Loading...
2022/03/01 Roadway Engineering & Contracting Inc. (5)ACORD ROADENG.Ol CERTIFICATE OF LIABILITY INSURANCE 3t3t2022 THIS CERTIFICATE IS ISSUEO AS A MATTER OF INFORMATION ONLYANO CONFERS NO RIGHTS UPON THE CERTIFICATE HOLOER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BYTHE POLICIESBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE TSSUING INSURER(S), AUTHORIZEO REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, pRooucER Liconso # 0C36861 lnland Empire-Alliant lnsurance Services, lnc 685 Csrnoglo Dr Sto 265 San 86rnardino, CA 92408 IMPORTANT: It the certlflcate holder is an ADDITIONAL INSURED, the policy(les) must hav6 ADDITIONAL INSURED provisions or bo ondorsod.lf SUBROGATION lS WAIVED, subject to the terms and conditions ofthe policy, certaln ollcles may requlre an endorsement. A slatement onthls certlflcato does nol confer ri hts to the certlflcate holder ln lieu of such endorseme s flilEicr Christlna t'it Mountz lI3,*n[, .,0, (sos) ses-saer EmEss cmountz@alliant.com [iI, rcr,(eoe) 886-20ig Roadway Engineering & Contractlng lnc '10965 Banana Ave Fontana, CA 92337 I NSU RER(S} AFFORDING COVERAGE tNsuRER a: Greenwich lnsurance company rNsuRER B: XL Specialty lnsurance Company rNsuRERc: Everest Premier lnsurance company INSUREO INSURER D INSURER E INSIIRER F TE NUM POLICY NUMBER NPC10045090't X X N8A"1004510-01 N r/A x 600017355221 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 INDICATEO, NOTWITHSTANDING ANY REOUIREI\,IENT, TERI\,I OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTOWHICH 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 8Y PAID CLAIMS, INSR TYPE OF INSURANCE A x x COMMERCIAL GENERAL LIABILITY POLICYEFF 31112022 3t1t2023 31112022 31112023 3t'1t2022 311t2023 EACH OCCURRENCE OAMAGE TO RENTED PREMISES (Ea occurcnce) MEO ExP (Ary on6 p€6on) PERSONAL & AOV INJURY AOD LIMITS CLAIMS-MADE X occuR $5,000 PD ded/Occ GEN L AGGREGATE LIMIT APPLIES PER eorrcv X !fl6o1 Loc OTHER: $ $ $ I s $ xx GENERAI A6GRE64TE 1,000,00( 100,00( 5,00r 1,000,00( 2,000,00r 2,000,00( 1,000,00r 1,000,00t PRODUCTS COMP/OP AGG EBL AGGREGATE B AUTOIOBIIE UAAIUTY X mry rut'o OWNED SCHEDULED ALTTOS ONLY AUTOS COMBINEO SINGLE LIMIT BOOTLY INJURY (Per peEon) BOO LY INJURY (Per accident) PROPERry DAJ\,IAGEx x IlFEo" o"," x NON OWNED $1,000 Coll D6dil.000 comp O6d X c WORKERS COMPENSATIONANO EMPLOYERS' LIABILIIY ANY PROPRIE TORYPARiNER/EXECUTIVEOFFICFR/MFMBFR FXCI IJDFO' DESCRIPTION OF OPERATIONS berow x EL. EL STATUTE OTH ER EACH ACCIDENT DISEASE . EA EM 5,000,00r 5,000,00r r,000,00( 't,000,00r 1,000,00rE L DISEASE POLICY LIMIT DESCRIPTION OF OPERATIONS / LOCATIONS /V€HICLES (ACORD 101, Addrtion.l R.m..b Sch.dlle, hay bo.lt.chod irmor..p.c. i! r.qun6d) Re: #1207 - Monif.e Road and Garbani Road Tratfic Signal lmprovements CIP 21-'ll City ot Menifee and its elected officials, ofticers, employees, agents, representatives, consultants, contract employees and volunteers are addiliooal insureds, primary and non-conlributory, waiver ot subrogation as respecls to general liability per ehdorsemenk attached; additional insureds, primary and non-contributory, waiver of subrogation as aespectB to auto liability per endorsements attached; waiver of lubrogation as respects to workers' compensation per endorsemsnt attached. Per Project Aggregate applies. A IJMBRET-IaLraE X EXCESS LIAB oeo X nererrror.r s OCCUR CLAIMS.MAOE 0 x NEC-6006403-01 3t1t2022 311t2023 EACH OCCURRENCE AGGREGATE OYer GUAUEL City of Menifee 29E44 Haun Rd. Menifee, CA 92586 H SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CAI{CELLEO BEFORE THE EXPIRATIOTI DATE THEREOF, NOTICE wlLL BE OELIVERED IN ACCORDAT{CE wlTH THE POLICY PROVISIONS, ff1t l*'-- ACORo 2s (2016/03) E O 1988-2015 ACORD CORPORATION. All rlghts reserved. 22322 37885 16045 $ THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY _ OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILIry COVERAGE PART LIOUOR LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABI LITY COVERAGE PART POLICY NUMBER: NPC 100450901 The following is added to the Other lnaurance Condition and supersedes any provision to the contrary: Primary And Noncontributory lnsurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named lnsured under such other insurance: and COMMERCIAL GENERAL LIABILITY cG 20 01 12 19 (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution irom any other insurance available to the additional insured. cG 20 01 12 19 @ lnsurance Services Office, lnc., 2018 Page 1 of I 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 LIABILIry COVERAGE PART SCHEDULE POLICY NUMBER: NPCl OO4 50901 A. Section ll - Who ls An lnsured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions: or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1, The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. lf coverage provided to the additional insured is required by a conlracl or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreemenl to provide for such additional insured. COMMERCIAL GENERAL LIABILITY cG 20 10 12 19 B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment fumished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. Name Ot Additional lnsured Person(s) Or Organization(s)Location(s) Of Covered Operations Blanket as required by wri.tten contract Blanket as required by written contract lnformation required to complete this Schedule, if not shown above, will be shown in the Declarations cG 20 10 12 19 @ lnsurance Services Omce, lnc., 2018 Page l of 2 C. With respect to the insurance afforded to these additional insureds, the following is added to Section lll - Limits Of lnsurance: lf coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable limits of insurance: whichever is less. This endorsem€nt shall not increase the applicable limits of insurance. @ lnsurance Services Office, lnc., 2018 cG 20 1012 19Page 2 ol 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS _ COMPLETED OPERATIONS This endorsement modifies insurance provided under the following COMIVIERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILIry COVERAGE PART SCHEDULE POLICY NUMBER: NPCIOO45O9OI A. Section ll - Who ls An lnsured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products-completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. lf coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than thal which you are required by the contract or agreement to provide for such addilional insured. B. With resoect to lhe insurance afforded to theseadditional insureds, the following is added to Section lll - Limits Of lnsurance: lf coverage provided lo the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. Name Of Additional lnsured Person(s) Or Organization(s)Location And Description Of Completed Operations Blanket as required by written contracE Blankec as required by written contract: lnformation required to complete this Schedule, if not shown above, will be shown in the Declarations cG 20 37 12 ',tg @ lnsurance Services Omce, lnc., 2018 Page 1of 1 COMMERCIAL GENERAL LIABILITY cG 20 37 12 19 POLICY NUMBER:NPC I OO45O9O I COMMERCIAL GENERAL LIABILITYcc 25 03 05 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESTGNATED CONSTRUCTTON PROJECT(S) GENERAL AGGREGATE LIMIT Designated Construction Project(s): Policy aggregate limit applies per work site lnformation required to compl€te this Schedule, if not shown above, will be shown in the Declarations 3. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the Designated Con- struction Projecl General Aggregate Limit for that designated construction project. Such payments shall not reduce the General Ag- gregate Limit shown in the Declarations nor shall they reduce any other Designated Con- struction Pro.ject General Aggregate Limit for any other designated construction project shown in the Schedule above. 4. The limits shown in the Declarations for Each Occurrence, Damage To Premises Rented To You and Medical Expense conlinue to apply. However, instead of being subject to the General Aggregate Limit shown in the Decla- rations, such limits will be subject to the applF cable Designated Construction Pro.lect Gen- eral Aggregate Limit. cG 25 03 05 09 O lnsurance Services office, lnc., 2008 Page'l of 2 tr A. For all sums which the insured becomes legally obligated to pay as damages caused by 'occur- rences" under Section I - Coverage A, and for all medical expenses caused by accidents under Seclion I - Coverage C, which can be attributed only to ongoing operations at a single designated construction project shown in the Schedule above: 1. A separate Designated Construction Project General Aggregate Limit applies to each des- ignated construction project, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 2. The Designated Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under Coverage A, ex- cept damages because of "bodily injury" or "property damage" included in the "products- completed operations hazard", and for medi- cal expenses under Coverage C regardless of the number of: a. lnsureds; b. Claims made or'suits" brought; or c. Persons or organizations making claims or bringing "suits". This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE I/VORKERS COMPENSATION AT.ID EMPLOYERS LIABILITY INSURANCE POLICY \rc040306 WAVER OF OUR RIGHTTO RECOVER FROM OTHERS ENDORSEMENT- CALIFORNIA We have the right to recovor our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization narned 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 remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2 otherwise due on such remuneration. 