CERTIFICATE OF LIABILITY INSURANCE - 10-0039-UT-D CERTIFICATE OF LIABILITY INSURANCE DATE�wwyv�y)
101120201
THIS CERTIFICATE IS, ISSUED AS A MA17ER OF INFORMATION OINLY AND CONFERS NO RIGHTS UPONTHE CIERTItFiliCATE HOLD514. THIS
CERTIFICATE' DOES NOT AFFIRMATWELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLWIES
BELOW, THIS CEIRTIF11CATE OF INSURANCE DOES NOT CONSTITUTE A, CONTRACT BEIWEEN THE, ISSUING �NSUIRER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE Hii
RTANT�. 11 the cartificate hiolder Is an ADDITIONAL,INSURE0, the policy(Jes) must have ADDITIONAL INSURED provisions oir be endorsed.
If SUBROGATION IS WAIV'ED, subject to,the terms and condItIons of the polli certa�n pollicles may require an endorsement. A Statement On
this certificate does not confer rights to the certificate holder N%lieu of such 6"dorsament ii
PRODUCER
Aftur J. 00agher&CIE, 1nSLfl`,,VX.e Brokerv,,�of CA, 4 15 391 15 10 0 FAIX !i2hJ1 5,391-1882
1265 Battery Street#450
San Fran6s,co CA 94111 APQ '0 P�rRN�qf Qmv-,�ppl-- —............................................. ......................... .............
INSURE'' §)Aff9i DMOCOVERAGE Nli
23035
... ........
INSURED GARIV311014,0,? 81�-Travleiers ProF� qt�pz "!�y C"o of Arnerica, 25674
Gafney HoWing Company/Garney Cloiinpan�es, Mc,/
Garney, Coins trij ct o ntGarn ey Racific, �rlc/Garney MAu,Rr,,p,c:: BerW. ey�s ince Ccrnp��n
Federal, 4ic, 1333 NW Vi0on Road mwmva o� Ohio Ca ft insuraince Corn iy 24074
P
�51'�4�4'y
sais Gity MO 64118 INSPRkp'k
coi"C-N-Zi—s CERTIFICATE NiUMBER:1002126599 REVISION NUMBEW
THlS G TO CEIRIWY THIAT THE POL,0ES OF WS�WANCE USTED EIEUDW HAVE BEEN iSSIJED TO THE "4SURED NAMED ABOVE, POR THE POILICY PEMOD
iNIDICATED, NOTWITHSTANDING ANY RF.GUREMEN"r, TERM OF1 CONUTION OF ANY CONTRACTOR (YNfER DOCUMEN'r wrni RESi 70 WI-IiCH DIG
CEnTIMATE MAY HE ISSUIU) i MAY PERTAiN, THE �NMJRANCE, AFFORDED BY THE POLICIFS DESCRIBED HERMlJ IS SL6jECT1 ALIL THE TERMS,
EXCLUSIONS AND CUNDITIONSOF Sux',�i POLICIES,LMIS SHOWN MAY HAVE BEEN FiEDUCED BYPAM CLAUS.
LUTS
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A X COMMEIRCIALGENERALUAIMMY v y T8264142.6942720 IOM12020 �01112027 EACH 0Cr OURRENCE,
00
�',LAJMSMADE 0(,(N)R pl, 300 000
pneppsoy,� 511,000
——-------------
T1,JERS0NAL K AI,'J,V KUR Y S3010,000
GENEPAL hP.Xill EGA
10
ry) w"�y X, '00PAPADF1 AGG 615,000,000
QrHER $
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$
A AUTOMOBILE IJAMUTY y y AS215414269427W 1011112020 1
x ANYAUTO W)DI Y IN PAlY�Pwpe r 8 a n)
()WNED sc�*Imxtu E4001LY NX.MY Mm,acc0ipm
Af,,1'()S rli'C Y AV rOS
HiSED x ii OWNE PRok ri�'r,y DAMAGE
AUTOS 0% A 0 (3)4 L Y
.......... .......
8 X MORELLA LIAS x Y ZUF114S7945220NF �(VV2020 *Nr2c?l EACM OC4�URNENCE S 10 W)G 200
ENCESS UAS
CLAIMS MADE i AGUR EGA�E 10 001
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NLT 215 1
A WORKERS COMPENSAPON 7'"' , (),H.
WA26'042694'2730 M1112020 1000,)21 X R
AND EMPLOYFAS'LIABILITV
......... ii EACHACUMff $10010 W
�WA' 0
(Aili f"Nil!) E L rASEASE :,Ai EMKCYIEE� I I,=00,10
A LAO Y 1,OWT 1,0owwo
1) 1,KRfl:Y`K'JN(X )P$7 A110N �L912�y I r 0,073r- ,E,POLK!!'
y 1A
C Y PCADR50I073,9i020 ICMIZ02() M/1121021 Eia C"ani, MA
"g`d Marine, y QT0301L1645(0ri1L2G 10)112 020 1001t,2021,
ECO2155700446 I Oil Q020 10/1121(�21 5,D
.......................... ..........
VMS,VIi (AC0R0101,Addffl*nW ri kfhediu�4,rway The aftwIludihi w Is rdquked)
.............. ....... ....--
RE WatarTreatnientNc 2 -ContrRct4: Revevse0smk)s�sPWn,tS4oE�(pansiori Pwjisct 10,M39,U1'-(1D) TheCIty ofCliearwater, ReisrEngii kvc,, arld
W oftr pw-sons or enfibes as jpeed to per written cor&act, are scIdItlor4�nsured under ihe Geniei,W UabflI�y and Aullornob0o �Jab�fty pOicy�frequi;ied by'a"
wriften contract wit ,�"Wj$red,but,only for thie(;overagie and Ionits,provklield 4y9ie pioiJicy and the addibional insured eindorsenivirit GerlcrM Jab;fity
P0cv incitides,PrerniseslOperabons and Pfioducts,Completed Operations Contirart%4 Liabiky coverage IR=Iuded,wjbpect to the terrris amid randitions of the
po4cy Walvw of Subragatmi appii�eis to Workers'Caryfdmiabon, ("j'oneral LiabHity and Autio Uabifity a,s reqwmd by w6fter,coo�actwhere perinissibIa by law,
General: bab�fity pdicy�nCWdvs cortractual IlabiRV am.. explosion,ccAnpse wid:underground covierage
............ ........
CERTIF11CATE HOLDER CANCELLAnON
S"OULD�ANY OF THE ABOVE DESCRIBED Fw01.JCIES BE CANCELLED BEFORE
1NE EXPMATION, DATE "THEREOF, NOTICE WILL BE DELIVERED IN
Cft, of 0earwa ACCORDANCE WI:TH THE POL110Y PROVISIONS,
�ter, Eng I
101�S. Myrt e Ave. v e.
