PROOF OF INSURANCE (2023 - 2024) CLOSEDDATE (MMIDDIYYYY)
CERTIFICATE OF LIABILITY INSURANCE
05/03/2023
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: Kyle Tyrpak
The Evans Agency, LLC PHONE (716) 926-8688 C gd,; (716) 926-8690
6460 Main Street t-MAIL 5: ktyrpak@evansagencyins.com
AOORE
Suite 200 INSURER(S) AFFORDING COVERAGE NAIC #
Williamsville NY 14221 INSURERA Hartford Underwriters Ins Co 30104
INSURED
INSURER B : Republic Franklin Ins Co
12475
Buffalo Computer Graphics Inc
INSURER C : Travelers Indemnity Company (The)
25658
INSURER D
4185 Bayview Rd
INSURER E ;
INSURERF:
Buffalo NY 14219-2732
COVERAGES CERTIFICATE NUMBER: Master 23-24
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 INSD -
LTR TYPE OF INSURANCE I WV0 POLICY NUMBER
JMM29=MMIDD LIMITS
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
CLAIMS -MADE �X OCCUR
PREMISES Eaocrurxensz
$ 1,000,000
_
MED EXP (Any one person)
'....... $ 10,000
PERSONAL & ADV INJURY
$ 1,000,000
A
01SBAASOD38
04/29/2023
04/29/2024
GEN'L.AGGREGATE L1MIT APPLIES PE R:
GENERAL AGGREGATE
$ 2,000,000
POLICY1:1 JECTPR4'9• �
- LOC
PRODUCTS - COMP/OP AGG
.. '$ 2,000,000
$
OTHE'.W
AUTOMOBILE LIABILITY
OOMBNr'l'FD S INGL.ELIMIT
Ea accldenl
$ 1,000,000
BODILY INJURY (Per person)
$
ANY AUTO
A
OWNED SCHEDULED
AUTOS ONLY AUTOS
01 SBAASOD38
04/29/2023
04/29/2024
BODILY INJURY (Per accident)
$
NON-OWNED
�,.... HIRED F-5<_
AUTOS ONLY AUTOS ONLY
PROPERTY DAMAGE
Per aroident
$
X..... UMBRELLA LIAR I X'. OCCUR
EACH OCCURRENCE
$ 10,000,000
A
EXCESS LIAB ri CLAIMS -MADE
01 SBAASOD38
04/29/2023
04/29/2024
AGGREGATE
$ 10,000,000
DED I X ReTENTION $ 10,000
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBEREXCLUDED?
(Mandatory In NH)
NIA
5473900
10/01/2022
10/01/2023
" PEE,RTUTE. ER
/4
H A NT
E.L. EAC CCIDE
1,000,000
$
E.L_ DISEASE , EA EMPLOYEE
$ 1,000,000
If yes, describe under
DESCRIPTION OFOPERATIONS below
E..L..DISEASE -POLICY LIMIT
1,000,000
$
Excess Liability (follow form)
C EXAT621263
Each Occurence
04/29/2023 04/29/2024
10,000,000
Aggregate
10,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additlonal Remarks Schedule, maybe attached If more space Is required)
l".F'RTIIFIfIATFI1191 nF'R'
r.Aldrr-1 I. ,&TInN
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of El Segundo Fire Department
ACCORDANCE WITH THE POLICY PROVISIONS.
314 Main Street
AUTHORIZED REPRESENTATIVE
ElSegundo CA 90245
pIr "
@ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
PI-MANU-1 (01/00)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
11 ",1 ?
GENERAL LIABILITY DELUXE ENDORSEMENT: INTEGRATED TECHNOLOGY \
TH.-I.S F.,.WDORSEIMENT C71A1.14GEaS IIHE.� POL,ICY. 1'L,EA`3E READ Uf CAREE'ULLY.
GENERAL LIABILITY IDELUXE ENDORSEMENT': INITGRA.'_FED T'TECHNOLOGY
This endorsernent mod-ifies insurance provided under the foll.owi,nq-
COMME..', RC IAL GENERAL LAABELITlY COVERAGE PART
It -is understood and agreed Lhat the foil.owinq extensi(:xns only a.pp.J..y in th(..
ver'Lt that no otkier spec-if.j.c coverage for the indicated ioss exposur..'e is
provided. undexthis t')oli.Cy. If such spec-i-f-J.-c (:.,.ove2age appi-Les, the terms,
condi.t.ions and Iiinits of that cove-r-age are the sole and. exc.].usj..-qe cover -age
appii.cab'le undei, thi.s policy, uniess OthO.rWi_se nated on Lhi.s endorseiiient.
