2021/08/31 True Recovery LPA,CORD TRUEREC-O.I
CERTIFICATE OF LIABILITY INSURANCE 7 t1412022
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFTCATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSI.JRANCE OOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: lf tho certificate holdor ls an ADDITIOI'aAL INSUREO, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.lf SUBROGATION lS WAIVED, subject to the terms and conditions ofthe policy, certain policies may requi.e an endorsement. A statemonl on
this cortlflcate does not confer rlghts to tho certificate holdsr in lieu of such endorsement(s).
True Recovery LP
Nancy X. Bohl,lnc. D.B.A. The Counseling Team lnternational
20351 SW Acacia Stroet Floor 2
Nowport Beach, CA 92660
INSIIRERT^;;l^;.l;,;..t^.*"
INSURER
PIIONE
INSURED
r Jyoti Phillips
19100
23747
INSI]RER(S) AFFOROING COVERAGE
pRoDLrcER License # 0757776
HUB lntornational lnsurance Sorvlces lnc
1525 Faraday AvenueSuite 200Carlsbad, CA 92008
e ,4MCO !!q ularce! e![!aly
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E:
a , Nationwide Mutual lnsurance Company
(A/c, No, E{: (A.rC, No)
EimLss jyoti.phillips@hubinternational.com
CE IVIBER
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOWHAVE BEEN ISSUEDTOTHE INSURED NAi'ED ABOVE FOR THE POLICY PERIOD
INOICATED NOTWTHSTANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WTH RESPECT TO W]ICH THIS
CERTIFICATE I\4AY BE ISSUED OR I\4AY PERTAIN, THE INSURANCE AFFOROED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERIMS,
EXCLUSIONSAND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REOUCED BY PAID CLAIMS
1,000,000
1,000,000
20,000
1,000,000
3,000,000
3,000,000
I occun x ACP 3019795490x
A:x COMMERCIAL GENERAL LIABILITY
CLAIMS MADE
GEN'L AGGR€GAIE LIM T APPLIES PER
OTHER:
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EACH OCCUR&E}I_CE
OAMAGE TORENTEO
PBEMISESiEa-occurffcai
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PRODI]CTS . COMPOP AGG I t
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OWNEDAUTOS ONLY
HIREDAUTOS ONLY
SCHEOULEOAUTOS
AUTOIl,IOBILE LIABILITY
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4cP3019795490 8t31t2021
L EACH OCCURRENCE 5,000,000
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8t31t2021 8t3112022
oeoiXlnerert'ors 10,000
EXCESS LlAA
I PER I OTH.I I STATUTE ER _-l
ler e-rcr rccroer.r[-a . o,a*aa a^ ar".o"Jt-,----;;**;;;
ANY PROPRIETOR/PARTNER,EXECUTlVEOFF CERI'l!iEMAER EXCLUOED 7
DESCR PTrON OF OPERATIONS bolow
WORX€RS COMP€NSATIONANO E MPIOYERS' LIABILIfi
A
Protessional Liab
Abuse Liability
ACP 301979S90
acP 3019795490
813'l/2021
4t31t2021
8/31/2022 See below for limit
8/31/2022 See below for limit
OESCRIPiOI| OF OP€RATIONS / LOCAnONS / VEHICLES (AcORo 101, Addtlon.l R.r rt. S.h.dul., Ny b. .tl,ch.d tr moE rp.c. l. EqurEd)Professional Liability I Occurrence Form I t1,000,000 Per Claim/33,000,000 Aggregate
Abuss Llability I Occurence Form | $1,000,000 Per Claim/S3,000,000 Aggregate
Business Ofrice Policy Property Locationsl
1881 Business Center Dr. Suite 11, 12 A & '12 B, San Bernardino, CA 92408
1545 Anacapa Rd Suite 7C, victorville, CA 92392
4/r4 Camino Oel Rio South, Suite 215 & #208, San Diego CA 92108
SEE ATTACHED ACORD 1O,I
CERTIFICATE HOLDER CANCELLATION
City of Menifee and lts offlceG, erhploye€s, agents, and
authorized voluntsors
298,14 Haun Road
Menifee, CA 92585
SHOULD ATIY OF THE ABOVE DESCRIEED POLICIES BE CANCELLEO BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVEREO IN
ACCOROANCE wlT}I THE POLICY PROVISIONS,
AUTHORIZED REPRESENTATIVE
ACORO 25 (2016/03)O 1988-2015 ACORD CORPORATION. All rights reserved
The ACORD name and logo are registered marks o, ACORD
8t31t2021 8t3112022t
ACPCAA30't 9795490
oh
AGENCY CUSTOMER ID, TRUEREC-01
LOC f: 1
ADDITIONAL REMARKS SCHEDULE
JWU,I
ACORD"Page I of I
License * 07577
UB lnternational lnsurance Services lnc
EE PAGE 1
EE PAGE 1 SEEPl
NAIIiED INSUREDTtue Rscoveru LP
Nancv K. Bohl, lnc. D.B.A. The Counsoling Toam lnternational2035{ Sw Aca;la Str€et Floor 2Newport Beach, CA 92660
EFFEonvE oarE, SEE pAGE 1
ADDITIONAL REMARKS
@ 2008 ACORO CORPORATION. All rights reserved
The ACORO name and logo are registered marks of ACORD
THIS ADOITIONAL REMARKS FORM IS A SCHEOULE TO ACORD FORM,
FORM NUMBER: ACORo 25 FORM TITLE: Certificate of Li:bility lnsurance
Description of OperationsrLocationslVehicles:
74075 El Paseo Suite A9 & A15, Palm Desert, CA 92260
4160 Temescal Canyon Rd Ste 309, Corona, CA 92883
41750 Rancho Los Palmas Dr ST #D-2, Rancho Mirage, CA 92270
39755 Murrieta Hot Springs Rd, Suite D160, Murrieta, CA 92563
'135 S State College Blvd Ste 200, Brea, CA 92821
70'l Palomar Airport Rd, #300, Carlsbad, CA 92011
232 Harrison Ave Ste D, Claremont, CA 91711
Certificate Holder is named as Additional lnsureds with respects to General Liability per form CG8128 01/'18. Waiver of subrogation
applies for General Liability. All forms valid where required by written contract.
