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KAPOK TERRACE SANITARY SYSTEM PROJECT - 15-0036-UT - CERTIFICATE OF LIABILITY INSURANCE�"�"����"� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) ����-� io�i��,�aoi� 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(s). PRODUCER ��N�-e��'� T���9��' I�3.ii�':St�a"1 VTC Insurance Group Ft. Myers Office 4110 Center Point Drive #215 Ft Myers FL 33916 INSURED �mm � Suncoast Development of Pinellas County, Inc. 2340 Destiny Way Odessa, Florida 33556 ���, (239) 275-8226 whingson@vtcins.com INSLIRERlS1 AFFORDING COVERAGE � ..., ., INSLIRER A Vd11EV ForQe Insurance Cc iNsuaeRa.National Fire Insurance c _ w.. � ,, -��--- _...._._..... � _ � ., wsuaear_Certain Underwriters at ] IN$URER D: INSURER E : 's (239) 275-8837 NAIC 20508 rd 20478 COVERAGES CERTIFICATE NUMBER:2017-2018 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 THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ,....�..,.... TYPE OF IN �.._._.__. p���ry�, SUBR .,......... ........... .. ,,,,,_, ... POLICY EFF POLICY EXP,. ,,,.. ��TR SURANCE iuen wvn POI,ICV {JI,I�IAB�R l��Wl�l]/KXYVI InIIM/D4/YVYY1 LIMITS � 7{ COMMERCIAL GENERAL LIABILITY EAGH bCCURRENCE $ 1, 000, 000 p _ CLAIMS-MADE � X.I OCCUR �/t�+1AC! 41�.'k I�FNT� C1 $ 100, 000 � w�.�4 �1G yC x �� t u� �,kNr�u�,r,M ad� .� ,,.,,, , . ,.�m. � �n� ��;�1't C,rar�L.o:r���:rax:�,1 X Y 5084100174 1/1/2017 1/1/2016 MED EXP (Any one person) $ 15, 000 _ LiabilitV�'�s.�,�+t� Form PD PERSONAL & ADV INJURY $ 1, 000 000 � L•h�l"�„ AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGAT ,�,... _�_ _ v � E g 2,000 000 --... _. _..... ' _.._._. F'P3LICY X�p�4,�f' �� PRODUCTS-COMP/OPAGG $ 2�000,000 f_- ��.�,�. _ _ _ ���,.d�-:��: $ AUTOMOBILE LIABILITY ��:��v1f�19Nf f9 ` IN4 I F I W�ll f' � 1 000 000 ��[',M,eroa e i�ia��a� �� n ,,, , m, X ANY AUTO BODILY INJURY (Per person) $ B__ ,,... „ �..,, .,, � e �,m ALLOWNED X ��������"'�� }{ y 4034190163 1/1/2017 1/1/2018 BODILYINJURY(Peraccident) $ AUTOS �. ��� ����D PROPERTY DAMAGE X HIRED AUTOS X pIJ'TCY,�i tPar arr rian�r `� ...., ,.... ....�..... PIP-Raeir. '� ...... . ..__....._.. UMBRELLA LIAB OCCUR EAG4i (7CGUFiFtEPJCE_ $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ Dm,,,.,... ....... .,_---- -----... Ep RFTFNTInN R � WORKERS COMPENSA710N ]{ ��H �� �" AND EMPLOYERS' LIABILI7Y STATl1TF FR A �F ^IC� [ ryEMBER EXCLUDED? ECUTIVE �YNNI N� p Y q034190132 1/1/2017 1/1/2018 � L DaSEASE �I�A FMPI t�YEE $ 1 000 000 If yes, describe under DESCRIPTION OF OPERATIONS below E,L, DISEASE - POLICY LIMIT � 1. 000 . 000 C Pollution Liability and PGIARK05414-01 9/17/2016 9/17/2017 �9,OQO,Q00 Per Occurence $10, 000 C Professional Liability PGx�x05414-01 9/17/2016 9/17/2017 $1,006,QQQF'er�laim Deductible DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Addltlonal Remarks Schedule, may be attached if more space Is requlred) Project: Kapok Terrace Sanitary System, Project #15-0036-UT Where required by written contract, the City of Clearwater is add'1 insured for General Liability (GL) as respects ongoing & completed operations on a primary & non-contributory basis and add'1 insured with respects to Automobile liability. GL, Auto & Workers Comp policies include a waiver of subrogation on behalf of the City of Clearwater as required by written contract and where allowed by law. Insurer will endeavor to mail 30 days written notice of cancellation to the certificate holder. � CANC��.�A SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Clearwater THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Engineering Department ACCORDANCE WITH THE POLICY PROVISIONS. Construction Office Specialist P O BOX 4748 AUTHORIZED REPRESENTATIVE Clearwater, FL 33758-4748 - - . ,. �- GVa�nr3y H:9.r�c�s�ra/V5].CJ • "-"�, ��, . �- OO 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014l01) The ACORD name and logo are registered marks of ACORD INS025 �zoiao�� �p� DATE (MMIDDIYYYY) ��`'�"" #� CERTIFICATE OF LIABILITY INSURANCE io/la/aoi� 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(s). Pao�ucea c�a�axn�,�' Gr���s�� �°�a.�a��on VTC Insurance Group Troy Office 1175 W Long Lake Road, #200 Troy MI 48098 .,,m..... ......... .. ,,., .,,,�,�,-._,_, , ._, INSURED Suncoast Development of Pinellas County, Inc 2340 Destiny Way Odessa, Florida 33556 gl�u (239) 275-8226 � � I�'"�� czs9y 275-68374 ---- -.._._ — f �A. f; d4G�?� -- _,,,,, M whingson@vtcins.com IN$I1RER A:St . PdLll Fire and Marine Ins . Co . .__—....... ......... ............. ....... ................................ iNsuReR e:Travelers Prop. Casualtv Co of Amer INSURER D : INSURER E : COVERAGES 4���iT'��I�ATE NWNMBER:z017-2018 L7t�r IM 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 THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INb__. . _,... ------ LTR POLICY EFF POLICY EXP � TYPE OFINSURANCE in�c � wvn POLICY Nl1MeER lM..mlloo/VVVVI !MM/_DD/VyY�1 LIMITS COMMERCIAL GENERAL LIABILITY �� FP,CH C7Cf_;UFiK�FIVCF � .... � CLAIMS-MADE I. � C��CUFd PaFnnicFc r�ENTEC7m � 9CShAqAGE l C) -..,�Fa n ,n 1 � .. ,,, ,,, ��4,. ....... P�ED E7C4' (d�nY �ne t�rsan� $ � PERSONAL & ADV INJURY � GEN'L AGGREGATE LIMIT APPLIES PER: �EI`JEFildL AGGRF_GPo7E $ -- Ga�CG� POLICY �' Y��',;� �__� LOC PRODUCTS COMP/OPAGG $ __ - t7�F�t'�: $ AUTOMOBILELIABILITY ��YfM�➢I�i"C)uI�1C�u LIM4B1 � 1�;r_� ir�ir��uu..t� --- ----- .., . �ANY AUTO BODILY INJURY (Per person} $ ALL OWNED .. S�HEC7IJI_F_D � _.... __ „ , „ m......._ �� AUTOS m, ,,,,.,, AUTO5 BODILY INJURY (Per acciden4) $ . NON-OWNED I�I��'bp"�{i1"'Y C1�tlU�a�ky $ HIRED AUTOS AUTOS _,(f'�u �ec;dr9�.rit �' �� __,_ __m mm�n�.� $ X UMBRELLA LIAB X OCCUR � EACH OCCURRENCE � _ 4,OOOr000 . �_ .. m. A EXCESSLIAB CLAIMS-MAbE ZUP-91M7304A-17-NF 1/1/2017 1/1/2018 p�(aCxFiECaATF_ $ Q.ppp ppp � __ _ _ --. � _ „ .. ,,,, „ . � ,._ _.._.. f)Ff7 X RETENTION $ 0 Follows GL, Auto, Work Comp �; WORKERS COMPENSATION ��� ������' AND EMPLOYERS' LIABILITY Y� N ST??i iTF � FR ANY PROPRIETOR/PARTNER/EXECUTIVE E,L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? � N I A — � (Mandatory In NH} E.L. DISEASE - EA EMPLOYE ,$ If yes� d�s��iaia� under � _...... ��. DESCRpp��N'� d(S�� OF OPERATIONS below E,t f31S�A4F F�tlI..,ICY I IMIP R B Inland Marine QT-660-6F301211-Tii,-17 1/1/2017 1/1/2018 Leased/Ren[ed $300, 000 Any One 14em DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Addltlonal Remarks Schedule, may be attached if more space Is requlred) Project: Kapok Terrace Sanitary System, Project #15-0036-UT Umbrella/Excess liability coverage follows form over GL, Auto & Work Comp. Insurer will endeavor to mail 30 days written notice of cancellation to the certificate holder. TE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Clearwater THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Enqineerinq Department ACCORDANCE WITH THE POLICY PROVISIONS. Construction Office Specialist P O BOX 4748 AUTHORIZEDREPHESENTATIVE Clearwater, FL 33758-4748 A:1_ar� c"t��nct.l�:r�VS:I�J � -- ____._.._.� O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 �2o�ao�> Blanket Addrtional Insured - Owners, Lessees or Confracfors - with Praducts-Completed Operations Coverage - Limited Liability Endorsement This endarsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART It is understood and agreed as folfows I. q Isc,w 'h���t� C' � /��d C�d'�����C":�� ��s �A�a� n� �rr��� n����I' ��� �ai¢I ���t �kxp ���,t����� sao�� ��s�i;,�m� ��r' ����������=�,:�t��A�n ���N�c�u�� ����� �,�r��s��t.� Nr�M���a�4��;� I� w��,t��Jo���� ���« �����ktc�aN ���r��Na�.t 0���:���� .K,� ���tw �tr,1�?i��a�r�dal Nr���a�c��r� �rr� tl�p��, �'a�vu�� ��au�� �"��cf, �d'�� lu'�ua�r� ����� �aa�.�� p���o�°;��a� t��'�� �sa����r�n�����l�a����pa a'( ��n�y� �,�� cm��r ����� ^ � � �a�s�dP� ���k �.��¢ �r� 8��.��'������ �4l<�� ����w�*p"�9 trz� l�zs��� � r��Pr�r� �;� o����ut_ � f�a�v��.w�aNa'� ����a���r ���s",'�aau� r���� ����w�fiNt°tia,�w�ii�rrt w;» ��A� IN�;����o�°��sE �r��8y w�a�lr m�,������.c'�� ��� M;u���,G� �.r�:r,.��auz °:�d a�����M���i������r;rm� "�; lc�����l�t� for: A. bodily injury, property damage, or personal and adverfising injury to fhe extent caused by: 1. the Namec! Insured's acfs or omissions; or 2. the acts or omissions of those acting on the Named Insured's behalf, in the performance of the Named Insured's ongoing operatians specified in the written contract; or g. �o��rA�r �����try or g�� �ap���^r�,y da���;���w� i��9�6°re extent caused by your work specified in the written contract and inc1�������'� ir� the prma�c��+m�.�ti,r�-con�����k��1 ��aerations hazard, and only if 1. the written contract requires the Named Insured to provide the additional insured such coverage; and 2. this coverage parf provides sueh eoverage. II. �.��,p��J����:� always to the ierms and canditions of this policy, including the limiis of insurance, the Insurer will not �,�p��+���9� such additional insured with: A. coverage broader than required by the wriften contract; or B. a higher limit of insurance than required by the written contract. III. The fir°��:m�france granted by this �a������rsement to the a��<Cu�N��r�°1r��d insured �J�.b��:�� n�r�� ����'���ly to bodily injury, property dam;��p�, �r persona! and adve�ri6�,'rng injury arising ����� r��: A. acts or omissions of the addiiional insured, or of a���ra'Mr�rU �.'�cting on CCuu� �a��di9u�auu�P insured's behalf; or B. the rendering of, or the failure to render, any professional architectural, engineering, or surveying services, including: 9, the preparing, approving, or faid�t��� ta pr�'���r�re or approve maps, shop drawings, apinions, reports, surveys, field orders, change ordr;�r� car dra�uod��ds and specifications; and 2. supervisory, inspection, architectural or engineering activities; or C. any N�s������'�a5es or work for whi� ar �N�ro�� addi��'k���pP���l insured is sp�cifically listed as an additional insured on another end�:��a9�,��'�ent attached to this r°�aw�'�q�age ������r�. f'�. N�a��r�ti�P���Y�rNaM9irro��� ,�����ih'-uur��, d�:� tPq� t�r�����,'ror�w�� rrm al��s;�� ��,�,^�w�r��� a rutbll��.,� (���d���I R�t����� C�N�' f�b ���t� N S�«�3�i� �T�"�"' f;��lUC7�"'�"���C���, �N��.