'T.'h.e fol.l.ow-inq is as surnmary of thc..,. Lin'�its of in suza.rrce and additional
coverage r.,rrovi.(ied by this endo-r-sement,. For complete deta-ils on specific,
cove raqes th.e poii.cy conty.act wording.
Coverage Appl_icabl.e
Lirr,lit Of
Page #
Damage to Premises Rented to You
$a., OC)O, C)OC)
Page 2
Expec,ted. or Entended Injury
P-roperty Damage
I ri cl. u de. d.
Page 2
Limited Rental. L,ease Aqi,.eement Cor,�tra.ctua.l Liability
$50, 000
Page 2
Non Owned Watercraft
Less than 58 feet
Page '3
Daynage t.o Property You Own, Rent: or. Oc('.°Llpy
$30,000
Page 3
Med_i.ca]. Payments
$20, 000
Page 3
All other terms and conditions of this Policy remain unchanged.
Page 1 of 12
PI-MANU-1 (01/00)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
Medi.cal IIayments CCeport-Lnq Pe.rl-od
3 Yea rs
Page 3
ALJn.1..eti.c
Amended
Page 3
Supp-.Lc,,nerita.a� y Payments
BaLl Boar
$2, 500
Page 4
Sur,.)],plementa.ry Payments Loss of Earninqs
$500 per day
PagE. 4
rnp Layee Defense. Cc)verage
$25, 000
Page 4
Nho I's An Insured
Ernpl.oyees and Volunteer. Workers Good Sarnar.J.Larc Acts,
Md..i.ti-onal. Insured. Newly A(,,qul-red or F'onned. Orcjarizriticjn Add.Ltiona.L lnsurc',d
Marlagerg and "."upervisors (with Cell ow E�rnj,aIoyee Cover age)
Add-itc.ona,l. Insu-ned 1,i,.-o,adened Njarned lnsu-red
Add.1 t-i-cma-1. Ensured E31ariket Acid I L.Lona L Tnsu.y.cedes When Requ...red by
Contrac:t
Add.i..t-lonal. Insured Lessees of Preun.Lses
Addl.ti-on.al fnsur-ed Endepend.rent Contractor-s
I ncl.uded
Pacies 11 to 5
Drat Les J.n the Event of Occurrence,, Off.ense, C.I.a.J.vi or SuLt
Included
I . lage 6
I ran sf. er of Ri-ghts of Recovery Agai.rcst Others I'o Us
C I a.r. J. f. :L.cra t.!.. o z
Page G
L J, b (,.t r a I., i z as tJ 0 n
] nc Luded
Page 6
uni,ntcant ional Failure to Di.sc,Iose Hazay.ds
Inc.,-Luded
Page 6
All other terms and conditions of this Policy remain unchanged.
Page 2 of 12
PI-MANU-1 (01/00)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFU.L
Bod�lv Injury Includes Ment-al AIWIU'ish
J':.ncluded
P'yqe i
Per Sona 1. and Adver Lin i nq � i I j ury I nc, Ludr,-< ohuno of P ror-x-,ss, DLscr i Ti'i i nAt i, on
uderd
P'Aqe /
A,, Damage to Preynises Rented to You
If darnage by :fire to preen per rented to you is not otherwise ex(-,:1uded Erom
this Coverage F..-Iart�:
I. T'he Damage To Premises Rented To You L,irnit section of the Declarat.Lons
.is amended to the greater of:
b. The arnount. shown in the Dec.l.arations as Damage to Premises Rented
to Yol..l I.,imit.
This is the most we will. pay for all darnage proximately caused by the sarne
euent, wfiether such damage results from fire, lightning, explosion, smoke,
or leaks Erom automatic Eire protect.i.Ve systems or any comb inat.J_on thereof;
2. 'Me word fire is changed. to fire, lightning, expl.(.,sion, sinok(c:, or
leakage front automatic fire prot.ective systems where it appears in.
a.. The last paragraph of SEC'PION 1. COVERAGES, COVERAGE A. BOI)IL,Y INJURY
AND PROPERTY DAM AGE LIABEL'ITY, Subsection 2. Exclusions;
b. SECT [ON II"I !: LIM.LTS OF INSURANCE, Paragraph 6. ; and
SFCT1 ON V: DEFINITIONS, Paragrapl�i. 9. a. ; and.
