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HomeMy WebLinkAbout6046 - COI - Skillings Inc.2Client#: 324969 SKILLINC12 ACORE CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 2/18/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorse 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER USI Insurance Services NW PR 601 Union Street, Suite 1000 Seattle, WA 98101 INSURED Skillings, Inc. P. O. Box 5080 Olympia, WA 98509 COVERAGES `�""1AO1 Please See Below: NAME: a"cC o E:t ; 206 441=6300 F aI DRIESS. Seattle.PLCertRequest@usi.com RECEIVE® INSURER(S) AFFORDING COVERAGE INSURER A: Travelers Indemnity Company of CT INSURER B : Travelers Property Cas. Co. of America FEB 2 5 2022 INSURER C : XL Specialty Insurance Company INSURER D : City of Bremerton INSURER E : CERTIFICATE NUMB REVISION NUMBER: ;610-362-8530 NAIC # 25682 25674 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY X X 6805H5600292147 12/18/2021 12/18/2022 EACH OCCURRENCE $1 OOO 000 CLAIMS -MADE OCCUR PREMISES (Ea RENTED ) $150003000 MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $250005000 POLICY F X 1 JECOT D LOC PRODUCTS - COMP/OP AGG $ 23000,000 OTHER: $ A AUTOMOBILE LIABILITY X X BA2R54921 A2147G 12/18/2021 12/18/2022 COMBINED SINGLE LIMIT Ea accident 1 000 000 r � X ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ X AUTOS ONLY X NON -OWNED AUTOS ONLY B X UMBRELLA LIAB X OCCUR X X CUP7892Y1662147 12/18/2021 12/18/2022 EACH OCCURRENCE $5300%000 EXCESS LIAB CLAIMS -MADE AGGREGATE s5,000,000 DED I X RETENTION $10000 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBEREXCLUDED? � (Mandatory in NH) N/A X 6805H5600292147 (WA Stop Gap) 12/18/2021 12/18/202 PER ST TU E OTH- E E.L. EACH ACCIDENT $1 OOO OOO E.L. DISEASE - EA EMPLOYEE $1 000 000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1 ,000,000 C Professional X DPR9989731 3/02/2022 03/02/20231 $3,000,000 per claim Liability $3,000,000 annl aggr. Incl. Pollution DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Project No. 19149; Project Name: Washington & 1Ith Improvement Project. The City of Bremerton, State of Washington, their officers, employees and agents are additional insureds on the general liability and automobile liability and a waiver of subrogation applies when required by written contract. General liability is primary and non-contributory when required by written contract. CERTIFICATE HOLDER CANCELLATION City of Bremerton 345 - 6th Street, Suite 100 WA 98337-0000 Bremerton, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S34980351/M34977196 MCMZP This page has been left blank intentionally. ROLICYR 6905H5600292147 CAMMERCIAL GENERAL LIABILITY THIS ENDGRSEMEN I CHANGES THE POLICY. PLEASE READ I u CAREFULLY. i s W r.. � j 1 This endorsement modifies insurance provided under the following; SY HEai �trE Names of Additional insured t�ersan(s} ar r�rganizattan(s}: Any person or organization that you agree in a written contract to inplude as an additi�al insured qn this Coverage part, provided that such written contract was signed by you before,and Is in effect when, the "bodily injury" or "property damage" occurs or the "personal Injury" or "advertising injury" offense is committed.. l.acatit�n of Covered �peratian$: Any project to which a written contract with ttie Additional insured Persons) or drganization(s) in the Schedule applies. (Iniorrfiiakion required t+� oornplekg kfiis Schedule, if nok ;shown above, wiil be shown in the Declarations,} A. Sdction p —Who Is An Insured is amended to in- This- Insurance does not apply trs "bodily injury" or clods as an additional Insured the persons} or "proporty damage" occurring, or "personal injury„ organization(s) shown in the Schedule, but only or "advertising injury" arising out of an offense with respect to liability for "bodily injury', "property committed, after: damage" "personal injury'" or "advertising injury" 1. All work, including materials, parts or equip- caused, In whole or in part, by; ment furnished in connection with such work,. 1. Your acts or CDriiissions, or on the project (other than service, riiainte= 2. The acts or omissions of those acting on your name or repairs) to be performed by or on behalf; behalf of the additional Insured(s) at the loca� In the performance of your ongoing operations for bon of the covered operations has been com- pleted; or the additional insured(s) at the location(s) deslg- natod above. 2. That portion of "your work" out of which the B. With respect to Hie insurance afforded to these Injury or damage arises has been put to its in- tended use by any person or organization additional insureds, the following additional exclu- other than another contractor or subcontrac- skons apply; tar engaged In performing operations for a principal as a part of the same project, CC D� 61 03 t}5 �opyrlght �bt}�a i`he St. Pact Travelers i;ompanies, 1ne. All rights reserved, �includes copyrighted material of insurance Services t_3ffce, lnc. with its permission. MATE OF ISSIJEt 11/05/2021 Page I'OLIGY: 5505H5500292147 GC7MMERCIAL GENERAL LIABILITY UMIt t:KU1AL UtNtKAL LIAtSIL1` Y' UU'VEKA L F+C'}KM ariaus 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, and any other person or organization qualifying as a Named Insured under this policy, The words '"we" "us" and our" refer to the company providing this insurance. The ward "insured" means any person or organization cualifying as such under Section 11 — Who is An Insured. other words and phrases that appear in quotation marks have special meaning. Refer to Section V 6efinitions. SEt:'ilt�N I -- Ct?VERAGES .