HomeMy WebLinkAboutMOBILE ED PRODUCTIONS, INC,-City of Santa Ana
�► Clerk of the Council
AGREEMENT TERMINATION FORM
core attics use onj
T..
�. fg},�T, 61 IN rT H ; F--R
Please complete this form in its entirety when the attached agreement and all
amendments (if any) are no longer in effect.
Note: If your agreement is grant related, please ensure that all grant retention requirements
have been satisfied prior to signing the termination form.
Is the agreement(s) a permanent record? Yes No
Return form to the Clerk of the Council Office (M-30).
Call 647-1520 if you have any questions.
The agreement with _I 1 00
No. N-2022-046
was completed on
(List a.!! amendments. Use space below if needed.)
hagreementslformsVorm - agreement termination form,geldenred,dec
io V1-3
Department:
Phone/Ext.:
Signature:
Date:
C2-
and final payment has been made.
INSURANCE NE ON FILE N-2022-046
WORK MAY NOT PROCEED
CLERK OF COUNCIL
DATE: AGREEMENT TO PROVIDE STEAM ACTIVITY AT CITY LIBRARY EVENT
THIS AGREEMEN is made and entered in o on this(& day of February 2022 by and between Mobile
99 Ed Productions, Inc., a Michigan corporation, ("Provider"), and the City of Santa Ana, a charter city and
M municipal corporation organized and existing under the Constitution and laws of the State of California
sit ("City„).
m
W RECITALS
496
A. The City desires to retain a provider having special skill and knowledge in the field of providing
STEAM Museum activities to present to the public at the City's public library.
B. Provider represents that Provider is able and willing to provide such services to the City.
C. In undertaking the performance of this Agreement, Provider represents that it is knowledgeable in
its field and that any services performed by Provider under this Agreement will be performed in
compliance with such standards as may reasonably be expected from a professional contracting
firm in the field.
D. The Parties acknowledge that the City intends to provide activities to the public but must balance the
need to comply with all COV1D-19 guidance and restrictions.
NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the terms
and conditions hereinafter set forth, the parties agree as follows:
1. SCOPE OF SERVICES
Provider shall perform the tasks and obligations set forth in Exhibit A, attached hereto and
incorporated by reference. Such obligations include but are not limited to setting up and tearing down the
exhibition as well as providing a minimum of ten (10) exhibits between 10:30 am — 2:00 pm.
2. COMPENSATION
a. City agrees to pay, and Provider agrees to accept as total payment for its services for City, the
rates and charges identified in Exhibit A and Exhibit B. The total amount to be expended
during the term of this Agreement shall not exceed One Thousand Two Hundred Ninety -Five
Dollars and Zero Cents ($1,295.00).
b. Payment by City shall be made within thirty (30) days following receipt of proper invoice
evidencing work performed, subject to City accounting procedures. Payment need not be made
for work which fails to meet the standards of performance set forth in the Recitals which may
reasonably be expected by City.
3. TERM
This Agreement shall commence on the date first written above and will terminate on April 30,
Page 1 of 8
2022 after the event or one calendar day after the event, whichever occurs first, unless terminated
earlier in accordance with Section 11 below,
4. INDEPENDENT CONTRACTOR
Provider shall, during the entire term of this Agreement, be construed to be an independent
contractor and not an employee of the City. This Agreement is not intended nor shall it be construed to
create an employer -employee relationship, ajoint venture relationship, or to allow the City to exercise
discretion or control over the manner in which Provider performs the services which are the subject
matter of this Agreement; however, the services to be provided by Provider shall be provided in a
manner consistent with all applicable standards and regulations governing such services. Provider shall
pay all salaries and wages, employer's social security taxes, unemployment insurance and similar taxes
relating to employees and shall be responsible for all applicable withholding taxes. Provider is not an agent,
representative or employee of City and Provider shall have no authority to act on behalf of the City.
5. INSURANCE
Prior to undertaking performance of work under this Agreement, Provider shall maintain and shall
require its subcontractors, if any, to obtain and maintain insurance as described below:
a. Minimum Scope and Limit of Insurance:
Commercial General Liability Insurance. Provider shall maintain commercial general.
liability insurance, which shall include, but not be limited to, protection against claims
arising from bodily and personal injury, including death resulting therefrom and damage
to property, resulting from any act or occurrence arising out of Provider's operations in the
performance of this Agreement, including, without limitation, acts involving vehicles.
Insurance Services Office Form CO 00 01 covering CGL on an "occurrence" basis,
including products and completed operations, property damage, bodily injury and personal
& advertising injury with limits no less than $1,000,000 per occurrence. If a general
aggregate limit applies, either the general aggregate limit, shall apply separately to this
project/location (ISO CG 25 03 or 25 04) or the general aggregate limit shall be twice the
required occurrence limit.
2. Automobile Liability. ISO Form Number CA 00 01 covering any auto (Code 1), or if
Provider has no owned autos, hired, (Code 8) and non -owned autos (Code 9), with a limit
no less than $1,000,000 per accident for bodily injury and property damage.
3. Worker's Compensation Insurance. In accordance with California State law, Provider,
if Provider has any employees, is required to be insured against liability for worker's
compensation or to undertake self-insurance. Prior to commencing the performance of the
work under this Agreement, Provider agrees to obtain and maintain any employer's liability
insurance with limits not less than $1,000,000 per accident.
4. Sexual Abuse or Molestation (SAM) Liability. If the work will include contact with
minors, and the CGL policy referenced above is not endorse to include affirmative
Page 2 of 8
coverage for sexual abuse or molestation, Speaker/Performer shall obtain and maintain a
policy covering Sexual Abuse and Molestation with a limit not less than $100,000 per
occurrence or claim for an individual Speaker/Performer and with a limit no less than
$1,000,000 per occurrence or claim for an organization. SAM liability insurance is not
required if City staff is present throughout event.
5. If the Provider maintains broader coverage and/or higher limits than the minimums shown
above, the City requires and shall be entitled to the broader coverage and/or the higher
limits maintained by the Provider. Any available insurance proceeds in excess of the
specified minimum limits of insurance and coverage shall be available to the City.
b. Other Insurance Provisions
Additional Insured Status: The City, its officers, officials, employees, and volunteers are
to be covered as additional insureds on the CGL policy with respect to liability arising out
of work or operations performed by or on behalf of the Provider including materials, parts,
or equipment furnished in connectionwith such work or operations. General liability
coverage can be provided in the form of an endorsement to the Provider's insurance (at
least as broad as ISO Form CG 20 10 1185 or if not available, through the addition of both
CO 20 10, CG 20 26, CG 20 33, or CG 20 38; and CG 2037 if a later edition is used).
2. Primary Coverage: For any claims related to this contract, the Provider's insurance
coverage shall be primary coverage at least as broad as 180 CG 20 0104 13 as respects the
City, its officers, officials, employees, and volunteers. Any insurance or self-insurance
maintained by the City, its officers,officials, employees, or volunteers shall be excess of
the Provider's insurance and shall not contribute with it.
3. Notice of Cancellation: Each insurance policy required above shall provide that coverage
shall not be canceled, except with notice to the City.
4. Waiver of Subrogation: Provider hereby grants to City a waiver of any right to
subrogation that any insurer of said Provider may acquire against the City by virtue of the
payment of any loss under such insurance. Provider agrees to obtain any endorsement that
may be necessary to affect this waiver of subrogation, but this provision applies regardless
of whether or not the City has received a waiver of subrogation endorsement from the
insurer.
5. Self -Insured Retentions: Self -insured retentions must be declared to and approved by the
City. The City may require the Provider to purchase coverage with a lower retention or
provide proof of ability to pay losses and related investigations, claim administration, and
defense expenses within the retention. The policy language shall provide, or be endorsed
to provide, that the self -insured retention may be satisfied by either the name_ d insured or
City.
Page 3 of 8
6. Acceptability of Insurers: Insurance is to be placed with insurers authorized to conduct
business in the state with a current A.M. Best's rating of no less than A:VII, unless
otherwise acceptable to the City.