Clewwater Ft., 337��
01 U,
U SA
13
C 1988-2015 ACORD GORPORA'TION, All rights reserved,
ACORD 25(201&03)1 p re registered mai of ACORD
r en
2,nif25 IT58
2 o 3766
POLICY NUMBER:'TB264 1426942720 COMMERCIAL GENERAL LIABILITY
CG 20 10 04 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - SCHEDULED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
A. Section 11 — Who Is An Insured is amended to 1. All work, including materials, parts or
include as an additional insured the person(s) or equipment furnished in connection with such
organization(s) shown in the Schedule. but only with work, on the project (other than service,
respect to 'liability for "bodily injury.', "property maintenance or repairs) tp be performed: by,'or
clamage�' or "personal and advertising injury' on behalf of the additional, insured(s) at the
caused,in whole or in part, by. location of the covered operations has been'
1. Your acts or omissions;or completed; or
2. The acts or omissions -of those acting on your 2. That portion of "your work" out of which the
behalf; injury or damage arises has been put to its
in the pprformande of your ongoing operations for intended use by any,person or organizatlion
-the additional insured(s) ' at the location(s) other than another contractor or subcontractor
designated above. engaged in performing operations for a
principal as a part of the same project.
However: C. With respect to the insurance afforded to these
1. The insurance afforded to such additional additional insureds, the following is added."to
insured only applies to the extent permitted by Sectlom III—Limits Of Insurance:
law; and if coverage provided to the additional insured is.
2. If coverage provided, to the additional insured Is required by a contract or agreement, the most we
required by_ a contract or agreement, the will pay on behalf of the additional insured is the
insurance afforded to such additional insured will amount,of insurance:
not be broader than that which you are required 1. Required by the contract or agreement; or
by the'contract or agreement to provide for such!
additional insured. 2. Available under the applicable Limits of
B. With respect to the insurance afforded to these Insurance shown in the Declarations;
additional Insureds,, the following �additional whichever is less.
exclusions apply- This endorsement shall not increase the
This insurance does not apply to "bodily injury' or applicable Limits of Insurance shown in the
"property damage" occurring after: Declarations.
SCHEDULE
NameOf Additional Insured Person(s) Location(s) Of Covered Operations
Or Organ ization(s):
Any owner, lessee,or contractor for whom you have Any location listed in such agreement
agreed in writing prior to a loss to provide liability
insurance
Information required to complete this Schedule, if not shown above,will be shown In the Declarations.
CG 20 10 04 13 Insurance Services Office, Inc., 2012 Page 1 of 1
3*of 25
POLICY NUMBER:TB2641426942720 COMMERCIAL,GENERAL LIABILITY
CG 20;37 04 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERSp LESSEES OR
CONTRACTORS - COMPLETED: OPERATIONS
This endorsement modifies insurance.provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
A. Section 11 — Who Is An -insured is amended to B. With respect to the insurance afforded to these
include as an additional insured the person(s) or additional insureds, the following is added to
oraanizatlon(s) shown in the Schedule, but only Section III—Limits Of Insurance:
Ath respect to liability for "bodily injury" or
"property damage" caused. in whole or in part, by If coverage provided to the additional insured is
"Your wok' at the location designated and required �by a contract or agreement. the most we
described in the Schedule of this endorsement YAII pay on behalf of the additional insured is the
performed for that additional insured and included amount of insurance:
in the"Products-completed operations hazard". 1. Required by the contract or agreement; or
However: 2. Available under the applicable Limits of
1. The insurance afforded to such additional Insurance shown in the Declarations;
insured only applies to the extent permitted by whichever is less.
:law,and This endorsement shal[not increase the applicable
2. If coverage provided to the additional insured is Urnits of insurance shown,in the Declarations.
required by a contract or agreement, the
insUrance afforded to such additional insured
will, not be broader than that which you are
required by the contract or agreement to
provide for such additional insured.
SCHEDULE
Name Of Add-Itionall Insured Person(s)
Or Org5nization(p): Location And Description Of Completed Operation.s
Any owner, lessee, or contractor for whom you have Any location.listed in such agreement
agreed in,writing prior to a loss to proMde liability
insurance
Infon-nation.required to complete this Schedule, if not shown above,will be shown in the Declarations.
CG 20 37 04 13 Insurance Services Office, Inc., 2012 Page 1 of 1:
4*025 3768
POLICY NUMBER: T132641426942720 COMMERCIAL GENERAL LIABILITY
CG 20 010413
THISENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
PRIMARY AND NONCONTRIBUTORY
OTHER INSURANCE CONDITION
This endorsement modifies ihsurance.pyovided undet the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTSICOMPLETED OPERATIONS LIABILITY COVERAGE PART
The following is added to the Other Insurance (2) You. have agreed in writing in a contract or
Condition, and supersedes any provision to the agreement that this insurance would be
contrary- primary and would not seek contribution-
Primary And Noncontributory insura.nce from any other insurance available to the
This Insurance is primary to, and will not seek ad.ditiona.1 iinsured.
contribution from any ot her insurance available
to an additional insured under your policy
provided that;
(1) The additional Insured is a Named Insured
under such other Insurance; and
CG 20-0104 13 @ Insurance Services Office, Inc., 2012 Page 11 of I
TV25 3768
POLICY NUMBER: TB2641426942720 COMMERCIALGENERAL LIABILITY
CG 24 04 05 09
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTSICOMPLETED OPERATIONS LIABILITY COVERAGE PART
The following is added to Paragraph 8. Transf6r Of
Rights Of Recovery Against Others To Us of
Section IV—Conditions:
We waive any righ t of recovery we may have against
the person or organization shown in the Schedule
below because of payments we make for injury or
damage arising out of your ongoing operations or
"your work" done under a contract with that person
or organization and included in the"products-
completed operations hazard". Th Is waiver applies
only to the person or organization shown in the
Schedule below.
SCHEDULE
Name Of Person Or Organization:
As required by written contract or agreement entered into prior to los'S.
Information:required to complete this Schedule, if not shown above,Will be shown in the Declbrations.
CG 24 04 05 09 Q Insurance Services Office, Inc., 2008 Page I of 1.
WOO 3768
POLICY NUMBER:*TB2641426942720 COMMERCIAL GENERAL LIABILITY
CG 20 28 04 13
THIS ENDORSEMENT CHANGES THEPOLICY. PLEASE READ WCAREFULLY.
ADDITIONAL INSURED - LESSOR OF
�LEASED EQUIPMENT
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
A. Section 11 — Who Is An Insured is amended to B. With respect to the insurance afforded to these
include as an additional insured the person(s) or additional -insureds, this insurance does not apply
organization(s) shown in the Schedule, but only to any "occurrence which 'takes place after the
with respect to liability for. "bodily injury', "property equipment lease expires.
damagd' or "Personal. and advertising Injury' C. W!th respect to the insurance afforded to these
caused, in whole or in part, by your maintenance, additional insureds, the. following is added to
operation or use of equipment leased to you by Section III—Limits Of Insurance:
such person(s) or organizatfon(s). If coverage provided to the additional insured Is
However: required,,by a contract or agreement, the most we
1. The insurance afforded to such additional will pay on behalf of the additionai insured is the
.Insured only applies to the extent permitted by amount of.insurance:
law; and 1,* Required by the contract or agreement;or
2. If coverage provided to'the additional insured is 2. Available under the applicable Limits of
required by a contract or agreement, the Insurance shown in the'Declarations;
insurance afforded to such additional insured
will not be broader than that which you are whichever is less.
required by the contract or agreement to This endorsement shall not-increase the applicable
provide for such addiUonal insured. Limits of 1nsurance shown in the Declarations.