7o of the California workers' compensation premium SCHEDULE PERSON OR ORGANIZATION JOB DESCRIPTION ANY PERSON OR ORGANIZATION EOR WHOM THE NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WA]VER BLANKET WAIVER OF SUBROGATION -199E by the Wo.i(erC Co rpeBation lnsurance Raling Bureau of Calilbrnia. Al righb ros.rv6d. From the WCIRB'S Califomia Workers' Corpensation lnsurance Forms llibnual - 1999. A. B. POLICY NUMBER: NBA-1 0045'l 0-01 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. XL PLUS BUSINESS AUTO EXTENSION ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM COVERAGE DESCRIPTION Temporary Substitute Auto Physical Damaga Who ls An lnsured 1. Broad Form lnsurod 2. Employees As lnsureds 3. Additlonal lnsured By Contract, Agreement oi Permlt 4. Employee Hired Autos Supplementary Payments Amended Fellow Employee Exclusion Physical Damag6 Coverage 1. Rental Roimbursement 2. Extra Expense - Broadened Coverage 3. Personal Effects Coverage 4. Leaso Gap 5. Glass Repair - Waiver Of Deductible Physical Damage Coverage Extensions 1. AdditionalTransportationExpense 2. Hired Auto Physical Damage Business Auto Conditions 1. Notice Of Occurrence 2. Waiver Of Subrogation 3. Unintentional Failure To Disclose Hazards 4. Primary lnsurance Bodily lnjury Redefined Extended Cancellation Condition O 2013 X.L. America, lnc. All Rights Reserved. May not be copied without permission. lncludes copyrighled material of lnsurance Services Office, lnc., with its permission c D E F G H t. xrc 421 1013 Page 1 of 6 xtc 421 1013 A. Temporary Substltute Auto Physical Damage SECTION I - COVERED AUTOS, C. Certain Trailers, Mobile Equipment And Temporary Substitute Autos is changed by adding the following: lf Physical Damage coverage is provided by this Coverage Form, the following lypes of vehicles are also covered "autos" for Physical Damage coverage: Any "auto'you do not own while used with the permission of its own€r as a temporary substitute for a covered "auto" you own that is out of service because of its: Breakdown; "Loss"; or Destruction B.Who ls An lnsured SECTION ll - COVERED AUTOS LIABILITY COVERAGE, A. Coverage, 1. Who ls An lnsured is changed by adding the following: 1 a. b. c. d. e. 1 Broad Form lnsured For any covered "auto", any subsidiary, affiliale or organization, other lhan a partnership or joint venture, as may now exist or hereafter be constituted over which you assume active management or maintain ownership or majority interest, provided that you notify us within ninety (90) days from the date that any such subsidiary or affiliate is acquired or formed and that there is no similar insurance available to that organization. However, coverage does nol apply to "bodily injury" or "property damage" that occurred before you acquired or formed the organization. 2. Employees As lnsureds Any "employee" of yours is an "insured" while using a covered "auto" you don't own, hire or borrow, in your business or your personal affairs. 3. Additional lnsured By Contract, Agreement Or Permit Any person or organizalion with whom you have agreed in writing in a contract, agreement or permit, to provide insurance such as is provided under this policy, provided that the "bodily injury' or "property damage" occurs subsequent to the execution of the written contract, agreement or permil. 4.Employee Hired Autos An "employee" of yours is an "insured" while operating an "auto" hired or rented under a contract or agreement in that "employee's" name, with your permission, while performing duties related to the conduct of your business. xtc 421 '1013 Page 2 of 6 Repair; Servicing; O 2013 X.L. America, lnc. All Rights Reserved. May not be copied wilhout permission. lncludes copyrighted materialof lnsurance Services Office, lnc., with its permission. c SECTION lV - BUSINESS AUTO CONDITIONS, B. General Condltlons, 5. Other lnsurance, b. is replaced with the following: b. For Hired Auto Physical Damage Coverage, the following are deemed to be covered "autos" you own: (1) Any covered "auto" you lease, hire, rent or borrow; and (21 Any covered "auto" hired or rented by your "employee' under a contract in that individual "employee's" name, with your permission, while performing dutios related to the conduct of your business. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered 'auto'. Supplemontary Paymonts SECTION ll - COVERED AUTOS LIABILITY COVERAGE, A. Coverage, 2. Coverage Extensions, a. Supplementary Paymonts is changed as follows: Item (2) is deleted and replaced by the following: Up to $3,500 for cost of bail bonds (including bonds for related traffic law violations) required because of an "accident" we cover. We do not have to furnish these bonds. Item (4) is deleted and replaced by the following: (4) All reasonable expenses incurred by the "insured" at our request, including actual loss of eamings up to $500 a day because of time off from work. Amended F6llow Employee Exclusion SECTION ll - COVERED AUTOS LIABILITY COVERAGE, B. Exclusions, 5. Fellow Employee does not apply. The insurance provided under this Provision D. is excess over any other collectible insurance. Physical Damage Coverage SECTION lll - PHYSICAL DAMAGE COVERAGE, A. Coverage is changed by adding the following: 1. Rental Roimbursement We will pay for rental reimbursement expenses incurred by you for the rental of an "auto' because of "loss" to a covered "auto". Payment applies in addition to the otherwise applicable amounl of each coverage you have on a covered "auto". No deductibles apply to this coverage. We will pay only for those expenses incurred during the policy period beginning twenty-four (24) hours after the "loss" and ending, regardless of the policy's expiration, with the lesser of the following number of days: 12) E