7. Verification of Coverage: Provider shall furnish the City with original Certificates of
Insurance including all required amendatory endorsements (or copies of the applicable
policy language effecting coverage requiredby this clause) and a copy of the Declarations
and Endorsement Page of the CGL policy listing all policy endorsements to City before
work begins. However, failure to obtain the required documents prior to the work beginning
shall not waive the Provider's obligation to provide them.
The City reserves the right to require complete, certified copies of all required insurance
policies,including endorsements required by these specifications, at any time.
8. Subcontractors: Provider shall require and verify that all subcontractors maintain
insurance meeting all the requirements stated herein, and Provider shall ensure that City is
an additional insured on insurance required from subcontractors.
9. Special Risks or Circumstances: City reserves the right to modify these requirements,
including limits, based on the nature of the risk, prior experience, insurer, coverage, or
other special circumstances.
6. INDEMNIFICATION
Provider agrees to and shall defend, indemnify and hold harmless the City, its officers, agents,
employees, contractors, special counsel, and representatives from liability for personal injury, damages,
just compensation, restitution, judicial or equitable relief arising out of claims for personal injury,
including death, and claims for property damage, which may arise from the direct or indirect operations
of the Provider or its contractors, subcontractors, agents, employees, or other persons acting on their
behalf which relates to the services described in section 1 of this Agreement. The Provider further
agrees to indemnify, hold harmless, and pay all costs for the defense of the City, including fees and costs
for special counsel to be selected by the City, regarding any action by a third party asserting personal
injury, damages, just compensation, restitution, judicial or equitable relief due to personal or property
rights arising by reason of the terms of, or effects arising from this Agreement. City may make all
reasonable decisions with respect to its representation in any legal proceeding. This indemnification
provision No. 6 shall survive any expiration or termination of this Agreement.
7. CONFLICT OF INTEREST
Provider covenants that it presently has no interests and shall not have interests, direct or
indirect, which would conflict in any manner with performance of services specified under this
Agreement.
Page 4 of 8
8. NOTICE
Any notice, tender, demand, delivery, or other communication pursuant to this Agreement shall
be in writing and shall be deemed to be properly given if delivered in person or mailed by first class or
certified mail, postage prepaid, or sent by fax or other telegraphic communication in the manner
provided in this Section, to the following persons:
To City: Clerk of the Council
City of Santa Ana
20 Civic Center Plaza (M-30)
P.O. Box 1988
Santa Ana, CA 92702-1988
Fax (714) 647-6956
With copy to: Executive Director of Library Services
City of Santa Ana
20 Civic Center Plaza (M-75)
P.O. Box 1988
Santa Ana, California 92702
Fax (714) 571-4211
To Provider: Mobile Ed Productions, Inc.
26018 W Seven Mile
Redford, Michigan 48240
Main: 800-433-7459
Fax:313-533-8445
CindyK(a mobilegdnroductions com
A party may change its address by giving notice in writing to the other party. Thereafter, any
communication shall be addressed and transmitted to the new address. If sent by mail, communication
shall be effective or deemed to have been given three (3) days after it has been deposited in the United
States mail, duly registered or certified, with postage prepaid, and addressed as set forth above. If sent
by fax, communication shall be effective or deemed to have been given twenty-four (24) hours after the
time set forth on the transmission report issued by the transmitting facsimile machine, addressed as set
forth above. For purposes of calculating these time frames, weekends, federal, state, County or City
holidays shall be excluded.
9. EXCLUSIVITY AND AMENDMENT
This Agreement represents the complete and exclusive statement between the City and Provider
regarding the subject matter herein, and supersedes any and all other agreements, oral or written,
between the parties. In the event of a conflict between the terms of this Agreement and any attachments
hereto, the terms of this Agreement shall prevail. This Agreement may not be modified except by
written instrument signed by the City and by an authorized representative of Provider. The parties agree
that any terms or conditions of any purchase order or other instrument that are inconsistent with, or in
addition to, the terms and conditions hereof, shall not bind or obligate Provider or the City. Each party
Page 5 of 8
to this Agreement acknowledges that no representations, inducements, promises or agreements, orally or
otherwise, have been made by any party, or anyone acting on behalf of any party, which is not embodied
herein.
10. ASSIGNMENT
The experience, knowledge, capability and reputation of Provider were a substantial inducement
for City to enter into this Agreement. Therefore, Provider may not assign, transfer, delegate, or
subcontract any interest herein without the prior written consent of the City and any such assignment,
transfer, delegation or subcontract without the City's prior written consent shall be considered null and
void.
11. TERMINATION
This Agreement may be terminated by the City upon ten (10) days written notice of termination
In such event, Provider shall be entitled to receive, and City shall pay Provider, compensation for all
services rendered prior to the effective date of termination.
12. RECORDS
Provider shall keep records and invoices in connection with the work to be performed under this
Agreement. Provider shall maintain complete and accurate records with respect to the costs incurred
under this Agreement and any services, expenditures, and disbursements charged to the City for a
minimum period of three (3) years, or for any longer period required by law, from the date of final
payment to City under this Agreement. Provider shall allow inspection of all work, data, documents,
proceedings, and activities related to this Agreement for a period of three (3) years from the date of final
payment to City under this Agreement.
13. NON-DISCRIMINATION
Provider shall not discriminate because of race, color, creed, religion, sex, marital status, sexual
orientation, gender identity, gender expression, gender, medical conditions, genetic information, or
military and veteran status, age, national origin, ancestry, or disability, as defined and prohibited by
applicable law, in the recruitment, selection, teaching, training, utilization, promotion, termination or other
employment related activities or any services provided under this Agreement. Provider affirms that it is
an equal opportunity employer and shall comply with all applicable federal, state and local laws and
regulations.
14. JURISDICTION —VENUE
This Agreement has been executed and delivered in the State of California and the validity,
interpretation, performance, and enforcement of any of the clauses of this Agreement shall be
determined and governed by the laws of the State of California. Both parties further agree that Orange
County, California, shall be the venue for any action or proceeding that may be brought or arise out of,
in connection with or by reason of this Agreement.
Page 6 of 8
15. LICENSES N-2022-046
Provider shall, throughout the term of this Agreement, maintain all necessary licenses, permits,
approvals, waivers, and exemptions necessary for the provision of the services hereunder and required
by the laws and regulations of the United States, the State of California, the City of Santa Ana and all
other governmental agencies.
16. SEVERABILITY
In the event that one or more of the phrases, sentences, clauses, paragraphs or sections contained
in this Agreement shall be declared invalid or unenforceable by valid judgment or decree of a court of
competent jurisdiction, such invalidity or unenforceability shall not affect any of the remaining phrases,
sentences, clauses, paragraphs or sections of this Agreement, which shall be interpreted to carry out the
intent of the parties hereunder.
17. EXHIBITS
All Exhibits referenced herein and attached hereto shall be incorporated as if fully set forth in the
body of this Agreement.
18. AUTHORITY
The person(s) executing this Agreement on behalf of the parties hereto warrant that they are duly
authorized to execute this Agreement on behalf of said parties and that be so executing this Agreement, the
parties hereto are formally bound to the provisions of this Agreement.
IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above
written.
ATTEST: CITY OF SANTA ANA
..p
Daisy Gomez Kristine Ridge-�s.--
Clerk of the Council City Manager
APPROVED AS TO FORM:
SONIA R. CARVALHO
City Attorney
By:
'ii radon Salvatierra
Deputy City Attorney
MOBILE ED PRODUCTIONS, INC.
Glorra Hall
Vice President
[signatures continued on next page]
Page 7 of 8
FOR APPROVAL:
Executive Directorb�ary Services
Page 8 of 8
I
Exhibit A
SCOPE OF SERVICES
VENDOR INFORMATION:
Mobile Ed Productions, Inc.
26018 W Seven Mile
Redford, Michigan 48240
Main Office: 800433-7459
Fax:313-533-8445
CindvKAmo bileedorod uctions. com
www.mobileedproductions.com
EVENT: Children's Day, Book Day (Dia de los Nin"os, Dia de los Libros)
SERVICE DATE(S): Saturday, April 30, 2022
COMPENSATION: Not to exceed $1,295.00
DESCRIPTION:
This vendor will provide a STEAM Museum activity for a one -day event on Saturday, April 30, 2022 at
the Main Library, 26 Civic Center Plaza, Santa Ana CA 92701.
