Loading...
HomeMy WebLinkAbout1 - Original Submission_ 59589049_Renewal_Insured_Copy_1184of59589049001795235ROXY BREMERTON DBA (360)692-6131 THE ROXY BREMERTON FOUNDATION KURESMAN INSURANCE LLC PO Box 1218 9321 BAYSHORE DR NW STE 111 Bremerton,WA 98337 SILVERDALE,WA 98383-8350 KURESMAN INSURANCE LLC (360)692-6131 1-844-325-2467 Policyholder Information Named Insured &Mailing Address Agent Mailing Address &Phone No. Dear Policyholder: We know you work hard to build your business.We work together with your agent, to help protect the things you care about.Thank you for selecting us. Enclosed are your insurance documents consisting of: To report a claim,call your Agent or DS 70 20 01 08 Commercial Package. (360)692-6131 (360)692-6131 1-844-325-2467 To find your specific coverages,limits of liability,and premium,please refer to your Declarations page(s). If you have any questions or changes that may affect your insurance needs,please contact your Agent at . .Verify that all information is correct.If you have any changes,please contact your Agent at.In case of a claim,call your Agent orReminders You Need To Know .CONTINUED ON NEXT PAGE DocuSign Envelope ID: D12037B8-2BDD-4090-8D4F-3FCF8C1EB44E 284ofYou Need To Know -continued .NOTICE(S)TO POLICYHOLDER(S) The Important Notice(s)to Policyholder(s)provide a general explanation of changes in coverage to your policy.The Important Notice(s)to Policyholder(s)is not a part of your insurance policy and it does not alter policy provisions or conditions.Only the provisions of your policy determine the scope of your insurance protection.It is important that you read your policy carefully to determine your rights,duties and what is and is not covered. FORM NUMBER TITLE CNI90 11 07 18 Reporting A Commercial Claim 24 Hours A Day NP 72 42 02 20 Terrorism Insurance Premium Disclosure And Opportunity To Reject NP 74 44 09 06 U.S.Treasury Department’s Office of Foreign Assets Control (OFAC)Advisory Notice to Policyholders NP 89 69 11 10 Important Policyholder Information Concerning Billing Practices NP 96 00 10 14 General Liability Access Or Disclosure Of Confidential Or Personal Information Exclusions Advisory Notice To Policyholders SNI04 01 01 20 Liberty Mutual Group California Privacy Notice .This policy will be direct billed.You may choose to combine any number of policies on one bill with your billing account.Please contact your agent for more information. DocuSign Envelope ID: D12037B8-2BDD-4090-8D4F-3FCF8C1EB44E 384of595890490017952351(844)325-2467 1(844)325-2467 CNI 90 11 07 18 REPORTING A COMMERCIAL CLAIM 24 HOURS A DAY 484of01/03/21 ROXY BREMERTON DBA BKS (22)59 58 90 49 THE ROXY BREMERTON FOUNDATION From 02/25/2021 To 02/25/2022 PO Box 1218 Bremerton,WA 98337 (360)692-6131 KURESMAN INSURANCE LLC 9321 BAYSHORE DR NW STE 111 SILVERDALE,WA 98383-8350 NP 72 42 02 20 584of59589049001795235ROXY BREMERTON DBA BKS (22)59 58 90 49 THE ROXY BREMERTON FOUNDATION From 02/25/2021 To 02/25/2022 NP 72 42 02 20 684ofNP 74 44 09 06 784of59589049001795235NP 89 69 11 10 IMPORTANT POLICYHOLDER INFORMATION CONCERNING BILLING PRACTICES NP 89 69 11 10 884ofNP 96 00 10 14 GENERAL LIABILITY ACCESS OR DISCLOSURE OF CONFIDENTIAL OR PERSONAL INFORMATION EXCLUSIONS ADVISORY NOTICE TO POLICYHOLDERS 984of59589049001795235 1084ofLIBERTY MUTUAL GROUP CALIFORNIA PRIVACY NOTICE Commercial Lines (excluding Workers’Compensation) (Effective January 1,2020) 1184of59589049001795235 1284of 1384of59589049001795235 1484of 1584of59589049001795235 1684ofThis page intentionally left blank. DocuSign Envelope ID: D12037B8-2BDD-4090-8D4F-3FCF8C1EB44E 1784of5958904900179523501/03/21 59589049 POLSVCS 235 NCXFPPNO 001795 17 84INSUREDCOPYPAGEOF Ohio Security Insurance Company ROXY