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HomeMy WebLinkAbout1 - Original Submission_ COI_HDR Engineering_06012025Page 1 of 2 fir' g �/ DA7EiMPA/DDlVYYY) J �IFI �! IL'� T I 05/09/2024 IfVIPORTANT: if the certfficate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURE® 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 an this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Willie Towers Watson Midwest, Znc. c/o 26 Century Blvd P.O. Sox 305191 Nashwill®, TN 372305191 USA INSURED HDR Engineering, Znc. 1917 South 67th Street Omaha, NE 68106 • `� ��` � + `" _ WTW C®rtificate Center 1--B77-945-7378 oertificates@wtwca.com Liberty Mutual Fire Tnauranoe Company B, Ohio Casualty Snaurance Company INSURERC: Liberty Tnaurance Corporation INSURER D INSURER E �__._ i\ \ lip:. 1-868-467-237B 23035 24079 42404 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, iL7R TYPE OF INSURANGE IADDL'SUBR POLICY NUFABER � MM DDlYYYY M�LN'I D YYYY LIMITS �( COMMERCIALOENERAL LIABILITY CLAIMSMADC � OCCUR I � i � EACHOCCURRENCB $ 2, 000, 000 GE ORENTFD PREMISES (Eapccurrenre) $ 1 , 000, 000 A �{ _- Contractual Liability � Y j Y I TB2-641-444950-039 �06/01/2029 i 06/O1/2025 MED EXP (Any ono person) ___ ;� 10, 000 PERSONAL& ADVINJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: �� POLICY �, jE � � LOC � i i GENCRAL AGGREGATE ��� PRODUCTS •COMP/OP AGG $ 4, 000, 000 $ 9,000,OOp $ OTHER: I i I � AUTOMOBILE _ X LIABILITY ANY AUTO i � , i COMBINED SINGLE LIMIT (E� accidonl) __ BODILY INJURY (Per person) $ 2, 000, 000 _, $ A OWNED SCHEDULED AUTOS ONLY ___ AUTOS HIRED NON OWNED AUTOS ONLY AUTOS ONLV Y � Y � AS2-641-449950-044 !06/Ol/2024 i i O6/Ol/2025 BODILY INJURYIPoraccidenq$ PROPERTY DAMAGE (I'er 3c,cidenl) iI $ __ ' i li (( f � B UMBRELLALIAB (X OCCUR � EACH OCCURRENCE $ 5,000,000 �( EXCEjSSLtAB � CLAIMS•MAUE Y Y EUO(25)57919363 06/O1/2024 06/O1/2025 AGGREGATE $ 5,000,000 DED X RETENTION$ 0 �, ! $ C � ANYPROPRIEpOR� ARANpR/EXEGUTIVE Y! N AND EMPLOYERS'LIABILITY Na OFFICER/MEPABEREXCLUDED? (Mandaloiy In NH) NlA ' Y i WA7-64D-494950-014 06/O1/2024 � 06/Ol/2025 �.1-STATUTE. OWN (E L. CACH ACCIDENT (E.I_. DISEASE EA EMPLOYEE $ 1, 000, 000 $ 1, 000, 000 II yes, describe under DESCRIPTION OF OPERATIONS bolow j E.L. DISEASE � POLICY LIMIT $ 1, 000, 000 I i I � I� I DESCRIPTION OF OPERATIONS ! LOCATIONS I VEHICLES (ACORD 101, Addgional Remarks Schedule, maybe nnached If moro space Is requlrod) Certificate Holder is nam®d as Additional Tnaured on General Liability, Automobile Liability and Umbrella/Excess Liability on a Primary, Non-contributory basis where required by written contract, Waiver of Subrogation applies on General Liability, Automobile Liability, Umbrella/Excess Liability and Workers Compensation where required by written contract and as permitted by law. Umbrella/Excess policy is Follow form over General Liability, Auto Liability and Employers Liability. CERTIFICATE HOLDER CANCELLATION City of Bremerton Attn; Linda Fulton 345 6th Street, Suite 100 Bremerton, WA 98337 - _ SHQULD ANY OF THE ABOVE DESCRIBED PQLIGIES BE CANCELLEb BEFARE THE EXPIRATIC)N DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORbANGE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE �a �: z���«r•�s�Itr•�•��er.��r��n��t�m� , ,wg �.a ACORD 25 (2016/03) The ACORD name and loge are registered marks of ACORD 5R xo; 25830812 aArcx: 3959790 524; 2 Of 10 i - � :: � L®C #: �, � � � „� � AGENCY NAMED INSURED FIOR Engineering, Ina, Willis 'Pow®rs Watson Mi.dwes�., Ina. 1917 South 67th Street Omaha, NE 66106 ________ __ POLICY NUMRER see Pag® i CARRIER NAIC CODE See Page l Sae Pagca 1 -._- -- EFFECTIVE DATE: Sme cage 1 7h® �CC�R® name and lago are registered marks of AC®�® SR ID:25830812 EaATCH:3959790 CERT:W33525282 524: 2 of 10 ■ _l - . � _- � � . � ,.. . � .. �� .