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HomeMy WebLinkAboutPort Ludlow Village Council Trails Committee $2,004.64 (ins ex 6.1.23) - 122021 Riai4: AGREEMENT FOR 2022 HOTEL-MOTEL FUNDING FOR TOURISM SERVICES PORT LUDLOW VILLAGE COUNCIL This Agreement is by and between JEFFERSON COUNTY(hereinafter known as "COUNTY" and PORT LUDLOW VILLAGE COUNCIL (hereinafter known as "PLVC-TRAILS COMMITTEE-Trails Committee"). WHEREAS,PORT LUDLOW VILLAGE COUNCIL is a non-profit corporation of the State of Washington; and WHEREAS,the COUNTY desires to promote tourism in unincorporated Jefferson County, as authorized by Chapter 67.28 RCW and Jefferson County Code Chapter 3.25; and WHEREAS,the Jefferson County Lodging Tax Advisory Committee reviewed and recommended funding the lodging tax proposal by PLVC-TRAILS COMMITTEE to implement a strategy for the unincorporated area of Jefferson County to promote tourism activities; "e IN CONSIDERATION of the mutual covenants and agreements herein it is agreed by the parties as follows: SECTION 1: SERVICES TO BE PERFORMED PLVC-TRAILS COMMITTEE shall use its capabilities and utilize up to $2,004.64 of funding provided under this agreement to promote the Port Ludlow Trails by constructing and installing --�, interpretive signs, restricted to any of the eligible items in the itemized list of proposed tourism promotion services, a copy of which is incorporated herein as Exhibit A. SECTION 2: RESPONSIBILITIES OF PLVC-TRAILS COMMITTEE: 1. On or before April 30; July 31; October 31,2022; and January 31, 2023,provide to the COUNTY: see Exhibit C, attached hereto and incorporated; • A quarterly report of the use, services,programs and activities of PLVC-TRAILS COMMITTEE under this Agreement for the prior quarter; • A quarterly financial statement detailing revenues, expenses and cash balances for the prior quarter; and for the final quarter report,the financial statement shall also include a detailed financial statement for all 2022. 2. On or before January 31,2022 OR upon execution of this agreement,whichever is later, provide to the COUNTY: • A billing invoice requesting payment of Hotel-Motel Funding for the current year. 3. For a minimum of six (6) years, maintain documented proof of payments made, contracts executed, and other expenditures authorized under this Agreement. Upon reasonable notice,provide access to County or State representatives to audit those records. 4. Funding provided by this Agreement may only be expended on the services described in Section 1 of this Agreement. Any monies used for other services or purposes shall be refunded to Jefferson County Hotel/Motel Fund. Any monies under-expended of the total Page: 1 of 13 Port Ludlow Village Council funding allocated under this Agreement shall be refunded to Jefferson County by January 31, 2023. 5. By February 28th of each year provide the following information on Exhibit B, attached hereto and incorporated by reference for the previous year. a. Each festival,event,or tourism facility owned and/or operated by PLVC-TRAILS COMMITTEE. b. The amount of lodging tax revenue allocated for expenditure(whether actually expended or not)by PLVC-TRAILS COMMITTEE on each festival, event or tourism facility. c. Estimated number of tourists served at each festival, event or tourism facility. ("Tourist" includes persons traveling more than 50 miles to the location of the event, festival or facility and overnight stays in the area). d. Estimated lodging stays. ("Lodging"refers to commercial lodging such as hotels, motels, resorts,bed and breakfasts,or commercial campgrounds). e. Measurements that demonstrate the impact of increased tourism attributable to the event, festival or facility. SECTION 3: RESPONSIBILITY OF JEFFERSON COUNTY 1. The COUNTY will provide PLVC-TRAILS COMMITTEE funding from Hotel-Motel Tax receipts to be used in support of their responsibilities as defined under this agreement. 2. Said funding is in the sum of$2,004.64 for 2022. Payment will be made by the COUNTY upon receipt of an invoice on the next available billing cycle. SECTION 4: TERM This Agreement shall be for a term of one year, commencing on January 1,2022 and ending on December 31,2022, except for the reports referenced in Section 2, due January 31, 2023 and February 28,2023. Work performed during the term and pursuant to this Agreement, but prior to its complete execution, is hereby ratified. SECTION 5: ASSIGNMENT Either party to the agreement shall not assign this Agreement, except by signed amendment. SECTION 6: MODIFICATION This Agreement may be modified by mutual written agreement executed by both parties. SECTION 7: TERMINATION The Agreement may be terminated, in whole or in part, by the County upon thirty(30)days written notice in the event expected or actual revenue from the Hotel-Motel Tax is reduced or limited in any way, or for non-performance of duties under this Agreement, or for any reason. PLVC- TRAILS COMMITTEE may terminate this Agreement upon thirty(30)days written notice to the COUNTY. In the event of termination under this clause, the County shall be liable to pay only for services rendered prior to the effective date of termination. If termination covers a period for which Page: 2 of 13 Port Ludlow Village Council payment has already been made, PLVC-TRAILS COMMITTEE shall refund to the COUNTY a pro-rated share of the payment based upon the balance of time remaining in the paid period, unless otherwise negotiated. SECTION 8: HOLD HARMLESS The PLVC-TRAILS COMMITTEE shall indemnify and hold the COUNTY, and its officers, employees, and agents harmless from and shall process and defend at its own expense, including all costs, attorney fees and expenses relating thereto, all claims, demands, or suits at law or equity arising in whole or in part, directly or indirectly, from the PLVC-TRAILS COMMITTEE's negligence or breach of any of its obligations under this Agreement; provided that nothing herein shall require the PLVC-TRAILS COMMITTEE to indemnify the COUNTY against and hold harmless the COUNTY from claims, demands or suits based solely upon the conduct of the COUNTY, its officers, employees and agents, and; provided further that if the claims or suits are caused by or result from the concurrent negligence of: (a) the PLVC-TRAILS COMMITTEE's agents or employees; and, (b)the COUNTY, its officers, employees and agents, this indemnity provision with respect to claims or suits based upon such negligence, and/or the costs to the COUNTY of defending such claims and suits, etc., shall be valid and enforceable only to the extent of the PLVC-TRAILS COMMITTEE's negligence, or the negligence of the PLVC-TRAILS COMMITTEE's agents or employees. The PLVC-TRAILS COMMITTEE specifically assumes potential liability for actions brought against the COUNTY by the PLVC-TRAILS COMMITTEE's employees, or any other persons engaged in the performance of any work or service required of the PLVC-TRAILS COMMITTEE under this Agreement and, solely for the purpose of this indemnification and defense, the Contractor specifically waives any immunity under the state industrial insurance law, Title 51 RCW. The PLVC-TRAILS COMMITTEE recognizes that this waiver was specifically entered into pursuant to provisions of RCW 4.24.115 and was subject of mutual negotiation. SECTION 9: INSURANCE The PLVC-TRAILS COMMITTEE shall obtain and keep in force during the term of the Agreement, or as otherwise required,the following insurance with companies or through sources approved by the State Insurance Commissioner pursuant to RCW 48. 1. Worker's Compensation and Employer's Liability Insurance as required by the State of Washington. The PLVC-TRAILS COMMITTEE shall maintain Workers' Compensation coverage as required under the Washington State Industrial Insurance Act, RCW Title 51, for all PLVC-TRAILS COMMITTEE employees, agents and volunteers eligible for such coverage under the Industrial Insurance Act. 2. Commercial Automobile Liability Insurance providing bodily injury and property damage liability coverage for all owned and non-owned vehicles assigned to or used in the performance of the work for a combined single limit of not less than $1,000,000 per occurrence in connection with PLVC-TRAILS COMMITTEE's performance of the contract, including: Page: 3 of 13 Port Ludlow Village Council a. Owned Automobiles; b. Hired Automobiles; and c. Non-owned Automobiles. 3. General Commercial Liability Insurance in an amount not less than a single limit of one million dollars ($1,000,000.00)per occurrence and an aggregate of not less than two (2) times the occurrence amount($2,000,000.00 minimum) for bodily injury, including death and property damage, unless a greater amount is specified in the contract specifications. The insurance coverage shall contain no limitations on the scope of the protection provided and include the following minimum coverage: a. Broad Form Property Damage, with no employee exclusion; b. Personal Injury Liability, including extended bodily injury; c. Broad Form Contractual/Commercial Liability—including: completed operations; d. Premises—Operations Liability (M&C); e. Independent Contractors and subcontractors; f. Blanket Contractual Liability. Said commercial automobile liability policy and general commercial liability policy shall name the County as an additional insured and shall include a provision prohibiting cancellation or reduction of coverage of said policy except upon thirty (30) days prior written notice to the County. Certificates of coverage as required by this Section shall be delivered to the County within thirty(30) days of execution of this Agreement. The County may, upon the Contractor's failure to comply with any or all provisions of this contract relating to insurance, withhold payment or compensation that would otherwise be due to the Contractor. If the proof of insurance or certificate indicating the County is an"additional insured"to a policy obtained by the Contractor refers to an endorsement (by number or name) but does not provide the full text of that endorsement, then it shall be the obligation of the Contractor to obtain the full text of that endorsement and forward that full text to the County. All insurance policies obtained by PLVC-TRAILS COMMITTEE in order to comply with this Section shall be primary and non-contributory as against any coverage provided through any memorandum of coverage for third party liability claims or actions obtained and retained by the County through a Ch. 48.62 RCW"Risk Pool." It is agreed by the parties that insurers shall have no right of recovery or subrogation against the County (including its employees and other agents and agencies), it being the intention of the parties that the insurance policies so affected shall protect both parties and be primary coverage for any and all losses covered by the above described insurance. The insurance maintained by PLVC-TRAILS COMMITTEE under this Agreement shall not in any manner limit or qualify the liabilities or obligations of PLVC-TRAILS COMMITTEE under this Agreement. Page: 4 of 13 Port Ludlow Village Council SECTION 10: INDEPENDENT CONTRACTOR The PLVC-TRAILS COMMITTEE and the COUNTY agree that the PLVC-TRAILS COMMITTEE is an independent contractor with respect to the services provided pursuant to this agreement. Nothing in this agreement shall be considered to create the relationship of employer and employee between the parties hereto.Neither the PLVC-TRAILS COMMITTEE nor any employee of the PLVC-TRAILS COMMITTEE shall be entitled to any benefits accorded County employees by virtue of the services provided under this agreement. The COUNTY shall not be responsible for withholding or otherwise deducting federal income tax or social security or for contributing to the state industrial insurance program, otherwise assuming the duties of an employer with respect to the PLVC-TRAILS COMMITTEE, or any employee, representative, agent or contractor of the PLVC-TRAILS COMMITTEE. The PLVC-TRAILS COMMITTEE shall be responsible for all applicable withholdings, deductions, state industrial insurance,tax reports, business licenses, registrations, and all other obligations of an independent organization. SECTION 11: COMPLIANCE WITH LAWS PLVC-TRAILS COMMITTEE shall comply with all Federal, State, and local laws and ordinances applicable to the work to be done under this Agreement. This Agreement shall be interpreted and construed in accord with the laws of the State of Washington and venue shall be in Jefferson County, Washington. SECTION 12: DISCRIMINATION PROHIBITED PLVC-TRAILS COMMITTEE with regard to the project to be completed under this agreement, will not discriminate on the grounds of age, sex, marital status, sexual orientation, race, creed, color, national origin, honorably discharged veteran or military status, or the presence of any sensory, mental, or physical disability or the use of a trained dog guide or service animal by a person with a disability, unless based upon a bona fide occupational qualification in the selection and retention of employees, materials, supplies, contractors or subcontractors. SECTION 13: INTEGRATED AGREEMENT This agreement together with attachments or addenda represents the entire and integrated agreement between the County and PLVC-TRAILS COMMITTEE and supersedes all prior negotiations, representations, or agreements written or oral. This agreement may be amended only by written instrument signed by both the County and PLVC-TRAILS COMMITTEE. Page: 5 of 13 Port Ludlow Village Council APPROVED and signed this 21/4---1‘day oft .e4^1-&"-y--,2021. JEFFERSON COUNTY Attest: EROARD OF COMMISSION RS Carolyn Odllaway-7(, Kate Dean,Chair Clerk of the Board Approved as to Form: Port Ludlow Wage Council C- December 7,2021 Philip C. Hunsucker, Authorized Official Chief Civil Deputy Prosecutor Page: 6 of 13 Port Ludlow Village Council EXHIBIT A Itemized List of Proposed Tourism Promotion Services —Proposed 2022 promotion, facility,event or activity budget including income and expenses. Cost Estimate for PLVC-Trails Benches Total Item Dimension Cost Number Total# Cost Vendor 12ft Armor guard Composite Decking x5.3inxlin 26.67 6 160.02 HD Hemlock or DF PT 2x6x12 12ft x 6 x 2 19.38 1 10 193.8 lowes Hemlock or DF PT 4x4x18 4x4x8 11.23 2 4 44.92 lowes Peak Prod.Grand spike 24 in 4inx4inx24in 15.77 2 20 315.4 hd Galv carriage bolts 3/8"x 7 1.57 20 31.4 lowes Galv carriage bolts 3/8"x10 1.91 20 38.2 lowes Galv flat washers 3/8" 0.16 40 6.4 lowes Galv lock washers 3/8" 0.22 40 8.8 lowes Galv nut 3/8" 0.13 40 5.2 lowes Deck Screws 8 x" 28 280 34.98 lowes Total 839.12 Taxes 9% 75.5208 Total 914.6408 Estimate for Gravel 3/4 inch(-) Gravel from Shine Pit 5cy 150 1 5 750 Shine Gravel Truck Haul 1 truck load 50 1 5 250 Roethle Trkin Subtotal 1000 Taxes 9% 90 Total Cost 1090 Total Cost of Project 2004.641 Page: 7 of 13 Port Ludlow Village Council Exhibit B Jurisdiction Lodging Tax Reporting Form - To Be Submitted to Jefferson County Administrator's Office No Later than February 28th of each Year Lodging Tax Reporting Form receri-ing.fundina to promote fernv-als.Tecial event and rou.-tm-reLeted artisities through tourum-related faciline o-x-ned or sponsored hy non-profit organizanon:or the local jurisdiction are required to complete thl-form for EACH activitT 1 Orgthiratioc Name: R.epartrg Yen: Sponsor Type Theck°ca: 0 501 1,:f.3 0 501(cX6) QTiriUun1icnce °Other:71La : 3 AchtrryT.'411M 4 Arm:Icy Type(Check 044: 0 Event Tetiyal' 0 Facility* 0 Kuie-jzr 5 AnnIty Stan Date': Aulydy End Date- 'Total'Zoe:of Activity. 1 Ammar R.equeted: 9 Amor=Awarded: Oveta2 Auer:dance 13 Number of ArreedeerW ed Over:4U in Tapaii ArrcaYvoirson; a ?Renee a) Pmerree Arm:* b) Attn:' Methodology Cbe Oce:. °Direct Court' c Me:bode:op: heck Gee:: (7)DirKt 2lo'sir* .4-ea Com' ORgueaenranve Survey" 0 2nr2L-e:7 1c OResametradve SIrcey• Olin '" °Structured. E-inalace* 0 afoL.'• °Ocher,:e•clain,!.: °Other eup1a, 11 2:ua..")er of Antecii Who Traveled f Miler or More` 1-1 Number of AraMeer L-LLT.11- 1= Pm:erred' a) ?reed b) kraal' b) Arra? c) Methodology Check Ow; ()Direct Came c: Meibodoioev Cne C;)72,:res- IP indirect Cam- 0 FA:mamma Solver 0 Idireci Coact' OReprthec:17-e 1c5ormal Sumer Q Structured E,,--rmre' ( 'rminrrr:11 Solver 0'imicanK F. 0 Other(explain:: Q Other„ec1.214: 12 Nmrhar of Are Who Inve.K • 15 Number of Paid Loigng a) Pro:ectee Projected* b) Actia2" b) Arran? c) Methodokigy:Chesi Ocel 0 Direct Co Metboaakc 1:Check Ono: 0:next 2crzr• 0 ledirKt Cagan* °Representative Survey* :mama Court" ()Represent:rave`:,:zver 0:thforthal STMT. 0 Structural E wimate• 0'nfraw-11 51.troey* (7)Smacnned 00111ff!,E,T LIM;: CtbitT *See Lodging Tax Yearly Reporting Definition-,Inrrru dons NIT or Initv.thral'Al°Prepared Repot: PhOCA Addrerr RETURN ill!S FORM TO: Jefferson County iminutrator's Office :82.0 345er:on Street P.O.Box:22C Port Tovrasanii.WA 9336S u o:efferzon.ava.us DE:OLD-E.February:9th of Each Reporting Year Page: 8 of 13 Port Ludlow Village Council LTAC Yearly Reporting Definitions/Instructions Activity Type: Event/Festival: Short-term activity occurring between specific dates(e.g.,4th of July celebration,local marathon) Facility: Municipally-owned facility that operates some or all of the year(e.g.,county historical museum, convention center) Marketing: Activity that provides information to encourage visitors to an area; is typically a year-round activity but may also operate for less than a full year. Activity Date: Activity beginning and ending dates. Actual: Persons estimated to have actually participated in event/festival or visiting a facility. For marketing activity,enter the number of persons estimated to have actually visited area as result of marketing activity. Projected: Persons expected to participate in event/festival or visiting a facility. For marketing activity,enter the number of persons expected to visit area as result of marketing activity. Methodology: Select the methodology used to estimate the actual number of visitors/participants. Direct Count: Actual count of visitors using methods such as paid admissions or registrations,clicker counts at entry points,vehicle counts or number of chairs filled.A direct count may also include information collected directly from businesses,such as hotels,restaurants or tour guides, likely to be affected by an event. Indirect Count: Estimate based on information related to the number of visitors such as raffle tickets sold, redeemed discount certificates,brochures handed out,police requirements for crowd control or visual estimates. Representative Survey: Information collected directly from individual visitors/participants.A representative survey is a highly structured data collection tool,based on a defined random sample of participants,and the results can be reliably projected to the entire population attending an event and includes margin of error and confidence level. Informal Survey: Information collected directly from individual visitors or participants in a non-random manner that is not representative of all visitors or participants. Informal survey results cannot be projected to the entire visitor population and provide a limited indicator of attendance because not all participants had an equal chance of being included in the survey. Structured Estimate: Estimate produced by computing known information related to the event or location. For example,one jurisdiction estimated attendance by dividing the square footage of the event area by the international building code allowance for persons(3 square feet). Other: (please describe) Overall Attendance: Total projected and estimated actual attendance recorded for event,facility or resulting from marketing activity. Total Attendees Traveling 50 miles or more: Total: Total projected and estimated actual number of visitors traveling more than 50 miles to attend event or facility. For marketing organizations,report visitors traveling more than 50 miles to visit area. Of total,attendees who traveled from another state or country: Of the total projected and estimated actual number of visitors traveling more than 50 miles to attend event or facility or visit area,report projected and estimated actual number of visitors who traveled from another state or country. Attendees who stayed overnight: Paid Accommodations: Total projected and estimated actual number of visitors staying in paid lodging establishments such as hotels,motels,bed and breakfasts,etc. Unpaid Accommodations: Total projected and estimated actual number of visitors staying in unpaid accommodations such as family and friends. Paid Lodging Nights: Total projected and estimated actual number of paid lodging nights. One Lodging night=one or more persons occupying one room for one night. Page: 9 of 13 Port Ludlow Village Council EXHIBIT C 1st QUARTER Due by April 30th to afrncknight@co,jefferson.wa.us Organization: Contact person: Mailing Address : Phone Number/Email: STARTING BALANCE + REVENUE THIS _ EXPENSES THIS _ ENDING BALANCE PREVIOUS QUARTER QUARTER QUARTER — THIS QUARTER Please attach supportive documents.Any attachments may be subject to disclosure as a public record under the Public Records Act, RCW Chapter 42.56. For a minimum of six(6)years,maintain documented proof of payments made,contracts executed,and other expenditures authorized under this Agreement. Upon reasonable notice,provide access to County or State representatives to audit those records. Please provide your reports of the revenue, marketing,services,programs and activities of the prior quarter. JANUARY Incoming Revenue Outgoing Expenses Total FEBRUARY Incoming Revenue Outgoing Expenses Total MARCH Incoming Revenue Outgoing Expenses Total Page: 10 of 13 Port Ludlow Village Council • EXHIBIT C 2"d QUARTER Due by July 315"to afmcknight@cojefferson.wa.us Organization: Contact person: Mailing Address : Phone Number/Email: STARTING BALANCE + REVENUE THIS EXPENSES THIS _ ENDING BALANCE PREVIOUS QUARTER QUARTER QUARTER — THIS QUARTER Please attach supportive documents.Any attachments may be subject to disclosure as a public record under the Public Records Act, RCW Chapter 42.56. For a minimum of six(6)years,maintain documented proof of payments made,contracts executed,and other expenditures authorized under this Agreement. Upon reasonable notice,provide access to County or State representatives to audit those records. Please provide your reports of the revenue,marketing,services,programs and activities of the prior quarter. APRIL Incoming Revenue Outgoing Expenses Total MAY Incoming Revenue Outgoing Expenses Total JUNE Incoming Revenue Outgoing Expenses Total Page: 11 of 13 Port Ludlow Village Council EXHIBIT C 3rd OUARTER Due by October 315"to afrncknight@cojefferson.wa.us Organization: Contact person: Mailing Address : Phone Number/Email: STARTING BALANCE + REVENUE THIS _ EXPENSES THIS _ ENDING BALANCE PREVIOUS QUARTER QUARTER QUARTER — THIS QUARTER Please attach supportive documents.Any attachments may be subject to disclosure as a public record under the Public Records Act, RCW Chapter 42.56.For a minimum of six(6)years,maintain documented proof of payments made,contracts executed,and other expenditures authorized under this Agreement. Upon reasonable notice,provide access to County or State representatives to audit those records. Please provide your reports of the revenue,marketing, services,programs and activities of the prior quarter. JULY Incoming Revenue Outgoing Expenses Total AUGUST Incoming Revenue Outgoing Expenses Total SEPTEMBER Incoming Revenue Outgoing Expenses Total Page: 12 of 13 Port Ludlow Village Council EXHIBIT C 4th OUARTER Due by January 3151 to afmcknight@cojefferson.wa.us Organization: Contact person: Mailing Address : Phone Number/Email: STARTING BALANCE + REVENUE THIS _ EXPENSES THIS _ ENDING BALANCE PREVIOUS QUARTER QUARTER QUARTER — THIS QUARTER Please attach supportive documents. Any attachments may be subject to disclosure as a public record under the Public Records Act, RCW Chapter 42.56.For a minimum of six(6)years,maintain documented proof of payments made,contracts executed,and other expenditures authorized under this Agreement. Upon reasonable notice,provide access to County or State representatives to audit those records. Please provide your reports of the revenue, marketing,services,programs and activities of the prior quarter. OCTOBER Incoming Revenue Outgoing Expenses Total NOVEMBER Incoming Revenue Outgoing Expenses Total DECEMBER Incoming Revenue Outgoing Expenses Total Page: 13 of 13 Port Ludlow Village Council Consent Agenda Commissioners Office JEFFERSON COUNTY BOARD OF COUNTY COMMISSIONERS AGENDA REQUEST TO: Board of County Commissioners FROM: Adiel McKnight, Executive Assistant DATE: December 20,2021 SUBJECT: AGREEMENT re: 2022 Hotel Motel (Lodging Tax) Grant Funding; In the Amount of$2,004.64; Port Ludlow Village Council—Trail Committee STATEMENT OF ISSUE: This agreement provides grant funding for 2022 to certain non-profit agencies for the promotion of tourism and ongoing preservation of Jefferson County's heritage. The Lodging Tax Advisory Committee met on November 2, 2021 and reviewed request for proposals. This funding has been budgeted from the Hotel Motel (Lodging Tax) Fund, and approved by the Board of County Commissioners on November 15, 2021. FISCAL