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2018 SEWER POINT REPAIRS AND IMPROVEMENTS PROJECT - 17-0060-UT - CERTIFICATE OF LIABILITY INSURANCE (2) 7T/E(MM/DD/YYYY) A16. ! '® CERTIFICATE OF LIABILITY INSURANCE 18/2018 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 CONTACT Kell Johnson NAME: y Stahl & Associates Insurance, Inc. a/c NNo Ext: (727)391-9791 AA/XC No: (727)393-5623 110 Carillon Parkway ADDRESS:kelly.Johnson@stahlinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# St. Petersburg FL 33716 INSURERA:FCCI Insurance Group 10178 INSURED INSURER B Rowland Inc. INSURER C: 6855 102nd Avenue N INSURER D: INSURER E: Pinellas Park FL 33782 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1871243097 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. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYY MM/DD/YYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1:1 OCCUR DAMAGE TO RENTED CLAIMS-MADE PREMISES Ea occurrence) ccurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY -PRO ❑ LOC PRODUCTS-COMP/OP AGG $ JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS APer accident UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N N/A A (Mandatory in NH) 001WC18A74875 4/1/2018 4/1/2019 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Project: 2018 Sewer Point Repair & Improvements Project 17-0060-UT CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Clearwater - Engineering Dept THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: Construction Office Specialist ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 4748 Clearwater, FL 33758-4748 AUTHORIZED REPRESENTATIVE Kelly Petzold/RUSS ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) Client#: 1916902 69ROWLAINC DATE(MM/DD/YYYY) ACORDT. CERTIFICATE OF LIABILITY INSURANCE 9/17/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Cyndi Ross McGriff Insurance ServicesPHONE 727 327-7070 FAX 8886328451 (A N12485-28th Street North E-MAILo,Ext): (A/c,No): ADDRESS: Cynthia.Ross@McGrifflnsurance.com Saint Petersburg, FL 33716 INSURER(S)AFFORDING COVERAGE NAIC# 727 327-7070 INSURER AGreat American Assurance Company 26344 INSURED INSURER B:Travelers Indemnity Company 25658 Rowland Inc 10172 INSURER C:Westchester Surplus Lines Insurance 6855102nd Avenue Pinellas Park, FL 33782 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 CONTRACTOR 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. ADDLSUBR LTR TYPE OF INSURANCE NSR WVD POLICY NUMBER POLICY EFF POLICY EXP/YLIMITS (MM/DDYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY X X GLP3763293 07/01/2018 10/01/2018 EACH OCCURRENCE $1,000,000 CLAIMS-MADE 4 OCCUR PREMISESOEa occur°nce $100,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY JECT � LOC PRODUCTS-COMP/OPAGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY X X CAP376392 07/01/2018 10/01/201 EOaaccs cidentINGLELIMIT $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident B UMBRELLA LAB X OCCUR ZUP-16N215128-18 07/01/2018 07/01/2019 EACH OCCURRENCE s5,000,000 X EXCESS LAB CLAIMS-MADE AGGREGATE s5,000,000 DED I X RETENTION$10000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ C Pollution 671152613001 07/01/2018 07/01/2019 See Below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) General Liability&Auto include 60 Day Notice of Cancellation with 10 Days Notice for Non-Payment Pollution$1,000,000 Each Pollution Condition; $2,000,000 General Aggregate subject to$2,500 Deductible; Pollution policy includes Additional Insured/Primary Non Contributory/Waiver of Transfer of Rights of Recovery Against Others-all as required by contract City of Clearwater is an Additional Insured on a Primary and Non-Contributory basis with a waiver of (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION Cit of Clearwater Engineering SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City g g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Department ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Construction Office Specialist PO Box 4748 AUTHORIZED REPRESENTATIVE Clearwater, FL 33758-4748 ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD #S20992415/M20823650 DVP DESCRIPTIONS (Continued from Page 1) subrogation on the General Liability when required by written contract subject to the terms and conditions of the policy. SAGITTA 25.3(2016/03) 2 of 2 #S20992415/M20823650 II "07/02/2018" GLP-3763293-00-02 GREAT AMERICAN ASSURANCE CO 0648162 CG 82 16 (Ed. 02/15) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COVERAGE PLUS COMMERCIAL GENERAL LIABILITY ENDORSEMENT This endorsement modifies and is subject to the insurance provided under the following form: COMMERCIAL