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CERTIFICATE OF LIABILITY INSURANCE (944)
DATE(MM/DD/YYYY) A�"® CERTIFICATE OF LIABILITY INSURANCE 01/11/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Jim Goodwyne NAME: IRONWOOD INSURANCE SERVICES,LLC HCONNo Ext): (404)503-9100 FAX, C,No: (404)503-9101 3715 Northside Parkway NW E-MAIL ADDRESS: jgoodwyne@ironwoodins.com Suite 1-500 INSURER(S)AFFORDING COVERAGE NAIC# Atlanta GA 30327-2868 INSURERA: Charter Oak Fire Insurance Company 25615 INSURED INSURER B: The Phoenix Insurance Company 25623 Control Southern Inc. INSURERC: Travelers Indemnity Co.of CT 25682 3850 Lakefield Drive INSURER D: INSURER E: Suwanee GA 30024-0241 INSURER F: COVERAGES CERTIFICATE NUMBER: CL1861820491 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 TYPE OF INSURANCE POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER (MM/DD/WW) (MM/DD/WW) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR DAMAGE ToRENTEDPREMISES(Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 A Y 6301G276020 07/01/2018 07/01/2019 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PE0 LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: Employee Benefits $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ B X OWNED SCHEDULED Y BA 1G281171 07/01/2018 07/01/2019 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ X AUTOS ONLY IX AUTOS ONLY Per accident Uninsured motorist $ 1,000,000 X UMBRELLA LAB X OCCUR EACH OCCURRENCE $ 10,000,000 B EXCESS LAB CLAIMS-MADE Y CUP 7J645378 07/01/2018 07/01/2019 AGGREGATE $ 10,000,000 DED I X RETENTION$ 10,000 $ WORKERS COMPENSATIONX PER OTH- Y/N AND EMPLOYERS'LIABILITY STATUTE ER 1,000,000 Q ANY PROPRIETOR/PARTNER/EXECUTIVE N/A UB 7K426465 07/01/2018 07/01/2019 E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate Holder is additional insured on the General Liability,Automobile Liability,and Umbrella Liability policies with respect to the liability resulting from the operations of the Named Insured as required by written contract.Coverage provided for additional insured(s)under GL is primary and non-contributory with respect to any similar insurance held by an additional insured as required by written contract.30 day notice of cancellation,except 10 days for non-payment,applies to City of Clearwater. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Clearwater Attn:Purchasing Department, ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 4748 AUTHORIZED REPRESENTATIVE Clearwater FL 33758-4748 44_� ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Additional Named Insureds Other Named Insureds Shining Light Properties, LLC Limited Liability Company, Additional Named Insured OFAPPINF(02/2007) COPYRIGHT 2007,AMS SERVICES INC UMBRELLA (3) Any statute, ordinance or regulation relat- borrow while it is being used in your busi- ing to the sale, gift, distribution or use of ness. alcoholic beverages. None of the following is an insured under (1) This exclusion applies only if you are in the or(2) above: business of manufacturing, distributing, sell- (a) Any person employed by or engaged ing, serving or furnishing alcoholic beverages. in the duties of an auto sales agency, This exclusion does not apply to "bodily in- repair shop, service station, storage jury"or"property damage"to which any policy garage or public parking place that of "underlying insurance" listed in the you do not operate; SCHEDULE OF UNDERLYING INSURANCE (b) The owner or lessee of any "auto" of the DECLARATIONS of this insurance, or hired by or for you or loaned to you, any renewal or replacement thereof, applies and any agent or employee of such or would apply but for the exhaustion of its owner or lessee. limits of liability. Coverage provided will follow the same provisions, terms, definitions, ex- b. Except as respects the "auto hazard": clusions, limitations and conditions of the pol- (1) Your executive officers, employees, direc- icy(ies) of "underlying insurance" listed in the tors or stockholders while acting within SCHEDULE OF UNDERLYING INSURANCE the scope of their duties; and of the DECLARATIONS of this insurance. (2) Any person or organization while acting SECTION II —WHO IS AN INSURED. as real estate manager for you. 1. If you are designated in the Declarations as: c. Any organization you newly acquire or form, a. An individual, you and your spouse are insur- other than a partnership or joint venture, and eds, but only with respect to the conduct of a over which you maintain ownership or major- business of which you are the sole owner. ity interest, will be deemed to be a Named In- b. A partnership or joint venture, you are an in- sured. However, coverage does not apply to: sured. Your members, your partners, and (1) "Bodily injury" or "property damage" that their spouses are also insureds, but only with occurred before you acquired or formed respect to the conduct of your business. the organization; and c. A limited liability company, you are an in- (2) "Personal injury" or "advertising injury" sured. Your members are also insureds, but arising out of an 'offense" committed be- only with respect to the conduct of your busi- fore you acquired or formed the organiza- ness. Your managers are insureds, but only tion. with respect to their duties as your managers. d. Any person or organization having proper d. An organization other than a partnership,joint temporary custody of your property if you die, venture or limited liability company, you are but only: an insured. (1) With respect to liability arising out of the e. A trust, you are an insured. Your trustees are maintenance or use of that property; and also insureds, but only with respect to their (2) Until your legal representative has been duties as trustees. appointed. 