SCHEDULE
Name Of Additionai Insured Pdrson(s) Or Organization(s):
All persons or organizations leasing equipment to you.
Information required to complete this Schedule,.ff not,shown above,will be shown in the Declarations.
CG 20 28 04 13 Insurance Services Office, Inc., 2012 Page, 1 of 1
7*025 .3768
POLICY NUMBER: TB2641426942720 COMMERCIAL GENERAL LIABILITY
CG 25 04 05 09
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
DESIGNATED LOCATION(S)
GENERAL AGGREGATE LIMIT
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
A. For all sums which the insured becomes �legally B. For all sums which the insured becomes legally
obligated to pay as damages caused by ',occur- obligated to pay as damages caused by
rences" under Section I — Coverage A. and for all Roccurrences" under Section I—Coverage A, and
medical expenses caused by accidents under for all medical expenses caused by accidents
Section I — Coverage C, which can be.attributed under Section [— Coverage C, which cannot be
only to operaEons at a single designated I'loca- attributed only to operations at a tingle designated,
flon"shown in the Schedule below: "location"shown in the Schedule below:
1. A separate Designated Location General, 1. Any payments made under Coverage A for
Aggregate Limit applies to each designated damages or under Coverage rC for medical
"location", and that limit is equal to the expenses shall reduce the' amount available
amount of the General Aggregate Limit under the General Aggregate Limit or the
shown in the Declarations. Prod ucts-completed Operations Aggregate
2. The Designated Location General Aggregate Limit,whichever is applicable,and
Limit is the most we %WIll pay for the sum of all 2. Such payments shall, not reduce any
damages under Coverage A, except dam- Designated Location General Aggregatelimit.
ages because of "bodily injury" or "property I
ts C. When coverage for liability, arising out of the
clamage�' included in the "PrDduc -compjeted ti
opprptlions hazard", and for medical expenses products-completed operations hazard" is prd�-
under Coverage C regardless of -the number vided, tiny payments for damages because of
of: "bodily injury' or "property darriage!' included in
the "products-completed operations haza.rd" will.
a. Insureds; reduce the Products-completed Operations Agg-
b. lClaims made or"suits",brought;or regate Limit, and not reduce the General
c. Persons or organizations making claims or Aggregate Limit nor the Designated Location
,bringing"suits". General Aggregate Limit,
3. Any payments made under Coverage A for D. For the purposes of this, endorsement, the
damages or under Coverage C for medical Definitlow Section is amended by the addition of
expenses shall reduce the Designated Loca- thefollowing definition: .
tion General Aggregate Limit for that desig- "Location" means premises involving the same or
nated "location". Such payments shall not re- connecting lots, or. premises whose connection is
duce the -General Aggregate Limit shown in intiarrupted only by a street,, roadway, waterway or
the Declarations nor shall they reduce any right-of-way of a railroad.
other Designated Location General Aggre- E. The provisions of Section III—Limits Of Insurance
gate Limit for any other designated "location" not otherwise modified by this endorsement shall
shown in the Schedule below. continue-to apply as stipulated.
4. The limits shown in the Declarations for Each
Occurrence, Damage To Premises Rented To
You and Medical Expense continue to apply.
However, instead of being subject to the
General Aggregate Limit shown in the Decl'a-
rations. such limits will be subjett to the appil-
cable Designated Location General Aggre-
gate Limit.
CG 25 04 05 09 0 Insurance Services Office, Inc,, 2008 Page I of 2
V of 25 3768
SCHEDULE
Designated Location(s):
All locations With a total aggregate for all construction locations of$20,000,000
information required to complete this Schedule, if not shown above,will be shown in the Declarations.
CG 25 04,05 09 0 Insurance Services Office, Inc., 2008. Page 2 of 2
0*of 25 3768
POLICY NUMBER: TB2641426942720 COMMERCIAL.GENERAL LIABILITY
CG 2417 10 01
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CONTRACTUAL LIABILITY - RAILROADS
This endorsement modifies insurance provided Under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
With respect to operations performed -for, or affecting, party to pay for"bodily injury' or"property dam-
a Scheduled Railroad at a Designated Job Site, the age�l to a,thlrd person or organization. Tort li-,
definition of "insured contract!' in'the Definitions sec- ability means a liability that would be imposed
Von is replaced by the following: by law in the absence of, any contract or
9. "Insured Contract' means: agreement.
a. A contract for a lease of premises. However, Paragraph f. does 'not include that pan of any
that portion of the contract for a lease of prem- contract or agreement:
ises that indemnifies any �person or organiza- (1) That indemnifies an architect. engineer or
Von for damage by fire to premises while rented surveyor for injury or damage arising out of:
to you or temporarily occupied by you with (a) Preparing, approving or failing to pre-
permission of the owner is not an "insured con- pare or approve maps, shop drawings,
tract'; opinions, reports, surveys, field orders,
b. A sidetrack agreement: change orders or drawings and specifi-
c. Any easement or license agreement; cations,, or
d. An obligation. as required by ordinance, to (b) Giving directions or instructions, or fail-
indemnify a municipality, except In connection ing to give them. if that is the primary
with work for a: municipality, cause of the injury or damage;
e. An elevator maintenance agreement; (2) Under which the insured, if an architect,
engineer or surveyor, assumes liability for
f. That part of �ny other cOntract or agreement an injury or damage arlsing ,out of the im.
pertaining. to your business (including an In- sured's rendering or failure to render pro-
demnificaflon of a Municipality in connection fessional service's, including those listed in
With work performed for a municipality) under Paragraph (1) above, and supervisory, in-
which you assume the tort liability of another spection, architectural or engineering activi-
ties.
SCHEDULE
Scheduled Railroad: Designated Job Site:
Any,railroad for which you are�performlng operations All jobsItes.
and.for which no Railroad Protective Liability Policy has
been purchased for the railroad by you,or any railroad
for which'�ygur woTW'has been completed or put to its
intended use.,
(if no entry appears above, information required to complete this endorsement Will be shown in the Declarations
as applicable to this endorsement.)
CG 24 1710 01 0 ISO.Properties, Inc., 2000. page 1 of 1
10*025 3768
POLICY NUMBER—�B2641426942720 COMMERCIAL GENERAL LIA131LITY
CG 20 1104 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - MANAGERS OR LESSORS OF
I PREMISES.