Mobile Ed Productions, Inc. will:
• Provide a staff member who will arrive at 8:30 am for setup
• Provide a minimum often exhibits as part of the STEAM Museum from 10:30 am — 2:00 pm
• Will assign staff to take a 15 minute break sometime between 8:30 am and 2:00 pm
• Will assign staff to take a 30 minute lunch at 2pm and will tear down after lunch
Santa Ana Public Library will:
• Provide an enclosed canopy space with side walls
• Provide 8 banquet tables
• Provide 1 outlet or I generator
• Provide staff to be present during entire service time
Mobile Ed Productions, Inc. understands that payment will be due after the services are provided. No
deposit will be required.
mobile ed
productions, inc.
26018 West Seven Mile Road
Redford, Michigan 48240
(800) 433.7459 - Toll Free
(313) 533-4455 - Office
(313) 533-8445 - Fax
Billing Address -
Client Name Lupita Arroyo
"119 c4Elan 2brou6lt �nferE4inin¢nf r
Venue Santa Ana Public Library
Address 26 Civic Center Plaza
City, State Zip Santa Ana CA 92701
Venue Phone (714) 647-5251
Amount Date
Make all checks payabe to:
Mobile Ed Productions, Inc.
VISA anEnww DISC VER. Quote SENT
ewnEss w 12/21 f2021
.
Send money via PayPal to:
info@mobileedproductions.com
Invoice Date:
Quote #:
Purchase Order #:
Invoice Quote
12/21 /2021
131649
Payment Terms
BALANCE IS DUE BY DATE OF SHOW.
`Balances not paid within 30 days of the performance date are
subject to a late fee.
See contract for more information.
Do not pay the performer directly.
$1,295.00
Show Price Total:
Payments Rec'd:
Balance Due:
Special Notes and Instructions
$1.295.00
$0.00
$1,295.00
c'T- - - - - - - - - - - - - - - Write Quote Number on your check for it to be properly applied.
------- ------- ----- --- ______ --------------------------------
mobile ed Detach and return this slip with your payment
productions, inc.
26018 West Seven Mite Road
Redford, Michigan 48240 Quote Number: 131649
Toll Free (800) 433-7459
Balance Due: $1,295.00
If you have any questions concerning this invoice quote,
contact Mobile Ed Productions, Inc. at 800-433-7459.
FEIN 38-2463141
Dig itallysigned by Tori Pierson
Tori Pierson Date: 1.11.1111109:07:00
-0T00'
1
'4�f 'ems CERTIFICATE OF LIABILITY INSURANCE
L.I IY Y
DAT/1712DlYYYI�
3177/2022
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsemen s .
PRODUCER License # 958967
c TACT Lynn Gillow
Johnston Lewis Associates, Inc.
5600 New King, Ste. 210
Troy, MI 48098
�,vc°, No Ext ; (24$) 687-7748 FAX No
E•MAI lynng@jlains.com
INSURERS AFFORDING COVERAGE
NAIC 0
INSURER A: Cincinnati Insurance Company
10677
INSURED
INSURER B :
INSURER C :
Mobile Ed Productions, Inc.
INSURER D ;
26018 W. Seven Mile Road
Redford, MI 48240
INSURER E :
INSURER F :
CnVERAr.FS r_FRTIFIr_ATF MtIMR1=0- 0011101M 1101FRA12=12.
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 CONTRACTOR 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.
INSR
TYPE OF INSURANCE
ADDL
SUBR
POLICY NUMBER
POLICY EFF
POLICY EXP
LIMITS
A
X
COMMERCIAL GENERAL UABIL17Y
CLAIMS -MADE F_X] OCCUR
ENP 0059666
11112022
11112023
EACH OCCURRENCE
$ 1,000,000
DAMAGE PREMISETO RENTED
500,000
MED EXP (Anyoneperson)
5,000
PERSONAL & ADV INJURY
1,000,000
GEMLAGGREGATE LIMITAPPLIESPER,
POLICY El ja F] LOG
GENERAL AGGREGATE
2,000,000
PRODUCTS -COMPIOPAGG
2,000,000
OTHER:
A
AUTOMOBILE
LIABILITY
MBINED SINGLE LIMIT
$
BODILY INJURY(Per Orson
$ 1,000,040
ANYAUTO
OWNED SCHEDULED
AUTOS ONLY ALITOpSyy�Ep
ENP 0059666
•11112022
11112023
Ix
BODILY INJURY Peraccident
$
Pe�accdent AMAGE
$
AUTOS ONLY Ix AUTOS ONLY
A
X
UMBRELLA LIAS
X
OCCUR
EACH OCCURRENCE
$ 1,000,000
AGGREGATE
1,000,t100
EXCESS LIAS
CLAIMS -MADE
ENP 0059666
11112022
11112023
DED I I RETENTION$
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNERlEXECUWE YIN
FICERIMEMggEEREXCLUDED? �N
andatory In NH)
If yos, describe under
DESCRIPTION OF OPERATIONS below
NIA
EWC 0294345
1/112022
11112023
X PER LITE OTH-
STAT ER
E.L. EACH ACCIDENT
1 '���'���
E.L. DISEASE- EA EMPLOYE
1,0U0,000
E.L. DISEASE -POLICY LIMIT
1,000,000
DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORO 101, Additional Remarks Schedule, maybe attached If more space Is reulred`
The City of Santa Ana, Its officers, officials, employees, agents and volunteers are Included Additional Insureds with respects to General Liability, per policy
forms & conditions, when required by written contract. Blanket Additional Insured applies when required by written contract.
Such Insurance as is afforded by this policy shall be primary, and any Insurance carried by Santa Ana Unified School District shall be excess and
noncontributory.
A 30 Day Notice of Cancellation will be provided with exception for non-payment where as a 10 Day Notice of Cancellation will be provided.
Waiver of Subrogation applies to the General Liability and Workers Compensation policies, when required by written contract.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
The City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Risk Management Division
20 Civic Center Plaza
Santa Ana, CA 92702 AUTHORIZED REPRESENTATIVE
UVEe7 DlD i
r� Itr+,±PEirAE➢7 & APPRSY9�'.
ACORD 25 2016103 c
{ ) O 1988-2015 ACORD CORI
The ACORD name and logo are registered marks of ACORD R,sk Ma ge tC1,ictlhole
POLICY NUMBER: HNP 005 96 66
COMMERCIAL GENERAL LIABILITY
CG 20 26 0413
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - DESIGNATED
PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s) Or Organization(s):
THE CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES, AGENTS AND REPRESENTATIVES
20 CIVIC CENTER PLZ k
SANTA ANA, CA 92701-4058 '
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",
"property damage" or "personal and advertising
injury" caused, in whole or in part, by your acts
or omissions or the acts or omissions of those
acting on your behalf:
1. 1n the performance of your ongoing
operations; or
2. In connection with your premises owned by
or rented to you.
However:
1. 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.
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 Tess.
This endorsement shall not increase the
applicable Limits of Insurance shown in the
Declarations.
CG 20 26 0413 O Insurance Services Office, Inc. 2012
a t Vhfi m
�ry'Risk AAana�e�rxrSa Clerical Aide
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CANCELLATION OR NONRENEWAL BY US
NOTIFICATION TO A DESIGNATED ENTITY
This endorsement modifies insurance provided under the following:
BUSINESSOWNERS PACKAGE POLICY
CLAIMS -MADE EXCESS LIABILITY. COVERAGE PART
COMMERCIAL AUTO COVERAGE PART
COMMERCIAL GENERAL LIABILITY COVERAGE PART
COMMERCIAL UMBRELLA LIABILITY COVERAGE PART
DENTIST'S PACKAGE POLICY
ELECTRONIC DATA LIABILITY COVERAGE PART
EXCESS LIABILITY COVERAGE PART
LIQUOR LIABILITY COVERAGE PART
OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART
POLLUTION LIABILITY COVERAGE PART
PRODUCTSICOMPLETED OPERATIONS COVERAGE PART
PRODUCT WITHDRAWAL COVERAGE PART
PROFESSIONAL LIABILITY COVERAGE PART
PROFESSIONAL UMBRELLA LIABILITY COVERAGE PART
PROFESSIONAL UMBRELLA LIABILITY COVERAGE PART - CLAIMS -MADE
RAILROAD PROTECTIVE LIABILITY COVERAGE PART
UNDERGROUND STORAGE TANK POLICY
SCHEDULE
Name and mailing address of person(s) or organization(s):
THE CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES, AGENTS AND REPRESENTATIVES
20 CIVIC CENTER PLZ
SANTA ANA, CA 92701-4058
Number of days notice (other than nonpayment of premium): 30
A. if we cancel or nonrenew this policy for any statutorily permitted reason other than nonpayment of
premium we will mail notice to the person or organization shown in the Schedule. We will mail such notice
at least the number of days shown in the Schedule before the effective date of cancellation or nonrenewal.
