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HomeMy WebLinkAbout20220103_5861_Certtificate of Insurance 12312022 EXPINSR ADDLSUBRLTRINSRWVD DATE (MM/DD/YYYY) PRODUCER CONTACTNAME: FAXPHONE(A/C, No):(A/C, No, Ext): E-MAILADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY)(MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE INSURER(S) AFFORDING COVERAGE NAIC # Y / N N / A (Mandatory in NH) ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED? EACH OCCURRENCE $ DAMAGE TO RENTED $PREMISES (Ea occurrence)CLAIMS-MADE OCCUR MED EXP (Any one person)$ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ $ PRO- OTHER: LOCJECT COMBINED SINGLE LIMIT $(Ea accident) BODILY INJURY (Per person)$ANY AUTO OWNED SCHEDULED BODILY INJURY (Per accident)$AUTOS ONLY AUTOS AUTOS ONLYHIRED PROPERTY DAMAGE $AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE $ CLAIMS-MADE AGGREGATE $ DED RETENTION $$ PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMIT $DESCRIPTION OF OPERATIONS below POLICY NON-OWNED SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer any rights to the certificate holder in lieu of such endorsement(s). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORDACORD 25 (2016/03) ACORDTM CERTIFICATE OF LIABILITY INSURANCE Alaska National Insurance Company Great American E & S Insurance 12/30/2021 Propel Insurance Seattle Commercial Insurance 601 Union Street, Suite 3400 Seattle, WA 98101-1371 Emily Muir 800 499-0933 866 577-1326 emily.muir@propelinsurance.com Award Construction, Inc. 980 Willey's Lake Road Ferndale, WA 98248 38733 37532 A X X X $5,000 PD DED X 21LPS31967 12/31/2021 12/31/2022 1,000,000 100,000 5,000 1,000,000 2,000,000 2,000,000 A X X X 21LAS31967 12/31/2021 12/31/2022 1,000,000 A X X X 10,000 21LLU31967 12/31/2021 12/31/2022 8,000,000 8,000,000 A N 21LPS31967 WA STOP GAP 12/31/2021 12/31/2022 X 1,000,000 1,000,000 1,000,000 A B B Leased/Rented Eq Pollution Liab Professional Liab 21LIA31967 CPBE78426400 CPBE78426400 12/31/2021 12/31/2021 12/31/2021 12/31/2022 12/31/2022 12/31/2022 350,000 3,000,000 / 3,000,000 1,000,000 / 1,000,000 2107 WWTP Slide Gates The City, its officials, employees, agents and volunteers are included as additional insured City of Bremerton Department of Public Works and Utilities 100 Oyster Bay Ave. N. Bremerton, WA 98312 1 of 1 #S4948831/M4948477 AWARCONSClient#: 107456 EJM00 1 of 1 #S4948831/M4948477 This page has been left blank intentionally. ANIC GL 1187 07 16 Page 1 of 6 CONTRACTORS’ GENERAL LIABILITY ENHANCEMENT ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Coverage afforded under this extension of coverage endorsement does not apply to any person or organization covered as an additional insured on any other endorsement now or hereafter attached to this Coverage Part. SCHEDULE OF COVERAGES ARE SUMMARIZED BELOW 1. Miscellaneous Additional Insureds 8 additional insured extensions. Primary and Noncontributory Insurance 2. Damage To Premises Rented to You Limit increased to $500,000. 3. Medical Payments Limits increased to $15,000. Reporting period increased to three years from the date of accident. 4. Non-owned Watercraft Increased to 50 feet. 5. Supplementary Payments Cost of bail bonds increased to $10,000. Daily loss of earnings increased to $500. 6. Newly Formed Or Acquired Organizations Coverage extended to the end of the policy period or the next anniversary of this policy’s effective date. 7. Liberalization Clause 8. Unintentional Failure To Disclose Hazards 9. Notice of Occurrence 10. Broad Knowledge of Occurrence 11. Bodily Injury - Extension of Coverage 12. Expected Or Intended Injury Reasonable force - bodily injury or property damage. 13. Blanket Waiver of Subrogation Waiver of subrogation where required by written contract or written agreement. 14. In Rem Actions 1. MISCELLANEOUS ADDITIONAL INSUREDS Section II Who Is An Insured is amended to include as an additional Insured any person or organization described in Paragraphs 2.a. through 2.h. below whom you are required to add as an additional insured on this policy under a written contract or written agreement. However, the written contract or written agreement must be: 1. Currently in effect or becoming effective during the term of this policy; and 2. Executed prior to the “bodily injury”, “property damage” or “personal injury and advertising injury”, but Only the following persons or organizations are additional insureds under this endorsement and coverage provided to such additional insureds is limited as provided herein: a. State or Governmental Agency or Subdivision or Political Subdivi- sions Any state or governmental agency or subdivision or political subdivision that has issued a permit in connection with operations performed by you or on your behalf and that you are required by any ordinance, law or building code to include as an additional insured on this coverage part is an additional insured, but only with respect to liability for “bodily injury”, “property damage”, “personal and advertising injury” arising