ACORD 101 (2008/0't)
COMMERCIAL GENERAL LIABILITY
cG 81 28 01 18
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE BEAD IT CAREFULLY.
GENERAL LIABILITY ENHANCEMENT: HUMAN SERVICES
This endorsement modifies insurance provided under the following:
COIVN/ERCIAL GENERAL LIABILITY COVERAGE FORT,4
It is underslood and agreed that the following extensions only apply in the event that no olher specilic coverage lor the
indicat€d l06s exposure is provided under this policy. ll such other more specilic coverago applies, the lerms, conditions, and
limits ol that coverage are the sole and exclusive coverage applicable under this policy, unless otherwise noted on this
endorsemenl. The lollowing is a summary of the Limils ol lnsurance and additional coverages provided by this endorsement.
For complete details on specitic coverages, consull the policy contract wording.
lncludes copyrighted malerial of lnsurance Services Oflice, Inc.,
with its permission.
Coveraqe Applicable Limit ol lnsurance Paqe #
Additional lnsured - As Required by Contracl lncluded 7
Additional lnsured - Broad Form Vendors lncluded 5
Additional lnsured - Funding Source lncluded
Addilional lnsured - Grantor of Franchise lncluded 6
Additional lnsured - Grantor of Permits lncluded 4
Additional lnsured Home Care Providers lncluded 4
Additlonal lnsured - Lessors Ol Leased Equipment - Aulomatic Stalus
When Required ln Lease Agreement With You lncluded 4
Additional lnsured - [,4anagers, Landlords, Or Lessors Of Premises lncluded
Addational lnsured - t\.,ledical Directors And Administrators lncluded
Additional lnsured - State Or Polilical Subdivision lncluded 5
Broadened Deflnillon Oi Bodilv lniury lncludes l,,lental Anquish I
Damaqe To Premises Flented To You
$1,000,000
(lncludes Expanded Perils)B
Damaqe To Propertv You Own, Rent, Or Occupy $s0,000 2
Dulies ln The Evenl Of Occurrence. Claim Or Suit lncluded B
Emplovee lndemnilication Defense Coverage For Employee $25,000 3
Extended Propeny Damaq€lncluded 3
Key And Lock Replacement Janitorial Services Client Coverage $15,000 2
Liberalization lncluded B
Limited Rental Lease AOreemenl Conkactual Liabilily $100,000 3
Medical Payments $20,000 3
l\.4edical Payments - Athletic Activities Amended 3
l\ledical Payments - Ext€nded Feporting Period 3 Years 3
Named lnsured - Broadened Named lnsured lncluded 3
Named lnsured - Newlv Acquired lncluded 3
Non-Owned Watercrall Less than 58 leet 2
Personal And Advertising lnjury lncludes Abuse Ol Process And
Discrim natron lncluded I
Supplementary Paymenis - Bail Bonds $7,500 3
Supplementary Paymenls - Loss Ol Earnings $1,500 per day 3
Transler Of Riqhts Of Recovery Aqainst Other To Lls Clarilication B
Unintentional Failure To Disclose A Hazard lncluded 8
cG 81 28 01 18 Page 1 oI 9
cG 81 28 01 18
A. Key and Lock Replacement - Janitorial Services
Client Coverage
1. We will pay lor the cosl to replace keys and locks
at the "clienl's" premises due lo lhe,t or other
loss to keys entrusted lo you by your "clienl", up
to a $15,000 limit per occurrence/$ 1 5,000 policy
aggregate.
2. We will not pay for loss or damage resulting lrom
thett or any other dishonest or criminal act that
you or any of your partners, members, olficers,
"employees", "managers", directors, lrustees,
authorized representatives or any one to whom
you entrust the keys ol a "client" tor any purpose
commil, whether acting alone or in collusion with
other persons.