GENERAL LIABILITY COVERAGE FORM This is a summary of the various additional coverages and coverage modifications provided by this endorsement. For complete details on specific coverages, consult the actual policy wording. Coverage Limit of Insurance Page Non-Owned Aircraft Included 2 Non-Owned Watercraft Included 2 Property Damage Elevators Included 3 Property Damage Liability - Borrowed Equipment Included 3 Damage to Premises Rented to You $ 500,000 3 Contractual Personal and Advertising Injury Included 4 Medical Payments Extension and Increased Limit $ 20,000 4 Supplementary Payments - Bail Bonds $ 2,500 5 Supplementary Payments - Loss of Earnings $ 500 5 Automatic Additional Insured - Owners, Lessees, and Contractors when Required in Written Contract or Agreement with you Included 5 Broadened Named Insured Included 7 Newly Formed or Acquired Organizations Included 7 Knowledge of Occurrence, Claim or Suit Included 7 Primary and Non-Contributory Additional Insured Extension Included 8 Unintentional Failure to Disclose Hazards Included 8 Amended Bodily Injury Definition Included 8 Broadened Mobile Equipment Included 8 Includes copyrighted material of Insurance Services Office, Inc., with its permission CG 82 16 (Ed. 02/15) (Page 1 of 10) II "07/02/2018" GLP-3763293-00-02 GREAT AMERICAN ASSURANCE CO 0648162 The following extensions of coverage apply only if a YES is typed next to the coverage: Type YES below Limit of Coverage for coverage Insurance Page Who Is an Insured - Fellow Employee Extension - Management Employees YES Included 9 Personal and Advertising Injury Definition Amendment of Discrimination or Humiliation YES Included 9 Incidental Malpractice Liability YES Included 9 A. Non-Owned Aircraft Under paragraph 2. Exclusions of SECTION I - COVERAGE A - Bodily Injury and Property Damage Liability, exclusion g. Aircraft, Auto or Watercraft does not apply to an aircraft provided: 1. it is not owned by any insured; 2. it is hired, chartered or loaned with a trained paid crew; 3. the pilot in command holds a currently effective certificate, issued by the duly constituted authority of the United States of America or Canada, designating him or her a commercial or airline pilot; and 4. it is not being used to carry persons or property for a charge. However, the insurance afforded by this provision does not apply if there is available to the Insured other valid and collectible insurance, whether primary, excess (other than insurance written to apply specifically in excess of this Policy), contingent or on any other basis, that would also apply to the loss covered under this provision. B. Non-Owned Watercraft Under paragraph 2. Exclusions of SECTION I - COVERAGE A - Bodily Injury and Property Damage Liability, subparagraph (2) of exclusion g. Aircraft, Auto or Watercraft is replaced by the following: This exclusion does not apply to: (2) A watercraft you do not own that is: (a) less than 51 feet long; and (b) not being used to carry persons or property for a charge. However, the insurance afforded by this provision does not apply to watercraft 27 to 51 feet long if there is available to the Insured other valid and collectible insurance, whether primary, excess (other than insurance written to apply specifically in excess of this Policy), contingent or on any other basis, that would also apply to the loss covered under this provision. Includes copyrighted material of Insurance Services Office, Inc., with its permission CG 82 16 (Ed. 02/15) (Page 2 of 10) II "07/02/2018" GLP-3763293-00-02 GREAT AMERICAN ASSURANCE CO 0648162 C. Property Damage - Elevators 1. Under paragraph 2. Exclusions of SECTION I - COVERAGE A - Bodily Injury and Property Damage Liability, subparagraphs (3), and (4) of exclusion j. Damage to Property do not apply if such "property damage" results from the use of elevators. 2. The following is added to SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, Condition 4. Other Insurance, paragraph b. Excess Insurance: The insurance afforded by this provision of this endorsement is excess over any property insurance, whether primary, excess, contingent or on any other basis. D. Property Damage Liability - Borrowed Equipment 1. Under paragraph 2. Exclusions of SECTION I - COVERAGE A - Bodily Injury and Property Damage Liability, subparagraph (4) of exclusion j. Damage to Property does not apply to "property damage" to borrowed equipment while not being used to perform operations at a job site. 2. The following is added to SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, Condition 4. Other Insurance, paragraph b. Excess Insurance: The insurance afforded by this provision