• 1. Insuring Agreen'tent a. We will pay those sums that the insured becomes legally obligated to pay as damages because of "bodily injury" or "property damage" 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" or "property damage" to which this insurance noes not apply. We may, at our discretion, investigate any "occurrence" and settle any claim or "suits' that may result But: (1) The amount we will pay for damages is limited as described in .Section IIi — Limits of Insurance; and (2 ) Our right and duty to defend end when we have used up the applicable limit of insurance in the payment of judgments or settlements under Coverages A or B or medical expenses under Coverage C. No other obligation or liability to pay sums or perform acts or services is covered unless explicitly provided for under Supplementary payments, b. This insurance applies to "bodily injury" and "property damage" only if; (1} The "bodily injury" or "property damage" is caused by an "occurrence" that takes place in the "coverage territory"; (2) The "bodily ry" or "property damage" occurs during the policy period; and {3j Prier to the policy period, na insured listed under Paragraph 1. of Section 11 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, e. dily injury" or "property damage" which occurs during Lite policy period and was not, prior to the policy period, known to have occurred by any insured listed under paragraph 1, of Section 11 — Who Is An Insured or any "employee" authorized by you to give or receive notice of an "occurrence" or claim, includes any continuation, change or resumption of that "bodily injury" or "property damage" after the end of the policy period. d. "Bodily injury" or "property damage" will be deemed to Etave been knowrn to have occurred at the earliest time when any insured listed under Paragraph 1. of Section 11 — 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 pail, of the „bodily injury„ or "property damage" to us or any other insurer; (2) Receives a written or verbal demand or claim for damages because of #�e "bodily injury" or "property damage'; or (3) Becomes aware by any other means that "bodily injury" or "property damage" has occurred or 17as begun to occur. CG 'Y"1 il0 U2 1� � 20t7 Tlr�i Travelers laage � of �1 Indemnity �omper�y, �!I rights reserved, lrje�udes co�ayr�hted rtsateri�t ei insuranr� �ertic�5 Cilfl�a, tr3e_ w1tlt fts pe�rrnlsslc�n. venture or limited liability company that is not shown as a Named Insured in the Declarations, This paragraph does not apply to any such partnership, joint venture or limited liability company that otherwise qualifies as an insured under Section 11 — Who Is An Insured, SECTIQN III — LIC4tITB tJF IhIStJRANCE 1. 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. The. General Aggregate Limit is the most we will pay for the sum of: a. Medical expenses under Coverage C% b. Damages under Coverage A. except damages because of "bodily injury" or "property damage" included in the "products -completed operations hazard"; and c. Damages under Coverage B. 3. The Products -Completed Operations Aggregate Limit is the most we will pay under Coverage A for damages because of "bodily injury" and "property damage" included in the "products -completed operations hazard". �1. Subject to Paragraph 2. above, the Personal And Advertising Injury Limit is the most we will pay under Coverage B for the sum of all damages because of all "personal injury" and "advertising injury" sustained by any one person or organization. 5. Subject to Paragraph 2, or 3. above, whichever applies, the Each Occurrence Limit is the most we will pay for the sum of: a. Damages under Coverage A, and b. Medical expenses under Coverage C. because of all "bodily injury" and "property damage" arising out of any one "occurrence". For the purposes of determining the applicable Each Occurrence Limit, all related acts or omissions committed in providing or failing to provide first aid or "Good Samaritan services" to any one person will be deemed to be one "occurrence". 6. Subject to Paragraph 5. above, the barrage To Premises Rented To You Limit is the most we will pay under Coverage A for damages because of "premises damage" to any one premises, The Damage To Premises Rented To You Limit will be: a. The amount shown far the Damage To Premises Rented To You Limit in the Declarations of this Coverage part; or b, $300,000 if no amount is shown for the Damage To Premises Rented To You Limit in the Declarations of this Coverage Part. 7 . Subject to Paragraph S. above, the Medical Expense Limit is the most we will pay under Coverage C for all medical expenses because of "bodily injury" sustained by any one person. The Limits of Insurance of this Coverage Part apply separately to each consecutive annual period and to any remaining period of less than 12 months, starting with the beginning of the policy period shown in the Declarations, unless the policy period is extended after issuance for an additional period of less than 12 rrronths. In that case; the additional period will be deemed part of the last preceding period for purposes of determining the Limits of Insurance, �. Bankruptcy Bankruptcy or insolvency of the insured or of the insured's estate will not relieve us of our obligations under this Coverage Part. 