CERTIFICATE OF LIABILITY INSURANCE (257)CERTIFICATE OF LIABILITY INSURANCE I � DAn^�MMIDDM'YY)
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 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(s1.
PRODUCER
lames C. Jenkins Insurance Service, Inc.
_icense #0545478
'O Box 13847
iacramento CA 95853-3847
INSURED
DKS Associates
1970 Broadway, Suite 740
Oakland CA 94612
COVERAGES
���►�y���
CERTIFICATE NUMBER: 104376960
INSURER E :
REVISION NUMBER:
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 'fHE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADDL SUBR POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE INSR WVD POLICY NUM D/YYYY MM/DD/YYYY LIMITS
A GENERAL LIABILI7Y JZ91459167 �? �� �' .•� J/�B�ti ; /1/2014
� EACH OCCURRENCE $1,000 000
X �°o� � DAMAGE TO RENTED
COMMERCIAL GENERAL LIABILITY � PREMISES Ea occurrence $300,Oi70
CLAIMS-MADE � OCCUR MED EXP (Any one persan) $0 _
� -. . � � I � � � � - PERSONAL & ADV INJURY $1,000.000
� GENER,4LAGGREGATE $2,000.000
(� ... t �., „ . -
GEN'LAGGREGATELIMITAPPLIESPER "'' ```' � �'�� " -- PRODUCTS-COMP/OPAGG $2,000_000
�� � ` ,�.
POLICY X PRO- LOC L._'_`, ,�-,.:� t �... �.Vo.. ' $
A AUTOMOBILE LIABILIN ASJZ91459167 /1I2013✓ �./1/2014 Ea accident g1,000 �00
� -- ------
ANY AUTO �iI BODILY INJURY (Per person) $
ALL OWNED SCHEDULED BODILY INJURY (Per accident) $
AUTOS AUTOS
NON-OWNED PROPERTY DAMAGE $
x HIRED AUTOS X AUTOS Per accident _
X No Owned Aut $
UMBRELLA LWB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION $ $
g WORKERS COMPENSATION C2Z91459167 /1/2013 /1/2014 X �^/C STATU- OTH-
AND EMPLOYERS' LIABILITY T RY I R _
ANY PROPRIETOR/PARTNER/EXECUTIVE Y� N E.L. EACH ACCIDENT $1,000,000
OFFICER/MEMBER EXCLUDED? � N � A
(Mandatory in NH) E.L. DISEASE - EA EMPLOYE $1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1,000,000
� Errors and Omissions � SP005280H /1/2013 /1I2014 Per Claim $1,OOO,C�00
Claims Made Aggregate $1,o00,C�00
i
Deductible $50,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more spxe is required)
RE: RFQ 16-12. City of Clearwater is and Additional Insured as respects General Liability and Automobile Liability per the attached forms.
Primary wording and Waiver of Subrogation applies to General Liability per the attached form.
CERTIFICATE HOLDER
City of Clearwater
Attn: City Clerk
P.O. Box 4748
Clearwater FL 33758-4748
ACORD 25 (2010/05)
TION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
�..� ;��� ���,., .,
O 1988-2010 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
POLICY NUMBER: YVJZ91459167
COMMERCIAL GENERAL LIABILITY
CG 20 10 07 04
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - SCHEDULED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s)
Or Or anization s: Location s Of Covered O erations
Any person or organization where the named insured has agreed
by written contract to include such person or organization as a
designated insured.
Information re uired to com lete this Schedule, if not shown above, will be shown in the Declarations.
A. Section II — Who Is An Insured is amended to
include as an additional insured the person(s) or
organization(s) shown in the Schedule, but 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 or omissions of those acting on your
behalf;
in the performance of your ongoing operations for
the additional insured(s) at the location(s) desig-
nated above.
B. With respect to the insurance afforded to thes�e
additional insureds, the following additional exclui-
sions apply:
This insurance does not apply to "bodily injury" Gr
"property damage" occurring after:
1. All work, including materials, parts or equip-
ment furnished in connection with such work,
on the project (other than service, maintenance
or repairs) to be performed by or on behalf af
the additional insured(s) at the location vf 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 in-
tended use by any person or organization other
than another contractor or subcontractor en-
gaged in performing operations for a principal
as a part of the same project.
