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Endorsement No. ,1 Effective Date: 49 01'2(j2 @12:01 a.m.Standard Time at the address of the Named Insured Policy Number: is002 7 00 Insured Name Tait 8c"i'sbclates ink; Issuing Company:AXIS Surplus Insurance Company Additional (Return) Premium: If the Endorsement Effective Date is blank,then the effective date of this Endorsement is the Inception Date of the Policy. ADDITIONAL INSURE® - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: SPECIALTY PACKAGE POLICY SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Locations Of Covered Operations sir ul[ d fayfn.. #a i ,f# rrctn ..r �tae s rgdird bY.! n ccirci ig., fe �ir .c� nj _ _��. �ql.OR W . laa Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section III — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply; with respect to liability for Bodily Injury, Property This insurance does not apply to Bodily Injury or Damage or Personal And Advertising Injury property Damage occurring after: caused, in whole or in part, by: 1. Your acts or omissions; or 1. All work, including materials, parts or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the location(s) location of the covered operations has been designated above. completed; or However: 2. That portion of Your Work out of which the injury or damage arises has been put to its 1. The insurance afforded to such additional intended use by any person or organization insured only applies to the extent permitted by other than another contractor or subcontractor law; and engaged in performing operations for a 2. If coverage provided to the additional insured is principal as a part of the same project. required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract .or agreement to provide for such additional insured. Includes copyrighted material of Insurance Services Office,Inc with its permission CG20100413 SPP 201013(02 14) Page 1 of 2