Loading...
PROOF OF INSURANCE (2020 - 2020) CLOSEDA� ® CERTIFICATE OF LIABILITY INSURANCE I DAT4�1�2019YYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER (CONTACT NAME: Woodruff -Sawyer & Co. PHONE FAX 50 California Street, Floor 12 I (A/C. No. ExtC 415-391-2141 (A/C, No): 415-989-9923 San Francisco CA 94111 I E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Travelers Prop Casualty Co of America 25674 INSURED COULTEC-01 INSURER B: Lloyds of London ChargePoint, Inc. 240 E Hacienda Avenue I INSURER C: Travelers Property Casualty Insurance Company 36161 Campbell CA 95008 1 INSURER D I INSURER E: I INSURER F: COVERAGES CERTIFICATE NUMBER: 1318366097 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/DD/YYYYI (MM/DD/YYYYI A X COMMERCIAL GENERAL LIABILITY Y Y 6305144X310 3/29/2019 3/29/2020 EACH OCCURRENCE $ 1 000 000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Master Services and Subscription Agreement The City of EI Segundo, its officials, and employees are included as additional insureds with respect to General Liability, as per attached. Coverage is primary and non-contributory with respect to General Liability, as per attached. A Waiver of Subrogation applies in favor of General Liability per attached form. 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. City of EI Segundo 350 Main Street AUTHORIZED REPRESENTATIVE EI Segundo CA 90245 14 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD DAMAGE TO RENTED CLAIMS -MADE � OCCUR PREMISES (Ea occurrence) $ 1,000,000 MED EXP (Any one person) $ 10,000 PERSONAL &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X PRO - POLICY ❑JECTPRO ❑LOC PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER: $ C AUTOMOBILE LIABILITY BA91<943697 3/29/2019 3/29/2020 COMBINED SINGLE LIMIT $ 1,000,000 fEa accident) X ANY AUTO BODILY INJURY (Per person) $ OWNEDSCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON -OWNED PROPERTYDAMAGE $ AUTOS ONLY AUTOS ONLY fPer accident) A X UMBRELLALIAB OCCUR CUPOJ88357A 3/29/2019 3/29/2020 EACH OCCURRENCE $10,000,000 EXCESS LIAB CLAIMS -MADE H AGGREGATE $ 10,000,000 DED I X I RETENTION $ n $ A WORKERS COMPENSATION UB009J783574 2/1/2019 2/1/2020 X I SPER TATUTE EORH AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y / N E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? [--]N/A (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 B Errors & Omissions/Cyber W252B9180101 11/14/2018 11/14/2019 Per Claim/ Aggregate $5,000,000 (Professional Liability) DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Master Services and Subscription Agreement The City of EI Segundo, its officials, and employees are included as additional insureds with respect to General Liability, as per attached. Coverage is primary and non-contributory with respect to General Liability, as per attached. A Waiver of Subrogation applies in favor of General Liability per attached form. 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. City of EI Segundo 350 Main Street AUTHORIZED REPRESENTATIVE EI Segundo CA 90245 14 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Policy Number: 6305144X310 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OTHER INSURANCE -ADDITIONAL INSUREDS - PRIMARY AND NON-CONTRIBUTORY WITH RESPECT TO CERTAIN OTHER INSURANCE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following is added to Paragraph 4. a., Primary insurance, of SECTION IV — COMMERCIAL. GEN- ERAL LIABILITY CONDITIONS: However, if you specifically agree in a written contract or agreement that the insurance afforded to an addi- tional insured under this Coverage Part must apply on a primary basis, or a primary and non-contributory basis, this insurance is primary to other insurance that is available to such additional insured which covers such additional insured as a named insured, and we will not share with that other insurance, provided that: (1) The "bodily injury" or "property damage" for which coverage is sought is caused by an 'occurrence" that takes place; and (2) The "personal injury" or "advertising injury" for which coverage is sought arises out of an offense that is committed; subsequent to the signing and execution of that con- tract or agreement by you. CG D4 25 07 08 Q 2008 The Travelers Companies, Inc. Page 1 of 1 6305144X310 