CG 20 10 07 04 O ISO Properties, Inc., 2004 Page 1 of 1 ❑
POUCY NUMBER: ASJZ91459167
COMMERCIAL AUTO
CA 20 48 02 99
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
DESIGNATED INSURED
This endorsement modifies insurance provided underthe following:
BUSINESS AUTO COVERAGE FORM
GARAGECOVERAGEFORM
MOTOR CARRIER COVERAGE FORM
TRUCKERS COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless
modified by this endorsement.
This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provi-
sion of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form.
This endorsement changes the policy effective on the inception date of the policy unless another date is indi-
cated below.
Endorsement Effeetive: 5/1/13
Named Insured: DKS Associates
SCHEDULE
Name of Person�s) or Organization(s):
Any person or organization where the named insured has agreed by written contract to include such
person or organization as designated insured.
(If no entry appears above, information required to complete this endorsement will be shown in the Declaration.s
as applicable to the endorsement.)
Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the e�ctent
that person or organization qualifies as an "insured" under the Who Is An Insured Provision containe��
in Section II of the Coverage Form.
CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 ❑
'THIS ENDORSEMENT CHANGES THE POL.ICY. PLEAS� REA.D IT CAREFULLY.
LIBERTY DirectSolurions £or Professional Services
Tlus endorsement modifies insuiazice provided under the followin,g:
COMMERCLAT C3ENERAL IdAIiILITY COVLRt1GE PART
This endoisement modifies insurance by broadening the insurance provided by CG 00 Ol,
Index o€ modified items:
Xtem 1- REASONABI.E BORCE
Item 2. - NON-�WNED WA'I'ERCRAFT �XTENSION
Item 3. - ALIENATED PREMISES
Item 4. - DAMAGE TO BORROVVED EQUIPMENT
Item 5. - PROPERTY IN YOUR CARE, CUSTODY OR CONTROL
Item 6. - DAMAGE T� PREMISES RENTED TO YOU - EXPANDED COVERAGE
Item 7. - BODILY INJURY TO CO-EMPI.OYEES
Item 8. - HEALTH CARE PROFESSIONALS AS INSUREDS
Item 9. - NEWLY FORMED OR ACQUIRED ENTITIES
Itein 10. - BLANKET ADDITIONAL INSURED AND WAIYER OF SUBROGATION—MANAGERS OR LESSORS
OF PREMISES
Item 11. - BI.ANKET ADDiTIONAL INSURED AND WAIVER OF ST7BR�GATION - PER50N OR
ORG.ANIZATION
Item 12. - ADDITI�NAL INSURED - STA,TE, ML7NICIPALITY OR POLITICAL SUBDIVISION - PERMITS
Item 1.3. - ADDITIONAL INSURED AND WAIVER �F SUBROGATION - LESSOR OF LEASED EQUIPMEN'I'
Item 14. - KNOWLEDGE OFt OCCURRENCE
Item 15. - UNINTENTIONAL ERRORS AND OMISSTONS
Item 16. - BODILY INJURY REDEPINITION
Ttem 17. - MOBILE EQUII'MENT AEDEFIATITION
Item IS. - SUPPLEMENTARY PAYMENTS
Item 19. - LIBERAI.IZATION
Tktese changea brpaden the policy secrions described unlesa d�lffeting language �is aeparately endotsed to the coverage
par:.
Item 1. - REASONABLE FORCE
Exclusion a. of Coverage A is replaced by the following:
a. Expected oi Intended Injury
°Bodily injury° ox "properCy damage" expecYed or intendec3 frozn the standpou�t of the ulsured. This exclusiori
does iiot appl�� to "bodily injuty" ox "pzoperty damage" fesulting from che use of reasonaUle foxce to protece
persons ot prope�ty.
Itein 2. - NON-OVi�TED WATERCRAF'i' EXT'TNSION
Subpatagzaph g_(2) a£ Bxclusion g. of Coverage A(Secdon T- Coveiages) is replaced Uy the folIowing:
(2) A waterctaft you do not own that is;
(a) Jyess than 55 feet long; and
(h} Not being used for public rranspor.tation or as a common carrier.
Item 3. - ALIENATED I'REMISES
1. Subparagtaph y.(2) of ExcIusions of Section I- Coverages - Bcxiily Injury Aud Property llamage Liability is
ieplaced by dle following.
(Z) Pxemises you sell, give away, or abandon, if the "property damage" ai7ses out of any part of those premises, and
occuis from hazards that wexe known by you, oz should have reasonably been known by you, at the time the
ptoperty was transferred or abandoned.