� ����rt�rS��rr� �t�a�tf�� t�k�lw��a° C�a �ar�����.�, I�ao� �c� ����a-�P���� �, �.s �.��e� r � ��� daq9 ��rdsr�'��e� sati zk���r�� �� ����°ai1 �@r��:^ R�� dd��w u�t�l�id���rr°im;;�l W�� �iia�;��;� �+�Ir�=sCtl�r��P� �r� ��� �rrq��H�sa��y � x�� ������� ����r��u�"m����.rdP a�,d� a�P�� «t���� a 9a ��s�:� I����v�:�wd �� ot d�u�, 1r7��+�ro�,a��ra�� �.� �a:�r�a.A������i C:�� w��r°��.t���+w� �r�r���r���:4 ��a �wt�� ��wi��M���e��r� ti�iaa�.� ��a��h a���a��i��tl��,a�ti��r�v 4f�o g ir� 4�p �r7i;n �,�iIP �ra„ ����io`r�aue� ��rr�'� w°u���o.. �w��pb�oik.���w���ar�� r��f��Ydv�� ;����Y��ly t�a n��:,t�r��srra�� �ed� �+��°wu� Yi 9��a� ���9ti�p�4�;�o�w��t3 arw.�.�G��.��� � m�.e u���rr�a��l ����.���t�P�6, V. Sa�Prw°ly'�d'P�r respect to the insurance gran,ed by this endorsement, the secfion entitled COMMERCIAL GCNEfiAL L�e�aF�II.,C`1""��" CONDITIONS is amended as follows: C;IVf�,7�yC1�1Xi4 (1.�;�) F'�r�e 1 aif t �;r�pyQiyuqC G:u�d4 f4�R µ'<ic�}k�C. G�tn..;^�:�cva.t�8. Oo�u��..t9az,.ro capryria�Pturc4 dtt�icmu�:�ri�l t�� Oo�ia:G���auv¢ac `���vue:r^s 6�6�icc:, Idxc.,. �roRV�u'�P., pa rrr��i°��^;Irrri� Blanket Additional Insured - Owners, Lessees or Contractors - with Producfs�Completed Operateons Coverage - Limited Liability Endorsement �...�...._ a __.... .. m __ � . . _. �. ...._ ... _� .m___ ... -_� � �. The Condition entitled puties In The Event of Occurrence, Offense, Claim or Suit is amended with the addition of the following: Any additional insured pursuant to this endorsement will as soon as practicable: 1. give the Insurer written notice of any claim, or any occurrence or offense which may result in a claim; 2. except as provided in Paragraph IV, of this endorsement, agree to make available any other insurance the additional insured has for any loss covered under this coverage pari; 3. send the Insurer copies of all legal papers received, and otherwise cooperate with the Insurer in the investigation, defense, or settlemenf of the claim; and 4. tender the defense and indemnity of any claim ta any other insurer or self insurer whose policy or program applies to a loss that the Insurer covers under this coverage part. However, if the written contract requires this insurance to be primary and non-contributory, this paragraph 4 does nof apply to insurance on which the additional insured is a named insured. The Insurer has no duty to defend or indemnify an additional insured under this endorsement until the Insurer receives wrilten notice af a claim fram the additional insured. VI. Solely with respect to the insurance granted by this endorsement, the section entitled DEFINITIONS is amended to add the following definition: 1,�'rw�t;��� co����ta���ct r���r���ns �a� varritten contract or written agr������cfi���t that requires the ��������� Insured to make a p��r� ;�,res� a�r or����aiza��caa� an �r�����ional insured on this cover.;x��� ���r°'�, provided the con��,'-��4 c�r «;�greement: A. is currently in effect or becomes effective during the term of tl�is policy; and B. was executed prior to: 1. The bodily injury or properiy damage; or 2. The offense that caused the personal and advertising injury for which the additional insured seeks coverage. Any coverage granted by tliis endorsement shall apply solely ta the extent perrnissible by law. All other terms and conditions of the Policy remain unchanged. � � .., . �,,�,_ __ �h forms .� pari oi �nd is for �fta..� �, ...., e� �. � __.,, �e . .� ���___ �hs,, �ndorsement whio �.. chment to tfle Policy issu�d by the designat�d Insurers� tak�s eff�ct on the �(fective �f�ie af sas¢� F'oli�y �i th� hour stated in s�id �'alicy„ un(�:ss ancather effective date is shown t��lavv, and a �{�a�.��.�.; con� �.r��rr �Y�x�i� with said I ���K��:y ........ �. � , . ,..,.. .. _. ., ___. _ _ ....... ._._... . CfV�,75089XX (1-15} 1'�ge 'I_ oi 2 4�sGyyrr`rqP�yV �,oVA� �!0 FW6yu'et� G�tC�r,c;rv�Qd Our�cusu�G��� 2:��s,�°iri�Y7V�d rt��ak�ria�l r.a�4 On^�aurn��a�cn�, ba:u�,d�rc.a�aa �7Ysh��� do�c wt�fl8� :���i p?�.�u�ois�si�r.rob, ' al Liabilit Extension Endorsement Contractors Gener y ..�.. . n...� _ - � .. --- _ � � . _... .. ____�..n.. _. ..w�. �a It is understoad and agreed thaf this endorsement amends the COMMERCIAL GENERAL LIABILITY COVERAGE g��,��" as f��dlows. i� �ny �ot�°����p �°ri��'���r���,�ntitc.��t°i!� �..lfr:���hr����'�� fo this policy amends any pr���rpsion �i�s�'� am��a��f��d by this ��r�c���a��^�em��u�, then ��t���t oaPt����o� �.r���a����.�,��wrd��e��t �;�^rr�t���,�s9�� �r��h respect ta such provision, <���'c�g��� the �;d�w�.���ges ��r����� by this ��u�Y�wr� �em��s���S with r��s����ct tt� ���u�°�°b �r°��ru��a����� ��a� r�bc�� �a�����d�. TABLE QF CONTENTS 1. Additionallnsureds „ „ 2. Additional fnsured Primary And Non Cvn�tributory To Additional_Insured's Insurance .�e... 3. Bodily Injury– Expanded Definition 4. yBroad Know... _ .�....._..... . .. �a� , ledge of Occurrence! Notice of Occurrence 5. Bro.,..� ...._ �.... .... , .._ �„� e.e ad Named Insured 6. Broa�.� h, g g d Your Work dened Liabili Covera Ye For Dama e To You r Product An.__. .�. ....... � __._.. ,.....— ..e_..n_ . m.r . 7. Contractual Liability - Railroads Electronic Data Liab� 8. _.�� �...... . , .. ility ... �...�� _ 9. �states Le al Re resentat � e., �_.,_. � _ ., . ... m., �. - , g p ives and Spouses � �. _. , �� � ,.... 10. Ex ected O�• lntende . _..... e. p � ry p orce _..�,� , n.�..._._ .��, d In u Exce tion for Reasonable F�_., _ � . , �_.., � ��. .. _._ 11, General Aggregate Limits of Insurance – Per Project � ....� m.. . .�, .....,,,,.�. 12. In Rem Actions 13. lncidental Health Care Mal ractice sm. .. w m _. ..,�. � � ��,. � � p Coverage ..���. ....., . m � ,.� r�..._ _ . . ....... .. ... .... , _ _ 14. Joint Ventures/Partnership/Limited Liability Companies .... .. ,,,, _ . _ �., . P, .. a . . �, , ..... , ..,.,w ... ���� .. � Mm....._ . . e.. �.,.� 15. Legal Liabilify � Damage To Premises ! AlienaYed Premises P Property In The Named fnsured's Care, Custody or Contro� �. � _�._ .... .. �.,_ _ 16. Liquor Liability 17. Medic���� ��� �„ �� � �� ,� :_ r al Payments __. ���__. � . � __ .._ ... m --- ..... — 18. Non-0wned Aircraft Coverage ...., . ... ..n. .n ._ _ , ... ...._� . _ „ .... _ . 19. Non-owned Watercraft 20. Perso...... �,a � __ .. ... ,.._ �...._ „ . . ��_ ,w. nal And Advertising lnjury � Discnminatian or Humifiation 21. Personal And Advertising In�ury - Contract �� �� �������� �� .. � �� ' ' ual Liability �.._... �, . � ,..... �,.... 22. Property Damage - Elevators 23. Sua ..��.�ww ,,. �_. .�_, ._ .�.. pp mentary Payments m.... . ..__ _...._ ..m .. ..� . �. 24. Unintentional Failure To Disclose Hazards _�, _. ,. �_ .m,..., _ __ ._ __ w., e, � ._ � . 25. Waiver of Subrogation – Blanket _ �� �.� .. . . __ ._ 26. Wrap-Up Exten � ����� � �� ���� .m �,� .. sion' OGIP CCIP,, or Consolidated (Wrap Up� Insuranc� Programs �._ �_. CNA74705XX (1-1�i� �' �c�� "fl �; � `tl �' G;eappyrr�'wa�P�iP �t:':V�dW �di0 I�%oc�yPtl.� V��a:,^a�r'are:aE, uu'o��Ui.u�c�= �as:rp�yri�o¢�Y�iOp+^a:u r'o'u�P.�uoa�� rzV� �nsuaowancm: �c:avrVz,e��� �:7ffuce�^, M1er�: ,�nridVr iCr� gar,.���i'u�uu��vr,.urx, ' ` y Extens'on Endorsement � ..�., . �P.. ... General L�abilit. .., v ���.m� �a... . ..�.....�..... .� ,...._ �..... . a.� Ne,.a Contractors..� 1. ADDITIONAL INSUREDS a. WHO IS AN INSURED is amended to include as an Insured any persan or organization described in paragraphs A. through H. below whom a Named Insured is required to add as an additional insured on this Coverage Part under a written contract or wrilten agreement, provided such contract or agreement: (1} is currently in effect or becomes effective during the term of fhis Coverage Pari; and (2) was executed prior to: (aj fhe bodily injury or properly damage; o� (b) the offense that caused the personal and advertising injury, for which such additional insured seeks coverage. b. However, subjecl always io the terms and conditions of this policy, including the limits of insurance, the Insurer will not provide such additional insured with: (1) a higher limit of insurance than required by such contract or agreement; or (2) coverage broader than required by such contract or agreement, and in no �vent broader than that described by the applicable paragraph A. through H. below. Any coverage granted by this endorsement shall apply only to the extent permissible by law. A. Controlling Interesf Any person or organization with a controlling interest in a Named Insured, but only with respect to such person or organization's liabiliiy for bodily injury, property damage or personal and advertising injury arising out of: 1. such person or organization's financial control of a Named Insured; or 2. premises such person or organizaiion owns, maintains or controls while a Named Insured leases or occupies such premises; provided that the coverage granted by this paragraph does not apply to strucfural alferations, new construction or demolition operations performed by, on behalf of, or far such additional insured. B. Co-owner of Insured Premises A co-awner of a premises co-owned by a Named Insured and covered under this insurance but only with respect to such co-owner's liability far bodily injury, property damage or personal and advertisfng injury as ca-owner of such premises. C. Lessor of Equipment Any person or organization from whom a Named Insured leases equipment, but only with respect to liability for bodily injury, properiy damage or personal and advertising injury caused, in whole or in part, by the Named Insured's rrraintenance, operafion or use of such equipment, provided that the occurrence giving rise ta such bodify injury, property damage or the offense giving rise to such personal and adverfising injury takes place prior ta the termination af such lease. D. Lessor of Land Any person or organization from whom a Named Insured leases land but only with respect to liability for bodily injury, property damage or personal and advertising injury arising out of the awnership, maintenance ar use of such land, provided that tlie occurrence giving rise ta such bodily injury, property damage or the offense giving rise to such personal and advertising injury takes place prior to the termination of such lease. -Che caverage granled by this paragrapli does not apply to siructural alterations, new construction or demolition operations performed by, on behalf of, or for such additional insured. �°.fV��4r�w�X� ��...