D a b xtc 421 1013 Page 3 of 6O 2013 X.L. America, lnc. All Rights Reserved. May not be copied without permission. lncludes copyrighted material of lnsurance Services Office, lnc., with its permission. c e d (1)The number of days reasonably required to repair or replace the covered 'auto". lf "loss" is caused by theft, this number of days is added to the number of days it takes to locate the covered 'auto" and retum it to you. (21 Thirty (30) days (1) Necessary and actual expenses incurred (21 $50 any one day per private passenger "auto"; $100 any one day per truck; $1,500 any one period per private passenger "auto"; $3,000 any one period per truck; or Higher limits if shown elsewhere in this policy. This coverage does not apply while there are spare or reserve "autos" available to you for your operations. lf "loss" results from the total theft of a covered "auto" of the private passenger type, we will pay under this coverage only that amount of your rental reimburssment expenses which is not already provided for under the Physical Damage Coverage Extension. @ 2013 X.L. America, lnc. All Rights Reserved. May nol be copied without permission. lncludes copyrighted materialof lnsurance Services Office, lnc., with its permission 3. 2.Extra Expense - Broadened Coverage We will pay for the expense of retuming a stolen covered "auto" to you Personal Effects Covorage lf you have purchased Comprehensive Coverage on this policy for an "auto" you own and that "auto" is stolen, we will pay, without application of a deductible, up to $500 for'personal effects" stolen from the 'auto'. As used in this endorsement, "personal effects" means tangible property that is worn or carried by an "insured'. "Personal effects" does not include tools, jewelry, money or securities. ln the event of a total ,loss" to a covered "auto' shown in lhe Declarations, we will pay any unpaid amount due on the lease or loan for a covered 'auto", less: The amount paid under the Physical Damage Coverage Section of the policy; and Any: (1) Overdue lease/loan payments at the time of the "loss"; l2l Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage; (3) Security deposits not returned by the lessor; (4) Costs for extended wananties, Credit Life lnsurance, Health, Accident or Disability lnsurance purchases with the loan or lease; and (5) Carry-over balances from previous loans or leases. a b xrc 421 10'13 Page 4 of 6 Our payment is limited to the lesser of the following amounts: 4. Lease Gap F 5. Glass Repalr - Waiver Of Deductible No deductible applies to glass damage if the glass is repaired rather than replaced. Physical Damago Coverage Extensions SECTION lll - PHYSICAL DAMAGE COVERAGE, A. Coverage, 4. Coverage Extensions is amended by the following: 1. AdditionalTransportationExpense Sections a. and b. are amended to provide a limit of $50 per day and a maximum limit of $1,000. 2. Hired Auto Physical Damage The following section is added: Any "auto' you lease, hire, rent or bonow is deemed to be a covered "aulo" for physical damage coverage. The most we will pay for each covered "auto" is the lesser of: (1) the actual cash value; (21 the cost for repair or replacement: or (3) $50,000, or higher limit if shown on the Declarations for Hired Auto Physical Damage Coverage. For each covered 'auto" a deductible of $100 for Comprehensive Coverage and $1,000 for Collision Coverage will apply. Business Auto Conditions SECTION lV- BUSINESS AUTO CONDITIONS, A. Loss Conditions is changed by the following: 1. Notlce Of Occurrence Section 2. - Duties ln The Event Of Accident, Claim, Suit Or, Loss, a. is changed by adding the following: lf you report an injury to an "employee" to your workers' compensation carrier and if it is subsequently determined that the injury is one to which this insurance may apply, any failure to comply with this condition will be waived if you provide us with the required notice as soon thereafter as practicable afler you know or reasonably should have known that this insurance may apply. 2.Waiver Of Subrogation Section 5. Transfer Of Rights Of Recovery Against Others To Us is changed by adding the following: However, this Condition does nol apply to any person(s) or organization(s) with whom you have a wriften contract, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under such contract with that person or organization. O 2013 X.L. America, lnc. All Rights Reserved. May not be copied without permission. lncludes mpyrighted material of lnsurance Services Oflice, lnc., with ils permission xtc 421 10't3 Page 5 of 6 H SECTION lV - BUSINESS AUTO CONDITIONS, B. General Conditions is changed by the following: 3. Unintentional Failure To Disclose Hazards The following condition is added: Your unintentional failure to disclose all hazards as of the inception date of the policy shall not prejudice any insured with respect to the coverage afforded by this policy. 