-_ � � x rt � �. �r This endorsement modifies insurance provided under the following: III I���tia�t�� �w��d by �r r�nt�d to the tJam�d Ir�s�r�d Information required to complete this Schedule, if not shown above, will be shaven in the Declarations. A. Far all sums which the insured becomes legally b. Claims made or'"suits" brought; or obligated to pay as damages caused by "occur- c, Persons ar organizations making claims ar rences" under Section I —Coverage A, and far all bringing "suits". medical expenses caused by accidents under Section I —Coverage C, which can be attributed �• Any payments made under Coverage p for only to operations at a single designated "loco- damages ar under Coverage C for medical tion" shown in the Schedule above: expenses shall reduce the Designated Loca- l. A separate Designated Location General tion General Aggregate Limit for that desig- nated "location". Such payments shall not re - Aggregate Limit applies to each designated duce the General Aggregate Limit shown in "location", and that limit is equal to the the Declarations nor shall they reduce any amount of the General Aggregate Limit other Designated Location General Aggre- shown in the Declarations, gate Limit for any other designated "location" 2. The Designated Location General Aggregate shown in the Schedule above. Limit is the most we will pay far the sum of all 4. The limits shown in the Declarations for Each damages under Coverage A, except damag- Occurrence Dama e Ta Premises Rented To es because of "bodily injury" or "property g damage" included in the "products -completed You and �Aedical Expense continue to apply. o erations hazard", and for medical ex enses However, instead of being subject to the P p General Aggregate Limit shown in the Decla- under Coverage C regardless of the number rations, such limits will be subject to the appli- of: cable Designated Location General Aggre- a. Insureds; gate Limit. © Insurance Services Office, Inc,, 2008 524: 3 of 10 13. For all sums which the insured becomes legally �. When coverage for liability arising out of the obligated to pay as damages caused by "occur- "products -completed operations hazard" is pro- rences" under Section I —Coverage A, and for all vided, any payments for damages because of medical expenses caused by accidents under "bodily injury" or "property damage" included in Section I ®Coverage �, which cannot be at- the "products completed operations hazard" will tributed only to operations at a single designated reduce the Products -completed Operations Ag- "location" shown in the Schedule above: gregate Limit, and not reduce the General Ag- �. Any payments made under Coverage A far gregate Limit nor the Designated Location Gen - damages or under Coverage G for medical eral Aggregate Limit. expenses shall reduce the amount available �. For the purposes of this endorsement, the L1efr- under the General Aggregate Limit or the raitions Section is amended by the addition of Products -completed Operations Aggregate the following definition; Limit, whichever is applicable; and "Location" means premises involving the same or 2. Such payments shall not reduce any Desig- connecting lots, or premises whose connection is Hated Location General Aggregate Limit. interrupted only by a street, roadway, waterway or right-of-way of a railroad. �. The provisions of Section III -- Limits Of Insur- ance not otherwise modified by this endorsement shall continue to apply as stipulated. O Insurance Services Office, Inc,, 2008 �G 25 04 OS Q9 52A, 3 or 1 � ��.- may= ,Rr t�.i* �.j This endorsement modifies insurance provided under the fiollowing; COMMERCIAL GENERAL LIABILITY COVERAGE PART Information required to complete this Schedule, if not shown abave, will be shown in the Declarations. A. For all sums which the insured becomes legally obligated to pay as damages caused by "occur- rences" under Section I —Coverage ,4, and for all medical expenses caused by accidents under Section I —Coverage C, which can be attributed only to ongoing operations at a single designated construction project shown in the Schedule abave: 1. A separate Designated Construction Project General Aggregate Lirnit applies to each des- ignated construction project, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 2. The Designated Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under Coverage A, ex- cept damages because of "bodily injury" or "property damage" included in the "products - completed operations hazard", and for medi- cal 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 Con- struction Project General Aggregate Limit for that designated construction project. Such