�;� k��a.���o� � cr�f� � � Garay�fr�l�l CYdA rll( Fti,r�hl^� CCc�s�r�sr.��ri. I'�rcluatt^;;. rca�:�,y^rlgV�iCed rn�la^r�itbi c�f Rttsuranas� .:�¢�evdce�; y C'�4fce, frrc � wlilt it:s �aenr7f�»,iarr. � � � � , �.___ Y � �__ _ ��.. _�..�u_ . w _.� ........ , _ _ � A�.. ._.. _ ..... . � y ion Endorsement � . �.� . ._ .... u.� Contractors -General Liabilit Extens � _ �_r .. ... . _ , r ....a. E. Lessor of Premises An owner ar lessor of preinises leased to the Named Insured, or such owner or lessor's r�al estate r�����a�����r, but only with r� ���,������d C���� liability ior l��<,�t�ily injury, property damage oc �a�arc'�r�r�r��N and advertising i�ro�t�r°�' �rising out of the �°�wvrt���':;a�brp, mainten���ro�.��m or use of such part of the pre���r�z���w� I��-����ed to the Named Jr�stcred, and provided tl7a# tl��: occurrer�ce giving rise to such bodily injury or prape�ty ciam�c�e, or the ��,4���^���„�e �iving r����^ to such persafial and �a�t�c����#isir�g injury, take� pl�ce prip� �� thc i��r�d���'r�aro�`�i��a�� of such N�M����. '��Ite cavt�r��„��e granCed Y�y� ii�is parag���;�Pr ����s not apply lo struclural alt�r�.r���:wns, d�����w� ��b��������ctinn or demolition operafions performed by, on behalf of, or for such additional insured. F. Morfgagee, Assignee or Receiver A mortgagee, assignee or receiver of premises but only with respect to such mortgagee, assignee or receiver's liability for bodily injury, property damage or personal and advertising injury arising out of the Named Irtsu►•ed's ownership, maintenance, or use of a premises by a Named Insured. The coverage granted by this paragr�ph does not apply fo structural alterations, new construction or demolition operatians performed by, an behalf af, or for such additional insured. G. State or Governmental Agency or Subdivision ar Political Subdivisions — Permits A st�te or governmental agr:,wb����+� or s��k��fu�i��„iG���w or poht�r�•���@ ���b�°�r��w�i �d��t`� that has issued a permit or authorization but only wiih r�:�����^ct to �����G�1��� :��,�le or go�r�������rt������� ���;��-��ncy or subdivision or political subdivision's liability for bodily injury, property damage or personal and advertising injury arising out of: 9. the following hazards in connection with premises a Named Insured owns, rents, or controls and to which this insurance applies: a. lhe existence, maintenance, repair, construction, erection, ar removal of advertising signs, awnings, canopies, cellar enirances, coal holes, driveways, manhales, marquees, hoistaway openings, sidewalk vaults, street banners, or decorations and similar exposures; ar b. the construction, erection, or removal of elevators; or c. the ownership, maintenance or use of any elevators covered by this insurance; or 2. the permitted ar authorized operatians perFormed by a Named Insured or on a Named Insured's behalf. The coverage granted by this paragraph does not apply to: a. BodiPy injury, property damage or personal and advertising injury arising aut of operations perfarmed for ihe state or governmental agency or subdivision or political subdivision; or b. Bodily injury or praperty damage included within ihe products-completed operations hazard. With respect to this provision's requirement that additional insured status must be requested under a written contract or agreement, the Insurer will treat as a written contract any governmental permit that requires the Named Insured to add the governmental entity as an additional insured. H. Trade Show Event Lessor 9. Wrth respect to a Named Insured's participation in a trade show evenf as an exhibitor, presenter or displayer, any person or organization whom the Narned Insured is required to include as an additional insured, but only with respect to such persan or organization's liability for bodily injury, property damage or personal and advertising injury caused by: a. fhe Named Insured's acts or omissians; or b. the acts or omissions of those acting on the Named Insured's behalf, ��J�7�70��)C (T-15} P��r�� 3 of 1 i C�;vpyri,�trfl �Na� la,6( Ri,y@a(�s V'dcesr�svec4 Inc.lucle^r r,c��ryrB�hY�:�� rnxsferi�tl erf fri,ur�rmc:e: ,°;¢�rvac��s O[CcG�.*., Cib�:., ua�iHl�@ if^� y�errnis5ior0 ' ilit Extension Endorsement Contractors General L.iab y in the performance of the Narned Insured's ongoing operations at the trade show event premises during the trade show event. 2. The coverage granted by this paragraph does not apply to bodily injury or property damage included within the products-completed operations hazard. 2. ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY TO ADDITIONAL INSURED'S INSURANCE The Other lnsurance Condition in the COMMERCIAL GENERAL LIABILITY CONDITIONS Section is amended to add the following paragraph: �� 'f,Pa�� �M:��:7���� Nrr�:a�r�a� I�� � �ra�ra����d ar� +�✓rpqad�c�p iru <a t��M�C��ro�:t c�r ���°��rrr�s�6 �qr�1 �PGu;� rW�.;��id�n�asr�.�: M;� �Sri�����ry� �A�� r��rr�.. N.��'WG"h�P6�%�1R�P'�" f���»��PWQ°. ��� e"�d"V ���f�dC6��["�v,N� �C�:ii.9r°"��"��`°.,`w C3'�W{E i�q°��k14r,i�19C,t"�h �AMC�.GI ��G#�u"� Y�Y:"aiaCc-6d7�'C:"� A;�a ���Nn1���C��+ z�0"i(� ��Y� IOY�I�NI�� W'v"}G� ru��. �a����Ww �r�llrsE������e�an 1�c�rr�� �����& ��N�� r ta��ta�r':sr't�,�. 1=��� tik�� p�t�r���,�r ��t ltb��`r ��r���ra�;r��n�� � , fk�� �'a�B�BiG��r���P �qu���ta���l",� �v�u� Ia.H�;4�.YYr�N�tl��d�' �"G1i;�1Y�� tlN'@�I�R���G�BI�: i"�N"4 �,+9ti�1d;�4 ��kG? .�l"�C�ikR9z���7�� ���.�C�f�'�i tlo�� x"� p'�'��iTlE7�S� q��,���6i���a �)��iC���+"o°I��„", �X7� Y"uC7��4"6CN�'���1t��i�f��� anything to the contrary ���r��rha;�e in this Con��iAon, the insurance provided to such person or organization is excess of any other insur�r��� �:�vailable to such p��.rsoi� or organization. 3. 80DfLY INJURY — EXPANDED DEFINITION Under DEFINITIONS, the definition of bodily injury is deleted and replaced by the following: �s�����'y injury ����x:���w���� phy;�se,w�P a���ac�, sia����za���:� or disease sustained by a person, including death, humiNr��t�c�n, ,„�p��per�;�k„ mental ��r�;�ara��� or �r���u�t�� yr��a��ry :�u���t������d by that person at any time which results as a consequers����� of the physical injury, sickness or disease. 4, BROAD KNOWLEDGE OF OCCURRENCE! NOTICE OF OCCURRENCE Under CONDITIONS, the condition entitled Duties in The Event of Occurrence, Offense, Clairn or Suit is amended to add the following provisions: A. BROAD KNOWLEDGE OF OCCURRENCE The fJamed Insured must give the Insurer or the Insurer's authorized representative notice of an occurrence, offense or claim only when the occurrence, offense or claim is known to a natural person Named Insured, to a partner, executive officer, rnanager or member of a Named Insured, or an employee designated by any of the above to give such notice. B. NO710E OF OCCURRENCE The Named Insured's rights under this Coverage Part will not be prejudiced if the Named Insured fails to give the Insurer notice of an occurrence, affense or claim and that failure is solely due to the Named Insured's reasc�r���le belief that the bodily injury or prop��t� ti��rr����e is n��� ���r�;;�ra��' trw�r���:�wr this Coverage Part. However, �.��� Named Insured shall give written notrd::��� �'�� ����A�wB'� occur�r�:ii��:, �����f�r��p�� or daim to the Insurer as soon as the Named Insured is aware that this insurance may apply to such occurrence, offense or claim. 5. BROAD NAMED INSURED WNO IS AN INSURED is amended to delete its Paragraph 3. in its entirety and replace it with the following: 3. Pursuant to the limitations described in Paragraph 4. below, any organization in which a Named Insured has management control: a. on the effective date of this Coverage Part; or b. by reason of a Named Insured creating or acquiring the organization during the policy period, qualtfies as a Named Insured, pr��va�,9��d that there is ����� a�atl��ar� vm���r"'�ilar li��k��lr��� ar���wr��r'7�:��, �hetP�c�r p�r��r������°, contribuloiy, excess, contingent or c7tl����rawise, which pr�-��va�i�:� �;�,�'�'����'��ge to ;�.a����� �ar�����t'����ai�a��� or wR��i�c;�u ������'1� have prov)ded coverage but for the exhaustion of ils 6'����9�i, ��ws���' uvudhout �zn��u�d�°� �d:a '�°��e�tB�s��"r its �,w.rw��ra��� i� broader or narrower than that provided by this insurance,. ��:I�f��T47Q5iC}� �1-15} ���c��� �d of 17 Cop�rV_yhfl C:fVh f�ll Fii€�ttP°� F2es�rved, Vrrc:Mucfe� c�y4�yric�lyle;d m�{�nial raP Insa}o�anc:c Scr'.✓ic�:s C)IPICk;, i�YC.,, VV1il1 145 {:£:PtP11S51CPfY ' eneral Liabilit Extension Endorsement Contractors G Y [3ut this BROAD NAMED INSURED provision does not apply to: (a) any partnership, limited liability company orjoint venture; or (b) any organiiation for which coverage is excluded by another endorsement attached to this Coverage Pa rt. For the purpose of this provision, management control means: A. owning interests repr��c�r��ar�g more fhan 50% of the voting, appointment or designation power for the selection of a majorit� �� tf�� Board of Directors of a corporation; or B, having the right, pursuant to a wriiten trust agreement, to protect, control the use of, encumber or transfer or sell property held by a trust. 