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PROOF OF INSURANCE (2015) CLOSEDMOORIAC -01 SHANNONH
CERTIFICATE OF LIABILITY INSURANCE
DATE 10129/DDfYl�Ylf)
10/29/2014
THIS CERTIFICATE IS ISSUED AS ATWITTER 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 corlifloMe holder is an ADDITIONAL INSURED, the policy(iss) must 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 en nt(s).
PRODUCER
Cook Insurance Services
276 Dolores Ave
San Leandro, CA 94577
Moore larolor,p A Golisman, Inc.
DBA: MIG
800 Hearst Avenue
Berkeley, CA 94710
F:
352 -2731
Hartford Fire Ins. Co.
Sant IneI Insurance C
COVERAGE
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
352 -8272
NAIC
19,682
11000
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.
m.... _.... _ .....m
BIB St@ .. -
LTR TYPE OFerSURANCE POLICY NUMBER MM/DD/yYYy WwOu"YYYj LIMITS
A
X
EACH OECTCi U"RDREEMO N CE
$ 1,000,00
m
GLAjmSMADE
X
57UUN UNS227
04/01/2014
0/01/2015
..
.. -
300 00
PREMISES Ea urre e
S .... .
..........
MED EXP (Any one Person)
$ 10,0
..._.- .,......
--GR
PERSONAL8ADVINJURY
..GENERAL
$ 1,000,00
GENT
TE LIMITAPPLIE'_S PEP-
AGGREGATE
$ 2.000,00
PRO- 0
POUCY 11 JECY LOC
PRODUCTS- COMP /OPAGG
S 2,000,00
OTHER
$
AUiiOYOBI.ELIABILM
—'
COMBINED ''I L LIMIT
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$
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A
my
UUNUNS227
W0112014
04/01/2015
BODILY INJURY (Per person)
mmm
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ALL OtFD
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BODILY INJURY (Peracdderrl)
..........
i
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$
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$
LIAB OCCUR
EACH OCCURRENCE
5
EXCM AB
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STATUTE ERH
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04/01/2014
04/0112015
X EAgi,n�I�M
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s 1,000,0
-- - - - - --
(may n N)
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EA
L DISEASE - EA EMPLOYEES
1,
if descrbe under
D" aC' RIP'IRO�B#',i'�W'RA'TIND�'S W.
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E.L DISEASE - POLICY LIMIT
_
S 1,000,00 .
OESCRPTION OF OPERATIDILS I LOCATIONS / VEHICLES (ACORD 1411, AdimW Remarks ScheAulq nay be attached if mare space is )
slob 13408.00
Coverages shall not be cancelled except after thirty (30) days prior notice has been provided unless cancelled for non - payment of premium, then ten (10) days
notice shall be given.
Re:1340BAO El Segundo Smokey Hollm Specific Plan
City of 0 Segundo, a general law city and municipal corporation, its officials and employees are additional insured for general liability per HG00010605
aUwJwd, form includes primary coverage: waiver of subrogation for workers compensation per WC040306 attached.
CANCELLA
M
w
Client#: 2042 MOOREIACO
ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE 101(MMIDD (MMIDD/YYYY)
4
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 "'
ADDITIONA I
L INSURED, he the policy(ies) must 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 NAME: Jo Lusk
Dealey, Renton & Associates PHONE
d ..�.k ,...x.,,5.1, 0 465-3090 irc, rrrp 510 452 - 2193
A/c No End
P. O. Box 12675 E- MAUI '
ADDRESS:
Oakland, 09 94604 -2675 INSURE -- ---- can I)AFF AFFORDING ompany 22667c
510 465 -3090 INSURER(S) OVERAGE
Amer/ rance C
INSURED UR ER
INS B
Moore lacofano Goltsman, Inc. INS °�
800 Hearst Ave. INSURER c x
Berkeley, CA 94710 INSURER D R
INSURER E 3
COVERAGES CERTIFICATE NUMBER: 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
CONTRACTOR
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.
,flak,
LTR
..YP NSURANGE MSSL
TYPE OF INSU
B
POLICY ......... ............
NUMBER
POLICY EFF
MMdpDfYYYYI
— POLICY EXP
MMIDDIYYYY _
I LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$
COMMERCIAL GENERAL
O
,
rOCCUR
CLA MS MADE
MEX one person)
$
PERSONAL & ADV INJURY....__-$..----______.
.. ..............................
ENE
GRALAGGREGATE
$
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS COMP /OP AGG
PRO
�.J.�
$
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....... _ ........m.
AUTOMOBILE LIABILITY
7
IN aLEeII ......
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...............................
ANY AUTO
BODILY INJURY (Per person)
$
. ALL OWNED SCHEDULED
BODILY INJURY (Per accident)
$
AUTOS AUTOS
NON-
OAMAGE .,
..(Re
$.........
HIRED AUTOS
a deg0
..
.... ................ ........ .. .......
...
UMBRELLA LIAB OCCUR
—
.........
--- --
.......... ,.,.,.
EACH OCCURRENCE ......._
$ . —
EXCESS LIAR CLAIMS -MADE
AGGREGATE
$
DED RETENTION $
$
WORKERS COMPENSATION
WC STATU --T--
TH-
AND EMPLOYERS' LIABILITY Y/N
— TORY LIMRTS.• m.— �B
... - - - --_
ANY PROPRIETOR /PARTNER /EXECUTIVE '
E L EACH ACCIDENT
$
OFFICERIMEMBER EXCLUDED? f �
NIA
- -- - - —•
•••••• ••••••
(Mandatory in NH)
DISEASE EA EMPLOYEE
$
If yes, describe under
.. -- .. .. §-. ...,.
...... -.
DRIP IOPERnpoNSIO
.....................
EL DISEASE- POLICY LIMIT
_r __.... -.-
$ _... ...........
A
Professional
G2165 6434011
7/01/2014
071011201
$2,000,000 per claim
Liability
$2,000,000 annl aggr.
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
Re: Smoky Hollow Specific Plan Update
City of El Segundo y t
Planning & Bldg. Dept. ) p
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Attn: Kimberly Christensen
350 Main Street
El Segundo, CA 90245 -3813
AUTHORIZED REPRESENTATIVE
©1988 -2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD
#S1147305/M1026709 JXL
#57UUNUN8227
COMMERCIAL GENERAL LIABILITY COVERAGE
Various provisions in this policy restrict coverage. Read
the entire policy carefully to determine rights, duties and
what is and is not covered.
Throughout this policy the words "you" and "your" refer to
the Named Insured shown in the Declarations, and any
other person or organization qualifying as a Named
Insured under this policy. The words 'We", "us" and "our"
refer to the stock insurance company member of The
Hartford providing this insurance.
The word "insured" means any person or organization
qualifying as such under Section II — Who Is An Insured.
Other words and phrases that appear in quotation marks
have special meaning. Refer to Section V —Definitions.
SECTION I — COVERAGES
COVERAGE A BODILY INJURY AND PROPERTY
DAMAGE LIABILITY
1. Insuring Agreement
a. We will pay those sums that the insured becomes
legally obligated to pay as damages because of
"bodily injury" or "property damage" to which this
insurance applies. We will have the right and duty
to defend the insured against any "suit" seeking
those damages. However, we will have no duty to
defend the insured against any "suit" seeking
damages for "bodily injury" or "property damage" to
which this insurance does not apply. We may, at
our discretion, investigate any "occurrence" and
settle any claim or "suit" that may result. But:
(1) The amount we will pay for damages is limited
as described in Section III — Limits Of
Insurance; and
(2) Our right and duty to defend ends when we
have used up the applicable limit of insurance in
the payment of judgments or settlements under
Coverages A or B or medical expenses under
Coverage C.
No other obligation or liability to pay sums or
perform acts or services is covered unless explicitly
provided for under Supplementary Payments —
Coverages A and B.
b. This insurance applies to 'bodily injury" and
"property damage" only if.