2. [rubes In The Event Of Occurrence, Offense, Claire Or Bur% a. You must see to it that we are notified as soon as practicable of an "occurrence" or an ofifense which may result in a claim. To the extent possible, notice should include: {1} How,when and where the "occurrence" or offense tank place: {2} The names and addresses of any injured persons and witnesses; and {3} The nature and location of any injury or " damage arisint3 out of the occurrence" or offense. b. if a claim Is made or '"suit" is brought against any insured, you roust: {1} Immediately record the specifics of the claim or "suit" and the date received; and {z} Notify us as soon as practicable. You must see to it that we receive written notice of the claim or "suit" as soon as practicable. u and any other involved insured must: c. Yo {�} Immediately send demands, notices. papers received its claim or "suit' summonses or legal us copies of any connection wit17 the CG T1 00 02 19 �++ 2Qt 7 T7ict Travefz3r , Page 13 of � 1 tndernnity �c�mp€rny, All rights reserved. Inc�rrdt3s capyt�Hhlad rnat�riat a! tnsur�na� S�evlc�� ttfNc�, fna. vritlfi its perr�is5ion. COMMERCIAL GENERAL LIABILITY (Z) Authorize us to obtain records and other 011) An executive officer or director of information; any other organization; or (3) Cooperate with us in the investigation or (#v) A trustee of any trust; settlement of the claim or defense against that is your partner, joint venture the "suit";and member, manager or trustee; or (4) Assist us, upon our request, in the enforcement of any right against any (b) Any employee authorized by such person or organization which may be liable partnership, joint venture, limited to the insured because of injury or damage liability company, trust or other organization to give notice of an to which this insurance may also apply. "occurrence" or offense. d. No insured will, except at that insured's own (3) Notice to us of such "occurrence" or cost, voluntarily make a payment, assume any offense will be deemed to be given as soon obligation, or incur any expense, other than for as practicable if it is given in good faith as first aid, without our consent, soon as practicable to your workers' e. The following provisions apply to Paragraph a. compensation insurer. This applies only if above, but only for purposes of the insurance you subsequently give notice to us of the provided under this Coverage Part to you or any "occurrence" or offense as soon as insured listed in Paragraph 1. or 2, of Section 11 practicable after any of the persons — Who Is An insured: described in Paragraph e,(1) or (2) above discovers that the "occurrence" or offense (1) Notice to us of such "occurrence" or may result in sums to which the insurance offense must be given as soon as provided under this Coverage Part may practicable only after the "occurrence" or apply, offense is known to you (if you are an However, if this policy includes an endorsement individual), any of your partners or that provides limited coverage for "bodily injury" members who is an individual (if you are a or "property damage" or pollution costs arising partnership or joint venture), any of your out of a , release discharge, managers who is an individual (if you are a " which 9 contains a requirement escape of irement that limited liability company); any of your pollutants" the discharge, release or escape of "pollutants'" °executive officers" or directors (if you are roust be reported to us within a specific number an organization other than a partnership, of days after Its abrupt commencement, this joint venture, or limited liability company), Paragraph e. does not affect that requirement, any of your trustees who is an individual (if you are a trust) or any "employee, 3• Legal Action Against Us authorized by you to give notice of an No person or organization has a right under this "occurrence" or offense, Coverage Part: (2) If you are a partnership, joint venture, a. To join us as a party or otherwise bring us into limited liability company or trust, and none a "suit" asking for damages from an insured; or of your partners, joint venture members. b. To sue us on this Coverage Part unless all of managers or trustees are individuals, notice its terms have been fully complied with. to us of such "occurrence'" or offense must be given as soon as practicable only after A person or organization may sue us to recover on the "occurrence" or offense is known by: an agreed settlement or on a final judgment against an insured; but we will not be liable for damages (a) Any individual who is: that are not payable under the terms of this (i) A partner or member of any Coverage Part or that are in excess of the partnership or joint venture; applicable limit of insurance. An agreed settlement means a settlement and release of liability signed by (ii) A manager of any limited liability Lis, the insured, and the claimant or the claimant's company; legal representative. Page '[� of 21 �s� 2i�1? Tl�a Travolars Indemnity Company, All rights ras€arved, �G T'i 0� o� 1! fne3uxfss aepyt�ghl€�d nsatarial Ql In�u�imee Seivlees C)lfic�, Inc_ vritli lt� pc�rrNlsslon. rLIMIA 1 111111111 1 V3112101 4, Other insurance (i1) That is insurance for "premises If valid and collectible other insurance is available to damage"; the insured for a loss we cover under Coverages A (III) If the loss arises out of the or B of this Coverage Part, our obligations are maintenance or use