3. The following, when used in this coverage only,
are defined as follows:
a- 'Employee" means:
(1) Any natural person:
(a) While in your services or lor 30
days after termination ol service;
(b) Who you compensate directly by
salary, wages or commissions; and
(c) Who you have the right to directand control while perlorming
services for you: or
(2) Any natural person who is lurnished
tsmporarily to you:
(a) To substitute for a permanent,employee" as defined in Paragraph
(1) above, who is on leavei or
(b) To meet seasonal or short-lerm
workload conditions:
while thal person is subjecl to your
direction and control and
performing services for you.
(3) "Employee" does not mean:
(a) Any agent, broker, person leased to
you by a labor leasing lirm, iactor,
commission merchant, consignee,independent contraclor or
representative of the same general
characteri or
(b) Any "manager", director or trustee
except while perlorming acts
coming within the scope ol lhe
usual duties ol an "employee".
b. Nilanagea means a person servrng rn a
directorial capacity lor a limited liabilily
company.
B. SECTION I - COVERAGES, COVERAGE A -
BODILY INJURY AND PFOPEHTY DAMAGE
LIABILITY,2. Exclusions is amended as tollows:
'!. Exclusion a. Expected or lntended lniury is
deloted and replaced wilh:
a. Bodily injury" or "property damage"
expecled or inlended from the stand point ot
the insured. This exclusion does not apply to
"bodily injury" or "property damage' resulting
from the use o, reasonable rorce lo protect
persons or property.
2. Exclusion g. Aircraft, Auto or Watercralt
Paragraph (2) is deleted and replaced w th:
(2) A watercraft you do not own that is:
(a) Less than 58 feel long; and
(b) Not being used lo carry persons or
Property ior a charge;
This provision applies lo any person, who wilh
your consent, eilher uses or is responsible for
lhe use of a watercratt. This insurance is excess
over any other valid and collectible insurance
available to the insured whelher pri'nary. excess.
or contingenl.
3. Exclusion i. is amended as follows:
(a) Exclusion i.(1) is deleted and replaced with:
(1) Property you own, renl , or occupy,
including any costs or oxpenses
incurred by you, or any olher person,
organizalion or enlity, lor repair,
replacement, enhancement, restoration
or maintenance of such property for any
reason, including prevention ol injury toa person or damaqe to another's'
property, unless the damage to properly
is caused by your "client", in such casewe will provide coverage for such
"property damage" for which You are
legally obligated to pay up to a $50,000
limii per "occurrence". This limit is the
only limit ol insurance tor such "property
damage" and will nol be combined wilh
the Each Occurrence Limit set for this in
Section lll - Limits o, lnsurance and
will be included within and not in
addition to the Each Occurrence Limil.
Any and all damages paid under the
terms and condition of lhis provision will
further be applied against and will
reduce the Aggregate Limit of lnsurance
shown on lhe Dsclarations page, and as
provided in the Commercial General
Liability Coverage Form in the same
manner and in addilion to all other
coveraoes of the Commercial General
Liabilily Coverage Form that are also
subjoct to lhe Aggregate Limil.
4. The lollowing is added to Paragraph (2) of
Exclusion b, Conlractual Liabilily ol SECTION I
- COVERAGES, COVERAGE A. BODILY
INJURY AND PROPERTY DAMAGE LIABILITY,
under Subsection 2. Exclusions:
We agree to indemnify the Named lnsured lor
their liabilily assumed in a conlract or agreement
lncludes copyrighted material of lnsurance Services Office, lnc.,
with its permission.
Page 2 ot I cG 81 280t 18
regarding the rental or lease ol a premises on
behall of their "clienl", up to $100,000 per
"occurrence", This limit of insurance is the only
limlt of insurance lor your liability assumed in a
contract or agreement regarding th€ rental or
lease of a premises on behalf of your "client"
whether or not such contract qualifies as an
''insured contracl". This limit will not be combined
with the Each Occurrence Limit set lorth in
Seclion lll - Limits ol lnsurance and is
included within and not in addition to the Each
Occurrence Limit. This coverage extension only
applies to renlal lease agreemenls. This
coverage is excess over any rentels liability
insurance of the "client".
Any and all damages paid under the terms and
conditions ol this provision will further be applied
against and will reduce the Aggregate Limit ol
lnsurance shown on the Declaralions page, as
provided in the Commercial General Liability
Coverage Form in the same manner and in
addition to all olher coverages of the Commercial
General Liablity Coverage Form that are also
subjecl to the Aggregate Limit.
5. The last Paragraph of Subsection 2- Exclusions
is replaced by the following:
It damage by fire to premises rented to you is nol
otherwise excluded, exclusions c. through n. do
not apply to damage by lire, lightning, explosion,
smoke or sprinkler leakage to premises while
rented to you or temporarily occupied by you with
permission of the owner. A separate lirnit ol
insurance applies to this coverage as described
in Section lll- Limits ol lnsurance.