(1) The "bodily injury" or "property damage" is
caused by an "occurrence" that takes place in
the "coverage territory";
(2) The "bodily injury" or "property damage" occurs
during the policy period; and
(3) Prior to the policy period, no insured listed
under Paragraph 1. of Section II — Who Is An
Insured and no "employee" authorized by you to
give or receive notice of an "occurrence" or
claim, knew that the "bodily injury" or "property
damage" had occurred, in whole or in part. If
such a listed insured or authorized "employee"
knew, prior to the policy period, that the "bodily
injury" or "property damage" occurred, then any
continuation, change or resumption of such
"bodily injury" or "property damage" during or
after the policy period will be deemed to have
been known prior to the policy period.
c. "Bodily injury" or "property damage" will be deemed
to have been known to have occurred at the
earliest time when any insured listed under
Paragraph 1. of Section II — Who Is An Insured or
any "employee" authorized by you to give or
receive notice of an "occurrence" or claim:
(1) Reports all, or any part, of the "bodily injury" or
"property damage" to us or any other insurer,
(2) Receives a written or verbal demand or claim
for damages because of the "bodily injury" or
"property damage'; or
(3) Becomes aware by any other means that
"bodily injury" or "property damage" has
occurred or has begun to occur.
d. Damages because of "bodily injury" include
damages claimed by any person or organization for
care, loss of services or death resulting at any time
from the "bodily injury".
e. Incidental Medical Malpractice
(1) "Bodily injury" arising out of the rendering of or
failure to render professional health care
services as a physician, dentist, nurse,
emergency medical technician or paramedic
shall be deemed to be caused by an
"occurrence", but only if:
(a) The physician, dentist, nurse, emergency
medical technician or paramedic is
employed by you to provide such services;
and
(b) You are not engaged in the business or
occupation of providing such services.
HG 00 0106 05 Page 1 of 18
© 2005 The Hartford
(includes copyrighted material of Insurance Services Office, Inc. with its permission.)
#57UUNUN8227
(2) For the purpose of determining the limits of
insurance for incidental medical malpractice,
any act or omission together with all related acts
or omissions in the furnishing of these services
to any one person will be considered one
"occurrence'.
2. Exclusions
This insurance does not apply to:
a. Expected Or Intended Injury
"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
reasonable force to protect persons or property.
b. Contractual Liability
"Bodily injury" or "property damage" for which the
insured 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:
(1) That the insured would have in the absence of
the contract or agreement; or
(2) Assumed in a contract or agreement that is an
"insured contract', provided the "bodily injury" or
"property damage" occurs subsequent to the
execution of the contract or agreement. Solely
for the purposes of liability assumed in an
"insured contract ", reasonable attorney fees and
necessary litigation expenses incurred by or for
a party other than an insured are deemed to be
damages because of "bodily injury" or "property
damage ", provided:
(a) Liability to such party for, or for the cost of,
that party's defense has also been assumed
in the same "insured contract"; and
(b) Such attorney fees and litigation expenses
are for defense of that party against a ci vil or
alternative dispute resolution proceeding in
which damages to which this insurance
applies are alleged.
c. Liquor Liability
"Bodily injury" or "property damage" for which any
insured may be held liable by reason of
(1) Causing or contributing to the intoxication of any
per;
(2) The furnishing of alcoholic beverages to a
person under the legal drinking age or under the
influence of alcohol; or
(3) Any statute, ordinance or regulation relating to
the sale, gift, distribution or use of alcoholic
beverages.
This exclusion applies only if you are in the
business of manufacturing, distributing, selling,
serving or furnishing alcoholic beverages.
d. Workers' Compensation And Similar Laws
Any obligation of the insured under a workers'
compensation, disability benefits or unemployment
compensation law or any similar law.
e. Employer's Liability
"Bodily injury" to:
(1) An "employee" of the insured arising out of and
in the course of
(a) Employment by the insured; or
(b) Performing duties related to the conduct of
the insured's business; or
(2) The spouse, child, parent, brother or sister of
that "employee" as a consequence of
Paragraph (1) above.
This exclusion applies:
(1) Whether the insured may be liable as an
employer or in any other capacity; and
(2) To any obligation to share damages with or
repay someone else who must pay damages
because of the injury.
This exclusion does not apply to liability assumed
by the insured under an "insured contract'.
f. Pollution
(1) "Bodily injury' or "property damage" arising out
of the actual, alleged or threatened discharge,
dispersal, seepage, migration, release or
escape of "pollutants ":
(a) At or from any premises, site or location
which is or was at any time owned or
occupied by, or rented or loaned to, any
insured. However, this subparagraph does
not apply to:
(i) "Bodily injury' if sustained within a
building and caused by smoke, fumes,
vapor or soot produced by or originating
from equipment that is used to heat, cool
or dehumidify the building, or equipment
that is used to heat water for personal
use, by the building's occupants or their
gum;
(ii) "Bodily injury" or "property damage" for
which you may be held liable, if you are a
contractor and the owner or lessee of
such premises, site or location has been
added to your policy as an additional
insured with respect to your ongoing
operations performed for that additional
insured at that premises, site or location
and such premises, site or location is not
and never was owned or occupied by, or
rented or loaned to, any insured, other
than that additional insured; or
Page 2 of 18 HG 00 0106 05
#57UUNUN8227
(iii) "Bodily injury" or "property damage"
arising out of heat, smoke or fumes from
a "hostile fire';
(b) At or from any premises, site or location
which is or was at any time used by or for
any insured or others for the handling,
storage, disposal, processing or treatment of
waste;
(c) Which are or were at any time transported,
handled, stored, treated, disposed of, or
processed as waste by or for:
(i) Any insured; or
(ii) Any person or organization for whom you
may be legally responsible;
(d) At or from any premises, site or location on
which any insured or any contractors or
subcontractors working directly or indirectly
on any insured's behalf are performing
operations if the "pollutants" are brought on
or to the premises, site or location in
connection with such operations by such
insured, contractor or subcontractor.
However, this subparagraph does not apply
to:
(i) "Bodily injury" or "property damage"
arising out of the escape of fuels,
lubricants or other operating fluids which
are needed to perform the normal
electrical, hydraulic or mechanical
functions necessary for the operation of
"mobile equipment" or its parts, if such
fuels, lubricants or other operating fluids
escape from a vehicle part designed to
hold, store or receive them. This
exception does not apply if the "bodily
injury' or "property damage" arises out of
the intentional discharge, dispersal or
release of the fuels, lubricants or other
operating fluids, or if such fuels,
lubricants or other operating fluids are
brought on or to the premises, site or
location with the intent that they be
discharged, dispersed or released as part
of the operations being performed by
such insured, contractor or
subcontractor,
(di) "Bodily injury' or "property damage"
sustained within a building and caused
by the release of gases, fumes or vapors
from materials brought into that building
in connection with operations being
performed by you or on your behalf by a
contractor or subcontractor, or
(iii) "Bodily injury' or "property damage"
arising out of heat, smoke or fumes from
a "hostile fire'; or
(e) At or from any premises, site or location on
which any insured or any contractors or
subcontractors working directly or indirectly
on any insured's behalf are performing
operations if the operations are to test for,
monitor, dean up, remove, contain, treat,
detoxify or neutralize, or in any way respond
to, or assess the effects of, "pollutants ".
(2) Any loss, cost or expense arising out of any:
(a) Request, demand, order or statutory or
regulatory requirement that any insured or
others test for, monitor, dean up, remove,
contain, treat, detoxify or neutralize, or in
any way respond to, or assess the effects of,
"pollutants "; or
(b) Claim or suit by or on behalf of a
govemmental authority for damages
because of testing for, monitoring, cleaning
up, removing, containing, treating,
detoxifying or neutralizing, or in any way
responding to, or assessing the effects of,
"pollutants ".
However, this paragraph does not apply to
liability for damages because of "property
damage" that the insured would have in the
absence of such request, demand, order or
statutory or regulatory requirement, or such
claim or "suit" by or on behalf of a govemmental
authority.
g. Aircraft, Auto Or Watercraft
"Bodily injury" or "property damage" arising out of
the ownership, maintenance, use or entrustment to
others of any aircraft, "auto" or watercraft owned or
operated by or rented or loaned to any insured. Use
includes operation and "loading or unloading ".
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" or
"property damage" involved the ownership,
maintenance, use or entrustment to others of any
aircraft, "auto" or watercraft that is owned or
operated by or rented or loaned to any insured.
This exclusion does not apply to:
(1) A watercraft while ashore on premises you own
or rent;
(2) A watercraft you do not own that is:
(a) Less than 51 feet long; and
(b) Not being used to cant' persons for a
charge;
(3) Parking an "auto" on, or on the ways next to,
premises you own or rent, provided the "auto" is
not owned by or rented or loaned to you or the
insured;
HG 00 0106 05 Page 3 of 18
(4) Liability assumed under any "insured contract'
for the ownership, maintenance or use of
aircraft or watercraft;
(5) "Bodily injury" or "property damage" arising out
of the operation of any of the equipment listed in
Paragraph f.(2) or f.(3) of the definition of
"mobile equipment"; or
(6) An aircraft that is not owned by any insured and
is hired, chartered or loaned with a paid crew.