of aircraft, limited as described in Paragraphs a. and b. below, "autos" or watercraft to the extent As used anywhere in this Coverage Part, other not subject to any exclusion in this insurance means insurance, or the funding of Coverage Part that applies to losses, that is provided by, through or on behalf of: aircraft, "autos" or watercraft; (i) Another insurance company; (Iv) That is insurance available to a premises owner, manager or (i1) Us or any of our affiliated insurance companies, lessor that qualifies as an insured except when the Non cumulation of Each under Paragraph 4, of Section tl — Occurrence Limit provision of Paragraph S. of Who Is An insured, except when Section III — Limits Of Insurance or the Non Paragraph d. below applies; or cumulation of Personal and Advertising injury (v) That Is insurance available to an Limit provision of Paragraph 4. of Section III — equipment lessor that qualifies as Limits of Insurance applies because the an insured under Paragraph S. of Amendment Non Cumulation Of Each Occurrence Limit Of Liability And Non Section II — Who Is An Insured, Cumulation Of Personal And Advertising Injury except when Paragraph d. below Limit endorsement is included in this policy; applies. (Ili) Any risk retention group; or (b) Any of the other insurance, whether primary, excess, contingent or on any (Iv)Any self.insurance method or program, in other basis, that is available to the which case the insured will be deemed to be insured when the insured is an the provider of other insurance. additional insured, or is any other Other insurance does not include umbrella insured that does not qualify as a insurance, or excess insurance, that was bought named insured, under such other specifically to apply in excess of the Limits of insurance. Insurance shown in the Declarations of this (2) When this insurance is excess, we will Coverage Part, have no duty under Coverages A or B to As used anywhere in this Coverage Part, other defend the insured against any "suit" if any insurer means a provider of other insurance, As other insurer has a duty 'to defend the Insured against that suit . If no other used in Paragraph c, below, insurer means a insurer defends, we will undertake to do so, provider of insurance_ but we will be entitled to the insured's rights a. Primary insurance against all those other insurers, This insurance is primary except when (3) When this insurance is excess over other Paragraph b. below applies, If this insurance is insurance, we will pay only our share of the primary, our obligations are not affected unless amount of the loss, if any. that exceeds the any of the other insurance is also primary. Burn of: Then, we will share with all that other insurance (a) The total amount that all such other by the method described in Paragraph c. below, insurance would pay for the loss in the except when Paragraph d. below applies, absence of this insurance; and b. Excess insurance (b) The total of all deductible and self - insured amounts under all that other (1) This insurance is excess oven insurance. (a) Any of the other insurance, whether (4) We will share the remaining loss, if any, primary, excess, contingent or on any with any other Insurance that is not other basis: described in this Excess insurance provision and was not bought specifically to (I) That is Fire, Extended Coverage, apply in excess of the Limits of Insurance Builder's Fisk, Installation Disk or shown in the Declarations of this Coverage similar coverage for "your work"; Part, CCa T1 �0 02 '1� �� 20t7 Trio Travorr+t, Page 1� of 21 Indeninity �cmpany, AU rights r�sarved, rNc��ci,��cepyt�151ad rnateriaM ®i Insur�nek S�rwlces ilrric�, Inc. w•1th itc p�srr>jisslgn. c, Method Of sharing If all of 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 ether insurance does net 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. !f you specifically agree in a written contract or agreement that the insurance afforded to an insured under this Coverage Part must apply on a primary basis, or a primary and non- contributory basis, this insurance is primary to other insurance that is available to such insured which covers such insured as a named insured, and we will not share with that other insurance, provided that: (1j The "bodily injury„ or property damage" for which coverage is sought occurs; and (2) The "personal and advertising injury" for which coverage Is sought is caused by an offense that is committed; subsequent to the agreement by you. 5, t�remium Audit signing of that contract. or a. We will compute all premiums for this Coverage @art in accordance with our rules and rates. b. Premium shown in this Coverage Part as advance premium is a deposit premium only, At the close of each audit period we will compute the earned premium for that period and send notice to the first Named Insured. The due date for audit and retrospective premiums is the date shown as the due date on the bill. if the sum of the advance and audit premiums paid for the policy period is greater than the earned premium, we will return the excess to the first Named insured. c. The first Named Insured must keep records of the information we need for premium computation, and send us copies at such times as we may request. �. flepresenta#ions. By accepting this policy, You agree. a. The statements in the Declarations are accurate and complete, b. Those statements are based upon representations you