IMPACT: Port Ludlow Village Council—Trail Committee $2,004.64 RECOMMENDATION: Approve and sign the agreement. REVIEWED BY: Z1 Zi Mark McCauley terim County Administra taki Date: CONTRACT REVIEW FORM Clear Form (INSTRUCTIONS ARE ON THE NEXT PAGE) CONTRACT WITH: Port Ludlow Village Council-Trails Committee Contract No: LTAC PLVC-Trails Contract For: Lodging Tax Term: 1yr COUNTY DEPARTMENT: County Administrator Contact Person: Adiel McKnight Contact Phone: 360-385-9102 Contact email: afmcknight@co.jefferson.wa.us AMOUNT: $2,004.64 PROCESS: Exempt from Bid Process Revenue: _ Cooperative Purchase Expenditure: _ Competitive Sealed Bid Matching Funds Required: Small Works Roster Sources(s)of Matching Funds Vendor List Bid Fund# 125 _ RFP or RFQ Munis Org/Obj 1 2551 990/41 1 1 1 3 Other: APPROVAL STEPS: , STEP 1: DEPARTMENT CERTIFIES C I N E)W JCC 3 5.080 AND CHAPTER 42.23 RCW. CERTIFIED: I I N/A:0 I (4 d a f ignature Date STEP 2: DEPARTMENT CERTIFIES THE PERSON P OSED FOR CONTRACTING WITH THE COUNTY (CONTRACTOR) HAS N T BEE DEB ED BY ANY FEDERAL, STATE, OR LOCAL AGENCY, CERTIFIED: a N/A: ® f tire Date STEP 3: RISK MANAGEMENT REVIEW(will be added electronically through Laserfiche): Electronically approved by Risk Management on 12/7/2021. STEP 4: PROSECUTING ATTORNEY REVIEW(will be added electronically through Laserfiche): Electronically approved as to form by PAO on 12/7/2021. Stnandard County grant contract. STEP 5: DEPARTMENT MAKES REVISIONS & RESUBMITS TO RISK MANAGEMENT AND PROSECUTING ATTORNEY(IF REQUIRED). STEP 6: CONTRACTOR SIGNS STEP 7: SUBMIT TO BOCC FOR APPROVAL o4 o is Board of County Commissioners , ,,,,„ o Cosf0 1820 Jefferson Street .T7 ;�4 �' rt PO Box 1220 Port Townsend, WA 98368 t ---,co, Kate Dean,District 1 Heidi Eisenhour,District 2 Greg Brotherton,District 3 �84/NU- December 20, 2021 Port Ludlow Village Council -Trails Committee Tim Rensema 190 Drew Lane Port Ludlow,WA 98365 Dear Tim Rensema, Enclosed for signature are two (2) originals for AGREEMENT re: 2022 Hotel Motel (Lodging Tax) Grant Funding; In the Amount of$2,004.64; Port Ludlow Village Council-Trail Committee Please sign both, keep one and return the second to: Jefferson County Commissioner's Office Attn: Adiel McKnight P.O. Box 1220 Port Townsend, WA 98368 • Please remember that on or before April 30; July 31; October 31, 2021 and January 31, 2022 you are required to provide to the County: A quarterly report of the use, services, programs and activities under this agreement for the prior quarter. • A quarterly financial statement detailing revenues, expenses and cash balances for the prior quarter; and for the final quarter report, the financial statement shall also include a detailed financial statement by February 28th of each year along with Exhibit B attached to your contract. • Insurance shall be obtained as outlined in the terms of the Agreement and provide a copy to this office. • Payment will be provided upon invoice, subject to the terms of the Agreement Thank you for your assistance. Sincerely, Adiel McKnight Executive Assistant Phone (360) 385-9100 Fax (360) 385-9382 jeffbocc@co.jefferson.wa.us Western National Mutual Insurance Company 4700 West 77th Street WESTERN NATIONAL Edina, MN 55435 '"°""'"C` The relationship rnmpany www.wnins.com A Mutual Company WN IL 49 07 10 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGES Policy Change Number 003 POLICY NUMBER POLICY CHANGES COMPANY CPP 1265898 00 EFFECTIVE GROUP NUMBER 03/14/2022 Western National Mutual Insurance Company 0001177492 NAMED INSURED AUTHORIZED REPRESENTATIVE PORT LUDLOW VILLAGE COUNCIL 08133 425-775-6446 PO BOX 65012 INSURANCE SERVICES GROUP INC PORT LUDLOW WA 98365 PO BOX 1658 EDMONDS, WA 98020-1658 COVERAGE PARTS AFFECTED CHANGES ADDED PRIMARY/NON-CONTRIBUTORY FORM Authorized Representative Signature XI NO CHANGES [ [ TO BE ADDITIONAL RETURN NEW ANNUAL .) ADJUSTED PREMIUM PREMIUM PREMIUM J AT AUDIT $ $ $787.00 0 Includes copyrighted material of Insurance Services Office, with its permission Issued Date: 03/14/2022 TLU WN IL 49 07 10 INSURED COPY Page 1 of 1 Western National Mutual Insurance Company w 4700 West 77th Street Edina, MN 55435 www.wnins.com A Mutual Company INS Group # 0001177492 WffsTER^N NATIONAL COMMERCIAL GENERAL LIABILITY ANCE The relationship company COVERAGE PART Policy Period: From JUNE 1, 2021 To JUNE 1, 2022 Policy# CPP 1265898 00 12:01 A.M.standard time at the Named Insured's mailing address. Transaction AMENDED DECLARATION Effective: MARCH 14, 2022 Additional/Return Premium Due: $0.00 Insured Name and Address Agent PORT LUDLOW VILLAGE COUNCIL INSURANCE SERVICES GROUP INC 08133 PO BOX 65012 PO BOX 1658 PORT LUDLOW WA 98365 EDMONDS, WA 98020-1658 Telephone: 425-775-6446 Business Description Type of Business Audit Period Billing Type COMMUNITY ASSOCIATION NOT-FOR-PROFIT ANNUAL DIRECT IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY. LIMITS OF INSURANCE General Aggregate Limit (Other than Products-Completed Operations) $ 3,000, 000 Products -Completed Operations Aggregate Limit $ 3,000,000 Each Occurrence Limit $ 1, 000,000 Personal and Advertising Injury Limit, any one person or organization $ 1, 000,000 Medical Expense Limit, any one person $ 5,000 Damage to Premises Rented to you, any one premises $ 100,000 LOCATIONS OF ALL PREMISES YOU OWN, RENT OR OCCUPY Refer to attached schedule. CLASSIFICATIONS Refer to attached schedule. PREMIUM FOR THIS COVERAGE PART $ 787.00 DISCLOSURE OF PREMIUM: The portion of your annual premium attributable to coverage for certified acts of terrorism is $ 3.00 Forms and Endorsements Applicable to this Policy See Forms and Endorsements Schedule Issued Date: 03/14/2022 WN GL 06 07 07 INSURED COPY Page 1 of 5 Western National Mutual Insurance Company Policy Number:CPP 1265898 00 4700 West 77th Street AMENDED DECLARATION Edina, MN 55435 Named Insured: www.wnins.com PORT LUDLOW VILLAGE COUNCIL COMMERCIAL GENERAL LIABILITY EXTENSION OF DECLARATIONS LOCATION OF PREMISES Location of All Premises You Own, Rent or Occupy: 001 120 SPINNAKER PL PORT LUDLOW WA 98365 PREMIUM Premium Rate Advance Premium Location Classification Code No. Exposure Base* Prem.Ops. Prod/Comp Prem/Ops. Prod/Comp Ops. Ops. 001 88133 1,600 T 0.356 INCL $570 INCL CLUBS-CIVIC, SERVICE OR SOCIAL-WITHOUT BUILDINGS "Products - completed operations are subject to the General Aggregate Limit" -A =Area Extension of Declarations --Total Advance Annual Premium $570 • -C =Total Cost " -E =Each • -M =Admissions • -0 =Total Operating Expenses • -P =Payroll • -S = Gross Sales • -T =See Classification Notes • -U =Units Issued Date: 03/14/2022 WN GL 06 07 07 INSURED COPY Page 2 of 5 mik Western National Mutual Insurance Company Policy Number: CPP 1265898 00 4700 West 77th Street AMENDED DECLARATION Edina, MN 55435 Named Insured: www.wnins.com PORT LUDLOW VILLAGE COUNCIL COMMERCIAL GENERAL LIABILITY CLASSIFICATION SCHEDULE Loc St Terr Code Premium Base Exposure Rate Per Coy Premium Classification Description 000 WA 44444 N/A SPLENH $75 GENERAL LIABILITY SPECIALTY ENHANCEMENT 001 WA 502 88133 SEE CLASS NOTES 1,600 Unit EMPLL $139 CLUBS-CIVIC, SERVICE OR SOCIAL-WITHOUT BUILDINGS CG0442 - STOP GAP -EMPLOYERS LIABILITY Issued Date: 03/14/2022 WN GL 06 07 07 INSURED COPY Page 3 of 5 Western National Mutual Insurance Company Policy Number: CPP 1265898 00 4700 West 77th Street AMENDED DECLARATION Edina, MN 55435 Named Insured: www.wnins.com PORT LUDLOW VILLAGE COUNCIL LOCATION ADDRESS SCHEDULE Prem # 001 120 SPINNAKER PL PORT LUDLOW, WA 98365 Issued Date: 03/14/2022 WN IL 27 07 07 INSURED COPY Page 4 of 5 Western National Mutual Insurance Company Policy Number: CPP 1265898 00 4700 West 77th Street AMENDED DECLARATION Edina, MN 55435 Named Insured: www.wnins.com PORT LUDLOW VILLAGE COUNCIL FORMS AND ENDORSEMENTS SCHEDULE Coverage Line Form Number Ed. Date Description General Liability IL0123 (11/13) WA Changes - Defense Costs General Liability IL0146 (08/10) WA Common Policy Conditions General Liability IL0198 (09/08) Nuclear Energy Liab Excl Endt General Liability CG0001 (04/13) Comml Gen Liab Coverage Form General Liability CG0197 (12/07) WA Chgs-Empl-Related Practices General Liability CG0442 (11/03) Stop Gap-Employers Liab-WA General Liability CG0450 (05/08) WA Changes - Who Is An Insured General Liability CG2001 (04/13) Primary and Noncontributory General Liability CG2106 (05/14) Excl-Access or Disclosure General Liability CG2109 (06/15) Exclusion-Unmanned Aircraft General Liability CG2171 (01/15) Excl Oth Acts Terr Outside US General Liability CG2176 (01/15) Excl Punitive Damages General Liability CG2426 (04/13) Amendment of Ins. Contract Def General Liability CG3220 (01/15) WA-Cond Excl of Terrorism General Liability CGMU1078 (12/20) Gen Liab Specialty Solutions General Liability CGMU431 (12/20) Excl-Ammunition or Fireworks General Liability CGMU448 (12/20) Excess Provision General Liability CGMU505 (12/20) Exclusion-Trampolines General Liability CGMU588 (12/20) Excl-Mech Op Amusement Devices General Liability WNGLO2 (07/10) Punitive Damages Exclusion General Liability WNGL10 (01/04) Excl-Lead Liability Endt General Liability WNGL15 (12/16) Exclusion-Asbestos General Liability WNGL21 (07/14) Abuse or Molestation Excl Issued Date: 03/14/2022 WN IL 26 07 07 INSURED COPY Page 5 of 5 IL 01 23 11 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WASHINGTON CHANGES - DEFENSE COSTS This endorsement modifies insurance provided under the following: COMMERCIAL AUTOMOBILE COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART COMMERCIAL LIABILITY UMBRELLA COVERAGE PART COMMERCIAL PROPERTY COVERAGE PART — LEGAL LIABILITY COVERAGE FORM COMMERCIAL PROPERTY COVERAGE PART — MORTGAGEHOLDER'S ERRORS AND OMISSIONS COVERAGE FORM ELECTRONIC DATA LIABILITY COVERAGE PART FARM COVERAGE PART FARM UMBRELLA LIABILITY POLICY LIQUOR LIABILITY COVERAGE PART MEDICAL PROFESSIONAL LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCT WITHDRAWAL COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK COVERAGE PART A. The provisions of Paragraph B. are added to all 5. Coverage C — Mortgageholder's Liability Insuring Agreements that set forth a duty to under the Mortgageholder's Errors And defend under: Omissions Coverage Form. 1. Section I of the Commercial General Liabil- Paragraph B. also applies to any other provision ity, Commercial Liability Umbrella, Elec- in the policy that sets forth a duty to defend. tronic Data Liability, Farm, Liquor Liability, B. If we initially defend an insured ("insured") or Owners And Contractors Protective Liabil- pay for an insured's ("insured's") defense but ity, Pollution Liability, Products/Completed later determine that none of the claims Operations Liability, Product Withdrawal, ("claims"), for which we provided a defense or Medical Professional Liability, Railroad Pro- defense costs, are covered under this insur- tective Liability and Underground Storage ance, we have the right to reimbursement for Tank Coverage Parts, Auto Dealers Cover- the defense costs we have incurred. age Form and the Farm Umbrella Liability Policy; The right to reimbursement under this provision will only apply to the costs we have incurred 2. Section II under the Auto Dealers, Business after we notify you in writing that there may Auto and Motor Carrier Coverage Forms; not be coverage and that we are reserving our 3. Section III under the Auto Dealers and rights to terminate the defense or the payment Motor Carrier Coverage Forms; of defense costs and to seek reimbursement 4. Section A. Coverage under the Legal Liabil for defense costs. ity Coverage Form; and IL 01 23 11 13 © Insurance Services Office, Inc., 2013 Page 1 of 1 IL01460810 WASHINGTON COMMON POLICY CONDITIONS All Coverage Parts included in this policy are subject to the following conditions. The conditions in this endorsement replace any 3. We may cancel the Commercial Property similar conditions in the policy that are less Coverage Part and the Capital Assets favorable to the insured. Program (Output Policy) Coverage Part, if A. Cancellation made a part of this policy, by mailing or delivering to the first Named Insured and 1. The first Named Insured shown in the the first Named Insured's agent or broker Declarations may cancel this policy by written notice of cancellation at least five notifying us or the insurance producer in days before the effective date of can- one of the following ways: cellation for any structure where two or a. Written notice by mail, fax or e-mail; more of the following conditions exist: b. Surrender of the policy or binder; or a. Without reasonable explanation, the c. Verbal notice. structure is unoccupied for more than 60 consecutive days, or at least 65% Upon receipt of such notice, we will cancel of the rental units are unoccupied for this policy or any binder issued as evidence more than 120 consecutive days, un- of coverage, effective on the later of the less the structure is maintained for sea- following: sonal occupancy or is under construc- a. The date on which notice is received or tion or repair; the policy or binder is surrendered; or b. Without reasonable explanation, prog- b. The date of cancellation requested by ress toward completion of permanent the first Named Insured. repairs to the structure has not occur- 2. We may cancel this policy by mailing or red within 60 days after receipt of delivering to the first Named Insured and funds following satisfactory adjustment the first Named Insured's agent or broker or adjudication of loss resulting from a fire; written notice of cancellation, including the actual reason for the cancellation, to the c. Because of its physical condition, the last mailing address known to us, at least: structure is in danger of collapse; a. 10 days before the effective date of d. Because of its physical condition, a cancellation if we cancel for non- vacation or demolition order has been payment of premium; or issued for the structure, or it has been b. 45 days before the effective date of declared unsafe in accordance with cancellation if we cancel for any other applicable law; reason; e. Fixed and salvageable items have been except as provided in Paragraphs 3. and 4. removed from the structure, indicating below. an intent to vacate the structure; f. Without reasonable explanation, heat, water, sewer and electricity are not fur- nished for the structure for 60 con- secutive days; or g. The structure is not maintained in substantial compliance with fire, safety and building codes. IL 01 46 08 10 © Insurance Services Office, Inc., 2010 Page 1 of 4 4. If: 7. If this policy is cancelled, we will send the a. You are an individual; first Named Insured any premium refund due. If we cancel, the refund will be pro b. A covered auto you own is of the rata. If the first Named Insured cancels, the "private passenger type"; and refund will be at least 90% of the pro rata c. The policy does not cover garage, auto- refund unless the following applies: mobile sales agency, repair shop, a. For Division Two — Equipment Break- service station or public parking place down, if the first Named Insured can- operations hazards; cels, the refund will be at least 75% of we may cancel the Commercial Automobile the pro rata refund. Coverage Part by mailing or delivering to b. If: the first Named Insured and the first Named Insured's agent or broker written (1) You are an individual; notice of cancellation, including the actual (2) A covered auto you own is of the reason for cancellation, to the last mailing "private passenger type"; address known to us: (3) The policy does not cover garage, a. At least 10 days before the effective automobile sales agency, repair date of cancellation if we cancel for shop, service station or public nonpayment of premium; or parking place operations hazards; b. At least 10 days before the effective and date of cancellation for any other (4) The first Named Insured cancels; reason if the policy is in effect less than the refund will be not less than 90% of 30 days; or any unearned portion not exceeding c. At least 20 days before the effective $100, plus 95% of any unearned por- date of cancellation for other than non- tion over $100 but not exceeding payment if the policy is in effect 30 $500, and not less than 97% of any days or more; or unearned portion in excess of $500. d. At least 20 days before the effective The cancellation will be effective even if we date of cancellation if the policy is in have not made or offered a refund. effect for 60 days or more or is a 8. sufficient proof of notice. If notice is mailed, proof of mailing will be renewal or continuation policy, and the reason for cancellation is that your driver's license or that of any driver B. Changes who customarily uses a covered "auto" The policy contains all the agreements between has been suspended or revoked during you and us concerning the insurance afforded. policy period. The first Named Insured shown in the Declara- 5. We will also mail or deliver to any tions is authorized to make changes in the mortgage holder, pledgee or other person terms of this policy with our consent. This shown in this policy to have an interest in policy's terms can be amended or waived only any loss which may occur under this by endorsement issued by us and made a part policy, at their last mailing address known of this policy. to us, written notice of cancellation, prior C. Examination Of Your Books And Records to the effective date of cancellation. If can We may examine and audit your books and cellation is for reasons other than those records as they relate to this policy at any time contained in Paragraph A.3. above, this during the policy period and up to three years a notice will be the same as that mailed or fterward. delivered to the first Named Insured. If cancellation is for a reason contained in D. Inspection And Surveys Paragraph A.3. above, we will mail or 1. We have the right to: deliver this notice at least 20 days prior to a. Make inspections and surveys at any the effective date of cancellation. time; 6. Notice of cancellation will state the effec- b. Give tive date of cancellation. The policy period you reports on the conditions we will end on that date. find; and c. Recommend changes. Page 2 of 4 © Insurance Services Office, Inc., 2010 IL 01 46 08 10 2. We are not obligated to make any inspec- G. Nonrenewal tions, surveys, reports or recommen- 1. We may elect not to renew this policy by dations, and any such actions we do mailing or delivering written notice of non- undertake relate only to insurability and the renewal, stating the reasons for non- premiums to be charged. We do not make renewal, to the first Named Insured and the safety inspections. We do not undertake to first Named Insured's agent or broker, at perform the duty of any person or organ- their last mailing addresses known to us. ization to provide for the health or safety of We will also mail to any mortgage holder, workers or the public. And we do not pledgee or other 9 person shown in this warrant that conditions: policy to have an interest in any loss which a. Are safe or healthful; or may occur under this policy, at their last b. Comply with laws, regulations, codes mailing address known to us, written or standards. notice of nonrenewal. We will mail or deliver these notices at least 45 days 3. Paragraphs 1. and 2. of this condition before the: apply not only to us, but also to any rating, advisory, rate service or similar organiza- Expiration of the policy; or tion which makes insurance inspections, b. Anniversary date of this policy if this surveys, reports or recommendations. policy has been written for a term of 4. Paragraph 2. of this condition does not more than one year. apply to any inspections, surveys, reports Otherwise, we will renew this policy un- or recommendations we may make relative less: to certification, under state or municipal a. The first Named Insured fails to pay the statutes, ordinances or regulations, of renewal premium after we have ex- boilers, pressure vessels or elevators. pressed our willingness to renew, in- E. Premiums cluding a statement of the renewal The first Named Insured shown in the Declara premium, to the first Named Insured tions: and the first Named Insured's insurance 1. Is responsible for the agent or broker, at least 20 days before p payment of all pre- the expiration date; miums; and b. Other coverage acceptable to the in- 2. Will be the payee for any return premiums sured has been procured prior to the we pay. expiration date of the policy; or F. Transfer Of Your Rights And Duties Under This c. The policy clearly states that it is not Policy renewable and is for a specific line, Your rights and duties under this policy may sub- classification, or type of coverage not be transferred without our written consent that is not offered on a renewable except in the case of death of an individual basis. Named Insured. 2. If: If you die, your rights and duties will be trans- a. You are an individual; ferred to your legal representative but only while acting within the scope of duties as your b. A covered auto you own is of the legal representative. Until your legal represen- passenger type"; and tative is appointed, anyone having proper tern- c. The policy does not cover garage, auto- porary custody of your property will have your mobile sales agency, repair shop, serv- rights and duties but only with respect to that ice station or public parking place property. operations hazards; IL 01 46 08 10 © Insurance Services Office, Inc., 2010 Page 3 of 4 the following applies to nonrenewal of the b. We will not refuse to renew Liability Commercial Automobile Coverage Part in Coverage or Collision Coverage solely place of G.1.: because an "insured" has submitted a. We may elect not to renew or continue claims under Comprehensive Coverage this policy by mailing or delivering to or Towing And Labor Coverage. you and your agent or broker written c. If we fail to mail or deliver proper notice at least 20 days before the end notice of nonrenewal and you obtain of the policy period, including the other insurance, this policy will end on actual reason for nonrenewal. If the the effective date of that insurance. policy period is more than one year, we will have the right not to renew or con- tinue it only at an anniversary of its original effective date. If we offer to renew or continue and you do not accept, this policy will terminate at the end of the current policy period. Failure to pay the required renewal or continu- ation premium when due shall mean that you have not accepted our offer. Page 4 of 4 © Insurance Services Office, Inc., 2010 IL 01 46 08 10 IL01980908 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NUCLEAR ENERGY LIABILITY EXCLUSION ENDORSEMENT (Broad Form) This endorsement modifies insurance provided under the following: COMMERCIAL AUTOMOBILE COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART COMMERCIAL LIABILITY UMBRELLA COVERAGE PART FARM COVERAGE PART FARM UMBRELLA LIABILITY POLICY LIQUOR LIABILITY COVERAGE PART MEDICAL PROFESSIONAL LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY 1. The insurance does not apply: C. Under any Liability Coverage, to "bodily A. Under any Liability Coverage, to "bodily injury" or "property damage" resulting from injury" or "property damage": "hazardous properties" of "nuclear mater- ial", if: (1) With respect to which an "insured" under the policy is also an insured (1) The "nuclear material" (a) is at any under a nuclear energy liability policy "nuclear facility" owned by, or oper issued by Nuclear Energy Liability ated by or on behalf of, an "insured" or Insurance Association, Mutual Atomic (b) has been discharged or dispersed Energy Liability Underwriters, Nuclear therefrom; Insurance Association of Canada or any (2) The "nuclear material" is contained in of their successors, or would be an "spent fuel" or "waste" at any time insured under any such policy but for possessed, handled, used, processed, its termination upon exhaustion of its stored, transported or disposed of, by limit of liability; or or on behalf of an "insured"; or (2) Resulting from the "hazardous prop- (3) The "bodily injury" or "property erties" of "nuclear material" and with damage" arises out of the furnishing by respect to which (a) any person or an "insured" of services, materials, organization is required to maintain parts or equipment in connection with financial protection pursuant to the the planning, construction, mainten- Atomic Energy Act of 1954, or any law ance, operation or use of any "nuclear amendatory thereof, or (b) the "in- facility", but if such facility is located sured" is, or had this policy not been within the United States of America, its issued would be, entitled to indemnity territories or possessions or Canada, from the United States of America, or this Exclusion (3) applies only to any agency thereof, under any agree- "property damage" to such "nuclear ment entered into by the United States facility" and any property thereat. of America, or any agency thereof, with2. As used in this endorsement: any person or organization. "Hazardous properties" includes radioactive, B. Under any Medical Payments Coverage, to toxic or explosive properties; expenses incurred with respect to "bodily injury" resulting from the "hazardous prop- "Nuclear material" means "source material", erties" of "nuclear material" and arising out "Special nuclear material" or "by-product of the operation of a "nuclear facility" by material"; any person or organization. IL 01 98 09 08 © ISO Properties, Inc., 2007 Page 1 of 2 "Source material", "special nuclear material", (c) Any equipment or device used for the and "by-product material" have the meanings processing, fabricating or alloying of given them in the Atomic Energy Act of 1954 "special nuclear material" if at any time the or in any law amendatory thereof; total amount of such material in the "Spent fuel" means any fuel element or fuel custody of the "insured" at the premises component, solid or liquid, which has been where such equipment or device is located used or exposed to radiation in a "nuclear consists of or contains more than 25 grams reactor"; of plutonium or uranium 233 or any combination thereof, or more than 250 "Waste" means any waste material (a) containing grams of uranium 235; "by-product material" other than the tailings or wastes produced by the extraction or concen (d) Any structure, basin, excavation, premises tration of uranium or thorium from any ore or place prepared or used for the storage or processed primarily for its "source material" disposal of "waste"; content, and (b) resulting from the operation by and includes the site on which any of the foregoing any person or organization of any "nuclear facility" is located, all operations conducted on such site included under the first two paragraphs of the and all premises used for such operations; definition of "nuclear facility". "Nuclear reactor" means any apparatus designed or "Nuclear facility" means: used to sustain nuclear fission in a self-supporting (a) Any "nuclear reactor"; chain reaction or to contain a critical mass of fissionable material; (b) Any equipment or device designed or used for (1) separating the isotopes of uranium "Property damage" includes all forms of radioactive or plutonium, (2) processing or utilizing contamination of property. "spent fuel", or (3) handling, processing or packaging "waste"; © Page 2 of 2 © ISO Properties, Inc., 2007 IL 01 98 09 08 COMMERCIAL GENERAL LIABILITY CG 00 01 04 13 COMMERCIAL GENERAL LIABILITY COVERAGE FORM Various provisions in this policy restrict coverage. (2) The "bodily injury" or "property dam- Read the entire policy carefully to determine rights, age" occurs during the policy period; duties and what is and is not covered. and Throughout this policy the words "you" and "your" (3) Prior to the policy period, no insured refer to the Named Insured shown in the Dec- listed under Paragraph 1. of Section II larations, and any other person or organization — Who Is An Insured and no qualifying as a Named Insured under this policy. "employee" authorized by you to give The words "we", "us" and "our" refer to the or receive notice of an "occurrence" or company providing this insurance. claim, knew that the "bodily injury" or The word "insured" means any person or organiza "property damage" had occurred, in tion qualifying as such under Section II — Who Is whole or in part. If such a listed insured An Insured. or authorized "employee" knew, prior to the policy period, that the "bodily Other words and phrases that appear in quotation injury" or "property damage" occurred, marks have special meaning. Refer to Section V then any continuation, change or re- -Definitions. sumption of such "bodily injury" or SECTION I — COVERAGES "property damage" during or after the COVERAGE A — BODILY INJURY AND PROPERTY policy period will be deemed to have DAMAGE LIABILITY been known prior to the policy period. 