However, this exception does not apply if the
insured has any other insurance for such "bodily
injury" or "property damage", whether the other
insurance is primary, excess, contingent or on
any other basis.
h. Mobile Equipment
"Bodily injury" or "property damage" arising out of:
(1) The transportation of "mobile equipment" by an
"auto" owned or operated by or rented or loaned
to any insured; or
(2) The use of "mobile equipment" in, or while in
practice for, or while being prepared for, any
prearranged racing, speed, demolition, or
stunting activity.
i. War
"Bodily injury" or "property damage ", however
caused, arising, directly or indirectly, out of:
(1) War, including undeclared or civil war,
(2) Warlike action by a military force, including
action in hindering or defending against an
actual or expected attack, by any government,
sovereign or other authority using military
personnel or other agents; or
(3) Insurrection, rebellion, revolution, usurped
power, or action taken by governmental
authority in hindering or defending against any
of these.
j. Damage To Property
"Property damage" to:
(1) Property you own, rent, or occupy, including any
costs or expenses incurred by you, or any other
person, organization or entity, for repair,
replacement, enhancement, restoration or
maintenance of such property for any reason,
including prevention of injury to a person or
damage to anothers property;
(2) Premises you sell, give away or abandon, if the
"property damage" arises out of any part of
those premises;
(3) Property loaned to you;
(4) Personal property in the care, custody or control
of the insured;
(5) That particular part of real property on which
you or any contractors or subcontractors
working directly or indirectly on your behalf are
performing operations, if the "property damage"
arises out of those operations; or
(6) That particular part of any property that must be
restored, repaired or replaced because "your
work' was incorrectly performed on it.
Paragraphs (1), (3) and (4) of this exclusion do not
apply to "property damage" (other than damage by
fire) to premises, including the contents of such
premises, rented to you for a period of 7 or fewer
consecutive days. A separate limit of insurance
applies to Damage To Premises Rented To You as
described in Section III — Limits Of Insurance.
Paragraph (2) of this exclusion does not apply if the
premises are "your work" and were never occupied,
rented or held for rental by you.
Paragraphs (3) and (4) of this exclusion do not
apply to "property damage" arising from the use of
elevators.
Paragraphs (3), (4), (5) and (6) of this exclusion do
not apply to liability assumed under a sidetrack
agreement.
Paragraphs (3) and (4) of this exclusion do not
apply to "property damage" to borrowed equipment
while not being used to perform operations at the
job site.
Paragraph (6) of this exclusion does not apply to
"property damage" included in the "products -
completed operations hazard ".
k. Damage To Your Product
"Property damage" to "your product' arising out of it
or any part of it.
I. Damage To Your Work
"Property damage" to 'your work' arising out of it or
any part of it and included in the "products -
completed operations hazard ".
This exclusion does not apply if the damaged work
or the work out of which the damage arises was
performed on your behalf by a subcontractor.
m. Damage To Impaired Property Or Property Not
Physically Injured
"Property damage" to "impaired property" or
property that has not been physically injured,
arising out of
(1) A defect, deficiency, inadequacy or dangerous
condition in 'your product" or'your work; or
(2) A delay or failure by you or anyone acting on
your behalf to perform a contract or agreement
in accordance with its terms.
This exclusion does not apply to the loss of use of
other property arising out of sud3ldn and aerttal
physical injury to "your prod or'your wo after
it has been put to its intended use.
Page 4 of 18 HG 00 0106 05
#57UUNUN8227
n. Recall Of Products, Work Or Impaired
Property
Damages claimed for any loss, cost or expense
incurred by you or others for the loss of use,
withdrawal, recall, inspection, repair, replacement,
adjustment, removal or disposal of
(1) "Your produt;
(2) "Your work; or
(3) "Impaired property";
if such product, work, or property is withdrawn or
recalled from the market or from use by any person
or organization because of a known or suspected
defect, deficiency, inadequacy or dangerous
condition in it.
o. Personal And Advertising Injury
"Bodily injury" arising out of "personal and
advertising injury".
p. Electronic Data
Damages arising out of the loss of, loss of use of,
damage to, corruption of, inability to access, or
inability to manipulate electronic data.
As used in this exclusion, electronic data means
information, facts or programs stored as or on,
created or used on, or transmitted to or from
computer software, including systems and
applications software, hard or floppy disks, CD-
ROMS, tapes, drives, cells, data processing
devices or any other media which are used with
electronically controlled equipment.
q. Employment - Related Practices
"Bodily injury" to:
(1) A person arising out of any "employment —
related practices'; or
(2) The spouse, child, parent, brother or sister of
that person as a consequence of "bodily injury"
to that person at whom any "employment -
related practices" are directed.
This exclusion applies:
(1) Whether the insured may be liable as an
employer or in any other capacity; and
(2) To any obligation to share damages with or
repay someone else who must pay damages
because of the injury.
r. Asbestos
(1) "Bodily injury" or "property damage" arising out
of the "asbestos hazard ".
(2) Any damages, judgments, settlements, loss,
costs or expenses that:
(a) May be awarded or incurred by reason of
any claim or suit alleging actual or
threatened injury or damage of any nature or
kind to persons or property which would not
have occurred in whole or in part but for the
"asbestos hazard ";
(b) Arise out of any request, demand, order or
statutory or regulatory requirement that any
insured or others test for, monitor, dean up,
remove, encapsulate, contain, treat, detoxify
or neutralize or in any way respond to or
assess the effects of an "asbestos hazard ";
or
(c) Arise out of any claim or suit for damages
because of testing for, monitoring, cleaning
up, removing, encapsulating, containing,
treating, detoxifying or neutralizing or in any
way responding to or assessing the effects
of an "asbestos hazard ".
Damage To Premises Rented To You — Exception
For Damage By Fire, Lightning Or Explosion
Exclusions c. through h. and j. through n. do not apply
to damage by fire, lightning or explosion to premises
while rented to you or temporarily occupied by you with
permission of the owner. A separate limit of insurance
applies to this coverage as described in Section III —
Limits Of Insurance.
COVERAGE B PERSONAL AND ADVERTISING
INJURY LIABILITY
1. Insuring Agreement
a. We will pay those sums that the insured becomes
legally obligated to pay as damages because of
"personal and advertising injury' to which this
insurance applies. We will have the right and duty
to defend the insured against any "suit" seeking
those damages. However, we will have no duty to
defend the insured against any "suit" seeking
damages for "personal and advertising injury" to
which this insurance does not apply. We may, at
our discretion, investigate any offense and settle
any claim or "suit" that may result. But:
(1) The amount we will pay for damages is limited
as described in Section III — Limits Of
Insurance; and
(2) Our right and duty to defend end when we have
used up the applicable limit of insurance in the
payment of judgments or settlements under
Coverages A or B or medical expenses under
Coverage C.
No other obligation or liability to pay sums or
perform ads or services is covered unless explicitly
provided for under Supplementary Payments —
Coverages A and B.
b. This insurance applies to "personal and advertising
injury" caused by an offense arising out of your
business but only if the offense was committed in
the "coverage territory" during the policy period.
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2. Exclusions
This insurance does not apply to:
a. Knowing Violation Of Rights Of Another
"Personal and advertising injury' arising out of an
offense committed by, at the direction or with the
consent or acquiescence of the insured with the
expectation of inflicting "personal and advertising
injury'.
b. Material Published With Knowledge Of Falsity
"Personal and advertising injury" arising out of oral,
written or electronic publication of material, if done
by or at the direction of the insured with knowledge
of its falsity.
c. Material Published Prior To Policy Period
"Personal and advertising injury" arising out of oral,
written or electronic publication of material whose
first publication took place before the beginning of
the policy period.
d. Criminal Acts
"Personal and advertising injury' arising out of a
criminal act committed by or at the direction of the
insured.
e. Contractual Liability
"Personal and advertising injury' for which the
insured has assumed liability in a contract or
agreement. This exclusion does not apply to liability
for damages that the insured would have in the
absence of the contract or agreement.
f. Breach Of Contract
"Personal and advertising injury" arising out of a
breach of contract, except an implied contract to use
anthers "advertising idea" in your "advertisement'.
g. Quality Or Performance Of Goods — Failure To
Conform To Statements
"Personal and advertising injury" arising out of the
failure of goods, products or services to conform
with any statement of quality or performance made
in your "advertisement'.
h. Wrong Description Of Prices
"Personal and advertising injury" arising out of the
wrong description of the price of goods, products or
services.
i. Infringement Of Intellectual Property Rights
"Personal and advertising injury" arising out of any
violation of any intellectual property rights such as
copyright, patent, trademark, trade name, trade
secret, service mark or other designation of origin
or authenticity.
However, this exclusion does not apply to
infringement, in your "advertisement', of
(1) Copyright;
(2) Slogan, unless the slogan is also a trademark,
trade name, service mark or other designation
of origin or authenticity; or
(3) Title of any literary or artistic work.