This endorsement modifies Iri-surance provided under the following:
COMMERCIAL GENERAL LIABILITY-COVERAGE PART
A. Section 11 — Who Is An Insured Is amended to 2. If coverage provided to the addigonal insured Is
Include as an additional. Insured the�person(s)- or required by a contract �or agreemen't. the
organization(s) shown In the Schedule, but,only Insurance afforded to such additional insured
with respect to liability arising,out of the ownership, Wil riot be broader than that which you are
maintenance or use of that part of the premT5�s required by the conttact or agreement to
leased to you and shown, in the Schedule and prcMde for such additional insured. -
subject to the following additional exclusions: B. With respect to the insurance afforded to these
This insurance does not apply to: additional insureds.. the following Is �idded to
1. Any "occurrence!' which takes place after you Section III—Limits Ofinsurance:
cease to�e a tenant in that premises. If coverage provided to the additional insured is
2. Structural alterations, new construction or required by 4 contract or agreement, the most we
will pay on behalf of the additional insured is the
dernoligon operations. performed by or 'on
behalf of the' person(s) or organization(s) amount of Insurance.,
shown In the Schedule. 1. Required by the contract or agreement or
However, 2. Available under the applicable Limits of
1. The Insurance ,afforded to such additional insurance shown in the Declarations;
insured only. applies'6 the extent perafitied by whichever is less.
law;and This endorsement shall not increase the applicable
Limits of Insurance shown in the Declarations.
SCHEDULE
Designation Of Premises(Part Leased To You): Name Of Person(s)Or Organization�s)
(Additional Insured):
Where required by contract or written agreement. Prior Adi person(s� or.organization(s) leasing premises to you
to an 11occurrenceP or offense, to provide additional where required by written contract lor agreement
insured status entered into prior to loss
information required to complete this Schedule,if not shown above,Will be shown in the 0eclaraticris.
CG-20 1104 13 0 Insurance Services Office, Inc.,1012 Page I of I
I I*of 25 3768
POLICY NUMBER:TE2641426942720 COMMERCIAL GENERAL LIABILITY
CG 20 12 04 13
THIS*ENDORSEMENT CHANGES THEPOLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - STATE OR GOVERNMENTAL.
AGENCY OR SUBDIVISIM OR POLITICAL
SUBDIVISION - PERMITS OR AUTHORIZATIONS
This endorsement modifies Insurance provided under thefoll.cwlng:
COMMERCIAL GENERALLIA131LITY COVERAGE PART
A. Section 11 — Who Is An Insured Is amended to 2. This!.ri.s-urance does not apply to:
include as an additional insured any state or a. "Bodily. injury', "property damage!' or
governmental agency or su'bd'lAslon or political "personal and.advertising.I njury' ads I ng.out
subdiNfislon shown in the Schedul% subject to the of operations performed for the federal
follovdng provisions: government,state or rn-unicipaliV.'or -
1. This insurance. applies only with respect to b. "Bodily .injury' or "property. darnagd'
operation s performed by you or on your behalf for 'included within the "Products.completed
which the state or governmental agency or bpeiatidnis hazard".
subdivision or political- subdivision has Issued a B. With respect to the insurance afforded to these
permit or authorization. additional' insureds, the following� is added to
However: Sectionfl,11 4AmI60finsurandw
a. The insurance afford6d to such additional If coverage provided to the addiriona[ insured is
insured only applies tothe extent-pennifted by required, by a contract or agreement, the most we
law;andl will pay on behalf of the additionali insured is the
b. if coverage provided to the additional Insured amount ol"Insurance:
is required by a contract or agreement, the 1. Required by the contract or agreement;or
Insurance afforded to such addiftnal Insured
will not be broader than that which you. are 2. A41able under the applicable Limits of
required by the contract or agreement to Insurance shown In the Declarations;
providefor such additional Insured. whichev&is less.
This endorsement shall not increase the applicable
Limits of Insurance shown In the Declarations.
scHEDuLE
State Or.Governmental Agency Or SubdIvIsIdn Or Political�ubdlvlslon:
Where required by contract or written agreement, prior to an lloc.curri�n.ce or offense, to prWde-additIonal Insured
status
Information required to complede th!s Schedule,if not shown above.will be shown in the Declarations.
CG 20 12 04 13 Insurance Semce;s,Office, inc,.2012 Page 1 of I
112*of 25 3768
POLICY NUMBFR:AS2641426942710 COMMERCIALAUTO
CA 20 48 10,13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
DESIGNATED INSURED FOR
COVERED AUTOS LIABILITY COVERAGE
This endorsement modifies'Insurance provided under the following:
AUTO DEALERS COVERAGE FORM
BUSIN J ESS AUTO COVE'RAGEFORM
MOTOR CARRIER COVERAGE FORM
With respect to coverage provided bythis endorsement, the provisions of-the Coverage� Form apply unless
modified.by the endorsement.
This endorsement identifies pqrson(s) or organization(s)who ore"insure8s"for Covered Autos Liability Coverage
under the 'Who Is An Insured pfavision of the Coverage Fornt This endorsement doe& not alter coveragle
provided In the Coverage'Form;
SCHEDULE
Imame Of Person(s) Or Ordanizad..on(s):
Any person or organization whom you have agreed in writing to add as an additional insured, but only to
coverage and minimum limits,of'lnsurance required by the written agreement, and in no event to exceed:either
the scope of coverage or the limits of insurance provided in this policy,
information required to complete this Schedule, if not shown abovej will-be shown-in the:Declarabons.
Each person or organization shown in the Schedule Is
an "insured"for Covered Autos Liability Coverage,but
only to the extent that person or organization qualifies
as an,"insured"under the Who Is An Insured provision
contained in Paragraph A. A. of Section I[,- Covered
Autos Liability Covera& in the Business Auto and.
Motor Carrier Coverage Forms,and'Paragraph D.2. of
Section I - Covered Autos Coverages of the Auto
Dealers Coverage Form.
CA 20 48 10 13 0 Insurance Services Office, Inc., 2011 Page I of 1.
13'of 25 3769
Policy Number: AS2641426942710
Issued by: Liberty Mutual Fire Insurance Co.
THIS ENDORSEMENT CHANGES THEYOLICY. PLEASE READ IT CAREFULLY.
DESIGNATED INSURED - NONCONTRIBUTING
This endorsement modifies insurance provided unde,r the following:
BUSINESS AUTO COVERAGE FORM
GARAGE COVERAGE FORM
MOTOR CARRIERS 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
P-rovisfon of the Coverage Form, This endorsement does not alter coverage provided in the Coverage form.
Schedule
Name of Person(s)or Organizallons(s):
Any person or organization whom you have agreed in w'riting to add a's an
additional insured, but only tp coverage and minimum Jimits of insural�ce
require d by the written agFeement, ancI- in no event to exceed either the scope of
coverage or the limits of :�nsurance p4ovided in this policy.