of this endorsement is excess over any property insurance, whether primary, excess, contingent or on any other basis. E. Damage to Premises Rented to You If Damage to Premises Rented to You is not otherwise excluded from this Coverage Part: 1. Under paragraph 2. Exclusions of SECTION I - COVERAGE A - Bodily Injury and Property Damage Liability: 3. The last paragraph of paragraph 2. Exclusions is deleted in its entirety and replaced by the following: Exclusions c. through n. do not apply to damage by fire, lightning, or "explosion," to premises while rented to you or temporarily occupied by you with permission of the owner. A separate Limit of Insurance applies to this coverage as described in SECTION III - LIMITS OF INSURANCE. 2. Paragraph 6. under SECTION III - LIMITS OF INSURANCE is deleted in its entirety and replaced with the following: 6. Subject to paragraph 5. above, the most we will pay under Coverage A for damages because of "property damage" to any one premises, while rented to you, or in the case of damage caused by fire, lightning, or "explosion," while rented to you or temporarily occupied by you with the permission of the owner, for all such damage caused by fire, lightning, or "explosion," proximately caused by the same event, whether such damage results from fire, lightning, or "explosion," or any combination of the three, is the higher of $ 500,000 or the amount shown in the Declarations for the Damage to Premises Rented to You Limit. 3. Under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, subsection 4. Other Insurance, paragraph b. Excess Insurance item (ii) of the Occurrence Form and item (iii) of the Claims Made Form where the words "Fire insurance" appear they are changed to "insurance for fire, lightning, or "explosion."" Includes copyrighted material of Insurance Services Office, Inc., with its permission CG 82 16 (Ed. 02/15) (Page 3 of 10) II "07/02/2018" GLP-3763293-00-02 GREAT AMERICAN ASSURANCE CO 0648162 4. As regards coverage provided by this provision E. Damage to Premises Rented to You - paragraph 9.a. of DEFINITIONS is replaced with the following: 9.a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire, lightning, or "explosion," to premises while rented to you or temporarily occupied by you with the permission of the owner is not an "insured contract." 5. As regards coverage provided by this provision E. DAMAGE TO PREMISES RENTED TO YOU, DEFINITIONS is amended by the addition of the following definition: "Explosion" means a sudden release of expanding pressure accompanied by a noise, a bursting forth of material and evidence of the scattering of debris to locations further than would have resulted by gravity alone. Explosion does not include any of the following: (a) artificially generated electrical current including electrical arcing, that disturbs electrical devices, appliances or wires; (b) rupture or bursting of water pipes; (c) explosion of steam boilers, steam pipes, steam engines or steam turbines owned or leased by you, or operated under your control; or (d) rupture or bursting caused by centrifugal force. F. Contractual Personal and Advertising Injury Under paragraph 2. Exclusions of SECTION I - COVERAGE B - Personal and Advertising Injury Liability, exclusion e. Contractual Liability is deleted in its entirety: 2. Exclusions Exclusion e. is deleted in its entirety. G. Medical Payments Extension and Increased Limits If Coverage C - Medical Payments is not otherwise excluded, the Medical Payments provided by this Policy are amended as follows: Under paragraph 1.a. Insuring Agreement of SECTION I - COVERAGE C - Medical Payments, paragraph 1.a.(b.) is amended as follows: (b.) The expenses are incurred and reported to us within three years of the date of the accident; and The Medical Expense Limit in paragraph 7. of SECTION III - LIMITS OF INSURANCE is replaced by the following Medical expense Limit: The Medical Expense Limit provided by this Policy shall be the greater of: a. $20,000; or b. the amount shown in the Declarations for Medical Expense Limit. This provision 7. is subject to all the terms of SECTION III - LIMITS OF INSURANCE. Includes copyrighted material of Insurance Services Office, Inc., with its permission CG 82 16 (Ed. 02/15) (Page 4 of 10) II "07/02/2018" GLP-3763293-00-02 GREAT AMERICAN ASSURANCE CO 0648162 H. Supplementary Payments 1. In the Supplementary Payments - Coverages A and B provision, paragraph 1.b. is replaced with: b. Up to $2,500 for the cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these bonds. 