J. Insureds In Media And Internet Type
Businesses
"Personal and advertising injury" committed by an
insured whose business is:
(1) Advertising, broadcasting, publishing or
telecasting;
(2) Designing or detemnining content of web sites
for others; or
(3) An Internet search, access, content or service
provider.
However, this exclusion does not apply to
Paragraphs 17.a., b. and c. of "personal and
advertising injury" under the Definitions Section.
For the purposes of this exclusion, placing an
"advertisement" for or linking to others on your web
site, by itself, is not considered the business of
advertising, broadcasting, publishing or telecasting.
k. Electronic Chatrooms Or Bulletin Boards
"Personal and advertising injury" arising out of an
electronic chatroom or bulletin board the insured
hosts, owns, or over which the insured exercises
control.
I. Unauthorized Use Of Another's Name Or
Product
"Personal and advertising injury" arising out of the
unauthorized use of another's name or product in
your e-mail address, domain name or metatags, or
any other similar tactics to mislead another's
potential customers.
m. Pollution
"Personal and advertising injury" arising out of the
actual, alleged or threatened discharge, dispersal,
seepage, migration, release or escape of
"pollutants" at any time.
n. Pollution - Related
Any loss, cost or expense arising out of any:
(1) Request, demand, order or statutory or
regulatory requirement that any insured or
others test for, monitor, dean up, remove,
contain, treat, detoxify or neutralize, or in any
way respond to, or assess the effects of,
"pollutants "; or
(2) Claim or suit by or on behalf of a governmental
authority for damages because of testing for,
monitoring, cleaning up, removing, containing,
treating, detoxifying or neutralizing, or in any
way responding to, or assessing the effects of,
"pollutants ".
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o. War
"Personal and advertising injury", however caused,
arising, directly or indirectly, out of
(1) War, including undeclared or civil war,
(2) Warlike action by a military force, including
action in hindering or defending against an
actual or expected attack, by any government,
sovereign or other authority using military
personnel or other agents; or
(3) Insurrection, rebellion, revolution, usurped power,
or action taken by governmental authority in
hindering or defending against any of these.
p. Internet Advertisements And Content Of Others
"Personal and advertising injury" arising out of:
(1) An "advertisement" for others on your web site;
(2) Placing a link to a web site of others on your
web site;
(3) Content, including information, sounds, text,
graphics, or images from a web site of others
displayed within a frame or border on your web
site; or
(4) Computer code, software or programming used
to enable:
(a) Your web site; or
(b) The presentation or functionality of an
"advertisement" or other content on your
web site.
q. Right Of Privacy Created By Statute
"Personal and advertising injury" arising out of the
violation of a person's right of privacy created by
any state or federal act.
However, this exclusion does not apply to liability
for damages that the insured would have in the
absence of such state or federal act.
r. Violation Of Anti Trust law
"Personal and advertising injury" arising out of a
violation of any anti-trust law.
S. Securities
"Personal and advertising injury" arising out of the
fluctuation in price or value of any stocks, bonds or
other securities.
It. Discrimination Or Humiliation
"Personal and advertising injury" arising out of
discrimination or humiliation committed by or at the
direction of any "executive officer", director,
stockholder, partner or member of the insured.
u. Employment- Related Practices
"Personal and advertising injury" to:
(1) A person arising out of any "employment—
related practices"; or
(2) The spouse, child, parent, brother or sister of
that person as a consequence of "personal and
advertising injury" to that person at whom any
"employment- related practices" are directed.
This exclusion applies:
(1) Whether the insured may be liable as an
employer or in any other capacity; and
(2) To any obligation to share damages with or
repay someone else who must pay damages
because of the injury.
v. Asbestos
(1) "Personal and advertising injury" arising out of
the "asbestos hazard ".
(2) Any damages, judgments, settlements, loss,
costs or expenses that:
(a) May be awarded or incurred by reason of
any claim or suit alleging actual or
threatened injury or damage of any nature or
kind to persons or property which would not
have occurred in whole or in part but for the
"asbestos hazard';
(b) Arise out of any request, demand, order or
statutory or regulatory requirement that any
insured or others test for, monitor, clean up,
remove, encapsulate, contain, treat, detoxify
or neutralize or in any way respond to or
assess the effects of an "asbestos hazard';
or
(c) Arise out of any claim or suit for damages
because of testing for, monitoring, cleaning
up, removing, encapsulating, containing,
treating, detoxifying or neutralizing or in any
way responding to or assessing the effects
of an "asbestos hazard ".
COVERAGE C MEDICAL PAYMENTS
1. Insuring Agreement
a. We will pay medical expenses as described below
for "bodily injury" caused by an accident:
(1) On premises you own or rent;
(2) On ways next to premises you own or rent; or
(3) Because of your operations;
provided that:
(1) The accident takes place in the "coverage
territory' and during the policy period;
(2) The expenses are incurred and reported to us
within three years of the date of the accident;
and
(3) The injured person submits to examination, at
our expense, by physicians of our choice as
often as we reasonably require.
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b. We will make these payments regardless of fault.
These payments will not exceed the applicable limit
of insurance. We will pay reasonable expenses for
(1) First aid administered at the time of an accident;
(2) Necessary medical, surgical, x -ray and dental
services, including prosthetic devices; and
(3) Necessary ambulance, hospital, professional
nursing and funeral services.
2. Exclusions
We will not pay expenses for "bodily injury":
a. Any Insured
To any insured, except'Volunteer workers ".
b. Hired Penton
To a person hired to do work for or on behalf of any
insured or a tenant of any insured.
c. Injury On Normally Occupied Premises
To a person injured on that part of premises you
own or rent that the person normally occupies.
d. Workers Compensation And Similar Laws
To a person, whether or not an "employee" of any
insured, if benefits for the "bodily injury' are payable
or must be provided under a workers' compensation
or disability benefits law or a similar law.
e. Athletics Activities
To a person injured while practicing, instructing or
participating in any physical exercises or games,
sports, or athletic contests.
f. Products - Completed Operations Hazard
Included within the "products- completed operations
hazard ".
g. Coverage A Exclusions
Excluded under Coverage A.
SUPPLEMENTARY PAYMENTS — COVERAGES
AANDB
1. We will pay, with respect to any claim we investigate or
settle, or any "suit" against an insured we defend:
a. All expenses we incur.
b. Up to $1,000 for cost of bail bonds required
because of accidents or traffic law violations arising
out of the use of any vehicle to which the Bodily
Injury Liability Coverage applies. We do not have
to furnish these bonds.
c. The cost of appeal bonds or bonds to release
attachments, but only for bond amounts within the
applicable limit of insurance. We do not have to
furnish these bonds.
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.
e. All costs taxed against the insured in the "suit'.
C Prejudgment interest awarded against the insured
on that part of the judgment we pay. If we make an
offer to pay the applicable limit of insurance, we will
not pay any prejudgment interest based on that
period of time after the offer.
g. All interest on the full amount of any judgment that
accrues after entry of the judgment and before we
have paid, offered to pay, or deposited in court the
part of the judgment that is within the applicable
limit of insurance.
These payments will not reduce the limits of insurance.
2. If we defend an insured against a "suit" and an
indemnitee of the insured is also named as a party to
the "suit', we will defend that indemnitee if all of the
following conditions are met:
a. The "suit' against the indemnitee seeks damages
for which the insured has assumed the liability of
the indemnitee in a contract or agreement that is an
"insured contract;
b. This insurance applies to such liability assumed by
the insured;
c. The obligation to defend, or the cost of the defense
of, that indemnitee, has also been assumed by the
insured in the same "insured contracr';
d. The allegations in the "suit" and the information we
know about the "occurrence" are such that no
conflict appears to exist between the interests of
the insured and the interests of the indemnitee;
e. The indemnitee and the insured ask us to conduct
and control the defense of that indemnitee against
such "suit' and agree that we can assign the same
counsel to defend the insured and the indemnitee;
and
f. The indemnitee:
(1) Agrees in writing to:
(a) Cooperate with us in the investigation,
settlement or defense of the "suit
(b) Immediately send us copies of any
demands, notices, summonses or legal
papers received in connection with the "suit;
(c) Notify any other insurer whose coverage is
available to the indemnitee; and
(d) Cooperate with us with respect to
coordinating other applicable insurance
available to the indemnitee; and
(2) Provides us with written authorization to:
(a) Obtain records and other information related
to the "suit; and
(b) Conduct and control the defense of the
indemnitee in such "suit'.
So long as the above conditions are met, attorneys'
fees incurred by us in the defense of that indemnitee,
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necessary litigation expenses incurred by us and
necessary litigation expenses incurred by the
indemnitee at our request will be paid as
Supplementary Payments. Notwithstanding the
provisions of Paragraph 2.b.(2) of Section I —
Coverage A — Bodily Injury And Property Damage
Liability, such payments will not be deemed to be
damages for "bodily injury' and "property damage" and
will not reduce the limits of insurance.