2. Each of the following is also an insured: e. Your legal representative if you die, but only a. As respects the "auto hazard": with respect to duties as such. That represen- (1) Anyone using an "auto" you own, hire or tative will have all your rights and duties un- borrow including any person or organiza- der this insurance. tion legally responsible for such use pro- f. Any other person or organization insured un- vided it is with your permission; and der any policy of the "underlying insurance" (2) Any of your executive officers, directors, listed in the SCHEDULE OF UNDERLYING partners, employees or stockholders, op- INSURANCE of the DECLARATIONS of this erating an "auto" you do not own, hire or insurance for whom you have agreed in a written contract executed prior to loss to pro- vide insurance. This insurance is subject to all Page 6 of 13 Copyright, The Travelers Indemnity Company, 2003 UM 00 01 11 03 UMBRELLA the limitations upon coverage under such pol- Non cumulation of Personal and Advertising In- icy of "underlying insurance", and, the limits jury Limit — If "personal injury" and/or "advertising of insurance afforded to such person or or- injury" is sustained by any one person or organi- ganization will be: zation during the policy period and during the pol- (i) The difference between the "underlying icy period of one or more prior and/or future poli- insurance" limits and the minimum limits cies that include a COMMERCIAL EXCESS of insurance which you agreed to provide; LIABILITY (UMBRELLA) INSURANCE policy for or the insured issued by us or any affiliated insur- ance company, the amount we will pay is limited. (ii) The limits of insurance of this policy This policy's Personal and Advertising Injury Limit whichever is less. will be reduced by the amount of each payment If the minimum limits of insurance you agreed made by us and any affiliated insurance company to provide such person or organization in a under the other policies because of such "per- written contract are wholly within the"underly- sonal injury" and/or"advertising injury". ing insurance", this policy shall not apply. 5. Subject to 2. or 3. above, whichever applies, the No person or organization is an insured with re- Each Occurrence Limit is the most we will pay for spect to the conduct of any current or past part- the sum of damages under Coverage A because nership or joint venture that is not shown as a of all "bodily injury" and "property damage" arising Named Insured in the Declarations. out of any one "occurrence". No person is an insured as respects "bodily in- Non cumulation of Each Occurrence Limit— If one jury" to a fellow employee unless insurance for "occurrence" causes "bodily injury" and/or "prop- uch liability is afforded by the "underlying insur- erty damage" during the policy period and during sce". the policy period of one or more prior and/or fu- ture policies that include a COMMERCIAL EX- SECTION III— LIMITS OF INSURANCE. CESS LIABILITY (UMBRELLA) INSURANCE 1. The Limits of Insurance shown in the Declarations policy for the insured issued by us or any affiliated and the rules below fix the most we will pay re- insurance company, the amount we will pay is gardless of the number of: limited. This policy's Each Occurrence Limit will a. Insureds; be reduced by the amount of each payment made by us and any affiliated insurance company under b. Claims made or"suits" brought; or the other policies because of such "occurrence". c. Persons or organizations making claims or To determine the limit of our liability, all "bodily injury" bringing "suits". and "property damage" arising out of continuous or 2. The Products-Completed Operations Aggregate repeated exposure to the same general conditions Limit is the most we will pay under Coverage A shall be considered one "occurrence". for damages because of injury and damage in- The limits of this insurance apply separately to each cluded in the "products-completed operations consecutive annual period and to any remaining hazard". period of less than 12 months. The policy period 3. The General Aggregate Limit is the most we will begins with the effective date shown in the Declara- pay for damages under Coverage A and Cover- tions. If the policy period is extended after issuance age B, except: for an additional period of less than 12 months, the a. Damages because of injury and damage in- additional period will be deemed part of the last cluded in the "products-completed operations preceding period. hazard"; and SECTION IV—CONDITIONS. b. Damages because of injury and damage in- 1. APPEALS. cluded in the "auto hazard". a. If the insured or the insured's "underlying in- 4. Subject to 3. above, the Personal and Advertising surer" elects not to appeal a judgment which Injury Limit is the most we will pay under Cover- exceeds the "applicable underlying limit", we age B for the sum of all damages because of all may do so. "personal injury" and all "advertising injury" sus- b. If we do, we will pay all costs of the appeal. tained by any one person or organization. We will also pay all costs on appeals related UM 00 01 11 03 Copyright, The Travelers Indemnity Company, 2003 Page 7 of 13 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO EXTENSION ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GENERAL DESCRIPTION OF COVERAGE—This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. BROAD FORM NAMED INSURED H. HIRED AUTO PHYSICAL DAMAGE — LOSS OF B. BLANKET ADDITIONAL INSURED USE—INCREASED LIMIT C. EMPLOYEE HIRED AUTO I. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES—INCREASED LIMIT D. EMPLOYEES AS INSURED J. PERSONAL PROPERTY E. SUPPLEMENTARY PAYMENTS — INCREASED K. AIRBAGS LIMITS L. NOTICE AND KNOWLEDGE OF ACCIDENT OR F. HIRED AUTO — LIMITED WORLDWIDE COV- LOSS ERAGE—INDEMNITY BASIS M. BLANKET WAIVER OF SUBROGATION G. WAIVER OF DEDUCTIBLE—GLASS N. UNINTENTIONAL ERRORS OR OMISSIONS PROVISIONS A. BROAD FORM NAMED INSURED this insurance applies and only to the extent that The following is added to Paragraph A.1., Who Is person or organization qualifies as an "insured" An Insured, of SECTION II —COVERED AUTOS under the Who Is An Insured provision contained LIABILITY COVERAGE: in Section II. Any organization you newly acquire or form dur- C. EMPLOYEE HIRED AUTO ing the policy period over which you maintain 1. The following is added to Paragraph A.1., 50% or more ownership interest and that is not Who Is An Insured, of SECTION II — COV- separately insured for Business Auto Coverage. ERED AUTOS LIABILITY COVERAGE: Coverage under this provision is afforded only un- An "employee" of yours is an "insured" while til the 180th day after you acquire or form the