made to us; and e. We have issued this policy in reliance upon Your representations, The unintentional omission of, or unintentional error in, any information provided by you which we relied upon in issuing this policy will not prejudice your rights under this insurance, However, this provision does not affect our right to collect additional premium or to exercise our rights of cancellation or nonrenewal in accordance with applicable insurance laws or regulations, i, Stiparatil on Of Insureds Except with respect to the Limits of Insurance, and any rights or duties specifically assigned in this Coverage Part 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 claim is made or "suit" is brought. $. Transfer Of flights Of Recovery Against Others To Us If the insured has rights to recover all or part of any payment we have made under this Coverage Part, these 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. 9. When We Do Net Renew If we decide not to renew this Coverage @art, we will mail or deliver to the first Named insured shown in the declarations written notice of the nonrenewal not less than 30 days before the expiration date. If notice is mailed, proof of mailing will be sufficient proof of notice. SECTION V — DEFINITIONS 1. "Advertisement" means a notice that is broadcast or published to the general public or specific market segments about your goods, products or services for the purpose of attracting customers or supporters. For the purposes of this definition; a. Notices that are published include material placed on the Internet or on similar electronic means of communication; and b. Regarding websites, only that part of a website that is about your goods, products or services for the purposes of attracting customers or supporters is considered an advertisement. @acJe 16 of � 1 �� 20t 7 Ttit� Traveloa ,Indemnity Company. All rights rasorved, �� 'I'1 �0 Q2 � g fne3�a�s cnpytt�t�t�d ns�t�r{al of Insurann� S�3i�lc€ Grtiab, Inc. vrikh its p�rrt�isalon. POLICY: 6305H5600292147 "in1a CIVpt)MOM M NT CHANGES 1 Hr. r ULi .Y. VLEASE RMAU I I GAKWE ULLYa This endorsement modifes insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE DART GENERAL [?ESCRlPTiON OF CaVERAGE —This endorsement broadens coverage. Hourever, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to this Coverage Part, and these coverage broadening provisions Jo not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general coverage description only. Read all the provisions of this endorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered, A. Non -Owned Watercraft — 75 Feet Long �r Less f3. Who Is An Insured — unnamed Subsidiaries 1 Who Is An Insured — Retired Partners, Members, Directors And Employees D, Who Is An Insured —Employees And Volunteer Workers — Bodily Injury To Co -Employees, Co - Volunteer Workers And Retired Partners, Members, Directors And Employees E. Who Is An Insured v Newly Acquired Or Farmed Limited Liaty Companies F, Blanket Additional Insured — Controlling Interest G. Blanket Additional Insured Mortgagees, Assignees, Successors Or Receivers PRQ1iISIQNS A, NON -OWNED WATERCRAFT � 75 FEET LONG OR LESS H. Blanket Additional. Insured — ,Governmental Entities — Permits Or Authorizations Relating To Premises 1. Blanket Additional Insured — Governmental Entities — Permits Or Authorizations Relating To Operations J. Incidental Medical Malpractice K, Medical Payments ® Increased Limit L. Amendment Of Excess Insurance Condition — Professional Liability N. Contactual Liability `Railroads uses or Is responsible for the use of a watercraft that you do not own 117ak is: {1) 75 feet long or less, and i, The following replaces Paragraph (2) of {2) Not being used to carry any person Exclusion g., Aircraft, Auto Or Watercraft, or property for a charge; I n Paragraph 2. of SECTION i — B, WHO iS AN INSURED — UNNAMED COVERAGES - COVERAGE A — BODILY SUBSIDIARIES INJURY AND PROPERTY DAMAGE Tile following is added to SECTION 11 ® WHO IS LIABILITY: AN INSURED: (2) A watercraft you do not own that is: Any of your subsidiaries, other than a partnership (a) 75 feet long or less, and or joint venture, that is not shown as a Named (b) Not being used to carry any person Insured in the Declarations is a Named Insured or property for a charge; if: 2. The following replaces Paragraph 2.e. of a. You are the sole owner of, or maintain an SECTION 11 — WHO IS AN INSURED; ownership interest of more than 50% in, such e. Any person or organization that, with subsidiary on the first day of the policy your express or implied consent, either period, and :G D3 79 02 19 t, 2017 Via Ttayel€,rs Itutumnity Company. Ail n0fits reserver. Page 1 of 6 Q3aiurres copyrighted material of Insurance Services office, Inc, with Its pernissitrn. CUMMERCIAL GENERAL LIABILITY b. Such subsidiary is not an insured under similar other insurance, No such subsidiary is an insured for bodily injury" or "property damage" that occurred, or "personal and advertising injury" caused by an offense committed: a. I�efore you maintained an ovrner'ship interest of more than 50% in such subsidiary; or b, After the date, if any, during the policy period that you no longer maintain an ownership interest of more than 50% in such subsidiary. ►�or purposes of Paragraph 1. of Section It � Who is An Insured, each such subsidiary will be deemed to be designated in the Declarations as: a. A limited liability company; b, An organization other