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HomeMy WebLinkAbout6012 - SCJ AllianceSCJALLI-01 M DATE (MMIDDIYYYY) 1 ACOROry CERTIFICATE OF LIABILITY INSURANCE 611W2023 Iikl�RTIFICATE HOLDERs THIS NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON SSUINGENSURER(S), AUTHORIZED CERTIFICATE DOES NOT AFFIRMATIVELY OR BELOW. THIS CERTRI IC)kTE OF U ER!AND HE CERTIFICATNCE DOES E HOLDERTUTE A CONTRACT BETWEEN ONAL INSURED provisions or be endorsed. REPRESENTATIVE O IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the polthe p (ies, certain must have ci SUBROGATION IS WAIVED, subject to the terms ho de conditions nlieu of sucheendorsement(s) policies may require an endorsement. A statement on If SU co CT Melanie Kelly this certificate does not confer rights to the certificate NAME: PRODUCER License # OC36661 RECEIVED PHONE AIC, No): (AIC, No, Ext on Seattle-Alliant Insurance Services, Inc. E-MAIL . IVjelanje.Kelly@alliant.c0tn 1420 Fifth Ave 15th Floor OD ES NAIC# Seattle, WA 98101 J U N 2 0 2023 INSURERS AFFORDING COVERAGE of America 25674 INSURER A Travelers Property Casualty Company pf sremertc�l� wsuRERe :Travelers Casualty Insurance Company of Amer(c 19046 City 19070 INSURED INSURERC:Standard Fire Insurance COM an 20443 Shea, Carr & Jewell, Inc. dba: SCJ AllianceA�tlEge1nBnt INSURERD:Continental Casual Corn an 8730 Tallon Lane NE, Suite 200 ►NSURERE: Lacey, WA 98516 OVERAGE CERTIFICATE NUMBER:SPECT NT TERM OR CONDITION OF ANY CONTRACT ODESCRIBED HEREIN IS SUB ECT TO ALLO HEITERMS, R OTHER DOCUMENT WITH RE THI S IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERT INDICATED, NOTWITHSTANDING ANY REQUIRE CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE IN MAY AFFORDED BY THE ECYOFFCI PO DDY EXP LIMITS EXCLUSIONS AND CONDITIONS OF SUCH AOpL su D LIMITS SHOWN Y NUMBERVE BEEN REDUoD D BY PAID CLAIMS. SR TYPE OF INSURANCE I EACH OCCURoRc�lrcnENCE _ 1.000,1 A X COMMERCIAL GENERAL LIABILITY 68O-3S2$$42A 611512023 611512024 CLAIMS -MADE ❑X OCCUR X X GEN'L AGGREGATE LIMIT APPLIES PER: POLICY JECT LOC OTHER: B AUTOMOBILE LIABILITY X X BA-3S293103 6/15/2023 6/15/2024 X ANY AUTO SCHEDULED OWNED AUTOS AUTOS ONLY NIRED NON -OWNED AUTOS ONLY AUTOS ONLY A X UMBRELLA LIAB X OCCUR CUP-3S296295 6/15/2023 6115/2024 EXCESS LIAB CLAIMS -MADE DED RETENTION $ WORKERS COMPENSATION 611512023 6115/2024 AND EMPLOYERS' LIABILITY Y 1 N ANY PROPRIETORIPARTNERIEXECUTIVE N I A (Mandatory in NH) EXCLUDED? 591920345 p IProflPollution Liab t.L. UIJCra�' 611512023 611512024 Each Claim 6115/2023 6/1512024 Aggregate 'RIPTION OF OPERATIONS /LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Project 00-070204 Kltsap Way &Warren Ave of Bremerton and Washington State Department of Transportation are Additional Insured per forms attache . City of Bremerton 345 6th St #100 Bremerton, WA 98337-0000 1 1,000,0 5,000,uuu 5,000,000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ACCORDA NE WI in THE POL CY PROVISNONSCE WILL BE DELIVERED IN AUTHORIZED REPRESENTATIVE © 1988-2015 ACORD CORPORATION. All rights reserved ACORD 25 (2016103) The ACORD name and logo are registered marks of ACOR COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. EXTENSION ENDORSEMENT BUSINESS AUTO This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM coverage for an be excluded or L DESCRIPTION OF COVERAGE —This endorsement rvisionseof this endorsement may be onot apply to verages Howeverp GENERA expenses described in any provisions d injury, damage or medical exp e part, and these coverage broadening p generalis a cover,* limited by another endorsement to the Coverage such an endorsement. The following listing rov sions of this en - the extent that coverage is excluded or limited by I to these coverages. Read all the p age description only. Limitations and exclusions may apply and PHYSICAL DAMAGE — LOSS OF ent and the rest of your policy carefully to determine rights, dutiesAUTO pH t Is and is not covered. dorsem H. HIRED A. BROAD FORM NAMED INSURED USE — INCREASED LIMIT TRANSPORTATION B. BLANKET ADDITIONAL INSURED 1, PHYSICAL DAMAGE C. EMPLOYEE HIRED AUTO EXPENSES — INCREASED LIMIT i. PERSONAL PROPERTY D. EMPLOYEES AS INSURED Ke AIRBAGS E, SUPPLEMENTARY PAYMENTS — INCREASED Le NOTICE AND KNOWLEDGE OF ACCIDENT OR LIMITSLOSS F. HIRED AUTO — LIMITED WORLDWIDE COV- M BLANKET WAIVER OF SUBROGATION ERAGE — INDEMNITY BASIS G. WAI VER OF DEDUCTIBLE — GLASS N. UNINTENTIONAL ERRORS OR OMISSION nsurance applies and only to the extent that PROVISIONS this i A. BROAD FORM NAMED INSURED person or organization qualifies as an "insured" following is added to Paragraph A.1., Who Is under the Who Is An Insured provision contained The in Section II. An Insured, of SECTION II —COVERED AUTOS C EMPLOYEE HIRED AUTO LIABILITY COVERAGE: is added to Paragraph A.1., Any organization you newly acquire or form dur- 1 The following in the policy period over which you maintain Who Is An Insured, of SECTION II — COV- g interest and that is not ERED AUTOS LIABILITY COVERAGE: 50% or more ownership