or- operating an "auto" hired or rented under a ganization or the end of the policy period, which- contract or agreement in an "employee's" ever is earlier. name, with your permission, while performing duties related to the conduct of your busi- B. BLANKET ADDITIONAL INSURED ness. The following is added to Paragraph c. in A.1., 2. The following replaces Paragraph b. in B.5., Who Is An Insured, of SECTION II —COVERED Other Insurance, of SECTION IV — BUSI- AUTOS LIABILITY COVERAGE: NESS AUTO CONDITIONS: Any person or organization who is required under b. For Hired Auto Physical Damage Cover- a written contract or agreement between you and age, the following are deemed to be cov- that person or organization, that is signed and ered "autos"you own: executed by you before the "bodily injury" or (1) Any covered "auto" you lease, hire, "property damage" occurs and that is in effect rent or borrow; and during the policy period, to be named as an addi- (2) Any covered "auto" hired or rented by tional insured is an "insured" for Covered Autos your "employee" under a contract in Liability Coverage, but only for damages to which an "employee's" name, with your CA T3 53 02 15 ©2015 The Travelers Indemnity Company.All rights reserved. Page 1 of 4 Includes copyrighted material of Insurance Services Office,Inc.with its permission. COMMERCIAL AUTO permission, while performing duties (a) With respect to any claim made or "suit" related to the conduct of your busi- brought outside the United States of ness. America, the territories and possessions However, any "auto" that is leased, hired, of the United States of America, Puerto rented or borrowed with a driver is not a Rico and Canada: covered "auto". (i) You must arrange to defend the "in- D. EMPLOYEES AS INSURED sured" against, and investigate or set- tle any such claim or "suit" and keep The following is added to Paragraph A.1., Who Is us advised of all proceedings and ac- An Insured, of SECTION II —COVERED AUTOS tions. LIABILITY COVERAGE: (ii) Neither you nor any other involved Any "employee" of yours is an "insured"while us- "insured" will make any settlement ing a covered "auto"you don't own, hire or borrow without our consent. in your business or your personal affairs. E. SUPPLEMENTARY PAYMENTS — INCREASED (iii)We may, at our discretion, participate LIMITS in defending the "insured" against, or in the settlement of, any claim or 1. The following replaces Paragraph A.2.a.(2), "suit". of SECTION II — COVERED AUTOS LIABIL- (iv)We will reimburse the "insured" for ITY COVERAGE: sums that the "insured" legally must (2) Up to $3,000 for cost of bail bonds (in- pay as damages because of "bodily cluding bonds for related traffic law viola- injury" or"property damage" to which tions) required because of an "accident" this insurance applies, that the "in- we cover. We do not have to furnish sured" pays with our consent, but these bonds. only up to the limit described in Para- 2. The following replaces Paragraph A.2.a.(4), graph C., Limits Of Insurance, of of SECTION II — COVERED AUTOS LIABIL- SECTION II — COVERED AUTOS ITY COVERAGE: LIABILITY COVERAGE. (4) All reasonable expenses incurred by the (v) We will reimburse the "insured" for "insured" at our request, including actual the reasonable expenses incurred loss of earnings up to $500 a day be- with our consent for your investiga- cause of time off from work. tion of such claims and your defense of the "insured" against any such F. HIRED AUTO — LIMITED WORLDWIDE COV- "suit", but only up to and included ERAGE—INDEMNITY BASIS within the limit described in Para- The following replaces Subparagraph (5) in Para- graph C., Limits Of Insurance, of graph B.7., Policy Period, Coverage Territory, SECTION II — COVERED AUTOS of SECTION IV — BUSINESS AUTO CONDI- LIABILITY COVERAGE, and not in TIONS: addition to such limit. Our duty to (5) Anywhere in the world, except any country or make such payments ends when we jurisdiction while any trade sanction, em- have used up the applicable limit of bargo, or similar regulation imposed by the insurance in payments for damages, United States of America applies to and pro- settlements or defense expenses. hibits the transaction of business with or (b) This insurance is excess over any valid within such country or jurisdiction, for Cov- and collectible other insurance available ered Autos Liability Coverage for any covered to the "insured" whether primary, excess, "auto" that you lease, hire, rent or borrow contingent or on any other basis. without a driver for a period of 30 days or less (c) This insurance is not a substitute for re- and that is not an "auto" you lease, hire, rent quired or compulsory insurance in any or borrow from any of your "employees", country outside the United States, its ter- partners (if you are a partnership), members ritories and possessions, Puerto Rico and (if you are a limited liability company) or Canada. members of their households. Page 2 of 4 ©2015 The Travelers Indemnity Company.All rights reserved. CA T3 53 02 15 Includes copyrighted material of Insurance Services Office,Inc.with its permission. COMMERCIAL AUTO You agree to maintain all required or (2) In or on your covered "auto". compulsory insurance in any such coun- This coverage applies only in the event of a total try up to the minimum limits required by theft of your covered "auto". local law. Your failure to comply with No deductibles apply to this Personal Property compulsory insurance requirements will not invalidate the coverage afforded by coverage. this policy, but we will only be liable to the K. AIRBAGS same extent we would have been liable The following is added to Paragraph B.3., Exclu- had you complied with the compulsory in- sions, of SECTION III — PHYSICAL DAMAGE surance requirements. COVERAGE: (d) It is understood that we are not an admit- Exclusion 3.a. does not apply to "loss" to one or ted or authorized insurer outside the more airbags in a covered "auto" you own that in- United States of America, its territories flate due to a cause other than a cause of "loss" and possessions, Puerto Rico and Can- set forth in Paragraphs A.1.b. and A.1.c., but ada. We assume no responsibility for the only: furnishing of