4. Primary lnsurance Condition 5. Other lnsurance is changed by adding the following: For any covered "auto' this insurance shall apply as primary and not contribute with any other insurance where such requirement is agreed in a written contract executed prior to a 'loss". Bodily lnjury Rodofin6d SECTION V - DEFINITIONS, C. "Bodily injury' is replaced by the following: "Bodily injury" means bodily injury, sickness or disease sustained by a person including mental anguish, mental injury, shock, fright or death resulting from any of these at any time. Extended Cancellation Condition COMMON POLICY CONDITIONS (Form lL 00 17), A. Cancellation, 2.b. is replaced by the following: The greater of sixty (60) days or the time required by any applicable state amendatory endorsement before the effective date of cancellation if we cancel for any other reason. All other terms and conditions of this policy remain unchanged @ 2013 X.L. America, lnc. All Rights Reserved. May not be copied without permission. lncludes copyrighted material of lnsurance Services Office, lnc., with its permission xtc 421 10't3 Page 6 of 6 t. ENDORSEMENT # This endorsement, effective 03101122 12iO1 a.m., forms a part of Policy No. NPC100450901 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY XL Plus Endorsement This endorsement modifies insurance provjded under the following COI\,IMERCIAL GENERAL LlABlLlry COVERAGE PART GENERAL DESCRIPTION OF COVERAGE - This endorsement broadens coverage. The following listing is a general coverage description only. Limitations and exclusions may apply to these coverages. Read this endoGement carefully to determine rights, duties, and what is and is not covered. A. Reasonable Force - Bodily lnjury or Property Damage B. Damage To Premises Rented To You Extension r Perils of fire, lightning, explosion, smoke, aircraft or vehicles, riot or civil commotion, vandalism, leakage from fire extinguishing equipment or water damage r Limit increased to $300,000 C. Aircraft Chartered with Crew D. Non-Owned Watercraft E. Personal and Advertising lnjury - Assumed by lnsured Contract F, lncreased Supplementary Payments o Cost for bail bonds increased to $5,000 . Loss of earnings increased to $'1,000 per day G. Broadened Named lnsured H. Blanket Additional lnsured - Managers or Lessors of Premises l. Blanket Additional lnsured - Lessor of Leased Equipment J. lnjury to CG.Employees and Co-Volunteer Workers K. Knowledge and Notice of Occurrence or Offense L, Unintentional Omission M. Liberalization N. Blanket Waiver of Subrogation O. lncidental Medical Malpractice lnjury P. Extension of Coverage - Bodily lnjury Q. Coverage Tenitory Form XIL 436 1208 @ 2008, XL America, lnc. lncludes copyrighted material of lnsurance Services Offjcs, lnc., with its p€rmission Page 'l of 8 A. REASONABLE FORCE - BODILY INJURY OR PROPERW DAMAGE Exclusion a. Expected Or lntended lnjury of Part 2., Exclusions of Coverage A. Bodily lnjury And Property Damage Liability of Section l- Coverages is deleted in its entirety and replaced by the following: ffhis insurance does not apply to:) Expected or lnlended lnjury or Damage "Bodily injury" or "property damage" expected or inlended from the standpoinl of the insured. This exclusion does not apply to "bodily iniury" or'property damage" resulting from the use of reasonable force to protect persons or property. B. DAMAGE TO PREMISES RENTED TO YOU EXTENSION 1. The last paragraph of 2. Exclusions of Coverage A. Bodily lnjury And Property Damage Liability of Section I - Coverages is deleted in its entirety and replaced by the following: Exclusions c. through n. do not apply to damages to premises while rented to you, or temporarily occupied by you with permission of the owner, caused by fire, lightning, explosion, smoke, aircraft or vehicles, riot or civil commotion, vandalism, leakage from fire extinguishing equipment or water damage. A separate limit of insurance applies to this coverage as described in Section lll- Limits of lnsurance. 2. This insurance does not apply to damage to premises while rented to you, or temporarily occupied by you with permission of the owner, caused by: a. Ruplure, bursting, or operation of pressure relief devices; b. Rupture or bursting due to expansion or swelling of the contents of any building or structure, caused by or resulting from water; or c. Explosion of steam boilers, steam pipes, steam engines, or steam turbines. 3. Paragraph 6. of Section lll- Limits of lnsurance is deleted in its entirety and replaced by the following: 6.a. Subject to Paragraph 5. above, the Damage To Premises Rentod To You Limit is the most we will pay under Coverage A for damages because of "property damage" to any one premises while rented to you, or temporarily occupied by you with permission of the owner, caused by fire, explosion, lightning, smoke, aircraft or vehicle, riot or civil commotion, vandalism, leakage from fire extinguishing equipment or water damage. The Damage To Premises Rented To You Limit will apply to all damage proximately caused by the same "occurrence", whether such damage results from Rre, explosion, lightning, smoke, aircraft or vehicle or riot or civil commotion, vandalism, leakage from fire extinguishing equipment or water damage or any combination of any of these. b. The Damage to Premises Rented lo You Limit will be the higher of: (1) $300,000t or (2) The amount shown on the Declarations for Damage to Premises Rented to You Limit. Form xlL 436 1208 @ 2008, XL America, lnc. lncludes copyrighted material of lnsurance Services Office, lnc., with its psrmi6saon Page 2 of 8 4. Paragraph 9.a. ofthe deflnition of insured contract" under Section V- Definitions, is deleted in its entirety and replaced by the following: ["lnsured contract" means:l a. A contract for a lease of premis€s. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire, lightning, explosion, smoke, aircraft or vehicle, riot or civil commotion, vandalism, leakage from fire extinguishing equipment or water damage to premises while rented to you, or temporarily occupied by you with lhe permission of lhe owner is not an "insured contract". 5. This Article B. does not apply if coverage for Damage to Premises Rented to You of Coverage A. Bodily lnjury And Property Damage Liability of Section I - Coverages is excluded by endorsement. C. AIRCRAFT CHARTERED WITH CREW 1. The following is added to the exceplions contained in Exclusion 9., Aircraft, Auto or Watercraft in Part 2., Exclusions of Coverage A. Bodily lnjury And Property Damage of Section I - Coverages: [fhis exclusion does not apply to:) Aircraft chartered wilh crew to any insured. 2. This Article C. does not apply if the chartered aircraft is owned by any insured. 3. The insurance provided by this Article C. shall be excess over any valid and collectible insurance available to the insured, whether primary, excess, contingent or on any other basis, except for insurance purchased specifically by you to be excess of this policy. D. NON.OWNED WATERCRAFT 1. The exception contained in Subparagraph (2) of Exclusion g. Aircrafl. Auto or Watercraft in Part 2., Exclusions of Coverage A. Bodily lnjury And Property Damage Liability of Section I - Coverages is deleted in its entirety and replaced by the following: (2) A watercraft you do not own that is: (a) 50 feet long or less; and (b) Not being used to carry persons or property for a charge; 2. This Article D. applies to any person who, with your expressed or implied consent, either uses or is responsible for the use of the watercraft. 3. This insurance provided by this Article D. shall be excess over any other valid and collectible insurance available to the insured, whether primary, excess, contingent or on any other basis, except for insurance purchased specifically by you to be excess of this policy. E. PERSONAL ANO ADVERTISING INJURY _ ASSUMED BY INSURED CONTRACT 1. Exclusion e. Contractual Liability in Part 2., Exclusions of Coverage B. Personal And Advertising lnjury Liability of Section I - Coverages is deleted in its entirety and replaced by the following: Form xll 436 1208 O 2008, XL America, lnc. lncludes copyrighted materialof lnsurance SeNices Office, lnc., with its p€rmission- Page 3 of I [his insurance does not apply to:) F. INCREASEDSUPPLEMENTARYPAYMENTS Subparagraphs 1. b. and d. of Supplementary Payments - Coverages A And B of Section I Coverages are amended as follows: 1 . ln Subparagraph b., the amount we will pay for the cost of bail bonds is increased up to $5,000. 2. ln Subparagraph d., the amount we will pay for a loss of eamings is increased up to $1 ,000 a day. G. BROADENED NAMED INSURED 1. The Named lnsured in ltem 1. of the Declarations is as follows: The person or organizations named in ltem 1. of the Declaralions and any organization, other than a partnership or joint venture, over which you maintain ownership or majority interest on the effective date of the policy. However, coverage for any such organization will cease as of the date that you no longer maintain ownership of, or majority interest in, such organization. 2. This Article G. does not apply to any person or organization for which coverage is excluded by endorsement. Form XIL 436 1208 O 2008, XL America, lnc. lndudes copyrighted matsrial of lnsurancs Services Offlce, lnc., with ats p6rmission Page 4 of 8 e. Contractual Liability "Personal and Advertising lnjury" for which the insured has assumed liability in a contracl or agreement. This exclusion does not apply to liability for damages: 1. That the insured would have in the absence ofthe contract or agreement; or 2. Assumed in a written contract or agreement that is an "insured contract"; provided the "personal and advertising injury' is caused by an offense which occurs subsequent to the execution of the contract or agreement. 2. Subparagraph f. of the definition of "insured contract" Section V.- Definitions is deleted in its entirety and replaced by the following: f. That part of any other contract or agreement pertaining to your business, including an indemnification of a municipality in connection for work performed for a municipality, under which you assume the tort liability of anther party to pay for "bodily injury", "property damage" or'personal and advertising inrury" to a third party or organization. Tort liability means a liability that would be imposed by law in the absence of any contract or agreement. 