An "employee" of yours is an "insured" while separately insured for Business Auto Coverages operating a "auto" hired or rented under a Coverage under this provision is afforded only un- til the 180th day after you acquire or form the or,,, contract or agreement in an , employee's" ganization or the end of the policy period, which- name, with your permission, while pour busg ever is earlier. duties related to the conduct of y Hess. Be BLANKET ADDITIONAL INSURED laces Paragraph b. in B.5., Paragraph c. in A.1.1 2. The following rep The following is added to SECTION ICOVERED Other Insurance, of SECTION IV — BUSI- Who Is An Insured, NESS AUTO CONDITIONS: Cover - AUTOS LIABILITY COVERAGE: b. For Hired Auto Physical Damagedeemed to be cov- Any person or organization who is required under age, the following are ou and ered "autos" you own: a written contract or agreement between y (1) Any covered "auto" you lease, hire, that person or organization, that is signed It and o rent or borrow; and executed by you before the "bodily injury "property damage" occurs and that is in effect �2� Any y covered auto hired or rented b during the policy period, to be named as an ad& your "employee" under a contract in tional insured is an "insured" for Covered Autos to which an "employee's" name, with your Liability Coverage, but only for damages Page 1 of 4 CA T3 53 02 15 © 2015 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL AUTO permission, while performing duties related to the conduct of your busi- ness. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto", D• EMPLOYEES AS INSURED The following is added to Paragraph A.1., Who Is An Insured, of SECTION II — COVERED AUTOS LIABILITY COVERAGE: Any "employee" of yours is an "insured" while us- ing a covered "auto" you don't own, hire or borrow in your business or your personal affairs. E. SUPPLEMENTARY LIMITS PAYMENTS —INCREASED 7. The following replaces Paragraph A,2,a,(2), Of SECTION II — COVERED AUTOS LIABIL- ITY COVERAGE: (2) Up to $3,000 for cost of bail bonds (in- cluding bonds for related traffic law viola- tions) required because of an we "accident" cover. We do not have to furnish these bonds. 2. The following replaces Paragraph A.2.a.(4)1 Of SECTION II — COVERED AUTOS LIABIL- ITY COVERAGE: (4) All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $500 a day be- cause of time off from work. F• HIRED AUTO — LIMITED WORLDWIDE COV- ERAGE — INDEMNITY BASIS The following replaces Subparagraph (5) in Para- graph 8.7., Policy Period, Coverage Territory, Of SECTION IV — BUSINESS AUTO C TIONS: ONDI- (5) Anywhere in the world, except any country or jurisdiction while any trade sanction, em- bargo, or similar regulation imposed by the United States of America applies to and pro- hibits the transaction of business with or within such country or jurisdiction, for Cov- ered Autos Liability Coverage for any covered "auto" that you lease, hire, rent or borrow without a driver for a period of 30 days or less and that is not an "auto" you lease, hire, rent or borrow from any of your "employees", partners (if you are a partnership), members (if you are a limited liability company) or members of their households. Page 2 of 4 (a) With respect to any claim made or "suit" brought outside the United States of America, the territories and possessions of the United States of America, Puerto Rico and Canada: (i) You must arrange to defend the "in- sured" against, and investigate or set- tle any such claim or "suit" and keep us advised of all proceedings and ac- tions. (ii) Neither you nor any other involved insured" will make any settlement without our consent. We may, at our discretion, participate in defending the "insured" against, or in the settlement of, any claim or "suit". (iv) We will reimburse the "insured" for sums that the "insured" legally must Pay as damages because of "bodily injury" or "property damage" to which this insurance applies, that the "in- sured" pays with our consent, but only up to the limit described in Para- graph C., Limits Of Insurance, of SECTION II — COVERED AUTOS LIABILITY COVERAGE. (v) We will reimburse the "insured" for the reasonable expenses incurred with our consent for your investiga- tion of such claims and your defense of the "insured" against any such "suit", but only up to and included within the limit described in Para- graph C., Limits Of Insurance, of SECTION II — COVERED AUTOS LIABILITY COVERAGE, and not in addition to such limit. Our duty to make such payments ends when we have used up the applicable limit of insurance in payments for damages, settlements or defense expenses. (b) This insurance is excess over any valid and collectible other insurance available to the "insured" whether primary, excess, contingent or on any other basis. (c) This insurance is not a substitute for re- quired or compulsory insurance in any country outside the United States, its ter- ritories and possessions, Puerto Rico and Canada. © 2015 The Travelers Indemnity Company, All