I.G 32 38 U9 07 Page 1 of 7
Item 4. - DAMAG� TO BORROWEU EQUIPMENT
A. F,xclusiozt j. of Covexage A(Section I— Coverages) is amended to add the following
Paragraphs (3) and (4) do not apply to "propetty damage" to borrowed equipment either loaned to you ot in your caxe,
custady or control.
B. Snbject to Paragraphs 2., 3., and 5. of Sectioi� III — Limits OF Insurance, the most we will pay fox dannages undex this
e�doxsement is $35,000 fox all "occutxences" dusing the poficy period.
T1ie insurance provided by this endorsement is excess oveT any other valid aud coIlectiUle propexry insurance {including
uiy deductible poxtion thereo fl available m the insured whether primaxy, excess, contingent or on any other basis.
Item 5. - PROPERTY IN YOUR CARE, CUST�DY OR CONTROI.
1. Subparagraphs (3) and (4) of exclusion j. of coverage A. do not apply except to
(a) boxrowed equipnnent, or
(b) "property damage" to property in your caie, custody and conttoT while in transit.
This insurance does not apply to any portion of a loss fot which tlie insured has avazlable any other valid and collectible
insurance, whether pcimary, excess, contingent, ot on any othex basis, unless such other ins�ance was specifically
purchased by the ittsuxed to apply in excess of this policy.
2. Limits of Insurance
Subject to Paragraphs 2., 3., and 5. of Section iII — Limits Of Tnsurance, the most we will pay fot insurance.
provided by paragraph 1., above is:
�10,0()0 Each Occutrence I.imit
$25,000 Aggxegate L'unit
'Z$e Each Occurrence Litnit for this coverage ap�lies to all damages as a resulE of anp one "occurrence" regardless
of the numbex Uf persons or organizarions who sustain damage becaLtse of that "occunence."
The A�gregate J.,imit is the most we will p�y for the sum of alI occurrences covered by this provisiot�,
Itern 6. - DAMAGE TO PR�MTSES RENTED TO YOU - EXPANDED COVERAGE
A. I'ixe, Lightnin� Or Explosion Damage
The lasx paragtaplt oE 2. Lxclusions under Secdon I�- Covexage A is replaced by the Following:
Exclusions c. through t�. do not apply to damage to premises rented to you or tempoxarilp occupied by you.
with permission of the ownex when the damage is caused by £ue, light�vng, or explosion or subsequeiit damagcs
resulting £rom sueh fixe, li�htning ot explosion, iucluding water damage. A sep:►rate limit of insurance applies
to this coverage as desczibed it� Sectio�n TTT — Limits of Insurance.
B. Limits foT Damage to Premises Rented to You
Paragraph 6, of Section III — Limits of Ix�surance is replaced by the following:
Subject to 5. above, the Damage to Yremsses Rented to You Limit is the rnost we will pay undex Covexage A
fot any combivation of:
(a) damage caused bp fire, lightning, ar explosion or subsequent dainages resulting from such fire,
lightning or explosion, including water damage to premises rented to you, or temporarily occupied
by you with permisslon af the owner; and
(b) "piopeity dainage" (other than dainage by fire) to premises, including the contents of such
piemises, rented to you for a period of 7 or fewer consecutive days.
Ttem 7. - BODILY INJURY TO CO-EMI'LOYEES
LG 32 38 09 07 Page 2 of 7
1. Snbject to the Each Occurrence Limit and the Genexal As�regate Lirnit, T'aragtaphs 2.a.{1)(a), (b) and (c) of
Section II – Who Is an Insured do not apply to youx supervisory or management "employees" £ot "bodily iiijucy"
only. _
Z. Subject to the Each Occuxrence Limit and tbe Genexal Aggregate Limit, Paragraphs 2.a.(1)(a), (b) and (c) of
Secdon TI – Who Ta att Insured do not apply to your "employees" or "volunteet woxl�ers" for "bodily injury"
arising out of a Good Samaritan act to a co-"employee" oi co-"vohu�teez worker." A Good Samaritan act means an
atteinpt to xescue or aid a person in ianminent or serious pesil, provided the attempt is not recklessly made.
Dainages owed to an injureci co-"employee" or "volunteer worke�" will he reduced by any amount paid or available to
the injured co-"employee" oz `bolunteez workei" Lu�derany other valid and collectible insurance.
