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HomeMy WebLinkAboutCOI Expires 12.31.25-Project #5893 (#881) Bremerton Lewis Ave Sewer Repl-Pape & Sons ConstructionANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED? INSR ADDL SUBRLTRINSDWVD 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) 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 EACH OCCURRENCE $ DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person)$ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT OTHER:$ COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person)$ OWNED SCHEDULED BODILY INJURY (Per accident)$AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $AUTOS ONLY 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 LIMITDESCRIPTION OF OPERATIONS below INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y / N N / A (Mandatory in NH) 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 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.ACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) $ $ $ $ $ The ACORD name and logo are registered marks of ACORD 12/23/2024 (800) 442-1281 (425) 291-5100 14376 Pape & Sons Construction, Inc. 9401 Bujacich Road Suite 1A Gig Harbor, WA 98332 A 1,000,000 X X S 2567868 12/31/2024 12/31/2025 300,000 10,000 1,000,000 2,000,000 2,000,000 1,000,000A X X S 2567868 12/31/2024 12/31/2025 5,000,000A X X S 2567868 12/31/2024 12/31/2025 10,000 5,000,000 PROJECT: 881 - Bremerton Lewis Sewer Replacement Certificate Holder is included in Blanket Additional Insured as required by written contract or agreement as attached forms listed below: CG 79 88 10 23, CG 73 00 10 23 #881 Lewis Ave Sewer - The City, its officials, employees, agents and volunteers are included as additional insureds Blanket Primary Non-Contributory Additional Insured, including completed operations and Blanket Waiver of Subrogation applies in favor of any person or organization if called for by written contract or agreement, per policy forms and conditions; Belfair Water District #1 is included as additional insured City of Bremerton 345 Sixth Street Suite 100 Bremerton, WA 98337 PAPE&SO-01 JMOSLEY Acrisure Northwest Partners Insurance Services, LLC 19401 40th Ave W, Suite 440 Lynnwood, WA 98036 Jenni Mosley jmosley@acrisure.com Selective Casualty Insurance Company AGG X X X X X X Copyright, 2023 Selective Insurance Company of America. All rights reserved. CG 73 00 10 23 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 10 ElitePac® General Liability Extension Endorsement COMMERCIAL GENERAL LIABILITY CG 73 00 10 23 SUMMARY OF COVERAGES (including index) This is a summary of the various additional coverages and coverage modifications provided by this endorsement. No coverage is provided by this summary. Refer to the actual endorsement (Pages 3-through-9) for changes affecting your insurance protection. DESCRIPTION PAGE FOUND Additional Insureds — Primary and Non-Contributory Provision Page 8 Blanket Additional Insureds — As Required By Contract Page 5 • Owners, Lessees or Contractors (includes Architects, Engineers or Surveyors) • Lessors of Leased Equipment • Managers or Lessors of Premises • Mortgagees, Assignees and Receivers • Any Other person or organization other than a joint venture • Grantors of Permits Broad Form Vendors Coverage Page 7 Damage To Premises Rented To You (Including Fire, Lightning or Explosion) Page 3 Electronic Data Liability ($100,000) Page 4 Employee Definition Amended Page 9 Employees As Insureds Modified Page 5 Employer’s Liability Exclusion Amended (Not applicable in New York) Page 3 Incidental Malpractice Exclusion modified Page 8 Knowledge of Occurrence, Claim, Suit or Loss Page 8 Liberalization Clause Page 8 Mental Anguish Amendment (Not applicable to New York) Page 10 Newly Formed or Acquired Organizations Page 5 Non-Owned Aircraft Page 3 Non-Owned Watercraft (under 60 feet) Page 3 Not-for-profit Members — as additional insureds Page 5 Personal And Advertising Injury — Discrimination Amendment (Not applicable in New York) Page 9 Products Amendment (Medical Payments) Page 4 Supplementary Payments Amended — Bail Bonds ($5,000) and Loss of Earnings ($1,000) Page 4 Two or More Coverage Parts or Policies Issued By Us Page 9 Unintentional Failure to Disclose Hazards Page 8 Waiver of Transfer of Rights of Recovery (subrogation) Page 8 When Two or More Coverage Parts of this Policy Apply to a Loss Page 3 Copyright, 2023 Selective Insurance Company of America. All rights reserved. CG 73 00 10 23 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 of 10 THIS PAGE IS INTENTIONALLY LEFT BLANK. Copyright, 2023 Selective Insurance Company of America. All rights reserved. CG 73 00 10 23 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 3 of 10 ElitePac® General Liability Extension Endorsement COMMERCIAL GENERAL LIABILITY CG 73 00 10 23 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies the insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The SECTIONS of the Commercial General Liability Coverage Form identified in this endorsement will be amended as shown below. However, if (a) two or more Coverage Parts of this policy, or (b) two or more forms or endorsements within the same Coverage Part apply to a loss, coverage provision(s) with the broadest language will apply, unless specifically stated otherwise within the particular amendment covering that loss. With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. COVERAGES — Amendments SECTION I — COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY EXCLUSIONS Employer’s Liability Amendment (This