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, TECHNOLOGY XTEND ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE —This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to this Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsainont, The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what Is and is not covered, A. Reasonable Force Property Damage — Ex- ception To Expected Or Intended Injury Ex- clusion S. Non -Owned Watercraft Loss Than 75 Feet C. Aircraft Chartered With Pilot D. Damage To Promises Rented To You E. Increased Supplementary Payments F. Who Is An Insured — Employees And Volun- teer Workers — First Aid G. Who Is An Insured — Employees — Supervi- sory Positions H. Who Is An Insured — Newly Acquired Or Formed Organizations 1, Blanket Additional Insured — Owners, Manag- ers Or Lessors Of Premises J. Blanket Additional Insured — Lessors Of Leased Equipment PROVISIONS B. A. REASONABLE FORCE PROPERTY DAMAGE — EXCEPTION TO EXPECTED OR INTENDED IN- JURY EXCLUSION The following replaces Exclusion a., Expected Or Intended Injury, in Paragraph 2., of SECTION 1— COVERAGES —COVERAGES — COVERAGE A BODILY IN- JURY AND PROPERTY DAMAGE LIABILITY: a. Expected Or Intended Injury Or Damage "Bodily injury" or "property damage" expected or intended from the standpoint of the insured. This exclusion does not apply to "bodily injury" or .property damage" resulting from the use of rea- sonable force to protect any person or property. K. Blanket Additional Insured — Persons Or Or- ganizations For Your Ongoing Operations As Required By Written Contract Or Agreement L. Blanket Additional Insured — Broad Form Vendors M. Who Is An Insured — Unnamed Subsidiaries N. Who Is An insured — Liability For Conduct of Unnamed Partnerships Or Joint Ventures i 1 O. Medical Payments — Increased Limits P. Contractual Liability — Railroads Q. Knowledge And Notice Of Occurrence Or Of- fense R. Unintentional Omission S. Blanket Waiver Of Subrogation NON -OWNED WATERCRAFT LESS THAN 75 FEET The following replaces Paragraph (2) of Exclusion g., Aircraft, Auto Or Watercraft, in Paragraph 2, of SECTION I — COVERAGES — COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY: (2) A watercraft you do not own that is: (a) Less than 75 feet long; and (b) Not being used to carry any person or property for a charge, AIRCRAFT CHARTERED WITH PILOT The following is added to Exclusion 9., Aircraft, Auto Or Watercraft, in Paragraph 2. of SECTION CG D4 17 01 12 (D2012 The'rFavolers Indemnity Company. All rights reserved. Page I of 6 fricludes copyrighted material of Insuranvo Servicos Office, Inc with its permission. COMMERCIAL GENERAL LIABILITY I — COVERAGES — COVERAGE A BODILY IN- JURY AND PROPERTY DAMAGE LIABILITY: This exclusion does not apply to an aircraft that is: (a) Chartered with a pilot to any insured; (b) Not owned by any insured; and (c) Not being used to carry any person or prop- erty for a charge. D. DAMAGE TO PREMISES RENTED TO YOU 1. The first paragraph of the exceptions in Ex- clusion I., Damage To Property, in Para- graph 2. of SECTION I — COVERAGES ,- COVERAGE COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY is deleted. 2. The following replaces the last paragraph of Paragraph 2., Exclusions, of SECTION I — COVERAGES — COVERAGE A BODILY IN- JURY AND PROPERTY DAMAGE LIABIL- ITY: Exclusions c-, g. and h., and Paragraphs (1), (3) and (4) of Exclusion)., do not apply to "premises damage". Exclusion f,(1)(a) does not, apply to "premises damage" caused by fire unless Exclusion f. of Section I — Cover- age A — Bodily Injury And Property Damage Liability is replaced by another endorsement to this Coverage Part that has Exclusion - All Pollution Injury Or Damage, or Total Pollution Exclusion in its title. A separate limit of insur- ance applies to "premises damage" as do - scribed in Paragraph 6. of Section Of — Limits Of Insurance. 