Ite�n 8. - HEALTH CAItE PROFESSTONALS AS INSUREDS
Paragraph 2.a. (1) (d) of Section II – Who Is An Insuted is deleted unless:
{i) You are engaged in the occupat�on ot business of providing or o£fer3ng ixiedical, surgical, dental, x-iaj= or nursing
sexvices, treabnent, advice or inst�uction; ox
(ii) The "employee" has auy other insur�nce that would also caver claims u-ising �andet this provision, whether the
other insurance is priinarp, excess, conangent ot on any othez basis.
Item 9. - NEWLY FORMED OR ACQUIRED ENTITIES
Paiagraph 3. of Section II – Who Is An Tnsured is xeplaced bq the following;
3. Any organixaeion, other than a joint venture, you newiy acqaire ox fox�rrz and oveT which you maintain majority
ownexshlp or majoziry interesr, will qualify as a Named Ii�sured if there is no otliet similax inswxance available to
ehat oxganizafiion.
a, Coverage under this provision is afforded anly until
i, the 180th day after you acquire or fotm the organization; or
ii. sepatate coverage is purchased for the org;anization; or
iii. the end of the policy perioci,
whiche�vex is eatliet.
b. Coverage A does not apply to "bodily injury" or "propetty damage" thar occurted beEore you acquired or
foxmed the organization; and
c. Caverage B does not apply to "personal and adverrising injuzy" acisimg out o£ an offense committed before
you acquired or fortned die organization.
No person or organization is an ulsured wid� respect to the conduct o£ any past pararexship, cuirent or past joint venture
or �ast limited liabillty company that is not sliown as a Named Insured in the Declarations.
Item 10. - BLANKET ADDI'xIONAL INSURED AND WANER Ol� SUBROGATION—MAl\iAGL�RS OR I.ESSORS
OP PREMISES
A. Section II -- Who Is Att Insuted is ainended to include as an insured an}� managez ox lessoz of premises leased by }•ou
in which the written lease agreement oUligates sou to procure additional insured coverage, provided tha�
1. the "bodily iujuzy", "pzopeny damage" ot "personal and adveztising 3njuxy" �ving rise eo liabiliry occuxs
subsequent ro the execution of the agreem.eat; and
2. the wutten agteement is in effect at the time of the "bodily itijury", "property damage", "pexsonal wd
advextising injury" Eor which coverag�e is sou�;ht.
That person or organization shall be zeferred to as the ldditional insured.
The coverage afforded to the additional insuted is limited to liability in contiection with the ownership, maintenance oi
use of the pcemises leased to 3=ou and caused, in whoie or in part, by some negligent 1cCs or. omissions of ynu, your
employees, your agents, or your subc�ntxactots, f'here is no covetage for ehe adclitional insured foc "bod'tly injury",
"property damage" oe "personal and advertising injury" arising out of the sole negligence of the addidonal insur.ed or by
those acting on behalf oE che additional insured, except as pxovided bele�w.
LG 32 38 09 07 Page 3 of 7
If d�e written a�;reement to indemnify au additional insured rec�tutes that you indemniCy the Additional inst�red fox ics sole
uegiigence, ther� the coverage for the addidonal insured shall conform to that agreement; provicled, however, rhat the:
�ontractual indernnification langua�;e of the agreement is valid uuder the law of rize state where the agreement was
formed. If tl�e written a�eement provides that a partict�lar state's law will apply, d�en such provision will be honored.
B. Waiver Of Subrogation
I'ox any additional insured that obtains insured status on tivs policy through patagtaph A., above, we waive any right ol'
recovery we may have against the additional i.nsuted because of payments we nnalse for "bodily injury", "property
damage" or "petsonal atid adverdsing injury" tb which this insurance applies.
C. Exclusions
This insuxance does not applq to;
1. Any "occurrence" that takes place after you cease to be a tenant in t}aat pxeinises.
2. Any consrruction, renovntion, demolition ox installation operarioz�s perfotmed by ox on behalf of the Additional.
Insured.
3. Any pxelnises for which coverage is excluded by endorsement,
D. Other Tnaurance
The insurance provided by this endorsement applies onlq to coverages and lunits �f iiasurance required by written
agreemenk but ia no event esceeds eithei the scope of covexage or the liinits of insurance Available within this polic}�.
Thiis insurance shall be excess ovet aay othex insurance available to the additiona! insured, wliatl�et such insurance is on
an excess, contingent or primaty basis, unless you are obligated undex a written agreement to ptovide liability insurance
foe that additional insured on anp od�er basis. In that event, ttus policy will apply solelp on the basis required by such
written agreement.