provision is not applicable in the State of New York). The following is added to Exclusion e. Employer’s Liability under COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, 2. Exclusions: This exclusion also does not apply to any “temporary worker”. Non-Owned Aircraft, Auto or Watercraft A. Paragraph (2) of Exclusion g. Aircraft, Auto Or Watercraft under COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, 2. Exclusions is deleted in its entirety and replaced with the following: (2) A watercraft you do not own that is: (a) Less than 26 feet long and not being used to carry persons or property for a charge; or (b) At least 26 feet, but less than 60 feet long, and not being used to carry persons or property for a charge. Any person is an insured who uses or is responsible for the use of such watercraft with your expressed or implied consent. However, if the insured has any other valid and collectible insurance for “bodily injury” or “property damage” that would be covered under this provision, or on any other basis, this coverage is then excess, and subject to Condition 4. Other Insurance, b. Excess Insurance under SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS. B. The following is added to Exclusion g. Aircraft, Auto Or Watercraft under COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, 2. Exclusions: This exclusion does not apply to: (6) Any aircraft, not owned or operated by any insured, which is hired, chartered or loaned with a paid crew. However, if the insured has any other valid and collectible insurance for “bodily injury” or “property damage” that would be covered under this provision, or on any other basis, this coverage is then excess, and subject to Condition 4. Other Insurance, b. Excess Insurance under SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS. Damage To Premises Rented to You A. The last paragraph of Paragraph 2. Exclusions under COVERAGE A BODILY INJURY AND PROPERTY DAMAGE is deleted in its entirety and replaced with the following: Exclusions c. through n. do not apply to damage by fire, lightning or explosion to premises rented to you or temporarily occupied by you with the permission of the owner. A separate limit of insurance applies to this coverage as described in SECTION III — LIMITS OF INSURANCE. Copyright, 2023 Selective Insurance Company of America. All rights reserved. CG 73 00 10 23 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 4 of 10 B. Paragraph 6. under SECTION III — LIMITS OF INSURANCE is deleted in its entirety and replaced with the following: 6. Subject to Paragraph 5. above, 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 caused by fire, lightning or explosion, while rented to you or temporarily occupied by you with permission of the owner, for all such damage caused by fire, lightning or explosion proximately caused by the same event, whether such damage results from fire, lightning or explosion or any combination of the three, is the amount shown in the Declarations for the Damage To Premises Rented To You Limit. C. Paragraph a. of Definition 9. “Insured contract” under SECTION V — DEFINITIONS is deleted in its entirety and replaced with the following: a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire, lightning or explosion to premises while rented to you or temporarily occupied by you with the permission of the owner is not an “insured contract”; Electronic Data Liability A. Exclusion p. Access or Disclosure Of Confidential Or Personal Information And Data-related Liability under COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, 2. Exclusions is deleted in its entirety and replaced by the following: p. Access or Disclosure Of Confidential Or Personal Information And Data-related Liability Damages arising out of: (1) Any access to or disclosure of any person’s or organization’s confidential or personal information, including patents, trade secrets, processing methods, customer lists, financial information, credit card information or any other type of nonpublic information; or (2) The loss of, loss of use of, damage to, corruption of, inability to access, or inability to manipulate “electronic data” that does not result from physical injury to tangible property. This exclusion applies even if damages are claimed for notification costs, credit monitoring expenses, forensic expenses, public relations expenses or any other loss, cost or expense incurred by you or others arising out of that which is described in Paragraph (1) or (2) above. B. The following paragraph is added to SECTION III — LIMITS OF INSURANCE: Subject to 5. above, the most we will pay under COVERAGE A for “property damage” because of all loss of “electronic data” arising out of any one “occurrence” is a sub-limit of $100,000. SECTION I — COVERAGE C MEDICAL PAYMENTS EXCLUSIONS Any Insured Amendment Exclusion a. Any Insured under COVERAGE C MEDICAL PAYMENTS, 2. Exclusions is deleted in its entirety and replaced with the following: a. Any Insured To any insured. This exclusion does not apply to: (1) “Not-for-profit members”; (2) “Golfing facility” members who are not paid a fee, salary, or other compensation; or (3) “Volunteer workers”. This exclusion exception does not apply if COVERAGE C MEDICAL PAYMENTS is excluded by another endorsement to this Coverage Part. Product Amendment Exclusion f. Products-Completed Operations Hazard under COVERAGE C MEDICAL PAYMENTS, 2. Exclusions is deleted in its entirety and replaced with the following: f. Products-Completed Operations Hazard Included within the “products-completed operations