3. The words fire insurance are changed to insi..aran.ce for fire, lightning,
exp.J.(-)sJ.on, smok�-,.:, or, leakage from automatic fire protective systems where it
appears in SECr J01,j V1, rpy
F 1 . . COMMER.ClAL GENERAL LJABI .1 CONDITIONS, Subsection
4. Other Insurance, Paragraph b. Excess Insuirance.
All other terms and conditions of this Policy remain unchanged.
Page 3 of 12
PI-MANU-1 (01/00)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
B . Expected or Intended Enjury Property [)arnage
SECTION I: COVEl U: GES, COVERAGE A BODILY ENJURY AND PROPER'IY DAM AGE
LEARILITY, 2. Exclus.-Ions, Paragrapl-i. a.. ExpecLed Or. Intended Injury ts
deleted in its entir.ety and replaced by the following:
a. Expected Or Intended [njury
Podily injury or property damage expected or -intended frora rhe standpoint of
the insured. Tliis exclusion does not. apE.)I.y to bodily J.n.jUly or, property
darriage resulting froni the use of reasonable force to protect person,s or
properLy.
CLimited. Rental Lease Agreenient Cont.r.actual. Ldabiiity
SFCrpION I. COVE: RAGES, COVEI.Z.AGE A. BOI[MLY ENJURY AND PRO'E.JUY DAMAGE
1,1A,BJjjrFY, 2. Exclus.I.Ons, Paragraph. b. Contractual Liabil.l.ty Ls amended. by
adding the followijng�
Lased on the named insureds r'equest at the time of cla-Lin, we agree to
indemnify the nained insured for tlaeir liability assi.rrned in a. contract or
agreement regarding the rental. or lease of a prernises on behalf of their
cl.ient, up to $50,000.
rrhi.s co,,,/er..age extension only app.lies to rental lease agreements and is
excess over any renters liabil.ity Lnsurance of the cla.ent.
E). NonOwned Watercraft
SECq,10N I- COVERAGES, COVERAGE P, BODILY I.NJURY. AND PROPERI'Y DAM AGE
IAABILJ.T'Y, 2. Exclus-ions, 9, Aircraft, Auto Or Watercraft, ParagrapIn (2) is
amended to read as foliows:
(2) A watercraft you do not own that is(a.) Less than 58 feet Long; and
(b) Not be.j.nq used to carry persons or property for a charge;
This provision applies to any person, who with your consent, either uses or
is responsible for the use of a. waLercr.aft. This LnSU.rance a..s excess over
any other val.J.d and collectible Lnsurance availalole to the insured whether.
All other terms and conditions of this Policy remain unchanged,
Page 4 of 12
PI-MANLI-1 (01/00)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
pri.Tnary, excess, or. contingent.
E . Darnage to Property You Own, Rent or Occupy
SECTION t:�, CO'VERAGES, COVERAGE A BODII,Y IN,JURY AND PROPERTY DAM AGE:
1,1ABILITY, 2. Exclusions, j. Damage To Property, Parag.raph (1) is deleted in
.its entirety and rep.Laced with the following�
(1) Property you own, rent or occupy, including alny CO3tS or expenses
incu.rred by yoti, or any other person, organ.j.zation or.., entity' for. repair,
replacement, enhanceriient, restoration or niaintenance of such property for
any -reason, JLncluding prevenLion of injury to a pe.rson or damage to anothers
property, unless the damage to property is caused by your cl.ient, up to a
$30,000 linn i.t. A cal .i.ent is riE fined us a person under your di.rect care and
siuperv.i sion
F". Medical. Payments
I. If COVERAGE C MEDICAL PAYNIENTS is not otherwise excluded froin thi.s
Coverage Part:, the Medical. Expense Limit is changed subject. to all. of the
tern.is of SECTION H.I. J'IMLrrS OF INSTLIFLANCE to the greater of.
a,. $20,000; or
b. The Medical Expense 1,-imit shown in the Declaratir,)ns of tti.i.s Crm/erage
Part .
2. Under SECTION I. COVERAGES, COVERAGE C MED - ICAL PAYMENTS, Subsection 1.
Insuring Agreenient, Paragraph a.,:Ilea". (b) is amended to read.'.:
(b) The expenses are Lricur-red and reported to us within three years of the
date of the acciderit; and.