payments shall not reduce the General Ag- gregate Limit shown in the Declarations nor shall they reduce any other Designated Con- struction 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 continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Decla- rations, such limits will be subject to the appli- cable Designated Construction Project Gen- eral Aggregate Limit. � I f ! © Insurance Services Office, Inc., 2008 ",�- �" 524; 4 of 10 �. For all sums which the insured becames legally C. When coverage for liability arising out of the obligated to pay as damages caused by "occur- "products -completed operations hazard" is pro- rences" under Section I —Coverage A, and for all vided, any payments for damages because of medical expenses caused by accidents under "bodily injury" or "property damage" included in Section I � Coverage C, whioh cannot be at- the "products-car�lpleterl operations hazard" will tributed only to ongoing operations at a single reduce the Products -completed Operations Ag- designated construction project shown in the gregate Limit, and not reduce the General Ag- Schedule above: gregate Limit nor the Designated Construction 1. Any payments made under Coverage A for Pr"oject General Aggregate Limit. damages or under Coverage C for medioal �. If the applicable designated construction project expenses shall reduce the amount available has been abandoned, delayed, or abandaned under the General Aggregate Lirnit ar the and then restarted, or if the authorized contract - Products -completed Operatians Aggregate ing parties deviate from plans, blueprints, de- limit, whichever is applicable; and signs, specifications ar timetables, the project will 2. Such payments shall not reduce any Desig- still be deemed to be the same construction pro- nated Construotior7 Project General Aggre- 1ect, gate Lirnit. �. The provisions of Section III —Limits Of Insur- ance nat otherwise modified by this endorsement shall continue to apply as stipulated. k © Insurance Services Office, Inc,, 200� • � i � 5?_4; A of 1C POLICY NUMBER: TB2-041-444950- 034 This endorsement modifies insurance provided under the fallowing: COMMERCIAL GENERAL LIABILITY COVERAGE PART COMMERCIAL GENERAL LIABILITY CG 20 10 12 19 A Section II —Who Is An Insured is amended to 1, All work, including materials, parts or include as an additional insured the persons) or equipment furnished in connection with such organizations) shown in the Schedule, but only with work, on the project (other than service, respect to liability for "bodily injury", "property maintenance or repairs) to be performed by or damage" or "personal and advertising injury" an behalf of the additional insureds) at the caused, in whale or in part, by: location of the covered operations has been 1, Your acts or omissions; or completed; or 2. The acts or omissions of those acting on your 2. That portion of "your work" out of which the behalf; injury or clamage arises has been put to its in the performance of your ongoing operations for intended use by any person or organization the additional insureds) at the locations) other than another contractor or subcontractor engaged in peWrming operations for a designated above, principal as a part of the same project. klowever: C, With respect to the insurance afforded to these 1. The insurance afforded to such additional additional insureds, the following is added to insured only applies to the extent permitted by Section III —Limits Of Insuranae: law; and If coverage provided to the additional insured is 2. If coverage provided to the additional insured is required by a contract or agreement, the most we required by a contract or agreement, the will pay a� behalf of the additional insured is the insurance afforded to such additional insured will amount of insurance: not be broader than that which you are required 1. Required by the contract or agreement; or by the contract or agreement to provide for such additional insured. 