To die extent that t11e addiuonal insuted has the right to pursue any other insuxance caxrier for coverage, including a
de£ense, we shall share that right with the additional insured.
Item 11. - BLANI�T ADDITTONAL INSURED AND WAIVER OI� SUBR�GATION -- PERSON OR
ORGANIZATION
A. Sectaon IT — Who Is An Insured is amended to include as an adciirional insured any person ot organization to whom.
you are oUligated Uy a written agreement t� pracure additional insured coverag�e, but only with respect to liability for
"bodily lnjury", "property damage" or "peisonal and advertising injury" caused, in whole ot in part, bp your acts or
omissions or the acts or omissions of those acting on your behalf:
1. In ehe performance of your ongoiug operatians; or
2. Tn connection with prexnises owned by you
provided thar
{a). the "bodily injury", "property damage" or "personal and advertising injuiy" giving xise to liability occurs
subseguent to the execution o1f the a�xeemenr, and
{b) the written agreement is in effect at the time of the "bodiiy injur�', "property clamage", "personal3njury" oa
"advextisiiig injur}�' for which coverage is sought.
That pezson or ox�anixation shall be refexred to as the additional insuxed.
There is no coverage for the additiozial insaced for `1�odily injury", "property damage" ox "personal and advertising;
injuxy" arising out of the sole negligence of the addi�ional insured ot by rhose acting on behalf of the additional insured,
except as provideci belo�cv.
If the v✓i7tten agceement to indemrufy an additional insured xequues that pou indemnifg the acidirional insured for its sole
negligence, khen the cc>verage for the additional insured shall confoxm to that agreement; provided, however, that the
contxactual indeinnification language of the agreement is valid under the law of the s�te where the agreement was
foxmed. If the written agieement ptovides that a particular state's law will apply, then such provision will be honored.
B. Waiver Of Snbrogation
LG 32 38 09 07 Page 4 of 7
For any addztiona] insured that obtains insured status on this pnlicy thxough paragraph A., above, we wuve any right of
recovery we may have against tl�e additional insured because of payments we make for "bodily injiuy", "property
damage" o� "personal and advertising injury" to wluch this insurance applies,
G. Exciusions
This uzsutance does not apply to;
1. A.iiy premises or equipment leased to 5•au,
2. t1�1y construction, reuovation, demolition ox installation operations perforined by or oa behaif of you, or those
operatuig on your behalf
D. Other Insutance
The insuxance pxovided by this endotsement applies only to covetages and limlts of insurance required by written
agreemeiit, but in no event exceeds either the scope of coverage or che liixiits of insutance available wir.itin rhis policy.
This insurance shsill be excess o�ver any other insurance available to the additional insured, whether such insurance is on
an excess, conungent or pstimary basis, unless you are obligated under a written agreement to provide liabl]ity insurance
for that additional insared on 2ny othet basis. In that evene, this policy will apply soleiy on the basis requixed by such
wtitten agreemen�
To the extent that the adcfiitional insured h�s the right to .pursue anp other insurance carxier for covexage, including a
defense, we shall shaxe that r3ghk with the additional insuted.
item 12. - ADDITIONtiL INSURED — STATE, Mi3NICIPALITY OR POLITICAL SUBDIVISION - PERMITS
Section II — Who Is An Insured is amended to include as an addieional insured any state, municipality or political
subdivision with respect to any operations pexformed bp you, or on youx behalf, for which the state, municipality ox
political suUdivision has issued a pertnit
Howevex, dus insurance does not apply ta
1. "Bodily injuty," "property damage" or "personal and advettising injuty" arising out of operations
pexformed foz the state, m�uiicipality or palitical subdivision; or
2. Any "bodily injury" ox "pxoperty damage" included within the "products-completed operations l�azard",
except when required by wtitten contract oi agreement initiated piior to loss; or
3. �Bodily uijury," "pxoperty damage" or "personal and advertising injury," unless negligently oaused, in
whole or in part, by you oz those acting on your behalf,
Item 13. - ADDTTIONAL TNSURED AND WAIVER OF SUBROGATION — LESSOR OF LEASED EQUIPMENT
A. Sect:ion II - Who Is An Tnsured is amended ta include as an additional insured any person ox oiganizadon from
whom you lease equipment when you and .such person ox oro ni�ation have agreed in a written agreement th.1t such
pexson or organization be added as an additional insured oix youx policy. 5uch petson or org�nization is an ansured
only with lrespect to liability for "bodIly injury", "proper�,y damtige" or "pexsonal and arlvextising injury'" caused, in
whole or in part, by your maintenance, aperation or. use of equipment leased to you by such person or or.ganization.