4. With respect to organizations which qualiiy as Named Insureds by virtue of Paragraph 3. above, this insurance does not apply to: a. bodily injury or property damage lhat first occurred prior to the date of management control, or that first occurs after management control ceases; nor b. �'��'mr'�.��,��'���I or advertising ��tjury caused by an offense that first occurred prior to the date of �o���m���e°;����ent control or that �i�rsl occurs after m�inagement control ceases. 5. The �r�,���krr �q����=� provided by lfrG�� �,cau�r"��r��� Part appqt��� to NaNmra�w�<d lnsureds when ��p��.�auw¢� under their own nam��;� ��� �Aa��'����r such other �xa���ii�ra� r�a��r�z�. ���sr doing-b���,��}��ess-aM� ����o��es (dba) as any ��a��'y���r�� Insured should choose to employ. 6. BROADENED LIABILITY COVERAGE FOR DAMAGE TO YOUR PRODUC7 AND YOUR WORK A. Under ����i."I'���.�� �a Coverage A— Bodily lar�ta'o�r and i�r�;ap��rt� Damage Liability, t��� paragraph entitled Exclu's���r�� d���.����r„«u'r��ed to delete exclusions !�. ��t"rc� f. an� r����i�;���� them with the follow�rw�'� This insurance does not apply to: k. Damage to Your Product Property damage to your product arising out of it, or any part of it except when caused by or resulting from: (1) fire; (2) smoke; (3} collapse; or (4) explosion. I. Damage to Your Work Prape�ty damage to your work arising out of it, or any part of it and included in the products-completed operations hazard. This exclusion does not apply: (1) If the damaged work, or the work out of which the damage arises, was performed on the Named Insured's behalf by a subcontractor; or (2p If'the cause of loss to the d�maged work �ri�es as � re,�ult of: (a) (ire; (b) smoke; (c) collapse; or CNA74765YX (1-15j F'age 5 of 17 1'�r.ro�roy��iqRul: C;d�F4�';III �'�u�ghiks k�t�r,a:rva�96:R Oo"i,r,li.iG�a:;a c';a�qyric��xla!�rf Rrr�u�o�ia�f aif 8rt:�'su�r;�rac� ��vr.��i�vice,.��. uJ�fltici��, Nnc., Wval07 �M1� p'��rr'��i^�;>iar��t ' tension Endorsemeni Contractors General Liabelify Ex (d) explosion. B. The following paragraph is added fo LIMITS OF 1NSURANCE: Subject to 5. above, $100,000 is the most the Insurer will pay under Coverage A for the sum of damages arising out of ar�� +��r��� occurrence �����use of property �i�r�^��ge to your' b���rt����ct aa�� y'����r ��r�k tl��� �� caused by fire, �rr�r�p��,, collapse or �����osion and is inclu���c� within the p�a°�a�N.��t-cort���l�ta�d �,���a•ati�A�:a hazard. This sublimit does not apply to property damage to your work if the damaged work, or the work out of which the damage arises, was performed on the Named Insured's behalf by a subcontractor. C. This Broadened Liability Coverage For Damage Ta Your Praduct And Your Work Provision does not apply if an endorsement of the same name is attached to this policy. 7. CONTRACTUAL LIABILI7Y — RAILROADS With respect to operations perFormed within 50 feet of railroad property, the definition of insured contract is replaced by the following: Insured Contract means: a. A contract for a le�se of premises, However, ihat porlion of the contract for a lease of premises that indemnifies any psrsan or organization for damag� by fire to premises while rented to a Named Insured or temporarily occupied by a Named Insured with permission of the owner is not an insured contract; b. A sidefrack agreement; c. Any easement or license agreement; d. An obligation, as required by ordinance, to indemnify a municipality, except in cannection with work for a municipality; e. An elevator maintenance agreement; f. TFrat g:���ar°S ��� ���°�y other ������r���ct or .ac���a��ament pa.>����ining to the Named Insured's business (including an indc.nrs9'if'0� �:o�i�rr� of a m�wr�r�`�¢�a�A�!�lity in �����A��ection �vofl�� work performed for a municipality) under which the Named �r�;��Nr�d assumes the tort liability ��P �:��'b���iha-tis` ��arty to pay for b�dily ir����ry or pro������+ �d�orG�;���r���� to a third pe�;;���� �aw�mr organization. Tort liability n�xtiz�xb:� w� h;��d��fity that would be impo ��.� by law in ld i�° �aq� �� u��,�� ���� any contract or agreement. Paragrapl� f. does not include that part of any contract or agreement: (9) That indemnifies an architect, engineer or surveyor for injury or damage arising out of: (a) Pr��Mu�orig, a�a��r'cavfr°�g or failing to pr��p;���re or approve maps, shop drawings, opinions, reports, surv��y:y� field rr�'r��:�r�'b, change orders or �r��wings and specificat+ons; or (b} Giving directions or instructions, or failing to give them, if that is thie primary cause of the injury or darnage; (2) �:�'����,'�er which the Insured, if an �ir��7d6.ect, engineer or surveyor, assumes liability for an injury or damage ��;���p�,png out of the insured's ren��R�'i��� or failure io render professional services, including those listed in (1) above and supervisory, inspection, architectural or engineering activities. 8, ELECTRONIC DATA LIABILITY A. Under COVERAGES, Coverage A— Bodily Injury and Property Damage Liability, the paragraph entitled Exclusions is amended to delete exclusion p. Electronic Data and replace it with the following: This insurance does not apply to: p, Access dr Disclosure df Confidential Or Personal Information And Data-related Liabilify Damages arising out of: ��iv�a�a����� �� �,�} r����. r �t °P � +';ra�yri�yl�r( �YdF� f41112ighl� k'�t���rv¢��d. @rrwlueS�;, �;nf:r.yrr�P�u¢:�a Krr�rlrrial UP lirawnarrc:e ��rvi�::ars t::)fiic:�, ln�... ^eviV£� fC:a p.rpa�rr�issian. ' General Liabilit Extension Endorsement Contractors Y (1) any access to or disclosure of any ���°�`;�or�"�' or �r�������d����Nu��'� �»� ���a"gfb��e����•�� �� f��"� �����°��I informati��r�, including patents, trade secrets, pr��� ���snr�c� mr�Cl��ra��' A� ia'wda'�d�ui�� C� ��s ��a���ra� ���I oaw�'a�ur"�'�ation, crd�:,�,N��t card information, health information or any �?����er I�p::d� ��d �r�rm�.���x�6p�'= ����'���"'����"�""�� �"�a'� (2) the Va��„�� of, I���� of use of, dan�������. t'��, corruption of, inability to access, or inability to manipulate elecC�'�raic d�4x�u �hat does not re�u���! �i"���'�'� F�hysical injury to tangible property. Nowever, unless Paragraph (1) above applies, this exclusion does not apply to damages because of bodily injury. 'Q�����., c*���a�t��a�rr �����,'r�°��fp�� �;n�^���a� if �f�r��w��w��t.� ,�:�r��� d��'�r�t�b�J ��:�r' ��d�trPl�w��r�tiot ��a�slT�, ��e���d� �oG��rlitoring exq� r���g,��, ���c��� r�,.,��� �„���b��i�,��.�ti�p p.���l�C'���,, p��latia��r�� t.x�,u���:�a�.h or ��urr�^ �yC����;�" 9���M.�„ a����^�� ��� +�����a������!� �u��i,a�"r�d by the P�,��rurt�� dp���raradtC ��°ar c�9�ro�.��� «�N�a ,ot���� �'��i�� of tlN�a� w�8��(����u �� de�»����°n���a�.� id"i i" �a����r�.re���� �"���i a'�sp' ��� ������va.7,, 8. The following paragraph is added to LIMI7S OF INSURANCE: Su&������P. ��� �- above, $101�r��'��8 is the pr'�d°rWs�� the Insurer will pay under Coverage A'f��r� �II damages arising out of �rr��y� c.'���u!� occurrence ����.���.�se of ������`�erty damage that results from physica@ i�r���ory to tangible property and arises out of electronic data. C. Tlie foliowing definition is added to DEFINITlONS: 6"I��;�r�s���N�. �i��t;��,r A�at ��n»'� �A�fi�.9�r��s����ra�rfle„ i.��� t�a �^��° �q'��M����wfl�:� � ���r� ui �b � ��S' �ar� � �c °���al or Gp���,�1 k�r�„ t`�� a��tcw���°�°raikrwa� �a�u ��� t����� ��e�r����aGa�a�c ^`���f'��ru�a��� �,����,tl��w�C���� ,Ay+���rdR�r�'� �4����1 ��������fi� ��i����w.� ��s°�fd�r��ar���. $r���;��� oi° �I�������y r1fi�'„���� � I:�-���;�,�G�"��a 4�s���M�d ��r�+��w��, r��mlR�, rlsrCp;� �pr�x���^�M�uaS��� ��¢.�w�a,�.;� ���r�� ��r�� ��t��°�flo�r r�te,9�di�� �rv��dc�� a�rr. a�^��rr� wit!°t ���N�.��,lru�c�Ge,.�,�1@� ic.�������adq�.���d' equipment. p. For the purp�,;��� ���� the coverage provia�'s�a°,� by this ELECTRONIC DATA LIABILITY Provision, the definition of property da�w°����:��� in DEFINII'IONS is ra�}�;alaced by the following: Property damage means: a. ����i�p;�ical inju�� ta.� tangible property, including all resulting loss of use of that property. All such loss of use ���«�N� be d�er��c��� to occur at the time of the physical injury that caused it; b, Loss of use of iangil�le �roperiy that is not physically injured. All such loss of use shall be deemed to occur at the time of the occt�rrence that caused it; or c. Loss of, loss of use of, damage to, corruption of, inaN:add�ty to access, or ind�ka�P��ty to g�Kr����:�rP,� manipul b��:� electronic data, resulting from physical injury to tangid���: property. All such Ga��,� s�f ek+..��r°��wt�c data s�lH��ptl be deemed to occur at the time oF the occurrence that caused it. For the purposes of this insurance, electronic data is not tangible property. E. If Ele�;q�'��nic Dafa Liability is provided at a higher fimit by aX��rGWier endou >�r��+.n��t attaclied to this poli�y�„ khen the $"�C'���000 IiriiiC provided by tl�is ELECTRONIC DATA LId�����fLITY Pr��e�i�ed���re is parl of, and not in w�:��R�ution fo, that higher limit. [STA7ES, LEGAL REPRESEN7ATIVES, AND SPOUSES ����� �.��a�@a�.�, �����rc �G Cus��,a� r� �7ruH.arrva�CK�����r�,b �-sr������� �;��a��s���:� c`� a;�n�p+� r� �9����u��d g�� w.a���� ��M ��tNc,�t� �����q� s�C c� la�� afi� ��soa�:��'� uu���l���� ��o��� �r�.w@�r �r ��d�'��Ia�����.p ��ow�a�v��,�r° �,a.uv��;�����:�a��^ a-W ��f�������;��a� Rr� ���u.r� a ��<rC�'��. B�� r���-,� V� a��°�d ���.�a�a a����t �trvw °w, �r�r�i ;�A�a��.��� A� � �rr�0� ��,r r aw���r� ��� ,�i�r* ir�ua� ����8�:�i,� �r�x� ��i CNa,�dt a�4���p�:y��+�Wd�' �a�,� B xliq�� �s. .,ai��N�7 w�H�� iri ��b�� �.,4;� ��� r.�� �� ��x��rt� ���� ^�f�a���;�' � uaA,���u s,l,a�x�� �,:�a cT�d,a ���,��r��rt�r��U, fr�rrrr a-rs�Po9��l ;°�.r.rrt°aNrhr�,m���fl�^ �ro���;,�rk��, ��.