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PROOF OF INSURANCE (2010) CLOSEDACORD CERTIFICATE OF LIABILITY INSURANCE OP ID KT DATE(MMIDD/YYYY)
SOUTH -5 12 02 09
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
John Huttinger ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
* * * Pacific Unified Ins * * * HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P . O . Box 68 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Lawndale CA 90260
Phone : 310 - 370 -5000 Fax: 310 - 370 -5454 INSURERS AFFORDING COVERAGE NAIC #
............................................... -- ............ . .......... .. ........ ._.....
INSURED INSURER A: Markel American Insurance Co.
.......... _ ... ................. . -.
South Bay Children's Health irNisuRER p. HartfordnInsuranceoxaDnan
Center Association Inc. 22357
410 So. Camino Read
Redondo Beach CA 90277 _.
INSURER E:
COVERAGES
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, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
INSR ADD`
INSR TYPE OF INSURANCE....., 1111.. �C1L(C`Y EFPtefiVE 'POLICY EX'PIRATIO � ...._, .... 1111.
POLICY NUMBER DATE MM /DD/YY DATE MM /DD LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1, 000 000
A
X
LIABILITY
X COMMERCIAL GENERAL L
3602SS311218 -1
03/31/09
03/31/10
'DAMAGE (aoccuece)_
$EaOccurren.
cu,IMSMADE X OCCUR
P An one person)
MED EX 1111..
$10,000
-..- ---- -- - ----
PERSONAL &ADV INJURY w.
11 ..
... - 11 . 1111..
$ 1 / 000 000
...
GENERAL AGGREGATE
s3,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS COMP /OP AGG,
$ 3 ,_9_0_ 9 F O O O
PRO -
POLICY JECT X LOC
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
$1,000,000
A
ANY AUTO
3602SS311218 -1
03/31/09
03/31/10
(Ea accident)
.. _ ....... .... __
__ __.1.111
ALL OWNED AUTOS
BODILY INJURY
$
SCHEDULED AUTOS
(Per person)
-- --
X HIREDAUTOS
1111
BODILY INJURY
$
X NON -OWNED AUTOS
(Per accident)
PROPERTY DAMAGE
$
(Per accident)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
ANY AUTO
OTHER THAN _EA ACC
$ _.
AUTO ONLY: AGG
$
EXCESS /UMBRELLA LIABILITY
EACH OCCURRENCE
$
OCCUR CLAIMS MADE
AGGREGATE
$ ...........
DEDUCTIBLE
--------
1111. -- -- - -. ................ 111,1,. .., „..........
$
„_1111. .... 1111. ,........
RETENTION $
$
WORKERS COMPENSATION AND
X TORY LIMITS ER
B
023WK00166
12/01/09
12/01/10
EL EACH ACCIDENT $1,000,000
ANY RO RIIETORIPARTNER/EXECUTIVE
OFFICERIMEMBER EXCLUDED?
E.L. DISEASE - EA EMPLOYEE $ 1 , 000 , 000
If yes, describe under
SPECIAL PROVISIONS below
..... ....... ....... .1. .... 111..
E L. DISEASE - POLICY LIMIT $14001000
OTHER
C
Loc. #1 /Repl Cost
I
72SBAKZ7773- SPECIAL FORM
03/04/09
03/04/10
BUILDING 275,000
C
Loc. #1/E2 1 Cost
72SBAKZ7773- SPECIAL FORM
03/04/09
03/04/10
CONTENTS 76,400
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
*10 day notice IF cancelled for nonpayment of premium or nonreporting of
payroll. Certificate Holder is included as Additional Insured per the
general liability extension form MGL232 (04/07). RE:Counseling of abused
children and their families who are referred to the South Bay Youth Project.
* *Revised on 12/02/09 to supersede certificate issued on 11/05/09 & 03/30/09
CERTIFICATE HOLDER
City of E1 Segundo CDBG Grant
Attn: Tina Gall
350 Main Street
El Segundo CA 90245
CANCELLATION
CITYOFE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRAT101
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL *30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
HITai4
ACORD 2512001/081 11_1'' © ACORD CORPORATION 1988
_ OP ID X " DATE (MMIDDIYYYY)
acoRV C TIFICAT OF LIA ILI SU NCE .�.....__OUH- DA5 09
PRODUCER ITHI CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
John Huttinger ? ONLY OONFERS NO RIGHTS UPON THE CERTIFICATE
* ** Pacific Unified Ins * ** HOLDER. t MS CERTIFICATE DOES NOT AMEND, EXTEND OR
P.O. Box 68 ALTER THE, OVERAGE AFFORDED BY THE POLICIES BELOW.
Lawndale CA 90260
Phone: 310- 370 -5000 Fax : 310- 370 -5454 INSURERS AFFORDING COVERAGE NAIC #
................ _ ....... .
INSURED I)&SUi2 E' >> ''�E ,xMRel American Insurance Co.
INSURER B Discover PXC /Travelers
South Bay Children's Health INSURERC Hartford Insurance Co an 22357
Center Association Inc. � .. .. � y._..
410 So. Camino Read INSURER D S
Redondo Beach CA 90277 - - -- - -- _m ...,...... , , _ ....m...._.�.......
INSURER E:
COVERAGES
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR AD= w W.. POLICY POLTOYEF� ad ,fivo'"POLlOY'IEX01RAN"ION..... _......._ ...... ....... .