G. Athletic Activlties
SIECI-I-ON 1: COVERAGES, Cr."WERAGE C MEDECAL PAYMENTS, 2. Exciusions, Paragraph.
e,, Athletics Activiti.es is deleted. Ln its entirety and re 1.,olac(,-�d with the
.f ol. 1. 0 uai r u g
All other terms and conditions of this Policy remain unchanged.
Page 5 of 12
PI-MANU-1 (01/00)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
(:* . ALhlet'acs AcLM.L-ics
To a. person injured while taking loai,.-t i.n athl.et.i.cs.
ll. Supp.lemenLary Payments
SE,CTlON T. COVERAGES, SUP PLEF[ME'NTARY PAYMENTS: COVERAGES A. AND B, Iterns :lab.
and. I.d.a are ainended. as fol.1ows-
b. Th.e lArait for the cost of ba.A.A. bonds is changed from. $250 to $2,500;
and d.. The IA,.mit for Loss of earnings is ch.anged from $250 a day to $500 as
day.
:1 . Ernpl.oyee IDdeTnrii.E-icat.i.on Defense Coverage
SECrl:,:F.ON 1: COVERAGES, SUPPLEMENTARY PAYMEMTS': COVERAC-3ES A AND B a.s amended
to inciude the fo-1.1owing:
We wili pay, on your beha1f, defense costs i.ricurred by an empl.oyee in a.
cri.xiidnal. proceeding.
'Fhe most we will pay for, any employee who is di.rectLy invol.ved in a crinii-nal.
proceeding is $25,000 regardl.ess of the rlUrabers of ernpl.oyees, cl.ai.nis or
suits brought or.. persons o r organizat-ions ma.ki.nq c1ai.ais or bri.ng-ing suits.
J. Who is An I:nsu.red
SECTION u::l:: a WHO IS AN INSURED is amended as follows:
1— Paragraph 2.a,. (1) !.a del.eLed. in its enti.rety and repl.aced wi.th the
fol..Lowi.ng. Each of. Lhe fol.-Lowing i.s a1so an insured-
s. Your vrol.unteer workers only wh-J.1e performing duties related. to the
conduct of your business, or you-r.. empl.oyees, other than either your
executi.ve off-J.cers (J.f you are an organizati.on other than a partnership,
joint aenture or. IiTnited. Ii.abil.it.y cornpany) or your mana.gers (if you are a.
I.A.m.i.ted liabilAty company), but only for acts withi.n the scope of their
enqpl.oyanent 1<y you or wh-ile; performing duties -.rel.ated to the conduct of your
business. Bowever, none of these einpl..oyees or raol.unteer workers are insureds
for. �
(1) Bodi1y injury or persona.A. and advertising irajury-
All other terms and conditions of this Policy remain unchanged.
Page 6 of 12
PI-MANU-1 (01/00)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
ypayaitnerhip 3(a) To nrroint
VE�'IILUre), to you.r iT.Lernber3 (J.f you are a lirri-ited I.A.a.bility cornparly), to a
co employee while in thee cour3e of hi.s or hex. empioyment. o-r pe.rfo.rrning
dut-ies related to the conduct of your busa.ness, or.. to your. other volunteer
workers wbi.].e perforin.ing dut.l.es related to thEs conduct of your. business;
(b) To then spouse, child, pa -rent, brother or s�.ster of that cc) eTTIP.J.oyee or,
volunteer worker- as a consequeice ofParagraph (1) (a) above;
(c) For which there Ls any ob].J.gatiori. to share daniages wi.th or -repay
someone else who must pay darnages because of. the injury desc-ribed -iri
Paragraphs (1y (a) or., (b) above; or
(d) Ai.ising out of his o-r.. her providing or failing to prov.j.de pr.ofessional.
health ca.:r.e ser..'Vj Ces .
However:
Pax agraphs Q1) (a) and (1) (d) do not. apply to you-Yenq.)Ioyees or vo].unteer.
workers, wh.o are not erriployed. by you o.r volunteering for. you as hea".).th care
prof ess j. ona.-I s, for toodily irijury ari.s.j.nq o-Lit of Good. Samar.�.tan Acts while
the employee or vol.unteer worker. is perfo_rrning duties Y.e_.Iated to the conduct.
of your busi.rIaSS, Good Sarnaxi.tan Acts mean any as=..-,istarhce of a rned.-ical
nature rendered or. provl.ded Li� an enie-rgency situation for wlaicja no
remuneration i.s dernanded or rece-ived.
