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HomeMy WebLinkAboutTE ROBERTS, INCASURANCE ON FILE A-2020-091.03 WORK MAY PROCEED UNTIL INSURANCE EXPIRES _ 'III 17wU QIda t1 k4i� Vfyo ti r 11 01 r vir ivLivmig . i v iwLNnr,r..ivir,iv ■ 1 V rmv v LJr, un-LACE EMERGENCY WATER AND SEWER SYSTEM REPAIR SERVICES THIS FIRST AMENDMENT to the above -referenced agreement is entered into on May 5, 2020, by and between T.E. Roberts, Inc. ("Contractor"), and the City of Santa Ana, a charter city and municipal corporation organized and existing under the Constitution and laws of the State of California ("City"). RECITALS 0 N A. The parties entered into Agreement No. A-2019-142-03, dated August 20, 2019, by which N Contractor agreed to provide on -call emergency water and sewer system repair services for cv the City's Public Works Agency ("Agreement") B. The term of the Agreement is for three years, and the Agreement remains in effect through August 19, 2022, with provision for extension. C. The parties now wish to amend the Agreement to increase the shared aggregate amount to be expended under the Agreement and two related agreements. The Parties therefore agree: 1. Section 2.a, Compensation, is amended to read in its entirety: "City neither warrants nor guarantees any minimum or maximum compensation to Contractor under this Agreement. Contractor shall be paid only for actual services performed under this Agreement at the rates and charges identified in Exhibit B. Contractor is one of three contractors selected to provide services on an as -needed basis under RFP No. 19-032. The annual compensation for services provided by all contractors selected under RFP No. 19-032 shall not exceed the shared aggregate amount of $750,000 during the term of this agreement, including any extension periods." 2. Except as modified by this First Amendment, all terms and conditions of the Agreement shall remain in full force and effect. IN WITNESS WHEREOF, the parties hereto have executed this First Amendment to the Agreement on the date and year first written above. ATTEST Misy Gomez Clerk of the Council CITY OF SANTA ANA Kiistine Ridge City Manager - signatures continue on next page - Page 1 of 2 APPROVED AS TO FORM Sonia R. Carvalho City Attorney By: Kr 1 \ JUn M. Funk Name: Assistant City Attorney Title: RECOMMENDED FOR APPROVAL �J=JSG ., Nabil Saba Executive Director Public Works Agency Page 2 of 2 'thy lZot�� � d tnd- � 1 ItKVbtK I-U INHIP Y DATE IM9/12/20192019 I A%. i CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement($). PRODUCER License # 0757776 c TAcT Kimberly Shippey Newport Beach, CA - HUB International Insurance Services Inc. 4695 MacArthur Court, Suite 600 Newport Beach, CA 92660 PHONE Fez arc No, Ertl: c NgI: I� . kimberly.shi ahubinternafional.com INSURGRISI AFFORDING COVERAGE NAIC# INSURERA:Old Republic General Insurance Cori). 24139 INSURED IN URERB,Travellem Property Casualty Company of America 26674 IN UREa : T.E. Roberts, Inc. INSURER D: 306 W. Katella Ave Unit B Orange, CA 92867 INSURE0. E: INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMRER- 01 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. WSR 118. TYPE OF INSURANCE ADOL SUER POLICY NUMBER POLICY lFF POLICY E%P I LIMITS A X COMMERCUILGENERALLIABILnY LLMMS-MADE X OCCUR ❑ X AlCG13971801 911I2019 9/1/2020 EACH OCCURRENCE S 1,000,006 DAMAGE TO RENTED 100,000 S 51000 MED EXP " PERSONAL S ADV INJURY S 1,000,000 NL AGGREGATE UNIT APPLIES PER: POLICY j ❑ LOG GENERALAGGREGATE S 2,000,000 PRODUCTS - COMPIOP AGG S 2,000,000 S OTHER: A AUTOMOSILELIABILITY OMBINEO SINGLE LIMIT 1,000.00D X ANY AUTO OWNED AUTOS ONLY SCJH t 1CA13971801 91112019 W1/2D20BODILYINJURY Pa rn BODILY INJURY Per accident] S 4:ta4ZOAMAGE XAUONLY �ULED ApRTapp S B X UMBRELLA LINE L X OCCUR EACH OCCURRENCE 10,000,000 EXCESS LIRE CtAIM'MADE UP-91NO3112.19-NF 911/2019 911/2020 AGGREGATE DED X RETENTION$ 10,000 S 10,000,000 A WORKERS COMPENSATION AND EMPLOYERTLUUNLItt ANY PROPRIETORIPARTNER/EXECUTIVE YIN O�FFFICERIMEEM99��pp EXCLUDED? ❑ '$tndaloryln NN) N yea.4e"o"N wMer DE CRIPTI NOF PERATIONS NiA lCW13971801 91112019 91112020 )( PER H- E.L EACH ACCIDENT S 1,000,000 E.L DISEASE- EA EMPLOYEE 3 1,000,00D L DISEASE -POLICY MIT 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES 1ACOAD t01, A441aonal RenuMP S[M1etlule,,,py bo alMNed ll ma,e ape<e la requFatll Re: Agreement for #8208 -On Call Sewer and Water System Repair Services; A-2019-0142-03, A-2014-230-01, IFB 16.104 Water Meter Vault Replacement City of Santa Ana, Its officers, employees, agents, volunteers and representatives are included as additional Insureds, as respects general liability and auto liability, which is primary and non-contributory, subject to the terms and conditions of the policy, and attached forms. Separation of Insureds applies. 