, but is away for a short time on
your business; or
(3) "Personal and advertising injury"
0 offenses that take place through the
co Internet or similar electronic means of
M communication
a
N provided the insured's responsibility to pay
Ln N damages is determined in the United States of
c America (including its territories and
c possessions), Puerto Rico or Canada, in a
* "suit" on the merits according to the
substantive law in such territory, or in a
settlement we agree to.
7. "Electronic data" means information, facts or
programs:
= a. Stored as or on;
b. Created or used on; or
c. Transmitted to or from
computer software, including systems and
applications software, hard or floppy disks,
CD -ROMS, tapes, drives, cells, data
processing devices or any other media which
are used with electronically controlled
equipment.
S. "Employee" includes a "leased worker".
"Employee" does not include a "temporary
worker".
° —
S. "Executive officer" means a person holding
any of the officer positions created by your
charter, constitution, by -laws or any other
MOM similar governing document.
10. "Hostile fire" means one which becomes
uncontrollable or breaks out from where it was
intended to be.
11. "Impaired property" means tangible property,
other than "your product" or "your work ", that
cannot be used or is less useful because:
a. It incorporates "your product" or "your work"
that is known or thought to be defective,
deficient, inadequate or dangerous; or
b. You have failed to fulfill the terms of a
contract or agreement;
if such property can be restored to use by:
a. The repair, replacement, adjustment or
removal of "your product" or "your work ";
or
b. Your fulfilling the terms of the contract or
agreement.
12. "Insured contract" means:
a. A contract for a lease of premises.
However, that portion of the contract for a
lease of premises that indemnifies any
person or organization for damage by fire,
lightning or explosion to premises while
rented to you or temporarily occupied by
you with permission of the owner is
subject to the Damage To Premises
Rented To You limit described in Section
D. – Liability and Medical Expenses Limits
of Insurance.
b. A sidetrack agreement;
c. Any easement or license agreement,
including an easement or license
agreement in connection with construction
or demolition operations on or within 50
feet of a railroad;
d. Any obligation, as required by ordinance,
to indemnify a municipality, except in
connection with work for a municipality;
e. An elevator maintenance agreement; or
f. That part of any other contract or
agreement pertaining to your business
(including an indemnification of a
municipality in connection with work
performed for a municipality) under which
you assume the tort liability of another
party to pay for "bodily injury" or "property
damage" to a third person or organization,
provided the "bodily injury" or "property
damage" is caused, in whole or in part, by
you or by those acting on your behalf.
Tort liability means a liability that would be
imposed by law in the absence of any
contract or agreement.
Paragraph f. includes that part of any
contract or agreement that indemnifies a
railroad for "bodily injury" or "property
damage" arising out of construction or
demolition operations within 50 feet of any
railroad property and affecting any railroad
bridge or trestle, tracks, road -beds, tunnel,
underpass or crossing.
However, Paragraph f. does not include
that part of any contract or agreement:
Form SS 00 08 04 05 Page 21 of 24
BUSINESS LIABILITY COVERAGE FORM
(1) That indemnifies an architect,
engineer or surveyor for injury or
damage arising out of:
(a) Preparing, approving or failing to
prepare or approve maps, shop
drawings, opinions, reports,
surveys, field orders, change
orders, designs or drawings and
specifications; or
(b) Giving directions or instructions,
or failing to give them, if that is the
primary cause of the injury or
damage; or
(2) Under which the insured, if an
architect, engineer or surveyor,
assumes liability for an injury or
damage arising out of the insured's
rendering or failure to render
professional services, including those
listed in (1) above and supervisory,
inspection, architectural or
engineering activities.
13. "Leased worker" means a person leased to
you by a labor leasing firm under an
agreement between you and the labor leasing
firm, to perform duties related to the conduct of
your business. "Leased worker' does not
include a "temporary worker".
14. "Loading or unloading" means the handling of
properly:
a. After it is moved from the place where it is
accepted for movement into or onto an
aircraft, watercraft or "auto ";
b. While it is in or on an aircraft, watercraft or
"auto "; or
c. While it is being moved from an aircraft,
watercraft or "auto" to the place where it is
finally delivered;
but "loading or unloading" does not include the
movement of property by means of a mechanical
device, other than a hand truck, that is not
attached to the aircraft, watercraft or "auto ".
15. "Mobile equipment" means any of the following
types of land vehicles, including any attached
machinery or equipment:
a. Bulldozers, farm machinery, forklifts and
other vehicles designed for use principally
off public roads;
b. Vehicles maintained for use solely on or
next to premises you own or rent;
c. Vehicles that travel on crawler treads;
d. Vehicles, whether self - propelled or not, on
which are permanently mounted:
Page 22 of 24
(1) Power cranes, shovels, loaders,
diggers or drills; or
(2) Road construction or resurfacing
equipment such as graders, scrapers
or rollers;
e. Vehicles not described in a., b., c., or d.
above that are not self - propelled and are
maintained primarily to provide mobility to
permanently attached equipment of the
following types:
(1) Air compressors, pumps and
generators, including spraying,
welding, building cleaning,
geophysical exploration, lighting and
well servicing equipment; or
(2) Cherry pickers and similar devices
used to raise or lower workers;
f. Vehicles not described in a., b., c., or d.
above maintained primarily for purposes
other than the transportation of persons or
cargo.