L 1R NSI TYPE OF INSURANCE NUMBER DATE MM/DD/YY DATE MIM )DODfYY LIMITS
GENERAL LIABILITY EACH OCCURRENCE '11,000 .` 000_
INTAGE' "1'OFRENTE'D" r_
' ) , ..curren
_ —9-00
A X X COMMERCIAL GENERAL LIABILITY 3602SS311218-1 03/31/09 03/31/10 NITLNItlp,ES(Eaoccurence $Ea OC
CLAIMS MADE � OCCUR _MED EXP (Any one person) $ 10 _
.,, .w..,, me,.,...., ....... .......... ..__ ...PERSONAL. ..._ ...___ . 1 , , e w.w.
&ADVINJURY $ 1 OOO � 000
....
GENERAL AGGREGAT _ ... 3 f 000..1 000 E
$
POLICY I Iwo_ LIES PER: PRODUCTS COMPIOP AGG s3,000,000
GEN'L AGGREGATEJLEIMITT APP
X LOC
AUTOMO &LE LIABILITY
COMBINED SINGLE LIMIT $1,000,000
A ANY AVrO 3602SS311218 -1 03/31/09 03/31/10 (Ea accident)
AI..L OWNEDAUIOS BODILY INJURY
Sd I� EDULED AUTOS (f er Peraon) $
141RED AUTOS BODILY INJURY
X NON -OWNED AUTOS (Per accident) $
PROPERTY DAMAGE $
(Per accident)
_ ... ..._._ _.. __. ._.._ _.._
GARAGE LIABILITY AUTO ONLY EA ACCIDENT $
ANY AUTO v U I HEH I HAN EA ACC S
AUTO ONLY: AGG $
EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $
m..
OCCUR CLAIMS MADE it AGGREGATE $
_ ...........
DEDUCTIBLE $
WORKERS COMPENSATION AND X TORY $
RETENTION $
ANY PROPRIETOR/PARTNERIEXECUTIVE AS 0TH
ACCIDENT _ ER
B EMPLOYERS'LIABILITY D284W00666 12/01/08 12/01/09 E.L. EACH
.. 1 r OOOI 000
OFFICERIMEMBER EXCLUDED? E,L. DISEASE - EA EMPLOYEE $ 1, 00 0
If yoo, dcaorib6 udndor
SPECIAL PROVISIONS balewo Ell DISEASE - POLICY LIMIT 1 , 000,000
OTHER �y _.
C LOc. #1 /Repl Cost 72SBAKZ7773- SPECIAL FORM 03/04/09 03/04/10 BUILDING 275,000
C LOC. #1 Re 1 Cost 72SBAKZ7773- SPECIAL FORM 03/04/09 03/04/10 CONTENTS 76,400
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
*10 day notice IF cancelled for nonpayment of premium or nonreporting of
payroll. Certificate Holder is included as Additional Insured per the
general liability extension form MGL232 (04/07). RE:Counseling of abused
children and their families who are referred to the South Bay Youth Project.
* *Revised on 11/05/09 to supersede certificate issued on 03/30/09.
CERTIFICATE HOLDER CANCELLATION
CITYOFE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL TO MAIL *30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, NMI FIR
City of E1 Segundo CDBG Grant
Attn: Tina Gall
350 Main Street
El Segundo CA 90245 ADTI ° REI NTAriE
ACORD 2512nA110R1 n ACORD CORPORATION 1988
ATTACHED TO AND FORMIINQ PART OF
POLICY NUMBER; 3602SS31 1218 -1
COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
COMMERCIAL GENERAL LIABILITY PLUS tXTENSION
Various provisions In this endorsement modlty coverage Read the entire policy carnally, to determine rights, duties
and what is and Is not covered.
Throughout this endorsement the words "you" and 'your" refer to the Named Insured Shown In the Ions_ The
words"we," %W and "our refer to the Company provildinq this insurance
This endorsement moci ies Inwrance provided under the following;
COMMERCIAL GENERAL LIABILITY COVERAGE FORM
Unless speciftaRy stated In this endorsement all other terms, conditions and eirDlusions of the policy remain
unchanged.
I i ,
�r A,. � ° w ♦ w ,. ♦ e N a w� n ;, f w w:W w # �..
SCHEDULE
Medical Payments
Supplementary Payments
Bat Bonds
Loss of EarN gls
Damage to Promises Ranted to You
Non - awned WWotraft
pion -Oumed Aircraft
Property Damage from Elevator Use
Broadened Definitlon of Insured
Marital Anguish Restiit ng from Bodily Injury
Adveftng Injury from Televised orWeolaped Mai eriat
Broadened Definition of Mobile Equipxnent
Per Location and Per Projed Aggregotm
Additional Insured - Martagers or Lessors of Premises
AddMonal Insured - Vendors "Red)
Additional Insured -8y Written Contract Agmetnent
or Permit
Additional InsurecWort; Assignee, or Receiver
Extended "Property DemmW - Expected or Intended
Injury
Properly Damage to Borrowed Equipment
Property Dernage to'Customers' Goods'
Medical Personnel Coverage
Limited "Product Withdrawal' Errpense Coverage
Waiver of Transfer of Rights of Recovery
Duttee In the Event of "Occurrence ", Claim or "SW
Unintentional Failure to disclose Hazards
Lb6mIzoort
Increased to $10,000 per peryon (unress excluded)
Up to $5000
Up to $500 a day
Up to the C3wwml Liability Emit Occurrenm Limit
Increased to 51 feat long
If rented or loaned wiih a paid brow
included
Included
Included
Included
Included
Included
Included
Included
Included
Included
Irxiuded
Up to $10,1700 per "occurrence"
Up to $10,000 per "occur rtce'S
Up to $100,00 per M "ocrwrronc4" It no other coverage form
applies
$10,000 per "Product WAthdrawrirl"
Included
Included
included
Included
MGL232 (04M7) PRO$1 of 14
L Medical Payments
The foilowing applies only 9 Medical payments Coverage is not excluded from the!poucy to which this endorsement
Is attached,,
SECTION III - LIMITS OF INSURANCE, paragraph T. Is deleted in its entlrety and 2reptaeed by the following:
7. Sutged to parag' h S, Section I'll - Litnfts of Insurance, the Medical se Unift to squat to ttlwe medical
Expense Limit stated In the er lons ail to a armWmurn of $10,tiiltl a is the most was wilJ pay under
Cov C for all rned exp of'bodrty injury'" sublet -ned try one on,
SUPPLEMENTARY PAYMENTS - SAIL 13ONDS AND LOSS OF EARNINGS
SUPPLEMENTARY PAYMENTS - COVERAGES A AND B, paragraphs i.b_ and 111.d- are deleted in their erMrsty
and replaced by the fbllowhag: I
SECTION III - LIMITS OF INSURANCE, paragraph 7. Is deleted In Its entirety and Replaced by the following:
b. tip to $5000 for rat of bail bonds required because of acoidenta or traflie lowty aliens adoing r�A of the use of
any v+ahloa to �h Bodiy Ludy Liability G ov a�ee We not have I'urniM tie bonds;
d. Al reasonabte expenses Incurred by the Insured at our rawest to asalst us In investigation or defense of the
claim or, " "sulf , Including ace t loss of earnings up to $500 a day because of UM off tiff work;
Ill. DANIAGE TO PREMISES RENTEDTO YOU
A- When Damage To Premiaee Rented To You Limit is shown In the Dedaratiorwk Exclusion J. of Coverage A.