30 days notice of cancellation, 10 days for non-payment of premium. REVIEWED & APPROVED By Rift MANACfEMENT DIVISION CERTIFICATE HOLDFR It I eCD 1 O 9ngn rAIJr GI I ATIMM OIJLO ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Santa Ana SA THA M. LAMBE KHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CCORDANCE WITH THE POLICY PROVISIONS. Risk Management Division, 4th Floor 20 Civic Center Plaza AUTHORIZEDDR,EEPJRESENTATIVE Santa Ana, CA 92702 rj,To('� 1V1 dL_ ACORD 25 (2016103) 01988.2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICYNUMBER: AlCG13971801 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) OrOmanizationrst 1 ___.• ^` ^ TERMS OF A WRITTEN CONTRACT THAT WAS FULLY EXECUTED PRIOR TO THE DATE OF THE "OCCURRENCE", AND ANY OTHER PERSONS OR ENTITIES SPECIFICALLY REQUIRE➢ By, AND IDENTIFIED HY NAME IN, THAT SAME CONTRACT. A. Section If — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: I. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is 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. ( 4 CG 20 10 04 13 e "I ® I LOCATIONS AS REQUIRED SY AN EXECUTED WRITTEN CONTRACT. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. nsurance Services unite, Inc., 2012 Page 1 of 2 C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or Page 2of2 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. O Insurance Services Office, Inc., 2012 CG 20 10 04 13 POLICYNUMBER: A1CG13971801 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) THE OWNER AND CONTRACTOR, IF HAT WAS BY TAE TERMS OF A WRITTEN CONTRACT THAT WAS FULLY EXECUTED PRIOR TO THE DATE OF THE "OCCURRENCE", onAnd Descri tion Of Completed Operations LOCATIONS AS REQUIRED BY AN EXECUTED WRITTEN CONTRACT. AND ANY OTHER PERSONS OR ENTITIES SPECIFICALLY REQUIRED BY, AND IDENTIFIED BY NAME IN, THAT SAME CONTRACT. Information required to Complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the 'products -completed operations hazard". However: I. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. if coverage provided to the additional insured is 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 c ntract or agreement to provide for su(h adc tional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 37 04 13 i /� 0 Insurance Services Office, Inc., 2012 Page 1 of 1 OLD REPUBLIC GENERAL INS 'RANCE: CORPORATION CHANGES ADDITIONAL INSURED PRIMARY WORDING SCHEDULE THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: COMMERCIAL GENERAL LIABILITY COVERAGE FORM Name of Additional Insured Person(s) Location(s) of Covered Operations Or Organization(s): WHERE REQUIRED BY AN EXECUTED WRITTEN CONTRACT. As required by written contract. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The insurance provided by this endorsement is primary insurance and we will not seek contribution from any other insurance of a like kind available to the person or organization shown in the schedule above unless the other insurance is provided by a contractor other than the person or organization shown in the schedule above for the same operation and job location. If so, we will share with that other insurance by the method described in paragraph 4.c. of Section IV — Commercial General Liability Conditions. All other terms and conditions remain unchanged. Named Insured T.E. Roberts, Inc. Policy Number AICG13971801 Endorsement No. 01 Policy Period 09/01/2019 to 09/01/2020 Endorsement Effective Date: 09/Ol/2019 Producer's Name: HUB International Insurance Services, Inc. Producer Number: 27N12 CG EN GN 0029 I DATE POLICY NUMBER: AICA13971801 COMMERCIAL AUTO CA 20 48 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: T.E. Roberts, Inc. Endorsement Effective Date: 09/01/2019 SCHEDULE Name Of Person(s) Or Organization(s): WHERE REQUIRED BY AN EXECUTED WRITTEN CONTRACT. Information required to complete this Schedule if not shown above will be shown in the Declarations Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Paragraph A.1. of Section If — Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I — Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 4810 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 OLD REPUBLIC GENERAL INSURANCE- CORPORATION ADDITIONAL INSURED -PRIMARY AND NON-CONTRIBUTORY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement Identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. cruFni u c Name of Persons) or Organization(s) WHERE REQUIRED BY EXECUTED WRITTEN CONTRACT. (If no entry appears above, Information required to complete this endorsement will be shown