However, self - propelled vehicles with the
following types of permanently attached
equipment are not "mobile equipment" but
will be considered "autos ":
(1) Equipment, of at least 1,000 pounds
gross vehicle weight, designed
primarily for
(a) Snow removal;
(b) Road maintenance, but not
construction or resurfacing; or
(c) Street cleaning;
(2) Cherry pickers and similar devices
mounted on automobile or truck
chassis and used to raise or lower
workers; and
(3) Air compressors, pumps and
generators, including spraying,
welding, building cleaning,
geophysical exploration, lighting and
well servicing equipment.
16. "Occurrence" means an accident, including
continuous or repeated exposure to substantially
the same general harmful conditions.
17. "Personal and advertising injury" means injury,
including consequential "bodily injury", arising
out of one or more of the following offenses:
a. False arrest, detention or imprisonment;
b. Malicious prosecution;
Form SS 00 08 04 05
Form SS 00 08 04 05 Page 23 of 24
BUSINESS LIABILITY COVERAGE FORM
c. The wrongful eviction from, wrongful entry
Work that may need service, maintenance,
into, or invasion of the right of private
correction, repair or replacement, but
occupancy of a room, dwelling or
which is otherwise complete, will be
premises that the person occupies,
treated as completed.
committed by or on behalf of its owner,
The "bodily injury" or "property damage"
landlord or lessor;
must occur away from premises you own
d. Oral, written or electronic publication of
or rent, unless your business includes the
material that slanders or libels a person or
selling, handling or distribution of "your
organization or disparages a person's or
product" for consumption on premises you
organization's goods, products or services;
own or rent.
e. Oral, written or electronic publication of
b. Does not include "bodily injury" or
material that violates a person's right of
"property damage" arising out of:
privacy;
(1) The transportation of property, unless
f. Copying, in your "advertisement ", a
the injury or damage arises out of a
person's or organization's "advertising
condition in or on a vehicle not owned
idea" or style of "advertisement ";
or operated by you, and that condition
0
g. Infringement of copyright, slogan, or title of
was created by the "loading or
Cl
r
any literary or artistic work, in your
unloading" of that vehicle by any
m "advertisement
"; or
insured; or
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N
h. Discrimination or humiliation that results in
( The existence of tools, uninstalled
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injury to the feelings or reputation of a
equipment or abandoned or unused
o
natural person.
materials.
in
18. "Pollutants" means any solid, liquid, gaseous or
20. "Property damage" means:
°
thermal irritant or contaminant, including smoke,
a. Physical injury to tangible property,
vapor, soot, fumes, adds, alkalis, chemicals and
including all resulting loss of use of that
waste. Waste includes materials to be recycled,
property. All such loss of use shall be
reconditioned or reclaimed.
deemed to occur at the time of the
a
19. "Products - completed operations hazard ";
physical injury that caused it; or
mows
a. Includes all "bodily injury" and "property
b. Loss of use of tangible property that is not
damage" occurring away from premises
physically injured. All such loss of use
you own or rent and arising out of "your
shall be deemed to occur at the time of
product" or "your work" except:
"occurrence" that caused it.
(1) Products that are still in your physical
As used in this definition, "electronic data" is
EM
possession; or
not tangible property.
(2) Work that has not yet been completed
21. "Suit" means a civil proceeding in which
or abandoned. However, "your work"
damages because of "bodily injury", "property
will be deemed to be completed at the
damage" or "personal and advertising injury"
earliest of the following times:
to which this insurance applies are alleged.
(a) When all of the work called for in
"Suit" includes:
your contract has been completed.
a. An arbitration proceeding in which such
(b) When all of the work to be done at
damages are claimed and to which the
the job site has been completed if
insured must submit or does submit with
your contract calls for work at
our consent; or
more than one job site.
b. Any other alternative dispute resolution
_—
(c) When that part of the work done at
proceeding in which such damages are
a job site has been put to its
claimed and to which the insured submits
_
intended use by any person or
with our consent.
organization other than another
22. "Temporary worker" means a person who is
contractor or subcontractor
furnished to you to substitute for a permanent
working on the same project.
"employee" on leave or to meet seasonal or
short-term workload conditions.
23. "Volunteer worker" means a person who:
a. Is not your "employee ";
Form SS 00 08 04 05 Page 23 of 24
t
BUSINESS LIABILITY COVERAGE FORM
b. Donates his or her work;
c. Acts at the direction of and within the
scope of duties determined by you; and
d. Is not paid a fee, salary or other
compensation by you or anyone else for
their work performed for you.
24. "Your product ":
a. Means:
(1) Any goods or products, other than real
property, manufactured, sold, handled,
distributed or disposed of by:
(a) You;
(b) Others trading under your name;
or
(c) A person or organization whose
business or assets you have
acquired; and
(2) Containers (other than vehicles),
materials, parts or equipment
furnished in connection with such
goods or products.
b. Includes:
(1) Warranties or representations made at
any time with respect to the fitness,
quality, durability, performance or use
of "your product"; and
Page 24 of 24
(2) The providing of or failure to provide
warnings or instructions.
c. Does not include vending machines or
other property rented to or located for the
use of others but not sold.
25. "Your work ":
a. Means:
(1) Work or operations performed by you
or on your behalf; and
(2) Materials, parts or equipment
furnished in connection with such work
or operations.
b. Includes:
(1) Warranties or representations made at
any time with respect to the fitness,
quality, durability, performance or use
of "your work "; and
(2) The providing of or failure to provide
warnings or instructions.
Form SS 00 08 04 05