2. In the Supplementary Payments - Coverages A and B provision, paragraph 1.d. is replaced by the following: d. All reasonable expenses incurred by the Insured at our request to assist us in the investigation or defense of the claim or "suit," including actual loss of earnings up to $ 500 a day because of time off work. I. Automatic Additional Insured - Owners, Lessees, and Contractors when required in Written Contract or Agreement with You A. SECTION II - WHO IS AN INSURED, paragraph 2. is amended to include as an additional insured any person or organization who you are required to add as an additional insured on this Policy under a written contract or agreement; but the written contract or agreement must be: 1. currently in effect or becoming effective during the term of this Policy; and 2. executed prior to the "bodily injury," "property damage," or "personal and advertising injury." B. The insurance provided to the additional insured person or organization applies only to "bodily injury," "property damage" or "personal or advertising injury" covered under SECTION I - COVERAGE A - Bodily Injury and Property Damage and SECTION I - COVERAGE B - Personal and Advertising Injury, 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, and resulting directly from your ongoing operations performed for the additional insured, which is the subject of the written agreement. C. However, the insurance afforded to such additional insured described above: 1. only applies to the extent permitted by law; and 2. will not be broader than that which you are required by the contract or agreement to provide for such additional insured. A person's or organization's status as an additional insured under this endorsement ends when your operations for the additional insured are completed. 3. With respect to the insurance afforded to these additional insureds, the following is added to SECTION III - LIMITS OF INSURANCE: The most we will pay on behalf of the additional insured is the amount of insurance: a. required by the contract or agreement you have entered into with the additional insured described in paragraph A.; or Includes copyrighted material of Insurance Services Office, Inc., with its permission CG 82 16 (Ed. 02/15) (Page 5 of 10) II "07/02/2018" GLP-3763293-00-02 GREAT AMERICAN ASSURANCE CO 0648162 b. available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. D. The insurance provided to the additional insured person or organization does not apply to "bodily injury," "property damage," or "personal and advertising injury" arising out of the rendering or failure to render any professional architectural, engineering or surveying services, including: 1. the preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders, drawings or specifications; and 2. supervisory, inspection, architectural or engineering services. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by the Insured, if the "occurrence" which caused the "bodily injury" or "property damage," or the offense which caused the "personal and advertising injury," involved the rendering of, or the failure to render, any professional architectural, engineering or surveying services. E. The additional insured must see to it that: 1. we are notified as soon as practicable of an "occurrence" or offense that may result in a claim; 2. we receive written notice of a claim or "suit' as soon as practicable; and 3. a request for defense and indemnity of the claim or "suit' will promptly be brought against any policy issued by another insurer under which the additional insured may be an insured in any capacity. This provision does not apply to insurance on which the additional insured is a Named Insured; if the written contract or agreement requires that this coverage be primary and non-contributory. F. For the coverage provided by this endorsement: 1. The following paragraph is added to paragraph 4.a. of the Other Insurance Condition of SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS: This insurance is primary insurance with respect to our coverage to the additional insured person or organization, where the written contract or agreement requires that this insurance be primary and non-contributory. In that event, we will not seek contribution from any other insurance policy available to the additional insured on which the additional insured person or organization is a Named Insured. 