hazard”. This exclusion does not apply to “your products” sold for use or consumption on your premises, while such products are still on your premises. This exclusion exception, does not apply if COVERAGE C MEDICAL PAYMENTS is excluded by another endorsement to this Coverage Part. SECTION I — SUPPLEMENTARY PAYMENTS — COVERAGES A AND B Expenses For Bail Bonds And Loss Of Earnings A. Subparagraph 1.b. under SUPPLEMENTARY PAYMENTS — COVERAGES A AND B is deleted in its entirety and replaced with the following: b. Up to $5,000 for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which Bodily Injury Liability Coverage applies. We do not have to furnish these bonds. Copyright, 2023 Selective Insurance Company of America. All rights reserved. CG 73 00 10 23 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 5 of 10 B. Subparagraph 1.d. under SUPPLEMENTARY PAYMENTS — COVERAGES A AND B is deleted in its entirety and replaced with the following: d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or “suit”, including actual loss of earnings up to $1,000 a day because of time off from work. SECTION II — WHO IS AN INSURED — Amendments Not-for-Profit Organization Members The following paragraph is added to SECTION II — WHO IS AN INSURED: If you are an organization other than a partnership, joint venture, or a limited liability company, and you are a not-for-profit organization, the following are included as additional insureds: 1. Your officials; 2. Your trustees; 3. Your members; 4. Your board members; 5. Your commission members; 6. Your agency members; 7. Your insurance managers; 8. Your elective or appointed officers; and 9. Your “not-for-profit members”. However only with respect to their liability for your activities or activities they perform on your behalf. Employees As Insureds Modified A. Subparagraph 2.a.(1)(a) under SECTION II — WHO IS AN INSURED does not apply to “bodily injury” to a “temporary worker” caused by a co-”employee” who is not a “temporary worker”. B. Subparagraph 2.a.(2) under SECTION II — WHO IS AN INSURED does not apply to “property damage” to the property of a “temporary worker” or “volunteer worker” caused by a co-”employee” who is not a “temporary worker” or “volunteer worker”. C. Subparagraph 2.a.(1)(d) under SECTION II — WHO IS AN INSURED does not apply to “bodily injury” caused by cardio-pulmonary resuscitation or first aid services administered by a co-”employee”. With respect to this provision only, Subparagraph (1) of Exclusion 2. e. Employer’s Liability under SECTION I — COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY does not apply. Newly Formed Or Acquired Organizations A. Subparagraph 3.a. under SECTION II — WHO IS AN INSURED is deleted in its entirety and replaced with the following: a. Coverage under this provision is afforded only until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier. However, COVERAGE A does not apply to “bodily injury” or “property damage” that occurred before you acquired or formed the organization. B. The following paragraph is added to SECTION II — WHO IS AN INSURED, Paragraph 3: If you are engaged in the business of construction of dwellings three stories or less in height, or other buildings three stories or less in height and less than 25,000 square feet in area, you will also be an insured with respect to “your work” only, for the period of time described above, for your liability arising out of the conduct of any partnership or joint venture of which you are or were a member, even if that partnership or joint venture is not shown as a Named Insured. However, this provision only applies if you maintain or maintained an interest of at least fifty percent in that partnership or joint venture for the period of that partnership or joint venture. This provision does not apply to any partnership or joint venture that has been dissolved or otherwise ceased to function for more than thirty-six months. With respect to the insurance provided by this provision, Newly Formed or Acquired Organizations, the following is added to SECTION IV — COMMERCIAL GENERAL LIABILITY, Paragraph 4. Other Insurance, Subparagraph b. Excess Insurance: The insurance provided by this provision, Newly Formed or Acquired Organizations, is excess over any other insurance available to the insured, whether primary, excess, contingent or on any other basis. (All other provisions of this section remain unchanged) Blanket Additional Insureds — As Required By Contract A. Subject to the Primary and Non-Contributory provision set forth in this endorsement, SECTION II — WHO IS AN INSURED is amended to include as an additional insured: 1. Owners, Lessees or Contractors/Architects, Engineers and Surveyors a. Any person or organization for whom you are performing operations when you and such person or organization have agreed in a written contract, written agreement or written permit that such person or organization be added as an additional insured on your commercial general liability policy; and Copyright, 2023 Selective Insurance Company of America. All rights reserved. CG 73 00 10 23 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 6 of 10 b. Any other person or organization, including any architects, engineers or surveyors not engaged by you, whom you are required to add as an additional insured under your policy in the contract or agreement in Paragraph a. above: Such person or organization is an additional insured only with respect to liability for “bodily injury”, “property damage” or “personal and advertising injury” caused, in whole or in part, by: (1) Your acts or omissions; or (2) The acts of omissions of those acting on your behalf; in the performance of your ongoing operations performed for the additional insured in Paragraph a., above. However, this insurance does not apply to: “Bodily injury”, “property damage” or “personal and advertising injury” arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services by or for you, including: (1) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and (2) Supervisory, inspection, architectural or engineering activities. Professional services do not include services within construction means, methods, techniques, sequences and procedures employed by you in connection with your operations in your capacity as a construction contractor. A person or organization’s status as an additional insured under this endorsement ends when your operations for the person or organization described in Paragraph a. above are completed. 2. Other Additional Insureds Any of the following persons or organizations with whom you have agreed in a written contract, written agreement or written permit that such persons or organizations be added as an additional insured on your commercial general liability policy: a. Lessors of Leased Equipment Any person or organization from whom you lease equipment, but only with respect to liability for “bodily injury”, “property damage” or “personal and advertising injury” caused, in whole or in part, by your maintenance, operation or use of equipment leased to you by such person or organization. With respect to the insurance afforded to these additional insureds, this insurance does not apply to any “occurrence” which takes place after the equipment lease expires. b. Managers or Lessors of Premises Any person or organization from whom you lease premises, but only with respect to liability for “bodily injury”, “property damage” or “personal and advertising injury” caused, in whole or in part, by you or those acting on your behalf in connection with the ownership, maintenance or use of that part of the premises leased to you. This insurance does not apply to any “occurrence” which takes place after you cease to be a tenant of that premises. c. Mortgagees, Assignees or Receivers Any person or organization with respect to their liability as mortgagee, assignee or receiver and arising out of the ownership, maintenance or use of your premises. This insurance does not apply to any “occurrence” which takes place after the mortgage is satisfied, or the assignment or receivership ends. d. Any Person or Organization Other Than A Joint Venture Any person or organization (other than a joint venture of which you are a member), but only with respect to liability for “bodily injury”, “property damage” or “personal and advertising injury” caused, in whole or in part, by your acts or omissions or the acts of omissions of those acting on your behalf in the performance of your ongoing operations or in connection with property owned by you. e. State or Governmental Agency or Political Subdivision — Permits or Authorizations Any state or governmental agency or subdivision or political subdivision, but only with respect to: (1) Operations performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization; or Copyright, 2023 Selective Insurance Company of America. All rights reserved. CG 73 00 10 23 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 7 of 10 (2) The following hazards for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization in connection with premises you own, rent or control and to which this insurance applies: (a) The existence, maintenance, repair, construction, erection or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults, street banners or decorations and similar exposures; (b) The construction, erection or removal of elevators; or (c) The ownership, maintenance or use of any elevators covered by this insurance. This insurance does not apply to: i. “Bodily injury” or “property damage” arising out of operations performed for the federal government, state or municipality; or ii. “Bodily injury” or “property damage” included within the “products-completed operations hazard”. With respect to Paragraphs 2.b. through 2.d., this insurance does not apply to structural alterations, new construction or demolition operations performed by or on behalf of such person or organization. B. The insurance coverage afforded to the additional insureds in this coverage extension: 1. Does not apply unless the written contract or written agreement has been signed by the Named Insured or written permit issued prior to the “bodily injury” or “property damage” or “personal and advertising injury”; 2. Only applies to the extent permitted by law; and 3. Will not be broader than that which you are required by the written contract, written agreement, or written permit to provide to such additional insured. Broad Form Vendors Coverage Subject to the Primary and Non-Contributory provision set forth in this endorsement, SECTION II — WHO IS AN INSURED is amended to include as an additional insured any person or organization (referred to below as vendor) for whom you have agreed in a written contract or written agreement to provide coverage as an additional insured under your policy. Such person or organization is an additional insured only with respect to “bodily injury” or “property damage” arising out of “your products” which are distributed or sold in the regular course of the vendor’s business. However, the insurance afforded the vendor does not apply to: a. “Bodily injury” or “property damage” for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement; however this exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; b. Any express warranty unauthorized by you; c. Any physical or chemical change in the product made intentionally by the vendor; d. Repackaging, unless unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; e. Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business in connection with the sale of the product; or f. Products which, after distribution or sale by you, have been labeled or re-labeled or used as a container, part of ingredient of any other thing or substance by or for the vendor; however this insurance does not apply to any insured person or organization, from who you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing such products. The provisions of this coverage extension do not apply unless the written contract or written agreement has been signed by the Named Insured prior to the “bodily injury” or “property damage”. Copyright, 2023 Selective Insurance Company of America. All rights reserved. CG 73 00 10 23 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 8 of 10 Incidental Malpractice Subparagraph 2.a.(1)(d) under SECTION II — WHO IS AN INSURED is deleted in its entirety and replaced with the following: (d) Arising out of his or her providing or failing to provide professional health care services. This does not apply to nurses, emergency medical technicians or paramedics if you are not in the business or occupation of providing any such professional services. This also does not apply to “bodily injury” caused by cardio-pulmonary resuscitation or first aid services administered by a co-”employee”. This provision does not apply if you are a Social Service or Senior Living risk. SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS — Amendments Knowledge Of Occurrence, Claim, Suit Or Loss The following is added to Paragraph 2. Duties in the Event of Occurrence, Offense, Claim or Suit under SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: The requirements under this paragraph do not apply until after the “occurrence” or offense is known to: 1. You, if you are an individual; 2. A partner, if you are a partnership; 3. An “executive officer” or insurance manager, if you are a corporation; 4. Your members, managers or insurance manager, if you are a limited liability company; or 5. Your elected or appointed officials, officers, members, trustees, board members, commission members, agency members, or your administrator or your insurance manager if you are an organization other than a partnership, joint venture, or limited liability company. Primary and Non-Contributory Provision The following is added to Paragraph 4. Other Insurance, b. Excess Insurance under SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: This insurance is primary to and we will not seek contribution from any other insurance available to an additional insured under this policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in a written contract, written agreement or written permit that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. Unintentional Failure To Disclose Hazards The following is added to Paragraph 6. Representations under SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: However, if you should unintentionally fail to disclose any existing hazards in your representations to us at the inception date of the policy, or during the policy period in connection with any additional hazards, we shall not deny coverage under this Coverage Part based upon such failure to disclose hazards. Waiver Of Transfer Of Rights Of Recovery The following is added to Paragraph 8. Transfer of Rights Of Recovery Against Others To Us under SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: We will waive any right of recovery against a person or organization because of payments we make under this Commercial General Liability Coverage Part. This waiver applies only if the insured has agreed in a written contract or written agreement to: 1. Waive any right of recovery against that person or organization; or 2. Assume the liability of that person or organization pursuant to a written contract or written agreement that qualifies as an “insured contract”; and 3. Include such person or organization as an additional insured on your policy. Such waiver by us applies only to that person or organization identified above, and only to the extent that the insured has waived its right of recovery against such person or organization prior to loss. Liberalization The following condition is added to SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: If we revise this Coverage Part to provide more coverage without additional premium charge, subject to our filed company rules, your policy will automatically provide the additional coverage as of the day the revision is effective in your state. Copyright, 2023 Selective Insurance Company of America. All rights reserved. CG 73 00 10 23 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 9 of 10 Two or More Coverage Parts or Policies Issued By Us (This provision is not Applicable in the state of New York or Wisconsin). The following condition is added to SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: It is our intention that the various coverage parts or policies issued to you by us, or any company affiliated with us, do not provide any duplication or overlap of coverage. We have exercised diligence to draft our coverage parts and policies to reflect this intention. However, if the facts and circumstances that