than a partnership, joint venture or limited liability company; or c, A trust; as indicated in its name or the documents that govern its structure, WHa is AN INSURED � RETIRED PARTNERS, Mr.W11OER2119 DIRECTDRS AND EMPLt)YEES The following is added to Paragraph 2, of SECTiON 11 � WHO IS AN INSURED. Any person who is your retired partner, member, director or "employee" that is performing services for you under your direct supervision, but only for acts within the scope of their employment by you or while performing duties related to the conduct of your business. However, no such retired partner, member, director or "employee" is an insured for. (1) "Bodily injury": (a) To you, to your current partners or members {if you are a partnersh"rp or joint venture), to your current members (if you are a limited liability company) or to your current directors; (b) To the spouse, child, parent, brother or sister of that current partner, member or director as a consequence of Paragraph (1)(a) above; (c) For which there is any obligation to share damages with or repay sorncoric else who must pay damages because of the injury described in Paragraph (1)(a) or (b) above; or (d) Arising out of his or her providing or failing to provide professional health care services, Unless you are in the business or occupation of providing professional health care sen+ices, Paragraphs (1)(a), (b), (c) and (d) above do not apply to "bodily injury" arising out of providing or failing to provide first aid or "Good Samaritan services" by any of your retired partners, members, directors or "employees", other than a doctor. Any such retired partners, members, directors or "employees" providing or failing to provide first aid or "Good Samaritan services" during their work hours for you will be deemed to be acting within the scope of their employment by you or performing duties related to the conduct of your business. (2) "Personat injury": (a) To you, to your current or retired partners or members (if you are a partnership or joint venture), to your current or retired members (if you are a limited liability company), to your other current or retired directors or "employees" 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; (Ia) To the spouse, child, parent, brother or sister of that current or retired partner, member, director, "employee" or "volunteer worker" as a consequence of Paragraph (2)(a) above; (r;) For which there is any obligation to share damages v�ith or repay someone else who mint pay damages because of the injury described in Paragraph (2)(a) or (b) above; or (d) Arising out of his or her providing or failing to provide professional health care services. (3) "Property damage" to property: (a) Livened, occupied or used by; or (b) Rented to, in the care, custody or control of, or over whichphysical control is being exercised for any purpose by; you, any of your retired partners, members or directors, your current or retired "employees" or "`volunteer workers", any current partner or member (if you are a partnership or joint venture), or any current member (if you are a limited liability company) or current director. Page 2 of 6 16 2017 'fihts "rtavulars Indornnil� Gor�Spanp, Ali rights resmed. CG D3 7$ 02 19 (n�iuci�� ae�yrfgtii+�� nuai�risl of l�os�ratiGe S�rvlc�� CSlflc�, Ire, 4MAJ1 its pernilsslrsn, D. WHO IS AN INSURED — EMPLOYEES AND VOLUNTEER WORKERS — E30DiLY INJURY TO CO -EMPLOYEES, CO -VOLUNTEER WORKERS AND RETIRED PARTNERS, MEMBERS, DIRECTORS AND EMPLOYEES The following is added to Paragraph 2.a.0) of SECTION II . WHO IS AN INSURED: Paragraphs (1j(a), (b) and (t) above do not apply to "bodily injury" to a current or retired co- "employee" while in the course of the co - "employee's" employment by you or performing duties related to the conduct of your business, or to "'bodily injury" to your other "volunteer workers" or retired partners, members or directors while performing duties related to the conduct of your business. E. WHO iS AN INSURED —NEWLY ACQUIRED OR FORMED LIMITED LIABILITY COMPANIES The following replaces paragraph 3. of SECTION II - WHO IS AN INSURED: 3. Any organization you newly acquire or form, other than a partnership or joint venture, and of which you are the sole owner or in which you maintain an ownership interest of more than 50%, 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: (1) Until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier, if you do not report such organization in writing to us within 180 days after you acquire or form it; or (2) Until the end of the policy period, when that date. is later than 180 days after you acquire or form such organization, if you report such organization in writing to us within 180 days after you acquire or form It: b. Coverage A does not apply to "bodily ury" or ppraperty damage" that occurred before you acquired or farmed the organization: and e. Coverage B does not apply to "personal and advertising injury" arising out of an offense cgmmitied before you acquired or formed the organization. For the purposes of Paragraph 'I. of Section 11 -- Who Is An Insured, each such caIv11ViERCIAL GENERAL LIADILI I T organization will be deemed to be designated in the Declarations as: a. A limited liability company; la. An organization other than a partnership, joint venture or limited liability company, or c. A trust: as indicated in its name or the documents that govern its st(ucture. F. BLANKET ADDITIONAL INSURED — CONTROLLING INTEREST 9. The following is added to SECTION If WHO IS AN INSURED: Any person or organization that has financial control of you is an insured with respect to liability for "bodily injury". "property damage" or "personal and advertising injury" that arises out of: a. Such financial control; or such person's or organization b. 