3. The following replaces Paragraph 6. of SEC- TION III — LIMITS OF INSURANCE: 6. Subject to 5. above, the Damage To Premises Rented To You Limit is the most we will pay under Coverage A for damages because of "premises damage* to any one promises. The Damage To Promises Rented To You Limit will be: a. The amount shown for the Damage To Premises Rented To You Limit on the Declarations of this Coverage Part; or b. $300,000 if no amount is shown for the Damage To Premises Rented To You Limit on the Declarations of this Coverage Part, 4. The following replaces Paragraph a. of the definition of "insured contracC in the DEFINI- TIONS Section: a. A contract for a lease of promises. How- ever, that portion of the contract for a lease of promises that indemnities any person or organization for "premises damage" is not an "insured contract"; 5. The following is added to the DEFINITIONS Section: "Premises damage" means "property dam- age" to: a. Any premises while rented to you or tem- porarily occupied by you with permission of the owner;or b. The contents of any premises while such premises Is rented to you, it you rent such promises for a period of seven or fewer consecutive days. 6. The following replaces Paragraph 4.b.(1)(b) of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: (b) That is insurance for "premises damage"; or 7. Paragraph 4.b.(1)(c) of SECTION IV — COMMERCIAL GENERAL LIABILITY COW DITIONS is deleted. E. INCREASED SUPPLEMENTARY PAYMENTS 1. The following replaces Paragraph 1.b. of SUPPLEMENTARY PAYMENTS — COVER- AGES A AND 8 of SECTION I — COVER- AGES; b. Up to $2,500 for cost of bail bonds re- quired because of accidents or traffic law violations arising out of this use of any vehicle to which the Bodily Injury Liability Coverage applies, We do not have to fur- nish these bonds, i 2. The following replaces Paragraph I.d. of SUPPLEMENTARY PAYMENTS — COVER- AGES A AND 8 of SECTION I — COVER- AGE$: d. All reasonable expenses incurred by the insured at our request to assist us in the Investigation or defense of the claim or .suit", including actual loss of earnings up to $500 a day because of time off from work, Page 2 of 6 G 2012 The Travelers Indemnity Company. All rights reserved. CO D4 17 01 12 Includes copyrighted malarial of insurance Services Office, Inc. with its permission. F. WHO IS AN INSURED — EMPLOYEES AND VOLUNTEER WORKERS — FIRST AID 1. The following is added to the definition of "oc- currence" in the DEFINITIONS Section: Unless you are in the business or occupation of providing protessionahealth care services, "occurrence" also means an act or omission committed by any of your "employees" or "volunteer workers", other than an employed or volunteer doctor, in providing or failing to provide first aid or "Good Samaritan services" to a person, 2. The following is added to Paragraph 2.a.(1) of SECTION 11 —WHO IS AN INSURED: Unless you are in the business or occupation of providing professional health care services, Paragraphs (11 )(a), (b), (c) and (d) above do not apply to "bodily injury" arising out of pro- viding or failing to provide first aid or "Good Samaritan services" by any of your "employ- ees" or "volunteer workers", other than an employed or volunteer doctor. Any of your "employees" or "volunteer workers' providing or failing to provide first aid or "Good Samari- tan services" during their work hours for you will be deemed to be acting within the scope of their employment by you or performing du- ties related to the conduct of your business, 3. The following is added to,,Paragraph S. of SECTION III — LIMITS OF INSURANCE; For the purposes of determining the applica- ble Each Occurrence Limit, all related acts or omissions committed by any of your "employ- ees" or "volunteer workers" in providing or failing to provide first aid or "Good Samaritan services" to any one person will be deemed to be one "occurrence". 4. The following is added to the DEFINITIONS Section: "Good Samaritan services" means any emer- gency medical services for which no compen- sation is demanded or received, G. WHO IS AN INSURED — EMPLOYEES — SU- PERVISORY POSITIONS the following is added to Paragraph 2.a.