will respond to any claim or “suit” give rise to actual or claimed duplication or overlap of coverage between the various coverage parts or policies issued to you by us or any company affiliated with us, the limit of insurance under all such coverage parts or policies combined shall not exceed the highest applicable limit under this coverage, or any one of the other coverage forms or policies. This condition does not apply to any Excess or Umbrella policy issued by us specifically to apply as excess insurance over this coverage part or policy to which this coverage part is attached. SECTION V — DEFINITIONS Discrimination (This provision does not apply in New York). A. The following is added to Definition 14. “Personal and advertising injury”: “Personal and advertising injury” also means “discrimination” that results in injury to the feelings or reputation of a natural person, however only if such “discrimination” or humiliation is: 1. Not done by or at the direction of: a. The insured; or b. Anyone considered an insured under SECTION II — WHO IS AN INSURED; 2. Not done intentionally to cause harm to another person. 3. Not directly or indirectly related to the employment, prospective employment or termination of employment of any person or persons by any insured. 4. Not arising out of any “advertisement” by the insured. B. The following definition is added to SECTION V — DEFINITIONS: “Discrimination” means: a. Any act or conduct that would be considered discrimination under any applicable federal, state, or local statute, ordinance or law; b. Any act or conduct that results in disparate treatment of, or has disparate impact on, a person, because of that person’s race, religion, gender, sexual orientation, age, disability or physical impairment; or c. Any act or conduct characterized or interpreted as discrimination by a person based on that person’s race, religion, gender, sexual orientation, age, disability or physical impairment. It does not include acts or conduct characterized or interpreted as sexual intimidation or sexual harassment, or intimidation or harassment based on a person’s gender. Electronic Data The following definition is added to SECTION V — DEFINITIONS: “Electronic data” means information, facts or programs stored as or on, created or used on, or transmitted to or from computer software, including systems and applications software, hard or floppy disks, CD-ROMS, tapes, drives, cell, data processing devices or any other media which are used with electronically controlled equipment. For the purpose of the Electronic Data Liability coverage provided by this endorsement, Definition 17. “Property damage” is deleted in its entirety and replaced by the following: 17. “Property damage” means: a. Physical injury to tangible property, including all resulting loss of use of that property. All such loss of use shall be deemed to occur at the time of the physical injury that caused it; or b. Loss of, loss of use of, damage to, corruption of, inability to access, or inability to properly manipulate “electronic data”, resulting from physical injury to tangible property. All such loss of “electronic data” shall be deemed to occur at the time of the “occurrence” that caused it. For the purpose of the Electronic Data Liability coverage provided by this endorsement, “electronic data” is not tangible property. Employee Amendment Definition 5. “Employee” under SECTION V — DEFINITIONS is deleted in its entirety and replaced by the following: 5. “Employee” includes a “leased worker”, or a “temporary worker”. If you are a School, “Employee” also includes a student teacher. Golfing Facility The following definition is added to SECTION V — DEFINITIONS: “Golfing facility” means a golf course, golf club, driving range, or miniature golf course. Copyright, 2023 Selective Insurance Company of America. All rights reserved. CG 73 00 10 23 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 10 of 10 Mental Anguish Amendment (This provision does not apply in New York). Definition 3. “Bodily injury” under SECTION V — DEFINITIONS is deleted in its entirety and replaced with the following: 3. “Bodily injury” means bodily injury, sickness or disease sustained by a person, including death resulting from any of these at any time. This includes mental anguish resulting from any bodily injury, sickness or disease sustained by a person. (In New York, mental anguish has been determined to be “bodily injury”). Not-for-profit Member The following definition is added to SECTION V — DEFINITIONS: “Not-for-profit member” means a person who is a member of a not-for-profit organization, including clubs and churches, who receives no financial or other compensation. Copyright, 2023 Selective Insurance Company of America. All rights reserved. CG 79 88 10 23 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 4 Contracting, Installation, Service and Repair General Liability Extended ElitePac® Endorsement COMMERCIAL GENERAL LIABILITY CG 79 88 10 23 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. A. BLANKET ADDITIONAL INSUREDS 1. Ongoing Operations SECTION II — WHO IS AN INSURED is amended to include as an additional insured: a. Any person or organization for whom you are performing operations when you and such person or organization have agreed in a written contract, written agreement or written permit that such person or organization be added as an additional insured on your commercial general liability policy; and b. Any other person or organization, including any architects, engineers or surveyors not engaged by