Section I Is replaced by the following:
j. Damage To Property
"Property damage "" to:
(1) Property you own, rent or occupy, lincludim any costs or ex Incurred by you, or any other
person, orgarlxatlon of entity, for repair, mplacement, enhancement Ir istonaitlon or maintenance of
such property for any reason, Including prevention of injury to a pa n or damage to another's
proPe►tY
(Z) Premises you sell, give away cn abandon, if the 'properly datnsgeP arlses out of any part of those
(3) PMedy loaned to you;
(4) Personal property in the care, custody or control of the Insures
(ii) That parftbr part of real property on which you or any contractors or "contractors working di oily
or indtroctly on your behalf area performing opwatlons, if the "propertyldamagd` arls+aws out of those
operations, or I
(s) That particular part of any property that must be reWred. repaired or teplaoed because "your work"
was Inoorreolly'perforrm d on It
ParoVaphe (1), (3) and (4) of this exclusion do riot apply to "properly dame" (other than damage by fire)
to premises, Including the contents of such premises, rented to you. A sepairate limit of Insurance applies
to Damage To Premises Rented To You as described in Section ill - Llrnits ensurance.
Paragraph (2) of this exclusion does not apply If the premises are your wofk" and were never occupied.
rented or held for rental by you.
MOL232 (04107) Page 2 of 14
Paragraphe t3), (4), (6) end (6) of this exclusion do not apply to iiabifty assumed under a sidetrack
agra ment
i
Paragraph (b) of this exclusion does not apply to "property damage" included fn the "products - completed
operations hazard'
B. SECTION i - COVERAGE A.2 Exclusions is amended to delete the last *agraph and Is replaced by the
following:
Exclusions, c. ttruugih n. do root apply to damage by fire., lightnnng), explosilon, smoke or sprinkler leakage
darnage to premises while ranted to you or temporarily oocuplad by you Wth Penn on of ibis owner. A
separate limit of ii urance applies to this cov as described In Soctlori III � Units of insurance
C_ SECTION in - LIMITS OF INSURANCE, Paragraph S, is replaced by the following:
a. Subjd t to 6- above, the Damage To Premises Dented To Ym Limit Is the oat we will pay under Coverage
damages for dama because of ""property damage" to any one prarnmfw w e rented to you, or, In case of
damage by lire, lightning. explosion, smoke, or sprinkler leakage whip rented to you or temporarily
occ:upled by you with permission of the owner.
The Damage To Premises Rented T'o You ]Emit Is the Each Occurrence Un-A shown in the Genre! Liability
Declarations
M SECTION IV - COMMERCIAL GENERAL UA131UTY CONDITIONS, para�aph 4.b.(1)(b) to deleted and
replaced by the following:
(b) That IB fire, lightning, aVlosion, smoke or sprinkler leakage Insurance !for premises rented to you or
tearnporadly occupied by you with permission of the owner, or
E SECTION V -DEFINITIONS, pwagreog.a. Is deleted and replaced by the faltriwing:
a. A oontmd for a lease of premises. However, that portion of the conbak for a lease of premises that
Indemnifies any person or organization for damage by fire, lightning, expioifon, smoke or sprinkler leakage
to premises while rented to you or temporarily occupied by you with permission of the owner is not an
"insured rontraor; } i.
IV. NON-OWNEi] WA FT AND NON - OWNED AIRGWT RENTED OR LOANED TO YOU WITH A GREW
I
SECTION I - COVERAGES, COVERAGE A. BODILY iNJURY AND PROPERTY DAMAGE LIABILITY, Exckaslon
g. - Aircraft, Auto or Watercraft, paragraph (2). Is deleted In its entirely and replaced with the following:
(2) A watercraft you do not own that Is: ;.
(a) Less than 61 feet long; and
(b) Not being used to carry persona or property for a change
The following is added to S.