1. Insuring Agreement c. "Bodily injury" or "property damage" which occurs during the policy period and was a. We will pay those sums that the insured not, prior to the policy period, known to becomes legally obligated to pay as have occurred by any insured listed under damages because of "bodily injury" or Paragraph 1. of Section II — Who Is An "property damage" to which this insurance Insured or any "employee" authorized by applies. We will have the right and duty to you to give or receive notice of an "occurr- defend the insured against any "suit" ence" or claim, includes any continuation, seeking those damages. However, we will change or resumption of that "bodily have no duty to defend the insured against injury" or "property damage" after the end any "suit" seeking damages for "bodily of the polic y y period. injury" or "property damage" to which this d. "Bodily injury" or "property damage" will insurance does not apply. We may, at our be deemed to have been known to have discretion, investigate any "occurrence" occurred at the earliest time when any and settle any claim or "suit" that may insured listed under Paragraph 1. of result. But: Section II — Who Is An Insured or any (1) The amount we will pay for damages is "employee" authorized by you to give or limited as described in Section III — receive notice of an "occurrence" or claim: Limits Of Insurance; and (1) Reports all, or any part, of the "bodily (2) Our right and duty to defend ends injury" or "property damage" to us or when we have used up the applicable any other insurer; limit of insurance in the payment of judgments or settlements under Coy- (2) Receives a written or verbal demand or erages A or B or medical expenses claim for damages because of the under Coverage C. "bodily injury" or "property damage"; or No other obligation or liability to pay sums (3) Becomes aware by any other means or perform acts or services is covered that "bodilyin unless explicitly provided for under Supple injury" or "property dam mentary Payments — Coverages A and B. age" has occurred or has begun to occur. b. This insurance applies to "bodily injury" and "property damage" only if: e. Damages because of "bodily injury" include damages claimed by any person or organ- (1) The "bodily injury" or "property dam- ization for care, loss of services or death age" is caused by an "occurrence" that resulting at any time from the "bodily takes place in the "coverage territory"; CG 00 01 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 16 injury". use of alcoholic beverages. 2. Exclusions This exclusion applies even if the claims This insurance does not apply to: against any insured allege negligence or other wrongdoing in: a. Expected Or Intended Injury employ- "Bodily injury" or "property damage" ex- (a) The supervision, hiring,pected or intended from the standpoint of othmeers by ttrahat ignsured; or monitoring of others that insured; or the insured. This exclusion does not apply (b) Providing or failing to provide to "bodily injury" resulting from the use of reasonable force to protect persons or transportation with respect to any property. person that may be under the influence of alcohol; b. Contractual Liability "Bodilyinjury" orif the "occurrence" which caused the "property damage" for "bodily injury" or "property damage", invol- which the insured is obligated to pay ved that which is described in Paragraph damages by reason of the assumption of (1), (2) or (3) above. liability in a contract or agreement. This exclusion does not apply to liability for However, this exclusion applies only if you damages: are in the business of manufacturing, distributing, selling, serving or furnishing (1) That the insured would have in the ab- alcoholic beverages. For the purposes of sence of the contract or agreement; or this exclusion, permitting a person to bring (2) Assumed in a contract or agreement alcoholic beverages on your premises, for that is an "insured contract", provided consumption on your premises, whether or the "bodily injury" or "property dam- not a fee is charged or a license is required age" occurs subsequent to the execu- for such activity, is not by itself considered tion of the contract or agreement. the business of selling, serving or fur- Solely for the purposes of liability nishing alcoholic beverages. assumed in an "insured contract", d. Workers' Compensation And Similar Laws reasonable attorneys' fees and neces- sary litigation expenses incurred by or Any obligation of the insured under a for a party other than an insured are workers' compensation, disability benefits deemed to be damages because of or unemployment compensation law or any "bodily injury" or "property damage", similar law. provided: e. Employer's Liability (a) Liability to such party for, or for the "Bodily injury" to: cost of, that party's defense has also been assumed in the same (1) An "employee" of the insured arising out of and in the course of: "insured contract"; and (b) Such attorneys' fees and litigation (a) Employment by the insured; or expenses are for defense of that (b) Performing duties related to the party against a civil or alternative conduct of the insured's business; dispute resolution proceeding in or which damages to which this in- (2) The spouse, child, parent, brother or surance applies are alleged. sister of that "employee" as a con- c. Liquor Liability sequence of Paragraph (1) above. "Bodily injury" or "property damage" for This exclusion applies whether the insured which any insured may be held liable by may be liable as an employer or in any reason of: other capacity and to any obligation to (1) Causing or contributing to the intoxica- share damages with or repay someone else who must pay damages because of the tion of any person; injury. (2) The furnishing of alcoholic beverages to This exclusion does not apply to liability a person under the legal drinking age or assumed by the insured under an "insured under the influence of alcohol; or (3) Any statute, ordinance or regulation relating to the sale, gift, distribution or Page 2 of 16 © Insurance Services Office, Inc., 2012 CG 00 01 04 13 contract". sponsible; or f. Pollution (d) At or from any premises, site or (1) "Bodily injury" or "property damage" location on which any insured or arising out of the actual, alleged or any contractors or subcontractors threatened discharge, dispersal, see- working directly or indirectly on any page, migration, release or escape of insured's behalf are performing op "pollutants": erations if the "pollutants" are brought on or to the premises, site (a) At or from any premises, site or or location in connection with such location which is or was at any operations by such insured, con- time owned or occupied by, or tractor or subcontractor. How- rented or loaned to, any insured. ever, this subparagraph does not However, this subparagraph does apply to: not apply to: (i) "Bodily injury" or "property (i) "Bodily injury" if sustained damage" arising out of the within a building and caused by escape of fuels, lubricants or smoke, fumes, vapor or soot other operating fluids which are produced by or originating from needed to perform the normal equipment that is used to heat, electrical, hydraulic or me- cool or dehumidify the building, chanical functions necessary for or equipment that is used to the operation of "mobile equip- heat water for personal use, by ment" or its parts, if such fuels, the building's occupants or lubricants or other operating their guests; fluids escape from a vehicle (ii) "Bodily injury" or "property part designed to hold, store or damage" for which you may be receive them. This exception held liable, if you are a con- does not apply if the "bodily tractor and the owner or lessee injury" or "property damage" of such premises, site or loca- arises out of the intentional tion has been added to your discharge, dispersal or release policy as an additional insured of the fuels, lubricants or other with respect to your ongoing operating fluids, or if such operations performed for that fuels, lubricants or other oper- additional insured at that ating fluids are brought on or to premises, site or location and the premises, site or location such premises, site or location with the intent that they be is not and never was owned or discharged, dispersed or re- occupied by, or rented or leased as part of the operations loaned to, any insured, other being performed by such than that additional insured; or insured, contractor or subcon- (iii) "Bodily injury" or "property tractor; damage" arising out of heat, (ii) "Bodily injury" or "property smoke or fumes from a "hostile damage" sustained within a fire"; building and caused by the re- (b) At or from any premises, site or lease of gases, fumes or vapors location which is or was at any from materials brought into that time used by or for any insured or building in connection with op others for the handling, storage, erations being performed by disposal, processing or treatment of you or on your behalf by a con waste; tractor or subcontractor; or (c) Which are or were at any time OM "Bodily injury" or "property transported, handled, stored, treat- damage" arising out of heat, ed, disposed of, or processed as smoke or fumes from a "hostile waste by or for: fire". (i) Any insured; or (e) At or from any premises, site or location on which any insured or (ii) Any person or organization for any contractors or subcontractors whom you may be legally re- CG 00 01 04 13 © Insurance Services Office, Inc., 2012 Page 3 of 16 working directly or indirectly on any (a) Less than 26 feet long; and insured's behalf are performing operations if the operations are to (b) Not being used to carry persons or test for, monitor, clean up, remove, property for a charge; contain, treat, detoxify or neutra- (3) Parking an "auto" on, or on the ways lize, or in any way respond to, or next to, premises you own or rent, assess the effects of, "pollutants". provided the "auto" is not owned by or (2) Any loss, cost or expense arising out of rented or loaned to you or the insured; any: (4) Liability assumed under any "insured (a) Request, demand, order or stat- contract" for the ownership, mainten- utory or regulatory requirement that ance or use of aircraft or watercraft; or any insured or others test for, (5) "Bodily injury" or "property damage" monitor, clean up, remove, contain, arising out of: treat, detoxify or neutralize, or in any way respond to, or assess the (a) The operation of machinery or effects of, "pollutants"; or equipment that is attached to, or part of, a land vehicle that would (b) Claim or suit by or on behalf of a qualify under the definition of "mo- governmental authority for dam- bile equipment" if it were not ages because of testing for, mon- subject to a compulsory or financial itoring, cleaning up, removing, responsibility law or other motor containing, treating, detoxifying or vehicle insurance law where it is neutralizing, or in any way re- licensed or principally garaged; or sponding to, or assessing the ef- fects of, "pollutants". (b) The operation of any of the mach- inery or equipment listed in Para- However, this paragraph does not graph f.(2) or f.(3) of the definition apply to liability for damages because of "mobile equipment". of "property damage" that the insured h. Mobile Equipment would have in the absence of such request, demand, order or statutory or "Bodily injury" or "property damage" regulatory requirement, or such claim arising out of: or "suit" by or on behalf of a govern- (1) The transportation of "mobile equip- mental authority. ment" by an "auto" owned or operated g. Aircraft, Auto Or Watercraft by or rented or loaned to any insured; "Bodily injury" or "property damage" or arising out of the ownership, maintenance, (2) The use of "mobile equipment" in, or use or entrustment to others of any air- while in practice for, or while being craft, "auto" or watercraft owned or prepared for, any prearranged racing, operated by or rented or loaned to any speed, demolition, or stunting activity. insured. Use includes operation and i. War "loading or unloading". "Bodily injury" or "property damage", how- This exclusion applies even if the claims ever caused, arising, directly or indirectly, against any insured allege negligence or out of: other wrongdoing in the supervision, hiring, employment, training or monitoring of 111 War, including undeclared or civil war; others by that insured, if the "occurrence" (2) Warlike action by a military force, which caused the "bodily injury" or "prop- including action in hindering or de- erty damage" involved the ownership, fending against an actual or expected maintenance, use or entrustment to others attack, by any government, sovereign of any aircraft, "auto" or watercraft that is or other authority using military owned or operated by or rented or loaned personnel or other agents; or to any insured. (3) Insurrection, rebellion, revolution, This exclusion does not apply to: usurped power, or action taken by gov- (1) A watercraft while ashore on premises ernmental authority in hindering or you own or rent; (2) A watercraft you do not own that is: Page 4 of 16 © Insurance Services Office, Inc., 2012 CG 00 01 04 13 defending against any of these. and". j. Damage To Property This exclusion does not apply if the "Property damage" to: damaged work or the work out of which (1) the damage arises was performed on your Property you own, rent, or occupy, behalf by a subcontractor. including any costs or expenses incur- red by you, or any other person, m. Damage To Impaired Property Or Property organization or entity, for repair, re Not Physically Injured placement, enhancement, restoration or "Property damage" to "impaired property" maintenance of such property for any or property that has not been physically reason, including prevention of injury to injured, arising out of: a person or damage to another's prop- (1) A defect, deficiency, inadequacy or erty; dangerous condition in "your product" (2) Premises you sell, give away or aban- or "your work"; or don, if the "property damage" arises (2) A delay or failure by you or anyone out of any part of those premises; acting on your behalf to perform a con- (3) Property loaned to you; tract or agreement in accordance with (4) Personal property in the care, custody its terms. or control of the insured; This exclusion does not apply to the loss of (5) That particular part of real property on use of other property arising out of sudden which you or any contractors or sub- and accidental physical injury to "your contractors working directly or indir product" or "your work" after it has been ectly on your behalf are performing put to its intended use. operations, if the "property damage" n. Recall Of Products, Work Or Impaired arises out of those operations; or Property (6) That particular part of any property that Damages claimed for any loss, cost or must be restored, repaired or replaced expense incurred by you or others for the because "your work" was incorrectly loss of use, withdrawal, recall, inspection, performed on it. repair, replacement, adjustment, removal or Paragraphs (1), (3) and (4) of this exclusion disposal of: do not apply to "property damage" (other (1) "Your product"; than damage by fire) to premises, including (2) "Your work"; or the contents of such premises, rented to you for a period of seven or fewer (3) "Impaired property"; consecutive days. A separate limit of if such product, work, or property is with- insurance applies to Damage To Premises drawn or recalled from the market or from Rented To You as described in Section Ill — use by any person or organization because Limits Of Insurance. of a known or suspected defect, defi- Paragraph (2) of this exclusion does not ciency, inadequacy or dangerous condition apply if the premises are "your work" and in it. were never occupied, rented or held for o. Personal And Advertising Injury rental by you. "Bodily injury" arising out of "personal and Paragraphs (3), (4), (5) and (6) of this advertising injury". exclusion do not apply to liability assumed p. Electronic Data under a sidetrack agreement. Paragraph (6) of this exclusion does not Damages arising out of the loss of, loss of apply to "property damage" included in the use of, damage to, corruption of, inability "products-completed operations hazard". to access, or inability to manipulate elec tronic data. k. Damage To Your Product However, this exclusion does not apply to "Property damage" to "your product" liability for damages because of "bodily arising out of it or any part of it. injury". I. Damage To Your Work As used in this exclusion, electronic data "Property damage" to "your work" arising means information, facts or programs out of it or any part of it and included in stored as or on, created or used on, or the "products-completed operations haz- CG 00 01 04 13 © Insurance Services Office, Inc., 2012 Page 5 of 16 transmitted to or from computer software, Limits Of Insurance; and including systems and applications soft- (2) Our right and duty to defend end when ware, hard or floppy disks, CD-ROMs, we have used up the applicable limit of tapes, drives, cells, data processing de- insurance in the payment of judgments vices or any other media which are used or settlements under Coverages A or B with electronically controlled equipment. or medical expenses under Coverage C. q. Recording And Distribution Of Material Or No other obligation or liability to pay sums Information In Violation Of Law or perform acts or services is covered "Bodily injury" or "property damage" unless explicitly provided for under Supple- arising directly or indirectly out of any mentary Payments - Coverages A and B. action or omission that violates or is b. This insurance applies to "personal and alleged to violate: advertising injury" caused by an offense (1) The Telephone Consumer Protection arising out of your business but only if the Act (TCPA), including any amendment offense was committed in the "coverage of or addition to such law; territory" during the policy period. (2) The CAN-SPAM Act of 2003, including 2. Exclusions any amendment of or addition to such This insurance does not apply to: law; (3) The Fair Credit Reporting Act (FCRA), a. Knowing Violation Of Rights Of Another and any amendment of or addition to "Personal and advertising injury" caused by such law, including the Fair and or at the direction of the insured with the Accurate Credit Transactions Act knowledge that the act would violate the (FACTA); or rights of another and would inflict "per- (4) Any federal, state or local statute, or- dinance or regulation, other than the b. Material Published With Knowledge Of TCPA, CAN-SPAM Act of 2003 or Falsity FCRA and their amendments and addi- "Personal and advertising injury" arising tions, that addresses, prohibits, or out of oral or written publication, in any limits the printing, dissemination, manner, of material, if done by or at the disposal, collecting, recording, sending, direction of the insured with knowledge of transmitting, communicating or dis- its falsity. tribution of material or information. c. Material Published Prior To Policy Period Exclusions c. through n. do not apply to damage by fire to premises while rented to you "Personal and advertisinginjury" arising out of oral or writtent or temporarily occupied by you with permission publication, inn any of the owner. A separate limit of insurance manner, of material whose first publication applies to this coverage as described in Section took place before the beginning of the III - Limits Of Insurance. policy period. COVERAGE B - PERSONAL AND ADVERTISING d. Criminal Acts INJURY LIABILITY "Personal and advertising injury" arising 1. Insuring Agreement out of a criminal act committed by or at the direction of the insured. a. We will pay those sums that the insured becomes legally obligated to pay as e. Contractual Liability damages because of "personal and "Personal and advertising injury" for which advertising injury" to which this insurance the insured has assumed liability in a applies. We will have the right and duty to contract or agreement. This exclusion does defend the insured against any "suit" not apply to liability for damages that the seeking those damages. However, we will insured would have in the absence of the have no duty to defend the insured against contract or agreement. any "suit" seeking damages for "personal f. Breach Of Contract and advertising injury" to which this insurance does not apply. We may, at our "Personal and advertising injury" arising discretion, investigate any offense and out of a breach of contract, except an settle any claim or "suit" that may result. implied contract to use another's adver- But: tising idea in your "advertisement". (1) The amount we will pay for damages is limited as described in Section III - Page 6 of 16 © Insurance Services Office, Inc., 2012 CG 00 01 04 13 g. Quality Or Performance Of Goods - Failure name or product in your e-mail address, To Conform To Statements domain name or metatag, or any other similar tactics to mislead another's poten- "Personal and advertising injury" arising tial customers. out of the failure of goods, products or m. Pollution services to conform with any statement of quality or performance made in your "ad- "Personal and advertising injury" arising vertisement". out of the actual, alleged or threatened discharge, dispersal, seepage, migration, h. Wrong Description Of Prices release or escape of "pollutants" at any "Personal and advertising injury" arising time. out of the wrong description of the