out of such operations. ANIC GL 1187 07 16 Page 2 of 6 The insurance provided to such state or political subdivision does not apply to any “bodily injury”, “property damage” or “personal and advertising injury” arising out of operations performed for that state or political subdivision. b. Controlling Interest Any persons or organizations with a controlling interest in you but only with respect to their liability arising out of: (1) Their financial control of you, or (2) Premises they own, maintain or control while you lease or occupy these premises. This insurance does not apply to structural alterations, new construc- tion and demolition operations performed by or for such additional insured. c. Managers or Lessors of Premises A manager or lessor of premises but only with respect to liability arising out of the ownership, maintenance or use of that specific part of the premises leased to you and subject to the following additional exclusions: 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 con- struction or demolition operations performed by or on behalf of such additional insured. d. Mortgagee, Assignee or Receiver A mortgagee, assignee or receiver but only with respect to their liability as mortgagee, assignee, or receiver and arising out of the ownership, maintenance, or use of a premises by you. This insurance does not apply to structural alterations, new construc- tion or demolition operations performed by or for such additional insured. e. Owners or Other Interests From Whom Land Has Been Leased An owner or other interest from whom land has been leased by you but only with respect to liability arising out of the ownership, maintenance or use of that specific part of the land leased to you and subject to the following additional exclusions: This insurance does not apply to: (1) Any “occurrence” which takes place after you cease to lease that land; or (2) Structural alterations, new con- struction or demolition operations performed by or on behalf of such additional insured. f. Co-owner of Insured Premises A co-owner of a premises co-owned by you and covered under this insurance but only with respect to the co-owners liability as co-owner of such premises. g. Lessor of Equipment Any person or organization from whom you lease equipment. Such person or organization is an additional insured 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, oper- ation or use of equipment leased to you by such person or organization. A person’s or organization’s status as an additional insured under this endorsement ends when their written contract or written agreement with you for such leased equipment ends. With respect to the insurance afforded these additional insureds, the following additional exclusions apply: This insurance does not apply: (1) To any “occurrence” which takes place after the equipment lease expires; or ANIC GL 1187 07 16 Page 3 of 6 (2) To “bodily injury”, “property damage”, or “personal and advertising injury” arising out of the sole negligence of such additional insured. h. Owners, Lessees or Contractors (1) Such person or organization is an additional insured for “bodily injury”, “property damage” and “personal and advertising injury” if, and only to the extent that, the injury or damage is caused by negligent acts or omissions of you or your subcontractor in the performance of “your work” to which the written contract applies. This person or organi- zation does not qualify as an additional insured with respect to injury or damage caused in whole or in part by independent negligent acts or omissions of such person or organization. (2) However, this insurance does not apply to “bodily injury”, “property damage” or “personal and advertising injury” arising out of an architect’s, engineer’s, or surveyor’s rendering of or failure to render any professional services including: i. the preparing, approving, or failing to prepare or approve maps, drawings, opinions, reports, surveys, change orders, design or specifications; and ii. supervisory, inspection, or engineering services. (3) The insurance provided to this additional insured, does not cover "bodily injury" or "property damage” caused by your negligent acts and omissions in the performance of "your work" that occurs within the "products- completed operations hazard", unless the written contract contains a specific requirement that you procure completed operations coverage or coverage within the "products-completed operations hazard" for the additional insured. However, even if coverage within the "products-completed operations hazard" is required by the written contract, such coverage is available to the additional insured only if the "bodily injury" or "property damage" occurs prior to the end of the time period during which you are required by the written contract to provide such coverage or the expiration date of the policy, whichever comes first. Any insurance provided to an additional insured designated under Paragraphs 2.a. through 2.g. above does not apply to “bodily injury” or “property damage” included within the products-completed operations hazard.” Primary And Noncontributory Insurance The following is added to the Other Insurance Condition and supersedes any provision to the contrary: This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. Section III - Limits of Insurance, the following is added: With respect to the insurance afforded to the additional insureds described in Paragraphs a. through h. above, the most we will pay on behalf of such additional insured is the amount of insurance: (1) Required by the contract or agreement; or (2) Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. ANIC GL 1187 07 16 Page 4 of 6 This provision shall not increase the applicable Limits of Insurance shown in the Declaration. 2. Damage To Premises Rented to You SECTION III – LIMITS OF INSURANCE, Paragraph 6. is replaced by the following: 6. Subject to Paragraph 5. above, the Damage to Premises Rented to You Limit is the most we will pay under Coverage A for damages because of “property damage” to any one premises, while rented to you, or in the case of damage by fire, while rented to you or temporarily occupied by you with permission of the owner. If a limit is shown for Damage to Premises Rented to You the most we will pay under Coverage A for damages because or “property damage” to any one premises is the Limit shown in the Declarations or $500,000, whichever is greater. 3. MEDICAL PAYMENTS A. Section lll – Limits of Insurance, Paragraph 7. is replaced by the following: 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. If a limit is shown for Medical Expense in the Declarations the most we will pay under Coverage C for all medical expenses because of “bodily injury” sustained by any one person is the Limit shown in the Declarations or $15,000, whichever is greater. B. This provision 5. (Medical Payments) does not apply if Section I - Coverage C Medical Payments is excluded either by the provisions of the Coverage Part or by endorsement. C. Paragraph 1.a.(3)(b) of Section I - Coverage C - Medical Payments, is replaced by the following: (b) The expenses are incurred and reported to us within three years of the date of the accident; and 4. NON-OWNED WATERCRAFT A. If endorsement CG 21 09, CG 21 10, CG 24 50, or CG 24 51 is attached to the policy, Paragraph A. 2. g. (2) (b) is replaced by the following: (b) A watercraft that you do not own that is: (i) Less than 50 feet long: and (ii) Not being used to carry persons or property for a charge. B. If Paragraph A. does not apply, Paragraph g. (2) of 2. EXCLUSION under SECTION l – COVERAGES, COVERAGE A – BODILY INJURY AND PROPERTY DAMAGE LIABILITY is replaced by the following: (2) A watercraft that you do not own that is: (a) Less than 50 feet long; and (b) Not being used to carry persons or property for a charge. 5. SUPPLEMENTARY PAYMENTS A. Under Section I - Supplementary Payments - Coverage A and B, Paragraph 1.b., the limit of $250 shown for the cost of bail bonds is replaced by $10,000; B. In Paragraph 1.d., the limit of $250 shown for daily loss of earnings is replaced by $500. 6. NEWLY FORMED OR ACQUIRED ORGANIZATIONS Paragraph 3.a. of Section II - Who Is An Insured is deleted and replaced by the following: Coverage under this provision is afforded only until the end of the policy period or the next anniversary of this policy’s effective date after you acquire or form the organization, whichever is earlier. ANIC GL 1187 07 16 Page 5 of 6 7. LIBERALIZATION CLAUSE If we adopt a change in our forms or rules which would broaden coverage for contractors under this endorsement without an additional premium charge, your policy will automatically provide the additional coverages as of the date the revision is effective in your state. 8. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS SECTION IV – COMMERCIAL GENERAL LIABILITY CONDITIONS – Paragraph 6. – Representations is replaced by the following: 6. Representations 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 c. We have issued this policy in reliance upon your representations. The unintentional omission of, or unintentional error in, any information you provided to us 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 laws and regulations. 9. NOTICE OF OCCURRENCE The following is added to Paragraph 2. of Section IV - Commercial General Liability Conditions - Duties In The Event of Occurrence, Offense, Claim or Suit: Your rights under this Coverage Part will not be prejudiced if you fail to give us notice of an “occurrence”, offense, claim or “suit” and that failure is solely due to your reasonable belief that the “bodily injury” or “property damage” is not covered under this Coverage Part. However, you shall give written notice of this “occurrence”, offense, claim or “suit” to us as soon as you are aware that this insurance may apply to such “occurrence”, offense, claim or “suit.” 10. BROAD KNOWLEDGE OF OCCURRENCE The following is added to Paragraph 2. of Section IV - Commercial General Liability Conditions - Duties in The Event of Occurrence, Offense, Claim or Suit: You must give us or our authorized representative notice of an “occurrence”, offense, claim, or “suit” only when the “occurrence”, offense, claim or “suit’ is known to: (1) You, if you are an individual; (2) A partner, if you are a partnership; (3) An executive officer or the employee designated by you to give such notice, if you are a corporation; or (4) A manager, if you are a limited liability company. 