Regarding,Designated Contract or Project:
Each person or organization shown in the Schedule of this endorsement is an "Insured"for Liability Coverage, but
only to the ektent that person or organization qualifies as an "insured" under-the Who Is An Insured Provision
contained in Section 11 of the Coverage Form.
The following is added to the Other Insurance Condition:
If you have agreed in a written agreement that this policy will be primary and wlthoLAt right of contribution
from any insurance in force for anAdditional Insured'for liability. arising out of your operations, and the
agreement was executed prior to the "bodily inJury" or "property damage", then this insurance will be
.primary and we w!LII not seek contribution from such insurance.
AC 84 23 08 11 Q 201 0,:Li'berty Mutual Group of Companies. All''rights reserved. Page 1 of 1
Includes copyrighted material�of Insurance Services Office, Inc.,
with its permission.
14'025 3768
POLICY NUMBER: AS2641426942710 COMMERCIALAUTO
CA 04 44 10 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
- WAIVER OF TRANSFER OFRIGHTS :OF RECOVERY
AGAINST OTHERS TO US (WAIVER ;OF SUBROGATION)
This endorsement modifies insurance provided under the following:
AUTO DEALERS COVERAOE:FORM
BUSINESS AUTO COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
With-respectto coverage provided by this endorsement,,the provisionsof the Coverage Form apply unless modified
by the endorsement.
SCHEDULE
-Na.mle.(s) Of Person(s)'Or Organizatlon(s):
Any person or organization.for whomyou perform work under a written contract if the contract requires you to
obtain this agreement from us, but only if the contract is executed prior to the injury or damage occurring.
Premium: $ INCL
Information required to complete this Schedule, if not shown above, will'-be shown in the Declarations.
The Transfer Of Rlg�ts Of RecoverY Against
-Others' ' -To Us condition does not apply to the
person(s) or organization(s)-shown In the Schedule,
but only to the extent that subrogation Is waived prior
to the "accident' or the "lots" under a contract with
that person or organization,
CA 04 44 10 13 0 Insurance Services Office, Inc., 2011: Page I of I
15'025 3768
WAIVER'OF OUR RIGHT TO 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.obtal n this agreement from us.)
This agrikpment shall not oppratp directly or Indirectly W benefit anyone not named In the Schedule.
Not applicable In Kentucky.
Schedule
Any person or organization for which the emp)oyer has.agreed by written contract, -executed prior to loss, may
execute.a walver of subrogatlom.However, for purposes�of work performed by the employer In Missouri,this waiver
6f subro' gation does not apply to phy construction group of classifications as designated by the waiver of right to
recover from others (subrogatidn) rule in our manual,
Where required by contract o r written ag ree ment prior to loss and allowed
by law.
In the s(ates.of Alabama,kizona,Arkansas, Colorado, District of
Columbia, Georgia, Indiana,-Kansas, New Mexico, Oklahoma, South Carolina,
Tennessee,Vermont and West Virginia,the premium charge Is 0%of the
total manuall premium,subject to a minimum premiurn,of$0 per policy.
In the state of North Carolina, the premium charge Is 2% of the total'
manua I premium, subject to a minimum premium of$100 per policy.
In the state-cif Virginia, the premium charge Is 5%of'the total manual
premium,subject to a minimum premium of$250,por policy..
In the states-of Florida, Iowa, Maryland, Mississippi,,and Nebraska,the
prem'lurn:ch'arga Is 1%of the total manua.1 premium,sqbje.pt to a minimum
premium of$250 per policy.
In the state of Hawall,the premium charge It$250 and determined as
follows:The.premium charge for this endorsement Is 1%of the total
manual premium,subject to a minimum premium of$250 parpolicy.
In the state of Louisiana,the premium charge.Is 2% of the total standard
premium, subject to a minimum premium of$2.50 per policy.
Is'sued by Liberty Mutual Fire Insurance Company 16686
For attachment to Policy No.WA264D426942730 Effective oate Prernlurn$
Issued to Gamey Cornpanles, Inc.
WC 00 0313 @ 1983 National Council on-Compensation Insurance. Page I of I
EdA410111984
.16'of 2S 3768
WAJVER:OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-
CAUFORNIA
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 organizadon: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.)
You must maintain payroll records accurately segregating the �ernuneratlon of your employees while engaged In
the work descrilied In the Schedule.
The additional premium for this endorsement shall be 20/6 of the California workers' compensation premium
otherwise-due on such remuneration.
Schedule
Additional premium is 6 percent Of the California ManLial Workers Compensation premium. Subject to a minimum
premium charge of S 250 per policy
Person or Organization Job Descriptlom
Where required by contract or
written agreement pribr,to loss and
allowed by law.
Issued by Liberty Mutual Fire Insurance Company 16586
For attachment to Policy No. WA264D426942730 Effective Date Premium$
Issued to Garney Companies3ric.
WC 04 03 06 Page 1 of 1,
Ed:104/1984
17'of 25 3768
TEXAS WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
This endorsement applies only to the insurance prt)vlded by the policy because Texas Is shown in Item&A. of the
Informalion Page.
We have the right to recover our payments from anyone liable for an Injury covered by this policy, We Will not
enforce ourright against the person ororganization named in the-Schedule, but this walverapplies onlywith respect
to bodily injury arising out of the operations described In the Schedule vvhereYOL are requiredby a written contract
to obtain this waiver from us.
This.endorsement shall not operate directly or Indirectly to benefit anyone.not named in the Schedule.
The premium forthls endorsement-is,shown in the Schedule.
Schedule
1. Specific Waiver
Name of person or organization
(X) Blanket Waiver
Any Person or organization4or whom the Named Insured has agreed by written contract to furnish this waiver.
2. Operations:
All Texas Operatlons
3. Premium:
The premium charge for this endorsement shall be 2 percent of the premium developed on payroll in
connection with work performed for the above person(s) or organization(s) arising out of the operations
described.
4. Advance Premium:
Issued by Llherty Mutual Fire,insurance Company 16586
For attachment to Policy No.WA264D426942730 -Effectivo Date Premium$
Issued to Gamey Companies,Inc,
WC 42'03:04 B (D Copyright 2014 National Council on Compensation Insurance, Inc. Page 1 of 1
Ed.06/01/2014 Al.Rights Reserved.
1W 025 3768
UTAH-WAIVER OF SUBROGATION ENDORSEMENT
This endorsement applies only to the Insurance provIded by the policy,because-Utah is shown In item 3.A. of the
Information Page.
We have.-the tight 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 SchedWe. (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,opgrate directly or Indirectly to-be'nefil anyone not named In the Schedule..Our waiver of
rights does:not release your employees' rights against third parties and does not release our aulhority as trustee of
claims against third parties.
Schedule
Where required by contract or written agreement
prior'to loss and allowed by:law.
The-premium chargeis 0%,of the total manual
premium, subject to a minimum premium of$0 per
policy.