(a) An aircraft not owned by any Insured that Is rented or loaned to you wish a paid 6w,
If other insurance applies to a loss bemuse of ""prrrparly damage " to non -owned W ercralt or aircraft as described
in (2)(a) and (b) or (0) above, the Insurance provided by this Coverage Form dcr not apply whether the other
Insurance is primary, excess, contingent, or Issued on any other basis.
V. PROPERTY DAMAGE COVERAGE ARISING OUT OF ELEVATOR USE
SECTION I - COVERAGES, COVERAGE A. BODILY INJURY AND PROPERTY 6AMAGE LIABILITY, Exclusion
J. Is amended to Include the following:
MOL232 (04107) Page 3 of 14
Paragraphs (3), (4) and (6) shall not apply to tlabft ariaing out of the use of etevoors.
if other valid and collectible insurance applies to a toes becawe of -prolm aty d m a`" arlslr Drat of the use of
olavators, this age Form shall ap* excess of the other Insurance. whe this other Insurance fa primary,
excoss„ co rant, or Issued on arty other boats
VI. WHOISANINSURED i
SECTION A - WHO IS AN IN311RED, Is amended by the fbPowing.
A. Paragraph 2. is amended to Include the following as insureds:
a. Any legally incorporated entity of which you own at least 5196 of the vo&f stock on the inception date of
this Coverage Form and on the date of any covered "occurrence', claim or 'Ault'
This hwranoe shall not apply to any entRy that to ~y an insured under Any offw Insurance provided by
any company or that would be an insured but for the exhwistioo of lta limits of fr lurancer.
B. Newly Acquired or Formed Organization N
W
Paragraph 3.a. Is deleted in it$ entirety and replaced with: d
a. Coverage for• your newly acquired or formed orgenizelion shall be:
1. Effective on the date of acqulellion or affirmation; and
2. Afforded until the end of the policy period of this Coverage Form
C. The Mowing Is added to Paragraph 2.a.;
i
Paragraph (1) does not apply to executive officers, or to managers at the supervisory level or above
,
VIL MENTAL ANGUISH COVERAGE THAT' REGULT9 FROM BODILY INJURY
SECTION V. DEFINITIONS, Item 3., Bodily Injury, is deleted in its entirety and repl*ed with the following;
3. "Bodily Injury" means:
a. Bcr y injury, spar or dl se sustained by a person, and also irrJude Mental anguish or emotional
provided such mental anguish or emotional distress results from anYof Owe; and
b. Death resulting from bodily injury, sickness or disease [
I
Vlll. ADVERTISING INJURY
A. SECTION V- DEFINITIONS, Item 14, Personal and Advertising Injury, paragreph6 d. and e. are deleted In their
entlrety and replaced with the following•
d. Oral, wrtkfen or professionally produced televised or videotaped puNicsoon df material In any monrw that
slanders or libels a person or organizatlorr, or disparages a parsaWs or arWift tWs, goods, prot uCts of
services;
e Oral, written or ixotessionatly produced televised or videotaped ptblcetlon it material in any manner that
violates a person's right to privacy; i
t3, SECTION 1 - COVERAGE, COVEWE S. PERSONAL INAW AND TI WING INJURY LIABILITY,
�tluslor b. and e. are deleted In their or direly and repl000d wvlth the fotiorlrrirrg:
b. 'Personal and advertising Injuryo arising out of oral, written or proleatkinally produced televised or
vkWMped publication of material In any manner, if done by you or at your direction vAh knoWedge of its
falsfty;
MOL232 (04M?') Page 4 of 14
"Personal and advertising injury' arising out of oral, written or * produced televised or
videotaped publication of rtteltal whose first publication took place befbre the beginning of the policy
period.
IX. MOBILE EQUIPMENT
SECTION V - DEFINITIONS, Item 12., Mobb Equipment; paragraph t(1) is amended to add the fonowing:
This shall not apply to self-propelled vehWm of lase than 4000 pounds gores tut weight
X. PER LOCATION AND PER PROJECT AGGIREOATES
SECTION III - LIMITS OF INSURANCE, Is amended to add the following:
a., Insureds;
M131.232 (04107) Pago 5 of 14
C, When iw -. x o for :b r. out of the "products-complejeo operotene hazee is proyidect any
PaymerAs for dwvges because of w w w wi opro er.y w n :, Jind � � w Y M A
'w
w w w reduce the Products-Completed � w reduce
CS "w w p w w ojec + w
For
purposes of e section: of this o. ww ie,,• nf, "Loogtion,,
connecOng lots, or premises whose connedlon Is hWm4ftd' ordy by
w of w••d
E. If the applIcalAetovered construction pro ct has been abandoned, deleyed, 0 abardon0d and than restarted„
or It the authorized contacting parties deviate from plans, laluspt(nta, designsa,19pectflcallons or timetables, the
project of i soli be deemed to be fire same construction pr+ojed
F. The provisions of Limas of Insurance (SECTION 110 nol otherwise modHied by This endorsement shag conttnue
to apply as stipulated.