2. The following paragraph is added to paragraph 4.b. of the Other Insurance Condition of SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS: This insurance is excess over: Any of the other insurance, whether primary, excess, contingent or on any other basis, available to an additional insured, in which the additional insured on our policy is also covered as an additional insured by attachment of an endorsement to another policy providing coverage for the same "occurrence, " claim or "suit." This provision does not apply to any policy in which the additional insured is a Named Insured on such other policy and where our policy is required by written contract or agreement, executed prior to the date of loss, to specifically require that this insurance provide coverage to the additional insured on a primary or non-contributory basis. When a written Includes copyrighted material of Insurance Services Office, Inc., with its permission CG 82 16 (Ed. 02/15) (Page 6 of 10) II "07/02/2018" GLP-3763293-00-02 GREAT AMERICAN ASSURANCE CO 0648162 contract or written agreement between you and an additional insured does not require this insurance to be primary or primary and non-contributory, this insurance is excess over any other insurance for which the additional insured is designated as a Named Insured. G. This endorsement does not apply to an additional insured which has been added to this Policy by an endorsement showing the additional insured in a Schedule of additional insureds, and which endorsement applies specifically to that identified additional insured. J. Broadened Named Insured Under SECTION II - WHO IS AN INSURED, the following item 2.e. is added: e. Any subsidiary and subsidiary thereof, of yours which is a legally incorporated entity of which you own a financial interest of more than 50% of voting stock on the effective date of this Coverage Part. The insurance afforded herein for any subsidiary not named in this Coverage Part as a Named Insured does not apply to injury or damage with respect to which an insured under this Coverage Part is also an insured under another policy or would be an insured under such policy but for its termination or the exhaustion of its Limits of Insurance. K. Newly Formed or Acquired organizations Paragraph 3. of SECTION II - WHO IS AN INSURED is replaced by the following: 3. Any organization you newly acquire or form and over which you maintain ownership or majority interest, will qualify as a Named Insured if there is no other similar insurance available to that organization. However: a. coverage under this provision is afforded only until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier; b. coverage A does not apply to "bodily injury" or "property damage" that occurred before you acquired or formed the organization; c. coverage B does not apply to "personal and advertising injury" arising out of an offense committed before you acquired or formed the organization; and d. records and descriptions of operations must be maintained by the first Named Insured. No person or organization is an insured with respect to the conduct of any current or past partnership, joint venture or limited liability company that is not shown as a Named Insured in the Declarations or qualifies as an insured under this provision. L. Knowledge of Occurrence, Claim or Suit Under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, the following is added to Condition 2. Duties in the Event of Occurrence, Offense, Claim or Suit: Knowledge of any 'occurrence," claim, or "suit' by any agent, servant or "employee" of the Named Insured does not in itself constitute knowledge by the Insured unless notice of such 'occurrence," claim or "suit' shall have been received by: a. you, if you are an individual; b. a partner, if you are a partnership; or c. an executive officer or insurance manager, if you are a corporation. Includes copyrighted material of Insurance Services Office, Inc., with its permission CG 82 16 (Ed. 02/15) (Page 7 of 10) II "07/02/2018" GLP-3763293-00-02 GREAT AMERICAN ASSURANCE CO 0648162 M. Primary and Non-Contributory Additional Insured Extension This provision applies to any person or organization who qualifies as an additional insured under any form or endorsement under this Policy. Condition 4. Other Insurance of SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: a. The following is added to paragraph a. Primary Insurance: This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) the additional insured is a Named Insured under such other insurance; and (2) you have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. b. The following is added to paragraph b. Excess Insurance: When a written contract or written agreement, other than a premises lease, facilities rental contract or agreement, an equipment rental or lease contract or agreement, or permit issued by a state or political subdivision between you and an additional insured does not require this insurance to be primary or primary and non-contributory, this