certificates of insurance, or a. If that "auto" is a covered "auto" for Compre- for compliance in any way with the laws hensive Coverage under this policy; of other countries relating to insurance. b. The airbags are not covered under any war- G. WAIVER OF DEDUCTIBLE—GLASS ranty; and The following is added to Paragraph D., Deducti- c. The airbags were not intentionally inflated. ble, of SECTION III — PHYSICAL DAMAGE We will pay up to a maximum of $1,000 for any COVERAGE: one"loss". No deductible for a covered "auto" will apply to L. NOTICE AND KNOWLEDGE OF ACCIDENT OR glass damage if the glass is repaired rather than LOSS replaced. The following is added to Paragraph A.2.a., of H. HIRED AUTO PHYSICAL DAMAGE — LOSS OF SECTION IV—BUSINESS AUTO CONDITIONS: USE—INCREASED LIMIT Your duty to give us or our authorized representa- The following replaces the last sentence of Para- tive prompt notice of the "accident" or "loss" ap- graph AA.b., Loss Of Use Expenses, of SEC- plies only when the "accident" or "loss" is known TION III—PHYSICAL DAMAGE COVERAGE: to: However, the most we will pay for any expenses (a) You (if you are an individual); for loss of use is $65 per day, to a maximum of (b) A partner(if you are a partnership); $750 for any one"accident". (c) A member (if you are a limited liability com- I. PHYSICAL DAMAGE — TRANSPORTATION pany); EXPENSES—INCREASED LIMIT (d) An executive officer, director or insurance The following replaces the first sentence in Para- manager (if you are a corporation or other or- graph A.4.a., Transportation Expenses, of ganization); or SECTION III — PHYSICAL DAMAGE COVER- (e) Any "employee" authorized by you to give no- AGE: tice of the"accident" or"loss". We will pay up to $50 per day to a maximum of M. BLANKET WAIVER OF SUBROGATION $1,500 for temporary transportation expense in- The following replaces Paragraph A.5., Transfer curred by you because of the total theft of a cov- Of Rights Of Recovery Against Others To Us, ered "auto" of the private passenger type. of SECTION IV — BUSINESS AUTO CONDI- J. PERSONAL PROPERTY TIONS: The following is added to Paragraph AA., Cover- 5. Transfer Of Rights Of Recovery Against age Extensions, of SECTION III — PHYSICAL Others To Us DAMAGE COVERAGE: We waive any right of recovery we may have Personal Property against any person or organization to the ex- tent required of you by a written contract We will pay up to $400 for "loss" to wearing ap- signed and executed prior to any "accident" parel and other personal property which is: or"loss", provided that the"accident" or"loss" (1) Owned by an"insured"; and arises out of operations contemplated by CA T3 53 02 15 ©2015 The Travelers Indemnity Company.All rights reserved. Page 3 of 4 Includes copyrighted material of Insurance Services Office,Inc.with its permission. COMMERCIAL AUTO such contract. The waiver applies only to the The unintentional omission of, or unintentional person or organization designated in such error in, any information given by you shall not contract. prejudice your rights under this insurance. How- N. UNINTENTIONAL ERRORS OR OMISSIONS ever this provision does not affect our right to col- The following is added to Paragraph B.2., Con- lect additional premium or exercise our right of cealment, Misrepresentation, Or Fraud, of cancellation or non-renewal. SECTION IV—BUSINESS AUTO CONDITIONS: Page 4 of 4 ©2015 The Travelers Indemnity Company.All rights reserved. CA T3 53 02 15 Includes copyrighted material of Insurance Services Office,Inc.with its permission. COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. XTEND ENDORSEMENT FOR COMMERCIAL INDUSTRIES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE—This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to this Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. Broadened Named Insured J. Bodily Injury To Co-Employees And Co-Volunteer B. Blanket Additional Insured — Broad Form Vendors Workers C. Damage To Premises Rented To You K. Aircraft Chartered With Crew • Perils of fire, explosion, lightning, smoke, L. Non-Owned Watercraft— Increased From 25 Feet water To 50 Feet • Limit increased to $300,000 M. Increased Supplementary Payments D. Blanket Waiver Of Subrogation Cost of bail bonds increased to $2,500 E. Blanket Additional Insured — Owners, Managers Loss of earnings increased to $500 per day Or Lessors Of Premises F. Blanket Additional Insured — Lessors Of Leased N. Medical Payments- Increased Limit Equipment O. Knowledge And Notice Of Occurrence Or Offense G. Incidental Medical Malpractice P. Unintentional Omission H. Personal Injury—Assumed By Contract Q. Reasonable Force — Bodily Injury Or Property I. Amended Bodily Injury Definition Damage PROVISIONS B. BLANKET ADDITIONAL INSURED — BROAD A. BROADENED NAMED INSURED FORM VENDORS 0 1. The following is added to SECTION II—WHO The following is added to SECTION II — WHO IS IS AN INSURED: AN INSURED: Any organization, other than a partnership or Any person or organization that is a vendor and joint venture, over which you maintain owner- that you have agreed in a written contract or ship or majority interest on the effective date agreement to include as an additional insured on of the policy qualifies as a Named Insured. this Coverage Part is an insured, but only with re- However, coverage for any such organization spect to liability for "bodily injury" or "property will cease as of the date during the policy pe- damage"that: riod that you no longer maintain ownership of, or majority interest in, such organization. a. Is caused by an "occurrence"that takes place after you have signed and executed that con- 2. The following replaces Paragraph 4.a. of tract or agreement; and SECTION II—WHO IS AN INSURED: c a. Coverage under this provision is afforded b. Arises out of "your products" which are dis- only until the 180th day after you acquire tributed or sold in the regular course of such or form the organization or the end of the vendor's business. policy period, whichever is earlier, unless The insurance provided to such vendor is subject reported in writing to us within 180 days. to the following provisions: CG D4 58 07 13 ©2013 The Travelers Indemnity company.All rights reserved. Page 1 of 7 Includes copyrighted material of Insurance Services Office, Inc.with its permission. 