Our obligation to defend an insured's indemnitee and
to pay for attorneys' fees and necessary litigation
expenses as Supplementary Payments ends when:
a. We have used up the applicable limit of insurance
in the payment of judgments or settlements; or
b. The conditions set forth above, or the terms of the
agreement described in Paragraph f. above, are no
longer met.
SECTION II —WHO IS AN INSURED
1. If you are designated in the Declarations as:
a. An individual, you and your spouse are insureds,
but only with respect to the conduct of a business
of which you are the sole owner.
b. A partnership or joint venture, you are an insured.
Your members, your partners, and their spouses
are also insureds, but only with respect to the
conduct of your business.
c. A limited liability company, you are an insured.
Your members are also insureds, but only with
respect to the conduct of your business. Your
managers are insureds, but only with respect to
their duties as your managers.
d. An organization other than a partnership, joint
venture or limited liability company, you are an
insured. Your "executive officers" and directors are
insureds, but only with respect to their duties as
your officers or directors. Your stockholders are
also insureds, but only with respect to their liability
as stockholders.
e. A trust, you are an insured. Your trustees are also
insureds, but only with respect to their duties as
trustees.
2. Each of the following is also an insured:
a. Employees and Volunteer workers
Your 'volunteer workers" only while performing
duties related to the conduct of your business, or
your "employees ", other than either your "executive
officers" (if you are an organization other than a
partnership, joint venture or limited liability
company) or your managers (if you are a limited
liability company), but only for acts within the scope
of their employment by you or while performing
duties related to the conduct of your business.
However, none of these "employees" or 'volunteer
workers" are insureds for:
(1) "Bodily injury" or "personal 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 employment 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 that co- "employee" or that '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 Paragraphs (1)(a) or (b) above;
or
(d) Arising out of his or her providing or failing to
provide professional health care services.
If you are not in the business of providing
professional health care services, Paragraph (d)
does not apply to any nurse, emergency
medical technician or paramedic employed by
you to provide such services.
(2) "Property damage" to property:
(a) Owned, occupied or used by,
(b) Rented to, in the care, custody or control of,
or over which physical control is being
exercised for any purpose by
you, any of your "employees ", 'volunteer
workers ", any partner or member (if you are a
partnership or joint venture), or any member (if
you are a limited liability company).
b. Real Estate Manager
Any person (other than your "employee" or
'volunteer worker'), or any organization while
acting as your real estate manager.
c. Temporary Custodians of Your Property
Any person or organization having proper
temporary custody of your property if you die, but
only:
(1) With respect to liability arising out of the
maintenance or use of that property; and
(2) Until your legal representative has been
appointed.
d. Legal Representative If You Die
Your legal representative if you die, but only with
respect to duties as such. That representative will
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57UUNUN8227
have all your rights and duties under this Coverage
Part
e. Unnamed Subsidiary
Any subsidiary, and subsidiary thereof, of yours
which is a legally incorporated entity of which you
own a financial interest of more than 50% of the
voting stock on the effective date of the Coverage
Part
The insurance afforded herein for any subsidiary
not named in this Coverage Part as a named
insured does not apply to injury or damage with
respect to which an insured under this Coverage
Part is also an insured under another policy or
would be an insured under such policy but for its
termination or the exhaustion of its limits of
insurance.
3. Newly Acquired or Formed Organization
5. Nonowned Watercraft
Any organization you newly acquire or form, other than
a partnership, joint venture or limited liability company,
and over which you maintain financial interest of more 6.
than 50% of the voting stock, will qualify as a Named
Insured if there is no other similar insurance available
to that organization. However:
a. Coverage under this provision is afforded only until
the 180th day after you acquire or form the
organization or the end of the policy period,
whichever is earlier;
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 and
advertising injury" arising out of an offense
committed before you acquired or formed the
organization.
4. Mobile Equipment
With respect to "mobile equipment" registered in your
name under any motor vehicle registration law, any
person is an insured while driving such equipment
along a public highway with your permission. Any other
person or organization responsible for the conduct of
such person is also an insured, but only with respect to
liability arising out of the operation of the equipment,
and only if no other insurance of any kind is available
to that person or organization for this liability. However,
no person or organization is an insured with respect to:
a. "Bodily injury" to a co-"employee" of the person
driving the equipment; or
b. "Property damage" to property owned by, rented to,
in the charge of or occupied by you or the employer
of any person who is an insured under this
provision.
With respect to watercraft you do not own that is less
than 51 feet long and is not being used to carry
persons for a charge, any person is an insured while
operating such watercraft with your permission. Any
other person or organization responsible for the
conduct of such person is also an insured, but only
with respect to liability arising out of the operation of
the watercraft, and only if no other insurance of any
kind is available to that person or organization for this
liability.
However, no person or organization is an insured with
respect to:
a. "Bodily injury" to a co "employee" of the person
operating the watercraft; or
b. "Property damage" to property owned by, rented to,
in the charge of or occupied by you or the employer
of any person who is an insured under this
provision.
Additional Insureds When Required By Written
Contract, Written Agreement Or Permit
The following person(s) or organization(s) are an
additional insured when you have agreed, in a written
contract, written agreement or because of a permit
issued by a state or political subdivision, that such
person or organization be added as an additional
insured on your policy, provided the injury or damage
occurs subsequent to the execution of the contract or
agreement.
A person or organization is an additional insured under
this provision only for that period of time required by
the contract or agreement.
However, no such person or organization is an insured
under this provision if such person or organization is
included as an insured by an endorsement issued by
us and made a part of this Coverage Part.
a. Vendors
Any person(s) or organization(s) (referred to below
as vendor), but only with respect to "bodily injury"
or "property damage" arising out of "your products"
which are distributed or sold in the regular course
of the vendor's business and only if this Coverage
Part provides coverage for "bodily injury" or
"property damage" included within the "products -
completed operations hazard ".
(1) The insurance afforded the vendor is subject to
the following additional exclusions:
This insurance does not apply to:
(a) "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;
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(b) Any express warranty unauthorized by you;
(c) Any physical or chemical change in the
product made intentionally by the vendor,
(d) Repackaging, except when unpacked solely
for the purpose of inspection, demonstration,
testing, or the substitution of parts under
instructions from the manufacturer, and then
repackaged in the original container,
(e) 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
connection with the distribution or sale of the
products;
(f) Demonstration, installation, servicing or
repair operations, except such operations
performed at the vendor's premises in
connection with the sale of the product;
(g) 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
(h) "Bodily injury" or "property damage" arising
out of the sole negligence of the vendor for
its kwon acts or omissions or those of its
employees or anyone else acting on its
behalf. However, this exclusion does not
apply to:
(i) The exceptions contained in Sub-
paragraphs (d) or (f); or
(ii) 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.
c. Lessors of Land or Premises
Any person or organization from whom you lease
land or premises, but only with respect to liability
arising out of the ownership, maintenance or use of
that part of the land or premises leased to you.
With respect to the insurance afforded these
additional insureds the following additional
exclusions apply:
This insurance does not apply to:
1. Any "occurrence" which takes place after you
cease to lease that land; or
2. Structural alterations, new construction or
demolition operations performed by or on behalf
of such person or organization.
d. Architects, Engineers or Surveyors
(2) This insurance does not apply to any insured
person or organization, from whom you have
acquired such products, or any ingredient, part
or container, entering into, accompanying or e'
containing such products.
b. Lessors of Equipment
(1) Any person or organization from whom you
lease equipment; but only with respect to their
liability for "bodily injury", "property damage" or
"personal and advertising injury" caused, in
whole or in part, by your maintenance, operation
or use of equipment leased to you by such
person or organization.
(2) 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.
Any architect, engineer, or surveyor, but only with
respect to liability for "bodily injury", "property
damage" or "personal and advertising injury"
caused, in whole or in part, by your acts or
omissions or the acts or omissions of those acting
on your behalf:
(1) In connection with your premises; or
(2) In the performance of your ongoing operations
performed by you or on your behalf.
With respect to the insurance afforded these
additional insureds, the following additional
exclusion applies:
This insurance does not apply to "bodily injury",
"property damage" or "personal and advertising
injury" arising out of the rendering of or the failure
to render any professional services by or for you,
including:
1. The preparing, approving, or failing to prepare
or approve, maps, shop drawings, opinions,
reports, surveys, field orders, change orders or
drawings and specifications; or
2. Supervisory, inspection, architectural or
engineering activities.