B. If we can oel this policy for nonpayment of premium, we will mail notice to the person or organization shown
in the Schedule. We will mail such notice at least 10 days before the effective date of cancellation.
C. If notice is mailed, proof of mailing to the mailing address shown in the Schedule will be sufficient proof of
notice.
D. In no event will coverage extend beyond the actual expiration, termination or cancellation of the policy.
IA 4087 0917
I R w ewm &APPF3ovm Sr
I�� I�` �/d'et �tc�t4axa2
""'"" Risl<Maru�ge�raent Clerical FtieEe
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
PRIMARYMONCONTRIBUTORY - OTHER INSURANCE
CONDITION SCHEDULED PERSON
OR ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTSICOMPLETED OPERATIONS LIABILITY COVERAGE PART
SCHEDULE
Name of Person or Organization:
THE CITY of SANTA ANA, RISK MANAGEMENT DIVISION
20 CIVIC CENTER PLZ
SANTA ANA, CA 92701-4058
The following is added to the Other Insurance
Condition and supercedes any provision to the con-
trary.
Primary and Noncontributory Insurance
This insurance is primary to and will not seek
contribution from any other insurance available
to an additional insured described in the
Schedule of this endorsement provided that:
GA 4094 0917
(1) The additional insured is a Named In-
sured under such other insurance; and
(2) You have agreed in writing in a contract or
agreement that this insurance would be
primary and would not seek contribution
from any other insurance available to the
additional insured.
k�
" & fir
'%zc. �C�TMz�aa
Rsla Man�gemrnt Clerical Ai r/e
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
COMMERCIAL GENERAL LIABILITY EXTENDED
ENDORSEMENT
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
A.. Endorsement -Table of Contents:
Coverage: Begins on Page:
1.
Employee Benefit Liability Coverage.......................................................................................3
2.
Unintentional Failure To Disclose Hazards.............................................................................9
3.
Damage To Premises Rented To You......................................................................................9
:... 4.
Supplementary Payments......................................................................................................10
5.
180 Day Coverage For Newly Formed Or Acquired Organizations...................................10
f 6.
Walver_Of Subrogation...........................................................................................................10
.
7.
Automatic Additional Insured -Specified Relationships: ................................. ................
11
• Managers Or Lessors Of Premises;
• Lessor Of Leased Equipment;
• Vendors;
• State Or Governmental Agency Or Subdivision Or Political Subdivision - Permits
Or Authorizations Relating To Premises; and
• Mortgagee, Assignee Or Receiver
8.
Property Damage -To Borrowed Equipment.........................................................................14
9.
Employees As Insureds - Specified Health Care Services And Good Samaritan
Services...................................................................................................................................15
10.
Broadened Notice Of Occurrence.........................................................................................15
11.
Nonowned Aircraft..................................................................................................................15
12.
Bodily Injury Redefined..........................................................................................................15
13.
Expected Or Intended injury Redefined...............................................................................15
14.
Former Employees As Insureds............................................................................................15
B. Limits Of Insurance:
The Commercial General Liability Limits of Insurance apply to the insurance provided by this endorse-
ment, except as provided below:
1. Employee Benefit Liability Coverage
Each Employee Limit: $1,000.000
Aggregate.Limit: $3,000,000
Deductible Amount: $ '1,000
3. Damage To Premises Rented To You
The lesser of:
` a. The Each 0ocurrenee Limit shown in the Declarations; or
b. $500,000 unless otherwise stated $
4. Supplementary Payments
a. Bail Bonds: $2,500
b. Loss Of Earnings: $ 500
Includes copyrighted material of Insurance
GA 227 0917 Services Office, Inc., with its permission.
IRsAeAfm &APPRovm Sr
I�� I�` �/d'et �tc�t4axa2
""'"" Risl<Maru�ge�raent Clerical FtieEe
8. Property Damage To Borrowed Equipment
Each Occurrence Limit: $10,000
Deductible Amount: $ 250
Includes copyrighted material of Insurance
GA 227 0917 Services Office, Inc., with its permission.
tiAtJ7"A ANA
C. Coverages
2} Occurred prior to the
1. Employee Benefit Liability Coverage
"first effective date" of
a. The following is added to Section I -
this endorsement pro -
vided:
Coverages:
a) You did not have
Employee Benefit Liability Cover-
tY
knowledge of a
age
claim or "suit" on or
(1) Insuring Agreement
before the "first ef-
fective date" of this
(a) We will pay those sums that
endorsement.
the insured becomes legally
You will be
obligated to pay as damag-
deemed to have
es caused by any act, error
knowledge of a
or omission of the insured,
or of any other person for
claim or "suit'
whose acts the insured is
when any "author -
legally liable, to which this
ized representa-
insurance applies. We will
tive';
have the right and duty to
1) Reports all, or
defend the insured against
any part, of the
any "suit' seeking those
act, error or
damages. However, we will
omission to us
have no duty to defend
or any other
against any "suit' seeking
insurer;
damages to which this in-
surance does not apply. We
11) Receives a
may, at our discretion, in-
written or ver-
vestigate any report of an
bal demand or
act, error or omission and
claim for dam -
settle any claim or "suit' that
ages because
may result. But:
of the act, er-
The amount we will a
) pay
ror1 or orris-
Sion; and
for damages is limited
as described in Section
b) There is no other
HI - Limits Of Insur-
applicable insur-
ance; and
ante.
2) Our right and duty to (2)
Exclusions
defend ends when we
have used up the appli-
This insurance does not apply to:
cable limit of insurance
(a) Bodily Injury, Property
in the payment of judg-
Damage Or Personal And
ments or settlements.
Advertising Injury
No other obligation or liabil-
'Bodily injury", "property
ity to pay sums or perform
damage" or "personal and
acts or services is covered
advertising injury".
unless explicitly provided for
under Supplementary
(b) Dishonest, Fraudulent,
Payments.
Criminal Or Malicious Act
(b) This insurance applies to
Damages arising out of any
damages only if the act, er-
intentional, dishonest,
ror or omission, is negligent-
fraudulent, criminal or mali-
ly committed in the "admin-
cious act, error or omission,
istration" of your "employee
committed by any insured,
benefit program"; and
including the willful or reck-
1) Occurs during the policy
less violation of any statute.
period; or
Includes copyrighted material of Insurance eww &APPRmSr
GA 227 0917 Services Office, Inc., with its permission.
Poa
(c)
Failure To Perform A Con-
effort and cooperation of the
tract
Insured, from the applicable
funds accrued or other col -
Damages arising out of fail-
lectible insurance.
ure of performance of con-
tract by any insurer.
(1) Taxes, Fines Or Penalties
(d)
Insufficiency Of Funds
Taxes, fines or penalties, in-
cluding those imposed un-
Damages arising out of an
der the Internal Revenue
insufficiency of funds to
Code or any similar state or
meet any obligations under
local law.
any plan included in the
"employee benefit program".
(j) Employment -Related Prac-
tices
(e)
Inadequacy Of Perfor-
mance Of Invest-
Any liability arising out of
mentfAdvice Given With
any:
Respect To Participation
('[) Refusal to employ;
Any claim based upon:
(2) Termination of employ
1) Failure of any invest-
ment;
ment to perform;
(3) Coercion, demotion,
2) Errors in providing in-
evaluation, reassign -
formation on past per-
ment, discipline, defa-
formance of investment
mation, harassment,
vehicles; or
humiliation, discrimina-
tion or other employ-
3) g Y
ment - related practices,
person with respect to
acts or omissions; or
that person's decision to
participate or not to par-
(4) Consequential liability
ticipate in any plan in-
as a result of (1), (2) or
cluded in the "employee
(3) above.
benefit program".