BREMERTON DBA (360)692-6131 THE ROXY BREMERTON FOUNDATION KURESMAN INSURANCE LLC PO Box 1218 9321 BAYSHORE DR NW STE 111 Bremerton,WA 98337 SILVERDALE,WA 98383-8350 BKS (22)59 58 90 49 From 02/25/2021 To 02/25/2022 01/03/21 Coverage Is Provided In: Common Policy Declarations Named Insured &Mailing Address Agent Mailing Address &Phone No. Policy Number: Policy Period: 12:01 am Standard Time at Insured Mailing Location Issue Date Authorized Representative To report a claim,call your Agent or 1-800-366-6446 DS 70 21 11 16 OTHER FUND RAISING AND PROMOTION FOR ROXY THEATER Named Insured Is: Named Insured Business Is: In return for the payment of the premium,and subject to all the terms of this policy,we agree with you to provide the insurance as stated in this policy. -CUSTOM PROTECTORSUMMARYOFCOVERAGEPARTSANDCHARGES This policy consists of this Common Policy Declarations page,Common Policy Conditions,Coverage Parts (which consist of coverage forms and other applicable forms and endorsements,if any,issued to form a part of them)and any other forms and endorsements issued to be part of this policy. COVERAGE PART CHARGES Commercial General Liability $500.00 $500.00 $3.00 Total Charges for all of the above coverage parts: Certified Acts of Terrorism Coverage:(Included) Note:This is not a bill IMPORTANT MESSAGES .This policy is auditable.Please refer to the conditions of the policy for details or contact your agent. DocuSign Envelope ID: D12037B8-2BDD-4090-8D4F-3FCF8C1EB44E 1884of01/03/21 59589049 POLSVCS 235 NCXFPPNO 001795 18 84INSUREDCOPYPAGEOF Ohio Security Insurance Company ROXY BREMERTON DBA (360)692-6131 THE ROXY BREMERTON FOUNDATION KURESMAN INSURANCE LLC PO Box 1218 9321 BAYSHORE DR NW STE 111 Bremerton,WA 98337 SILVERDALE,WA 98383-8350 BKS (22)59 58 90 49 From 02/25/2021 To 02/25/2022 1-844-325-2467 Coverage Is Provided In: Common Policy Declarations Named Insured Agent Policy Number: Policy Period: 12:01 am Standard Time at Insured Mailing Location In witness whereof,we have caused this policy to be signed by our authorized officers. Mark Touhey David Long Secretary President To report a claim,call your Agent or DS 70 21 11 16 SUMMARY OF LOCATIONS This policy provides coverage for the following under one or more coverage parts.Please refer to the individual Coverage Declarations Schedules,or,the individual Coverage Forms for locations or territory definition for that specific Coverage Part. 0001 423 PACIFIC AVE 402,BREMERTON,WA 98337 POLICY FORMS AND ENDORSEMENTS This section lists the Forms and Endorsements for your policy.Refer to these documents as needed for detailed information concerning your coverage. FORM NUMBER TITLE CG 00 01 04 13 Commercial General Liability Coverage Form -Occurrence CG 01 81 05 08 Washington Changes CG 01 97 12 07 Washington Changes -Employment-Related Practices Exclusion CG 04 42 11 03 Stop Gap -Employers Liability Coverage Endorsement -Washington CG 04 50 05 08 Washington Changes -Who Is An Insured CG 20 02 11 85 Additional Insured -Club Members CG 21 06 05 14 Exclusion -Access Or Disclosure Of Confidential Or Personal Information And Data-Related Liability -With Limited Bodily Injury Exception CG 21 70 01 15 Cap on Losses from Certified Acts of Terrorism DocuSign Envelope ID: D12037B8-2BDD-4090-8D4F-3FCF8C1EB44E 1984of5958904900179523501/03/21 59589049 POLSVCS 235 NCXFPPNO 001795 19 84INSUREDCOPYPAGEOF Ohio Security Insurance Company ROXY BREMERTON DBA (360)692-6131 THE ROXY BREMERTON FOUNDATION KURESMAN INSURANCE LLC PO Box 1218 9321 BAYSHORE DR NW STE 111 Bremerton,WA 98337 SILVERDALE,WA 98383-8350 BKS (22)59 58 90 49 From 02/25/2021 To 02/25/2022 1-844-325-2467 Coverage Is Provided In: Common Policy Declarations Named Insured Agent Policy