2. Newly Acquired or.. Formed. Organization
If coverage for newly acqu-J..red or forrned organ-iza.ti.ons is riot. otherw_'Lse
ex.cluded fromn t h i. s
Coverage Part., Paragraph 3.a. Ls aME,Mded to read�
a. Cover -age undeT. this provision i.s afforded unt.-I.I. the end of'f the pol.A.cy
period;
3. Each of the foll.owing is also an insured:
a.,. iAanagens, and Supervisors„ Your inanagers and supervisors are also
All other terms and conditions of this Policy remain unchanged,
Page 7 of 12
PI-MANU-1 (01/00)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
insureds, but only with respect to their duties as your managers and
supervisors. Managers and supervisors who are your employees are also
insureds for bodily injury to a co employee while in the course of his or
her employment by you or performing duties related to the conduct of your
business.
This provision does not change Item 2.a.(1)(a) as it applies to managers of
a limited liability company.
b. Broadened Named Insured: Any organization and subsidiary thereof which
you control and actively manage on the effective date of this Coverage Part.
However, coverage does not apply to any organization or subsidiary not named
in the Declarations as Named Insured, if they are also insured under another
similar policy, but for its termination or the exhaustion of its limits of
insurance.
c. Blanket Additiona:ll. Insureds When Require.d. :by Contract.: Any person or
organization where requ..xed by a wr-itten c°ontract executed prior to the
occurrence of a loss. Such person or organization is an add::i..t.t.ona7i.. i.nasured
for bod.i..]...y injury, property damage or, personal and advertising injury but.
only for JJ.ability arising out of the negligence of ttie named .J.-insured. "I'lle
I.. imi..ts of insurance applicable to these add.i.t:i.ona:.l.. :insureds are the :I.ews„ eer
of the p:o.licy 1...:units or tho se lirnits specified :in a contract ori.. agreement.
These 1 .aai>Its are included w..J.thi..n and not in addition to the ltms.f.ts of
Lnsuranc.e shown in the Dec :larat.J.ons.
d. Lessees of Premises: Any person or organization who leases or rents a
part of the premises you own or manage who you are required to add as an
additional insured on this policy under a written contract or written
agreement, but only with respect to liability arising out of your ownership,
maintenance or repair of that part of the premises which is not reserved for
the exclusive use or occupancy of such person or organization or any other
tenant or lessee.
This provision does not apply;
(1) To liability arising out of such persons or organizations sole
negligence; or
All other terms and conditions of this Policy remain unchanged.
Page 8of12
PI-MANU-1 (01/00)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
(2) After the person or organization ceases to lease or rent premises from
you.
e . IndependeriL. ContracLors Any independeriL contractor, but on.Ly wh.J.le
acting wi.th.in the scope of a written contract and only With respect to
liability arising out. of your products or.. your work.
K. Duties in the Event of Oc-cairrence, Offense, Clairn or- Suit
1.. SECq,10N IV: COPIMEPCIAL GENERAL LIABILITY CONIXI.TIONS, 2.a,, the
reqUireinenL- that you rnuslt, see to it that we are notified as soon as
practicable of an occurrence or an offense, applies only when the occurrence
or offense is known to�:
a.. YOU, 1.f you are an Lridividual;
b. A, partner, if YOU are a. partnersh.ip; or
C. An execut.-Lve officei'. or. insuranCe Manager, if YOLY are a. corporation.
2. SECT'ION IV. COI.�IMERCIAL GENERAL LIABILITY CONDITIONS, 2. b. the
requirement that you must see to -i..t that we receive mortice of. a claim or
suit as soon as practicable w.j.1.1 not be considered breached unless the
breach occurs after such claim. or suit is known ter:
a. You, if you are an J.ndividual,
b. A partner, if you ae:e a. partnershi.p; or
C. An executi.,ve officer or.. A.nsurance manager, if you are a corporation.
3, SECTION IV: COMMERCIAL GENERAL, 1 IABIj'Ir.1.1y COND.Irl.IONS, 2. -is amended to
include tire fol.lowing additional. Pr.M,7i.si=
Your rights under this coverage part will not be prejudiced if you fail to
gi.ve us notice of an occurrence, offense, c-1-aicri or- su-it and. that fai.lure is
so.Le-Ly due to your reasonable belief. that t1he bod.J.1y injury or property
damage is riot covered Under th-.i-s coverage part. However, you sha.1-1 give
written notice of this occurrence, offense, cl.aini. or suit to us as soon as
All other terms and conditions of this Policy remain unchanged.