2. Available under the applicable limits of B. With respect to the insurance afforded to these insurance; additional insureds, the following additional whichever is less. exclusions apply: This endorsement shall not increase the This insurance does not apply to "bodily injury" ar applicable limits of insurance. "property damage" occurring after: Nar�eOfAdditionallnsured Persons) Or Organization(s); SCHEDULE Locations) Of Covered Operations Any person or organization with whom you have agreed All locations as required by a written contract or through written contract, agreement or permit to provide agreement entered into prior to an "occurrence" or additional insured coverage offense Information required to complete this Schedule, if not shown above, will be shaven in the Declarations. CG2010121J (7 Insurance Services Office, Inc., 2018 Page 1 of 1 524: 5 or 10 POLICY NUMBER: TB2-G41-444950- COMMERCIAL, C�LNLRAL LIABILITY 034 CCU 20 37 1;? 19 T'�II� �N®C)��.MI��1T C;iIAIVC�� T�i� F'®LIC;Y. PL�A�� ��A� IT �Af°�.F�ULLY. This endorsement modifies insurance provided under the following,: COMMERCIAL GENERAL LIABILITY COVERAGC PART PRObUCTS/COMf'LETEb OPERATIONS LIABILITY COVERAGC PART A Sertion II ®Who Is An Insured is amer�dc;d to B. Wikh respect ko the insruaru:e afforded to these include as an additional insured the persons) ar additional insureds, the following is added to organizations) shown in the Schedule, but only Section III — Lirnits Of Insurance: with respect to liability far "baclily injury" or If coverage provided to the additional insured is ,property damage" caused, in whole or in park, by required by a contract or agreement, the mast we your work" at the location designated and will pay an behalf of the adclitioraal insured is the clescribecl in the Sahedr.rle of this endorsement a171ount of insurance: per�fornaod for that additional insured and included in the "products -completed operations hazard". 1. Required by the contract or agreer7lent; or However: 2. Available under the applicable limits of 1. The insurance afforded to such additional irasrrrance; insured only applies to the oxtent penacitted by whichever is less. law; and This endorsement shall not increase the applicable 2. If coverage provided to the additional insured is limits of insurance. regr.rired by a rantract or agreement, the insur'anre afforded to such additional insured will not be broader that, that which you are required by the contract or agreement to provide for such additional insured. SCHEbl1LE Narne Of Additional Insured Persons) Or Organi�ation(s): Laoation And besa-iption C)f Can�pleted Olaerations Any person or organization to wkaom or to which you are Any location where you have agrcaecl, through writken, required to provide additional insured status in a written contract, agreement, or permit, to provide additional contract, agreement or permit except where s�rch insured coverage for completed operations contact or agreet7lentis prohibited. Information required to complete this Schedule, if not Shawn above, will be shown in tho baalaratioras. CG203712'19 Insurance Services Office, Ina., 2018 Page 1 of 1 524: 5 of 1 This endorsement modifies insurance provided under the following, COMMERGIAL GENERAL LIABILITY GOVERAGE PART ELECTRONIC DATA LIABILITY GOVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES PRODUCTS/COMPLETED OPERATIONS LIABILITY GOVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLIGY DESIGNATED TANKS As required by written contractor agreement. Information this Schedule, if not shown above, will be shown in the Declarations. • � .• • �. ... M � � �: We waive any right of recovory against the persons) or organizatian(s) shown in the Schedule above because of paymonts we make under this Coverage Part. Such waiver by us applies only to tha extent that the insured has waived its right of recavery against such persons) or arganization(s) prior to loss. This endarsemont applies only to the porson(s) or organizations) shown in the Schedule above. ©Insurance Services Office, Inc., 2018 �z�r; s or �o Policy Number TB2-641-444950-Q34 Issued by Liberty Mutual Fire Insurance Company This endorsement modifies insurance provided r.nider the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTSlCOMPLETED OPERATIONS LIABILITY COVERAGE PART The fallawing is added to Section IV —Conditions 4. other Insurance and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will nat seek contribution from any other insurance available to an additianal insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed prior fio a loss, that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. (3} This insurance is excess over any other insurance available to the additional insured far which it is also covered as an additional insured by attachment of an endorsement to another policy praviding coverage far the same "oacurrence", claim or "suit". L® 24 1S3 Q6 16 O 2Q1�a Liberty Mutual Insurance Page 1 of 1 Includes copyrighted material oP Insurance Services ©ffice, Inc., with its permission. 