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POLICY NUMBER: PPK1781002 <br />N , .2-0(5 - 653 <br />COMMERCIAL GENERAL LIABILITY <br />CG 20 10 04 13 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />ADDITIONAL INSURED - OWNERS, LESSEES OR <br />CONTRACTORS - SCHEDULED PERSON OR <br />ORGANIZATION <br />This endorsement modifies insurance provided under the following: <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART <br />SCHEDULE <br />Name Of Additional Insured Person(s) <br />Or Organization(s) <br />Locations Of Covered Operations <br />AS WHERE REQUIRED BY WRITTEN <br />ALL COVERED LOCATIONS. <br />CONTRACT PRIOR TO LOSS. <br />This insurance does not apply to 'bodily injury" or <br />Information required to complete this Schedule if not shown above will be shown in the Declarations. <br />A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these <br />include as an additional insured the person(s) or <br />additional insureds, the following additional <br />organization(s) shown in the Schedule, but only <br />exclusions apply: <br />with respect to liability for "bodily injury", 'property <br />This insurance does not apply to 'bodily injury" or <br />damage" or 'personal and advertising injury" <br />"property damage" occurring after: <br />caused, in whole or in part, by: <br />1. All work, including materials, parts or <br />1. Your acts or omissions; or <br />equipment furnished in connection with such <br />2. The acts or omissions of those acting on your <br />work, on the project (other than service, <br />behalf; <br />maintenance or repairs) to be performed by or <br />in the performance of your ongoing operations for <br />on behalf of the additional insured(s) at the <br />the additional insured(s) at the location(s) <br />location of the covered operations has been <br />designated above. <br />completed; or <br />However: <br />2. That portion of 'your work' out of which the <br />injury or damage arises has been put to its <br />1. The insurance afforded to such additions <br />intended use by any person or organization <br />insured only applies to the extent permitted by <br />other than another contractor or subcontractor <br />law; and <br />engaged in performing operations for a <br />2. If coverage provided to the additional insured <br />principal as a part of the same project. <br />is required a contract or agreement, the <br />.by <br />insurance afforded to such additional insured <br />will not be broader than that which you are <br />REVIEWED BY. <br />required by the contract or agreement to <br />provide for such additional insured. <br />x <br />44 2 <br />,(,L � 9 <br />PAGE -a: a i <br />CG 20 10 0413 © Insurance Services Office, Inc., 2012 Page 1 of 2 <br />