11. EXPANDED BODILY INJURY Section V - Definitions, the definition of “bodily injury” is changed to read: “Bodily injury” means bodily injury, sickness or disease sustained by a person, including death, humiliation, shock, mental anguish or mental injury by that person at any time which results as a consequence of the bodily injury, sickness or disease. 12. EXPECTED OR INTENDED INJURY Exclusion a. of Section I - Coverage A - Bodily Injury and Property Damage Liability is replaced by the following: a. “Bodily injury” or “property damage” expected or intended from the standpoint of the insured. This exclusion does not apply to “bodily injury” or “property damage” resulting from the use of reasonable force to protect persons or property. This endorsement changes the policy to which it is attached and, unless otherwise stated, is effective on the date issued at 12:01 A.M. standard time at your mailing address shown in the policy. The information below is required only when this endorsement is issued subsequent to commencement of the policy. Endorsement Effective Policy No. Insured Endorsement No. Countersigned By Includes copyrighted material of Insurance Services Office, Inc., with its permission ANIC GL 1187 07 16 Page 6 of 6 13. BLANKET WAIVER OF SUBROGATION The Transfer Of Rights Of Recovery Against Others To Us Condition (Section IV - Commercial General Liability Conditions) is amended by the addition of the following: We waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of: 1. Your ongoing operations; or 2. “Your work” included in the “products- completed operations hazard.” However, this waiver applies only when you have agreed in writing to waive such rights of recovery in a contract or agreement, and only if the contract or agreement: 1. Is in effect or becomes effective during the term of this policy; and 2. Was executed prior to loss. 14. IN REM ACTIONS Any action in rem against any vessel owned, operated by or for, or chartered by or for you will be treated in the same manner as though the action were in personam against you. AFP-META2-03-PRINT001-0624-0095-Y 25-CC-089947-0 POLICY NUMBER: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Project(s): Information required to complete this Schedule, if not shown above, will be shown in the Declarations. COMMERCIAL GENERAL LIABILITY CG 25 03 05 09 A.For all sums which the insured becomes legally obligated to pay as damages caused by occurrences under Section I Coverage A, and for all medical expenses caused by acci- dents under Section I Coverage C,which can be attributed only to ongoing operations at a sin- gle designated construction project shown in the Schedule above: 1.A separate Designated Construction Project General Aggregate Limit applies to each designated construction project, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 2.The Designated Construction Project Gen- eral 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 regardless 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 Designated Construction Project General Aggregate Limit for that designated construction project. Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they reduce any other Designated Construction Project General Aggregate Limit for any other designated construction project shown in the Schedule above. 4.The limits shown in the Declarations for Each Occurrence, Damage To Premises Rented To You and Medical Expense con- tinue to apply. However, instead of being subject to the General Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Designated Con- struction Project 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 and for all medical expenses caused by acci- dents under Section I Coverage C,which cannot be attributed only to ongoing operations at a single designated construction project shown in the Schedule above: 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 CG 25 03 05 09 Page 1 of 2 EP Insurance Services Office, Inc., 2008 **** REPRINTEDFROM THE ARCHIVE. THE ORIGINAL TRANSACTIONMAY INCLUDE ADDITIONAL FORMS **** AFP-META2-03-PRINT001-0624-0096-Y 2.Such payments shall not reduce any Desig- nated Construction Project General Aggre- gate Limit. C.When coverage for liability arising out of the products-completed operations hazard is pro- vided, any payments for damages because of bodily injury or propery 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 Designated Construction Project General Aggregate Limit. D.If the applicable designated construction project has been abandoned, delayed, or abandonedand