(1) of SECTION 11— WHO IS AN INSURED: Paragraphs (1)(a), (b) and (c) above do not apply to "bodily injury" or "personal injury"' to a co - ""employee" it) the course of the co-Ilemployools" employment by you arising out of work by any of COMMERCIAL GENERAL LIABILITY your "employees" who hold a supervisory posi- tion. H. WHO IS AN INSURED — NEWLY ACQUIRED OR FORMED ORGANIZATIONS The following replaces Paragraph 4. of SECTION 11 — WHO IS AN INSURED of the Commercial General Liability Coverage Form, and Paragraph 3. of SECTION 11 — WHO IS AN INSURED of the Global Companion Commercial General Liability Coverage Form, to the extent such coverage forms are part of your policy: Any organization you newly acquire or form, other than a partnership or joint venture, of which you are the sole owner or in which you maintain the majority ownership interest, will qualify as a Named Insured if there is no other insurance which provides similar coverage to that organiza- tion. However: a. Coverage under this provision is afforded only: (1) Until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier, it you do not report such organization in writing to us within 180 days after you acquire or form it; or (2) Until the end of the policy period, when that date is later than 180 days after you acquire or form such organization, it you report such organization in writing to us within 180 days Wier you acquire or form it, and we agree in writing that it will con- tinue to be a Named Insured until the end of the policy period; b. Coverage A does not apply to "bodily injury" or "property damage" that occurred before you acquired or formed the organization; and c. Coverage B does not apply to "personal in - i or "advertising injury" arising out of an offense committed before you acquired or formed the organization. BLANKET ADDITIONAL INSURED — OWNERS, MANAGERS OR LESSORS OF PREMISES 'The following is added to SECTION 11— WHO IS AN INSURED: Any person or organization that is a premises uwnor, manager or lessor is an insured, but only with rospe(A to liability arising out of the owner- sKp, maintenance or use of that part of any prem- ises leased to you. The insurance provided to such pre1TIiS06 owner, manager or lessor does not apply to: CG D4 17 01 12 V 26.2 The Travelers Indemnity Company, All rights reserved. Page 3 of 6 Includes copyrighted material of Insurance Services OffIce, Inc. with its pormissloa, COMMERCIAL GENERAL LIABILITY a. Any "bodily injury" or "properly damage" caused by an "occurrence" that takes place, or "personal injury" or "advertising injury" caused by an offense that is committed, after you cease to be a tenant in that premises; or lb. Structural alterations, now construction or demolition operations performed by or on be- half of such promises owner, manager or les- sor. J. BLANKET ADDITIONAL INSURED — LESSORS OF LEASED EQUIPMENT The following is added to SECTION 11 — WHO IS AN INSURED: Any person or organizaIjorl that Is an equipment lessor is an insured, but only with respect to liabil- ity for "bodily injury', "property damage", "per- sonal injury" or "advertising injury" caused, in outrule or in part, by your acts or omissions in the mainlor+ance, operation or use by you of equip- ment leased to you by such equipment lessor. The insurance provided to such equipment lessor does not appy to any "'bodily injury" or "properly darnagie" caused by an "occurrence" that takes place, or "personal injury" or "advertising injury" ciusod by an offense that is committed, after the equipment lease expires, K. BLANKET ADDITIONAL INSURED — PERSONS OR ORGANIZATIONS FOR YOUR ONGOING OPERATIONS AS REQUIRED BY WRITTEN CONTRACT OR AGREEMENT The following is added to SECTION 11 — WHO IS AN INSURED; Any person or organization that is not otherwise an insured under this Coverage Part and thol you have agreed in a written contract or agreement to include as an additional insured on this Coverage Part is an insured, but only with respect to liability for "bodily injury" or "property damage" that: a. Is caused by an "occurrence" that takes place after you have signed and executed that con- tract or agreement; and b. Is caused, in whole or in part, by your acts or omissions in the performance of your ongoing operations to which that contract or agree- mont applies or the acts or omissions of any person or organization performing such op- erations on your behalf, The limits of insurance provided to such insured will be the limits which you agreed to provide in the written contract or agreement, or the limits shown in the Declarations, whichever are less. L. BLANKET ADDITIONAL INSURED — BROAD FORM VENDORS The following Is added to SECTION 11 — WHO IS AN INSURED: Any person or organization that is a vendor and that you have agreed in a written contract or agreement