005875 COMMERCIAL GENERAL LIABILITY a. The limits of insurance provided to such ven- JURY AND PROPERTY DAMAGE LIABIL- dor will be the limits which you agreed to pro- ITY: vide in the written contract or agreement, or Exclusions c. through n. do not apply to dam- the limits shown in the Declarations of this age to premises while rented to you, or tem- Coverage Part, whichever are less. porarily occupied by you with permission of b. The insurance provided to such vendor does the owner, caused by: not apply to: a. Fire; (1) "Bodily injury" or "property damage" for b. Explosion; which the vendor is obligated to pay damages by reason of the assumption of c. Lightning; liability in a contract or agreement. This d. Smoke resulting from such fire, explosion, exclusion does not apply to liability for or lightning; or damages that the vendor would have in e. Water. the absence of the contract or agreement; A separate limit of insurance applies to such (2) Any express warranty unauthorized by damage to premises as described in Para- you; graph 6. of Section III— Limits Of Insurance. (3) Any physical or chemical change in "your This insurance does not apply to damage to products" made intentionally by such premises while rented to you, or temporarily vendor; occupied by you with permission of the (4) Repackaging, unless unpacked solely for owner, caused by: the purpose of inspection, demonstration, a. Rupture, bursting, or operation of pres- testing, or the substitution of parts under sure relief devices; instructions from the manufacturer, and then repackaged in the original container; b. Rupture or bursting due to expansion or swelling of the contents of any building or (5) Any failure to make such inspections, ad- structure, caused by or resulting from wa- justments, tests or servicing as vendors ter; agree to perform or normally undertake to perform in the regular course of business, c. Explosion of steam boilers, steam pipes, in connection with the distribution or sale steam engines, or steam turbines. of"your products"; 2. The following replaces Paragraph 6. of SEC- (6) Demonstration, installation, servicing or TION III—LIMITS OF INSURANCE: repair operations, except such operations Subject to 5. above, the Damage To Prem- performed at such vendor's premises in ises Rented To You Limit is the most we will connection with the sale of "your prod- pay under Coverage A for damages because ucts"; or of "property damage" to any one premises (7) "Your products"which, after distribution or while rented to you, or temporarily occupied sale by you, have been labeled or rela- by you with permission of the owner, caused beled or used as a container, part or in- by fire; explosion; lightning smoke resulting gredient of any other thing or substance from such fire, explosion, or lightning; or wa- by or for such vendor. ter. The Damage To Premises Rented To Coverage under this provision does not apply to: You Limit will apply to all damage proximately a. Any person or organization from whom you caused by the same "occurrence", whether have acquired "your products", or any ingre- such damage results from fire; explosion; dient, part or container entering into, accom- lightning; smoke resulting from such fire, ex- panying or containing such products; or plosion, or lightning; water; or any combina- b. Any vendor for which coverage as an addi- tion of any of these. tional insured specifically is scheduled by en- The Damage To Premises Rented To You dorsement. Limit will be the higher of: C. DAMAGE TO PREMISES RENTED TO YOU a. $300,000; or 1. The following replaces the last paragraph of b. The amount shown on the Declarations of Paragraph 2., Exclusions, of SECTION I — this Coverage Part for Damage To Prem- COVERAGES — COVERAGE A BODILY IN- ises Rented To You Limit. Page 2 of 7 ©2013 The Travelers Indemnity Company.All rights reserved. CG D4 58 07 13 Includes copyrighted material of Insurance Services Office,Inc.with its permission. COMMERCIAL GENERAL LIABILITY 3. The following replaces Paragraph a. of the a. Is "bodily injury" or"property damage" caused definition of "insured contract" in the DEFINI- by an "occurrence" that takes place, or "per- TIONS Section: sonal injury" or "advertising injury" caused by a. A contract for a lease of premises. How- an offense that is committed, after you have ever, that portion of the contract for a signed and executed that contract or agree- lease of premises that indemnifies any ment; and person or organization for damage to b. Arises out of the ownership, maintenance or premises while rented to you, or tempo- use of that part of any premises leased to rarily occupied by you with permission of you. the owner, caused by: The insurance provided to such premises owner, (1) Fire; manager or lessor is subject to the following pro- visions: (2) Explosion; a. The limits of insurance provided to such (3) Lightning; premises owner, manager or lessor will be (4) Smoke resulting from such fire, ex- the limits which you agreed to provide in the plosion, or lightning; or written contract or agreement, or the limits (5) Water. shown on the Declarations of this Coverage Part, whichever are less. is not an "insured contract"; b. The insurance provided to such premises 4. The following replaces Paragraph 4.b.