rights reserved. Includes copyrighted material of Insurance Services Office, Inc, with its permission. CA T3 53 02 15 COMMERCIAL AUTO (2) In or on your covered "auto' all required or only in the event of a total You agree to maintain such coun- This coverage applies ulsory insurance in any by theft of your covered "auto", comp limits requiredto this Personal property try up to the minimum comply with No deductibles apply local law. Your failure tOuirements will coverage compulsory insurance requirements afforded by 3„ Exclu- coverag AIRBAGS Be not invalidate t the we will only be liable to the K. is added to Paragraph this policy, ile sions, of SECTION 111 — PHYSICAL DAMAGE extent we would have been liable The following same lied with the compulsory COVERAGE• had you comp does not apply to "loss" to one or surance requirements. Exclusion 3•a. you own at in,o "loss" more airbags in a covered "auto" outside the {late due to a cause other than a cause of '. but (d) It is understood that insurer not an admit- aragraphs A•1,b. and A• ted or authorized erica, its territories Set forth in P United States of Am Can- only: ossess4 0, Puerto Rico and covered "auto" for Compre- and p ons0bility for the a If that auto is a olic ada. We assume no resp hensive Coverage under this p y' war - furnishing of certificates withrthe laws Hance in any b, The airbags are not covered under any for comp • to in Of other countries relating ranty; and DEDUCTIBLE —GLASS c The airbags were not intentionally inflated. G. WAIVER OF Deduct" u to a maximNing um of $1,000 for any is added to Paragraph D., e will pay p The follo SECTION III —PHYSICAL DAMAGE W one "loss". ble, of 1 to L. NOTICE AND KNOWLEDGE OF ACCIDENT O COVERAGE "auto will apply r acovered LOSS rah A.2.a., of No deductible if the glass is repaired rather than The following is added to Paragraph glass damage BUSINESS AUTO resenta- replaced. LOSS OF SECTION IV — ED AUTO PHYSICAL DAMAGE — Your duty to give us or our atoll "accident ore" loss" ap- H HiR five prompt notice of the „loss" is known USE— INCREASED LIMIT lies only when the "accident' or The following replaces the last sentence °of SEC- p Loss Of Use Expenses, to: graph A•4•b•• GE COVERAGE (a) You (if you are an individual); TION Ill — PHYSICAL DAMAGE expenses you are a partnership); a for any p b A partner (if Y limited liability com- However, the most we will Pay ay to a maximum of (c) A member (if you are a for loss of use e „accident . pany); director or insurance $750 for any _ TRANSPORTATION (d) An executive officer, DAMAGE ('rf you are a corporation or other or- I. PHYSICAL manager EXPENSES — INCREASED LIMIT ganization); or give no- te laces the first sentence in Para,* you to g The following p Expenses, (e) Any "employee" authorized by graph A•4•a•• Transportation COVER- . _PHYSICAL DAMAGE tice of the "accident" or "loss". OF SUBROGATION SECTION III ra h A•5„ Transfer AGE: to a maximum of M• BLANKET WAIVER 50 per day maxim in- The following replaces Parag p We will pay up tO $ p ortation expenseRights Of Recovery Against Others CONDI- orary transp Of Rig _ BUSINESS AUTO $1,500 for temp of SECTION IV curred by you because eof the get typeof a cov- Against " of the private p TIONS : Of Recovery eyed "auto of Rights OPERTY 5, Transfer j, PERSONAL PR A.4„ Cover- Others To Us we may have The following is added to ParagraphPHYSICAL We waive any right of recovery of SECTION I11 — person or organization to the ex - age Extensions, against any p you by a written contract COVERAGE tent required of y riot to any "accident" DAMAGE signed and executed p personal Property to wearing ap- provided that the "accident' la ed Sby to $400 for "loss or "loss", p of operations contemp We will pay up personal property which is: arises out parel and other p "insured"; and Page 3 of 4 COM N4 ERCIAL AUTO such contract. The waiver applies onl person organization y to the The unintentional contract. designated in such error in, an °mission of, or unintentional u n/ / /V TENTIONAL ERRORS O y information given b N' following is added top R OMISSIONS prejudice your rights under Y YOU shall not T r' e aragraph B,2 ever this provision this insurance. How- � om / ment, Misrepresentation COn' lect does not affect our right SECTION IV — BUSINESS , Or Fraud, of additional ght to col - AUTO CONDITIONS: cancellation or premium or exercise our right of non -renewal Page 4 of 4 ©2015 The Travelers Indemnit Includes copyrighted material of Insurance ervices Office, Inc. pa ny, qll rights reserved . with its permission. CA T3 53 02 IS COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY WITH OTHER INSURANCE This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM PROVISIONS 1. The following is added to Paragraph A.1.c., Who is An Insured, of SECTION II — COVERED AUTOS LIABILITY COVERAGE: This includes any person or organization who you are required under written on tract 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". 