Permits Issued By State Or Political
Subdivisions
Any state or political subdivision, but only with
respect to operations performed by you or on your
behalf for which the state or political subdivision
has issued a permit.
With respect to the insurance afforded these
additional insureds, this insurance does not apply
to:
(1) 'Bodily injury", "property damage" or "personal
and advertising injury" arising out of operations
performed for the state or municipality; or
(2) "Bodily injury" or "property damage" included
within the "products-completed operations
hazard ".
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f. Any Other Party
Any other person or organization who is not an
insured under Paragraphs a, through e. above, but
only with respect to liability for "bodily injury",
"property damage" or "personal and advertising
injury" caused, in whole or in part, by your acts or
omissions or the acts or omissions of those acting
on your behalf
(1) In the performance of your ongoing operations;
(2) In connection with your premises owned by or
rented to you; or
(3) In connection with 'your work'O"and included
within the "products-completed operations
hazard ", but only if
(a) The written contract or agreement requires
you to provide such coverage to such
additional insured; and
(b) This Coverage Part provides coverage for
"bodily injury" or "property damage" included
within the "products- completed operations
hazard ".
With respect to the insurance afforded to these
additional insureds, this insurance does not apply
to:
"Bodily injury", "property damage" or "personal and
advertising injury" arising out of the rendering of, or
the failure to render, any professional architectural,
engineering or surveying services, including:
(1) The preparing, approving, or failing to prepare
or approve, maps, shop drawings, opinions,
reports, surveys, field orders, change orders or
drawings and specifications; or
(2) Supervisory, inspection, architectural or
engineering activities.
The limits of insurance that apply to additional insureds
under this provision is described in Section III — Limits
Of Insurance.
How this insurance applies when other insurance is
available to the additional insured is described in the
Other Insurance Condition in Section IV — Commercial
General Liability Conditions.
No person or organization is an insured with respect to the
conduct of any current or past partnership, joint venture or
limited liability company that is not shown as a Named
Insured in the Declarations.
SECTION III — LIMITS OF INSURANCE
1. The Most We will Pay
The Limits of Insurance shown in the Declarations and
the rules below fix the most we will pay regardless of
the number of
a. Insureds;
b. Claims made or "suits" brought; or
c. Persons or organizations making claims or bringing
"suits ".
2. General Aggregate Limit
The General Aggregate Limit is the most we will pay
for the sum of:
a. Medical expenses under Coverage C;
b. Damages under Coverage A, except damages
because of "bodily injury" or "property damage"
included in the "products- completed operations
hazard'; and
c. Damages under Coverage B. �
3. Products - Completed Operations 7�lggregate Limit
The Products - Completed Operations Aggregate Limit
is the most we will pay under Coverage A for damages
because of "bodily injury" and "property damage"
included in the "products-completed operations
hazard ".
4. Personal and Advertising Injury Limit
Subject to 2. above, the Personal and Advertising
Injury Limit is the most we will pay under Coverage B
for the sum of all damages because of all "personal
and advertising injury" sustained by any one person or
organization.
5. Each Occurrence Limit
Subject to 2. or 3. above, whichever applies, the Each
Occurrence Limit is the most we will pay for the sum
Of..
a. Damages under Coverage A; and
b. Medical expenses under Coverage C
because of all "bodily injury" and "property damage"
arising out of any one "occurrence".
6. Damage To Premises Rented To You Limit
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 "property damage" to any one
premises, while rented to you, or in the case of
damage by fire, lightning or explosion, while rented to
you or temporarily occupied by you with permission of
the owner.
In the case of damage by fire, lightning or explosion,
the Damage to Premises Rented To You Limit applies
to all damage proximately caused by the same event,
whether such damage results from fire, lightning or
explosion or any combination of these.
7. Medical Expense Limit
Subject to 5. above, the Medical Expense Limit is the
most we will pay under Coverage C for all medical
expenses because of "bodily injury" sustained by any
one person.
8. How Limits Apply To Additional Insureds
If you have agreed in a written contract or written
agreement that another person or organization be
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added as an additional insured on your policy, the
most we will pay on behalf of such additional insured is
the lesser of:
a. The limits of insurance specified in the written
contract or written agreement; or
b. The Limits of Insurance shown in the Declarations.
Such amount shall be a part of and not in addition to
Limits of Insurance shown in the Declarations and
described in this Section.
The Limits of Insurance of this Coverage Part apply
separately to each consecutive annual period and to any
remaining period of less than 12 months, starting with the
beginning of the policy period shown in the Declarations,
unless the policy period is extended after issuance for an
additional period of less than 12 months. In that case, the
additional period will be deemed part of the last preceding
period for purposes of determining the Limits of Insurance.
SECTION IV — COMMERCIAL GENERAL LIABILITY
CONDITIONS
1. Bankruptcy
Bankruptcy or insolvency of the insured or of the
insured's estate will not relieve us of our obligations
under this Coverage Part.
2. Duties In The Event Of Occurrence, Offense, Claim
Or Suit
a. Notice Of Occurrence Or Offense
You or any additional insured must see to it that we
are notified as soon as practicable of an
"occurrence" or an offense which may result in a
claim. To the extent possible, notice should include:
(1) How, when and where the "occurrence" or
offense took place;
(2) The names and addresses of any injured
persons and witnesses; and
(3) The nature and location of any injury or damage
arising out of the "occurrence" or offense.
b. Notice Of Claim
If a claim is made or "suit" is brought against any
insured, you or any additional insured must:
(1) Immediately record the specifics of the claim or
"suit" and the date received; and
(2) Notify us as soon as practicable.
You or any additional insured must see to it that we
receive written notice of the claim or "suit as soon
as practicable.
c. Assistance And Cooperation Of The Insured
You and any other involved insured must:
(1) Immediately send us copies of any demands,
notices, summonses or legal papers received in
connection with the claim or "suiC;
(2) Authorize us to obtain records and other
information;
(3) Cooperate with us in the investigation or
settlement of the claim or defense against the
"suit"; and
(4) Assist us, upon our request, in the enforcement of
any right against any person or organization which
may be liable to the insured because of injury or
damage to which this insurance may also apply.
d. Obligations At The Insureds Own Cost
No insured will, except at that insured's own cost,
voluntarily make a payment, assume any
obligation, or incur any expense, other than for first
aid, without our consent.
e. Additional Insureds Other Insurance
If we cover a claim or "suit" under this Coverage
Part that may also be covered by other insurance
available to an additional insured, such additional
insured must submit such claim or "suit" to the
other insurer for defense and indemnity.
However, this provision does not apply to the
extent that you have agreed in a written contract or
written agreement that this insurance is primary
and non-contributory with the additional insured's
own insurance.
f. Knowledge Of An Occurrence, Offense, Claim
Or Suit
Paragraphs a. and b. apply to you or to any
additional insured only when such "occurrence ",
offense, claim or "suit" is known to:
(1) You or any additional insured that is an
individual;
(2) Any partner, if you or an additional insured is a
partnership;
(3) Any manager, if you or an additional insured is a
limited liability company;
(4) Any "executive officer" or insurance manager, if
you or an additional insured is a corporation;
(5) Any trustee, if you or an additional insured is a
trust; or
(6) Any elected or appointed official, if you or an
additional insured is a political subdivision or
public entity.
This duty applies separately to you and any additional
insured.
3. Legal Action Against Us
No person or organization has a right under this
Coverage Part:
a. To join us as a party or otherwise bring us into a
'suit' asking for damages from an insured; or
b. To sue us on this Coverage Part unless all of its
terms have been fully complied with.
A person or organization may sue us to recover on an
agreed settlement or on a final judgment against an
insured; but we will not be liable for damages that are
not payable under the terms of this Coverage Part or
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that are in excess of the applicable limit of insurance.
An agreed settlement means a settlement and release
of liability signed by us, the insured and the claimant or
the claimant's legal representative.
4. Other Insurance
If other valid and collectible insurance is available to
the insured for a loss we cover under Coverages A or
B of this Coverage Part, our obligations are limited as
follows:
a. Primary Insurance
This insurance is primary except when b. below
applies. If other insurance is also primary, we will
share with all that other insurance by the method
described in c. below.
b. Excess Insurance
This insurance is excess over any of the other
insurance, whether primary, excess, contingent or
on any other basis:
(1) Your Work
That is Fire, Extended Coverage, Builder's Risk,
Installation Risk or similar coverage for 'your
work';
(2) Premises Rented To You
That is fire, lightning or explosion insurance for
premises rented to you or temporarily occupied
by you with permission of the owner,
(3) Tenant Liability
That is insurance purchased by you to cover
your liability as a tenant for "property damage"
to premises rented to you or temporarily
occupied by you with permission of the owner,
(4) Aircraft, Auto Or Watercraft
If the loss arises out of the maintenance or use
of aircraft, "autos" or watercraft to the extent not
subject to Exclusion g. of Section I — Coverage
A — Bodily Injury And Property Damage Liability;
(5) Property Damage to Borrowed Equipment Or
Use Of Elevators
If the loss arises out of "property damage" to
borrowed equipment or the use of elevators to
the extent not subject to Exclusion j. of Section
- Coverage A - Bodily Injury And Property
Damage Liability;
(6) When You Are Added As An Additional
Insured To Other Insurance
Any other insurance available to you covering
liability for damages arising out of the premises
or operations, or products and completed
operations, for which you have been added as
an additional insured by that insurance; or
(7) When You Add Others As An Additional
Insured To This Insurance
Any other insurance available to an additional
insured.