price of n. Pollution related goods, products or services stated in your "advertisement". Any loss, cost or expense arising out of i. Infringement Of Copyright, Patent, Trade- any: mark Or Trade Secret (1) Request, demand, order or statutory or "Personal and advertising injury" arising regulatory requirement that any insured out of the infringement of copyright, or others test for, monitor, clean up, patent, trademark, trade secret or other remove, contain, treat, detoxify or intellectual property rights. Under this neutralize, or in any way respond to, or exclusion, such other intellectual property assess the effects of, "pollutants"; or rights do not include the use of another's (2) Claim or suit by or on behalf of a gov- advertising idea in your "advertisement". ernmental authority for damages be- However, this exclusion does not apply to cause of testing for, monitoring, infringement, in your "advertisement", of cleaning up, removing, containing, treating, detoxifying or neutralizing, or copyright,trade dress or slogan. in any way responding to, or assessing j. Insureds In Media And Internet Type the effects of, "pollutants". Businesses o. War "Personal and advertising injury" com ^Personal and advertising injury", however mitted by an insured whose business is: caused, arising, directly or indirectly, out (1) Advertising, broadcasting, publishing or of: telecasting; (1) War, including undeclared or civil war; (2) Designing or determining content of (2) Warlike action by a military force, web sites for others; or including action in hindering or de- (3) An Internet search, access, content or fending against an actual or expected service provider. attack, by any government, sovereign However, this exclusion does not apply to or other authority using military per- Paragraphs 14.a., b. and c. of "personal sonnel or other agents; or and advertising injury" under the Defini- (3) Insurrection, rebellion, revolution, tions section. usurped power, or action taken by For the purposes of this exclusion, the governmental authority in hindering or placing of frames, borders or links, or defending against any of these. advertising, for you or others anywhere on p. Recording And Distribution Of Material Or the Internet, is not by itself, considered the Information In Violation Of Law business of advertising, broadcasting, pub "Personal and advertising injury" arising lishing or telecasting. directly or indirectly out of any action or k. Electronic Chatrooms Or Bulletin Boards omission that violates or is alleged to vio- "Personal and advertising injury" arising late: out of an electronic chatroom or bulletin (1) The Telephone Consumer Protection board the insured hosts, owns, or over Act (TCPA), including any amendment which the insured exercises control. of or addition to such law; I. Unauthorized Use Of Another's Name Or (2) The CAN-SPAM Act of 2003, including Product any amendment of or addition to such "Personal and advertising injury" arising law; out of the unauthorized use of another's CG 00 01 04 13 © Insurance Services Office, Inc., 2012 Page 7 of 16 (3) The Fair Credit Reporting Act (FCRA), b. Hired Person and any amendment of or addition to To a person hired to do work for or on such law, including the Fair and Ac- behalf of any insured or a tenant of any curate Credit Transactions Act insured. (FACIA); or c. Injury On Normally Occupied Premises (4) Any federal, state or local statute, To a person injured on that part of prem- ises or regulation, other than the ises you own or rent that the person TCPA, CAN-SPAM Act of 2003 or normally occupies. FCRA and their amendments and additions, that addresses, prohibits, or d. Workers' Compensation And Similar Laws limits the printing, dissemination, dis To a person, whether or not an "employee" posal, collecting, recording, sending, of any insured, if benefits for the "bodily transmitting, communicating or dis- injury" are payable or must be provided tribution of material or information. under a workers' compensation or disability COVERAGE C - MEDICAL PAYMENTS benefits law or a similar law. 1. Insuring Agreement e. Athletics Activities a. We will pay medical expenses as described To a person injured while practicing, in- below for "bodily injury" caused by an structing or participating in any physical accident: exercises or games, sports, or athletic con- tests. (1) On premises you own or rent; (2) On ways next to premises you own or f. Products-Completed Operations Hazard rent;• or Included within the "products completed (3) Because of your operations; operations hazard". provided that: g. Coverage A Exclusions (a) The accident takes place in the Excluded under Coverage A. "coverage territory" and during the SUPPLEMENTARY PAYMENTS - COVERAGES A policy period; AND B (b) The expenses are incurred and 1. We will pay, with respect to any claim we reported to us within one year of investigate or settle, or any "suit" against an the date of the accident; and insured we defend: (c) The injured person submits to a. All expenses we incur. examination, at our expense, by b. Up to $250 for cost of bail bonds required physicians of our choice as often as because of accidents or traffic law vio- we reasonably require. lations arising out of the use of any vehicle b. We will make these payments regardless of to which the Bodily Injury Liability fault. These payments will not exceed the Coverage applies. We do not have to applicable limit of insurance. We will pay furnish these bonds. reasonable expenses for: c. The cost of bonds to release attachments, (1) First aid administered at the time of an but only for bond amounts within the accident; applicable limit of insurance. We do not (2) Necessary medical, surgical, X-ray and have to furnish these bonds. dental services, including prosthetic d. All reasonable expenses incurred by the devices; and insured at our request to assist us in the investigation or defense of the claim or (3) Necessary ambulance, hospital, profes " sional nursing and funeral services. suit", including actual loss of earnings up to $250 a day because of time off from 2. Exclusions work. We will not pay expenses for "bodily injury": e. All court costs taxed against the insured in a. Any Insured the "suit". However, these payments do not include attorneys' fees or attorneys' To any insured, except "volunteer work- ers". Page 8 of 16 © Insurance Services Office, Inc., 2012 CG 00 01 04 13 expenses taxed against the insured. ance available to the indemnitee; f. Prejudgment interest awarded against the and insured on that part of the judgment we (2) Provides us with written authorization pay. If we make an offer to pay the to: applicable limit of insurance, we will not (a) Obtain records and other informa- pay any prejudgment interest based on that tion related to the "suit"; and period of time after the offer. g. All interest on the full amount of any (b) Conduct and control the defense of the indemnitee in such "suit". judgment that accrues after entry of the judgment and before we have paid, offered So long as the above conditions are met, attor- to pay, or deposited in court the part of the neys' fees incurred by us in the defense of that judgment that is within the applicable limit indemnitee, necessary litigation expenses incur- of insurance. red by us and necessary litigation expenses These payments will not reduce the limits of incurred by the indemnitee at our request will be paid as Supplementary Payments. Not- insurance. withstanding the provisions of Paragraph 2. If we defend an insured against a "suit" and an 2.b.(2) of Section I — Coverage A — Bodily indemnitee of the insured is also named as a Injury And Property Damage Liability, such party to the "suit", we will defend that payments will not be deemed to be damages indemnitee if all of the following conditions are for "bodily injury" and "property damage" and met: will not reduce the limits of insurance. a. The "suit" against the indemnitee seeks Our obligation to defend an insured's indem- damages for which the insured has nitee and to pay for attorneys' fees and assumed the liability of the indemnitee in a necessary litigation expenses as Supplementary contract or agreement that is an "insured Payments ends when we have used up the contract"; applicable limit of insurance in the payment of b. This insurance applies to such liability judgments or settlements or the conditions set assumed by the insured; forth above, or the terms of the agreement described in Paragraph f. above, are no longer c. The obligation to defend, or the cost of the met. defense of, that indemnitee, has also been assumed by the insured in the same SECTION II — WHO IS AN INSURED "insured contract"; 1. If you are designated in the Declarations as: d. The allegations in the "suit" and the in- a. An individual, you and your spouse are formation we know about the "occurrence" insureds, but only with respect to the are such that no conflict appears to exist conduct of a business of which you are the between the interests of the insured and sole owner. the interests of the indemnitee; b. A partnership joint venture,p p or you are an e. The indemnitee and the insured ask us to insured. Your members, your partners, and conduct and control the defense of that their spouses are also insureds, but only indemnitee against such "suit" and agree with respect to the conduct of your busi- that we can assign the same counsel to ness. defend the insured and the indemnitee; and c. A limited liability company, p y, you are an f. The indemnitee: insured. Your members are also insureds, (1) Agrees in writing to: but only with respect to the conduct of (a) Cooperate with us in the in- your business. Your managers are insureds, but only with respect to their duties as vestigation, settlement or defense your managers. of the "suit"; d. An organization other than a partnership, (b) Immediately send us copies of any joint venture or limited liability company, demands, notices, summonses or you are an insured. Your "executive of- legal papers received in connection ficers" and directors are insureds, but only with the "suit"; with respect to their duties as your officers (c) Notify any other insurer whose or directors. Your stockholders are also coverage is available to the indem- insureds, but only with respect to their nitee; and liability as stockholders. (d) Cooperate with us with respect to e. A trust, you are an insured. Your trustees coordinating other applicable insur- CG 00 01 04 13 © Insurance Services Office, Inc., 2012 Page 9 of 16 are also insureds, but only with respect to "volunteer worker"), or any organization their duties as trustees. while acting as your real estate manager. 2. Each of the following is also an insured: c. Any person or organization having proper a. Your "volunteer workers" only while per- temporary custody of your property if you forming duties related to the conduct of die, but only: your business, or your "employees", other (1) With respect to liability arising out of than either your "executive officers" (if you the maintenance or use of that prop- are an organization other than a partner- erty; and ship, joint venture or limited liability (2) Unil your legal representative has been company) or your managers (if you are a appointed. limited liability company), but only for acts within the scope of their employment by d. Your legal representative if you die, but you or while performing duties related to only with respect to duties as such. That the conduct of your business. However, representative will have all your rights and none of these "employees" or "volunteer duties under this Coverage Part. workers" are insureds for: 3. Any organization you newly acquire or form, (1) "Bodily injury" or "personal and adver- other than a partnership, joint venture or tising injury": limited liability company, and over which you maintain ownership or majority interest, will (a) To you, to your partners or mem- qualify as a Named Insured if there is no other bers (if you are a partnership or similar insurance available to that organization. joint venture), to your members (if However: you are a limited liability company), to a co-"employee" while in the a. Coverage under this provision is afforded course of his or her employment or only until the 90th day after you acquire or performing duties related to the form the organization or the end of the conduct of your business, or to policy period, whichever is earlier; your other "volunteer workers" b. Coverage A does not apply to "bodily while performing duties related to injury" or "property damage" that occurred the conduct of your business; before you acquired or formed the organ- (b) To the spouse, child, parent, ization; and brother or sister of that co- c. Coverage B does not apply to "personal "employee" or "volunteer worker" and advertising injury" arising out of an as a consequence of Paragraph offense committed before you acquired or (1)(a) above; formed the organization. (c) For which there is any obligation to No person or organization is an insured with share damages with or repay some- respect to the conduct of any current or past one else who must pay damages partnership, joint venture or limited liability corn- because of the injury described in pany that is not shown as a Named Insured in the Paragraph (1)(a) or (b) above; or Declarations. (d) Arising out of his or her providing SECTION III — LIMITS OF INSURANCE or failing to provide professional 1. The Limits of Insurance shown in the Dec- health care services. larations and the rules below fix the most we (2) "Property damage" to property: will pay regardless of the number of: (a) Owned, occupied or used by; a. Insureds; (b) Rented to, in the care, custody or b. Claims made or "suits" brought; or control of, or over which physical c. Persons or organizations making claims or control is being exercised for any purpose by; bringing "suits". you, any of your "employees", "volun 2. The General Aggregate Limit is the most we teer workers", any partner or member will pay for the sum of: (if you are a partnership or joint yen- a. Medical expenses under Coverage C; ture), or any member (if you are a b. Damages under Coverage A, except dam- limited liability company). ages because of "bodily injury" or "prop- b. Any person (other than your "employee" or erty damage" included in the "products- Page 10 of 16 © Insurance Services Office, Inc., 2012 CG 00 01 04 13 completed operations hazard"; and (1) How, when and where the "occurr- c. Damages under Coverage B. ence" or offense took place; 3. The Products-Completed Operations Aggregate (2) The names and addresses of any in- Limit is the most we will pay under Coverage A jured persons and witnesses; and for damages because of "bodily injury" and (3) The nature and location of any injury or "property damage" included in the "products- damage arising out of the "occurrence" completed operations hazard". or offense. 4. Subject to Paragraph 2. above, the Personal b. If a claim is made or "suit" is brought And Advertising Injury Limit is the most we will against any insured, you must: pay under Coverage B for the sum of all damages because of all "personal and ad- (1) Immediately record the specifics of the vertising injury" sustained by any one person claim or "suit" and the date received; or organization. and 5. Subject to Paragraph 2. or 3. above, whichever (2) Notify us as soon as practicable. applies, the Each Occurrence Limit is the most You must see to it that we receive written we will pay for the sum of: notice of the claim or "suit" as soon as a. Damages under Coverage A; and practicable. b. Medical expenses under Coverage C c. You and any other involved insured must: because of all "bodily injury" and "property (1) Immediately send us copies of any damage" arising out of any one "occurrence". demands, notices, summonses or legal to Paragraph 5. above, the Damage To papers received in connection with the 6. Subject 19 9 claim or "suit"; Premises Rented To You Limit is the most we will pay under Coverage A for damages (2) Authorize us to obtain records and because of "property damage" to any one other information; premises, while rented to you, or in the case of (3) Cooperate with us in the investigation damage by fire, while rented to you or or settlement of the claim or defense temporarily occupied by you with permission of against the "suit"; and the owner. (4) Assist us, upon our request, in the en- 7. Subject to Paragraph 5. above, the Medical forcement of any right against any Expense Limit is the most we will pay under person or organization which may be Coverage C for all medical expenses because liable to the insured because of injury of "bodily injury" sustained by any one person. or damage to which this insurance may The Limits of Insurance of this Coverage Part apply also apply. separately to each consecutive annual period and d. No insured will, except at that insured's to any remaining period of less than 12 months, own cost, voluntarily make a payment, starting with the beginning of the policy period assume any obligation, or incur any ex- shown in the Declarations, unless the policy period pense, other than for first aid, without our is extended after issuance for an additional period consent. of less than 12 months. In that case, the additional 3. Legal Action Against Us period will be deemed part of the last preceding period for purposes of determining the Limits of No person or organization has a right under Insurance. this Coverage Part: SECTION IV — COMMERCIAL GENERAL LIABILITY a. To join us as a party or otherwise bring us CONDITIONS into a "suit" asking for damages from an insured; or 1. Bankruptcy b. To sue us on this Coverage Part unless all Bankruptcy or insolvency of the insured or of of its terms have been fully complied with. the insured's estate will not relieve us of our obligations under this Coverage Part. A person or organization may sue us to recover on an agreed settlement or on a final judgment 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit against an insured; but we will not be liable for damages that are not payable under the terms a. You must see to it that we are notified as of this Coverage Part or that are in excess of soon as practicable of an "occurrence" or the applicable limit of insurance. An agreed an offense which may result in a claim. To settlement means a settlement and release of the extent possible, notice should include: CG 00 01 04 13 © Insurance Services Office, Inc., 2012 Page 11 of 16 liability signed by us, the insured and the entitled to the insured's rights against claimant or the claimant's legal representative. all those other insurers. 4. Other Insurance (3) When this insurance is excess over If other valid and collectible insurance is other insurance, we will pay only our available to the insured for a loss we cover share of the amount of the loss, if any, under Coverages A or B of this Coverage Part, that exceeds the sum of: our obligations are limited as follows: (a) The total amount that all such other a. Primary Insurance insurance would pay for the loss in the absence of this insurance; and This insurance is primary except when Paragraph b. below applies. If this (b) The total of all deductible and self- insurance is primary, our obligations are insured amounts under all that not affected unless any of the other other insurance. insurance is also primary. Then, we will (4) We will share the remaining loss, if share with all that other insurance by the any, with any other insurance that is method described in Paragraph c. below. not described in this Excess Insurance b. Excess Insurance provision and was not bought spec- ifically to apply in excess of the Limits (1) This insurance is excess over: of Insurance shown in the Declarations (a) Any of the other insurance, wheth- of this Coverage Part. er primary, excess, contingent or c. Method Of Sharing on any other basis: If all of the other insurance permits contrib- (i) That is Fire, Extended Cover- ution by equal shares, we will follow this age, Builder's Risk, Installation method also. Under this approach each Risk or similar coverage for insurer contributes equal amounts until it "your work"; has paid its applicable limit of insurance or (ii') That is Fire insurance for prem- none of the loss remains, whichever comes ises rented to you or tempor- first. arily occupied by you with If any of the other insurance does not permission of the owner; permit contribution by equal shares, we will (iii) That is insurance purchased by contribute by limits. Under this method, you to cover your liability as a each insurer's share is based on the ratio tenant for "property damage" of its applicable limit of insurance to the to premises rented to you or total applicable limits of insurance of all temporarily occupied by you insurers. with permission of the owner; 5. Premium Audit or a. We will compute all premiums for this (iv) If the loss arises out of the Coverage Part in accordance with our rules maintenance or use of aircraft, and rates. "autos" or watercraft to the extent not subject to Exclusion b. Premium shown in this Coverage Part as g. of Section I Coverage A advance premium is a deposit premium Bodily Injury And Property only. At the close of each audit period we Damage Liability. will compute the earned premium for that (b) Any other primaryinsurance avail- period and send notice to the first Named Insured. The due date for audit and able to you covering liability for retrospective premiums is the date shown damages arising out of the prem- as the due date on the bill. If the sum of ises or operations, or the products the advance and audit premiums paid for and completed operations, for the policy period is greater than the earned which you have been added as an premium, we will return the excess to the additional insured. first Named Insured. (2) When this insurance is excess, we will c. The first Named Insured must keep records have no duty under Coverages A or B of the information we need for premium to defend the insured against any "suit" if any other insurer has a duty to defend the insured against that "suit". If no other insurer defends, we will undertake to do so, but we will be Page 12 of 16 © Insurance Services Office, Inc., 2012 CG 00 01 04 13 computation, and send us copies at such cluding any attached machinery or equip- times as we may request. ment; or 6. Representations b. Any other land vehicle that is subject to a By accepting this policy, you agree: compulsory or financial responsibility law a. or other motor vehicle insurance law where The statements in the Declarations are it is licensed or principally garaged. accurate and complete; However, "auto" does not include "mobile b. Those statements are based upon repre- equipment". sentations you made to us; and 3. "Bodily injury" means bodily injury, sickness or c. We have issued this policy in reliance upon disease sustained by a person, including death your representations. resulting from any of these at any time. 7. Separation Of Insureds 4. "Coverage territory" means: Except with respect to the Limits of Insurance, a. The United States of America (including its and any rights or duties specifically assigned in territories and possessions), Puerto Rico this Coverage Part to the first Named Insured, and Canada; this insurance applies: b. International waters or airspace, but only if a. As if each Named Insured were the only the injury or damage occurs in the course Named Insured; and of travel or transportation between any b. Separately to each insured against whom places included in Paragraph a. above; or claim is made or "suit" is brought. c. All other parts of the world if the injury or 8. Transfer Of Rights Of Recovery Against Others damage arises out of: To Us • (1) Goods or products made or sold by you If the insured has rights to recover all or part of in the territory described in Paragraph any payment we have made under this Coy- a. above; erage Part, those rights are transferred to us. (2) The activities of a person whose home The insured must do nothing after loss to is in the territory described in Para- impair them. At our request, the insured will graph a. above, but is away for a short bring "suit" or transfer those rights to us and time on your business; or help us enforce them. When We Do Not Renew (3) "Personal and advertising injury" of- 9. fenses that take place through the If we decide not to renew this Coverage Part, Internet or similar electronic means of we will mail or deliver to the first Named communication; Insured shown in the Declarations written provided the insured's responsibility to pay notice of the nonrenewal not less than 30 days damages is determined in a "suit" on the before the expiration date. merits, in the territory described in Paragraph If notice is mailed, proof of mailing will be a. above or in a settlement we agree to. sufficient proof of notice. 