This endorsement 15 executed by the Liberty Mutual.Flre'Insurance Company'1658. 6
Premium$
Effective Date Expiration Date
For attachment to Policy No. WA264D426942730
WC 43 03 05
Page I
Ed.712000
0 2000 National Council on Compensation Insurance.
19'oF25 3768
UMBRELLA
charge unless it is specIfied in the 2. Separate�y to eachi insured against
Declarations as adjustable, whorn c[airy) �s madia or "sult" �s
P. PROHIBITED COVERAGE UNLICENSED brought.
INSURANCE t WAIVER OR TRANSFER OF RIGHTS OF
1. With riespect to loss sustained by any RECOVERY AGAINST OTHERS TO US
�4'isured in a country or jurisdiction In 1. if the Insured has rIghts to recover
hich we are not licensed to provide a�l or part of any payment we! havie
this Insurance, this Insurance does made unider this insurance, thiose
not apply to the extent, that �nsuring rights are transferred to us and the
such loss wou�d violate the laws or insured must do nothing after Ioss to
regu�atlons of such country or irnpair thern. At our request, the
jurisdiction. 4isured Mill bring SUit or, transfer
2. We do niot assurne respoins�bIhty for., those rights to us and help us, and
with respect 'to Coverage A, the
a 'rhie payment of any fine, fee, %nder[y�ng �nsurer", enforcle thern.
penafty or other charge that rnay if the insured has agreed in
be imposeld on any person or, a contract. or agreement �to wa�ve
organization In any country or that I nsuiired's, right of recovery
jurisd�ction because we are rwt against any person or organiIzatlori,
licensed to prov�de insuirance In vve waive ouir dght of recovery
such country c,")r juHsdictlon; or against that person or organIzation,
b. 'rhe furnishkig of certificates or but only for psyments we rnake
other ev�dence of insurance In any because of an ""event" that takes
corintry or jurisdiction �n which we place or, is committed subseqUent to
are not licensed to prov�ide the execution of that contract or
lnsurance. agreernen't by !such insured,
(L PROHIBITED COVERAGE - TRADE OR 2. Reimbursement of any amount
ECONOMIC SANCTIONS reclovered will be imade 41 the
Wie wM provide coverage for any �oss, followiniq ordien
or otherwise will provide any benefit, a. F I r'st, to any person or
only to the extent that pro'Odlng SUCh organizatiori ncluding us or the
coverage or benefit does not expose Lis insured) who has paId any atTiount
,or any, of our affMated or parerit in excess of the apphcab�e lirnit
companies to: of insurance;
1. Any trade o�r econory'nc sancflon, under, b� Next, to us; and
any, Iew or regulation of the United c. Then, to any person or
States of America; or organizatior-i Oncluding the Insured
2, Any, other, apphicab�e trade or and wfth respect to Coverage A,
I
economic sanction, prohibWon or the "underly�inq �nsurer") that Is
restOctiom entItled to ciahii the rema�nder, if
R,, REPRESENTATIONS any.
By accepting this Insurance, you algree: 3. Explenses incurred iri the process of
recovery wM be divided among all
1. "me statements in the Declarations persons or organizations receiv�ing
and any subsequient nofice relating to amounts recovered according to the
"unde0ying insurance"' are accurate ratio of their respective recovedes.
and compiete; U. TRANSFER OF YOUR RIGHTS AND DUTIES
Z 'Those statements are based upon UNDER THIS INSURANCE
representations you rnade t10 US; and `1� 'Your rights and duties under this
3. We have iSSLIed th�s insurance In �nsurance may not be transferred
rellance upon your representations. wfthout our written consent except In
S. SEPARATION OF INSUREDS thie case of death of an lindividua�
Narned �nsured,,
Except 'with respect to the Urnits of 2. If yolu die, your, rlghts and duties will
insuranice, and any r1ghts or dufles, be transf erred to your, ilegal
specifically ass�gned in this pofty to, representative but oniy while acting
the first Narned �nsured shown in the withln ttie scope of dutIes as your
Declaratiorm, this insurance app�Ies, legai representative. UntH your legal
t A,s if each Narried �r)SUrf.,'id were the representative is appointed, any�onie
only Narned Insured; and having proper temporairy custody �of
your property Mil have your rights
and duties but only Mth respect -to
that property,
Page 16 of 23 0 21016 The TraveWrs �ndeninfty Company, AH 6ghts reserved. �EU 00 01 07 16
20"af 25 3168
VVLLU 1 V,�N L1MVUJ 11 T
POUCY NUMBER� PCADB5010735102(i Page�0 19,
M. Information Technology Products rreans, a coirnputer or Wecornrnurkztion hardware or, soMware
l,-)roduct or other electronic product that is used, created, develloped or rnanufachved by or l'or you,
lndudkig software updales,swvlce packas and other !Tiain�enarce reteases for suchi products
N, Informatio�n Technology Ser,vicos aioanls�
'I. C onsulting on, design of,dravelotarnent oll, arWys�s of, integration of, lnterface of, rniodificaliorr ol andi
prograrnming of saftwaxe, hardware, rretwoff(s,telermrnmurkat�on systems and electrork or digital
devices, perforr'ned by yart ot on your behaff for youir clients�
2, ktstallafion of,training�n the use of, support of, servicing of, maintenance of, rojmir of your Information
Technology Products�
1 Markefiniq of, selhing of, 4,,-enslng of and distribUflM of Information Technology ProducW
4, stiorage of, warehousing of, n1ining of and processing of data by ywl
5, rnanaging, operatir�g, administering and hosting tiriformation Technology Products for,your cflents� or
6� activitles performed on yotv websfte(s)�
but shall riot mean Information Technology PrOducts,
O� Insured rneans:
1� the Named lnsured� or
2. any ftilly owned subsd�ary corporations or subsidiary Harited riabifty cornparfles of the Named
Insured, of any filer, ir� Ow past, as now consfituted�or hereafter constiluted, subject to the limilations
in Paragrapt'�9, of this Defirniflon for the newly arx;Wred or forared,entities descrIbef,"I thereir), o�
3, any present or former pariner, director,, officer, manager', membeir, stiareholder, pdrx;fpal, IrUstee, or
empioyee (,"J the Named Insured solely wti!Hle acfing on betialf of the Named Insured, but thls
Paragraph 3, shall not r'nake any entity an Insured sdely berause of its participation with the Named
Insured�n a kagW enfitysuch as a joint VerltUre or hinited liabilfty,cornpany�or
C any Insured with regard to its participation: in a legal entity, including a joint venture ar Iii-nited kabillty
cornpany, bUt SOWY fOr the Named Insurod's legal HaWty arrsing out of the performance of
Professional Services, Contractor Activilles, Media Activities or, Information Technology