2. The following is added to Paragraph B.5., Other Insurance of SECTION IV — BUSINESS AUTO CONDITIONS: Regardless of the provisions of paragraph a. and paragraph d. of this part 5. Other Insurance, this insurance is primary to and non-contributory with applicable other insurance under which an additional insured person or organization is the first named insured when the 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, requires this insurance to be primary and non-contributory. CA T4 74 02 16 ©2016 The Travelers Indemnity Company. All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, XTEND ENDORSEMENT FOR ARCHITECTS ENGINEERS AND SURVEYORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE — This endorsement broadens coverage. However, 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 provisons do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a i 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 B. Who Is An Insured — Unnamed Subsidiaries C. 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 —Newly Acquired Or Formed Limited Liability Companies F. Blanket Additional Insured — Controlling Interest G. Blanket Additional Insured — Mortgagees, Assignees, Successors Or Receivers PROVISIONS A. NON -OWNED WATERCRAFT — 75 FEET LONG OR LESS 1. The following replaces Paragraph (2) of Exclusion g., Aircraft, Auto Or Watercraft, in Paragraph 2. of SECTION COVERAGES — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE LIABILITY: (2) A watercraft you do not own that is: (a) 75 feet long or less; and (b) Not being used to carry any person or property for a charge; 2. The following replaces Paragraph 2.e. of SECTION II — WHO IS AN INSURED: e. Any person or organization that, with H. Blanket Additional Insured — Governmental Entities — Permits Or Authorizations Relating To Premises I. 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 M. Blanket Waiver Of Subrogation — When Required By Written Contract Or Agreement N. Contractual Liability —Railroads uses or is responsible for the use of a watercraft that you do not own that is: (1) 75 feet long or less; and (2) Not being used to carry any person or property for a charge; B. WHO IS AN INSURED — UNNAMED SUBSIDIARIES The following is added to SECTION II WHO IS AN INSURED: Any of your subsidiaries, other than a partnership or joint venture, that is not shown as a Named Insured in the Declarations is a Named Insured a. You are the sole owner of, or maintain an ownership interest of more than 50% in, such subsidiary on the first day of the policy period; and CG D3 79 02 19 ©2017 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. Page 1 of 6 COMMERCIAL 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. Before you maintained an ownership 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. For purposes of Paragraph 1. of Section II — 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. C. WHO IS AN INSURED — RETIRED PARTNERS, MEMBERS, DIRECTORS AND EMPLOYEES The following is added to Paragraph 2. of SECTION II — 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 partnership 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 someone 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 services, 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 "em„ ployees 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) "Personal 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; (b) To the spouse, child, parent, brother or sister of that current or retired partner, member, director, "employee" or It volunteer worker" as a consequence of Paragraph (2)(a) above; (c) For which there is any obligation to share damages with or repay someone else who must pay damages because of the injury described in 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) Owned, occupied or used by; or (b) Rented to, in the care, custody or control of, or over which physical control is being exercised for any purpose by; you, any of your 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 ©2017 The Travelers Indemnity Company. All rights reserved. CG D3 79 02 19 Includes copyrighted material of Insurance Services Office, Inc. with 4ts permission. COMMERCIAL GENERAL LIABILITY D. WHO IS AN INSURED — EMPLOYEES AND VOLUNTEER WORKERS — BODILY INJURY TO CO -EMPLOYEES, CO -VOLUNTEER WORKERS AND RETIRED PARTNERS, MEMBERS, DIRECTORS AND EMPLOYEES The following is added to Paragraph 2.a.(1) of SECTION If — WHO IS AN INSURED: Paragraphs (1)(a), to) and (c) 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 injury" or "property damage" that occurred before you acquired or formed the organization; and c. Coverage B does not apply to "personal and advertising injury" arising out of an offense committed before you acquired or formed the organization. For the purposes of Paragraph 1. of Section II — Who Is An Insured, each such organization 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. F. BLANKET ADDITIONAL INSURED CONTROLLING INTEREST 1. The following is added to SECTION II — 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 b. Such person's or organization'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 following is added to Paragraph 4. of SECTIO N II — WHO IS 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 committed, 9 02 19 ©2017 The Travelers Indemnity Page 3 of 6 COMMERCIAL GENERAL LIABILITY 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. b. 