Tbeze zs no covezage for the additional insured fox "bodily injury", "property damage" or "personal and acivertising
iujuxy" lrising out of the sole negligence of the addirional 'zusuzed or by those acting on behalf of the 1dd'ztiona.l
uisuced,
A person's or organization's status as an additional insured under this endorsement ends wheti the agreement with you
for such les�sed equipment ends.
B. Waivez of Subrogation
LG 32 38 09 07 Page 5 of 7
For any adclitional insuied that obtains insured status on this policy tFArough para.graph A., above, wa waive any right
of recovery we may have against the additional insured because of payments we make for "bcxlily injury", "propexty
dunage" or "personal and advertising injury" caused, in whale vr an paxt, by your maineenance, operation or use of'
equipment leased to you by such person oi nrganizauon.
C. Other Insutance
'This insurance shall. be exeess over any other insurance available to the additional insured, whether such insurance is
on an excess, conrrngent or pximary Uasis, unless you ase obligated undei a written agreement to provicie liabzlity
insnrance for that additional insured on any other Uasis. In that evet�t, this policy will apply solely on the basis
reqezired by such wxitten agreement.
To the extent that the additional i�lsured has the right to pursue any othei; insurance cairier Eor coverage, u�cluding a
defense, we sha11 share that xight with the addirional insured.
Item 14. - RNOWLEDGE OF OCCURRENCE
Subparagtlph 2.a., b. and c. of Condirion 2. Section YV — Commercial General I.,ilbility Conditions are amended to add
the following:
As used in this paragraph, the woxd "you" refers to an "executive officer", partner, member ot legal representative, and
any othei "employee" with insurance or risk management responsibilities.
Item 15. - UNINTENTx4NAL ERRORS AND OMISSIONS
Paiagraph 6. of Section N— Commercial General Liability CondiCions is amended to add die following;
Any unintenrional exror or omission in the desctiption oE, or fai(uxe to completely describe, any ptemises ot
operarions intended to be coveted by tllis policy will not invalidatc ot affect covetage for those pcemises or
operarions. However, you must report such error oi omission to us as soon as pracacahle after its discovery,
This pxovision does not affect our xight to collect additional pxemium ot exetcise our right of cancellation or non-
renewal,
Item 16. - BODILY INJIIRY ItEDEPINITION
The defmition of "bodily injury" in Section V- Definitions is replaced by tkae following.
"Bodily injury" means bodily injury, sickness or disease sustained by a person. It includes death ot mental anguish,
which xesults at any time from such plzysical haxzn, physical sicl�ness or physical disease. Mental anguish means any
ty�e of inental or emotional illness or distress.
Item 17. - MOBTLL EQUIPM�N'I' REDEFINITION
Paragraph 12. f.(1) (a}, (b} and (c) of Section V— Definitions does not apply to self-pxopelled vehicles of less than 1000
pounds gross vehicle weight.
Item 18. - SUPPLEMENTARY PAYMENTS
Section I- Cover�es, Supplementaxy Payments - CoPerages A a.nd B, item 1. b. and 1. d., respectively, axe repl�nced
with:
b. Up to $2,500 for cost of batl bonds tequired because oP accidents ox trafEc law violations atising out of the use
of any vehicle to which the Bodily Injury 1'.iaUilitp Coverage applies. We do not have to furrush these bonds,
d. All ceasonable expenses incutred by the insuted at our xequest to assist us in the investigarion or deCense of'the
claim or "suit" including substaatiated loss of earnings np to $540 a day because of time off from wor�.
Item 19. - LIBERALIZATION
Section IV - Commercial Genexal Liabilit� Conditions �s amended to add the following:
LG 32 38 09 07 Page 6 of 7
0
�
10. Liberalization
If we adopt a change in our £orms or riile which would Uxoaden your coverage wicl�out an extta charge, tl�e.
broader coverage will apply to this policy. Tkus extension is effecrive upon dze approval of snch broader
coverage in your state.
Tlvs endoxsement is esccutcd by dic
Premium :
� E,+ffcctavc l�atc 5/1/13
For attacFunnnt to Pulicy No.
Audit Basis Annual
Issued To DKS Associates
Is,gued
LG 32 38 49 0'�
Expiration Datc 5/1/14
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Countersigned hy
5ales OE�ce and No.
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End. Setial Na,
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