then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same construction project. E.The provisions of Section III Limits of Insur- ance not otherwise modified by this endorsement shall continue to apply as stipulated. Page 2 of 2 **** REPRINTEDFROM THE ARCHIVE. THE ORIGINAL TRANSACTIONMAY INCLUDE ADDITIONAL FORMS **** ANIC CA 1150 10 13 Page 1 of 4 BUSINESS AUTO COVERAGE ENHANCEMENT ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM Various provisions in this endorsement 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 company providing this insurance. Other words and phrases that appear in quotation marks have special meaning. Refer to SECTION V – DEFINITIONS in the Business Auto Coverage Form. The coverages provided by this endorsement apply per “accident” and, unless otherwise specified, are subject to all of the terms, conditions, exclusions and deductible provisions of the policy, to which it is attached. SECTION II – COVERED AUTO LIABILITY COVERAGE, Paragraph A.1. Who Is An Insured is amended to include: d. Any “employee” of yours while operating an “auto” hired or rented under a contract or agreement in an “employee’s” name, with your permission, while performing duties related to the conduct of your business. e. Any person or organization for whom you have agreed in writing to provide insurance such as is afforded by this Coverage Form, but only with respect to liability arising out of the ownership, maintenance or use of “autos" covered by this policy. If such person or organization has other insurance then this insurance is primary to and we will not seek contribution from the other insurance. SECTION IV – Business Auto Conditions, Paragraph A. 5. – Transfer of Rights of Recovery Against Others To Us is amended to include: 5. Transfer of Rights of Recovery Against Others to Us This condition does not apply to any person(s) or organization(s) to the extent that subrogation against that person or organization is waived prior to the “accident” or the “loss” under a contract with that person or organization. SECTION II – COVERED AUTO LIABILITY COVERAGE, Paragraph A.2.a. (2) – Supplementary Payments is replaced by the following: (2) Up to $10,000 for cost of bail bonds (including bonds for related traffic law violations) required because of an “accident” we cover. We do not have to furnish these bonds. SECTION II – COVERED AUTO LIABILITY COVERAGE, Paragraph A.2.a. (4) – Supplementary Payments is replaced by the following: (4) All reasonable expenses incurred by the “insured” at our request, including actual loss of earnings up to $500 a day because of time off from work. ANIC CA 1150 10 13 Page 2 of 4 SECTION II – COVERED AUTO LIABILITY COVERAGE, Paragraph A.2.c. – Voluntary Property Damage is added as follows: c. Voluntary Property Damage At your written request, we may make a voluntary payment for Property Damage caused by an “insured”, but without liability to a third party, up to $25,000. We will not make a Voluntary Property Damage payment to anyone who is an “insured” under this policy. SECTION III – PHYSICAL DAMAGE COVERAGE, Paragraph A.2. – Towing is replaced by the following: Towing We will pay up to $500 for towing and labor costs incurred each time a covered “auto” that is a: a. Private passenger; b. Truck; c. Pick-up truck; d. Panel ; or e. Van type vehicle under 20,000 lbs. of Gross Vehicle Weight is disabled. However, the labor must be performed at place of disablement. SECTION III – PHYSICAL DAMAGE COVERAGE, Paragraph A.3. – Glass Breakage – Hitting a Bird or Animal – Falling Objects or Missiles is replaced by the following: Glass Breakage – Hitting a Bird or Animal – Falling Objects or Missiles If you carry Comprehensive Coverage for the damaged covered “auto”, we will pay the following under Comprehensive Coverage: a. Glass Breakage; b. “Loss” caused by hitting a bird or animal; and c. “Loss” caused by falling objects or missiles. However, you have the option of having glass breakage caused by a covered “auto’s” collision or overturn considered a “loss” under Collision Coverage. Glass Repair – Waiver of Deductible No deductible applies to glass breakage, if the glass is repaired rather than replaced. SECTION III – PHYSICAL DAMAGE COVERAGE, Paragraph A.4.a. – Transportation Expenses is replaced by the following: a. Transportation Expenses We will pay up to $200 per day to a maximum of $1,500 for temporary transportation expense incurred by you because of the total theft of a covered “auto” that is a: (1) Private passenger; (2) Truck; (3) Pick-up truck; (4) Panel; or (5) Van type vehicle under 20,000 lbs. of Gross Vehicle Weight. We will pay only for those covered “autos” for which you carry either Comprehensive or Specified Causes of Loss Coverage. We will pay for temporary transportation expenses incurred during the period beginning 48 hours after the theft and ending, regardless of the policy’s expiration, when the covered “auto” is returned to use or we pay for its “loss”. ANIC CA 1150 10 13 Page 3 of 4 SECTION III – PHYSICAL DAMAGE