5. "Employee" includes a "leased worker". "Em- SECTION V — DEFINITIONS ployee" does not include a "temporary 1. "Advertisement" means a notice that is worker". broadcast or published to the general public or 6. "Executive officer" means a person holding any specific market segments about your goods, of the officer positions created by your charter, products or services for the purpose of constitution, bylaws or any other similar attracting customers or supporters. For the governing document. purposes of this definition: 7. "Hostile fire" means one which becomes a. Notices that are published include material uncontrollable or breaks out from where it was placed on the Internet or on similar intended to be. electronic means of communication; and 8. "Impaired property" means tangible property, b. Regarding web sites, only that part of a other than "your product" or "your work", that web site that is about your goods, cannot be used or is less useful because: products or services for the purposes of attractingcustomers or supportersa. It incorporates "your product" or "your is work" that is known or thought to be considered an advertisement. defective, deficient, inadequate or danger- 2. "Auto" means: ous; or a. A land motor vehicle, trailer or semitrailer designed for travel on public roads, in- CG 00 01 04 13 © Insurance Services Office, Inc., 2012 Page 13 of 16 b. You have failed to fulfill the terms of a failing to give them, if that is the contract or agreement; primary cause of the injury or damage; or if such property can be restored to use by the (3) Under which the insured, if an repair, replacement, adjustment or removal of "your product" or "your work" or your fulfilling architect, engineer or surveyor, as the terms of the contract or agreement. sumes liability for an injury or damage 9. "Insured contract" means: arising out of the insured's rendering or failure to render professional services, a. A contract for a lease of premises. How- including those listed in (2) above and ever, that portion of the contract for a supervisory, inspection, architectural or lease of premises that indemnifies any engineering activities. person or organization for damage by fire 10. "Leased worker" means a person leased to you to premises while rented to you or by a labor leasing firm under an agreement temporarily occupied by you with permis- between You and the labor leasing firm, to sion of the owner is not an "insured contract"; perform duties related to the conduct of your business. "Leased worker" does not include a b. A sidetrack agreement; "temporary worker". c. Any easement or license agreement, except 11. "Loading or unloading" means the handling of in connection with construction or demoli- property: tion operations on or within 50 feet of a a. After it is moved from the place where it is railroad; accepted for movement into or onto an air- d. An obligation, as required by ordinance, to craft, watercraft or "auto"; indemnify a municipality, except in connec- b. While it is in or on an aircraft, watercraft or tion with work for a municipality; "auto"; or e. An elevator maintenance agreement; c. While it is being moved from an aircraft, f. That part of any other contract or watercraft or "auto" to the place where it agreement pertaining to your business (in- is finally delivered; cluding an indemnification of a municipality but "loading or unloading" does not include the in connection with work performed for a movement of municipality) under which you assume the property by means a mechanical device,, other than a hand truck, tort liability of another party to pay for that is not attached to the aircraft, watercraft "bodily injury" or "property damage" to a or "auto". third person or organization. Tort liability means a liability that would be imposed by 12. "Mobile equipment" means any of the law in the absence of any contract or following types of land vehicles, including any agreement. attached machinery or equipment: Paragraph f. does not include that part of a. Bulldozers, farm machinery, forklifts and any contract or agreement: other vehicles designed for use principally off public roads; (1) That indemnifies a railroad for "bodily injury" or "property damage" arising b. Vehicles maintained for use solely on or out of construction or demolition opera next to premises you own or rent; tions, within 50 feet of any railroad c. Vehicles that travel on crawler treads; property and affecting any railroad d. Vehicles, whether self-propelled or not, bridge or trestle, tracks, road-beds, tun- nel, underpass or crossing; maintained primarily to provide mobility to permanently mounted: (2) That indemnifies an architect, engineer (1) Power cranes, shovels, loaders, diggers or surveyor for injury or damage arising or drills; or out of: Preparing, approving, or failing to (2) Road construction or resurfacing equip- (a) ment such as graders, scrapers or prepare or approve, maps, shop rollers; drawings, opinions, reports, sur- veys, field orders, change orders or e. Vehicles not described in Paragraph a., b., drawings and specifications; or c. or d. above that are not self-propelled and are maintained primarily to provide (b) Giving directions or instructions, or mobility to permanently attached equip- Page 14 of 16 © Insurance Services Office, Inc., 2012 CG 00 01 04 13 ment of the following types: of material that slanders or libels a person (1) Air compressors, pumps and gener or organization or disparages a person's or ators, including spraying, welding, organization's goods, products or services; building cleaning, geophysical explora- e. Oral or written publication, in any manner, tion, lighting and well servicing equip- of material that violates a person's right of ment; or privacy; (2) Cherry pickers and similar devices used f. The use of another's advertising idea in to raise or lower workers; your "advertisement"; or f. Vehicles not described in Paragraph a., b., g. Infringing upon another's copyright, trade c. or d. above maintained primarily for dress or slogan in your "advertisement". purposes other than the transportation of persons or cargo. 15. "Pollutants" mean any solid, liquid, gaseous or thermal irritant or contaminant, including However, self-propelled vehicles with the smoke, vapor, soot, fumes, acids, alkalis, following types of permanently attached chemicals and waste. Waste includes materials equipment are not "mobile equipment" but to be recycled, reconditioned or reclaimed. will be considered "autos": 16. "Products-completed operations hazard": (1) Equipment designed primarily for: a. Includes all "bodily injury" and "property (a) Snow removal; damage" occurring away from premises (b) Road maintenance, but not con- you own or rent and arising out of "your struction or resurfacing; or product" or "your work" except: (c) Street cleaning; (1) Products that are still in your physical (2) Cherry pickers and similar devices possession; or mounted on automobile or truck chas (2) Work that has not yet been completed sis and used to raise or lower workers; or abandoned. However, "your work" and will be deemed completed at the earli- est of the following times: (3) Air compressors, pumps and gener- ators, including spraying, welding, (a) When all of the work called for in building cleaning, geophysical explora your contract has been completed. tion, lighting and well servicing equip- (b) When all of the work to be done at ment. the job site has been completed if However, "mobile equipment" does not include your contract calls for work at more any land vehicles that are subject to a than one job site. compulsory or financial responsibility law or (c) When that part of the work done at other motor vehicle insurance law where it is a job site has been put to its licensed or principally garaged. Land vehicles intended use by any person or subject to a compulsory or financial respons- organization other than another ibility law or other motor vehicle insurance law contractor or subcontractor work- are considered "autos". ing on the same project. 13. "Occurrence" means an accident, including Work that may need service, mainten- continuous or repeated exposure to substant- ance, correction, repair or replacement, ially the same general harmful conditions. but which is otherwise complete, will 14. "Personal and advertising injury" means injury, be treated as completed. including consequential "bodily injury", arising b. Does not include "bodily injury" or "prop- out of one or more of the following offenses: erty damage" arising out of: a. False arrest, detention or imprisonment; (1) The transportation of property, unless b. Malicious prosecution; the injury or damage arises out of a condition in or on a vehicle not owned c. The wrongful eviction from, wrongful entry or operated by you, and that condition into, or invasion of the right of private was created by the "loading or un- occupancy of a room, dwelling or premises loading" of that vehicle by any insured; that a person occupies, committed by or on behalf of its owner, landlord or lessor; (2) The existence of tools, uninstalled equipment or abandoned or unused d. Oral or written publication, in any manner, materials; or (3) Products or operations for which the CG 00 01 04 13 © Insurance Services Office, Inc., 2012 Page 15 of 16 classification, listed in the Declarations the scope of duties determined by you, and is or in a policy Schedule, states that not paid a fee, salary or other compensation by products-completed operations are sub- you or anyone else for their work performed for ject to the General Aggregate Limit. you. 17. "Property damage" means: 21. "Your product": a. Physical injury to tangible property, in- a. Means: cluding all resulting loss of use of that (1) Any property. All such loss of use shall be goods or products, other than real deemed to occur at the time of the physical property, manufactured, sold, handled, injury that caused it; or distributed or disposed of by: b. Loss of use of tangible property that is not (a) You; physically injured. All such loss of use shall (b) Others trading under your name; or be deemed to occur at the time of the (c) A person or organization whose bus "occurrence" that caused it. iness or assets you have ac- quired; For the purposes of this insurance, electronic and data is not tangible property. (2) Containers (other than vehicles), mater- As used in this definition, electronic data ials, parts or equipment furnished in means information, facts or programs stored as connection with such goods or pro- or on, created or used on, or transmitted to or ducts. from computer software, including systems b. Includes: and applications software, hard or floppy disks, CD-ROMs, tapes, drives, cells, data processing (1) Warranties or representations made at devices or any other media which are used any time with respect to the fitness, with electronically controlled equipment. quality, durability, performance or use 18. "Suit" means a civil of "your product"; and proceeding in which (2) The r damages because of "bodily injury", "propertyproviding of or failure to provide damage" or "personal and advertising injury" to warnings or instructions. which this insurance applies are alleged. "Suit" c. Does not include vending machines or includes: other property rented to or located for the a. An arbitration proceeding in which such use of others but not sold. damages are claimed and to which the 22. "Your work": insured must submit or does submit with a. Means: our consent; or b. Any other alternative dispute resolution (1) Work or operations performed by you or on your behalf; and proceeding in which such damages are claimed and to which the insured submits (2) Materials, parts or equipment furnished with our consent. in connection with such work or opera- 19. "Temporary worker" means a person who is tions. furnished to you to substitute for a permanent b. Includes: "employee" on leave or to meet seasonal or (1) Warranties or representations made at short-term workload conditions. any time with respect to the fitness, 20. "Volunteer worker" means a person who is not quality, durability, performance or use your "employee", and who donates his or her of "your work"; and work and acts at the direction of and within (2) The providing of or failure to provide warnings or instructions. Page 16 of 16 © Insurance Services Office, Inc., 2012 CG 00 01 04 13 COMMERCIAL GENERAL LIABILITY CG 01 97 12 07 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WASHINGTON CHANGES - EMPLOYMENT-RELATED PRACTICES EXCLUSION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. The following exclusion is added to Paragraph B. The following exclusion is added to Paragraph 2., Exclusions of Coverage A — Bodily Injury 2., Exclusions of Coverage B — Personal And And Property Damage Liability (Section I — Advertising Injury Liability (Section I — Cover- Coverages): ages): This insurance does not apply to: This insurance does not apply to: "Bodily injury" to: "Personal and advertising injury" to: 1. A person arising out of any: 1. A person arising out of any: a. Refusal to employ that person; a. Refusal to employ that person; b. Termination of that person's employ- b. Termination of that person's employ- ment; or ment; or c. Employment-related practices, policies, c. Employment-related practices, policies, acts or omissions, such as coercion, acts or omissions, such as coercion, demotion, evaluation, reassignment, demotion, evaluation, reassignment, discipline, defamation, harassment, discipline, defamation, harassment, humiliation, discrimination or malicious humiliation, discrimination or malicious prosecution directed at that person; or prosecution directed at that person; or 2. The spouse, child, parent, brother or sister 2. The spouse, child, parent, brother or sister of that person as a consequence of "bodily of that person as a consequence of injury" to that person at whom any of the "personal and advertising injury" to that employment-related practices described in person at whom any of the employment- Paragraphs a., b. and c. above is directed. related practices described in Paragraphs This exclusion applies: a., b. and c. above is directed. 1. Whether the injury-causing event described This exclusion applies: in Paragraphs a., b. or c. above occurs 1. Whether the injury-causing event described before employment, during employment or in Paragraphs a., b. or c. above occurs after employment of that person; before employment, during employment or 2. Whether the insured may be liable as an after employment of that person; employer or in any other capacity; and 2. Whether the insured may be liable as an 3. To any obligation to share damages with or employer or in any other capacity; and repay someone else who must pay 3. To any obligation to share damages with or damages because of the injury. repay someone else who must pay However, Paragraphs 1.a. and 2. of this damages because of the injury. exclusion do not apply if such "bodily injury" is However, Paragraphs 1.a. and 2. of this sustained by any "employee" of the insured exclusion do not apply if such "personal and whose employment is subject to the Industrial advertising injury" is sustained by any Insurance Act of Washington (Washington "employee" of the insured whose employment Revised Code Title 51). is subject to the Industrial Insurance Act of Washington (Washington Revised Code Title 51). CG 01 97 12 07 Copyright, ISO Properties, Inc., 2006 Page 1 of 1 POLICY NUMBER: CPP 1265898 00 COMMERCIAL GENERAL LIABILITY CG 04 42 11 03 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. STOP GAP - EMPLOYERS LIABILITY COVERAGE ENDORSEMENT - WASHINGTON This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE Limits Of Insurance Bodily Injury By Accident $ 1,000,000 Each Accident Bodily Injury By Disease $ 1,000,000 Aggregate Limit Bodily Injury By Disease $ 1,000, 000 Each Employee (If no entry appears above, the information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. The following is added to Section I - Cover- b. This insurance applies to "bodily injury ages: by accident" or "bodily injury by dis- COVERAGE - STOP GAP - EMPLOYERS LIABIL- ease" only if: ITY (1) The: 1. Insuring Agreement (a) "Bodily injury by accident" or a. We will pay those sums that the in- "bodily injury by disease" takes sured becomes legally obligated by place in the "coverage terri Washington Law to pay as damages tort'"; because of "bodily injury by accident" (b) "Bodily injury by accident" or or "bodily injury by disease" to your "bodily injury by disease" arises "employee" to which this insurance ap- out of and in the course of the plies. We will have the right and duty injured "employee's" employ- to defend the insured against any "suit" ment by you; and seeking those damages. However, we (c) "Employee", at the time of the will have no duty to defend the insured injury, was covered under a against any "suit" seeking damages to which this insurance does not apply. worker's compensation policy pp y. and subject to a "workers corn- We may, at our discretion, investigate any accident and settle any claim or pensation law" of Washington; a "suit" that may result. But: and (1) The amount we will pay for l21 The: dam- ages is limited as described in Sec- (a) "Bodily injury by accident" is tion III - Limits Of Insurance; and caused by an accident that oc- (2) Our right and duty to defend end curs during the policy period; or when we have used up the appli- (b) "Bodily injury by disease" is cable limit of insurance in the pay- caused by or aggravated by ment of judgments or settlements conditions of employment by under this coverage. you and the injured "employ- ee's" last day of last exposure No other obligation or liability to pay to the conditions causing ag- sums a - sums or perform acts or services is gravating such "bodily injury by covered unless explicitly provided for under Supplementary Payments. disease" occurs during the poli- under period. CG 04 42 11 03 Copyright, ISO Properties, Inc., 2003 Page 1 of 4 c. The damages we will pay, where recov e. Violation Of Law ery is permitted by law, include dam- "Bodily injury by accident" or "bodily ages: injury by disease" suffered or caused (1) For: by any employee while employed in vi- a) Which you are liable to a third olation of law with your actual knowl- party by reason of a claim or edge or the actual knowledge of any of "suit" against you by that third your "executive officers". party to recover the damages f. Termination, Coercion Or Discrimination claimed against such third party Damages arising out of coercion, criti- as a result of injury to your cism, demotion, evaluation, reassign- "employee"; ment, discipline, defamation, harass- (b) Care and loss of services; and ment, humiliation, discrimination (c) Consequential "bodily injury by against or termination of any "employ accident" or "bodily injury by ee", or arising out of other employment disease" to a spouse, child, par- or personnel decisions concerning the ent, brother or sister of the in- insured. jured "employee"; g. Failure To Comply With "Workers Com- provided that these damages are pensation Law" the direct consequence of "bodily "Bodily injury by accident" or "bodily injury by accident" or "bodily injury injury by disease" to an "employee" by disease" that arises out of and when you are: in the course of the injured "em- (1) Deprived of common law defenses; ployee's" employment by you; and or (2) Because of "bodily injury by acci- (2) Otherwise subject to penalty; dent" or "bodily injury by disease" to your "employee" that arises out because of your failure to secure your of and in the course of employ- obligations or other failure to comply ment, claimed against you in a with any "workers compensation law". capacity other than as employer. h. Violation Of Age Laws Or Employment 2. Exclusions Of Minors This insurance does not apply to: "Bodily injury by accident" or "bodily injury by disease" suffered or caused a. Intentional Injury by any person: "Bodily injury by accident" or "bodily injury by disease" intentionally caused (1) Knowinglyln as tod by you in vio oany law or aggravated by you, or "bodily injury lation of law age; or by accident" or "bodily injury by dis- (2) Under the age of 14 years, regard- ease" resulting from an act which is less of any such law. determined to have been committed by i. Federal Laws you if it was reasonable to believe that an injury is substantially certain to oc Any premium, assessment, penalty, fine, benefit, liability or other obligation cur. imposed by or granted pursuant to: b. Fines Or Penalties (1) The Federal Employer's Liability Act Any assessment, penalty, or fine levied (45 USC Section 51-60); by any regulatory inspection agency or authority. (2) The Non-appropriated Fund Instru- mentalities Act (5 USC Sections c. Statutory Obligations 8171-8173); Any obligation of the insured under a (3) The Longshore and Harbor Work- workers' compensation, disability bene- ers' Compensation Act (33 USC fits or unemployment compensation Sections 910-950); law or any similar law. (4) The Outer Continental Shelf Lands d. Contractual Liability Act (43 USC Section 1331-1356); Liability assumed by you under any (5) The Defense Base Act (42 USC contract or agreement. Sections 1651-1654); Page 2 of 4 Copyright, ISO Properties, Inc., 2003 CG 04 42 11 03 (6) The Federal Coal Mine Health and D. For the purposes of this endorsement, Section Safety Act of 1969 (30 USC Sec- III - Limits Of Insurance, is replaced by the fol- tions 901-942); lowing: (7) The Migrant and Seasonal AgricuI- 1. The Limits of Insurance shown in the tural Worker Protection Act (29 Schedule of this endorsement and the rules USC Sections 1801-1872); below fix the most we will pay regardless (8) Any other workers compensation, of the number of: unemployment compensation or a. Insureds; disability laws or any similar law; or b. Claims made or "suits" brought; or (9) Any subsequent amendments to c. Persons or organizations making claims the laws listed above. or bringing "suits". j. Punitive Damages 2. The "Bodily Injury By Accident" - Each Ac- Multiple, exemplary or punitive dam- cident Limit shown in the Schedule of this ages. endorsement is the most we will pay for all k. Crew Members damages covered by this insurance be- cause of "bodily injury by accident" to one "Bodily injury by accident" or "bodily or more "employees" in any one accident. injury by disease" to a master or mem- ber of the crew of any vessel or any 3. The "Bodily Injury By Disease" - Aggregate member of the flying crew of an air- Limit shown in the Schedule of this en craft. dorsement is the most we will pay for all damages covered by this insurance and B. The Supplementary Payments provisions apply arising out of "bodily injury by disease", re- to Coverage - Stop Gap Employers Liability as gardless of the number of "employees" well as to Coverages A and B. who sustain "bodily injury by disease". C. For the purposes of this endorsement, Section 4. Subject to Paragraph D.3. of this endorse- II - Who Is An Insured, is replaced by the fol- ment, the "Bodily Injury By Disease" - Each lowing: "Employee" Limit shown in the Schedule of If you are designated in the Declarations as: this endorsement is the most we will pay 1. An individual, you and your spouse are in- for all damages because of "bodily injury sureds, but only with respect to the con- duct of a business of which you are the The limits of the coverage apply separately to sole owner. each consecutive annual period and to any re- 2. A partnership or joint venture, you are an maining period of less than 12 months, starting insured. Your members, your partners, and with the beginning of the policy period shown their spouses are also insureds, but only in the Declarations, unless the policy period is with respect to the conduct of your busi extended after issuance for an additional period of less than 12 months. In that case, the addi- ness. tional period will be deemed part of the last 3. A limited liability company, you are an in- preceding period for purposes of determining sured. Your members are also insureds, but the Limits of Insurance. only with respect to the conduct of your E. For the purposes of this endorsement, Con- business. Your managers are insureds, but dition 2. - Duties In The Event Of Occurrence, only with respect to their duties as your Claim Or Suit of the Conditions Section IV is managers. deleted and replaced by the following: 4. An organization other than a partnership, 2. Duties In The Event Of Injury, Claim Or Suit joint venture or limited liability company, you are an insured. Your "executive of- a. You must see to it that we or our agent ficers" and directors are insureds, but only are notified as soon as practicable of a with respect to their duties as your officers "bodily injury by accident" or "bodily or directors. Your stockholders are also in- injury by disease" which may result in a sureds, but only with respect to their lia- claim. To the extent possible, notice bility as stockholders. should include: No person or organization is an insured (1) How, when and where the "bodily with respect to the conduct of any current injury by accident" or "bodily injury or past partnership, joint venture or limited by disease" took place; liability company that is not shown as a (2) The names and addresses of any in- Named Insured in the Declarations. jured persons and witnesses; and CG 04 42 11 03 Copyright, ISO Properties, Inc., 2003 Page 3 of 4 (3) The nature and location of any in- 4. "Coverage territory" means: jury. a. The United States of America (including b. If a claim is made or "suit" is brought its territories and possessions), Puerto against any insured, you must: Rico and Canada; (1) Immediately record the specifics of b. International waters or airspace, but the claim or "suit" and the date re- only if the injury or damage occurs in ceived; and the course of travel or transportation (2) Notify us as soon as practicable. between any places included in a. above; or You must see to it that we receive writ- ten notice of the claim or "suit" as c. All other parts of the world if the injury soon as practicable. or damage arises out of the activities of a person whose home is in the territory c. You and any other involved insured described in a. above, but who is away must: for a short time on your business; (1) Immediately send us copies of any provided the insured's responsibility to pay demands, notices, summonses or damages is determined in the United States legal papers received in connection (including its territories and possessions), with the injury, claim, proceeding Puerto Rico, or Canada, in a suit on the or "suit"; merits according to the substantive law in (2) Authorize us to obtain records and such territory, or in a settlement we agree other information; to. (3) Cooperate with us and assist us, as G. The following are added to the Definitions Sec- we may request, in the investiga- tion: tion or settlement of the claim or 1. "Workers Compensation Law" means the defense against the "suit"; Workers Compensation Law and any Occu- (4) Assist us, upon our request, in the pational Disease Law of Washington. This enforcement of any right against does not include provisions of any law pro- any person or organization which viding non-occupational disability benefits. may be liable to the insured be- 2. "Bodily injury by accident" means bodily in- cause of injury to which this insur- jury, sickness or disease sustained by a ance may also apply; and person, including death, resulting from an (5) Do nothing after an injury occurs accident. A disease is not "bodily injury by that would interfere with our right accident" unless it results directly from to recover from others. "bodily injury by accident". d. No insured will, except at that insured's 3. "Bodily injury by disease" means a disease own cost, voluntarily make a payment, sustained by a person, including death. assume any obligation, or incur any ex- "Bodily injury by disease" does not include pense, other than for first aid, without a disease that results directly from an acci- our consent. dent. F. For the purposes of this endorsement, Para- H. For the purposes of this endorsement, the defi- graph 4. of the Definitions Section is replaced nition of "bodily injury" does not apply. by the following: Page 4 of 4 Copyright, ISO Properties, Inc., 2003 CG 04 42 11 03 COMMERCIAL GENERAL LIABILITY CG04500508 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WASHINGTON CHANGES - WHO IS AN INSURED This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Paragraphs 2.a.