Number: Policy Period: 12:01 am Standard Time at Insured Mailing Location To report a claim,call your Agent or DS 70 21 11 16 POLICY FORMS AND ENDORSEMENTS -CONTINUED This section lists all of the Forms and Endorsements for your policy.Refer to these documents as needed for detailed information concerning your coverage. FORM NUMBER TITLE CG 21 76 01 15 Exclusion of Punitive Damages Related to a Certified Act of Terrorism CG 24 26 04 13 Amendment of Insured Contract Definition CG 26 02 04 13 Washington Changes -Amendment Of Liquor Liability Exclusion Exception For Scheduled Premises or Activities CG 26 77 12 04 Washington -Fungi or Bacteria Exclusion CG 32 21 01 15 Washington Conditional Exclusion of Terrorism Involving Nuclear,Biological or Chemical Terrorism (Relating to Disposition of Federal Terrorism Risk Insurance Act) CG 84 99 08 09 Non-Cumulation Liability Limits Same Occurrence CG 88 10 04 13 Commercial General Liability Extension CG 88 60 12 08 Each Location General Aggregate Limit CG 88 61 12 08 Property Damage -Customers’Goods CG 88 66 12 08 Property Damage -Borrowed Equipment CG 88 77 12 08 Medical Expense At Your Request Endorsement CG 89 01 12 08 Hired Auto And Non-Owned Auto Liability CG 89 27 10 09 Washington Exclusion -Asbestos CG 92 48 01 16 Sexual Misconduct or Abuse Exclusion IL 01 23 11 13 Washington Changes -Defense Costs IL 01 46 08 10 Washington Common Policy Conditions IL 01 98 09 08 Nuclear Energy Liability Exclusion Endorsement (Broad Form) DocuSign Envelope ID: D12037B8-2BDD-4090-8D4F-3FCF8C1EB44E 2084ofThis page intentionally left blank. DocuSign Envelope ID: D12037B8-2BDD-4090-8D4F-3FCF8C1EB44E 2184of5958904900179523501/03/21 59589049 POLSVCS 235 NCXFPPNO 001795 21 84INSUREDCOPYPAGEOF Ohio Security Insurance Company Commercial General Liability Declarations BKS (22)59 58 90 49 From 02/25/2021 To 02/25/2022 1-844-325-2467 DS 70 22 01 08 Coverage Is Provided In:Policy Number: Policy Period: 12:01 am Standard Time at Insured Mailing Location To report a claim,call your Agent or OccurrenceBasis: ROXY BREMERTON DBA (360)692-6131 THE ROXY BREMERTON FOUNDATION KURESMAN INSURANCE LLC Named Insured Agent SUMMARY OF LIMITS AND CHARGES Commercial DESCRIPTION LIMIT General Liability Limits of Insurance Each Occurrence Limit 1,000,000 Damage To Premises Rented To You Limit (Any One Premises)1,000,000 Medical Expense Limit (Any One Person)15,000 Personal and Advertising Injury Limit 1,000,000 General Aggregate Limit (Other than Products -Completed Operations)2,000,000 Products -Completed Operations Aggregate Limit 2,000,000 Explanation of DESCRIPTION PREMIUM Charges General Liability Schedule Totals 420.00 Policy Writing Minimum Premium Adjustment 77.00 Certified Acts of Terrorism Coverage 3.00 Total Advance Charges:$500.00 Note:This is not a bill DocuSign Envelope ID: D12037B8-2BDD-4090-8D4F-3FCF8C1EB44E 2284of01/03/21 59589049 POLSVCS 235 NCXFPPNO 001795 22 84INSUREDCOPYPAGEOF Ohio Security Insurance Company Commercial General Liability Declarations Schedule BKS (22)59 58 90 49 From 02/25/2021 To 02/25/2022 1-844-325-2467 DS 70 23 10 16 Coverage Is Provided In:Policy Number: Policy Period: 12:01 am Standard Time at Insured Mailing Location To report a claim,call your Agent or ROXY BREMERTON DBA (360)692-6131 THE ROXY BREMERTON FOUNDATION KURESMAN INSURANCE LLC Named Insured Agent SUMMARY OF CLASSIFICATIONS -BY LOCATION 0001 423 PACIFIC AVE 402,BREMERTON,WA 98337 ROXY BREMERTON DBA 41670 Insured: CLASSIFICATION - Clubs -Civic,Service Or Social -No Buildings Or Premises Owned Or Leased Except For Office Purposes - Not For Profit Products-Completed Operations Are Subject To The General Aggregate Limit. EACH Premise/Operations 5 Number of Members 3.926 $20.00 Minimum Premium Adjustment $156.00 Included RATED /PER COVERAGE DESCRIPTION PREMIUM BASED ON -PREMIUM Total: SUMMARY OF OTHER COVERAGE COVERAGE DESCRIPTION PREMIUM Hired Auto Liability See Policy Forms and Endorsements List.