(1)(b) owner, manager or lessor does not apply to: of SECTION IV — COMMERCIAL GENERAL (1) "Bodily injury" or "property damage" LIABILITY CONDITIONS: caused by an "occurrence" that takes (b) That is insurance for premises rented to place, or "personal injury" or "advertising you, or temporarily occupied by you with injury" caused by an offense that is com- the permission of the owner; mitted, after you cease to be a tenant in D. BLANKET WAIVER OF SUBROGATION that premises; or (2) Structural alterations, new construction or The following is added to Paragraph 8., Transfer demolition operations performed by or on Of Rights Of Recovery Against Others To Us, behalf of such premises owner, manager of SECTION IV — COMMERCIAL GENERAL LI- or lessor. ABILITY CONDITIONS: c. The insurance provided to such premises We waive any right of recovery we may have owner, manager or lessor is excess over any �= against any person or organization because of valid and collectible other insurance available payments we make for injury or damage arising to such premises owner, manager or lessor, out of premises owned or occupied by or rented unless you have agreed in a written contract or loaned to you; ongoing operations performed for this insurance to apply on a primary or by you or on your behalf, done under a contract contributory.basis. with that person or organization; "your work"; or F. BLANKET ADDITIONAL INSURED — LESSORS "your products". We waive this right where you OF LEASED EQUIPMENT have agreed to do so as part of a written contract, The following is added to SECTION II —WHO IS executed by you prior to loss. AN INSURED: E. BLANKET ADDITIONAL INSURED — OWNERS, Any person or organization that is an equipment MANAGERS OR LESSORS OF PREMISES lessor and that you have agreed in a written con- The following is added to SECTION II — WHO IS tract or agreement to include as an additional in- _ AN INSURED: sured on this Coverage Part is an insured, but Any person or organization that is a premises only with respect to liability for "bodily injury", owner, manager or lessor and that you have "property damage", "personal injury" or "advertis- e= agreed in a written contract or agreement to ing injury"that: name as an additional insured on this Coverage a. Is "bodily injury" or"property damage" caused Part is an insured, but only with respect to liability by an "occurrence" that takes place, or "per- for "bodily injury", "property damage", "personal sonal injury" or "advertising injury" caused by injury" or"advertising injury"that: an offense that is committed, after you have CG D4 58 07 13 ©2013 The Travelers Indemnity company.All rights reserved. Page 3 of 7 Includes copyrighted material of Insurance Services Office, Inc.with its permission. 005878 COMMERCIAL GENERAL LIABILITY signed and executed that contract or agree- 3. The following is added to Paragraph 2.a.(1) of ment; and SECTION II—WHO IS AN INSURED: b. Is caused, in whole or in part, by your acts or Unless you are in the business or occupation omissions in the maintenance, operation or of providing professional health care services, use by you of equipment leased to you by Paragraphs (1)(a), (b), (c) and (d) above do such equipment lessor. not apply to any "bodily injury" arising out of The insurance provided to such equipment lessor any providing or failing to provide "incidental medical services" by any of your"employees", is subject to the following provisions: other than an employed doctor. Any such a. The limits of insurance provided to such "employees" providing or failing to provide equipment lessor will be the limits which you "incidental medical services" during their work agreed to provide in the written contract or hours for you will be deemed to be acting agreement, or the limits shown on the Decla- within the scope of their employment by you rations of this Coverage Part, whichever are or performing duties related to the conduct of less. your business. b. The insurance provided to such equipment 4. The following exclusion is added to Para- lessor does not apply to any "bodily injury" or graph 2., Exclusions, of SECTION I — COV- "property damage" caused by an "occurrence" ERAGES — COVERAGE A BODILY INJURY that takes place, or "personal injury" or "ad- AND PROPERTY DAMAGE LIABILITY: vertising injury" caused by an offense that is Sale Of Pharmaceuticals committed, after the equipment lease expires. "Bodily injury" or "property damage" arising c. The insurance provided to such equipment out of the willful violation of a penal statute or lessor is excess over any valid and collectible ordinance relating to the sale of pharmaceuti- other insurance available to such equipment cals committed by, or with the knowledge or lessor, unless you have agreed in a written consent of,the insured. contract for this insurance to apply on a pri- 5. The following is added to Paragraph 5. of mary or contributory basis. SECTION III—LIMITS OF INSURANCE: G. INCIDENTAL MEDICAL MALPRACTICE For the purposes of determining the applica- ble Each Occurrence Limit, all related acts or 1. The following is added to the definition of"oc- omissions committed in the providing or fail- ing to provide "incidental medical services" to Unless you are in the business or occupation any one person will be considered one "oc- of providing professional health care services, currence". "occurrence" also means an act or omission 6. The following is added to Paragraph 4.b., Ex- committed in providing or failing to provide cess Insurance, of SECTION IV — COM- "incidental medical services"to a person. MERCIAL GENERAL LIABILITY CONDI- 2. The following is added to the DEFINITIONS TIONS: Section: This insurance is excess over any valid and "Incidental medical services" means: collectible other insurance, whether primary, excess, contingent or on any other basis, that a. Medical, surgical, dental, laboratory, x-ray is available to any of your "employees" for or nursing service or treatment, advice or "bodily injury" that arises out of providing or instruction, or the related furnishing of failing to provide "incidental medical services" food or beverages; to any person to the extent not subject to b. The furnishing or dispensing of drugs or Paragraph 2.a.(1) of SECTION II — WHO IS medical, dental, or surgical supplies or AN INSURED. appliances; H. PERSONAL INJURY — ASSUMED BY CON- c. First aid; or TRACT d. "Good Samaritan services". 