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C: H U a a" Liability Insurancc <br />Policy Period <br />Effechve Date <br />Policy Number <br />Insured <br />Name of Company <br />Date Issued <br />This Endorsement applies to the following forms: <br />GENERAL LIABILITY <br />ffi�= -� <br />Additional Insured - <br />Scheduled Person <br />Or Organization <br />Liability Insurance <br />MAY 17,2020 TO MAY 17,2021 <br />MAY 17,2020 <br />3602,53-12, TPA <br />CIVICPLIJS' LLC <br />GREAT NORTHERN INSURANCE COMPANY <br />MAY 15,2020 <br />Under Who Is An Insured, the following provision is added, <br />Persons or organizations shown in the Schedule are Insureds; but they are insureds only if you are <br />obligated pursuant to a contract or agreement to provide them with such insurance as is afforded by <br />this policy. <br />However, the person or organization is an insured only: <br />• if and then only to the extent the person or organization is described in the Schedule, <br />• to the extent such contract or agreement requires the person or organization to be afforded <br />status as an insured; <br />• for activities that did not occur, in whole or in part, before the execution of the contract or <br />agrees rent; and <br />• with respect to damages, loss, cost or expense for injury or damage to which this insurance <br />applies. <br />No person or organization is an insured under this provision-, <br />• that is more specifically identified under any other provision of the Who Is An Insured <br />section (regardless of any limitation applicable thereto)'. <br />• with respect to any assumption of liability (of another person or organization) by them in a <br />contract or agreement. This limitation does not apply to the liability for damages, loss, cost or <br />expense for injury or damage, to which this insurance applies, that the person or organization <br />would have in the absence of such contract or agreement. <br />Additional Insured - Scheduled Person Or ONanizadon <br />Form 80-02-2367 (Rev 5-07) Endorsement <br />cF Risk MmRgmedDMsiun <br />REVIEWED & APPROVED BY.- <br />F04c"�" P, VX*vd <br />RtWjanagementftalpt <br />