$59.00 Non-Owned Auto Liability See Policy Forms and Endorsements List.$56.00 Service Providers Custom Protector Coverages $50.00SeePolicyFormsandEndorsementsList 92400 Stop Gap -Employers Liability CG0442 -Stop Gap Employers’Liability -WA 18,156 Dollars of Payroll .176 $3.00 Minimum Premium Adjustment $76.00 RATED /PER CLASSIFICATION -PREMIUM BASED ON - DocuSign Envelope ID: D12037B8-2BDD-4090-8D4F-3FCF8C1EB44E 2384of5958904900179523501/03/21 59589049 POLSVCS 235 NCXFPPNO 001795 23 84INSUREDCOPYPAGEOF Ohio Security Insurance Company Commercial General Liability Declarations Schedule BKS (22)59 58 90 49 From 02/25/2021 To 02/25/2022 1-844-325-2467 DS 70 23 10 16 Coverage Is Provided In:Policy Number: Policy Period: 12:01 am Standard Time at Insured Mailing Location To report a claim,call your Agent or ROXY BREMERTON DBA (360)692-6131 THE ROXY BREMERTON FOUNDATION KURESMAN INSURANCE LLC Named Insured Agent SUMMARY OF OTHER COVERAGE -continued COVERAGE DESCRIPTION PREMIUM Commercial General Liability Schedule Total $420.00 DocuSign Envelope ID: D12037B8-2BDD-4090-8D4F-3FCF8C1EB44E 2484ofThis page intentionally left blank. DocuSign Envelope ID: D12037B8-2BDD-4090-8D4F-3FCF8C1EB44E 2584of59589049001795235COMMERCIAL GENERAL LIABILITY CG 00 01 04 13 COMMERCIAL GENERAL LIABILITY COVERAGE FORM CG 00 01 04 13 2684ofCG 00 01 04 13 2784of59589049001795235CG 00 01 04 13 2884ofCG 00 01 04 13 2984of59589049001795235CG 00 01 04 13 3084ofCG 00 01 04 13 3184of59589049001795235CG 00 01 04 13 3284ofCG 00 01 04 13 3384of59589049001795235CG 00 01 04 13 3484ofCG 00 01 04 13 3584of59589049001795235CG 00 01 04 13 3684ofCG 00 01 04 13 3784of59589049001795235CG 00 01 04 13 3884ofCG 00 01 04 13 3984of59589049001795235CG 00 01 04 13 4084ofCG 00 01 04 13 4184of59589049001795235CG 00 01 04 13 4284ofCOMMERCIAL GENERAL LIABILITY CG 01 81 05 08 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. WASHINGTON CHANGES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CG 01 81 05 08 4384of59589049001795235COMMERCIAL GENERAL LIABILITY CG 01 97 12 07 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. WASHINGTON CHANGES -EMPLOYMENT-RELATED PRACTICES EXCLUSION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CG 01 97 12 07 4484of1000000 2000000 1000000 POLICY NUMBER:COMMERCIAL GENERAL LIABILITY CG 04 42 11 03 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. STOP GAP -EMPLOYERS LIABILITY COVERAGE ENDORSEMENT -WASHINGTON This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM CG 04 42 11 03 4584of59589049001795235CG 04 42 11 03 4684ofCG 04 42 11 03 4784of59589049001795235CG 04 42 11 03 4884ofCG 04 42 11 03 4984of59589049001795235COMMERCIAL GENERAL LIABILITY CG 04 50 05 08 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. WASHINGTON CHANGES -WHO IS AN INSURED This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CG 04 50 05 08 5084ofCOMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -CLUB MEMBERS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. CG 20 02 11 85 Copyright,Insurance Services Office,Inc.,1984 WHO IS AN INSURED (Section II)is amended to include as an insured any of your members,but only with respect to their liability for your activities or activities they perform on your behalf. DocuSign Envelope ID: D12037B8-2BDD-4090-8D4F-3FCF8C1EB44E 5184of59589049001795235COMMERCIAL GENERAL LIABILITY CG 21 06 05 14 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. EXCLUSION -ACCESS OR DISCLOSURE OF CONFIDENTIAL OR PERSONAL INFORMATION AND DATA-RELATED