(1)(a), (b) and (c) of Section II — your business. However, none of these Who Is An Insured apply only to "employees" of "employees" is an insured for: the insured whose employment is not subject to (1) "Bodily injury" or "personal and adver- the Industrial Insurance Act of Washington (Washington Revised Code Title 51). tising injury": (a) To you, to your partners or mem- With respect to "employees" of the insured whose bers (if you are a partnership or employment is subject to the Industrial Insurance joint venture), to your members (if Act of Washington, the reference to "volunteer workers" is removed from Paragraph 2.(a) of yourare a limitedmolgee" company), or to a co-"employee" while that Section II — Who Is An Insured and Paragraph co-"employee" is either in the 2.a.(1) of Section II — Who Is An Insured is course of his or her employment or replaced with the following: performing duties related to the 2. Each of the following is also an insured: conduct of your business; a. Your "employees", other than either your (b) For which there is any obligation to "executive officers" (if you are an organiza- share damages with or repay some- tion other than a partnership, joint venture one else who must pay damages or limited liability company) or your because of the injury described in managers (if you are a limited liability Paragraph (1)(a) above; or company), but only for acts within the scope of their employment by you or while (c) or faAiling out of his or her providing performing duties related to the conduct of to provide professional health care services. CG 04 50 05 08 © ISO Properties, Inc., 2007 Page 1 of 1 COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 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 LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2) You have agreed in writing in a Condition and supersedes any provision to the contract or agreement that this insur- contrary: ance would be primary and would not Primary And Noncontributory Insurance seek contribution from any other insur ance available to the additional insured. 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 In- sured under such other insurance; and CG 20 01 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 COMMERCIAL GENERAL LIABILITY CG 21 06 05 14 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION - ACCESS OR DISCLOSURE OF CONFIDENTIAL OR PERSONAL INFORMATION AND DATA-RELATED LIABILITY - WITH LIMITED BODILY INJURY EXCEPTION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Exclusion 2.p. of Section I — Coverage A — As used in this exclusion, electronic Bodily Injury And Property Damage Liability is data means information, facts or pro- replaced by the following: grams stored as or on, created or used 2. Exclusions on, or transmitted to or from computer software, including systems and This insurance does not apply to: applications software, hard or floppy p. Access Or Disclosure Of Confidential disks, CD-ROMs, tapes, drives, cells, Or Personal Information And Data- data processing devices or any other related Liability media which are used with elec- Damages arising out of: tronically controlled equipment. (1) Any access to or disclosure of any B. The following is added to Paragraph 2. person's or organization's confi Exclusions of Section I — Coverage B — Per- dential or personal information, sonal And Advertising Injury Liability: including patents, trade secrets, 2. Exclusions processing methods, customer lists, This insurance does not apply to: financial information, credit card information, health information or Access Or Disclosure Of Confidential Or any other type of nonpublic infor Personal Information mation; or "Personal and advertising injury" arising (2) The loss of, loss of use of, damage out of any access to or disclosure of any to, corruption of, inability to ac person's or organization's confidential or cess, or inability to manipulate elec personal information, including patents, tronic data. trade secrets, processing methods, cus- tomer lists, financial information, credit This exclusion applies even if damages card information, health information or any are claimed for notification costs, credit other type of nonpublic information. monitoring expenses, forensic ex- penses, public relations expenses or This exclusion applies even if damages are any other loss, cost or expense in- claimed for notification costs, credit moni- curred by you or others arising out of toring expenses, forensic expenses, public that which is described in Paragraph (1) relations expenses or any other loss, cost or (2) above. or expense incurred by you or others arising out of any access to or disclosure of However, unless Paragraph (1) above any person's or organization's confidential applies, this exclusion does not apply or personal information. to damages because of "bodily injury". CG 21 06 05 14 © Insurance Services Office, Inc., 2013 Page 1 of 1 COMMERCIAL GENERAL LIABILITY CG21090615 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION - UNMANNED AIRCRAFT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Exclusion 2.g. Aircraft, Auto Or Watercraft This Paragraph g.(2) applies even if under Section I — Coverage A — Bodily Injury the claims against any insured And Property Damage Liability is replaced by allege negligence or other wrong- the following: doing in the supervision, hiring, em- 2. Exclusions ployment, training or monitoring of others by that insured, if the "oc- This insurance does not apply to: currence" which caused the "bodily g. Aircraft, Auto Or Watercraft injury" or "property damage" in- (1) Unmanned Aircraft volved the ownership, mainte- nance, use or entrustment to others "Bodily injury" or "property dam- of any aircraft (other than "un- age" arising out of the ownership, manned aircraft"), "auto" or water maintenance, use or entrustment to craft that is owned or operated by others of any aircraft that is an "un- or rented or loaned to any insured. manned aircraft". Use includes op This Paragraph g.(2) does not apply eration and "loading or unloading". to: This Paragraph g.(1) applies even if (a) A watercraft while ashore on the claims against any insured allege negligence or other wrong premises you own or rent; doing in the supervision, hiring, em- (b) A watercraft you do not own ployment, training or monitoring of that is: others by that insured, if the "oc- (i) Less than 26 feet long; and currence" which caused the "bodily injury" or "property damage" in- (ii) Not being used to carry per volved the ownership, mainte- nance, use or entrustment to others charge; of any aircraft that is an "un- (c) Parking an "auto" on, or on the manned aircraft". ways next to, premises you (2) Aircraft (Other Than Unmanned own or rent, provided the Aircraft), Auto Or Watercraft "auto" is not owned by or rented or loaned to you or the "Bodily injury" or "property dam- insured; age" arising out of the ownership, maintenance, use or entrustment to (d) Liability assumed under any "in- others of any aircraft (other than sured contract" for the own "unmanned aircraft"), "auto" or ership, maintenance or use of watercraft owned or operated by or aircraft or watercraft; or rented or loaned to any insured. Use includes operation and "loading or unloading". CG 21 09 06 15 © Insurance Services Office, Inc., 2014 Page 1 of 2 (e) "Bodily injury" or "property This exclusion applies even if the claims damage" arising out of: against any insured allege negligence or (i) The operation of machinery other wrongdoing in the supervision, hiring, or equipment that is at- employment, training or monitoring of tached to, or part of, a land others by that insured, if the offense which vehicle that would qualify caused the "personal and advertising under the definition of "mo injury" involved the ownership, mainte- bile equipment" if it were nance, use or entrustment to others of any not subject to a compulsory aircraft that is an "unmanned aircraft". or financial responsibility This exclusion does not apply to: law or other motor vehicle a. The use of another's advertising idea in insurance law where it is li- censed or principally ga— raged; or b. Infringing upon another's copyright, (ii) The operation of any of the trade dress or slogan in your "adver- tisement". machinery or equipment listed in Paragraph f.(2) or C. The following definition is added to the Defi- f.(3) of the definition of nitions section: "mobile equipment". "Unmanned aircraft" means an aircraft that is B. The following exclusion is added to Paragraph not: 2. Exclusions of Coverage B — Personal And 1. Designed; Advertising Injury Liability: 2. Manufactured; or 2. Exclusions 3. Modified after manufacture; This insurance does not apply to: to be controlled directly by a person from with- Unmanned Aircraft in or on the aircraft. "Personal and advertising injury" arising out of the ownership, maintenance, use or entrustment to others of any aircraft that is an "unmanned aircraft". Use includes oper- ation and "loading or unloading". Page 2 of 2 © Insurance Services Office, Inc., 2014 CG 21 09 06 15 COMMERCIAL GENERAL LIABILITY CG21710115 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION OF OTHER ACTS OF TERRORISM COMMITTED OUTSIDE THE UNITED STATES; CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY A. The following exclusion is added: c. Protracted loss of or impairment of the This insurance does not apply to: function of a bodily member or organ;or TERRORISM 3. The terrorism involves the use, release or escape of nuclear materials, or directly or "Any injury or damage" arising, directly or indirectly results in nuclear reaction or radiation indirectly, out of an "other act of terrorism" that is or radioactive contamination;or committed outside of the United States (including its territories and possessions and Puerto Rico), 4. The terrorism is carried out by means of the but within the "coverage territory". However, this dispersal or application of pathogenic or exclusion applies only when one or more of the poisonous biological or chemical materials;or following are attributed to such act: 5. Pathogenic or poisonous biological or chemical 1. The total of insured damage to all types of materials are released, and it appears that one property exceeds $25,000,000 (valued in U.S. purpose of the terrorism was to release such dollars). In determining whether the materials. $25,000,000 threshold is exceeded, we will With respect to this exclusion, Paragraphs 1. and include all insured damage sustained by 2. describe the thresholds used to measure the property of all persons and entities affected by magnitude of an incident of an "other act of the terrorism and business interruption losses terrorism" and the circumstances in which the sustained by owners or occupants of the threshold will apply for the purpose of determining damaged property. For the purpose of this whether this exclusion will apply to that incident. provision, insured damage means damage that B. The following definitions are added: is covered by any insurance plus damage that would be covered by any insurance but for the 1. For the purposes of this endorsement, "any application of any terrorism exclusions;or injury or damage" means any injury or damage covered under any Coverage Part to which this 2. Fifty or more persons sustain death or serious endorsement is applicable, and includes but is physical injury. For the purposes of this not limited to "bodily injury", "property provision, serious physical injury means: damage", "personal and advertising injury", a. Physical injury that involves a substantial "injury" or "environmental damage" as may be risk of death; or defined in any applicable Coverage Part. b. Protracted and obvious physical disfigurement; or CG 21 71 01 15 © Insurance Services Office, Inc., 2015 Page 1 of 2 2. "Certified act of terrorism" means an act that is 3. "Other act of terrorism" means a violent act or certified by the Secretary of the Treasury, in an act that is dangerous to human life, property accordance with the provisions of the federal or infrastructure that is committed by an Terrorism Risk Insurance Act, to be an act of individual or individuals and that appears to be terrorism pursuant to such Act. The criteria part of an effort to coerce a civilian population contained in the Terrorism Risk Insurance Act or to influence the policy or affect the conduct for a "certified act of terrorism" include the of any government by coercion, and the act is following: not a"certified act of terrorism". a. The act resulted in insured losses in excess Multiple incidents of an "other act of terrorism" of$5 million in the aggregate, attributable to which occur within a seventy-two hour period all types of insurance subject to the and appear to be carried out in concert or to Terrorism Risk Insurance Act; have a related purpose or common leadership shall be considered to be one incident. b. The act resulted in damage: (1) Within the United States (including its C. The terms and limitations of any terrorism territories and possessions and Puerto exclusion, or the inapplicability or omission of a Rico);or terrorism exclusion, do not serve to create coverage for injury or damage that is otherwise (2) Outside of the United States in the case excluded under this Coverage Part. of: D. If aggregate insured losses attributable to terrorist (a) An air carrier (as defined in Section acts certified under the federal Terrorism Risk 40102 of title 49, United States Insurance Act exceed $100 billion in a calendar Code) or United States flag vessel year and we have met our insurer deductible (or a vessel based principally in the under the Terrorism Risk Insurance Act, we shall United States, on which United not be liable for the payment of any portion of the States income tax is paid and whose amount of such losses that exceeds $100 billion, insurance coverage is subject to and in such case insured losses up to that amount regulation in the United States), are subject to pro rata allocation in accordance regardless of where the loss occurs; with procedures established by the Secretary of or the Treasury. (b) The premises of any United States mission;and c. The act is a violent act or an act that is dangerous to human life, property or infrastructure and is committed by an individual or individuals as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion. CG 21 71 01 15 © Insurance Services Office, Inc., 2015 Page 2 of 2 COMMERCIAL GENERAL LIABILITY CG 21 76 01 15 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION OF PUNITIVE DAMAGES RELATED TO A CERTIFIED ACT OF TERRORISM This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY A. The following exclusion is added: 2. The act is a violent act or an act that is dangerous to human life, property or This insurance does not apply to: TERRORISM PUNITIVE DAMAGES infrastructure and is committed by an individual or individuals as part of an effort to coerce the Damages arising, directly or indirectly, out of a civilian population of the United States or to "certified act of terrorism" that are awarded as influence the policy or affect the conduct of the punitive damages. United States Government by coercion. B. The following definition is added: C. The terms and limitations of any terrorism "Certified act of terrorism" means an act that is exclusion, or the inapplicability or omission of a certified by the Secretary of the Treasury, in terrorism exclusion, do not serve to create accordance with the provisions of the federal coverage for injury or damage that is otherwise Terrorism Risk Insurance Act, to be an act of excluded under this Coverage Part. terrorism pursuant to such Act. The criteria contained in the Terrorism Risk Insurance Act for a "certified act of terrorism" include the following: 1. The act resulted in insured losses in excess of $5 million in the aggregate, attributable to all types of insurance subject to the Terrorism Risk Insurance Act; and CG 21 76 01 15 © Insurance Services Office, Inc., 2015 Page 1 of 1 COMMERCIAL GENERAL LIABILITY CG 24 26 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT OF INSURED CONTRACT DEFINITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The definition of "insured contract" in the Paragraph f. does not include that part of Definitions section is replaced by the following: any contract or agreement: "Insured contract" means: (1) That indemnifies a railroad for "bodily a. A contract for a lease of premises. How- injury" or "property damage" arising ever, that portion of the contract for a out of construction or demolition opera- lease of premises that indemnifies any tions, within 50 feet of any railroad person or organization for damage by fire property and affecting any railroad to premises while rented to you or bridge or trestle, tracks, road-beds, tun- temporarily occupied by you with per- mission of the owner is not an "insured (2) That indemnifies an architect, engineer contract"; or surveyor for injury or damage arising b. A sidetrack agreement; out of: c. Any easement or license agreement, except (a) Preparing, approving, or failing to in connection with construction or dem prepare or approve, maps, shop olition operations on or within 50 feet of a drawings, opinions, reports, sur railroad; veys, field orders, change orders or drawings and specifications; or d. An obligation, as required by ordinance, to indemnify a municipality, except in connec (b) Giving directions or instructions, or tion with work for a municipality; failing to give them, if that is the e. An elevator maintenance agreement; primary cause of the injury or dam- age; or f. That part of any other contract or agree- (3) Under which the insured, if an archi- ment pertaining to your business (including tect, engineer or surveyor, assumes an indemnification of a municipality in con- liability for an injury or damage arising nection with work performed for a munici- out of the insured's rendering or failure pality) under which you assume the tort lia- to render professional services, in- bility of another party to pay for "bodily cluding those listed in (2) above and injury" or "property damage" to a third per- supervisory, inspection, architectural or son or organization, provided the "bodily in engineering activities. jury" or "property damage" is caused, in whole or in part, by you or by those acting on your behalf. However, such part of a contract or agreement shall only be con- sidered an "insured contract" to the extent your assumption of the tort liability is per- mitted by law. Tort liability means a liability that would be imposed by law in the absence of any contract or agreement. CG 24 26 04 13 © Insurance Services Office, Inc. 2012 0 Page 1 of 1 COMMERCIAL GENERAL LIABILITY CG 32 20 01 15 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WASHINGTON CONDITIONAL EXCLUSION OF TERRORISM (RELATING TO DISPOSITION OF FEDERAL TERRORISM RISK INSURANCE ACT) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY A. Applicability Of The Provisions Of This Endorsement 131 Redefine terrorism or make insur ance coverage for terrorism subject 1. The provisions of this endorsement become to provisions or requirements that applicable commencing on the date when differ from those that apply to other any one or more of the following first types of events or occurrences occurs. But if your policy (meaning the pol- this policy. icy period in which this endorsement ap- 2. If the provisions of this endorsement be- plies) begins after such date, then the pro- come applicable, such provisions: visions of this endorsement become applicable on the date your policy begins. a. Supersede any terrorism endorsement a. The federal Terrorism Risk Insurance already endorsed to this policy that ad- dresses "certified acts of terrorism" Program ("Program"), established by and/or "other acts of terrorism", but the Terrorism Risk Insurance Act, has only with respect to an incident(s) of terminated with respect to the type of terrorism (however defined) which insurance provided under this Coverage results in injury or damage that occurs Part or Policy; or on or after the date when the pro- b. A renewal, extension or replacement of visions of this endorsement become applicable (for claims made policies, the Program has become effective without a requirement to make terror- such an endorsement is superseded only with respect to an incident of ter ism coverage available to you and with revisions that: rorism (however defined) that results in (1) Increase our statutor a claim for injury or damage first being y percentage made on or after the date when the deductible under the Program for provisions of this endorsement become terrorism losses. (That deductible determines the amount of all certi applicable); and b. Remain applicable unless we notify you fied terrorism losses we must pay in a calendar year, before the feder of changes in these provisions, in re- al government shares in subsequent sponse to federal law. payment of certified terrorism 3. If the provisions of this endorsement do losses.); or NOT become applicable, any terrorism en- (2) Decrease the federal government's dorsement already endorsed to this policy, that addresses "certified acts of terrorism" statutory percentage share in po and/or "other acts of terrorism", will con- tential terrorism losses above such deductible; or tinue in effect unless we notify you of changes to that endorsement in response to federal law. CG 32 20 01 15 © Insurance Services Office, Inc., 2015 Page 1 of 2 B. The following definitions are added and apply 2. Radioactive material is released, and it ap- under this endorsement wherever the term pears that one purpose of the "terrorism" terrorism, or the phrase any injury or damage, was to release such material; or are enclosed in quotation marks: 3. The "terrorism" is carried out by means of 1. "Terrorism" means activities against per- the dispersal or application of pathogenic or sons, organizations or property of any na- poisonous biological or chemical materials; ture: or a. That involve the following or prepara- 4. Pathogenic or poisonous biological or tion for the following: chemical materials are released, and it (1) Use or threat