�sa�A9y Pu����i ��1����r��rR`� �,rs gr�a,��� r�� I�r arG ���M•����� �r��r��a Gr�,l��� rwa�dro��a��p ��a��.�€���� Cs�� r.�r�sr� Ru� �rr°;Pr ��r�'��o:�����+� 9��� ��a��ra ��s�r„ �.� �rr��a����� r1 f�:pfi ����r ur�w� c�s���' awr ��ru�a�a��'u����� a�� �.���u�r ���x,�i��� IM� Lw', �a �� ;u@ r'r��r��.�a�d��r9'���9��^��.r„ �;�r ����a������ G��afl ������� �d�p�� �.a:��¢��� ��f �H���.dM ����:�� a�a� �� � ��,ar�^rtl:� a�r �� ���� �.� �as��r �i �aia�avw��°�n bo���^r +�a.��� �P���t �P���,.�w�����<v �,� ,� o���z���a��,tim A:rrliu��,��a� d°�,P��so���� ����� Gor�^�fi �rurs9 f�r.��� w��c��r�;�wa; �d� an�� Pit�y��o���R aroi �� iaCr��,iw� ra� y:���el �q��w4�r��° rr��. �,Y�.qB��ABd.d":Ii�dD��k ���`h�q%9N".�".'� �4'"1`'.�G,�NC`"4°'���'» �.tll"d"�' ��'i"sllSl�'"("i',"�a "VG�{p &'(.�.,o�PM,�4:�� ��."E ":'aldd°',��9 ,.a,��d�Yld»a�C��d c��4,��,��',v,� d,�'604�,��"�''w� �.q� K.'7�i'18�i�vt'C���t:�e �N� �p14'��� �,��worJ���°�G aaf t���� N���r`����c� Br��aar�ro�¢:�" � ��td��ar7��.��. C; I'°J,� (*� 7CJ::r?Ci< i °� --� `� �4 �:::b��y�, 7 �>f '17 �e��ap�ri�,�hl l"fVR6 A411 I'"i,r,�Pt(^; f�rc;:verv+�d< Ir�clutf�s s:apryerir7hle�t rr'r�a°k,rial s�( In��;�ar�r+rc� `3�rvir:�:s f�Abfr,:�, Irec;.. vvip'� i[W� pa�e�nris�iurr. � ... . _._. _ ��. ... � � e . _ � ...� � _ ..w. � ,_�. .. �. .. � � . ... m ., �.. Contractors' General Liabi[ity Extension Endorsement 10. EXPECTED OR INTENqED INJURY— EXCEPTION FOR REASONABLE FORCE Under COVERAGES, Coverage A-- ���;��a�����ily Injury and Property Damage Liability, the parw�o���°����'sph entitled Exclusions is amended to delete the a�����.�usion entitled Expected or Intended Injury and rep��;��ti'o�� it with the following: This insurance does not apply to� Expected ar Intended lnjury ��c���ly injury or prr�perty a����r��age expected or in�a�����ed from the st�.�pr���oint of the Insured. This exclusion �9���as�6;, not apply 10 bodily i����r���y� or property dam��� resulting from N9���r, use of reasonable force to protect persons or property. 11. GENERAL AGGREGATE LiMITS OF IfVSURANCE - PER PROJECT q, 6��r +����'� con����ka��da�t°� ��c�a���,��'�d ���� �u��rr�� ���ti�r�ii��es the Named Insured owns oe�o�������Limitsdu����w,�qain C c,a�t�������ra��q��n F'e'�'��r,�� I�'��or� ��f �h�<pr��m ��r.���tt� �,io��r`�, ������i to the amount of the General A9g �. ���;�„ d�a��P �a°�rotion�, d�:� tP�w���� r°������� N�i���:•^, V�ruA�do����r w��1f ��r;ro�'I'�;��'the sum of: 9. All �9��M��ages ��a��f'�� t,:a�+��,�r'a9e A, erc��.�t damages because of bodily injury or property damage incl���t�;�� in the p�r�c��`��t�r1 M-��'m�rEnpleted �.a���r��tiorrs hazard; and 2. All medical expenses under Coverage C, �d��� ��ro��+^ �rr�a�t ��r� r��M��wr���� ��� ���a�'�en��, �'p�aw� N� ����¢�� ���, rtl��iN.,��jted solel� �r� �rocr��oim��� ��p:a�o��iirrou� � at that �;�ropro �aA����4d��r� �a�'�o�l��r��. ������d� �aw�.�y��r�r�p�fi�� s�N��Cf r�ut c�.^�,��s�.�� �1kav Ceneral ,�w������� �&��e � ipr�a�� ��w��r��w�� in the �Y��.� 1����ti'a��aww�„ r���� �ld� �����,.°���°�a�„������� �'o�.���:�ct &,r.r������9 �.���.����,�M�t�.� C..i��°mit of any ol���p�.� s,��r����,�[r�,uc�;�a�rrs pr���a��:�. B. All: 1. Damages under Coverage B, regardless of the number of locations or construction projects involved; 2. 11���"�M������» unde� �':��^v�.m�na�� �, �w�.�w�����a��N k;y�r �a�`+���rrences �ad���a t� u�.�����d���a� be attributed ����:�������Lly to ongoing sr��t���d�����a�� at a a����-�N�� ��K�wu�0�9��;lia:��k ����r�������„�, ��u���ept damx�a��.� hw�;^��.�G�°������ of Bodily in��r�°� or properfy Q��������'a;lc� ur�cludea'9 �r�m R�r�� ��'�c��wa� ����»•���:��r�rs9a�a����1 �aperations hazard; and 3. ��w�,���°�r� expenses under �:<��+��rage C caused by accidents which cannot be attributed solely to ongoing ar���r���ad��aa°��ns at a single con�w0.r����;��ion project, will reduce the General flggregate Limit shown in the. Declarations. C. k'��u�n aGrb���r.w �ep����nr�r ww� �V���M ��awr,l���R°�R���r�n�ro �r�r' �a��;�� ���.��a�ow�;�r���� �,, d`��w� Dam��r��u N a k"r�:s��aa a�� ����raq��.r� To Yo�a s���r��S #or �die.��s���� a:::��.�����w���, c.a�rr�ur°pa��^ ��.� �.�p�p��,rC�� 8:u���� v�id9 6��� �::�Ga����;�rfi ��� a�uQlwa�wr th� �;����dlr�.�a�kia°a�a O���aj�:��r.� �.���r7er�l Aga�y�r���,�ate N�_Md�Y��� ���' ������ ����.������d ���°�������������� G_rru��K �;��ry��uv�rr �r'� ��� IA��claratir�rts, dep�ndin� on whefhe� the oacurrence can ��P�a t:��d��Al����ry�� �G:71��py� �c� �ac����4a��rc.� ��p�,,r. �wr����a��� �+C r� �a�:��iwc���lar construction project. D. '�dEr�wH�y c���� ������;� ����� Aa��k�AV6i� a�¢f�'�¢a,�� rr��P� ��� 9P���� �����a1ti�a���F-�:���r������fl.t.���� c����w°���azrxns ha�����8 0�.� q��amvgr���;�Nd, ����� ���,.���yr���:��atl�� �uar ������rw�c�a�w� ��.�r..rc ��ax.w�� a°yN i��°�cPi�y �������r+� ��� �o-ra:ro��r���' ���������A�a<�c�� �rw� d���1a�:� in the �rr��tR������-����a��pfe�����'� a,s�g��c�d�tatw�rrr�M lu�w�����`�1 ��r¢�[ rrw����� s� ��u�� N�.�,r��s��,�c����.��� f�ar�'r�s���Ktr�a� C���� ra�9�r�';�a���r � AO�t,���.�gate �,�adwot ��9��u�r� in �9M�� Y:��.,� I������o�t��°� � ��.��������a��„ , � ��P �N��� ria���P��9aµ�r �er� p��c�p�� �°���� �r��^olved. E. NC u� ara����'� b°r�rtV,dr����P�rri �a���:��a��,� ��a�x�� 7p'��t�t� �um� rrag;�a �� ������`�d! �m� ��u' s� r�la �� ta q�ss°� Mnsured fo a d�a a:�r� ab �urNt�u�r�� ��� r����d fllqa��d ra� & ar@r���� ��r �� d8tr� ��r��(Pa�yxr�e�a� ��>�rk� �� iaiu� W� rt����.v ���,����Rc� Ga���mro plaiis, ��i�rr^��s'���9s, u�9t�.,������o�, ��p��:�;^�,���r����a�,r„�ru+, ��� firtiea.�.a0�9�:��sa d�m�. �k������r�� �raial ��4all �a��� ��r>� a���'Rsi ��, �a���, Ed6rW � ������e �,rx���:�rtructi�n q�cr������� F. The provisions of LIMITS OF INSURANCE not otherwise modified by this endorsement shall continue io apply as stipulated. �:;I'�a"�✓4'�C7aai��C (1-°P�r) p:��ac�� �i e7f 1 � G;�:>�:ryeigP�P �I�JA Flil I�'2irpl�f^; I'��+�.s� rwcd Irscl�.�riE°a �r�(ayerirgfrlr�.9 rir�1��;r��al u� Ir,^>i.ir�nctt `:rr�r�efe:�� t:'Y6fi,r..�� Irif,.. wvillr Its; �rrarrni�.,sicri7. Contractors' General Liability Extension Endorsemenfi 12. IN REM ACTIONS A quasi in rem action against any vessel owned or operated by or for the Named Insured, or chartered by or for the Named Insured, will be treated in the same manner as though the action were in personam against the Named Insured. 13. INCIDENTAL HEALTH CARF MALPRACTICE COVERAGE Solely with respect to bodily injury lhat arises out of a health care incident: A. Under COVERAG�S, Coverage A— Bodily Injury and Properiy Damage Liability, the paragraph entitled Insuring Agreement is amended to replace Paragraphs 1.b.(1) and 1.b.(2) with the following: b. This insurance applies to bodily injury provided that the professional health care services are incidental to the Named Insured's primary business purpose, and only if: (1) such bodily injury is caused by an occurrence that takes place in the coverage territory. {2) the bodily injury first occurs during the policy pe��Nra�f. All bodily injury aris'a��wg� �r��wra m�n occurrence will be deemed to have occurred at the time of t��a, �irst act, error, or omi�����a��� C����� is part of the occurrence; and B. Under COVERAGES, Coverage A— Sodily Injury and Property Damage Liability, the paragraph entitled Exclusions is amended to: add the following to the Employers Liability exclusion: This exclusion applies only if the bodily injury arising from a health care incident is covered by other liability insurance available to the Insured (or which would have been available but for exhaustion of its limits). ii. delete the exclusion entitled Contractual Liability and replace it with the following: This insurance does not apply to: Coniractual Liability the Insured's actual or alleged liability under any oral or written confract or agreement, including but not limiied to express warranties or guarantees. iii. add the following additional Pxr,liisi�ns� This insurance does not apply to: Discrimination any actual or alleged discrimination, humiliation or harassment, including but not limited to claims based on an individual's race, creed, color, age, gender, national origin, religion, disability, marital status or sexuaf orientation. Dishonesty or Crime Any actual or alleged dishonest, criminal or malicious act, error or omission. Medicare/Medicaid Fraud any actual or alleged violation of law with respect to Medicare, Medicaid, 7�ricare or any similar federal, state or local governmental program. Services Excluded by Endorsement Any healtf� care incident for whicf� coverage is excluded by endorsement. C. DEFINITIONS is amended to: � u������ r��u���� � � � w.��_ � ��,���� � �� °w � C;uipa�^o'ic�Oti9 G";C�IaX d4i0 '�ir�P�i �; Fdnt��rrrca¢�, �n<.lo.idr� ;�crn�yaricyhtl�;r� rvt�pmu�.aP r,:1� I�qsiem au¢-aa �`3raiw�c:r : f���s�¢s, Gr�c.