LIABILITY -WITH LIMITED BODILY INJURY EXCEPTION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CG 21 06 05 14 5284ofCOMMERCIAL GENERAL LIABILITY CG 21 70 01 15 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVELIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY CG 21 70 01 15 5384of59589049001795235COMMERCIAL GENERAL LIABILITY CG 21 76 01 15 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. EXCLUSION OF PUNITIVE DAMAGES RELATED TO A CERTIFIED ACT OF TERRORISM This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVELIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY CG 21 76 01 15 Page 1 of 1 5484ofCOMMERCIAL GENERAL LIABILITY CG 24 26 04 13 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. AMENDMENT OF INSURED CONTRACT DEFINITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART CG 24 26 04 13 Page 1 of 1 5584of59589049001795235POLICY NUMBER:COMMERCIAL GENERAL LIABILITY CG 26 02 04 13 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. WASHINGTON CHANGES -AMENDMENT OF LIQUOR LIABILITY EXCLUSION EXCEPTION FOR SCHEDULED PREMISES OR ACTIVITIES CG 26 02 04 13 5684ofCG 26 02 04 13 5784of59589049001795235COMMERCIAL GENERAL LIABILITY CG 26 77 12 04 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. WASHINGTON -FUNGI OR BACTERIA EXCLUSION CG 26 77 12 04 5884ofCOMMERCIAL GENERAL LIABILITY CG 32 21 01 15 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. WASHINGTON CONDITIONAL EXCLUSION OF TERRORISM INVOLVING NUCLEAR,BIOLOGICAL OR CHEMICAL TERRORISM (RELATING TO DISPOSITION OF FEDERAL TERRORISM RISK INSURANCE ACT) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVELIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY CG 32 21 01 15 5984of59589049001795235CG 32 21 01 15 6084ofCOMMERCIAL GENERAL LIABILITY CG 84 99 08 09 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. NON-CUMULATION OF LIABILITY LIMITS (SAME OCCURRENCE) 6184of59589049001795235COMMERCIAL GENERAL LIABILITY CG 88 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. COMMERCIAL GENERAL LIABILITY EXTENSION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 6284of 6384of59589049001795235 6484of 6584of59589049001795235 6684of 6784of59589049001795235 6884of 6984of59589049001795235COMMERCIAL GENERAL LIABILITY CG 88 60 12 08 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. EACH LOCATION GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Includes copyrighted material of ISO Properties,Inc.,with its permission.CG 88 60 12 08 Page 1 of 1 A.For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under Section I -Coverage A -Bodily Injury And Property Damage Liability,and for all medical ex- penses caused by accidents under Section I -Coverage C Medical Payments,which can be attributed only to operations at a single "location"owned by or rented to you: 1.A separate Each Location General Aggregate Limit applies to each "location",and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 2.The Each Location General Aggregate Limit is the most we will pay for the sum of all damages under Coverage A,except damages because of "bodily injury"or "property damage"included in the "products-completed operations hazard",and for medical expenses under Coverage C regard- less of the number of: a.Insureds; b.Claims made or "suits"brought;or c.Persons or organizations making claims or bringing "suits". 3.Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the Each Location General Aggregate Limit for that "location".Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they reduce any other Each Location General Aggregate Limit for any other "location". 