Page 9 of 12
PI-MANU-1 (01/00)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
you a.-r..e aware tkiat thi.s insurance may appl.y to such occurrenc,,,e, offense
claim or suit.
L . 111ransfer. of Iight..s of Rec.overy Against. Others To Us
SECTFON IVCOMME:RMA.I., GENE'RAI LIABET�F.TY CONDITFONS, Par.aojrar.:rh 8. Transfer
Of Rights Of. Recovery Against Others '110 U3 includes th�e fol.lowi.ng
c 1. a. ri f i. c a t -1. on :
Tl,erefore, the insured can waive the Lnsurers of recovery prior, to
the occurrence of a lcosset waiver is made in a written
cor, L ract.
M. 1,1 bE�ra -I.A. zati on
SEX"T.110M ]".V. COMIVIE'RC. EAI., GENERAL, CONDI'FIONS is amc nded. to inchade
the following addl.tiontal condition
-
-Libe-r.. ald. z at J. on
Cif we revise this endorsement to provide rnore coverage without additi.onal
I.-.)remium, cha-i,.ge, we wl.11 autoniatical-Ly prov.i.de the additi.con a.l. coverage to a.I.A.
endorsement holde.r.s as of the day the Y.ev-ision J,s effecti.VC in your state.
N. Unintentioj,ral Faiiure To Da dose Ha�r�a.rd.3
SECTI:ON IV, COMMERCPAL, GENERAL, L,IAB EL'UPY GOOD I'17IONS is amended tca include
the follow.ing additiona.l. condition-
Urd.r)Lentional. Fai..Lure To IDi.sc.Lose. Hazards
-It -is agmeed. th.at, based on our rel.iance on your rej,.)resenta.ticans as to
existing hazards, j..f you shoulof unintentionally fail to disclo-.;e al.]. such
hazards p--rioy. to the beginning of the policy period of this Cove -'rage, Part.,
we shall. not. deny coverage under thi.s Coverage Pay..t because of such
fa-ilure,.
0. Bodily lnjuiy Mental Anqul.sh
All other terms and conditions of this Policy remain unchanged.
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PI-MANU-1 (01/00)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
SECTION V: DEFINITI:ONS, Paragraph 3, is amended to readBod.1.1y injur.yo
a. Means bodil.y injury, sickness or disease sustained by a. person, and
inc-ludes mental. anquish resulting frorn any of these; and
}'a. Except for neni al.. anquish, includes deal h resulting frorri the foregoing
(Ttem a. above) at any ti.rne.
P. Personal and Adverti.sing J.:njury Abuse of Process, Discir..'im.i.nation
If COVERAGE B PERSONAL, AND ADVERTISI:NG INJURY LF.ABJ.j'jrj,y COVERAGE is not
otherwise excluded from this Coverage Part, the definition of personal. and
adverti-sinq injury is a.mended. as foll..ows:
1'. SECTION V, 1E.F'IN:rrY.1IONS, Paragraph. I.A., 1tem b. is revised to read.
L) . Ma-L-i-c-ioias prosecution or. abuse of px.ocess;
L. SECT.ION V: Paragraph "L/I. is amended to :i.nclude the
following -
Personal. and advertising in)ury also means discri.mina.t.i.oyi based. on raco,
co1or., rel.-igion, sex, age or nationalorigin, except. when:
a. Doric, intent-Lonally by or at the direction of, or w-ith the knowledgc or
consent of�
(1) Any insured; or,
(2) Any execuL.J..ve off-icer, director, sLockhoider, partner, or rnember of the
insured; or
b . D-i.rectly or i.nd.j.rectly re1ated to the erriployment, former or T.,.)rospecti�ve
employruent, terMi.nation of erap.l.oyii=t., or appl..-.i.cation for ernpioyment of any
person or persons by an Insured, or
C E)irectly or indirectly reel .aLed to the ,a ea, rental., 1ea.se or suh1ease
or prospective sale, rental., Lease or. sub lease of any roorn, dweiling or
prernises by or at the d.irection of any insured; or
All other terms and conditions of this Policy remain unchanged.
Page 11 of 12
PI-MANU-1 (01/00)
d . Insux-once: fo.r such. di.scr-Irrination. is ]p:i,..ohi.b:,.Led by or held in violat.i.on
of law, pub.'..Ac Legis.lati.on, court, dec.i.sion or admini..,st-rative
ru..I.A.nq .
The above does, not apply to fines or pperalties J,Tqposed because of..
All other terms and conditions of this Policy remain unchanged.
Page 12 of 12