2. This A(icle E. does not apply if Coverage B. Personal And Advertising lnjury Liability is excluded by endorsement. H. BLANKET ADDITIONAL INSUREO - MANAGERS OR LESSORS OF PREMISES 1. Section ll-Who ls An lnsured is amended to include as an insured any person or organization with whom you have agreed in a written contract execuled prior to loss (an "additiona' insured"), but only with respect to liability arising out of the ownership, maintenance or use of that part of any premises leased to you, subject to the following provisions: a. Limits of lnsurance. The Limits of lnsurance afforded to the "additional insured" shall be the limits you agreed to provide, or the limits shown on the Declarations, whichever is less. b. The insurance afforded to the "additional insured" does not apply to: (1) Any 'occurrence" that lakes place after you cease to be a tenant in that premises: (2) Any premises for which coverage is excluded by endorsement; or (3) Structural alterations, new conslruction or demolition operations performed by or on behalf of such "additional insured". 2. The insurance afforded to the "additional insured" is excess over any valid and collectible insurance available to such "additional insured", unless you have agreed in a written contract for this insurance to apply on a primary or contributory basis. I. BLANKET ADOITIONAL INSURED - LESSOR OF LEASED EQUIPMENT 1. Section ll-Who ls An lnsured is amended to include an "additional insured" (as defined in Article H. above), but only with respect to their liability arising out of maintenance, operation or use by you of equipment leased to you by such "additional insured", subject to the following provisions: a. Limits of lnsurance. The Limits of lnsurance afforded to the 'additional insured" shall be the limits which you agreed to provide, or the limits shown on the Declarations, whichever is less. b. The insurance afforded to the "additional insured" does not apply to: (1) Any "occurrence" that takes place after the equipment loase oxpires; or (2) "Bodily in1ury" or "property damage" arising out ofthe sole negligence of such additional insured. 2. The insurance provided to the "additional insured" is excess over any valid and collectible insurance available to such "additional insured", unless you have a written contract for this insurance to apply on a primary or contributory basis. J. INJURY TO CO-EMPLOYEES AND CO-VOLUNTEER WORKERS 1. Section ll- Who ls An lnsured is amended to include your "employees" as insureds with respect to "bodily iniury" to a co-'employee" in the course olthe co]employee's" employment by you, or lo your "volunteer workers" while performing duties related to the conduct of your business, provided that this coverage for your "employees" does not apply to acts outside the scope of their employment by you or while performing duties unrelated to the conduct of your business. Form XIL 436 1208 @ 2008, XL America, lnc. lncludes copyrighted material of lnsurance Services Office, lnc., with its pormission Page 5 of 8 2. Section ll - Who ls An lnsured is amended to include your "volunteer workers' as insureds with respect to'bodily injury" to a co-'volunleer workef' while performing duties related to the conduct of your business, or to your "employees" employment by you, provided that this coverage for your "volunteer workers" does not apply while performing duties unrelated to the conduct of your business. Knowledge of any other "employee(s)" of an 'occurrence" or of an offense does not imply that you also have such knowledge. Notice shall be deemed prompt if given in good faith as soon as practicable to your workers compensation insurer. This applies only if you subsequently give notice to us as soon as practicable after any insured listed under Paragraph 1. of Section ll Who ls An lnsured or an "employee" (such as an insurance, loss control, or risk manager or administrator) designated by you to give such notice discovers that the "occurrence", offense or claim may involve this policy. L. UNINTENTIONALOMISSION The following is added to Paragraph 6., Representations, of Section lV- Commercial General Liability Conditions: The unintentional omission of, or unintentional error in, any information provided by you shall not prejudice your rights under this insurance. However, this Article L. does not affect our right to collect additional premium or to exercise our right of cancellation or nonrenewal in accordance with applicable state insurance laws or regulations. M. LIBERALIZATION The following is added to Section lv-Commercial General Liability Conditions: Liberalization After the issuance of this policy, if we adopt a change in our forms or rules which would broaden the coverage provided by any form that is a part of this policy without a premium charge, the broader coverage will apply to this policy. This extension is effeciive upon the approval of such broader coverage in your state. Form XIL 436 1208 O 2008, XL America, lnc. lncludes crpyrightsd materialof lnsurance Services Oflice, lnc., with its permission Page 6 of 8 K. KNOWLEDGE AND NOTICE OF OCCURRENCE OR