CERTIFICATE OF LIABILITY INSURANCE (10)ACC?R>I?,?, CERTIFICATE F LIABILITY" INSURANCE 1, 1
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a1 ,t5 f,".FiS` THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICES BELOW.
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CERTIFICATE III i CANCELLATION ' I
2831441 SIiT tA I) NP OF TIT E AHCr'v'E 0'SC HIHi! I PC' L T 1 T BE CANCELLED IdF RE THE EA PIRATI€TN
Ih1I Iti51.uNT I9 r,THEH V,I? I KINXkXl? '0, MAIL 1: ?AY?5'vvHII°I'i
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I. 1]`, i'.:111+1' ?,. f•. I, I ( E TO T HE C E H T I i? l''A T 6COC 11 F R N AM11Ei1 TIE 1 H L I Ell".)eV, ,VV)f'll.(), -%'. ,.'X
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AruITfIGR' PFiESEHTATArE.
ACORC25(2001108) I prF{ugir-l,r'1,iI, lr,.T, ritstWnifiePfodl.,,r-tibn¢bovo-lilf,IrwC116ii Aril l JACORDCORPORATION 1988
POLICY NUMBER: 7CSEQU 950
HARTFORD
THIS ENDORSEMENT CHANCES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED BY CONTRACT OR AGREEMENT -
OPTION 11
This endorsement, 174?iri?ilt?:? insurano pi i 1 1 iti? fi:I?rjwing:
COh1f.11-r I,AL. GENERAL L.1AblLiTY COVERAGE PART
SCHEDULE
Name Of Additional insured Persii Or Organization(s):
Blai iki+ l _ ,<< as rewired by Ir?l
li?forllletl='rl rrgkltlred ?? ?,:;lsnt?l"rtE' lhi r e+,lliflt? If not shown abovi 111 k+ ! - ddr1 in the Dei In
A.. Section II -Who Is An InSUred I; ?wi,,i,iTlf,d I?; in,-Jude as an =aiirtftf 'if l-I it urt d the person(sI
ith9 whoin yuu 7lynlt'i_t I1I d .: i It1+511 or?tracf or Y f 14tf-11
it lilF nf. t? i f',.litri irlSlJl£3i1'„t' ti1_l, f ,_ fS .9 Fc l t C'1 uflidi'r INs F c y , I_;f1i 1n.'v' 4M1 0i respect to liaLiHtjr
[u l ii?yCil y^ 171J1k {Ji`C7?}t?IL'y 1[S,a+i?f'. 'r ?iFiI?;CJf??3 aifd AU',f?d by:
1 'Y11W ;i1 l$ Cff .,n 1I `,SI it y or the Oct ui UI? I til_ln5 ,A thf-ise iif-lln ' )n vi behalf;
a In ,lif, f;,,", t ]rfll?lEl?:E' of your ona i,, y ,ri-+'(E3tIC)I?5 for such insured at the
Cu;c]t,,N?l?,} f_i tiECtn23tF°rj ii'i the Schett4(2,
b, In , it f iI tiun 'v°"illl your pn m: es ff,:oi,:fl t-fy, i rented to you and shi in the S ? hE°;.s1.1 t. )r
I In iiwf,,i.t15r1 'Aith "your wurk for thr cii-1(11_ifin,il Iiisured at the pruj cti 5; or oclitJun s1
,"ILL,Ir .ilf'!,f III the Schedule ar d in,_.h-fdt,lj 4wilhirl th+' "prod ucts-coliIpfol a hi?1:',ard` but
oNk', if:
(1')= The written contr,Ii-?t nr LIIt?i?nfi,iIt rect(1i,??- ,I-?iu to provide: such vi??t: ;(, sfich additional
insured at the pig ;e,l 3) ,._lr I?.t.ill fl1 .?? ?t'??I r1 3t,?d ul thi ' h-m o wid
(2). This Covei,'?q,, F,t1-t for l?f ,iiy If.lury?" , ? ' l°tr,,,r ?dr11?i?1,.?^" li1.11.111e i (wilhi€1
the "pi i ill, f`- 1 fl€ili',lt tI 'lil?r ?kILPib t`1i3Zc"1R'd
The acts or (7i * i-,ioI - h,f tf IN ,l('ititlonal insured in oorian ,,tiClsl +,il.1l thi,fir gi'ffa?l q1
operations at thF pI {?l_t5 or l x,ft _,ns designated ire th l_.1`i°..11i.
B, Th hl 1?l zl1 ,: ? _'r-lt i1 ti; ?.ll? r. ;.slt,iltl 7n it ins,il ds applies orsly"°
,+r lil i e ti11t1f t quent to the f . ' f iti, ?n r,( ?:*f ll ':, ntten contract or
drTlt°.,Ill.fr'.'i'frl nt d11d
2. '?"JhEI?? oft wi l n[r ?l t )r written agreement is in 11nlil th, ,-nd of the "policy period",
?vl hover is e,-lrliei
C. With rf-,,} ,-f t to tilt ii!11f ir'l:e afforded t thee" ?<i 1 11 n,i0 inL_,fir,: iii ulii ter this end, the
adi_ftI )fIA i-f llsi?:,l ;applies:
This Ii1'?fl".EIIC;i- ifrjili 11'11 hn"bold'; lnjljryi", "pI0pk,,rty c1Gi13 {',i>I fir C+f' ii 3rllj w??;?t,ltl` I[1C?