insurance is excess over any other insurance for which the additional insured is designated as a Named Insured. Regardless of the written agreement between you and an additional insured, this insurance is excess over any other insurance whether primary, excess, contingent or on any other basis for which the additional insured has been added as an additional insured on other policies. N. Unintentional Failure to Disclose Hazards Under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, the following is added to Condition 6. Representations: Failure of the Insured to disclose all hazards existing as of the inception date of this Policy shall not prejudice the insurance with respect to the coverage afforded by this Policy, provided such failure or omission is not intentional on the part of the Insured. O. Amended Bodily Injury Definition Under DEFINITIONS, Definition 3. Bodily Injury is replaced by the following: 3. "Bodily injury" means bodily injury, sickness, or disease sustained by a person, including death of a person. "Bodily Injury" also means mental anguish, mental injury, or shock, if directly resulting from physical injury, sickness, or disease to that person. P. Broadened Mobile Equipment Under DEFINITIONS, Definition 12. Mobile Equipment, the following is added under 121(1): Provided that the vehicles have a Gross Vehicle Weight of 1 ,000 pounds or greater. Includes copyrighted material of Insurance Services Office, Inc., with its permission CG 82 16 (Ed. 02/15) (Page 8 of 10) II "07/02/2018" GLP-3763293-00-02 GREAT AMERICAN ASSURANCE CO 0648162 Q. Who Is an Insured - Fellow Employee Extension - Management Employees 1. The following is added to paragraph 2.a.(1) of SECTION II - WHO IS AN INSURED: Paragraph (a) and (b) above do not apply to "bodily injury" or "personal and advertising injury" caused by a co-"employee" while in the course of his or her employment or performing duties related to the conduct of your business. However, none of these co-"employees" are insureds for "bodily injury" or "personal and advertising injury" arising out of their willful conduct, which is defined as the purposeful or willful intent to cause "bodily injury" or "personal and advertising injury," caused in whole or in part by their intoxication by liquor or controlled substances. Paragraph (a) and (b) above do not apply to "bodily injury" or "personal and advertising injury" caused by an "employee" who is acting in a supervisory capacity for you. Supervisory capacity as used herein means the "employee's" job responsibilities assigned by you, including the direct supervision of other "employee" of yours. However, none of these "employees" are insureds for "bodily injury" or "personal and advertising injury" arising out of their willful conduct, which is defined as the purposeful or willful intent to cause "bodily injury" or "personal and advertising injury," caused in whole or in part by their intoxication by liquor or controlled substances. This coverage is excess over any other valid and collectable insurance available to your "employee" or "volunteer worker." R. Personal and Advertising Injury Definition Amendment of Discrimination or Humiliation Under DEFINITIONS, Definition 14. Personal and Advertising Injury. item 14.h. is added: h. discrimination or humiliation that results in injury to the feelings or reputation of a natural person, but only if such discrimination or humiliation is: (1) not done intentionally by or at the direction of; (a) an insured; or (b) any "executive officer" director, stockholder, partner or member of the Insured; and (2) not directly or indirectly related to the employment, prospective employment or termination of employment of any person or persons by any insured. S. Incidental Malpractice Liability 1. SECTION II - WHO IS AN INSURED is amended by deleting item 2.a.(1)(d) in its entirety and replacing it with the following: (d) Arising out of his or her providing or failing to provide professional health care services. However, this exclusion does not apply to nurses, emergency medical technicians or paramedics who are employed by you to provide medical or paramedical services. 