However, the following provisions apply to other
insurance available to any person or
organization who is an additional insured under
this coverage part.
(a) Primary Insurance When Required By
Contract
This insurance is primary if you have agreed
in a written contract or written agreement
that this insurance be primary. If other
insurance is also primary, we will share with
all that other insurance by the method
described in c. below.
(b) Primary And Non - Contributory To Other
Insurance When Required By Contract
If you have agreed in a written contract,
written agreement, or permit that this
insurance is primary and non-contributory
with the additional insured's own insurance,
this insurance is primary and we will not
seek contribution from that other insurance.
Paragraphs (a) and (b) do not apply to other
insurance to which the additional insured has
been added as an additional insured.
When this insurance is excess, we will have no
duty under Coverages A or B 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 entitled to the insured's rights against all
those other insurers.
When this insurance is excess over other
insurance, we will pay only our share of the amount
of the loss, if any, that exceeds the sum of:
(1) The total amount that all such other insurance
would pay for the loss in the absence of this
insurance; and
(2) The total of all deductible and self-insured
amounts under all that other insurance.
We will share the remaining loss, if any, with any
other insurance that is not described in this Excess
Insurance provision and was not bought specifically
to apply in excess of the Limits of Insurance shown
in the Declarations of this Coverage Part.
c. Method Of Sharing
If all of the other insurance permits contribution by
equal shares, we will follow this method also. Under
this approach each insurer contributes equal
amounts until it has paid its applicable limit of
insurance or none of the loss remains, whichever
comes first.
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If any of the other insurance does not permit
contribution by equal shares, we will contribute by
limits. Under this method, each insurers share is
based on the ratio of its applicable limit of
insurance to the total applicable limits of insurance
of all insurers.
5. Premium Audit
a. We will compute all premiums for this Coverage
Part in accordance with our rules and rates.
b. Premium shown in this Coverage Part as advance
premium is a deposit premium only. At the dose of
each audit period we will compute the earned
premium for that period and send notice to the first
Named Insured. The due date for audit and
retrospective premiums is the date shown as the
due date on the bill. If the sum of the advance and
audit premiums paid for the policy period is greater
than the earned premium, we will return the excess
to the first Named Insured.
c. The first Named Insured must keep records of the
information we need for premium computation, and
send us copies at such times as we may request.
6. Representations
a. When You Accept This Policy
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.
b. Unintentional Failure To Disclose Hazards
If unintentionally you should fail to disclose all
hazards relating to the conduct of your business
that exist at the inception date of this Coverage
Part, we shall not deny coverage under this
Coverage Part because of such failure.
7. Separation Of Insureds
Except with respect to the Limits of Insurance, and any
rights or duties specifically assigned in this Coverage
Part to the first Named Insured, this insurance applies:
a. As if each Named Insured were the only Named
Insured; and
b. Separately to each insured against whom claim is
made or "suit' is brought.
8. Transfer Of Rights Of Recovery Against Others To
Us
a. Transfer of Rights Of Recovery
If the insured has rights to recover all or part of any
payment, including Supplementary Payments, we
have made under this Coverage Part, those rights
are transferred to us. The insured must do nothing
after loss to impair them. At our request, the
insured will bring "suit' or transfer those rights to us
and help us enforce them.
b. Waiver Of Rights Of Recovery (Waiver Of
Subrogation)
If the insured has waived any rights of recovery
against any person or organization for all or part of
any payment, including Supplementary Payments,
we have made under this Coverage Part, we also
waive that right, provided the insured waived their
rights of recovery against such person or
organization in a contract, agreement or permit that
was executed prior to the injury or damage.
9. When We Do Not Renew
If we decide not to renew this Coverage Part, we will
mail or deliver to the first Named Insured shown in the
Declarations written notice of the nonrenewal not less
than 30 days before the expiration date.
If notice is mailed, proof of mailing will be sufficient
proof of notice.
SECTION V — DEFINITIONS
1. "Advertisement' means the widespread public
dissemination of information or images that has the
purpose of inducing the sale of goods, products or
services through:
a. (1) Radio;
(2) Television;
(3) Billboard;
(4) Magazine;
(5) Newspaper, or
b. Any other publication that is given widespread
public distribution.
However, "advertisement' does not include:
a. The design, printed material, information or images
contained in, on or upon the packaging or labeling
of any goods or products; or
b. An interactive conversation between or among
persons through a computer network.
2. "Advertising idea" means any idea for an
"advertisement".
3. "Asbestos hazard" means an exposure or threat of
exposure to the actual or alleged properties of
asbestos and includes the mere presence of asbestos
in any form.
4. "Auto" means a land motor vehicle, trailer or semitrailer
designed for travel on public roads, including any
attached machinery or equipment. But "auto" does not
include "mobile equipment".
S. "Bodily injury" means physical:
a. Injury;
b. Sickness; or
c. Disease
sustained by a person and, if arising out of the above,
mental anguish or death at any time.
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6. "Coverage territory" means:
a. The United States of America (including its territories
and possessions), Puerto Rico and Canada;
b. International waters or airspace, but only if the
injury or damage occurs in the course of travel or
transportation between any places included in a.
above; or
c. All other parts of the world if the injury or damage
arises out of:
(1) Goods or products made or sold by you in the
territory described in a. above;
(2) The activities of a person whose home is in the
territory described in a. above, but is away for a
short time on your business; or
(3) "Personal and advertising injury" offenses that
take place through the Internet or similar
electronic means of communication
provided the insured's responsibility to pay damages is
determined in the United States of America (including its
territories and possessions), Puerto Rico or Canada, in a
"suit" on the merits according to the substantive law in
such territory or in a settlement we agree to.
7. "Employee" includes a "leased worker". "Employee"
does not include a "temporary worker".
8. "Employment- Related Practices" means:
a. Refusal to employ a person;
b. Termination of a person's employment; or
c. Employment - related practices, policies, acts or
omissions, such as coercion, demotion, evaluation,
reassignment, discipline, defamation, harassment,
humiliation or discrimination directed at a person.
9. "Executive officer" means a person holding any of the
officer positions created by your charter, constitution,
by -laws or any other similar governing document.
10. "Hostile fire" means one which becomes uncontrollable
or breaks out from where it was intended to be.
11. "Impaired property" means tangible property, other
than 'your product" or "your work", that cannot be used
or is less useful because:
a. It incorporates 'your product" or 'your work" that is
known or thought to be defective, deficient,
inadequate or dangerous; or
b. You have failed to fulfill the terms of a contract or
agreement;
if such property can be restored to use by:
a. The repair, replacement, adjustment or removal of
"your product" or "your work "; or
b. Your fulfilling the terms of the contract or agreement.
12. "Insured contract" means:
a. 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 or explosion to premises while
rented to you or temporarily occupied by you with
permission of the owner is subject to the Damage
to Premises Rented To You Limit described in
Section III — Limits of Insurance;
b. A sidetrack agreement;
c. Any easement or license agreement, including an
easement or license agreement in connection with
construction or demolition operations on or within
50 feet of a railroad;
d. An obligation, as required by ordinance, to
indemnify a municipality, except in connection with
work for a municipality;
e. An elevator maintenance agreement;
That part of any other contract or agreement
pertaining to your business (including an
indemnification of a municipality in connection with
work performed for a municipality) under which you
assume the tort liability of another party to pay for
"bodily injury" or "property damage" to a third
person or organization, provided the "bodily irjury"
or "property damage" is caused, in whole or in part,
by you or by those acting on your behalf. Tort
liability means a liability that would be imposed by
law in the absence of any contract or agreement.
Paragraph f. includes that part of any contract or
agreement that indemnifies a railroad for "bodily
injury" or "property damage" arising out of
construction or demolition operations, within 50 feet
of any railroad property and affecting any railroad
bridge or trestle, tracks, road -beds, tunnel,
underpass or crossing.