1. The following replaces Exclusion e., Contrac- tual Liability, in Paragraph 2. of SECTION I "Good Samaritan services" means any emer- — COVERAGES — COVERAGE B PER- gency medical services for which no compen- SONAL AND ADVERTISING INJURY LI- sation is demanded or received. ABILITY: Page 4 of 7 ©2013 The Travelers Indemnity Company.All rights reserved. CG D4 58 07 13 Includes copyrighted material of Insurance Services Office,Inc.with its permission. COMMERCIAL GENERAL LIABILITY e. Contractual Liability the insured and the interests of the in- "Personal injury" or "advertising injury" for demnitee; which the insured is obligated to pay 4. The following replaces the first subparagraph damages by reason of the assumption of of Paragraph f. of the definition of "insured liability in a contract or agreement. This contract" in the DEFINITIONS Section: exclusion does not apply to: f. That part of any other contract or agree- (1) Liability for damages that the insured ment pertaining to your business (includ- would have in the absence of the ing an indemnification of a municipality in contract or agreement; or connection with work performed for a (2) Liability for damages because of municipality) under which you assume the "personal injury" assumed in a con- tort liability of another party to pay for tract or agreement that is an "insured "bodily injury," "property damage" or "per- sonal injury"to a third person or organiza- contract", provided that the "personal tion. Tort liability means a liability that injury" is caused by an offense com- would be imposed by law in the absence mitted subsequent to the execution of of any contract or agreement. the contract or agreement. Solely for I. AMENDED BODILY INJURY DEFINITION the purposes of liability assumed in an "insured contract", reasonable at- The following replaces the definition of "bodily in- torneys fees and necessary litigation jury" in the DEFINITIONS Section: expenses incurred by or for a party "Bodily injury" means bodily injury, mental an- other than an insured will be deemed guish, mental injury, shock, fright, disability, hu- to be damages because of "personal miliation, sickness or disease sustained by a per- injury", provided that: son, including death resulting from any of these at (a) Liability to such party for, or for any time. the cost of, that party's defense J. BODILY INJURY TO CO-EMPLOYEES AND has also been assumed in the CO-VOLUNTEER WORKERS same "insured contract"; and The following is added to Paragraph 2.a.(1) of (b) Such attorney fees and litigation SECTION II—WHO IS AN INSURED: expenses are for defense of that Paragraph (1)(a) above does not apply to "bodily party against a civil or alternative injury"to a co-,,employee" in the course of the co- dispute resolution proceeding in "employee's" employment by you or performing which damages to which this in- duties related to the conduct of your business, or surance applies are alleged. to "bodily injury"to your other "volunteer workers" 2. The following replaces the third sentence of while performing duties related to the conduct of Paragraph 2. of SUPPLEMENTARY PAY- your business. MENTS—COVERAGES A AND B: K. AIRCRAFT CHARTERED WITH CREW Notwithstanding the provisions of Paragraph The following is added to Exclusion g., Aircraft, 2.b.(2) of Section I — Coverage A— Bodily In- Auto Or Watercraft, in Paragraph 2. of SECTION jury And Property Damage Liability or Para- I — COVERAGES — COVERAGE A BODILY IN- graph 2.e. of Section I — Coverage B — Per- JURY AND PROPERTY DAMAGE LIABILITY: sonal and Advertising Injury Liability, such This exclusion does not apply to an aircraft that payments will not be deemed to be damages is: because of "bodily injury", "property damage" (a) Chartered with crew to any insured; or "personal injury", and will not reduce the (b) Not owned by any insured; and limits of insurance. (c) Not being used to car ryan y person or prop- 3. The following replaces Paragraph 2.d. of erty for a charge. SUPPLEMENTARY PAYMENTS — COVER- L. NON-OWNED WATERCRAFT a AGES A AND B: 1. The following replaces Paragraph (2) of Ex- d. The allegations in the "suit" and the in= clusion g., Aircraft, Auto Or Watercraft, in formation we know about the "occur- Paragraph 2. of SECTION I — COVERAGES rence" or offense are such that no conflict — COVERAGE A BODILY INJURY AND appears to exist between the interests of PROPERTY DAMAGE LIABILITY: CG D4 58 07 13 ©2013 The Travelers Indemnity Company.All rights reserved. Page 5 of 7 Includes copyrighted material of Insurance Services Office, Inc.with its permission. 005877 COMMERCIAL GENERAL LIABILITY (2) A watercraft you do not own that is: e. The following provisions apply to Paragraph (a) Fifty feet long or less; and a. above, but only for the purposes of the in- (b) Not being used to carry any person or surance provided under this Coverage Part to you or any insured listed in Paragraph 1. or 2. property for a charge. of Section II—Who Is An Insured: 2. The following is added to Paragraph 2. of (1) Notice to us of such "occurrence" or of- SECTION II—WHO IS AN INSURED: fense must be given as soon as practica- Any person or organization that, with your ex- ble only after the "occurrence" or offense press or implied consent, either uses or is re- is known to you (if you are an individual), sponsible for the use of a watercraft that you any of your partners or members who is do not own that is: an individual (if you are a partnership or (1) Fifty feet long or less; and joint venture), any of your managers who (2) Not being used to carry any person or is an individual (if you are a limited liability property for a charge. company), any of your trustees who is an M. INCREASED SUPPLEMENTARY PAYMENTS individual (if you are a trust), any of your "executive officers" or directors (if you are 1. The following replaces Paragraph 1.b. of an organization other than a partnership, SUPPLEMENTARY PAYMENTS — COVER- joint venture, limited liability company or AGES A AND B of SECTION I — COVER- trust) or any "employee" authorized by AGES: you to give notice of an "occurrence" or b. Up to $2,500 for cost of bail bonds re- offense. quired because of accidents or traffic law (2) If you are a partnership, joint venture, lim- violations arising out of the use of any ited liability company or trust, and none of vehicle to which the Bodily Injury Liability your partners, joint venture members, Coverage applies. We do not have to fur- nish these bonds. managers or trustees are individuals, no- tice to us of such "occurrence" or offense 2. The following replaces Paragraph 1.d. of must be given as soon as practicable only SUPPLEMENTARY PAYMENTS — COVER- after the "occurrence" or offense is known AGES A AND B of SECTION I — COVER- by. AGES: (a) Any individual who is: d. All reasonable expenses incurred by the insured at our request to assist us