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POLICY NUMBER: A0253953002 COMMERCIAL GENERAL LIABILITY <br /> CG 20 10 12 19 <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) Location(s) Of Covered Operations <br /> As required per Written Agreement All Locations and Operations <br /> or Contract <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 additional insureds, the following additional <br /> organization(s) shown in the Schedule, but only exclusions apply: <br /> with respect to liability for "bodily injury", This insurance does not apply to "bodily injury" or <br /> "property damage" or "personal and advertising "property damage" occurring after: <br /> injury"caused, in whole or in part, by: <br /> 1. All work., including materials, parts or <br /> 1. Your acts or omissions; or equipment furnished in connection with such <br /> 2. The acts 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 insured(s) at the <br /> the additional insured(s) at the location(s) location of the covered operations has been <br /> designated above. completed; or <br /> However: 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 additional intended use by any person or organization <br /> insured only applies to the extent permitted by other than another contractor or <br /> law; and subcontractor engaged in performing <br /> 2. If coverage provided to the additional insured operations for a principal as a part of the same <br /> is required by a contract or agreement, the project. <br /> insurance afforded to such additional insured <br /> will not be broader than that which you are <br /> required by the contract or agreement to <br /> provide for such additional insured. <br /> CG 20 10 12 19 ©Insurance Services Office, Inc., 2018 Page 1 of 2 <br /> A0253953 05/31/2024 <br /> Middlesex Insurance Company <br /> 1 00001 0000000000 24152 0 N 6577d55a-85ec-4688-a9ff-db2de49000f9 <br />