X1. ADDITIONAL INSURED - MANAGERS OR LESSORS OF PREMISES
%H0 IS AN INSURED (SECTION ll) is amended to locimie as an additional hsrlurad , person or organization who
lassos to you or manages property you car isase, but aaratyy with respect tea r sty faar "bodily tttjury°", "property
damage" or "personal and adv i g Injury " caused, In whine at in part„ by your atts or omissions or the acts or
omissions of those acting on your benoit in COMA00rl WIM that ,pert of the prernials leased or rented to yota and
strovm on the gyrations The following additional exclusions fly:
This Insurance does not apply to:
N
1 Any "oeowence° which talm place of w you cease to be a tenant in that premlos.
2. Structural alterations, new construction or demolition operations performed by )or on behalf of the person or
organization who leases to you or manages property you rent or tease
0. ADDITIONAL INSURMS - VENDORS (LIMITED) I
The followirig provision applies only if the policy to which this endorsement is sftached provides insurance for
"bodily injury" and "property damage" included In the "prod ucts -compl ted operstlorm moral";
WHO IS AN INSURED (SECTION IQ Is amended to include as an additional lnsu any person or organization
(referred to below as vendor) with whom you agree In a written contract or agreement to provide Insurance, but only
with respect to "bodily injury" or "property damageF arising out of "your praducW Whic i are distributed or sold in the
regular course of the vendoes busfn"s, subjed to the foliaMng additional exclusions:
1. The Insurance afforded the vendor does not apply to: s'
a., 'Bodily injury' or °property damage' for which the vendor is obligated top damages by reason of the
assumption of fability in a conlred or aaWeement This exclusion does not a to llabfity for damajes that
the vendor would have In the absence of the contract or agreernerah
IL Any earpress warranty unauthorized by you;
c. {Arty phyaloaT or chemical change in tfae product made intentionally by the vendgrw
d, ft packaging, except when unpacked solely for the purpose of Insp ection, ( sratonalralkan, loWng, OF the
substhttion of parts under Instructions from the manufadurar, and than r"cks sad In the original container;
e.
Any failure to make saach Inspections, adjustments, tests or servicing as the v odor has agreed to msW or
normally and to make Ira the usual course of bosInses, in connection wid the dlstat"bulion or sale of the
produi+s,
1
I
i
1111101.232 (04107) Page 6 of 14
I
f, Demonstr0on, Installation, servicing or repair operations, except such operglons performed at the vendor's
premises In connection with the sale of the product;
9 Products which, after distrlbuilon or sale by you, have bom labeled or rels"ed or used as a container, part
or Ingredient of any other thing or substance by or for the vendor;
h. Any failure to maintain the product In a merchentabie condition; or
R, Modily injury" or' "property dam ' arising out of the sole riagcge ce of the vendor for Itss own r
omissions or those of its employees or anyone else acting on itax behalf ever, Phis oxclusion does not
apply to: n
(1) The exceptions contained In subparagraphs d. or t.; or m
(2) Such Inspections.„ adjustments* tests or servicing as the vendor had agreed to make or normally
undortakes to make if) the usual course of business, In connection with the distribution or sale of the
products
Z. This inswave does not apply to any insured person or organization from r horn you have acdiutred such
Produeft. or any, ftnedlent; part or container entering lift, acoompanyIng or conrinining such products.
)(Ill. ADDITIONAL INSURED - BY WF21TT !N CONTRACT, AGREEMENT OR PERMIT
The foliowmg paragraph Is added to WHO IS AN INSURED (Section 11):
4. Airy parson or organWon for whom you are required by written contract, irigreement or permit to provide
insurance Is an Insured, subject to the following additional orrs;
a. The contract agreement or pemrrT must be in effect during the policy period ishown In the Declarations, and
must have been executed prior to the "bodily srJuryr, "property damage ", or" ,ersona) and advartising Injury"
b.. The person or organization Is an Insured only'to the extent you are held QabIJ due to-
(J) The ownership, maintenance or use of that part of premises you own, gift, lease or occupy subject to
the follorarng additional provistons:
(a) This insurance does not apply to any'occurrenoa" wwhkh takes place' after you cease to be a two ftt
in any premises leased to or rented to you;
(b) This insurance does not apply to any structural alterations, ndw construction or dernolltion
operations performed by of on behalf of the person or origanizatim;
(2) Your ongoing operations for that insured, whether the work Is performed try you or for you;
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(3) The maintop , operation or use by you of equipment leased to you �y such person or organization,
subject to the following additional provisions:
(a) The Insurance does not apply to any "accurrencW which takes pike after the equipment lease
expires;
(b) This Insurance does not apply to "bodily InJW or 'property r arising out of the sole
negligence of such person or organization;
(4) Permits Issued by any state or political subdivision with respect to operations performed by you or on
your behalf, subject to the following additional provision:
This insurance does not apply to "Codify injury", "property damage', or' , nal and advertising injury"
arising out of operations performed for that state or municipality 1
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MOL232 (041M Page 7 of 14
C. The Insurance with reaped 110 any archItod, ertg %near, or surveyor, added 86 an 'Insured"" by this coverage,
does not apply to "bodily injury", "piropefty dam , or "personal and advirtlaing, injury" arlsing out of the
rendering or falkirs to rendar any proliessiordil services by or for you, IndkA "
(1) The preparing, approving or failure to prepare or approve maps, drawl g% opinions, reports. surveys,
change orders, designs or speclMcations, and
(2) Supervisory, inspection or anginearing services,
d. This Insurance dues not apply to " bodiy injury" or "property damage' Included within the
x "products,„ plated o p Wa hazaW
A person's or organization's sWus ae an Insured under this endorsement ends :;when your operations for that
insured are completed.
No coverage will be provided It in the abserme of this endorsement, no iiablitty *0 be imposed by low on you.
