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Clinical Laboratories of San Bernardino, Inc. <br />Policy #04034939429 <br />G- 17957 -099 <br />(Ed. 10/01) <br />IMPORTANT: THIS ENDORSEMENT CONTAINS DUTIES THAT APPLY TO THE ADDITIONAL <br />INSURED IN THE EVENT OF OCCURRENCE, OFFENSE, CLAIM OR SUIT. SEE PARAGRAPH <br />CA, OF THIS ENDORSEMENT FOR THESE DUTIES. <br />ALSO, THIS ENDORSEMENT CHANGES THE CONTRACTUAL LIABILITY COVERAGE WITH <br />RESPECTS TO THE "BODILY INJURY " OR "PROPERTY DAMAGE" ARISING OUT OF THE <br />"PRODUCTS- COMPLETED OPERATIONS HAZARD. " SEE PARAGRAPH B.3. OF THIS <br />ENDORSEMENT FOR THIS COVERAGE CHANGE. <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />CONTRACTOR'S SCHEDULED AND BLANKET ADDITIONAL INSURED <br />ENDORSEMENT WITH LIMITED PRODUCTS - COMPLETED OPERATIONS <br />COVERAGE <br />This ondomement modifies insurance provided under the following: <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART <br />Q0`r <br />Name of Person or Crganfzationr <br />City of Sane Ana <br />M, <br />(Coverage under Phis endorsement is not affected by an entry or lank of entry In the Sohodule above,) <br />A. WHO IS AN INSURED (Section III is amended to <br />Include ss an insured any person or organization, <br />including an parson or organization shown In the <br />sohadule above, (called additional Insured) whom you <br />are required to add as an additional insured on this <br />policy under a written contract or written agreement; <br />but the written contract or written agreement must be; <br />1, Currently in affect or becoming effective during the <br />term of this policy; and <br />2. Executed prior to the "bodily injury," "properly <br />damago," or "personal and advertising Injury." <br />B. The Insurance provided to the additional insured is <br />_ limited as follows: <br />Z=4 1. That person or organization is an additional <br />MISS Insured solely for liability duo to your negligence <br />and specifically resulting from "your work" for the <br />additional Insured which Is the subject of the <br />m written contract or written agreement. No <br />coverage applies to liability resulting from the sole <br />negligence of the additional insured. <br />2. The Limits of Insurance applicable to the <br />additional Insured are those specified In the <br />written contract or written agreement or In the <br />0.17957 -G99 <br />(Ed. 10 /01) <br />l e� <br />Declarations of this policy, whichever is less. <br />These Limits of insurance are Inclusive of, and not <br />In addition to, the Limns of Insurance shown In the <br />Declarations. <br />3. The coverage provided to the additional insured <br />by this endorsement and paragraph f, of the <br />definillon of "Insured contract" under <br />DEFINITIONS (Section V) do not apply to "bodily <br />Injury" or "property damage" arising out of the <br />"produots- comploted operations hazard" unless <br />rsqulred by the written contract or written <br />agreement. When coverage does apply to "bodily <br />Injury" or "property damage" arising out of the <br />"products - completed operations hazard" such <br />coverage will not apply beyond: <br />a. The period of time required by the written <br />contract or written agreement; or <br />b. 5 years from the completion of "your walk" on <br />the project which is the subject of the written <br />contractor written agreement, <br />whichever is less, <br />4, The Insurance provided to the additional Insured <br />does not apply to "bodily Injury," "property <br />Page 1 of 2 <br />