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 —PERMITS OR AUTHORIZATIONS RELATING TO PREMISES The following is added to SECTION II — WHO IS AN INSURED: Any governmental entity that has issued a permit or authorization with 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. I. BLANKET ADDITIONAL INSURED — GOVERNMENTAL ENTITIES — PERMITS OR AUTHORIZATIONS RELATING TO OPERATIONS The following is added to SECTION II — WHO IS AN INSURED: Any governmental 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 "bodil" y injury, "property damage" or "personal and advertising injury" arising out of operations performed for the governmental entity; or b. Any "bodily injury" or "property damage" included in the "products -completed operations hazard". J. INCIDENTAL MEDICAL MALPRACTICE 1. The following replaces Paragraph be 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 "Good 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 2.a.(1) of SECTION II — 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 assistant, emergency medical technician, paramedic, athletic trainer, audiologist, dietician, nutritionist, Page 4 Of 6 ©2017 The Travelers Indemnity Company. All rights reserved. CG D3 79 02 19 Includes copyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL GENERAL LIABILITY 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 will 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 5. 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 or 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. 6. 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" for "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.(1) of Section II — Who Is An Insured. K. MEDICAL PAYMENTS — INCREASED LIMIT The following replaces Paragraph 7. of SECTION III — LIMITS OF INSURANCE: 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, 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 The following is added to Paragraph 4.b., Excess Insurance, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: This insurance is excess over any of the other insurance, whether primary, excess, contingent or on any other basis, that is Professional Liability or similar coverage, to the extent the loss 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 8., 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 insured's right of recovery against any person or organization, we waive our right of recovery against such person or organization, but only for payments we make because of: "Bodily injury" or "property damage" that a. occurs; or b. "Personal and advertising injury" caused by an offense that is committed; subsequent to the signing of that contract or agreement. 3 79 02 19 ©2017 The Travelers Indemnity CG DCompany. All rights reserved. Page 5 of 6 Includes copyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL GENERAL LIABILITY N. CONTRACTUAL LIABILITY — RAILROADS 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.(1) of the definition of "insured contract" in the DEFINITIONS Section is deleted. Page 6 of 6 ©2017 The Travelers Indemnity Company. All rights reserved. CG D3 79 02 19 Includes copyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY., PLEASE READ IT CAREFULLY, BLANKET ADDITIONAL INSURED (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. The following is added to SECTION II —WHO IS AN INSURED: Any person or organization that you agree in a "written contract requiring insurance" to include as an additional insured on this Coverage Part, but: a. Only with respect to liability for "bodily injury", "property damage" or "personal injury"; and b. If, and only to the extent that, the injury or damage is caused by acts or omissions of you or your subcontractor in the performance of "your work" to which the "written contract requiring insurance" applies, or in connection with premises owned by or rented to you. The person or organization does not qualify as an additional insured: c. With respect to the independent acts or of of such person or organization; or d. For "bodily injury", "property damage" or "personal injury" for which such person or organization has assumed liability in a contract or agreement. The insurance provided to such additional insured is limited as follows: e. This insurance does not apply on any basis to any person or organization for which coverage as an additional insured specifically is added by another endorsement to this Coverage Part. f. This insurance does not apply to the rendering of or failure to render any "professional services". g. In the event that the Limits of Insurance of the Coverage Part shown in the Declarations exceed the limits of liability