Coverage will be limited to the extent of your negligence or fault according Ip the appritmble prinsdpWs of
comparative tacit
ThI's Additional insured provision doss root apply to Managers or Lessors of P a, Vendors, or Mortmees,
A as" or hers. For Iulane or Lessors of Framtsss, rotor to ADDIit 'F.GR INSURED - MANAGERS
OR RU OF PREM For Vendors, %r ACiUITIONA4 INSURED - OORS, For Mortg
Assigneas or Receivers, r to ADDITIONAL INSURED - MORTGAGEE, ASSIGN RECEIVER,
7(11:• ADDITIONAL INSURED - MORTMAAGEE, ASSIGNEE, OR RECEIVER I
V*10 IS AN INSURED (Section II) is amended to include as an Insured the psrson6 organization with respect to
the# llablity as mortgagee, assignee, or receiver and arisltrg out of the ownership, nrp intenance, or use of prern
by you
Tide Insurance does not apply to structural alterations, new construction and dwnul0m operations performed by or
for that person or organization. i
XV, EXTENDED "PROPERTY DAMAGE" - EXPECTED OR INTENDED INJURY
Exclusion 2.e" of SECTION 1- COVERAGES, COVERAGE A is deleted In its entirety end replaced by the folowing:
a. "Bodily injury" or `property damage" expected or tHwWad from the standpoint. of the insured This exclusion
does not apply to "bodily Ir4ur/ or 'property damage" resulting from the useiof reasonable fume to protect
persona or property.
XVI. PROPERTY DAMAGE - BORROWED EQUIPMENT
A. Paragraph (41 of Exctusion j of SECTION I - COV'9RAGES, COVERAGE A does not apply to
"property damage" to borrowed equipment while that equlpmerd is; i
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1. Not being used to perform operaliansi and
2. Away from an Irrsured's promises ;
a. The Insurame afforded by this proviston Is excess over any valid and coliardfble� pMorly Insurance (Including
any deductible) available to the In stmed +a lath ;primary, excess. con&Voit or on ony other basis
C. SECTION III - LINTS OF INSURANCE is amended to add the following: n
Subject to the General Aggregate provision, the most we will pay under this prtn for "property damage" to
harrowed equipment is $10.000 per "occurraneo"
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MOL232 (04107) Page 8 of 14
XVIL PROPERTY DAMAGE - "CUSTOMERS' GOODS"
A. paragraphs (3), (4), and (8) of Exdusion j of SECTION I - COVERAGES, COVERAGE A does not apply to
"ProPartY dentage" to "cuetorner's goods" while on your prernioes.
B. The insurance afforded by this provision is excess over any valid and couWA08 property Insurance (Including
any deductible) available to the insured whether primary, excess, contingerd or any other basis
C. SECTION lit - UNTS OF INSURANCE Is amend to add the folfowl t .
Subject to the General Aggregarts provision, the mast we wdl pay under this provision for "property
damage" to crtomer "s goods Is $10 „000 per "occurrence
XVIII. MEDICAL PERSONNEL.
The fbilaMng applies only If no other Ornilar coverage is included on or ad* to the poky to which this
endorsement Is attached:
The - following Is added to SECTION I COVERAGES, COVERAGE A Bodily InJiuy and Property
Damage Liability - Insuring Agreement: l
A. We will pay them sums the insured b000rnes legally obligated to pay as a t of an -occurrence arising out
of your employed reglatered nurse, liceunsed ,praacal nurse, oertifled emerg enc rnedical tevbnk4an or c,artffled
paramedic performing professional health we services This applies only to'•those professional health care
services arlstrV out of duties related to the conduct of your business The rag tansd nurse, licensed practical
nurses, certified emeWcy medical technician or certified paramedic must be yoi(r' "employee""
B. SECTION It - WHO Its AN INSURED Is afrended to Include Ilse alcove designated "employees” for acts within
ttta scope of their erwOoyment by you while performing duties related to the conduct of your business Irtdrrding
ditties arlsing out of his or her providing or failure to provide pWessional health services
C. BEGTION III - LIMTS Or WaURANGS Is amended to add the following;
Subject to the General A gale provision, the most we will pay under adlcol Personnel coverage is
$100,000 for all professional stealth services sustained by any one person, j
)OX. LIMITED PRODUCT WITHDRAWAL EXPENSE COVERAGE
THIS COVERAGE ONLY PROVIDES REIMBURSEMENT TO YOU FOR EXPENSE II URRED BE CAUSE OF A
COVERED "PRODUCT WITHDRAWAL". THIS COVERAGE DOES NOT PR'OVID ANY LIABILITY COVERAGE
OR COVERAGE FOR THE COST OR EXPENSE OF DEFENDING ANY CLAIM OR tUrr
A. The folbwsng Is added to Section I - Coverages:
SECTION I - LIMITED PRODUCT WITHDRAWAL EXPENSE COVERAGE
1. Insuring Agreement i
a
(a) We will reimburse you for "product withdroml expense" incurred by you because of a "product
wlfhdrawaf to which this insurance applies.
The amount of such mirnbUn0ement is limited as described in Section IM . LWte of Insurance No
other obligation or liability to pay sums or perform acts or services Is cover6d.
(b) This Insurance applies to a "product withdrawal" only if the "product WthdrawaN is Initiated in the
"coverage territory' during the policy period because:
(1) You determine that the "product with drawer to necessary: or
(2) An authorized government entity has ordered you to conduct a 'product %Mthdrawarl.
MOL.232 (LI4W) Page 9 of 14
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(c) We W,TI reimburse "product withdrawal expenses" only If J.