4.The limits shown in the Declarations for Each Occurrence,Fire Damage and Medical Expense continue to apply.However,instead of being subject to the General Aggregate Limit shown in the Declarations,such limits will be subject to the applicable Each Location General Aggregate Limit. B.For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under Section I -Coverage A -Bodily Injury And Property Damage Liability,and for all medical ex- penses caused by accidents under Section I -Coverage C Medical Payments,which cannot be attrib- uted only to operations at a single "location"owned by or rented to you: 1.Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the amount available under the General Aggregate Limit or the Products-Completed Operations Aggregate Limit,whichever is applicable;and 2.Such payments shall not reduce any Each Location General Aggregate Limit. C.When coverage for liability arising out of the "products-completed operations hazard"is provided,any payments for damages because of "bodily injury"or "property damage"included in the "products- completed operations hazard"will reduce the Products-Completed Operations Aggregate Limit,and not reduce the General Aggregate Limit nor the Each Location General Aggregate Limit. D.For the purposes of this endorsement,the following definition is added to Sectio n V -Definitions: "Location"means premises involving the same or connecting lots,or premises whose connection is interrupted only by a street,roadway,waterway or right-of-way of a railroad. E.The provisions of Section III -Limits Of Insurance not otherwise modified by this endorsement shall continue to apply as stipulated. DocuSign Envelope ID: D12037B8-2BDD-4090-8D4F-3FCF8C1EB44E 7084ofCOMMERCIAL GENERAL LIABILITY CG 88 61 12 08 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. PROPERTY DAMAGE -CUSTOMERS’GOODS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Includes copyrighted material of ISO Properties,Inc.,with its permission.CG 88 61 12 08 Page 1 of 1 A.Under Section I -Coverages,Coverage A -Bodily Injury And Property Damage Liability,2.Exclusions, j.Damage To Property,items (3),(4)and (6)do not apply to "property damage"to "customers’goods" while on your premises. B.Under Section IV -Commercial General Liability Conditions,4.Other Insurance,b.Excess Insurance, the following is added: The insurance afforded by this endorsement is excess over any of the other insurance,whether primary,excess,contingent or on any other basis,that is property insurance. C.Under Section V -Definitions,the following definition is added: "Customers’goods"means property of your customer on your premises for the purpose of being worked on or used in your manufacturing process. Nothing contained in this endorsement shall be held to vary,alter,waive,or extend any of the terms, conditions,provisions,agreements or limitations of the policy,other than as stated above. DocuSign Envelope ID: D12037B8-2BDD-4090-8D4F-3FCF8C1EB44E 7184of59589049001795235COMMERCIAL GENERAL LIABILITY CG 88 66 12 08 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. PROPERTY DAMAGE -BORROWED EQUIPMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Includes copyrighted material of ISO Properties,Inc.,with its permission.CG 88 66 12 08 Page 1 of 1 A.Under Section I -Coverages,Coverage A -Bodily Injury And Property Damage Liability,2.Exclusions, j.Damage To Property,item (4)does not apply to "property damage"to borrowed equipment while that equipment is not being used to perform operations at a job site. B.Under Section IV -Commercial General Liability Conditions,4.Other Insurance,b.Excess Insurance, the following is added: The insurance afforded by this endorsement is excess over any of the other insurance,whether primary, excess,contingent or on any other basis,that is property insurance. Nothing contained in this