Servicss under, [fie respective legal entity, and stjch �egali entity rtself, or any other entity other than an
Insured that is part of the lcK
grO enfity,, are not lfisuiredw or
5 voth ;egard 'ro Ccvwage C or0y, any ir,:Rent of the Named Insured, or wher entfry ar person, thia,r the
Named Insurod is obfigah'xJ to, narre as arr� add�fionM in�,"Med or� ft�; Flc6cy pursuart to a wHtlen
�";cntract' agreern("'�nt' ei plei'mO eKecuted p6or W Aif�ierr We PoRution Claim w�isfirw ITHAde, and solely
as rrparts Poilution Conditions iesulfing i'rorri tire Narned Insured's perfonnarme ��!!iif Contractor
Actfvltlws� or,
6� any entity which is specifically Wentified as an Insured in the Declarations or b�y endorsernent to this
Pohw or
7 the estate, heirs, exect�'tors, shnref'�ddrers,i adri*illstralors or legal representatives�o�an Insured in the
event of su!di Insurecl's death, incapacAy, or bainkruptcy, or the spouse or �egal doniesbir, partr�er of
any, Insured, btri ar4y to the extent such Insured! would otl'*rwise. be prcMded coverage under tNs
Policy while acIring solely on behalf of the Named lnsured�or
8, any prior entity that tias been. refmrted to ris priar to when the First Party Claim or Claim was flrst
made and whose assets, partners, prOicipals, or shareholders were acqu*ed by the Named Insured,
and for which the Nornied I naured is required to provide liabOlty lnsurance under a writt en rx)Wract or
agreement executod before the IFirst Party Claim or Claim was,first made�or
9, any enfily rilowly �ormed or acquVed tiythe Named Insured during the Policy Period �rri wNctr Ore
Named Insured has rnore than 5016 legW or beneficlai Interest and over, which the Named insured
exer6sips aianageinienf or flnanc;W cxwrtrol and has agreed in witting to provide insurance for such
PoUcy Fortm PERFORM.10002(05-16)
P V M 25 3 760
Page 19 of 15)
J. Authorization Clause
By acceptance of this Poficy, Ifie first Named Insured Oak be 0"te so�e agent of and shaH act or� biehaH of
tt'ie Insurelds for alf purposes as to the POicy, �ncludlng but not krn�ted to ffie payment or return of
prervOlun, rx-,�f:,'cflpt and acceptam;e o� any endorsernent �SSUed to form a parl of this Policy, pra06ng and
receiving notkae of carceHafion, termination, or nonrenewW, the giving of notilces and reporting of First
�Party Claims, Claims and CO'CUMME"Inces, for cornplefing appilcations,and the rnaking of any staternents or,
reprerwmtations, for making ainy ctiange to the Pof�cy, and for the exeir6sirir,
I oir decHning to exercise ar�y
dght uindei fts POCY, �rrduOng the purchase of an Optrona�Extended Rqyarfirig Period.
K� SeverablIfty,of Policy Provisions
�f any materia] provision or dw,*e of this, PoHcy is dectared illegal or unenforceable by any court ol
competent lurisdlcbion and cannot be rnodlfied to be entomeable, that provts�on Mil inrmadLate�y becorrie!
n(A and void, �eaOng Ore rernarnder of th�s Poficy in fi,fil force and effect,
L. Severability of Insureds(Coveragiss B, C, D and E)
Except votth respect to the Limits of WhAity and Self-InsumW Retentions, thie Authorization 0aiu,,,,,oa, of tNs
Gondftions Section and as otherwise provided in thls PcAcy, this�nsuranceapp4es as if each insured were
the cmly �nstjired and separat#y to each Insured against whorn a Claim�s mride.
M. 011,wr Insurance
'N'��s l:�IoHcy �s excess over the 60-1ns�irod RrMeniiirw, and any ather valild and tx)He0b[e fiabiHty visumr�ce
avaMtoe ro yatv Whether svch, alher �Jnsurarmp is staled to be pr1mary, P]1'0'-�'811�11, ex,,(;ess,
ccnt�irlge�nl, self-�ilsured oi�� OOIWIMSe UnWSS �,WCAI Oth�e'� 01SUrance * wrMen splecify-,a4y exicess of this
Pokqy oy refeience in such other pollicy to the Pai�cy n,�rn6ku �n tNs Pc�icy's Dir,,mlarafions, WheH-� arry �,Ahw
visurarice, has ta dOy to defend a Ctaim, we wifli have no rMly to defend �,he Claliw it rio such Oier
irl$Ufanoe defends the Claim, we Wil have the rig��t b�ut not 1ho duty to defenid the Claim,
Orider Ccweragt,�, C o6y, when YOU wf) �'eqmi'ed by wnttpr r>)ntracl, oynttieri agreenlent, or ptnnO, exeo,aed
p6c,jr 1,() w�en the Pollution CWlm was Orst rnaide, �o 4ilciode any persor ar enfily as an ad6t�onai insured,
s�jc�,� coverage will be prowded a primary Ekind bias�s to flhf,�extont!so ri�xju4ed.
N. Choice of Law
AM rnaftc�,rs aris,ing tram or related to th�s Poficy, inck4ng Mthout HnAafion qjwOons relatedto the vaficilty,
Oterprelation, perforn"iance, arid entorcernertt of ltris Po��cy, all forn"ws of cordractuWi tort and estatutory
daOisi and all rernerAeis and enfiftnent to closts of attorneys' fees 4,) a 6spute over arry of the foreg6ng,
shaH The deterrrOned in accordance with V,ie law and practice of the Stale of New York (notwOrstanding
New York"s conflicts of law rWes),
0, Jurisdiction and Venue
it is agreed thal, �n the event of any d�qpute wising frorn or related to this PoRcy, �ncluding Mthout lirnitation
questions rela�ted to Oie vali!Wy, 4iterpretat*ri, perforrnance, and enforcernent of this Policy, and all f0flT15
of contractual, tort and statutory daima,,j you and we will subrrOt to the jurisdiction of any courl (State or
Federal� in New 'York and w[H comply with all the requkernerits necessary to give such court lUdcftfion,
Natlflng �n th�s dause consfitutes of shmAd be understrood to constnute a walver of your or our right to
reinove an aclion to the United States DislHct O',rurt, ii(�,%gardless of the judsdiction �n which an action ls
curnmenced,
Roflicy Forrw PERFORM-10002(05-16)
22'or 25 XTA
Berkley Assurance Company Flags I of I
Responsible Entity Waiver of Subrogation Affirmation Endorsement
Inconsideration of the premium paidi it-is understood and agreed that Section A.C. is deleted in Its entirety and replaced wifttha
following:
C. Subrogation
In the eVent of any payment unda�this Policy,we shall be subrogated to all of your fights of recovery thereof.You shall execute
and deiiver all requested instruments and papers in furtherance of such rights to us and do whatever else is reasonably
necessary to secure such rights.You shall do nothing to waive or prejudice such rights.We shall have priority in any recovery,
and any amounts recovered in excess of our total payment and the cost to us of recovery shall be paid to you. However,we
waive our rights of subrogation under this Policy against your clients or their designees (except for.a Responsible Entity)to
the extent such a waiver is required.by a written contract with you executed prior to the Claim.