(1) The expenses are incurred within one year of the date the "product vAb l " wrss Inklated; 1
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(2) The expenses are reported to us within one year of the date the 4ses were Incurred; and 1
(8) The product that is Me subject of the "product wfthdra"' v as prod) cad after the Inception date of
this policy or the date this endorsamant was added, whichever is earl or
(d) The Initiation of a "product withdrawal" will be deemed to have been n(9e only at the earliest of the
following times, 6,
(1) When you first announced, in any manner" to the genotal public, your, vendors, or to your employees
(other than those directly invotved in making the dateimination)Q your dedslam to Conduct or
perticipste Ina "product dr This appiles regardless of!whsther the determinstlon to
conduct a "Product withhdrawail " Is mane by you or is requested by a perty; or r
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(2) When you first recelved, either orally or in Writing, nouncation all an order from an authorized
government entity to conduct a "product °wtlhdr'awar i
{e) "Product withdrawal expartsesm Incurred to withdraw "your productal which contain the same or
substantiaity similar "defects" will be deemed to have arisen omit of the sahthe "product withdrawal',
2, 6rclustons
s w
This Insurance does not apply to "product withdrawal expenses" arising out of
;
(a) Breach of Warranty And Failure To Conform To intended Purpose b
Any "product whhdn, Mr initiated due to the failure of "your producCl, to accomplish their intended l
purpose, including arty breach of Warranty of fitness, whether written or 14pled_ This axdusicn does not
apply if such failure is reasonably expected to cause 'bodily i,yury" or physical damage to tangible
property other than "yow product"
(b) Infringement Of Copyright, patent, Trade Secrek Trade Dress Or Ttadem ik
i
Airy 'product w1hdrawaf' initiated due to copyright, palant, trade sei#ek trade dro=ss or trademark
inkingerrments
(c) Deterloratlo% Decornposition Or Chemlcat Transfommation
Any "product withhdmwsaT Inillated due to trareformation of a chef jcal nature, deterioration or
decomposition of "your produc"'. This excluslon does rot apply If It is ceuW by:
(1) An error in manufacturing, design or prom g; I
(2) Transportation of "your producf"; or,
($) "Product tampering'.
(d) Goodwlhl, Ntarket Share, Revenue, Profit Or Redesign
The costs Of goodwill, market share, revenue or "profit" or the costs of red ig1flIng "your product'
(e) Euptradon Of Shelf Life
Any "product withdrawal" initiated due to expiration of the designated shed, ft of "your product"
MOL.232 (OMT) Page 10 of 14
(tl Known Dsfeet
A "'product Vftdf~ Initiated because of a "defect" In "your productf know to sxlst by the Named
Insured or the Named Ins "s "Isxftuffm 01009W. prior to the dates %4kn this (I* ve"o Park was first
Issued to you or prior to the time "y our product" leaves your control or pftsession,
(g) Otherwise Excluded Products
A recall ll tai! any specift prod is for which 'b000lly Injury, or 'pro damage"" is excluded under
Coverage A - Modify Injury and Property DaronaIa Liability by endoc rrwer
(h) governmental Ban
A recall when your product" or a component contained within "your prodUd' has been;
(1) Banned from the market by an authorized government entity prior to the policy period; or
(2) Mtributed or sold by you subsequent to any governmental ben.
(t) Defense Of Maim
The defense of a claim or "slit" against you for liability arising out of a *prr duct withdrawal".
Q)
Third Pady Damages, Fines And Penalthe I
Any cornpensalory darneWs, fines, perdWes, Punitive or exemplsry or other non- compensatory
damages ImposW upon the Insured,
(k) Polltrtton- teelated Expenses
Any lass, cost, or expanse due to any- 9
(1) Request, deln", ordw, statutory or regulatory requIrenterd that insured oi others test for,
monNot, up!, remove, in, 'treat, detoxiry or norranze, or in way respond to, or assess
the erfe of, "Itoilutanw; or
(2) Claim or suit by or on behaff of a governmental atutlwrtty for a because of testing for,
monitoring, deartirrg up, rernoving, corrfalrting, troatlrt� dato>ofjring t nekrtrallzing, w in any way
responding to or at4wsslng the effects of,'pdtrtants"
S. For purposes of this w0orsernent Seetlon IN - LINUTS OF INSURANCE is replav*d by the fotiowing:
SECTION III - LIMITS OF INSURANCE
The most that we wif reimburse you rot under this coverage is $10,000 regardlessiof the number of
(a) Insureds;
(b) "Product withdrawals" Initiated; or
i
(o) Number of "your products" withdrawn.
The $10,000 limit Is the most that we wto reimburse you for the sum of all 14D*jct withdrawal expenses"
incurred for adl "product withdrawals" tnittated dwing the policy period.
AAfiL332 (7) Page 11 of 14
(1) How, when and where the "defect" was discovered:
(2) The names and addresses of any injured persons and witnesses; ani
(3) the nature,, IocaWn and drtwmstar=s or any injury or damage arlai v out of use or consumption of
'your ucr.
b. If a "product withdrawal" is infiiated, you must:
(1) Immedataly record the specifies of the "product wkhdrwM11 and the 4ata where it was initiated; mid
(2) Notify us as soon as practicable.
You must see to It that we recelve wditen notice of the "product wlthdraw*r as soon as practl=We
You must promptly take a1 reasonable steps to mitigate the expensO ROW01ated with a product
with Any " otfi " that you mGWe ftm Mllbating the a per as l be deducted from the amount
of reimbursement that you vAN receive for product wttttdrawal exile
i. You and any other Inw*ved Insured must;
I
(1) Imm0 send us copies of Pertinent correspondence received Ij connaMcm wllh the product
(2) Authorize us to obtain records and other Information; and
(3) Cooperate with us in our Inv0stigsilon of the "product vmhdrwmr
D. For the of this cover p
P�Pes� age, the foliowhng is added to Section IV -00
ondl
Concealment Or Fraud
We will not provide Coverage under Section I Io you, or any athar Insured, who at lany time.