This exclusion applies
(f)
Workers" Compensation
whether the insured may be
And Similar Laws
held liable as an employer
or in any other capacity and
An claim arising out of our
Y 9 Y
to any obligation to share
failure to comply with the
damages with or repay
mandatory provisions of any
someone else who must pay
workers' compensation, un-
damages because of the in -
employment compensation
jury
insurance, social security or
disability benefits law or any
(3) Supplementary Payments
similar law.
Section I - Coverages, Sup-
(g)
ERISA
plementary Payments - Cover-
ages A And B also apply to this
Dama es for which an
g Y in-
Coverage.
sured is liable because of li-
ability imposed on a fiduci-
b. Who Is An Insured
ary by the Employee Re-
tirement Income Security
As respects Employee Benefit Lia-
Act of 1974, as now or
bility Coverage, Section II - Who Is
hereafter amended, or by
An Insured is replaced by the follow -
any similar federal, state or
ing:
local laws.
(1) If you are designated in the Dec-
(h)
Available Benefits
larations as:
Any claim for benefits to the (a) An individual, you and your
extent that such benefits are spouse are insureds, but un-
available, with reasonable ly with respect to the con-
Includes copyrighted material of insurance EMEWM APPR�ED s
GA 227 0917 Services Office, Inc., with its permission. G ' ;D&Tja«
."." 2slc M}anagermtiCleric:l.4ide
duct of a business of which
liability company, and over which
you are the sole owner.
you maintain ownership or major-
ity interest, will qualify as a
(b) Apartnership or joint ven-
Named Insured if no other similar
tore, you are insured-
y
insurance applies to that organi-
Your members, your part-
zation. However, coverage under
ners, and their spouses are
this provision:
also insureds but only with
respect to the conduct of
(a) Is afforded only until the
your business.
180th day after you acquire
or form the organization or
(c) A limited liability company,
the end of the policy period,
you are an insured. Your
whichever is earlier; and
members are also insureds,
but only with respect to the
(b) Does not apply to any act,
conduct of your business.
error or omission that was
Your managers are in-
committed before you ac-
sureds, but only with respect
quired or formed the organi-
to their duties as your man-
zation.
agers.
c. Limits Of Insurance
(d) An organization other than a
partnership, joint venture or
As respects Employee Benefit Lia-
limited liability company, you
bility Coverage, Section III - Limits
are an insured. Your "execu-
Of Insurance is replaced by the fol-
tive officers" and directors
[owing:
are insureds, but only with
(1) The Limits of Insurance shown in
respect to their duties as
Section B. Limits Of Insurance,
your officers or directors.
1. Employee Benefit Liability
Your stockholders are also
Coverage and the rules below fix
insureds, but only with re-
the most we will pay regardless
spect to their liability as
of the number of.
stockholders.
(a) Insureds;
(e) A trust, you are an insured.
Your trustees are also in-
(b) Claims made or 'tufts"
sureds, but only with respect
brought;
to their duties as trustees.
(c) Persons or organizations
(2) Each of the following is also an
making claims or bringing
insured:
"suits';
(a) Each of your "employees"
(d) Acts, errors or omissions; or
who is or was authorized to
administer your "employee
(e) Benefits included in your
benefit program";
"employee benefit program".
(b) Any persons, organizations
(2) The Aggregate Limit shown in
or "employees" having prop-
Section B. Limits Of Insurance,
er temporary authorization
1. Employee Benefit Liability
to administer your "employ-
Coverage of this endorsement is
ee benefit program" if you
the most we will pay for all dam -
die, but only until your legal
ages because of acts, errors or
representative is appointed;
omissions negligently committed
or
in the "administration" of your
"employee benefit program".
(c) Your legal representative if
you die, but only with re-
(3) Subject to the limit described in
spect to duties as such. That
(2) above, the Each Employee
representative will have all
Limit shown in Section B. Limits
your rights and duties under
Of Insurance, 1. Employee
this Coverage Part.
Benefit Liability Coverage of
this endorsement is the most we
(3) Any organization you newly ac-
will pay for all damages sus -
quire or form, other than a part-
tained by any one "employee",
nership, joint venture or limited
including =---
Includes copyrighted material of Insurance � " �&APPRmerry:
GA227 "%e
0917 Services Office, Inc., with
its permission. a P&njoa
ARM
,,.P_'a�i,nAan 9r,�ncer��rwcae
such "employee's' dependents (d) We may pay any part or all
and beneficiaries, as a result of. of the Deductible Amount to
effect settlement of any
(a) An act, error or omission; or claim or "buit' and, upon no-
b) A series of related acts, er- tification of the action taken,
rors or omissions, regard- you shall promptly reim-
less of the amount of time burse us for such part of the
that lapses between such Deductible Amount as we
acts, errors or omissions; have paid.
negligently committed in the d. Additional Conditions
"administration" of your "employ- As respects Employee Benefit Lia-
ee benefit program". bility Coverage, Section IV - Com-
However, the amount paid under mercial General Liability Condi-
this endorsement shall not ex- Lions is amended as follows:
ceed, and will be subject to the (1) Item 2. Duties In The Event Of
limits and restrictions that apply Occurrence, Offense, Claim Or
to the payment of benefits In any Suit is replaced by the following:
plan included in the "employee
benefit program." 2. Duties In The Event Of An
4 Deductible Amount Act, Error Or Omission, Or
() Claim Or Suit
(a)
Our obligation to pay dam-
a. You must see to it that
ages on behalf of the in-
we are notified as soon
sured applies only to the
as practicable of an act,
amount of damages in ex-
error or omission which
cess of the Deductible
may result in a claim.
Amount stated in the Decla-
To the extent possible,
rations as applicable to
notice should include:
Each Employee. The limits
of insurance shall not be re-
(1) What the act, error
duced by the amount of this
or omission was
deductible.
and when it oc-
curred; and
(b)
The Deductible Amount
stated in the Declarations
(2) The names and
applies to all damages sus-
addresses of any-
tained by any one "employ-
one who may suf-
ee', including such "employ-
fer damages as a
ee's" dependents and bene-
result of the act,
fidades, because of all acts,
error or omission.
errors or omissions to which
this insurance applies.
b. If a claim is made or
"suit' is brought against
(c)
The terms of this insurance,
any insured, you must:
including those with respect
to:
(1) Immediately record
the specifics of the
1) Our right and duty to
claim or "suit' and
defend the insured
the date received;
against any "suits"
and
seeking those damag-
es; and
(2) Notify us as soon
as practicable.
2) Your duties, and the du-
ties of any other in-
You must see to it that
a
volved insured, the
we receive written no -
event of act, error
tice of the claim or "suit'
omission, or claim;
as soon as practicable.
apply irrespective of the ap-
c. You and any other in-
plication of the Deductible
volved insured must:
Amount.
Includes copyrighted material of InsuranceREMEWM& APPROVED Or
GA 227 0917 Services Office, Inc., with its permission. G 7«
."." 2�slc M}anage�rmtiCleric:�l.4ide
(1)
Immediately send
us ooples of any
demands, notices,.
summonses or le-
gal papers re-
ceived in connec-
tion with the ciaim
or "suit';
(2)
Authorize us to ob-
tain records and
other information;
(3)
Cooperate with us
in the investigation
or settlement of the
claim or defense
against the 'suit";
and
(4) Assist us, upon our
request, in the en-
forcement of any
right against any
person or organi-
zation which may
be liable to the in-
sured because of
an act, error or
omission to which
this insurance may
also apply.
d. No insured will, except
at that insured's own
cost, voluntarily make a
payment, assume any
obligation, or incur any
expense without our
consent.