� wru4�o iP,„, p; rii76s�si�.7ru ' i it Extension Endorsement Contractors General Liab ( y i. add the following definitions: Health care incident means an act, error or omission by the Named Insured's employees or volunfeer workers in the rendering of: a. professional health care services on behalf of the Named Insured or b. Good Samaritan services rendered in an emergency and for which no payment is demanded or received. Professional health care services means any health care services or the related furnishing of food, beverages, medical supplies or appliances by the following providers in their capacity as such but solely to the exient fhey are duly licensed as required: a. Physician; b. Nurse; c. Nurse practitioner; d. Emergency medical technician; e. Paramedic; f. Dentist; g. Physical therapist; h. Psychologist; i. Speech therapist; j. Oiher allied health professional; or Professional health care services does not include any services rendered in connection with human clinical trials or product testing. ii, delete the definition of occurrence and replace it with the following: Occurrence means a health care �rt��cl+�r��t. All acts, errors or �������Aicsns t���� are logically a�c���a�ected by any common fact, circumstance, sG����,����r�„ transaction, event, �cfvme,r�;�� or ��.:��a�sion will be cc�����,�dered to consiitute a single occurrence; iii. amend the definition of Insured to: a. add the following: • the Named Insured's employees are Insureds with respect to: (1) bodily injury to a co-ernployee while in the course of the co-employee's employment by the Named Insured or while perforrning duties related to the conduct of the Named Insured's business; and (2) bodily injury to a volunteer worker wtiile perfoirt�ir�y duties related to the conduct of the Named fnsured's business; when such bodily injury arises out of a health care incident. • the Named fnsured's vofunteer workers are Insureds wifh respect to: (1) bodily injury to a co-volunteer worker while performing duties related to the conduct of the Named Insured's business; and �;6�'�7�ICY5X.X (1-�P�a� f'�qF: 1� r�f 17 GagpyA'ippvf CNh ftCl �irpht^..; f2e�e r'uer.f. frtcl�rc9a.c; craF±yrie�hEer�9 oaz::(r.>.ri�f cyf Ins�aro.snca::+ ;iervcce., (?fPica�, Irrc , witdr ifs e�rrr�aissiorz �,. ,. p. _ � � .... .... . .. ... _ �.� , w, � � m... .� �.. ... �.� � �.. _.... Contractors' General Liability Extension Endorsement (2) bodily injury to an employee while in the course of the employee's employment by the Named Insured or while performing duties related to the conduct of the Named Insured's business; when such bodily injury arises out of a health care incident. b. delete Subparagraphs (a), (b), {c) and (d) of Paragraph 2.a.(1j of WHO IS AN INSURED. D. 7he Other Insurance condition is amended to deleie Paragraph b.(1) in its entirety and replace it with the following: Other Insurance b. Excess Insurance (1) To the extenf this ins�lrance applies, it is excess �;?���° any other ��t����a�a;�nce, self insurance or risk transfer instrument, whether primary, excess, conti��c,��,���t or on any evd�ae�r basis, except for insurance purchased specifically by the Named fnsured to be excess of this coverage. 14. JOINT VEN7URES / PARTNERSHIP / LIMITED LIABILITY COMPANIES WNO IS AN INSURED is amended to delete its last paragraph and replace it with the following: No }��� ���n or orgarnz�a��a�'��'� is an Insured with r�;�����K��;t to the conduct of any current or past partnership, joint ven�R�r���'�� a�r limited IiabiPd�� �`��mpany that is not s���.ro���� ��� a Named Insured in the Declarations, except that if the Named Insured was a joint venturer, partner, or member of a limited liability company and such joint venture, partner�;���'��,� or lirr����� liability company termin����:•r� �,���s°.��� to or dAarir��� lBu�.e� ����li���r period, such Named Insured is an Ins«r�� with ��a�.����:�ct to its interest in such ��a+����� �a�x���t�ire, par����,�w�°�� �wue���� ��� laiz'���'a�d liability company but only to the extent that: a. an� �r���:�'ise giving rise to p��r���r�al �rr•�+� adve��������r�c� im�,�'�.ary occurred �r'o��r�� to such termmat�a���r�� date, and the per°�������I and advertising Yrt�'�.�r� ar���6p����� out ofi .<�G+�°`N� 0�9����°���se first occurr�r�r�� aftersuckr termin�.�¢A�^�n date; b. the bodily injury or property damage first occurred after such termination date; and c. there is no other valid and collectible insurance purchased specifically to insure the partnership, joint venture or limited liability company; and ff the joint �wr��n���a�+re, p�rtnership or i��rvgC����i liability �,a��r��,��dny is or w����� ins��d��c�� under a c�rs���solida���� �wr',��„a-�j�) irtsurance p��r�y.�rarn, then such ir7���dr���u��s�e wrll ad'm�r��q�r� be consir�������rd v��ua�' �r�d �olf.�r.f��G� far tNa�� pur�:����e af para��p��h���.� �. ,�4.r�ro�r���. Brii ���i�� �m�����vis�on wilfi not s�„��r���.:+ ta exa:���a:�e bo�il�� i�ro�,��ry+', prape�ty damag�� u��r p�r�a����a� and ��a°�w++�rt������� ir�M,p�ury tl��a.�� wuw�'�at.s�'d �tlierwise be ad�a���a��red ur��Dku�r lhe (,:��nt�����4�wrs Gen�ra� Liabil���r E�ten��i��r� Endorsemenf provision entitled WRAP-UP EXTENSION: OCIP, CCIP, OR COfVSOLIDATED (WRAP-UP) INSURANCE PROGRAMS. Please see that provision for the definition of consolidated (wrap-up) insurance program. 15. LEGAL LIABILITY — DAMAGE TO PREMISES / ALIENATED PREMiSES / PROPERTY IN Ti-fE NAMED INSURED'S CARE, CUSTODY OR CON7ROL A. U�,���a,i�.��� COVERAGES, Coverage A— Bodily lnjuN�� ��rr�� Propett��^ ����rr� �ge �.����Nafl���r, the ����m�,�gra���w �:,ntitled ��,a�,�,�rs sions is amended to delete exclusion j. D��irr������ to Pr�r���s���� dr� its a,�m���ar'a.xk� and p�dqa����ce �� w�"tth the following: This insurance does not apply to: j. Damage to Property Property darnage to: (1) Property the Na���daa��� �nsured owns, rents, or occu��ri g including any costs or expenses incurc�ti� by you, or any other ���.br<�on, organization or entity, for �a,y�����ir, replacement, enhancement, restora9w�a� or _...._ _. _ �;f�o�,A4r'C.1�ii�7C (°� fl°:a} I'�a�� 41 ra9 'V C Cr��syrr�eg?r� C�f�FO FbA f�i�I�iYs: faa,�5c^rvec4. Iric:lur.9cs capryric�pi7Cd�,d rr���tr�n�ol �+( Irirs�arrtQ�7c¢� `acarvic:F��;; �:?(fic�=. Inu;.. wvill'i il^� ��a�:"nr�rl:;sicrn �%/ / / �" i; . � � - r � � . . •1 • maintenance of such praperty for any reason, including prevention of injury to a person or damage to another's property; (2) Premises the Nao-����� Insured sells, gives away or abandons, if fhe property damage arises out of any part of those �ar�c'a�ises; (3) Property loaned to the Named Ensured; (4j Personal property in the care, custody ar control of the Insured; (5) That pac�"r��.alar part af real property on which the Named Insured or any contit'���ors ar subcontr���„��rs working directly or indirectly on the Named Insured's behalf are p�,��'�orming operations, if the property damage arises out of those operations; or (6) That �;�����C������tlar pa�f a� �r�� property that must be restored, repaired or replaced because your work was idt�.�a�s�r��rtly perfprr��� �� on it. k�''�n�����a�pf�:�m �'1�� (�� ��r��� ��� r�� aVM'��:�'� ����Nn�����i�ro�� ��» ��.�tl W:ug�������^ ��°a ��rm'ea���.��� ���mr�r�a��� �������.�p� ������p� r�,:��� ar��e �wy� drs'�� &o°� ����,���r�.F�,:;m ��a�r���tt°9 ���k �ta�^ hV������r��� �x�������N ��r C��aw�����d^'���6� ���.����;tMp�bs.��C b�� �&��:.� �N,°�rr�t�c� !�� �a�r�r� +�ww�6� l�r� O��r�rd�,�.,MxK�,�p� c�� (tl�xa�� �+�+a������� u�a��r tc� t�'4� t���i��;;a°�A ���� y�,�x'�� r��d��� ,� r� rw���cf �� (Nr� I�,�,�w��r�r� Rw�u����wr �� ��e� �� �sa��ro���i rr� � c��` f`cmv,r�Mr' �.F���b.� �^:�a����� ����u�, 1�, �r:^��r�air�a����� C��r��� �a� ow��«���r�ct���„ ;������9����� �� A � .�wro��w��e��. `�� �.� f�r��o��A�,� ���� ��'a.oa�H���� �"�z �"�r�� as described in LIMI7S OF INSURANCE. Paragraph (2) of this exclusion does not apply if the premises are your work. Paragraphs (3), (4j, (5j and (6) of this exclusion da not apply to liability assumed under a sidetrack agreement. Paragraph (6) of this exclusion does not apply to property damage included in the products- completed aperations hazard. Paragraphs (3j and (4j of ihis exclusion do not apply ta property damage to: i. lools, or equipment the Named Insured borrows from others, nor ii. other p�s����,�� u��rti��l praperty of a�t�'o�rs in the Named Insured's care, custody or contral while being used in the V��K'���� Insured's op�s,ce=aCions away from any Named Insured's premises. However, the coverage grar7ted by this exception to Paragraplis (3) and (4j does not apply to: a. property a( d job site awaiting or during such praperty's installation, fabrication, or erection; b. property that is mobile equipment leased by an Insured; c. property that is an auto, aircrafi or watercraft; d. property in transit; or e. any portion of prcx�a��w°Ly darnage for which the fnsured has ���ti��V��bfe other valid and collectible insurance, or wouC�� I�w:mvo such insurance but far cxhau�tion of it^ N�a��wts, or but for application af one of its exclusions. A separate limit af insurance and deductible apply to such property of others. See LIMITS OF lNSURANCE as amended below. S. Under C�7V�Fi/�GES, Coverage A— Bodily fnjury and Property Damage L.iability, the paragraph entitled Exclusions is <rncnded to delete its last paragraF�M and replace it with the following: Exclusions c, ihrough n. do not apply Cca d�rr7aye lay fir� tc� �r�;mi�a�:� while rented to a Named Insured or ��rn�ar�rily accupied by a Named Insured wiih permission of the awner, nor to damage to the contents of �r�rr��s�s ��nted to a Named Insured for ��a�r�crci aJf 7�ar f�vv�r c,onsec�f.iv� d�ys• n.�.. .� . rage as described in LIMITS OF fNSURA -. � _ m, ,,� ._ ,.��e,.. ,.�. _e _.. , �... �___ � ��_, ,. ee_ ,......,, �, . ,. .� �. q��. �r� t� Pimit of ir��:��.�r�nce a ies o ils cove �.._._,., C"hJ�t74%C�:�XY (1-15) ����c�� 1Z r�i 1 l Gc�pyright C!J« �II Rights F2�s€:rv�d. I�rclu�lc,s co��yriylitcd rn�+Vrrial o( Instar�nce S� rvices CYfficr�, Ir'�r.. , 4vilh il� W�rmis�irsn ' I Liabilit Extension Endorsement Contracfors Genera y C. The following paragraph is added to LIMITS OF INSURANCE: '�����,�o�����:� to y�. ��B�.A�zF�,��, ����".�,���7� u.�� Itl�e r�'i����1 pN����� IpN.sa����° w�i�tl p�y ��t��i���a� ����w�� ��,.�c}�a� � for a:�N ���ro�r���� d.w�w,va��� +���� of ��sc��r ������u�. ac.��a��rr°r��rce �;�Qa.r ��wr�� ��� tf7�� ���w�� ��� ����iP ���°�a�����r�y �':I;a�ar r����� ���:u &��u�°rc��,r��<� toop:�x a�r d����.�l�vrrue����� .rc���.� to �°aiR��� ����rs��r���w ���ou�pe���� a�� ��4flt�srwa in �tl'��: �t�m�t����� br�:��.wr'�,d's a.�����, �,�s�����o����^ a���r ��;u°ar'r�rol, �lnil� 1s��6om�� t��v������� w�t Vhe ���ta��a1 P�t�w�sru���tl"�`� r�ap�<��s �lor�a�s �.r�wq��� ���rar�q r.�q�,�` d�,�M�r�t! IM� »�r�����`^� par�b���� �.