For Coverage A only,we will%not subrogate against a Responsible Entity,provided it has maintained Recoverable Insurance,
regardless of whether or not such-Recoverable Insurance is exhaus. ted or reduced.
Whenever printed in this Endorsement,the boldface type terms shall have the same meanings as indicated in the-Policy Form,All other provisions of
the Policy remain Unchanged.
,Insured
PCADB50107351020
Policy Number
Effective Date.of This'Endorsement -��orized Representative
. 10/01/2020
Policy Form:PERrORMT1 0 002(05-16) 34395-5010735-66819 9-PERFORM-1.0 118(0 2-19)
23*025 3768
POLICYNUMBER: QT630IL164501TIL20
COMMERCIAL INLAND-MARINE
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
BLANKET LOSS PAYEES
This endorsement modifies Insurance provided under the IM PAK COVERAGE FORM.
The following is added to Section E — ADDITIONAL 1b. Pay any claim for,loss or damage jointly to you
COVERAGE CONDITIONS: and the Loss Payee as your interests may ap-
Loss Payable Provision pear.
In the,event of a Covered Cause of Loss to Covered This endorsement applies to all Covered Property for
Property in which both you and ai Loss-Payee share which a Loss Payee Is on file with us or your insur-
an insurable interest, we wili: ance agent or insurance broker.
'a. �Adjust the loss or damage,with you, and
CM T5 60 61 10 0 2009 The Travelers indemnity Company Page 1 of I
Includes copyrighted material of Insurance Services Office,Inc.with Its permission.
24'of25 3766
PC L.�GY N IJ M B E R: Q T6 301 L1 64�50 IT�L 20
COMMERCIAL INLAND MARINE
their firianciai Interest in the Covered Prop- K Recovered Property
er,ty. If either you or we rpcover any property after Ioss
4, We n"my ellect to defend you against suits sefflernent, that party must givie the other prompt
adsing from clairns of owners of property, We notice, At your optioni, the property wHl be re-
wHl do this at our expense, turned to you, You must then reAurn to us O,ie
5. We wiH pay for covered ioss or damage arnount we pa�d �to you for the property,, We wiH
within 30 days after we receIve the sworn pay recovery expenw,' s arid the expenses, to re-
proolf of loss If you have comphed with a4 �the pa�r the recovered property. stjb�ect to the L�mit
terrns of this Coverage Part and� of insurance,
a, We have reachedagreement w4h you on 11, Reinstatement Of Limit After Loss
the arriount of the toss,-or The Limit of Insurarice will nolt be reduced by the
b. An appr,a�sal award has been rnade, payment (if any cia4n, except foir tota� �oss or
6. We wfi niol be fiabie for any part of a loss darnage o�f a scheduled Item in wNici'i event we
that has been paid or Made good by others, W4 refund the unearned premiurn on that Itern.
J. Transter Of Rights Of RecovieryAgainst
K Other Insurance OthersTo Us
I�, You may have offier OSUranire subject lothe If any person or organization to or for whorn we
sarne IpIari, terrns, condifions and pra0sions make payment under ft'iis Coverage Part has
as the Insurance under this Goverage Pafl- If 6ghts to recoveir damages from anotheir, those
you do, we will pay our share of the cavered rights are transferred to us to the extent of our
loss or darnage, Our share �s t�he proportion payment. That person or organization rnust dio
that the appkable L4Mt of Insurance under everything necessary to se(Affe our r��ghts and
this Coverage Part bears, to the Utrflts of In- musl, do nothing after toss to imjmIr thern. But
surance of all insurance covering on 'the youl may waJive YOUr rights against another party
sarne basJ& in vvrifing�
2. ff there �s other �nSUrance covering the sarne 'I. Priorto, a loss to your Cov�ered Property,
loss oir darnage, other than that descr�beld in 2. After a iOSS 10 YOUr Covered Property oniy if,
1. above, we wiii pay orfly for flie amount of
covered ioss or damage in, excess of the at firne of loss, that party is one of the foliow-
arnount due trom that other insurance, irlg�
whether you can coHect on it or not, But we 9. Someone Insured by tl'i�s Insurance;or
will not pay more than the applicable Limit of b. A businessfirm:
Insurance, (1), Owned or, controlled by you� or
G. Pair, Sets Or Parts, (2) That owns or contro�s you,
ll� Pair,Or Se,t This will not restrict your insuran(.*e,
In c,ase of Ioss or damage to, any part, of a GENERAL CONDITIONS
pair or set we may�
a. Repair or rep�ace any part to restore the A. Concealment, Misrepresentation Or Fraud
paIr or set to 4s vakie before the loros or This Goveragle Part is void In any c,ase of fraud,
darmage;or intentional conceaknent or rnisrepresentation of a
b. Pay thle difference between the vaiue of rroteihal fact, by you or aniy other insured, at any
the Pair or se�t before and after the loss or firne, concerNnq,
damage. 1. This Coverage Part,
2. Parts 2� The C'overed Property�
in case of ioss, or darnageto any part of Cov., 3. Your interest n the Covered Propeny� or,
ered Property consrsting of seve!4 parts 4. A Claiff) Under this Coverage Part,
when clornpiete, w,e wiH only pay for the vaIue
of the iost or darnaged parl,
Page 2 of 3 CM 00 DI 09 04
25"�Df 25 3 16a
Arthur,l, G,Oagher&Co insurance Brokers of CA., Inc,
'1160 Batt.er,y Streel
Suite 360
San Frm misco, CA 94111
Ceceived
OC T' 2 3 �2020
O?UY' Of 6'leartoater
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QTY0F CLEARWATER, IENG. DEPT
'100 8,MYRTi-E AVE
(,',LEAlR'WA7'ER, FL. 337516-5520 3768
We are providirig you with a Certificate of lnsuran(,','lc,,C0llN'Mklg OUr c,,,Hent's coverage,
Want to got certificates of insurance faster? 'Go GIVon Mh Gaflagher" by receiving (J�gita� COPiE�S of c(,)rtificates vO
e-MEO 6'ithe fuiture, Orl, do you no bnger reqtJre a certfficiale of insuranlcra� for our cHenl? Rease contact Us at
QQLU-p,dolWAyl-imjL,. AJ(L,)L.-Qc)tr!anij provide the (oHowinig �nfor mation to�r procw;s4'1,g�
'I, Confirmation tfiat a certificate Of il'ISUrance is no longer rcxjU�red; oir
2� E-maii addr(ass to send fUlure ceafficams of insurance ini keU of US, MaR delivery
3, insured Code found in the Imured section ori the encbsed certificate,An exarnpl('-,,,of tNs colde is XXXXXX-01
4, This Certificate NumbE,,r� '1002126599
lb �earn more ablout the �nsurance arid Rl�sk K'lnagement Services (,)ffered �by GaHag�'"mr, p�ease visit us at
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V 0 25 3768