(2) Item 5. Other Insurance is re-
placed by the following:
5. Other Insurance
If other valid and collectible
insurance is available to the
Insured for a loss we cover
under this Coverage Part,
our obligations are limited as
follows:
a. Primary Insurance
This insurance is prima-
ry except when c. below
applies. If this insurance
is primary, our obliga-
tions are not affected
unless any of the other
insurance is also prima-
ry. Then, we will share
with all that other insur-
ance by the method de-
scribed in b. below.
b. Method Of Sharing
If all of the other insur-
ance permits contribu-
tion by equal shares,
we will follow this meth-
od also. Under this ap-
proach each insurer
contributes equal
amounts until it has
paid its applicable limit
of insurance or none of
the loss remains,
whichever comes first.
If any of the other in-
surance does not permit
contribution by equal
shares, we will contrib-
ute by limits. Under this
method, each insurer's
share is based on the
ratio of its applicable
limit of insurance to the
total applicable limits of
insurance of all insur-
ers.
c. No Coverage
This insurance shall not
cover any loss for which
the insured is entitled to
recovery under any
other insurance in force
previous to the effective
date of this Coverage
Part.
e. Additional Definitions
As respects Employee Benefit Lia-
bliity Coverage, Section V - Defini-
tions is amended as follows:
(1) The following definitions are
added:
1. "Administration" means;
Indudes copyrighted material of Insurance
GA 227 0917 Services Office, Inc., with its permission.
a. Providing information to
"employees", including
their dependents and
beneficiaries, with re-
spect to eligibility for or
scope of "employee
benefit programs';
b. Interpreting
the "em-
ployee benefit pro-
grams';
c. Handling
records in
connection
with the
"employee
benefit pro-
arams": or
IRsAeww
&APPRovm fir
I�� I�`
�/d'et �tc�t4axa2
""'"" Risl<Maru�ge�raent Clerical FtieEe
d. Effecting, continuing or
ees" who are eligible
terminating any "em-
under the plan for such
ployee's" participation in
benefits;
any benefit included in
the "employee benefit
c. Unemployment insuur-
program".
anee, social security
benefits, workers' com-
However, "administration"
pensation and disability
does not include:
benefits; and
a. Handling payroll deduc-
d. Vacation plans, includ-
tions; or
ing buy and sell pro-
b. The failure to effect or
grams; leave of ab-
sence programs, includ-
maintain any insurance
ing military, maternity,
or adequate limits of
family, and civil leave;
coverage of insurance,
tuition assistance plans;
including but not limited
transportation and
to unemployment insur-
health club subsidies.
ante, social security
benefits, workers' com-
4. "First effective date" means
pensation and disability
the date upon which cover -
benefits.
age was first effected in a
2. "Cafeteria plans" means
series of uninterrupted re-
newals of insurance cover -
plans authorized by applica-
age
ble law to allow "employees"
to elect to pay for certain (2)
The following definitions are de -
benefits with pre-tax dollars.
leted in their entirety and re-
placed by the following:
3. "Employee benefit pro-
grams" means a program
8. "Employee" means a person
providing some of all of the
actively employed, formerly
following benefits to "em-
employed, on leave of ab-
ployees", whether provided
sence or disabled, or retired.
through a "cafeteria plan" or
"Employee" includes a
otherwise:
'leased worker". "Employee"
does not include a "tempo -
a. Group life insurance;
nary worker".
group accident or health
insurance; dental, vision
21. 'Suit" means a civil proceed -
and hearing plans; and
ing in which money damag-
flexble spending ac-
es because of an act, error
counts; provided that no
or omission to which this !n-
one other than an "em-
surance applies are alleged.
ployed' may subscribe
"Suit' includes:
to such benefits and
such benefits are made
a. An arbitration proceed -
generally available to
ing in which such dam -
those "employees' who
ages are claimed and to
satisfy the plan's eligibil-
which the insured must
ity requirements;
submit or does submit
with our consent;
b. Profit sharing plans,
employee savings
b. Any other alternative
plans, employee stock
dispute resolution pro -
ownership plans, pen-
ceeding in which such
sion plans and stock
damages are claimed
subscription plans, pro-
and to which the in-
vided that no one other
sured submits with our
than an "employee"
consent; or
may subscribe to such
c. An appeal of a civil pro -
benefits and such bene-
ceeding.
fits are made generally
available to all "employ -
Includes copyrighted material of Insurance
GA 227 0917 Services Office, Inc., with its permission.
Rsla N4sn�gemrnt Clerical Ai r/e
2. Unintentional Failure To Disclose Haz-
2) Rust or other cor-
ards
rosion, decay, de -
hidden
Section N - Commercial General Liabil-
latent defect
or latent
it Conditions, 7. Representations is
Y p
n
any quality in
a
amended by the addition of the following:
property that caus-
Based on our dependence upon your rep-
es it to damage or
resentations as to existing hazards, if un-
destroy itself;
intentionally you should fall to disclose all
3) Smog;
such hazards at the inception date of your
policy, we will not reject coverage under
4) Mechanical break -
this Coverage Part based solely on such
down, including
failure.
rupture or bursting
caused centrif-
a To Premises Rented To You
3. Damage
ugal force;
e;
a. The last Paragraph of 2. Exclusions
ti) Settling, cracking,
under Section I - Coverage A - Bod-
shrinking or ex-
ily Injury And Property Damage Li-
pansion;
ability is replaced by the following:
6) Nesting or
Exclusions c. through do not apply
g q• pp y
char e
tion, or discharge
to "property damage" by fire, explo-
or release of waste
sign, lightning, smoke or soot to
products or secre-
premises while rented to you or tem-
tions, by insects,
poranly occupied by you with permis-
birds, rodents or
sion of the owner, for which the
other animals; or
amount we will pay is limited to the
Damage To Premises Rented To
7) Presence, growth,
You Limit as described in Section III
proliferation,
- Limits Of Insurance.
spread or any ac-
fungus, in-
tivityb.
The insurance provided under Sec-
P
cui
eludingg mold or
tion I - Coverage A - Bodily Injury
mildew, and any
And Property Damage Liability ap-
myootoxins,
plies to "property damage" arising out
spores, scents or
of water damage to premises that are
byproducts pro -
both rented to and occupied by you.
duced or released
(1) As respects Water Damage Le-
by fungi.
gal Liability, as provided in Para-
(b) "Property damage" caused
graph 3.b. above:
directly or indirectly by any
The exclusions under Section I -
of the following:
Coverage A - Bodily Injury And
(i) Earthquake, volcanic
Property Damage Liability, 2.
eruption, landslide or
Exclusions, other than i. War
any other earth move -
and the Nuclear Energy Liabil-
ment;
ity Exclusion (Broad Form), are
deleted and the following are
(li) Water that backs up or
added:
overflows or is other -
wise discharged from a
This insurance does not apply to:
sewer, drain, sump,
(a) "Property damage":
sump pump or related
equipment;
(1) Assumed in any con-
tract or agreement or
(ii� Water under the ground
surface pressing on, or
(11) Caused by or resulting
flowing or seeping
from any of the follow-
through:
ing:
1) Foundations, walls,
1) Wear and tear;
floors or paved
surfaces;
Includes copyrighted material of insurance �&� mSr
GA 227 4917 Services Office, Inc., with its permission. a "%e P&naoa
t�... °. `.",•"""•R'islc flAarkngrnaent Crrriu-,LgicGe
2) Basements,
whether paved or
not; or
3) Doors, windows or
other openings.
(c) "Property damage" caused
by or resulting from water
that leaks or flows from
plumbing, heating, air condi-
tioning, fire protection sys-
tems, or other equipment,
caused by or resulting from
freezing, unless:
(i) You did your best to
maintain heat in the
building or structure; or
(ii) You drained the equip-
ment and shut off the
water supply if the heat
was not maintained,
(d) "Property damage" to:
(1) Plumbing, heating, air
conditioning, fire protec-
tion systems, or other
equipment or applianc-
es; or
(IQ The interior of any
building or structure, or
to personal property in
the building or structure,
caused by or resulting
from rain, snow, sleet or
ice, whether driven by
wind or not.
c. Limit Of Insurance
With respect to the insurance afford-
ed in Paragraphs 3.a. and 3.b. above,
the Damage To Premises Rented
To You Limit as shown in the Decla-
rations is amended as follows:
(1) Paragraph 6. of Section III -
Limits Of Insurance is replaced
by the following:
6. Subject to Paragraph 5.
above, the Damage To
Premises Rented To You
Limit is the most we will pay
under Coverage A - Bodily
Injury And Property Dam-
age Liability for damages
because of "property dam-
age" to any one premises:
GA 227 0917
you with permission of
the owner;
b. In the case of damage
by fire, explosion, light-
ning, smoke or soot,
while rented to you; or
c. In the case of damage
by water, while rented
to and occupied by you.