5?_4: 6 of 1C POLICY NUMBER: AS2-641-444950-044 ., _. _ _ �, �,.r � �� �:`_� � w ._� fly ':' _t�,� � � `,,- This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Caverage Form apply unless modified by this endorsement, This endorsement identifies persons) or organizations) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. Information required to camplete this Schedule, if not shown above, will be shown in the Declarations. Each person ar organization shown in the Schedule is an "insured" for Covered Autos Liability Caverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.1. of Section II — Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph I�.2. of Section I — Covered Autos Coverages of the Auto Dealers Coverage Form. ©Insurance Services Office, Inc., 2011 ►.i 4 524; 7 of 10 Policy Number: 7�. � � -- r:; �l ] � 9 a �l `'�';� �� - �'� 9 IssLred by. Z,1i��01"t:�r% t'tr.t�=L1Ctl L' _LI_C 211:?l11e�11C;O (.'Ottli ���111: This endorsement modifies insuranoe provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIERS COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Forrn apply unless modified by this endorsement. This endorsement identifies persons) or organizations) who are "insureds" and®r the Who Is An Insured Provision of the coverage Form. This endorsement does not alter coverage provided in the Coverage form. Rlarne ®f I'er�®n(�) �r c7rganizati®r7s(�): /\Il .t � `£ ,:�1'I .. � Y��£illl Fly-1r,ly �+JiiF'C%: r-11e I`itt1R�: �� �.l t.'lil"F9 ] ilcLl :t �Lt=9H � i.�ti ��lL 1. f: �-E',11 �'�_ilii t51�-r r-�_ :lli�'�1_I�_i�- �:;IlC11l ��HY.3i'�17 ,i ���Y�:j,_�li]'�.ar].Gll Each person or organization shown in the Schedule of this endorsement is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is Are Insured Provision contained in Section II of the Coverage Form. The following is added to the Miter In�uran�e Cc�ndiki�n: If you have agreed in a written agreement that this palicy will be primary and without right of contributior7 from any insurance in form for an Additional Insured for liability arising out of your operations, and the agreement was executed prior to the "bodily injury" or "property damage", then this insurance will he primary and we will not seek contribution from such insurance. AC r34 23 0� 1'I O 201 q, Liberty Mutual Group of Companies. All rights reserved Incltades copyrighted material of h�surance Services office, Inc., with its permissior7. Page 1 of 1 �z�; � or � This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. ®� Names) ®f Persc�n(s) car C�rganizati�n(s): Any person or organization for wham you perform work under a written contract of the contract requires you to obtain this agreement fi�om us but only if the contract is executed prior to the injury or damage occun�ing. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The 'Transfer ®f fights cif f�ea�very Against others io Us condition does not apply to the persan(s) ar arganizatian(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the "lass" under a c ontract with that person or organization. C7lnsurance Services Office, Inc., 2011 �zn: � or �o We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organi�ai:ion named in the Schedule. (This agreement applies only to the extent that you per�farm work under a written carltr'act that requires you to abtair7 this agreement from us,) This agreement shall not operate directly ar indirectly to benefit anyone not named in t{7e Schedule. Schedule Where required by contract ar written agreement prior to lass. Issuod by: Liberty Insuranco Corporation For attachrrrerit to Policy t`!o W�17 64D-444950-0'14 Issued to:HDR Engineering, Inc. WG 00 Q3 13 �d. 4l111�84 Effective Date 