of force or violence; appears that one purpose of the "terrorism" or was to release such materials; or (2) Commission or threat of a dan 5. The total of insured damage to all types of gerous act; or property exceeds $25,000,000. In deter- mining whether the $25,000,000 threshold (3) Commission or threat of an act that is exceeded, we will include all insured interferes with or disrupts an elec- damage sustained by property of all per- tronic, communication, information, sons and entities affected by the "terror- or mechanical system; and ism" and business interruption losses sus- b. When one or both of the following ap- tained by owners or occupants of the plies: damaged property. For the purpose of this (1) The effect is to intimidate or coerce provision, insured damage means damage a government or the civilian popula that is covered by any insurance plus tion or any segment thereof, or to damage that would be covered by any in- disrupt any segment of the econo surance but for the application of any my; or terrorism exclusions; or (2) It appears that the intent is to in- 6. Fifty or more persons sustain death or timidate or coerce a government, or serious physical injury. For the purposes of to further political, ideological, reli this provision, serious physical injury gious, social or economic objectives means: or to express (or express opposition a. Physical injury that involves a substan- to) a philosophy or ideology. tial risk of death; or 2. "Any injury or damage" means any injury b. Protracted and obvious physical disfig- or damage covered under any Coverage urement; or Part or Policy to which this endorsement is c. Protracted loss of or impairment of the applicable, and includes but is not limited function of a bodily member or organ. to "bodily injury", "property damage", "personal and advertising injury", "injury" Multiple incidents of "terrorism" which occur or "environmental damage" as may be de- within a 72-hour period and appear to be fined in any applicable Coverage Part or carried out in concert or to have a related pur- Policy. pose or common leadership will be deemed to be one incident, for the purpose of determining C. The following exclusion is added: whether the thresholds in Paragraphs C.S. or EXCLUSION OF TERRORISM C.6. are exceeded. We will not pay for "any injury or damage" With respect to this Exclusion, Paragraphs C.S. caused directly or indirectly by "terrorism", and C.6. describe the threshold used to mea- including action in hindering or defending sure the magnitude of an incident of "terror- against an actual or expected incident of ism" and the circumstances in which the "terrorism". But this exclusion applies only threshold will apply, for the purpose of when one or more of the following are attri- determining whether this Exclusion will apply buted to an incident of "terrorism": to that incident. When the Exclusion applies to 1. The "terrorism" is carried out by means of an incident of "terrorism", there is no coverage the dispersal or application of radioactive under this Coverage Part or Policy. material, or through the use of a nuclear The terms and limitations of any terrorism ex- weapon or device that involves or produces clusion, or the inapplicability or omission of a a nuclear reaction, nuclear radiation or terrorism exclusion, do not serve to create radioactive contamination; or coverage for injury or damage that is otherwise excluded under this Coverage Part. Page 2 of 2 © Insurance Services Office, Inc., 2015 CG 32 20 01 15 COMMERCIAL GENERAL LIABILITY WNGL020710 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PUNITIVE DAMAGES EXCLUSION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following exclusion is added to Paragraph 2., Exclusions of Section I — Coverage A— Bodily Injury And Property Damage Liability and Paragraph 2., Exclusions of Section I — Coverage B — Personal And Advertising Injury Liability: Punitive Damages This insurance does not apply to punitive or exemplary damages. However, in the event an insured is alleged to be legally liable for both compensatory damages and punitive damages, if we provide a defense to the claim for compensatory damages,we will also provide a defense to the claim for punitive damages. WN GL 02 07 10 Page 1 of 1 Includes copyrighted material of the Insurance Service Office,Inc.,with its permission. COMMERCIAL GENERAL LIABILITY WNGL100104 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION — LEAD LIABILITY This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following exclusion is added to Paragraph 2., Exclusions of Section I - Coverage A - Bodily Injury And Property Damage Liability and Paragraph 2., Exclusions of Section I - Coverage B - Personal And Advertising Injury Liability : This insurance does not apply to "bodily arising out of the actual, alleged, or injury", "property damage", or "personal and threatened absorption, ingestion, or advertising injury" arising out of: inhalation by any person of lead, lead based paint, or any other material or 1. The actual, alleged, or threatened substance containing lead; or absorption, ingestion, or inhalation by any person of lead, lead based paint, or any 3. Any loss, cost or expense arising out of other material or substance containing any governmental direction or request that lead; you test for, monitor, cleanup, remove, abate, contain, treat or neutralize lead, 2. Any legal obligation of yours for indemni- paint containing lead, or any other fication or contribution due to damages substance or material containing lead. WN GL 10 01 04 Page 1 of 1 Includes copyrighted material of the Insurance Service Office, Inc.,with its permission. III COMMERCIAL GENERAL LIABILITY WNGL151216 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION - ASBESTOS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. The following exclusion is added to Para- B. The following exclusion is added to Para- graph 2., Exclusions of Section I — Cover- graph 2., Exclusions of Section I—Cover- age A— Bodily Injury And Property Dam- age B — Personal And Advertising Injury age Liability: Liability: 2. Exclusions 2. Exclusions This insurance does not apply to: This insurance does not apply to: Asbestos Asbestos a. "Bodily injury" arising, in whole or in part, out of the actual, alleged, a. "Personal and advertising injury" threatened or suspected inhalation arising, in whole or in part, out of the of, or ingestion of, exposure to, "as- actual, alleged, threatened or sus- bestos" or "asbestos containing petted inhalation of, ingestion of, products"; contact with, exposure to, existence of, or presence of, "asbestos" or b. "Property damage" arising, in whole "asbestos containing products' or in part, out of the actual, alleged, b. Any loss, cost or expense arising, in threatened or suspected contact with, exposure to, existence of, or whole or in part, out of the abating, presence of, "asbestos" in any form testing for, monitoring, cleaning up, or "asbestos containing products", removing, containing, treating, de toxifying, neutralizing, remediating including the costs of remedial in- vestigations or feasibility studies, or or disposing of, or in any way re- to the costs of testing, monitoring, sponding to or assessing the effects of, contain- cleaning or removal of any property "asbestos" or "asbestos or substance;or ing products", by any insured or by any other person or entity. c. Any loss, cost or expense arising, in C. The following definitions are added to the whole or part, out of the abating, testing for, monitoring, cleaning up, Definitions Section: removing, containing, treating, de- 1. "Asbestos" means asbestos or asbestos toxifying, neutralizing, remediating fibers, in any form, including but not lim- or disposing of, or in any way re- ited to, chrysotile, amosite, crocidolite, sponding to or assessing the effects tremolite, anthophyllite, and actinolite, of, "asbestos" or any "asbestos con- asbestos particles, asbestos dust or as- taining products", by any insured or bestos compounds. by any other person or entity. 2. "Asbestos containing products" means any product in which "asbestos" is incor- porated or forms a part. WN GL 15 1216 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 1 of 1 COMMERCIAL GENERAL LIABILITY WNGL210714 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ABUSE OR MOLESTATION EXCLUSION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following exclusion is added to Paragraph 2., c. Supervision; Exclusions of Section I — Coverage A — Bodily Injury And Property Damage Liability and d. Reporting to the proper authorities, or Paragraph 2., Exclusions of Section I —Coverage failure to so report;or B—Personal And Advertising Injury Liability: e. Retention; This insurance does not apply to "bodily injury", of a person for whom any insured is or ever "property damage" or "personal and advertising was legally responsible and whose conduct injury"arising out of: would be excluded by Paragraph 1. above. 1. The actual or threatened abuse or molestation by anyone of any person,or 2. The negligent: a. Employment; b. Investigation; WN GL 21 07 14 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 1 of 1 COMMERCIAL GENERAL LIABILITY CGMU4311220 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION - AMMUNITION OR FIREWORKS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following exclusion is added to Paragraph 2. Exclusions of Section I - Coverages, Coverage A - Bodily Injury And Property Damage Liability, Paragraph 2. Exclusions of Section I - Coverages - Coverage B - Per- sonal And Advertising Injury Liability and Paragraph 2. Exclusions of Section I - Coverages - Coverage C - Medical Payments: This insurance does not apply to "bodily injury", "property damage", "personal and advertising injury" or medical expenses arising directly or indirectly out of the purchasing, selling, manufacturing, storage, han- dling, or igniting of any and all ammunitions or explosive devices including "fireworks", "dangerous fire- works", or "sparkling devices" regardless of whether such operations are conducted by you or on your be- half or whether the operations are conducted for you or for others. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured if the "occurrence" which caused the "bodily injury", "property damage", "personal and advertising injury" or medical expenses in- volved that which is described in the paragraph above. For the purpose of this endorsement, the following definitions apply: "Fireworks" means any combustible or exploding device for producing a striking display of light or loud noise, or any pyrotechnic display including but not limited to entertainment display fireworks, articles of py- rotechnic, special effects, consumer fireworks, blank cartridges, and "sparkling devices". "Dangerous fireworks" means any "fireworks" capable of causing serious physical injury and are firecrack- ers containing more than fifty (50) milligrams of any explosive substance, torpedoes, skyrockets, and rock- ets, roman candles, and bombs. "Sparkling devices" means any ground-based or hand-held device that produce a shower of white, gold, or colored sparks, a colored flame, an audible crackling or whistle, or smoke as their primary pyrotechnic ef- fect. CG MU 431 12 20 Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. COMMERCIAL GENERAL LIABILITY CGMU4481220 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCESS PROVISION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Paragraph 4. Other Insurance of Conditions (Section IV) is replaced by the following: The coverage afforded under this Coverage Part will be excess over any other valid and collectible insurance whether that insurance is primary, excess, contingent or on any other basis. CG MU 448 01 17 Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. COMMERCIAL GENERAL LIABILITY CG MU 505 12 20 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION - TRAMPOLINES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following exclusion is added to Paragraph 2. Exclusions of Section I - Coverages, Coverage A - Bodily Injury and Property Damage Liability, Paragraph 2. Exclusions of Section I - Coverage B - Personal and Ad- vertising Injury Liability and Paragraph 2. Exclusions of Coverage C - Medical Payments: This insurance does not apply to "bodily injury", "property damage", "personal and advertising injury" or medical expenses arising out of the ownership, maintenance or use of a trampoline or springboard. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured if the "occurrence" which caused the "bodily injury", "property damage", "personal and advertising injury" or medical expenses in- volved that which is described in paragraph above. CG MU 505 12 20 Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. COMMERCIAL GENERAL LIABILITY CG MU 588 12 20 THIS ENDORSEMENT CHANGES THE POLICY. O CY. PLEASE READ IT CAREFULLY. EXCLUSION -MECHANICALLY OPERATED AMUSEMENT DEVICES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following exclusion is added to Paragraph 2. Exclusions of Section I - Coverages, Coverage A - Bodily Injury and Property Damage Liability, Paragraph 2. Exclusions of Section I - Coverage B - Personal and Ad- vertising Injury Liability and Paragraph 2. Exclusions of Coverage C - Medical Payments: This insurance does not apply to "bodily injury", "property damage", "personal and advertising injury" or medical expenses arising out of the ownership, operation, maintenance or use of any mechanically operated amusement device. For purposes of this endorsement, a mechanically operated amusement device includes but is not limited to any mechanically operated device a person rides for enjoyment. This includes a ski tow or tow when used in connection with a water slide, or bungee operation or equipment. Mechanically operated amusement device does not include any video arcade or computer game. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured if the "occurrence" which caused the "bodily injury", "property damage", "personal and advertising injury" or medical expenses in- volved that which is described in paragraph above. CG MU 588 12 20 Page 1 of 1 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. COMMERCIAL GENERAL LIABILITY CG MU 1078 12 20 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. GENERAL LIABILITY SPECIALTY SOLUTIONS ENHANCEMENT This endorsement modified insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM (CG 00 01) SUMMARY OF COVERAGES Description Limit Of Insurance Abduction $50,000 per Abduction/$50,000 Aggregate/$1,000 deductible Additional Insured — Broad Form Vendors Included Additional Insured — Lessor Of Leased Equipment Included Additional Insured— Managers Or Lessors Of Premises Included Additional Insured — State Or Political Subdivisions — Permits Included Additional Insureds By Written Contract Included Broad Form Property Damage $25,000 Per Occurrence Broad Knowledge/Notice Of Occurrence Included Damage To Premises Rented To You $300,000 Any One Premises Designated Location(s) — General Aggregate Limit Included Employee Bodily Injury To A Co-Employee Included Insured Contract Amended Included Medical And Dental Payments $10,000 Medical Expense Limit Mobile Equipment Included Non-Owned Watercraft 51 Feet Occupational License Review Expense $2,500 Per Review/$5,000 Aggregate Property Damage Liability— Borrowed Equipment $25,000 Occurrence/$50,000 Aggregate Property Damage Liability— Elevator And Sidetrack Agreement Included Supplementary Payments Increased Limits Bail Bonds $2,500 Loss Of Earnings Per Day $1,000 Unintentional Failure To Disclose Hazards Included Waiver Of Transfer Of Rights Of Recovery Against Others To Us Included CG MU 1078 12 20 Page 1 of 11 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. The terms and conditions of this policy are amended as indicated below: I. Non-Owned Watercraft SECTION I — COVERAGES, COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE, Exclusion 2.g.(2) is revised as follows: This exclusion does not apply to: (2) A watercraft you do not own that is: (a) Less than 51 feet long; and (b) Not being used to carry persons or property for a charge; This provision applies to any person, who with your expressed or implied consent, either uses or is re- sponsible for the use of the watercraft. This provision does not apply if the insured has any other insurance for "bodily injury" or "property damage" liability that would also be covered under this provision, whether the other insurance is pri- mary, excess, contingent or on any other basis. In that case, this provision does not provide any insur- ance. II. Damage To Premises Rented To You Under SECTION I — COVERAGES, COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE, the last paragraph of 2. is deleted and replaced with the following: Exclusions c. through n. do not apply to "Property Damage" to the premises while rented to you or tem- porarily occupied by you with permission of the owner. A separate Damage To Premises Rented To You Limit of Insurance applies to this coverage which is the greater of: 1. The Damage To Premises Rented To You Limit for Each Occurrence shown in the Declarations; or 2. $300,000 Under Section III — LIMITS OF INSURANCE, paragraph 6. does not apply. III. Supplementary Payments SECTION I — COVERAGES, SUPPLEMENTARY PAYMENTS — COVERAGES A & B, are revised as fol- lows: 1. In paragraph 2.,the limit of $250 for bail bonds is increased to $2,500. 2. In paragraph 4., the limit of $250 for daily loss of earnings is increased to $1,000. IV. Medical And Dental Payments Under SECTION I — COVERAGES, COVERAGE C. MEDICAL PAYMENTS, if COVERAGE C. MEDICAL PAYMENTS, is not otherwise excluded from this Coverage Part: 1. The Medical Payments Limit is changed to the greater of: a. $10,000; or b. The Medical Expenses Limit shown in the Declarations of this Coverage Part. 2. The provision, in C.1.a.(2) that the expenses must be incurred and reported to us within one year of the date of the accident, is increased to three years. V. Broad Form Property Damage Under SECTION I — COVERAGE A, Exclusion 2.j. is amended as fol►ows: 1. Paragraph (3) does not apply. 2. Paragraphs (4) and (6) do not apply to customer's property at your described premises. We do not cover any property: 1. Subject to motor vehicle registration; or 2. While being used to perform construction operations. Our limit for any one "occurrence" under this coverage provision is $25,000. The insurance afforded by reason of this provision is excess over any valid and collectible property in- surance (including any deductible) available to the insured, and SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS 4. Other Insurance is changed accordingly. CG MU 1078 12 20 Page 2 of 11 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. VI. Occupational License Review Expense The following is added under SECTION I — COVERAGES, COVERAGE A. BODILY INJURY AND PROP- ERTY DAMAGE LIABILITY: 1. Insuring Agreement Subject to the per review and annual aggregate limits of insurance stated in this endorsement, we agree to pay the "insured" for reasonable and necessary covered expenses, as listed below, incurred and paid by the "insured" as a direct result of a "occupational license review", conducted by a gov- ernmental bureau, board, commission or department, occurring during the policy period and in the "coverage territory". a. Covered Expenses include: (1) Fees and expenses of any licensed independent investigative services or legal counsel, hired by the "insured" for the purpose of assisting or representing the "insured" at the "occupa- tional license review"; and (2) Costs of travel, accommodations, and meals incurred by the "insured" in order to appear be- fore the governmental bureau, board, commission or department. b. Exclusions This coverage will not pay for: (1) Hearing fees; or (2) Fines, judgments, lawsuits, or settlement amounts as the result of or in conjunction with the "occupational license review"; or (3) Expense(s) directly or indirectly caused or resulting from the fraudulent, dishonest, or crimi- nal acts of the "insured", any director or officer of the "insured", or agents thereof, whether acting alone or in collusion with others; or (4) Lost salary or wages claimed by or for any "insured" while preparing for or attending the "occupational license review". 2. For the purposes of the coverage provided by this provision, SECTION III — LIMITS OF INSURANCE is amended as follows: With respect to this endorsement only, the following apply: a. The per review limit of insurance shown in this endorsement is the most we will pay per review, regardless of the number of "insureds" reviewed or subject to the "occupational license review". b. The annual aggregate limit of insurance shown in this endorsement is the most we will pay for all covered expenses for each policy period. c. In the event that the "occupational license review" continues over more than one policy period, the expenses shall be limited to the annual aggregate applicable to the policy period when the li- cense review began. d. In no event will any expense claimed for an "occupational license review" be recoverable as ex- pense for another "occupational license review". e. The limits of insurance stated in this endorsement are not part of and are in addition to, the Li- ability Limits of Insurance shown in the Declarations for this policy. 3. For the purposes of the coverage provided by this provision, the following are added under SEC- TION IV-COMMERCIAL GENERAL LIABILITY CONDITIONS: a. In the event of a "occupational license review" during the policy period, the "insured" will: (1) Make every reasonable effort to give us immediate written notice and timely updates concur- rent with activity regarding the "occupational license review"; (2) Provide us with the official report of the "occupational license review"; and (3) Provide us with documentation, including receipts, for expenses claimed under this cover- age. b. The insurance under this endorsement will be excess over any other valid insurance or bond. CG MU 1078 12 20 Page 3 of 11 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. mumm 4. For the purposes of the coverage provided by this provision, the following are added under SEC- TION V — DEFINITIONS: a. "Insured" as used in this endorsement means an employee of the Named Insured shown in the Declarations, but does not include leased or temporary workers or volunteers. "Insured" does not include the Named Insured, unless the Named Insured is an individual person operating as a sole proprietorship, or any other business, whether corporation, partnership, limited liability company or other organization. "Insured" only includes natural persons. b. "Occupational license review" means a formal or informal proceeding conducted by a govern- mental bureau, board, commission or department charged with regulating the "insured's" occu- pational license and involving the review, modification, denial, suspension, or nonrenewal of the "insured's" occupational license or involving disciplinary action against the "insured", in- cluding proceedings to impose a forfeiture or penalty; but "occupational license review" does not include a proceeding concerning any criminal or civil charge brought against the "insured". VII. Abduction The following is added under SECTION I — COVERAGES, COVERAGE A. BODILY INJURY AND PROP- ERTY DAMAGE LIABILITY: 1. Insuring Agreement Subject to the limits, aggregate and deductible as stated in this endorsement, we agree to pay the insured for reasonable and necessary Covered Expenses, as listed below, incurred and paid by the insured or "Guardian(s)" as a direct result of an "abduction" occurring during the policy period and in the "coverage Territory", provided that such "abduction" is otherwise the subject of this en- dorsement hereunder. Payment of such Covered Expenses may continue until the earliest of the fol- lowing unless otherwise stated: a. Up to fourteen (14) days after the recovery of the "Covered Individuals►"; or b. Discovery of the death of the "Covered Individual(s)"; or c. Twelve (12) months after the date of the "abduction". Covered Expenses include the following incurred expenses: a. Fees and expenses of any independent investigative services, provided that we have given prior consent to the use of such independent investigative services; and b. Reward to an "Informant" for information leading to the recovery of the "Covered Individual(s)" and the arrest and conviction of the party(ies) responsible for the "abduction"; and c. Fees and expenses of independent forensic analysts engaged by the insured or "Guardian(s)" with prior authorization from us; and d. Fees and expenses of public relations consultants to assist in the location of the "Covered Indi- vidualls)"; and e. Publicity costs incurred solely and directly to assist in the resolution of an "abduction"; and f. Costs of travel and accommodations incurred by the insured or "Guardian(s) while attempting to resolve an "abduction"; and g. Rest and rehabilitation expenses including travel, lodging and meals of the "Covered Individual(s)" and "Guardian(s)" incurred by the "Guardian(s)" and paid by the insured following resolution of the loss covered hereunder. The total amount under this provision shall not ex- ceed $10,000 for any single loss; and h. Lost salary of "Guardian(s)", which is the amount of compensation paid at an annual rate in- cluding the average bonuses and commissions, that the "Guardian(s)" would normally have earned; and i. Fees for psychological or psychiatric counseling for the benefit of "Guardian(s)", or siblings of the "Covered Individual(s)" beginning on the date of recovery of the "Covered Individual(s)", until the earliest of the following: (1) Up to three (3) months after the recovery or discovery of the death of the "Covered Individ- ual(s)"; or (2) Twelve (12) months after the date of the "abduction"; and CG MU 1078 12 20 Page 4 of 11 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. j. Fees for psychological or psychiatric counseling for the benefit of "Covered Individual(s)" begin- ning on the date of recovery of the "Covered Individual(s)" and continuing up to twelve (12) months thereafter; and k. Medical services and hospitalization costs incurred for the "Covered Individual(s)" as a result of the "abduction" beginning on the date of recovery of the "Covered Individual(s)" and continuing up to twelve (12) months thereafter; and I. Funeral and burial expenses of "Covered Individual(s)" resulting from an "abduction". 