2. Under DEFINITIONS, Definition 3. Bodily Injury is replaced by the following: 3. "Bodily injury" means bodily injury, sickness, or disease or "incidental medical malpractice" sustained by a person, including death of a person. "Bodily Injury" also means mental anguish, mental injury, or shock, if directly resulting from physical injury, sickness, or disease to that person. Includes copyrighted material of Insurance Services Office, Inc., with its permission CG 82 16 (Ed. 02/15) (Page 9 of 10) II "07/02/2018" GLP-3763293-00-02 GREAT AMERICAN ASSURANCE CO 0648162 3. Under DEFINITIONS is amended by the addition of the following definition: "Incidental medical malpractice" means bodily injury arising out of the negligent rendering or failure to render medical or paramedical services to persons by any physician, dentist, nurse, emergency medical technician or paramedic who is employed by you to provide such services provided you are not engaged in the business or occupation of providing any services referred to in this definition. All other policy terms and conditions remain unchanged. Includes copyrighted material of Insurance Services Office, Inc., with its permission CG 82 16 (Ed. 02/15) (Page 10 of 10) II "07/02/2018" GLP-3763293-00-02 GREAT AMERICAN ASSURANCE CO 0648162 CG 85 28 (Ed. 0 8 10) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US - WHEN REQUIRED IN A WRITTEN CONTRACT OR AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART In SECTION IV - COMMERCIAL GENERAL LI- but only if: ABILITY CONDITIONS, the following is added at the end of Condition 8. Transfer of Rights of Recovery Against Others to Us: We waive any right of recovery we may have c. you and that person or organization have against a person or organization because of agreed, in a written contract or agree- payments we make for injury or damage aris- ment, that you waive such rights against ing out of: that person or organization; and a. your ongoing operations; or b. "your work" pursuant to a written contract d. the injury or damage occurs only after between you and that person or organiza- you and that person or organization have tion and included in the "products-com- signed the written contract or agreement pleted operations hazard"; described in c. This endorsement does not change any other provision of the Policy. Copyright, ISO Properties, Inc., 2010 CG 85 28 (Ed. 08/10) XS II "07/02/2018" GLP-3763293-00-02 GREAT AMERICAN ASSURANCE CO 0648162 CG 85 18 (Ed. 05 14) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AUTOMATIC ADDITIONAL INSURED CONTRACTORS - PRODUCTS/COMPLETED OPERATIONS ONLY This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. SECTION II - WHO IS AN INSURED is A person or organization described in Section amended to include as an additional insured A. of this endorsement is an additional insured any person or organization for whom you only as respects "bodily injury" or "property performed operations, but only when you and damage" that: that person or organization expressly agreed in writing, in a written contract or agreement 1. is within the "products-completed oper- made before the "bodily injury" or "property ations hazard"; and damage" occurs, that such person or organi- zation would be added as an additional insured 2. occurs after the making of the written under this Policy, specifically for liability with- contract or agreement described in Sec- in the "products-completed operations haz- tion A. of this endorsement. ard." Our coverage for such an additional in- sured is subject to the terms, conditions, ex- Under this endorsement, no person or or- clusions, and limitations of this insurance, as ganization is an additional insured as respects: modified by this endorsement. I. any "bodily injury" or "property dam- However: age" that is not within the "products- completed operations hazard"; 1. the insurance afforded to such additional insured only applies to the extent permit- ii. any "personal and advertising injury"; ted by law; and or 2. if coverage provided to the Additional In- iii. Coverage B - Personal and Adver- sured is required by a contract or agree- tising Injury Liability. ment, the insurance afforded to such ad- ditional insured will not be broader than C. As respects our coverage of an additional that which you are required by the con- insured described in Section A. of this en- tract or agreement to provide for such dorsement, the following provision is added at additional insured. the end of Coverage A - Bodily Injury and Property Damage Liability, 1. Insuring B. A person or organization described in Section Agreement, paragraph b.: A. of this endorsement is an additional insured only during the period of time for which such and additional insured status is required by the written contract or agreement between you (4) the "bodily injury" or "property damage" is and that person or organization, but in no included in the "products-completed op- event after the end of the policy period of erations hazard" and caused, in whole or in this Policy. part, by "your work" that is: Copyright, Insurance Services Office, Inc., 2010 CG 85 18 (Ed. 05/14) (Page 1 of 3)