C. SECTION I - COVERAGES, COVERAGE C -
MEDICAL PAYMENTS
1. lf COVERAGE C - MEDICAL PAYMENTS is not
olherwise excluded trom this Coverage Parl:
a. The Medical Expense Limit shown on lhe
Declarations is deleted and replaced by
$20,000. $20,000 is the only limil of
insurance lor i./edical Expenses and this
limit will not be combined wilh any olher limit
ol insurance.
b. Subsection 1. lnsuring Agreement,
Paragraph a.(3xb) is replaced by:
(b) The expenses are incurred and reported
to us within three years of lhe dale of
the accidenl; and
2. Subsection 2. Exclusions, is amended as
follows:
a. Exclusion a. Any lnsured is deleted and
replaced with:
a. Any lnsured
To any insured, except "volunteer
workers" or an insured as provided in e.
Athl€tic Activilies below.
cG 81 28 01 t8
b. Excluson e. Athletics Activities is deleted
and replaced with:
e. AthleticsActivities
To a person injured while practicing or
participating in any physical exercises
or games, sports or athlelic contests.
This exclusion shal not apply to an
insured while providing instruclion wilh
respecl to any ol the activilies otherwrse
excluded by lhis provision.
_ COVERAGES, SUPPLEMENTAHY
- COVERAGES A ANO B is amended
D. SECTION I
PAYMENTS
as tollows:
1. 1. b. is replaced with:
b. Up to $7,500 lor cost of bail bonds required
because of accidents or kalfic law violations
arising out ol the use ol any vehicle to which
the Bodily lnjury Liabilily Coverage applies.
We do not have to lurnish these bonds.
d. is replaced with:
All reasonable expenses incurred by the
insured at our requesl to assist us in the
"suit", including actual loss of earnings up lo
$1,500 a day because of time off lrom work.
3. The following provision is added:
We will reimburse you lor defense costs that you
incur in the defense ol an "employee" who is
directly involved in a criminal proceeding that
arises out ol such "employee's" acts or
omissions wilhin the scope ol their employment
by you or while pedorming duties related to the
conduct ol your business and which would
otherwise be covered by this insurance.
The most we will reimburse you lor defense
costs that you incur in the defense of an''employee" who is alleged to be directly involved
in a criminal proceeding is $25,000, subject to an
aggregate limit ol $25,0001or all reimbursements
that we make during the policy period on behalf
of all employees", regardless o, the numbers of
"employees", claims or "suits" brought or persons
or organizations making claims or bringing
"suits",
E. SECTION ll WHO lS AN INSURED is amended as
follows:
1. ll coverage for a newly acquired or formed
organization is not otherwise excluded from this
Coverage Parl, Paragraph 3.a. is replaced with:
a. Coverage under this provision is until the
end ot the policy period during which you
acquired or formed the organization;
2. The following is also an insured:
Broadened Named lnsured - Any organization
and subsidiary thereof which you control and
actively manage (whether through ownership of
voting securities, by conlract, or otherwise) on
lhe ellective date ol this policy. However,
coverage does not apply lo any organization or
1.
d.
2
lncludes copyrighted material of lnsurance Services Office, lnc.,
with its perm ission.
Page 3 ot IcG 81 28 01 18
cG 81 28 01 18
subsidiary not named in the Declaralions as a
Named lnsured, if they are also insured under
another similar policy, or would havo been
insured but lor such policy's termination or the
exhaustion of its limits ol insurance.
Each ol the lollowing is also an addilional
insured:
a. l\redical Directors and Administrators - Your
medical directors and administralors but
only while acting within the scope o, and
during the course of their duties as such.
Such dulies do not include the Iurnishing or
lailure to lurnish prolessional services as a
physician or psychiatrist in the lreatment of
a patient.
b. Funding Source - Any person or
organizalion wilh respecl to lheir liability
arising out of:
(1) Their linancial control o, you; or
(2) Premises they own, maintain or control
while you lease or occupy lhese
premises.
This insurance does not apply to:
(a) Any "occurrence" or orfense which
takes place after you cease to
lease or occupy that premrses: or
(b) Slructural alterations, newconslruction or demolition
operations performed by or onbohalf of that person or
organization.
c. Home Care Providers - At tho first Named
lnsured's option, any person or organization
under your direct supervision and control
while providing on your behall private home
respite or losler home care for the
developmentally disabled.
d. Managers, Landlords, or Lessors ol
Premises - Any person or organization with
respecl to liability arising oul of ihe
ownership, maintenance or use ol lhat part
of the premises leased or rented to you
subject to the following addilional
exclusions:
This insurance does nol apply to:
(1) Any "occurrence" which takes place
after you cease to be a tenant in that
premises.