��, .��.P-�r� �r���a��� � �� �YQ�.rli����lc��`p io ��w ,p� w��s�.;k� ��w��w�ai� r����°���re���'� ���r���s Nr�al ������ a.[�w11P �l�a� �;m������uoad aa� a���r�;!'a ��r�p�e.rio�w� ci��rr��a�� c�w d��.d��� `��„f����0 I lw��� tlr�.��rp��w�r I���� P�h���� ��±�kt� �i��t ��r��� ll�d�� ����t'�" ��� ����'�:�' �:;���� ��r,��aior� ��f �B�r�a�� �� Iw���b i�'� +��'t����' 1� c��f�a.t m�c���l��w������'��,. l� C��¢��.� ������¢�,g����,����,�,�����;� ilgw��G� �ir����, �kY� hP��r����d ���������i �rn�d prarnptly reirnburse �he fnsur�r for �ny s��ch amount. D. Paragraph 6., Damage To Premises Rented Ta You Limit, of LIM175 OF iNSURANCE is deleted and replaced by the fallowing: 6. Sul�jt�ct to Paragraph 5 abnve, (the rach Occurrence Limit} tt7e C7am«ge To @remises f�ented io Yau [u'�t��r's"C a��� t��p�� �'��a:�i� i:�'Ma� d�a.,�dc��F� ^�i�n ����! u.ar��a�r' �+�va���r'������ � f�.�c s9�x�������tp�^,� k.��n��.�a�r.a��,� �� prs�t���t�r�y t���G���r��a� ��� �r��� ����c �roo'�::��m�:������ w,��ai�ca r'�����.� �� ����� 1W�rr�r��� I�ti.�ce�o�a tB �p�° A� ��a���wd�'r'�iti�y c�r�����ary�6�„��� 8��� &Ys�, �`�N�a����:c� Ir�����r��� r��ri�i� tlt�� ���i�'���,���i�'�r� ���� ��� �'��r�roc�r� ir��:f����Kn�w� rsc���V�:�rrk�� ��� ,�o�a��i S�t�av�W�d�;� ��,��s��. tb ���� x�a�� P�,�ir�y�c� I������r�cq i��c' � �a���w'��� ��� � +�r ������r�t �r�r�M��.��i.r�w��r�'��y�. .��.��,��� C��,���w���p���� ��� �'ut,et�ar����,� f^���r���'.r� �i����'"��e.P �..i�ru��� r�� ��°M� r�r���1��w��. of: a. $500,000; or b. The Damage To Premises Rented To You Limit shown in the Declarations. Paragraph 4.b.(1}(a}{ii) of the Ofher Insurance Condition is deleted and replaced by the following: (ii) 7hat is praa�r�d�rLy insurance for pred���a.��pa ��� rented to the �I�t�Ma.��� �nsur��e��p for premises ��rriporarily oaa� taprA+��i by the Nawr��^��� l�rsured with the p���ro�a�����'�ion of the owr���, ���" 9��r pep;��k¢�rual prop�rly of athers in ihe ��r���^c�� Insured's care, custody or control; 16. L.IQUOR LIABILITY Under COVERAGES, Coverage A— Bodily Injury and Property Damage Liability, the paragraph entitled Exclusions is amended to delele the exclusion entitled Liquor Liability. This LIQUOR LIABILITY provision does not apply to any person or organization who otherwise qualifies as an additional insured on this Coverage Part. 17. MEDICAL PAYMENTS A. LIMITS OF IfVSVRANCE is amended to deleie Paragraph 7. (the Medical Expense Limit) and replace it with the fallowing: 7. "��w.r�r��;d`�t t� ���ur����ra��N� �. ����r��t� ���t�� C:�r��'� ��c��arr�°:szaM�� ��F�oit�� alu�w �u�"i������ �i �.��:��� pd �t�� Limit is the m�'���[ �,he tlrrv���m�:��` vvrWP �,����±� u�r�������° ����"r��pr ��� ,_ ����r:�ica�N a������uds ��t�� ����� u�C( ru��r�w�.�V ����'��� �i��w�ar�ss because of ��r<��t°@�ily �r���ur� .������t��r�bf;�� ?��� ����e.r,�" ��r�t� �,��� ��rr�w. i����� I����di���S �`��a�.���_ a,. P..cm�'wid a� �I�°s�� �1cea�a:�C.�:r�� ��fa (1) $9.5,000 unless a different amount is shown hcre: @@@@@(?(�(�@@@@@@; or (2) the amount shown ln the Declarations for Medical Expense Limit. B. Under COVERAGES, the Insuring Agreement of Coverage C— Medical Payments is amended to replace Paragraph 1.a.(3)(b) with the following: (b) The expenses are incurred and reported ta the Insurer within three years af the date of the accident; and This Paragraph B. does nol apply to medical expenses incurred in tlie state of Misso�ari. 18. NON-OWNED AIRCRAFT Under COVERAGES, Coverage A— Bodily Injury and Property Damage Liabilify, the paragraph entitled �_�cc6un �o�o�s fu ��r�rcir�clyd a�s fc�l(c��,�:�; ` 741 �t:,i�}� ( � -1 �a.._.e e.� _ ,e e .m � _ �, P�1� } �a�r�e 13 cpf i 7 C;a�pyrigfrt (:P�lA Ftlf FtighCv. F2¢=��*rve�J lncle.�des cupyricrfit�vd i7y:�keri�l b( fn>t�rarrc�: �;t:rvice� �3f(ic�. Irrc . vnith its per�rrissie�n _ .�... � �w. . .... _..— . � , _ __ .a � � W... ��.�,m� . _ � .._ � � . �, __ �,,, .._ . , J Confractors' General Liability Extension Endorsement The exclusion entitled Aircraft, Auto or Watercraft is amended to add the following: This exclusion does not apply to an aircraft not owned by any Named Insured, provided that: 1. the pifot in command holds a currently eFfec4�w�� ���:��'q�di���.�t�� issued by the duly constit�At�;�� auihority of the United States of America r�r Ganada, designati¢u�} ll����� ����r��.��t as a commercial or airline t��+r���porl pilot; 2. the aircraft is rented with a trained, paid crew to the Named Insured; and 3. the aircraft is not being used to carry persons or property for a charge. 19. NON-OWNED WATERCRAFT Under COVCR�,���:°w�„ Coverage A— B���wly Injury and Property dl�w�t"q�ge Liability, the w�G.�r�����r��ph entitled Exclusions is �t�'g�.��°.s��ed to delete subpa�Rs���raph (2) of the exclusion ��a�wCiEpr:°d Aircraft, Auto �a�' �'iY�fr��rcraft, and replace it with the following. This exclusion does not apply to: (2) a watercraft that is not owned by any Named lnsured, provided the watercraft is: (a) less than 75 feet long; and (b) not being used to carry persons or property for a charge. 20. PERSONAL AND ADVERTISING INJURY —DISCRIMINATION OR HUMILIATION A. Under DEFINITIONS, the deftnition of personal and advertising injury is amended to add the following tort: • Discrimination or humiliation that results in injury to the feelings or reputation of a natural person. B. Under COVERAGES, Coverage B— Persona! and Advertising Injury Liability, the paragraph entitled Exclusions is amended to: 1. delete the Exclusion entitled Knowing Violation Of Rights Of Another and replace it with the following: This insurance does not apply to: ICnowing Violation of Rights of Another Personal and advertising injury caused by or at the direciion of the Insured with the knawledge that fl���� <���st wyr��uC�� �aa��,;���°�� tl��E d`�t���C �a�i` ir�c�9��e:sx° a�����d would Ai�r�i��l ��rw����s�at�! ������� <�r��r� ��� rof�ug i�u���wM�°� � Yai�a� e,����st���a�rd��N ��h��aCO xi�,r� ����p���+ io �'���uc:�r�a��Nr���Rora4mr �o��� �����niliatican �If���f u� ���G��l�� a�� �o��u.bd'�r l�a q�a�� �r �alca�„�s �am° sr��w������p��ro�mu of ��r�aer�re�l ��t�r:��.�m�, C�a��� oruA� i� ��4�°��� �p���;s��"��Ar��ation or t���������Ndd��pe��r�G ��A a��a'� ���cm�� ip°�k��rp���a�r��Yly E��� �,�r� �t �R�� direction of: (a) the Named Insured; or (b) an� y��r��a��.u&iw�e c��'�wra��w"6 director, stockholder, partner, member or manager (if the Named lnsured is a ludr�r9���fl �����rfit���.���oam,�'��`���ny) ofthe Named Ins;ured. 2, add the following exclusions: This insurance does not apply to: Employment Related Discrimination Discrimination or humiliation directly or indirectly related to the employment, prospective employment, past employment or termination of employment of any person by any Insured. Premises Related Discrimination discrimination or hur7iiliation arising out of the sale, rental, lease or sub-lease or prospective sale, rental, lease or sub-lease of any room, dwelling or premises by or at the direction of any Insured. CfVF�,t�PTG�S:�Y {1 �"a� R�r:�q� 1+� of °£ i (;oSayrie�0�i9 CIVIt F�li Ri�l°iLs P'�dr;..�rrr�dd. Ir�cl,.a�.i�w c.��.7}rric�h4e�9 n�t�e9criti� oV� Ir?°�sur[trre� Se^evicLs C7(4icc°. Inc;., wiClt i4; �:a�rn�ie,si+�n. ' eneral Liabilit Extension Endorsement Contractors G y Notwithstanding the above, there is no coverage for fines or penalties levied or imposed by a governmental entity because of discrimination. The cover��c��� ,g�r�;r�rided by this �'[:�SONAL AND Ab��B:�TISING INJURY —DISC���flINATION OR HUMILIA76�1� Prrc��rr=�ion does not ap��al� ��r any person or org��ni��+:�'don whose status as an Ins��re� derives solely from • Provision 1. ADDITIONAL INSUF2ED of this endorsement; or • attachment of an additional insured endorsement to this Coverage Part. This PERSONAL AND ADVERTISING INJURY —DISCRfMINATION OR HUMILIATION Provision does not apply to any person or organization who otherwise qualifies as an additional insured on this Coverage Part. 21. PERSONAL AND ADVERTISING INJURY - CONTRACTUAL LIABILITY A. Under COVERAGES, Coverage B—Persanal and Advertising fnjury Liability, the paragraph entitled Exclusions is amcnded to delefe the exclusion entitled Contractual Liability. B. Solely for the purpose of the coverage provided by this P�%�C�NAL AND ADVERTI�I'�D� IN,�1.JF��` - CONTRACTUAL LIABILITY provision, the folfowing cha��c��� are made to the �K:�c�a�c�n ����ittlr:d SUPPLEMENTARY PAYMENTS — COVERAGES A AND B: 1. Paragraph 2.d. is replaced by the following: d. The allegations in the suit and the information the Insurer knows about the offense alleged in such suit are such that no conflict appears to exist between the interests of the Insured and the interests of the indemnitee; 2. The first unnumbered paragraph beneath Paragraph 2.f.(2)(b) is deleted and replaced by the following: �� V����� ��� ��h��;� ���r��+� r�c���tir��ua ���'+� r°����� �i��rr���s f�c:� dr����r"�eW� k�� idr� Nu7���r�.�" n�� ���� �'�t�f�,a���a� ��G �d�as� ir��1��r7�ro�ta�����„ r�u��..��;��rym �i�dc��ti�.�rr ����°p���a����� u���s.r��"���r�! Y�� ��Ws� Yr�ar��an°�w�s� ����s�! rs�.�,��s�a���y IadrG�q���tl����u ������;ua���,� �� 6r��;;K�rrr��t ka� tk�t5 artcfc'�ra'�r�ii�.0 �a �t��� Iawr�t�r��r°�; ��c����ry;�t wNll ta� �a�i� � a a�a>��a��� a���t; �ra�:#'� ���y��ac�r�:� r�+��! r�����C E��� ��:�r�u��i l�� ��� �������������� �s��R" �a��r���crra�u� �rmt;� ��ve:r������ur� �s�j�r�r �r���s�� �ald� d���u�t r�r�u��r� ���� �ir��mi.� ���ff� insurance. C. This PERSONAL AND ADVERTISING INJURY - CONTF2ACTUAL LIABILITY Provision does not apply if Coverage B—Personaf and Advertising fnjury Liability is excluded by another endorsement attached to this Coverage Part. This PERSONAL AND ADVERTISING INJURY - CONiRAC7UAL LIABILITY Provision does not apply to any person or organization who othenvise qualifies as an additional insured on this Coverage Part. 22. PROPERTY DAMAGE — ELEVATORS A. �.