06/01/2024 1983 National Council on Compensation Insurance, Ina. Page 1 of 1 Premium 524: II of 1C Policy Number TB2-641-444950-034 Issued by Liberty Mutual Fire Insurance Company This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE PART MOTOR GABBIER COVERAGE PART GARAGE COVERAGE PART TRUCKERS COVERAGE PART EXCESS AUTOMOBILE LIABILITY INDEMNITY COVERAGE PART SELF -INSURED TRUCKER EXCESS LIABILITY COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART EXCESS COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART COMMERCIAL LIABILITY —UMBRELLA COVERAGE FORM Schedule Name of Ather Pers�n(s) / ®rganizatic►n(s): Email Address gr mailing address: Number Gays N®tice: As required by written contract or As required by written contract or 30 written agreement written agreement A. If we cancel this policy for any reason other than nonpayment of premium, or make a material reduction in coverage, we will notify the persons or organizations shown in the Schedule above. We will send notice to the email or mailing address listed above at least 10 days, ar the number of days listed above, if any, before the cancellation becomes effective. In no event does the notice to the third party exceed the notice to the first named insured. B. This advance notification of a pending cancellation or material reduction of coverage is intended as a courtesy only. Our failure to provide such advance notification will not extend the policy cancellation date nor negate cancellation of the policy, Ali other terms and conditions of this policy remain unchanged. LIM 99 04 03 14 � 2014 Liberty Mutual Insurance. All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 524: 9 of 10 Policy Number AS2-641p444950-044 Issued by Liberty Mutual Fire Insurance Company This endarsernent modifies insurance provided under the following: BUSINESS AUTO COVERAGE PART MOTOR CARRIER COVERAGE PART GARAGE COVERAGE PART TRUCKERS COVERAGE PART EXCESS AUTOMOBILE LIABILITY INDEMNITY COVERAGE PART SELF -INSURED TRUCKER EXCESS LIABILITY COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART EXCESS COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART COMMERCIAL LIABILITY -UMBRELLA COVERAGE FORM Schedule Narrre of ether Pers�r�(s)1 email Address crr rrrailing address: Nurrrber Gays iVetice: Or�anizati®n(s): As required by written contract 30 or written agreement A. If we cancel this policy for any reason other than nonpayment of premium, or make a material reduction in coverage, we will notify the persons or organizations shown in the Schedule above. We will send notice to the email or mailing address listed above at least 10 days, or the number of days listed abovo, if any, befar�e the cancellation becomes effective. In no event does the notice to the third party exceed the notice to the first named insured. B. This advance notification of a pending cancellation ar material reduction of coverage is intended as a courtesy only. Our failure to provide such advance notification will not extend the policy cancellation date nor negate cancellation of the policy. All other terms and conditions of this policy remain unchanged. L.IM 99 Q4 03 94 C�� 2014 Liberty Mutual Insurance. All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission. �z�r: s or � A. If we cancel this policy for any reason other than nonpayment of premium, we will notify the persons ar organizations shown in the Schedule below. We will send notice to the email or mailing address listed below at least 10 days, or the number of days listed below, if any, before cancellation becomes effective. In no event does the notice to the third party exceed the notice to the first named insured. B. This advance notification of a pending cancellation of coverage is intended as a courtesy only. Our failure to provide such advance notification will not extend the policy cancellation date nor negate cancellation of the policy. �, r • All other terms and conditions of this policy remain unchanged. Issued by Uberty Insurance Corporation For attachment to Policy No. WA7-G4D-444960-014 Effective Bate 06I09/2024 Issued 4o HDR Engineering, Ina. WG 99 20 75 Ed. 12/01/2() t 6 © 2016 Liberty Mutual Insurance 30 Endorsement Page 9 of 1 524; 10 of 1( 524: 10 of 1