OFFENSE The following is added to Paragraph 2., Duties ln The Event of Occurrence, Offense, Claim or Suit of the Section lV - Commercial General Liability Conditions: Notice of an 'occunence" or of an offense which may result in a claim under this insurance shall be given as soon as practicable after knowledge of the "occurrence' or offense has been reported to any insured listed under Paragraph '1. of Section ll-Who ls An lnsured or any "employee" (such as insurance, loss control, risk manager or administrator) designated by you to give such notice. N. BLANKET WAIVER OF SUBROGATION The following is added to Section lV-Commercial General Liability Conditions: Waiver of Subrogation We waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of premises owned or occupied or rented or loaned to you; ongoing operations performed by you or on your behalf, done under a contract with that person or organization; "your work"; or "your products". We waive this right where you have agreed to do so as part of a written contract, execuled by you prior to loss. O. INCIDENTAL MEDICAL MALPRACTICE INJURY 1. For insurance applicable to this Article O, the definition of "bodily injury" in Section V - Definitions is amended to include, "lncidental Medical Malpractice lniury". 2. The following definition is added to Section V- Definitions: "lncidental medical malpractice injury" means "bodily injury", mental anguish, sickness or disease sustained by a person, including death resulting from any of these at any time, arising out of the rendering of, or failure to render, the following services: a. Medical, surgical, dental, laboratory, x-ray or nursing service or treatment, advice or instruction, or the related furnishing of food or beverages; b. The furnishing or dispensing of drugs or medical, dental or surgical supplies or appliances; c. First aid: or d. "Good Samaritan Services". As used in this Article O., "Good Samaritan Services" are those medical services rendered or provided in an emergency and for which no remuneration is demanded or received. 3. Paragraph 2.a.(1)(d) of Section ll -Who ls An lnsured does not apply to any registered nurse, licensed practical nurse, emergency medical technician or paramedic employed by you, but only while performing the services described in Paragraph 2. above and while acting within the scope of their employment by you. Any "employees" rendering "Good Samaritan Services" will be deemed to be acting within the scope of their employment by you. 4. The following exclusion is added to Paragraph 2. Exclusions of Coverage A. - Bodily lnjury And Property Damage Liability of Section I - Coverages: [his insurance does not apply to:) Willful Violation of Penal Statute Liability arising out of the willful violation of a penal statute or ordinance relating to the sale of pharmaceuticals by or with the knowledge or consent of the insured. 5. For the purposes of determining the applicable Limits of lnsurance, any act or omission, together with all related acts or omissions in the furnishing of services described in Paragraph 2.a. lhrough 2.d. above lo any one person, will be considered one "occurrence". 6. This Article O. does not apply if you are in the business or occupation of providing any of the services described in Paragraph 2. above. Page 7 of 8Form XIL 436 1208 O 2008, XL America, lnc. lncludos copyrighted material of lnsurance Services Ofllce, lnc., with its permission. 7. The insurance provided by this Article O. shall be excess over any other valid and collectible insurance available to the insured, whether primary, excess, contingent or on any other basis, except for insurance purchased speciflcally by you to be excess of this policy. P. EXTENSION OF COVERAGE - BODILY INJURY The delinition of "bodily injury'Section V- Definitions is deleted in its entirety and replaced by the following: 3. "Bodily injury" means bodily injury, mental anguish, mental injury, shock, fright, disability, humiliation, sickness or disease sustained by a person, including death resulting from any of these at any time. Q. COVERAGE TERRITORY The delinition of "coverage territory" Section V- Definitions is deleted in its entirety and replaced by the following: 4. "Coverage territory" means anywhere in the world. This insurance does not apply to: a. "bodily injury" or "property damage" that takes place; or b. "personal and advertising iniury" caused by an offense committed outside the United States of America (including its possessions and territories), Canada and Puerto Rico, unless a "suit" on the merits (to determine the insured's responsibility to pay damages to which this insurance applies) is brought in the United States of America (including its possessions and territories), Canada or Puerto Rico. This insurance does not apply to damage, loss, cost or expenses in connection with any "suit" brought outside the United States of America (including its possessions and territories), Canada or Puerto Rico. Page B of IForm XIL 436 1208 O 2008, xL America, lnc. lncludss copyrighted materialof lhsurance S€rvices Office. lnc.. with its permissaon.