in the Declarations as aDDlicable to tha i Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section II of the Coverage Form. If the person or organization shown in the schedule qualifies as an 'insured' for Liability Coverage, and they have coverage as a first named insured under another policy, this policy is primary to and non-contributory with that other insurance. All other terms, conditions, and exclusions apply. Roberts, Inc.umber ndorsement No.A1CA13971801 FNamejdInsuredT.E. eriod O1 9/01/2019 to09/01/2020 Endorsement Effective Date: r's Name: 09/01/2019 OHUB International Insurance Services. Inc. cer Number: 27N12 DATE CA EN GN 0044 02 12 Page 1 of 1 5,000 100,000 NAIC # 1,000,0001,000,0002,000,0002,000,0001,000,0001,000,0001,000,0001,000,000 10,000,00010,000,000 KSHIPPEY 351812028125674 10/23/2020 DATE (MM/DD/YYYY) $$$$$$$$$$$ (949) 891-0407 LIMITS OTH- FAX(A/C, No): PERSTATUTEER X EACH OCCURRENCE$DAMAGE TO RENTEDPREMISES (Ea occurrence)MED EXP (Any one person)$PERSONAL & ADV INJURY$GENERAL AGGREGATE$PRODUCTS - COMP/OP AGGCOMBINED SINGLE LIMIT(Ea accident)BODILY INJURY (Per person)$BODILY INJURY (Per accident)$PROPERTY DAMAGE(Per accident)EACH OCCURRENCEAGGREGATEE.L. EACH ACCIDENTE.L. DISEASE - EA EMPLOYEE$E.L. DISEASE - POLICY LIMIT REVISION NUMBER: TEROBERT-0 INSURER(S) AFFORDING COVERAGE © 1988-2015 ACORD CORPORATION. All rights reserved. (949) 623-3980 Executive Risk IndemnityFederal Insurance Company Travelers Property Casualty Company of America 9/1/20209/1/20219/1/20209/1/20219/1/20209/1/20219/1/20209/1/2021 POLICY EFFPOLICY EXP (MM/DD/YYYY)(MM/DD/YYYY) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INACCORDANCE WITH THE POLICY PROVISIONS. CONTACTNAME:PHONE(A/C, No, Ext):E-MAILADDRESS:INSURER A :INSURER B :INSURER C :INSURER D :INSURER E :INSURER F :CANCELLATION AUTHORIZED REPRESENTATIVE POLICY NUMBER 5431028154310280ZUP-91N03112-20-NF54310282 X The ACORD name and logo are registered marks of ACORD INSDWVDN / A ADDLSUBR CERTIFICATE OF LIABILITY INSURANCE N Y / N CERTIFICATE NUMBER: 10,000 LOC OCCURCLAIMS-MADE SCHEDULEDNON-OWNED XX PRO-JECT X X TYPE OF INSURANCE T.E. Roberts, Inc.306 W. Katella Ave Unit BOrange, CA 92867 City of Santa AnaRisk Management Division20 Civic Center PlazaSanta Ana, CA 92701 CLAIMS-MADEOCCUR License # 0757776 COMMERCIAL GENERAL LIABILITYPOLICYOTHER:ANY AUTOOWNEDAUTOS ONLYAUTOSHIREDAUTOS ONLYAUTOS ONLYUMBRELLA LIABEXCESS LIABDEDRETENTION$ XXX GEN'L AGGREGATE LIMIT APPLIES PER:AUTOMOBILE LIABILITY WORKERS COMPENSATIONAND EMPLOYERS' LIABILITYANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED?(Mandatory in NH)If yes, describe underDESCRIPTION OF OPERATIONS below THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEDREPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement onthis certificate does not confer rights to the certificate holder in lieu of such endorsement(s).THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ABCB PRODUCERINSURED COVERAGES DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)CERTIFICATE HOLDERACORD 25 (2016/03) LTR INSR Newport Beach, CA - HUB International Insurance Services Inc.4695 MacArthur CourtSuite 600Newport Beach, CA 92660 Re: Emergency Sewer and Water System Repair Services.The City of Santa Ana, its officers, employees, agents, and representatives are included as additional insured as respects general liability, as required by written contract, and is primary and non-contributory, subject to the terms and conditions of the policy and attached forms. Separation of Insureds applies.30 day notice of cancellation, except 10 days for non-payment. 1 of 1 Page CG 20 37 04 13 Limits Of Insurance: COMMERCIAL GENERAL LIABILITY 2012 Required by the contract or agreement; orAvailable under the applicable Limits ofInsurance shown in the Declarations; 1.2. With respect to the insurance afforded to theseadditional insureds, the following is added toSection III If coverage provided to the additional insured isrequired by a contract or agreement, the most wewill pay on behalf of the additional insured is theamount of insurance:whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. B. Location And Description Of Completed Operations ALL LOCATIONS WHERE REQUIRED BY WRITTENCONTRACT OWNERS, LESSEES OR SCHEDULE COMPLETED OPERATIONS is amended to © Insurance Services Office, Inc., Or Organization(s) Who Is An Insured CONTRACTORS ADDITIONAL INSURED Name Of Additional Insured Person(s) The insurance afforded to such additionalinsured only applies to the extent permittedby law; andIf coverage provided to the additional insuredis required by a contract or agreement, theinsurance afforded to such additional insuredwill not be broader than that which you arerequired by the contract or agreement toprovide for such additional insured. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. scribed in the Schedule of this endorsement 1.2. COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART Section II include as an additional insured the person(s) ororganization(s) shown in the Schedule, but onlywith respect to liability for "bodily injury" or"property damage" caused, in whole or in part, by"your work" at the location designated anddeperformed for that additional insured andincluded in the "products-completed operationshazard".However: WHERE REQUIRED BY WRITTEN CONTRACT, BUTONLY WHEN THE CONTRACT SPECIFIES COVERAGEFOR COMPLETED OPERATIONS Information required to complete this Schedule, if not shown above, will be shown in the Declarations. POLICY NUMBER:This endorsement modifies insurance provided under the following: A.CG 20 37 04 13 r d(s) at the Page 1of 2 CG 20 10 04 13 ctor or subcontracto COMMERCIAL GENERAL LIABILITY Location(s) Of Covered Operations All work, including materials, parts orequipment furnished in connection with suchwork, on the project (other than service,maintenance or repairs) to be performed by oron behalf of the additional insurelocation of the covered operations has beencompleted; orThat portion of "your work" out of which theinjury or damage arises has been put to itsintended use by any person or organizationother than another contraengaged in performing operations for aprincipal as a part of the same project. 1.2. With respect to the insurance afforded to theseadditional insureds, the following additionalexclusions apply:This insurance does not apply to "bodily injury" or"property damage" occurring after: B. SCHEDULE not shown above, will be shown in the Declarations. ce Services Office, Inc.,2012 ORGANIZATION is amended to © Insuran nsured the Schedule, but only Or Organization(s) ent modifies insurance provided under the following: CONTRACTORS – SCHEDULED PERSON OR ADDITIONAL INSURED – OWNERS, LESSEES OR Name Of Additional Insured Person(s) Your acts or omissions; orThe acts or omissions of those acting on yourbehalf;The insurance afforded to such additionalinsured only applies to the extent permitted bylaw; andIf coverage provided to the additional insured isrequired by a contract or agreement, theinsurance afforded to such additional insuredwill not be broader than that which you arerequired by the contract or agreement toprovide for such additional insured. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 1.2.1.2. COMMERCIAL GENERAL LIABILITY COVERAGE PART include as an additional insured the person(s) ororganization(s) shown inwith respect to liability for "bodily injury", "propertydamage" or "personal and advertising injury"caused, in whole or in part, by:in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: Information required to complete this Schedule, if POLICY NUMBER: This endorsemA.Section II – Who Is An ICG 20 10 04 13 mits of CG 20 10 04 13 nder the applicable Li ce shown in the Declarations; Available uInsuran 2. whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. ce Services Office, Inc.,2012 ment; or © Insuran uired by the contract or agree Req 1. With respect to the insurance afforded to these additional insureds, the following is added toSection III – Limits Of Insurance:If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: C.Page 2 of 2 1 of -15) 1 . 7 Ed Page -2461 ( 02 - 10 COMMERCIAL GENERAL LIABILITY Services Office, Inc., Location Of Covered Operations: ALL LOCATIONS , SCHEDULE with its permission. SECTION IV WRITTEN and supersedes any PRIMARY INSURANCE FOR Includes copyrighted material of Insurance SCHEDULED ADDITIONAL INSURED 15) - . 7 Other Insurance Ed 4. under such other insurance; andagreement that this insurance would beprimary and would not seek contribution fromany other insurance available to theAdditional Insured. The Additional Insured is a named insured You have agreed in writing in a contract or Additional Insured with respect to the Location 2461 ( THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. - Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to theOf Covered Operations shown in the Schedule under this policy provided that: (1)(2) 02 - POLICY NUMBER: This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Additional Insured: WHERE REQUIRED BY CONTRACT.(If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) With respect only to the Additional Insured and at the Location Of Covered Operations shown in the Schedule, the following is added to COMMERCIAL GENERAL LIABILITY CONDITIONSParagraph provision to the contrary: 10