(2) The most we will pay is limited as
described in Section B. Limits
Of Insurance, 3. Damage To
Premises Rented To You of this
endorsement.
4. Supplementary Payments
Under Section I - Supplementary Pay-
ments - Coverages A And B:
a. Paragraph 2. is replaced by the fol-
lowing:
Up to the limit shown in Section B.
Limits Of Insurance, 4.a. Bail Bonds
of this endorsement for cost of bail
bonds required because of accidents
or traffic law violations arising out of
the use of any vehicle to which the
Bodily Injury Liability Coverage ap-
plies. We do not have to furnish these
bonds.
b. Paragraph 4. is replaced by the fol-
[owing:
All reasonable expenses incurred by
the insured at our request to assist us
in the investigation or defense of the
claim or "suit', including actual loss of
earnings up to the limit shown in Sec-
tion B. Limits Of Insurance, 4.b.
Loss Of Earnings of this endorsement
per day because of time off from
work.
5. 180 Day Coverage For Newly Formed
Or Acquired Organizations
Section If - Who Is An Insured is
amended as follows:
Subparagraph a. of Paragraph 3. is re-
placed by the following:
a. Insurance under this provision is af-
forded only until the 180th day after
you acquire or form the organization
or the end of the policy period,
whichever is earlier;
a. While rented to you, or 6. Waiver Of Subrogation
temporarily occupied by Section IV -Commercial General Llabil-
Ity Conditions, 9. Transfa — — ' ' — ----
Includes copyrighted material of InsuranceREMEWM& APPROVED Sr.
Services Office, Inc., with its permission. :s«
M}anag-tiCll.4ide
Recovery Against Others To Us is
(1) Any "occurrence" which
amended by the addition of the following:
takes place after you
cease to be a tenant in
We waive any right of recovery we may
that premises;
have against any person or organization
against whom you have agreed to waive
(I Structural alterations,
such right of recovery in a written oontract
new construction or
or agreement because of payments we
demolition operations
make for injury or damage arising out of
performed by or on be -
your ongoing operations or- "your work""
half of such additional
done under a written contract or agree-
insured.
ment with that person or organization and
"products (b)
Lessor Of Leased Equip-
included in the -completed oper-
ment
ations hazard". However, our rights may
only be waived prior,to the "occurrence"
Any person or organization
giving rise to the injury or damage for
from whom you lease
which we make payment under this Cov-
equipment when you and
erage Part. The insured must do nothing
such person(s) or organiza-
after a loss to impair our rights. At our re-
tion(s) have agreed per Par -
quest, the insured will bring "suit" or trans-
agraph 7.a.(1) of this en-
fer those rights to us and help us enforce
dorsement to provide insur-
those rights.
ance. Such person(s) or or-
7. Automatic Additional Insured - Speci-
ganization(s) are insureds
fied Relationships
only with respect to liability
"bodily 'property
for injury',
a. The following is added to Section 11 -
damage" or "personal and
Who Is An Insured:
advertising injury' caused, in
()1 An person(s) or organization(s)whole
y P {)
or in part, by your
maintenance, operation or
described in Paragraph 7.a.(2) of
use of equipment leased to
this endorsement (hereinafter re-
you by such person(s) or or-
ferred to as additional insured)
ganization(s). A person's or
whom you are required to add as
organization's status as an
an additional insured under this
additional insured under this
Coverage Part by reason of a
endorsement ends when
written contract, written agree-
their contract or agreement
ment, written permit or written
with you for such leased
authorization.
equipment ends. However,
r (2) Only the following persons or or-
this insurance does not ap-
"occurrence"
ganizations are additional in-
ply to any
sureds under this endorsement,
which takes place after the
and insurance coverage provided
equipment lease expires.
to such additional insureds is lim- (c)
Vendors
ited as provided herein:
Any person or organization
(a) Managers 9 Or Lessors Of
(referred to below as ven-
Premises
dor) with whom you have
The manager or lessor of a
agreed per Paragraph
premises leased to you with
7.a.(1) of this endorsement
whom you have agreed per
to provide insurance, but on -
Paragraph 7.a.(1) of this en-
ly with respect to 'bodily in-
"property
dorsement to provide insur-
jury" or damage"
ante, but only with respect
arising out of" our products"
to liability arising out of the
which are distributed or sold
ownership, maintenance or
in the regular course of the
use of that part of the prem-
vendor's business, subject
ises leased to you, subject
to the following additional
to the following additional
exclusions:
exclusions:
(1) The insurance afforded
This insurance does not ap-
the vendor does not
ply to:
apply to:
Includes copyrighted material of Insurance
GA 227 0917 Services Office, Ina., its
RsAeww &APPRovmSr
"7,,i6V&njoot
with permission.
'cow. w'.....�rR I Ri'l, M—Sg--t Cl Ii-I/III dG
1)
"Bodily injury' or
"property damage"
for which the ven-
dor is obligated to
pay damages by
reason of the as-
sumption of liability
in a contract or
agreement. This
exclusion does not
apply to liability for
damages that the
vendor would have
in the absence of
the contract or
agreement;
2)
Any express war-
ranty unauthorized
by you;
3)
Any physical or
chemical change in
the product made
intentionally by the
vendor;
4)
Repackaging, ex-
cept when un-
packed solely for
the purpose of in-
spection, demon-
stration, testing, or
the substitution of
parts under in-
structions from the
manufacturer, and
then repackaged in
the original con-
tainer;
5) Any failure to make
such inspections,
adjustments, tests
or servicing as the
vendor has agreed
to make or normal-
ly undertakes to
make in the usual
course of busi-
ness, in connection
with the distribution
or sale of the
products;
6) Demonstration, in-
stallation, servicing
or repair opera-
tions, except such
operations per-
formed at the ven-
dor's premises in
connection with the
sale of the product;
Includes copyrighted material of Insurance
GA 227 0917 Services Office, Inc., with its permission.
7) Products which, af-
ter distribution or
sale by you, have
been labeled or re-
labeled or used as
a container, part or
ingredient of any
other thing or sub-
stance by or for the
vendor; or
8) 'Bodily injury' or
"property damage"
arising out of the
sole negligence of
the vendor for its
own acts or omis-
sions or those of
its employees or
anyone else acting
on its behalf_ How-
ever, this exclusion
does not apply to;
a) The excep-
tions contained
in Paragraphs
(c) (1) 4) or 6)
of this en-
dorsement; or
b) Such inspec-
tions, adjust-
ments, tests or
servicing as
the vendor has
agreed to
make or nor-
mally under-
takes to make
in the usual
course of
business, in
connection
with the distri-
bution or sale
of the prod-
ucts.
(ii) This Insurance does not
apply to any insured
person or organization:
1) From whom you
have acquired
such products, or
any ingredient, part
or container, enter-
ing into, accompa-
nying or containing
such products; or
2) When liability in-
cluded within the
'prc--------
'REMEWM& APPROVED Sr.
M}anag-tiCll.4ide
completed opera-
ceiver and arising out of the
tions hazard" has
ownership, maintenance, or
been excluded un-
use of the premises by you.
der this Coverage
However, this insurance
Part with respect to
does not apply to structural
such products.
alterations, new construction
and demolition operations
d State Or Governmental
()
performed by or for that per -
Agency Or Subdivision Or
son or organization.