��a�i�wt' ��k�v�V�..I��;t;����, �:�c��v����c��,^ � • d:�i���C�W� Irt����°� ��°����#' �ra����r�y C����ar�a�cw ����if�t�Y, 't�l�c �u��r��rr�o;�p�P'� ��c�r4i�:�ed ��a�a�E��;��i�r�s A�� ��roW.��,.r�r�c�e��d w;na��.Pr �N�u��t xYi�; ��:i�err��� ��� ���.��wr° P"�rs.�������.8 I����::P�sa�u� �n�i ��u���.��r�.��r��.������ ���. ��.�� �nd ��� t.�l �8�a� D�a��s���� t�� �'�r'�a�aa��tiy �x��4��,,a���rd ��'a'� r��l ���dy� ���r �ar°�ap:r���Cy� c�ara�a�� t17�-�� r�:�:�af8��� fr`�rr�°� tp�� A.a:�e: of elevators. B, u��,w���� for the pur��w�� �s�� �f the � r,,�a�;��� rcpr, �srov9�C���i by this PROPERTY DAMAGE — ELEVATORS Provision, the Q�E�w�� Insurance cr�,mA°�c��dCions n ��:�rr�� r���a��� to �d:���� the ft�llowing paragraph: '�N'r���� insurance is e�,v ���'aw� r�ver any of the other �bu��aar`��nce, whether �rs'��m'���p"y„ excess, contidme��r�yr�t' or on any a�Cl������a�r basis that is Pr���,���i'��ty fnsurance covering prr���ar.;w�i� of others dam„���+, �:9 ��`�r�m the use of el�.a+�4�d��rs. 23. SUPPLEMENTARY PAYMENTS The section entitled SUPPLEMENTARY PAYMENTS — COVERAGES A AND B is amended as follows: (;IV�7�d7�aX� �1-1a} �::x;����y � J �r� 3 � (;��qrpr;gLl' G;RV�L A�II f�Lic�I�t,P� N�a^��.a;arvs�d. Irpa.sa.ac9+*�� c�.crAa�righC�:.r9 n���aR��ri�l ta91¢�s�tiar�anr.,r:. w�,�rvece:�; C7(Vira�, P�ec., uviCVq iP.S �ne;e^irtis5i�on. ' ' bilit Extension Endorsement Contractors General Lia y A. Paragraph 1.b. is amended to delete the $250 limit shown for the cos[ of bail bonds and replace it with a $5,000. limit; and B. Paragraph 1.d. is amended to delete the limit of �250 shown for daily loss of earnings and replace it with a $1,000. limit. 24. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS If the N�����c� Insured uni�����r�d�i��q'��dpy �k�ils to disclose a!I existing hazards at the urt�c,���#u��� d�tl°c� of the Named Insured"� �c�uerage Part, t}�c� I'r���Ga�°�� �roid not deny coverage under this Coverage F��zr� h�^s �u=:��^ cwf such failure. 25. WAIVER OF SUBROGA710N - BLANKE7 Under CQNDITIONS, the condition entitled Transfer Of Rights Of Recovery Againsf Others To Us is amended to add the following: The Insurer waives any right of recovery the Insurer may have against any person or organization because of payments the Insurer makes for injury or damage arising out of: 1. the Named Insured's ongoing operations; or 2. your work included in the products-completed operations hazard. However, this waiver applies only when the Named Insured has agreed in writing to waive such rights of recovery in a written contract or written agreement, and only if such contract or agreement: 1. is in effect or becomes effective during the term of this Coverage Part; and 2, was executed prior to the bodify injury, property damage or personal and advertising injury giving rise to the claim. 26. WRAP-UP EXTENSION: OCIP, CCIP, OR CONSOLII7ATED (WRAP-UP) INSURANCE PROGRAMS Note: The following provision does not apply to any public construction project in the state of Oklahoma, nor to any construction project in the state of Alaska, that is not permitted to be insured under a consolidated (wrap- up) insurance program by applicable state statute or regulation. If the endorsement EXCLUSfON — CONSTRUCTION WFZAP-UP is attached to this policy, or another exclg.a���a���'�ry � r���sr�e�Yieni pertaining to �'.�w„�wr�s�r` Controlled Insurance Programs (D.C.I.P.) or Contractor Con��a.�����r� Ins�usr�rp�M���� Programs (C.C.I.P.) is ��n�� �a�a���:�d, then ihe following changes apply: A. The following wording is added to the above-referenced endorsement: With re��a��:t to a consolidated (wrap��z���a� insurance program �r°��,ect in ��nAa�h t����� �'�med Insu�p^�� is or was inv�:��l���a��, this exclusion does not ;��g�Py�� to those sums the N�rr'��d Ins�a�r��t�C b�����urr�� legally oblbc����'ed to pay as damages because of: 1. Bodily injury, property damage, or personal or advertising injury that occurs during the Named Insured's ongoing operations at the project, or during such operations of anyone acting on the Named Insured's behalf; nor 2. Bodily injury or property damage included within the products-completed operations hazard ihat arises out of those portions of the project that are not residential structures. B. Condition 4. Other Insurance is amend to add the following subparagraph 4.b.(1j(c): 7his insurance is excess over: (c) �rti�+ of the other i�rkMa����nce whether �rw���t�:�ry, excess, contingent or any a:��h��r basis that is insurance ,���ilable to the Na�r��;»e� Insured as a s�crw��rBR of the Named Insured being a p�-�r�icipant in a consolidated (wrap-up) insurance program, but only as respects the Named Insured's involvement in that consolidafed (wrap-up) insurance program. GsI'��7�8'TC7�a7C� (i-�"��� I"��c�� 1Qa c�f 'fl � C:a�:ayrs°i�l�i� CIVft lid! I�"tiql��vC: P�te„�r�r�aa�d fln��Pd,�c9�^::. r�ub�.r,qrri�Inl�uS rrsa�c�ri�l a� Iri�ua�aPtr�:G: ,`..amrvic�� C�C�c�c, Irr�;., w�iU7 ids �.a.r:.rrr�issiuri, � ,. .. . � .. .......... . m, m .� �_ _. .. ..m ..e., e � .F �.._�. _. . . .... ..._.... ........,. Contractors' General Liabifity Extension Endorsement C. DEFINITIONS is amended to add the following definitions: Consolidated (wrap-upj insurance program means a construction, erection or demolition project for which the ���ae��� �:�and�`�ctor/project manager �ar c�'�c���a�r of the c�i����r'���'�t�ion ��rr�j���ct has z�w�;�rr'ed general liability insu����r�r�rac� �c��r�^��i�tg some or all of the conC�����u'� or subcond������r,t�!��;� involv�+� in the pu°�r�����', such as an Owner Controlled lnsurance Program (O.C.I.P.) or Contractor Controlled Insurance Program (C.C.I.P.). Residential structure means any structure where 30% or more of tl�e square foot area is used or is intended to be used for human residency, including but not limited to: 1. single or multifamily housing, apartments, condominiums, townhouses, co-operaiives or planned unit developments; and 2. ihe common areas and structures appurtenant to the structures in paragraph 1. (including pools, hot tubs, detached garages, guest houses or any similar structures). However, when there is no individual ownership of units, residential structure does not include military housing, college/university housing or dormitories, long term care facilities, hotels or motels. Residential sfructure also does not include hospitals or prisons. This WRAP-UP EXTEN���i�: �C:��f�, CCIP, OR CONSOLICi.�"��D (WC��P-UP) INSb�f���PCE PR����4�4S Provision does not apply t�,�e ���}� ��������'� or organization who o@����rrns��se qu��9u�F�es as an a��it�t��'wal insur��[ �r� b'P�is Coverage Part. All other terms and conditions of the Policy remain unchanged. This endorsement, which forms a part of and is for attachment to the f'olicy issuea dy ine aesigna�eu �nsu�C��, �ane� effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below and c����wres concurra ��t��with said ����ab�.�. .......... ..,.,,.. CPVFi,1�"7QtrX� ��-i:;i} G��ca� i C r�f 1� (:o[ryric�G7t �P�Fi �t@I F�Ir;Y�I� aZcsc�rrce�. In¢`PucVc:Sy cu�ryric�P�fler,' r�p��aP�>'i;�P rsi Irosur�rr'�ee acRvie�^t; 47fficc, Irwc., writP's ils (a+;wrr�riss(oer, POLICY NUMBER: 403 190 0163 COMMERCIAL AUTO CA 20 48 02 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DES�'GNATED INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM 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 Provision 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 indicated below. Endorsement Effective: 01/01/2017 � Countersigned By: Countv Inc. �.��,��...w.. p... � �_.�� .g.. Named Insured Suncoast Develo m� � _� .�,.� _� , w___w_� ent o Pinellas Wend L. Hin son SCHEDUlE �����.m,��w.�....�w.w�. .u.�.w..... ._. �mm.. ........ ._. �.__...� �.a _�.�.� N�..�..,_.. . �......... ...m... � ..____m �.. _ � . __...�,,. ame of Person(s) or Organization(s): Clty of Clearwater (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in 5ection II of the Coverage Form. CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 CA0444 0310 �� � * -, - � • � • ` �, ' ` . +� ' • "" � � "` • a • This endorsement modi�es insurance provided under the following; BUSINESS AUTO COVERAGE FORM BUSINESS AUTO PNYSICAL DAMAGE COVERAGE FORM GARAGE COVERAGE FORM 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 the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named insured: Suncoast Development of ��� � ���� �� � ���� ���� � ������� ��������������� ������������������������ ������A� ��mPinellas County, Inc. �ndorsement Effective Date: 01/01/2017 SCHEDULE Name(s} Of Person(s) Or Organizatian(s): City of Clearwater Ir'�'��o�r���i�rra r��q���°��d to ���wr��ai��� thi.. � ._,� ...�� ... s��ha�c�r�C��, if not shown above, will be sk��a+�r� in the ���p�c��m ������ ������ ��........� � �... . � �I�C1a �....�V.�_..,m.q.�..,.,..�,,�,�,�_ ......_ ��..W��._... �_,..�,,.�.m e._........._.. _ .........�.�.a�.._.._...�.._..___...._��..w..�w�.�....��,._....m._.W... 2 i;; k''; � The Transfer Of Rights Of Recovery Against Others To Us Condition does not apply to the person(s) or �� � organizatlon(s) shown in the Schedule, but only to the extent �hat subrogation is waived prior b the "accident" � or the "loss" under a contract with that person or organization. ��� � WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 Suncoast bevelo.pment of Pinellas County, Inc. Policy #403 419 0132 WAIVER OF OUR RIGHT 70 RECOVER FROM OTHERS ENDORSEMENT 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 organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operafe directly or indirectly to benefit anyone not named in the Schedule. Schedule City of Clearwater Project: Kapok Terrace Sanitary System, Project #15-0036-UT WC 00 03 13 (Ed. 4-84) Copyright 1983 National Council on Compensation Insurance.