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UIVIO F-eji,[Ilty Oulvjuui::�. 1-1.I-A, Wta; <br />POLICY NUMBER: T87-Z91-458727-017 <br />COMMERCIAL GENERAL LIABILITY <br />CG 20 10 04 13 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />T <br />16�&w IN *RIA 0 <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 OWanizationill ,,oca1ioni(s1 Of Covered .OUeLMira <br />As specified in a written agreement which is signed in <br />Rdvance of the "ncourrenoe` or offense for which the <br />additional Insured seeks ooverage, <br />Information required to corn aFete this Schedule, if not shown abovewillbe shown in the Declarations, <br />A. Section 11 — Who Is An Insured is amended to B. With respect to the insurance afforded to these <br />include as an add1lonal 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" It property darnage" 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 acts or omissions of those aofing on your work, on the project (other than spervice, <br />behalf; maintenance or repairs) to be performed by or <br />in the performance af your ongoing operations for on behalf of the additional Insured(s) at the <br />the additional insured(s) at the locat-lon(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 subcontractor <br />law; and engaged in performing operations for a <br />2.. If coverage provided to the additional insured is principal as a part of the same project, <br />required by a contract or agreement, the <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 10 114 13 O Insurance Serv#ces Office, Inc., 2012 Page 1 of 2 <br />