you, whom you are required to add as an additional insured under your policy in the contract or agreement in Paragraph 1. above; If the written contract, written agreement, or written permit requires the additional insured be added with respect to liability arising out of your ongoing operations, or requires coverage for the additional insured to be included by the use of ISO’s Additional Insured – Owners, Lessees or Contractors – Scheduled Person Or Organization endorsement CG 20 10 10-01 edition or its equivalent, such person or organization is an additional insured only with respect to liability arising out of your ongoing operations performed under that contract, agreement, or permit. If the written contract, written agreement, or written permit does not require that the additional insured be added with respect to liability arising out of your ongoing operations, or requires coverage for the additional insured to be included by the use of ISO’s Additional Insured – Owners, Lessees or Contractors – Scheduled Person Or Organization endorsement CG 20 10 07-04 (or subsequent) edition or its equivalent, then such person or organization is an additional insured only with respect to “bodily injury”, “property damage” or “personal and advertising injury” caused in whole or in part by your ongoing operations performed under that contract, agreement, or permit. 2. Completed Operations SECTION II — WHO IS AN INSURED is amended to include as an additional insured: a. Any person or organization for whom you are performing or have performed operations when you and such person or organization have agreed in a written contract, written agreement or written permit that such person or organization be added as an additional insured on your commercial general liability policy; and b. Any other person or organization, including any architects, engineers or surveyors not engaged by you, whom you are required to add as an additional insured under your policy in the contract or agreement in Paragraph 1. above; Copyright, 2023 Selective Insurance Company of America. All rights reserved. CG 79 88 10 23 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 of 4 If the written contract, written agreement, or written permit requires the additional insured be added with respect to liability arising out of “your work” performed under that contract, agreement, or permit and included in the “products-completed operations hazard”, or requires coverage for the additional insured to be included by the use of ISO’s Additional Insured – Owners, Lessees or Contractors – Completed Operations endorsement CG 20 37 10-01 edition or its equivalent, such person or organization is an additional insured only with respect to their liability arising out of “your work” performed under that contract, agreement, or permit and included in the “products-completed operations hazard”. If the written contract, written agreement, or written permit does not require that the additional insured be added with respect to liability arising out of “your work” performed under that contract, agreement, or permit and included in the “products-completed operations hazard”, or requires coverage for the additional insured to be included by the use of ISO’s Additional Insured – Owners, Lessees or Contractors – Completed Operations endorsement CG 20 37 07-04 (or subsequent) edition or its equivalent, then such person or organization is an additional insured only with respect to liability for “bodily injury”, “property damage” or “personal and advertising injury” caused, in whole or in part, by “your work” performed under that contract, agreement, or permit and included in the “products-completed operations hazard”. 3. The insurance afforded to the additional insureds in Paragraphs 1. and 2. above: a. Does not apply unless the written contract or written agreement has been signed by the Named Insured or written permit issued prior to the “bodily injury”, “property damage” or “personal and advertising injury”; b. Only applies to the extent permitted by law; and c. Will not be broader than that which you are required by the written contract, written agreement, or written permit to provide to such additional insured. 4. Exclusions a. With respect to the insurance afforded to additional insureds under a. Ongoing Operations the following is added to 2. Exclusions under SECTION I — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE LIABILITY: This insurance does not apply to “bodily injury”, “property damage”, or “personal and advertising injury” occurring after: (1) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the site of the covered operations has been completed; or (2) That portion of “your work” out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. b. With respect to the insurance afforded to these additional insureds under a. Ongoing Operations and b. Completed Operations, the following is added to 2. Exclusions under SECTION I — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE LIABILITY: This insurance does not apply to: “Bodily injury”, “property damage”, or “personal and advertising injury” arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: (1) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (2) Supervisory, inspection, architectural or engineering activities. 