(2) Struclural alterations, new construction
or demolition operations performed byor on behalf of the person or
organization.
e- Lessor of Leased Equipment - Automatic
Status When Required in Lease Agreement
With You - Any person(s) or organization(s)
lrom whom you lease equipment when you
and such person(s) or organization(s) have
agreed in writing in a contract or agreement
thal such person(s) or organizalion(s) be
added as an additional insured on your
policy. Such person(s) or organization(s) is
an insured only with respect to liability ,or"bodily injury", "property damage" or
"personal and adverlising injury" caused, in
whole or in part, by your mainlenance,
operation or use ol equipmenl leased to youby such person(s) or organization(s).
However, the insurance alforded to such
additional insured:
('l) Only applies to lhe exlent permitted by
law;and
(2) Will not be broader than that which you
are required by the contract or
agreement to provide lor such additional
insured.
A person's or organizalion's status as an
additional insured under this endorsemenl
ends when their contract or agreement with
you lor such leased equipment ends.
With respect to the insurance afforded to
lhese additional insureds, this insurance
does not apply to any "occurrence" which
lakes place atter the equipment lease
expires.
Grantors of Permits - Any state or
governmenlal agency or subdrvisron or
political subdivision granting you a permit in
connection with your premises subject to the
f ollowing addilional provision:
This insurance applies only with respect to
the following hazards for which the state or
governmental agency or subdivision or
political subdivision has issued a permit or
authorizalion in conneclion wilh premises
you own, rent or control and lo which this
insurance applies:
(1) The existence. mainlenance. repair,
construction, erection or removal ol
advedising signs, awnings. canopies,
cellar entrances, coal holes, driveways,
manholes, marquees! hoist away
openings, sidewalk vaults, street
banners or d€corations and slmilar
exposures; or
(2) The construction, ereclion or removal of
elevators; or
(3) The ownership, maintenance or use ol
any elevators covered by this insurance.
Howeverl
(1) The insurance alforded to such
addilional insured only applies to the
extent permitted by law; and
lncludes copyrighted material of lnsurance Services Oflice, lnc.,
with its permission.
Page 4 ot 9 cG 81 28 01 18
(2) ll coverage provided to the additional
insured is required by a conlract or
agreement, the insurance atlorded 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.
g. State or Political Subdivision - Any state or
polltical subdivision wlth whom you agreed
under a written contract or agre€ment to add
as an additional insured 1o your policy but
only with respect lo their liability with respect
to on-going operations perlormed by you or
on your behall for which the state or polilical
subdivision has issued a permil or license.
This insurance does nol apply to:
'1. "Bodily injury", property damage' or
''personal and advertising injury" arising
out of operations performed for the slate
or political subdivision; or
2. 'Bodily injury" or "property damage"
included within the "products-complel6d
operations hazard",
The insurance provided to such additional
insured slate or political subdivision by this
endorsement is further limited as lollows:
1. The additional insured is covered onlyfor such sums that such additional
insured is legaily obligated to pay as
damages under tort law principles to lhe
injured party because ol 'bodily iniury",
"property damage" or "personal and
advertising iniury" to which lhis
insurance applies, and in accordance
with the stated policy limits, exclusions,
limitalions and conditions except as
expressly modilied by this endorsement.
2. The limits of insurance are lhose set
forth in the policy Declarations or lhose
specified in the written contracl or
agreement reterenced above, whichever
is less.
Other lnsurance
1. lf specilically required by the wrilten
conlracl or agreement rel€renced
above, any coverage provided by this
Subsection g. to an addilional insured
shall be primary and any olher valid and
collectible insurance availabl6 to the
additional insured shall be non-
contributory with this insurance. lf the
written contract does not require this
coverage to be primary and the
additional insured's coverage to be non-
contributory, then this insurance will be
excess over any other valid and
collectible insurance available to the
additional insured.
cG 81 28 01 18
2. Even it lhe requiremenls of Paragraph
f . immediately above are met
establishing this coverage as primary
and the additional insured's coverage
as being non-contributory. thrs coverage
will be excess over any olher irsurance
availabl6 to the additional insured whichis conferred onto said person or
organization by a separale additional
insured endorsement.
h. Broad Form Vendors - Any person(s) or
organizalion(s) which or who is or are a
vendor ol "your products" with whom you
agreed under a written conlract or
agreemenl to add as an addiiional insured lo
your policy, but only with respect to "bodily
injury" or "property damage" arising out of
'your products" which are distributed or soldin the regular course ol the vendor's
business, subjecl to the lollowing additional
exclusions:
The insurance alforded the vendor does not
apply lo:
1. "Bodily injury" or "property damage" for
which lhe vendor is obligated to pay
damages by reason ol the assumption
of liability in a contract or agreement.
