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Attachment Code: D488922 Certificate ID: 15085893 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY <br />ADDITIONAL INSURED BY CONTRACT OR AGREEMENT - PRIMARY BASIS <br />This endorsement modifies insurance provided under the following Coverage Form: <br />COMMERCIAL GENERAL LIABILITY <br />PRODUCTS/COMPLETED OPERATIONS LIABILITY <br />LIQUOR LIABILITY <br />POLLUTION LIABILITY <br />This endorsement changes the policy effective on the inception date of the policy unless another <br />endorsement effective date is indicated below. <br />SCHEDULE <br />Name of Additional Insured Person(s) or Organization(s): <br />As required by written contractor agreement when written contract or agreement is executed prior to an <br />occurrence, offense or loss to which this endorsement applies, but only for the limits agreed to in such <br />contract or the Limits of Liability provided by this policy, whichever is less. Any individually scheduled <br />additional insureds shall not be construed to override nor negate this blanket additional insured. <br />Designated Project, Location, or Work of Covered Operations: <br />As per written contract or agreement with the above described person(s) or organization(s). <br />CHANGES <br />SECTION II - WHO IS AN INSURED is amended to include: <br />4. The person(s) or organization(s) shown in the Schedule above with whom you have agreed in a written <br />contract to provide insurance such as is afforded under this Coverage Form, is included as an Additional <br />Insured subject to the below: <br />a. Insurance for such Additional Insured(s) scheduled above shall be afforded only to the extent <br />that such Additional Insured is liable for "bodily injury", "property damage" or "personal and <br />advertising injury" caused by your acts or omissions while actively engaged in the performance of <br />your ongoing operations involving the project(s), Iocations(s), or work designated in the Schedule <br />and as specified in the contract between you and the above scheduled Additional Insured(s). <br />b. The insurance afforded under this Coverage Form to such Additional Insured(s) applies only: <br />(1) If the 'occurrence" or offense takes place subsequent to the execution and effective <br />date of such written contract: and, <br />(2) While such written contract is in force, or until the end of the policy period, which ever <br />occurs first. <br />c. How Limits Apply to Additional Insured(s) <br />The most we will pay on behalf of the Additional Insured(s) scheduled above is the lesser of: <br />(1) The limits of insurance specified in the written contract or written agreement; or, <br />(2) The Limits of Insurance provided by the Coverage Form. <br />SNGL 023 1209 Safety National Casualty Corporation Page 1 of 2 <br />.., RldeMangonodpMeimt <br />y RElIEWm S APPROO®ar <br />�� Risk Management Analyst j <br />