in the (i) A partner or member of any part- investigation or defense of the claim or nership or joint venture; "suit", including actual loss of earnings up (ii) A manager of any limited liability to $500 a day because of time off from company; work. (iii)A trustee of any trust; or N. MEDICAL PAYMENTS—INCREASED LIMIT (iv)An executive officer or director of The following replaces Paragraph 7. of SECTION any other organization; III— LIMITS OF INSURANCE: that is your partner, joint venture 7. Subject to 5. above, the Medical Expense Limit is the most we will pay under Coverage member, manager or trustee; or C. for all medical expenses because of "bod- (b) Any "employee" authorized by such ily injury" sustained by any one person, and partnership, joint venture, limited li- will be the higher of: ability company, trust or other organi- (a) $10,000; or zation to give notice of an "occur- rence" or offense. (b) The amount shown on the Declarations of this Coverage Part for Medical Expense (3) Notice to us of such "occurrence" or of- Limit. fense will be deemed to be given as soon O. KNOWLEDGE AND NOTICE OF OCCUR- as practicable if is given in good faith as RENCE OR OFFENSE soon as practicable to your workers' compensation insurer. This applies only if The following is added to Paragraph 2., Duties In you subsequently give notice to us of the The Event of Occurrence, Offense, Claim or "occurrence" or offense as soon as prac- Suit, of SECTION IV — COMMERCIAL GEN- ticable after any of the persons described ERAL LIABILITY CONDITIONS: in Paragraphs e.(1) or (2) above discov- Page 6 of 7 ©2013 The Travelers Indemnity Company.All rights reserved. CG D4 58 07 13 Includes copyrighted material of Insurance Services Office,Inc.with its permission. COMMERCIAL GENERAL LIABILITY ers that the "occurrence" or offense may your rights under this insurance. However, this result in sums to which the insurance provision does not affect our right to collect addi- provided under this Coverage Part may tional premium or to exercise our rights of cancel- apply. lation or nonrenewal in accordance with applica- However, if this policy includes an endorse- ble insurance laws or regulations. ment that provides limited coverage for"bod- Q REASONABLE FORCE — BODILY INJURY OR ily injury" or "property damage" or pollution PROPERTY DAMAGE costs arising out of a discharge, release or escape of "pollutants" which contains a re- The following replaces Exclusion a., Expected Or quirement that the discharge, release or es- Intended Injury, in Paragraph 2. of SECTION I — cape of "pollutants" must be reported to us COVERAGES — COVERAGE A BODILY IN- within a specific number of days after its JURY AND PROPERTY DAMAGE LIABILITY: abrupt commencement, this Paragraph e. does not affect that requirement. a. Expected or Intended Injury or Damage P. UNINTENTIONAL OMISSION "Bodily injury" or "property damage" expected The following is added to Paragraph 6., Repre- or intended from the standpoint of the in- sentations, of SECTION IV — COMMERCIAL sured. This exclusion does not apply to "bod- GENERAL LIABILITY CONDITIONS: ily injury" or "property damage" resulting from The unintentional omission of, or unintentional er- the use of reasonable force to protect any ror in, any information provided by you which we person or property. relied upon in issuing this policy will not prejudice m= m N O O O� O m r n o� 0 a CG D4 58 07 13 ©2013 The Travelers Indemnity Company.All rights reserved. Page 7 of 7 Includes copyrighted material of Insurance Services Office,Inc.with its permission. 005878 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT OF COVERAGE - PROPERTY DAMAGE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART PROVISIONS to occur at the time of the 'occurrence" that The definition of "property damage" in SECTION V — caused it. DEFINITIONS is deleted in its entirety and replaced "Property damage" does not include loss of or dam- by the following: age to "electronic media and records". "Property damage" means: As used in this definition, "electronic media and a. Physical injury to tangible property, including all records" means: resulting loss of use of that property. All such loss a. Electronic data processing, recording or storage of use shall be deemed to occur at the time of the media such as films, tapes, discs, drums or cells; physical injury that caused it; or b. Data stored on such media; or b. Loss of use of tangible property that is not physi- c. Programming records for electronic data process- cally injured. All such loss of use shall be deemed ing or electronically controlled equipment. CG D2 56 11 03 Copyright, The Travelers Indemnity Company, 2003 Page 1 of 1 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OTHER INSURANCE - ADDITIONAL INSUREDS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS b. The"personal injury" or"advertising injury"for COMMERCIAL GENERAL LIABILITY CONDITIONS which coverage is sought arises out of an of- (Section IV), Paragraph 4. (Other Insurance), is fense committed amended as follows: subsequent to the signing and execution of that 1. The following is added to Paragraph a. Primary contract or agreement by you. Insurance: 2. The first Subparagraph (2) of Paragraph b. Ex- However, if you specifically agree in a written con- cess Insurance regarding any other primary in- tract or written agreement that the insurance pro- surance available to you is deleted. vided to an additional insured under this 3. The following is added to Paragraph b. Excess Coverage Part must apply on a primary basis, or Insurance, as an additional subparagraph under a primary and non-contributory basis, this insur- Subparagraph (1): ance is primary to other insurance that is avail- That is available to the insured when the insured able to such additional insured which covers such is added as an additional insured under any other additional insured as a named insured, and we will not share with that other insurance, provided policy, including any umbrella or excess policy. that: a. The "bodily injury" or "property damage" for which coverage is sought occurs; and CG DO 37 04 05 Copyright 2005 The St. Paul Travelers Companies, Inc. All rights reserved. Page 1 of 1