5. Conditions With respect to the insurance afforded to these additional insureds under a. Ongoing Operations and b. Completed Operations the following is added to Paragraph 4. Other Insurance, a. Primary Insurance under SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under this policy provided that: a. The additional insured is a Named Insured under such other insurance; and Copyright, 2023 Selective Insurance Company of America. All rights reserved. CG 79 88 10 23 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 3 of 4 b. You have agreed in a written contract, written agreement or written permit that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. B. PROPERTY DAMAGE CARE, CUSTODY OR CONTROL 1. The following is added to Exclusion j. under SECTION I — COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY: Paragraphs (4) and (5) of this exclusion do not apply for the limited purpose of providing the coverage and sub-limits of liability as set forth below. We will pay those sums that the insured becomes legally obligated to pay as damages because of “property damage” to: a. Personal property, including keys, in the care, custody or control of an insured; and b. That particular part of real property on which you or any contractors or subcontractors working directly or indirectly on your behalf are performing operations, if the “property damage” arises out of those operations. The most we will pay under a. and b. above in any one “occurrence” or for all damages during any one policy period is a sub-limit of $100,000. These limits are included in and not in addition to the Limits of Insurance shown in the Declarations of the Commercial General Liability Policy. Our right and duty to defend the insured against any “suit” for damages under a. and b. above ends when we have used up the applicable sub- limit of liability in the payment of judgments or settlements under it. 2. With respect this provision only, the following is added to Definition 17. under SECTION V — DEFINITIONS: “Property damage” also includes adjustment of locks to fit new keys or the cost of new locks, including their installation, when replacing keys covered in Paragraph 1.(a) above provided that such “property damage” is not a result of any dishonest act on the part of any insured, or the insured’s employees or agents, whether acting alone or in collusion. C. OTHER INSURANCE AMENDMENT — SUPPLEMENTAL COVERAGE FOR INSURED’S INVOLVEMENT IN A CONTROLLED (WRAP-UP) INSURANCE PROGRAM 1. The following is added to SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, Paragraph 4. Other Insurance b. Excess Insurance (1)(a): (v) That is covered by a “controlled (wrap-up) insurance program” in which you are enrolled for your ongoing operations or operations included within the “products- completed operations hazard”, unless such “controlled (wrap-up) insurance program” is specifically excluded from coverage on this policy. 2. The following is added to SECTION V — DEFINITIONS: “Controlled (wrap-up) insurance program” means a centralized insurance program under which one party has secured either insurance or self-insurance covering some or all of the contractors or subcontractors performing work on one or more specific project(s). D. FELLOW EMPLOYEE EXTENSION Under SECTION II — WHO IS AN INSURED Paragraphs 2.a. and 2.a. (1) are replaced by the following: a. Your “volunteer workers” only while performing duties related to the conduct of your business, or your “employees”, other than either your “executive officers” (if you are an organization other than a partnership, joint venture, or limited liability company) or your managers (if you are a limited liability company), but only for acts within the scope of their employment by you or while performing duties related to the conduct of your business. However, none of these “employees” or “volunteer workers” are insureds for “bodily injury” or “personal and advertising injury” arising out of his or her providing or failing to provide professional health care services. With respect to this provision only, Subparagraph (1) of Exclusion 2. e. Employer’s Liability under SECTION I — COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY does not apply. Copyright, 2023 Selective Insurance Company of America. All rights reserved. CG 79 88 10 23 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 4 of 4 E. CONTRACTUAL LIABILITY (RAILROADS) Definition 9. under SECTION V — DEFINITIONS is amended as follows: 1. Paragraph c. is deleted in its entirety and replaced by the following: c. Any easement or license agreement; 2. Paragraph f.(1) is deleted in its entirety. F. CONTRACTUAL LIABILITY AMENDMENT — (PERSONAL AND ADVERTISING INJURY) If it is required in a written contract, written agreement or written permit with the insured that any contractual liability exclusion for personal injury be removed from the policy, then Exclusion e. Contractual Liability under COVERAGE B PERSONAL AND ADVERTISING INJURY, 2. Exclusions is deleted in its entirety and replaced by the following: e. Contractual Liability “Personal and advertising Injury” for which the insured has assumed liability in a contract or agreement arising out of an “advertisement”. This exclusion does not apply to liability for damages that the insured would have in the absence of the contract or agreement”. G. WAIVER OF GOVERNMENTAL IMMUNITY We will waive, both in the adjustment of claims and in the defense of “suits” against the insured, any governmental immunity of the insured, unless the insured requests in writing that we not do so. Waiver of immunity as a defense will not subject us to liability for any portion of a claim or judgment in excess of the applicable limit of insurance. H. DAMAGE TO PREMISES RENTED TO YOU The Limit of Insurance for Damage To Premises Rented To You is increased to $1,000,000.