However, Paragraph f. does not include that part of
any contract or agreement:
(1) That indemnifies an architect, engineer or
surveyor for injury or damage arising out of:
(a) Preparing, approving, or failing to prepare or
approve, maps, shop drawings, opinions,
reports, surveys, field orders, change orders
or drawings and specifications; or
(b) Giving directions or instructions, or failing to
give them, if that is the primary cause of the
injury or damage; or
(2) Under which the insured, if an architect, engineer
or surveyor, assumes liability for an injury or
damage arising out of the insured's rendering or
failure to render professional services, including
those listed in (1) above and supervisory,
inspection, architectural or engineering activities.
13. "Leased worker" means a person leased to you by a
labor leasing firm under an agreement between you
and the labor leasing firm, to perform duties related to
the conduct of your business. "Leased worker" does
not include a "temporary worker".
14. "Loading or unloading" means the handling of property:
a. After it is moved from the place where it is accepted
for movement into or onto an aircraft, watercraft or
"auto",
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b. While it is in or on an aircraft, watercraft or "auto";
or
c. While it is being moved from an aircraft, watercraft
or "auto" to the place where it is finally delivered;
but "loading or unloading" does not include the
movement of property by means of a mechanical
device, other than a hand truck, that is not attached to
the aircraft, watercraft or "auto".
15. "Mobile equipment" means any of the following types
of land vehicles, including any attached machinery or
equipment:
a. Bulldozers, farm machinery, forklifts and other
vehicles designed for use principally off public
roads;
b. Vehicles maintained for use solely on or next to
premises you own or rent;
c. Vehicles that travel on crawler treads;
d. Vehicles, whether self -propelled or not, maintained
primarily to provide mobility to permanently
mounted:
(1) Power cranes, shovels, loaders, diggers or
drills; or
(2) Road construction or resurfacing equipment
such as graders, scrapers or rollers;
e. Vehicles not described in a., b., c. or d. above that
are not self - propelled and are maintained primarily
to provide mobility to permanently attached
equipment of the following types:
(1) Air compressors, pumps and generators,
including spraying, welding, building cleaning,
geophysical exploration, lighting and well
servicing equipment; or
(2) Cherry pickers and similar devices used to raise
or lower workers;
C Vehicles not described in a., b., c. or d. above
maintained primarily for purposes other than the
transportation of persons or cargo.
However, self - propelled vehicles with the following
types of permanently attached equipment are not
"mobile equipment' but will be considered "autos ":
(1) Equipment, of at least 1,000 pounds gross
vehicle weight, designed primarily for.
(a) Snow removal;
(b) Road maintenance, but not construction or
resurfacing; or
(c) Street cleaning;
(2) Cherry pickers and similar devices mounted on
automobile or trick chassis and used to raise or
lower workers; and
(3) Air compressors, pumps and generators,
including spraying, welding, building cleaning,
geophysical exploration, lighting and well
servicing equipment.
16. "Occurrence" means an accident, including continuous
or repeated exposure to substantially the same general
harmful conditions.
17. "Personal and advertising injury" means injury,
including consequential "bodily injury", arising out of
one or more of the following offenses:
a. False arrest, detention or imprisonment;
b. Malicious prosecution;
c. The wrongful eviction from, wrongful entry into, or
invasion of the right of private occupancy of a room,
dwelling or premises that a person occupies,
committed by or on behalf of its owner, landlord or
lessor,
d. Oral, written or electronic publication of material
that slanders or libels a person or organization or
disparages a person's or organization's goods,
products or services;
e. Oral, written or electronic publication of material
that violates a person's right of privacy;
L Copying, in your "advertisement", a person's or
organization's "advertising idea" or style of
"advertisement";
g. Infringement of copyright, slogan, or title of any
literary or artistic work, in your "advertisement'; or
h. Discrimination or humiliation that results in injury to
the feelings or reputation of a natural person.
18. "Pollutants" mean any solid, liquid, gaseous or thermal
irritant or contaminant, including smoke, vapor, soot,
fumes, acids, alkalis, chemicals and waste. Waste
includes materials to be recycled, reconditioned or
reclaimed.
19. "Products- completed operations hazard ":
a. Includes all "bodily injury" and "property damage"
occurring away from premises you own or rent and
arising out of "your product" or'yourwork" except:
(1) Products that are still in your physical
possession; or
(2) Work that has not yet been completed or
abandoned. However, 'your work" will be
deemed completed at the earliest of the
following times:
(a) When all of the work called for in your
contract has been completed.
(b) When all of the work to be done at the job
site has been completed if your contract
calls for work at more than one job site.
(c) When that part of the work done at a job site
has been put to its intended use by any
person or organization other than another
contractor or subcontractor working on the
same project.
Work that may need service, maintenance,
correction, repair or replacement, but which is
otherwise complete, will be treated as
completed.
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b. Does not include "bodily injury" or "property
damage" arising out of:
(1) The transportation of property, unless the
injury or damage arises out of a condition in or
on a vehicle not owned or operated by you,
and that condition was created by the "loading
or unloading" of that vehicle by any insured;
(2) The existence of tools, uninstalled equipment
or abandoned or unused materials; or
(3) Products or operations for which the
classification, listed in the Declarations or in a
policy schedule, states that products -
completed operations are subject to the
General Aggregate Limit.
20. "Property damage" means:
a. Physical injury to tangible property, including all
resulting loss of use of that property. All such loss
of use shall be deemed to occur at the time of the
physical injury that caused it; or
b. Loss of use of tangible property that is not
physically injured. All such loss of use shall be
deemed to occur at the time of the "occurrence"
that caused it.
As used in this definition, computerized or
electronically stored data, programs or software are
not tangible property. Electronic data means
information, facts or programs:
a. Stored as or on;
b. Created or used on; or
c. Transmitted to or from;
computer software, including systems and
applications software, hard or floppy disks, CD-
ROMS, tapes, drives, cells, data processing devices
or any other media which are used with electronically
controlled equipment.
21. "Suit" means a civil proceeding in which damages
because of "bodily injury", "property damage" or
"personal and advertising injury" to which this
insurance applies are alleged. "Suit' includes:
a. An arbitration proceeding in which such damages
are claimed and to which the insured must submit
or does submit with our consent; or
b. Any other alternative dispute resolution
proceeding in which such damages are claimed
and to which the insured submits with our
consent.
22. "Temporary worker" means a person who is
furnished to you to substitute for a permanent
"employee" on leave or to meet seasonal or short -
term workload conditions.
23."Volunteerworker' means a person who
a. Is not your "employee";
b. Donates his or her work;
c. Acts at the direction of and within the scope of
duties determined by you; and
d. Is not paid a fee, salary or other compensation by
you or anyone else for their work performed for
you.
24. "Your product":
a. Means:
(1) Any goods or products, other than real
property, manufactured, sold, handled,
distributed or disposed of by:
(a) You;
(b) Others trading under your name; or
(c) A person or organization whose business
or assets you have acquired; and
(2) Containers (other than vehicles), materials,
parts or equipment furnished in connection
with such goods or products.
b. Includes
(1) Warranties or representations made at any
time with respect to the fitness, quality,
durability, performance or use of "your
product'; and
(2) The providing of or failure to provide warnings
or instructions.
c. Does not include vending machines or other
property rented to or located for the use of others
but not sold.
25. "Your work ":
a. Means:
(1) Work or operations performed by you or on
your behalf, and
(2) Materials, parts or equipment fumished in
connection with such work or operations.
b. Includes
(1) Warranties or representations made at any
time with respect to the fitness, quality,
durability, performance or use of 'your worn",
and
(2) The providing of or failure to provide warnings
or instructions.
Page 18 of 18 HIS 00 0106 05
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF OUR RIGHT TO RECOVER FROM
OTHERS ENDORSEMENT - CALIFORNIA
Policy Number. s7 WE DD8525 Endorsement Number: 003
Effective Date: 04/012014 Effective hour is the same as stated on the Information Page of the policy.
Named Insured and Address: MOORE IACOFANO & GOLTSMAN iNc
800 HEARST AVE
BERKELEY
CA 94710
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce
our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you
perform work under a written contract that requires you to obtain this agreement from us.)
You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the
work described in the Schedule.
The additional premium for this endorsement shall be 2
otherwise due on such remuneration.
SCHEDULE
Person or Organization
ANY PERSON OR ORGANIZATION FROM WHOM
YOU ARE REQUIRED BY WRITTEN CONTRACT
OR AGREEMENT TO OBTAIN IS WAIVER
OF RIGHTS FROM US_
% of the California workers' compensation premium
Job Description
counkwakyted y
Authorized Representative
Form WC 04 03 06 (1) Printed in U-SA
Process Date: 04/012014 Policy Expiration Date: 04012015