2. Exclusions We will not pay any expense(s) directly or indirectly caused or resulting from: a. The fraudulent, dishonest, or criminal acts of any "Insured", any director or officer of the "In- sured", parents or "Guardian(s)" or agents thereof, whether acting alone or in collusion with others; or b. Any legal liability or costs of defense for administrative, regulatory, judicial or other claims hear- ings or lawsuits arising out of the "abduction"; or c. Payment of any "ransom" or demand for money. For the purposes of the abduction coverage provided by this provision, SECTION III — LIMITS OF IN- SURANCE is amended as follows: 1. The Limits of Insurance shown on this Endorsement and the rules below fix the most that we will pay regardless of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bring "suits". 2. The Aggregate Limit shown on this Endorsement is the most we will pay for all Covered Expenses for each policy period. All expenses arising from an act or series of related acts involving one or more persons or an act er- ror or event or a series of related acts, errors or events shall be treated as arising out of one "ab- duction". However we will not pay for any loss resulting from an "abduction" which is part of a ser- ies of related acts that began prior to the effective date of this insurance. 3. In no event will any expense claimed, incurred or paid under one "abduction" be recoverable under another "abduction". 4. The "abduction" limit is included as part of the Limits of Insurance under the Liability and Medical Expenses Aggregate Limit. 5. We will not pay for loss in any one "abduction" until the amount of loss exceeds the deductible shown on this Endorsement. We will than pay the amount of loss in excess of the deductible up to the applicable Limit of Insurance as shown in this Endorsement. The deductible will not reduce the Limit of Insurance. For the purposes of the abduction coverage provided by this provision, the following are added under SEC- TION IV-COMMERCIAL GENERAL LIABILITY CONDITIONS: 1. In the event of an "abduction" during the Policy Period, the "Insured" will make every reasonable effort to: (a) Determine that the "abduction" has actually occurred prior to incurring costs; and (b) Give immediate oral and written notice to us with periodic and timely updates concurrent with activ- ity occurring during the incident; and (c) Immediately notify local, national or other appropriate law enforcement agency having jurisdiction over the matter. 2. Confidentiality The "Insured" will use all reasonable efforts not to disclose the existence of this Endorsement. 3. Other Insurance The insurance under this Endorsement will be excess over any other valid insurance. CG MU 1078 12 20 Page 5 of 11 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 4. Cooperation You must cooperate with us in all matters pertaining to this insurance as stated in its terms and conditions. 5. Due Diligence You and every insured or "guardian" must exercise due diligence in doing all things reasonably practicable to avoid or diminish any loss covered under this insurance. For the purposes of the abduction coverage provided by this provision, the following are added under SECTION V — DEFINITIONS: 1. "Abduction" means the wrongful and illegal seizure of a "Covered Individual(s)", by someone oth- er than a "Guardian(s)" or an agent thereof, from the "premises" of the insured or on any other premises while such "Covered Individual(s)" are under the control of the insured occurring during the policy period. "Abduction" as used in this endorsement does not include the actions of any of- ficial acting within their lawful authority. 2. "Covered Individual(s)" means individual(s) under the care, custody and control of the insured. 3. "Informant" means any person, other than a "Covered Individual", providing information not other- wise obtainable solely in return for a reward offered by the insured. 4. "Guardian(s)" means the natural and legal Parent(s) or legal and appointed Guardian, step-Parent(s) or foster Parent(s) of a "Covered Individual(s)" regardless of who has legal custody. 5. "Premises" means any place the insured conducts business. 6. "Ransom" means a consideration paid or demanded for the release of a "Covered Individual(s)" from captivity. VIII. Property Damage Liability — Elevators And Sidetrack Agreements The following is added under SECTION I — COVERAGES, COVERAGE A. BODILY INJURY AND PROP- ERTY DAMAGE LIABILITY: 1. Exclusions j. (3), (4) and (6) do not apply to the use of elevators. 2. Exclusion k. does not apply to: a. The use of elevators; or b. Liability assumed under a sidetrack agreement. The insurance afforded by reason of this provision is excess over any valid and collectible property in- surance (including any deductible) available to the insured, and SECTION IV — COMMERCIAL GENER- AL LIABILITY CONDITIONS 4. Other Insurance is changed accordingly. IX. Designated Location(s)-General Aggregate Limit The following is added under SECTION I — COVERAGES, COVERAGE A. BODILY INJURY AND PROP- ERTY DAMAGE LIABILITY: 1. For all sums which the insured becomes legally obligated to pay as damages caused by "occur- rences" under COVERAGE A (Section I), and for all medical expenses caused by accidents under COVERAGE C (Section I), which can be attributed only to operations at a single designated "loca- tion" shown in the Declarations: a. A separate Designated Location General Aggregate Limit applies to each designated "location", and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. b. The Designated Location General Aggregate Limit is the most we will pay for the sum of all damages under COVERAGE A, except damages because of "bodily injury" or property dam- age" included in the "products-completed operations hazard", and for medical expenses under COVERAGE C regardless of the number of: (1) Insureds; (2) Claims made or "suits" brought; or (3) Persons or organizations making claims or bringing "suits". CG MU 1078 12 20 Page 6 of 11 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. c. Any payments made under COVERAGE A, for damages or under COVERAGE C for medical ex- penses shall reduce the Designated Location General Aggregate Limit for that designated "loca- tion". Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they reduce any other Designated Location General Aggregate Limit for any other des- ignated "location" also shown in the Declarations. d. The limits shown in the Declarations for Each Occurrence, Fire Damage and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Designated Location General Ag- gregate Limit. 2. For all sums which the insured becomes legally obligated to pay as damages caused by "occur- rences" under COVERAGE A (Section I), and for all medical expenses caused by accidents under COVERAGE C (Section I), which cannot be attributed only to operations at a single designated "lo- cation"shown in the Declarations: a. Any payments made under COVERAGE A for damages or under COVERAGE C for medical ex- penses shall reduce the amount available under the General Aggregate Limit or the Products-Completed Operations Aggregate Limit, whichever is applicable; and b. Such payments shall not reduce any Designated Location Aggregate Limit. 3. When coverage for liability arising out of the "products-completed operations hazard" is provided, any payments for damages because of "bodily injury" or "property damage" included in the "prod- ucts-completed operations hazard" will reduce the Products-Completed Operations Aggregate Limit, and not reduce the General Aggregate Limit nor the Designated Location General Aggregate Limit. 4. The following is added under SECTION V — DEFINITIONS "Location" means premises involving the same or connecting lots, or premises whose connection is interrupted only by a street, roadway, waterway or right-of-way of a railroad. 5. The provisions of LIMITS OF INSURANCE (SECTION III) not otherwise modified by this coverage shall continue to apply as stipulated. X. Property Damage Liability — Borrowed Equipment The following is added to Exclusion j. under Coverage A. (Section I): Paragraph (4) of this exclusion does not apply to equipment which you borrow unless the "property damage" occurs while such equipment is being used by an insured at a job site. Subject to all of the terms of SECTION III — LIMITS OF INSURANCE, the maximum limit in any one oc- currence is $25,000 and an annual aggregate of $50,000. This insurance afforded by reason of this provision is excess over any valid and collectible property in- surance (including any deductible) available to you, and SECTION IV — COMMERCIAL GENERAL LIABIL- ITY CONDITIONS 4. Other Insurance is changed accordingly. XI. Additional Insureds By Written Contract A. SECTION II — WHO IS AN INSURED is amended to include as an additional insured any person or organization that you are required to add as an additional insured to this policy by a written contract or written agreement that is: 1. Currently in effect or becoming effective during the term of this policy; and 2. Executed prior to the "bodily injury", "property damage", "personal and advertising injury". B. The insurance provided to the additional insured applies as follows: 1. That person or organization is only an additional insured with respect to liability caused by your negligent acts or omissions at or from: (a) Premises you own, rent, lease, or occupy or (b) Your ongoing operations performed for the additional insured at the job indicated by written contract or agreement. 2. The limits of insurance applicable to the additional insured are those specified in the written con- tract or agreement or in the Declarations of this policy whichever is less. These limits of insur- ance are inclusive of and not in addition to the limits shown in the Declarations. CG MU 1078 12 20 Page 7 of 11 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. C. With respect to the insurance afforded these additional insureds, the following additional insured exclusion applies: 1. If the additional insured is an architect, engineer, or surveyor, this insurance does not apply to "bodily injury", "property damage", "personal and advertising injury" arising out of the render- ing of or the failure to render any professional services by or for you, including: (a) The preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings, designs or specifications; or (b) Supervisory, inspection, architectural or engineering activities. 2. The insurance afforded the additional insured does not apply to: (a) "Bodily injury" or "property damage" occurring after: (1) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on the behalf of the additional insured(s) at the site 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 the contractor or subcontrac- tor engaged in performing operations for a principal as part of the same project. XII. Additional Insured — State or Political Subdivisions — Permits The following is added to SECTION II — WHO IS AN INSURED: 1. Any state or political subdivision which has issued a permit to you, subject to the following provi- sions: a. This insurance applies only with respect to operations performed by you or on your behalf for which the state, governmental agency or political subdivision has issued a permit or authoriza- tion. b. This insurance does not apply to: (1) "Bodily injury", "property damage", "personal and advertising injury" arising out of opera- tions performed for the federal government, state or municipality; or (2) "Bodily injury' or "property damage" included within the "products-completed operations hazard". XIII. Additional Insured — Managers Or Lessors of Premises The following is added to SECTION II - WHO IS AN INSURED : 1. Any manager or lessor of premises shown in the Declarations is also an insured, but only with re- spect to liability arising out of the ownership, maintenance or use of that part of the premises leased to you and shown in the Declarations and subject to the following additional exclusions: The following exclusions are added: 1. This insurance does not apply to: a. Any "occurrence" which takes place after you cease to be a tenant in that premises. b. Structural alterations, new construction or demolition operations performed by or on behalf of any manager or lessor of premises shown in the Declarations. XIV. Additional Insured — Lessor of Leased Equipment The following is added to SECTION II - WHO IS AN INSURED : 1. The person(s) or organization(s) who leases equipment to you for use in your business is also an insured, but only with respect to liability for "bodily injury", "property damage", "personal and advertising injury" caused, in whole or in part, by your maintenance, operation or use of equip- ment leased to you by such person(s) or organization(s). With respect to the insurance afforded to these additional insureds, this insurance does not apply to any "occurrence" which takes place after the equipment lease expires. CGMU 1078 12 20 Page 8of11 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. XV. Additional Insured — Broad Form Vendors The following is added to SECTION II - WHO IS AN INSURED : 1. Any person(s) or organization(s) (referred to below as vendor) with whom you agreed, because of a written contract or agreement to provide insurance is also an additional insured, but only with respect to "bodily injury" or "property damage" arising out of "your products" which are distrib- uted or sold in the regular course of a vendor's business, subject to the following additional exclu- sions: a. The insurance afforded the vendor does not apply to: (1) "Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; (2) Any express warranty unauthorized by you; (3) Any physical or chemical change in the product made intentionally by the vendor; (4) Repackaging, except when unpacked solely for the purpose of inspection; demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then re- packaged in the original container; (5) Any failure to make such inspections, adjustments, tests, or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in con- nection with the distribution or sale of the products; (6) Demonstration, installation, servicing or repair operations, except such operations per- formed at the vendor's premises in connection with the sale of the product. (7) Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor; or (8) "Bodily injury" or "property damage" arising out of the sole negligence of the vendor for its own acts or omissions or those of its employees or anyone else acting on its behalf. However, this exclusion does not apply to: (a) The exceptions contained in Sub-Paragraphs (4) or (6); or (b) Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products. b. This insurance does not apply to any insured person or organization, from whom you have ac- quired such products, or any ingredient, part or container, entering into, accompanying or con- taining such products. c. This provision does not apply to any vendor included as an insured by an endorsement issued by us and made part of the Coverage Part. d. This provision does not apply if "bodily injury" or "property damage" included within the "products-complete hazards" is excluded either by the provisions of the Coverage Part or by endorsement. XVI. Employee Bodily Injury To A Co-Employee SECTION II- WHO IS AN INSURED paragraph 2.a.(1) is replaced by the following: However, none of these "employees" or "volunteer workers" are insureds for "bodily injury" or "per- sonal and advertising injury": (a) To you, to your partners or members (if you are a partnership or joint venture), to your members (if you are a limited liability company), to a co-"employee" while in the course of his or her em- ployment or performing duties related to the conduct of your business, or to your other "volunteer workers" while performing duties related to the conduct of your business; (b) To the spouse, child, parent, brother or sister of the co-"employee" or "volunteer worker" as a consequence of Paragraph (1)(a) above; (c) For which there is any obligation to share damages with or repay someone else who must pay damages because of the injury described in Paragraph (1)(a) or (b) above; or (d) Arising out of his or her providing or failing to provide professional health care services. CG MU 1078 12 20 Page 9 of 11 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. However, if a suit seeking damages for "bodily injury" or "personal and advertising injury" to any co-"employee" or other "volunteer worker" arising out of and in the course of the co-"employee's" or "volunteer worker's" employment or while performing duties related to the conduct of your business, or a suit seeking damages brought by the spouse, child, parent, brother or sister of the co-"employee" or other "volunteer worker", is brought against you or a co-"employee" or a "volunteer worker", we will reimburse the reasonable costs that you incur in providing a defense to the co-"employee" or "volunteer worker" against such matters. Any reimbursement made pursuant to this sub-section will be in addition to the limits of liability set forth in the Declarations. XVII. Broad Knowledge/Notice Of Occurrence The following is added under SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS : The requirement in condition 2.a. that you must see to it that we are notified of an "occurrence" or offense applies only when the "occurrence" or offense is known to: 1. You, if you are an individual; 2. A partner, if you are a partnership; 3. A member, if you are a joint venture; 4. An "Executive Officer" or insurance manager, if you are a corporation; or 5. A member, if you are a limited liability company. The requirement in condition 2.b. that you must see to it that we receive notice of a claim or "suit" will not be considered breached unless the breach occurs after such claim or "suit" is known to: 1. You, if you are an individua►; 2. A partner, if you are a partnership; 3. A member, if you are a joint venture; 4. An "Executive Officer" or insurance manager, if you are a corporation; or 5. A member, if you are a limited liability company. If you report an accident to your Workers' Compensation insurance carrier which later develops into a liability occurrence, coverage for which is provided by this policy, failure to report such occurrence to us at the time of the accident shall not be a violation of the notification of loss condition in this policy (Condition 2. in Section IV). It is understood and agreed, however, that you shall give notification of such occurrence to us as soon as you are made aware of the fact that the particular accident has de- veloped into a liability claim. XVIII.Unintentional Failure To Disclose Hazards Under SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, paragraph 6. Representations is replaced by the following: By accepting this policy, you agree; 1. The statements in the Declarations are accurate and complete; 2. Those statements are based upon representations you made to us; and 3. We have issued this policy in reliance upon your representations; If you unintentionally fail to disclose any hazards existing at the inception date of your policy, we will not deny coverage under this Coverage Part because of such failure. However, this provision does not affect our right to collect additional premium or exercise our right of cancellation or non-renewal. CG MU 1078 12 20 Page 10 of 11 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. A�I® CERTIFICATE OF LIABILITY INSURANC DATE(MMDD/YYYY) �s ,+ 03/08/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS OiRF ATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. MAY �' IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must have ADDITIONAL INSURED proOv$tons or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may re_quire an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). JEFFE( y0N COUNTY PRODUCER CONTACT COUNTY 1 i PH : Alisha 3 Vm3Insurance Services Group ( ON PO Box 2077 _ACNo Ex): (360) 683-3355 (A � . ) 683-9098 E-MAIL Seguin WA 98382 ADDRESS: info®insuranceservicesgroup.com INSURER(S)AFFORDINGCOVERAGE _ NAICN INSURER A:Michigan Millers Insurance Com 14508 INSURED (817) 291-5669 INSURERS: Port Ludlow Village Council INSURER C: PO Box 65012 INSURERD: Port Ludlow WA 98365 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER:Cart ID 8567 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED.OR MAY-PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 1S SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP W LIMITS LTR INSD VD POLICY NUMBER (MMIDO/YYYY) (MM/DD/YYYY) A X COMMERCIALGENERALUABILITY EACH OCCURRENCE $ 1,000,000 TO CLAIMS-MADE X OCCUR Y Y CPP1265898 06/01/2022 06/01/2023 MAGE �tEMSES(EaENTED occurrence) $ 300,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 i X POLICY JECT Li LOC I PRODUCTS-COMP/OP AGG $ 3,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ . 1,000,000 A ANY AUTO _ CPP128436200 06/01/2022 06/01/2023 BODILY INJURY(Perperson) $ OWNED SCHEDULED BODILY INJURY(Peracddent) $ AUTOS ONLY AUTOS I I X HIRED X NON-OWNEDPROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- A AND EMPLOYERS'LIABILITY YIN CPP126589800 06/01/2022 06/01/2023 STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE STOP GAP LIABILTIY E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below . E.L.DISEASE-POLICY LIMIT,$ 1,000,000 1 ( 1 $ $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Certificate Holder is an additional insured (Primary/Non-Contributory) with waiver of subrogation as respects to the general liability coverage. Policy form CGMU1078 (12/20). 30 Day Notice of Cancellation applies to the general liability coverage and commercial auto coverage (Hired/Non-Owned) . CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Jefferson County Administrators Office PO Box 1220 AUTHORIZED REPRESENTATIVE Port Townsend WA 98368 �C..,.SY, ..., ........,,�._........._._........_. ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD XIX. Waiver Of Transfer Of Rights Of Recovery Against Others To Us Under SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, the paragraph 8. Transfer of Rights of Recovery Against Others To Us condition is amended by the addition of the following: We waive any right of recovery we may have against a person or organization 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 include in the "products — completed operations hazard" when you have waived such right of recovery under a written contract with that person or organiza- tion. Such written contract must be: 1. Currently in effect or becoming effective during the term of this policy; and 2. Executed prior to the "bodily injury", "property damage", "personal and advertising injury"; or 3. Executed after "bodily injury", "property damage", "personal and advertising injury" if: a. The terms and conditions of the written contract or written agreement had been agreed upon prior to the "bodily injury", "property damage", "personal and advertising injury"; and b. The insured can definitively establish that the terms and conditions of the written contract or written agreement ultimately executed are the same as those which had been agreed upon pri- or to the "bodily injury", "property damage", "personal and advertising injury . XX. Insured Contract SECTION V — DEFINITIONS, "Insured Contract" paragraph 9.a. is replaced by the following: A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire, lightning, explosion or sprinkler leakage to premises while rented to you or temporarily occupied by you with permission of the owner is not an "insured contract". XXI. Mobile Equipment The following is added under SECTION V — DEFINITIONS, 12. "Mobile Equipment": Paragraph f.(1) does not apply to self-propelled vehicles of less than 1,000 pounds gross vehicle weight. CG MU 1078 12 20 Page 11 of 11 Includes copyrighted material of Insurance Services Office,Inc.,with its permission.