This exclusion does not apply to liability
lor damages that the vendor would havein the absence ol the contract or
agreement;
2. Any express warranty unaulhorized by
you;
3. Any physical or chemical change the
vendor intentionally made to the
product;
4. Repackaging, except when unpacked
solely for the purpose of inspection,
demonstration, testing, or the
substitution of parts under instructionslrom lhe manulacturer, and then
repackaged in the original container;
5. Any failure to make such inspeciions,
adiustments, tesls or servicing as the
vendor has agreed to make or normally
undertakes to make in the usual courseof business, in connection with the
distribution or sale ot the products,
6. Demonstration. inslallalion, servicing orr€pair operations, excepl such
operations performed at the vendors
premises in connection with the sale of
the product;
7. Products which, after distribution or sale
by you, have been labeled or relabeledor used as a container, part or
ingredient of any other thing or
substance by or for the vendor; or
Includes copyrighted material of lnsurance Services Office, lnc.,
with its permission.
cG 81 28 01 18 Page 5 ot 9
cG 81 28 01 t8
8.'Bodily injury' or "property damage"
arising out ol lhe negligence ol the
vendor for its own acls or omissions or
those of its employees or anyone else
acting on its behalf and which was not
caused in whole or in part by you or any
person or organization acting on your
behalf. However, this exclusion does not
apply to:
(a) rhe excephons conta ned rn
Subparagraphs 4. or 6.; or
(b) Such inspections, adjustmenls,
tests or servicing as the vendor
has agreed lo make or normally
undertakes to make in the usual
course of business, in connection
with the distribution or sale ol the
products.
The insurance provided lo such additional
nsured vendor by this endorsement is
further limited as lollowsi
1. The additional insured is covered only,or such sums that such additional
insured is legally obligated to pay as
damages under tort law principles to lhe
injured party because ol "bodily injury",
"property damage" or "personal and
advertising injury" to which this
insurance applies, and in accordance
with the stated policy limits. exclusions.
limitations and conditions except as
expressly modilied by this endorsement.
2- The limits ol insurance are those set
forth in the policy Declarations or those
specilied in lhe written coniract or
agreement reterenced above in the first
paragraph of this Subsection h.,
whichever is less.
This insurance does not apply to any
insured person or organization, lrom whom
you have acquired such products, or any
ingredient, part or container, entering into,
accompanying or conlaining such products.
Other lnsurance
1, l, specilically required by the written
contract or agreement referenced above
in the lirst paragraph ol this Subsectionh., any coverage provided by this
endorsement to an additional insured
shall be primary and any other valid and
collectible insurance available to the
additional insured shall be non-
conlributory with this insurance. lf lhe
written contract does not require this
coverage to be primary and lhe
additional insured's coverage to be non-
conlributory, then lhis insurance will be
excess over any other valid and
collectible insurance available to the
addilional insured.
2. Even if the requiremenls of Paragraphf. immediately above are met
establishing lhis coverage as primary
and the additional insured's coverage
as berng non-contributory. thrs coverage
will be excess over any other insurance
availabl€ to the additional insured whichis conlerred onto said person or
organization by a separate additional
insured endorsement,
i. Grantor ol Franchise - Any person(s) or
organizalion(s) with whom you agreed under
a written contract or agreement to add as an
additional insured to your policy but only wilh
respect to their liability as granlor ol a
lranchise to you.
The insurance provided to such additional
insured lranchisor by this endorsement is
turlher limited as ,ollows:
1. The additional insured is covered only
for such sums that such additional
insured is legally obligated to pay as
damages under tort law principles to the
injured party because ol "bodily injury",
"prop€rty damage" or "personal and
advertising injury" to which this
insurance applies, and in accordance
with the staled policy limits, exclusions,
limitations and conditions excepl as
expressly modilied by this endorsement.
2. The limits of insurance are those set
torlh in lhe policy Declarations or ihose
specilied in the writlen contract or
agreement ref erenced above, whichever
is less.
Olher lnsurance
1. lf specifically required by the written
contract or agreement referenced above
in the first paragraph of this Subsectioni., any coverage provided by this
endorsemenl to an additional insured
shall be primary and any other valid and
collectible insurance available to the
addilional insured shall be non-
conlribulory with this insurance. ll lhe
writlen contract does not require this
coveraqe lo be primary and lhe
addilionai insured's coverage to be non-
contributory, then lhis insurance will be
excess over any other valid and
colleclible insurance available to the
addiiional insured.
2. Even if the requirements of Paragraph
f . immedialely above are met
establish'ng lhrs coverage as primary
and the additional insured's coverage
as berng non-contflbulory. this coverage
lncludes copyrighted material of lnsurance Services Oflice, lnc., CG 81 28 01 18
with its perm ission.
Page 6 ol I
l.
will be excess over any other insurance
available to the additional insured whichis conferred onto said person or
organizali6n by a separale additional
insured endorsement.