to include as an additional insured on this Coverage Part is an insured, but only with re- spect to liability for "bodily injury" or "property damage" that: a. is caused by an "occurrence" that takes place after you have signed and executed that con- tract or agreement; and b. Arises out of "your products" which are dis- tributed or sold in the regular course of such vendor's business, The insurance provided to such vendor is subject to the following provisions: a. The limits of insurance provided to such ven- dor will be the limits which you agreed to pro- vide in the written contract or agreement, or the limits shown in the Declarations, which- ever are less. b. The insurance provided to such vendor does not apply to: (1) Any express warranty not authorized by you; (2) Any change in "your products" made by such vendor; (3) Repackaging, unless unpacked solely 'or the purpose of inspection, demonstration, testing, or the substitution of parts under Instructions from the manufacturer, and then repackaged in the original container, (4) Any failure to make such inspections, ad- justments, tests or servicing as vendors agree to perform or normally undertake to perform in the regular course of business, in connection with the distribution or sale of "your products"; (5) Demonstration, installation, servicing or repair operations, except such operations performed at such vondor's promises in connection with the sale of "your prod- ucts"; or (6) "Your products" which, after distribution or sale by you, have been labeled or re- labeled or used as a container, part or in- gredient of any other thing or substance by or on behalf of such vendor. Pago 4 of 6 0 2a12 The Travelers Indemnify Company. All rights reserved, CG D4 17 01 12 Includes copyrighted material of insurance Services Office, Inc. with its permission, Coverage under this provision does not apply to: a. Any person or organization (rum whom you have acquired "your products", or any ingre- dient, part or container entering into, accom- panying or containing such products; or b. Any vendor for which coverage as an addi- tional insured specifically is scheduled by en- dorsement. M. WHO IS AN INSURED — UNNAMED SUBSIDI- ARIES The following is added to SECTION II — WHO IS AN INSURED: Any of your subsidiaries, other than a partnership or joint vonture, that is not shown as a Narned In- sured in tate Declarations is a Named Insured if: a. You maintain an ownership interest of more than 50% in such subsidiary on the first day of the policy period; and Ill Such subsidiary is not an insured under simi- lar other insurance. No such subsidiary is an insured for "bodily injury" or "property damage" that occurred, or "personal injuty"or "advertising injury" caused by an of- fense committe(E a. Before you maintained an ownership interest of more than 50% in such subsidiary; or b. After the date, if any, during the policy period that you no longer maintain an ownership in- terest of more than 50% in such subsidiary. N. WHO IS AN INSURED — LIABILITY FOR CON- DUCT OF UNNAMED PARTNERSHIPS OR JOINT VENTURES The following replaces the last paragraph of SECTION II —WHO IS AN INSURED: No person or organization is an insured with re- spect to the conduct of any current or past part- nership or joint venture that is not shown as a Named Insured in the Declarations. This para- graph does not apply to any such partnership or joint venture that otherwise qualifies as an in- sured under Section II — Who Is An Insured, O. MEDICAL PAYMENTS—INCREASED LIMITS The following replaces Paragraph T. of SECTION III —LIMITS OF INSURANCE: COMMERCIAL GENERAL LIABILITY (b) The amount shown on the Declarations of this Coverage Part for Medical Fxpense Limit. P. CONTRACTUAL LIABILITY — RAILROADS 1. The following replaces Paragraph c. of the definition of "Insured contract" in the DEFINI- TIONS Section: c. Any easement or license agreement; 2. Paragraph f.