required by the "written contract requiring insurance", the insurance provided to the additional insured shall be limited to the limits of liability required by that "written contract requiring insurance". This endorsement does not increase the limits of insurance described in Section III — Limits Of Insurance. h. This insurance does not apply to "bodily injury" or "property damage" caused by "your work" and included in the "products. completed operations hazard" unless the "written contract requiring insurance" specifically requires you to provide such coverage for that additional insured, and then the insurance provided to the additional insured applies only to such "bodily injury" or "property damage" that occurs before the end of the period of time for which the "written contract requiring insurance" requires you to provide such coverage or the end of the policy period, whichever is earlier. 2. The following is added to Paragraph 4.a. of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: The insurance provided to the additional insured is excess over any valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the additional insured for a loss we cover. However, if you specifically agree in the "written contract requiring insurance" that this insurance provided to the additional 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 available to the additional insured which covers that person or organizations as a named insured for such loss, and we will not share with the other insurance, provided that: (1) The "bodily injury" or "property damage" for which coverage is sought occurs; and (2) The "personal injury" for which coverage is sought arises out of an offense committed; after you have signed that "written contract requiring insurance". But this insurance provided to the additional insured still is excess over valid anI collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the additional insured when that person or organization is an additional insured under any other insurance. CG 381 0915 ©2015 The Travelers Indemnity Company. All rights reserved. Page 1 Of 2 Includes the copyrighted material of Insurance Services Office, Inc., with its permission COMMERCIAL GENERAL LIABILITY 3. The following is added to Paragraph 8., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: We waive any right of recovery we may have against any person or organization because of payments we make for "bodily injury", "property damage" or "personal injury" arising out of "your work" performed by you, or on your behalf, done under a "written contract requiring insurance" with that person or organization. We waive this right only where you have agreed to do so as part of the "written contract requiring insurance" with such person or organization signed by you before, and in effect when, the "bodily injury" or "property damage" occurs, or the "personal injury" offense is committed. 4. The following definition is added to the DEFINITIONS Section: "Written contract requiring insurance" means that part of any written contract under which you are required to include a person or organization as an additional insured on this Coverage Part, provided that the "bodily injury" and "property damage" occurs and the "personal injury" is used by an offense committed. a. After you have signed that written contract; b. While that part of the written contract is in effect; and c. Before the end of the policy period. Page 2 of 2 ©2015 The Travelers Indemnity Company. All rights reserved. CG D3 81 09 15 Includes the copyrighted material of Insurance Services Office, Inc., with its permission POLICY NUMBER: 68o-3S28842A.23.47 COMMERCIAL GENERAL LIABILITY ISSUE DATE:04/21/2023 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY, TOTAL AGGREGATE LIMIT OTHER THAN PROJECTS AND DESIGNATED PROJECT AND LOCATION AGGREGATE LIMITS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE —LIMITS OF INSURANCE AND DESIGNATED PROJECTS AND LOCATIONS LIMITS OF INSURANCE Total Aggregate Limit $ lo, 000, 000 (Other Than Projects and Products -Completed Operations) Designated Location Aggregate Limit $ 4,000,000 (Other Than Products -Completed Operations) Designated Project Aggregate Limit $ 4,000,000 (Other Than Products -Completed Operations) General Aggregate Limit $ 4,000,000 (Other Than Products -Completed Operations) Designated Projects: Each "project" for which you have agreed, in a written contract which is in effect during this policy period, to provide a separate General Aggregate Limit, provided that the contract is signed by you before the "bodily injury" or "property damage" occurs. Designated Locations: All locations listed in Item 3. of the Common Policy Declarations or I n any Master Pac Account Exposure Endorsement included in this policy. PROVISIONS 1. The General Aggregate Limit (Other Than Products -Completed Operations) shown in the Declarations is replaced by the Limits of Insurance shown in the Schedule — Limits Of Insurance And Designated Projects And Locations. 