endorsement shall be held to vary,alter,waive,or extend any of the terms, conditions,provisions,agreements or limitations of the policy,other than as stated above. DocuSign Envelope ID: D12037B8-2BDD-4090-8D4F-3FCF8C1EB44E 7284ofCOMMERCIAL GENERAL LIABILITY CG 88 77 12 08 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. MEDICAL EXPENSE AT YOUR REQUEST ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Includes Copyrighted Material of ISOProperties,Inc.,with its permission.CG 88 77 12 08 Page 1 of 1 The following is added to Section I -Coverage C -Medical Payments: If Medical Payments or Medical Expenses are not otherwise excluded from the policy,medical expenses will be paid only if an insured has requested that we pay such expenses. DocuSign Envelope ID: D12037B8-2BDD-4090-8D4F-3FCF8C1EB44E 7384of59589049001795235X X COMMERCIAL GENERAL LIABILITY CG 89 01 12 08 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. HIRED AUTO AND NON-OWNED AUTO LIABILITY This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Includes copyrighted material of Insurance Services Office,Inc., with its permission.CG 89 01 12 08 Page 1 of 2 Coverage A.Hired Auto Liability B.Non-Ownership Liability A.Insurance is provided only for those coverages when an "X"is shown in the Declarations or in the Schedule. 1.Hired Auto Liability The insurance provided under Section I -Coverage A -Bodily Injury And Property Damage Liabil- ity,applies to "bodily injury"or "property damage"arising out of the maintenance or use of a "hired auto"by you or your "employees"in the course of your business. 2.Non-Owned Auto Liability The insurance provided under Section I -Coverage A -Bodily Injury And Property Damage Liabil- ity,applies to "bodily injury"or "property damage"arising out of the use of any "non-owned auto" in your business by any person. B.For insurance provided by this endorsement only: 1.The exclusions,under Paragraph 2.Exclusion of Section 1 -Coverage A -Bodily Injury and Prop- erty Damage Liability,other than exclusions a.,b.,d.,f.,and i.and the Nuclear Energy Liability Exclusion,are deleted and replaced by the following: a."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 Para- graph (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 the dam- ages because of the injury. This exclusion does not apply to: (1)Liability assumed by the insured under an "insured contract";or (2)"Bodily Injury"arising out of and in the course of domestic employment by the insured unless benefits for such injury are in whole or in part either payable or required to be provided under any workers compensation law. b."Property damage"to: DocuSign Envelope ID: D12037B8-2BDD-4090-8D4F-3FCF8C1EB44E 7484ofIncludes copyrighted material of Insurance Services Office,Inc., with its permission.CG 89 01 12 08 Page 2 of 2 (1)Property owned or being transported by,or rented or loaned to the insured;or (2)Property in the care,custody or control of the insured. 2.Section II,Who Is An Insured,is replaced by the following: 1.Each of the following is an insured under this endorsement to the extent set forth below: a.You; b.Any other person using a "hired auto"with your permission; c.For a "non-owned auto": (1)any partner or "executive officer"of yours;or (2)any "employee"of yours but only while such "non-owned auto"is being used in your business;and d.Any other person or organization,but only for their liability because of acts or omissions of an insured under a.,b.or c.above. 