Political Subdivision -
Permits Or Authorizations
(3) The insurance afforded to addi-
' Relating'i'o Premises
tional insureds described in Par-
agraph 7.a.(1) of this endorse -
Any state or governmental
ment:
agency or subdivision or po-
litical subdivision with which
(a) Only applies to the extent
" you have agreed per Para-
permitted by law; and
graph 7.a.(1) of this en-
dorsement to provide insur-
b Will not be broader than that
( )
anee, subject to the follow
which you are required by
ing,additional provision:
the written contract, written
agreement, written permit or
This insurance applies only
written authorization to pro -
with respect to the following
vide for such additional in -
hazards for which the state
sured; and
or governmental agency or
subdivision or political sub-
(c) Does not apply to any per -
division has issued a permit
son, organization, vendor,
or authorization in eonnec-
state, governmental agency
tion with premises you own,
or subdivision or political
rent or control and to which
subdivision, specifically
this insurance applies:
named as an additional in-
sured under any other provi-
(i) The existence, mainte-
sion of, or endorsement
nance, repair, oonstruc-
added to, this Coverage
tion, erection or removal
Part, provided such other
of advertising signs,
provision or endorsement
awnings, canopies, cel-
covers the injury or damage
lar entrances, coal
for which this insurance ap-
holes, driveways, man-
plies.
holes, marquees, hoist
- away openings, side-
b. With respect to the insurance afford -
walk vaults, street ban-
ed to the additional insureds de-
ners or decorations and
scribed in Paragraph 7.a.(1) of this
similar exposures; or
endorsement, the following is added
to Section HI - Limits Of Insurance:
(IQ The construction, erec-
tion or removal of eleva-
The most we will pay on behalf of the
tors; or
additional insured is the amount of in-
surance:
(11117 The ownership, mainte-
nance or use of any el-
(1) Required by the written contract,
evators covered by this
written agreement, written permit
insurance.
or written authorization described
in Paragraph 7.a.(1) of this en-
(e) Mortgagee, Assignee Or
dorsement; or
Receiver
(2) Available under the applicable
Any person or organization
Limits of Insurance shown in the
with whom you have agreed
Declarations;
per Paragraph 7.a.(1) of this
endorsement to provide in-
whichever is less.
surance, but only with re-
This endorsement shall not increase
spect to their liability as
the applicable Limits of Insurance
mortgagee, assignee, or re-
shown in the
Includes copyrighted material of Insurance RsAeww
GA 227 0917 Services Office, Inc., with its permission. P&naoa
""'"" Ri'l, M—g--t cl ri_lAdc
c. Section IV - Commercial General
ment, the following additional provi-
Liability Conditions is amended to
sions apply:
include the following:
(1) The Limits of Insurance shown in
Automatic Additional Insured Pro-
the Declarations are replaced by
vision
the limits designated in Section
This insurance applies only if the
'bodily "property
B. Limits Of Insurance, 8.
Property Damage To Borrowed
injury' or damage"
Equipment of this endorsement
occurs, or the "personal and advertis-
with respect to coverage provid-
ing injury" offense is committed:
ed by this endorsement. These
(1) During the policy period; and
limits are inclusive of and not in
addition to the limits being re-
(2) Subsequent to your execution of
placed. The Limits of Insurance
the written contract or written
shown in Section B. Limits Of
agreement, or the issuance of a
Insurance, 8. Property Damage
written permit or written authork
To Borrowed Equipment of this
zction, described in Paragraph
endorsement fix the most we will
7.a.(1).
pay in any one "occurrence" re-
d. Section IV - Commercial General
gardless of the number of:
Liability Conditions is amended as
(a) Insureds;
follows:
(b) Claims made or "suits"
Condition 5. Other Insurance is
brought; or
amended to include:
(c) Persons or organizations
Primary And Noncontributory In-
making claims or bringing
surance
"suits".
This insurance is primary to and will
(2) Deductible Clause
not seek contribution from any other
Insurance available to an additional
(a) Our obligation to pay dam -
Insured per Paragraph 7.a.(1) of this
ages on your behalf applies
endorsement provided that:
only to the amount of dam-
ages for each "occurrence"
(1) The additional insured Is a
which are in excess of the
Named Insured under such other
Deductible Amount stated in
insurance; and
Section B. Limits Of Insur-
ante, 8. Property Damage
(2) You have agreed in writing in a
To Borrowed Equipment of
contract, a
agreement permit or
g p
this endorsement. The limits
authorization described in 7.a.(2)
of insurance will not be re -
of this endorsement that this in-
duoed by the application of
surance would be primary and
such deductible amount.
' would not seek contribution from
any other Insurance available to
(b) Section IV - Commercial
the additional insured.
General Liability Condi-
tions
fives, 2. Duties In The
Damage To Borrowed Equip-
8. Property y gEvent
Of Occurrence, Of-
ment
fense, Claim Or Suit, ap-
a. The following is added to Exclusion
plies to each claim or "suit'
2J. Damage To Property under Sec-
irrespective of the amount.
tion I - Coverage A - Bodily Injury
(c) We may pay any part or all
And Property Damage Liability:
of the deductible amount to
Paragraphs (3) and (4) of this exclu-
effect settlement of any
sion do not apply to tools or equip-
claim or "suit' and, upon no-
ment loaned to you, provided they are
tification of the action taken,
not being used to perform operations
you shall promptly reim-
at the time of loss.
burse us for such part of the
deductible amount as has
b. With respect to the insurance provid-
been paid by us.
ed by this section of the endorse-
Includes copyrighted material
of InsuranceREMEWM&APPROVED
GA 227 0917 Seances Office, Inc., with
its permission.«
9. Employees As Insureds - Specified
Health Care Services And Good Samar-
itan Services
Paragraph 2.a.(1)(d) under Section II -
Who is An Insured does not apply to:
a. Your "employees" who provide pro-
fessional health care services on your
behalf as a duly licensed nurse,
emergency medical technician or
paramedic in the. jurisdiction where an
'becurrence' or offense to which this
Insurance applies takes place; or
b. Your "employees" or "volunteer work-
ers", other than an employed or vol-
unteer doctor, providing first aid or
good samaritan services during their
work hours for you will be deemed to
be acting within the scope of their
employment by you or performing du-
ties related to the conduct of your
business.
10. Broadened Notice Of Occurrence
Paragraph a. of Condition 2. Duties In
The Event Of Occurrence, Offense,
Claim Or Suit under Section IV - Com-
mercial General Liability Conditions is
replaced by the following:
a. You must see to it that we are notified
as soon as practicable of an "occur-
rence" or an offense which may result
in a claim. To the extent possible, no-
tice should include:
(1) How, when and where the "oc-
currence" or offense took place;
(2) The names and addresses of
any injured persons and wit-
nesses; and
(3) The nature and location of any
injury or damage arising out of
the "occurrence" or offense.
This requirement applies only when
the "occurrence" or offense is (mown
to an "authorized representative".
11. Nonowned Aircraft
The following is added to Exclusion 2.g.
Aircraft, Auto Or Watercraft under Sec-
tion 1 - Coverage A - Bodily Injury And
Property Damage Liability:
This exclusion does not apply to an air-
craft you do not own, provided that:
a. The pilot in command holds a current
effective certificate, issued by a duly
constituted authority of the United
States of America or Canada, desig-
nating that person as a.commeraal or
airline transport pilot;
b. The aircraft is rented with a trained,
paid crew; and.
c. The aircraft does not transport per-
sons or cargo for a charge.
1.2. Bodily Injury Redefined
Section V - Definitions, 4. "Bodily injury'
is replaced by the following:
4. "Bodily injury' means bodily harm or
injury, sickness, disease, disability,
humiliation, shock, fright, mental an-
guish or mental injury, including care,
loss of services or death resulting
from any of these at any time.
13. Expected Or Intended Injury Redefined
The last sentence of Exclusion 2.a. Ex-
pected Or Intended Injury under Sec-
tion I - Coverage A - Bodily Injury And
Property Damage Liability is replaced by
the following:
This exdusion does not apply to 'bodily
injury" or "property damage" resulting from
the use of reasonable force to protect per-
sons or property.
14. Former Employees As Insureds
The following is added to Paragraph 2.
under Section Il -Who Is An Insured:
2. Each of the following is also an in-
sured:
Any of your former "employees', di-
rectors, managers, members, part-
ners or "executive officers", including
but not limited to retired, disabled or
those on Ieave of absence, but only
for acts within the scope of their em-
ployment by you or for duties related
to the conduct of your business.
Includes copyrighted material of Insurance
GA 227 0917 Services Office, Inc., with its permission.
IRsAeww &APPRovm Sr
I�� I�` �/d'et �tc�t4axa2
""'"" Risl<Maru�ge�raent Clerical FtieEe