nN_1r'r" [1 i5inft r11t oflil? i',:_?ll,li?iln?:) of i,?'lure to reader any lIr:,fn?_ I?:n 31 ,11, hi'.?, turrll
? nLjlfit_1t'ill?.t1 -?l ?i1rL }1.1.7 S{ r?I E l ?" r_1f fi'r'"( w, inclufiln :
1. The 1 !F i;l'llgCt" ell l f ]1?'Int{ .il f 0111,1 i,?,.'i I _I[:Vll1.(_1 rill ,5, !jh(p r!'f<i',',IrY ", opinions.
reports, fic?ld i_rils I?, ,-1 ,ln,]?_' '!lt r5, f? itfilS ur arr,d
2. Supervi r r, lil?Ll.li i,-a , i11, hit >?t a ifl ,_ r enginei activities
D. How Limits Apply To Additional Insureds
The t v,?ill pay of ht;ha°f ?fthe n !ditiim the doh+? :ill is tl:Ea l+__ =
. ?I +' II!r??t?'I irasurar ?e "inr,r e7?r,_; I;t lhlt' :v`!Itt iV'. !Ih! ;i;',t ?! .`,'iittt'n 1 "PC'r nN nt_, or
2Tito- .;!, ils of Insuran the ftr?[ ,
io )t shall be a pail c,f :I rid not in ad i, l ti:, Lirn it In ,urance shown in the Declarations
Stich
alt i c -ri ud in thi-;
E. Duties Of Additional Insureds In The Event Of Occurrence„ Offense, Claire Or Suit
Thn - Fill-, ('nI1 11iP I I in Section IV -Conditicils is j,-;, I by ft- f, ?I;,,Ir?t? rid applies to the
iit 11h(;rlr31 inSjr, d shown ir'I Illi?- ',che, h ilr-1. Notice Of Occurrence Or Offense
1hieadditional insured r)ii>h FT,, lkh Ir, r:Tan
or an it "ns? 11??'h !11;9?f r ?,.I i Ifl :t al!'1 tE-; thti_ t''!Ih i'i"D11?' rn[_-'tJl ?'ir'i111 1111-;?Il't-,
a. Hi`. , hor ::n! j(I
b. TI
c. Th a ncShLkn an?'! li n x1`{ IJ,,IL1!it : 911n,t'li' :,Jri',I11 -a _,Jr Lin, n e" or offense,
2, Notice Of Claim
If ri ll!?l s n l?l. it " is hsrou tri ,l.a,an,"t th J? iit_i it insurs 'itlrliul,? -?I Insured must:
a In !.ii .I t I !,a p l if,,, sp ecifics c! lhle r !aim or "-!.lit° and the date it- -k, d and
b. 1 tiff, 1 -is soon as I)racticable,
Th, ,,1c31tfnn:?1 insured must see to it ih it %i+ receive written notice of the cUirn or "suit" as soon a
pr,irlh_abl+_,
. Assistance And Cooperation Of The Insured
Th l insured mu ;t
a. Ire ?! !,isE?l w ",c:nd u? cu; of any demands nn0res, summonsc- ki-gal Pape! - -i . i-r1 in
oni-_ tlJr v4) the -1;-ilm , "suit":
b. Al th r'n ?I.ls to obtain !? is air ' ._ther ii?ft !m.?ticnr;
C, CiiE_F?i_irate with us in the , It9fI i.t r;F htl? !TIP )It of the claim or defense against the ?W".
and
d. Assist us, upon our request, in he -nforcernert of any right against any person ! r:h=tr?l?Itil n
which f-mi,, be liable to the insured because of injury or damage to which this insurorl :H tlnw,
?Itie ninl:l.d,
4. Obligations At The Additional insureds Own Cast
N _i Lj n;'itions! itnn;l.,!f t, %iil. except ?lt ?hljst irsured's own cost, voluntarily make a payment" ,_?,u!1113
ai?y° rl'Isti;lli_)n, L)r !nWLl!" LIn y r_Ah?°i than for first aid, without our consent.
5. Additional Insureds Other Insurance
ii ^vu o 4Ur a I l tiw ci! u!ii_i,: this i.'(,.i,,,nje Fart that may also be covered by ether insurance
av,i+! lble to theunsure 1;, such Li llditiornal insured must submit such claim r'"suit" tc 'he
Chi,! In?;ul! 1 i,[! of indemnity.
I iow ver ihE I,! I isi iri doi s not apply to the extent that you have agreed in a %ri'??!T) curt! ,1 t nI
v"JUt,n .nr?ri•irrr Est tlr_tt hits insurance is primary and non-contributory with the _i.+diti ?n ?I in ?own insu=,1r1e.
6. Knowledge Of A Occurrence, Offense, Claim Or Suit
F':nr??rnpfns 1. and 2. applies to the ii?!ilidonul only when such "occurrence,", err,--i-,?, Arn
r,r <" Itit" is kfi wn to:
a, Th L L0(lit k )rA in,,,ured that is -n individual„
b. Any tr'drl;i[ i, if the arf'di li,n tint ! d is a 13c1rt! -,t'ilp;
c. Any n?:AEI l ?i El the ?itiditioii? in Llrt,d is a limiti-?d habikty c I!npany;
d. Any ""eX r ,1tiVe niliir,[rr _!! insLEr.Ei t' manager, if this additinn".I insured is a i-firporation,
e. Any truss e, t ,hv ?i,1,-iitional insured is a trust. of,
f. Any elected or appointed official, if the additional insured is a political suLwii. -;]'Al or public e,!tih;
F. Other Insurance
±Iake, the Other
With respect to insurance p11.?.i?_>nt in ih" ? ,hxl(
Insurance Condition Section III - Conditions is replai rIJ by th°, foi; ;:? ing:
1. Primary Insurance