(1) of the definition of "insured contract' in the DEFINITIONS Section is de- leted. Q. KNOWLEDGE AND NOTICE OF OCCUR- RENCE OR OFFENSE The following is added to Paragraph 2., Duties In The Event of Occurrence, Offense, Claim or Suit, of SECTION IV — COMMERCIAL GEN- ERAL LIABILITY CONDITIONS: e. The following provisions apply to Paragraph a. above, but only for the purposes of the in- surance provided under this Coverage Part to you or any insured listed In Paragraph 1. or 2. of Section II —Who Is An Insured: (1) Notice to us of such "occurrence" or of- fense must be given as soon as practica- ble only after the "occurrence" or offense is known to you (if you are an individual), any of your partners or members who is an Individual (if you are a partnership or joint venture), any of your managers who is an individual (if you are a limited liaoility company), any of your trustees who is an individual (if you are a trust), any of your "executive officers" or directors (if you are an organization other than a partnershlp, joint venture, limited liability company or trust) or any "employee" authorized by you to give notice of an "occurrence" or offense, (2) If you are a partnership, joint venture, lim- ited liability company or trust, and none of your partners, joint venture members, managers or trustees are individuals, no- tice to us of such "occurrence" or offense must be given as soon as practicable only after the 'occurrence" or offense is known by: 7. Subject to 5. above, the Medical (Expense (a) Any Individual who is: Limit is the most we will pay uncer Coverage (i) A partner or member of any part - C for all medical expenses because of "bodily nership or joint venture; injury" sustained by any one person, and will be the higher of: (ii) A manager of any limited liability (a) $10,000; or company; CG D4 17 01 12 092012 The Travelers Indemnity company. All rights reserved. Page 5 of 6 Includes copyrighted material of Insurance Services Office, Inc, with its permission. COMMERCIAL GENERAL LIABILITY (111) A trustee of any trust; or (iv) An executive officer or director of any other organization; that is your partner, joint venture member, manager or trustee; or (b) Any "employee" authorized by such partnership, jUi6t venture, limited li- ability company, trust or other organi- zation to give notice of an "occur- rence" or offense. (3) Notice to us of such "occurrence" or of- fense will be deemed to. be given as soon as practicable if it is given in good faith as soon as, practicable to your, workers' compensation insurer This applies only if you subsequently give notice to us of tlj(i "occurrence" or offense as soon as prac- ticable after any of the persons described In Paragraphs e. (1) or (2) above discov- ers that the "occurrence" or offense may result in sums to which the insurance provided under this Coverage Part may apply - However, if this policy includes an endorse- ment that provides limited coverage for "bod- ily injury" or 'property darriage" or pollution costs arising out of a discharge, release or escape of "pollutants" which contains a re- quirement that the discharge, release or es- cape of "pollutants'* must, be reported to us within a specific number of days after its abrupt commencement, this Paragraph c. does not affect that requirement, R. UNINTENTIONAL OMISSION The following is added to Paragraph 6., Repre- sentations, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: The unintentional omission of, or unintentional er- ror in, any information proviced by you whict'i we regied upon in issuing this policy wil not prejudice your rights under this insurance. However, this provision does not affect our right to collect addi. iionol premium or to exercise our rights of carumi- lation or nonrenowal it) accordance with applica- ble insurance laws or regulations. S. BLANKET WAIVER OF SUBROGATION The foPowing is added to Paragraph 8., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV — COMMERCIAL GENERAL Lt. ABILITY CONDITIONS: If the insured has agreed in a contract or agree- ment to waive that insured's right of recovery against any person or organizalion, we waive our right of recovery against such person or orgarifza• tion, but only for payments we make because of: a. "Bodily injury" or "property damage" caused by an "occurrence" that takes place; or b, "Personal injury" or "advertising injury" caused by an offense that is committed; subsequent to the execution of the contract or agreement. Page 6 of 6 02012Ttia'travelers indemnity Goirrl)ofiy, All rights reserved, CG 0417 01 12 Includes vopynghted mralw,al at Insurance Seryces Office, Inc, with Its permission,