1. Engaged in fraudulent conduct; or
2. InOWMaNy concealed or misrepreserited a material tact cenaernIng a "pr�durt withdrawal" or "product
withdmwal experisser incurred by you under Section I of tills gaga
XX. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US
MOL.232 (04107) ! Page 12 of 14
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XXI. DUTIES IN THE EVENT OF OCCURRENCE, OFFENSE, CLAIM OR SUIT r,
SECTION IV- COMMERCIAL GENERAL LIABILITY CONDITIONS, Item ; 2., Duties in the Event of
Occurrence, Claim or Sufi. Is amended to include the fallowing:
e. 1"our obl OOOn to noti us ss soon pmci'icabte of an "occtrrr , offense, dalrra or °s lit" Is. satieriedi if' you
served us nolloo as soon as I ble after any of your *sac f* officers"', directors, partners,
Insurance m rs or I representatives aware or or should a roof sough
"cccurr6rt,W, olWse, Bohn or "null""
XXIL UNINTENTIONAL FAILURE TO DISCLOSE ALL HAZARDS
SECTION 1V - COMMERCIAL GENERAL LUIBLITY CONDITIONS, is amended to Include the following:
1o. Based on our reliance on your ropmeentations, as to eanisling hazards, If you l intanlionMy fail to discloss all
such hazards prior to the beginning of the y period of the Coverage Part, rr�$hall not deny coinage under
this Coverage Part because of such failure
XXIII. LIBERALIZATION
SECTION IV - COMMERCIAL GENERAL LUMUTY CONDITIONS, is amended to Include the following:
11. If we revise this Ooverage Fortin to Provide mars COMW w4hout additional lum charge, your policy will
atrlornaticafly provide ttis addigonal coverage as of than day the revision to effaotl Gn your slate
XXIV, DEFINITIONS
The following deflriftns are added:
1.. "Customers' goods" mean tanglbis personal property belonging to your customos and left with you for storage,
swvk a or repair "Customers' goods" do not include,
a. Accounts, bills, currency, deeds, Blood stafnpas or other evidences of do ,money, notes or seaxitles
Lottery tickets held for sale are rust' ties; n
b. Animals; i
c. Contraband, or property In the course of 090 transportation or trade;
d. Personal property while airborne or waterborne;
a. Property that Is connect under another coverap ball of We or any otl{er poky In which It Is more
specifically clawlbed, except for this excess of the amount We (mMather yogi can collect on it or not) from
that other Insuamce,
r. Vehicles or self-propelled machines (Including aircraft or watercraft) that re licensed for use on public
roads.
This paragraph does not apply to:
(1) Vehicles or self-propelled machines, other than 'autos", yw hold for sale or
(2) Rowboats or canoes out of water at the described premises;
g. The following property while culside of buitdiigs:
v
(1) Grain, hay, straw or othercroW, s
(2) Fences, raft or television antennas (including satallito dishes) and ll pair hued -in Wiring, rn or
towers, signs (other than signs attached to buIldings), tress„ shnuubsl or planrnis (other than tress,
shrubs or plants held for sale).
MGL232 (041017 ? Pape 13 of 14
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2. "Defect" means a defect, danrdency or inadequacy that croates a dangerous eorttion
3. ""p"radu t tgMp 'h" Is an act of InWitortal alteration of " our �
ed to case "bodily in rym ' p'it'y i inJur�r to � p th tour fir t "ar is, reasonably
' p rty ultra, titrrn�"yorur product'
1Pwan "Product tartwpsarin" is known, suspactsd or threatened, a °pduct �mwal" wltl be limited to those
batches of "your ucl" which ore known or saga to have tranipered lth
For purposes of this Inarwence. efedrvnic data 16 not tangible property. f
As Used in this deftffion, electronic data means hilbr netion, facta or PrOOMS *red as or on, created Of used g
, or transmitted 10 or from c4mPUter software, WJutft systems and sraftw " hard or floppy G
disks, 01)- lgOMS, tapes, "as, o;stis, dose processing devi rr or any ottrt rnudls whr�h are used with
aiecir�orricalfy oontroi'ted aquipmeN
4. "Product withdrowsP' means the recal or withdrawal:
u. From the market; or i
b. From use by any other person or orgerdzedon;
Of ""your products' or profits which contain ""your producle" °, because of own or sta
Property g"' whlch has than uramed or pa reasons* WWW tc catrse "bodtly in�taty�or physical Injury to tangible
" produ r
Far purposes of this Insurance, electrode data Is not tangible property.
i
As used in this deffnition, ef9clronic data ,means Information, facts:. err programs as or on, created or used
on, ar transmtffed to or from computer saftwere, Including Systems and applicado ns softare, hard or floppy
dlaks, CD IROMs, tapes, drives, we used wtdt soaps„ date processing devices, or any Other treadle wuhwhich aiedtronia ay controlloW agutprns
S. "Product withdrawal expensee" means those reasonable and necessary extra a ra s, listed below paid and
di r by rotated to a Vro4tvt withdrawal-:
s'. Costs of notification, ;
I
b. Costs of stationery, envelopes, production of announcements unit postage or fi.0simiies;
e. Costs of overtime pairs to your regular non-aalary employees and poste interred by your employees,
tnM(ling costs ottransportafloril and scr omnlodiionr;
d. Costs, of computer time; a
e. Comte of taring Independent oontractora and other temporary employees;
E Costs of transportation, shipping or packaging;
g. Costs ofwarehouse or storages
pace; or
h. Costs of proper dispposai of "your pa'od'uicts'"" or ioroduM that "yo " "drat can not be reused,
no(axca fi your phase price or your �t to prod's the pets,
6. "Profit" means the postdve gain from buskrese operation after subtracting for sit exrpea sea:
All other terms and conditfans remain the some
MOL,232 Mal) Page 74 of 94
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