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POLICY NUMBER: <br />COMMERCIAL GENERAL LIABILITY <br />CG 20 10 07 04 <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 />Home Of Additional Insured Person(s) <br />Or Organization(s): Location(s) Of Covered Operations <br />S A M P L E <br />Information required to complete this Schedule, if not shown above, will be shown in the Declarations. <br />A. Section 11 -Who is An Insured is amended to B. With rasped to the insurance afforded to these <br />include as an additional insured the person(s) or additional insureds, the following additional <br />organization(s) shown in the Schedule, but only exclusions apply: <br />with respect to liability for ^bodily injury", "property This insurance does not apply to "bodily injury" or <br />damage" or "personal and advertising injury" ^property damage" occurring after: <br />caused, in whole or in part, by: 1. All work, including materials, parts or <br />1. Your acts or omissions; or equipment furnished in connection with such <br />2. The ads or omissions of those acting on your work, on the project (other than service, <br />behalf; maintenance or repairs) to be performed by or <br />in the performance of your ongoing operations for on behalf of the additional insureds) at the <br />the additional insureds) at the location(s) location of the covered operations has been <br />designated above. completed; or <br />2. That portion of "your work" out of which the <br />injury or damage arises has been put to its <br />intended use by any person or organization <br />other than another contractor or subcontractor <br />engaged in performing operations for a <br />principal as a part of the same project. <br />CG 2010 07 04 <br />©ISO Properties, Inc., 2004 <br />Page 1 of 1 <br />TROXELL Ct}MAbURfiCAI'IONS, INC <br />