's ownership, maintenance or use of premises leased to or occupied by you, The insurance provided to such person or organization does not apply to structural alterations, new construction or demolition operations performed by or on behalf of such person or organization, 2. The fallofollowinging is added to Paragraph 4. of SECTIO N tl — WHO lS AN INSURED: This paragraph does not apply to any premises owner, manager or lessor that has financial control of you. G. BLANKET ADDITIONAL INSURED — MORTGAGEES, ASSIGNEES, SUCCESSORS OR RECEIVERS The following is added to SECTION II WHO IS AN INSURED: Any person or organization that is a mortgagee, assignee, successor or receiver and that you have agreed in a written contract or agreement to include as an additional insured on this Coverage Part is an insured. but only with respect to its liability as mortgagee, assignee, successor or receiver for "bodily injury"' "property damage" or "personal and advertising injury" that: a. is "bodily injury" or "property damage" that occurs, or Is "personal and advertising injury" . caused by an offense that is + ommitted 90219 f?=! 2017 The Travelers Womnity M . a subsequent to the signing of that contract or agreement; and b. Arises out of the ownership, maintenance or use of the premises for which that mortgagee, assignee, successor or receiver is required under that contract or agreement to be included as an additional insured on this Coverage Part. The insurance provided to such mortgagee, assignee, successor or receiver is subject to the Following provisions: a> The limits of insurance provided to such mortgagee, assignee, successor or receiver will be the minimum limits that you agreed to provide in the written contract or agreement, or the limits shown in the Declarations, whichever are less. ks. The insurance provided to such person or organization does not apply to: (1) Any "bodily injury" or °property damage" that occurs, or any "personal and advertising injury" caused by an offense that is committed, after such contract or agreement is no longer in effect, or (2) Any "bodily injury", "property damage" or "personal and advertising injury" arising out of any structural alterations, new construction or demolition operations performed by or on behalf of such mortgagee, assignee., successor or receiver. H. BLANKET ADDITIONAL INSURED GOVERNMENTAL ENTITIES � F'ERMtTS OR AUTHORIZATIONS RELATING TO PREMISES The following is added to SECTION It WHO IS AN INSURED; Any governmental entity that has issued a permit or authorisation �rith respect to premises owned or occupied by, or rented or loaned to, you and that you are required by any ordinance, law, building code or written contract or agreement to include as an additional insured on this Coverage Part is an insured, but only with respect to liability for "bodily injury" "property damage" or "personal and advertising injury" arising out of the existence, ownership, use, maintenance, repair, construction, erection or removal of any of the following for which that governmental entity has issued such permit or authorization, advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults, elevators, street banners or decorations. 1< BLANKET ADDITIONAL INSURED — GOVERNMENTAL ENTITIES — PERMITS OR AUTHORIZATIONS RELATING TO OPERATIONS The following is added to SECTION II -- WWt:? l5 AN INSURED: Any govemmental entity that has issued a permit or authorization with respect to operations performed by you or on your behalf and that you are required by any ordinance, law, building code or written contract or agreement to include as an additional insured on this Coverage Part is an insured, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" arising out of such operations. The. insurance provided to such governmental entity does not apply to. a. Any "bodily injury" "property damage"' or "personal and advertising injury'" arising out of operations performed for the governmental entity; or Any „bodily injury" b. included in the operations hazard", or "property damage" "products -completed J. INCIDENTAL MEDICAL MALPRACTICE 1. The following replaces Paragraph b. of the definition of "occurrence" in the DEFINITIONS Section: b. An act or omission committed in provIding or failing to provide "incidental medical services", first aid or "Goad Samaritan services" to a person, unless you are in the business or occupation of providing professional health care services. 2< The following replaces the last paragraph of Paragraph Z.a.(1) of SECTION 1I —WHO IS AN INSURED; Unless you are in the business or occupation of providing professional health care services, Paragraphs (1)(a), (b), (c) and (d) above do not apply to "bodily injury" arising out of providing or failing to provide: (a) "Incidental medical services" by any of your "employees" who is a nurse, nurse assistants emergency medical technician, paramedic, athletic trainer, audiologist, dietician, nutritionist, Page d of 6 �017 ilti� Trav���rrs Inclernnity Cor�tpany, Ail i7rs rasa:wod. CG D3 73 02 19 In�iud�s Ca}3}afrt�ri1�34� ntute�ri�i of rrssur�n� Serviet�s C?iflc�, Its. �veti� its petmission. occupational therapist or occupational therapy assistant, physical therapist or speech -language pathologist; or (b) First aid or "Good Samaritan services" by any of your "employees" or "volunteer workers", other than an employed or volunteer doctor. Any such "employees" or "volunteer workers" providing or failing to provide first aid or "Good Samaritan services" during their work hours for you wIII be deemed to be acting within the scope of their employment by you or performing duties related to the conduct of your business. 