1. The Limits of Insurance shown in the Declarations or the Schedule —Limits Of Insurance And Designated Projects And Locations, whichever apply, and the rules below fix the most we will pay regardless of the number of: 2. The following replaces Paragraph 1. of SECTION 111 —LIMITS OF INSURANCE: b. Claims made or "suits" brought; CG D4 69 02 19 © 2017 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. a. Insureds; Page 1 of 3 COMMERCIAL GENERAL LIABILITY c. Persons or organizations making claims or bringing "suits"; or d. "Projects" or "locations". 3. The following replaces Paragraph 2. of SECTION III — LIMITS OF INSURANCE: 2. a. The Total Aggregate Limit shown in the Schedule — Limits Of Insurance And Designated Projects And Locations is the most we will pay for the sum of all amounts under the Designated Location Aggregate Limit and all amounts under the General Aggregate Limit. This includes: (1) Damages under Coverage A, except damages because of "bodily injury" or "property damage" included in the "products -completed operations hazard"; (2) Damages under Coverage B; and (3) Medical expenses under Coverage C. b. The Designated Project Aggregate Limit shown in the Schedule — Limits Of Insurance And Designated Projects And Locations applies and is further subject to all of the following provisions: (1) The Designated Project Aggregate Limit is the most we will pay for the sum of: (a) Damages under Coverage A because of "bodily injury" and "property damage" caused by "occurrences"; and (b) Medical expenses under Coverage C for "bodily injury" caused by accidents; that can be attributed only to operations at a single "project". (2) The Designated Project Aggregate Limit applies separately to each "project". (3) The Designated Project Aggregate Limit does not apply to damages because of "bodily injury" or "property damage" included in the "products - completed operations hazard". Instead, the Products -Completed Operations Aggregate Limit described in Paragraph 3. below applies to such damages. (4) The Designated Project Aggregate Limit does not apply to damages under Coverage B. Instead, the General Aggregate Limit described in Paragraph 2.d. below applies to such damages. (5) Any payments made for damages or medical expenses to which the Designated Project Aggregate Limit applies will reduce the Designated Project Aggregate Limit for the applicable "project". Such payments will not reduce the Total Aggregate Limit, the General Aggregate Limit described in Paragraph 2.d. below, the Designated Project Aggregate Limit for any other "project" or the Designated Location Aggregate Limit. c. Subject to the Total Aggregate Limit described in Paragraph 2.a. above, the Designated Location Aggregate Limit shown in the Schedule — Limits Of Insurance And Designated Projects And Locations applies and is further subject to all of the following provisions: (1) The Designated Location Aggregate Limit is the most we will pay for the sum of: (a) Damages under Coverage A because of "bodily injury" and "property damage" caused by "occurrences"; and (b) Medical expenses under Coverage C for "bodily injury" caused by accidents; that can be attributed only to operations at a single "location". (2) The Designated Location Aggregate Limit applies separately to each "location". (3) The Designated Location Aggregate Limit does not apply to damages because of "bodily injury" or "property damage" included in the "products - completed operations hazard". Instead, the Products -Completed Operations Aggregate Limit described in Paragraph 3. below applies to such damages. (4) The Designated Location Aggregate Limit does not apply to damages under Coverage B. Instead, the General Aggregate Limit described in ©2017 The Travelers Indemnity COMMERCIAL GENERAL LIABILITY Paragraph 2.d. below applies to such General Aggregate Limit applies will damages, reduce: (5) Any payments made for damages or (a) The Total Aggregate Limit; and medical expenses to which the Designated Location Aggregate Limit (b) The General Aggregate Limit, applies will reduce: Such payments will not reduce the (a) The Total Aggregate Limit; and Designated Project Aggregate Limit for any "project" or the Designated (b) The Designated Location Location Aggregate Limit for any Aggregate Limit for the applicable "location". "location". Such payments will not reduce the 4. The following replaces Paragraph 3. of SECTION General Aggregate Limit described in III — LIMITS OF INSURANCE: Paragraph 2.do below, the 3. The Products -Completed Operations Aggre- Designated Project Aggregate Limit gate Limit shown in the Declarations is the or the Designated Location most we will pay under Coverage A for Aggregate Limit for any other damages because of "bodily injury" or "location". "property damage" included in the "products - completed operations hazard". Any payments d. Subject to the Total Aggregate Limit made for such damages will not reduce the described in Paragraph 2.a. above, the Total