2.None of the following is an insured: a.Any person engaged in the business of his or her employer for "bodily injury"to any co-"employee"of such person injured in the course of employment,or to the spouse, child,parent,brother or sister of that co-"employee"as a consequence of such "bodily injury",or for any obligation to share damages with or repay someone else who must pay damages because of the injury. b.Any partner or "executive officer"for any "auto"owned by such partner or officer or a member of his or her household; c.Any person while employed in or otherwise engaged in duties in connection with an "auto business",other than an "auto business"you operate; d.The owner or lessee (of whom you are a sublessee)of a "hired auto"or the owner of a "non-owned auto"or any agent or "employee"of any such owner or lessee; e.Any person or organization for the conduct of any current or past partnership or joint venture that is not shown as a Named Insured in the Declarations. C.Section III -Limits of Insurance,Paragraph 2.,The General Aggregate Limit,does not apply. D.The following additional definitions apply: 1."Business"means the business or occupation of selling,repairing,servicing,storing or parking "autos". 2."Hired Auto"means any "auto"you lease,hire,rent or borrow.This does not include any "auto" you lease,hire,rent or borrow from any of your "employees",your partners or you "executive Officers"or members of their households. 3."Non-Owned Auto"means any "auto"you do not own,lease,hire,rent or borrow which is used in connection with your business.This includes "autos"owned by your "employees",your partners or "executive officers",or members of their households,but only while used in your business or your personal affairs. DocuSign Envelope ID: D12037B8-2BDD-4090-8D4F-3FCF8C1EB44E 7584of59589049001795235COMMERCIAL GENERAL LIABILITY CG 89 27 10 09 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. WASHINGTON EXCLUSION -ASBESTOS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS AND COMPLETED OPERATIONS COVERAGE PART RAILROAD PROTECTIVELIABILITY COVERAGE PART 7684ofCOMMERCIAL GENERAL LIABILITY CG 92 48 01 16 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. SEXUAL MISCONDUCT OR ABUSE EXCLUSION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 7784of59589049001795235IL 01 23 11 13 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. WASHINGTON CHANGES -DEFENSE COSTS This endorsement modifies insurance provided under the following: COMMERCIAL AUTOMOBILE COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART COMMERCIAL LIABILITY UMBRELLA COVERAGE PART COMMERCIAL PROPERTYCOVERAGE PART -LEGAL LIABILITY COVERAGE FORM COMMERCIAL PROPERTYCOVERAGE PART -MORTGAGEHOLDER’S ERRORSAND OMISSIONS COVERAGE FORM ELECTRONIC DATA LIABILITY COVERAGE PART FARM COVERAGE PART FARM UMBRELLA LIABILITY POLICY LIQUOR LIABILITY COVERAGE PART MEDICAL PROFESSIONAL LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCT WITHDRAWAL COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVELIABILITY COVERAGE PART UNDERGROUND STORAGE TANK COVERAGE PART IL 01 23 11 13 7884ofIL 01 46 08 10 WASHINGTON COMMON POLICY CONDITIONS All Coverage Parts included in this policy are subject to the following conditions. IL 01 46 08 10 7984of59589049001795235IL 01 46 08 10 8084ofIL 01 46 08 10 8184of59589049001795235IL 01 46 08 10 8284ofIL 01 98 09 08 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. NUCLEAR ENERGY LIABILITY EXCLUSION ENDORSEMENT (Broad Form) This endorsement modifies insurance provided under the following: COMMERCIAL AUTOMOBILE COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART COMMERCIAL LIABILITY UMBRELLA COVERAGE PART FARM COVERAGE PART FARM UMBRELLA LIABILITY POLICY LIQUOR LIABILITY COVERAGE PART MEDICAL PROFESSIONAL LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY IL 01 98 09 08 8384of59589049001795235IL 01 98 09 08 8484ofThis page intentionally left blank. DocuSign Envelope ID: D12037B8-2BDD-4090-8D4F-3FCF8C1EB44E