3. The following replaces the last sentence of Paragraph S. of SECTION III — LIMITS OF INSURANCE: For the purposes of determining the .applicable Each Occurrence Limit, all related acts or omissions committed in providing or failing to provide "incidental medical services", first aid or "Good Samaritan services" to any one person will be deemed to be one "occurrence", 4. The following exclusion is added to Paragraph 2., Exclusions, of SECTION I COVERAGES . COVERAGE A � BODILY INJURY AND PROPERTY DAMAGE LIABILITY: Sale Of Pharmaceuticals "Bodily injury" or "property damage" arising out of the violation of a penal statute dr ordinance relating to the sale of pharmaceuticals committed by, or with the knowledge or consent of the insured. 5. The following is added to the DEFINITIONS Section: "Incidental medical services" means. a. Medical, surgical, dental, laboratory, x ray or nursing service or treatment, advice or instruction, or the related furnishing of food or beverages; or b. The furnishing or dispensing of drugs or medical, dental, or surgical supplies or appliances, s, The following is added to paragraph 4.b., Excess insurance, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: This insurance is excess over any valid and collectible other Insurance, whether primary, excess, contingent or on any other basis, that is available to any of your "employees" far "bodily injury" that arises out of providing or failing to provide "incidental medical services" to any person to the extent not subject to Paragraph 2,a.(i) of Section II — 1Nho Is An Insured. K. MEDICAL PAYMENTS —INCREASED LIMIT The following replaces Paragraph 7. of SECTION IiI — LIMITS OF INSURANCE: 7, Subject to Paragraph 5. above, the Medical Expense Limit is the most we will pay under Coverage C for all medical expenses because of "bodily injury" sustained by any one person, and will be the higher of; a. $10,000; or b. The amount shown in the Declarations of this. Coverage Part for Medical Expense Limit. L. AMENDMENT OF EXCESS INSURANCE CONDITION — PROFESSIONAL LIABILITY Tile following is added to Paragraph 4.b., Excess Insurance, of SECTION IV — CpMMERCiAL GENERAL LIABILITY CONDITIONS: This insurance. is excess over any of the other insurance; whether primary, excess, con#ingent or on any other basis, that Is Professional Liability or similar coverage, to the extent the Ions is not subject to the professional services exclusion of Coverage A or Coverage B, M. BLANKET WAIVER OF SUBROGATION WHEN REQUIRED BY WRITTEN CONTRACT OR AGREEMENT The following is added to Paragraph S., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS:. If the insured has agreed in a written contract or agreement to waive that insurecl's right of recovery against any person or organization, we waive our right of recovery against such person or organization, but only for payments the make because of: a. "Bodily injury" or "property damage" that occurs; or b. "personal and advertising injury" caused by an offense that is committed; subsequent to the signing of that contract or agreement. CG D3 79 D2 ') 9 � 2017 Tate Travelers Page 5 of 6itecfudes initmisity Corr�p�ry, All rights re$brve�f, conyaightct3 matotial of Irlsurarac© SRrYiGb6 Clfiice, Inc, with iiS rrerniassicrn, N. CpNTRA%�TUAL LIADILITY — RAILRQADS 1. The following replaces Paragraph c, of the definition of "insured contract' in the DEFINITIONS Section, c. Any easement or license agreement; 2. Paragraph f.(i) of the definition of "insured contract" in the DEFINITIONS Section is deleted. Page f) of 6 �� �tl17 il�o Tr�vurars Inti�rr�nity Campany, A11 rights rc��atved. OCa C}3 79 f?2 h 9 Iric�u�es capyri�htr�ti rr��tori3l of Insurancxi �s�rvletfs OIIIc�, tnewith its pctrnission. POLICY: SA21354921A2147G T11`115 ENDORSEMENT trrIANGES THE r LIGY, PLEASE REA[? IT CAREFULLY. This endorsement modifies insurance provided under the follotiving; 11111110 .. A �• Tile following i5 added to Paragraph c. in A.1., Who Cs An Insured, of SECTION 11 — COVERED AUTOS LIABILITY COVERAGE in the BUSINESS AUTO COVERAGE FORM and Paragraph e. in A.1., Who Is An Insurer!, of SECTION it � COVERED AUTOS UABIUTY COVERAGE in the MOTOR CARRIER COVERAGE FARM, whichever Coverage Form is part of your policy: This includes any person or organization who you are required under a written contract or agreement between you and that person or organization, that is signed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, to name as an additional insured for Covered Autos Liability Coverage, but only for damages to which this insurance applies and only to the extent of that person's or organization's liability for the conduct of another "insured". CA T4 37 U2 1G "tir 241� The Trav�$�rs Page 1 of 1 indemnity Cpra��an+�, All rlgtjl� refierved lnC€Ude� p�r�3yrtg3���d m�1erl�l pd �ttsutanr� �ervle�� f,]Ifi��, ►��. , vr�th its, p�rrnl�sinl�,