COVERAGE, Paragraph A.4.b. – Loss of Use Expenses is replaced by the following: b. Loss of Use Expenses – Hired, Rented, or Borrowed Automobiles We will pay expenses for which an “insured” becomes legally responsible to pay for loss of use of a vehicle hired, rented or borrowed without a driver under a written rental contract or agreement. We will pay for loss of use expenses, if caused by: (1) Other than Collision, only if the Declarations indicate that Comprehensive Coverage is provided for the vehicle withdrawn from service. (2) Specified Causes of Loss only if the Declarations indicate that Specified Causes of Loss Coverage is provided for the vehicle withdrawn from service. (3) Collision only if the Declarations indicate that Collision Coverage is provided for the vehicle withdrawn from service. However, the most we will pay for any expenses for loss of use is $200 per day, to a maximum of $1,500. SECTION III – PHYSICAL DAMAGE COVERAGE, Paragraph A.4.c. – Non-Transportation Loss of Use Expenses is added as follows: c. Non-Transportation Loss of Use Expenses We will pay up to $2,000 for non- transportation expense incurred by you, because of “loss” to a covered “auto”, if caused by: (1) Other than Collision, only if the Declarations indicate that Comprehensive Coverage is provided for the “auto” withdrawn from service; (2) Specified Causes of Loss only if the Declarations indicate that Specified Causes of Loss Coverage is provided for the “auto” withdrawn from service; or (3) Collision only if the Declarations indicate that Collision Coverage is provided for the “auto” withdrawn from service. SECTION III – PHYSICAL DAMAGE COVERAGE, Paragraph A.4.d. – Airbag Coverage is added as follows: d. Airbag Coverage We will pay for the cost to repair, replace, or reset an airbag that inflates for any reason other than as a result of a collision, if the Declarations indicate that the covered “auto” has Comprehensive Coverage or Specified Causes of Loss Coverage. SECTION III – PHYSICAL DAMAGE COVERAGE, Paragraph A.4.e. – Rental Reimbursement Coverage is added as follows: e. Rental Reimbursement Coverage We will pay up to $75 per day for rental reimbursement expenses incurred by you for the rental of an “auto” because of “loss” to a covered “auto” that is a: (1) Private Passenger; (2) Truck; (3) Pick-up truck; (4) Panel; or (5) Van type vehicle under 20,000 lbs. of Gross Vehicle Weight. Payment applies in addition to the otherwise applicable amount of each coverage you have on a covered “auto”. No deductibles apply to this coverage. This endorsement changes the policy to which it is attached and, unless otherwise stated, is effective on the date issued at 12:01 A.M. standard time at your mailing address shown in the policy. The information below is required only when this endorsement is issued subsequent to commencement of the policy. Endorsement Effective Policy No. Insured Endorsement No. Countersigned By © Insurance Services Office, Inc., 2009 ANIC CA 1150 10 13 Page 4 of 4 (1) We will pay only for those expenses incurred during the policy period beginning 24 hours after the “loss” and ending, regardless of the policy’s expiration, with the lesser of the following number of days: (a) The number of days reasonably required to repair or replace the covered “auto”. (b) 30 days. (2) This coverage does not apply while there are spare or reserve “autos” available to you for your operations. (3) The Rental Reimbursement Coverage described above does not apply to a covered “auto” that is described or designated as a covered “auto” on Rental Reimbursement Coverage Form CA 99 23. SECTION IV – BUSINESS AUTO CONDITIONS – Paragraph B.2. – Concealment, Misrepresentation Or Fraud is amended by adding Unintentional Failure to Disclose Hazards at the end of Paragraph B.2. as follows: Unintentional Failure to Disclose Hazards If you unintentionally fail to disclose any hazards existing at the inception date of your policy, we will not deny coverage under this Coverage Form because of such failure. However, this provision does not affect our right to collect additional premium or exercise our right of cancellation or non-renewal. SECTION IV – BUSINESS AUTO CONDITIONS – Paragraph B.5.b. – Other Insurance is replaced by the following: b. For Hired Auto Physical Damage Coverage, the following are deemed to be covered “autos” you own: (1) Any covered “auto” you lease, hire, rent, or borrow; and (2) Any covered “auto”” hired or rented by your “employee” under a contract in that individual “employee’s” name, with your permission, while performing duties related to the conduct of your business. However, any “auto” that is leased, hired, rented or borrowed with a driver is not a covered “auto”. SECTION V – DEFINITIONS – Paragraph C. – “Bodily injury” is replaced by the following: C. “Bodily injury” means bodily injury, sickness or disease sustained by a person including death or mental anguish resulting from any of these. Mental anguish means any type of mental or emotional illness or disease