Aggregate Limit, the General Aggregate General Aggregate Limit shown in the Limit, the Designated Project Aggregate Limit Schedule — Limits Of Insurance And for any "project" or the Designated Location Designated Projects And Locations Aggregate Limit for any "location". applies and is further subject to all of the following provisions: S. The following is added to the DEFINITIONS Section: (1) The General Aggregate Limit is the most we will pay for the sum of: "Location" means any designated location shown in the Schedule — Limits Of Insurance And (a) Damages under Coverage A Designated Projects and Locations that is owned because of "bodily injury" and by or rented to you. For the purposes of "property damage" caused by determining the applicable aggregate limit of "occurrences", and medical insurance, each "location" that includes a expenses under Coverage C for premises involving the same or connecting lots, "bodily injury" caused by or premises whose connection is interrupted only accidents, that cannot be by a street, roadway or waterway, or by a right -of - attributed only to operations at a way of a railroad, will be considered a single single "project" or a single "location". "location"; and "Project" means any designated project shown in (b) Damages under Coverage B. the Schedule — Limits Of Insurance And (2) The General Aggregate Limit does Designated Projects And Locations that is away not apply to damages for "bodily from premises owned by or rented to you and at injury" or "property damage" included which you are performing operations pursuant to in the "products -completed oper- a contract or agreement. For the purposes of ations hazard". Instead, the determining the applicable aggregate limit of Products -Completed Operations insurance, each "project" that includes a premises Aggregate Limit described in involving the same or connecting lots, or Paragraph 3. below applies to such premises whose connection is interrupted only by damages. a street, roadway or waterway, or by a right-of- way of a railroad, will be considered a single (3) Any payments made for damages or "project". medical expenses to which the CG D4 69 02 19 ©2017 The Travelers Indemnity Company. All rights reserved. Page 3 of 3 Includes copyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL GENERAL LIABILITY 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 other insurance does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. d. Primary And Non -Contributory Insurance If Required By Written Contract 7 If 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: (1) 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 signing of that contract or agreement by you. 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 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. Separation 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. 8. Transfer Of Rights Of Recovery Against Others To Us If has rights to recover all or part of any payment weave made under this Coverage Part, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request, the insured will bring "suit" or transfer those rights to us and help us enforce them. the insured 5. Premium Audit 9. When We Do Not Renew a. We will compute all premiums for this Coverage If we decide not to renew this Coverage Part, we will Part in accordance with our rules and rates. mail or deliver to the first Named Insured shown in b. Premium shown in this Coverage Part as the Declarations written notice of the nonrenewal advance premium is a deposit premium only. At not less than 30 days before the expiration date. the close of each audit period we will compute If notice is mailed, proof of mailing will be sufficient the earned premium for that period and send proof of notice. notice to the first Named Insured. The due date SECTION V — DEFINITIONS for audit and retrospective premiums is the date 1. "Advertisement" means a notice that is broadcast or shown as the due date on the bill. If the sum of published to the general public or specific market the advance and audit premiums paid for the segments about your goods, products or services policy period is greater than the earned for the purpose of attracting customers or premium, we will return the excess to the first supporters. For the purposes of this definition: Named Insured. c. The first Named Insured must keep records of a. Notices that are published include material the information we need for premium placed on the Internet or on similar electronic computation, and send us copies at such times means of communication; and as we may request. b. Regarding websites, only that part of a website 6. Representations that is about your goods, products or services for the purposes of attracting customers or By accepting this policy, you agree: supporters is considered an advertisement. Page 16 of 21 ©2017 The Travelers Indemnity Company. All rights reserved. CG T1 00 02 19 Includes copyrighted material of Insurance Services Office, Inc. with its permission.