As Required by Contract - Any person or
organizalion for whom "you" are performing
operalions, or to whom you are leasing.
subleasing or otherwise entrusting lhe use
or occupancy of premises owned by or
rented to "you", only as specilied under a
wrilten conlract, lease, sublease or
agreement that requires that such person or
organization be added as an addilional
insured on "your' policy. Such person or
organization is an addilional insured only
wilh respect to liability caused, in whole or in
part, by the acts or omissions ol the "Named
lnsured' or the acts the acts or omissions ol
those acting on your behall in ihe
performance of the "Named lnsured's"
ongoing operations lor the additional insured
or in connection with such premises owned
by or rented to a "Named lnsured", but in
both instances only as specilied under the
written contract, lease, sublease or
agreemenl. A person's or organization's
status as an addilional insured under this
endorsemenl ends the earlier ol when "your"
on-going operalions lor that additional
insured are completed or when 'you" no
longer are contractually required lo include
such person or organizatlon as an additional
insured under "your" policy.
The insurance provided to an addilional
insured by this endorsement is limited as
lollows:
1. The additional insured is covered only
for such damages which are caused, in
whole or in part, by lhe acts or
omissions of the "Named lnsured" to
which the additional insured is enlitledto be indemnilied by the Named
lnsured" pursuant lo the written
contract, lease, sublease or agreement
relerenced in lhe first paragraph of this
subsection i. above and only Jor those
sums thal the additional insured is
legally obligated to pay as damages
under lort law principles to the injuredparty because oi "bodily injury",
"propeny damage" or "personal and
advertising injury" to which this
insurance applies, and in accordance
with the stated policy limits and policy
conditions. This coverage does not
apply lor defense or indemnily of the
additional insured if state or federal law
does not permit indemnilication ol the
additional insured by the "Named
lnsured" lor the claim of the third pany.
cG 8t 28 0t t8
2. The limits of insurance are those set
lorth in the policy and Declarations or
those specified in the written contract,lease, sublease or agreement
referenced in the lirst Paragraph ol this
Subsection i., whichever is less.
With respect to the insurance af,orded to an
additiooal insured under this Subsection j.,
the lollowing exclusions are added:
1. This insurance does not apply if the
writlen contract, lease, sublease or
agreemenl referenced in lhe tirst
Paragraph of this Subsection j. above
was not executed by the "Named
lnsured" prior to the "occurrence" giving
rise to the additional insured's potential
liabilily.
2. This insurance does not apply to the
addilional insured's liability to indemnify,
delend or hold harmless a third party.
3. This insurance does not apply to "bodily
injury", "property damage" or "personal
and advertising injury" ior which the
additional insured is obligated to pay
damages by reason of the assumption
ol liability in a contract or agreement.
This exclusion does not apply lo liabilily
for damages that the addilional insured
would have in lho absence o, the
contract or agreement,
4. "Bodily injury", "property damage" or
'personal and advertising injury a^sing
out of the renderng of, or the failure to
render, any professional archilectural,
engineering or, surveying services.
including:
(a) The preparing, approving, or failing
to prepare or approve, maps, shopdrawings, opinions, reports,
surveys, tield orders, change orders
or drawinqs and specifications; and
(b)Supervisory, inspection, archi-
tectural or engrneering activities.
5. "Bodily injury" or "property damage"
occurring arter:
(a) All work, including materials, partsor equipment lurnished in
connection with such work, on theoroiect (olher than se.vice
maintenance or repairs) to be
perlormed by or on behalf ol the
additional insured(s) at the sile ot
the covered operations has been
compleled; or
(b) That portion ol "your work" out ol
whicl'the injury or damage arises
has been put to its intended use by
any person or organization otherthan another contractor or
lncludes copyrighled material of lnsurance Services Oflice, lnc.,
with its permission.
cG 81 28 01 18 Page 7 oI I
cG 81 28 01 18
subconlractor engaged in
performing operations for a
principal as a part ol the same
project.
Other lnsurance
1- lt specitically required by the writlen
contract, lease, sublease or agreement
referenced in lhs lirst Paragraph ol this
Subsection i. above, any coverage
provided by lhis endorsemonl lo an
additional insured shall be primary and
any other valid and collectible insurance
available to lhe additional insured shall
be non-contributory with this insurance.
lf the written contract, lease or sublease
does not require this coverage to be
primary and the additional insured's
coverage to be non-contributory, then
this insurance will be excess over any
olher valid and collectible insurance
available to the additional insured.
2. Even il ths requirements of Paragraph
f . immedialely above are met
establ,shing thrs coverage as primary
and the addilional insured's coverage
as being non-contribulory, this coverage
will be excess over other insurance
available lo the additional insured whichis conferred onto said person or
organization by a s€parate addilional
insured endorsement.
Delinitions
Solely tor purposes of the insurance
allorded to an additional insured by this
endorsement:
"Named lnsured" is delined as the entity to
whom the insurance policy is issued as
shown on the Declarations.
"You" or "your" means a "Named lnsured" as
delined above.
SECTION lll - LIMITS OF INSURANCE is amended
as tollows:
1. Paragraph 6 is replaced with:
6. Subject lo 5. above, lhe Damage To
Premises Rented to You Limit is the most
we will pay under Coverage A lor damages
because of 'property damage" lo any one
premises, while rented to you or in the caseoi damage by tire while rented to or
temporarily occupied by you with permission
ol the owner. The limit is increased to
$1.000,000.
However, if damage by fire to promises
rented to you is not otherwise excluded, the
word fire in the above paragraph is replaced
with fire, lightning, explosion, smoke or
sprinkler leakage.
G. SECTION IV - COMMERCIAL GENERAL LIABILITY
CONDITIONS is amended as follows:
1. Duties ln The Event Ot Occurrenco, Oflense,
Claim Or Suit is amended as follows:
a. The following is added to Paragraph a.:
However, this condilion only applies when
the "occurrence" or oflense is known to:
i. You, if you are an individual;
ii. A partner, il you are a parinership: or
iii. An execulive officer or insurance
manager, il you are a corporation,
b. The following is added to Paragraph b.:
However, this condition will not be
considered breached unless the breach
occurs after such claim or "suit" is known to:
i. You, if you are an individual;
ii. A partner, il you are a parlnership; or
iii. An executive olficer or insurance
manager, it you are a corporation.
2. Subsection 4. Other lnsulance, Paragraph b.
Excess lnsurance, ltem (lXaxii) is replaced by
the lollowing it damage to premises r€nted to you
is nol otherwise excluded:
(ii) That is lire, lightning, explosion, smoke or
sprinkler leakage insurance for premises
rented to you or temporarily occupied by you
with permission ol the owner.
3. Subsection 6. Representations is amended to
include:
d. Your failure to disclose all hazards or prior
"occurrences" or offenses existing as of the
inceplion dato of the policy shall not
prejudice lhe coverage aftorded by this
policy provided such failure to disclose all
hazards or prior "occurrences" or olfenses is
not inlentional. This provision does not attect
our right to collect additional premium or
exercise our righl ol cancsllation or
nonrenewal.
4. Subsection 8. Transter ol Rights ol Recovery
Against Others to Us is amended to include:
Therefore, the insured can waive the insurer's
Rights of R€covery prior 1o the occurrence of a
loss, provided the waiver is made in a writlen
contracl.
5. The following condition is added:
10. Liberalization
ll we revise this coverage lorm to provide more
coverage without additional premium charge,
your policy will automatically provide the
additional coverage as of the day the revision is
el,ective in your state, provided thal this
implementalion date lalls within 45 days prior toor during the policy period stated in the
Declarations.
F
lncludes copyrighted material oI lnsurance Services Office, lnc.,
wilh its perm ission.
Page I ot 9 cG 8t 280't 18
H. SECTION V - DEFINITIONS is amended as lollows;'1. Paragraph 3. "Bodily lnjury" is deleted and
replaced with the following:
"Bodily lnjury":
a. Means bodily injury, sickness, or disease
suslained by a person and includes menlal
anguish resulting lrom any of these; and
b. Except lor mental anguish, includes death
resulting from the foregoing (ltem a. above)
at any time.
2. lf damage by fire to premises renled to you is not
otherwise excluded, Paragraph 9. "lnsured
Contract", ltem a. is replaced by lhe following;
a. A contract lor a lease of premises. However,
that portion of the contracl for a lease of
premises that indemnifies any p6rson or
organization for damage by fire, lightning,
explosion, smoke or sprinkler leakage to
premises whil€ rented to you or temporarily
occupied by you with permission of the
owners is not an "insured conlract":
3. Paragraph 14. "Personal and Advertising lnjury"
is amended as follows:
a. ltem b. is deleted and replaced with lhe
following:
b. l\.4alicious prosecution or abuse of
process;
b. ltem h. is added:
h. 'Personal and advertising injury" also
means injury, including consequential'bodily injury", arising oul of
discrimination based on race, color,
religion, sex, age or national origin,
excepl when:
(1) Done intentionally by or at the
direclion of, or with the knowledge
or consgnl of:
(a) Any insured; or
cG 81 28 01 't8
b, Any executive ollicer, director,
stockholder, panner or
member of the insured; or
(2) Directly or indirectly related to the
employment, former or prospective
employment, termination ol
employment, demotion,,ailure lopromote or application lor
employment oi any person or
persons by an insured; or
(3) Directly or indirectly related to the
sale, rental, lease or sublease or
prospeclive salas, rental, lease or
sub-lease ol any room, dwelling or
premises by or al the direction of
any insured; or
(4) lnsurance for such discrimination is
prohibiled by or held in violation ol
law, public policy, legislation, court
decision or administrative ruling
This coverage does nol apply to lines or
penalties imposed because of discrimination.
4. "Cli€nt" as used in this endorsement means:
a. An individual, company or organization with
whom you have a written contracl or work
order lor your services lor a described
premrses and have billed lor your services;
or
b. A person under your direct care and
supervision ior whom you are providing
goods and/or services,
All terms and conditions ol this policy apply unless modilied by this endorsement.
lncludes copyrighted material of lnsurance Services Office, lnc.,
with its permission.
cG 81 28 01 18 Page 9 ol 9